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applicationsc Office Use Only ADDITION/ALTERATION PERMIT Permit#: rC -G SS 26 APPLICATION Permit Fee:$ 2 7. Z-0 742 Bay Road,Queensbury,NY 12804 D E C,E A: V E Vibe\ P:518-761-8256 www.queensbury.net Project Location: 0.2i &SU,L ked ek'o J( _SEP 16 2020 TOWN OF QUEENSBURY Tax Map ID#: )g2 , / 0 ' I j /5 subdivisomtww&CODES CONTACT INFORMATION: Applicant: , /, Name(s): WI ill ark3 (_(fhgtr Ux 11 A( Mailing Address, C S/Z: Y'v 'r24a (/7U 4l,' Ay /o1 Cell Phone• ( /te ) ` /-0.2/5' Land Line: (,S/r ) 95 79 Email: /,dd it"SSDnS-1-iP/Li Primary Owner(s): Name(s):Loeb ee Mailing Address, C/S/Z: PO ba., / C/ev co'k y /,) k2-) Cell Phon : Land Line: ( -7 ) 1 S' 'iv7© Email: k/c R2d P /a,,f4 (o- Check if all work will be performed by homeowner only, Contractor(s): Workers' Comp documentation must be submitted with this application Contact Name(s): 1n/ i I/I&rnS (>ns h l iO)-- Ake . Contractor Trade: &..' MailingAddress C S Z:#'U /5 C2,oZ$ C rdet,fee fiy / c c Cell Phone: ( 5/F ) 7 / ,2/90 Land Line: ( ) 65Z -j 7q Email: itiat nStohSy"0b7 1 (° - List all additional contractors on the back of this form Architect(s)/Engineer(s): m Business Name: S°tac - r l rl 'h- ( //NW(Aid.; Contact Name(s): /L/ C f Mailing Address, C/S/Z: / ..Dray 97 e Ye"(&eC77-4-0 f / as Cell Phone: Land Line: .31r ). /'e3(42 Email: PH/LA Contact Person for uildin VV& Code compliance: eyile ; ii ("I" Cell Phone; ( 5 M') 174 k t2/Y0 Land Line: ( ../ ) S e '3 3 7' Email: C, d h--3 Tok$ ) a7/i i A Addition/Alteration Application Revised February 2019 Contractor(s): Workers' Comp documentation must be submitted with this application Contact Name(s): riaNciaf/ c cava ' 7/ I s Cr/'e,Sa1/ Contractor Trade: EX'c€IVa' (T Mailing Address, C/S/Z: 63 /JoudcA-I c K a-u 6 4.,1 27.,t 6,e,le u/V /4'KCellPhone: ( Land Line: ( 57 ) 7c%3 / Email: Chi efe,cia ildricial met,i, cer— Contractor(s): Workers' Co pp..docume tation ust be submitted with this application Contact Name(s): e-/Y/C-- a/ _ Contractor Trade:eh'i Ca. / . Mailing Address, C/S/Z: fa 407C L5W 644 /a// dy 42 Cell Phone: ( . Land Line: (.5 /P ) 79V-a5?7. Email: 6/lk 7e/eSfe /. r il'/?i/• C or-- Contractor(s): Woorrk ers Copp documentation must be submitted with this application Contact Name(s): /te Contractor Trade: Pfidh end"///f Mailing Address, C S/Z: //s : (, 5'I /fig" , /,cesok-3 'l N /)1 V 1 V V Cell Phone: ( ) D a Land Line: ( ./ Email: • Contractor(s): Worker?' Comp d u/ment ion must be submitted with this application Contact Name(s): S G/dC1 L 4I. `k/ Contractor Trade:61-"e r Mailing Address, C/S/Z: /05 WO— P.CI ,1(`r 711a.Cti V7 S7V,3U Cell Phone: ( Land Line: ( R0c2 ) o2& 9fr Email: roots DS',Gc'iel/5`/ te, Ce^-- Contractor(s): Workers' Comp documentation must be submitted with this application Contact 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 Contact Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: ( Land Line: ( Email: Addition/Alteration Application Revised February 2019 PROJECT INFORMATION: TYPE: Commercial Y.Residential WORK CLASS: VSingle-Family Two-Family Multi-Family(#of units Townhouse Business.Office Retail Industrial/Warehouse _Garage (#of cars Other(describe ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE: 1st floor: v 1st floor: /9 25 2nd floor: NO( I _,.jj3 ) 2nd floor: 3rd floor: 3rd floor: Basement (habitable space): Basement(habitable space): Total square feet: / Total square feet:- /(fat ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost.of Construction: $ 6C?w 2. If Commercial project, what is the proposed use: 3. Source of Heat (circle one): Gas Oil " Propane Solar Other Fireplaces need a separate Fuel Burning App lances&Chimney Application 4. Are there any structures not shown on the plot plan? YES Explain: 5. Are there any easements on the property? YES 0 6. SITE INFORMATION: a. What is the dimensions or acreage of the parcel? .3 T- ae b. Is this a corner lot? YES NO )(' c. Will the grade be changed as a result of the construction? YES NO/ d. What is the water source? PUBLIC PRIVATE WELL X e. Is the parcel on SEWER or a PRIVATE SEPTIC system? p(ilietTe Addition/Alteration Application Revised February 2019 DECLARATION: 1. I acknowledge that no construction shall be commenced prior to issuance of a valid permit and 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 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 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 a certificate of occupancy. I have read and agree to the above: PRINT NAME: 1 . VV lll Gr/ t l'—S 4 SIGNATURE:DATE: g//5X200.z"' Addition/Alteration Application Revised February 2019 Office Use Only &C Permit#: =-'` JS4.--C) 5 ,i SEPTIC DISPOSAL PERMIT APPLICATION Permit Fee:$"-7,:%' gin; Invoice#: Town ofQueensbury Septic Variance? Yes No 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.cweensburv.net Tax Map ID#: 226.16-1-13 D Lc C E II V// IE -) Project Location: 23 Mason Road - Cleverdale SEP 16 2020 1 j, TOWN OF QUEENSBURY Applicant: BUILDING &CODES Name(s): Frederick& Linda McKinney Mailing Address, C/S/Z: 23 Mason Road, Lake George, NY 12845 Cell Phone: ( 518 ) 361-0670 Land Line: _( Email: fredmck12820@gmail.com Primary Owner(s): Name(s): Same Mailing Address, C/S/Z: Cell Phone: _( Land Line: _( Email: Check if all work will be performed by homeowner only Contractor: Workers' Comp documentation must be submitted with this application Contact Name(s): Crandall Excavating Contractor Trade: Site work Mailing Address, C/S/Z: 63 Woodchuck Hill Road Cell Phone: _( 518 ) 470-4694 Land Line: (518 ) 793-0431 Email: chriscrandalldigs@gmail.com Engineer(s): Name(s): Hutchins Engineering Mailing Address, C/S/Z: 169 Haviland Road, Queensbury, NY 12804 Cell Phone: _( Land Line: (518 ) 745-0307 Email: LWDobie@hutchinsengineering.com Contact Person for Building & Code Compliance: Chris Crandall Cell Phone: ( 518 ) 470-4694 Land Line: ( Email: Septic Application Revised February 2019 1 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms: X gallons per =total daily flow per day bedroom Garbage Grinder Yes No 1980 or older 150 Installed? (circle one) X 1981-1991 130 Spa or Hot Tub Yes No Installed? (circle one) X 1992-Present 110 4 110 440 PARCEL INFORMATION: Topography Flat Rolling Steep Slope Slope Soil Nature I Sand Loam Clay _Other(explain: Groundwater At what depth? Bedrock/Impervious material At what depth? Domestic Water Supply //fl f_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: Pi K *- FL y i P sTj TioA> RerM J0J1"4/7- Tank size 1250 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 ft.; Each Trench 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 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. 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: 4/ W..1/ j4 D o j L, '"'!'o ti(2 DATE: cJ 11)2a SIGNATURE: DATE: l'1/IIZ00 Septic Application Revised February 2019 IPF CIRF CIRF IRF IRF IPF 14)' LANDS N/F OF FACN & FAAD LAKE GEORGE TRUSTS 4653/174 LANDS N/F OF FREDERICK & LINDA McKINNEY 978/133 LANDS N/F OF FREDERICK & LINDA McKINNEY 978/133 31) 32) 33) 34) 108) 109) 110) 111) 71) 72) 73) 74) 112) 75) WOOD SEAWALL IRF Concrete Pad With Generator Crushed Stone Parking Area Retaining Wall Access Cover For Buried Propane Tank Shed 4" Birch Cluster 6" Birch Cluster Access Cover For Buried PropaneTankWood FenceDriveway Retaining Wall 14" Triple Birch 12" Cedar 6" Cedar Asphalt Driveway Crushed Stone Driveway Concrete Roof Overhang Typ.) OverheadWires ( Typ.) Concrete Pad Utility Pole With Elec Meter 4" Pvc Inv.= 325. 77' FF Elev.= 328. 22' FF Elev.= 327.80' Bench Mark Utility Pole With Nail Elev. = 328.60' Yard Drain TF = 325.61' Concrete Pad Wood Timbers Fence A/ C Unit 14" Spruce 14" Spruce 6" Triple Birch 12" Triple Birch 3" Birch 3" Birch Walk PatioCovered PorchFF Elev.= 328. 26'FenceSteps6 95. 19'6 199. 05'1 88.99'1 204. 45' 1 7.03'6 89.82' 6 165.00' FF Elev.= 327. 98'IRF IPF 0.7' North Of Corner 1 34. 16'Tie Line FF Elev.= 331. 79'One Story Wood Frame Garage Two Story Wood Frame House SLAB- ON-GRADE Concrete Walk Wood SeawallLANDS N/F OF MA FC 2012 Trust 5017/170 LANDS N/F OF MA FC 2012 Trust 5017/170 35) LANDS N/F OF FACN & FAAD LAKE GEORGE TRUSTS 4653/ 174 LANDS N/ F OF FACN & FAAD LAKE GEORGE TRUSTS 4653/ 157 1 154. 28' 1 89. 33' Dock Slip WithSunDeckRoof Overhang Typ.) One StoryHouse Steps Tie Line 33 2 3323313313303303293 2 93283 2 8 327 327 32 7 326 3263253253243 2 4 3233223223213 2 1320323AREA6475(6AREA64 75(6326 Garage 113)DockSlipWith S u n D e c k DockDeck Two Stor y Wood Fra m e House Concrete & Stone Retaining Wall Water Entry) Peak Elev = 352. 81' ApproximateLeech Field( 5) TRENCHES @ 50' EA. IRF 59'29' CIRF CIRF Utility Pole Nm 12 ORQJ 6KRUH FM FM FM FMFM FM FM FM FM FM FM F M Pump House323 328W W W W W W WFMFMCall Before You Dig Wait The Required Time Confirm Utility Response Respect The Marks