8610 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 8 610
WARREN COUNTY, NEW YORK
G
PERMISSION is hereby granted to Jon N. Gray 0
z
OWNER of property located at Lot 87 Pect y Ann Road Street,Road or Ave.
(Land O'Pines Subdivision)
in the Town of Queensbury,To Construct or place a One—Family Dwellin
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is 361 Ridge Road
Glens Falls, New York
r
2. CONTRACTOR or BUILDERS Name 0rt
Tim Chase Construction 00
J
ro
3. CONTRACTOR or BUILDERS Address W
Lake George Road w
Glens Falls, New York
4. ARCHITECT'S Name
O
N
5. ARCHITECT'S Address
i
6. TYPE of Construction—(Please indicate by X)
#X*Wood Frame ( ►Masonry ( )Steel ( 1
7. PLANS and Specifications
55161lx26' 4" per plot plan, specifications and o
No. application submitted including sewage system and :3
two car attached garage.
8. Proposed Use
One-Family Dwelling N•
N
$5. 00 C/O Paid
115. 00 �
$ PERMIT FEE PAID—THIS PERMIT EXPIRES January 1 1985
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
W
Dated at the Town of Queensbury this 2 9th Day of June 19 84
SIGNED BY for the Town of Queensbury
Building and Zoning I r
TOWN OF QUEENSBURY (Space inside block to be filled in by
WARREN COUNTY, NEWa YORK • Building Inspector)
Application ApplicationApplicationNo. .
for 1'rrmit Issued 19.
BUILDING AND ZONING PERMIT I',...-I„it }•:spires. 11.
%oniing District
\ ;din. nI Work i
THREE (3) Copies of a PLOT PLAN. Drawn to scale •\I'I"m c•d IW A...'�.—
showing the actual dimensions of the lot to be built Itc•niarKS•
upon, The exact size, and location on the lot of the •
building, to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
•
IToWNOFQuN .3S9
��
DATE
RE 0 E " E
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK AN1g8 \_0)
ANSWER ALL OF THE FOLLOWING. ,p7` O 60,z c_r p.M.
The undersigned hereby applies for a permit-to do the following work P,1y',; w` c���2 3�q.>i5�6
which will be done in accordance with the description, plans and specifi- 71819N. °
cations, and such special conditions as may be indicated on the permit. '. - a_-a- ' 0..
/R V���
The owner of this property is: .
MQ. Mom. Jol44 N• i'iaaf 361 Po .1ZOtaA). 1_$ kts AI-,\-5
INA'AE) (P.O.ADDRESS)
The person responsible for -supervision of the work insofar as the Building Code and the Zoning Ordinance apply is:
T►M NSG. lb,i(s G,e011-.<1,.c. .P,®l.%) L • N$. F�I.�.S. . .
(NAME) (P.O ADDRESS)
Name of Builder Tl!`^ C-It.1 `...........�,1'0. . . . . .Address 5Atl€
Name Of Plumber " tv Address '`
't,. ``
Name of Mason Address
Lot Number. . . W1 . . . . . Unit k Estimated value of proposed work I SC)) c
Name of Village J-91/4Ab O` V 1I�S .C.V crICD\N g V C rN)S B V W , .\.�
n
Name of Street i'E(11G'\( (WV\ V,o&A) Side of street: north 0, east 0, south b. west ❑
Nearest Cross Street 13 RAC DultA, PM. Distance from this cross street 15o ,Ft.
Property is north ❑,south ❑,east i 1, west. ' ,from Cross Street
If on Corner, which corner, northeast L), northwest 0, southeast 0, southwest
(Designate by marking with an "X" in the correct space.)
• NATURE OF PROPOSED WORK OCCUPANCY "
IA Construction of a new building. Main Building
❑ Addition to a building. . One-family dwelling 4
❑ Alteration to a building. Two-family dwelling ❑
❑ Demolition of a building. -family apartment house ❑
. Store building ❑
2 -car attached garage ►'2
Other:
• Accessory Building
• . One-car detached garage El
(] Oth• er work. Describe Two-car detached garage ❑
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, sire and setbacks of pro-
posed buildings, and the location of all existing buildings.
NORTH Show proposed buildings) in dotted line and existing
• lluilding(s) in solid liner .
Size of property )9.5 ft. x 1"0 ft.
Size and use of existing buildings, if any
I-- (5. 14\ M-\-\°) I-
tn III
i ��� Lam) m Size of proposed building 55a ', ft.x 2(,c ft.
Height (from grade to ridge) 4... ft.
Front yard 35 Fr•.("^,m) ft.
Side yards 25 ft. and 41 t ft.
Rear yard . . 90 — ft.
SOUTH If on corner,setback from side street ft..
Note: Al! distances are net, as measured from street side
line to nearest part of building.
(OVER)
7-73—M •
(cont'd.)
BUILDING SPECIFICATIONS.,
Kind of construction: Wood frame, fire safe, etc.?. . . W .`?® • 62AM�
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Will any second-hand lumber be used? f+1Q If so, for what? 1 et
Material of foundation walls C� RC- A1-E BL's(VCS Thickness Q
Depth of foundation walls below grade 1-. Continuous foundation? E5
Will there be a cellar? 4 $ If so, material of cellar floor . . .47. Cb14.00-- SLMS.
Type of roof: Sloped or flat? Sti"6 to Material of roof F16": cL cP CL "A,"5 .101M(g11-A_S
Size, wood studs 2.X " x 4 ®a. 6 ", spacing 1 . . . ."o.c., length. . .$ • ft.
Size, floor beams, 1st floor 2. "x 1 0 ", spacing 1(0 "o.c., span 12- ft.
Size, floor beams, 2nd floor 2. ." x 1 Q ", spacing 16 "o.c., span 12- ft.
Size, ceiling beams " x ", spacing "o.c., span ft.
Size, roof rafters or beams 2, "x 12. ", spacing 1 G "o.c., span 12- ft.
Exterior finish . . .WcoD. Cbr46 k-S 1 ,-Y5•A06.MCF.,- With what material?-51..e: lic.. V 4- 1-01 .11 el'V"' -
Finish of interior walls 11/2 SWE'<i G1L
If garage is to be attached, of what material is wall between garage and main building to be constructed?
.� .".yC' .s Ke: 12.&c-t < 0r^r1v4‘•5 witt-- b4q.�.1x&.". .. ...... .Q AV.%.u.
Is there to be an opening between garage and building? Y4 S - rtNiT l- I&.!S V L, bogs,). — -F ' ,ct,-
Kind of heating system .s1-•'&•-' Baia A0 ' 4 wo"fpm'3 Oil burner or coal? €Lc•C.
Will a flue-lined chimney be provided? N�"'o . Depth of chimney foundation below grade
Height of chimney above roof. . . L4". .(. . . . • . mg -• C$T®S .1 h 5 L• e. mp ).
Will there be a fireplace? . .�f4. Woi1.O.5.1 P.V E . . . Depth of fireplace hearth .2Qa. .f.!1V.1. , . 0. .
Will a toilet be installed? ' 4.25 CS
Will a kitchen sink be installed and connected to water supply?
Water supply (public water supply or pump) PVbI.I<C
Distance of cesspool from any private well feet
Will drainage system be provided with required traps, cleanouts, and vents?
AFFIDAVIT
Town of Queensbury
County of Warren
State of New York
I swear that to it bar of my know,ledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, are a true and co.,. lete statement of all proposed work to be done on the described pretenses and that a provisions of the BUILD-
INGand that such work is authorized bythe owner.
Sworn C�as� ®�,��v l�� with,whether epecifir not,
CODE,THE ZONIN ORDINANCE,and all other laws pertainingto theproposed work shall be complied T
P
(s') - '�
Sworn to before me this Signature N
OWNER,OWNER'S AGENT.ARCHITEC .CONTRACi�OR d '1 "
day of 19
NOTARY PUBLIC. WARREN COUNTY. N. Y.
SPECIAL CONDITIONS OF THE PERMIT: .
By
•
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 . I4.2' �.\=T- . •
2 . Type of heat 5 LG(. a&5i6oNith# FAN tAw( wax_ ViaS
3 . Is the building mechanically cooled? k )
4 . Percentage of area of windows and doors 14-.40
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? YES 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 floors exposed to ambient conditions
Rbo'F - 112'J o
2 . R value of exterior walls R� B�
3 . R value of glazed area C�"�2-35 2•�,.
4 . R value of doors R.- -a.
5. R value of floors over unheated spaces
6. R value of slab edge insulation - unheated slab
7 : R value of slab insulation - heated slab
8 . R value of heated basement/cellar walls (above grade) R"10'b
9 . R value of heated basement/cellar walls (below grade) R^ 4
g ri8EnA,►.. �ra1Ts/��1�-w;MS; 5° r sand,.11.4 s,
10 . Type of insulation a!• pS Fop" aoAOb"DOv•v..iMAS
C. Controls
0
1 . Thermostat maximum heat setting $2 r_
D. Duct Systems
1 . Is duct system installed in unheated spaces? YES
a. If YES , R value. of duct installation
b. R value of duct in other areas
E . Piping Insulation
1. Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulation
F. Service Water Heating
1 . Performance efficiency P4R •S. RQMTS
2. Temperature control setting maximum 9$o® f-
G. For Swimming Pool Only
1. Maximum heating •
Telephone No. J3" OtZ 1\MC\WSC. C01A'gNik- '0Pb
(applicant ' s signature)
TOWN OF QUFFNSBURY
BUILDING & ZONING DEPARTMENT
SEWAGE' DISPOSAL�- PERMIT APPLICATION
1. Owner ' s Name Me. �1\ 3- 3 O N. q R.k•-i
Address 361 e»44. 12.01th, ` 1,1...‹.
Telephone No. 192- 708C,
•
2. Property location L V $1 bF S6E - of Limb 01 P91,9c,,5 cvablV., 10€�6,1/4( ANN D
3. Name of person or firm responsible for installing system
N\ CikkS cOASTILviN kt)1 , Telephone No. 193-4M,a,
Address LM(e C.;4.-0Y7GE 42.wktt , (71Ls 1 1 Y •
4. Number of. bedrooms (residential buildings only) -3
5. Daily flow L15D gallons/day
6. Septic tank capacity MO ANL. . gallons
7. Topography: la:() rolling, steep .
%. of slope F t.1,`
8. Nature of soil .and depth
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 NWIA, <-\i'M-
12. Type of system proposed: drywell, tile field, other .togN W(9:L5(s .CP1G,c f[c
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.
Date Tuv\E 2�,�. ) S - 1 SP����, � coy 11--`))tN.latq *
signature of applicant auk
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
•
BUILDING DEPT.COPY OF APPLICATION FORM 46-EL.NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED.
CITY OR '
VILLAGE \)(-(-1-1� \-)g-?,, Ix1 ,\? TOWNSHIP COUNTY \\��`�111�i}'.: Z`1
STREET AND NO.OR �` . '
ROAD AND POLE NO. R''E C-4^7 V /=IA t (�Q 4,C� POLE NO.
BETWEEN WHAT TWO n i
CROSS STREETS IS \:-) �; 1\K It• gsI- ' `
PREMISES LOCATED? L•� 1 -` +� IA NvE SECTION BLOCK LOT
OCCUPANT'S BUILDING t n OCCUPANCY c. 1`.+\ _ /_-- % f�e- t'C
NAME i':�IL-/I`t�f-��- .j CI N. I���i !`.I`a�, �- il�-.
OWNER'S NAME -
AND ADDRESS t" •` 1, it' t� 1 i / a(.,}� C' •
CURRENT
SUBYPPLIED \ t i\NO FROM THEIR . OFFICE
BUILDING WORK . y� ' DEFECTS
IS NEW'�I, OLD El 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
Ceiling Side Attach't Switch Pendent Bracket No. Type H.P• No. Watts No. A W.G. NO WATTS
Wall Recept'Is Each EachGauge EACH
Out-
side
Sub-
base '
•
Base-
ment
1st Fl.
2nd Fl.
3rd Fl.
•
•
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: - DO NOT USE THIS SPACE.
•
•
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 cover the additional equipment,as provided by the applicant.
SIZE OF ELECTRIC SIGN TOTAL
MAINS FEEDERS LAMPS WATTS
CHARACTER EXPOSED GAS TUBE SIGN _
OF WORK CONCEALED TRANSFORMERS OF VA
WORK TO BE (NUMBER) ' .. (CAPACITY)
STARTED COMPLETED SIZE OF SIGN
SERVICE MAKER
ENTERS -
BUILDING • . OF SIGN
INSPECTION REQUESTED
ON OR AS NEAR AS
POSSIBLE -� NEW OLD ri
• AVOID DELAY BY GIV,ING=FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN.OR APPLICATION MAY BE RETURNED.
NAPAMEPLICOF-:',-- - ) 1 fly C.\-t1-.c( y \AC- F (.J(-l 'OV4 DATE OF • - 40iiC� Lk• ..
, � APPLICATION
STREET ADDRESSV. '
"x _ 1 t 1 tt •
-' CITY OR % L,J(.a( '-' 11 L L{, \, CODE I'f Ckl 1 LICENSE NO. .
WHEN APPLICABLE
K POST OFFICE
A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
TOWN ,t•.kF li,LJEENSBURY
Building Department
Inspectors Rye Date /0 /R3
Name TO I, G ►�
Location Lo F e7 1�e�i A-h11 Ro .;-�.
Permit No. 5?6 / d Weather
Remarks
Excaliation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing U U
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
• Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board
Ext. Porches 1,4„fr��
Finished Floor c/i(�//�`�
Interior Trim 1,/•(2 �'�
Stairs & Railings /9 %_✓
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimne
Water Meter Inst. •
Se tic A roval
FlboEs
Insulation FOUndatidn
Walls
Ceiling
�' �`-r '• t � •
Building Inspector
REMARKS
2 �.
1\,(
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date l C?/l ri3'I
Name V L,i i (1-rT 1
Location (0 — ,-+Apv' /
Permit No. O ft i 0 Weather
Remarks
Excat•Pa t on
Footing Forms
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
/\\C-1//'
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers /
Chimney
Water Meter Inst. )
Septic Approval �"
Floors
Insulation Foundation
Walls
Ceiling
Building Inspector
REMARKS
K 2— 0 /7—y c_A_Ic_ i(
•
•
TOWN OF'QUEENSBURY
Building Department
Inspectors Report Date /fl/ /0/1c/
Name T n-. G( ,se (�/=.
Location pc s /4-��ky �,.. .
No. (( / b Weather
Remarks
Excavation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding f
Masonry Veneer /
Rough Plbg. 1'
Relief Valves /Wall Board
Ext. Porches
Finished Floor f
Interior Trim /
Stairs & Railings
Cellar Dr. Tile 1
Concrete Floors 1
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
AF
Septic Approval % 2,‹(1i,f /%�
Floors '
Insulation
Foundation '
Walls
Ceiling
Building Inspector
• REMARKS
•
TOWN OF QUEENSBURY
Building Department
hispedorsRepart Date �i k4--(
Name t..1( ),AJ 1/11• 6,4/-1- i
Location 1. T `7 Pe Yfl/I/Au' el
Permit No. -3 Le. 0 eather
•
Remarks
Excavation
Footing Forms
Footing & Piers
Foundation t".-/n
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
Building Inspector
REMARKS •
r7CYz.IA-0 rid/✓
•
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date 7/17
• Name j b n) (40.e. / /
n• Locatio y } 1I,tJ L 1 L �
Permit No. i j b I C) Weather
Remarks
Excatta tion
Footing Forms
• 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
• Building Inspector
REMARKS
kyLoiosoili
TOWN OF QUEENSBURY
Building Department
hispedtars Report Date C s'74'
Nance
/ems qqCC�l�-��
Location pe j D fr/v/J rz_a- Lo r
Permit No. , '6/Q Weather
Remarks
Excatia tl on
Footing Forms
Footing & Piers t/ `J �, U Il^1
Foundation t/. f
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
5 i -
S7-S2 wilding Inspe for
REMARKS
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