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applicationsBuilding Permit Application ‘Vown of Queensbury —Dept of Community Development,742 Bay Road,Queensbury,NY (518)761-8256 A permit must be obtained before be No inspection will he made until app mticacrets|fecha SSAC RECey)‘valid building permit.All applicants?‘on this HEL Kee P: pplication must be completed and must appear on the ee S—— application form.FO Oe)Mae Myo.4 2009 ‘Applicant;Thomas Parone Thomas Parone BUC OU, Baltes Box 804,Ri prs BOxX-B804,Rout”9 Wo NSupy Gansevoort Gansevoort,NY 12831 20" Phone #f (518)587 8989 Phone (518)587-8989 FAX:518 584-2093 Office contact person:Geri Pastore Drpery Losaion:Lot Number:224/House Number /2 1 Kus HollowsNaetxMapNumber:29S,0-7 3.2. New Buil ise)commer Lstimated Market Value of Construction:$22527206. Addition Tesidence /commercial i ‘an Addition,what will use of new addition be? eooce Alteration:residence /con No change to exterior size:residence /com’! Other work (des ~~Oiher sq fleCheek[Occupancylnformatio Below Single family dwellh “Two family dwelling Townhouse Multifamily dwelling Hol units “Office ‘Mercantile Manufacturing T car detached garage Zear detached garage 3 car detached garage _Ye Bass Btc c ccoocoea Tear attached garage Zear allached garage ae GIO GU ~3 caratlached garage _u|eearesidential_J. oO “Other . ‘Will any second-hand or ungraded lumber be used?If'so,for what?oO ‘Type of Heating System:electric /oil 1s)woo Hforved hot air/baseboard /other: to be installed __ List below the person(s)responsible for supervision of work as regards (o building codes: Number of Fireplaces to be installed __©_Number of Woodstov Name Address Phone Number Builder [Thomas Faron same as above Plumber__|©&G Plumbing 654-7477 Mason Heath Russeli 796-3033 Electri Modern Electric _584-8341 iy read the statengelaration:please sign below after you Ia statements contained in this application,together with the plans and specifications nt ofall proposed work to be done on the described premises an that all 1ce and all other laws pertaining to the proposed work shall he complied work is authorized by the owner.Further,itis understood that Hove shall ficate of Compliance being issued,as requested by the Zoning sed surveyor,drawn to scale,showing actual “To the best of my knowledge submitted,are a truc and complete statem provisions of the Building Code,tl with,whether sp submit,prior toa Certificate of Occu Administrator oF Director of Building and Codes,an As Built Survey by a tics local II new construction.Quer.L talLo _owner,owner's agent,architect,contractorSignatur Application for Permit ~Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518)761-8256 1.OWNER INFORMATION:rngian Ridge Subdivision Office Us Location of installation:Lot_No.JA/House No./X ao TakMop No,_®9°4 "ane: Kosh He/loa>|Fie peneFeePaidOwner's Name: Thomas Parone —REcg;VED) Address:+O.Box 804,Route 9 Marar etsBoxBeRoute9ae12093 UneSaReMsauARSalocone Y Gansevoort,NY 12831 2,INSTALLER’S NAME :PHONE NO. 3,RESIDENCE INFORMATION:(circle year of dwelling,indicate #bedroom(s)and multiply #of bedrooms with applicable gallons per bedroom to equal total daily flow) x No.of B Cor jon Total Daily Floy 1980 or older x 150 gal/bdem 1980-1991 x 130 gaV/bdrm 1991 —present q x 110 gal/bdrm Garbago Grinder liistalled—yes__—/noSpaorWhirlpoolInstalledyes_~~/no FIO 4.PARCEL INFORMATION:(circle applicable information &indicate measurements) Ground Water Bedi at what depth|at what depth ‘municipal feet A.feet wellRolling Steep slope if well;water supply_%slope from any septic-system depth:absorption is___fi. other Porcolation Test:(To be completed by licensed professional engineer or architect) Rate:‘minute per inch 5,PROPOSED SYSTEM:For New Construction:All individual sewage disposal systems must be designed by a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision).Add 250 gallons to the size of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub, Septic Tank:L2SL_galon (min,size 1,000 gal) Tile Field:each trench SYED fi,Total System Length:PSD _p Seepage Pit(s):number of__©)size ofeach:fiby Size of Stone to be used:#“h /depth or thickness _feet Bed System Size: Alternative System:___/\Kiae length and/or size 6.HOLDING TANK SYSTEM:(if required) Number of tanks:1 Size of each:Lk eats {TOTAL Capacity:gallons ‘Note:Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 1.SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON (please read) For your protéction,please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval granted which is based upon or is granted in roliance upon any material mistepresentation or failure to make a material fact or circumstance known by or on behalf of an applicant,shall be void. Thave read the regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Signature of Lille person 5 ite