Loading...
applications Office Use Only bi PRINC -� C;�C; 3t Qe IPLESTRUCTURE PERMIT Permit#: — APPLICATION Permit Fee:$ €' .. Off *Rec. Fee: $ 742 Bay Road, Queensbury, NV 12804 r if P. 518-761-8256 `,1tvw .queen bu;v net Invoice#: Project Location: s`S.S 4556,-)M1 j)01 C-) Tax Map #: '22 - 1 ' Subdivision Name: TOWN BD.RESOLUTION 86-2013:$850 recreation fee for new dwelling units: single family, duplexes/two-family, multiplefamily, apartments,condominiums townhouses,and/or manufactured & modular homes, but not mobile homes. This is in addition to the permit fee(s). CONTACT INFORMATION: • Applicant: Name(s): e u i r1 cr\r\a. Mailing Address, C/S/Z: U,` C I' LI L L-ACL 'f Cell Ph.: _( 517 ) 3(0I 31 &' ¶ Land Line: ( ) Email: Kht4c% 14 r(- Y41/0° - CC • Primary Owner(s): Name(s): ' , c1 . \INtkr-kAic Mailing Address, C/S/Z: /5 S 11-,Sreeh os:i i 1L 6 Cell Ph.: (S I? ) Ti 9 -- Tia ?7" 'y Land Line: _( ) Email: RMKOKO r Z to c M • Contractor(s): Name(s):Clkick 1 ;oc(l-s u;'(\ 4A-mit C Mailing Address, C/S/Z; L �,,QE C tit le L Litz e r (Q-V. Y Cell Ph.: _(� ) 3��(-- £ �� L nd Line: ( ) Email: c - c - - il'1 LE v • Architect(s)/Enqineer(s): Name(s): , ,._ --, I r 1 OCT 09 2018 Mailing Address, C/S/Z: ----�-- OWN OE EJEE. -SE Cell Ph.: ( ) Land Line: ( ) BUHLE NO&CODES Email: Contact Person_for Building & Code Co pliance: Cell Ph.: ( `'- ) � JC.,Q '-- Ci` Land Line: _( ) Email: . ToQ Building&Code Enforcement Principle Structure Revised March 2018 PROJECT INFORMATION: TYPE: Commercial Residential RK CLASS: Single-Family Two-Family Multi-Family(#of ) Townhouse Business Office Retail Hotel/Motel Industrial/Warehouse Garage(#ofcars ) Other(describe ) STRUCTURE SQUARE FOOTAGE: GARAGE SQUARE FOOTAGE: 1ST floor: / co 1ST floor: 2nd floor: R.00 2"d floor: 3'floor: Total square feet: Basement(habitable space): Total square feet: 00 ADDITIONAL PROJECT INFORMATION: 1. Estimated Cost of Construction: (0J S COC) 2. Proposed use of the building: C , ‘ 3. If Commercial or Industrial, indicate the name of the business: . 4. Source of Heat (circle one): Gas Oil / Propane Solar Other: (Fireplaces need a separate Fuel Burning Appli ces& Chimney Application, one per appliance) 5. Are there any structures not shown on the plot plan? YES NO Explain: 6. Are there any easements on the property? YES .NQ, 7. SITE INFORMATION: - a. What is the dimensions or acreage,of the parcel? ` b. Is this a corner lot? YES NO c. Will the grade be changed as a result of the construction? -,, YES \NO d. What is the water source? PUBLIC (PRIVAT ) WELL e. Is the parcel on SEWER or a PRIVATE SEPTIC system. C'J Pt ic_- ToQ Building&Code Enforcement Principle Structure Revised March 2018 DECLARATION I. I acknowledge that no construction 6hall commence prior to issuance of a valid building Fermi_and wor- will be completed within a 12 month period. 2. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees and department approval. 3. I certify that the application, plans and supporting materials are a t rue and complete statement and/or description of the work proposed, that all work will be performed in accordance with the NYS Building Codes, local building laws and ordinances, and in conformance with local zoning regulations. 4. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 5. I understand that Ikve 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: PRINT NAME: SIGNATURE: DATE: /o/ /i1 ToQ Building&Code Enforcement Principle Structure Revised March 2018 R, ti, Office Use Only iftiPia t...., , ,,,!g•••• FUEL BURNINGAPPLIANCE & Permit#: e-L- 0ko5d0 • 2.szti bA i CHIMNEY APPLICATION Permit Fee: $ ! l r �_ Invoice#: of Queensbu 742 Bay Road, Queensbury, NY 12804 P: 518-761-8256 'vww quee' .ii,I net 3 5 Project Location: / A-55Y/ >f Map Tax ID: .(ibtqRoom of Install: itti t,'t 001,u, Planned Install Date: ---. I Zo1 `/, **ONE APPLICATI ON PER APPLIANCE** CONTACT INFORMATION: • Applicant: r Name(s): e 'N (tCrNAL Mailing Address, C/S/Z:9( 7 ;Q& C ksrk le. (--,.°1- ,(.._ UA-C c T nc____ 7?((t(.. Cell Ph.: __( (p 1 -31 (2 (f Land Line: _( ) Email: rs\t„c.kleivai,,, krtsw - C c,�* • Primary Owner(s): Name(s): el_t W-"4 IGA(._ Mailing Address, C/S/Z: . ,,,, g, -2"12T Cell Ph.: (1? ) 7Land Line: _( ) Email: • Installer/ ilder: Name(s): C-..,L \ C-,niNc, , Mailing Address, C/S/Z: ) c4 -Y' Cell Ph.: , _( ) _( ) Land Line: Email: Contact Person for Building p& Code Compliance: `c-- 4::" J Cell Ph.: ( ) Land Line: _( ) Email: Town of Queensbury Building&Code Enforcement EUEL BURNING APPLIANCE INFORMATION: TYPE OF DEVICE: \('' Stove Fireplace Insert Fireplace Fuel Fired Equipment(Garage Only,18"clearance per IMC 304.3) Fireplace, factory built** ** Manufacturer's Name: Q-- , Model #: SOURCE OF HEAT: Wood Coal Pellet Gas CHIMNEY INFORMATION: _Masonry: block brick stone Flue: tie steel size,in inches Material*: t double-wall '9 triple-wa II insulated (*Manufacturer's r-i a r-r-e : Model #: ADDITIONAL INFORMATION: 1_ Two inspections are required. A rough-in inspection,prior to installation and a final inspection,after installation. 2 Manufacturer's installation manual must be available at the time of inspection. 3 Masonry fireplaces & chimneys require plans to be submitted. 4 Twenty-four (24) hour notification is required for nspections. Declaration:Construction/installation must conform to NYS Fire Prevention&Building Code and/or manufacturer requirements.The applicant or owner agrees to comply with all applicable laws,ordinances, regulations and all conditions that are part ofthese requirements and also will allow the inspector to enter the premises to perform the required inspections. I have read and ag a to the above: - PRINT NAME: \ e- L) - �,, ' — SIGNATURE _ DATE © // Fuel Burning Appliance&C ' pplication