applicationsIN OF QUEENSBUR:
TOWN OF QUEENSBURMECEIVED
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
ApRi4 1992 Fee Paid
vate:Y/(4>BLDG.&CODE DEREviewed By
LOCATION OF PROPERTY FOR INSTALLATION:_iDY/oth xX Exile Soo,=Owner's Names Gn Werbhoard letOwner's Mailing Address:Duision Sh Qoeennlour 4
Installer's Name:Larry Clute Phone #:“743-7977
4
Number of bedrooms (if residential):3
Total daily flow (residential-compute @ 150 gal.per bedroom):YSO
Topography-Circle One:CFlat_)Rolling Steep Slope —_&of Slope
Soi]Nature-Circle One:Sand)Loam Clay Other /Depth:
Ground Water-At What Depth?Feet
Bedrock or Impervious Material-At What Depth?Feet
Percolation Test-Circle One:Not Required Required/Rate Min.Per Inch
ane =)Domestic Water Supply-Circle One:Municipal Me11 Other sc.eel
If domestic water supply is Gutciza
Separation:Water supply from any septic absorption feet
PROPOSED SYSTEM:Septic Tank (OOO gal.(Minimum size:1,000 gal.)
Tile Field:Each Trench SO feet//Total System Length _SQO_feet
Seepage Pit(s):Number of /Size each:ft.x ft.
Size of Stone to be used:#/Depth or Thickness feet
JenaHOLDINGTANKSYSTEMIF REQUIRED
No.of Tanks Size\of Each Gal.
Alarm system and associated electrical work to be inspected by a certified
agency.a JER IDI
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all reatreets Town of Queensbury Sanitary Sewage Disposal
Ordinance./
SIGNATURE OF RESPONSIBLE
fl
aeTOWNOFQUEENSBURYiD
REVIEWED BY:
FEE PAID:Sl TOWN OF QUEENSBURY
RECEIVED
permit no.:2-0 1D
BUILDING PERMIT APPLICATION BLDG.&CODE DEPT,
MAR 5 1992
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION.NO INSPECTIONS WILL BE MADE UNTILAPPLICANTHASRECEIVEDAVALIDBUILDINGPERMIT.
All applicants spaces on this application MUST be completed and the signature of theapplicantMUSTappearonthereversesideofthisapplication.SR RRR HE RAE E HARARE RARER ERE REEOwnerofProperty:Kolo.40 Aboard Xr
P.O,Address:Divisnon SN,Queers IY.icteoy PHONE 76%-B+f%<
Property Location:YM Sirvet Enlenron ,Glens Cable Tax Map Wo./5//7_1/5
Has there been any split of this property since October 1,1988?Yes No ><CbbsIfyes,Planning Board Review is necessary.
Subdivision Name,if applicable:Lot No.
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
Lorry Clule,B26 Boy Wo Queerssry 763-7977
NATURE OF PROPOSED WORK:ESTIMATED MARKET VALUE OF THE
CONSTRUCTION:$_%7O,000.°2
COMPLETE INFORMATION REQUIRED BELOW:
Size of Property:(oo ft.x loo ft.Existing Building Size:2s ft.x 35 ft.
’Proposed building -distance from
property line:
Construction of new buildingAdditiontobuilding
XK_Alteration to building(no change to exterior dimensions)ther work (describe)
::=
GROSS AREA OF PROPOSED STRUCTURE:
Ist Floor Ow Sq.Ft.
2nd Floor WIA sq.Ft.
Sq.Ft.
Front Yard Yo_ft.Rear yard 3 ft.Side Yards “27 ft.and OS Ft.If on corner,setback from side street-—ft.Other Floors
(not cellar or basement)
TOTAL FLOOR AREA:|OQlo/_Sq.Ft.
Size of New Structure:DZ ft.x SB ft.
OCCUPANCY INFORMATION:
Primary Building -
One Family Dwelling
Two Family DwellingFoundation:Multiple Dwelling/No.of UnitsPier/Slab/Crawl /Partial/irele One)———BusinessIndustrialNo.of stories (Habitable space)__/—™~otherHeight(grade to ridge)i ft.If residential,no.of familie
No.of rooms (excluding baths)
No.of bedrooms:
No.of bathrooms:
Primary heating syst Ges Hol AcTypeoffuel:
xo
OASNo.of fireplaces to be installed:Wiil-a woodstove be instalied?!TPCentralAirConditioning:Yes 0
If addition,what will use be?
Accessory Building:Detached Garage -One/Two CarAttachedGarage-One/Two CarPrivateStorageBuildingOther
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(OVER)
BUILDING PERMIT APPLICATION CONTINUED:
BUILDING SPECIFICATIONS:
Type of construction:wood frame,fire safe,etc.
Will any second-hand or ungraded lumber be used?If so,for what?
Foundation Wall Material:Covwrele Inlock Thickness:%
Depth of Foundation below grade (to bottom of footing):-WiIl there be a cellar?(es__Heated or Unheated?Unlycsled Floor Sq.Footage:Wi11 there be a basement?(,eS Will any portion be used as living space?WoIfso,what portion?_————q.Ft.Type of Use?
Type of Roof:Sloped/Flat/Shed/Other S/>\vuss Material of Roof ashphalt ShuralesoyeSize,wood studs "x __"-spacing "o.c.3 length _—sftt.Joists (floor beams):Ist Floor =="x "5.spacing “o.c.;span sft.Joists (floor beams):2nd Floor "x spacing “o.c.s span ft.Overlays (ceiling beams):"x "5 spacing 3 Span ft.Roof rafters:"x "3 spacing __oc.span ft.
Roof trusses (pre-engineered):spacing DY "0.c.;span O@ ft.ans ay!
Exterior Wall Finish:clasble Y ow of what material?
Interior Wall Finish:Khe chro &
If a garage is to be attached,describe materials to be used for FIRE SEPARATION:
Is there to be 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?____Height above roof ft.
Depth of chimney foundation below grade:ft.
Depth of fireplace hearth:ft._———~in.
Water supply -Municipal or private well:Muni Gi pal
SEPTIC SYSTEM:Distance from any private well (including adjoining properties:ft.
(A separate application is necessary for any repair or new installation of septic system.)
NAME OF BUILDER &ADDRESS:Ohekee Ballers Cas ry C (uhe\PHONE “293-7977
ve aNAMEOFPLUMBER&ADDRESS:PHONE,
NAME OF MASON &ADDRESS:V/A PHONE
NAME OF ELECTRICIAN &ADDRESS:*PHONE,Mf
DECLARATION
To the best of my knowledge and belief the statements contained in this application,together with the plans and specifications submitted,are a true and complete statement ofallproposedworktobedoneonthedescribedpremisesandthatallprovisionsoftheBUILDINGCODE,THE ZONING ORDINANCE,and all other laws pertaining “the proposed work shall”
be complied with,whether specified or not,and that such work i i
s
SPECIAL CONDITIONS OF THE PERMIT:
Code Enforcement Officer
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY,WARREN COUNTY -9000 HEATING DEGREE DAYS
Compliance Methods:TOWN OF QUEENSBURY
RECEIVED
PART 5 -Acceptable Practice Method -1 &2 Family Dwellings (ONLY)
PART 6 -Thermal Rating -Component Trade Offs -1&2 Family Owellings;MAR 5 1992
Multi-Family Dwellings
(3 Stories or Less)BLDG.&CODE DEPT.
PART 4 Design By Component Performance -Commercial Buildings -Hi-Rise Residential
PART 4 &6 -Compliance Methods Require Submission of Worksheets
Se Noglhosto «48£iT-THT SeFao TOW
PART 5 METHOD OF COMPLIANCE BY ACCEI
1.Gross Floor Area -Ob Sq.Ft.
2.Type of Heat -Elec.Base Board other_Gas \fot Nie
£PRACTICE:
3.Is Building Mechanically Cooled?YES Y<__No
4.Percentage of Area of Windows and Doors Over 17%Under 17%
THE R-VALUES GIVEN OM THIS SHEET MUST CORRESPOND TO REQUIREDTHER-VALUES SHOWM ON PLANS SUBMITTED!REQUIRED
Baseboard
5.Insulation Values:Actual Shown Elec.Heat Otherrf@Zo
A.Roof &Floors exposed to ambient temperatures\ux-RIG
B.Exterior Walls RQo
C.Glazed Area R
D.Exterior Doors R
E,Floors over unheated spaces RIF
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
6.Service (Domestic)Hot Water Heating Device
A.Conforms to minimum efficiency per code ><__YES No—‘TURE CONTROL MAXIMUM SETTING 140°-WILL NOT BE EXCEEDED
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INSPECTOR'S REMARKS :