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AST-0310-2020
w PRINCIPLE STRUCTURE Office Use Only - PERMIT APPLICATION Permit#: fir. 10 - 2.Z 2.-3 liAvn of(2peensbw}. Permit Fee: $ 125 — 742 Bay Road,Queensbury, NY 12804 *Rec. Fee: $ - -----' P: 518-761-8256 www.queens.bury.net Invoice#: 2-(42. "1'k Project Location: 1-f7 Aim' '013 �oa el MA) 0/410 5q/Ff porth) Tax Map #: — Subdivision Name: Sod•S-/-51 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: Ririo 5� ,S }TT/• Name(s): Mailing Address, C/S/Z: 5'97 4-vb:cbon Aotd, Gj ueens1ni"y N y — Cell Phone: ( 5/i ) 796 9r11 Land Line: ( ) Email: ©iteN inn o29t 6 phoo• Gow'I — • Primary Owner(s): Name(s): ,QF7 b £6'# 7'77 Mailing Address, C/S/Z: 5y7 1tiho" hoed, 6imens any N y Cell Phone: (5^/i ) 716 Qdr9e5- Land Line: ( ) Email: Q 0in,2o2`91fi yailoo • (041 IJ?cneck if all work will be performed by property owner only . • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: ) a r __ Land Li , ^' l t ;�.... Cell Phone: ( ) � 1 ; e — Email: — **List all additional contractors on the back of this JUN 19 2020 /, i( • Architect(s)/Engineer(s): TOWN OF OUEFI SE;UPY BUILDING&CODES Business Name: Contact Name(s): Mailing Address, C/S/Z: Cell Phone: ( ) Land Line: ( ) Email: Contact Person for Building & Code Comp 'ance: Cell Phone: ( _) . Land Line: ( ) Email: — Revised January 2020 PROJECT INFORMATION: TYPE: Commercial _ Residential WORK 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: 1ST floor: 01 70 1sT floor: Y)/ r 2'floor: /V011 2"d floor: /VO il ll 3`d floor: iVQY) Total square feet: NO Basement(habitable space): /VD Total square feet: ayo ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 5000.00 • , 2. Proposed use of the building: / "wk/ . . 3. If Commercial or Industrial, indicate the name of the business:div // inr) v`NeQnSfy. 4. Source of Heat: Gas Oil Propane Solar Other: — f'PY) (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 property? YES 0 7. SITE INFORMATION: 02 .� {�- a. What is the dimensions or acreage o he parcel? • b. Is this a corner lot? YES NO c. Will the grade be changed as a result of the construction? YES 0 d. What is the water source? PUBLI PRIVATE WELL . e. Is the parcel on SEWER or a PRIVATE SEPTIC system? /blur) 5e/4e' . n_...-...4 i, ..,... ln,n y . DECLARATION: I. I acknowledge that no construction shall commence prior to issuance ofavalid building permit and work will be completed within a 12 month period. 2. If the work is not completed by the l year 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 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: /9Fi-a (5A-r4 8/7114777 _,C164"/ . DATE: 61 18% ° SIGNATURE: • F.-i-..-'- .1 i S f 7.•-,-:,''...;i T4 W1-4-6 I--( IT , •:.,5 = --- ,•,..:.,.! i ED WA-R'D ,. ...m--1-t-1, Liyo i - . . i KA r"4 FEpL.po ?„.1\-1 . s TRA)..cri 1,.)A XL 1 6 p:-C„- 1'(a -, 0. Kt ..,-1 . . ....: T1-*(7 d Pt 1:.''n'.6114,I-4 At-l-112) (- 0 1-1 i'- t6-.;W LA-L. ..,_.TIL-AE Cak,I. iittd,...1...:L _Iwi,,45....±27 ........ -- - — fr . '--; --.51--). --)' '......rbk-W- \110 9--..-- 1".44:-',•-- - ---- -- ...,- : . . : . _ -11-4-I AT r---7- Cfro, D (-..7'T i cS-A.1 . .d-Fi. TH-6-7 Piao7a7,...T:s- - _ ,,:.-,.':•:,....... r VP1 L L , 5..0 P(IT / .s.:, ---:i t4?4•L, . c.,ETT.,&---12 _ , ,.... FP P-OVI 1\-1 el 7,-A L.t..,. ST)2,AACTU ,,E.A,:-L._, HE7_.t,.-.77., '1,47.3 • . i . I . ..., . .---..•......_._,. .. 1I,i I . . . . c o-1 r 1. . ... . 0 A/A l 1 t-7-- -D,\ -P-4-..) k---/ LAcOk.747 p. 0 4:1,.:-: .-. . _._...,..., ,i.::::-,. _i ,44,. i , !,-,.....,...• i 1 ,...0‘,.. . . . . , i .:•,. . • :.:,-•-, t:-.-.,,,,.•, 1 ,_,,:.•.,..,,,,,,..,: - ._ . . • , ,... ,.. . , ......,, , ..:::::: -. 1 4 -.. • .___... ,. ,.. : •• r,. .. . ..... . .