RC-0603-2020 Office Use Only
f ADDITION/ALTERATION PERMIT Permit#: QC-9420 202-0
APPLICATION Permit Fee:$ -
Town of Queensbury
742 Bay.Road,Queensbury,NY 12804 Invoice#:
P:518-761-8256 www.queensbury.net
Project Location: 23 Jay Road Z e
Tax Map ID #: 289.10-1-14 Subdivision Na - . / . 111111onr /II
T
020
CONTACT INFORMATION: B QUEENS NG&CODFSRY
• Applicant:
Name(s): Cifone Construction.Co.Inc.
Mailing Address, C/S/Z: PO Box 684
Cell Phone: ( 518 ) 361-0626 Land Line: ( 518 ) 792-9242
Email: mcifone@cifone.com
• Primary Owner(S):
Name(s): Gary& Sue Higley
Mailing Address, C/S/Z: 31:Chestnut Ridge Road,Queensbury NY 12804
Cell Phone: ( 518 ) 796-3342 Land Line: ( 518 ) 792-1497
Email: ghigley@gmail.com
Check if all work will be performed by homeowner only,
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): Cifone Construction Co. Inc.
Contractor Trade: General Contractor
Mailing Address, C/S/Z: PO Box 684 Glens:Fall, NY 12801
Cell Phone: ( 518 .) 361-0626 Land Line: ( 518 ) 792-9242:
Email: mcifone@cifone.com
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):
Business Name: Engineer America
Contact Name(s): George Yasenchak
Mailing Address, C/S/Z: 8 Fielding St Glens Falls, NY 12801
Cell Phone: ( 518) 421-9245 Land Line: ( 518 ) 615-0201
Email: georgeyas@yahoo.com
Contact Person for Building& Code Compliance: Matt Cifone
Cell Phone: ( 518 ) 361-0626 Land Line: ( 518 ) 792-9242
Email: mcifone@cifone.com
Addition/Alteration Application Revised February 2019
PROJECT I N FO RMATI O N:
TYPE: Commercial 1 Residential
WORK CLASS:
Single-Family _Two-Family _Multi-Family(#of units
Townhouse Business Office Retail
_Industrial/Warehouse _Garage (#of cars ) _Other(describe
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st.floor: 328.+ 590 = 918 1st floor:
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement(habitable space): 328 Basement (habitable space):
Total square feet: 1246 Total square feet:
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ $100,000
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one): Gas Oil Propane Solar Other seasonal:camp
Fireplaces need a separate Fuel Burning Appliances &Chimney Application
4. Are there any structures not shown on the plot plan? YES Explain:
5. Are there any easements on the property? YES Re
6. SITE INFORMATION:
a: What is the dimensions or acreage of the p�.rcel? 20199.6 Sq.Ft.
b. Is this a corner lot? YES I
c. Will-the grade be changed as aresult of the construction? YES
d. What is the water source? PUBLIC PRIVATE IN AL
e. Is the parcel on SEWER or a.PRIVA_ISEPTICsystem?
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: Matt Cifone
Digitally signed by Matthew J
SIGNATURE: Matthew J Cifone DATE:
DN:cn=Matthew J Cifone,
C• o=Cifone C.onst.Co.Inc.,ou,
I fO n e ' email mcifone@cifone.com,c=US
Date:2020.10.01 10:12:18-04'00'
Addition/Alteration Application Revised February 2019
FLOOD DAMAGE PREVENTION
APPLICATION.# 'G3 2-0Z
Appendix A
Floodplain Development Permit Application
Town of Queensbury,New York
This form is to be filled out in duplicate.
SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sign):
1. No work may start until a permit is issued.
2. The permit may be revoked if any false statements are made herein.
3. If revoked, all work must cease until permit is re-issued.
4. Development shall not be used or occupied until a Certificate of Compliance is is-
sued.
5. The permit will expire if no work is commenced within six months of issuance.
6. Applicant is hereby informed that other permits may be required to fulfill local,
state and federal regulatory requirements.
7. Applicant hereby gives consent to the local administrator or his/her representative
to make reasonable inspections required to verify compliance.
8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN
ATTACHMENTS TO THIS APPLICATI ARE, TO THE BEST OF MY
KNOWLEDGE,TRUE AND ACCURA -
(APPLICANT'S SIGNATURE) - - - -__ _ DATE 70 ,[.3 ;2/O.
SECTION 2:PROPOSED DEVELOPMENT(To be completed by APPLICANT)
NAME ADDRESS - TELEPHONE
APPLICANT
Gary & Sue Higley 23 Jay Rd 518-796-3342
BUILDER
Cifone Construction Co. Inc. PO Box 684 GF 5183610626
ENGINEER Hutchins Eng 169 Haviland Rd QB 5187450307
PROJECT LOCATION: 23 Jay Road 289.10-1-14
To avoid delay in processing the application, please provide enough information to eas-
ily identify the project location. Provide the street address, lot number or legal descrip-
tion (attach) and, outside urban areas, the distance to the nearest intersecting road or
91:Al 08-26-2002
QUEENSBURY CODE
well-known landmark. A sketch attached to this application showing the project loca-
tion would be helpful.
DESCRIPTION OF WORK(Check all applicable boxes):
A. STRUCTURAL DEVELOPMENT
ACTIVITY STRUCTURE TYPE
New Structure - Residentiat (1-4 Family)
Addition ▪ ? Residential (More than 4 Family)
Alteration , Non-residential(Floodproofing9 ❑Yes
Relocation Combined Use(Residential&Commercial
%'Demolition Manufactured(Mobile)Home(In Manufactured Home
Replacement Park?❑Yes)
ESTIMATED COST OF PROJECT$ $100,000
B. OTHER DEVELOPMENT ACTIVITIES:
Fill ❑Mining ❑Drilling rading
Excavation(Except for Structural Development Checked Above)
Watercourse Alteration(Including Dredging and Channel Modifications)
Drainage Improvements(Including Culvert Work)
Road, Street or Bridge Construction
Subdivision(New or Expansion)
Individual Water or Sewer System
❑Other(Please Specify)
After completing SECTION 2,APPLICANT should submit form to local administrator
for review.
SECTION 3: FLOODPLAIN DETERMINATION (To be completed by LOCAL AD-
MINISTRATOR)
The proposed development is located on FIRM Panel No. , Dated
The Proposed Development:
91:A2 08-26-2002
FLOOD DAMAGE PREVENTION
?n Is NOT located in a Special Flood Hazard Area (Notify the applicant that the
application review is complete and NO FLOODPLAIN DEVELOPMENT
PERMIT IS REQUIRED).
❑ Is located in a Special Flood Hazard Area.
FIRM zone designation is-_ -.
100-Year flood elevation at the site is Ft.
NGVD (MSL)
n Unavailable
n The proposed development is located in a floodway.
FBFM Panel No. __Dated_ _ _.-_ _
�4 See Section 4 for additional instructions.
SIGNED - .... . DATE . Ov /3 24-
SECTION 4: ADDITIONAL INFORMATION REQUIRED (To be completed by LO-
CAL ADMINISTRATOR).
The applicant must submit the documents checked below before the application can be
processed:
n A site plan showing the location of all existing structures, water bodies, adja-
cent roads, lot dimensions and proposed development.
n Development plans, drawn to scale, and specifications, including where appli-
cable: details for anchoring structures, proposed elevation of lowest floor (in-
cluding basement), types of water resistant materials used below the first floor,
details of floodproofing of utilities located below the.first floor and details of
enclosures below the first floor.
Also,
LI Subdivision or other development plans (If the subdivision or other develop-
ment exceeds 50 lots or 5 acres,whichever is the,lesser, the applicant must pro-
vide 100-year flood elevations if they are not otherwise available).
n Plans showing the extent of watercourse relocation and/or landform alterations.
n Top of new fill elevation Ft.NGVD (MSL).
91:A3 08-26-2002
QUEENSBURY'CODE
loodproofing protection level (nonresidential only) Ft. NGVD (MSL).
For floodproofed structures, applicant must attach certification from registered
engineer or architect.
ri Certification from a registered engineer that the proposed activity in a regula-
tory floodway will not result in any increase in the height of the 100-year flood.
A copy of all data and calculations supporting this finding must also be submit-
ted.
FYI Other:_ F46 o'( 44 if c 4 -4 4%J 7_6- p y
SECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINIS-
TRATOR)
I have determined that the proposed activity:
A. Is
B. 1
I Is not
in conformance with provisions of Local Law# 4J , 19 g 9. The permit is issued
subject to the conditions attached to and made part of this permit.
SIGNED04/1-77- ; DATE /d73 2p
If-BOX-A is checked, the Local Administrator may issue a Development Permit upon
payment of designated fee.
If`.BOX.B-is checked,the Local Administrator will provide a written summary of defi-
ciencies.Applicant may-revise and resubmit an application to the Administrator or may
request a hearing from the Board of Appeals.
APPEALS: Appealed to Board of Appeals?n Yes n No
Hearing date:
Appeals Board Decision-Approved?. Yes n No
Conditions.. _
SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before
Certificate of Compliance is issued)
91:A4 08-26-2002
FLOOD DAMAGE PREVENTION
The following information must be provided for project structures. This section must
be completed by a registered professional engineer or a licensed land surveyor (or at-
tach a certification to this application). Complete 1 or 2 below.
1. Actual (As-Built) Elevation of the top of the lowest floor, including basement
(in Coastal High Hazard Areas,bottom of lowest structural member of the lowest floor,
excluding piling and columns) is: FT.NGVD(MSL):
2. Actual (As-Built)Elevation of floodproofing protection is FT.
NGVD (MSL).
NOTE: Any work performed prior to submittal of the above information is at the risk
of the Applicant.
SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRA-
TOR)
The LOCAL ADMINISTRATOR will complete this section as applicable based on in-
spection of the project to ensure compliance with the community's local law for flood
damage prevention.
INSPECTIONS:
DATE BY DEFICIENCIES?E YES E NO
DATE - BY DEFICIENCIES?fl YES I._ NO
DATE BY DEFICIENCIES?r YES I NO
SECTION 8: CERTIFICATE OF COMPLIANCE (To be completed by LOCAL AD-
MINISTRATOR)
Certificate of Compliance issued:DATE: BY:
91:A5 08-26-2002
FLOOD DAMAGE PREVENTION
Appendix B
CERTIFICATE OF COMPLIANCE
FOR DEVELOPMENT IN A SPECIAL FLOOD
HAZARD AREA
Town of Queensbury,New York
(Owner Must Retain This Certificate)
Premises located at: 23 T4i gb
Owner: /Ii /.may Le t.pacri.zs
Address: 23 d4'/ go
Permit No.603—2-grui Permit Date: i o14( £.frs)r�et
Check One:
New Building
Existing Building
Fill
V Other: - /.lo-t.) ecr e
The Local Floodplain Administrator is to complete a. or b. below:
a. Compliance is hereby certified with the requirements of Local Law No. ,
19
Signed: _ Dated:
b. Compliance is hereby certified with the requirements of Local Law No. ,
19 ,as modified by variance no. ,dated
Signed: Dated:
91:A7 08-26-2002
NATURAL LIGHT,VENTILATION&EMERGENCY EGRESS CALCULATION SHEET
Project Location: 23 Jay Road
Primary Owner (s): Gary& Sue Higley
Habitable Sq. Ft. Required Actual Required Actual Sq. ft.
Rooms of Light Light Ventilation Ventilation opening
Room (8% of rm.) (sq. ft.) (4% of room) (sq. ft.) for Egress
Garys TV
Room 303 24.24 28.1 12.12 13.5 NA
riEllv „
OiT
011010
11
BUILD NGUEE�►Uy
Principle Structure Packet Revised February 2019
WINDOW SCHEDULE CALCULATION SHEET
Project Location: 23 Jay. Road
Primary Owner (s): Gary & Sue Higley
Habitable Garys TV
Rooms Room
Window#/letter 5
On Plan 1
Manufacturer
Name Pella Pella
Model/Type Double hung picture (fixes)
3 - 3353 2424
Unit/Block#
Cell Size
Rough Opening 99-3/4" W 24-3/4"
Width 53-3/4" H 24-3/4"
Sq. Ft. Vent
13.5
Sq. Ft. Egress/ 4.5
Clear Opening
Clear Opening- 29-5/16'
Width in inches
Clear Opening-
Height in inches 22-1/16"
Special Hardware
or instructions
U-Value
0.30 0.30
OCT 01 ?020
TBU CovvN,�GUEENc,_
&cp®EBRY
Principle Structure Packet Revised February 2019