applications .TOWN OF QUEENSI3URY
RE WED BY . � IOWN OF QUEENSBURY
RECEIVED
FEE PAID $ '
F � / PERMIT NO. — J L 3 0 19$) •
BUILDING PERMIT APPLICATION BLDG. & CODE DEPT.
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO INSPECTIONS "
WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT.
All applicants spaces on this application MUST be completed and the signature of the
applicant MUST appear on the reverse side of"this application.
- « « « « * «- « « « « « * « * ,«a' I* • * * « * * « « * * * * * « « « « « « « * * * * *
The owner of this property is:fetal anal /Land
P.O. Address/?/?S /2 XaS (A/W g - s�III Tel. ( ) 79:2- 4< y/J •
Property Location Xiwv:✓ Tax Map No. 32-- // l 7 3
_ Has there been any split of this property since October 1, 1988? / X RR S/f
If yes Planning Board Review is necessary. yes no
SUBDIVISION NAME, IF APPLICABLE LOT NO.
THE PERSON RESPONSIBLE FOR SUPERVISION OF. WORK AS REGARDS TO.BUILDING CODES IS:
*
NATURE OF PROPOSED WORK: * ESPIMATED MARKET VALUE OF •
Construction.of a new building • CONSTRUCTION: $ 7000—
Addition to a building * COMPLETE INFORMATION REQUIRED BELOW:-
)�/- * Size of property ft x ft.
( Alteration to a building * Existing Buildings(3) Size ft. x ft.
(no change to exterior dimensions) *
Proposed building - distance from property line:
Other work (Describe) * Front yard ft. Rear yard ft.
•
Side yards ft. and ft.
*
GROSS AREA OF PROPOSED STRUCTURE * If on corner, setback from side street ft.
•
1st Floor SG sq. ft.
* OCCUPANCY INFORMATION
2nd Floor . sq. ft. * Primary Building -
Other Floors sq. ft. it
One Family Dwelling
(not cellar or basement • Two Family Dwelling
TOTAL FLOOR AREA ,SG' sq. ft. * Multiple Dwelling/Number of units
Size of new structure ft x_ft. • Business
Foundation-pier/slab/CM. rtial/full * Industrial
" /;
(circle one • ' Other .
No. of stories (habitable space) •
Height (grade to ridge) /O ft. - , If addition, what will use be?
If residential, no. of families / . •
No. of rooms(excluding baths) 3. ' Accesso
ry Building
No. of bedrooms /
__Detached Garage ONE/TWO Car
No. of bathrooms / • •
Primary heating system /-47r,¢/i2 • _,,._Attached Garage ONE/TWO Car
Type of fuel_ 6if-S * Private storage building
No. of fireplaces to be installed '
Will a wood stove-be installed • X Other �orT/�G'�
Central Air conditioning NO '
• OVER
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe. etc. 0,0,f'
Will any second-hand or upgraded lumber be used? If so, for what? Af/O
Foundation wall material S7 7,(/ Thickness /a '
Depth of foundation below grade (to bottom of footing)
Will there be a cellar? NO Heated or unheated? Floor sq. footage sq ft.
Will there be a basement? ,/O Will any portion be used as living space?
(If so, what portion? sq ft. Type of use?
Type of roof sloped/flat/shed/other Material of roof %Sa//, 7 S6//,W,4ES
Size, wood studs Z. "x " spacing a" o.c. length g ft.
Joists (floor beams) 1st floor 2, "x 6 " spacing ,y "o.c. span /2 ft.
Joist (floor beams) 2nd floor 2 "x l spacing /G "o.c. Span /Z ft.
Overlays (ceiling beams) . "x " spacing " o.c. span ft.
Roof rafters 2 "x " spacing o.c. span ft.
Roof trusses (pre-engineered) spacing " o.c. span ft.
Exterior wall finish CA 4',00041-, Z7 of what material? , /oo.D
Interior wall finish ,Sfi`FE7 'O oh /9/fd/,bL/yG
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
Is there to he an opening between garage and dwelling? If so will a Fire-rated door, enclosure,
self-closing device be provided?
Will a•flue-lined chimney be installed? NO Height above roof ft.
Depth of chimney foundation below grade ft. _
Depth of fireplace hearth ft. in,
Water supply - Municipal or private well P,,e/W C{/.E2.2-
SEPTIC SYSTEM Distance from ANY private well (including adjoining properties /DO 1• ft.
(A separate application is necessary for any repair or new installation of septic system)
NAME OF BUILDER ADDRESS TEL. NO.
NAME OF PLUMBER ADDRESS TEL. NO.
NAME OF MASON ADDRESS TEL. NO.
NAME OF ELECTRICIAN ADDRESS TEL. NO.
DECLARATION
To the best of my knowledge and belief the.g+" ements 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 not, and that
such work is authorized by the owner.
Signature &‘'
wner, owner's agent, ar act, contractor
SPECIAL CONDITIONS OF THE PERMIT:
BY
TOWN OF QUE . VSBUR.•
WARREN COUNTY , NEW YORK i"O�i/id G� GUEElVSEl1RY
Application for : BUILDING: PERMIT IN COMPLIAN.CE WITH THE NEW YOR c�(tfED
STATE ENERGY CONSERVATION CODE _1���I q
- A permit must be obtained before beginning 0 .3 0 1990
ANSWER ALL of the following: BLDG. & CODE DEPT.
1. Gross floor area
2 . Type of heat Z, T+
3 ." Is the building mechanically cooled? . NO '
4 . Percentage of area of windows and doors A. Over 16% Only
1 . _ U value" of gross area of walls , roof/ceiling and floors
exposed to ambient conditions -
2 . Floor over heat-.3 spaces " YES NO "
a. Are foundat on walls insulated? YES NO
1. If YES , what is the R value?
3 . Slab on grade YES NO
• a. If YES , wh .t is the R- value of insulation around
perimeter of floor?
4. Is basement heated? YES NO -
a. R value of. insulation-
5. Type of insulation
B. Under 16% Only -
1. -R value of roof and floors exposed to ambient conditions
• �'r-30
2 . R value of exterior walls r/ -
3 . R value of- glazed area ,�X/Si//jam
4 . ' R value of doors .
5. R value of floors over -unheated spaces -
6. R value of slab edge insulation -. unheated slab
7 . ' R value of slab insulation - heated slab
8. R value of heated basement/cellar walls (above grade)
9 . R value of heated basement/cellar walls (below grade)
10. Type of insulation
•
C. Controls
1 . Thermosta-t maximum heat setting .
0: - Duct 'Systems " -
1 . Is duct system installed in unheated spaces? YES - NO
a.. If YES, R value of duct installation
b'. " R value of duct in other areas - -
E. Piping Insulation
1.. Size of hot water or cooling carrying agent pipe - -
2 R value of pipe insulation -
F. Service Water Heating
1. Performance efficiency -
2. " Temperature control setting maximum
G. For Swimming Pool Only :
1.. Maximum heating. .
Telephone No. $/ applicant ' s signature)