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applicationsOffice Use Only permit sts 2 C -UTES -2017 PRINCIPLE STRUCTURE PERMIT {|\V =)|APPLICATI f i 1472.00 742 Bay Road,Queensbury,NY 12804 Nov 22 pate N/A P:518-761-82:my ry I:356www.queensbury.net TOWN OF QUERABONRY:pa ILDING & Project Location: 159 Asenrsutr Fob 30 Subdivision Name:N/A).RESOLUTION 86-2013:$850 recreation fee for new dwelling units:single family,duplexes/two-family, Tnultiple family,apartments,condominiums,townhouses,and/or manufactured &modular homes,but not mobile homes.This Is In addition to the permit fee(s). TaxMapID#:29.7 CONTACT INFORMATION: ce licant: Name(s):_Michinass Greer Homes,UC Mailing Address,C/S/Z:_1_MASONS Way,MetHanicviiLe,NY 12S Cell Phone:_(AS_)BAA.oDI1 Land Line:('AS_)Baa,Sil Email;-SRONKER eC MICHAELS GROUP.COM «Primary Owner(s): Name(s):___BRUCE 4 SREAH BKOWIN, Mailing Address,C/S/2Z:_\e>Aceewmur Foy Ikeo,Gueswseuoy,NY Cell Phone:_()land Line:_(SIS)Sle -AD4AZ Email: ©Contractor(s): Business Name:__McCue Gear HOMSS LLC Contact Name(s):_“Tow Locescic Mailing Address,C/S/Z:\M>ZOWS Vibe|MECHANICILLE,NOY _1ZUD Cell Phone:_(2%_)_OF).244 Land Line:_(Si@_)_@AG.te) Email;__-)BanwWekeO Wort DAS CAT.COWL ©Architect(s)/Engineer(s): Business Name:KEITH Ruretcr ,FE. Contact Name(s): Mailing Address,C/S/Z: Cell Phone:_(AB _)_879.2402 Land Line:_() Email:Krureet o>!©NYCAr,Zz .COM Contact Person for Building &Code Compliance:_TON™LOCA2A0 Cell Phone:_(\S_)SST.A44 land Line:_() Email:TUScestio @ MICHMASOROP,CoM Town of Queensbury Building &Cade Enforcement Princtple Structure Application Revised February 2017 TYPE:Commercial %sides tat WORK CLASS: _%Single-Family __Two-Family __Multi-Family(#of ____) ___Townhouse ___Business Office __Retail ___Hotel/Motel __Industrial/Warehouse Garage (#ofcars )Other (describe. STRUCTURE SQUARE FOOTAGE:GARAGE SQUARE FOOTAGE: ;Sez floor:“We2h W159 b 2 floor:JAta)Gr So Total square feet:_We2tls Total square feet:_>12@ ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:$_0,000 7 SINGLE Fewiey Renibence 3.If Commercial or Industrial,indicate the name of the business: 2.Proposed use of the buildin, 4.Source of Heat (circle one):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?YES.Explain: 6.Are there any easements on the property?YES (WO 7.SITE INFORMATION: a.What is the dimensions or acreage of the parcel?1A sowess b.Is this a corner lot?YES ¢.Will the grade be changed as a result of the construction?(ES)NO d.What is the water source?PUBLIC WELL e.Is the parcel on SEWER or a PRIVATE SEPTIC system?SEP 1\C_ Town of Queensbury Suiting &Code Enforcement Principle Structure Apptation Revised February 2017 DECLARATIOI 1.|acknowledge that no construction shall commence prior to issuance of a valid building permit and work will be completed within a 12 month period. 2.If thework is not completed by the 1 year expiration date the permit may be renewed,subject to fees and department approval 3.|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.|acknowledge that prior to occupying the facilities proposed |,or my agents,will obtain a certificate of occupancy. 5.lalsounderstand that |/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. have read and agree to the above: Le Gs Cie ef.vs,Lm DATE:uf zift4i PRINT NAME: SIGNATURE: “Town af Queensbury Bullding &Code Enforcement Principle Structure Application Revised February 2017 Thomas R.Van NessTownofQueensburyHighwaySuperintendent Highway Home (518)745-0929 Department David Duell742BayRoad—Queensbury,NY 12801 Phone:(518)761-8211 Fax:(618)745-4466 Deputy Highway Superintendent Home (518)748-0988 DRIVEWAY PERMIT DATE:wi2zo)ia ‘APPLICANT NAME: MicHnas Greur Howes ,UC TELEPHONE NO.:B®-OHA.BI ADDRESS TO BE INSPECTED:_\SA\ASScumur POINT 1c>, RETURN ADDRESS:J Mpmons Luar MEE ANIOMILLE|NEY IZ 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: ‘Thomas R.Van Ness,Highway Superintendent David Duell,Deputy Highway Superintendent FUEL BURNING APPLIANCE &Office Use Only CHIMNEY APPLICATION permit #:LO—-O Her -7O14 Permit Fee:$ Town of Queensbury 742 Bay Road,Queensbury,NY 12804 Invoices: P:518-761-8256 www.queensbury.net Project Location:\SA\ASSAMRAY PONT zpTax Map ID #:_229.7 -\-SO Room of Install:Cszehor FOO Planned Install Date:“=> **ONE APPLICATION PER APPLIANCE** CONTACT INFORMATION: ©Applicant: Name(s):__MICHDELS.GeO HOMES,LLC Mailing Address,C/S/Z:|MA@IONS>Wer,MECHANKC VILLE,NY 1718 Cell Phone:_(4®_)SAG.o%"Land Line:_() Email:_J RANVEe *WICHMELS GDL,COM ¢Primary Owner(s): Name(s):Bac 4 oad RuCOW Mailing Address,C/S/Z:_\o2 Desay PoTD,Qveensmiziy,WY Cell Phone:_()land Line:_() Email: ¢ Installer/Builder: Business Name:_REST RES Hens $Pamo (incBuce) Contact Name(s):Geer,HELO Mailing Address,C/S/Z:\7leO Cec ANE,ALBANY,NEY 17705 Cell Phone:_(AZ _)_BeA.*NeoD Land Line:_() Email: Contact Person for Building &Code Compliance:__Tone LOCASOS Cell Phone:(ExB_)SS1.2A44 Land Lins ) Email:_TLSCRSAG ©MCHAELSC EOF.CON Fuel Burning Appliance &Chimney Application Revised March 2017 i _ FUEL BURNING APPLIANCE INFORMATION: 'YPE OF DEVICE: __Stove __Fireplace Insert _¥Fireplace ___Fuel Fired Equipment (Garage Only,18”clearance per IMC 304.3) _%Fireplace,factory built**@coO -CX **Manufacturer’s name:Hens -Ni-GjLe>Model #:(e201) SOURCE OF HEAT: __Wood __Coal __Pellet %Gas CHIMNEY INFORMATION: ___.Masonry:block __brick ___stone __Flue: __tie ___steel ___size,in inches __Material*: __double-wall __triple-wall___insulated (*Manufacturer’s name:Model #:) ADDITIONAL INFORMATION: 1.Two inspections are required.A rough-in inspection,prior to installation and a final inspection,after installation. 2.Manufacturer's installation manual must be available at the time of inspection. Masonry fireplaces &chimneys require plans to be submitted. 4.Twenty-four (24)hour notification is required for inspections. » 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 laws,ordinances,regulations and all conditions that are part of these requirements and also will allow the inspector to enter the premises to perform the required inspections. |have read and agree to the above: PRINT NAME: AlyACreeMfpheSIGNATURE:pare:11/21 Ne Fuel Burning Appliance &Chimney Application Revised March 2017 SEPTIC DISPOSAL PERMIT APPLICATION|office Use Only 742 Bay Road,Queensbury,NY 12804 Tow of Quensbury P:518-1 761-8256 www.queensbury.net Permit:_@C OSLO Tax Map ID #:Permit Fee:Invoice # Project Location:_\S9_AsSaurmur ona >Septic Variance?_____-Yes___No Primary Owner(s)MICHA COP HOMES LLC Mailing Address LMMEIONS IA,MECHANIC VI,NEY 12S : Phone &Email AS BAG lcm/SUNK ET ©MICHDEL SCRA,COM Installer/Builder CHUMCUES FICE MAN EXCANATING Mailing Address S44 Noe ST,HUDSON FALLS,NY 12869 Phone &Email AS .747,1ST Engineer HUTCHINS ENGINGE KING Mailing Address cA HILAND >GueENcsiney,Ne 12004 Phone &Email DS TW45 .0807 Contact Person for Building &Code Compliance:TOMY LCCASOC Phone:PIS -SST 24-4 RESIDENCE INFORMATION: Year Built #ofbedrooms|X gallons per bedroom_|=total daily flow Garbage Grinder Yes|flo) 1980 or older Installed?(circle ane) ‘Spa or Hot Tub Yesacaiinstalled?(circle one) 1992-Present 4 jlo 440 PARCEL INFORMATION: Topography Flat Rolling Steep Slope‘%Slope Soil Nature S<Sand Loam Clay Other Groundwater ‘At what depth?Ua Bedrock/Impervious material|At what depth? _ Vi4 or Lake Domestic Water Supply _Municipal_Z-Well (it 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: Tanksize [7232 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 320 Each Trench__GO __ft. ‘Seepage Pit with #3 stone How many:5 Alternative System Bed or other type: Holding Tank System Total required capacity?;tank size ;Hoftanks 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.| have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: SIGNATURE: ie de Zo Geer,DATE:Zz Li ue Bhhow pate:_Z/2-//1. Town of Queensbury Building &Code Enforcement Revised February 2017