AST-0291-2022 r
Office Use Only
j ADDITION/ALTERATION PERMIT Permit#: PST'� ° -9
APPLICATION permit Fee:$ 5'
Town ofQueensbwy
742 Bay Road,Queensbury,NY 12804 Invoice#: 411 5
P:518-761-8256 www.gueensbury.net
Flood Zone? Y N Reviewed By:
Project Location: 11 Lafayette Street
Tax Map ID#: 302.07-1-18 Subdivision Name: NA
PROJECT INFORMATION:
TYPE: Residential X Commercial, Proposed Use: Pole Barn cold storage
_Single-Family _Two-Family _Multi-Family(#of units ) —Townhouse
Business Office _Retail _Industrial/Warehouse _Garage (#of cars_)
X Other(describe enclosure of existing Oole barn storage building
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor: 436 SF
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement(habitable space): Basement(habitable space):
Total sq ft: Total sq ft: 436 SF
Scope of work to be done:
enclosure of existing pole barn.storage building. Cold storage for vehicles and equipment at Baker
Funeral Home.
DEt" E0VE
MAY 17 2022
TOWN OF QUEENSSURY
BUILDING&CODES
Addition/Alteration Application Revised January 2021
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ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 25,000
2. Source of Heat(circle one):_Gas _Oil _Propane _Solar_Other Unheated
Fireplaces/inserts need a separate Fuel Burning Appliances & Chimney Application
3. Are there any structures not shown on the plot plan? YES XNO Explain:
4. Are there any easements on the property? YES _X_ NO
SITE INFORMATION:
• Is this a corner lot? _YES X NO
• Will the grade be changed as a result of the construction? _YES X NO
• What is the water source? _PUBLIC _PRIVATE WELL No water
• What type of wastewater system is on the parcel? SEWER _PRIVATE SEPTIC No 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 If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of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 atrue 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: Ethan P. Hall -A�(rcchitect\Agent for the Applicant
SIGNATURE: C r DATE: 16 May 2022
Addition/Alteration Application Revised January 2021
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CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): CKT Enterprises, LLC -Starr Mowery
Mailing Address, C/S/Z: 2 Glendale Drive-Apt. B, Queensbury NY 12804
Cell Phone: 518 )232-0630 Land Line: 518 )761-9303
Email: smileckta-hotmaii.com
Primary Owner(s):
Name(s): CKT Enterprises, LLC-Starr Mowery
Mailing Address, C/S/Z: 2 Glendale Drive-Apt. B, Queensbury NY 12804
Cell Phone: 518 )232-0630 Land Line: ( 518 )761-9303
Email: smileckta-hotmail.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): Bruce Mowery
Contractor Trade. General Construction
Mailing Address, C/S/Z: 2 Glendale Drive-Apt. B, Queensbury NY 12804
Cell Phone: 518 )232-0630 Land Line: 518 )741-0268
Email:
**Workers' Comp documentation must be submitted with this application**
• Architect(s)/Engineer(s):
Business Name: Rucinski Hall Architecture
Contact Name(s): Ethan P. Hall
Mailing Address, C/S/Z: 134 Dix Ave, Glens Falls NY 12801
Cell Phone: 518 )260-2888 Land Line: 518 )741-0268
Email: ephall(aD-nycap.mcom
Contact Person for Compliance in regards to this project: Ethan P. Hall
Cell Phone: 518 )260-2888 Land Line: 518 )741-0268
Email: ephall(aD-nycap.rr.com
Addition/Alteration Application Revised January 2021