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applicationsOffice Use Only it #: BC -p\2-2OL0PRINCIPLESTRUCTUREPERMIT|Permt#: BC -DIBZ~7OLO APPLICATION Permit Fee:$.FAA.eo 742 Bay Road Queensbury,NV 2604 “Rec.Fee:§ LaveesViewsoff__P 518-76+8256 invoice ts 2A 82% Project Location:36 Jou cuewoew ey (Let 3) Tax Map #:_Z98,1S -2-3 Subdivision Name:Jom CLewoow Hunde ESTATES TOWN BD RESOLUTION 86-2013 $850 recreation fee for new dwelling uns single family,duplox-s two-family,Multiplefamily,apartments condominiums townhouses.and or manufactured &modular homes but not mobilehomes.This is in addition to the permit fee(s). CONTACT INFORMATION: ©Applicant: Name(s):FOOTHILLS Buicn ERS (Soe Leuci) Mailing Address,C/S/Z:4 MoUunTAINS IDE DRiveE Quecusouky WY leroyCellPh:|(S18 )741-14 33 Landtine:|(SIT)296-3520 (teu) Email:_FooTyecsBui Loers NY@ GmAje-cenr ¢PrimaryOwner(s): Name(s):SAME AS APPLICANT. Mailing Address,C/S/Z: CellPh:_(_)Land Line:_() Email: *Contractors): Name(s):__SAME AS APPLICANT Mailing Address,C/S/Z: Cell Ph.:_()Land Line:_() Email: *Architect(s)/Engineer(s): Name(s):DAM Ayan,PE (visiow Eneineekine ) Mailing Address,C/S/Z:20¢Glew <7 _SwiTe 66 GLews FAS RY I2f0 | Cell Ph.:__()Land Line:1 (s1¢_)792 -4264 Email:DRY AN@ Vision ENG.EMAIL Contact Person for Building &Code Compliance:JE LEwci Cell Phe 1 (SUF)141-1433 tand Line:|(S1¥)14¢-3520 (eet)Email:_FooTHitts guilogeswy@ EmAIL.com To fine &Code Fatoneoment Prince Strctute Revised March 7018 PROJECT INFORMATION: TYPE:——Commercial XK Residential WORK CLASS: X Single-Family __Two-Family —Mutti-Family(#of ___) Townhouse Business Office —Retail —Hotel/Motel —_Industria/Warehouse Garage (i#tofcars __)Other (describe,F STRUCTURE SQUARE FOOTAGE:GARAGE SQUARE FOOTAGE: I floor:__|0 24 floor:YO2"floor:__\\5 >2°*floor: 3"floor: Total square feet:_“14O Basement (habitable space): Total square feet;2!#2ADDITIONALPROJECTINFORMATION: oN ” Estimated Cost of Construction:$_2 °°.0¥? Proposed use of the building:Sin Cie Famicy Residential 'f Commercial or Industrial,indicate the name of the business: Source of Heat (circle one):(Gas”)Oil Propane Solar Other: (Fireplaces need a separate Fuel Burning Appliances &Chimney Application,one per appliance) Are there any structures not shown on the plot plan?YES (NO‘xplaln: Are there any easements on the property?YES (2) ‘SITE INFORMATION: ‘a.What is the dimensions or acreage ofthe parcel?_I 3_Ac Aes b,Is this a corner lot?Yes 7.Will the grade be changed as a result of the construction YES 0)d.What is the water source?PUBLIC WELL e.Is the parcel on SEWER or a PRIVATE SEPTIC system?_PAiwAie SevTic “To Bulldine A Cade Enforcement Prinine Strurtre Resid March 2008 DECLARATION: |.lacknowledge that no construction shall commence priorto issuance of a valid buildingpermandworkwillbecompletedwithina12monthperiod. 2.Ifthe 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 true and complete statementand/or description of the work proposed,that all work will be performed in accordance with theNYSBuildingCodes,local building laws and ordinances,and in conformance with local zoningregulations. 4.|acknowledge that prior to occupying the facilities proposed |,or my agents,willobtain acertificateofoccupancy. 5.|understand that lAve are required to provide an as-built survey byalicensedlandsurveyorofailnewlyconstructedfacilitiespriortoissuanceofacertificateofoccupancy. |have read and agree to the above: PRINTNAME;JOSEPH Leacl SIGNATURE:Cw tr oate:_3fiz/o« ‘oO Buldine&Code Enforcement Pence Smarts Rewind March 208 Office Use Only FUEL BURNING APPLIANCE &Permit #:_PC.-8\32 -2029 CHIMNEY APPLICATION Permit Fee:$, Invoice #: 742 Bay Road,Queensbu,Ny 2804 P 515-761-8256 Project Location:3¢JoWm CLE~>oM Tax Map ID:299.1 °-2-3 Room of Install:Livin@ Recom Planned Install Date:A “ONE APPLICATION PER APPLIANCE* CONTACT INFORMATION: ©Applicant: Name(s):_FooTHies Buieoers ec (Jee ceucy) Mailing Address,C/S/Z:4_MeveTAimsin€De GQueensaue4 wy 2804 Cell Ph:1 (S18)VI 1933 bend Line:_((5/8)196-3520 (cew) Email:_FooTH its uindersny @ EMAIL.com *PrimaryOwner(s): Name(s):__SAme AS ArrLIC AWT. Mailing Address,C/S/Z: Cell Ph.:__()Land Line:__(). Email: ©Installer/Bi Name(s):__SAmMEe AS ApPricAnd Mailing Address,C/S/Z: Cell Ph.:__()Land Line:__(). Email: Contact Person for Building &Code Compliance:Sue LEWC! Cell Ph:(SUF _)991-1433 tand Line:(516)WWe=3sze (ceuey mMEmail:__Seeriter—te FooTHILLSBUILDE RSW YK AIL,Com Town of Queensbury Buide:&Coa Entrcerent FUEL BURNING APPLIANCE INFORMATION: TYPE OF DEVICE: Stove x Fireplace Insert FireplaceHITEMountainmoner DvD3eFP30N TAHOE DELUXE —Fuel Fired Equipment (Garage Only,B"clearance,‘per IMC 304.3) —Fireplace,factory built™* **Manufacturer's Name:Model #: SOURCE OF HEAT: Wood Coal Pellet CHIMNEY INFORMATION: __Masonry: block brick ‘stone Flue: tie (oes)!2.size.in inches Material: doublewall __triple-wall_Insulated (Manufacturer's Marne:Model #: ADDITIONAL INFORMATION: ‘1.Two inspections are required.A rough-in Inspection,prior to installation and a final Inspection,afterinstallation. 2 Manufacturer's installation manual must be available at the time of inspection.Masonry fireplaces &chimneys require plans to be submitted.4 Twenty-four (24)hour notification &required for nspections. Declaration;Construction/installation must conform to NYS Fire Prevention &Building Code and/or manufacturerrequirements.The applicant or owner agrees to comply with allapplicable laws,ordinances,regulations and allConditionsthatarepartoftheserequirementsandalsowillallowtheinspectortoenterthepremisestoperform therequiredinspections. Ihave read and agree to the above: PRINTNAME:JosePiy Leucy _ SIGNATURE :Que tur DATE:shielze Fuel Burning Appliance &Chimney Application SEPTIC DISPOSAL PERMIT APPLICATION 72 Bay Road Queensbury,¥.Ls04 PSI8-76 1°56 Perm (8-2-3 Project Location:2G Joy CLENd OW Primary Owners)|Foot Mites auicners ec (Soe Leuci)|| {TAI €DR _Quéessoury ry[Gsw)0-933 (Cs)16-3526|Same AS APPLICANT Offic Tax Map iD#298 [Engineer en tevtek Pe -ira Aadress Io]_Wavicams RO Queensaugt wy 12604Phone&Email (sig)146-2515 Teen TER36 @ YAHoo.Lem Contact Person for Building &Code Compliance:2&LEX prone:(S10)151-1433|RESIDENCEWroRMATIONSSSG18)AG352ERESIDENCENFORMATION.S18)AG 3520 Year Built #of bedrooms_|X gallons per bedroom _|=totaldaily flow Garbage Grinder Yes {nstalled?{circle one) ‘Spa or Hot Tub Yes Installed?{circle one)(Lo - Topography x Flat Rolling ‘Soil Nature XSand|Groundwater _Atwhat depth?/AaBedrock/mperviousm:Atwhat depth?wv /A, Domestic Water Supply K Municipal Well {if well water supply from any septic system absorption sl)Percolation Test Rate -S per minute per inch {test to be completed by licensed engheer/arcitect)PROPOSED SYSTEM FOR NEW CONSTRUCTION Tanksize (cov gallons {min size 1000 gallons add 250 gallons for each garbage cylinder or spalhol tub System|Absorptionfieldwith#2 stone Totallength j ¢o fiz EachTrench_fo ‘fi. Seepage Pitwith #3 stone How many:Size:_ Alternative System Bed or other type HoldingTank System “Total required capacity?tank size #of tanks NOTES:tAlarmsystem &associated electrical work must be inspected bya Townapproved electrical inspectionagency:2.We willno longer allow systems to be covered until such time as an as-built plan's received and approved.The installed system must match the septic layout on file-no exceptions. Declaration:Any permt or approval granted which is based upon or fs granted in reliance upon any materialrepresentationorfailuretomake@materialfactorcircumstanceknownbyoronbehalfofanapplicant,shall be void.|have read the regulations and agree toabide by these and alllrequirements ofthe Town of Queensbury Sanitary SewageDisposalOrdinance. PRNTNAME JOSEPH Levct DATE ali u sourure (WV ;-pare alirhe Wvaenstury Ena 8 Cove Enforcement Fey ‘Town of Queensbury ‘Thomas R.Van NessHighwayDepartmentHighwaySuperintendent742BayRoad,Queensbury,NY 12804 Home:518-745-0929Phone:518-761-8211 Fax:518-745-4466 David Duell Deputy Highway Superintendent Home:518-745-0938 DRIVEWAY PERMIT Date:Byig (22 Applicant Name:FoorHitts puwoers (we uci) Telephone No.:(s1g)791-1433 /(518)796-3520 ‘Address to be inspected: Return Address:G_mountamsiDE DE QueerSBury KY [204 Applicant must show exact location and width of driveway(s)to be connected to the highway by placing stakesatthespecifiedlocation. ‘The Superintendent of Highways of the Town of Queensbury has reviewed this application.The followingactionhasbeentaken: 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 Bung B Code Enforcement Principal Structure Application Revised February 2037