application , \___
�4-wilding P erm. it ApP lication ,._ ,_ ,.
Town O,f QLeensbury - Dept. of community Development, 742 Bay Road, Quee„sbu,y, NY 128-4 [761-8256]
BUILDING & CODE ENFORCEMENT
NOTic1 . . . . .Requirements prior to issuance - r . .
A permit must be obtained before
of this permit: .PERMIT FILE NO. r�<-1M-b ��
beginning construction. No inspections •
PERMIT FEE PAID$� a)/
. will be made until applicant has received 11-:.fing Board Action
,-;-,' Zon
a VALID BUILDING PERMIT. All Area /Use //_/' '
applicants' spaces on this application —. /�ly7cs.er-s / D
MUST be completed atid•the signature [] Planning Board Actions` REVIEWED BY•
of the applicant•must appear on the vh ti /� - -S'
SPR / Subdivision /Other i S• fi,ding Inspector
lication.form. � y,. 5�
'"` J Recreation Fee Payment �o" ---1,, -
Applicant. i//�r�`.�r� Owner: •� � -� J
Address: 7‘,- �' , Address: &-`'� �--
Phone # ( ) /f2- f Phone # •( ) f7- ems
Property Location: /�'`�� �' / -M � .' . /
• Tax Map Number /4 . _`- ��
Subdivision Name: —
- Section Block' lot
NATUR OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THEg.25.6,pc) 2
. _.../ New New Bum di-ng:_ CONSTRUCTION: $ - 2_5
n-ee' / commercial
Addition to Building:
residence / commercial OCCUPANCY, INFORMATION:
Alteration to Building: Primary Building -
residence / commercial /,mangle Family Dwelling
i Residence / Commercial Two Family Dwelling
no change to exterior size . Family Dwelling
'i Office
Other Work " (describe below) Mercantile
Manufacturing
•
-��� Other
GROSS AREA OF PROPOSED STRUCTURE;/
If • ADDITION, what will use
1st Floor /3�'� s ft .� y 'K of new, addition be? :
2nd .Floor • fee,- sq. ft. VD
Other Floors sq. ft.
(not unfinished cellar or basement) ACCESSORY BUILDINGS: ?
Detached Garage 1, 2 car
TOTAL FLOOR AREA: -2-/,17 SQ. FT. 1/Attached Garage 1,
Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building
LII Other •
FEET X FEET
•
Foundation Type: e.- Will any second-hand or ungraded
' Number of Stories: lumber be used? f o; for what?
(habitable space only). e .,-
Height (grade to ridge): 26.- feet TYPE OF` HEATING ,SYSTEM:
Number of fireplaces and/or -w� . ove (circle all which a lies) •
to be installed: ,/' Elec '-c—/LQil/4-4si/ Wood
rced Hot Aire Baseboard / Other
Person responsible fo u ervi 'on of work as regards l bu ding
codes is : � � /I-� '� �/ - E ' v..,.. ,c � 2.�z..„??
Name Addresss Phone
Builder: iez� ��
Plumber: i/ i ,
• Mason: A," • >, -, �
Electrician: , i'.-- -yp
DECLARATION: Please sign below after you have carefully read the statement.
To the best of my knowledge the statements contained in this application, together with the plans •
and specifications submitted, are a true and complete statement of all proposed work to be done on
the described premises and that all provisions of the Building Code, the Zoning Ordinance and all •
• other laws pertaining to the proposed work shall be complied with, whether specified or noted, and
that such work is authorized by the owner. Further, it is understood that I/we shall submit prior to a
Certificate of Occupancy'or Certificate of Compliance being issued, an AS.BUILT PLOT PLAN by •
a licensed surveyor; drawn scale, show' g actual location of project on premises. •
Signature:
(owner, owner's agent, architect, contractor)
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury L/ fiu(/��d
Dept. of Community Development Permit No.
Building &Codes Office
742 Bay Road Fee Paid S
Queensbury, NY 12804
Location of property for installation: l �/�� G% % 24
�
Property Owner's Name: -�/,7,e�4€ ` ??, , ���� -
Property Owner's Mailing Address:
Installer's Name: � " �i��//' Phone #
• Number of bedrooms (if residential): Total daily flow:
(residential - compute @ 150 gal./bdrm.)
pography: ' rat, rolling, steep slope % of slope
• Soil Nature: sand, loam, clay, other I depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: not required, required [rate min. per inch]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is / --feet.
PROPOSED SYSTEM
Septic tank: anon (minimum size: 1,000 2a1.)
Tile field: each trench feet / Total system Iength: feet
Seepage pit(s): number of / size each: , ft. by ft.
Size of stone to be used: # / depth or thickness feet
•
HOLDING TANK SYSTEM: (if required) r
Number of tanks: Size of each: Pilo"FEB 01 2000
(AISXm system an associated electrical work to be inspected by a certified agm --
01F;
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any perm or
approval granted which is based upon or is granted in reliance upon any material misrepresentation 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 with respect to this application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: i � `� ` Date: 7 0�,
II
tf
TOWN OF QUEENSBURY
i; 742 Bay Rd., Queensbury, NY 12804 f
APPLICATION FOR SOLID FUEL BURNING APPLIANCES AND CHIMNEYS
II
_ • it 5r
�� : -C
Date . /` ,19 .j'" Permit No. 1
I'
APPLICATION IS HEREBY MADE to the Building Dept. for the issuance of a Building and Use Permit•
pursuant to the New York State Fire Prevention and Building Code. 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
all inspectors to enter premises to perform required inspections. -
Please fill out additional,form if more than one appliance and/or chimney.
i
Applicant f,. ° - , --j -°4, APPLIANCE (check appropriate boxes).
,,
Address 2,-- t--,-;,,- -,-„.`_ OVE: o.Woo ❑ Coal o Pellet o Gas
/ 0 FIREPLACE INSERT
,. Zip ' = 0 FIREPLACE, FACTORY-BUILT:
11 ❑ Wood ❑ Gas
Phone - ❑ FIREPLACE, MASONRY:
,. .- ❑ Wood ❑ Gas
Owner � °` ,'r' ';,.. :: ,Fa„,,� .,,7 ,.. . 0 FURNACE: ❑ Wood ❑ Gas ❑ Oil
Address •
`� r'r IF NON-MASONRY APPLIANCE:
s Manufacturer:
%- Zip 1 �-c- Model:
'.Phone ' . "-?
CHIMNEY (check appropriate boxes)
*EXACT ADDRESS of proposed construction
,I! f�' ® MASONRY: ❑ Block ❑ Brick ❑ Stone
} "` l FLUE: ❑ Tile b.-St-eel
Size: , .:2` inches . .
CONSTRUCTION / INSTALLATION MUST 0 FACTORY-BUILT:
CONFORM TO NYS FIRE PREVENTION & Manufacturer: Model:
BUILDING CODE. CONSULT AVAILABLE Listed By: , Number:
TOWN OF QUEENSBURY HANDOUTS 0 Double Wall I -Triple Wall
REGARDING REQUIRED INSPECTIONS. 0 Insulated ❑ Direct Venting
f
0 Chimney Liner
Cashieir's Department Town-of Queensbury, New York
Dept: Fire Marshal If Amount Collected Amount Refunded
Code Number Title '}5 .!i
A 173 3389 (190) Public Safety d
A 233 2655 (230) Minor Sales
Fee Collected..From or Refunded to: :;i'T:/,.,.., - '/ e la ..5 ?
Address:_ .-1"›,1...,
I; `�`. t" t l
Dated: , / ,"15.0 Town Clerk. or Deputy: , _ , k
White: Applicant Green: Fire Marshal Yellow:Bldg. Dept. Pink & Goldenrod: Cashier's Dept.
Ij
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