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Office Use Only Q 1 (:,. •''''.::..4:::;:-.s.,-'‘,) PRINCIPLE STRUCTURE PERMIT Permit#: 2—C •-• 0 2,5o • -2-cnci \'''ff"1-4`1•:'I APPLICATI ON Permit Fee: $ 14)5. 2,0 742 Bay Road Queensbury, NV 12804 P 518-761-8256 Invoice It: 1A5\ Project Location: 2-10 736 t"\ 0 CLA.s:PDbi,-) f-6 Tax Map #: 29 C • i Sr- - 2 - 41, ( Subdivision Name: -St OP Ca/Qui-) NO )Cf.) ..5-1711t-! TOWN BD RESOLUTION 86-2013 $850 recreation fee for new dwelling units single family. dupl,,, ,stwo-family, multiplefamily apartments condominiums townhouses.and'or manufactured & modular homes hut not mobile homes. This is in addition to the permit fee(s). CONTACT INFORMATION: • Applicant: Name(s): So0TfflLLS B Ix I L.,1) E S (15-0 E LelA C-1 ) Mailing Address, C/S/Z: cf AribuN)-ritips- lo -c-- bkive aueeosS -1 NV 12-ro`i Cell Ph.: t ( Si 'E ) NI - 1 33 Land Lino: I (S-/T ) 196-3S-2o (CELL) Email: F00-1-110., ay.t i__DER.,c NI g G-mAIL . Co Ari • Primary Owner(s): Name(s): seole AS APPLICANT Mailing Address, C/S/Z: Cell Ph.: ( ) Land Line: ( ) Email: • Contractor(s): Name(s): S Am S--- AS A Ppt....i c/AN-1- Mailing Address, C/S/Z: Cell Ph.: ( ) Land Line: _( ) Email: • Architectis)/Engineer(s): Name(s): bylsr,) fLyAt-i , PE LYIS10 .) ENG-INcegiN6- ) Mailing Address, C/S/Z: 2©o G--i-el-i --1- cukire 90 GLANS FALLs to-i' 1210 1 Cell Ph.: _( ) Land Line: 1 (s---/ S2 ) 19 2 - 1 241 Email: Contact Contact Person for Building & Code Compliance: 3°6- I-6 tk CI Cell Ph.: 1 (S.-AV ) ill- (133 Land Line: i (v•t? ) 1 ci - 3s-2.0 Email: FooT R it-LS 8tA i L/•)e Pss PP/e Crin II i 1— Co IV\ Ton Roildine R Code Enforcement Prinrinle Structure Revised March 201g PROJECT INFORMATION: TYPE: Commercial k Residential 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: 1ST floor: ) (o91f 1ST floor: 14- b 2nd floor: 2nd floor: 3rd floor: _ Total square feet: '-f b Basement(habitable space): Total square feet: / q'I ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ 1 S 0 0 0 2. Proposed use of the building: R e S i o r)-1' t i L 3, If Commercial or Industrial, indicate the name of the business: 4. Source of Heat(circle one): 10 Oil Propane Solar Other: (Fireplaces need a separate - 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 NO 7. SITE INFORMATION: a.What is the dimensions or acreage • the parcel? I a 2 A c ft s b. Is this a corner lot? YES d c.Will the grade be changed as a re the construction? YES NO d.What is the water source? PUBLI PRIVATE LL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? P e-I"A 1 C' Ton Building Si Code Enfnrcemant Prinrinlo Stnirtiiro Rovicori MUrrh 7n7R DECLARATION: I. I acknowledge that no construction shall commence priorto 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 lyear 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 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 Uwe are required to provide an as-buiit 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: J®.s PK DE titLl SIGNATURE: (-)\\ DATE: Lill-1 / C q 1 Toe Buildine&Code Enforcement Print-Into Strut-hire,RPVicPA kilttrth 9fl1 R Office Use Only 9 •#,2 4 -',---; ; - FUEL BURNING APPLIANCE & Permit#:_ L.c., -C2.-be) • ZQ,kl ".....* CHIMNEY APPLICATION Permit Fee:$ ,441 4-,-, Invoice #: 4 4 74 ' B,i y Road, Queensbu , NT -12804 P. 51 761-8256 Project Location: Lib SO 14 i-i C LEN,m,--) Tax Map ID: 2-9 C , I C — Room of Install: 6.19-t-iAl FAY\ Planned Install Date: **ONE APPLICATI ON PER APPLIANCE** CONTACT INFORMATION: • Applicant: Name(s): FOOTHILLS OtA(LDEK-S LLC (:Toe LEu C ) Mailing Address, C/S/Z: q mov‘,01 iNs toe DIL Quee,r4s6og--1 Ny I 21 c 1 Cell Ph.: I (S-1 g ) 19 1- ici 33 Land Line: ( ( Ss i g ) 1% - 3S-Zo ((EL() Email: FooTii ILLS 6tikiLD e R3 N 1 (0 C—In 19)L_, Co PA • Primary Owner(s): Name(s): Cilm-e- 11-s APO-I c ttive-r Mailing Address, C/S/Z: Cell Ph.: ( ) Land Line: ( ) Email: • Installer/Builder: Name(s): snry\E--- ils 19 pp L 1 cn,,,-.1 Mailing Address, C/S/Z: Cell Ph.: _( ) Land Line: _( ) Email: Contact Person for Building & Code Compliance: -3'D E 1--Ekkc I Cell Ph.: 1 (c-ir ) lei I - 16133 band Line: _t___( 5-/ g' ) 116 - 3s-2-(2 (ct Lt.) Email: -Pipe-T-14444,t4,- Fool-HO-4-c elAILDe es x)ye Gin AIL, co fr•, T,wn of Oueensbury&Odin &Cr.yie Enforcement FUEL BURNING APPLIANCE INFORMATION: TYPE OF DEVICE: Stove X Fireplace Insert Fireplace ri , i€' moL tN-Rrr� 6'obe . Dvb36FP3oa� `fANot D�LuX� Fuel Fired Equipment(Garage Only,13"clearance per IMC 3043) Fireplace, factory built** ** Manufacturer's Name: Model#: SOURCE OF HEAT: Wood Coal Pellet Cas CHIMNEY INFORMATION: Masonry: block brick stone Flue: 2 tie '�size,in inches Material*: double-wall triple-wa li_insulated (*Manufacturer's it-i inn = 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. 3 Masonry fireplaces & chimneys require plans to be submitted. 4 Twenty-four (24) hour notification is 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 baws,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: PRINTNAME: :SO-SE PH LEU SIGNATURE : DATE: -1 1 l 7 11 Fuel Burning Appliance& himney Application era SEPTIC DISPOSAL PERMIT APPLICA T I ON Office Use Qnl 7-f' Bay Road.Queensbury,\Y 12`04 P 518 761-ti`56 Perm,.r? �C-02b -Zb \ Tax MapSo ® ID#: ,` t� Z9 (t Z Li ' Permit i ve `;ti Ist,:o�:.= �' ' _t Project Location: a 3 0 14 N OZ. t- Do ,.J e;, i,: variance? Y.-<9 C] Primary Owner(s) FO 0 T H I LL S AA AI t_beg S LLC. (3o Le LA c 1) Mailing Address MOA-NTA INSIDE' U. Qu 4SNS8t4R N Phone & Email (fit$)71 l_19 33 �- )19(0-352� C FooTHtLLS But ILbeRSNyelrMAll Lt, Installer/Builder SIAriN€' AS A9PC_Ic Ftnit • Mailing Address Phone & Email Engineer To IN\ C t d .6•, i Mailing Address 16,1 Nflv 1 t:A N>) Rc Q,ln.. r NS 8 voK-y N`1 12 Phone & Email (S g)19 fo p a 1 S TC N-itE rZ 3(n @ yimo Q. Z a rYN Contact Person for Building&Code CompIir-t : 3 Le' -I F'hcri : (.S. t.)11I - 1933 RESIDENCE NFORMATION: Sd 0 ,.1 _ 2 0 Year Built # of bedrooms X gallons per bedroom = totaldaily flow Garbage Grinder Yes N 1980 or older Installed? {circle one) _-1981-1991 —y-a_ ,_� .._-, Spa or Hot Tub Yes Installed? (circle one) 192 Present PARCEL NFORMATION: Topography I mw9 `A Flat Rolling Steep Slope %Slope Soil Nature K Sand Loam Clay Other Groundwater At what depth? N (A - � P Bedrock/Impery bus material At what depth? p /A Domestic Water Supply V XMunicipal _Well {if well,water supply from any septic system absorption is ft.) Percolation Test ? Rate: /- C per minute per inch(test to be completed by licensed engneer/arcFtect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size ( b 0 0 gallons{min.size 1000 ga Ilons,add 250 ga lions for each garbage cylinder or spa/hot tub System Absorption field with#2 stone Total Ingth (c 6 ft.;Each Trench CO ft. Seepage Pit with#3 stone How many: Size: Alternative System Bed or other type: HoldingTank System Total required capacity? tank 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.1 have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.PRINT NAME: JO S tx e I-! 1.., ti,- ci DATE: I y / 17// 1 310 SIGNATURE: DATE: ' Town of Queensbury Etoir, ct&Code Enforcement Reae>°''February 2017 Town ofDavid Duell Highway Superintendent Highway � . 518-761-8212 Department ' Mark Benware 742 Bay Road -Oueensbury, NY 12801 Deputy Highway Superintendent 518-761-8210 Phone: (518) 761-8211 Fax: (518) 745-4466 DRIVEWAY PERMIT DATE: LO 12-2- I J`j APPLICANT NAME: Foote ti I LLS 3u i Li)t7t-S TELEPHONE NO.: Lc t bw 1"15 3 3 ADDRESS TO BE INSPECTED: `7'4 T6 +4 c-L8" t d IL)) RETURN ADDRESS: 9 mo„`NTb IDDE Di- 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