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applications Jate: 03- l7-).0/ 4o -- -- - Tax Map ID ,3 0 I f_3- ( Permit No. Permit Fee RE•000!c!�} ^ 20 ISO Zone Historic? _Yes )( No Ree Fee A Mzjof '4314a `03 / Subdivision Name Lot# Site Plan# Subdivision# Project Location 22 ' 10ar k v i e.,_-J Q ueoci e_ 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). FAddress mary Owner(s) 3o cleme a e r� S J ne/Email Applicant l`e'a Co 0 S"-/c, c4io Y1 L L G . Address > (7 Gjc�r✓!�r)T �'l UG'�'1Ct �� W"_/ 'S'66 'S'6 6 o Phone/Ema ll /©� 6 ,1 A o C, o Contractor %30� ����,.�o� (��-r-�,-��✓� ��s-�-L.C.C. Address So Phone/Email Contact Person for Building& Codes Compliance: _Rd to r"M(0 n —Phone(5-16) 376-gam TYPE OF CONSTRUCTION --/Check all that apply New Addition Alteration I"floor sf 2nd floor sf Total sf Height Single Family Two-Family Multi-Family (#of units_) , 92 Townhouse o� Business Office G ) Retail-Mercantile Factory-Industrial Attached Garage (1,02, , 4+) � Other Town of Queensbury Building&Codes Principal Structure Application revised January 2016 If commercial or industrial please indicate name of business Proposed use of building or addition S i 110 le 12eS/d c Source of Heat(circle one) has Oil PropAne Solar Other Fireplace: Complete a separate application for Fuel Burning Appliances & Chimneys (S-A-S -71 2 CP/qe-e__ Are there structures not shown on plot plan? lv/D Are there easements on the property? AJ 0 Site Information: a. Dimensions or acreage of lot '5"0 -o 1�c -es b. Is this a corner lot? Yes _No c. Will the grade be changed as a result of construction Yes X No d. Public water or Private well(circle one) ublic Private e. Sewer or Private Septic System (circle one) Sewer rivate Value of all work to be performed(labor or materials) $ %,3 U; Doc.) DECLARATION. 1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. 2. If work is not complete 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 / 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: Ca DATE:Q 3— /7--20//- SIGNATURE: 7-20%-SIGNATURE: DATE: U'� �/�rrie�rey► CvPSf LLG1 For office use only Operating Permit Issued: Yes No Occupancy Type Construction Classification Assembly Occupancy Limit Special Conditions -wn of Queensbury Building&Codes Principal Structure Application Revised January 2016 Fuel Burning Appliance & Chimney Application Office Use Only DATE: �7T/ 20/ 302.14-3-62 RC 144-2016 TAxMAP ID: 3o Gammon Construction ZONE: , ; Lot 75, House Park View Avenue SFD, 2 car aft. garage, fpl OWNER PHONE/E-MAIL ,5/e)3 7(.-9.12 ADDRESS 3 p clP/nexil- Ouenye-- ! c INSTALLER/ PHONE/E-MAIL BUILDER cox LLC s1,,6)376-8316 CONTACT PERSON FOR B1�UI,,L�DI//N,,G``&CODE COMPLIANCE: 7 V�Pr Gci s yl�o �-1 PHONE/E-MAIL` 2 f2¢ y i�at�Sr� •COY i BUILDINGADDRESS ROOM OF INSTALL: L i vel)G PLANNED INSTALL DATE: f 3 0/6, FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL NOTE: ROUGH-IN& STOVE FINAL INSPECTION ARE FIREPLACE INSERT REQUIRED. FIREPLACE,FACTORY BUILT` NOTE: FIREPLACE,MASONRY MANUFACTURER'S INSTALLATION MANUAL FURNACE(GARAGE ONLY) MUST BE AVAILABLE AT TIME OF INSPECTION *If factory built provide manufacturer name: 1-I e,5t+ A/ (s l o ; Model#:SLS SCy g Listed by: lt.L Number: A/A.)U-/o( yu, —061q CHIMNEY INFORMATION Masonry** (check one) BLOCK BRICK STONE Flue TIE STEEL 6 Size in inches Material DOUBLE WALL —TRIPLE WALL INSULATED ** If non-masonry provide manufacturer name: ; Model#: 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 inspector's to enter premises to perform required inspections. I HAVE READ AND AGREE TO THE ABOVE: PRINT NAME: o L 2r 4 DATE: SIGNATURE: 2C DATE: / Town of Queensbury Building&Codes Principal Structure Application Revised January 2016 SEP'T'IC DISP®SAI., APPLICATION err TT__CI-1- 302.14-3-62 RC 144-2016 DATE: U 3 `i7/ /� Gammon Construction TAx MAP ID: 30 �A . Lot 75, House Park View Avenue ZONE: SFD, 2 car att. garage, fpl APPLICANT C'4MMc"'1 6617�:&C kbr1 LL PHONE/E-MAIL ADDRESS .3eD C(elveil-74 Q+-enae- Sq/cY c' INSTALLER/ PHONE/E-MAIL BUILDER OWNER G +�Gr! 6x45'1_ LLG ADDRESS CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: Bo 6 t�sxtmzi a PHONE/E-MAIL 376 ` RESIDENCE INFORMATION Year Built #of bedrooms X gallons per bedroom =total Daily flow 1980 or older Garbage grinder installed _Yes No 1981-1991 Spa or Hot Tub installed _Yes No 1992-Present 3 /3 p Cpv 3 go G PARCEL INFORMATION Topographya rolling Steep slope %Slope Soil Nature V Sand Loam Clay Other Groundwater At what depth: Bedrock/Impervious material At what depth: !vI Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is_ft.) �' ' M per minute per inch(test to be completed by licensed engineer/architect) Percolation Test Rater PROPOSED SYSTEM FOR NEW CONSTRUCTION Tank size / 0 D gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub System Absorption field with#2 stone Total length ft.;Each Trench Seepage Pit with#3 stone How many: ;Size Alternative System Bed or other type: yi 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&approved. The installed system must match the septic system 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: DATE: C3 /17 l 02 D/6 SIGNATURE: , s �e ,,n r DATE: fir+5-1- L/ C. Town of Queensbury Building&Codes Principal Structure Application Revised January 2016 Town of Queensbury Thomas R. Van Ness Highway Department Highway Superintendent 742 Bay Road, Queensbury,NY 12804 Home: 518-745-0929 Phone: 518-761-8211 Fax: 518-745-4466 David Duell Deputy Highway Superintendent Home: 518-745-0938 DRIVEWAY PERMIT Date: Applicant Name: Telephone No.: C � '9 7 6 - S�31 (o Address to be Inspected /C V 1 e'e"& Gf V Return Address: 3 C7 c lPmel?l Ql uei'?u 2 sglq{O5q 51 ►01-my.S,/t✓. 0 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 302.14-3-62 RC 144-2016 Gammon Construction NEED ( ) Slight Swale Lot 75, House Park View Avenue ( ) Deep Swale SFD, 2 car att. garage, fpl ( ) 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 approval permit for a final approval. .STEP 2: ( ) Final Approval ( ) Rejected Date: Thomas R. Van Ness, Highway Superintendent David Duell, Deputy Highway Superintendent Town of Queensbury Building&Codes Principal Structure Application Revised January 2016