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applications ............... OFFICE USE ONLY •. •••• -� , S TAX MAP N0. ERMIT NO. E C E U 1 E FEES: PERMIT RECRE IONENGINEERING JUN 12 2009 D (If applicable) TOWNOF•QUEENS841R'Y PRINCIPAL ,STRUCTURE; BUILDING & CODES ,APPLICATION FOR ZONING APPROVAL & BUILDING PERMIT A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION. APPLICANT/BUILDER: lei/� /-_i eek OWNER: �Te —�✓ T Sry��r7l" ADDRESS: 10!z 7-L)bG111 7d, ADDRESS: /oy 7', '/ R). PHONE NOS._SIFf - 752 - -r>7p dd�23y87fS PHONE NOS. S/�- ?5Z-S/ 701.-3211,3w CONTACT PERSON FOR BUILDING &CODES COMPLIANCE: 5avne 4S a Lmse PHONE:jk-5126fz3z-ism LOCATION OF PROPERTY: 10j T ,`11 P HAS THERE BEEN A SITE PLAN REVIEW; VARIANCE OR SUBDIVISION APPROVAL? CI'Y S ❑ NO IF SO, INDICATE APPLICATION NO. AND DATE OF APPROVAL: /O /2z PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW: CHECK ALL THAT Z APPLY TO YOUR Z � LL PROJECT 0 0 O to LL w 0 00 tp F- L 0 F Lw LLw w ¢ axV Z Q ¢ :- d NdDuj�9LL 00a = ss SINGLE FAMILY P"''-Fr2n TWO-FAMILY MULTI-FAMILY (NO. of UNITS_) TOWNHOUSE BUSINESS OFFICE RETAIL- MERCANTILE FACTORY OR INDUSTRIAL / ATTACHED GARAGE(1,2,3) OTHER IF COMMERCIAL OR INDUSTRIAL- NAME OF BUSINESS: ESTIMATED CONSTRUCTION COST:4 I Sol FUEL TYPE:A9.J//04,4y/ 0011d HEAT TYPE:14-ALAL-t *HOW MANY FIREPLACE(S): AND/OR WOODSTOVES(S):�_ ZONING CATEGORY: F9-SQA. ARE THERE WETLANDS ON THIS SITE? NU IS THIS A HISTORIC SITE? Me) PROPOSED USE OF BUILDING OR ADDITION: 1r *Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in our office T07on of Queensbury • Communihj De7,elopment Office • 742 Bay Road, Queensbury, NY 12804 • 88-LGL I I-05 ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? / Jc, ARE THERE EASEMENTS ON PROPERTY? I acknowledge no construction activities shall be commenced prior to issuance of a valid permit. I certify that the application, plans, and supporting materials are a true and complete statement/description of the work proposed, that all work will be performed in accordance with the NY State Building Codes, local building laws and ordinances, and in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand that Uwe 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 haveAreaddd agree o the above. Signe Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction codes or septic systems) Zoning Administrator- 761-8218 (for questions regarding required permits, the permit process, application requirements or to schedule an appointment) ------------------------------------------------- ------.-..._-_.-•-•_- .- Permission is hereby granted to the above This application / proposed action described t - Applicant to erect or alter the building herein is found to be in accordance with the described herein in accordance with said zoning Laws of the Town of Queensbury. Application: BUI DING & CO EJq ROVAL ZON A PROVAL DAT DATE QUESTIONS? CALL 761.8256 OR EMAIL Office Use Only codesfii�cueensbury net VISIT OUR WEBSITE FOR MORE INFORMATION Operating Permit Issued: _Yes _No www.aueensbury net Occupancy Type: _ I Construction Classification: Assembly Occupancy Limit: Special Conditions: T07an of Queensbury,• Community Development Office • 742 Bay Road, Queensbury, NY 12804 ............................................................................... .�. .�.. ..�i. OFFICE USE ONLY ; TAX MAP NO. PERMIT NO. PERMIT FEE JUN 1ZURY : + APPROVALS: ZONING TOWN CLERK TOWN OF Q ............ .: :..BUILDING&.CODES-- APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT. A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. (yamr OWNER: �fd'!-/�G✓ l�.1 M4 Ce ..rL INSTALLER: J it✓ i"�.!� �Lw ADDRESS: I��'1 p7- i ,�I/�G�-!J• ADDRESS: IAOL/ J `.�_'/'/ PHONE NOS. SI r5 - / /2- '5J90 r'1Z3 17`d' PHONE NOS.0 ng- 7c/2-S I?0/23 Z-137 LOCATION OF INSTALLATION: ICh/ -T d14 •11 W• NO.OF RESIDENCE INFORMATION: BEDROOMS YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = INSTALLED? Ny 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present 3 X 110 gallon per bedroom = 3,3p INSTALLED? .VO PARCEL INFORMATION: / ✓ TOPOGRAPHY: Flat rolling r! Steep slope_ %Slope_ ✓ SOIL NATURE: Sand l/� Loam Clay Other ✓ GROUNDWATER: At what depth? none-- V BEDROCK/IMPERVIOUS MATERIAL: At what depth? NIA. ✓ DOMESTIC WATER SUPLY: Municipal_ Well 1/ (If well: Water supply from any septic system absorption is 2co / ft.) ✓ PERCOLATION TEST: Rate is A/`r,.n minutes per inch [MPI] (Test to be completed by a licensed professional engineer or architect.) 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). TANK SIZE: IZSD GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. SYSTEM TYPE: 9--ABSORPTION SORPTION FIELD (WITH NO. 2 STONE) Total length 3Uo ft. Each trench S X ❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ❑ ALTERNATIVE SYSTEM Bed or other type? ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? .. . .. .......,, NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. 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 Town of QUESTIONS? CALL 761.8256 OR EMAIL Queensbury Sanitary Sewage Disposal Ordinance. codesCa)aueensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION /Z/O7 www.aueensburv.net ,� tUrrfverlion Responsible Date Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804 B 5-LGL 6/06 I C8 2� I ta!"q Obnr?f C�:z , - ,4/ !'Cr Roatif- Nf ""olk.7 04 �-Vl 2. QT1`.1�jl nil, !I I L. AUN 122 DI-* paildt'l, C.r. C"ant ti''T Mal;, '1eirss7F1 .0 TO 0 U ENSBURY V no+ heeK c ­BULD1NG&C00n R1 APPLICATION FOR FUEL BURNING APPLIANCE & CHIMNEYS Application is hereby made to the Building & Codes Office for the issuance of a Building & Use Permit pursuant to the New York State Fire Prevention & 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. IMPORTANT NOTE TO APPLICANT: ROUGH-IN AND FINAL INSPECTIONS ARE REQUIRED. OWNER: 'u-C JOL-ce -r z INSTALLER/BUILDER: -r I IZ, ng,4 J,_) J�24,/,a JET ADDRESS: /04/ WC), ADDRESS: �d- PHONE NOS. 90 z- 1de 13?k� PHONENOS. 7� 2- ,5_/?0/23z- LOCATION OF PROPERTY. 10qT1kA73:11 J?d- SUBDIVISION NAME: Zsew/,C / :I- LOCATION OF PROPOSED CONSTRUCTION ANDIOR INSTALLATION: 1oqTLj­h-'# W. CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: 4s 4 " I PHONE: ✓ FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL STOVE FIREPLACE INSERT FIREPLACE,FACTORY BUILT' FIREPLACE,MASONRY FURNACE(GARAGE ONLY) *IF FACTORY BUILT,PLEASE PROVIDE: MANUFACTURER NAME: Q ueC)14 MODEL NO. LISTED BY: ?00M 14,EA7,-X5 —NUMBER: 30IY73 QUESTIONS? CALL 7615205 or 7615206 CHIMNEY INFORMATION BLOCK BRICK STONE OR EMAIL: MASONRY" CHECK ONE ✓ VISIT OUR WEBSITE TILE STEEL SIZE IN FOR MORE INFORMATION INCHES .neY FLUE is Ir DOUBLE TRIPLE WALL INSULATED DIRECT VENT CHIMNEY WALL LINER CHIMNEY MATERIAL CHECKONE "IF NON-MASONRY,PLEASE PROVIDE: MANUFACTURER NAME: MODEL NO. ADDITIONAL NOTE: CONSTRUCTION/INSTALLATION MUST CONFORM TO NYS FIRE PREVENTION &BUILDING CODE AND/OR MANUFACTURERS REQUIREMENTS. CONSULT AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED INSPECTIONS.