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,• - • :,; Permit#: 01 -2-QA t•;i; • PRINCIPLE STRUCTURE.PERMIT' Permi . APPLICATION Permit Fee:$ k 150 e q( *Rec. Fee:$ 6 • 742 Bay Road,Queensbury, NV V804 P: 518-761-8256 v.:'Tr.,. invoice#: 0-2-(o 0 Project Location: -04141e 163 R ( r .huir(664 p Ov4fAC bola) Ni 180i Ta* Map #: Z9 0 i 3 — Subdivision Name: TOWN BD.RESOLUTION 86-2013:$850 recreation fee for new dwelling units: single family,duplexes/tWo-family, multiplefamily, apartments,condominiums, townhouses,and/or manufactured & mid.1 righe;ffthiagebile- homes. This is in addition to the permit fee(s). D QQNTAQL INFORMATION: APR 1 1 2018 • Applicant: TOWN OF QUEENSBURY Name(s): 7 ,kr LiAle( BUILDING&Conp ;Mailing Address, C/S/Z: I 9 Titnyfewcroyl olienc Fkily j illy 12203 Cell Ph.: (518 ) qao - 96qs- Land Line: ( Email: 4yler-0 fp mo ark• Colv‘ • Primary Owner(s): Name(s): TV- L'AV1 Mailing Address, C/S/Z: TA-A y! id Di. 6;1?-4 if71;ik )2263 Cell Ph.: _(S/8 ) -9 ovc Land Line: ( Email: lyitY0 fpfrung,tvA" • Contractor(s): Name(s): 7P /1A6n4kkali Mailing.Address, C/S/Z: Ark get au/we-ALAI y 12,g6y Cell Ph.: ( ) 9z6-9e9..r Land ane: (05 ) -79.2-197 Email: lefAlp toollidnarl, COP" • Architect(s)/Enqineer(s): Name(s): -(1we ‘ tall pAci,5144JAW, -0-C411ECA1419—S Mailing Address, C/S/Z: (314 0 it Akfe &lir, AN (280 Cell Ph.: ( Land Line: (518 ) iLl 1 0268 Email: 91nck_11(& ny co,p. Corsi Contact Person for Building & Code Compliance: ___ Nts.1 Cell Ph.: ( ..) Land Line: (5lb ) 141.-c$24$ Email: 9)Via.it nrAt,.cr.e-to rn oQ Building&Code Enforcement Principle Structure Updated December 2017 r ftyyi—y f IraryroyiP11 IV1V. et TYPE: Commercial A Residential WORK CLASS: Single-Family Two-Family Multi-Family(#of • ) Townhouse Business Office Retail Hotel/Motel Industrial/Warehouse Garage(#ofcars ) Other(describe ) STRUCTURE SQUARE FOOT.GE: GARAGE SQUARE FOOTAGE: 1sTfloor: ZI09 STfloor: `712 2"d floor: 5 1 to. 2nd floor: 3rd floor: Total square feet: '712, 4th floor: Total square feet: 2.,(Qkk ADDITIONAL PROJECi INFORMATION: 1. Estimated Cost of Construction:$ I-7 C 00 2. Proposed use of the building: 1 \ YY t l?( V4S1OS•1C 3. If Commercial or Industrial, indicate the name of the business: 4. Source of Heat (circle one): Caas Oil Propane Solar Other: (Fireplaces need a separate Fuel Burning Appliances&Chimney Application, ,,rye per appliance) 5. Are there any structures not shown on the plot plan? YES &Explain: 6. Are there any easements on the property? YES NO 7. SITE INFORMATION: a.What is the dimensions or acreage of the parcel? -1 Acres b. Is this a corner lot? YE NO c. Will the grade be changed as a resul of the construction? YES NO d. What is the water source? PUBLIC PRIVATE WELL e. Is the parcel on SEWER or a PRIV, PTIC system? 'J41 oQ Building&Code Enforcement Principle Structure Updated December 2017 DEq_ARATRON .: • I. i acknowledge that no construction --hail prlor 'li-isuance :f ! !,' and \iiisor!-.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 approval. - 3. I certify that the application, plans and supporting materials are a t rue and complete statement and/or description of the work proposed, that ail 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 understand that lAive are required to provide an as-built .-.,..urvey by a licensed land surveyor of all newly constructed facilities priorto issuance of a certificate of occupancy. • I have read and agree to the above: PRINT NAME: Ifr . . SIGNATURE: kr DATE: oct Building&Code Enforcement Principle Structure Updated December 2017 • Highway Home (518) 74.5-092.9 Department 742 Bay Road-Oueensbury,NY 12801 David Dual Phone: (518)76 Y-82 Y Y Deputy Highway Superintc rident Fax: (his)745-4466 Home(518) 743-0936 DRIVEWAY P RNET DATE: 103 APPLICANT NAME: T.� �t Litt ►'. TELEPHONE NO.: 18 ' v()r 5- ADDRESS TO 6E INSPECTED: (Si 60 (� f`'"' RETURN ADDRESS: I �� jl�w � 5' G' '4 I`'Ils ; I` 3 Applicant must show exact location and width of driveway(s) to be connected to the highway by • placing stakes at the specified location. • The Superintendent of Highways of the Town of Queensbury has reviewed this.application, The following action has been taken: STEP 1: () Preliminary Approval NEED: ( ) Slight swale () Deep swale ( ) Level with the road ( ) Level with the top of the paved wing Size culvert pipe to be used (if necessary) ( ) 12" ( ) 15" ( ) 18" ( ) 24" ( ) 36" Preliminary inspection completed by: Date: Approval by Highway Supt: (or) Deputy Supt: Upon coENTpRetio se rr saolmiit this approved permit for a ffinai apprtvaio STEP 2:. () Final Approval ( ) Rejected Date: Thomas R. Van Ness, Highway Superintendent David Duell, Deputy Highway Superintendent I" `'� rici)- ii Permit#: i 1 11 f U'h ? `,--Er; T��:4 • ,, �`;= :a , Permit Fee:$ fimv ortjticcns(;ury 742 Bay Road,Queensbury, NY 12804 voice s: P:518-761-8256 www.aueensbury.net Project Location: 151. V- ; 1 Tax Trap ID#: Room of(Im t illh: viy i pop VY) Pliamimcd Install Date: *ONE APPLICATION PER APPLIANCE** CONTACT INFORMATION: e Applicant: Name(s): Tate- Lit4616-- Mailing Address, C/S/Z: . )41 lb ;E 1�1'-1/YzO e �. 6' UU Cell Phone: ( tea' L& ) 9.' d-6, Land Line: ( ) Email: Atter a A- onc,na It av 4 toWY1 e Primary Qwn rr(s): Name(s): 1 y Ungel Mailing Address, C/s/Z: )9 1 c Jp )6 Or i 61C°c" /in'as, )JY /2 ) Cell Phone: (5)8 ) 92i, -91'1 Land Linea ( ) Email: fyi-ff' -i'tvu.,rnivr, ,64r-. O installer//:e�Mlden Business , Name: M. C Y 514,,,,tA.4 G6n-kT M'7 L j C Contact Name(s): Mark' lksi rf Mailing Address, C/S/Z: PO, &,T. 36 6 gPlitartatiV /283) Cell Phone:_(,9)8 ) .6i `2-8, rb Land Line: _( ) Email: rA c 5+e(AhN i 66 rZi 3'"a ii.( "` Contact Person for Building & Code Compliance: 01441ta bVl..— Pile./451C-( '11VI./A 12-Ctit. Cell Phone: ( ) Land Line: _( & ) 741 .-07.46 Email: a calf,re ornyt Fuel Burning Appliance &Chimney Application Revised March 2017 c.-az_75..uroorvso •rear z...,00ntruvwZ.,jtror ,:intivrrog.I OR..95F3o TYPE OF DEViCE: Stove Fireplace insert Fireplace Fuel Fired Equipment(Garage Only, 18" clearance per NC 304.3) Fireplace,factory built** **Manufacturer's name: GlotAPPArie- Model#: ‘- SOURCE IF HEAT: Wood Coal Pellet /Gas CHIMNEY INFORMATlIN: Masonry: block brick stone Flue: tie steel size, in inches • X/laterial*: MW111.- Vdouble-wall triple-wall insulated (*Manufacturer's name: Model#: I JITIONAL ONFORMATis N: 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 ootificati©n is required for inspacti© s 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 ab,ove: PRINT NAME: 71çier e-ilye eViVzoil SIGNATURE: Ce-A DATE: • • Fuel Burning Appliance &Chimney Application Revised.March 2017 • SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only 742 Ba Rd Town ofQgeensbury Road •Queensbury,NY 12804 P:518-761-8256 www.gueensburv.net Permit#: Tax Map ID#: 290.9-1-4 Permit Fee:$ ; Invoice#: Project Location: Rockwell Road Septic Variance? Yes No Primary Owner(s) Tyler Lingel Mailing Address Phone & Email (518) 926-9645 Installer/Builder To Be Determined Mailing Address Phone& Email Engineer Hutchins Engineering Mailing Address 169 Haviland Road, Queensbury NY 12804 Phone& Email (518) 745-0307 / thutchinsehutchinsengineering.com Contact Person for Building&Code Compliance: Tyler Lingel Phone: (518) 926-9645 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 No Installed? (circle one) 1992-Present 110 4 110 440 PARCEL INFORMATION: Topography ✓ Flat Rolling Steep Slope %Slope Soil Nature 7— Sand Loam Clay Other Groundwater At what depth? 30" Bedrock/Impervious material At what depth? >38" Domestic Water Supply ✓Municipal _Well (if well,water supply from any septic system absorption is ft.) Percolation Test Rate: 13:00 per minute per inch(test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size 1,250 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 300 ft.; Each Trench 60 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. t PRINT NAME: .1/41 L; A DATE: 6)Zia� 1� SIGNATURE: DATE: .61 -4t-61 Town of Queensbury Building&Code Enforcement Revised March 2018 t. ,