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applicationsPRINCIPLE STRUCTURE Office Use Only PERMIT APPLICATION Permit #:_2<-07¢«Qe Town of Queensbury Permit Fee:$_©O'40 742 Bay Road,Queensbury,NY 12804 *Rec.Fee:$_N\Pr_“prow. P:518-761-8256 wwwqueensburynet 2Invoice22 Project Location:50Cussel\ Was@dTaxMap#:240,90 -\-G Subdivision Name: TOWN BD.RESOLUTION 86-2013:$850 recreation fee for new dwelling upits~-single-family;duplexes/two-family, multiple family,apartments,condominiums,townhouses,and/or manufactured)homes,bul homes.This is in addition to the permit fee(s).- CONTACT INFORMATION: ©Applicant: Name(s):MW \eanecal Noanes Mailing Address,C/S/Z: Cell Phone:(AAC 199AZ ZiS\Land Line:_( Ema cea Barth MHECLOWNAMES ConA \ *Primary Owner(s): Name(s):Weids and SdnnTo Can Mailing Address,C/S/2:_2021 Woodend Wow Oderton NY 2 >Cell Phone:(Yi )62S ALAA Land Line:_() Email:QwixaC\an @ eon\.Coss, CO.Check if all work will be performed by homeowner only *Contractor(s):Workers’Comp documentation must be submitted with this application Contractor Name(s):NW \enQedal Nose Contractor Trade: Mailing Address,/S/z:_424 Q.Gack PY Cell Phone:(S\W 943 I\S\Land Line:_() Email:Acea ©MOnngedainomes Coml **List all'additional contractors on the back of this form *Architect(s)/Engineer(s):, Business Name:I.Haw $Huresnas Entensees Contact Name(s):Fatpao Hew “Jom Hurenings Mailing Address,C/S/Z: Cell Phone:_(BIB )-0)Land Line:_(516)745-6; Email:EPUACe@>NYCAP,Be.com FEHUTe 1s a,HUTCHINS 66 WEEE!PG,Com, Contact Person for Building &Code Compliance @CEG HE EyCellPhone:(S18 _)Bel-3457 land Line:(El )WI27 21 By Email:_@@saaq muLim Peetpulomes.com Princine Structure Packet Revised February 2019 e Contractor(s):Workers’Comp documentation must be submitted with this application Contractor Name(s):MH Fmpeeiac Homes Contractor Trade:_G@eneenu— Mailing Address,C/S/Z:\42 OUTS A,FoeT Eoueed NY [2504 Cell Phone:(H(B_)ZF -2457 Land Line:) Email: *Contractor(s):Workers’Comp documentation must be submitted with this application Contractor Name(s):I ZOWDACK Contractor Trade: Mailing Address,C/S/Z: Cell Phone:(HI)461-0138 Land Line:_() Email: *Contractor(s):Workers’oe documentation must be submitted with this application Contractor Name(s):COMCZETE TEci|NoLogies Contractor Trade:__cetMailingAddress,C/S/2: Cell Phone:_(5IB)3716 -2E57 Land Line:_() Email: *Contractor(s):Workers’Comp documentation must be submitted with this application Contractor Name(s):_ADIZONDAEK.P Sm Contractor Trade:_Puum@rce &fracas cee Mailing Address,C/S/Z: Cell Phone:_(1%)Bel3334landLine:(B18 )773-3683Email: ©Contractor(s):Workers’Comp documentation must be submitted with this application Contractor Name(s):Geos Bees Erect.Contractor Trade:__Execerc. Mailing Address,C/S/Z: Cell Phone:_(51g _)_79).4889,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 PROJEGT INFORMATION: TYPE:_Commercial J.Residential WORK CLASS:t Single-Family __Two-Family __Multi-Family(#of units) __Townhouse __Business Office _Retail _Hotel/Motel __IndustrialWarehouse carase (#ofcars 2)__Other(describe ) STRUCTURE SQUARE FOOTAGE:GARAGE SQUARE FOOTAGE: a"floor:_(2S 1 floor:HRD 2"floor:nD 2"floor: 3"floor:See Total square feet: Basement (habitable space):_O Total square feet:HES ADDITIONAL PROJECT INFORMATION: 1,Estimated Cost of Construction:$450,005 2.Proposed use of the building SIMALE Faimtuty 3.If Commercial or Industrial,indicate the name of the business: 4,Source of Heat:Gas Oil Solar Other: (Fireplaces need a separate Fuel Burning Appliances &Chimney Application,one per appliance) 5,Are there any structures not shown on the plot plan?YES (@O)Explain: 6.Are there any easements onthe property?YES Ci) 7.SITE INFORMATION: a.What is the dimensions or acreage of the parcel?ZO,522~ b.Is this a corner lot?YES c.Will the grade be changed as a result of the construction?YES. d.What is the water source?PUBLIC PRIVATE CWELL) e.Is the parcel on SEWER or a PRIVATE SEPTIC system?_2IVATE Principe Structure Packet Revised February 2019 DECLARATION: |.lacknowledge that no construction shall commence priorto issuance of a valid building permit and work will be completed within a 12 month period. 2.Ifthe work is not completed by the 1year expiration date the permit may be renewed, subject to fees and department approval 3.I certify that the application,plans and supporting materials are a true and complete statement and/or description of the work proposed,that all work will be performed in accordance with the NYS Building Codes,local building laws and ordinances,and in conformance with local zoning regulations. 4,|acknowledge that prior to occupying the facilities proposed |,or my agents,will obtain a certificate of occupancy 5.|understand that lve are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance ofa certificate of occupancy. |have read and agree to the above: PRINT navéeae Ties SIGNATURE: | DATE:It [4/2014 Principle Structure Packet Revised February 2019 Office Use Only FUEL BURNING APPLIANCE &Permit#:2.aCHIMNEYAPPLICATIONPermitFee:$ Invoice #: 742 Bay Road,Queensbury,NY 2804 P:518-761-8256 wwwqueensburynet Project Location:6p fussene (isos Bo Tax Map ID:240 iw Room of Insta:Livia Rasen Planned Install Date:iamLeroy **ONE APPLICATION PER APPLIANCE** CONTACT INFORMATION: ©Applicant: Name(s):MU Smpeeine Homes Mailing Address,C/S/Z:429 Roure |Toer Eouwrmen Cell Ph:_(SIG)BLL -S457 Land Line:_(5'@ )192 24.5) Email:GEA MUTMPATdL\ones ,Con °Primary OuseName(s):_\EA0\douw Tar eb Mailing Address,C/S/2:22-7 LOoopeylucih WonY 20eesTonS mo 2413 Cell Ph.:_flo )B24214LandLine:_( Email: 0 Check if all work will be performed by homeowner only Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: Contact Person for Building &Code Compliance: Cell Ph.:__().Land Line:__(), Email:, Pringiple Structure Packet Revised February 2019 FUEL BURNING APPLIANCE INFORMATION: TYPE OF DEVICE:J __Stove _—Fireplace Insert Fired Equipment (Garage Only,18”clearance per IMC 304.3) Fireplace,factory built** (**Manufacturer’s name:Harutoe mode x:Noy 423i, SOURCE OF HEAT: ireplace ___Wood __Coal __Pellet x Gas CHIMNEY INFORMATION: ___Masonry (require plans to be submitted): block ___brick __stone __Flue: __tile YL steet B 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. Manufacturer's installation manual must be available at the time of inspection. Masonry fireplaces &chimneys require plans to be submitted. ‘Twenty-four (24)hour notification is required for inspections. Workers’Comp insurance information is required with this application. yey 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. Ihave read and agree to the above: PRINT NAME: SIGNATURE pate:I [o {roiq Principle Structure Packet Revised February 2019