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Office Use Only ¢ADDITION/ALTERATION PERMIT|permit y:__C.C60 80-20 own of Ogecestery AEEUICATION Permit Fee:$(00:60 742 Bay Road,Queensbury,NY 12804 .= P:518-761-8256 yoww.queensbury.net Invoice:ASSP Project Location:365 Aviation Road___ Tax Map ID #:301.8-1-35 Subdivision Name:_NA AE CEIYW IY p——— CONTACT INFORMATION:fi |FEB U4 a9 ©Applicant:q Ow Name(s):Dr.James lewis u Mailing Address,C/S/Z:365 Aviation Road,Queensbury NY 12804. Cell Phone:_610-420-4948,Land Line:_() Email:_james.b.lewis@gmail.com *Primary Owner(s): Name(s):Dr.James Lewis Mailing Address,C/S/Z:_365 Aviation Road,Queensbury NY 12804 Cell Phone:_610-420-4948 Land Line:_( Email:_james.b.lewis@gmail.com O Check if all work will be performed by homeowner only ©Contractor(s): Contact Name(s):Hilltop Construction _Contractor Trade:_General Contractor, Mailing Address,C/S/Z:51 Crowley Road,Hudson Falls NY 12839. Cell Phone:_518-229-8704.Land Line:_518-798-0338, Email:_tomjr@hilltopconstructionco.com _**List all additional contractors on the back of this form ©Architect(s)/Engineer( Business Name:Rucinski Hall Architecture Contact Name(s):_Ethan P.Hall Mailing Address,C/S/Z:_134 Dix Ave,Glens Falls NY 12801 Cell Phone:_518-260-2888.Land Line:_518-741-02638 Email:_ephall@nycap.rr.com. Contact Person for Building &Code Compliance:_Fthan P.Hall Cell Phone:_518-260-2888 Land Line:_518-741-0268, Email:_ephall@nycap.rr.com, ‘Addiion/alteration Application Revised February 2018 PROJECT INFORMATION: ¢= TYPE:@ Commercial CO Residential WORK CLASS: C Single-Family (CiTwo-Family C1 Multi-Family (#of units,) OTownhouse XBusiness Office Detail 1 Industrial/Warehouse CO Garage (#of cars )Cl Other (describe ) ADDITION SQUARE FOOTAGE:ALTERATION SQUARE FOOTAGE: 2,000 SF Basement (habitable space):Basement (habitable space): Total square fet Total square feet: ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:$$45,000, 2.if Commercial project,what is the proposed use:_Dental Office 3.Source of heat:6GasCIoilL1PropaneC solar Other Fireplaces need a separate Fuel Burning Appliances &Chimney Application 4,Are there any structures not shown on the plot plan?CIYES INO Explain 5.Are there any easements on the property?(ves INO 6.SITE INFORMATION: a.What is the dimensions or acreage of the parcel?_150’x 175’(0.60 acre). b.Is this a corner lot?Ces No c.Will the grade be changed as a result of the construction?Oyes No d.What is the water source?PUBLIC COPRIVATE WELL 2 Is the parcel on SEWER or a PRIVATE SEPTIC system?_Private. ‘Adgition/Atertion Applicaton 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.If thework 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. 4.1 acknowledge that prior to occupying the facilities proposed |,or my agents,will obtain a certificate of occupancy. 5.also understand that [Ave 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. have read and agree to the above: print NAME:__Estuan ‘P.Voawe -Weer ree pecan SIGNATURE Ee BALA pate:2 A&B 220 ‘Addition/Ateration Applicaton Revised February 2019