8101 BUILDING PERMIT
TOWN OF QUEENSBURY of
r�
WARREN COUNTY, NEW YORK it
PERMISSION is hereby granted to Walter Dombek
tr
3 S'
OWNER of property located at _ TIC* I-Stephanie Lane (St. #k l) Street,Road or Ave.
in the Town of Queensbury,To Constructor place a Ones' ily Dwelling
at the above location in accordance to application together with plot plans and o0w information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
Lake George, New York N
O
rr
2. CONTRACTOR or BUILDERS Name
Tim Chase ro
3. CONTRACTOR or BUILDERS Address
Box 62 tD
Glens Falls, New York r'
a
4. ARCHITECT'S Name
rf
5. ARCHITECTS Address
}vey
6. TYPE of Construction—(Piease indicate by'X)
(19 Wood Frame ( )Masonry 1 )Steel ( ) "
7. PLANS and Specifications 0
24 t x42.t per plot plan, specifications and
No. application submitted including sewage system. �
8. Proposed Use
One-Family Dwelling �c
d
$5. 00. C/O Paid
N
$70. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 1 19 84
(if a longer period is required an applicaton for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 16t h_ Day of September 19 83
SIGNED BY for the Town of Queensbury
Bulk hg and Zoning inspect
TOWN OF QUEENSBURY
BUILDING & ZONING DEPARTMENT. .
SEWAGF DISPOSAL" PERMIT APPLICATION
� }
1. Owner' s Name ajd/ d' kn
N� [-; �d�
/"� � a�' � Telephone No. 2`
/�. Property location ,4 1/JnJ 6 kelp h
Ci! fJ�"rUS ,
3 . Name of person or firm responsible for installing system
Telephone No.7 2j- r
Address a kt" . ) /Q
4. Number of bedrooms (residential buildings only)
5. Daily flow e6 gallons/day
6. Septic tank capacity f 67TO gallons
7 . Topography: la ', rolling, steep
% of slope •
8 . Nature of soil and depth 5 't-,.rx
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? ft.
10. Percolation test: A is required
B X is not required
C . If required what is the rate minutes/inch
11. Water supply: municipal, well, other /42"�Gcl ,e.--,) p yg
(! -12 . Type of system proposed: ::11
l tile field, other
Any contractor,, corporation, individual, etc. engaged in the construction
of a sanitary sewage disposal system who covers the same before inspection,
does not have an approved permit, or varies from the approved application
will be subject to a penalty of $250 as provided for in Section 6 . 010 of the
Queensbury Sanitary Sewage Ordinance. - s�
Date 4si nature of applicant
On separate sheet of paper submit a diagram of the proposed septic system
with all dimensions, including distance from any structure, distance from
property line and domestic water supply, etc . Include all dimensions of
the system itself.
Form 3-82
TOWN OF QUEENSBURY
' WARREN COUNTY , NEW YORK,
Application for: BUILDING PERMIT. IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
' A permit must be obtained before beginning work. -
ANSWER ALL of the following:
1. Gross floor area / at- S ,-Q -"t
2 . Type of heat •Eie-CA7Lt: �`,' .
'3 . Is the building mechanically, cooled? a
•
4 . Percentage, of area of windows and doors • '� 6- 7
A. ' Over 16% Only
1 . Uo value of gross area of walls , roof/ceiling and floors„
exposed to ambient conditions
2 . Floor over heated spaces YES NO
. • a. Are foundation walls insulated? YE.S NO
1. If YES, what is the R value?
3 . Slab on grade YES NO
a. If YES, what is the . R value of insulation • around _
perimeter of floor? •
.
4 . Is ,basement heated? YES NO - .
a. R value of insulation
5. Type of insulation
B. Under 16% Only . .
1. R value of roof and loor �sexposed to ambient conditions_
-
A? , - ,
2 . R value of exterior walls m L,-• .
• 3 . R value of glazed area . •
4 . R value of doors RI- - .
. , ___ _ ... ..... ______. _ f
. . ... . . . .
.._.....
, ,
5. R value of floors over unheated spaces . -•• 1
6. R value of slab edge insulation - unheated slab `
• • 7 . R value of slab insulation - heated slab • . l
8.. R value of heated basement/cellar walls (above grade) fit
9 . R value of heated basement/cellar 'walls (below grade) 129
• 10 . Type of insulation 3 .7 . ik, 10'0 C'p 4tia • eJ = - •C. Controls �, "
. ' 1. Thermostat maximum heat setting 7. i') `
D. Duct Systems
" 1.. Is duct system installed in unheated spaces? . ..YES a. If YES , .R value of- duct installation !//g""
b. R value of duct in other areas
•
E. Piping Insulation
. 1. Size of hot •water or cooling- carrying agent pipe %t "
2 . R value of pipe insulation i
F. Service Water Heating •
� / ..
.1. Performance efficiency ,V j�-- .
-2. Temperature control setting maximum i/17//?0
G. For Swimming- Pool Only . "
•
1 . Maximum heating .
•
. (14 - . •11 ")
Telephone No..-)q3"' V6�"
i.
• (applicant '-s signature)
TOWN OF QUEENSBURY I (Space inside block to be filled in by
WARREN COUNTY, NEW YORK Building Inspector)
Application Iication for . Application No. :
. Permit Issued 19.
BUILDING AND ZONING PERMIT ►'ermit Expires. I .
Zoning. District
. \ clue o1 Work ��.
THREE (31 Copies of a PLOT PLAN, Drawn to scale .\11)""I by -� -1 J.' .;c( 2
showingthe actual dimensions of the lot to be built. Itc'niarK$" ' '�����\'
upon, The exact size, and location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
�� �,/,,�� / > TOWN I(OF QZ31n'Es=���[(/s]153U�Y
"�7 ' �' ` DATE [ii V Il U
h 0
A PE
RMIT MUST BE OBTAINED BEFORE BEGINNING WORK
ANSWER ALL OF THE FOLLOWING. SEP 1 6 '9 3
The undersigned hereby applies for a permit'to do the following work �`a �� �'-7 p,�j,
which will be done in accordance with the description, plans and specifi- A.M: /�' //
glglg��t}�11�12)1,2)3141516
cations, and such special conditions as may be indicated on the permit. , • . 71 ' ' '
The owner of this pr rty(N •A''E) ya
�' l' A (P.O.( ADDRESS) •The person r sponsibie for e.,iarvisiori of the work insofar as the Building Code and the Zoning Ordinance apply is:
1•4 ert . •
(NAME) (P.O.ADDRESS)
4° Address d 1 $
Name of Builder f ft664
,p0
Name of Plumber b Address
` Name of Mason Address `t0�
9 ireLot Number.. ._, .. Unit Estimated value of proposed work S. ®i
Name of Village 60.4. b&t.
44140
Name of Street Vet it Aevi c �,�I � Side of street: north 0, east 0 south 0. west El
Nearest Cross Street
04 44.-le�sf Distance from this rross street ti CO Ft.
Property is north I ',south ❑,east i i, west 0 from Cross Street
If on Corner, which corner, northeast ❑, northwest ❑, southeast ❑, southwest
. (Designate by marking with an "X" in the correct space.)
•
. NATURE OF PROPOSED WORK OCCUPANCY
® Construction of a new building. Main Building
❑ Addition to a building. One-family dwelling •
❑ Alteration to a building. Two-family dwelling • ❑
❑ Demolition of a building. -family apartment house ❑
Store building El
-car attached garage ❑
. Other:
' Accessory Building
. One-car detached garage
Other work. Describe Two-car •detached garage El
• Private chicken house ❑
Private storage building ❑
Other:
ZONING SPECIFICATIONS. Fill in for new building, or addition to existing building,or a change of occupancy.
' Indicate on the plot plan street names, the location and
size of the property, the location, size and setbacks of pro-
posed buildings,and the location of all existing buildings.
NORTH Show proposed buildings) in dotted line and existing
4 huilding(s) in solid line.'
' e Size of property r ft. x Ot "' 6 ft.
/34 Size and use of existing buildings, if any
t I
H ® et N
Vir W Size of proposed building a° 1 ft.x re* ft.
• 0)0 Height (from grade to ridge) °4i'" ft.
Front yard Yla ft.
'a Side yards 1 t ft. and 3 o ft.
4 + e Rear yard . / 3 4 ft.
Sou-r" If on corner,setback from side street ft..
Note: All distances are net, as measured from street side
line to nearest part of building.
(OVER) .
7-73-m
(cont'd.)
BUILDING SPECIFICATIONS.,
ttibnPrA
Kind of construction: Wood frame, fire sa e
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . .
Will any second-hand lumber be used? If so, for what
Material of foundation walls r Thickness
Depthiof foundation walls below grade Co tinuous foundation?
Will there be a cellar? 9 If so, material of cellar floor . . .e, .d . . . '
�.Type of roof: Sloped or flat? . .. • • • • • • Material of roof 4Se J
Size,wood studs A- "x ", spacing .., '. . w. . . ."o.c., length . . ft.
Size, floor beams, 1st floor ate. "x Ai,
", spacing if 6 . . . ."o.c., span f a. ft.
Size, floor beams, 2nd floor " x ", spacing "o.c., span ft.
Size, ceiling beams 2. " x G ', spacing / (e "o.c., span / Lb ft.
Size, roof rafters or beams . . . .2„,,i "x _. se ", spacing ®4. . . "o.c., span . . ./a,. ft.
Exterior finish Of 6.40v 0 71a With what material?
Finish of interior walls. . . Vitey ii0 pa y
If garage is to be attached, of what material is wall between garage and main building to be constructed?
Is there to be an opening et een aran and building?
Kind of heating system . 7 0.C.„ Oil burner or coal?
Will a flue-lined chimney be provided? Depth of chimney foundation below grade
Height of chimney above roof
Will there be a fireplace? Depth of fireplace hearth
Will a toilet be installed? `�let
. Will a kitchen sink be installed and connected to water suply? . . y
Water supply (public water supply or pump) . . . .f0 P t i
Distance of cesspool from any private well ) 61,46440 feet
Will drainage system be provided with required traps, cleanouts, and vents? ite
AFFIDAVIT
Town of Queensbury
County of Warren
State of New York
I swear that to tr. ova r of my knowledge and belief the statements contained in this applictition,together with the plans and specifications sub-
mitted, are a true and co.i.plete statement of all proposed work to be done on the described premises and that all provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertaining to the p tied work sha to ..mplied with,whether specified or not,
and that such work is authorized by the owner. • ® '
Sworn to before me this Signature
0 NER,OWNER'S AGENT,ARCHITECT.CONTRACTOR
/ 4 day of COPY 19.... .1
NOTARY PUBLIC. WARREN COUNTY. N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
•
•
By •
BUILDING DEPT.COPY OF APPLICATION FORM 46-EL.NEW YORK BOARD OF FIRE UNDERWRITERS.
' FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED.
CITY OR � It ))
VILLAGE t;y'r j ^��ft, S -)\,( /i C.-4 • TOWNSHIP . COUNTY k,, / P " /2. (If ,f
STREET AND NO.OR - �/(r_ /
r 7 A)ROAD AND POLE NO. �,) l ''" 1 1 C ('A 7"-U POLE NO. ,A
BETWEEN WHAT TWO /
CROSS STREETS IS / •
PREMISES LOCATED? ._i--. ' -, „' ` I.t Li t SECTION BLOCK LOT
OCCUPANT'S I ! j j t,:, .'r� . ;' . ''t r' I.' BUILDING - /1 "I -
NAME [,A1.. ( `•_/\. i 1 y D"s /_, - OCCUPANCY ,a_-
OWNER'S NAME )
AND ADDRESS ter.:' U. `� /' :<� ;i.JJ '1'''r F.)C 1\ -
CURRENT >,. [[ (( _
SUPPLIED r'iJ . , _.. i JEi 4 it(: :` A. ,/J( FROM THEIR •-.. ( 'f'?! (1- '/-)I OFFICE
BUILDING ��--yy,I C WORK DEFECTS
IS NEW L3,, OLD❑ REMODELED ❑ IS - NEW ❑ ADDITIONAL❑ REMOVED ❑
LIST BELOW ALL EQUIPMENT-WHICH YOU INSTALLED
No.of Fixtures& BRANCH
NUMBER OF OUTLETS Lamp Receptacles MOTORS HEATERS CIRCUITS LAMPS
Loca-
tion Side Attach't H.P. Watts A W.G. WATTS
Ceiling Wall Recept'Is Switch Pendent Bracket-y No. Type Each No. Each No. Gauge NO. EACH
Out- r l -
side �i•
Sub- • .
base
Base- f ..
ment
1st FI. to 6 (-UJ —
2nd Fl.
3rd Fl.
REMARKS: LIST PTHERIELEC-TRICALDEVICES NOT,SET FORTH-ABOVE:.'ti. ,l r ,�.- DO NOT USE THIS SPACE.
- L.
This application is intended to cover the above-listed equipment to be inspected but-if at time of inspection there is found additional equipment not above listed,
you are authorized to make the inspection and adjust the fee to,eoy4rthe additional equipment,as provided by the applicant.
SIZE
OF --) /•r-7) ,l f,� /= ` ELECTRIC SIGN TOTAL
MAINS G-'-- (. /, FEEDERS LAMPS WATTS
CHARACTER - ,, i„ EXPOSED GAS TUBE SIGN
OF WORK G'� / ...j. CONCEALED TRANSFORMERS OF VA
WORK TO BE ?irf.-T / ' ' ? (NUMBER) (CAPACITY)
STARTED / • /` COMPLETED SIZE OF SIGN
ENTERSSERVIC /+.``. /'`-- .V1 MAKER
BUILDING OF SIGN '
INSPECTION REQUESTED /,=' f� ,.;V• • •
ON OR AS NEAR AS i / '
POSSIBLE - NEW I j�"�I OLD I n I
AVOID DELAY BY fi}VING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
NAME OFf f \•'-;i ! 1 APPLICANT APPLICATION
STREET ADDRESS --
CITY OR '•;") r i_:-("; _., y'j`+'l/�'•\ /•`t/ ,�+.^ ��
f
ZIP (",/f LICENSE NO.
POST OFFICE ! CODE - WHEN APPLICABLE
A SEPARATE APPLICATION MUST-BE FILED FOR.EACH SEPARATE BUILDING
•
TOWN I®F QUEENSBURY
Building Department
Inspectors Report Date
Name /7/„.
Location 1� i"✓/G` ��,�
. Permit No. /CZ Weather
•
,,Z ////4 //t/ P Remarks
Excavation
Footing Forms
Footing & Piers (V7// f
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer • •
Rough Plbg.
Relief Valves
Wall Board /
Ext. 'Porches L/
Finished Floor 1.7
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors ��� 1/1
Plbg. Fixtures Gar. Fireproofing /(4
Door Closers A///
Chimney (((
Water Meter Inst.
Septic Approval °.
Floors
Insulation Founder ion
Walls ' �•,
Ceiling
Building Inspector
REMARKS
eiz.„ P
/lop Z-- •
3
1
zA
` K •
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date R-l 7-8 3
.
Location Geri- (o S 6P/ At
. Permit No. 7 7Din/G - Weather
31 0 ( Remarks
Excavation I Footing Forms (f)
Footing & Piers / -^
Foundation
\Cement Coat
. 'Waterproofing
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Floors
Insulation Foundation •
Walls -
Ceiling "4/01- 0
Building Inspector
i
REMARKS
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