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PRINCIPLE STRUCTURE Office Use Only ‘ATIONPERMITAPPLIC; permit #:RC.-021 B+2020 Town of Queensbury Permit Fee:$-@ e 742 Bay Road,Queensbury,NY 12804 *Rec.Fee:§B50 —Vy BA -6d P:518-764-8256 www.queensbury net .:Invoice # Project Location:5 Aces Circle Tax Map #:3]S.lo -J-S27 SubdivisionName:_LJcst Mt Sshtes TOWN BD.RESOLUTION 86-2013:$850 recreation fee for new dwelling units:single family,duplexes/two-family, multiplefamily,apartments,condominiums,townhouses,and/or manufactured &modular homes,but not mobile homes.This is in addition to the permit fee(s), CONTACT INFORMATION:"a ©Applicant: Name(s):Cerrone hui ders Mailing Address,C/S/2:_/5 9%Rowte TFL Eduad NY 123723 Cell Phone:(51%_)724%7477 land Line:(5:3)1Z0*77S0 Email: +Primary Owner(s): Name(s): Mailing Address,C/S/Z:N\A Cell Phone:_()fc LA |NViakenine: 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): Contractor Trade:Zz y 4} Mailing Address,C/S/Z:LAME Cell Phone:_()—\TT land tine:_() Email: **List all additional contractors on the back of this form +Architect(s/Engineer(s): Business Name:__Vision Engi necany Contact Name(s):Dera Ban J Mailing Address,c/s/z:___20 (2 Gea <b. Cell Phone:_()landline:(519)7492 -F26y Email: Contact Person for Building &Code Compliance:2 daw s S imunte Cell Phone:(Si 6)124-7477)tand tin Email: () PROJECT INFORMATION: TYPE:__Commercial K Residential WORK CLASS: Xsingle-Family __Two-Family __Multi-Family(#of units __) ___Townhouse __Business Office __Retail __Hotel/Motel __Industria/Warehouse __Garage(#ofcars__)__Other(describe ) STRUCTURE SQUARE FOOTAGE GARAGE SQUARE FOOTAGE: a floor:|G3 ifloor:"YF 2"floor:2"floor: 3°floor: Basement (habitable space):Seo Total square feet:__1 V4| Total square feet:2132 ADDITIONAL PROJECT INFORMATION: Estimated Costof Construction:$4lb,v0-e Proposed use of the building:Residvha | If Commercial or Industrial,indicate the name of the business: Source of Heat:Gg2 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 {9 explain: .Are there any easements on the property?YES (Kip) SITE INFORMATION: ‘a.What is the dimensions or acreage of the parcel?1.04 acre b.Is this a corner lot?eS No c.Will the grade be changed asa resultafthe construction?YES @Q) d.What is the water source?PRIVATE WELL e.Is the parcel on SEWER or a PRIVATE SEPTIC system?Septic DECLARATION: |.lacknowledge that no construction shall commence prior to issuance of a valic)building permit and wor'<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 zoni 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 byalicense:land surveyor ofalnewlyconstructedfacilitiespriortoissuanceofacertificateofoccupancy. |have read and agree to the above: PRINT NAME:Cicer Sune ng SIGNATURE:Os LE pare.SU (8 _ NATURALLIGHT,VENTILATION &EMERGENCY EGRESS CALCULATION SHEET Project Location:Sf Ars Crk Primary Owner (s):Cesrone—Boildys Habitable|Sq.Ft.|Required|Actual|Required Actual Sq.ft Rooms|of Light Light|Ventilation|Ventilation|openingRoom|(8%ofrm.)|(sq.ft)|(4%of room)|(sq.ft)|for Egress Kleen|Gio|sud|az¢|ma|287Wal|ob|at|aa io bide WS Ve wi od 10.4 aeas|NA 1,0 60 \S a [a gh 4,0 WS.ana S [eR gai9lye|wa|at $a tootQuai»wesGeo|wh 1,0 wr we)\S Vegegsieet Que aa |eai awe “Wh Quae® Office Use Onl FUEL BURNING APPLIANCE &Permit #:__UC-02\@-2020 CHIMNEY APPLICATION Permit Fee:$ Invoice #: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 a Project Location:Aerts Ciel Tax Map ID:S-lo-1-57 Room of Install:Liss Ny ic n Planned Install Date:)-fo“1 **ONE APPLICATION PER APPLIANCE** CONTACT INFORMATION: ©Applicant: Name(s)Cerrone byt \Nor Mailing Address,c/siz:_\Q94_Wak 4 Pr ued Nt i 2H Cell Ph ($1.9)Jta-747)Land Line:(413)4-750 Email: ©Primary Owner(s): Name(s): Mailing Address,C/SIZ:al Cell Ph:_(_)NSU cand tine:CyEmaila 0 Check if all work will be performed by homeowner only e Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()land Line:_() Email: Contact Person for Building &Code Compliance:_(m Lan S AoneCellPh:(Sih)“TL 7417 Land Line:) Email: 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) __Fireplace,factory built** (**Manufacturer’s name:Maj est c model:Uh 36") SOURCE OF HEAT: __Wood __Coal ___Pellet _X Gas CHIMNEY INFORMATIOI ___Masonry (require plans to be submitted): block __brick __stone __Flue: __tile __steel____size,in inches ___Material*:double-wall _triple-wall ___insulated (*Manufacturer’s name:Mareotic Models:US 36 ) 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 notification is required for inspections. 5,Workers’Comp insurance information is required with this application. 1: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 conditions that are part of these requirements and also will allow the inspector to enter the premises to perform the required inspections. |have read and agree to the above: PRINT NAME: pate;_$721 20SIGNATURE:CJ Principle Structure Packet Revised February 2019 Office Use Only a p__ UCnr -2029|tee SEPTIC DISPOSAL PERMIT APPLICATION|Permit CC.-n2.\%>-2028 Septic Variance?Yes Wo 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Tax Map ID #:Zid \o-1-57 Project Location:GSAgesGicle©Applicant:Costs neName(s):oi\dos Mailing Address,C/S/Z:__1524 Yale V FT Elwer NY i068 Cell Phone:_(G1%_)_N14.41.Land Line:_(4t®)440-7750 Email:___Gicani G Ceitoae wilhoo-Com ©Primary Owner(s): Name(s): Mailing Address,C/S/Z: Cell Phone:_()NAV WU—tandtine:_() 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):Ered sonrbh Contractor Trade:Fscco oto Mailing Address,C/S/Z:Noma pve 3S ue OAH Cell Phone:_(S\}')HG (9456 land Line:_() Email: e Engineer(s): Name(s):Don Waa Mailing Address,C/S/Z:_JOG Glen St GE_NY-12701 Cell Phone:_()Land Line:(S1}_). Email: Contact Person for Building &Code Compliance:(aia ant Siurore Cell Phone:(Gi¥_)7924-741)Land Line:(Sit)ABo-159 Email: 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|fo} 1980 or older}150 Installed?(circle one) 1981-1991 130 Spa or Hot Tub Yes|Ne] Installed?(circle one)1992-Present|110 HO|4% PARCEL INFORMATION: Topography XC Fiat Rolling Steep Slope %Slope Soil Nature _XOSand eloam Clay —_Other (explain:) Groundwater At what depth? Bedrock/Impervious material|At what depth?ore =] Domestic Water Supply XMunicipal___Well (if well,water supply from any septic system absorption is___ft.) Percolation Test Rate:per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size [LZ gallons (min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub System Absorption field with #2 stone_|Total length ft;Each Trench @ ft Seepage Pit with #3 stone Alternative System Bed or other type’_| Holding Tank System Total required capacity?3 tank size 5 #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:(yones g Soave vare:_(p-4-20 SIGNATURE:=oate:_Go 4-29CO Principle Structure Packet Revised February 2018 ?Town of Queensbu:David Duellof2"y Highway SuperintendentHighway518-761-8212 Department 742 Bay Road —Queensbury,NY Mark Benware oso,Deputy Highway Superintendent 518-761-8210Phone:(618)761-8211 Fax:(518)745-4466 DRIVEWAY PERMIT DATE:~L\-29 APPLICANT NAME:Cerrone boil bus TELEPHONE NO.:516-114-107 ADDRESS TO BE INSPECTED:S Aores Circle RETURN ADDRESS:1534UAFrhu,NA trget 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 approved permit for a final approval. STEP 2:()Final Approval ()Rejected Date: David Duell,Highway Superintendent Mark Benware,Deputy Highway Superintendent