2003-044 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,1VY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
CE1V`*'-vLIFICATE OF OCCUPANCY
Permit Number: P20030044 Date Issued: Friday, May 23, 2003
This is to certify that work requested to be done as shown by Permit Number P20030044
has been completed.
Tax Map Number: 523400-308-008-0001-049-000-0000
Location: 33 BURNT HILLS Dr
Owner: BURNT HILLS LLC
Applicant: BURNT HILLS LLC
This structure may be occupied as a:
By Order of Town Board
Garage - 2 Cars Attached TOWN OF QUEENSBURY
Single Family Dwelling
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Director of Building&Code Enforcement
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TOWN OF QUEENSBURY
742 Bay Road,Queensbuty,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030044 Application Number: A20030044
Tax Map No: 523400-308-008-0001-049-000-0000
Permission is hereby granted to: BURNT HILLS LLC
For property located at: 33 BURNT HILLS Dr
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: BURNT HILLS LLC
15 F BIRDIE Dr Garage-2 Cars Attached
Single Family Dwelling 122,500.00
QUEENSBURY,NY 12804-0000 Total Value 122,500.00
Contractor or Builder's Name/Address Electrical Inspection Agency
CLUTF,F,NTFRPRISF,S COMMONWF,ALTH F,LFCTRTCAL I
13 DAWN Rd RON MUMBLO
OUF,F,NSBURY.NY 12804-0000
NY 12804-0000
Plans&Specifications
2003-044 Lot 25, House No. 33 BURNT HILLS DRIVE
1580 SQ FT SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE AS PER PLOT PLAN
SPECIFICATIONS
$229.60 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,February 26,2004
(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 f own Que, sr; day,February 26,2003
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Building Permit Application
Town of Queensbury-Dept of Community Development,742 Bay Road, Queensbury,NY
(518)761-8256
i?‘. C6 j�
A permit must be obtained before beginning construction. . Permit File No.� %0 •L Ee O
No inspection will be made until applicant has received a Fee Paid $ rl js• 0 2 1 2003
valid building permit. All applicants' spaces on this Rec. Fee Paid L ''j. 'a�,e�� I• Qij
application must be completed and must appear on the Reviewed By: � NGq/VO NSe(/
1plicati•n firm. v A CoDE.
Applicant: T Owner: c -,A- ;a . 5
Address: ‘-1-, [-.,,3 Address:
Phone#( ) "NS- '7D-71 Phone#( ) -
Email Address: (1u c,k 0 ; -ter,c- .Email Address:
Property Location: Lot Number: i S / House Number 33 / ` - -A ,\.\5 Dc--.
Sub4ivision Name: bus-e--ic .\,`� Tax Map Number: Sol. s — (— ycy
z New Buildin: residence commercial Estimated Market Value of Construction: $ \ 'D) ,So
❑ Addition: re i•ence/ commercial If an Addition,what will use of new addition be?
❑ Alteration: residence/ commercial
O No change to exterior size: residence/com'l .
❑ Other work(describe )
Check Occupancylnformation 1"Floor 2°d Floor Other floor Total
Below sq.ft. sq.ft. sq.ft. Square Feet
(10G
Single family dwelling -7c-)J "-Z9 e 1 S`-O
a Two family dwelling !
o Townhouse
o Multifamily dwelling -
#of units
o Office
o Mercantile
o Manufacturing
o 1 car detached garage
❑ 2 car detached garage 'I,
o 3 car detached garage O
❑ 1 car attached garage
A--- 2 car attached garage Lio: L{0�
a 3 car attached garage
O Storage building-
commercial
o Storage building-
residential
a Other
What is the proposed height of the structure 2, feet inches
Will any second-hand or ungraded lumber be used? If so, for what? �JD
Type of Heating System: electric/ oil gas ood forced hot baseboard/other:
Number of Fireplaces to be installed C./3 Number of Woodstoves to be installed CO
List below the person(s)responsible for supervision of work as regards to building codes:
Name Address Phone Number
Builder \...a 5-r-`A r 1,_) . -
Plumbe
Mason r
Electrician c e'"r'
.`L. - e_c 'c't-Q-� C
•
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 • d all other laws pertaining to the proposed work shall be complied
with,whether specified • • e•, •id that such work' a•thorized by the owner. Further,it is understood that Uwe shall
submit,prior to a C= ficate of Occ,pancy or ' .cate •f Compliance being issued,as requested by the Zoning
Administrator • •irector of Buil•'.1:• and 'odes, A 'uilt Sury• by a licensed surveyor;drawn to scale,showing actual
location of• new construction./ ��,
Signa i�" ��� owner,owner's agent,architect,contractor
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION: )
Offi
Location of installation: �3 ��-,�� �,\ ' er .p RECEI / Use
$,off — I `'-(`)' File Permit No ��
Tax Map No. / /
F F R 2 1 2003
Fee Paid
Owner's Name: ¶ kc ,,�.� .�\� L�L TOWN QF QUEENSBURY
BUILDING AND CODE
Address: 6' kie
2. INSTALLER'S NAME : (Dv-›--t t.3k-1 PHONE NO. 3 7 '77
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 = S30
Garbage Grinder Installed yes_ / no ,
Spa or Hot Tub Installed yes / no >e
4. PARCEL INFORMATION: (circle applicable information& indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material D • r Supply
sand at what depth at what depth rv`nici 1
oiling 1?am feet feet well
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: 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: (oo gallon (min. size 1,000 gal.)
Tile Field: each trench '56 ft. Total System Length: 20" ft.
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # / depth or thickness feet
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 -gulatio . wi. respect to this a. •ation and agree to abide by these and all
requireme. of the To of• eensb Sa . 'ewage Disposal Ordinance.
Aighbri '
igf ?iponsible person Date
0 All% ENERGY CODE COMPLIANCE APPLICATION
IF WARREN COUNTY
� TOWNQUEENSBURY,
E DAYS RECEIVED
9000 HEATING DE
Compliance Methods:Part 5 -Acceptable Practice Method— 1&2 Family Dwellings (only)
FFR ? i2[)03
OFUEENSBURY
Part 6*-Thermal Rating—Component trade Offs 1&2 Family DwiiattiOF QUEENSBURY
Multi-Family Dwellings(3 Stories or less) BUILDING AND CODE
Part 4*-Design by Component Performance, Commercial Buildings-Hi
Rise Residential
*Requires submission of worksheets
APPLICANT'S NAME: PROPERTY LOCATION:
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area- i 't t> square feet
2. Type of heat- Electric Oil Gas Other
3. Is building mechanically cooled? yes No
4. Percentage of area of windows and doors Over 17% Under 17%
' 5. R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R VALUES AS $
SHOWN ON PLANS SUBMITTED:
a. Roof R Sc
b. Exterior walls R tg
c. Glazed areas R .• '
d. Exterior doors R 1`1
e. Floors over unheated spaces R \
f. Edge of slab on grade(heated building) R
g. Basement/cellar walls(above grade) R
h. Basement/cellar walls (below grade) R —
i. Heating/cooling-ducts-piping in unheated space R (4,
6. Service (domestic)hot water heating device
Conforms to minimum efficiency per code No
T ., 'ERATU CONTR AXIMUM SETTING 140—WILL NOT BE EXEEDED
Applicant' i natu e Date Phone Number
i_ .-N L) "791 +7�?-7
INSPEC OR'S REMARKS:
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MAP REF
ERENCE: ';r
BURNT HILLS SUBDIVISION f
DKC HOLDINGS, INC. %r
DATED: JULY 23, 2001
LAST REVISED: JANUARY 17, 2002
BY: VAN DUSEN & STEVES
LAND SURVEYORS, LLC
T--�".-'"'f��fy m 1 n e
BURNT HILLS DRIVE _ _ . �,�02 � G w
._..._-____..___._ __._. ___w _ _._._._._._____....__________ -_. - 326 .
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24 N 30,649 sq ft �aY
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0.70 acres 20 3
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ID
FILE
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I HEREBY CERTIFY THAT THI5 MAP WAS PREPARED
FROM AN ACTUAL FIELD SURVEY.
THIS CERTIFICATION SHALL RUN ONLY TO THE PERSONS
FOR WHOM THE SURVEY WAS PREPARED. AND ON THEIR
BEHALF TO THE TITLE COMPANY. GOVERNMENTAL AGENCY
178.70 AND LENDING INSTITUTION LISTED HEREON.
587027110.w CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL
INSTITUTIONS OR SUBSEQUENT OWNERS.
CERTIFIED TO: JAMIE R. HALL
= 5U5AN E. HALL
COUNTRYWIDE HOME LOANS, INC., ITS SUCCESSORS
AND/OR ASSIGNS
V x �
/ 7
CHICAGO TITLE INSURANCE COMPANY
s
._ CERTIFIED BY,
. r MATTHEW G. STEVES, LLS NYS 50135
, pew
DATED, MAY 23, 2003
Date: MARCH 141, 2005
yj "UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY �( - SGaIe I II�301
aMAP BEARWG A LICENSED LAND SURVEYORS SEAL IS A Map of a Survey made for
(I,_ NOLA ON OF SECTION 7209.SUB-DIVISION 2.OF THE
J`C�CP. NEW YORK STATE EDUCATION LAW."
S 'ONLY WITH OME5
ONGINROM LORIGINAL 5URVEfOR5
MARKED WITH AN ORIGINAL OF THE LAND 5UNEYORS � 1
SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES." JAM I E R. & S U S AN E . HALL 1
'CERTIFICATIONS INDICATED HEREON SIGNIFY THAT
THIS SURVEY WAS PREPARED WI ACCORDANCE YAlF1 THE
■y-�■ EXISTING CODE OF PRACTICE FOR LAND SURVEYORS ADOPTED
L a i l d Surveyors BY
SURVEYORSL SAID CERTIK STATE FICATIONS SHALL CIATION OF PROFESSIONAL
ONLY pp������
TO THE PERSON FOR WHOM THE SURVEY IS PREPARED.AND SHEET 1 OF 1
ON HIS BEHALF TO THE TIME COMPANY.GOVERNMENTAL
AGENCY AND LENDING INSTITUITION LISTED HEREON.AND Town of Queensbury, Warren County, New York
169 Haviland Road Queensbury, New York 12804 TO THE A551GNEE5 OF THE LENDING IN5TITUTION!
GLUTE
(518) 792-8474 New York Lic. No. 50135 NO. DATE DESCRIPTION DWG. NO. 99241-25 `