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Office Use Only ADDITION/ALTERATION PERMIT|Permit #_CC~OO\O" 292.0 APPLICATION Permit Fee:$_7-00TownofQueensbury 742 Bay Road,Queensbury,NY 12804 Invoice #:_'2250% P:518-761-8256 www.queensbury.net Project Location:_390 Quaker Rd Tax MapID#:___303.Subdivision Name: CONTACT INFORMATIO! ©Applicant: Name(s):Jeffery L Shorr Jt.-President,Saratoga Auto'Si Mailing Address,C/S/Z:_288 Milton Ave,Ballston Spa,NY 12026 Cell Phone:_(518 _)301-2657 Land Line:(518 _)_793.3473 Email:,jeff.shorr@saratoganapa.com «Primary Owner(s): Name(s):David Saleem Mailing Address,C/S/Z:__120 Coolidge Ave,Glens Falls,NY_12804 Cell Phone:_(518 _)260-759 Land Line:_() Email:dsaleem1414@yahoo.com O Check if all work will be performed by homeowner only ©Contractor(s):Workers’Comp documentation must be submitted with this application Contact Name(s):Munter Enterprises,Inc. Contractor Trade:General Contractor Mailing Address,C/S/Z:881 Murray Road,Middle Grove,NY_12850 Cell Phone:_(518 _)858-1779 land Line:(518 _)584-6174 Email: **List all additional contractors on the back of this form ¢Architect(s)/Engineer(s): Business Name:Paone Architecture,PC Contact Name(s):John Paone Mailing Address,C/S/Z:547 Route 9P,Saratoga Springs,NY 12866 Cell Phone:_()Land Line:(518 _)580-0017 Email:patarch@aol.com Contact Person for Building &Code Compliance:John Paone Cell Phone:_{)Land Line:(518)580-0017 Email:patarch@aol.com Adition/Ateration Application Revised February 2019 PROJECT INFORMATION: TYPE:X__Commercial Residential WORK CLASS: ___Single-Family _Two-Family __Multi-Family (#of units ) ___Townhouse ___Business Office X Retail ___Industrial/Warehouse __Garage (Hf of cars )__Other (describe ) ADDITION SQUARE FOOTAGE:ALTERATION SQUARE FOOTAGE: Ast floor:_n/a Ast floor:_1,750sf of overall 7,000sf 2"floor:_n/a 2"floor:nla 3%floor:_n/a 3°floor na Basement (habitable space):Basement (habitable space):na Total square feet:_/Total square fe oO ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:$_$25,000 +/- If Commercial project,what is the proposed use:Existing Mercantile/Storage with no occup.change Source of Heat (circle one):Gas Oil Propane —_— Solar Other Fireplaces need a separate Fuel Burning Appliances &Chimney Application Are there any structures not shown on the plot plan?YES NO Explain:N/a,interior work only Are there any easements on the property?YES NO SITE INFORMATION: What is the dimensions or acreage of the z rcei?"a,interior work only Is this a corner lot?YES Will the grade be changed as a construction?YES PRIVATE WELLWhatisthewatersource? Is the parcel off SEWER gr a PRIVATE SEPTIC system? paoge -Addition/2teration Application Revised February 2019, DECLARATION: 1.|acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. 2,Ifthework is not completed by the 1 year expiration date the permit may be renewed,subject to fees and department approval. 3.|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,|acknowledge that prior to occupying the facilities proposed |,or my agents,will obtain a certificate of occupancy. 5.lalso understand that IAve are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of acertificate of occupancy, I have read and agree to the above: PRINT NAME:iran L.Sho Te-Resnest SIGNATURE: \,Ren.pate:(2-119 “adaiton/ateraton Application Revised February 2019,