RC-0745-2020 . Office Use Only ,
PRINCIPLE STRUCTURE PERMIT
Permit#: eC " CY j- 292,O
APPLICATION
Permit Fee:$ )cTD1'2-'0 t2 1.20
Town of Queensbury
*Rec. Fee:$ q-00
742 Bay Road, Queensbury, NV 12804 3z�5
Invoice#:
P: 518-761-8256 www .queensbury.net
1.516v 156
Project Location: 15 Luzerne Road — Building # /Z (..
Tax Map #: 309.10-1-97 Subdivision Name:
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:
Name(s): Hayes & Hayes LLC
Mailing Address, C/S/Z: 297 Saratoga Road, South Glens Falls NY 12803
Cell Ph.: ( ) Land Line: 518-792-9142
Email:jamiehayes4@outlook.com
• Primary Owner(s):
Name(s): Hayes & Hayes, LLC l,.
Mailing Address, C/S/Z: 297 Saratoga Road, South Glens Falls NY 12803 ;
Cell Ph.: ( ) Land Line: 518-792-9142
Email:jamiehayes4@outlook.com -
• Contractor(s):
Name(s): Hayes & Hayes, LLC
Mailing Address, C/S/Z: 297 Saratoga Road, South Glens Falls NY 12803
Cell Ph.: ( ) Land Line: 518-792-9142
Email:jamiehayes4@outlook.com
• Architect(s)/Engineer(s):
Name(s): Ethan P. Hall— 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. Hall
Cell#.: 518-260-2888 Land Line: 518-741-0268
Email:ephall@nycap.rr.com
Principle Structure Application Revised January 2019
PROJECT INFORMATION:
TYPE: ❑ Commercial ® Residential
WORK CLASS:
❑ Single-family Two-family ❑ Multi-family (#of units:
❑ Townhouse ❑ Business Office ❑ Retail ❑ Hotel/Motel
❑ Industrial/VVarehouse ❑ Garage (#of cars_J ❑ Other(describe
STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE:
1sT floor: 1,241 1sT floor:
2nd floor: 1,265 2nd floor:
3rd floor:
Total square feet:
Basement(habitable space): 1,098
Total square feet: 3,604
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $_$500,000
2. Proposed use of the building:Two family Residence
3. If Commercial or Industrial, indicate the name of the business:
4. Source of Heat: ®Gas ❑Oil ❑Propane ❑Solar DOther:
(Fireplaces need a separate Fuel Burning Appliances&Chimney Application,one per appliance)
5. Are there any structures not shown on the plot plan? DYES ®NO Explain:_
6. Are there any easements on the property? DYES ®NO
7. SITE INFORMATION:
a. What is the dimensions or acreage of the parcel? 3.47 acres
b. Is this a corner lot? DYES ®NO
c. Will the grade be changed as a result of the construction? ®YES ❑NO
d.What is the water source? ®PUBLIC ❑PRIVATE DWELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Sewer
Principle Structure Application Revised January 2019
• DECLARATION:
I. I acknowledge that no construction shall commence priorto issuai ce 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 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 I/we are required to provide an as-built survey by a licensed land surveyor of
a II newly constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: Ethan P. Hall —Architect\Agent for the Applicant
SIGNATURE: Crcaaf.A Fi/all DATE: 27 Nov 2020
Principle Structure Application Revised January 2019
• CHECKLIST-SINGLE FAMILY Project Location : 15 Luzerne Road — Building # /2
REQUIRED -2 SETS YES NO N/A
1. Building Permit application, completed ® El El
2. Energy Code inspector's report from REScheck, completed & signed ® El El
3. Septic alteration application, if applicable ❑ ❑
4. Solid Fuel Burning or Gas Appliance form completed, if applicable El ❑ ►'�
5. Driveway Permit, if applicable El ❑ CZ
6. Structural Drawings: El El
a. Floor plans
b. Foundation plans
c. Cross Sections
d. Elevations
e. Window & Door Schedule
f. Natural Light,Ventilation & Emergency Egress
7. Plot Plan: Show proposed structure(s) with setback dimensions ® El El
from all surveyed property lines
8. Electrical inspection agency selected El El El
CHECKLIST- MULTI-DWELLING/COMMERCIAL Project Location: 15 Luzerne Road
REQUIRED -2 SETS YES NO N/A
1. Building Permit application, completed El ❑ ❑
2. Energy Code inspector's report from COMcheck, completed & El El El
signed
3. Septic alteration application, if applicable El ❑ El
4. Solid Fuel Burning or Gas Appliance form completed, if applicable El El El
5. Driveway Permit, if applicable El El El
6. Structural Drawings: ❑ El ❑
a. Floor plans
b. Foundation plans
c. Cross Sections
d. Elevations
e. Design loads including floor, snow&wind load
f. Seismicdesign
g. Plans signed & sea led by registered architect or engineer
h. Window & Door schedule
7. Plot Plan: Show proposed structure(s),with setback dimensions El El ❑
from all surveyed property lines
8. Electrical inspection agency selected ❑ ❑ ❑
9. FINALAS-BUILT PLANS SUBMITTED ELECTRICONICALLY El El El
Principle Structure Application Revised January 2019
L U Z E R N E R D
11A ST JAMES PL
28B ST JAMES PL
31B ST JAMES PL
20A ST JAMES PL
27A ST JAMES PL
32A ST JAMES PL
12B ST JAMES PL
24A ST JAMES PL
19A ST JAMES PL
35B ST JAMES PL
16A ST JAMES PL
15A ST JAMES PL
28A ST JAMES PL
20B ST JAMES PL
23B ST JAMES PL
12A ST JAMES PL
24B ST JAMES PL
11B ST JAMES PL
19B ST JAMES PL
31A ST JAMES PL
16B ST JAMES PL
15B ST JAMES PL
27B ST JAMES PL
32B ST JAMES PL
23A ST JAMES PL
35A ST JAMES PL
St. James PlaceAddress Map
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Map Produced by TOQGIS: 12/2020DRAFT
Service Layer Cred its: NYS ITS GIS ProgramOffice
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FILE COPY
309.10-1-97 RC-0745-2020
Hayes & Hayes LLC
15 Luzerne Rd, Bldg. 12
2-family dwelling 3604 s.f.
40 20 0 10 20 40
GRAPHIC SCALE
" = 40'-O"
NOV " 0 2020
THE SEAL BELOW IS AN ORIGINAL SEAL
AND IS IN RED INK. ONLY SEALS IN RED INK
SHALL BE CONSIDERED TRUE ORIGINALS
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