2024-0109 .M
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4116
&' � Office Use Only ADDITION/ALTERATION PERMIT Permit#: 20 0 I O
7oivu ofQuecnsbiirj APPLICATION
Permit Fee: _ 2 ZC)
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Invoice# I
Flood Zone? Y N Reviewed B .
Project Location: l9(4 th.ax\o_ Ave' Qvipt,nsiowur
Tax Map ID #: i i 1 — \ - (c 9 Subdivision Name:
PROJECT INFORMATION: • ,
TYPE: E' Residential ❑ Commercial, Proposed Use:
1E1/Single-Family ❑ Two-Family ❑ Multi-Family (#of units_) ❑ Townhouse
❑ Business Office ❑ Retail ❑ Industrial/Warehouse ❑ Garage (#of cars )
•
❑ Other (describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement (habitable space): Basement (habitable space):
Total sq ft: Total sq ft:
Scope of work to be done: c_..(}t- J.�j(ti;�nnx- � rer ode( K / Mi SC.�puw
(trJurY � - war d)
Fit—dE ii IN IT,EI r-7-i I
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TOWNURY
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Addition/Alteration Application Revised June 2022
i%
ADDITIONAL PROJECT INFORMATION:
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1. Estimated Cost of Construction: $ an)vvv-W
2. Source of Heat(circle one): ❑ Gas ❑ Oil ❑ Propane ❑ Solar ❑ Other:
Fireplaces/inserts need a separate Fuel Burning Appliances & Chimney Application
3. Are there any structures not shown on the plot plan? ❑ YES ❑ NO Explain:
4. Are there any easements on the property? ❑ YES ❑ NO
SITE INFORMATION:
• Is this a corner lot? ❑ YES ❑ NO
• Will the grade be changed as a result of the construction? ❑ YES ❑ NO
• What is the water source? ❑ PUBLIC ❑ PRIVATE WELL
• 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 atrue 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.
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:
PRINT NAME: t/6 6?`- 20
SIGNATURE: DATE: d d i r/ I
Addition/Alteration Application Revised June 2022
4z
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• A. licant• ll
Name(s): t�CIA Ltl1LP�LC t� t 6/10,YANk-tAkt GARAT
Mailing Address, C/S/Z: to afcao - Avei Sou*lt, 6laAvIkik, 0/ t -60
Cell Phone: (5($ ) "AU- �f D�� Land Line: ( Gig ) nl4 bR`)
Email: Ylofrf.;0pfo\)trw\ Gpu.¢, Cam- -• Primary Owner(s):
Name(s): l) ' MA 0,A-ems
Mailing Address, C/S/Z: CDk Wteuc-' -PkVZ-
Cell Phone: ( 51B ) - (i( L' 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:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
Contact Person for Compliance in regards to this project: -had C111&Gl
Cell Phone: ( 51(1 ) k(M. Land Line: ( St( ) `l4S'S1
Email: ivovvu.iiv,p4MAwArviii �' IUNPF
Addition/Alteration Application Revised June 2022
Pt Rebuilding Project Management Team 3,S'20
b James Strack Jim Van Vorst Dan Symer
0,6 Together. Program Director Field Project Manager Field Project Manager
James@RTSaratoga.org Jim@RTSaratoga.org Dan@RTSaratoga.org
TOWN OF 6 5 ebb nounty Office#518.587.3315 Office#518.587.3315 Cell#518.810.5539
BUILDING
Rasari nn nur limited examination,compliance
with our comments shall not be construed as
indicating the plans am specifi Codes
are in FILE
BID FORIM FILE COPY
full compliance with the BuildingCodes o
New York State.
Project #: 202421c1ick or tap here to enter text. Bid Due Date: 2-24-2024
2-9-024 E1) E LE E
Homeowner Name: Linda Morehouse `�
Project Address: 64 Indiana Ave, Queensbury, NY 12804 1. LMAR 0 4 2024
Contact Info: 518-223-6626 TgWiti OF OEF;_ 3J y
NOTICE TO CONTRACTORS:
• This work scope provides descriptions of the work to be completed. Contractors are
responsible for field-confirmation of dimensions, site specific conditions, and
reasonably detected defects prior to bidding.
• Change orders will not be issued for discovery items that are not hidden defects.
• All work should be done in a professional manner using materials equal to or better
than original materials.
• All work should meet or exceed local code.
• Any material colors, if applicable, should be the choice of the RTSC Client from
contractor stock (Custom colors/materials are not allowed).
• The Contractor agrees to:
o Acquire local building permits for all projects and provide RTSC with a copy of
the permit. If a permit is not required a document/email from the local
authority stating, no permit is required or an email from the Contractor stating
that the local authority has informed them no permit is required.
o Provide a one (1) year warranty for workmanship effective the date the project
is completed.
o Follow specific property/project standards to ensure work is conducted safely
and meets all applicable Federal, State and Local codes.
Project start date: Estimated time to completion:
Contractor Signature:
TOWN OF QUFEN B 4'1 ASSESSOR'S COPY
Reviewed
Date: /� �
1. Building Permit $
2. Debris Removal $
3. $
MAIN BATHROOM
Remove & Dispose of existing tub/shower unit.
Provide & Install 60" acrylic tub, acrylic shower surround with built in
shelves, American Standard, Sterling or equal.
Provide & Install tub/shower/drain controls with adjustable hand-held
sprayer, Moen or equal. Install shower curtain rod and weighted
shower curtain.
Raiamn-e:as required; install water resistant drywall (taped and finished
to smooth). Repair any drywall damage in bathroom, Prime and paint
with (2) coats of semi-gloss paint. (I-Iomeowner has choice of color)
Repair and fill subflooring as required. Silicone and Trim.
Provide & Install (2) Grab Bars in area of Tub/shower unit custom to
homeowner use.
Provide & Install toilet paper holder.
TOILET (COMFORT HEIGHT)
Remove &Dispose of existing Toilet.
Provide & Install comfort height low flow toilet, round or elongated
bowl (Homeowner choice), Kohler or equal complete with all plumbing
connections, new floor flange and wax seal and water supply with shut
off valve and toilet seat.
Provide & Install up to 32 Sq ft. of any sub flooring that is damaged
or deteriorated in toilet area.
Bathroom Flooring (Moisture Resistant)
Remove &Dispose of existing Flooring.
Provide & Install 9 mil min. laminated flooring or Sheet vinyl
(homeowners choice) over suitable base, Armstrong or equal; owner's
choice of standard colors/patterns.
Install transitions as required. Install '/ round trim along base; stained
or paint to closely match flooring or trim.
Exhaust Fan
Page 2 of 7
Provide&Install Utilitech or equal 100 cfm exhaust fan/light
combination vented to outside and terminated in louver, complete with
wall mounted operating switch.
4. Master Bedroom Bathroom $
Remove &Dispose of existing Shower unit.
Provide &Install 36" acrylic shower base; Kohler or equal, acrylic
shower surround with shelves.
Provide & Install shower/drain controls with adjustable hand-held
sprayer, Moen or equal. Install shower curtain rod and weighted
shower curtain.
Reframe as required; install water resistant drywall (taped and finished
to smooth). Repair any drywall damage in bathroom, Prime and paint
with (2) coats of semi-gloss paint. (Homeowner has choice of color)
Repair and fill subflooring as required. Silicone and Trim.
Provide & install (2) Grab Bars in area of Shower unit custom to
homeowner use.
Bathroom Flooring (Moisture Resistant)
Remove & Dispose of existing Flooring.
Provide & Install 9 mil min. laminated flooring or Sheet vinyl
(homeowners choice) over suitable base, Armstrong or equal; owner's
choice of standard colors/patterns.
Install transitions as required. Install 1/4 round trim along base; stained
or paint to closely match flooring or trim.
Exhaust Fan
Provide &Install Utilitech or equal 100 cfm exhaust fan/light
combination vented to outside and terminated in louver, complete with
wall mounted operating switch.
TOILET (COMFORT HEIGHT)
Remove &Dispose of existing Toilet.
Provide & Install comfort height low flow toilet, round or elongated
bowl (Homeowner choice), Kohler or equal complete with all plumbing
connections, new floor flange and wax seal and water supply with shut
off valve and toilet seat.
Provide & Install up to 32 Sq ft. of any sub flooring that is damaged
or deteriorated in toilet area.
Page 3 of 7
Bathroom Flooring (Moisture Resistant)
Provide & Install 9 mil min. laminated flooring or Sheet vinyl
(homeowners choice) over suitable base, Armstrong or equal; owner's
choice of standard colors/patterns.
Install transitions as required. Install '/n round trim along base; stained
or paint to closely match flooring or trim.
Wall Mounted Sink
Secure wall mounted sink to wall.
5. Main 3" PVC Waste Line/Pipe(Cellar) $
Provide & Install hangers on entire 3"PVC Waste Line/Pipe in cellar.
Be sure to pitch properly for continuous flow.
6. Cellar Stairs & Handrail $
Remove & Dispose of existing Cellar Stairs.
Provide & Install new Stringers and Treads construct to local code.
Re-install existing handrail.
7. Bilco Door $
Remove &Dispose of existing Bilco door.
Provide & Install Steel bilco door, with locking mechanism, hinges
and sealed for a fully functioning bilco door.
Provide & Install handrails on_b-oth-sides-:of-steps.
8. Front Porch Steps $
Remove &Dispose of existing Steps and handrails.
Provide &_Install-new Pressure Treated-Handr-ails,-Balusters,'-=
Stringers,-Ticads-,-and-closed risers-on-top-of cap=blocks.
Page 4 of 7
9. Roof $
House Main Roof (30 ,yr. architectural)
a. Remove &Dispose of existing House roofing materials.
b. Replace deteriorated substrate with new material.
c. Provide & Install new 1" aluminum drip edging, color white.
d. Provide & Install 2 courses "Grace" or equal ice and water on eaves
and valleys and 1 course on rake edges and around any roof
penetrations.
e. Provide & Install new boots, flashing and/or vent covers for any
roof penetrations & Sidewalls.
f. Provide & Install Synthetic Underlayinent (Titanium UDL 25 or
similar products) on roof surfaces not covered with "Grace".
g. Provide & Install 30-year architectural shingles, owner's choice of
standard colors, Owens Corning "Oakridgc" or equal.
h. Provide & Install vented ridge cap, Owens Corning"Vent sure" or
equal.
**Protect Homeowners property, landscaping and personal belongings
from shingles debris and sweep property with magnet for nails at least
twice after installation.**
INTERNAL ESTIMATE TOTAL: $
Page 5 of 7
Construction Agreement
(To be signed at Pre-Construction meeting)
Based upon the work scope items listed above, the Contractor and RISC reasonably expect the
following:
The project will start and take to complete.
This information is subject to change due to unforeseen project costs or delays.
CONSTRUCTION TERMS AND CONDITIONS:
1. Any necessary changes to the work scope must be approved by RTSC and a change order must be documented.
Staff,volunteers, and contractors are not allowed to add items to the work scope without discussion and
approval.
2. Homeowners may not personally pay for additional work from the Contractor until the after the Rebuilding
Together approved work is completed and a final inspection has been conducted.
3. The Homeowner(s) agree to:
a. With reasonable notification, provide RTSC staff,volunteers,and contractors with access to the home to
perform pre-and post-inspections and complete RTSC Services.
b. Pack up and remove all personal belongings from the work area(s) prior to the workday. RTSC is not
responsible for damage to personal possessions that occurs within the scope of performing the RTSC
Services.
c. Remove or confine all pets from the work area during the workday(s).
d. Remove any firearms and/or dangerous weapons from the house,or ensure that they are properly
secured, prior to the workday(s).
e. Acknowledge that RTSC may need to remove, discard, or relocate objects within the home to enable
contractors and volunteers to perform home repairs and to provide a safe, sanitary, and healthy
environment for the homeowner(s) and/or family members. If a Homeowner authorizes RTSC to discard
objects, this authorization is final and RTSC will not return the objects later or be held liable for their
value.
f. Acknowledge that no alcoholic beverages or non-prescription drugs may be consumed on the premises
during the workday(s) or at any time in the presence of RTSC staff,volunteers, and contractors.
4. The Contractor agrees to:
a. Acquire local building permits for all projects and provide RTSC with a copy of the permit or proof that a
permit is not required.
b. Coordinate with the homeowner regarding the start of the project.
c. Provide a warranty for 1 year from the completion of work.
Page 6 of 7
d. Follow specific property and project standards to ensure that work conducted is decent, safe,
sanitary, and meets all applicable federal, New York State, and/or Local Code requirements upon
completion.
5. Rebuilding Together Saratoga County agrees to:
a. Provide contractor payment upon completion of the final project inspection.
b. Provide mediation support in case of disputes between the homeowner(s) and contractor.
RTSC's role is to provide financing to cover the cost of the project.The agreement for the work to be completed and
work to be completed is contracted between the homeowner and the Contractor.
RTSC reserves the right to cancel a portion of or the entirety of a project at any time,for reasons including but not
limited to: access to the home or work area becomes difficult or is denied, project work is not in compliance with
funding requirements, unsafe work conditions, adversarial relationship with the Homeowner or other residents.
Project completion is contingent upon availability of funding.
1. Homeowner: Date:
2. Contractor: Date:
3. RTSC: Date:
Page 7 of 7