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applications Building Permit Application Town of Queensbury,=Dept of Community Development,742 Bay Road,Queer sbury,NY (518)761.8256 A permit must be obtained before beginning construction. Permit File No. __L_�(Q No inspection will be made until applicant has received a Fee Paid $ 7 s -a_.v valid building permit. All applicants' spaces on this Rec.Fee Paid $ • • application must be completed and must appear on the Reviewed By; application form. - Applicant: c1 I( c ?�— Owner: J' t,d► - • Address: 3 30 0-orAek, l iA Address: ;o l it so , hp • CAZer.A.s yr ` 4/Vr ,/ Phone#(a51 ) - O 1 Phone#(W )7%—- 677 r Property Location: Lot Number: / House Number V3 31 6 v r -I All -- Subdivision Name: 1,�,a%- 1404.--_ Tax Map Number: r 0 New Building: resid commercial Estimated Market Value of Construction: $ /570(20 ddition: residence/ ommereial If an• teration: enee/ commercial Addon,w t/�w�ill use of etv d o,f be? a No change to exterior size: residence/com'l Obn►• ire Pa .' '�r00,17 o Other work(describe ) Check Occupancylnformation 1"Floor 2nd Floor Other floor Total Below sq.ft. sq.ft. sq.ft. Square Feet Single family dwelling ,P Po 6 °', A.., o Two family dwelling o Townhouse a Multifamily dwelling #of units a Office. o Mercantile o Manufacturing C I a 1 car detached garage a 2 car detached garage 7 D 09 a 3 oar detached garage 0 1 oar attached garage T�' '` �'� c l' t:NSBURY 0 2 oar attached garage _�"--- t .1.1u c;ODLE O 3 car attached garage 0 Storage building- commercial 0 Storage building- residential . 0 Other What is the proposed height of the structure fe t inches Will any second-hand or ungraded lumber be used? If so,for what? 0 Type of Heating System: elec. ' o' / gas/wood /forced hot air/ baseboard/other: Number of F1rer.iaces to be installed 0 Number of Woodstoves to be installed_,__,_, List below the person(s)responsible for supervision of work as regards to building codes: _- _ Nsma Address - - Phone Number _ Builder ..li m b�e, 1 L r� /.en lei.- 4/®5—Ye,,2 Plumber 4,,„� Corefeusc.� Mason ��., �����/� �,�.--�'�-�® Mwtlh s. -0>// — fhit Electrician 00R. AAlar ?eLeea� a 7�% / f Declaration: please sign below after you have carefully read the statement: To the best of my Imowledge 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,as requested by the Zoning A6*++9„aatrator or Dir ctor of Building Codes,an As Built Survey by a licensed surveyor;drawn to scale,showing actual location of all news ns! coon, Signature: �_ owner,owner's agent,architect,contractor .. Fire Marshal's Office l Town of Qucensbury,`742 Bay.Road,Qucensbury,NY (518)761-8205 co: ,1 � Application for:Fuel Burning.Appliances & Chimneys c.. pp -applicable to solid fuel & vented gas appliances - Date , 20 Permit No. ‘-f Application is hereby made to the Building& Codes Offcce for the issuance of a Building/and Use Permit pursuant to the New York State Fire Prevention and Building Code. The applicant or o7her 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 perfr rm required inspections‘. NOTE to-applicant: Rough-in and Final Inspections are required. _.; Applicant Information Fuel.Bi mining Appliance Information (circle appropriate words) Name: �f f�l/ �\,r' ram,l� © w , Stove: :,a<vood coal pellet gas • Fireplace insert Address: 3 3o 42,4.r-r,,r r /.a .1,., • Fireplace, factory-built:c- woody gas ` Fireplace, masonry:. wood gas Furnace: wood gas oil Phone: -7 ,2 -()71 X , If non-masonary applicance,please provide Owner " •,a`.r , Manufacturer Name: © f/ '/- -, Jfl ro-tp 1, Address: a ',, :'� - ,Model'Number: S c - r -_ ,, Chimney Information , (circle appropriate words) Rhone; ,;; Masonry block brick stone • ;` Flue f tile steel size: inches ',: . Exact Address: •- • of construction or installation -Facto Built , ; , o t Manufacturer name: / lt:°�i: '`c 7;, C.64(., C<ri'D . Model Number: Sy ` Listed By: -Number: Note: (E1.- / Construction/Installation must - conform to,NYSFire Prevention &Building Indicate(circle) chimney material: 'I Code. Consult available Town of Queensbury ,._- Handouts regarding{required inspections. ( Double wail Triple wall l Insulated / Direct venting Chimney Liner , Gat ffel-'sec 17epEsa-tm t—'Tomcr. of Quee mebui y, 3d'ewrrr orl3: Fire Marshal Code# $Collected $Refunded Received from(refunded to):_r^-- ,Ji 1 ,,k..,. 1 1,i i 7 t ,-'' lY. . .. 5 -address:s A 173 3389 (190)i ui lhsc -s I : A 233 2655 (23a)t e 'or Sa DATDATE: a 1 ar1 If(I a e t ' White(Applicant) / Green(Fire Marshal) / Yellow(Bldg.Dept.) / Pink&Goldenrod(Cashier's.Dept.) Fire Marshal's Office Town of Quecnsbury,742 Bay Road,,Queensbury,NY (518)761-8205 Application for Fuel Burning Appliances & Chimneys / . . applicable to solid fuel & vented gas appliances. Date , 20 Permit No. , .- 0 4 i Application is hereby made to.the.Building&Codes Office for the issuance of a Building and Use Permit pursuant to the New York State Fire Prevention and 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. NOTE to applicant: Rough-in and Final'Inspections are required. Applicant Information Fuel Burning"Appliance Information ° T .. (circle appropriate words)' Name: i1 l /,= Stove wood coal pellet gas ;- Fireplace insert Address .:' . ) ( i t y:ne k : ' ,r! :.<. _ Fireplace, factory-built: (wood) gas ' Z.r ,a ,,, Fireplace,-masonry: wood gas :, " Furnace: wood gas oil . Phone: t, "j f.` ':-+. If non-masonary applicance, please provide 1 �, O "1" C , { " ''N1ai�ufacturer Name: i 1 i ; i # � 't wrier. d \ t._ l ' Model Number: `" ":, 2 L( .Address: _ ,�, i t Fh ili Chimney Information Phone: ,. S;I ' pit (circle appropriate words) " Masonry block brick stone E`i Flue tile steel size: inches Exact Address: _ _� .,., - ,. of construction or installatioia ( Factory-Built y .--Manufacturer name: Mil ; :-?"tfi. Cr tvA t',cYe.Y" . Model Number: .`s K. ' .Note: Listed By:t.i L Number:Z(.,°` 79 i , Construction/Installation must •• conform to NYS Fire Prevention &Building. - Indicate (circle) chimney material: . Code. Consult available Town of Queensbury --•—--,.. Handouts regarding required inspections. 4., Double wall) / Triple wall / Insulated / Direct venting Chimney Liner Coa Sabi er'il:.Dep -rtmexat—Z'oi of Qi eeizsrbury, .14Tievarr 7[r.or1 s''''''*'''''') Fire Marshal Code if $.Collected $Refunded . Received from (refunded tc). cf.. _ 1 r addres:s: A 173 3389 (190) Public Safety • . A 233 2655 (230 Minor Sales , , i , DATE: fit ,4. ..r irLI ' OP I ).,b AR ) �/ i White(Applicant). ,/ Green(Fire Marshal) / Yellow(Bldg"Dept,) / Pink°°&.Goldenrod(Cashier's Dept.)