8629 ,,..C/o Paid
CERnFICKM
A
To Cif f URY
WARMN +CEQUWY, I*W YORK
Dace December 5 19 8 4v
This is to cerdh thu work requested to be done as shoat► by Pernsit No
-
has has been r kmwd•
This stnw�mft any be owu�d as a
one-Family Dwelling
don Lot 24 Pine Wood Hollow Road (Street No. 3)
Lea
Ow►ndr Ken Mattson
By Order Town Board
TOWN OF QUEENSBURY
Bn"09 Ql &aeig respect
i. GIR�A7IYE '"1!l�TA r�,►�.rtN4 -OLtR]R; nwets M M ttlOt IStel)R]5{RR s ,�...,.. l .s... ...._..._......,...__........_.,..y._..-...v' 's....--
i
BUILDING PERMIT
TOWN OF QUEENSBURY No. 8629
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Ken Mattson
Street No. 3 n
OWNER of property located at Lot 24 Pine Wood Hollow Road Street,Road or Ave. X
rr
in the Town of Queensbury,To Construct or place a One—Family Dwelling
at the above location in accordance to application together with plot plans and other information hereto filed and 0
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'SAddressis 64 Blind Rock Road-
Glens Falls, New York
N
0
rt
2. CONTRACTOR or BUILDERS None
N
Same its
ro
Nr
3. CONTRACTOR or BUILDERS Address M
tD
Same
rto
• o
a
4. ARCHITECT%Neme O x
• O
H
O
6. ARCHITECT'S Address
0
Sv
6. TYPE of Construction—(Phase indicate by X)
(A Wood Frame ( )Masonry ( )Steel ( )
7. PLANS and Specifications
53 'x3 6 n per plot plan, specifications and
No. application submitted including two-car attached
garage and sewage system-
o
8. Proposed Use
One-Family Dwelling
$5. 00 C/O Paid February 19 85
$108. 00 PERMIT FEE PAID -THIS PERMIT EXPIRES
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the A
town of Queensbury before the expiration date.) M
Dated at the Town of Queensbury this 10th Day of duly 1984
SIGNED BY Q. �C,� for the Town of Queensbury
Building and Zoning Inspector
THE NEW
YORK BOARD. OF FIRE UNDERWRITERS '
4046458 BUREAU OF ELECTRICITY a
(— 41 STATE STREET,ALBANY,NEW YORK 12207
Date January 16, 1985 Application No.on file 463268-84 A 633365
THIS CERTIFIES THAT application number in thepremiees of
ones the electrical equipment as described below and in&odaced by the applicant named on the above
Ken Mattson, Pinovood 90110w, Glans Fails, Now York
in the following location; zi Basement 1st Fi. ❑ 2nd Fl. outside Section Block Lot _
12/3/84 and found to be in compliance with the requirements of this Board.
was examined on ,r
FIXTU RANGES COOKMld DEGAS OISM WASN�S EXHAUST FANS
RX1UM AMI SINK CM NCANDESCEM FLUORESCENT AMT. K.W. MAT. K.W. AMT. K.W. T. K.W. AMT. K P.
28 45 27 26 2
REE i sKpAt"CTT TUM ass E!<l UNIT HEATERS t11111TF OUTIET DIMMERS
{ DR1f�s MMACE MOTORS MAN AMANC! f1fSTEMi .AMT.- wATrs
K.W. OIL •.M.P. GAS R.P. AMT. NO. I A.W.G. MAT. MA►. AMT. AM►S. TRANS. AMT. N.P. NO,OF FNT
f
f
i 1 ange 6
S E R V 1 C E
i�AETER 1/4W 1 �SW S d 3W S 14W NO.F C.CONO. OF CC COND.
NO.OF WLEG OF�wqA ; NO.OF I�UTRAtS Of I�NRAI
MAT. MAP. TYPE EQ111F.
'. 1 200 CS 1 s
1 4/0
OTMER AKARATUS:
Electric Heaters: 4- 2.0 k.w.
1- 4. I.W.— Water Heater 3- 1.5 k.w.
1- G.F.C.i.
1- Smoke Detector 2- 1..0 k.w.
2- .75 k.a.
2- .5 k.w.
L A. X* Dion 11*CtriC 239,
104 Mt, View Drive GER
South Glens Falls, Now York 12801
r
i
COPY FOR BUILDING DEPARTMENT_TH1SCOPY OF CEIRTiFtCATEMUST NOT BE ALTERED N ANY N R._
I
TOWN OF •'i UEENSBURY
r (Space inside block to Ix• tilled in by
WARREN COUNTY, NEW YORK ' . Building Inspector)
Application for Application No. .
pp 1'crmit Issued 19.
BUILDING AND ZONING PERMIT 1', riitil Expires. lq.
'toning. District
. \ aluc• of Work'
THREE 131 Copies of a PLOT PLAN, Drawn to scale \1'1'( "c•c1 by
showing the actual dimensions of the lot to be built 1zc'iii ii'KS'
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 OF t. UERNSD .:k
yo _ .�- y C1z8 61- RE.GinvED
ATE
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK Ui9 l98'. 7"
ANSWER ALL OF THE FOLLOWING. r/3 oy / P.M.
A.The undersigned hereby applies for a permit. to do the following work • 79,£?1g11G)�.111.2)it.-1,21314:1 6
which will be done in accordance with the description, plans and specifi- a ° ' a
�z
cations, and such special conditions as may be indicated on the permit. Cfji / h. (
Thej A k-ir of this r�rty-50la_ . c. BL1 NCB . IC— -0 G .f. N-?,. . .
L (NA E) (P.a.ADDRESS)
The rson responsible for supervision of the work insofar as the Building Code and the Zoning Ordinance apply is:
11\I.0,o s0l<-A. 64- E;u.00 t c_ 2D . G, - .• R---
`/ (NAME�)p ,{(P.O.ADDRESS) . _�
Name of Builder 1�' �v \'D'T��N. Address 64• 2Ll� 214" '
Name of Plumber Address
Name of Mason I - Address
Lot Number. . 2 ti^Unit ( Estimated value of proposed work S .`7d,OCO
Name of Village .
{�R. L-0� '
Name of Street . l'. .e r �o n (.- Side of street: north 0, east Es, south . west 0
�I Nearest Cross Street INV •• 90 iNq0 Distance from this rross street . . . . 1.1.G . . . . . . . . . . Ft.
Property is north ❑,south ►i ,east. , west 0 from Cross Street
If on Corner, which corner, northeast 0, northwest ❑, southeast ❑. southwest
(Designate by.marking with an "X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY "
g Construction of a new building. Main Building
❑ Addition to a building. One family dwelling. Q
❑ Alteration to a building. Two-family dwelling
❑ Demolition of a building. -family apartment house ❑
Store building ❑
-car attached garage ❑
Other:
. Accessory Building
One-car detached garage ❑
0 Other 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, site and setbacks of pro-
posed buildings,and the location of all existing buildings.
NORTH Show proposed buildings) in dotted line and existing
c: t E ( W' OD .. COL,-O c.e� . building(s) in solid line.
-10, c ., Size of property . .Z2�' 2 6' ft. x l3o ft.
vi NON`
t: ' Size and use of existing buildings, if any
. F
win
Igo' m Size of proposed building . . ...-7?. . . . ft.x 36' ft.
Height(from grade to ridge) /' ft.
Front yard . 45- ft.
- Side yards 44 / ft. and 3> ft.
•
Rear yard /Z- ft.
SOUTH If on corner,setback from side street ki4 ft.. .
• Note: All distances are net, as measured from street side
. line to nearest part of building.
(OVER)
7-73—M
(cont'd.) e'
BUILDING SPECIFICATIONS.,
avf� G
Kind of construction: Wood frame, fire safe, etc.?. . . .\,t.➢. . . . . . . . . • • • • • • • • • • •• • • • • • • • • • • . . . . . . . . . . . . . .
Will anysecond-hand lumber be used? . . . . (`C7• , . . . . . If so, for what7
Material of foundation walls Thickness l 0,
r<96-k c_. C3 c�c,1 --
Depth of foundation walls below grade ' Continuous foundation? . .`{ . . .
Will there be a cellar? "4' If so, material of cellar floor . . .C,p--\-G
Type of roof: Sloped or flat? r✓-WP Material of roof . . g&.L. , Sk\-14'L
Size, wood studs 2.- "x 4- ",spacing ( (- "o.c., length ft.
Size, floor beams, 1st floor 2 " x t C ", spacing I. C- "o.c., span /6, -� i 4 ft.
Size, floor beams, 2nd floor t`1o'""e-- " x ", spacing "o.c., span ft.
Size, ceiling beams T24-2e---'C- " x ", spacing 2 "o.c., span ft.
> � 2 liAg � zC1'
Size, roof rafters or beams �5 " x ", spacing "o.c., span ft.
Exterior finish . . .(�.00O U 1 ' S‘0t4._14. With what material? . .Woo�
Finish of interior walls G \D 15?P '
If garage is to be attached, of what m terial is wall between garage and main bui<IQing to be constructed?
2-71 4- w, .572 e.- 2-Ec Sg tZ
Is there to be an opening between garage and building? . . .'1 '
Kind of heating system - V. 13A P • Oil burner or coal?
Will a flue-lined chimney be provided? `1 • Depth of chimney foundation below gradeGC?6-i-_.
Height of chimney above roof S
Will there be a fireplace? lam, Depth of fireplace hearth
Will a toilet be installed? • `1 S '
Will a kitchen sink be installed and connected to water supply? `l
Water supply (public water supply or pump) l�` �L
Distance of cesspool from any private well -C"-- feet
Will drainage system be provided with required traps, cleanouts, and vents? `t`-S
AFFIDAVIT
Town of Queensbury
County of Warren
State of New York
I swear that to tt A, i of my knowledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, are-a true and co.a. lete statement of all proposed work to be d e on the desr ibed premises and that all provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertain to the propose ork shkll be complied with,whether specified or not,
and that such work is authorized by the owner.
Sworn to before me this Signature `�J -s ram,
OWNER,r OWNER'S AGENT,ARCHITECT,CONTRACTOR
day of Jvf`�� 19G�
NOTARY PUBLIC, WARREN COUNTY, N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
•
•
By
TOWN OF QUEENSBURY
e • 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 I1-49C7
2 . Type of heat
3 . Is the building mechanically cooled? kAlc7
4 . Percentage of area of windows and- doors tO 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? 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_
2 . R value of exterior walls 1I
3 . R value of glazed area 5
4. R value of doors C
5. R value of floors over unheated spaces ti.
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) 7.,
i
9 . R- value of heated basement/cellar walls (below'. grade) /1>
10 . Type of insulation i'l at-, QDelT5 4 t O
C. Controls .
1 . Thermostat maximum heat setting g
D. Duct Systems
1. Is duct system installed in unheated spaces? YES NO
a. If YES, R value of duct installation
b. R. value of duet 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
2. Temperature control setting maximum
G. For Swimming Pool Only
1. Maximum heating -
6 Telephone No. �Z 1 -
(a plicant ' s signature)
TOWN OF QUEENSBURY
BUILDING & ZONING DEPARTMENT
SEWAGF DISPOSAL PERMIT APPLICATION
1. Owner ' s Name ?.1614
Address lv rg,lAtAn epeAL- -o p
EoL S `S �J�`'t,, Telephone No. `Zea_ -
2. Property location L _
Pt W o c,D 'Pp An
3 . Name of person or firm responsible for installing system
0- P2.- (/;(2-64L6VIr Telephone No.-74-1 -- 17-62)
Address
4. Number of bedrooms (residential buildings only) 3
5. Daily flow 445.0 gallons/day
6. Septic tank capacity teXoO gallons
7. Topography: flat, rolling, steep
% of slope 5
8. Nature of soil, and depth -
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? {.1,Qt ft.
10. Percolation test: A -�-- is required
B is not required S <- .
C If required what is the rate 21-5 minutca/inch
11. Water supply: municipal, well, other 11:3 1.
12.. Type of system proposed: drywell, 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
( s. /b
Sanitar Sewage Ordinance.
Date [i
signa ure 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.
E wvoD -loc.up Sv43P I J .
PAN-P..
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 Kl --- , -. /; ( •
VILLAGE TOWNSHIP \ +:_Z--\--__ V. , ' COUNTY ��t...JJJ l�;'�(2' --i--• -
STREET AND NO.OR Lt. _ 7 /�
ROAD AND POLE NO.=' /-.:--1� '%( i-4,- l-- ---LI ' •`j(..'.i_ ii /} ' POLE NO. •
BETWEEN WHAT TWO -� .
CROSS STREETS IS .`\ _ _
PREMISES LOCATED?`'---- '. -- -s I -- '` •f . SECTION BLOCK LOT
OCCUPANT'S BUILDING
NAME OCCUPANCY •
OWNER'S NAME (j 'yr
AND ADDRESS ,`-; 1 - i., },\j\-� %-y )fit_
CURRENT
PPLIED c.�
SU \ `\ ',f\�I t•k. f FROM THEIR OFFICE
BUILDING WORK DEFECTS
IS NEW❑ OLD❑ REMODELED El IS NEW ❑ ADDITIONAL CI 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 No. Type Each No. Each No. Gauge NO. 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 OF SIGN
BUILDING
INSPECTION REQUESTED •
ON OR AS NEAR AS
POSSIBLE NEW 111 OLD
r
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
i ,
NAME OF r' i v t .�I, -DATE OF f, /-
APPLICANT it I \ APPLICATION' )/ (4� -% ,/
STREET ADDRESS —- ty •-'r- i;,, te. , --r---i
CITY OR • (t 1 _ _,I ZIP I-7r.-i) I LICENSE NO.
POST OFFICE ,. t::; i CODE i 1' WHEN APPLICABLE •
A SEPARATE APPLICATION MUST BE'FILED FOR EACH SEPARATE BUILDING
TOWN OF'QUEENSBURY
Building Department
Inspectors Report Date /?AI/,
Name jer,s , c t/ / �
Location �j,//.n �i?�� A //fTh
Permit No. G 9-9 Weather
Remarks
Excat)a 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 �/ (l:/•c17
Ext. Porches
Finished Floor
Interior Trim C,:1(C/
Stairs & Railings �n �/l/
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
ie/eC7/i/C No "✓
Ski 7Ze —
•
114 F • I z15 /8Y
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date /0 /2/ '
Name k yr16,it 6)
Location L 0( h-e Q A d
Permit No. Weather
Remarks
Excavation
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. �Q
Septic Approval [/ ( �-
Floors
Insulation Foundation
Walls
Ceiling
Building Inspector
REMARKS
Cra'` a4
•
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date
Name It Z,i J 4-7-74-3-6.4 •
Location y 61}07.3
. Permit No. % ) Weather
• Remarks
Excavation
Footing Forms
• Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing � Lr'
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 �1
Gar. Fireproofing j
Door Closers
•
Chimney
Water Meter Inst.
Septic Approval
Floors
Insulation Foundation
Walls
'Ceiling
Bui ing Inspector
REMARKS
Tugs t i l`-(
TOWN OF•QU•EENSBURY
Building Department
Inspectors Report Date Pri.3 '
Name Ke/o m A-7'T S o' )
Location r y e iue (.4 .)1-•,r111 7 tI o
Permit No. B Weather
Remarks
Excatia ti on
Footing Forms •
Footing & Piers
Foundation
Cement Coat 041,' -
Waterproofing p 4c ( Art—
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
• Rough Plbg. -
Relief Valves
Wall Board /
Ext. Porches /t
Finished Floor \ if
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
X
Building Inspector
REMARKS
TOWN OF QUEENSBURY
Building Department
Inspectors Report. Date - /
Name /(/_.41' "124 F 1/v
Location i 1 /Y%�/4/(i J Z-_c V. '
Permit No. ti 2! Weather
Remarks
Excavation " J
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 N\
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Floors
Insulation Foundation
Walls
'Ceiling
Building spector
REMARKS
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