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applicationsOffice Use Only PRINCIPLESTRUCTUREPERMT|Petmtt 2c —0142 201 APPLICATION Permit Fee:$_V5O.20 nec.fee:$_O70742BayRoad,Queensbury,NV 2804 tec Fee:$_& P:818-761-8256 wens ques Linea!Invoice #:__2144 Projéct Location:;ill Drive Tax Map #:oleils Subdivision Name: TOWN BD.RESOLUTION 86-2013:$860 recreation fee for new dwelling-u |Sxesytwo- multiplefamily,apartments,condominiums townhouses,and'c or mand ee reane ‘but not mobile homes.This is in addition to the permit fee(s).. CONTACT INFORMATION: ©Applicant:. Name(s):Hexlerquosks Homes Malling Address,C/S/Z:_19lp “Purdeck St Schenectady,NY 1230l Cell Ph:_(_)Land Line:(5/8Y-.35b-|: Emait Pout @ \nadorowskiacoup com NOV 08 2019||)|“|| »Primary Owner(s): Name(s):_Mission Buildecs Mailing Address,C/S/Z:a st 1a Cell Ph.:_(Land Line:(518 )~35e -!435 Email:_Pout@®hodorows kigroup,com *Gontractor(s): Name(s):Hodeorowski Homes Malling Address,C/S/Z:I4lp “Purclecks Sk Schenectady NY 12506 Coll Ph.:_(_).. Land Line:_(51)=14 Emait Pout@hodoconskiacous,Com, *Architect(s)/Engineer(s): Name(s):Norstar Home “De:ions,Lit Mailing Address,C/S/Z:_Jolnn Wo-Zoni efcr0k 35 OhercaWee.Lo wh Von,AY 12803 Cell Ph:_(__)Land Line:_(S18)S0le-54%51 Email:_SWyo7z \9G8 ©ousop.Ce.Com Contact Person for Building &Code Compliance:_Nea\Souloca Cell Ph.:__(5/8 _)365-8805"Land Line:_() Email:_NeaiS @ Ineclorousskiarausp.com. PROJECT INFORMATION: TYPE:=Commercial _Residential WORK CLASS: Y single-Family __Two-Family __Multi-Family(of ___) Townhouse ___Business Office __Retail ___Hotel/Motel __IndustriaWarehouse __Garage(#ofcars__)_Other (describe. STRUCTURE SQUARE FOOTAGE:GARAGE SQUARE FOOTAGE: 4foo:_lo4g */-1 floor:__(e071 (- 2 floor:__1 O45 *l-2"floor:_floor:3M floor Total square feet:lor */- Basement (habitable space} Total square feet:AVY Th ADDITIONAL PROJECT INFORMATIO! 1,Estimated Cost of Construction:$_AOO,OOD2.Proposed use of the building:mil NG 3.If Commercial or Industrial,indicate the name of the business: 4.Source of Heat(circle one):Oil Propane Solar Other: (Fireplaces need a separate Fuel Burning Appliances &Chimney Application,one per appliance) 5,Are there any structures not shown onthe plot plan?YES Co)eia 6.Are there any easements on the property?YES () 7.SITE INFORMATION:4/aa.What is the dimensions or acreage of the parcel?atl b,Is this a corner lot?YES (NO c.Will the grade be changed as a result of the construction?Yes CuQ> d.What is the water source?d PRIVATE WELL e.Is the parcel on SEWER or &PRIVATI ‘Sysi DECLARATION: |.lacknowledge that no construction shall commence priorto issuance of a valid building perm and workwill be completed within a 12 month period. 2.Ifthe work is not completed by the tyear 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,focal 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 ofoccupancy. 6,[understand that Idve are required to provide an as-builtsurvey bya licensed land surveyor of all newly constructed facilities priorto issuance ofa certificate of occupancy. |have read and agree to the above: PRINT NAME:a sienarure:_L“(_*pare:lt]lia Office Use Only FUEL BURNING APPLIANCE &Permit #:Qc -6342 -20 5 CHIMNEY APPLICATION Permit Fee:$ SSR Invoice #: of Queensbu: 742 Bay Road,Queensbury.NY 2804 P: SIG-76+8256 www quecisinury net Project Location:WoBicdhmnadhillDr.Tax Map 1D:308.T-|-Te Room of Install:Fai Boom Planned Install Date: ““ONE APPLICATION PER APPLIANCE* CONTACT INFORMATION: ®Applicant: . Name(s):Hodscoursks Home: Mailing Address,C/S/Z:19.Burdeck St Schenectade NY 12306 Cell Ph.:_()Land Line:_(SIE )356 -435. Email:PO.L\@ Woderoost.acoug pm ©Primary Owner(s): Name(s):_Missing Puilders Mailing Address,C/S/Z:7!ur &enecs N Cell Ph.:_(Land Line:(5/8 B5le 1435 Email:p00 @ Inedercus Kk.agoup.cDm ©Installer/Builder: Name(s):Hadecowsks Homes Malling Address,C/SIZ:194 Purdeck St Schenectady,NY /2306 Land Line:(518 )356 -1435 acu. Contact Person for Building &Code Compliance:Nea \Saveca. Cell Ph.:__(518_)_365 -8508 Land Line:__() Email:_Neo\S@ Nodomonks rep Cem, FUEL BURNING APPLIANCE INFORMATION: ‘TYPE OF DEVICE: Stove __Fireplace Insert srepace ___Fuel Fired Equipment (Garage Only,B"clearance per IMC304 3) Fireplace,factory built™ ™Manufacturer's Name:_Su pecior Model #DPT 2025 SOURCE OF HEAT: Wood Coal Pellet CHIMNEY INFORMATION: ule Gas diceck vent__Masonry: block brick stone Flue: tie steel __size,in inches. Material": double-wall _triple-walll_insulated (“Manufacturer's im za rt :——_______—Model ADDITIONAL INFORMATION: 41 Two inspections are required,A rough-in inspection,prior to installation andafinalinspection,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 is required for nspections. Declaration;Construction/instaliation must conform to NYS Fire Prevention &Building Code and/or manufacturer Tequirements.The applicant or owner agrees to comply withallapplicable laws,ordinances,regulations and all conditions that are part ofthese requirements and also will allow the inspector to enter the premises to perform the requited inspections. Ihave read and agree to the above: PRINTNAME:“url Xodorouosku _ SIGNATURE:VO =: DATE:ul alia Fuel Burning Appliance &Chimney Application SEPTIC DISPOSAL PERMIT APPLICATION. 742 Bay Road,Queensbury,NY 12804 P.518-76 18256.ayer jane sours 08.1-1-1b i iM Primary Owner(s)|Mission PurldersMalingAccress_|74¢Burdeck &&Schenectady,NV 12300 F18-35-1435 Paul @ hodorouaski group.CoHodocouskiHomes. Wu Burdeck St Schenectady NY 1AZ00 SIP-35e-1435 Paul ©hodoransks apoup.comVonDusen+Steve§Laod Sucveyocs.see hese Wu Haviland Rd.Queensbury,AY 1o404 Phone &Emi|5/8-199-g414 Contact Person for Bukiing &Code om pliance:Neal SaubcOspone:519 -365-8308 RESIDENCE NFORMATION: Office Use On! Permt#:_&C -0%42 -Zor Tax Map ID#:Permit Fee:$Invoice #: Project Locatior Septic Variance? +No Phone &Email installer/Builder Malling Address Phone &Email Engineer YearBuilt|#of bedrooms_|X gallons per bedroom|=totaldaily flow||Garbage Grinder Yes eo)| “BBD or older Installed?{circle one) 7981-B91 ‘Spa or Hot Tub Yes &Installed?{circle one)mrresent]LL0 {76 PARCEL NFORMATION: ‘Topography X Flat Roling Steep Slope _____%Slope ‘Soil Nature XSand _Loam ___Clay__Other Groundwater Atwhatdepth?maotthiy 7O 677 Bedrock/imperviousmaterial|Atwhatdepth?on)Q- Domestic Water Supply Municipal Well {if weil water supply from any septic system absorption is__ft.) Percolation Test Rate:1/4"per minute per inch (test to be completed by licensed engheer/arcitect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tanksize _[/2&O gallons {min.size 1000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub System Absorptionfieldwith#2stone [Totallength Qgp _fi.;EachTrench y@xofi. ‘Seepage Pitwith #3 stone [How many:__—-Size: Alternative System Bed or other type: HoldingTank System [Total required capacity?“tank size #of tanks NOTES:1Alarmsystem &associated electricalworkmustbe inspected bye Townapproved electrical inspection agency:2.Wewillno longer allow systems to be covered untilsuch time as an as-builtplan received and approved. The installed system must match the septic layout on file-no exceptions, Declaration:Any permit or approval grarited which fs based upon or is granted in reliance upon any material representation or fallure to make a material fact or circumstance known by oron behalf of an applicant,shall be void. haveread the regulations and agree to abide by these and allrequirements ofthe Town of Queensbury Sanitary Sewage Disposal Ordinance. DATE:\\4 \9,a pare 114. PRINT NAME: SIGNATURE: