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applications ?Z►S _ O F E USE ONLY TAX MA NO. /— PERMIT NO. p c2 FEES: PERMIT _ RECREATION 0l ENGINEERING NOV 0 2 20a9 u (If applicable) .- t� ENSBU 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. Aej APPLICANT/BUILDEER: AW (G,f?/vc , ; (J/lL-10OWNER: (/�GHf/,vC, 44 '/V, ADDRESS: 3 / �� ✓� �l d, ADDRESS: 7/� ✓1`{ ��, /T , PHONE NOS._ ���- 9�y� PHONE NOS.// Zy2 - J�V�L CONTACT PERSON FOR BUILDING &CODESCOMPLIANCE�4 r4.,?c% PHONE: 76/---�16/' LOCATION OF PROPERTY: L 0 ¢ HAS THERE BEEN A SITE PLAN REVIEW; VARIANCE OR SUBDIVISION AP RO AL? YES ❑ NO IF SO, INDICATE APPLICATION N . AND DATE OFL: 0 PLEASE INDICAT EASUREMENTS AS REQUIRED BELOW: CHECK ALL THAT Z APPLY TO YOUR z 0 a d a w LL co PROJECT 0 � Or co 0 � _ FW- LLLL LLLL 2 ¢ aCDU z ° a s ° N ° o � o � ww � _-- -- -_-- t- LL a x as SINGLE FAMILY /;_7 C TWO-FAMILY / MULTI-FAMILY (NO.of UNITS_) TOWNHOUSE BUSINESS OFFICE RETAIL- MERCANTILE FACTORY OR INDUSTRIAL ATTACHED s� GARAGE(1,2,3) OTHER IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS: ESTIMATED CONSTRUCTION COST: '� ®0i0o0 FUELTYPE: C�{1 HEATTYPE:h1ral ,I *HOW MANY FIREPLACE(S): AND/OR WOODSTOVES(S): ZONING CATEGORY: ARE THERE WETLANDS ON THIS SITE? /(�1 IS THIS A HISTORIC SITE? / PROPOSED USE OF BUILDING OR ADDITION: S-/-7Fr, /4t le F , /4 *Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in our office Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804 B 3-LGL I I-05 ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? 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 I/we 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 have read and agree to the above. Signed 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 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: JBUI & PROVALZONING APPROVAL DATE QUESTIONS? CALL 761-8256 OR EMAIL codes a9 aueensbury net Office Use Only VISIT OUR WEBSITE FOR MORE INFORMATION Operating Permit Issued: _Yes _No www.gueensbury.net Occupancy Type: _ c-5EQ Construction Classification: Assembly Occupancy Limit: Special Conditions: Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804 r........................ .— ................-........-..-.............. ..-..................... FICE USE ONLY TAX M P N0. MIT NO.077—�ERMIT FEE APPROVALS: ZONING TOWN CLERK ...................................................... 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. / OWNER: �� ��U✓� INSTALLER: �X./ 01 rG"00 ADDRESS: 7 �n� �I �i ��7 /tea!` ADDRESS: ���� /J• S(/�5 7 �/ PHONE NOS. PHONE NOS. 7'n1 T sZ LOCATION OF INSTALLATION: NO.OF RESIDENCE INFORMATION: BEDROOMS YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = INSTALLED? .y0 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X 110 gallon per bedroom = O INSTALLED?—/" PARCEL INFORMATION: / ✓ TOPOGRAPHY: Flat rolling vSteep slope_ %Slope_ ✓ SOIL NATURE: Sand -4�1L/oam Clay Other ✓ GROUNDWATER: At what depth? ✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth? ✓ DOMESTIC WATER SUPLY: Municipal� Well_ (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is Q-.f-lorPc 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: GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa of/Whi Ipoo tub. SYST TYPE: ABSORPTION FIELD (WITH NO. 2 STONE) Total length�ft. Each trench -2 X rU ❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? ,/ Size? El ALTERNATIVE SYSTEM Bed or other type? /v ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? tAillk 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 Cade 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. codesna oueensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION www.aueensburV.net SigSig at�on Responsible ateResponsible ate Town of Queensbury • Community Developnlent Office • 742 Bay Road, Queensbury, NY 12804 B 5-LGL 6/06 Fire Marshal's Office Town of Queensbury• 742 Ray Road • Qnrrnshnry, .Niru, York•1;804 Michael 1. Palmer, Fire Marshal • Gary Slil nim. [Vjw if Firc Mar,hal APPLICATION FOR FUEL BURNVVG 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 RE UIRED. OWNER: // ,/ INSTALLER/BUILDER: G� ADDRESS:. //` n /�-o • ADDRESS: 'jo PHONE NOS. `�'7 N — Y l PHONE Nor. ,!�/�2 � LOCATION OF PROPERTY: C0 / SUBDIVISION NAME: LOCATION OF PROPOSED CONSTRUCTION AND/OR INSTALLATION: J'�/^� '*- ' � Q CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: /�'(r `/� Mel �j PHONE: T ✓ FUEL BURNING APPLIANCE WOOD COAL PELLET GAS OIL INFORMATION STOVE FIREPLACE INSERT FIREPLACE FACTORY BUILT" FIREPLACE,MASONRY FURNACE(GARAGE ONLY( �J "IF FACTORY BUILT,PLEASE PROVIDE: MANUFACTURER NAME: /_FS )e C MODEL NO.46VT74 P✓ LISTED BY: NUMBER: QUESTIONS ? CALL 761-8205 or 761-8206 CHIMNEY INFORMATION BLOCK BRICK STONE OR EMAIL: firernar --y net MASONRY" CHECKONE ✓ VISIT OUR WEBSITE TILE STEEL SIZE IN FOR MORE INFORMATION INCHES www.aueensbuury.nnet FLUE CHECKOHE ✓ AF c DOUBLE TRIPLE WALL INSULATED DIRECT VEN I CHIMNEY WALL LINER CHIMNEY MATERIAL CHECKONE ✓ "IF NON-MASONRY,PLEASE PROVIDE: MANUFACTURER NAME: / l k 1(.IC MODEL NO.- �L72TV/o � 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. Fire Marshal's Office Town of Queensbury• 742 Ilay Road • Queeu./vrry. New York `12804 Michael 1. Palmer, Fire Marshal•Gary Stillman, nepaty Fire Mnaarl i , 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 RE UIRED. OWNER: a'✓ INSTALLERIB^U�IL�DJER: ADDRESS: �` n /C-O". ADDRESS: J 7��/ r�'J �5 �� PHONE NOS. �I — Y l � PHONE NOS. W�7 �fA/y/y-9ry� LOCATION OF PROPERTY: 1 / SUBDIVISION NAME: Uh I.- a LOCATION OF PROPOSED CONSTRUCTION AND/OR INSTALLATION: /��/^/f CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: ///i� (� Ile/l PHONE: . ✓ FUEL BURNING APPLIANCE WOOD COAL PELLET GAS OIL INFORMATION STOVE FIREPLACE INSERT FIREPLACE,FACTORY BUILT` FIREPLACE,MASONRY FURNACE(GARAGE ONLY) `IF FACTORY BUILT,PLEASE PROVIDE: MANUFACTURER NAME: 4 II G.f?1C MODEL NO.Zb V7? Pt/ LISTED BY: NUMBER: QUESTIONS 7 CALL 761-6205 or 761-6206 CHIMNEY INFORMATION BLOCK BRICK STONE OR EMAIL: firemarshalAgueens bury.net MASONRY" CHECK ONE ✓ VISIT OUR WEBSITE TILE STEEL SIZE IN FOR MORE INFORMATION INCHES www.gueensbury.net FLUE CNECKONE ✓ G 'l— P6 DOUBLE CHIMNEY D WALL TRIPLE WALL INSULATED DIRECT VEN LINER CHIMNEY MATERIAL CHECKONE ✓ - l NO. "IF NON-MASONRY,PLEASE PROVIDE: MANUFACTURER NAME: / G I( Ll�( MODEL 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.