CC-0060-2021 Office Use Only":
ADDITION/ALTERATION PERMIT. Permit#: CL — OO(00 202�
APPLICATION
:�
Town ofQueensbury Permit Fee:$
742_Bay Road,Queensbury,.NY 12804 Invoice.#: . .. .
P.:518-761-8256- www.gueensbuiv.net N evi Flood Zone? Y. ewed
Project Location: �wg v�4�%ov� ��C "
Tax.Map.ID #: Subdivision Name:-
PROJECT INFORMATION:
TYPE: Residential Commercial,-Proposed Use:
- .Single-Family Two_Family Multi-Family(#of units ) _ToWnhouse
Business Office . Retail Industrial/Warehouse. Garage (#of cars )
Other(describe
ADDITION SQUARE FOOTAGE:.- ALTERATION.SQUARE FOOTAGE:.
1st floor: . 1st floor:- 6d0 sT
2nd floor: 2nd floor .
3rd.floor: 3rd floor: .
Basement-(habitable space): Basement (habitable space):
Total sq ft: Total sq ft: 5�=.
Scope of work to be done: k�;2�. ckg�,p. N�L `�1P
DTE
FEB' 1.2 2021
TOWN OF QUEENSBURY
BUILDING&CODES
Addition/Alteration Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
ct7 .
1. Estimated Cost of Construction: $ 16Q,Q6�-
2. Source of Heat (circle one): _Gas _Oil Y Propane _Solar_Other
Fireplaces/inserts need a separate Fuel Burning Appliances & Chimney Application
3. Are there any structures not shown on the plot plan? _YES � NO Explain:
4. Are there any easements on the property? _YES —KNO
SITE INFORMATION:
• Is this a corner lot? YES NO
• Will the grade be changed as a result of the construction? _YES ' NO
• What is the water source? PUBLIC _PRIVATE WELL
• What type of wastewater system is on the parcel? _SEWER 41 PRIVATE SEPTIC
DECLARATION:
1. I acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be
completed within a 12 month period. Any changes to the approved plans prior to/during construction will require
the submittal of amended plans, additional reviews and re-approval.
2. If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of
Queensbury.After 1 year from the initial application date, 100% of the fee is retained.
3. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. 1 certify that the application, plans and supporting materials are atrue and a complete statement and/or description
of the work proposed,that all work will be performed in accordance with the NYS Building Codes, local building laws
and ordinances, and in conformance with local zoning regulations.
.5. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
6. 1 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 certificate of occupancy.
I have read and agree to the above:
PRINT NAME:
SIGNATURE: DATE:
Addition/Alteration Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):
Mailing Address, C/S : Ci r-r 4
Cell Ph e: 51 k ) 37- y SS Land Line: ( SI�S
Email: 'Xjeo,J c�nj W\
• PrimarV Owners
Name(s):
Mailing Address, C/S/Z: `I of ' - nS _
Cell Phone: Land Line:
Email:
❑ Check if all work will be performed by property owner only
• Contractors . (List all(�dditional contractors on the back of this form)
Contact Name(s): �S l��Gu cViC� L-.0
Contractor Trade: CP ne�c.\
Mailing Address, C/S/Z: _Qg�q
Cell Ph ne: Sk t ) 337-7 SS Land Line: 3\% - --2
Email: &�Iy A4-14 CCWV-N
**Workers' Comp documentation must be submitted with this application**
• Architects En ineer s : (� `
Business Name:
Contact Name(s): Q.
Mailing Address, C/S/Z: 7 C_ev-.k oe LN . , .
Cell Phone: 119 Land Line: %S )_ L15a - 3�73
Email: 5�� r� s'c
Contact Person for Compliance in regards to this project: 44m-, S-
Cell Ph we: ( Ske ) 337- Land Line: 7"74-1L1
Email: e-c w c\r y C Qrv-,
Addition/Alteration Application Revised January 2021
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s): f'y-'\4p C�O
Contractor Trade:
Mailing Address, C/S/Z: q4 C-O, a- e-`\ �"CS..
Cell Phone: Land Line:S I - 3yb - y67S
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s): \-�fl p1ub��S
Contractor Trade: P\`?-m\o•ev--
Mailing Address, C/S/Z: S3aS— R� �03 �GSSeiv �• ���`3
Cell Phone: Land Line: — ,
5,e - ayc?� 73a�
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade: C
Mailing Address, C/S/Z: 6q3 Gro\\
Cell Phone: Land Line:
Email: 5 t cG 753 -7 8qa
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s): C f�\ &\� �V y
Contractor Trade:
Mailing Address, C/S/Z: a5 C ,()o de- (Z.rG\2. SLs3s'm\\A
Cell Phone: Land Line: cxD &Ot
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z: a0O A\pct'`c� ��\`' e- r �e-c�y��\Gv'��-• �V \a�\�
Cell Phone: Land Line: `vt- '3g3 a551�
Email:
Addition/Alteration Application Revised January 2021
Clearances
In all buildings more than one story in height and in buildings where the roof/ceiling assembly is required to
have a fire resistance rating, the duct must be enclosed in a continuous enclosure from the lowest fire=
rated ceiling or floor above the hood, through any concealed spaces, to or through the roof to maintain the
integrity of the fire separations required by the applicable building code provisions. If the building is less
than 4 stories in height, the enclosure shall have a fire resistance rating of not less than 1 hour. If the
building is 4 stories or more in height, the enclosure shall have a fire resistance rating of not less than 2
hours. Single wall grease duct is primarily intended for use in non-combustible surroundings. When
installed in an open room where an enclosure is not required..double wall grease duct or chimney.systems
may be located near combustible material to reduce clearance in accordance with.Table.1. When
combining double wall and single wall grease duct for the purpose of clearance reduction, a.Double_Wall
End Cap Assembly is required.
Table 1 -Grease Duct and Building Heating Appliance Chimney Clearances
..._.._.........._..._..... _..._................_..._........__.. ....._.._..............._.._..-- ...._...._.-------= ----......._.._..__.:_.._...._
Inner Diameter Outside Clearance to C : Clearance to
Duct Model (ID) Diameter Combustibles '..Non'-Corn' bustibles
DW 5"-36" = ID 18„ (1) 011
5"-16" ID + 4 3/4" 2 0"
€' DW-2R
;l
(3) ;18" ID + 4 0"
DW-2R TYPE HT I 5"-16" ID + 4 2"(4) 0"
_._...---._....._............_...............---........................................._ _.._..-- ---..__...._._..__..._._._._
DW-3R ( 5"-24" ID + 6 3/4" (5) 0"
a
! DW -3Z 1 5"-36" ID + 6 0,, (6) 0"
i
The information in Table 1 represents air space, in inches, to surroundings.
Refer to the latest edition of NFPA 96, Chapter 3 Definitions. This chapter explains the definitions
on combustible, non-combustible and limited combustible material.
(1)Single Wall duct clearance to combustibles from the surface of the duct; refer to single wall grease
ductwork manual for more information.
(2)DW- 2R: 3/4"clearance to combustibles from the surface of the duct outer shell; zero inch clearance
from combustibles from the tip of the outer V-band.
(3)DW-2R: 1"clearance to combustibles from the surface of the duct outer shell;zero inch clearance from
combustibles from the tip of the outer V-band.
(4)DW-2R TYPE HT: unenclosed, 2" clearance to combustibles from the surface of the chimney outer
shell.
(5)DW-3R: 3/4" clearance to combustibles from the surface of the duct outer shell; zero inch clearance
from combustibles from the tip of the outer V-band.
(6)DW-3Z: 0"clearance to combustibles from the surface of the duct outer shell.
NOTE: Double wall duct systems with reduced clearance"R" have been tested using condition B—
installed within non-ventilated unenclosed combustible enclosure. See Figure 1 for representation
of reduced clearance note, the V-band may be in contact with a combustible surface:
C E IE CL 00 Go • M21
D �
0
MAR 12 2021
TOBUILp NGU&CODES Y
'
Figure I -Grease Duct Reduced Clearance
1 Combustible Surface
2. Duct * 1
3. Doub|eV-band
A. Reduced Clearance
^ 2R sizes 5^-1S'' = 3/4^
^ 2Rsize 18^ = 1^
, 3R=3/4^ '
^ 3Z = �
`^
'