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applications Office Use Orly : :7N Permit Ai QC ' 0k6-2.01(6 PRINCIPLE STRUCTURE PERMIT ti Permit Fee:5 1014.5 Q APPLICATION 742 Bay Road Queensbury. NV 12804 Rec. t ee: j 850. P 518=76 i-82.55 invoice n: fl 50q-- 22 t9 Et' MIN vm©ksu Project Location: Sn'Io g�� 'tn�e ►� ��U • 5Z. Tax Map #: 34g•e ` C- 2 l<84. 4 Subdivision Name: E T /Zt o&-C TOWN BD RESOLUTION 86-2013 S850 recreation fee for new dwelling un dup ; two-family: multiplefamily apartments cord•: ..tni urr S ort' a:it:l be ;., ;t ;� ;�,•=�� -:o�.��e .and manufactured ri,,.i �, homes ., not �"���:i homes. This is in addition to the permit fee(s). CONTACT INFORMATION: Applicant: Name(s): Et)v T H I LC S g E gS ( OE 1-Lk:(_t ) Mailing Address, CfSIZ: _ 61 f`r)is uhi TA tpS t b e. bR t vv Quiv s8 .1 WLf 124o-f _ Cell Ph.: t ) ---1q t - t9 33 Land -biro: 1 (Sty' ) Th-3s2.0 (c. r-�) Email: Foo t t-(ti..A.S t3.k. -f)ERs l ry' r C--n flt t< • crc "\ O Primary Owner(s): Name(s): S'ArriE 19 S >A PPL C..AN i Mailing Address, CfSIZ: Cell Ph. ( ) Land Line: .( , Email: iJill 122018 N E • Cantracterts): ' jJ: Name(s): S A m AS P i �i�N� A I �, .ter+ � r' Mailing Address, CISIZ: 6JOI':��,,r�"_;_ ES Cell Ph.: ( ) Land Line: ( ) Email: • Architects)/Enetineer(s): E-FRAN HAt_1 - (3L lDix. Ate€ G-Les3s FALL' N"( Name(s): 1 Mailing Address, C/S/Z: " -� - I Cell Ph.: ( ) . Land Line: I ( s'i ' ) kr q i "02ce8 Entail: H Au- N CAP, O Contact Person for Building & Code Compliance: Jc L v. f Cell Ph.: f (Stg. ) -�` 1, 1133 Earrd Line: i(1 iT ) ! `t(r; C26 (LC�-t-. Email: Foc i Hit.k-56k.,1; ;fit.• S Tor)A ri'riira R CrotIFFnfnrrpripnt Prinrinle CItTitrIfIrtz,Rplicpri March 7C iR 4 'PRWECT INFORMATION: TYPE: Commercial . X Residential WORK CLASS: Single-Family _)c Two-Family Multi-Family(#of ) Townhouse Business Office Retail Hotel/Motel IndustrialiWarehouse Garage(#ofcars ) Other(describe STRUCTURE S 1,01.AIE FOOTAGE: GARAGE SQUARE FOOTAGE: is'floor: 9 0 1ST floor: 2.3 rd floor: 2nd floor: 3rd floor: Total square feet: .3 I Basement(habitable space): S- Total square feet: ADDITIONAL PROJECr INFORMATION: 1. Estimated Cost of Construction:$_17 3 000 2. Proposed use of the building: sg.ESIDENcriAL 1Wo -rain.L.L.L4 3. if Commercial or Industrial,indicate the name of the business: 4. Source of Heat(circle one): 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 gartia.in: 6. Are there any easements on the property? YES NO 7. SITE INFORMATION: 0, S-c) a,What is the dimensions or acreage of the parcel? 'C).. " /.'14 b. Is this a corner lot? YES leto c.Will the grade be changed as a res the construction? ei) NO d.What is the water source? UBLI• PRIVATE WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? SelYT IL %C6-6- PriTAC 14 eb C- btr4 6- ( LAN Tor)Buildin2 PrifOrCP1716>IIS PrinrinLa Striirthrs4 Ravicart hel=rch 7frIR • DECLARATION: I. I acknowledge that no construction shall commence priorto issuance of a valid ouilding perm and work will be completed within a 12 month period. 2. lithe work is not completed by the lyear expiration date the permit may be renewed, subject to fees and department approval 3. certify that the application, plans and supporting materials are a t rue and complete statement andfor description of the work proposed, that all work will be performed in accordance with the NYS Building Codes, boal building laws and ordinances, and in conformance With low zoning regulations. 4. 1 acknowledge that prior to occupying the facilities proposed I,or my agents, Will obtain a certificate of occupancy. 5. I understand that liWe 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: oc EP t-k t-EtA SIGNATURE DATE: - Prinrinie Sim trtura RavicAri ToQ Buildime Code tnforceim.nt _ _— , . . • 4r4N7.% • SEPTIC, DISPOSAL PERMIT APPLICATI ON 7 Say Road.Qu-:-..-,,ri;bury,\\• ,ii-1 • ' t ' P 51N 76 : 56 Perm" - Ta, Map ID# ,36t, - t-2.1 •0 s—1 . . ; Project Location: . - - Primary Ovvner(s) FOC;THR-L$ . v,(L-beg U.( C0c i_etA (-1) 11 Mailing Address 0 i ilioi-A..rv-TA I t-).S i De '6P... Qt/t .: .'',',-s 13'02-'1 .H i r2go\-/ , . ,._ . 11 Phone& Email 6'10'111-19-33 / (C101967-1 2. Installer/Buik:ler S‘NriNe .i° n9 PC.I C Ft Aft' ,Mailing Address i Phone & Email ' i Engineer ,------ • i TO ry. .c.F;,,,„-i-6-e, 1 Mailing Address 1(pl 14Piv-I LAN .R6 C4AA_--e-er-s 8,A g._-1 ici`-i 1 2-F 0 i t i • _.,. ... Phone & Email '(S-1 0 2.,S-1 5' TC...Gt.rit.,c ik3Co @ YALLIop, torn I • - -30 e- Le1c1 Contact Person for Building&Code G c>rry p I i.a ri . .-. f="1--1 c:+a-l!e•: l'H - (9 33 RESIDENCE NFORMATiON: I i Year Built # of bedroo ms i X gallons per bedrOom I = totaidaily flow 1 Garbage Grinder 'i Yes (Da laSO or older r-------------1 Installed? {circle one . ..,.........._ ,,„ i • ' -----7-crt Tub-:."7"----------rVeS N •, spa or,. -1981--G91 1 1 I Installed? (circle one).-a92-PfeSehir----1-''''—"- i t , - PARCEL [NFORMATiON: • Topography sce--- p.i....A u Flat Roiling Steep Slope %Slope Soil Nature Sand Loam Clay _ Other Groundwater • At what depth? NT, _ . . ,. ___ .... _„ ....... _ ___ • ____......,______ Bed rockftrnpery bus material At what depth? 1,../0 Domestic Water Supply Municipal Well (if well.water sUpply from any Septic system absorption is ft.i - — . — Percolation Test . Rate. j-S per minute per hch(test to be completed by licensed encheertarcliect) ,---, — _ PROPOSED SYSTEM FOR NEW(ONSTRLITI ON:. — L_____ Tank size J0 0 0 gallons{min.size .1000 gallons,add 250 ga lions for each garbage cylinder or spalhot tub, — 11 1 System Absorption field with#2 stone Total ngtl-i ...,_t--0 tt.:Each Trench /S-C) 41..._ L----- i Seepage Pit with#S stone How many: • Size:, i__. r- - — f I Alternative System -Bed or other type: i t--------+--- if I HoldingTank System Total required capacity? -tank size # of tanks - '. ' • NOTES:1 Alarm system&associated electrica two rk must.be inspected by a Tow n approved electrical inspection agency;2 We Will no longer allow systems to be covered until such time as an as-built plan'§received and approved. The installed system must match the septic layout oh 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 voici,i have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Diehosa}Ordinance. PRINT NAME: 30 S e•P 0 Lesa-c--1 DATE. Le hi iSr (9 itilie SIGNATUR_ . - DATE:— - 1--„,.-:.:••:.,..,.:•..--.i...-....,.i •.:-..:;.(:-.••:.-e i--;-:%.::-:.,-.:,-,-:.„7.,-