Loading...
applications PRINCIPLE STRUCTURE t 0104 Office Use Only PERMIT APPLICATION Permit#: - O 6-ZO "ZQ 2--0 Town ofQgeensbury Permit Fee: $ 5 TJ 742 Bay Road,Queensbury, NY 12804 *Rec. Fee: $ O O — 1425 P: 518-761-8256 www.queensbury.net ? � �J J Invoice#: Project Location: I 4/-ZS , cc c_ Tax Map #: C, 1 Ste ) /. (Q Subdivision Name: C--)V TOWN BD.RESOLUTION 86-2013:$850 recreation fee for new dwelling units: single family, duplexes/two-family, multiplefamily, apartments,condominiums, townhouses,and/or manufactured & modular homes,but not mobile homes. This is in addition to the permit fee(s). CONTACT INFORMATION: • Applicant:((Uiv Name(s): nL 1Z u Mailing Address, C/S/Z: 15 F'i. 'IL\-c 1 2-? Cell Phone: �l ) 7�°�- 7'-17 7 Land Line: ( ) Email: G r' cAl,ni CC_f ibac 6u kA-U5_ co • Primary Owner(s): Name(s): Mailing Address, C/S/Z: Cell Phone: ( ) SA/II-C-Land Line: ( ) Email: ❑ Check if all work will be performed by property owner only • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: � Mailing Address, C/S/Z: at-� ' - E © U V E 1�1 Cell Phone: ( ) Land Line: ( OCT 0 7 2020 Email: **List all additional contractors on the back of this form TOWN OF OUEENSBURY BUILDING&CODES • Architect(s)/Enqineer(s): Business Name: E�,��i►C,eri 2� Contact Name(s): 0 an Yad, Mailing Address, C/S/Z: Cell Phone: ( ) Land Line: (S)i ) 7 17 - 1 z6 y Email: Contact Person for Building & Code Compliance: C-t(.cA o<^, cJ i /mite Cell Phone: (mil 3 ) j 7_01-"7c-/7 7 Land Line: ( ) Email: (7,1i AA,w 0 C< \Atrs, Co ren n...._:—i,,ca.....«.....o....L,.« Rnvicarl in min 9Nn PROJECT INFORMATION: TYPE: _Commercial Residential WORK CLASS: Jingle-Family Two-Family _Multi-Family(#of units ) Townhouse Business Office Retail Hotel/Motel Industrial/Warehouse _Garage(#of cars ) _ Other (describe ) STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE: 1sT floor: j Sva 1ST floor: 11(J� 2"d floor: 2"d floor: 3rd floor: Total square feet: 4-6-5 a Basement(habitable space): Total square feet: /�e10 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ S co( 00 0 2. Proposed use of the building: e5 AR 3. If Commercial or Industrial, indicate the name of the business: 4. Source of Heat: 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? YES6;) Explain: 6. Are there any easements on the property? YES 0 7. SITE INFORMATION: a. What is the dimensions or acreage o the parcel? 'c)v 7c 0 b. Is this a corner lot? YES NO c. Will the grade be changed as a resu t • e construction? YES ligP d. What is the water source? 'UBLIC PRIVATE WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? ep c Iannani 7VT f1 DECLARATION: I. lacknowledge that no construction shall commence priorto issuance of a valid 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 bcal 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 IMre are required to provide an as-built survey by a licensed land surveyor of a II newly constructed facilities priorto issuance of a certificate of occupancy. I have read and agree to the above: PRINT NAME: SIGNATURE: DATE: fr 7- Z3 41IW Rnvicari lannanr 7fl fl / Office Use Only Permit#: Qom--0 ko ZO -2,0 Town ofQ ccnsbury SEPTIC DISPOSAL PERMIT APPLICATION Permit Fee: $ ; Invoice#: Septic Variance? Yes No 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Tax Map ID#: '415- I' (0 Project Location: I-7 11-te i 0, Octoc, • Applicant: Name(s): (i'Y1me_ I5 Mailing Address, C/S/Z: 1530i (Z„oJ k `/ F E� -A 1247,7 Cell Phone: _( i)13 ) 72f—7L(7-7 Land Line: _( ) Email:. 6iat.n.n I &SD:ALIPLA. U1)4/5, to,4^.. • Primary Owner(s): Name(s): 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): Contractor Trade: Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( Email: • Engineer(s): Name(s): OCt/1 ('y'ot,r1 Mailing Address, C/S/Z: Cell Phone: _( ) Land Line: _( 6(7 ) `7 3i Il(t Email: t Contact Person for Building & Code Compliance: 671a/1 pl( ( r►io� Cell Phone: _( 3 j 7 ) -719 —7"I7 1 Land Line: ( Email: Principle Structure Packet Revised January 2020 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms: X gallons per =total daily flow per day bedroom Garbage Grinder Yes 1980 or older 150 Installed? (circle one) 1981-1991 130 Spa or Hot Tub Yes o 1992-Present 110 2 Installed? (circle one) PARCEL INFORMATION: Topography Flat Rolling Steep Slope %Slope Soil Nature )(Sand �,—roam _Clay _Other(explain: Groundwater At what depth? Bedrock/Impervious material At what depth? Domestic Water Supply _k/lunicipal _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 MOO 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 N.`j ft.; Each Trench ,J3 ' ft. Seepage Pit with#3 stone How many: 3 ;Size: sS Alternative System Bed or other type: Holding Tank System Total required capacity? /000;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: 6(c-4 J DATE: ::: :: SIGNATURE: DATE: Principle Structure Packet Revised January 2020