2003-1006 BuRding Permit Application
Town of Queensbury—Dept of Community Development,742 Bay Road,Queensbury,NY
(518)761-8256
A permitmustbe..obtained before beginning construction. Permit File'No.
No inspection will be made until applicant has received a Fee pad $ z,
valid building permit. An applicants' spaces on this - Rec.Fee Paid $
application must be completed and must appear on,the . Reviewed By:
application form. -
Applicant: r C'c xY rl n n_ Owner:
Address: W Nxie Address I
Phone 3 Phone#
Property Location Lot Number: / House Number.
Subdivision Name: Tax Map Number� _� L11
0 New Building: residence /-commercial timated Market Value of Construction:
D Addition: - residence/ commercial If n an Additio ,dwhat will use of new addition be?
Alteration: ?p us
x ileac / eial
No change to,eacte6 size: residenc
Other work(=oriba �tl l'nSu 0. t2X1,� C YLCC1=4
Check Occutpaneylnformation V Floor 2° Floor Other floor TO. 1 h��•.
Below sq.ft. sq.ft, sq.ft. Square_Feet
S' a family dwelling ,
ax�
o Two family dwelling
a Townhouse
o Multifamily dwelling
#of units
a Office
o Mercantile
n 1vZtraufacturin
0 1 car detached garage
0 2 car detached garage '
a 3 car detached garage
1 car.attached garage
cr -2 car attached garage
0 3 car attached garage_
at Storage building-
commercial
Storage building-
residential
o Other
What is the proposed height of the structure Inches
Will any second-hand or ungraded lumber be used? If so,for what? 0 ii__
Type of Heating System: electric/ oil 1gas/wood /forced hot air baseboard other: )4 04� lli AQQ__
Number of FAenlaces to be installed -)e5— Number of Woodseoves to be installed
List below the persons)responsible for supervision of work as regards to building codes:
Name, Address., Phone Number
Builder
Plumber a
Mason
Electrician a -
nec1= ion-pleasetsignbelow'aSai'you have,earefully read the statement:
To the best of my knowledge the-statements-coniained.iai this application,together with:the plans and specifications
submitted,are a true and complete statement of all proposed work to be done on the described premises and that all
provisions of the Building Code,the Zoning Ordinance and all other laws pertaining to the proposed work shall be complied
with,whether specified or noted,and that such work is authorized by the owner. Further,it is'understood"that Lwe shall
submit,prior to�Administrator
Certificate_of Occupancy or Certif cate'of Compliance being issued,as.requested by the Zoning
Director o Building and Codes,an js Built Survey,by a licensed surveyor;drawn to scale,.showing actual
location of w cons on.
Signatures weer,owner's agent,architect,contractor
403 - 10�
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY
9000 HEATING DEGREE DAYS
Compliance Methods:Part 5 -Acceptable Practice Method;1&2 Family Dwellings.(only)
Part 6*-Thermal Rating—Component trade Offs 1&2 Family"Dwelling,
Multi Family Dwellings(3 Stories or less)
Part 4*-Design by Component Performance,Commercial Buildings-fu
Rise Residential
*Requires submission-of worksheets
APPLICANT'S NAME: PROPERTY LOCATION:
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area. t L? square feet
2. Type.`of heat- Electric . . Oil Gas Other
3. Is building mechanically cooled? yes Y No
4. Percentage of area of windows and doors Over 17% Under 17%
5. R VALUES.FOR INSULATION GIVEN BEL0,W MUST CORRESPONDTO R VALUES AS
SHOWN ON PLANS SUBMITTED: -
a: Roof R
b. Exterior walls. R,J-0
C. Glazed.areas R
d. Exterior doors R
e. Floors over unheated spaces R" t
L 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
6. Service(domestic)hot water heating device
Conforms to minimum efficiency per code, Yes No
TEMPERATURE CONTROL%MAXIMUM SETTING 140—WILL NOT BE EXEEDED,
App
' is Signature Date 1'h a Num e
INSPECTOR'S REMARKS:
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