applications ...............
OFFICE USE ONLY •.
•••• -� ,
S TAX MAP N0. ERMIT NO. E C E U 1 E
FEES: PERMIT RECRE IONENGINEERING JUN 12 2009 D
(If applicable)
TOWNOF•QUEENS841R'Y
PRINCIPAL ,STRUCTURE; BUILDING & CODES
,APPLICATION FOR ZONING APPROVAL & BUILDING PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO
REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.
APPLICANT/BUILDER: lei/� /-_i eek OWNER: �Te
—�✓ T Sry��r7l"
ADDRESS: 10!z 7-L)bG111 7d,
ADDRESS: /oy 7', '/ R).
PHONE NOS._SIFf - 752 - -r>7p dd�23y87fS PHONE NOS. S/�- ?5Z-S/ 701.-3211,3w
CONTACT PERSON FOR BUILDING &CODES COMPLIANCE: 5avne 4S a Lmse
PHONE:jk-5126fz3z-ism
LOCATION OF PROPERTY: 10j T ,`11 P
HAS THERE BEEN A SITE PLAN REVIEW; VARIANCE OR SUBDIVISION APPROVAL? CI'Y S ❑ NO
IF SO, INDICATE APPLICATION NO. AND DATE OF APPROVAL:
/O /2z
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT Z
APPLY TO YOUR Z � LL
PROJECT 0 0 O to LL w
0 00 tp
F-
L 0 F Lw LLw w ¢ axV
Z Q ¢ :- d NdDuj�9LL 00a = ss
SINGLE FAMILY P"''-Fr2n
TWO-FAMILY
MULTI-FAMILY
(NO. of UNITS_)
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL /
ATTACHED
GARAGE(1,2,3)
OTHER
IF COMMERCIAL OR INDUSTRIAL- NAME OF BUSINESS:
ESTIMATED CONSTRUCTION COST:4 I Sol FUEL TYPE:A9.J//04,4y/ 0011d
HEAT TYPE:14-ALAL-t *HOW MANY FIREPLACE(S): AND/OR WOODSTOVES(S):�_
ZONING CATEGORY: F9-SQA. ARE THERE WETLANDS ON THIS SITE? NU
IS THIS A HISTORIC SITE? Me)
PROPOSED USE OF BUILDING OR ADDITION: 1r
*Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in our office
T07on of Queensbury • Communihj De7,elopment Office • 742 Bay Road, Queensbury, NY 12804
• 88-LGL I I-05
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? / Jc,
ARE THERE EASEMENTS ON PROPERTY?
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans, and supporting materials are a true and
complete statement/description of the work proposed, that all work will be performed in
accordance with the NY State Building Codes, local building laws and ordinances, and in
conformance with local zoning regulations. I acknowledge that prior to occupying the
facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand
that Uwe are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I haveAreaddd agree o the above.
Signe
Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction
codes or septic systems)
Zoning Administrator- 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
------------------------------------------------- ------.-..._-_.-•-•_- .-
Permission is hereby granted to the above This application / proposed action described t
- Applicant to erect or alter the building herein is found to be in accordance with the
described herein in accordance with said zoning Laws of the Town of Queensbury.
Application:
BUI DING & CO EJq
ROVAL ZON A PROVAL
DAT
DATE
QUESTIONS? CALL 761.8256 OR EMAIL
Office Use Only
codesfii�cueensbury net
VISIT OUR WEBSITE FOR MORE INFORMATION
Operating Permit Issued: _Yes _No www.aueensbury net
Occupancy Type: _ I Construction Classification:
Assembly Occupancy Limit: Special Conditions:
T07an of Queensbury,• Community Development Office • 742 Bay Road, Queensbury, NY 12804
............................................................................... .�. .�.. ..�i.
OFFICE USE ONLY
; TAX MAP NO. PERMIT NO. PERMIT FEE JUN 1ZURY :
+
APPROVALS: ZONING TOWN CLERK
TOWN OF Q
............ .: :..BUILDING&.CODES--
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT.
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
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OWNER: �fd'!-/�G✓ l�.1 M4 Ce ..rL INSTALLER: J it✓ i"�.!� �Lw
ADDRESS: I��'1 p7- i ,�I/�G�-!J• ADDRESS: IAOL/ J `.�_'/'/
PHONE NOS. SI r5 - / /2- '5J90 r'1Z3 17`d' PHONE NOS.0 ng- 7c/2-S I?0/23 Z-137
LOCATION OF INSTALLATION: ICh/ -T d14 •11 W•
NO.OF RESIDENCE INFORMATION:
BEDROOMS
YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = INSTALLED? Ny
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present 3 X 110 gallon per bedroom = 3,3p INSTALLED? .VO
PARCEL INFORMATION: /
✓ TOPOGRAPHY: Flat rolling r! Steep slope_ %Slope_
✓ SOIL NATURE: Sand l/� Loam Clay Other
✓ GROUNDWATER: At what depth? none--
V BEDROCK/IMPERVIOUS MATERIAL: At what depth? NIA.
✓ DOMESTIC WATER SUPLY: Municipal_ Well 1/ (If well: Water supply from any septic
system absorption is 2co / ft.)
✓ PERCOLATION TEST: Rate is A/`r,.n minutes per inch [MPI]
(Test to be completed by a licensed professional engineer or architect.)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by
a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: IZSD GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whirlpool tub.
SYSTEM TYPE:
9--ABSORPTION SORPTION FIELD (WITH NO. 2 STONE) Total length 3Uo ft. Each trench S X
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
.. . .. .......,,
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any
permit 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 QUESTIONS? CALL 761.8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codesCa)aueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
/Z/O7 www.aueensburv.net
,� tUrrfverlion Responsible Date
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6/06
I C8 2�
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L. AUN 122 DI-*
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TO 0 U ENSBURY
V no+ heeK c BULD1NG&C00n R1
APPLICATION FOR FUEL BURNING APPLIANCE & CHIMNEYS
Application is hereby made to the Building & Codes Office for the issuance of a Building & Use Permit
pursuant to the New York State Fire Prevention & 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.
IMPORTANT NOTE TO APPLICANT: ROUGH-IN AND FINAL INSPECTIONS ARE REQUIRED.
OWNER: 'u-C JOL-ce -r z INSTALLER/BUILDER: -r
I IZ, ng,4 J,_) J�24,/,a JET
ADDRESS: /04/ WC), ADDRESS: �d-
PHONE NOS. 90 z-
1de
13?k� PHONENOS. 7� 2- ,5_/?0/23z-
LOCATION OF PROPERTY. 10qT1kA73:11 J?d- SUBDIVISION NAME: Zsew/,C / :I-
LOCATION OF PROPOSED CONSTRUCTION ANDIOR INSTALLATION: 1oqTLjh-'# W.
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: 4s 4 " I PHONE:
✓ FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL
STOVE
FIREPLACE INSERT
FIREPLACE,FACTORY BUILT'
FIREPLACE,MASONRY
FURNACE(GARAGE ONLY)
*IF FACTORY BUILT,PLEASE PROVIDE: MANUFACTURER NAME: Q ueC)14 MODEL NO.
LISTED BY: ?00M 14,EA7,-X5 —NUMBER: 30IY73 QUESTIONS?
CALL 7615205 or 7615206
CHIMNEY INFORMATION BLOCK BRICK STONE OR EMAIL:
MASONRY" CHECK ONE ✓
VISIT OUR WEBSITE
TILE STEEL SIZE IN FOR MORE INFORMATION
INCHES .neY
FLUE is Ir
DOUBLE TRIPLE WALL INSULATED DIRECT VENT CHIMNEY
WALL LINER
CHIMNEY MATERIAL CHECKONE
"IF NON-MASONRY,PLEASE PROVIDE: MANUFACTURER NAME: MODEL NO.
ADDITIONAL NOTE: CONSTRUCTION/INSTALLATION MUST CONFORM TO NYS FIRE PREVENTION &BUILDING CODE AND/OR
MANUFACTURERS REQUIREMENTS. CONSULT AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED
INSPECTIONS.