1999-771 BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 91500 Building Permit No. 99771
TAX MAP NO. 48 . -3-34 . 1
Permission is hereby granted to S CHERMF P HOP N, P I CH?R n .TR
Owner of property located at LOT 34 #k 21 BLIND ROCK ROAD
in the Town of Queensbury,to construct or place a SI win 'AMILY DWELLING
at the above location in accordance to application together plot pans and otner nuormation hereto filed and
approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
•
Owner's Address:
& BETH 79 MASTER COMMONS NORTH
QUEENSBURY, NY 12804
Contractor or Builder's Name:
SCHEPMRPHORN CONSTR1lCTTON
Contractor or Builder's Address:
43H HUNTERBROOK LANE
QUEENSBURY, NEW YORK 12804
Electrical Inspection Agency:
COMMONWEALTH ELECTRICAL AGENCY
PO BOX 706
HAGUE, NY 12836
Type of Construction:
SINGLE FAMILY DWELLING
Plans and Specifications:
1411 SQ FT SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE
AS PER PLOT PLAN SPFCTFTCATTONS
Proposed Use:
SINGLE FAMILY DWELLING
$ 189 PERMIT FEE PAID—THIS PERMIT EXPIRES December 22 2001
(If a longer period is required,an application for an extension must be made to the Code Enforcement
Officer of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this}(� 22 Day of December 1999
SIGNED BY for the Town of Queensbury
• Code Enforcement Officer
•
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queenshu,:v,NY 12804 (518) 761-8256
WNER INFORMATION:
Ofre e
Location of installation: 1,.,1 J lock At f!of j r 77
File Permit No.
Tax Map No. y 8 / 3 / 3 y./
a Jr Fee Paid
Owner's Name:
S� )R ��,�n P r�or.,v C�,.�s f�
Address: 95 * u A'-e r 5 rook_ L A)•
2. INSTALLER'S NAME : SatQ vi4 f.ti aft 54. Cc rp. PHONE NO. ? 8"-0
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply ii 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 = RECE.FIVPD
1980—1991 x 130 gal/bdrin =
1991 —present 3 x 110 gal/bdrm = 3 3 a C E C 2 1 1999
7-gm�,'1J 7� Cr' _,tel't -,•J Y Garbage Grinder Installed yes / no. u �t16E®IPJr ,i}�°CODE
. Spa or Whirlpool Installed yes / no y(
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
•
1 pivraphy S9Uature Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat and at what depth at what depth n _nicipal
Wiling loam /g feet / feet '
Steep slope clay • if well; water supply
_%slope other from any septic-system
•
• depth: absorption is /oo ft.
other
Percolation Test: •(To be completed by licensed professional engineer or architect)
• Rate: minute 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: o G 6 gallon(min. size 1,000 gal)
Tile Field: each trench 3-0 ft. Total System Length: o ft.
•
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: it _2 / depth or thickness / • feet
Bed System Size: ' I/ x al/ft
Alternative System: , length and/or size /11/19
6. HOLDING TANK SYSTEM: (if required)
Number of tanks:dill)/ 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 To of Quee sbu Sanitary Sewage Disposal Ordinance.
9
Signature of responsible person Date.
Building .Permit Application
Town of Queensbury - Dept. of Conuuunity Development, 742 Bay Road, Queensbuty, NY 12804 1761-8256J
BUILDING & . CODE ENFORCEMENT
NOTICE Requirements prior to issuance
( of this permit: PERMIT FILE NO.
A permit must bo obtained before
beginning construction. No inspections •
/'J;.RMl'I'FEE PAID$
will be made until applicant has received fib Zoning Board Action
a VAI,ID BUILDING PERMIT. All • Area /Use ,[+R•,C ? if Q
"''RGCRI ATION FE I'AID$
applicants' spaces on this application =-. j
MUST be completed and.the signature [] Planning Board ActionDE t; 2 t`I CK vIEWED BY:
of the applicant-must appear on the SPR / Subdivision /Other ` 1`
Building Inspector
rh
application form. m,k,ou. ) Recreation Fee PaytnenCit.,. . .;;- C__. :L....;; t-;r iV
. Applicant: Sc)1 e.C','mil Gt.Hike rAJ Co A \-. (�' ,r p Owire-I':e--- --- Sc'li P-rP4',-c/�nr.t/ Co--7 f 7 Ov.27.
' Address: 14 H- 11-v n-e f 3(oo k LA)• Address: h'3 f9 rr fP r'/oo P Lu
Phone # ( 5)8 ) 12.3 - D 6'7 Z •
Phone # (5/i ) 29 d - 6 67
Property Location: /;r7 4 ,Qod.k 4d. io+ 3' " .'
Subdivision Name:
• Tax Map Number_ fY /S l3 9,
- Section Block Tot
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
X New Building: CONSTRUCTION:
(residence')/ commercial $ 9/. 500
Addition to Building:
residence / commercial OCCUPANCY INFORMATION:
Alteration to Building: - Primary Building -
- residence / commercial , x Single Family Dwelling
Residence / Commercial Two Family Dwelling
no change to exterior size Family Dwelling
Office -
OtherWork (describe below Mercantile
1..) Manufacturing
Other
GROSS AREA;OF PR " t 0R0g "STRUCTU E:
gL ! fQ If ADDITION, what will use
1st Floor �0 5 S sq, ft of new addition be? :
2nd .Floor - 05.5 sq. f . f
Other ,Floors Y sq. f , /
(not .unfinislk�c. c llar or basem nt
' CESSORY BUILDIN S:�
' �� \ Detached Gara•e 1 car
TOTAL FLOOR AREA:, 1�I) SQ. ,FT. X Attached Garage 1, 2 ear`
\. Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building
$/ FEET Xo FEET Other
Foundation Type: Con C!'a/ Will any second-hand or ungraded
' Number of Stories: 2. lumber be used? If so, for what?
(habitable space only) ^/4
Height (grade to ridge) : a feet TYPE OF HEATING SYSTEM:
Number of fireplaces and/or woodstove (circle all which applies)
to be installed: .- a— Electric Oil /(Gas) / Wood
Forced IIot Air)/ Baseboard / Other
Person responsible for supervision of work as regards to building
codes i s : Se.li e r v+l e.6-+o,0 A,/ t".o et s 7 C0 t79. `72 g-o(arp /
Name Addresss Phone
Builder: Sc./A e.r'm e-4,o r A./ Cc.,i s t Co('1O . 17 9$-- o G-7 /
Plumber: 51n.1;0 AI/e Ai 7V7 - Seo 9 3
Mason: , 7 r fja.ld w,,11 -.7 - 1371
Electrician: ;/( (°ei.,,,,s ky y95/-39 6.5
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 I/we shall submit prior to a
Certificate of Occupancy'or Certificate of Compliance being issued, an AS BUILT PLOT PLAN by
a licensed surveyor; d awn to scale, showing actual location of project on premises.
Signature: 4t—eiti
.
(owner, owner's agent, architect, contractor)
•
617'7 7/
ENERGY CODE COMPLIANCE APPLICATION
• 3= TOWN OF QUEENSBURY, WARREN COUNTY
9000 HEATING DEGREE DAYS RForLf -n.
Compliance Methods: PART 5 - Acceptable Practice Methoe ' 6 0 1999
1&2 Family Dwellings (o•nay)
PART 6* - Thermal Rating - Componentl`Tzade' ,Offs`'`�'�
1&2 Family Dwellings; Multi=Family `
Dwellings (3 stories or less)
PART 4* -• Design by Component Performance
Commercial Buildings-Hi Rise Residential
*Requires submission of worksheets
APPLICANT' S NAME: PROPERTY
{- / PROPERTY LOCATION: /� �j Q /
SGNe,ri1�1N, r 0riu (..o/1$/• at, /of .3Y A'Nd /T0G'l� l�Clo
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1 . Gross Floor Area - /1/// square feet
•
• 2 . Tv-De of Heat - Electric Oil X . Gas Other •
3 . Is building mechani daily cooled? Yes Y No
4 . Percentage of area of windows and doors Y Over 17% Under 17%
5 . R.-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS
SHOWN ON PLANS SUBMITTED:
a . Roof R 3�
b . Exterior walls R 9
c . Glazed areas R /8
d. Exterior doors • R a_5
e . Floors over unheated spaces R j q
_ . Edge of slab on grade (heated 'building) R //
g. Basement/cellar walls (above grade) R
h . Basement/cellar walls (below grade) R /9
i . Heating/cooling-ducts-piping in unheated space R f,/,.
6 . Service (domestic) hot water heating device .
Conforms to minimum efficiency per code s' Yes No
• TEMPERATURE CONTROL MAXIMUM SETTING 140° - WILL NOT BE EXCEEDED
App 1 f _t� s�S= gn tLr e Da_e - J 9 Phone7. Number
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INSPECTOR' S REMARKS:
SCHERMERHORN
CONSTRUCTION CORPORATION
43H HUNTER BROOK LANE •QUEENSBURY,NEW YORK 12804
• (518) 798-0674 m FAX(518) 743-9653 ,
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