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applications Office Use Only ' PRINCIPLE$lf1qUERW EFiArnit#: ,2,C -6 3cl 7—ZU( QJ APPL lAryl ON Permit Fee:$ -Z Y g`LJUN122019742 Ba Road Queensbu NV 12804 ' Fee: $ r�� ,� L� e�Y ry. P 518-761-8256 TOWN OF QUEENSBUR4nvoice#: /(p S 3 BUILDING&CODES Project Location: y 35 Nm CLU/0 D8 t Tax Map #: Z9 S , 1 c ' Z. - S Subdivision Name: So AP cCiz t G 11Ip N CSTA-fd TOWN BD RESOLUTION 86-2013 8850 recreation fee for new dwelling unit, single family dup! 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): Fo o T H i LLS B u!co ERS (So C LEu c.t ) Mailing Address, C/S/Z: R m o urJ TA (.c i b C tR i ve atkEe0st3KQy NY 12.ro Cell Ph.: t ( st ) -7R! - t9 33 Lan-Line: i(S-t1 ) '?tb-3sZo (CEo.) Email: FooTtilLLS But L.rERswig C-mA1z• ccry • Primary Owner(s): Name(s): SA r'n E As A PPt_t C.AN T Mailing Address, C/S/Z: Cell Ph.: _( ) Land Line: ( ) Email: • Contractor(s): Name(s): S AmE AS A Ppu CAN-" Mailing Address, CISIZ: Cell Ph.: ( ) Land Line: ( ) Email: • Architect(s)/Enqineer(s): Name(s): ,`11qt• PE EvlStotJ FNG,NLse.,Nt- ) Mailing Address, C/S/Z: too Crtkra 5'f Su,Te" 567 GLCNS FAt.zs r'`1 12.$0 Cell Ph.: ( ) Land Line: I (S't P ) i9 Z - 2.4,y Email: t 1 AN@ i'IStoN ENG-, EMAIL- Contact Person for Building & Code Compliance: ,)06 LEN C Cell Ph.: t(S"I ' ) 111- 1133 becrld Line: i (vt? ) 1 3c2..o ( € -0 Email: Foe TNlt-t-SA,t,.ttmEtZS ( / G-mA Corr Inn Ruildine R(bda Fnfnrrprnrnt Prinrinlh Strurtura Reviced March 7f1731 PRO!ECT INFORMATION; TYPE: Commercial X Residential WORK CLASS: A Single-Family Two-Family Multi-Family(#of ) Townhouse Susness Office Retail Hotel/Motel Industrial/Warehouse Garage(#ofcars ) Other(describe ) STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE: 1St floor: 16 (O D 1sT floor: city 2"d floor: 12-1r 6 2nd floor: 3rd floor: Total square feet: Basement(habitable space): Total square feet: - / 4 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ tigibt 2.-J20 Ua 0 2. Proposed use of the building: ReS I'D i A 3. If Commercial or Industrial, indicate the name of the business: 4. Source of Heat(circle one): Gas Oil Propane Solar Other: (Fireplaces need a separate uel Burning Appliances&Chimney Application,one per appliance) S. Are there any structures not shown on the plot plan? YES N ) Explain: 6. Are there any easements on the property? YES C ‘r41°� 7. SITE INFORMATION: a. What is the dimensions or acreag ofihe parcel? ( r I A C-e--C b. Is this a corner lot? YES NO c. Will the grade be changed as a r he construction? YES NO d.What is the water source? PUBLIC PRIVATE WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? t 14-1 V A 1 mo Building R.Code Enforcement Prinrinie Stn.rtnr.Rc.viceri Marrh 7111R DECLARATION: I. Iacknowledge that no construction shall commence priorto issuance of a valid ouilding 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, bcal 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 IAve 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: S ( P N Lb-t SIGNATURE: DATE: (f It J, t ToO Building&Code Enforcement Prinrinio Grmrt,ro Rovicnrl Marrh 7f111% Office Use Only FUEL BURNING APPLIANCE & Permit#:_2 -0 Zp )4* 14- CHIMNEY APPLICATION Permit Pee Invoice#: 74.. 8_. Road. Queensbu , N, 12804 P 51i, 761-8256 Project Location: (.0jd ({fr./ CLCN e n S Tax Map ID: 21 l S-2 Room of Install: Z e-rt F-A\ • Planned Install Date: Pv- G-t-i3 t Z Q t 1 **ONE APPLICATI ON PER APPLIANCE** CONTACT INFORMATION: • Applicant: Name(s): 1=o o H 1 u_s g u t w E RS i-L(. ( To LEu C Mailing Address, C/S/Z: 9 m0NN`+ A)N106 7g- Que-rNsgo Ny JUC )' Cell Ph.: I (S-I g' ) 1R I- (61 33 band-Line: t ( S I g ) 194' -3S20 (ce-LL-) Email: F'0o1KlcLs g,,ktLt)CR314 1 CO Gel- nu cvrv\ • Primary Owner(s): Name(s): SRrcv. A. AM!c Pr��' Mailing Address, C/S/Z: Cell Ph.: ( ) Land Line: ( ) Email: • Installer/Builder. Name(s): S rime- As a P - c-fl, l Mailing Address, C/S/Z: Cell Ph.: ( ) Land Line: _( ) Email: Contact Person for Building & Code Compliance: Joe i.-EtA-C I Cell Ph.: ( (s (5 ) 7q I - t 133 bend Line: Email: - a� }�T:T- — - Fo 'FtIt4S8uLtL1E Rs y@ G-mA1Lbc.o''- �c�u� Town of Oueensoury Budd,n 8.^.oi?Enforcement FUEL BURNING APPLIANCE INFORMATION: TYPE OF DEVICE: Stove X Fireplace Insert —Fireplace wNr TE: mout Neill,n./ Mcbet! Dvb3‘ FP30r-i THHvc. 1)61- )4E Fuel Fired Equipment(Garage Only,13"clearance per IMC304.3) _ Fireplace, factory built** " Manufacturer's Name: Model#: SOURCE OF HEAT: Wood Coal Pellet Gases', CHIMNEY INFORMATION: _Masonry: block brick stone Flue; tiete C 2 size,in inches Material*: double-wall _ triple-wa Il_insulated (*Manufacturer's r-t.a rir-)e : Model#: ADDITIONAL INFORMATION: 1 Two inspections are required. A rough-in ilspection,prior to installation and a final nspection,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 nspections. Declaration: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: ,vSCPt-I Leu (--1 — CSIGNATURE : A -6--)" DATE: ( t)Z/I I Fuel Burning Appliance& himney Application 'dal► SEPTIC DISPOSAL PERMIT APPLICATION r �, Office Use Ord 742 Bay Road,Quensbury,\l' i2s0-1 P 518-761.s.Soo Permr -0 ?jc)'3-• 24) tC Ta� MaplD#: 21s • 1S - 2-- r Project Location:_ CQ Y 76 H W C I N D t,-) k.i.) -;.=,fit' .anance? , 1.l. , Primary Owner(s) I G T li L.S Au I L beg S 1_ _( -_ ( c LE H c-1, Mailing Address I 1`f�(.I Li,NTA INS'De 9 Phone & Email I Cs -'rit-1`133 `3 i __�� t$)i96 S2c FoaTcttusgtAtLbEQsr�y �'GmAlL,co Installer/Builder l s € uAs A9PLIcRNA Mailing Address Phone & Email -- Engineer -- ._._..—_ — i Tr' cets r eR P.C. I Mailing Address hp l N{vY I L-A N r3 Rc t t.LLF-rr N S g kg4 xp-i 12s 01 I Phone& Email (Si 79(0-ZS-1 S TCeN 16R3(, @ YAHo©. troll Contact Person for Buikling&Code C lc,mpliance:l'Ge- LEkLI F'hc,ne: (S l$)11 i - 1933 RESIDENCE NFORMATION: L Si e) /9 Co-3S-2-0 _ - _Year Built # of bedrooms X gallons per bedroom = totaldaily flow Garbage Grinder Yes t 1980 or older - - Installed? {circle one) Spa or Hot Tub Yes Cilh 198981-1091 -r_ Installed? {circle one) 1gg2:Present S l 10 S S-U — ___ ._ _ w__.... PARCEL NFORMATION: Topography 1 l Flat Rolling Steep Slope %Slope Soil Nature �!^ j 4(Sand _Loam Clay _Other Groundwater At what depth? N i Bedrock/Impery bus material I At what depth? N A - --- Domestic Water Supply X Municipal _ Well{if well.wate r supply from any septic system absorption is_it.) Percolation Test Rate./ 'S per minute per inch{test to be completed by licensed engneer/arcttect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size gallons{min.size 11000 ga llons,add 250 ga lions for each garbage cylinder or spa/hot tub System Absorption field with#2stone 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? lank size :# of tanks NOTES:1.Alarm system&associated electrica(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.l have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: 1-0 S C P IA f'rldt C / DATE: 6 i t 2 f t SIGNATURE: (4)(\i\- 6.. ` - �2 /l)1 DATE:-01 Town:.v Oueensour,E. i<<.-1&Code Enforcement Town of Queensbury David Duell � , Highway Superintendent Highway 518-761-8212 Department 4 �.��> Mark Benware 7 2 Bay Road—Queensbury, NY Deputy Highway Superintendent 12801 -� Phone: (518) 761-8211 518-761-8210 Fax: (518) 745-4466 DRIVEWAY PERMIT DATE: ( 1 I Z 1 1'5 APPLICANT NAME: F'a aT H ILLS B U i LD TELEPHONE NO.: Cc I g-) ) ' l- 1133 ADDRESS TO BE INSPECTED: Co `f 5o H N RETURN ADDRESS: ci (Yl b u-N-14 S I D e b R- a� Ny l2E°y 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 approved permit for a final approval. STEP 2: ( ) Final Approval ( ) Rejected Date: David Duell, Highway Superintendent Mark Benware, Deputy Highway Superintendent