applications——™
Déparlment of Community Development Reviewed B;Building &Code Enforcement ;Town of Queensbury Permit No742BayRoadFiseeNewYork12804TeePaid$J8)761-8256 ony:...Building Permit Application
BE OBTAINED BEFORE BEGINNING CONS'TRUCTION.NO INSPECTIONSAPPLICANS_RECBIVED A VALID BUILDING PERMIT.DD.
1
7 spac application MUSY be completed and thesignatureoftheapp.appear on the application form.
Applicant:Rayal Classic Hom owner Kevin Gordon
Address:2t Hickory,Gansevoork add 1 Wefferson,Gleas Falls
Phone #(518)798-1685 Phone #(5)
Property Location:&a~Section Block Lot
NALURE OF PROPOSED WORK:
New Building:residence /commercialAdditiontoBuilding:
fIMALED MARKET VALUE OF THE
CONSTRUCTION:$_130,coe
residence /commercial OCCUPANCY INFORMATION:iAlterationtoBuilding:Primary Building -6-Y/,
_
residence /commercial ~Single Family DwellingResidence/Commercial _=two Family DwellingnochangetoexteriorsizefsFamilyDwelling.=OfficeOtherWork(describe below)——Mercanti}JUL 11 1996mas—Manufacturing———_otherGROSSanEAoFProroseDstnuctuns:/44a0 If ADDITION,what will useofnewadditionbe?:lst Floor
BNC eRUOO Ler 2c «she 0 $5 sq.ft.odOtherFloorssq.£not unfinished ce oF(ished cellar or uae Acces eeSsyDetachedGarage ae car
(AL FLOOR AREA:Z3aloO SQ.ryt Attached Garage ,1
SIZE OF NEW STRUCTURE:
«N55 sq.fe SE3
Private Storage BuildingCommercialStorageBuildingOther
[TEN
27'6"resy x 42!oO”reer
Foundation Type:Poured Gaere*ve|wia any second-hand or ungradedi NeNuwberofStories:2 lumber be used?If so,for what?(habitable space only)=Height (grade to ridge):26 feet TYPE OF HEATING SYSTEMNumberoffireplacesand/orwoodstove|(circle all_which applies)to be installed:l ect:(Oily Gas /WoodBaseboard /Other
Person responsible for supervision of work as regards to buildingcodesis:Riek “Raw bow
Nay Addresgs Phone _:Buildsti Riek “Rarabow 21“HiebSry Gansevoy rn?798-1685Plumbe:SameMasonCluteEns.Electrician:SAME
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,ate 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 V/we shall submit prior to a
Certificate of Occupancy or Certificate of Com nce being issued,an AS BUILT PLOT PLAN by
a licensed surveyor;drawn to scale,showing aclual location of project on premises.uate a ,
(ownerowner's agent,architect
Application for
Location of property for in
bor5,Stene"er
Byler Ene Royal lacsic Homes
owner's Mailing AddrestZiwekery
CrceleGansevoe
sonatiers Nene:CLWTE ERY.theme #793-7277
otal daily Nlow (resident 1 compute @ 150 gal.per bedroom):eeiaFreat
Grepeprarty|a(A hate el lio Oo Bicep Stove eiettters 22 Reor
soil Nature:[_]Sand CI boom TO cy (I Otter Depth:——
See yeet ta chavrvs cs
sonar vepnt NO9Z—tet
Foreniatlun Tests [ZA Now Required I Reauiredtate RecentBedrockorImperviousMaterial
estie Water Supply:I Manicipat Cor went CO otter
De
Itdomestie water supply is a WELL water supply from any septic absorption is ————
LOE gal,(minimum size:1.000 eal.)septic
‘tile Field:each vont,2G fect.totat system length ZOO tect
1
seepage Pil):number of Oj sine exc:——1Soeeweektiaye
HOLDING ‘TANK SYSTEM:(if required)
Number of tanks:Size of each:gal.
\
Tilarm system and associated electrical work to De inspected by a certified agency.
sini peut protrefios,pee wote Wat porsusnt ip Seta 136-29 ofthe Code of the Town of
Queensbury,any permit or approval granted cinieh is based wpon or is granted in reliance upon
oi material misre presentation or failure fo make &material fact or ci
hehalfofan applicant,shall be void:
nstance known by or on
application and agree to abide by these aud all
sewage Disposal Ordinance.
isp
pad oe GaiThavereadtheregulationswithrespecttoi
of Queensbur}requirements ofthe Tom
Signature of responsib’e person:
AMNASNAING
JO
NMO
TOWN OF Q UEENSB URY
el 531 Bay Rd., Queensbury, NY 12804
APPLICATION FOR SOLID FUEL BURNING APPLIANCES AND CHIMNEYS
Date `� 19 µ_ �> € /
k 1v ' -- W,- >, . . r d �' Permit No.
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 re.uirements and also will allow
all inspectors to enter premises to perform required inspections.. ' ''` i
Please fill out additional form.if,more than one appliance andL.or chimney.
J
Applicant ovo) Llossic Wry/nos ' APPLIANCE (check appropriate boxes)
Address 21 W, c kor y C 1 re- I e_,- El STOVE: ❑Wood o Coal' o Pellet ❑ Gas
' ❑ FI REPLACE INSERT
an'€VO t °( Zip 12 f- .? : 1l"FIREPLACE, FACTORY-BUILT:
j iWood ❑ Gas
Phone tw... .i.--- "PIS-7165 0 FIREPLACE, MASONRY:
_, ❑ Wood 0 Gas
Owner Ke.Vin o r o r ID/FURNACE: 0 Wood p Gas ❑ Oil -
Address
9 . e rso. j- > IF NON-MASONRY APPLIANCE:
,� Manufacturer: crs' 1 \:?; a c..}c"
� .'1;e ' a \ ►.5 N'Zip \ 7- Sb k. Model: t
Phone 7 q 2., — , - 9'2
``` CHIMNEY (check appropriate boxes)
EXACT ADDRESS of proposed ;construction
t,cOf 5 6 i e ftri niQ1(--Dr ►lie.- 0 MASONRY: 0 Block ❑ Brick 0 Stone
'' - 0 re se J wr 5 .. '
, -, FLUE: 0 Tile 0 Steel
Size: inches
CONSTRUCTION / INSTALLATION=MUST OFFACTORY-BUILT:
CONFORM TO NYS FIRE PREVENTION & Manufacturer: h: ,e i 1/o (Model: A,) t-u—e
BUILDING CODE. CONSULT AVAILABLE Listed By Number:
TOWN OF QUEENSBURY HANDOUTS &Double Wall 0 Triple Wall
'REGARDING REQUIRED INSPECTIONS. 0 Insulated 0 Direct Venting
- ❑ Chimney Liner
Cashier's Department Town of Queensbury, New York
Dept: Fire Marshal Amount Collected Amount Received
Code Number Title 0
A 173 3389 (190) Public Safety -
A 233 2655 (230) Minor Sales
`Fee Collected Fronl.dr Refunded to: f TA-1
Address: .,
Dated ") M. / / z-) 0 Town Clerk or Deputy: �`J`,,' '
h _...i, e r-,
White: Applicant Green: Fire Marshal KYello;iv: Bldg Dep a ,Pink &-Goldenrod. Ga hier's Deptf