RC-0002-2023 Office Use Only
_ ADDITION/ALTERATION PERMIT permit#:'0S-- 0002_-2C�2_3
Town of bQu�eens w7 APPLICATION permit Fee:$ 2 b-&90
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Invoice#: ���
Flood Zone? YDN Reviewed B
Project Location: 131 Grant Ave. Ext. Queensbury, NY
Tax Map ID#: 302.18-2-3-8 Subdivision Name:
PROJECT INFORMATION:
TYPE: W Residential ❑ Commercial, Proposed Use:
W 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:
lstfloor: 1st floor:
211 floor: 2"d floor:
3rd floor: 3rd floor:
Basement (habitable space): Basement (habitable space)768
Total sq ft: Total sq ft: 768
Scope of work to be done: Finish aprox 768 sf of basement space into
Habitable space. Family Room, Bathroom & Home/Office
D ECEOWE
JAN 0 3 2023
TOWN OF QUEENSBURY
BUILDING&CODES
Addition/Alteration Application Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 19,500
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 ® NO
SITE INFORMATION:
• Is this a corner lot? ❑ YES ® NO
• Will the grade be changed as a result of the construction? ❑ YES 0 NO
• What is the water source? ® PUBLIC ❑ PRIVATE WELL
• What type of wastewater system is on the.parcel? ❑ SEWER ® 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of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.a certificate of occupancy.
I have read and agree to the above: Digitally signed by Matthew J
W"j,"'.
Cifone
PRINT NAME: M a tt h e DN: cn=Matthew J Cifone,
{ " .o=Cifone Const. Co. Inc., ou,
SIGNATURE: DATE:
c1tone c=US 04
Date: 2022.12.30 14:13:02 -05'00'
Addition/Alteration Application Revised June 2022
'i
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Cifone Construction Co.
Mailing Address, C/S/Z: PO Box 684, Glens Falls NY 12801
Cell Phone: ( _)518 361-0626 Land Line: �_)518 792-9242
Email:office1@cifone.com
• Primary Owner(s).:
Name(s): Elenor DelSignore
Mailing Address, C/S/Z: PO Box 178,3349 Travis Point, Kattskill Bay NY 12844
Cell Phone:�_)518 796-0595 Land Line: 1518 656-9517
Email:-brown66s@verizon.net
❑ 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): Cifone Construction Co
Contractor Trade: General Contractor
Mailing Address, C/S/Z: PO Box 684,Glens Falls NY 12801
Cell Phone:._(_)518 361-0626 Land Line: �_)518 792-9242
Email:-officel@cifone.com
**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: A
Email:
Contact Person for Compliance in regards to this project: Matt Cifone
Cell Phone: ( )518 361=0626 Land Line: 518 792-9242
Email:-mcifone@cifone.com
Addition/Alteration Application Revised June 2022
w
a+
Nor
o,
w
w
m
o
o. a ^'
FY
ro HH
��V
m
UfD
p V
l3
4
G
O
K
CA
CA
03
O
r
pp
�j•�ggd��S��Y�4g4 F�p}Q$�}Q$69
°y
�
�M
p
01
` J
M
O
�
m
tt
O
'd
P
D
rn
2 �3
� co
m
ca
:iI ASPHALT DME
p y
ci
J�
z y
O
�
o Z
1- p w
w
Fr 0
� D
z rn
o
3
(D
ww
ID
a
r+
►:
n
g
ON
a�
o
N°0
z
00
O
m
y,
W
o 11n 5
C: c
t.,
v
d
,OO
rnz0
r'�^
.
rn c
p
Vl
ru Z
n O
m o
o'
o
"�
�..►
o
c
�
WC.,
i
z
o
C)
-21
tp
N04"54'211E
157.59'
N
�0
�OV VJ
AQ
n y 9
a
m
157.59'
N
SO4"58'10'W
N
b
D
r
m D
N D A 0
�m0
rn "
vmimm�7z�;Uz
m z O o i "' txj
rn(n0 C)tt+1
� w , (n z
Z?ot0=.1
003 D O
41 A A
CO
I
)SAS'
^ O�
burr a►x atd r
to
r'0 G7
CD
� z
C4
W 't7
O
.21