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CC-0050-2023 Office Use Only -._1 ADDITION ALTERATION PERMIT Permit#: CC-'" 00�©` 202`�j �—"� 1 APPLICATION Town of Queensbury Permit Fee: $ Y\5 *8 Q 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Invoice#: Flood Zone? Y Reviewed : :41. Project Location: �. - d3i09% Iec 5ll,/J AV ' .- ��� Tax Map ID#: 2-CA.-CA. (D • °I �.� Subdivision Name: 0 E .f____EiKgc 11 FEB 0 7 2023 PROJECT INFORMATION: TOWN ® OUE-NczB U,RY BUILDING L CODES TYPE: El Residential Residential Commercial, Proposed Use: 00 %D S 0cfiie= ❑ Single-Family ❑ Two-Family El Multi-Family (#of units_) ❑ Townhouse El Business Office ❑ Retail El Industrial/Warehouse ❑ Garage (#of cars ) ❑ Other (describe ) ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE: 1st floor: 1st floor: a 6 5 sQp% 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: 4 if /Iv 6 C / e-SO W /LS &.JI j S R '7--)i 00c,' try ,i6Gc' ptrat.-7 *-d it'; i mil A 0) JO /r o®4'/1 L 6')Cofqtr, ka,in s i , 44V 5(i5"/-7,7� Addition/Alteration Application Revised June 2022 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 5 0,, Qr0of 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the-Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3.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 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:DA Vila T—A J( //G"/% SIGNATURE: {),(?iW DATE: 0 :y.a0cZ Addition/Alteration Application Revised June 2022 • CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): 06,9 /if j6/C Mailing Address, C/S/Z: 67.` IOLLS71P j/ ,Q A a/ ¢(�,iuy / off-(A Cell Phone: �R ) a' Land Line: (5'f '; ) Email:�� � �� i` • Primary Owner(s): �� Name(s): a 17, ' o • ,/� 10 4-4 �',, (i1t' Mailing Address, C/S/Z: j'f►/// s%, ./ O R b s/g 8 P i,tJ A i c-/ 48° Cell Phone: (5/ ') '5?' 6.7V.3' Land Line: (a Sig) �� 0 oo Email: c) ,Y�,f��+/ c_m�'�'C e �� 0'J vi ❑ 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): Dig o ,F.f9�ilc / SL A' (: 0Al sf"i L,( 1/ Contractor Trade: &Z s‘/ X'�-r►� Mailing Address, C/S/Z: /iV,001 'T'Z/ ,J/C W e FtW,3 /VY Jai c Cell Phone: (5/W ) � �' 5 Land Line: (61$) o 6 00 Email: C ��� �. /:0'� � /� e 1� G C-0 his, **Workers' Comp documentation must be submitted with this application**- • Architect(s)/Engineer(s): Business Name: 4/ , c //� ic/1 7 fa Contact Name(s): R`,O 5c.,777— Mailing Address, C/S/Z: 1 Iv, c;�./ iqe h OO $ R.r3,c/'e S Cell Phone: ( ) Land Line: / ) '� `( 3 / 9 7 Email: R fr 2 c7 /�,�'CA ,o"' /t/e Cow Contact Person for Compliance in regards to this project: /D / ✓j ( /1 j/c i,"/. Cell Phone: 17 57 _ Land Line: (,,c/ 3 0600 Email: L , 79E' C/-fiA (? eR "r`" / 0 � tJ" Addition/Alteration Application Revised June 2022 01.11k. FIRE MARSHAL'S OFFICE Town of Queensbury 742 , NY 12804 Bay Road, Queensbury, "Home of Natural Beauty ... A Good Place to Live " PLAN REVIEW 375 Bay LLC, Suite 101 CC-0050-2023 2/8/2023 The following comments are based on a review of submittals: • Verify fire extinguisher location and inspection • Verify paths of egress • CO detection is required • Locks /Latches to comply with Chapter 10 of IFC • Provide Knox Box and entry key for FD • Function test exit/El lighting, these are required per Fire Code section 1031 • NFPA 72 letter required for movement or placing of any fire alarm devices. • NFPA 13 letter of compliance required for any changes to sprinkler system NE Michael` J Palmer Fire Marshal 742 Bay Road Queensbury NY 12804 firemarshal@queensbury.net Fire Marshal 's Office • Phone: 518-761-8206 • Fax: 518-745-4437 firemarshal@queensbury.net • www.queensbunj.net a .5 �b fi w51 e..e F � (JJ gY Sg $ 3 � Llrrn s or q IMFgn �r 5 M n � c m -p i e BAY ROAD D m Z 0 a � D � � rn tlan Dus� _ �f y - Yy,_,swTMT euN I.r p S e V e S - _ a M170112 uPDA,e r ciRimcADWS Land Surveyors _ __ 375 Bay Road., LLC 3 lllosAs sow HpRow7Aw7s lbo n..,l.w R.W Qeawkoq.New Tart IaeW 2 ,1 6 OERTR,CATKAYS r::..r Q...,,karai i,rru CeeM'.New T.rt , 11 saw aatlaMn,9 61i 91t-a{T4 Rew Turk Le.N.. 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