applications • TOWN_ - F QUEENSBURY REVIEWED -BY:_ _t,_ --
CQMMUNITY DEVELOPMENT DEPARTMENT ! • / d �s=-P
BUILDING & CODE ENFORCEMENT . FEE PAID: r! ,-c -
531 BAY ROAD v 4,
1 +
QUEENSBURY, NEW YORK 12804 ', "'` PERMIT NO. L4 55
(518 ) 745-4447
BUILDING PERMIT APPLICATION O "
•
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 application form.
OWNER OF PROPERTY: euR-'i5 !7 -, fl'1A;q, rar% —L• `fit 0, (A--%CI
Mailing Address : c�L <--,-f�.; •r Gc) (2 .,-,4 k NV / &' ,)e
Telephone Number( s ) : Work„-, _�5aa,o Home 6.c q e,,„is Other
PROPERTY LOCATION: y,t, , 7) 71-u 1/2 2 R
Tax Map Num er: Section /a 3 Block / Lot /q,,„2
• Subdivision Name: Lot No.
NATURE 'OF PROPOSED WORK: ESTIMATED MARKET VALUE OF T)IE
CONSTRUCTION: • $ eepg /}lj0
X NEW BUILDING:
ECE
RESIDENCE/COMMERCIAL OCCUPANCY INFORMATION:
RESITION SIDENCE/COMMERCIAL. PRX ASingleRY LFamily Dv �®
ALTERATION TO BUILDING: Two Family Dw lling �V �
RESIDENCE/COMMERCIAL Family Dw ll ' i
(NO CHANGE TO EXTERIOR SIZE) Office 1 0 91995
OTHER WORK (DESCRIBE BELOW) Mercantile TOWN
Warehouse OF QUEENSBURY
Manufacturing BUl�DINGANDCODr
Other
GROSS AREA OF PROPOSED STRUCTURE:
1ST FLOOR ,f y gg SQ. FT. t !O
O IF ADDITION, USE OF NEW ADDITION:
2ND FLOOR b50 SQ.. FT. C
OTHER FLOURS SQ. FT. ' c9.7 5R n0
(not unfinished cellar or basement) ACCESSORY BUILDINGS:
c)U Detached Garage - One/Tv Car
TOTAL FLOOR AREA: 3$, $ SQ. yC Attached Garage - One/dr Car
3 00. 00 Private Storage Building
SIZE OF NEW STRUCTURE : Commercial Storage Building .
Other
,3 FEET X L FEET
Foundation Type: . _ bloc Will any second-hand or ungraded
Number of Stories : a lumber be used? If so, for what?
(habitable space only) OD Height (grade to ridge) : ,9 6r feet Type of Heating System:
Number of fireplaces and/or woodstove (circle al - _.ich applies)
to be installed: I Electric / Oi / Gas / Wood
Forced Hot Air / Baseboard / Other
PERSON RESPONSIBLE FOR' SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS :
NAME OF BUILDER/ADDRESS/PHONE : C ,tv4 l5 J. RD,,jJFIn c A+]Sake -1 4
NAME OF PLUMBER/ADDRESS/PHONE : (", o-f ,4 ' , f;n c.:LL�-I I a si
NAME OF MASON/ADDRESS/PHONE : Rp brn't T. C<% c» ,i 3<, 41,4( art co, Rci asbv/, ,As'tpq
NAME OF ELECTRICAN/ADDRESS/PHONE: --i-FsAP, rr ,lk,7be , l Laktvru,Th t L:44nyr 1
/ DECLARATION
To the best of my knowledge the statements contained- in this appli-
cation, together with the plans and specifications submitted, are a true
and complete statement of all proposed work to be done on the described
_.c .L L..- n... l .4: .,.,. r".-..-1.-. +-1-,e 7,-n 4 n, n r rl i n a n!,P
TOWN OF QUEENSBURY
531 Bay Rd., Queensbury, NY 12804
APPLICATION FOR SOLID FUEL BURNING APPLIANCES AND CHIMNEYS
Date �l ,19 ta. r ..
Permit Nm.
APPLICATION IS HEREBY MADE to the Building Dept. 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.
Please fill out additional form if more than one appliance and/or chimney.
Applicant t1,,. , < (I`t�sr?,. n , APPLIANCE (check appropriate boxes)
Address 0,;,E ; ,4, 4 ❑ STOVE: ❑Wood o Coal o Pellet o Gas
0 FIREPLACE INSERT
? V Zip /3p FIREPLACE, FACTORY-BUILT:
0 Wood ❑ Gas
Phone ` _),4, , Ll-4 �, ,. , ,�, d 0 FIREPLACE, MASONRY:
❑ Wood ❑ Gas
Owner ., 0 FURNACE: ❑ Wood ❑ Gas ❑ Oil
Address IF NON-MASONRY APPLIANCE:
Manufacturer:
Zip Model:
Phone
CHIMNEY (check appropriate boxes)
*EXACT ADDRESS of proposed construction
❑ MASONRY: 0 Biock ❑ rick ❑ Stone
d ;1/,e—1 .to, / FLUE: ❑'Tile /ALIStyel
n,
Size / inches
CONSTRUCTION I INSTALLATION MUST IV FACTORY-BUILT: o t Banc
CONFORM TO NYS FIRE PREVENTION & Manufacturer: Model:
BUILDING CODE. CONSULT AVAILABLE Listed By: Number:
TOWN OF QUEENSBURY HANDOUTS o Double Wall ,®'Triple Wall
REGARDING REQUIRED INSPECTIONS. 0 Insulated .❑ Direct Venting
❑ Chimney Liner
Cashier's Department Town of Queensbury, New York.
Dept: Fire Marshal Amount Collected Amount Received
Code Number Title c
A 173 3389 (190) Public Safety
A 233 2655 (230)Minor Sales
Fee Coll-ected From or Refunded to (;ti x , ' }rt ,T,. RO,...31....a/v----;\--)
Address: ? ,,
Dated: 9 - t Town Clerk or Deputy: =:; , `
White: Applicant Green: Fire Marshal Yellow: Bldg. Dept. Pink & Goldenrod: Cashier's Dept.
Application for
SEPTIC DISPOSAL PERMIT STAMP RECEIVED
Location of property for installation: i v (j '" 0,,c 62 6/
'ERM,IT NUMBER
Owner's Name: ( ,)P,-Ii. -+- r -1 r'?�o - �. �ot.i(��,�
/!
Address: ST, lot•
Installer's Name: FEE PAID
Phone #: ( )
Number of bedrooms (if residential):
Total daily flow (residential -compute 50 gal. per bedroom): 30D
Topography: lat Rolling 17 St ep Slope % of Slope .30
Soil Nature: Sand n Loam Clay n Other /Depth:
Ground Water: at what depth? / feet
Bedrock or Impervious Material: at what depth? I.`5 feet
.Percolation Test: r-1 Not Required FYI Required/Rate min. per inch
Domestic Water Supply: r— I Municipal Fg1 Well Other
If domestic water supply is a WELL: water supply from any septic absorption is feet
PROPOSED SYSTEM:
Septic tank/Ono gal. (minimum size: 1,000 gal.)
Tile Field: each trench J Q feet. / total system length cC(O r) feet.
Seepage Pit(s): number of. / size each: - ft. x ft.
Size of stone to be used: # / depth or thickness / feet.
I-IOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gal.
Alarm system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 o f 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 o f an applicant, shall be void.
1 have read the regulations with respect to this application and agree to abide by these and all
requirements of the Town of Quee isbury Sanitary Sewage Disposal Ordinance.
Signature o f responsible person': _ , , Date• c.
Itii
r.
•
..i;ii 4 ENERGY CODE COMPLIANCE APPLICATION
' ' ar'` TOWN OF QUEENSBURY, WARREN COUNTY
`': -t:� 9000 HEATING DEGREE DAYS
Compliance Methods : PART 5 Acceptable Practice Method -
- 1.&2 Family Dwellings (only)
- PART (i k Therma.l. Rating - Component Tirade Offs
1.&2 Family Dwellings; Multi-Family
Dwellings ( 3 stories or. less )
PART 4* - Design by Component- Performance
Commercial Buildings-Ill Rise Residential
*Requires submission of worksheets
APPLICANT' S NAME : ' PROPERTY LOCATION:
t-I-1 s 6, -v rJ i g/s uo, .-/-.- �11`" 1Fi e, CI ' r\CI 1 v 1 ( i o s�c1 -----
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE :
I . Gross Floor Area -- -j - R square feet
2 . Type of Heat - Electric X Oil Gas Other
3 . Is building mechanically cooled? Yes X No
4 . Percentage, of area of windows and doors Over 17% )( Under 17%
5 . R-VALUES FOR INSULATION GIVEN BELOW .MUST CORRESPOND TO R-VALUES AS
SHOWN ON PLANS SUBMITTED:
a . Roof R 30
b. Exterior walls It L.
c . Glazed areas R _j , •-.7
d. Exterior. doors >R ,,2. j-
e . Floors over unheated spaces R '3
f . Edge of slab on grade ( heated building) R /0 vF'.
g. Basement/cellar walls (above grade) R /
h . Basement/cellar walls (below grade) R ip
i . Healing/cooling-ducts-piping in unheated space R _ d, /,e)
6 . Service (domestic) hot water heating device
��/
Conforms to minimum efficiency per code j� Yes No
TEMPERATURE CONTROL MAXIMUM SETTING 140° - WILL NOT BE EXCEEDED
p�1 ' c' a ' s iq� aLure DaLe Phone Number
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INSPECTOR' S REMARKS : •