applications 1-1-67-2- &te-e7,9C( VinD LY/117
Office Use Only
Permit#: /2C 17 3 v (7
PRINCIPLE STRUCTURE PERMIT
•
APPLICATION Permit Fee:$ "o 1 O •�p
TOW of cILaecr xbur} *Rec Fee: $
/f P P‘), POO
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Invoice#: Dc1' \
Project Location: Ui J-ec,NsVziy
1
Tax Map ID#: 9,1 L — t --1 Subdivision Name:
*TOWN BD.RESOLUTION 86-2013: $850 recreation fee for new dwelling units: single family,duplexes/two-family, I/
multiple family, apartments, condominiums,townhouses, and/or manufactured & modular homes, but not mobile
homes. This Is In addition to the permit fee(s).
CONTACT INFORMATION: "1.6) ECIEEIV/ E0
• Ap Iicant: a :
R �
Name(s)., T
Mailing Address C/S/Z: 3o t3�N tZ� �msw�� T�..1 '-f NYCd W 1 QuLIEILSBURY
Y t7E�°ELC�PMEP,IT
Cell Phone: ( 5 ) 3kx>5 . 1249 Land Line: ( )
Email: T O tv-� c va-c\s Cc
• Primary Owner(s):
Name(s): 1� ).._\c.,.T
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ,44414
Email:
A
• Contractor(s): vr,"
A
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
• Architect(s)/Engineer(s):
Business Name: A1/41.\n -e .J • \- 01AID It 'P.E.. P.C •
Contact Name(s): p��a�sz� �oN,c�•t
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
Contact Person for Building &Code Compliance:
Cell Phone: ( ) Land Line: ( )
Email:
Town of Queensbury Building&Code Enforcement Principle Structure Application Revised February 2017
PROJECT INFORMATION:
TYPE: Commercial
WORK CLASS:
)4, Single-Family Two-Family Multi-Family(#of
Townhouse Business Office Retail Hotel/Motel
Industrial/Warehouse Garage(#ofcars ) Other(describe
STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE:
isT floor: 2 t`a).(:,2- 'is 1ST floor: 914
2nd floor: 09 41 2nd floor:
t,1•
I66r: , "2)0 efYl\-1/*(LIA •
Ps Total square feet: '11 43
4th floor:
Total square feet: S \'11 c1/23
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ LI `JOioo0
2. Proposed use of the building: '-- \%4c--O-e- FAAQi t
3. If Commercial or Industrial, indicate the name of the business:
4. Source of Heat (circle one): 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 -1C1Explain:
6. Are there any easements on the property? YES c15))
7. SITE INFORMATION: 403
a. What is the dimensions or acreage of the parcel? 4664 P-C__
b. Is this a corner lot? 1I NO
c. Will the grade be changed as a result of the construction? YES NO
d. What is the water source? U B PRIVATE WELL
e. Is the parcel oneifor a PRIVATE SEPTIC system?
PrIP.C;Die
DECLARATION:
|. | acknowledge that noconstruction shaUcornrnence priorto issuance ofavaUd bui|ding permit and
work will be completed within a 12 month period.
2. |f the work is not completed by the l year 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
[odes, local building laws and ordinances, and in conformance with local zoning regulations.
4. | acknowledge that prior to occupying the facilities proposed |, or my agents, will obtain a certificate
of occupancy.
5. |also understand that |/we are required to provide an as-built survey bya licensed land surveyor of all
newly constructed facilities prior to issuance of a certificate of occupancy.
| have read and agree tm the above:
PRINT NAME:
i \
SIGNATURE: ~~~~~~- [)ATE:
Town o/uveen,uury Building&Code Enforcement Principle Structure Application Revised February zon
CHECKLIST—SINGLE FAMILY Project Location: ti2 C-rol'kh Qi‘J`e-
REQUIRED—2 SETS YES NO N/A
1. Building Permit application, completed
2. Energy Code inspector's report from REScheck, completed & signed
3. Septic alteration application, if applicable
4. Solid Fuel Burning or Gas Appliance form completed, if applicable
5. Driveway Permit, if applicable
6. Structural Drawings:
a. Floor plans
b. Foundation plans
c. Cross Sections
d. Elevations
e. Window & Door Schedule
f. Natural Light, Ventilation & Emergency Egress
7. Plot Plan: Show proposed structure(s) with setback dimensions
from all surveyed property lines
8. Electrical inspection agency selected
CHECKLIST— MULTI-DWELLING/COMMERCIAL Project Location:
REQUIRED—2 SETS YES NO N/A
1. Building Permit application, completed
2. Energy Code inspector's report from COMcheck, completed &
signed
3. Septic alteration application, if applicable
4. Solid Fuel Burning or Gas Appliance form completed, if applicable
5. Driveway Permit, if applicable
6. Structural Drawings:
a. Floor plans
b. Foundation plans
c. Cross Sections
d. Elevations
e. Design loads including floor, snow & wind load
f. Seismic design
g. Plans signed & sealed by registered architect or engineer
h. Window & Door schedule
7. Plot Plan: Show proposed structure(s) with setback dimensions
from all surveyed property lines
8. Electrical inspection agency selected
9. FINAL AS-BUILT PLANS SUBMITTED ELECTRICONICALLY
Town of Queensbury Building&Code Enforcement Principal Structure Application Revised February 2017
sf
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FUEL BURNING APPLIANCE & Office Use Only
„el Obikt.
CHIMNEY APPLICATION Permit#:
Permit Fee:$
Town of(hjcctt.httry
742 Bay Road,Queensbury, NY 12804 Invoice*
P:518-761-8256 www.queensbury.net
Project Location: 42 C1 N \—� -- Tax Map ID#: g
Room of Install: Cl1zEi % \ Planned Install Date: v, -1
**ONE APPLICATION PER APPLIANCE I C L o W E
CONTACT INFORMATION: TOWN OF QUEENSBURY
COMMUNITY DEVELOPMENT
• Applicant:
Name(s):,
Mailing Address, C/S/Z: 3� ���+� TZ 1�-errs L� �A•�r 1,1`r 1 Z.24 4
Cell Phone: ( S 2) ) �coS. 1249 Land Line: ( )
Email: rTS Qj-t' G c'in\ \a.e c rv.},�. C o AA
• Primary Owner(s):
Name(s): / Awt_kc-c<'urt
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: ( )
Email:
• Installer/Builder:
Business Name: ( Ak\ -
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
Contact Person for Building & Code Compliance:
Cell Phone: ( ) Land Line: ( )
Email:
Fuel Burning Appliance&Chimney Application Revised March 2017
FUEL BURNING APPLIANCE INFORMATION:
TYPE OF DEVICE:
Stove Fireplace Insert )( Fireplace
____ Fuel Fired Equipment (Garage Only, 18" clearance per IMC 304.3)
S Fireplace,factory built**
**Manufacturer's name: 1--11 -N- CO-0 Model #: 11?-0 - 4Z.. (
SOURCE OF HEAT:
Wood Coal Pellet y Gas
CHIMNEY INFORMATION:
Masonry:
block brick stone
Flue:
tie steel ____size, in inches
Material*:
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.
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: av\J inn\clA6te\
SIGNATURE: DATE:
Fuel Burning Appliance&Chimney Application Revised March 2017
c;2 0 1 6y4-- -(- p
FUEL BURNING APPLIANCE & Office Use Only
1- ."----,-_-_-_---, CHIMNEY APPLICATION Permit#:
-,..,;;-„------ --(.2
Permit Fee:$
_
imtii or()jc,11,1nit.1
742 Bay Road,Queensbury, NY 12804 invoicelt:
P: 518-761-8256 www.queensbury.net
Project Location: 4-2- C\rr---t44"."->4‘ -.' cZ-• Tax Map ID#: ,, g`i 1 •-•-• '
'eoc,VIA
Room of Install:--"Jirp.. --.,-1 --ritler—ft-i—t, .--, — . ---,-
Planned Install Date: r,)\ ..4,..-..) i
1
**ONE APPLICATION PER APPLIANCE** I)
-,-
„,. ,, •, , - .
.. ,- ,
CONTACT INFORMATION:
TOWN OF QUEENSBURY
• Applicant:
COMMUNITY DEVELOPMENT
, .
,
Name(s):1' r-- ilue-.,i 0 1---A\c_'- - -
Mailing Address, C/S/Z: "Rz,0 17-a Ta''.- 2 V.A711- 1?--k LL_ raP4,/, 1-4%-r \22:i 4 4
Cell Phone: ( -." 1'2) ) 7..L,S . V-2_49 Land Line: ( )
Email; '—\---- .06,-,,,,--e C lifTh\c,i,Ao As: cfc.),-,(;:k r --A
- , - '
• Primary Owner(s):
Name(s): -74--•-sw.e.- i...-Mailing Address,Address, C/S/Z:
Cell Phone:_( ) Land Line: J )
Email:
• Installer/Builder: 7
/ j.,_ N
Business Name: I rV'ied;_\C" V- \)
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: ( )
Email:
Contact Person for Building & Code Compliance:
Cell Phone: _( ) Land Line: ( )
Email:
Fuel Burning Appliance&Chimney Application Revised March 2017
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** 36,
**Manufacturer's name: t-kt ..A -- CsL-cD Model #: `-1' C..) --
SOURCE OF HEAT:
Wood Coal Pellet Gas
CHIMNEY INFORMATION:
Masonry:
block brick stone
Flue:
tie steel size, in inches
Material*:
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.
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: 6CVNJ 1, ete\
SIGNATURE: /"
.' DATE: L) 0)(�I
r
Fuel Burning Appliance&Chimney Application Revised March 2017
Town of Queensbury Thomas R. Van Ness
Highway Superintendent
Highway Home (518) 745-0929
Department
742 Bay Road—Queensbury, NY 12801 David Duell
Deputy Highway Superintendent
Phone: (518) 761-8211
Fax: (518) 745-4466 Home (518) 743-0938
DRIVEWAY PERMIT
DATE: d-I I t7
APPLICANT NAME: `!• ibb.,NACI \1044A.��.s
TELEPHONE NO.: S"2 . 3lc'� . t24
ADDRESS TO BE INSPECTED: 42 cSz.p.4 11›NI\ 7 t
RETURN ADDRESS: . � '1 ,
\Z--A V\ x" 11 rvY t - 4 4-
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:
Thomas R. Van Ness, Highway Superintendent David Duell, Deputy Highway Superintendent