applications PRINCIPLE STRUCTURE Office Use Only
PERMI- 7..ttAli ON
t- PeEn
Permit#: /2-6 -OS ZGi
‘, 1n of(2uccio.hury Permit Fee: $ 5-O?. 110
742 Bay Road. Queensbury, NY 12804
AUG 0 7 2019 101Rec. Fee: $ 5 GCS
P: 518-761-8256 www.queensbury.net TOWN OF OUEENSSURY Invoice#: 15/7 Y
BUILDING & CODES
Project Location: // OGO ttic=s i LN i' e,J 'Pd
Tax Map #: 295.• 6 Subdivision Name:
TOWN BD.RESOLUTION 86-2013: $850 recreation fee for new dwelling units: single family, duplexes/two-family,
multiple family apartments. condominiums townhouses,and/or manufactured & modular homes. but not mobile
homes. This is in addition to the permit fee(s).
CONTACT INFORMATION:
• Applicant: ,,// �
Name(s): /'')/(� Lt�GJ/-S /7 /Gh� /F�A/s /Fr /TOME
Mailing Address, C/S/Z: J2 Fx Xv'✓
Cell Phone: ( Si8 ) 9V8-3327 Land Line: ( Si8 ) 191/- 7265
Email: ji9i/cEL6-4//S 4 /71/G//PE116 Z.°G#o Cone
• Primary Owner(s):Name(s): S/t 4,etto &L141540 At 11 _4t1 /S
Mailing Address, C/S/Z: 9 iiJCR AP- /4o7 4/ 2)
Cell Phone: ( J'8 ) 79/- 743 / Land Line: (
Email: / 986 679,i1o . re)Al
❑ Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s): "fr. Ld'cJ >S
Contractor Trade: gv/40
Mailing Address, C/S/Z: 52 /ax / I C1?tSi 7 a4J evy /25/ 7
Cell Phone: ( JIB ) 'f78-332 7 Land Line: ( S/8 ) '/9% 7765
Email: /► dl e:". LF'w/S Q. / -/iCei0 4-/?S LoG1510 M ES. Co m
**List all additional contractors on the back of this form
• Architect(s)/Enqineer(s):
Business Name: //Mae72,V 1(F4J IoG , No 7,—(r)6,E4/7Jor)6--s, LLC
Contact Name(s): L)ENQ/ jM(22 MR(/
Mailing Address, C/S/Z: /08/ .Sht eM Chiww# 1 J „601E6aT4G M /784'
Cell Phone: f ) Land Line: ( S 70 /) -76S- 72 93
Email: /08-Ahai ',mmoe/►7,9Ne/6a2/ff}ic--A1Loe-/fo01E6 • Conn
Contact Person for Building & Code Compliance: Z1.)FNO/ z��10/')6 I) 4n/
Cell Phone: ( ) Land Line: (S7o ) 76S- 7Z 93
Email: ji) d/ -i irpi e /h'-nJ 7759.66 ,54,/Fxl Co,s./,o ft)66. Co M
Princiole Structure Packet Revised February 2019
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s): .5 i s A 7 C T10/U'`
Contractor Trade: AM-Sod/4 y � -M/,JG
MailingAddress, C/S/Z: /6 SovTH TWT GR-Xe gd/ /4n'°^rr /'r Ai 1 /Z8z 9
Cell Phone: ( S S ) 23 Z. 3219 Land Line: ( c$)8 ) 61/41 —3o63
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s): '`g /9QE/71/612 Co N/�! /3-CTJAIG G�
Contractor Trade: /M EC//f}nf/CR-G S ` Et.6"-CT,e/C/}G, f"/8/n &-
Mailing Address, C/S/Z: FF1e.e45 .oson/ /R-ycs /V y I Z 839
Cell Phone: ( S l8 ) 68/- 6rSea Land Line: (
Email: ,�onrl�2-ii)BB g lS'Mg 1G . Co m
• 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: (
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:
Principle Structure Packet Revised February 2019
PRO-'5_CT INFORMATION:
TYPE: Commercial x Residential
WORK CLASS:
Single-Family Two-Family Multi-Family(#of units )
Townhouse Business Office Retail Hotel/Motel
Industrial/Warehouse _Garage(#ofcars ) _ Other(describe )
STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE:
1'floor: /3 92 1ST floor:
J
2"d floor: o 6 2"d floor:
3rd floor:
Total square feet:
Basement(habitable space):
Total square feet: /6�p
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 2 11 SYS
2. Proposed use of the building: 4-6iOF tt cS/46Vte f i'"
3. If Commercial or Industrial, indicate the name of the business: c
4. Source of Heat: Gas Oil Propane Solar Other: GL4 C7?'lG
(Fireplaces need a separate Fuel Burning Appliances & Chimney Application, one per appliance)
5. Are there any structures not shown on the plot plan? YES 0 Explain:
6. Are there any easements on the property? YES NO
7. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? g 7 4--ex S
b. Is this a corner lot? YES 40
c. Will the grade be changed as a result of the construction? YES NO
d. What is the water source? CPUBLrCD PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Ae/14R-7
•
DECLARATION:
I. I acknowledge that no construction hall ;ommen.:e prior to issuance -f a
erm and wor will be completed within a 12 month period
2. If the work is not completed by the 1 year e ;piration date the permit may be renewed
subject to fees and department approva I.
3. I certify that the application, plans and supporting materials are a t ue 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 zonin
regulati ns.
4. I cknowledge that prior to occupying the facilities proposed I, or m agent wi obta n a
certificate of occupancy
5. I and :rstand that Ihve are required to provide an as-built survey by a licens land surveyor o
a newly constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: M/G1/6-6-2 FLEWS
SIGNATURE: 7/7A 41K• �✓J DATE: AAy/H` Z0/9
WINDOW SCHEDULE CALCULATION SHEET
.0 1-0 iti&-Z5T A vAJ 7 „1/ /fai
Project Location:
Primary Owner (s): s ;56/4:- A.v6 C,9-/067f0 Ai 4 ',174.0/115-ie - G6-e.i/s
Habitable ' / 0/Ai/4 -/6' 57,-) A, s--6' / \.7:,,,,,-; i -
1
Rooms Ai// it, 4'... /It) jc,-, ,,, i4)/ ,,, ' , S i'
n N ;,e/5-6.-,, /4,,,- -,-.
Window#/letter l/AS -7 3337
..... -
On Plan 3.;,_-) -.) , 0 7- '
(2) uNi-,--„, - , , — J.--33...7 (2) oft oitS
Manufacturer
Name A„----Z4/7- /)E-2.-'Z 6 A 1-L19 P b-66,5 "eZz,/1
Model/Type ,
, ,...i., L4V,:_i_l , odetz--- t)i),61c6- Opo&ez /1466-zyk,to-
L./wig-4 7- ,, Ai,
404147 Itioiti if-iveig
Unit/Block#
Cell Size
Rough Opening
Width jig 7 3 S •, , i, 3•1,., a. .;.: /9` A ..... . - -
.... s
Sq. Ft. Vent • /
IT , i ,.
L, - b
,.., • 0 5 ;',:' 5- 2()
Sq. Ft. Egress/
t
C -1 ' S, f Clear Opening k, w ..? '
5-25-2';'•tx,...-1
Clear Opening- 7
- - ,
° 4 V'....
17 ,..-
Width in inches _6 . • , 23.F 1 3 Z?-:.? - 2.1;g/s 2 6 - c‘
Clear Opening-
Height in inches / , , Ze,),2_ ZS,ZS .." :- .7_'-':
Special Hardware
or instructions
U-Value
, . r
- , -
inciple Structure Packet
Revised February 2019
WINDOW SCHEDULE CALCULATION SHEET
Project Location: // OI.D IJ�=5 i /K/oUNTf}//l1 / J
Primary Owner (s): �E5 5 iF r Cj4-/v1Ei'0At 4 G',¢,eo/✓EI - Lt4i)/S
Habitable P'1 T /ri46rei ,;)6-0Te -` /!`1 /11.1:!AJ( L/dMNg-
Rooms 166-Mc/i eem,„r' Y ez oct ,e?.ee IV / eo/Y,1 A a v Al
Window #/letter 29.97 31/43 i'? 72620
On Plan 2S17-2. L0 /7 33s"7 0) ofv,7-5 (Z) Ocv77.
Manufacturer
Name PL fir_` ? 1EGt/+ 4W F /" EztA, /4e'LL/9 16-7-f 6
Model/Type ,(1o1 /xf O atie 001A6L.6" //0 di .
/71 G ,�
-�RlG �!ti�+1!A1 r r`���nlr h1c1ltl �U�t�- �L'�
Unit/Block #
Cell Size
Rough Opening ! , 3 'ti 31/t.sil;� 2 lq'°I� 3jY 21 r�3iY' b C
Width - S
Sq. Ft. Vent
l
Sq. Ft. Egress/
Clear Opening 3, `" J:20 3, 1 't• ' /5, Z.
Clear Opening- i ?
Width in inches 75,0 /- -- 5.��3 q, � � �� ($
Clear Opening-
Height in inches 20,2- — c75, 2 AO,a-. 20 , S 51 4
Special Hardware
or instructions
U-Value
`'- 3
Principle Structure Packet Revised February 2019
•
REQUIREMENTS FOR SUBMTTAL:
1. Completed Principle Structure permit application.
2. Completed Septic Disposal permit application, if applicable.
3. Completed Driveway Permit, if applicable.
4. Checklist for single family or multiple dwelling(commercial)project,if applicable.
5. Fuel Burning Appliance permit application (one application per unit),if applicable.
TWO (2) COPIES OF THE FOLLOWING:
6. Structural drawings, which include:
Signed &sealed registered architect's or engineer's stamp IF:
• The cost of construction is over $20,000
- Single Family Dwelling is 1500 square feet or greater
• Any commercial project
Floor plan
Foundation plan
Cross sections
-. Elevations
f. Window & Door schedules
g. Calculation sheet for natural light,ventilation &emergency egress
7. Plot plan, using a survey map if possible, which includes:
Drawn to scale (i.e. 1inch = 1foot)
Indicate proposed changes,with setbacks
c. Include all structures on the property
d. Include location of water supply (well or water lines)
e. Include location &configuration of septic system or sewer line
8. REScheck (residential projects) or COMcheck (commercial projects), signed and stamped- check
for a downloadable version.
ADDITIONAL INFORMATION:
1. Prior to issuance of a Certificate of Occupancy for a new residential or commercial structure, an as-
built survey/plot plan certified by a NYS licensed surveyor must be filed with our office.
2. Any changes to the approved plans prior to or during construction will require the submittal of
amended plans, additional reviews and re-approval.
3. If for any reason, the building permit application is withdrawn, 20`, of the fee is retained by
the Town of Queens bury. After 1year from the initial application date, 100 of the fee is
retained
Revised February 2019
Principle Structure Packet
•
WINDOW SCHEDULE CALCULATION SHEET
Project Location: 1U) 6--Z.5 7 UN P54 tti
Primary Owner (s): 1-ES / 191+1,0 69-171 5A9e -rpoe,Dree-le—
Habitable
Rooms P--(.5t,/re gjot
Window #/letter —V Ill F c, fi7
On Plan (2) u/v/7:5 Manufacturer
Name Name A-zie
Model/Type t-)4 •
Unit/Block # •
Cell Size ,,
Rough Opening
Width 44,
2
Sq. Ft. Vent — ' 1
•
Sq. Ft. Egress/
Clear Opening
Clear Opening-
Width in inches :J,
Clear Opening-
Height in inches
Special Hardware
or instructions
U-Value
rinciple Structure Packet Revised February 2019
fit
Office Use Only
r� v".tQwc,rshun. SEPTIC DISPOSAL PERMIT APPLICATION Permit#: C- -��j2� Z`d
Permit Fee: $ ; Invoice #:
Septic Variance? Yes No
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net
Tax Map ID #: li?S. '-/ -8
Project Location: /1 OLD WEL5T /o ui✓7 /k1 Rd
• Applicant:
Name(s): / 11/'6 L6 J/S
Mailing Address, C/S/Z: S Z F x Am/
Cell Phone: _( c5 /9 ) 4/78-332 7 Land Line: ( (5/8 ) 1/91/- 726 S
Email: M,/{€Lv/J/s /7/4-NA 4 LoG . Con)
• Primary Owner(s):
Name(s): Fss, 14-449 �9 Mtr�4orJ �A7eon/ - C64J/S
Mailing Address, C/S/Z: y /in6C// 44/4-y /9-Pr 5' D
Cell Phone: _( Sig ) 79/- 703/ Land Line: (
Email: et-Et,/is /9& , . Yf, aa• Co,"
❑ Check if all work will be performed by homeowner only
• Contractor: Workers' Comp documentation must be submitted with this application
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: (
Email:
• Engineer(s):
Name(s): c�,4-R/eE?f gti&id C2 S ,
Mailing Address, C/S/Z: / Z 14-31" G/19-,SN/n✓6 ra,V ..s T S-Ct' %IJ /tts, /UY °
Cell Phone: _( ) Land Line: ( S/B ) 7 9Z -z 9'0 7
Email: A ei 677-PNi/nle-&—/2s . CCM
Contact Person for Building & Code Compliance: 7 oi►9
Cell Phone: J ) Land Line: ( (5/8 ) 792--Z90 7
Email: T z-1;94gErr@. e eF7l cA!6.iA/e . Co M
Principle Structure Packet o�••: �a -•• �+�
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms: X gallons per =total daily flow
per day bedroom Garbage Grinder Yes No
1980 or older 150 Installed? (circle one)
1981-1991 130 Spa or Hot Tub Yes o•
Installed? (circle one)
1992-Present 110 740
PARCEL INFORMATION:
Topography Flat Rolling X Steep Slope %Slope
Soil Nature _Sand Loam _Clay _Other(explain:
Groundwater At what depth?
Bedrock/Impervious material At what depth?
Domestic Water Supply Municipal _Well (if well, water supply from any septic system absorption is ft.)
Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size 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 ft.; Each Trench 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 and 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. 3. As-built drawings must be
submitted prior to the inspection, if there has been a change to the submitted plans.
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: /''/K- ( W/S DATE: / /4/ "/ Z''
SIGNATURE: ‘ 1,,,A/Z) DATE: M'T 7 /1/1 ' /
9
Principle Structure Packet Revised February 2019