applications \�
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OFFICE USE ONLY
TAX MAP NO. . � , ' dam - \ 'q P BAiII NO. E E!VED
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FEES: PERMIT RECREATION FEE ENGINEERING
PAID (If applicable) ; A0.0 0 2 2006
CN�IJ ° Q�i 0NSBURY
1 ZS BUILDING ��D CODE
PRINCIPAL STRUCTURE:
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: c\ °J -\ b(.• ' OWNER:
--RAADDRESS: C-Oli \ ADDRESS: C.-§--A--\.. evik, \7::) 6 3 )
PHONE NOS. a �_"1 Er q PHONE NOS.
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE. o1Q0�`� PHONE: d Cs
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- ,---,---- . - - - ,' ' r:_• -1)----v.___,,,:'' ,---- -774..,-.
LOCATION OF PROPERTY: " ,0 .4 ,,1 11:,'- _ - : �� t.�-^�nY �,, 'I i
SUBDIVISION NAME: \--0, Y'- G (OJ _ . Tv � a_��� -'
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT p cc o C. 0 1
APPLY TO YOUR z E cc
PROJECT R cc 8 - � •
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SINGLE FAMILY
ingl /o24 Sz ` z52-4
TWO-FAMILY
MULTI-FAMILY
(NO.of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACHED 51-
GARAGE(1,2,3) c5-7
OTHER
4- /F;i--pbtce
IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS: if 2(
ESTIMATED CONSTRUCTION COST: �-" ( `- Please complete a separate Application
f for"Fuel Burning Appliances&Chimneys"
HOW MANY FIREPLACE(S): I AND/OR WOODSTOVES(S): available in our office
ZONING CATEGORY: S` ARE THERE WETLANDS ON THIS SITE? (k.)�
IS THIS A HISTORIC SITE?
PROPOSED USE OF BUILDING OR ADDITION: \c\oQ '\ , ` , sc-
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? �� `
1,cK Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
ARE THERE EASEMENTS ON PROPERTY? Iw
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 I/we 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 nd agre the above. ED
Signed 7,29-d(o
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)
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Permission is hereby granted to the above ; This application / proposed action described
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:
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B LDING & CODES APPROVAL ZONING APPROVAL
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DAT
DATE
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(dUESTIONS? OALL 761-6256 OR EMAIL
codes C�ga,aeensbsarynet
VISIT OUR wEBSITE FOR MORE INFORMATION
WWW.r ueensbur�;.net
.y�L l Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury,NY 12804
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OFFICE USE ONLY 1-9 ' *RECEIVED
TAX MAP NO. AN.)� �
PERMIT NO. PERMIT FEE ; AUG 0 2 200
6
APPROVALS: ZONING TOWN CLERK ; TOVVN Or SBUI=1Y
BUIL_M /a ►' CGDE,
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.
OWNER: 1 SS INSTALLER: I k 3 S Sc •
ADDRESS: • 01 ADDRESS: Cf.\\(\- ° 1
PHONE NOSE NIA PONE NOS. ac' U
LOCATION OF INSTALLATION: \ 1 1 ,\ Of 3 .., Jz� ?A+rerci, e�
NO.OF 1 I 60 `..ESIDENCE INFORMATION:
YEAR BUILT I X j COMPUTATION= = TOTA DAILY FLOW ..
BEDROOMS ! GARBAGE GRINDER
1980 or older J X 1 150 gallon per bedroom = INSTALLED? I J M
1981 -1991 I X I 130 gallon per bedroom ( =
SPA OR HOT TUB
1992-present X i 110 gallon per bedroom ; _ y
INSTALLED? NO
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLA OLLING STEEP SLOPE %SLOPE
✓ ,SOIL NATURE: SAND x LOAM, X CLAY OTHER
✓ GROUNDWATER:� J WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
V DOMESTIC WATER SUPLY: MUNICIPAL WELL
av�2
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS lob c FT. )
✓ PERCOLATION TEST: RATE IS 1I,NI/;v 365fVPER MIINUTE PER INCH (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). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.✓ SEPTIC TANK: (2.50 a,4LLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH 7/J FT.
✓ TOTAL SYSTEM LENGTH: 27-0 FT. SEEPAGE PIT(S): HOW MANY?
V SIZE OF EACH FT. X_ FT. •
tc
• SIZE OF STONE TO BE USED: # Z /DEPTH OR THICKNESS / Z. FT.
I
✓ BED SYSTEM SIZE: ?j(7 x
t{
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
IN
✓ GALLONS./TOTAL CAPACITY: 0 GAL.
•
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN I••.
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 sof the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Que nsbury Sanitary Sewage Disposal Ordinance. codes@aueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
7 — 2 9_c76_ www.queensburv.net
Signatu a of Person Responsible Date
Jz.,y Town of Queensbury • Community Development Office ® 742 Bay Road, Queensbury NY 12804
Fire Marshal's Office Town of Queensbury,742 Bay Road,Queensbury,NY •
(518)761-8205
Application for Fuel Burning Appliances & Chimneys
applicable to solid fuel & vented gas appliances
Date_ ' , 20 QLP . Permit No. e �*40-
,
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
(circle appropriate words)
Name: \ R 1NS L - Stove: wood coal pellet gas
Fireplace insert
Address: (0-7 7 R\C____.9 Fireplace, factory-built: wood :as
c.r-NSe i o.D 'v-I Fireplace, masonry: wood gas
W
Furnace: wood \ gas oil L�Phone: �-q-� 4
If non-masonary applicance, please provide\ /1�
Owner: �1,, 0 ` • • Manufacturer Name: VePAU\A-CN--S-VI �1'J SP
Address: .Model Number: V\O � bZ
. , Chimney Information
Phone: (circle appropriate words)
_-�o Q i- /� I� Masonry block brick stone
1 t-t� Flue tile steel size: inches
Exact Address: n h
of construction or,instdllation Factory-Built
or 3 N.. ; f a„ F1Cct..._ Manufacturer name: Ves VNA. 4- Cocs4 t
Model Number: V
. Note: Listed'By: Number:
Construction/Installation must
conform to NYS Fire Prevention &.Building Indicate(circle) chimney material:
Code. Consult available Town of Queensbury
Handouts regarding required inspections. ouble wall Triple wall / Insulated / Direct venting
Chimney Liner
C7a satier'aer Mocpa.rizem®xit—Tor - z totir Qazeexzeobu z'y, Areaw�eox'l
i
Fire Marshal Code# $Collected $Refunded Receive •o ' efundced to)• I
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p- .
I:_____ ,- . Osess:_ - i/ .
, ,
A 173 3389 (190) Public Safety _ Al ,, "
A 233 2655 (230)Minor Sales _ ef air
DATE: G►!
e.
wciwLa /O O — svw eee4h 02 D ,
White(Applicant) / G - (Fire Marshal) / Yellow(Bldg. pt.) / Pink&Goldenrod(Cashier's Dept.) J
;TOWN OFQUEENSBURY.;`k:-i
HIGHWAY Richard A. Missita
DEPARTMENT Highway Superintendent t
Home(518)798-5127
742 Bay Road*Queensbury,NY. 12804 Michael F. Travis
Deputy Highway Superintendent
Office Phone:(518) 761-8211 (518)798-0413
Fax:(518) 745-4466
__. DRIVEWAY PERMIT_
DATE: 7
/2$' icr
APPLICANT NAME: .Ps "S��' C9
TELEPHONE NO.: Ric C -)_9
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ADDRESS TO BE INSPECTED: 1� � � •3 Fe-
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RETURN ADDRESS:
Applicant must show exact location and width of driveway(s) to be connected to the highway by
placing stakes at the specified location.
The Superintendent of Highways of the Town of Queensbury has reviewed this application. The
following action has been taken:
STEP 1: ( ) Preliminary Approval ,
ct)
NEED: ( ) Slight swale
( ) Level with the road
( ) Deep swale
Size pipe to be used (if necessary)
( )12" ( )15" ( )18" ( )24" ( )36„
Preliminary inspection completed by DATE
Approval by Highway Supt. Deputy Supt
Upon completion, please resubmit this approved permit for a final approval.
STEP 2: ( ) Final Approval
( ) Rejected
DATE:
Richard A. Missita, Highway Superintendent
E-mail:highway@queensbury.net
5