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applications PRINCIPLE STRUCTURE Office Use Only PER 2 22 � G t5 l� �n V L5 ��& Permit RC p I51 _ ZO( lu�tin cif(?uce,i<hu,v — 1 Permit Fee: $ 5)v . 8 t 742 Bay Road, Queensbury, NY 12804 M MAR 19 2019 Li *Rec. Fee: $ 350, OO P: 518-761-8256 www.queensbury net TOWN OF QUEENSBURY Invoice#: I )0: BUILDING&CODES Project Location: .6 L 2 2 Tax Map #: 308 jj- -77.3 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 & modular homes but not mobile homes. This is in addition to the permit fee(s). CONTACT INFORMATION: • Applicant: Name(s): 0,10i0 Tay E iLypff5r95 LL( Mailing Address, C/S/Z: L/! 140,414 12r( (fir {)'( 1? Y)V Cell Phone: (515 ) 1jf,/ 1713 Land Line: ( Email: (i(icP et (re:, ! /Y • Primary Owner(s): Name(s): 6Ct,V11'84\ 1 iIft:,j Mailing Address, C/S/Z: �i/ Cell Phone: ( ) Land Line: ( Email: ❑ Check if all work will be performed by homeowner only • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): 3ra ,nxP_ ct Ajpl'tc=.,� Contractor Trade: Mailing Address, C/S/Z: Cell Phone: ( ) Land Line: ( Email: **List all additional contractors on the back of this form • Architect(s)/Enqineer(s): Business Name: Contact Name(s): Mailing Address, C/S/Z: Cell Phone: ( ) Land Line: ( Email: Contact Person for Building & Code Compliance: )14.00 440(N)(11/ Cell Phone: ( 5(e, ) �f(�/-171'� Land Line: ( Email: (11r,2 u,. (:�nc i£,cc c \ Principle Structure Packet Rcvimrl Fahrnnrv'7n,o PROJECT INFORMATION: TYPE: Commercial A 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: 1ST floor: E,B© 1ST floor: y(i 2"d floor: `70j.2 2"d floor: 3rd floor: Total square feet: Yc< Basement(habitable space): Total square feet: I t?,)? ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ e.10 OcX1 2. Proposed use of the building: )-INS 3. If Commercial or Industrial, indicate the name of the business: 4. Source of Heat: Ga Oil Propane 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 1 Explain: 6. Are there any easements on the property? YES NO 7. SITE INFORMATION: a. What is the dimensions or acreage of the parcel? j..5 fk.r,� b. Is this a corner lot? YES N� c. Will the grade be changed as a result .f the construction? YES NO d. What is the water source? PUBLIC PRIVATE WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? 5ggo Lc Principle Structure Packet Revised February 2019 DECLARATION: I. I acknowledge that no construction shall commence priorto issuance of a valid building perm and work will be completed within a 12 month period. 2. If the work is not completed by the 1year expiration 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 rue 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 regulati:ns. 4. I acknowledge that prior to occupying the facilities proposed I, or my agents. will obtain a certificate of occupancy. 5. I understand that I/we are required to provide an as-built survey by a licensed land surveyor of al newly constructed facilities prior to issuance of a certificate of occupancy. I have read and agree to the above: PRINT NAME: IltoicI ObAb,ly SIGNATURE: ,,,,�,,rv1A✓LR DATE: 3/Jc//9 Principle Structure Packet Revised February 2019 Office Use Only a,t�,��,r ���,„,h��n� Permit#: -—0131- 2-0 VI SEPTIC DISPOSAL PERMIT APPLICATION Permit Fee: $ ; Invoice#: Septic Variance? Yes No 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensburv.net Tax Map ID#: 3 )P . Project Location: 351 ) ii z.ekvtL „fed • Applicant: Name(s): I' (acue Civi vpj' i5Q5 1 LL Mailing Address, C/S/Z: y 1 12e0tA d uby ►'\Y )c\ y Cell Phone: _( 5)¢j ) Lib) -)713 Land Line: _( Email: C Joe.. ek (oc -G. r'ow\ • Primary Owner(s): Name(s): r�r�xte. N, r^lD _ Mailing Address, C/S/Z: Cell Phone: _( ) Land Line: _( )_ Email: ❑ Check if all work will be performed by homeowner only • Contractor: Workers' Comp documentation must be submitted with this application Contact Name(s): COak)/1os FilitdrnfrA 1=a.r'alied-i, Contractor Trade: i ds+iDi\ Mailing Address, C/S/Z: /4-ocipon Fe, )a. y' Cell Phone: _( 51f1 ) 3 -,1- )7y4 --re F4 Land Line: _( Email: • Engineer(s): Name(s): ())4 Mailing Address, C/S/Z: Cell Phone: _( ) Land Line: _( Email: Contact Person for Building & Code Compliance: (01)0 Olonsoitv Cell Phone: ( 5/!i ) Vb)- )7ij Land Line: ( Email: doe a Loot.g. coon Principle Structure Packet Revised February 2019 • RESIDENCE INFORMATION: Year Built Gallons #of bedrooms: X gallons per =total daily flow per day bedroom Garbage Grinder Yes 6:5 1980 or older 150 Installed? (circle one) 1981-1991 130 Spa or Hot Tub Yes i Installed? (circle one) 1992-Present 110 3 , iCS 33U PARCEL INFORMATION: Topography l7& Flat Rolling Steep Slope %Slope Soil Nature Sand Loam Clay Other(explain: Groundwater At what depth? 17 faA_ Bedrock/Impervious material At what depth? ni A- Domestic Water Supply Lic 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 i 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 J 50 ft.; Each Trench ,3. 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: L DATE: Th f ip)I0 3 1 SIGNATURE: 2f` DATE: 3)(1j// Principle Structure Packet Revised February 2019 • Town of Queensbury �~ David Duell Highway Superintendent Highway 518-761-8212 Department 742 Bay Road—Queensbury,NYC Mark Benware 12801 Deputy Highway Superintendent Phone: (518) 761-8211 518- 61-8210 Fax: (518) 745-4466 DRIVEWAY PERMIT DATE: 31 011kl APPLICANT NAME: I ),(ISoi.Lk ciAL 2.>e_5L_LC_ TELEPHONE NO.: y je Lib/- ) 7))) ADDRESS TO BE INSPECTED: 35 I Li.i zet/A.E Xfi RETURN ADDRESS: L(( l2t9t;PX .)/(l nbY f\,y 1,)MOy 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 completion, please resubmit this approved permit for a final approval. STEP 2: ( ) Final Approval ( ) Rejected Date: David Duell, Highway Superintendent Mark Benware, Deputy Highway Superintendent