Loading...
applications Office Use Only PRINCIPLE STRUCTURE PER Permit#: pc, 69-2-57-,)-ei 8 M'dliipo, 4,,, 4, - Vt:1- :.76' Permit Fee: * $ C 7?-c-'"" 4=0,444, APPLICATION *Rec. Fee: $ tOi-evioi..i_S cii-)--e 742 Bay Road. Queensbury, NV 12804 P 518-761-8256 Invoice#: 0, c I 1 7/" i Project Location: 1 5 CAQA) ,1:._6,,,.(2_,a._ 11?,. , 1. ' Tax Map #: .:>1).'i - , VI - .",-2- - 2DC-) Subdivision Name: ((,) / A TOWN BD RESOLUTION 86-2013 $850 recreation fee for new dwelling units singlerarnily:duplexesifwo-family_ multiple family. apartments.condominiums townhouses,andlor manufactured & modplailhipe, :b41-pcit mobile F71 homes. This is in addition to the permit fee(s). iLii _....._____ - Li II 1 i CONTACT INFORMATION: i •-",--T & ,) 4: ,.) 1 i Lii • Applicant c(lriR( '' r\.,CFr--1F'vF:Efrd3Pfjki)g ,, 9- : Name(s): ,A,-...._, 1A., . \„_..\,,(..c,.,,_,,,.._ Mailing Address, C/S/Z: ? 0 . T3c,)(. 1 (,, t....<1---V--e- qe_c,C'Cli Q. j 1)‘q, l ki6 Cell Ph.: (5(I() 171(k-5" - -..)-'',5--Y Land Line: ( ) Email: h )a. (old erYNAL ezzidit36 ---- • Primary Owner(s): Name(s): c)0 A. )e..I.,QAelp tyx e.n A (:) .- i Mailing Address, C/S/Z: 'P., c) . "P-J. S'S" C.2..' \,4,, cp,k . 1,-)'1/41 t ....0(,, Cell Ph.: (-51%.") 1^-N,5-- SS'',7-S-S-- Land Line: _( ) Email: • Contractor(s): Name(s): .7Sk-se-,i've...:.‘pc)o k_- -i)(2-‘),--. ET.0,,ce,(\ \--- „Q ).3(,,,,.._A-Lc,(,.:,,k_.Q..cr, y...._\)\(. 3:..r, c t Mailing Address, C/S/Z: t-P.C_) ' z.:, ?c. 4 (..\._':\,,c- ,.,-, 1.--7),. 'k... '1,3 k( j •,2 OG, c-- Cell Ph.: (6(Y) '1.:(1•S- a 3--w Land Line: (5 I ) Email: • Architect(s)/Enqineer(s): ‘Name(s):Arc,i,,,:t-e_ek — I tri,, • tr, ' vN t rl E. r Mailing Address, C/S/Z: kA0A(1.4,,z--c.,1, 111,06,5 Nt C.r(erv5 i- 1 k s--(;_c L -1-',,‘:a--; F'• i `8-c,-)1 , , Cell Ph.: (1-1,S1 ) ,:5-'31 - 11-.:S-3 T,,,, Land Line: (St v'' ) 676, - +-i s.5. Email: Contact Person for Building & Code Compliance: ---iv-ic....v---1 j ,---L) Cell Ph.: ____( ,..."5 ) 'Sal - t 5.3 j Land Line: _( ) 1..,/ A Email: A;7 4 Tat Ruildine it Code Fnforrement Prinrinle Structure Revised March 701R PROJECT INFORMATION: "TYPE: Commercial Residential WORK CLASS: 11/Single-Family Two-Family _Multi-Family(#of ) _Townhouse Business Office Retail Hotel/Motel _ `Industrial/Warehouse Garage(#of cars ) Other(describe ) STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE: 1ST floor: 1sT floor: IJ/ 2nd floor: I 2nd floor: 3rd floor: Total square feet: 1\i//- Basement(habitable space): Total square feet: ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ f '. 2. Proposed use of the building: 1, re- 3. If Commercial or Industrial, indicate the name of the business: / 4. Source of Heat(circle one): Gas Oil Propa Solar Other: (Fireplaces need a separate Fuel 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 of the parcel? I 1 -Pt QS- Q b. is this a corner lot? YES c. Will the grade be changed as a result of the construction? YES (NO) d.What is the water source? PUBLIC PRIVATE WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? Tan Buildin¢&Cndh Fnfnrcamant Prinrinlh Strurtnra Ravicad Marrh 7A1R 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 1year 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 Ikve 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: AvAev._c vo SIGNATURE: j DATE. °i Too Building&Code Enforcement Prinrinla Striirt,ira Ravicari Marrh 7111R golik Office Use Only AFUEL BURNING APPLIANCE & Permit#: 0 b2S. 24)--r5 tv, CHIMNEY APPLICATION Permit Fee:$ Invoice#: 742 Bay Road, Queensbury NY 12804 P: 516-761-8256 net Project Location: e -Tax Map ID: 9,9-r - a �`? — 2 — 30 Room of Install: r TKAy Planned Install Date: -( 019 **ONE APPLICATI ON PER APPLIANCE** CONTACT INFORMATION: • Applicant: Name(s): \ , \A0 � Mailing Address, C/S/Z: 1� C) . `i a��-x- k G� , �«\tom Cy ej 31 1: 11 Cell Ph.: ( (S\') °15 - Land Line: _( ) Email: • Primary Owner(s): Name(s): e`.)cc,A_ QA e.n\ a SI .s< <-:.. t ec-n "�"LI/ Mailing Address, C/S/Z: ?.c,,. x vt'V4s 1 10`I 1 �, O Cell Ph.: (`7 lam Land Line: _( ) Email: • Installer/Builder: Name(s): Mailing Address, C/S/Z: Cell Ph.: ( ) Land Line: _( Email: Contact Person for Building & Code Compliance: k- c' -n Cell Ph.: _( 5 lam) Z - i 6 5 I Land Line:_( Email: ! /I 1 Town of Queensbury Burldin.^&Code Enforcement FUEL BURNING APPLIANCE INFORMATION: TYPE OF DEVICE: Stove Fireplace Insert .Fireplace Fuel Fired Equipment(Garage Only,13"clearance per IMC 304.3) Fireplace, factory built** ** Manufacturer's Name: Model#: SOURCE OF HEAT: Wood Coal Pellet Gas CHIMNEY INFORMATION: Masonry: block brick stone Flue: tie (teels size,in inches Material*: double-wall — triple-wa Ii_insulated ("Manufacturer's 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 notifications required for hspections. Declaration:Construction/installation must conform to NYS Fire Prevention&Building Code and/or manufacturer requirements.The applicant or owner agrees to comply with ail applicable laws,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: PRINT NAME: —k SIGNATURE : "_ �� ""' "` cCS SAT E: :71-1 Fuel Burning Appliance&Chimney Application ., .. , , ;i SEPTIC DISPOSAL PERMIT APPLICATI ON Office Use Onl �.` ,-•.. 7-1' Bay Road,Queensbury, NY 1 804 , P 518-76 I-8'56 Perrot it '° ©(Q,Z.- 2c .t e Tax Map ID#: X 7 , Lr7 - a' - '30 Permit fee S IfIVOu.t2 ti Pro ect Location: t(5/''t tk .�U e_v cA Se variance? Y•.,, • Septic? �p 9 - 1\1 c Primary Owner(s) S jC-c)0W Q,,e>6 -i)e_v QA(f410 VA.e.n k cif l mf` \h T C.►r' 13.il--- C, Mailing Address 7 ' "'7 — Phone & Email Installer/Builder C Mailing Address \ t l t „ Phone & Email (-T.`S _ 79 3 _ Q`i 3 { Engineer t) rN r, 5 rY\ca_a_ -Ar'o' Mailing Address ':l e.rg '�i\ 44� ci y: { Z110 s 2, e h �l l�l l Phone & Email Contact Person for Building&Code Com p I is ri ce: P h one RESIDENCE NFORMATION: __ _ __ Year Built # of bedrooms X gallons per bedroom = totaldaily flow Garbage Grinder v Yes 0 1980 or older; Installed? {circle one) 1981 091 I Spa or Hot Tub Yes CI Installed? {circle one) - .9 resent-- _.._ --- ------- __.______--- PARCEL NFORMATION: Topography Flat Rolling Steep Slope %Slope Soil Nature _Sand _Loam Clay _Other Groundwater At what depth? Bedrock/k-ripery bus material At what depth? Domestic Water Supply _Municipal _Well{if well,wate r supply from any septic system absorption is_ft.) Percolation Test Rate: per minute per inch{test to be completed by licensed engneer/arcltect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size gallons{min.size 1,000 ga llons,add 250 ga lions for each garbage cylinder or spa/hot tub System Absorption field with#2 stone Total length ft.;EachTrench 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 I wo rk 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.) have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: DATE: SIGNATURE: DATE: Town of Queensbury B,.viainq&Code Enforcement Revsed February 2017 T9wn of Queensbury Thomas R.Van Ness Highway Department Highway Superintendent • 742 Bay Road,Queensbury, NY 12804 Home:518-745-0929 Phone:518-761-8211 Fax:518-745-4466 David Duell Deputy Highway Superintendent Home:518-745-0938 DRIVEWAY PERMIT Date: 7 -( � Applicant Name: Telephone No.: cJ SS - — sS 3-t`5%- Address to be Inspected: l `'k Q\e-U . Return Address: 0 i6, 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 approval permit for a final approval. STEP 2: ( ) Final Approval ( ) Rejected Date: Thomas R. Van Ness, Highway Superintendent David Duell, Deputy Highway Superintendent Town of Queensbury Building&Code Enforcement Principal Structure Application Revised February 2017 I Sal - Office U se Only r" ACCESSORY STRUCTURE UCTURE j:. Permit#: PERMIT APPLICATION 742 Bay Road,Queensbury,NY 12804 Permit Fee:$ P:518-761-8256 Invoice#: Project Location: Tax Map ID#: la°7d t"T '- . - 30 Subdivision Name: 1U l\ CONTACT INFORMATION: • Applicant: D \ Y Name(s): 5'�ot1 ev o© � V e-t 012 M Mailing Address,iC/S/Z: P. �C , b � 14"A I Cell Phone: J� r1'6 ) �t 5 - g J.5 F,S Land Line: Email: • Primary Owner(s): MailingAddress, C S Z: 1 -C) / / � Cell Phone: (J'i'q ) 4 q 5- �� Land Line: Email: G D Check if all work will be performed by homeowner only • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): U', e rs Contractor Trade: c,J&o L 'i, rtu e F Rim I61�, Mailing Address, C/S/Z: seu rQ, (;I er,s T--a-A1s N ° / 1 Cell Phone: (�5'I Y ) 74 L} -37 7S_ Land Line: Email: "List all additional contractors on the back of this form • Architect(s)/Enein_e_er(s): Business Name: Contact Name(s): "t-iry\ V\e-1\9,.uq 1 r� Mailing Address, C/S/Z: Cell Phone: ( .Ike )_ 5 a 7- 7 6-S5 Land Line: Email: Contact Person for Building&Code Compliance: Cell Phone:�_) Land Line: Email: Accessory Structure Application Revised February 2019 I5q • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): at� L Contractor Trade: D.% —Ey\c Mailing Address, C/S/Z: r VpV-- IR Cell Phone: ( 3iS ) 'Ya.'7 -M S�317 Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone:�_) Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone:_� ) Land Line: Email: • Contractor(s):Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone:_j =) Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone:�_) Land Line: Email: • Contractor(s): Workers Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: _� ) Land Line: Email: Accessory Structure Application Revised February 2019 �J PROJECT INFORMATION: 1/ TYPE: Commercial x Residential WORK CLASS: 1� Deck,Open Porch _Solar Panels(w/o rafter upgrades) --Carport _Cell Tower Shed _Pavilion,Pole Barn,Canopy _Dock _Gazebo _Detached Garage _Boathouse(with or w/o sundeck) _3-Season Porch —Other(description: ) SQUARE FOOTAGE OF STRUCTURE: 1st floor: 2nd floor: Total square feet: L ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction:$ J> 3 2. If Commercial project,what is the proposed use:_ 3. Are there any structures not shown on the plot plan? YES D_NOExplain: 4. Are there any easements on the property? YES " NO DECLARATION: 1. I acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be completed within a 12 month period. 2. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees and department approval. 3. 1 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 regulation-s-. 4. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 5. 1 also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of certificate of occupancy. I have read and agree to the above: PRINT NAME: ��� _\. �r�c� SIGNATURE:-- �� o �� DATE: J\ Z �^I Accessory Structure Application Revised February 2019