applications TOWN OF QUEENSBURY REVIEWED 8 r
COMMUNITY DEVELOPMENT DEPARTMENT I .
BUILDING & CODE ENFORCEMENT FEE PAID:
531 BAY ROAD
QUEENSBURY, NEW YORK 12804 PERMIT NO. (dels-,, -
(518) 745-4447
BUILDING PERMIT APPLICATION �•a- C,
ti
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO • - I S�
WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT. /
All applicants ' spaces on this application MUST be completed ands the -L'
signature of the applicant MUST appear on the application form. $Z93i�£
OWNER OF PROPERTY: (1 1 '-h cc,<. eS P l v✓`, e‘ 5•/y , tr2J- CP LL el S.6 t-�
Mailing Address : e 1 ,_C/{ Z2 y
Telephone Number(s ) : Work ! t� Other
PROPERTY LOCATION:
Tax Map Number: Section X Block Lot
Subdivision Name: Lot No .
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
CONSTRUCTION: $ 19 n()
NEW BUILDING:
RESIDENCE/COMMERCIAL OCCUPANCY INFORMATION:
r)!2.> ADDITION TO BUILDING: PRIMARY BUILDING -
RESIDENCE/COMMERCIAL Single Family Dwelling
ALTERATION TO BUILDING: Two Family Dwelling
RESIDENCE/COMMERCIAL Family Dwelling
(NO CHANGE TO EXTERIOR SIZE) office
OTHER WORK (DESCRIBE BELOW) Mercantile
Warehouse
Manufacturing
Other
GROSS AREA OF PROPOSED STRUCTURE:
1ST FLOOR 2.2 `! SQ. FT.
IF ADDITION, USE OF NEW ADDITION:
2ND FLOOR SQ. FT. 0,62 n
OTHER FLOORS SQ. FT.
(not unfinished cellar or basement) ACCESSORY BUILDINGS :
Detached Garage - One/Two Car
TOTAL FLOOR AREA: SQ. FT. Attached Garage - One/Two Car
Private Storage Building
SIZE OF NEW STRUCTURE : Commercial Storage Building
Other
FEET X FEET
Foundation Type: 1zr��r� Will any second-hand or ungraded
Number of Stories : I lumber be used? If so, for what?
(habitable space only)
Height (grade to ridge) : feet Type of Heating System:
Number of fireplaces and/or woodstove (circle all which applies )
to be installed: Electric / Oil / Gas / Wood
Forced Hot Air / Baseboard / Other
PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS :
NAME OF BUILDER/ADDRESS/PHONE: SS�"(-✓^ (c.11cc,._ j 2 ,IS ill Icy )54, -- 36' ^
NAME OF PLUMBER/ADDRESS/PHONE:
NAME OF MASON/ADDRESS/PHONE :
NAME OF ELECTRICAN/ADDRESS/PHONE : .5c-
DECLARATION
To the best of my knowledge the statements contained in this appli-
cation, 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
drawn to scale, showing actual location of pryb ect o� e ses .
Signaturen us F�
(Owner, owner's agent, architect, contractor)
FOR ANY SPECIAL PROVISIONS - SEE REVERSE SIDE:
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY,WARREN COUNTY000HEATINGDEGREEDAYS
Compliance Me:ds:PART 5 -Acceptable Practice Method -182 Family Dwellings (only)PART 6*-Thermal Rating -Component Trade Offs1&2 Family Dwellings;Multi-FamilyDwellings(3 stories or less)PART 4*-Design by Component PerformanceCommercialBuildings-Hi Rise Residential*Requires submission of worksheets
APPLICANT'S NAME:PROPERTY LOCATION:
Shesn Gehan Rider Roce (a2)
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTIC!
1.Gross Floor area -__22 |square feet
2.‘Type of Heat -Electric _X oil Gas Other
3.Is building mechanically cooled?Yes 4.No
4.Percentage of area of windows and doors over 178 _K under 173
5.R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES ASSHOWNONPLANSSUBMITTED:a.Roof rR 3%b.Exterior walls R44c.Glazed areas Rd.Exterior doors Re.Floors over unheated spaces R Bof£..Edge of slab on grade (heated building)Rg.Basement/cellar walls (above grade)Rh,Basement/cellar walls (below grade)Ri.Heating/cooling-ducts-piping in unheated space R
6.Service (domestic)hot water heating deviceConformstominimumefficiencypercode Yes No
TEMPERATURE CONTROL MAXIMUM SETTING 140°~WILL NOT BE EXCEEDED
Applicant'sbe ature Date,Phone Numberfar73656-3010
INSPECTOR’S REMARKS: