applications Office Use Only
le Permit#: giC - 0kNO - 2z(i
PRINCIPLE STRUCTURE PERM(T
�► APPLICATION Permit Fee:$ o3. ea
742 Bay Road Queensbury, NV 12804
*Rec. Fee:$ 1•3\PV
P 518-761-8256 Invoice#: lT
Project Location: S(e '3-0 A)-) C Lf`'N D"J Az
Tax Map #: Subdivision Name: a NN C LP-N p6 k1 alb)tiny
TOWN BD RESOLUTION 86-2013 S850 recreation fee for new dwelling uni'. single family dup! x s two-family,
6s7AreS
multiple family apartments condominiums townhouses and or manufactured :ti modular homes but not mobile
homes. This is in addition to the permit fee(s).
CONTACT INFORMATION:
• Applicant:
Name(s): O 0 T iH I LC..S B to i LD E t2S ( 30 E LetA c-t
Mailing Address, C/S/Z: ci m o u IQ TA f p s- i O e- hR 1 vE Qt>,Eeps3,tQ4 ,it 12to Li
Cell Ph.: t ( St S ) 7R I - i 3 Land Line: t (Stfr ) 1%6-3s22a ( .Eu_)
Email: Foc 1-(1LcSButL-DEr;SNVg C—mfllc.. cecv1
• Primary Owner(s):
Name(s): Sink rnEAs A PPLt c.AN-r
Mailing Address, C/S/Z:
Cell Ph.: ( ) Land Line: ( )
Email: --
LI ` MAR 082019
• Contractor(s): _ .. �
Name(s): S Am T AS A P p Lk C AN-T 6�. __...__.m..,�..s,._ ,�._..�.
oo,N 4. R.'L( [ARV
Mailing Address, CIS/Z: — BUi i °:NG �' ES
Cell Ph.: ( ) Land Line: _-( )
Email:
• Architect(s)/Enqineer(s):
Name(s): b A rJ ?y AtJ i -PE Lv I S i o e(4Cr 1 N e K+N C- )
Mailing Address, C/S/Z: 20 0 G-Leto S i SLu►Tc Sfo G L€-s FAu_ ry`f 12SO I
Cell Ph.: ( ) Land Line: I (S-1 p ) -79 2 - 124'1
Email: t) 1AJ@ V1 topENi;. £mP1L
Contact Person for Building & Code Compliance: JoE L Lk C I
Cell Ph.: j_(S"I? ) ill- 16133 EttnsEl Line: i (st8 ) 1 `t/C-3S2o (Lel-i--)
Email: Fin i IA I t.t-5 6 t UM e -S r'J 7 e C M A i L-, co rv‘
Ton Ruildina R Code Fnfnrrement Prinrinle Stoic-tore Revised March 201R
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
X Single-Family _Two-Family _Multi-Family(#of )
Townhouse Business Office Retail HotellMotel
`Industrial/Warehouse Garage(#ofcars ) Other(describe )
STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE:
1ST floor: q 1l3 1ST floor: L{4 C7
2nd floor: ( I S 3 2nd floor:
3rd floor:
Total square feet: `f U
Basement(habitable space):
Total square feet: 2.X.)9 (c
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ °, '7
2. Proposed use of the building: RES 1 D elt)71 A L
3. If Commercial or Industrial, indicate the name of the business:
4. Source of Heat(circle one) as Oil Propane Solar Other:
(Fireplaces need a separate Fuel Burning Appliances&Chimney Application,one per appliance)
S. Are there any structures not shown on the plot plan? YES 0 plain:
6. Are there any easements on the property? YES NO
7. SITE INFORMATION:
a.What is the dimensions or acreage parcel? I, '7 A t Re S
b. Is this a corner lot? YES
c. Will the grade be changed as a re construction? YES NO
d.What is the water source? PUB PRIVATE WELL
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? 19R-1 v^q 7
Ton Euiklina 14 Code Enforcement Prinrinha Stn,rtura Rai.d MUrrh Jf1A
DECLARATION:
1. I acknowledge that no construction shall commence prior to issuance of a valid building
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, local building laws and ordinances, and in conformance with Iocal zoning
regulations.
4. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a
certificate of occupancy.
5. 1 understand that 1,We are required to provide an as-built survey by a licensed land surveyor of
all newly constructed facilities priorto issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: 36S e P N L L L/
SIGNATURE: DATE: 7 /7 / /
To°Building&Code Enforcement PrinrinIP Stnu-tara Raviwri Marrh 7flt R
7 TM SEPTIC DISPOSAL PERMIT APPLICATI ON office use C)nl
7-12 Bay Road,Qunbury,N.l !_-04
P 518-76 :; 56 Perm F Q.C. ,0tvz.- LG:4 1
Tax Map ID#. —_-- , =rm: i liv
Project Location: .---(a b H C (€N r7 -
Primary Owner(s) I TO T I-1 t LLS t3A I L�e iZ S Lt,C C30 ti L&N (-1)
Mailing Address I
1 m0 '`N` ,A laS'De bg, QI.A6 NSB(n{L� t--)j ago NI
Phone & Email CSI )1'i I-(g133c I$�19 6'3SZc_.._
/� FooTHtLI-SF3cArt_bgRSNy e6-mA1L,Gsrn
Installer/Builder 3intrr.6" ft5 APPLIC ANIT'
Mailing Address ; ^—
Phone & Email _.. ---------_.-_—.—..—_
Engineer
Mailing Address 16;1 tAtaPrlt-ANIJ Pb I aloe rvSgt/L2.y 1.Jy 12801
r Phone & Email !
. � CS i019G,-25 I $' TCLNTL fZ3(p @ yA goo. Lb,-+'\Contact Person for Building&CodeCorr p•Iianci:�0e- Leu(-1 Phone: (s )0111 ' (933
RESIDENCE NFORMATION: SI�� �`} 'x�2 0
Year Built__ # of bedrooms X gallons per bedroom = totaidaily flow Garbage Grinder Yes No
'd980 or older `3L ( u 3 S 0 Installed? (circle one)
1981-1991 -- _ ___—.._._ _ __ti Spa or Hot Tub Yes 6
m Installed? {circle one)
892-Pfesent— �. _. ____�
PARCEL NFORMATION:
Topography • Flat Rolling �� w_ Steep Slope %Slope
Soil Nature Sand _Loam Clay _Other
___.
Groundwater ; At what depth? N(� _v—
Bedrock/knperviausmaterial ' At what depth? N(A
Domestic Water Supply ,Municipal —Well{if well.water supply from any septic system absorption is_ft.)Percolation Test Rate (- S per minute per inch{test to be completed by licensed engneer/arcttect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size ( tro U gallons{min.size 1000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length / Co ft.:EachTrench S- ft.
Seepage Pit with#3 stone How many: -Size:
Alternative System Bed or other type:
I — HoldingTank System Total required capacity? tank size ;# of tanks
NOTES:/Alarm system&associated electrica I work must be inspected bya 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.1
have read the regulations and agree to abide by these and all requirements of the Town ofQueensbury Sanitary Sewage
Disposal Ordinance.
PRINT NAME: 3.1)S Ls-1 I.1 Li ut L'I DATE: 3 J7 /l
5'
SIGNATURE: DATE: 3 (7/1;
Tc.. v...=c, .. , t ,C:o.s,Enforcement
Town of Queensbury David Dwell
Highway Superintendent
Highway 518—7 61-8212
Department
742 Bay Road—Oueensbury, NY : Mark Benware
12801 ``-- a Deputy Highway Superintendent
1 i 518-761.-8210i a
11
Phone: (518) 761-8211
� , ,; }
bi't
Fax: (518) 745-4466 r�� j
MAR 0 8 2019
LOy;,'N OFOuE y
DRIVEWAY PERMIT
DATE: b\
APPLICANT NAME: \\S blAA8r -S
TELEPHONE NO.: `D1$ • 11 • � �f PD16 • "}ci f, .�2f5j
ADDRESS TO BE INSPECTED: 56 CI h n C 4 _y' .on
RETURN ADDRESS: °1u ��s,dc, a�
1260t I
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 Duel!, Highway Superintendent Mark Benware, Deputy Highway Superintendent