RC-0436-2021 FUEL BURNING APPLIANCE & Office use Only
} CHIMNEY APPLICATION Permit#: V-c 0g3b-XZA
Permit Fee:$
Town of Queensbury
Invoice#:
742 Bay Road,Queensbury, NY 12804
P:518-761-8256 www.gueensbury.net
**ONE APPLICATION PER APPLIANCE**
Project Location: �as►' t "Lt'tE�A� 1�C1 Tax Map ID#: 3p2 • h • l"moo
Room of Install: .5 SQn cm w-Oft Planned Install Date:
FUEL BURNING APPLIANCE INFORMATION: D C E O W E
TYPE OF DEVICE:
Stove Fireplace Insert _Fireplac AUG 19 2012
TOWN OF QUEENSBURY
Fuel Fired Equipment(Garage Only: 18" clearance per IMC 304.3) BUILDING&CODES
Fireplace,factory built**
(**Manufacturer's name: Model#: �L /V
SOURCE OF HEAT:
Wood _Coal _Pellet +/ Gas
CHIMNEY INFORMATION:
Masonry(require plans to be submitted):
block brick stone
_Flue:
the _steel _size, in inches
_Material*:
,double-wall triple-wall_insulated sV
(*Manufacturer's name: Model#: )
Fuel Burning Appliance&Chimney Application Revised December 2020
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CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): xn
Mailing Address, C/S/Z: )Z_ 8ZT
Cell Phone: Land Line: �)
Email:
• Prim ry Owners
Name(s): k
Mailing Address, C/S/Z: i3nS
Cell Phone:_O Land Line: _( )
Email:
❑ Check if all work will be performed by property owner only - -
• Installer Buil er: Workers' Comp clocumenta ion must be submitted with this application
Contact Name(s): S
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
Contact Person for any questions regarding this project:
Cell Phone: ) Cp f3ti1: Land Line: �)
Email:
ADDITIONAL INFORMATION:
1. Two (2) inspections are required. A rough-in inspection, prior to installation and a final inspection,
after installation.
2. Manufacturer's installation manual must be available at the time of inspection.
3. Masonry fireplaces & chimneys require plans to be submitted.
_ _ -4. Twenty-four_(24) hour notification is,r-equired for inspections. _
5. Workers'Comp insurance information is required with this application.
Declaration: Construction/installation must conform to NYS Fire Prevention & Building Code and/or
manufacturer requirements. 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 the inspector to enter the
premises to perform the required inspections.
I have read and agree to the above:
PRINT NAME: C�
SIGNATURE: DATE: Z—
Fuel Burning Appliance&Chimney Application Revised December 2020
Office Use Only
ADDITION ALTERATION PERMIT Permit#: .-'
APPLICATION
Permit Fee:.$_
Town ofQueensbury
742 Bay Road,Queensbury,NY 12804
Invoice#•
P:518-761-8256 www.gueensbury:net .d.
Flood Zone? Y No Reviewed By:
Project Location: ! vC;T. �j-M is, -Y
Tax Map ID#: ��a , �'\ i-� Subdivision Met
PROJECT INFORMATION: SUN o -`2021'
OWN bi=
QUEENSBURy :.. .;
BUILDING CQ®Bg.-
TYPE: Residential Commercial, Propose .
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: `Z2 1st floor:
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement(habitable space): Basement(habitable space):
Total sq ft: � Total.sq ft:
Scope of work=to be done:
Ol�lSt_ 5v�9` a. C1
Addition/Alteration Application Revised January 2021
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $
2. Source of Heat(circle one):_Gas Oil _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 )INO Explain:
4. Are there any easements on the property? YES NO
SITE INFORMATION:
• Is this a corner;lot?' ` ' _YES kd NO
• Will the grade be changed;as.a.result of the construction? _YES XNO
• What is the'Water source? PUBLIC _PRIVATE WELL
• What type of wastewater system is on the parcel? SEWER PRIVATE SEPTIC
DECLARATION:
1. 1 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. ;Ifthework is not completed by the 1 year:'expi,ration date the permit may be renewed, subject to fees
,and department approval.
4. .I 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 1regulations.
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 a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: r1
SIGNATURE: DATE: V r
Addition/Alteration Application Revised January 2021
I.
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CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
'6 Applicant:
Name(s): J 4�
MaiIing Address, C/S/Z: Li )�
Cell Phone:) Land Line:
Email: �® 4C A ,.;.► 04�.Ti� � c��� 'U C-6 -C► A"k
• Primar y Owner s
Name(s): S
Mailing Address, C/S/Z: la)t, t3 y Jj�j
Cell Phone: ( �1� ) ���,, r bLih(c Land Line:
Email: v nok, CAYvI
❑ Check if all work will be performed by property owner only
• Contractor(s): (List all additional-contractors_on the back of-this form)
Contact Name(s):-
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: (o — Land Line: ( :
Email: 345-2
"Workers' Comp documentation must be submitted with this application"
• Arch itect(s)/En ineer(s):
Business Name: -
Contact Name(s): "
Mailing Address, C/S/Z:
Cell Phone:�_) Land Line:
Email:
Contact:Person for.Compliance.in regards.to'this project: : °'t='��s►5!�.
Cell Phone: ( <1 V 1 Land Line: � )
Email:
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Addition/Alteration Application Revised January 2021
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):. ,� ,�.
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
CeII�Phone• S1� r Land Line::. .
{. � 2 �o .
Email:
• Contractor(s): Workers' Comp documentation must be submitted with-this application
Contractor Name(s):
Contractor Trade: _. . ..... ..
Mailing Address, C/S/Z:
Cell Phone: - Land Line:
Email: -
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contractor Name(s):
Contractor Trade:
Mailing'Address, C/S/Z:
Cell Phone: Land Line:
• Contractor(s):.Workers' Comp documentation must,be submitted with this application .
Contractor Name(s): . _. ..
Contractor Trade: .-.
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Addition/Alteration Application Revised January 2021
WINDOW SCHEDULE CALCULATION SHEET
(please complete if details are not provided on plans)
Project Location: \ V1 C—) -2.,���
Primary Owner (s):
!
f.
Habitable
Rooms 5`'^ P-�'i'"� ��l�Lcev• 5�•�¢c9,.� �icl�
Window#/letter C
�.krltn�sr
9
On Plan
Manufacturer
Name
Model/Type
00 L/W Seri u s
Unit/Block#
Cell Size
Rough Opening 3&%`x -�,3/'�„ k �13/� X X
Width
Sq. Ft. Vent
Sq.. Ft. Egress/ , s
!
Clear.Opening - 2-0 Sb.
i
Clear Opening-
Width.in inches A ' -
Clear Opening- l ,
Height in inches '
Special Hardware
or instructions
U-Value
xiple Structure Packet Revised January 2021
4 76 o 2c-D2 1
Residential Plan Review: 1- and 2- Family Dwellings
Y/N/NA (1 of 2)
ti Two (2)full sets of plans
J + Over 1,500 sq. ft. requires engineering stamp
1, Design loads on plans: 115 Wind Floor Loads 40 psf
(North of Rte. 149 60) 50 Ground Snow Load Sleeping Areas &Attics 30 psf
Calculations Decks 40 psf
Wind design for lake front properties
Window schedule with glass size & main doors/Air leakage < .5 cfm for doors, < .3 cfm for
lh windows/Tempered glass in bathrooms
Door schedule/Main entr8nce 36" door
Emergency Escape or Bedrooms & Habitable Space
Above-grade: 5.7 sq. ft.
Grade: 5.0 sq. ft.
24" (h)x 20" (w) minimum
44" maximum height above door
Window control devices 24" or less 2nd story or 72" above grade
Egress window from basement 5.0 sq. ft.
Pc Floor system sizing per table 502.3.1
t� Residential check ERI or Prescriptive method
Driveway length: 300' or more-12' width required/500' or more,turnaround required
Foundation drainage on plans, if required
6" drop in 10' exterior grade
Framing cross section for each roof line, vertical fire stopping every 10' where
required/joist spans pg. 127
Ice &snow shield —24" from exterior wall
Platforms at exterior doors
Stairway headroom 6'8"; all stairs 36" width
Stair run and rise
Winder run and rise
j�- Spiral stairs meet requirements
�►►� Smoke detectors—battery backup & proper location, interconnectedtl �t —
Q Bathroom fixtures—proper clearance
Hall width-36" width
Handrails more than four risers on open sides
Railing &guards > 30"/basement stairs included/closed risers more than 4" in height
Safety glazing notes for required areas
Garage fire separation: %" gable end/5/8" under living space &%" on walls/20 min. door
and closer
Garage floor sloped
)b Attic access: gasket seal & R-value equal to roof insulation
19— Roof over 30"—22" x 30"/Crawl spaces 18" x 24" access
Continued on back 4 4
Residential Plan Review Revised October 2021
Residential Plan Review: 1- and 2- Family Dwellings
Y/N/NA (2 of 2)
•, Carbon Monoxide detector outside lowest sleeping area, on every level & interconnected
JCI� within 15' of sleeping area
Soil test results, if required
Septic to well or water line separation
l All paperwork signed
Note on plans energy saving light bulbs 90%
Blower door test agency paperwork
Floodplain Permit required —check map: 2 feet above flood elevation
Hurricane clips required
7 Floors less than 2 x 10 covered by%" gypsum or 5/8" wood panel
Manuals S &J required for heating system. Cold air return hard piped
& Separate room for draft HVAC or hot water heater with fresh air
/J A HRV shown and calculations
Baffles at eaves for insulations and knee walls
Makeup air for range hood >400 cfm
/�- Continuous header for garage doors to end wall
Chimney rain cap shown for fireplaces
Deck hold down shown not less than 4 lags and bolts per table 507.2
Residential Plan Review Revised October 2021
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