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applications t t Office Use Only . ADDITION/ALTERATION PERMIT Permit#: C"01b Z ' ZQ ) ` f APPLICATION Permit Fee: $ 241":D .. Quwc� Town of ecnsbury 742 Bay Road,Queensbury,NY 12804 Invoice#: P:518-761-8256 www.queensbury.net Project Location: \0 WOO �(i 1c� \tst p t_. utubeoctAi 1 Q(6 Lt 5 t kr. r- r. A Tax Map ID#: .a '1 ,_4 Subdivision Name: FILLIA\Ca-V Sc&At,.601c&O CONTACT INFORMATION: • App.licant: Name(s): . L11) Caf VI 11Dir) Mailing Address, C/S/Z: i i ctUr% ST, SW±ii I4b1 C A& & �Pn1 S, N4 1 Cell PhoQe: ( ) Land Line: ( 6 i ) 1450`- ii 4 - Email: 1M(U0OL O i1i)'COLL.tb , LaYYI • Primary Owner(s): nCr6:8-ADName(s):_ -- `1 Q, C l,�,C. 1 ��1\ Mailing Address C/S/Z: iG &oil& Nom i ik ecl(Od i Li.. NJ 011-1-jS' Cell Phone: (a®) ) 5CK1— i4 i _ Land Line: ( ) Email: lziIefm. rPncnrr� r--a 1 9 L U 1I L67 0 1 • Contractor(s): C APR1 Business Name: k I�,R�i . CDfl1,1 'l Lii2o18 Contact Name(s): 1 ;1& 1'?i.1 (76,1 Ada `'\ 1l (IX( .J I TOWN OF rli_:PPni PI rev° I MailingAddress, C S Z: k S l l'il60 1 Witt 461 A 1.1� )� '� 'itf'k•.:s• I Cell Phone: (5'g )3 1(7--QbA3 (']"t Land Line: ( 54� ) 45O`-1b + Email: ! � --� le_ ��(�3f 16.Clb •Lbl`r1 /lAxY\ �, l o i Ext. ,Lbfl- • Architects) Engineer(s)• Business Name: 1 (m*{� „ GT.. 1 butm Ill' w ki t\ers6.• Contact Name(s): Mailing Address, C/S/Z: \ b( N) E0 1-ft,t ., N i c (_.v_---\ -TIP Cell Phone: ( ) Land Line:0 ('1 ; ) ��— `7i,)D Email: Contact Person for Building & Code Compliance: e6 k-Pal (f)(Lt Cell Ph ne: ( 5i ) 3-16 ` "V!3 Land Line: ( 5 ) ' 45b--Mu( Email: I 0. 6-(iJ ( C\ `Cana. bi)& (.1.b . WO") Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018 PROJECT INFORMATION: • TYPE: Commercial x Residential WORK CLASS: 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: 1st floor: 1« 1st floor: 1 1 0 2nd floor: 2nd floor: 3rd floor: 3rd floor: c_-0Q0 Basement (habitable space): Basement (habitable space): Total square feet: 1'0131) Total square feet: CP) ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ a , J ;\ 2. If Commercial project, what is the proposed use: 01 R. 3. Source of Heat (circle one): Gas Oil Propane Solar Other Fireplaces need a separate Fuel Burning Appliances& Chimney Application 4. Are there any structures not shown on the plot plan? YES Explain: 5. Are there any easements on the property? YES NO 6. SITE INFORMATION: y1 p , a. What is the dimensions or acreage of thee rcel? • b. Is this a corner lot? YES NO c. Will the grade be changed as a result of the constr .etighr— Y S NO d. What is the water source? PUBLIC RIVATE WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? , Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018 L „t DECLARATION: • 1. I acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. 2. If the work 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: ! VOY-00 v _ SIGNATURE: . • DATE: `t \gjlis Town of Queensbury Building&Code Enforcement Addition/Alteration Application Revised March 2018 LL FUEL BURNING APPLIANCE & Office Use Only CHIMNEY APPLICATION Permit#: t t 2-' Permit Fee:$ Town of Qgeensbury 742 Bay Road,Queensbury, NY 12804 Invoice:#: P:518-761-8256 www.queensbury.net Project Location: 1O \NODdc )1b1r1 ' L(�t�� Tax Map ID#: Q 3q Room of Install: fJ!yAIU Valn Planned Install Date: 0(26 lad). **ONE APPLICATION PER APPLIA C --- CONTACT INFORMATION: APRLT218i TOWN OF CT1117j,., time • Applicant: p � BAIL D/NG& Name(s): 6.1). C,a\ ,t � �.. CG Mailing Address, C/S/Z: t 1� 6rcirl S P •40I g J 1 Thk_b r t 1 t Sti OCd Cell Phoonee: ( ) Land Line: ( 5)c � t fi � Y5 D4 Email:\ �1(\QL b. bortateCO Y • Primary Owner(s): /`� ,_ Name(s): M(ti Q 5�(l1) >- �-S ( ;LPro,.t l.V� �)I C� Mailing Addrds, C/S/Z: t\ Y -�. y- 10' rk n Q M 1 fl _ ) D1 '' Cell Phone:_(c�(71 ) q S—1— t` W5 Land Lnne: _( ) Email: • Installer/Builder: (���� �r� Business Name: 66))6&t) ` A\ 0n Contact Name(s): 1Ma1 ► NC-DCf 0 Mailing Address S/Z: (� hVIG(nn ` '. LO� J1(L-llf& , W� la v�o Cell Phone: _ �� Ci 3`l,1.0—Q (1-4Vr ) Land L^'4tie: _ J4t� u) (} - 10(0 EmailriMR-1 COCC) (LUX) . COS Contact Person for Building & Code Compliance `N\ L�W GUA Cell Phone: ( hi(‘ ) 5-119—a( {3 Land Line: ( )Email: 9 . L Ocr\ ( )7.r) Fuel Burning Appliance& Chimney Application Revised March 2017 FUEL BURNING APPLIANCE INFORMATION: TYPE OF DEVICE: Stove Fireplace Insert Fireplace Fuel Fired Equipment (Garage Only, 18" clearance per IMC 304.3) 1t Fireplace,factory built** j **Manufacturer's name: ' Model#: 1F s04r) SOURCE OF HEAT: Wood Coal Pellet ;x Gas CHIMNEY INFORMATION: Masonry: block brick stone X Flue: tie steel size, in inches Material*: double-wall triple-wall insulated (*Manufacturer's name: Model#: ADDITIONAL INFORMATION: 1. Two inspections are required. A rough-in inspection, prior to installation and a final inspection, after installation. 2. Manufacturer's installation manual must be available at the time of inspection. 3. Masonry fireplaces & chimneys require plans to be submitted. 4. Twenty-four(24) hour notification is required for inspections. Declaration:Construction/installation must conform to NYS Fire Prevention & Building Code and/or manufacturer requirements. The applicant or owner agrees to comply with all applicable laws,ordinances, regulations and all conditions that are part of these requirements and also will allow the inspector to enter the premises to perform the required inspections. I have read and agree to the abpi r• � • n l PRINT NAME: f • SIGNATURE: ,{ DATE: L\i 1 \')C o Fuel Burning Appliance&Chimney Application Revised March 2017 FUEL BURNING APPLIANCE & Office Use Only ikfjm CHIMNEY APPLICATION Permit#: Q —0162.--2,0 Permit Fee:$ Town of Queensbury 742 Bay Road, Queensbury, NY 12804 Invoice:#: P:518-761-8256 www.queensbury.net Project Location: 10 �.1)[)1)6S Win+ ►lam Tax Map ID#: cc 7"1.� � t — 1 Room of Install: til lsl, l &COI i Planned Install Date: **ONE APPLICATION PER APP NCE** RECEOVIT CONTACT INFORMATION: APR 18 2018 • Applicant: /e CIPG+CUalbP, TOWN O UE N BU► Y Name(s): lc� BUILPIN+ &��3 Mailing Address, C/S/Z: '6 )I)11)i S(t fl 61Ji i 4.01 66--f1(1:� —1z5w y Cell Phone: ( ) Land Line: ( 61 K ) 450- iOt 14 Email: )1 - OLLU • () • Primary Owner(s): � ii ff Name(s): �k( Lf:& `AAbre, cus lJ� i 1' X6 1D Mailing Addres' , C/S/Z: PVCI ter ` artZ1PA $f MLQ MS 67-1 j$ Cell Phone: (ab I ) i - 114C19 Land Line! 1 ( Email: • Installer/Builder,: Business Name: ij)D(YQ(10CC1\S 67OI Contact Name(s): �..�'. i C.tC1 O Mailing Address, C/S/Z: I h(V 1Si'0i) ( 401 ►&o - 1\_\,y 1 agteto Cell Phone: ( 1)1S ) 1(o Q0C (li(r Land Line: ( I ) Ll ib- 1M Email: ifYl Fvntt.Oz N 'P bfl6.0 u3 MY) Contact Person for Building & Code Compliance: I Il l CoL(0 or r o- (-)A ��'e Cell Phone: ( 3 11` ) 3 QDC ') tlirn')Land Line: ( 6ji�, ) i,1 -)D y� Email. �‘IM G Nil tab.CDSYl I;`Yl � N1r(i, (.[)(Yl Fuel Burning Appliance&Chimney Application Revised March 2017 • -€ FUEL BURNING APPLIANCE INFORMATION: TYPE OF DEVICE: Stove Fireplace Insert Fireplace Fuel Fired Equipment (Garage Only, 18" clearance per IMC 304.3) f\Fireplace,factory built** i fi **Manufacturer's name: "Kri tl IV 'Gib Model#: �Jt)(:)V C SOURCE OF HEAT: Wood Coal Pellet y Gas CHIMNEY INFORMATION: Masonry: block brick stone Flue: tie ,1 steel size, in inches Material*: V double-wall triple-wall insulated (*Manufacturer's name: Model #:_ ) ADDITIONAL INFORMATION: - 1. Two inspections are required. A rough-in inspection, prior to installation and a final inspection, after installation. 2. Manufacturer's installation manual must be available at the time of inspection. 3. Masonry fireplaces & chimneys require plans to be submitted. 4. Twenty-four (24) hour notification is required for inspections. Declaration:Construction/installation must conform to NYS Fire Prevention & Building Code and/or manufacturer requirements. The applicant or owner agrees to comply with all applicable laws,ordinances, regulations and all conditions that are part of these requirements and also will allow the inspector to enter the premises to perform the required inspections. I have read and agree to the above: PRINT NAME: e,410A SIGNATURE: DATE: Fuel Burning Appliance& Chimney Application Revised March 2017 ; SEPTIC-DISPOSAL PERMIT APPLICATION Office Use Only 742 Bay Road,Queensbury,NY 12804 Town ogQgeo"Sbaaty P:518-761-8256 www.queensbury.net Permit#: - 01 E3-2- " Sot$ Tax Map ID#: 2.73C1. t8-I -Z-1 Permit Fee:$ ; Invoice#: Project Location: IC)N1t cte51),7-c0 Septic Variance? Yes No Primary Owner(s) INA 4.---n„V� �` L�� —/t4tL C Mailing Address `q vim"A� - Ar J t1� cr-/A-t'3 Phone & Email Z©� '" eg?_1.49. t-0. -® rY,,Vct..cAPwt. Installer/Builder 1-4,4G!a Cc1VVI t Aite—Tt b't� Mailing Address tg>.st ywork •VA P ` ,4 1•4G.:,It•rf Phone & Email 518 50,4—c c=p..7 Engineer '=N"/ L I Mailing Address A 't'o. Phone& Email r4�K " �-� �1 t•L. Contact Person for Building&Code Compliance:Dax .ttt 6c_Et_- LA'S Phone: ' 1$ Tegr A444 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms X gallons per =total daily flow per day bedroom Garbage Grinder Yes 1980 or older 150 Installed? (circle one) 1981-1991 130 Spa or Hot Tub Yes 66 1992-Present 110 Installed? (circle one) PARCEL INFORMATION: Topography Flat Rolling Steep Slope 1© %Slope Soil Nature ✓Sand ✓Loam Clay Other Groundwater At what depth? '3 Bedrock/Impervious material At what depth? > I Domestic Water Supply _Municipal _Well(if well,water supply from any septic system absorption is_ft.) Percolation Test Rate:Za1 per minute per inch(test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size 1Z5Ogallons(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 3.._1E.P4. Bed or other type: GAF 77-1ENc lrir .44411X Holding Tank System Total required capacity? ;tank size.Q ;#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, :t`l'htlK::) DATE: 5" k—V8 SIGNATURE 17:5MAC-- - ' DATE: 5"'4 S Town of Queensbury Building&Code Enforcement Revised March 2018