2024-0375 Office Use Only
,,,, l ,
7 ADDITION ALTERATION a2e9R4
Kermit#: "e3°75.
�_ IOp�L� 1, E p i n0 0
Town of Qucensbury A ,P 1 Permit Fee:$ �f .. d0.
742 Bay Road,Queensbury,.NY 12804 LL��rr lVJ 07 �
P:518-761-8256 www.queensbury.net. Invoice#: o'er,0-(.
JUL 25 2024 -
. Flood Zone? Y TYPE: ; ��
TOWN OF OUEENSBLIRY
75 Carey RD, Sui e 2 BUILD9Nt� &CODES Reviewed By: �.S
Project Location:
Tax Map ID#: 3V0- .o - l'.G 3 Subdivision Name: n/a
PROJECT INFORMATION: _
TYPE: ❑ Residential ['Commercial, Proposed Use:, New C-CFct. 5i�cc .
❑ Single-Family ❑ Two-Family ❑ Multi-Family (#of units ) ❑ Townhouse
8 Business Office ❑ Retail ❑ Industrial/Warehouse ❑ Garage (#of cars _., )�'
❑ Other (describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor:440 .•. . 1st floor: , ... _
2nd floor: na 2nd floor:
3rd floor: na 3rd floor:
Basement(habitable space):na` Basement(habitable space):.,.
Total sq ft: .,. Total sq •ft: ;j :� .
Scope of work to be done: Reducing size of office lobby and adding one 9'x 9' room. ,;
Addition/Alteration Application Revised May 2024
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction:$ $7,600.00
2. Source of Heat (circle one): ® Gas ❑ Ail;. ❑,Propane ❑ Solar 8 Other: Heat pump
Fireplaces/inserts need a;separate Fuel Burning Appliances & Chimney Application
3. _Are there any structures not shown on the plot plan? 8 NO. ❑ YES Explain:
4. Are there any easements on the property? 8 NO 0 YES
SITE INFORMATION:
• Is this a corner lot? B NO ❑ YES _.
• Will the grade be changed as a result of the construction? 8 NO ❑ YES
• What is the water source? MI PUBLIC ❑ PRIVATE WELL. ❑ OTHER:
• What type of wastewater system is on the parcel? ® SEWER ❑ PRIVATE SEPTIC
DECLARATION:
1. I acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be
completed within a 12 month period.Any changes to the approved plans prior to/during construction will require . .
the submittal of amended plans,additional reviews and re-approval.
2. If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of
Queensbury.After,1,year from the initial application date, 100%of the fee is retained.
3. °If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. I certify that the application, plans and supporting materials are a true and a complete statement and/or description
- of the work proposed,that all work will be performed in accordance with the NYS Building Codes,.local building laws
and ordinances, and in conformance with local zoning regulations. V V
5. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy. •
6. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above: OK e relo4 ee kes C L-
PRINT NAME: Michael A. O r
SIGNATURE: DATE: 7/22/24
Addition/Alteration Application Revised May 2024
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Michael A. O'Connor
Mailing Address, C/S/Z: PO Box 34 Cohoes, NY 12047
Cell Phone: 518-857-1555 Land Line: na
Email:zmikeoc1@yahoo.com
• Primary Owner(s):
Name(s): Same as Applicant
Mailing Address, C/S/Z:
Cell Phone: 518-857-1555 Land Line:
Email:
Check if all work will be performed by property owner only
• Contractor(s): (List all additional contractors on the back of this form)
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
**Workers' Comp documentation must be submitted with this application**
• Architect(s)/Engineer(s):
Business Name: Mark Bergreon P.E.
Contact Name(s): Mark Bergreon
Mailing Address, C/S/Z: 62 Van Vranken Road, Clifton Park, NY 12065
Cell Phone: 518-248-0906 Land Line: 518-723-9163
Email:mpbdindustries@aol.com
Contact Person for Compliance in regards to this project: Michael A. O'Connor
Cell Phone: 518-857-1555 Land Line: na
Email:zmikeocl@yahoo.com
Addition/Alteration Application Revised May 2024
JUL 2 5 2024 1�
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308.20-1-3.3 CC-0109-2023
Orkin/Okie Properties
75 Carey Rd, Ste 4
Interior Alterations 1588 s.f.
AL7A(ACcN LAMP TITI-I:. SU?�YEY
pa�M19��i Y,NvWN Ah 415 GAPIEYYiOAD
Mark P. BeLqe: r li,_,PE62 Van Vrankeri Rd. Cfifton P Lrj�.�' 12065
"E,e T 91T) 2743-0956 Email" rripbd�r�d�.istries@ao�.rorTi
Septeniber 9, 2024
("Xieensbury &,iH6ng & Code Enforcernent
742 Bay Road
QUeensbury, NY 12804
Attri, Code Enforcement Officer
Re,: Office/Warehouse FW�P
'75 Carey Road -- Suite 2
QUeensbury, NY 12804
F�t--Up Complefion and Request for, C.eftfficate of Occupancy
Genflernen,
This �etter serves to confirm that � have made peho6c 'inspecfloins for the above
refe,renced project throughout the C.OrlSb"W',,fion process. 'To the be of my knowledge,
the construction is substantiaHy cornp te in satisfactory conformance with the approved
plans for the above referenced project
I am re(JUesfing ttmt a Cerhficate of Occuj:)aincy be 'issued for th proie(;t.
If YOU have any quesfiorns, please call,
Sinceir0y,
()F W-
Mark �P. Berqerwi, FE
`14 7 7
Cc- Oke Properties, LLC - Me O'Cory r