applications Office Use Only
AleIhk Permit#: VZ-C `GS yI 2°
PRINCIPLE STRUCTURE PERMIT
APPL TION ,
Permit Fee:$ 7Z/S ,DU
Totem of Queensbury I � S ' U
742 Bay Road,Queensbury,NY 12804 LE _''" `i JL!! IIeC Fee:$
P:518-761-8256 www.queensbury.net }oece#: C 13 I
Is)
AUG 242018 iris;
Project Location: CHESTNUT LANE(WE )
f OWN OF QUEENSBURY
BUILDING & CODES Tax Map ID#: 226.19-1-20 su tsforrName: SHORE COLONY
*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): LAURA MCNEICE
Mailing Address, C/S/Z: 38 REEVES AVE
Cell Phone: (646 ) 643-6784 Land Line: ( )
Email: TMM616@AOL.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: FRANK JELLEY/ED LAPOINT(ARCHITECT) TOM CENTER, HUTCHINS ENGINEERING
Contact Name(s):
Mailing Address, C/S/Z: LAKE GEORGE,NY 169 HAVILAND RD,QUEENSBURY,NY
Cell Phone: (518 )796-2515 (CENTER) Land Line: ( 518 ) 796-5611 (JELLEY)
Email: TCENTER36@YAHOO.COM FJELLEY@NYCAP.RR.COM
Contact Person for Building & Code Compliance: FRANK JELLEY
Cell Phone: ( ) Land Line: ( 518 ) 796-5611
Email:
Town of Queensbury Building&Code Enforcement Principle Structure Application Revised February 2017
PROJECT INFORMATION:
TYPE: Commercial X id 1_:I
WORK CLASS:
X Single-Family Two-Family 1 ulti Family(#of )
Townhouse Business Office Retail Hotel/Motel
Industrial/Warehouse Garage(#ofcars Other(describe )
STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE:
1ST floor: 77 SF(BASEMENT) 1sT floor:
2 floor: 912 SF 2nd floor:
3rd floor 661 SF Total square feet: N/A
floor:
Total square feet: 1,650 SF
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 150,000
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 Propan 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? 7,500 SF
b. Is this a corner lot? YES coo
c. Will the grade be changed as a result of the construction? • NO
d. What is the water source? PUBLIC PRIVATE VIEW
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? PRIVATE SEPTIC
Ravr5er p r
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 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: Lau ( Mt Nieje_
SIGNATURE: ( : ,'), 771 DATE: (0/20
Town of Queensbury Building&Code Enforcement Principle Structure Application Revised February 2017
FUEL BURNING APPLIANCE & Office Use Only
CHIMNEY APPLICATION G-g
Permit#:� 9 • ZOArJ
t 1
Permit Fee:$
Town of CLcensbur
742 Bay Road, Queensbury, NY 12804 Invoice:#:
P: 518-761-8256 www.queensbury.net
Project Location: CHESTNUT LANE Tax Map ID #: 226.19-1-20
Room of Install: FIRST FLOOR LIVING ROOM Planned Install Date: FALL 2018
**ONE APPLICATION PER APPLIANCE**
CONTACT INFORMATION:
• Applicant:
Name(s): LAURA MCNEICE
Mailing Address, C/S/Z: 38 REEVES AVE, EAST FAMINDALE,NY 11735
Cell Phone: ( 646 ) 643-6784 Land Line: (
Email: TMM616@ICLOUD.COM
• Primary Owner(s):
Name(s): SAME AS APPLICANT
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _(
Email:
• Installer/Builder:
Business Name: SAME AS APPLICANT
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
Contact Person for Building & Code Compliance: FRANK JELLEY
Cell Phone: ( 518 )796-5611 Land Line: (
Email: FJELLEY@NYCAP.RR.COM
Fuel Burning Appliance&Chimney Application Revised March 2017
FUEL BURNING APPLIANCE INFORMATION:
TYPE OF DEVICE:
X Stove _ Fireplace Insert Fireplace
Fuel Fired Equipment (Garage Only, 18" clearance per IMC 304.3)
X Fireplace, factory built**
VERMONT CASTINGS DEFIANT FLEX BURN 1975
**Manufacturer's name: Model #:
SOURCE OF HEAT:
X Wood Coal Pellet Gas
CHIMNEY INFORMATION:
Masonry:
block brick stone
X Flue:
tie X steel size, in inches
X Material*:
double-wall X triple-wall X insulated
(*Manufacturer's name: DURA VENT Model #: 6 IN
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:
ff
PRINT NAME:
SIGNATURE: )C /The 7_-1-,(7 DATE: (U/7,0�
Fuel Burning Appliance &Chimney Application Revised March 2017
SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
742 Bay Road,Queensbury,NY 12804
r<,K„•PcLke,:.iti,ri P:518-761-8256 www.eueensbury.net Permit#: -.0—0 AOI • 23 uo
Tax Map ID#: 226.19 1 20 Permit Fee: $ ; Invoice#:
Project Location: CHESTNUT LANE(WEST LOT) Septic Variance? Yes No
Primary Owner(s) LAURA MCNEICE
Mailing Address 38 REEVES AVE., EAST FARMINGDALE,NY 11735
Phone& Email 646-643-6784 TMM616@AOL.COM
Installer/Builder SAME AS OWNER
Mailing Address
Phone & Email
Engineer HUTCHINS 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 2 110 220
PARCEL INFORMATION:
Topography X Flat Rolling Steep Slope 5 %Slope
Soil Nature X Sand X Loam Clay Other
Groundwater At what depth? 32"
Bedrock/Impervious material At what depth? NA
Domestic Water Supply _Municipal X Well (if well, water supply from any septic system absorption is NA ft.)
Percolation Test Rate: 7 per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size 1000 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: 300 SF
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 HUTCHINS ENGINEERING DATE: 8/10/18
SIGNATURE: DATE: 8/10/18
Town of Queensbury Building&Code Enforcement Revised February 2017