CC-0308-2021 Office Use Only
{=* ADDITION/ALTERATION PERMIT Permit#: CI.
APPLICATION Permit Fee: $ 7-00
7bW1 or(Leen busy
742 Bay Road,Queensbury,NY 12804 Invoice#:_ 1�t)(o9lz)
P:518-761-8256 www.gueensbury.net
Flood Zone? Y N Reviewed By:
Project Location: '5
Tax Map ID #: 3o 3 .5' — I 7-6' Subdivision N
PROJECT INFORMATION:
MAY 0 5 2021
TOWN OF QUEENSBURY
TYPE: Residential Commercial, Propose D NG&CO S
_Single-Family _Two-Family Multi-Family (# of units ) _Townhouse
V/Business Office _Retail Industrial/Warehouse _Garage (# of cars_)
Other (describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:
2nd floor: J� 2nd floor:
3rd floor: / 3rd floor:
Basement (habitable space): Basement (habitable space):
Total sq ft: �nZ Total sq ft:
Scope of work to be done: C�-I US)
ivy- W6t GI �r� H6 I CA/I s .�
Com 6INYA lytb 0 A-Rs lq+0 q V-r-1 v soc"c . at M&td qM ctd-d'/s
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Addition/Alteration Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ to do. UV
2. Source of Heat (circle one): r/Gas _Oil _Propane _Solar_Other
Fireplaces/inserts need a separate Fuel Burning Appliances& Chimney Application
3. Are there any structures not shown on the plot plan? _YES ZNO Explain:
4. Are there any easements on the property? /YES NO I l d�Wux'
SITE INFORMATION: // (G� ArmaU'c.f j
• Is this a corner lot? YES 'ENO
• Will the grade be changed as a result of the construction? YES (�N0
• What is the water source? ✓ PUBLIC _PRIVATE WELL
• What type of wastewater system is on the parcel? EWER _PRIVATE SEPTIC
DECLARATION:
I. I 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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.
�. If the work 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:
SIGNATURE: DATE:
Addition/Alteration Application Revised January 2021
a i 1
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):
Mailing Address, C/S/Z:
Cell Phone: K ) c23A— Ca 1 &--7- U land Line:
Email:5 Ole� q--4 �q 0 �61 C u
Primary Owners : '
Name(s): YJ
Mailing Address, C/S/Z: 42 Lairot!j
Cell Phone: ( ��[�) a3Z— Ce ( &�- Land Line:) -��-�/ l
Email: JIB u;
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):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: �_) Land Line: � )
Email:
**Workers' Comp documentation must be submitted with this application**
• Arch itect(s)/Enei nee r(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: �_) Land Line: � )
Email:
Contact Person for Compliance in regards to this project: % Lt
Cell Phone: � ) —(.P( �'f' Land Line:
Email: JO A n
Addition/Alteration Application Revised January 2021
QUANTUM`C•HIROP,RACTIC
DR.BRUCE.STEINBERG,D.C...
QUANTUM 1
NY Lisc,4.0113.17;NPI. 1275606576.
:
C H I R O'PR A.0 T I:C Tax Id.
.Fpy:
Duo
: . May 1,,2021 .
. . • . MAY: p.�: Z02t . . :. •� .: :� . •
Town Of Qusbury een
Building andCodes Department TG GF QUEENS .
.7.42:Bay.Road BUILDING&CODES . : .
Queensbury;.NY-:1.2804:
RE. CERTIFICATE OF-O.CC.UPANCY.APPLICATLON
Dear•Sirs,. .
Enclosed.yo.0 will.:find our application:for.an.:Aci'dition/Alteration.Permit:for.our recently pur:
•.chased'office located•at•357 Ridge Road irvQueehsbury:
1 .wanted to. include•a.note.because [wasn't. needed to submit.this appli
cation:or just a.:Certifcate of:Occupancy application. l .spoke.with the fre marshal and one of the la
dies in your office.thereb. t:it seems.like:we.are infhat.fringe area�wfiere:iiit.bould%g' :either.way."I
have decided to submit.the permit application.-along,with.:an.electrical-.insp:ection:and.await further..
guidance:°l'm:also,unclear:on how:to.calculate the permit,fee so.1 have enclosed the $200.00:mini-:
mum.for.:the time being: .: .
..,We.,have done a.•considerable-amount�of cosmetic work-with the.exception of taking.down-a
wall and-replacing it with�•half walls: No square.footage has.changed:.On.April 29th; we had.Ron.
M.um.blo.from.Commonwealth:Electrical.come in.to.inspect all:of.'the:electrical .involved, in those .
: .walls; the.lighting:that. chariged.-overto-.LED�afid.the outlets:where:we swapped new receptacles..
•: °for:old.ones that would no.jonger hold a.plug:.Mr.:Mumkilo°will be.forwarding his inspection°report°di
rectly.to your office:'.
I .look.forward:to.hearing#rom you.arid,appreciate your.ongoing,guidance,throtagh this process:
en Steinberg-..'
eral.Manager
357.RIDGE.ROAD. •� .QUEENSBURY: .NEW:YORK i. 12804-.' .:
TELEPHONE_(518).'79,8.-1.111:•-.•FAX (5�18)•792-3943-
Map Reference
Map of a Survey made for / \
Janet Huston Bell
Dated i: March 26, 1993 Ra�pc
By: Van Duren b Staves / s
Land Surveyors + S
Se \ Lands N)F of
h� °Sy \ Mead's Nursery Inc
8:584 P:725
\Geed Reference Lends N)F of + Area 303.5.1.79
Mead's Nursery Inc 3278
8.8 Sq. Feet
:7
To \
Janet Huston Ball8:584 P25 0.75 Acres+/
Thomas M Callaghan 303.5-1-70 / - \
Dated: March 15, 2007
Recorded on: March 16, 2007
AS Instrument N: 2007-2627 N,AB gN/lPt
+ VIA
-
:_ mo
-
-
I MEREDY f,ER11FY THAT rH15 MAP WAS PREPARED RFFERENCt 151/ERLBY NAi)E r0 A COMMITMENS FOR}TILE Lf{SUf:.VIGE
FROM NI ACTUAL M V SURVEY. 4' J ____ _ 155UE0 IVY GLENWOOD ABSTRACT.LLC,A5 AGENT FOR OLD REPUBLIC
THIS CERNYICATION SIINL RUN ONLY 10 Tilt PERSONS Ba v P'P= _—�_ _an Ifole' ,yA NATIONAL TITLE INSURANCE COMPANY,DATED JANUARY 11,2021,
FOR WHOM THE SURVEY WAS PREPARED,AND ON THEIR IP SC, ��/ BEARING FILE NUMBER 21-GA-3144.AS RELIEVED BY VNI M35f11
BEHNP TO 111E TITLE COMPANY,GOVERNMENTAL AGENCY \?S, ____ __ �',. SIEVES LAND SURVEYORS.
AND LENDING INSTITUTION U5TED HEREON.
CERTIFICATIONS ARE NOT TRANIZAPIE TO ADDITIONN PARCEL 19 5VWECI TO Alff PASUAW15 OF RECORD
NDILS.
3 j .
IN5TITUTIONS ORSUBSCDUENTTW �Ao' :—=—=_--—_ __—_ _ _ THIS MAP WA9 PREPARED PROM AN ACTUAL PInD 5URVCY MADE IN
ACCORDANCE WITIi TIIE U15TING CODE OF PRACTICE ADOPTED BY TIIE
CfRIIfIYD TO: EMPIRE STATE CERTIFIED DEVELUPAfCNr CORPORATION NEW YORA 51ATE A550CIATION OF PROFESSIONAL LAND 511RVEYOR5.
HRUCE STEINBERG 1 JENNIPER 51EINMR/:
OLD R[PUBUC NATIONAL TITLE INSURANCE COMPANY 4.1 THIS MAP IS UNAWGIR ZED AL VAN DUSF.N 1 STEWS LAND
T
SURVEYORS.UHAUTILOWIED ALTERATION OR ADOITIOI(TO THIS
DOCUMENT 15 VIOLATION OF SECOON 7209,SUBDIVISION 2.OF NEW
YORK STATE EDUCATION LAW.
ARE
Lands N)F Of01 CpRESTO113 BETWEEN PROPERTY UNES AND HALF fO0i AND ARE FOR THE 50lE PURP�2ppT07)1E
Tanya SOmTeT'S INTERPRETING THEIR CONFORMANCE WITH ZONING AND NOT INTENDED
8:5324 P:128 TO ND IN THE E5TABLI511MENT OR RETRACEMENT OF PROPERTY UNFS.
77 CERIIPIED BY: 303.5-1- _ _--
G.) UNDERGROUND UTILITIES.IP ANf,ARE NOT SHOWN HEREON.
MATTHEW C.9TEVE5,I15 NTS 50135
DATED: JANVARY G.2021 _ 7.) THE 91VRVEYCD PARCEL 15 5UDJECr TO MIATEVVV.R PJGIIT5,TIILC Olk
INTCRZST THE TOWN OF QUEMBBURY AND Tilt PeOPTE Of THE STATE OF
NEW YORA MAY HAVE TO MAINTAIN THE ROADS.AND TO WHATEVER
RIGHTS.TITLE OR INTEREST THE TRAVELING PUBLIC MAY HAVE TO THE
BLD OF THE ROADS.
n e: anunry ,
'v a u s e, Map of a Survey made for SCnle Ia=20'
Stever S-1
Land Surveyors Queensbury Family Chiropractic —
SWEE7I OF I
169 Havilend Road burueene , New York 12804 M.,�„e,.,o„,,,.,,,.,, Town of Queensbury, warren County, New York
Q y OBY Fam.ly Chvopnctw
(518) 792-8474 New York Lie. No. 50135 NO. DATE DESCRIPTION ONG.NO.92-354 C3528
303.5-I.78
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