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application (":40—rik-b ` Office Use Only PRINCIPLE STRUCTURE PERMIT Permit It Q-c- 022-1— 2-020 APPLICATION Permit Fee:$ °11 -c, n--+438 Town of Queensbury *Rec. Fee:$ c J 742 Bay Road,Queensbury, NV 12804 Invoice#: P: 518-761-8256 www .queensburynet Project Location: 10 Westberry Way Tax Map #: 308.7-1-24 Subdivision Name: 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): Adam Taylor & Jen Lockhart Mailing Address, C/S/Z: 38 Franklin Street, Glens Falls NY 12801 Cell Ph.: (518) 932-2263 Land Line: ( ) - — Email: jenlockhart09@yahoo.com 1 V • Primary Owner(s): Name(s): David Howard ilij MAY 2 8 2020 Mailing Address, C/S/Z: 500 Luzerne Road, Queensbury NY 1280 TOWN OF QUEENSBURY Cell Ph.: 518-361-0714 Land Line: ( ) BUILDING&CODES Email: howard35_2000@yahoo.com • Contractor(s): Name(s): David Howard Mailing Address, C/S/Z: 500 Luzerne Road, Queensbury NY 12804 Cell Ph.: 518-361-0714 Land Line: ( ) Email: howard35_2000@yahoo.com • Architect(s)/Engineer(s): Name(s): Rucinski Hall Architecture— Ethan P. Hall Mailing Address, C/S/Z: 134 Dix Ave, Glens Falls NY 12801 Cell Ph.: 518-260-2888 Land Line: 518-741-0268 Email: ephall@nycap.rr.com Contact Person for Building & Code Compliance: Ethan P. Hall Cell #.: 518-260-2888 Land Line: 518-741-0268 Email:ephall@nycap.rr.com Principle Structure Application Revised January 2019- PROJECT INFORMATION: TYPE: 0 Commercial ® Residential WORK CLASS: ® Single-family ❑ Two-family ❑ Multi-family (#of units: ❑ Townhouse ❑ Business Office ❑ Retail ❑ Hotel/Motel ❑ Industrial/Warehouse ❑ Garage (#of cars_J ❑ Other(describe STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE: 1ST floor: 2,204 SF 15 floor:859 SF 2nd floor: 2nd floor: 3rd floor: Total square feet: 859 SF Basement(habitable space): Total square feet: 2,204 SF ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $$440,000 2. Proposed use of the building: Single Family Residence 3. If Commercial or Industrial, indicate the name of the business: 4. Source of Heat: ®Gas ❑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? OYES ©NO Explain: 6. Are there any easements on the property? OYES ®NO 7. SITE INFORMATION: a. What is the dimensions or acreage of the parcel? 0.77 Acres b. Is this a corner lot? OYES ®NO c. Will the grade be changed as a result of the construction? EYES ONO d. What is the water source? ®PUBLIC El PRIVATE DWELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Private Septic Principle Structure Application Revised January 2019 DECLARATION: I. I acknowledge that no construction shall commence prior to issuance of avalid building permit and work will be completed within a 12 month period. 2. If the work is not completed by the 1year expiration 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 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. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 5. I understand that INve are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities priorto issuance of a certificate of occupancy. I have read and agree to the above: PRINT NAME: Ethan P. Hall —A chitect\Agent for the Applicant SIGNATURE: Ntd4 DATE: l_ ) ZOP Principle Structure Application Revised January 2019 t : . as SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only Permit#: ec-o221 - 2532c"5 Town of Qcensbury Permit Fee:$ ; Invoice#: 742 Bay Road,Queensbury,NY 12804 Septic Variance? Yes No P:518-761-8256 www.queensbury.net • Primary Owner(s): Project Location: 10 Westberry Way Name(s): David Howard Tax Map ID#: 308.7-1-24 Mailing Address, C/S/Z: 500 Luzerne Road, Queensbury NY 12804 Cell Ph.: 518-361-0714 Land Line: ( ) Email: howard35_2000@yahoo.com • Installer/Builder: Name(s): David Howard Mailing Address, C/S/Z: 500 Luzerne Road, Queensbury NY 12804 Cell Ph.: 518-361-0714 Land Line: ( ) Email: howard35_2000@yahoo.com • Enqineer(s): Name(s): Rucinski Hall Architecture Mailing Address, C/S/Z: 134 Dix Ave, Glens Falls NY 12801 Cell Ph.: 518-260-2888 Land Line: 518-741-0268 Email: ephall@nycap.rr.com Contact Person for Building&Code Compliance: Ethan P. HallCell Ph.:518-260-2888 RESIDENCE INFORMATION: __ Year Built Gallons #of bedrooms X gallons per I --;total daily flow per day bedroom 1980 or older 150 _ _ _ Garbage grinder installed? ❑yes no')' 1981-1991 130 _ _ _ Spa or hot tub installed? ❑yes ❑Tno 1992-Present 110 4 110 440 PARCEL INFORMATION: Topography ►.Flat Rolling ❑Steep Slope %Slope _ _ Soil Nature ®Sand ❑Loam ❑Clay ❑Other Click or tap here to enter text. Groundwater At what depth?+91" Bedrock/Impervious material At what depth? +91" Domestic Water Supply ®Municipal ❑Well(if well,water supply from any septic system absorption is_ft.) Percolation Test Rate:1.25 per minute per inch(test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size 1,250 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 200 ft.; Each Trench 50 ft. Seepage Pit with#3 stone How many: ;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. PRINT NAME: Ethan .Hall— chit \Agent for the Applicant SIGNATURE: DATE:22 May 2020 Principle Structure Application Revised January 2019