RC-0670-2022 r- =,
Office Use Only
ADDITION/ALTERATION PERMIT Permit#:
Town ofQueensbw7 APPLICATION Permit Fee:$ ZZM
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Invoice#: �Z'
Flood Zone? Y Reviewed 1316f�
Project Location:
265 Aviation Rd
Tax Map ID#: 295.14-3-14 ,:L Subdivision Name: NA
PROJECT INFORMATION:
TYPE: ® Residential ❑ Commercial, Proposed Use:
® Single-Family ❑ Two-Family ❑ Multi-Family (#of units_) ❑ Townhouse
❑ Business Office ❑ Retail ❑ Industrial/Warehouse ❑ Garage (#of cars )
❑ Other(describe )
ADDITION SQUARE FOOTAGE: ALTERATIONS OTAGE:
1st floor: 1st floor: 0 a C 9�n
2"d floor: 2"d floor: V
3rd floor: 3rd floor: NOV 03 Z022
Basement (habitable space): Basement (habita le spp e
Total sq ft: Total sq ft: 'B�ILF O QUSSNSB
DING& COD)-zgRY
Scope of work to be done: Remove 8' x T garage door.
Install 36" exterior door and double hung window.
Garage is used as storage and a personal "workshop".
Use to remain the same.
Space is unheated and will remain unheated.
Addition/Alteration Application Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ $500
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 R 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? ® PUBLIC ❑ PRIVATE WELL
• What type of wastewater system is on the parcel? ❑ SEWER 8 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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. 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 a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: Devin T. Dickinson
Digitally signed by Devin Dickinson
SIGNATURE: Devin Dickinson 'Date:2022.11.03 12:59:43-04'00' DATE: 11/3/2022
Addition/Alteration Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Devin Dickinson
Mailing Address, C/S/Z: 265 Aviation Rd.,Queensbury, NY 12804
Cell Phone: ( _)518-339-7451 Land Line: � )
Email:devin9909@gmail.com
Primary Owner(s):
Name(s): same as applicant
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
® 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: Devin Dickinson
Cell Phone:()518-339-7451 Land Line:
Email:devin9909@gmail.com
Addition/Alteration Application Revised June 2022
` 7
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EXISTING PROPOSED
Proposed Window
Proposed 3/0 G/8
Existing Garage Door Exterior Door
1 2.0'
Existing dbl.2x8"header Existing dbl.2x8"Header
Proposed Window
Proposed 3/0 9/8
Existng Garage Door 6.8' Exterior Door
r
8"Concrete Block
to Match Existing
G"#2 stone base
114" = 1 foot