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application
Office Use Only ADDITION/ALTERATION PERMIT|permit:Cco-020 6 =2020 wa tf Oneonta APPLICATION Permit Fee:$_\t5 742 Bay Road,Queensbury,NY 12804 |Invoice #:_2556P:518-761-8256 www.queensbury.net Project Location:|Quakay Ry. Tax Map ID 4:Subdivision Name:D)ECEIyV CONTACT INFORMATION:MAY 19 2029 ©Applicant:reeName(s):_Ted Simmons Mailing Address,C/S/Z:_1004 Hudson River Rd,Mechanieville,NY 12118 Cell Phone:_(518)390-9392 land Line:_(518)__664-1315. Email: ¢Primary Owner(s): Name(s):_Hannaford Bros. Mailing Address,C/S/Z:_145 Pleasant Hill Rd.,Scarborough,ME.04074 Cell Phone:_(207)329-1423 Land Line:_(207)885-2533. Email:_george.lekousi@retailbusinessservices.com O Check if all work will be performed by homeowner only ©Contractor(s Contact Name(s):P&M Construction Contractor Trade:General Contractor. Mailing Address,C/S/Z:_1004 Hudson River Rd.,Mechanicville,NY 12118 Cell Phone:_(518)390-9392,Land Line:_(518)664-1315, Email:tsimmons@pnmconstruct.com, **List all additional contractors on the back of this form ©Architect(s)/Engineer(s): Business Name:L2M,Inc. Contact Name(s):__Jon TowleMailingAddress,C/S/Z:811 Cromwell Park Drive,Suite 113,Glen Burnie,Maryland,21061 Cell Phone:_()_Not available Land Line:_(410)863-1302 Email:jtowle@L2m.com Contact Person for Building &Code Compliance:Jon Towle Cell Phone:_()Not available land Line:_(410)863-1302 Email:__jtowle@L2m.com AAdsition/Alteration Application Revised February 2019 ©Contractor(s): Contact Name(s):Colonie Mechanical Contractor Trade:_Refrigeration. Mailing Address,C/S/Z:_17 Railroad Ave.,Albany,NY 12205 Cell Phone:_(518)365-5811.Land Line:_(518)982-2237. Email:_jtremblay@coloniemechanical.com, ¢Contractor(s): Contact Name(s):J&M Flooring Contractor Trade:__Flooring, Mailing Address,C/S/Z:__PO Box 1087Westbrook ME 04098-1087. Cell Phone:_(207)939-9621_Land Line:_207)854-4132 Email:matt@jmincflooring.com ©Contractor(s): Contact Name(s):MG Electric Contractor Trade:Electrical Mailing Address,C/S/Z:_97 Edie Rd..Saratoga,NY 12866. Cell Phone:_(518)366-4955,Land Line:_()_N/A, Email:_mgroff002@gmail.com ©Contractor(s): Contact Name(s Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Ema ©Contractor(s) Contact Name(s} Contractor Trade: Mailing Address,C/S/Z Cell Phone:_()Land Line:_() Email:_ ©Contractor(s): Contact Name(s): Contractor Trade: Mailing Address,C/S/Z Cell Phone:_()Land Line: Email: Addition Ateration Application Revise ary 2019, PROJECT INFORMATIO! TYPE:®&Commercial Cl Residential WORK CLASS: CO Single-Family Citwo-Family—-CAMulti-Family (#of units ) (CTownhouse CiBusiness Office x Retail C Industrial/Warehouse C Garage (#of cars )C1 Other (describe ) ADDITION SQUARE FOOTAGE:ALTERATION SQUARE FOOTAGE: Ast floor:Ast floor:4500, 2°floor:2"floor:3 floor:3 floor Basement (habitable space): Total square feet: ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:§_235,495.43 2.If Commercial project,what is the proposed use:_« 3.Source of heat:XiGas_OilPropane(1Solar CiOther Burning Appliances &Chimney Application Basement (habitable space): Total square feet:__4500 Grocery store, Fireplaces need a separate Fuel 4,Are there any structures not shown on the plot plan?CIYES KINO Explain: 5.Are there any easements on the property? 6.SITE INFORMATION: Oves no a.What is the dimensions or acreage of the parcel? Is this a corner lot?Oyes aos What is the water source?PUBLIC 2 Adtion Alteration Application no Will the grade be changed as a result of the construction?DaYES COPRIVATE WELL Ono Is the parcel on SEWER or a PRIVATE SEPTIC system? Revised February 2018 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 |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. Ihaveread and agree to the above: PRINT NAME:__Ted Sim: SIGNATURE:DATE:_5/14/20. ‘Addition/Alteration Application Revised February 2019