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applications Fire Marshal's Office Town of'Quecnsbury,742 Bay Road,Queensbury,NY • ' (518)76l-8205 Application for Fuel Burning Appliances & Chi ej applicable to solid fuel & vented gas.appliances L"/ Date / — Z Z , 20 ac( J Permit o. Tory . 2 92 '• BU NOF 04 Application is hereby made to the Building& Codes Office for the issuance a ;,•, ,e, 1� g0. . Permit pursuant to.the New York State Fire Prevention and Building Code. The applic or owns o y agrees to comply with all applicable laws, ordinances, regulations, and all conditions that are o these requirements and also will allow all inspectors to enter premises to perform required inspections. • NOTE to applicant: Rough-in and Final Inspections are required. Applicant Information Fuel Burning Appliance Information. ,, (circle appropriate words) • Name: i 4-5 .¢yse' GI A l Stove: wood coal pellet gas Fireplace insert Address: eRt v R Fireplace, factory-built: wood gas . 4 �5' t l�Sa•41 V.14 WV L 3 Fireplace,masonry: wood gas 7 • Furnace: wood gas oil Phone: (..i'r$) kG Y�Ss If non-masonary applicance,please provide Owner: site. ,„I �_ Manufacturer Name: Address: .c.5;0 Model Number: • •- • • Chimney Information Phone: Ce`(- g's 7-as-Yo :e'-'/ (circle appropriate words) Masonry block brick stone`t ,• Flue tile steel size:S inches Exact Address: 13 c{ c4.„t p,Etr,.C t- f�� of construction or installation Factory-Built Manufacturer name: h:cnsvok Model Number: Got„ .36,2, Note: Listed By: O L, Number: e 2 7 Construction/Installation must conform to NYS Fire Prevention &Building Indicate(circle) chimney material: Code. Consult available Town of Queensbury Handouts regarding required inspections. Double wall / Triple wall / Insulated / Direct venting • Chimney Liner Cgz, ifex'iit Dejpm tri=ezit--Tolianu of Queeszsirbu xvy, 1Velar�orl .. • Fire Marshal Code# $Collected $Refunded I ceived fio (ref nded to): XIS- (--1 (j address: . A 173 3389 (190) Public Safety ---- - A 233 2655 (230) inor Spies . 40 DATE. 0 O rua"wr o- T ww [ice oz Dera7. White(Applicant) / Green(Fire Marshal) / Yellow(Bldg.Dept.) / Pink R.Goldenrod(Cashier's Dept.) Building Permit Application RECEIVED Town of Queensbury—Dept of Community Development,742 Bay Road,Queensbury,NY • (518)761-8256 JA'N 2 9 2004 • A permit must be obtained before beginning construction. PermitFile No. BUILDING A TOWN©F,Q AND NDFVSB URY No inspection will be made until applicant has received a Fee Paid CODE valid building permit. Re All applicants' spaces on this Rec. - d�3a Paid $ application must be completed and must appear on the . Reviewed By: 6 =���a� application form. _ • VP . Appli ant: f i$DL a Owner:' /.74E ss: a �, Address: �4 • -t o• / 4. ' z 7 \ Phone#( ) -. „SS. Phone#(.71Z1) O_ _,TI, bed((cf.A1) li Property Location: Lot Number:/3/ / House Number .,...I:_-' / cat i pp e 4 Cfrt-I,E Subdivision Name: Tax Map Number:/ Z147.— i 'y i f y ' New Building: residence /commercial Estimated Market Value of Construction: $ IS/ D Addition: residence/ commercial If an Addition,what will use of new addition be? o -Alteration: residence/ commercial a No change to exterior size: residence/com'l o Other work(describe ••303 3�j Check Occupancylnforination 1"Floor 2°°Floor Other floor Total Below sq.ft. sq.ft. sq.ft. Square Feet 4 Single family dwelling /3 Z•t g? 92Za.so 2?. CZ.3 xio•z- a Two family dwelling ' o Townhouse o Multifamily dwelling #of units o Office o Mercantile a Manufacturing a 1 car detached garage • _ • 0 2 car detached garage 0 3 car detached garage -. O 1 car attached garage 2 car attached garage 564., 3 0 3 car attached garage S�2 .3 v�G,Z Cl Storage building- commercial O Storage building- residential o Other • What is the proposed height of the structure 3 Z l feet inc %�� Will any second-hand or ungraded lumber be used? If so,for what? hes Type of Heating System: electric/ oil /(20. ood / (reed hot air baseboard/other: 4_. Number of Fireplaces to be installed / Number of Woodstoves to be installed__ -AlDS � List below the person(s)responsible for supervision of work as regards to building codes: Name Address Phone Number Builder G' Plumber _ -_ __ `� �"� —_-_----. -mason------4 f 14)- Electrician &115.!' f/"r �1vtt/i 65- i z 4,W 12-I 3 7 •• ••. ...........1•mimum...,•1••••• 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,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 Uwe shall submit,prior to a Certificate of Occupancy or Certificate of Compliance being issued,as requested by the Zoning Administrator or Director of Building and Codes,an AT Built Survey by a licensed surveyor;drawn to scale,showing actual location of all negp nst ruction, Signature: ma/ J �x,��e,„ caner, wner's agent,architec t,contractor Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518)761-8256 1. OWNER INFORMATION: Office Use Location of installation: /s'c/ C Ii,�,o p i= 4 1/4_,24.4 .1 lO�t 2 ! Fie Permit 3� Tax Map No. 97 / 'D/ l B WN OF • ionn • tik Q(lF ee Paid Owner's Name: /f R AS %4 /� 5 /�GAN Q� Address: L0 W'z/f S • 2. INSTALLER'S NAME : f 1550 GeWTe 3 PHONE NO. gs ---0S'YD 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#'bedroom(s) and multiply#of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily Flow 1980 or older x 150 gal/bdrm = 1980 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = el zio Garbage Grinder Installed yes / no Y Spa or Hot Tub Installed yes / no )4. 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) • Toographv etH ature Ground Water Bedrock or Impervious Material . Dom Sr; ater Su 1 (F at) sand, at what depth at what depth municipal Rolling loam /it feet „,(76Y' feet Steep slope clay if well; water supply %slope other from any septic-system depth: absorption is ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: /' 1;:0 5 ,,a.1minute per inch 5. 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). Add 250 gallons to the size of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub. • Septic Tank: /25 c? gallon(min. size 1,000 gal) • Tile Field: each trench 1 ft. Total System Length: 2 7 D ft. Seepage Pit(s): number of size of each: ft, by ft. Size of Stone to be used: # / depth or thickness Z feet r Bed System Size: x Alternative System: length and/or size • 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. --- - -- - - 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) 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 Queensbury Sanitary Sewage Disposal Ordinance. y jease,bc?6,164 / Si nat r of responsible `•9 p ible person Date . • 1,';4° ''I'pwlt of (IUt;l''t;41)ttt•y Sewers stilt! liewilne I)Isposal ( lint)ter_ • ,. ' Aj miltlix (: • Atilit)Itivl'i(.)N V'IEIJI.) ', . • SI:I'nit/l,'1'1WN 1ti�t21.311tItitilI,:hl'I'S . • • .' ' N. ... &12), . '''''' ''''''%*\''N'e' 1 j �QNQ(' 1111 vjgi.L. IN tlm1eA. e + #3 1 f f Lt'rwl . \----"--r. 1 . . . • /" cr r \ l 7 /, ,r-i 0,"°:::. (-....rs �, . A\ . • Sc Pi 1c, t i 1. .1 1r.1 tY. • . \.,...,..„.. . . . , i . \ • • TM�r . �r+r . K . . .. • • . • ;. ' ;: •. ., 7. SIGN,A►.TURE &INFORMATIOli FOB. SrOisi ;s1,4 r=Cwvr, W,90.0.0...,..., • A