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applications OFFICE USE TAX MAP NO. 6:-7? i C�`• 1- .2t2- E ONLY ...................... ,...._...........,. � FEES: PERMIT Es�;t'v PERMIT N0. 3-'3C47 )1 �, CREATION l- ENGINEERING"`� c ' o;-e; P7p"rl L J $:t PRINCIPAL STRUCTURE: e • i APPLICATION FOR ZONING APPROVAL & BUILDING A PERMIT MUST BE OBTAINED BEFORE BEGINNING PERMIT CONSTRUCTION. REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTIIONAPPLICATION IS SUBJECT TO APPLICANT/BUILDER: C E� C oryS 1. OWNER: �Ob1^j, �e1.tk ADDRESS: . . .. n.. 1e .LS r�i4U.S eti ,t Lsi-►-ke PHONE NOS.�tg> Qat.� t.. { So` ADDRESS: ( Ee 6ecs ���c�, t2$�( PHONE NOS. - 'ata S „ Q*dI CONTACT PERSON FOR BUILDING & CODES COMPLIANCE: -11:_i_%____ __,"C� ., o► LOCATION OF PROPERTY: LAT.LAT. fitPHONE:�� %�e��a HAS THERE BEEN A SITE PLAN REVIEW; VARIANCE OR SUBDIVISION APPROVAL? IF SO, INDICATE APPLICATION NO. AND 'ES NO DATE OF APPROVAL: D 0 ' Z.Z, Zo 13 PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW: CHECK ALL THAT z Ce APPLY TO YOUR 0 PROJECT O o 00 do P o LL co LI- 1 w -' CLi i zo W -J U- �� N � OFWz < Q � � F- LL a = mss SINGLE FAMILY .e.d. Mill TWO-FAMILY MI MULTI-FAMILY (NO.of UNITS ) MI TOWNHOUSE MI BUSINESS OFFICE RETAIL- MERCANTILE FACTORY OR INDUSTRIAL .1 ATTACHED GARAGE(1,2© t LI OTHER IF COMMERCIAL OR INDUSTRIAL- NAME OF BUSINESS: ESTIMATED CONSTRUCTION COST: 350 , .0.: D GLIGL TVDC• f.--11-‹ B 3-LGL 11-05 4 ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN'? ARE THERE EASEMENTS ON PROPERTY? I acknowledge no construction activities shall be commenced,prior:to issuance of a valid permit. I certify that the applic tion, plans, and supporting materials are a true and • complete statemeot/cescripti n of the work,proposed,,that all work will be performed in accordance with the NY to Building Codes,;local building laws and ordinances, and in conformance with local zoning regulations. I acknowledge that prior to occupying the :facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newt •° constructed facilities prior to issuance of a,certificate of occupancy. y • I have read and agree to the above. Signed °Pllik Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction codes or septic systems) Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process, application requirements or to schedule an appointment) I Permission is hereby granted to the above This application / proposed action described Applicant to erect or alter the building herein is found to be in accordance with the described herein in accordance with said zoning Laws of the Town of Queensbury. Application: ______ __,__Iii .juTh BUILDING & CODES AP OVAL ZONING APPROVAL al4,3 DAT DATE - - - - QUESTIONS? CALL 761-8256 OR EMAIL Office Use Onl CO desCcc�pueensbury net VISIT OUR WEBSITE FOR MORE INFORMATION ODeratinn Parrn;+ i,.....„-J. -. Office Use Only Town of Queensbury Building & Codes Received: SEPTIC DISPOSAL PERMIT Tax Map ID: Permit No.: 3 to A permit must be obtained before beginning construction Permit Fee: $ Approvals: Applicant: ROBIN BENAK Installer/Builder \'4?NI C-L-- TNLt-10.1.1 Address: 40 ALEXY LANE Address P o .? 0`./t. v QUEENSBURY NY 12804 L S S 144 1280 Phone: Phone (...51 a) —la a-cle\ Owner: (SAME AS APPLICANT) Location of Installation 40 ALEXY LANE Address: Phone Contact Person for Building&Code Compliance: Day Phone: Residence Information: Year Built #of Bedrooms x Gallons Der bedroom =Total Daily Flow 1980 or older x 150 = Garbage Grinder installed? NO 1981 —1991 x 130 = Spa or Hot Tub Installed? NO 1992—Present 3 x 110 = 330 Parcel Information: Topography X Flat Rolling Steep Slope %Slope Soil Nature Sand X Loam Clay Other Groundwater At what depth? >4' Bedrock/Impervious Material At what depth? >4' Domestic Water Supply Municipal X Well(if well,water supply from any septic system absorption is 115+/- ft.) Percolation Test Rate- 2:0 5 per minute per inch(Test to be completed by a licensed professional engineer or architect) 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). Tank size 1,000 gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub System Type: Absorption Field(with#2 stone) Total length 150 ft. Each trench 3 X 50 Seepage Pit(S)(with#3 stone) How many? Size? Alternative System Bed or other type? Holding Tank System Total required capacity? Tank size? #of tanks? NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system layout on file. There will be no exceptions. For your protection,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 reliance upon any material misrepresentation or failure to make a material fact or circumstance known by or on behalf of an applicant,shall be void. ✓I have 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. �+ Print Name: dOV‘V . Cvot _ Date: RIS 4' I 3 Signature: Date: j 511 3 Town of Queensbury Buildi &Codes Septic Disposal Permit 518-761-8256 r1C ( f-7) Cz bk).\ Revisea 4/14/2010 APPLICATION FOR FUEL BURNING APPLIANCE & CHIMNEYS Application is hereby made to the Building & Codes Office for the issuance of a Building & Use Permit pursuant to the New York State Fire Prevention & Building Code. The applicant or owner agrees to comply with all applicable laws, ordinances, regulations, and all conditions that are part of these requirements and also will allow all inspectors to enter premises to perform required inspections. Important Note To Applicant: Rouqh-ln and Final Inspections Are Required: Owner:: o\ol i4 3 Q 4 A\ Installer/Builder: Q' Cors-' • Address: L O A•112..y.y Li4ne , Loce iCeiM Address: Ilbc+ G\et►4S Fy4U.S I.r..(, 1 Z$ t— -k l X80 t Phone Nos.: --7, , ..D 4 G 6., Phone Nos.: (J l&> - c=t a. a Location of Property: 4O pAe v„,Ak_.,5qL4 Subdivision Name: l..wrk•.e 4 reoc-q e, Location of Proposed Construction and/or Installation: ltO A-te.tic.L- W -1 , L-aAkC.e. �-� e Contact Person for Building & Codes Compliance: ,t N 1 Fuel Burning Applicance (-.Wood) Coal Pellet Gas • Oil Information Stove Fireplace Insert Fireplace,factory built* Fireplace, Masonry Furnace, (Garage Only) * If Factory Built, Please Provide: Manufacturer Name: Model No. Listed By: Number: Chimney Information BLOCK BRICK STONE Masonry** Check Ones/ TILE STEEL SIZE IN INCHES Flue Check One / DOUBLE WALL TRIPLE WALL INSULATED DIRECT CHMNEY VENT LINER Chimney Material Check One✓ ** If Non-Masonry, please provide: Manufacturer Name: Model No. ADDITIONAL NOTE: CONSTRUCTION / INSTALLATION MUST CONFORM TO NYS FIRE PREVENTION & BUILDING CODE AND/OR MANUFACTURER REQUIREMENTS. CONSULT AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED INSPECTIONS Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804 P.) ? 3tP) Revised 4/14/2010 APPLICATION FOR FUEL BURNING APPLIANCE & CHIMNEYS Application is hereby made to the Building &Codes Office for the issuance of a Building & Use Permit pursuant to the New York State Fire Prevention & Building Code. The applicant or owner agrees to comply with all applicable laws, ordinances, regulations, and all conditions that are part of these requirements and also will allow all inspectors to enter premises to perform required inspections. Important Note To Applicant: Rouqh-In and Final Inspections Are Required: Owner:: rPN 0\01 N, 13 e N A Installer/Builder: CI CorS+ • Address:40 pkte, 4 LA-ne (AkeC e - 0•,4,Address: t'-� .3- 0•,4, 61604.61604. i\Q 5 �'14.LL' N►-1 I Z >�t'S !J�-1 t 7-bo Phone Nos.: . u 4 c1 Phone Nos.: (3t S Location of Property: 40 pAse u..ALJA1/4.4 . Subdivision Name: N� Location of Proposed Construction and7'or Installation: 160 P tQ,Nc,k-k W14.1.1 L_i4 ..ti C C Contact Person for Building & Codes Compliance: J c N Cl Fc r- Fuel Burning Applicance Wood Coal Pellet - Oil Information Stove I Fireplace Insert Fireplace, factory built* Fireplace, Masonry Furnace, (Garage Only) * If Factory Built, Please Provide: Manufacturer Name: Model No. Listed By: Number: Chimney Information f BLOCK BRICK STONE Masonry** Check One/ TILE STEEL SIZE IN INCHES Flue Check One✓ DOUBLE WALL TRIPLE WALL INSULATED DIRECT CHMNEY VENT LINER Chimney Material Check One/ ** If Non-Masonry, please provide: Manufacturer Name: Model No. ADDITIONAL NOTE: CONSTRUCTION / INSTALLATION MUST CONFORM TO NYS FIRE PREVENTION & BUILDING CODE AND/OR MANUFACTURER REQUIREMENTS. CONSULT AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED INSPECTIONS Town of Queensbury* Community Development Office *742 Bay Road, Queensbury NY 12804