applications PRINCIPLE STRUCTURE
Office Use Only
PERMIT APPLICATION
Permit#: CC, --0-2-tab.zo t,, j
Town of(becnsbury Permit Fee:$ SAcyj 1-U
742 Bay Road,Queensbury, NY 12804 *Rec. Fee: $ N\fir
P: 518-761-8256 www.queensburynet
Invoice#: 14?)�j
Project Location: 22/ Cor,,,4-1, �, -�� „i , /2ei,.&/
Tax Map #: 30?./3-2-2S- Subdivision Name: .i/4
TOWN BD.RESOLUTION 86-2013:$850 recreation fee for new dwelling units: single family, duplexes/two-family,
multiplefamily, apartments,condominiums, townhouses,and/or manufactured &modular homes,but not mobile
homes. This is in addition to the permit fee(s).
CONTACT INFORMATION:
• Applicant:
Name(s): S4(eke�
Mailing Address, C/S/Z: 2 '�7 .5,2e,. �Y, / 2.«2<c)
Cell Phone: L579 ) 7,�y-k/a4he Land Line: (, "/' )5gj /2o1 €k4, 11211�
Email: Stce:r 0 5.16,),As. oitoj<Grow?
• Primary Owner(s):
Name(s): C14e,r-.. ; Corporr<4;-0<1
Mailing Address, C/S/Z: 29'07 Ao *e ; i3ct111:/c#-, -g5 / / roz-
Cell Phone: (5/9 ) ;/2y9-44,‘/y Land Line: (s-/z' ) -fig/-/A� f eyi, 4/2L7
Email: ��dC�;� rL; le st-fs
❑ Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):..51—ekk,c4.5 510,os CA.,:,74.r�-140 ,
Contractor Trade:
Mailing Address, C/S/Z: 2907 2o6,4e 9-04/sio,,, ,NY' ,'&o 3
Cell Phone: (.57? ) 77`1-h/o'/'i/ Land Line: (.5-'/2 )3 'i al7
Email: �f�e�o oArei; C Ste ,.z.-7
**List all additional contractors on the back of this form
• Architect(s)/Enqineer(s):
Business Name:
9
Contact Name(s): 5c G4-4- ki4-c.hne.r
Mailing Address, C/S/Z: 2507 /20;s3-e c - /;�11sfo� cam /zo D
Cell Phone: ( ) Land Line: (.S'/Sr )� /-/2„0/ ex-A, i1419
Email: ..514+4ct,nte 9
Contact Person for Building & Code Compliance:) eve i.;rc',k rJ
Cell Phone: (5/e ) 7?`f-%l ey Land Line: (5"/Y ) ex,t, 2e/2
Email: c
Principle Structure Packet Revised February 2019
PROJECT INFORMATION:
TYPE: .Commercial Residential
VORK CLASS:
Single-Family Two-Family Multi-Family(#of units )
Townhouse Business Office ,Retail Hotel/Motel
Industrial/Warehouse Garage(#ofcars ) Other(describe )
STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE:
15T floor: 11)1 1'T floor:
2nd
floor: it. 4 2nd floor:
3rd floor: ,V/4
s Total square feet:
Basement(habitable space): si/,cJ
Total square feet: 49971.
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 370,000
2. Proposed use of the building:Conti, c+nne �J;4h seiC!; rat.54o); c%44c.4.A.,�c.
4ervo.r11- 4tauC'C v
3. If Commercial or Industrial, indicate the name of the business: oc,,43 Silo?_s
4. Source of Heat: Gas Oil Propane Solar Other: ,rlc ,,�,�e, e„ c�.€n� 1,4
(Fireplaces need a separate Fuel Burning Appliances &Chimney Application, one per appliance)
5. Are there any structures not shown on the plot plan? YES NO..% Explain:
6. Are there any easements on the propertylle NO
7. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? 2,g -es
b. Is this a corner lot? ': NO
c. Will the grade be changed as a result of the construction? YES NO ,°
d. What is the water source? PUB PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? 6 '
Principle Structure Packet Revised February 2019
DECLARATION:
I. Iacknowledge that no construction shall commence priorto issuance of a valid building
permit and work will be completed within a 12 month period.
2. If the work is not completed by the 1year expiration date the permit may be renewed,
subject to fees and department approva I.
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 understand that Itive are required to provide an as-built survey by a licensed land surveyor of
all newly constructed facilities priorto issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: . oi.e , h;cc.;0,e d;
SIGNATURE: 4
/ DATE: Y,%hc,
Principle Structure Packet Revised February 2019
Office Use Only
Permit#: CC "
� ��� � , ADDITION/ALTERATION PERMIT 2-6-t) 2s3A)
a `=' APPLICATION Permit Fee:$
Town of Queensbury
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.queensbury.net
Project Location:22/ Cr,,- i, I-2"b - Q�eer,s6„r ,NX /2"Y
Tax Map ID #: 30 c/. /3 -2-2 s'' Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): , Per,
Mailing Address, C/S/Z: 2907 /?axle 9 &//sue, Stec./ .✓y /2o2a
Cell Phone: (47 ) 72 y-kto yy Land Line: (She ) ,. flj -/2 D/ exJ. `/a ti7
Email: S/;cc. arcl, (r�cFewu. asSl�_
• Primary Owner(s):
Name(s): ' Chops Coyor...4;c,
Mailing Address, C/S/Z: 29o7 Ro�Jc 9 /. .1/s5n Spc. / .✓/ /a02 o
Cell Phone: (5/4 ) )7y-/pteyy Land Line: (Sid' ) ex1 Ye'?
Email: Sl cc. rJ; oL��e��..asr�. c. co.
❑ Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):
Business Name: ,54{0 ,- s S! r r-
reor«44007
Contact Name(s): 5 44- 1c �GL�tr
Mailing Address, C/S/Z: 2'o ' &.c 9 -B4/44o,, SPA, NY /tut a
Cell Phone: ( ) Land Line: (S/e )ssIJ-/2o/ ex-I. yzy9
Email: Slc14-oL,isrr ce Skwar�ssl,.�t . ..,
Contact Person for Building & Code Compliance:cteipl,en Zi ccickrcJ
Cell Phone: (S/x ) ?7,/-64 'Y Land Line: (S/X ) Sf'/-/?.o/ ex.. y?Y?
Email:s/ecc;ac-d; e St"c, .,4ssshrc. co,,-,
Addition/Alteration Application Revised February 2019
PROJECT INFORMATION:
TYPE: )( 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: 1st floor: /21r,
2"floor: 2nd floor:
3rd floor: 3rd floor: —'
Basement (habitable space): Basement (habitable space):
Total square feet: Total square feet: /2.V 3
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 7S000
2. If Commercial project, what is the proposed use: Grleru -re.)Is .✓G4;00.,1 13u.►k
3. Source of Heat (circle one): Gas Oil Propan Solar Other
Fireplaces need a separate Fuel Burning Ap lances& Chimney Application
4. Are there any structures not shown on the plot plan? YES NO xplain:
5. Are there any easements on the property? YES NO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? 24 08
b. Is this a corner lot? �� NO
c. Will the grade be changed as a result of the construction? YES NO
d. What is the water source? PUBLI PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? 5 ., r-
Addition/Alteration Application Revised February 2019
A - a
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: ciee e,1 L; c rdi
SIGNATURE: /44e,gov,4 DATE: -0s://9
Addition/Alteration Application Revised February 2019