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CC-0015-2021 Office Use Only r ADDITION/ALTERATION PERMIT Permit CC-081,5- 207-1 APPLICATION permit Fee:$ 200 Town of Queensbury 742 Bay Road,Queensbury,NY 12804 Invoice#: P:518-761-8256 www.aueensbury.net Flood Zone? Y 41aReviewed Project Location: 428 Corinth Rd, Queensbuty,NY 12804 Tax Map ID#: 308.15-1-40 Subdivision Name: Click or tap hereto enter text. PROJECT INFORMATION: TYPE: ❑ Residential ❑ Commercial, Proposed Use: Click or tap here to enter text. ❑ Single-Family ❑.Two-Family ❑ Multi-Family (#of units Click or tap here to enter text.) ❑ Townhouse ❑ Business Office ❑.Retail x❑ Industrial/Warehouse ❑ Garage (#of cars Click or tap here to enter text. ) ❑ Other (describe Click or tap here to enter text. ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE: 1st floor: Click or tap here to enter text. 1st floor: Click or tap here to enter text. 2nd floor: Click or tap here to enter text. 2nd floor: Click or tap here to enter text. 3rd floor:Click or tap here to enter text. 3rd floor: Click or tap here to enter text: Basement (habitable space): Click or tap here t ) enter t xt. Basement (habitable space Click or tap here to enter text. Total sq ft: Click or tap here to enter text. Total sq ft: Click or tap here to enter text. Scope of work to be done:Raise 3 door openings by removing 2 courses of concrete blocks and reinstalling existing lintels. D JAN 14 2021 TOBUILD NGU& CODES ENSBURY. Addition/Alteration-Application, Revised December 2020 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ $4922 2. Source of Heat (circle one): © Gas ❑ Oil ❑ Propane ❑ Solar El Other Click or tap here to enter text. Fireplaces/inserts need a separate Fuel Burning Appliances & Chimney Application 3. Are there any structures not shown on the plot plan? ❑ YES © NO Explain: Click or tap here to enter text. 4. Are there any easements on the property? ❑ YES © NO SITE INFORMATION: • Is this a corner lot? ❑ YES ❑X NO • Will the grade be changed as a result of the construction? ❑ YES © NO • What is the water source? ❑X PUBLIC ❑ PRIVATE WELL • What type of wastewater system is on the parcel? ❑ SEWER ❑X PRIVATE SEPTIC DECLARATION: 1. 1 acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be completed within a 12 month period.Any changes to the approved plans prior to/during construction will require the submittal of amended plans, additional reviews and re-approval. 2. If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3. ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees and department approval. 4. 1 certify that the application, plans and supporting materials are a true and a 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. 5. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 6. 1 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 certificate of occupancy. I have read and agree to the above: PRINT NAME: Michael Alford SIGNATURE: DATE: 1/13/2021 Addition/Alteration Application Revised December 2020 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): Michael Alford/Burch Bottle& Packaging Mailing Address, C/S/Z: 428 Corinth Rd, Queensbury,NY 12804 Cell Phone: (518) 369-6245 Land Line: (518) 273-1845 ext. 104 Email: malford@burchbottle.com • Primary Owner(s): Name(s): Michael Alford,Daniel Rainville, George Ide III, George Ide IV Mailing Address, C/S/Z: 428 Corinth Rd, Queensbury,NY 12804 Cell Phone: (518) 369-6245 Land Line: (518) 273-1845 ext. 104 Email: malford@burchbottle.com ❑ Check if all work will be performed by.property owner only • -Contractor(s): (List all additional contractors on the back of this form) Contact Name(s): Jeff Mercure/Rozell Industries Contractor Trade: Construction Mailing Address, C/S/Z: 129 Park Rd, Queensbury,NY 12804 Cell Phone: (518) 361-2943 Land Line: (518) 793-2865 E ma i I: Click or tap here to enter text. **Workers' Comp documentation must be submitted with this application** • Architect(s)/Engineer(s): Business Name: Haanen Engineering Contact Name(s): Daniel De Nero Mailing Address, C/S/Z: 254 Bay Rd, Queensbury,NY 12804 Cell Phone: Click or tap here to enter text. Land Line: (518) 793-7444 Email:'hjh@hjhllc.com Contact Person for Compliance in regards to this project: Michael Alford Cell.Phone: (518) 369-6245 Land Line: (518) 273-1845 ext. 104 Email: malford@burchbottle.com Addition/Alteration Application Revised December 2020