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applicationsPRINCIPLE STRUCTURE Office Use Only PERMIT APPLICATION Permit#:_(REQOSS-2eLOfETownofQueensbury 7 Mit Fee:$_&7//O 742 Bay Road,Queensbury,NY 12804 Q EC mA Ve .Fee:§,Dd.06 P:818-761-8256 www queensbury net fl reas 2019 bce #:__2370 Project Location:2 Eionbiuly LAN Fe eaeTaxMap#:30f.i8 -2-29.)Subdivision Nathe: TOWN BD.RESOLUTION 86-2013:$850 recreation fee for new dwelling units? multiplefamily,apartments,condominiums.townhouses,and/or manufacturé homes.This is in addition to the permit fee(s). CONTACT INFORMATION: *Applicant: Name(s):Nowoux Entugsi 52S Lic Mailing Address,C/S/Z:__"1)Deorse Del (by VY 280% Cell Phone:_(ie,)Yb)-17)>Land Line:_() Email:Qnve ¢G0CTe.Com +Primary Owner(s): gle family,duplexes/two-family, jodular’homes,but not mobile |FEB 10 2020 Name(s):Sc.me a Ap ii + Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: O Check if all work will be performed by homeowner only ©Contractor(s):Workers’Comp documentation must be submitted with this application Contractor Name(s):Foe,Hacks Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()land Line:_() Email: **List all additional contractors on the back of this form *Architect(s)/Engineer(s): Business Name: Contact Name(s): Mailing Address,C/S/Z: Cell Phone:)|Land Line:_() Email: Contact Person for Building &Code Compliance:__Dare /Moaiow/ Cell Phone:_(Sit)_)Yb)-71>Land Line:_() Email:_Dowe «Loca corm Prince Structure Packet,Revised February 2018 _ PROJECT INFORMATIOI "TYPE:__Commercial Residential WORK CLASS: A Single-Family __Two-Family __Multi-Family(#of units ___)o __Townhouse __Business Office _Retail __Hotel/Motel __Industrial/Warehouse __Garage(#ofcars__)__Other(describe___) STRUCTURE SQUARE FOOTAGE:GARAGE SQUARE FOOTAGE: 15"floor:BRY.1"floor:LO sy 2"floor:2"floor: 34 floor:Saetos|eeeTotalsquarefeet:__LOBasement(habitable space):__{?* Total square feet:__J SD ADDITIONAL PROJECT INFORMATION: 1.Estimated Cost of Construction:$_250,(300 2.Proposed use of the building:___Houp 3.If Commercial or Industrial,indicate the name of the business: 4.Source of Heat;Gas)Oil Propane Solar Other: (Fireplaces need a separate Fuel Burning Appliances &Chimney Appli in,one per appliance) 5.Are there any structures not shown on the plot plan?YES (NQ_Explain: 6.Are there any easements on the property?YES (NO: 7.SITE INFORMATION: a.What is the dimensions or acreage of the parcel?i50 b.Is this a corner lot?Yes (iO) c.Will the grade be changed as a result.afthe construction?YES (@O d.What is the water source?‘UBLI PRIVATE WELL e.Is the parcel on SEWER or a PRIVATE SEPTIC system?peti Princiole Structure Packet Reviced Fehaey 2140 DECLARATION: |.lacknowledge that no construction shall commence prior to issuance of a valid building permit and work will 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,local building laws and ordinances,and in conformance with local zoning regulations. 4,acknowledge that prior to occupying the facilities proposed |,or my agents,willobtain a certificate of occupancy. 5.understand that live are required to provide an as-built survey by a licensed land surveyor of ail newly constructed facilities prior to issuance ofa certificate of occupancy. |have read and agree to the above: PRINT NAME:Tru icl Moarous SIGNATURE:wl.DATE:_ala Jar Princiole Structure Packet Roviced Fahnary 2010, Office Use Onh FUEL BURNING APPLIANCE &Permit #:22-6 OEF-2O20 CHIMNEY APPLICATION Permit Fee:$ Invoice #: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 que Project Location:2 )cimbiely Ln Tax Map ID:__208.)-2-29. Room of Install:Gea Doo Planned Install Date:Ape.|ano ““ONE APPLICATION PER APPLIANCE* INF ©Applicant: Name(s):Mowyove Endlyatises Lit Mailing Address,C/S/Z:“11 Rurzre Del Ghy OY BEDY Cell Ph:__(4/))YbI-1%Land Line:__() Email:Dave ce OOcr Fe co @ Primary Owner(s): Name(s):wi ck Peal ad Mailing Address,C/S/Z: Cell Ph.:_(___)Land Line:_(__) Email: O Check if all work will be performed by homeowner only *Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s):Enon Adachi e200ContractorTrade: Mailing Address,C/S/Z: Cell Phone:_()land Line:_() Email: Contact Person for Building &Code Compliance:Dove WomourCellPh.:__(Sip )4b)-)y Land Line:__() Email:__jyue a Goct f.cory Principle Structure Packet Revised February 2019 ”FUEL BURNING APPLIANCE INFORMATION: ‘TYPE OF DEVICE: __Stove _Fireplace Insert ___Fireplace ___Fuel Fired Equipment (Garage Only,18”clearance per IMC 304.3) ol.Fireplace,factory built** (**Manufacturer’s name:Hoot+bio Model #:Qt Loan c ) Fi,Stowe to Drrtale +veatSOURCEOFHEAT:Sareicen FseAse +enaae ___Wood __Coal __Pellet of Gas CHIMNEY INFORMATION: Lentiny On val ___Masonry (require plans to be submitted):A Venti ene bebe Wall __block __brick _stone __Flue: __tile __steel ___size,in inches __Material*: ___double-wall —__triple-wall __insulated (*Manufacturer’s name:Model #:) ADDITIONAL INFORMATIO! 1.Two inspections are required.A rough-in inspection,prior to installation and a final inspection,after installation. Manufacturer's installation manual must be available at the time of inspection. Masonry fireplaces &chimneys require plans to be submitted. Twenty-four (24)hour notification is required for inspections. Workers’Comp insurance information is required with this application. yee 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 conditionsthatarepartoftheserequirementsandalsowillallowtheinspectortoenterthepremisestoperformtherequired inspections. \have read and agree to the above: PRINTNAME:David Moasouy SIGNATURE:a DATE:abho Principle Structure Packet Revised February 2019 Office Use Only p PC ODDS -22reneaesSEPTICDISPOSALPERMITAPPLICATION|permit 8.FC=CSSS>ZZSepticVariance?__—Yes No 742 Bay Road,Queensbury,NY 12808 518-761-8256.www.queensbur.net Tax Map ID #:20%.1%-2-29.1 Project Location:2 Kinbinly Ln *Applicant: Name(s):Meusouv Entyerises Let Mailing Address,C/S/Z:__*(|_Deorxe cl Obey AY 12pOY Cell Phone:_(_4/¢,_)__Y)-11>Land Line:_() Email:__fYuwe 02 GOcTF.Com ¢Primary Owner(s): Name(s):we GA ePiiseat Mailing Address,C/S/Z:‘ Cell Phone:_()Land Line:_() Email: O Check if all work will be performed by homeowner only ¢Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s):Warles friedmen £,tis Contractor Trade:EF aravotne Mailing Address,C/S/Z:Se Now Sb Hudson Folly AY Cell Phone:_()land line:_(_/®)_2Y7-937) Email: ©Engineer(s): Name(s): Mailing Address,C/S/Z: Cell Phone:_(),Land Line:_() Email: Contact Person for Building &Code Compliance:___J\u-e (WoaouyCellPhone:_(Sip _)_4B/-)71 Land Line:_() Email:__(Nuxe of Oct F.coro Principle Structure Packet Revised February 2019 RESIDENCE INFORMATION: Year Built Gallons|#of bedrooms:|X gallons per|=total daily flow per day bedroom Garbage Grinder Yes [Qa 1980 orolder|150 Installed?(circle one) 7981-1991 30 %=Spa or Hot Tub |Yes|@oy Installed?(circle one)1992-Present|110 3 ho 330 PARCEL INFORMATION:= Topography.ol Flat Rolling Steep Slope %Slope Soil Nature ¥f Sand ___Loam Clay __Other (explai ) Groundwater Atwhatdepth?flo Fae! Bedrock/Impervious material|At what depth?Now Piece Domestic Water Supply Municipal __Well (if well,water supply from any septic system absorption is___ft.)|Percolation Test Rat per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size JOC.gallons (min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub System Absorption field with #2 stone|Totallength __)=()ft;EachTrench__Q_ft. Seepage Pit with #3 stone How many:;Size: Alternative System Bed or other type: Holding Tank System __| Total required capacity?jtanksize;#of tanks NOTES:1.Alarm system and 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.3.As-built drawings must be submitted prior to the inspection,if there has been a change to the submitted plans. 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:Dovid WW vate:_a/»he SIGNATURE:—pare:_)»Jy, Principle Structure Packet Revised February 2019,