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applications Office Use Only , PRINCIPLE STRUCTURE PERMIT Permit#: Re- (p:)-6?-.).6 i Y�f-f. APPLICATION Permit Fee:$ (Sr3`�'�' f?SZ- f kec.e *Rec. Fee:$ 742 Bay Road. Queensbury, NV 12804 P 518-761-8256 Invoice#: 09100 Project Location: 1°:5 --.(e-uQ-' &c%--\,Q- ��L 7 Tax Map #: . -" 11 - I ` .A- Subdivision Name: iu / A TOWN BD.RESOLUTION 86-2013.$850 recreation fee for new dwelling units single family. duplexes/two-family, multipiefamily, apartments condominiums townhouses,and'or manufactured modular homes but not mobile homes. This is in addition to the permit fee(s). CONTACT INFORMATION: J) -, si t$.`S • Applicant: h $_? Name(s): A.P :,.e,, 1ti V ektm .- Mailing Address, C/S/Z: P. 0, 3ccjc t C., ‘-‘-- C ve: 8.i kil '[ -i sty 5 Cell Ph.: ,(J( ) Kt ;.- ': .:5 Land Line: ( ) Email: • Primary Owner(s): Name(s): ��� i e.� 0 C� �ve�� wn e�-f 0c 1�0; ' ecL S�c_r 17 Q�-( l 1Q J Mailing Address, C/S/Z: c7 e). �x Li , Cl I -c,e `Rt MN i accoc Cell Ph.: ( 1.Vi ) "1,q 5- J Land Line: ( ) Email: • Contractor(s): Name(s): 'S. i1 c,c,,L �v .,©1:A,ne•rvk oc 13 - C'-e_r n ) ..) `'t,1 J n c Mailing Address, C/S/Z: ?,c), -6a.1. '^-ki r GA ic(C>,, ? `- 1 , I LC c S Cell Ph.: _( 06/) q i- Land Line: ( ) Email: • Architect(s)/Engineer(s): Name(s): ,, k — m le= ,A.,L .1A � 1,„ r ) r' W\0..c.Eln� Mailing Address, C/S/Z: R I o n I Cz(t-„S 3,l; L C. t 210( Cell Ph.: (5 i 3 ) 5,9. 1 757 ) it LLnci tine: _( 0.-1 ) C3 76 " ii '4 5S'1/47.) Email: Contact Person for Building &Code Compliance: r" k�ri l `'c' a-. Cell Ph.: _(ii 1 ) 7cpc - k $ 3 i Land Line: ( ) /07;,4 Email: to (A TnO Ruilding R Cndp Fnfnrrampnt Prinrinip Strurturp RPvic d March 701R PROJECT INFORMATION: TYPE: Commercial )c Residential WORK CLASS: Single-Family Two-Family Multi-Family(#of ) Townhouse Business Office Retail Hotel/Motel Industrial/Warehouse Garage(#of cars ) Other(describe ) STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE: 1ST floor: I a °7 11 1ST floor: it3/ A 2"d floor: 21/4 floor: 3rd floor: Total square feet: X'/ A Basement(habitable space): Total square feet: L\J 10 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ s C.CC, ___ 2. Proposed use of the building:%tiv-i\ ' .1 3. If Commercial or Industrial, indicate the name of the business: kVA 4. Source of Heat(circle one): Gas Oil ro an-e) Solar Other: (Fireplaces need a separate Fuel Burning Appliances&Chimney Application,one per appliance) S. Are there any structures not shown on the plot plan? YES NQ)Explain: 6. Are there any easements on the property? YES NO 7. SITE INFORMATION: a.What is the dimensions or acreage of the parcel? K kcre b. Is this a corner lot? YES (140 _ c. Will the grade be changed as a result of the construction? YES NO} d.What is the water source? PUBLIC PRIVATE WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? lose Tn0 Ruildin¢R(nrip Fnfnrr.PmPnt Prinrinla Strurtur, Rinricarl Marrh 901R DECLARATION: I. I acknowledge that no construction shall commence prior to 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 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 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 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 IANe 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: 1 Too Building&Code Enforcement Prinrinla Striirtnnra Rol/kiwi Man4 1111R zi lh Office Use Only e. FUEL BURNING APPLIANCE & Permit#: R-C,— 0 tQ2\Q. ° 2ai C. � CHIMNEY APPLICATION ° Permit Fee:$ -t , • Invoice#: 742 Bay Road, Queensbur, NY 12804 P: 518-761-8256 Project Location: is Ck-`e3-)Q.:',&(.,V c�Tax Map ID: 7 1 1 — . V7 - )- - 9-S' Room of Install: -Yt\A+t, 1k7�>cy, Planned Install Date: 4 t cI / **ONE APPLICATI ON PER APPLIANCE** CONTACT INFORMATION: • Applicant: Name(s): 0- - \"' e Mailing Address, C/S/Z: `P. . 'max 1(.o , ,te..z c _,c),x,e. i ki kl l V +.1 S Cell Ph.: _(+51 ) *q,"5-Wg, Land Line: _( ) Email: • Primary Owner(s): Name(s): --J 1breeAo Ac°,& I. caU k\a ev,°\c-_n oc -er-q ( In Mailing Address, C/S/Z: . © yy- 4 C- CLij, .� Cell Ph.: (,•)c ) R `1 - ,L-5-- Land Line: _( ) Email: • Installer/Builder: Name(s): Mailing Address, C/S/Z: Cell Ph.: _( ) Land Line: _( ) Email: Contact Person for Building & Code Compliance: 61`lcz-117Lack6)2 Cell Ph.: (S V$ ) '7(00 — i 3I Land Line: _( ) Al/A Email: Ivy A Town of Queensbury Building&Code Enforcement FUEL BURNING APPLIANCE INFORMATION: TYPE OF DEVICE: Stove _Fireplace Insert X Fireplace Fuel Fired Equipment(Garage Only,B"clearance per IMC304.3) Fireplace, factory built** ** Manufacturer's Name: Model#: SOURCE OF HEAT: Wood Coal Pellet Gas CHIMNEY INFORMATION: _Masonry: block brick stone Flue: tie steel' size,in inches Material*: double-wall _ triple-wa Il_insulated (*Manufacturer's r-i 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 s required for inspections. peclaration:Construction/installation must conform to NYS Fire Prevention&Building Code and/or manufacturer requirements.The applicant or owner agrees to comply with all applicable bws,ordinances,regulations and all conditions that are part ofthese 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: � — SIGNATURE :Fuel Burning Appliance&Chimney Application � SEPTIC DISPOSAL PERMIT APPLICATI ON Office Use On' 742 Bay Road,Queensbury, NY 1'804 P 518-76 i-825b Permt": - 0 b.Lb •2 t€ Tax Map ID#: c,r 1 —, ...V Permit r ee 111Vcrsce Project Location: 1 ��v ' � TN, d Septic'variance? Y s - N c Primary Owner(s) k'-e.-.> ��� L� e vu c d \kAc.c vY\ 1\ Mailing Address ; �li{ l „ 'L[ I li Phone & Email __t — q % Installer/Bulkier p,rk. •` � Qq1� �� n Cc�vyra �lGU.i Mailing Address & \ :�cc � `�i j ,� _r jl[ S1`� Phone & Email 0.-k - 79 - — 09'5 1 \ i Engineer - Mailing Address 44 Phone& Email Contact Person for Building&Code Corn p I is n ce: P F�once RESIDENCE NFORMATION:_ Year Built #of bedrooms X gallons per bedroom = totaldaily flow Garbage Grinder Yes �N_o; '880 or older Installed? {circle one) 1981-1991 Spa or Hot Tub Yes Go, Present —� Installed? {circle one) PARCEL NFORMATION: Topography Flat Rolling Steep Slope %Slope Soil Nature _Sand _Loam Clay _Other Groundwater At what depth? Bedrock/Impervious material At what depth? Domestic Water Supply — Municipal _Well{ifwell,water supply from any septic system absorption is_ft.) Percolation Test r Rate: per minute per inch{test to be completed by licensed engneer/arcltect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size gallons{min.size 1000 ga Ilons,add 250 ga lions for each garbage cylinder or spa/hot tub System Absorption field with#2 stone Total length ft.;EachTrench ft. Seepage Pit with#3 stone How many: Size: _ Alternative System Bed or other type: _ HoldingTank System Total required capacity? -tank size ;# of tanks NOTES:1.Alarm system&associated electrica Iwo rk 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.' have read the regulations and agree to abide by these and all requirements oftheTown of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: \ ;\\VA�<3,271 DATE: 1 SIGNATURE: -1 ' c�p ' I� DATE: Town of Queensbury B_s,a nq&Code Enforcement Reyt;&1 February 2017 Town of Queensbury Thomas R.Van Ness Highway Department Highway Superintendent 742 Bay Road,Queensbury, NY 12804 Home:518-745-0929 Ptione:518-761-8211 Fax:518-745-4466 David Duell Deputy Highway Superintendent Home:518-745-0938 DRIVEWAY PERMIT Date: et Applicant Name: , 4c, yM c�ya Telephone No.: sj c)t5 Address to be Inspected: i C J c3-— _ "— Return Address: \(c) L. 9 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 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&Code Enforcement Principal Structure Application Revised February 2017 Office Use Only ACCESSORY STRUCTURE Permit#. PERMIT APPLICATION Permit Fee:$ 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 Invoice#: Project Location: `S� L°-\w er �-1Q .. E1� r' t— •1 fit-- � ) Tax Map ID#: �`� -1., " - Subdivision Name: i DEC 15 2020 � CONTACT INFORMATION: • Applicant: Name(s): u�l�W�o� �eV� 07ur1�n� oq' �AuQ:'x -z �-n� Mailing Address, C/S/Z: 7 d k' d.li46rn �'�- �`t tZ n 65;_ Cell Phone: ( j 1� ) '� 4 z5-z?LL5_ e Land Line: ) Email: • Primary Owner(s): Name(s): Mailing Address, C/S/Z: O , B O)c Cell Phone: 5( 4'< ) hl t S` 28' Land Line: Email: G ❑ Check if all work will be performed by homeowner only • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): -0 1) -�—-� l� S Contractor Trade: V: Arb F f - t 04- 0'53aa V Mailing Address, C/S/Z: So Gl--f 5 )="o kks, N`( l -�_ 1? ©� Cell Phone:��3 ) q ,4 y - 3 7 7 3 Land Line: Email: "List all additional contractors on the back of this form • Architect(s)/Eneineer(s): Business Name: i Contact Name(s): Tt m c c��\ '�^ Mailing Address, C/S/Z: w_.p�tn ` -- Cell Phone: 01r 3_27 - MIT-) Land Line: Email: Contact Person for Building & Code Compliance: aro�1 �uJr,� Cell Phone: �+_) Land Line: �!} Email: Accessory Structure Application Revised February 2019 �J • Contractor(s): Workers' Comp documentation must be submitted with this application � Contractor Name(s): �t�-` 2`�-z' Contractor Trade: t Pal. W�e�-\ ©��s ��r�-�`�` c�` ��c Mailing Address, C/S/Z: 1 0 2 69 Ql�r©o Ls U Q anlet- 0 �(l Q (��( 13'� g-6 Cell Phone: (,,5r_) $9-ri - 1--( 5- f 7 Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone:�_) Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: �_) Land Line: �) Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone:�_) Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone:�_) Land Line: Email: Accessary Structure Application Revised February 2019 jj PROJECT INFORMATION: TYPE: Commercial Residential WORK CLASS: Deck,Open Porch _Solar Panels(w/o rafter upgrades) --Carport _Cell Tower Shed _Pavilion,Pole Barn,Canopy _Dock _Gazebo _Detached Garage _Boathouse(with or w/o sundeck) —3-Season Porch _Other(description: ) SQUARE FOOTAGE OF STRUCTURE: 1st floor: 2"d floor: Total square feet: l ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction:$ 1 , 2. If Commercial project,what is the proposed use: 3. Are there any structures not shown on the plot plan? YES NO Explain: 4. Are there any easements on the property? OYES NO DECLARATION: 1. 1 acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. 2. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees and department approval. 3. 1 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 local zoning regulations. 4. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 5. 1 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 certificate of occupancy. I have read and agree to the above: PRINT NAME: SIGNATURE: _ � n —'"`� -- DATE: ZA Accessory Structure Application Revised February 2019