The URL can be used to link to this page

applicationti ADDITION/ALTERATION PERMIT|Permit #:KC -013~-Fo 14. -APPLICATION Permit Fee:$_2/4 YoTown 742 Bay Road,Queensbury,NY 12804 Invoice #:_AUB 4 P:518-761-8256 www.gueensbury.net Project Location:15°\Wlacten St.Queen sloury J NY TaxMap ind:304-17 -1—|2.Subdivision Name: CONTACT INFORMATION: °icant: Name(s):Die Edaerly (Sanes) Mailing Address,C/S/2:See.below Cell Phone:_()Land Line:_{) Email:, *PrimaryOwner(s):aName(s):wim Edaeduy (James) Mailing Address,C/S/z:__iS fare.TSt.,Hudsim Falls,NY (2734 Cell Phone:_().Land Line:_(), Email:, O check if all work will be performed by homeowner only ©Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s):Themas Du Four Contractor Trade: Mailing Address,C/s/z:__5%Oraytot RA Et,Aun iy (L827 Cell Phone:_(Ft?_)Z6O -F573 Land tine:_{) Email _Mx22man@ yahoo.Com **List all additional contractors on the back of this form enees Wane ‘Se wm Buekle,fe.,Price Contact Name(s):Mack 3.Guckled Mailing Address,C/s/z:__P.0.Gox Hol Wsilsboro,NY (2tte Cell Phone:_(St¥Y)S7¥-474(landline:(51%)769-4UCT Email:buckleaan @wsillen,Gone Contact Person for Building &Code Compliance: Cell Phone:_{)Land Line:_{). Email: ‘Addition/Alteration Application Revised February 2019 DECLARATION: 1,l acknowledge that no construction shall be commenced prior to issuance of a valid permit and will becompletedwithina12monthperiod. 2.Ifthework is not completed by the 1 year expiration date the permit may be renewed,subject tofeesanddepartmentapproval. 3.|certify that the application,plans and supporting materials are a true and complete statement and/ordescriptionoftheworkproposed,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.|acknowledge that prior to occupying the facilities Proposed |,or my agents,will obtain a certificateofoccupancy. 5.also understand that I/we are required to provide an as-built survey by a licensed land surveyor of alnewlyconstructedfacilitiespriortoissuanceofacertificate:‘of occupancy. I have read and agree to the above: PRINT NAME:_7 Abroas Lovee<ISIGNATURE:<7 Zo pate:_2/-/9-/F ‘Aditon/Alteration Appcation Revised February 2019, PROJECT INFORMATION: TYPE:Commercial /Residential ‘WORK CLASS: 1 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: Ast floor:1st floor:_6992"floor 2"floor:__3.6.0 3"floor:3"floor: Basement (habitable space):Basement (habitable space): Total square feet:Total square feet:04% ADDITIONAL PROJECT INFORMATION: (1)Estimated Cost of Construction:$. 2.If Commercial project,what is the proposed use: 3.Source of Heat (circle one):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 (NO)Explain: (5)Are there any easements on the property?YES No 6,SITE INFORMATION: What is the dimensions or acreage of ti rcel?O49 Is this a corner lot?YES Will the grade be changed as a re:construction?YES.(wo) What is the water source?(PUBLIC)PRIVATE WELL Is the parcel on SEWER or a PRIVATE SEPTIC system? __ S¢wet paoge ‘Addition/Aiteration Application Revised February 2018