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applications t Office Use Only �* w Permit#: � ' bi®1b ° 2'AM ck ' a PRINCIPLE STRUCTURE PERMIT APPLICATION Permit Fee: $ ) 26 �. *Rec. Fee:$ �p 742 Bay Road,Queensbury, NV 12804 P: 518-761-8256 Invoice#: p Project Location:A/ l pe ®(� Subdivision Name: . A&se 1 �f�1% /�l� �- Tax Map #:. a23 4 3/ ��`" �_ TOWN BD.RESOLIJTION 36-2013.$850 recreation fee for new dwelling units single family,du,;pl zgsltwolfamily, multiple family apartments,condominiums townhouses,andii©r manufact 11 ul --hvingi *bib homes. This is in addition to the permit fee(s). - ;ram kuizt CONTACT INFORMATION: LA19 • Applicant; "IMAM OF CUEENSBURY e Name(s): 4/1'1cS ev,v-!a SZ - BUIL_DING&CODES Mailing Address, C/S/Z: P® c 80 90 /I-4-re e„ �� /04 9 Y Cell Ph.: ( 9/ ) d30 q 7 3_ Land Line: ( ) Email )/9 ri, cs RI-e s # 50, ivy/ • Primary Owner(s): Name(s): 7;1 Ai I!) - R' " Mailing Address, C/S/Z: et? t4j_ -6 Y( Cell Ph.: ( 9O/ )d -. 9 7 _ Land Line: ( ) &/Gen sou%� �f • Contractor(s): Name(s): aii7c( %i'!�, � (I° y/ �6tr/9, e Mailing Address, C/S/Z: q iA ,? � K N %690 Cell Ph.: 0, )36/- 392 k Land Line: •__( ) Email:Ac,,�i &t 41//4;9 .dse../,p/ij i9,4 4i L - Cc • Architect(s)/Engineer(s): Name(s): WA / S,94' AA/7- Mailing Address, C/S/Z: A' V.T j/ect L 0 Li/r 4c ti 7aa''i -, Cell Ph.: _( ) Land Line: (W03 ) qS 7 /cc Q Email: or/I G we�1e Contact Person for Building & Code Compliance: if&A Ave/ ,4 Cell Ph.: _(47 ) 36/ 3 f?9 Land Line: ( ) Email: 1��� �P� �:��:� �,�a- -e�5 � � y.d,njf ToQ Building&Code Enforcement Principle Structure Updated December 2017 PROJECT INFORMATION: / TYPE: Commercial Residential W� CLASS: Single-Family Two-Family _Multi-Family(#of ) Townhouse Business Office Retail Hotel/Motel _IndustriaUWarehouse Garage(#of cars 3 ) _ other(describe ) STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE: 1ST floor: 15T floor: 2'floor: 2"d floor: 3rd floor Total square feet: J 4th floor: Total square feet: /7 7 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 2. Proposed use of the building: N► t 3. If Commercial or Industrial, indicate the name of the business: 4. Source of Heat (circle one): cets 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 Explain: 6. Are there any easements on the property? YES 7. SITE INFORMATION: a.What is the dimensions or acreage o he parcel? 5,0 C b. Is this a corner lot? YES IN c. Will the grade be changed as a result of the construction? YES d.What is the water source? BLIC PRIVATE WELL e. Is the parcel on SEWER or a PRIVATE IC system? eg/v/.ire eip ToQ Building&Code Enforcement Principle Structure Updated December 2017 DECLARATION: i 1 acKnowlecige tnat no construction hall ;on-linen e prior to issuance • ern i and wor will be completed within a 12 month period 2. If the work is not completed by the 1year e joiration 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 i ue 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 I acknowledge that prior to occupying the facilities proposed I, or my agents will obtain a certificate of occupancy 5. I understand that !Awe 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: , SIGNATURE: DATE: ToQ Building&Code Enforcement Principle Structure Updated December 2017 FUEL BUkNING APPLIANCE & Office Use Only CHIMNEYAPPLICATION C— q Permit off: �.. ©��� • Z© � Permit Fee:$ I tli It+tt(),(It. FhuP. Invoice:f;: 742 Bay Road,Queensbury, NY 12804 P:518-761-8256 Project Location: 5 ACC55/A L) / Room of Install: , r /at , Planned Install Date: 7-`q **ONE APPLICATION PER APPLIANCE** CONTACT INFORMATION: o Applicant: Name(s): / atic� ,00 /t ) _. Mailing Address, C/S/Z: G e _a /- nr ., f Y ___---r_—__ Cell Phone: 1TO' _ ) _,;)30"5473 Land Line: ( Email: ,)4A1ts d .$ 6kr`-s %1 �> I , dijeT • Primary Owner(s): Name(s): �' �)'It'1 .�,�� - <T tz'S . Mailing Address, C/S/Z: /0 is go /249 Cell Phone:_(9'0/ ) duo - 3 y 7 3 Land Line: �( _ ) Email:;, 441e) ?Me5 .Se/I se4, f /1e4/ • Installer/Builder: Business Name: 'A/Oa -rri) 4 ccs- ,t5 Contact Name(s): Hall. Mailing Address, C/S/Z: 6fl A-er c /A 012 Cell Phone: _(,''f8' ) `3 f/ 1 3'e7d Land Line: _( ) Email: 1yr� t 2,:P:« Zihti5c.� � ' (.5/if*/eG� Contact Person for Building & Code Compliance: ie LA/9d M �� Cell Phone: _( ) 36 . --J � '� _ Land Line: ( ) Email: /13 74,1— .9„4 `ram, eL9-,114.` .Ce1.4! Fuel Burning Appliance&Chimney Application Revised March 2017 FUEL BURNING APPLIANCE INFORMATION: TYPE OF DEVICE: Stove /Fireplace Insert __ Fireplace Fuel Fired Equipment (Garage Only, 18" clearance per!MC 304.3) Fireplace,factory built** **Manufacturer's name: Model#: SOURCE OF HEAT: Wood Coal Pellet /Gas CHIMNEY INFORMATION: d Masonry: block brick stone / Flue: _-__ tie / steel ___ size, in inches Material*: / l 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. 2. Manufacturer's installation manual must be available at the time of inspection. 3. Masonry fireplaces&chimneys require plans to be submitted. 4. Twenty-four(24) hour notification is required for inspections. 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. I have read and agree to the above: PRINT NAME: �-`"'L`4-S e ,S f,-.0 SIGNATURE. G4 DATE: 17102 If Fuel Burning Appliance&Chimney Application Revised March 2017 40.0 DISPOSAL PERMITP A l Office use Only r Q€say Road.QuGensbuiv,ilti 12804 ! nntthf aa.a ' 5 y6 V5 Peisnip : 2.-C-- t9 t) = Z0 L1 Tax Map ID 4:.� /S ' J %OO 3/ c ( t Permit Fee:$ • invoice#: Project Location:1 76 475 s$, ,'A- / Septic Variance? Yes No Primary Owner(s) _:7/9v es 2,--Do.w/vi'3- 5-73/7-2- $ Mailing Address p ) t K- So (.,� ,� %a,� /l-� /2 eve' r L Phone & Email Installer/Builder /4/0,447/ty ewe� IA-45444p=� R: ,h,-.--d 1-4 G/ Mailing Address 6-Cess/A 7A Phone & Email .5n .36/ -$v 7 /L(ov.,,'771`0) ztL' 4.9--ciG -,1iv e .-,-,4-ft,Ce Engineer Mailing Address Phone & Email Contact Person for Building&Code Compliance: X9eciA Ad Lf Phone:('s//_3 '7tJ RESIDENCE INFORMATION: Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes 0 1980 or older Installed? (circle one) 1981-1991 Spa or Hot Tub Yes 6, Installed? (circle one) 1992-Present 3 PARCEL INFORMATION: Topography Flat Rolling Steep Slope %Slope Soil Nature Sand Loam Clay Other Groundwater At what depth? NA Bedrock/Impervious material At what depth? NA Domestic Water Supply /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 /0cc> 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_doo ft.; Each Trench 5-0 ft. Seepage Pit with#3 stone How many: J Size: Alternative System Bed or other type: 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 and approved. The installed system must match the septic 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. ii PRINT NAME: O -e s P, • Jet'-S DATE: V/ (°` �/ 9 SIGNATURE: r- v i--4,_ DATE: 97 (l Town of Queensbury Building&Code Enforcement Revised February 2017 Town of Queensbury Highway Superintendent Highway Home(518) '7/,,(-52i2- Department 749 Bay Road—Queensbury,NY 12801 Mai-k- 13efgL- "L Phone: (518) 761-8211 Deputy Highway Superintendent Home(518) -77i/ h'2-/h✓ Fax: (518) 745-4466 DRIVEWAY PERMIT DATE: 5 dq APPLICANT NAME: .57)/O / f�+tit�J'/ ,4 ! TELEPHONE NO.: f/ ?3 q73 / S7 -36/ 3.9761 ADDRESS TO BE INSPECTED: tor £ A L,P / ) aP RETURN ADDRESS: ?{f 4(/C A4 vA 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 RECEIVED Town of Queensbury NEED: ( ) Slight swale () Deep swale MAR 2 9 2019 ( ) iel with the road Level with the top of the paved wing Highway Department Size culvert pipe to be used (if necessary) ( ) 12" ( ) 15" ( ) 18" ( ) 24" ( ) 36" Preliminary inspection com leted by: /7/6-A W Date: Y //5 Approval by Highway Supt: [ 44' (or) Deputy Supt: Upon completion, please resubmit this approved permit for a final approval. STEP 2: ( ) Final Approval ( ) Rejected Date: Thomas R. Van Ness, Highway Superintendent David Duell, Deputy Highway Superintendent