application Office Use Only
ADDITION//ELT€RATinni IT Permit#: C
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Town of Queensbury
742 Bay Road,Queensbury,NY 12804 I voice#: 0 g D „
P: 518-761-8256 www.queensbury.net OCT 2 5 2018
Project Location: 347 Everts Avenue TOWN OF QUEENSBURY
BUILDING&CODES
Tax Map !Dirk 302.12-1-44 Subdivision Name: N.A.
CONTACT INFORMATION:
• Applicant:
Name(s): Wainschaf Associates
Mailing Address, C/S/Z: 589 3rd Ave. Extension, Rensselaer, NY 12144
Cell Phone: ( 518 ) 365-3319 Land Line: ( 518 ) 449-2220 Ext. 4
Email: Dave@waiconstruction.com
• Primary Owner(s):
Name(s): Community Work&Independence, Inc.
Mailing Address, C/S/Z: 37 Everts Ave., Queensbury, NY 12804
Cell Phone: ( ) Land Line: ( 518 ) 793-4700
Email:
• Contractor(s):
Business Name: Wainschaf Associates, Inc.
Contact Name(s): Dave Canfield
Mailing Address, C/S/Z: 589 3rd Ave. Extension, Rensselaer, NY 12144
Cell Phone: ( 518 ) 365-3319 Land Line: (
Email: Dave@waiconstruction.com
• Architect(s)/Engineer(s):
Business Name: Gary McCoola, Architect, PLLC
Contact Name(s): Gary McCoola
Mailing Address, C/S/Z: 3 Broad Street, NY 12801
Cell Phone: ( 518 ) 681-2305 Land Line: f 518 ) 792-0050
Email: mccoola_architects@msn.com
Contact Person for Building & Code Compliance: Gary McCoola
Cell Phone: ( ) Land Line: )
Email:
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018
PROJECT INFORMATION:
TYPE: x Commercial Residential
WORK CLASS:
Single-Family Two-Family Multi-Family (#of units
Townhouse X Business Office Retail
Industrial/Warehouse Garage (#of cars ) _Other(describe_ _)
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 320 SF ADA Ramp 1st floor: 12,500
2" floor: 2nd floor:
3rd floor: 3rd floor:
Basement (habitable space): Basement (habitable space):
Total square feet: 320 Total square feet: 12,500
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 600,000
2. If Commercial project, what is the proposed use: same as existing/expanding
3. Source of Heat (circle one): Ga . Oil Propane Solar Other
Fireplaces need a separate Fuel Burning Appliances & Chimney Application
4. Are there any structures not shown on the plot plan? YES 1 NO) Explain:
5. Are there any easements on the property? YES NO unknown
6. SITE INFORMATION:
a. What is the dimensions or acreage of the,parcel? approx. 350' x 500'
b. Is this a corner lot? YES
c. Will the grade be changed as a resylt�f the construction? YES NO
d. What is the water source? TUBLI9 PRIVATE WELL
e. Is the parcel o SEWER r a PRIVAtEStPTIC system?
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018
DECLARATION:
1. I acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to
fees and department approval.
3. I certify that the application, plans and supporting materials are a true and 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.
4. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate
of occupancy.
5. 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: David Canfield
SIGNATURE: DATE: _10/24/18
Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018