application PRINCIPAL STRUCTURE APPLICATION Office Use Only
Date: 12r19i2018 Permit No. C C - C - Z ;t
Tax Map ID Permit Fee 1 3+0
Zone Historic? Yes _No Rec Fee
Subdivision Name Lot# Site Plan#
Subdivision#
Project Location 24 Quaker Ridge Blvd Queensbury,NY 12804
TOWN BD.RESOLUTION 86-2013: $850 recreation fee for new dwelling units—single family,duplexes/two-family,multiple family,
apartments,condominiums,townhouses,and/or manufactured&modular homes,but not mobile homes. This is in addition to the
permit fee(s).
Primary Owner(s) Walmart Inc
Address 2001 se 10th street bentonville ar
Phone/Email 479-273-4000
Applicant Leticia Martinez/W Harrison French and Associates
Address 1705 S Walton Blvd, Suite 3 Bentonville, AR 72712
Phone/Email 479-273-7780x263
Contractor TBD
Address
Phone/Email
Contact Person for Building& Codes Compliance: Leticia Martinez Phone 479-273-7780x263
TYPE OF CONSTRUCTION Renovation - M
✓Check all that apply New Addition Alteration 1"floor sf 2n4 floor y T4til Eff r
Single Family
DFC 2 8 2018 fri
Two-Family
TOW P4- ' r1I BURY
Multi-Family BU i Oi;, r 01:"S
(#of units )
Townhouse
_ k
Business Office
Retail-Mercantile 1AV214
Remodel 5,241 SQFT
Factory-Industrial
Attached Garage
(1, 2, 3, 4+)
Other
Town of Queensbury Building&Codes Principal Structure Application revised January 2016
,)
If commercial or industrial please indicate name of business Walmart 4403
Proposed use of building or addition M
Source of Heat(circle one) Gas Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances&Chimneys
Are there structures not shown on plot plan?
Are there easements on the property?
Site Information:
a. Dimensions or acreage of lot
b. Is this a corner lot? Yes X No
c. Will the grade be changed as a result of construction Yes No
d. Public water or Private well(circle one) Public Private
e. Sewer or Private Septic System(circle one) Sewer Private
Value of all work to be performed(labor or materials) $ 650,000.00
DECLARATION:
1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. If work is not complete 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 /
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: Leticia Martinez w/Harrison French &Associates DATE: 12/19/2018
SIGNATURE: DATE:
For office use only
Operating Permit Issued: Yes No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
Town of Queensbury Building&Codes Principal Structure Application Revised January 2016