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applications Office Use Only PRINCIPL TRUCTURE RMIT----_._-permit#: lC 071q- ?vIq ' A p9a-Grg 11 \V Town of Queensbury i ermit Fee DEC 0 6 2019 I Rec. Fee:$ �S'O.00 742 Bay Road,Queensbury, NV 12804 I voice#: o�a`6 P: 518-761-8256 www .queensburyn TOWN OF�:UELNSBU Ye t:01)Ps Project Location: 45 Richmond Hill Drive Tax Map #: 308.7-1-48.4 Subdivision Name: Barringer Heights 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: • Applicant: Name(s): David Howard Mailing Address, C/S/Z: 500 Luzerne Road, Queensbury, NY 12804 Cell Ph.: L518i361-0714 Land Line: ( ) Email: howard35_2000@yahoo.com • Primary Owner(s): Name(s): David Howard Mailing Address, C/S/Z: 500 Luzerne Road,Queensbury, NY 12804 Cell Ph.: (518)361-0714 Land Line: ( ) Email: howard35_2000@yahoo.com • Contractor(s): Name(s): DDDJ Enterprises Mailing Address, C/S/Z:470 West Mountain Road, Queensbury, NY 12804 Cell Ph.: (518)361-0714 Land Line: ( ) Email: howard35_2000@yahoo.com • Architect(s)/Engineer(s): Name(s): Rucinski Hall Architecture Mailing Address, C/S/Z: 134 Dix Ave, Glens Falls, NY 12801 Cell Ph.: ( ) Land Line: (518)741-0268 Email: ephall@nycap.rr.com Contact Person for Building & Code Compliance: Ethan Hall Cell #.: ( ) Land Line: (518)741-0268 Email:ephall@nycap.rr.com Principle Structure Application Revised January 2019 4 Y PROJECT INFORMATION: TYPE: 0 Commercial ® Residential WORK CLASS: Single-family ❑ Two-family ❑ Multi-family (#of units: ❑ Townhouse ❑ Business Office ❑ Retail ❑ Hotel/Motel ❑ Industrial/Warehouse ❑ Garage (#of cars_J ❑ Other (describe STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE: 1ST floor: 1607 1ST floor: 525 2"d floor: 2"d floor: 3rd floor: Total square feet:_525 Basement(habitable space): Total square feet: 1,607 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $_150,000 2. Proposed use of the building:_Single Family Residence 3. If Commercial or Industrial, indicate the name of the business: 4. Source of Heat: ®Gas ❑Oil ❑Propane ❑Solar ❑Other: (Fireplaces need a separate Fuel Burning Appliances&Chimney Application, one per appliance) 5. Are there any structures not shown on the plot plan? OYES NO Explain: 6. Are there any easements on the property? DYES ►0 NO 7. SITE INFORMATION: a. What is the dimensions or acreage of the parcel? _45,175 SF b. Is this a corner lot? DYES ®NO c. Will the grade be changed as a result of the construction? OYES ®NO d.What is the water source? ®PUBLIC ❑PRIVATE DWELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? _Private Principle Structure Application Revised January 2019 DECLARATION: I. I acknowledge that no construction shall commence priorto issuance of a valid building permit and work will be completed within a 12 month period. 2. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees and department approva I. 3. I certify that the application, plans and supporting materials are a true and complete statement and/or description of the work proposed, that all work will be performed in accordance with the NYS Building Codes, local building laws and ordinances, and in conformance with local zoning regulations. 4. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 5. I understand that INve are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities priorto issuance of a certificate of occupancy. I have read and agree to the above: PRINT NAME: David Howard SIGNATURE: DATE: /G/ • Principle Structure Application Revised January 2019 Office Use Only FUEL BURNING APPLIANCE & Permit#: ' CHIMNEY APPLICATION Permit Fee:$ Invoice#: Tannof Queensbury 742 Bay Road, Queensbury, NY 12834 P: 518-761-8256 www .queensbury net Project Location: _45 Richmond Hill Drive Tax Map ID: 308.7-1-48.4 Room of Install: Family Planned Install Date: Mar 2020 **ONE APPLICATI ON PER APPLIANCE** CONTACT INFORMATION: • Applicant: Name(s): David Howard Mailing Address, C/S/Z: 500 Luzerne Road,Queensbury, NY 12804 Cell Ph.: (518)361-0714 Land Line: ( ) Email: howard35_2000@yahoo.com • Primary Owner(s): Name(s): David Howard Mailing Address, C/S/Z: _500 Luzerne Road, Queensbury, NY 12804 Cell Ph.: (518)361-0714 Land Line: ( ) Email: howard35_2000@yahoo.com • Installer/Builder: Name(s): DDDJ Enterprises Mailing Address, C/S/Z: 470 West Mountain Road, Queensbury, NY 12804 Cell Ph.: (518)361-0714 Land Line: ( ) Email: howard35_2000@yahoo.com Contact Person for Building & Code Compliance: Ethan Hall Cell Ph.: ( ) Land Line: (518)741-0268 Email:ephall@nycap.rr.com Principle Structure Application Revised January 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:_Quadrafire QV-32 Model#:_QV-32 SOURCE OF HEAT: ❑Wood ❑Coal El Pellet ®Gas CHIMNEY INFORMATION: ❑ Masonry(requires plans to be submitted): ❑ block ❑brick CI stone El Flue: ❑ tile ❑ steel _size, in inches El Material*: El double-wall ❑ triple-wall ❑ insulated (*Manufacturer's name:_Quadrafire Model#: ADDITIONAL INFORMATION: 1. Two (2) 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. Declaration: 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. I have read and agree to the above: PRINT NAME: _David H• - • SIGNATURE: DATE: C, Zo/q Principle Structure Application Revised January 2019 SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only Permit#: Q.0 - all— 20 ( Town of Quccnsbury Permit Fee:$ •all- #: 742 Bay Road,Queensbury,NY 12804 Septic Variance? Yes No P:518-761-8256 www.queensbury.net • Primary Owner(s): Project Location:_45 Richmond Hill Road_ Name(s): David Howard Tax Map ID#:_308.7-1-48.4 Mailing Address, C/S/Z: 500 Luzerne Road,Queensbury, NY 12804 Cell Ph.: (518)361-0714 Land Line: ( ) Email: howard35_2000@yahoo.com • Installer/Builder: Name(s): DDDJ Enterprises Mailing Address, C/S/Z: 470 West Mountain Road,Queensbury, NY 12804 Cell Ph.: (518)361-0714 Land Line: ( ) Email:_howard35_2000@yahoo.com • Enuineer(s): Name(s):_Rucinski Hall Architecture Mailing Address, C/S/Z:_134 Dix Ave, Glens Falls, NY 12801 Cell Ph.: ( Land Line: (518)741-0268 Email: ephall@nycap.r..com Contact Person for Building&Code Compliance: Ethan Hall Cell Ph.:(518)260-2888 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms X gallons per =total daily flow per day bedroom 1980 or older 150 _ _ _ Garbage grinder installed?❑ yes ® no 1981-1991 130 _ _ _ Spa or hot tub installed? ❑yes ►� no 1992-Present 110 3 110 330 PARCEL INFORMATION: Topography ►I Flat Rolling ❑Steep Slope %Slope Soil Nature ®Sand El Loam ❑Clay ❑Other Click or tap here to enter text. Groundwater At what depth?+64 inches Bedrock/Impervious material At what depth? NA Domestic Water Supply ll Municipal ❑Well(if well,water supply from any septic system absorption is_ft.) Percolation Test Rate:_1'—30"_per minute per inch(test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size _1,000_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_150_ft.; Each Trench_2_ft. Seepage Pit with#3 stone How many: :Size: Alternative System Bed or other type: Holding Tank System Total required capacity? :tank size ;#of tanks NOTES:1.Alarm system&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. 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. I have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: _Davi ward SIGNATURE: DATE: 6 / Zo!q Principle Structure Application Revised January 2019 g Town of Queensbury David Due11 Highway Superintendent Highway '<t t 518-761-8212 Department 742 Bay Road-Queensbury,NY Mark Benware Deputy Highway Superintendent 12801 Phone: (518) 761-8211 ��.— S18-761-8210 Fax: (518) 745-4466 DRIVEWAY PERMIT DATE:_3 April 2019 APPLICANT NAME: David Howard TELEPHONE NO.: 518-361-0714 ADDRESS TO BE INSPECTED:_45 Richmond Hill Drive RETURN.ADDRESS:_500 Luzerne Road _Queensbury,NY 12804 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: El Preliminary Approval NEED: ❑ Slight swale O Deep swale O Level with the road ❑ Level with the top of the paved wing Size culvert pipe to be used (if necessary) ❑ 12" 0 15" 0 18" Cl 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 Principle Structure Application Revised January 2019