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CC-0467-2023 Office Use Only ADDITION ALTERATION PERMIT Permit#: CC-- 0/-"A 202. ry APPLICATION I Town ofQueensbu Permit Fee:$ - iia t k 200 , 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Invoice#: /MUM—, b it I^ Flood Zone? Y IC) Reviewed By: if Project Location: 22 Main St. Tax Map ID#: Subdivision Name: PROJECT INFORMATION: TYPE: ❑ Residential © Commercial, Proposed Use: Dunkin' Donuts ❑ Single-Family El Two-Family ❑ Multi-Family(#of units_) ❑ Townhouse El Business Office ❑ Retail El Industrial/Warehouse El Garage (#of cars ❑ Other(describe ) ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE: 1st floor: 1st floor: 1656 2nd floor: 2nd floor: 3rd floor: 3rd floor: Basement(habitable space): Basement(habitable space): Total sq ft: Total sq ft: 1656 `r Exterior Remodel, New framing of vestibule monolith with new siding Scope of work to be done. Replace existing corrugated panels with smooth panels, paint building exterior Add accent bands and drive thru order station with menuboards. New signs Omitting the LROD accent wall and verbage Addition/Alteration Application Revised June 2022 f ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 75,000 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 8 NO Explain: 4. Are there any easements on the property? ❑ YES El NO SITE INFORMATION: • Is this a corner lot? 8 YES ❑ NO • Will the grade be changed as a result of the construction? ❑ YES 8 NO • What is the water source? 8 PUBLIC ❑ PRIVATE WELL • What type of wastewater system is on the parcel? 8 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3.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. 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: Pat Shaw SIGNATURE: DATE: 7/26/2023 Addition/Alteration Application Revised June 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): Pat Shaw(T. Shaw Inc.)Mailing Address, C/S/Z: 449 State Route 281,Tully, NY 13159 Cell Phone: ( )315-440-5283 Land Line: ( ) Email:Patshaw280@gmail.com • Primary Owner(s): Name(s): Thomas J Burke(North Star Donut Group LLC) Mailing Address, C/S/Z: 509 NY 67, Malta, NY 12020 Cell Phone: ( )518-209-3397 Land Line: ( ) Email:tomburke@theburkecompanies.com ❑ 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): Pat Shaw Contractor Trade: General Contractor Mailing Address, C/S/Z: 449 State Route 281,Tully, NY, 13159 Cell Phone: ( )315-440-5283 Land Line: ( ) Email:Patshaw280@gmail.com **Workers' Comp documentation must be submitted with this application** • Architect(s)/Engineer(s): Business Name: Ahoronian and Associates inc. Contact Name(s): Erik Medeiros Mailing Address, C/S/Z: 310 George Washington Highway Suite 100,Smithfield Rhode Island 02917 Cell Phone: ( )401-232-5010 Land Line: ( ) Email:emedeiros@arch-eng.com Contact Person for Compliance in regards to this project: Pat Shaw Cell Phone: ( )315-440-5283 Land Line: ( ) Email:Patshaw280@gmail.com • Addition/Alteration Application Revised June 2022