application Office Use Only
^; ADDITION/ALTERATION PERMIT Permit#: ` d Z5i - 20 2.0
APPLICATION
Town of Queensbury Permit Fee:$ 20 '35FJ- o
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Invoice#: ��;Z J
Project Location: 677 Glen Street
Tax Map ID#: 302.10-1-7 Subdivision Name:N/A
CONTACT INFORMATION:
• Applicant: RECIEUVE5
Name(s): Emco Construction
Mailing Address, C/S/Z: 2050 Western Ave Suite 210 Guilderland, NY 12I JUN 0 3 2020
Cell Phone: (518)857-0058 Land Line: (518)456-1853 _
Email: kevinh@emcoconstruction.com TOWN OF QUEENSBURY
BUILDING&CODES
• Primary Owner(s):
Name(s): The Golub Corporation
Mailing Address, C/S/Z: 461 Nott Street Schenectady, NY 12308
Cell Phone: ( ) Land Line: (518)379-1484
Email: denislyons@pricechopper.com
Check,if all work will be performed by homeowner only
• Contractor(s):
Contact Name(s): EmcoDistributors Inc. dba Emco Construction
Contractor.,Trade: Construction Manager
Mailing Address, C/S/Z: 2050 Western Ave Suite 210 Guilderland,NY 12084
Cell Phone: (518)857-0058 Land Line: (518)456-185
Email: kevinh@emcoconstruction.com
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):
Business Name: L2M Architecture
Contact Name(s): John Towle
Mailing Address, C/S/Z: 90 Bridge Street Suite 420 Westbrook, Maine 04092
Cell Phone: _( ) Land Line: (410)863-1302
Email: Jtowle@L2M.com
Contact Person for Building & Code Compliance: Click or tap here to enter text.
Cell Phone:_( ) Land Line: (410)863-1302
Email: Jtowle@L2M.com
AdditiortterationApplication Revised Feb ruary2019
PROJECT INFORMATION:
•
TYPE: El Commercial ❑ Residential
WORK CLASS:
❑ Single-Family OTwo-Family El Multi-Family(#of units
❑Townhouse ❑Business Office ®Retail 0 Industrial/Warehouse
❑ Garage (#of cars ) 0 Other(describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor: 67,850 sqft
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement (habitable space): Basement(habitable space):
Total square feet: Total square feet: 67,850
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $2,400,000.00
2. If Commercial project, what is the proposed use: Grocery Store
3. Source of heat: ®Gas❑Oil❑Propane❑Solar ❑Other Fireplaces need a separate Fuel
Burning Appliances&Chimney Application
4. Are there any structures not shown on the plot plan? DYES ONO Explain:
5. Are there any easements on the property? OYES ONO
6. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel?
b. Is this a corner lot? OYES ONO
c. Will the grade be changed as a result of the construction? OYES ONO
d. What is the water source? ❑PUBLIC ❑PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system?
•
Addition/Alteration Application Revised February 2019
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: Kevin Hun " t s
SIGNATURE: ATE: May 2, 2020
•
Addition/Alteration Application Revised.February 2019