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RC-0685-2021 Office Use Only �� l ADDITION/ALTERATION PERMIT Permit#: RC r ©k.b APPLICATION Permit Fee:$ Town ofQuccnsbury 742 Bay Road,Queensbury,NY 12804 Invoice#: P:518-761-8256 www.gueensbury.net Flood Zone? Y N eviewed L Project Location: �— ` r Tax Map ID #: . 1 _ Z„ram Subdivision Nam L �' �; ------ PROJECT INFORMATION: IE TOWN OF tU -t 3_8 J�R`� E3tJILD;I�ii t f ?DE,S TYPE: Residential Commercial, Proposed Use: _::"14 _ v - - of units Townhouse Single-Family _Two, Family _Multi Family(# ) _ Business Office _Retail _Industrial/Warehouse _Garage(#of cars_) Other(describe ) ADDITION SQUARE FOOTAGE: ALTERATION cSQUARE FOOTAGE: 1st floor: 1st floor: 2nd floor: 2nd floor: 3rd floor: 3rd floor: Basement(habitable.space): Basement(habitable space): Total sq ft: Total sq ft: 377 ft Scope of work to be done: e A44�CAV 50 6i Dot, --o S4-6 0(_) ice mc �t' C 4V-\,k\�s G� 5NOrC— ftSiLUox f (1 Q� co Crv`�l / I`1(1(C�atv1 C a. �00''� ��.i'Y�dV�i 5}4 cc7C Y`-t v�qC� �� -�t av\ ( P - t (\SU)0 eV\ r c e 66\s_ l 6 c l e av) C1 V\ U<— Cd®ln'\ �'k vat je, Addition/Alteration Application Revised January 2021 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ ) 2. Source of Heat(circle one):_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 NO Explain: 4. Are there any easements on the property? YES v NO SITE INFORMATION: • Is this a corner lot? YES NO • Will the grade be changed as a result of the construction? _YES NO • What is the water source? V PUBLIC PRIVATE WELL • What type of wastewater system is on the parcel? VSEWER _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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3. Ifthe.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. I 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 a certificate of occupancy. I have read and agree to the above: PRINT NAME: Q' SIGNATURE: DATE: l Addition/Alteration Application Revised January 2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: (� Name(s): Mailing Address, C/S/Z: � ' �� d Lf Cell Phone:_( .5_1 r) al`�a 303 Land Line: V � ) Email: • Primary Owner(s): s : Name( c�f1t✓�. C l �V� �, ��? 1� Gl �v�l f ) Mailing Address, C/S/Z: " a S JLCinS wr (�1 Cell Phone:_ a 31 — 3o _Land Line: _( S�� ) 7L( 3—,76 cI _� 4'� Cam Email: o h i a� ��v►� � � a��f6 ❑ 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" • Architect(s)/Engineer(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: Cell Phone: Land Line: ( ) Email: Addition/Alteration Application Revised January 2021 r • Contractor(s): Workers' Comp docum_en atioj m}�st b sub fitted with this application Contractor Name(s): Phwd P"e A6l�- �oSv;G/P Contractor Trade: zec&)�,� ply��/�.� tl C Mailing Address, C/S/Z: 1'-55--/ Cell Phone: 518, 33 9 Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: • Contractor(s): Workers' Comp documentation most.be submitted with this application Contractor Name(s): Contractor Trade:- Mailing Address, C/S/Z: Cell Phone: Land Line: Email: Addition/Alteration Application Revised January 2021 FILE COPY wA� no Cn,c-:,,ee GA Jemn oavA r 6o m L n t n 4-0 c Ct r"J Gam.� ri t� c� � � �, ;Q�.C�c e C�•�j �1�� (itI Lit s r t lccL o Gtaid Cc s Sam q(VIJ 5le l ii � r Anc ? �'� G� � ax - Z 4 r �. t opol �w K Aii CL i �� oe� 3 � r Fortsville M.H. & R.V. Supply CERTIFIED/BONDED MANUFACTURED HOUSING SERVICE CENTER AUTHORIZED WARRANTY SERVICE CENTER FOR COLEMAN AND MILLER SHIPPING:484 Fortsville Rd. DATE: July 9,2021 MAILING:135 Fortsville Rd. GANSEVOORT,NY 12831 Phone:(518)793-8089 Fax:(518)793-8089 FOR: Palangi Electrical and mechanical repairs due TO: to fire. Frank&Renee Palangi 1 Newcomb St Queensbury,NY 12804 TY' RATE :"AMOUNT' PTI •;'DESCRION �;,,,�"-;:"• r�=� ,";»'Q ,:;;: Checkout of home due to fire damage from lighting strike. $;_; ;„: 's`:` :,':•" Fire damage primarily in back garage.Inspect back garage area and adjacent rooms for fire and water and smoke damage.Check electrical ",• and mechanical.Multiple electrical circuits and the stove circuit appear to be damaged.Due to extent of damage,adjacent rooms may have additional repairs needed but is concealed at this time. Checkout mechanicals of water,drain and HVAC systems.Ductwork replacement/repair/needed. ^ At this time,a complete estimate can not be assessed due to concealed areas and damage.A better estimate and assessment can be performed ".,'TCJV`Iljt"O"' t1J EPNSBURY CODES after fire and water restoration company does initial demo. This will open areas for better inspection and assessment. I Proposed repair schedule: Make better damage/repair assessment after initial demo is completed. Locate and disconnect effected electrical circuits. Call in electrical inspection from Commonwealth Electrical inspection service to have National Grid reconnect power. -^r' Make necessary electrical repairs on effected circuits. Complete water and drain inspection and make necessary repairs. Complete HVAC inspection and tests on equipment,make repairs/replacement of components as necessary. *Note*Due to concealed damage,best inspection should be made after damage demo performed. SUBTOTAL TAX RATE I AGREE TO TERMS OF ESTIMATE: SALES TAX - 60%deposit is required before start of work OTHER Estimate good for 30 days TOTAL $: Make all checks payable to FORTSVILLE M.H.SUPPLY Total due in 10 Days.Overdue accounts subject to a service charge.. THANK YOU FOR YOUR BUSINESSI