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i : eI i IM, PRINCIPLE STRUCTURE Office Use Only PERMIT APPLICATI ON ---- Permit#: G ---ems I 5 Totivn ofQucens6ury Permit Fee: $Q 742 Bay Road,Queensbury, NY 12804 *Rec. Fee: $ P: 518-761-8256 www.queensburynet Invoice#: Project Location:�� ih �' C- Lo'� 2-- Tax Map #: k5" 2-5 Subdivision Name: F119Q Ct TOWN BD.RESOLUTION 86-2013:$850 recreation fee for new dwelling units: single family, duplexes/two-family, multiplefamily, apartments,condominiums, town houses,and/or manufactured & modular homes,but not mobile homes. This is in addition to the permit fee(s). CONTACT INFORMATION: • Applicant: _ _ Mailing Address, C/S/Z: 3 5- Fr,0,vf S7" l.A/<v 6ecr&2 /J Y• �33�y5 Cell Phone: ( 5 l ) 36,T �-8 7 �t. Land Line: �) Email: CJ,rw f-,< a,J b <:011,1 • Primary Owner(s): -� Name(s): ie,izi Ce lle p Fnn rL Mailing Address, C/S/Z: a jj, e f11 Cell Phone: ) rAtoe Land Line: 5 2020 Email: ,; 8 A , `J f3UlLDlt�►:.`uL`'B�lS�tlr�Y ❑ Check if all work will be performed by homeowner only - • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): #k, I/1—P 6nPJf- �/JC Contractor Trade: CT Mailing Address, C/S/Z: Z Ce/A//P CAJ- A)A-cry rf l& �U • '� 1 %��i Cell Phone: —( /,9 ) 3( !wry yI' Land Line: �) Email: "List all additional contractors on the back of this form • Arch itect(s)/Enciineer(s): Business Name: (ira,y xi iU Contact Name(s): S'Ahjg Mailing Address, C/S/Z: Cell Phone: Land Line: Email: Contact Person for Building & Code Compliance: Cell Phone: S/Y ) 365- SF3. z Land Line: �) Email: t f1/,�P Princinle Structure Packet Revised February 2019 I PI4OJECT'INFORMATION: TYPE: Commercial _ Residential WORK CLASS: ✓ Single-Family Two-Family _Multi-Family(#of units ) Townhouse Business Office _Retail —Hotel/Motel IndustrialMarehouse —Garage(#ofcars _Other(describe ) STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE: 11T floor: j 11T floor: 9 (:,6 2"d floor: 2"d floor: 3 rd floor: Total square feet: I 0 Basement(habitable space): Total square feet: 7.57 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: $ L] L( I/ 2. Proposed use of the building: S tLv) 3. If Commercial or Industrial, indicate the name of the business: 4. Source of Heat- G 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? YES Explain: 6. Are there any easements on the property? YES0 7. SITE INFORMATION: a. What is the dimensions or acreage he parcel? /JID '� b. Is this a corner lot? YES Ptof c. Will the grade be changed as a resu the construction? YES NO d. What is the water source? UBLI PRIVATE WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system? S e _ . RovicPd Fahniary 9019 J DECLARATION: I. 1 acknowledge that no construction shall commence priorto ussuance of a valid building permit and work wi II 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. 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 regulations. 4. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 5. 1 understand that INve are required to provide an as-bui It 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: PRINTNAME: K'? 'j Co 11'eTl P SIGNATURE: �� DATE: Prinrinla Ctnirtura Pnrkat RPVI[Pfi Fahninry 7n19 G � � Office Use Only FUEL BURNING APPLIANCE & Permit#: ?-rz-gb52."102t� CHIMNEY APPLICATION Permit Fee:$ Invoice#: 742 Bay Road,Queensbury, NY 12804 P:518-761-8256 www.queensbury.net Project Location: - fAiAlu Y Tax Map ID: Room of Install: LWILr k6_111 Planned Install Date: 1 **ONE APPLICATION PER APPLIANCE** CONTACT INFORMATION: • Applicant: Name(s): Mailing Address, C/S/Z: _ 3,? Ce llc 17-r L,&I • Ac,i t-AJ/S �%� �• �,�g ?Q Cell Ph.: _( ,�-/I? Land Line: Email: • Primary Owner(s): Name(s): gelu C. %/N Ife Mailing Address, C/S/Z: Cell Ph.: _( /5' ) E 5 S 5' 3 2 Land Line: _O Email: ❑ Check if all work will be performed by homeowner only • Installer/Builder: Workers' Comp documentation must be submitted with this application Contact Name(s): R;Plu C&A-r Contractor Trade: 64 C Mailing Address, C/S/Z: S,/ig) r Cell Phone:_( ) Land Line: _( ) Email: Contact Person for Building & Code Compliance: k-IV/U lklre Cell Ph.: _( ) �,�r>>F Land Line: _( ) Email: Principle Structure Packet Revised February 2019 FUEL BURNING APPLIANCE INFORMATION: J TYPE OF DEVICE: Stove _ Fireplace Insert _ Fireplace Fuel Fired Equipment (Garage Only, 18" clearance per IMC 304.3) Fireplace, factory built** (**Manufacturer's name: 14,ir f 6/a Model #: aV ) SOURCE OF HEAT: Wood _Coal _ Pellet ZiG a s CHIMNEY INFORMATION: Masonry (require plans to be submitted): block brick stone _ Flue: / r/ tile ✓ steel size, in inches Material*: ©iRe ct veor double=wall _triple-wall _insulated (*Manufacturer's name: 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 notification is required for inspections. 5. Workers' Comp insurance information is required with this application. 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: #0 SIGNATURE: �1"" DATE: Principle Structure Packet Revised February 2019 C � � Office Use Only Town ofQuccn ry SEPTIC DISPOSAL PERMIT APPLICATION Permit#: ex,-ocpgL • ZO 2iu Permit Fee: $ ; Invoice#: Septic Variance? Yes No 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Tax Map ID#: Project Location: 1-1-1 1P-P«n '(2T • Applicant: Name(s): to//9//-'P G4A �L Mailing Address, C/S/Z: [o//P-j# L,�- 14u(P- o J Cell Phone:_( Land Line: _( ) Email: • Primary Owner(s): Name(s): lepi C� Me /)� Mailing Address, C/S/Z: '3 5- f=,-aj,-r St L4 . J D RYS' Cell Phone:_( 'I-V ) ,rS� Land Line: _( ) Email: ❑ Check if all work will be performed by homeowner only • Contractor: Workers' Comp documentation must be submitted with this application Contact Name(s): A) . CeI/TPe Contractor Trade: Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( ) Email: • Engineer(s): Name(s): Q&L> ��►r•� Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( 75 2 9 6 0 LI Email: Contact Person for Building & Code Compliance: kVIIJ G Me Cel I Phone: J 61 Land Line: ( ) 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 No 1980 or older 150 Installed? (circle one) 1981-1991 130 Spa or Hot Tub Yes No Installed? (circle one) 1992-Present 110 3 //0 30 PARCEL INFORMATION: Topography Flat Rolling Steep Slope %Slope Soil Nature _Sand Loam _Clay _Other(explain: ) Groundwater At what depth? Bedrock/Impervious material At what depth? Domestic Water Supply _✓Municipal _Well (if well,water supply from any septic system absorption is ft.) Percolation Test Rate:_L�j_per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size I_j��_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_2p 3 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 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. 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: kC e/0 C6 j/.hr., DATE: i l 1/16 421 SIGNATURE: DATE: Principle Structure Packet Revised February 2019 Town of Queensbury Davin nueu ,! ' •� Highway Superintendent Highway 518-761-8212 Department Mark Benware 742 Bay Road—Queensbury, NY Deputy Highway Superintendent 12801 Phone: (518) 761-8211 518-761-8210 Fax: (518) 746-4466 DRIVEWAY PERMIT DATE: zl l q l :90 APPLICANT NAME: IA C, TELEPHONE NO.: ADDRESS TO BE INSPECTED: �,,'� C-T' RETURN ADDRESS: 3,p (-o N `/;- LA FA Ils , lu, a . 1 S? 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 ( j 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 TOWN OF O UEENSBURY 742 Bay Road, Queensbury, STY. 12804-5902 Se"tic System Checklist Plan to scale 16 eceived Deep hole perc test results from.engineer/Architect if applicable(Town Approved ZEn ineers and Archutects)(Ju ne 30 to April 15 Town lEngineer for unapproved Engineers and ArPchiteces) ll wells on property and adjacent properties shown �lWater line shown Municipal or well 10'separation to any part of system jaSetback.to property lines show 10'or more for any part of system Septic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'frorvr any waterline Septic tank to foundation crawl space/slab on grade,grade in crawl space must be above top of septic tank for 0',Separation required (field verification required) Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage,grrindereach ?: Leech Field 20'from foundation 100'from any well 10'from water line Seepage.pit 150'from well 50"from septic.tank Seepage Pits 3-times diameter apart Septic tank and pump stations over 30 gallons 50'from watercourse or-wetland t�distance from bottom of trench or system 24"to bedrock or mottling 36"within 1000'of lake george 9- Leech field 100'from watercourse or wetland NLkToe of mound or bottom of retaining wall 10'from property line 100'from well 20'ftom Foundation Va Provide Engineer/Architect stamp for bed or design systems oepartrnent of Health Approval for all rnobiie home park new systems Flood Plain requirements j1 2'above established flood elevation to bottom of system h�_AII tanks anchored or 2' above-flood elevation " Home of Natu.ral Beauty ... A. Good Flaee to Dive " G�Z - 20 2,<5 Residential Plan Review: 1- and 2- Family Dwellings Y/N/NA (1 of 2) Two (2) full sets of plans Over 1,500 sq. ft. requires engineering stamp Design loads on plans: 115 Wind Floor Loads 40 psf (North of Rte. 149 60) 50 Ground Snow Load Sleeping Areas &Attics 30 psf Calculations Decks 40 psf Wind design for lake front properties x. Light and vent room schedule Window schedule with glass size & main doors/Air leakage < .5 cfm for doors, < .3 cfm for windows/Tempered glass in bathrooms ' Door schedule/Main entrance 36" door Emergency Escape or Bedrooms & Habitable Space y Above-grade: 5.7 sq. ft. Grade: 5.0 sq. ft. YV24" (h)x 20" (w) minimum 44" maximum height above door Window control devices 24" or less 2"d story or 72" above grade Egress window from basement 5.0 sq.ft. Floor system sizing per table 502.3.1 Residential check ERI or Prescriptive method All foam plastic on foundation &crawl space covered by 15 minute thermal barrier Driveway length: 300' or more-12' width required/500' or more, turnaround required Foundation drainage on plans, if required — ti . t'� 6" drop in 10' exterior grade Framing cross section for each roof line, vertical fire stopping every 10' where required/joist spans pg. 127 Ice & snow shield—24" from exterior wall Platforms at exterior doors t Stairway headroom 6'8"; all stairs 36" width Stair run and rise Winder run and rise ► Spiral stairs meet requirements Smoke detectors—battery backup & proper location, interconnected Bathroom fixtures—proper clearance Hall width-36" width Handrails more than four risers on open sides Railing&guards > 30"/basement stairs included/closed risers more than 4" in height Safety glazing notes for required areas A/,dM— y Garage fire separation: %" gable end/5/8" under living space &%" on walls/20 min. door and closer Garage floor sloped Residential Plan Review Revised August 2020 Residential Plan Review: 1- and 2- Family Dwellings j Attic access: gasket seal & R-value equal to roof insulation Roof over 30"—22" x 30"/Crawl spaces 18" x 24" access Y/N/NA (2 of 2) Carbon Monoxide detector outside lowest sleeping area, on every level & interconnected l)� within 15' of sleeping area Soil test results, if required Septic to well or water line separation All paperwork signed J� Note on plans energy saving light bulbs 6b/ Blower door test agency paperworkPIC Floodplain Permit required—check map: 2 feet above flood elevation Hurricane clips required Floors less than 2 x 10 covered by%" gypsum or 5/8" wood panel 414_Z.X`o Manuals S &J required for heating system. Cold air return hard piped Separate room for draft HVAC or hot water heater with fresh air HRV shown and calculations Baffles at eaves for insulations and knee walls Makeup air for range hood >400 cfm -1--c 4 Continuous header for garage doors to end wall/3" nailing pattern/strapping Chimney rain cap shown for fireplaces Deck hold down shown not less than 4 lags and bolts per table 507.2 Residential Plan Review Revised August 2020