RC-0510-2020 Office Use Only
ADDITION/ALTERATION.PERMIT J: Permit# � � :�2
APPLICATION
Town ofQeensbury . Permit Fee:$
742 Bay Road,,Queensbury,NY 12804
P:518 761-8256 www.queensburv.net Invoice# 2��
Project Location: 25 Masters Common North
Tax Map ID.#: 29017-1-30 Subdivision Name: N/A
CONTACT INFORMATION:
• : .Applicant:
Name(s): Laurence B. Wadler,individually and as executor of theAllen B:_Wadler Estate
Mailing Address,C/S/Z: 7 Maple Avenue, Unit 10, Morristown, NJ 07960
Cell Phone: _(201)486-4242 : Land Line: _( )
Email: larryw@precisionanalytics.com
▪ Primary-Owner(s):
Name(s): Currently owned by the Allen B. Wadler. Estate, soon to be transferred.to Laurence B.Wadler,
Mailing Address, C/S/Z See above.
Cell Phone: Land Line:
Email:
❑ Check if all work will be performed by homeowner only
• ::Contractor(s):
Contact Name(s):Albany Elevator,Inc - Sales and:Installation
Contractor Trade:
MailingAddress,'C/S/Z: 438 N. Pearl Street,Albany, 12207 ' . ,
Y ,�
Cell Phone:_( ) Land Line (518) 476-0800 IT= i kits
Email:.
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):. 18 q
Business Name: Inclinator Company of America- Manufacturer a2. `; ;.�
Contact Name(s)::_ ,,:3
Mailing Address, C/S/Z: 601 Gibson Blvd, Harrisburg, PA 17104 ..
Cell Phone:_( ) Land Line: (717)93.9-8420
Email:
•
Contact Person for Building &Code Compliance;
Cell Phone:-( . ) Land Line:' _( )
Email:
Addition/Alteration Application Revised February 2019
PROJECT INFORMATION
TYPE: ❑ Commercial X - Residential
WORK CLASS:
X Single-Family, ❑Two-Family : ❑Multi-Family (#of units ),
❑Townhouse ❑Business Office ❑Retail ❑ Industrial/Warehouse
E Garage (#of cars.- ) 0 Other (describe )
ADDITION SQUARE.FOOTAGE: : ALTERATION SQUARE FOOTAGE:
1st floor: :1st floor: 53" x 56"
2nd floor: 2nd floor: 53" 56"
3rd floor: 3rd floor:
Basement (habitable space): Basement (habitable space): 53"x 56":
Total square feet: Total square.feet:_61.83`.
[determines the applications price—30 cents per square foot, Minimum$200. —probably$200 here]-$18.55
.ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ $51,079.00- Project was completed.by Allen Wadler;deceased:.
2. If Commercial project, what is the proposed user N/A.
3. Source of heat::❑GasO0il0PropaneOSolar. ❑Other N/A : Fireplaces need a separate Fuel
Burning Appliances &-Chimney.Application
4. Are there any structures not shown on the plot plan:? OYES. ONO' Explain: N/A
5. Are there any_easements.on.the property? OYES ❑NO N/A
6: SITE INFORMATION:.
a: What is the dimensions or acreage of the parcel? N/A
b. Is this a corner lot? OYES ONO N/A
c. Will the grade be changed as a result of the construction? OYES: NO
d:. What is:the water source?-_ ❑PUBLIC ❑PRIVATE WELL N/A
Is the parcel on SEWER;or a PRIVATE SEPTIC.system? N/A
Addition/Alteration Application Revised February 2019
DECLARATION:
•
The construction is already completed by the prior owner and I
am seeking a permit after the fact.
•
to fccz and dopartmcnt .al. N/A
3. I certify that the application, plans and supporting materials are a true and complete statement and/or
description of the work imposed performed, that to the best of my knowledge all work will-was 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 prier-te-oseu;yingus-i »Ρ g the facilities- proposed my nts, will obtain a
building permit is required from the Town.
5.
•
N/A.
I have read and agree to the above:
PRINT NAME: : Laurence B.Wadler,individually and as executor of the Allen B.Wadler Estate
SIGNATURE: DATE: k f33a1"
Addition/Alteration Application Revised February 2019