applications Office Use Only
Permit#: PC,^O4 1 l 2O%
.4414,744. PRINCIPLE STRUCTURE PERMIT
APPLICATION Permit Fee:$ Lo.9 Z'
Town of Queenibury *Rec Fee:$
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Invoice#:
Project Location: 3 GLEN HALL ROAD
Tax Map ID#: 289.11-1-27 Subdivision Name: N/A
*TOWN BD. RESOLUTION 86-2013: $850 recreation fee for new dwelling n a,a_y—u,��ex /t o family,
multiple family, apartments, condominiums,townhouses, and/or manufactur lad r to e s\.buLrio bile
homes. This Is In addition to the permit fee(s).
CONTACT INFORMATION: L JUN 2 2018
• Applicant: TOWN OF OUEENSBURY
BUILDING&CODES
Name(s): SHERWOOD ACRES,DAN BARBER
Mailing Address, C/S/Z: 81 NOTTINGHAM DRIVE
Cell Phone: (914 ) 621-8202 Land Line: ( 518 ) 251-2132
Email: BARBERBL@HOTMAIL.COM
• Primary Owner(s):
Name(s): SAME AS APPLICANT
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
• Contractor(s):
Business Name: SAME AS APPLICANT
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
• Architect(s)/Engineer(s):
Business Name: PETER JENSEN(ARCHITECT) TOM CENTER,NACE ENGINEERING
Contact Name(s):
Mailing Address, C/S/Z: 17 WEST ROAD,SOUTH GELNS FALLS,NY 169 HAVILAND RD,QUEENSBURY,NY
Cell Phone: (518 )796-2515 (CENTER) Land Line: ( 518 ) 798-3859 (JENSEN)
Email: TCENTER36@YAHOO.COM
Contact Person for Building & Code Compliance: PETER JENSEN
Cell Phone: ( ) Land Line: ( 518 ) 798-3859
Email:
Town of Queensbury Building&Code Enforcement Principle Structure Application Revised February 2017
PROJECT INFORMATION:
TYPE: Commercial X Residential
WORK CLASS:
X Single-Family Two-Family Multi-Family(#of )
Townhouse Business Office Retail Hotel/Motel
Industrial/Warehouse Garage(#ofcars ) Other(describe )
STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE:
157 floor: 1,044 1'T floor:
2nd floor: 1,020 2nd floor:
3rd floor:
Total square feet: N/A
4th floor:
Total square feet: 2,064
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 300,000
2. Proposed use of the building: RESIDENTIAL
3. If Commercial or Industrial, indicate the name of the business: N/A
4. Source of Heat (circle one): Gas Oil Solar Other:
(Fireplaces need a separate Fuel Burning Appliances &Chimney Application, one per appliance)
5. Are there any structures not shown on the plot plan? YES ®Explain:
6. Are there any easements on the property? • NO
7. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? 9,371.1 SF
b. Is this a corner lot? YES (s)
c. Will the grade be changed as a result of the construction? NO
d. What is the water source? PUBLIC PRIVATE t�jg1►
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? HOLDING TANKS,PRIVATE
Prin.-tnls>CI-.•>`h.n as-1 A .nnh�: R PVICPfI .1;"
DECLARATION:
I. I acknowledge that no construction shall commence prior to issuance of a valid building permit and
• work will be completed within a 12 month period.
2. If thework is not completed by the 1 year expiration date the permit may be renewed, subject to
fees and department approval.
•
3. I certify that the application, plans and supporting materials are a true and 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.
4.. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate
of occupancy.
5. I 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: DAN BARBER,SHERWOOD ACRES BUILDERS
SIG NATURE. DATE: 6i27n8
•
Town of Queensbury Building&Code Enforcement Principle Structure Application Revised February 2017
CHECKLIST—SINGLE FAMILY Project Location: 3 GLENS HALL ROAD
REQUIRED —2 SETS YES NO N/A
1. Building Permit application, completed
2. Energy Code inspector's report from REScheck, completed & signed x
3. Septic alteration application, if applicable
4. Solid Fuel Burning or Gas Appliance form completed, if applicable
5. Driveway Permit, if applicable
6. Structural Drawings:
a. Floor plans
b. Foundation plans
c. Cross Sections
d. Elevations
e. Window & Door Schedule
f. Natural Light, Ventilation & Emergency Egress
7. Plot Plan: Show proposed structure(s) with setback dimensions
from all surveyed property lines
8. Electrical inspection agency selected
CHECKLIST— MULTI-DWELLING/COMMERCIAL Project Location: 3 GLEN HALL ROAD
REQUIRED —2 SETS YES NO N/A
1. Building Permit application, completed
2. Energy Code inspector's report from COMcheck, completed &
signed
3. Septic alteration application, if applicable
4. Solid Fuel Burning or Gas Appliance form completed, if applicable
5. Driveway Permit, if applicable
6. Structural Drawings:
a. Floor plans
b. Foundation plans
c. Cross Sections
d. Elevations
e. Design loads including floor, snow & wind load
f. Seismic design
g. Plans signed & sealed by registered architect or engineer
h. Window & Door schedule
7. Plot Plan: Show proposed structure(s) with setback dimensions
from all surveyed property lines
8. Electrical inspection agency selected
9. FINAL AS-BUILT PLANS SUBMITTED ELECTRICONICALLY
Town of Queensbury Building&Code Enforcement Principal Structure Application Revised February 2017
F
SEPTIC DISPOSAL PERMIT APPLICATION office Use Only
742 Bay Road,Queensbury,NY 12804 ��
Tax°rr :t('jic�nsburs• P:518-761-8256 www.gueensbury.net Permit#: �J
Tax Map ID#: 289.11-1-27 Permit Fee:$ ; Invoice#:
Project Location: 3 GLEN HALL ROAD Septic Variance? Yes No
Primary Owner(s) DAN BARBER, SHERWOOD ACRES
Mailing Address 81 NOTTINGHAM DRIVE, QUEENSBURY NY
Phone &Email 914-621-8202 BARBERBL@HOTMAIL.COM yl
Installer/Builder SAME AS OWNERS
Mailing AddressRY
Phone.& Email 06' JiE L AE
NT
Engineer NACE ENGINEERING,TOM CENTER
Mailing Address 169 HAVILAND RD QUEENBSURY,NY
Phone & Email 518-796-2515 TCENTER36@YAHOO.COM
Contact Person for Building&Code Compliance: T CENTER Phone: 5187962515
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes o
1980 or older Installed? (circle one)
1981-1991 Spa or Hot Tub Yes
Installed? (circle one)
1992-Present 3 110 330
PARCEL INFORMATION:
Topography Flat Rolling Steep Slope 11 %Slope
Soil Nature X Sand X Loam Clay Other
Groundwater At what depth? GREATERTHAN 6 FT
Bedrock/Impervious.material 1 At what depth? NA
Domestic Water Supply _Municipal X Well(if well,water supply from any septic system absorption is100+ft.)
Percolation Test Rate:_2 25_per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size I JQM gallons (min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length Jgf ft.; Each Trench 25 ft.
Seepage Pit with#3 stone How many: ;Size:
Alternative System Bed or other type:
Holding Tank System Total required capacity? ;tank size ;#of tanks
NOTES: 1.Alarm system&associated electrical work must be inspected by a Town approved electrical inspection
agency;2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved.
The installed system must match the septic layout on file—no exceptions.
Declaration:Any permit or approval granted which is based upon or is granted in reliance upon any material
representation or failure to make a material fact or circumstance known by or on behalf of an applicant,shall be void. I
have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage.
Disposal Ordinance.
PRINT NAME: TOM CENTER NACE ENGINEERING DATE: 9/26/18
SIGNATURE: DATE: 9/26/18
Town of Queensbury Building&Code Enforcement Revised February 2017