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applicationsPRINCIPLE STRUCTURE Office Use Onh PERMIT APPLICATION permit#:[2-0100-2020 Town of Queensbury Permitfee:s S(O GO742BayRoad,Queensbury,NY 12804 |MAR 09 2020 *Rec.Fi BSD.00 P:618-761-8256 wwwqueensburynet | Invoice #:__2 937 Project Location:24 Biuplishive Tyce Tax Map #:_200.i2-/-a Subdivision Name:(Ged Qrucl Close TOWN BD.RESOLUTION 86-2013:$850 recreation fee for new dwelling units:single family,duplexes/two-family, multiple family,apartments,condominiums,townhouses,and/or manufactured &modular homes,but not mobile homes.This is in addition to the permit fee(s), CONTACT INFORMATION: Applicant: Name(s):Measour Enteprisos Lie Mailing Address,C/S/2:41 Revi Del by AY apoy Cell Phone:_(5/8)Yb/-)2)%Land Line:_() Email:__Drve ee Gori £.com +PrimaryOwner(s): Name(s):ay above Mailing Address,C/S/2: Cell Phone:_()land Line:_() Email: O Check if all work will be performed by homeowner only ©Contractor(s):Workers’Comp documentation must be submitted with this application Contractor Name(s):___Frown AHockeel Morey Fa tupe,ser 100 Contractor Trade: Mailing Address,C/S/Z:thttelkCosette 21380!Cell Phone:_(5/%_)_Yo)-19 Land Liné:_() Email:___aue a Goci ©.© **List all additional contractors on the back of this form *Architect(s)/Engineer(s) Business Name: Contact Name(s): Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: Contact Person for Building &Code Compliance:_/weCellPhone:_(5/2)_)_Yp)-)25 Land Line:_() Email:__aue ¢.Goci £.com _ PROJECT INFORMATION: TYPE:__Commercial _&Residential WORK CLASS: Single-Family __Two-Family __Multi-Family (#of units ___) __Townhouse __Business Office _Retail __Hotel/Motel __Industrial/Warehouse __Garage(#ofcars__)__Other (describe ) STRUCTURE SQUARE FOOTAGE:GARAGE SQUARE FOOTAGE: 1 floor:|7270 1 floor:5 2L 2™floor:2 floor: 3°floor: Basement (habitable space): Total square feet:__52. Total square feet:{20> ADDITIONAL PROJECT INFORMATION: Estimated Cost of Construction:$_A50,UCr) Proposed use of the building:Ho wi If Commercial or Industrial,indicate the name of the business: Source of Heat Oil Propane—Solar Other: (Fireplaces need a separate Fuel Burning Appliances &Chimney Application,one per appliance) Are there any structures not shown on the plot plan?YES (@G)Explain: ‘Are there any easements on the property?YES. SITE INFORMATION: a.What is the dimensions or acreage of the parcel?15D &ALO b.Is this a corner lot?YES c.Will the grade be changed as a result.ofthe construction?YES.(N d.What is the water source?éuBLic)PRIVATE WELL e.Is the parcel on SEWER or a PRIVATE SEPTIC system?__4aadcr DECLARATION: |.lacknowledge thatno construction shall commence prior to issuance of a valid building permit and work will be completed within a 12 month period 2.Ifthe work is not completed by the tyear 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 kcal 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 bya licensed land surveyor of all newly constructed facilities priorto issuance of a certificate of occupancy. |have read and agree to the above: PRINT NAME:__Dawid \Lonaou v SIGNATURE:ll iMiocabit pate:__aliob Office Use Only FUEL BURNING APPLIANCE &Permit#:_%C-O\00 -2078 CHIMNEY APPLICATION Permit Fee:$ Invoice #: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 wwwaqueensburynet Project Location:_34 Ayla Tia Tax Map ID:_208./@-!l-43.2 Room of Install:_2\u.Nb iar on Planned Install Date:__/\an **ONE APPLICATION PER APPLIANCE** CONTACT INFORMATION: ©Applicant: Name(s):Monrpur Fatypjecs Lil Mailing Address,C/S/Z:__4(Reveve Rel Cell Ph.:(Si)_)YI 191 Land Line:__() Email:Anup @ GOCTF,Co. @ Primary Owner(s): Name(s)Sout on Age \iecat Mailing Address,C/S/Z: Cell Phi:_()Land Line:__() Email O Check if all work will be performed by homeowner only Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s):fo DNase Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()land Line:_() Email: Contact Person for Building &Code Compliance:Drwie 4 Nou Cell Ph.:__(4/9 _)Ybi-220 Land Line:__( Email:__lowe GO:oe Principle Structure Packet Revised February 2019 FUEL BURNING APPLIANCE INFORMATION: ‘TYPE OF DEVICE: __Stove x Fireplace Insert ___Fireplace ___Fuel Fired Equipment (Garage Only,18”clearance per IMC 304.3) _X.Fireplace,factory built**Tos raluicl by Serctosn Fisiplaw +Onmrey (**Manufacturer’s name:__Hrot t bie Model #:__007>¢) SOURCE OF HEAT: __Wood __Coal __Pellet 4 Gas CHIMNEY INFORMATION:A verted Ons Goble weit de __Masonry (require plans to be submitted): block __brick —__stone __Flue’ __tile ___steel __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 andafinalinspection,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. Sere 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. |have read and agree to the above: PRINT NAME:2 Dawid MowougSIGNATURE:Hee be pate:_2 Jiahe Principle Structure Packet Revised February 2019, Office Use Only "onan"SEPTIC DISPOSAL PERMIT APPLICATION|fer™t #—ECO SG (0 ES Septic Variance?Yes No 1742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Tax Map ID #:208.)A-}-4%,2 Project Location:_.2Y yoo Save Tita ¢Applicant: Name(s):Mowyoue Catuperses Lit Mailing Address,C/S/Z:__)Renee Mel (by AY Japoy Cell Phone:_(_5if._)__WbJ-122 Land Line:_() Email:__Qhwe &Gocre ©Primary Owner(s): Name(s):Lowe an Ayplicont Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: O Check if all work will be performed by homeowner only ©Contractor:Workers’Comp documentation must be submitted with this application Contact Name(:Fxted Maa Extracting Tite Contractor Trade:FAcrwetoy Mailing Address,C/S/2:__54 login 5+Hudsor fila ¥ Cell Phone:_()landline:(51@ )_27-9371 Email: ©Engineer( Name(s):nla Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: Contact Person for Building &Code Compliance:uw id Mossouv Cell Phone:(518 _)_Ybi-11)>Land Line:_() Email:__daue «¢boc:F.co. brincole Structure Packet Revised February 2019 RESIDENCE INFORMATION: Year Built [Gallons|#of bedrooms:|X gallons per|=total daily flow - per day bedroom Garbage Grinder Yes (te, 1980 or older|150 -Installed?(circle one) 1981-1991 730 -Spa or Hot Tub.Yes [Qo Installed?(circle one)1992-Present|110 |a Ho 2230 "PARCEL INFORMATION: Topography._&Flat Rolling Steep Slope %Slope Soil Nature _aL Sand loam __Clay__—_Other (explain:) Groundwater Atwhat depth?lows aun _ 7Bedrock/Impervious material|Atwhatdepth?owe Dyrrel Domestic Water Supply J Municipal Well (if well,water supply from any septic system absorption is__ft.) L Percolation Test Rate:per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Ta ‘1020 gallons (min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub Absorption field with #2 stone_|Totallength__/50)ft;EachTrench__J.ft Seepage Pit with #3 stone How many:Size: Alternative System =|Bed orother type: ___ _L 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.|have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME:wre pate:__ai@ be SIGNATURE:—— us pate:ahighe Principle Structure Packet Revised February 2019,