1986-215 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date November 25 19 a - ,
S01, ll - a Li3
Permit No. 86-215
work requested to be done as shown by e
This is to certify that
has been completed.
• This structure may be occupied as a
One-Family Dwelling
Location I5'' Ir1 R. Lelf It-Lot 2 Tina Lane (M & M Subdivision)
` Richard Bailey
Owner
By Order Town Board
irOZIZI OF QUEF� BVire
i
iie ell
Bui�wn{ & Zoning Inspector •
I
BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-215
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Richard Bailey
n
OWNER of property located at Lot 2 Tina Lane (M & M Subdivision) Street,Road or Ave.
ri
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
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. DINNERS Addressis 37 Western Ave.
Glens Falls, New York
2. CONTRACTOR or BUILDERS Name
Harvey's Specialty Shop ,y
3. CONTRACTOR or BUILDERS Address \
RD #1 Box 1432
r
Lake George, New York 12845 7
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
(xi Wood frame ( )Masonry 1 )Steel 1 1
7. PLANS and Specifications
30'x61' per plot plan, specifications and application submitted
No.
including sewage system and one-car attached garage.
9
8. Proposed Use "`
One-Family Dwelling ,m
e
C
m
$5.00 C/0 Paid
110.00 December 1 fg 86 w
$ PERMIT FEE PAID-THIS PERMIT EXPIRES
(If a longer period is requied an application for an extension must be made to the Building and Zoning inspector of the
town of Ooeambrry before the expiration date.)
Dated at the Town of Queensbury this 1�44t�lhI//pDayy of ,ems May 1g 86
SIGNED BY Mad 1 ad (/_ iSj 2v) for the Town of Queensbury
Building and Zoning Inspector a
TO BE COMPLETED BY BLDG. DEPT.
Cc�7
/ Application No.
awn of QueenJbury Permit Issued 19 _ TOWN OF QUEENSEUT""
BUILDING and ZONING DEPARTMENT Permit Expires 19 H IE C LS t'u V I�;
IS
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation o
Queensbury, New York 12801 Variance No. OOOO OO
Site Plan Review N . APR
Q 198.
Approved by,� 2 A.M. I I J F-Qt' tj '• M.
�
APPLICATION FOR 718I9P41121314I 5I6
BUILDING AND ZONING PERMIT
s n a a r ♦ * r a e w • u r n a a • • * • e * * * * • it. N n • • • • • • • n .,*
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. ANSWER ALL OF THE FOLLOWING.
The undersigned hereby applies for a Building Permit to do the following work which will
be done in accordance with the description, plans and specifications submitted, and such
special conditions as may be indicated on('the Permit. pp
The owner of this property is: )�r . RiCalar- cL ea., ` ej
P.O. Address 37 vie5+er ,n A ✓e , Gle,.5F41IS , N .y /aso/ Tel. 79a-53 / 0
Property Location: `®'t fi a — 1 ,7n w F_a.. e Tax Map No./lc / (o / 2.
Street number or building lot number
Subdivision name (if applicable) 01 v-- Y1^
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
Name P.O. Address Tel. No.
Name of builder{ ,a�l rv¢MO Spee!git 1,ep Address RC2 !--($ -e oi/4/3a Lo ce 6cor -Tel, 79F- 7/Sol,
Name of plumber Allrn K tell¢ Se Address Qo F, rle.- .Pct.6/015 Fa9(sTel.
Name of mason Address Tel.
NATURE OF PROPOSED WORK: * ZONING INFORMATION:
)( Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
Addition to a building * drawn reasonably to scale and attached hereto,
_Alteration to a building * showing clearly and distinctly all buildings,
(no change to exterior dimensions) * whether existing or proposed and indicate all
Other work (describe) * set-back dimensions from property lines. Give_
* street and number or lot number and indicate
FOR DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot. Show location
LOCATION OF STRUCTURES AFFECTED. of water supply and location and configuration
* of septic disposal area.
*
* COMPLETE INFORMATION REQUIRED BELOW.
2//5-0o SF P'e 5-"reck
* Size of property ft X ft.
* Existing building(s) Size — ft X — ft.
*
PROPOSED BUILDING AND USE: * Existing building(s) Use --- -- - -
1 Size of new structure 30 ft X Gift *
Foundation-pier/slab/crawl/partial MTP * Proposed building, distance from property line
(circle one) *
No. of stories (habitable space) * Front yard 6 O ft Rear yard /' O ft
Height (grade to ridge) .*1 7 ft. * Side yards .3 5- ft and a o ft
If residential, no. of families * If on corner, setback from side street ft
No. of rooms(excluding baths) G * OCCUPANCY INFORMATION
No. of bedrooms 3 *
* PRIMARY BUILDING -
No. of bathrooms Primary heating system Q lecir, C base& cA: - )(One family dwelling
Two family dwelling
Type of fuel flk ar,r i')^) * Multiple dwelling / Number of units
No. of fireplaces to be installed /
Will a wood stove be installed? *go
* _Permanent occupancy
Central Air conditioning? no * _Transient occupancy
* Business
BUILDING STYLE, PRIMARY STRUCTURE A. Industrial
Ranch CContemporar,; Log cabin Other '
Raised ranch Mansion Duplex * If addition, what will use be.
Split level Old style Bungalow *
Cape Cod Cottage Other * ACCESSORY BUILDING-
Colonial Row Town House _Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * K Attached garage. ; two car/ car
* * * * * * * * * * * * * * * * * Private storage bui •rng
ESTIMATED MARKET VALUE OF Other
CONSTRUCTION *
$ / oOloOc
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form BPA 4/86 and-vl
-
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc. Fe/c O C Q u M e
Will any second-hand or ungraded lumber be used? If so, for what? Y'1 C
Foundation wall material con cref e black Thickness / O
if
Depth of foundation below grade (io bottom of footing) S % ,L 1 .
Will there be a cellar? yp5 Heated or unheated? vahCate yloor sq. footage sq ft
Will there be a basement? Will any portion be used as living space?
(If so, what portion? sq.ft. - - Type of use?
Type of roof - flat/shed/other Material of roof cNerp'DS Sti„' IR-,
Size, wood studs "X 4( " spacing /6 "o.c. length $' ft.
Joists(floor beams) 1st. floor A "X C " spacing / 6 "o.c. span St`/ft.
Joists (floor beams) 2nd. floor ). "X G " spacing /6 "o.c. span Sc,Kfi.
Overlays(ceiling beams) "X " spacing "o.c. span ft.
Roof rafters "X /a " spacing .al-/o.c. span ft.
Roof trusses (pre-engineered) spacing "c.c. span ft.
Exterior wall finish ✓c hL..\ cedor IV,,.\, Of what material?
Interior wall finish �j , /\""'
If agarage is to be attached, describe materials to be used for FIRE SEPARATION: S/g-
hre I �+tc S R.
Is there to be an opening between garage and dwelling? no If so will a Fire-rated
door, enclosure, and self-closing device be provided?
Will a flue-lined chimney be installed? e1 o Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well ✓47 N a , C 9
SEPTIC SYSTEM _ Distance from ANY private well(including adjoining properties /S O ft.
(A separate application is necessary for any repair or new installation of septic system)
Town of Queensbury AFFIDAVIT County of Warren STATE OF NEW YORK
I swear that to the best of my knowledge and belief the statements contained
in 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 not, and that such work is
authorized by the owner.
SWORN TO BEFORE ME THIS Signature_ --DIN,
Owner, owner's agent,arcnit ct,c ntractor
_Z9 day of Arta-. 19,96.
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 / T / s S . �•
2 . Type of heat e� ec ' C Lose Lour of
3. Is the building mechanically cooled? r1 0
4 . Percentage of area of windows and doors / 0
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 proof and floors exposed to ambient conditions
!Doc 7S0 . 5 49 ' I
2 . R value of exterior walls / /
3. R value of glazed area R kS
J/
4 . R value of doors /4/ i
5. R value of floors over unheated spaces h //
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)
9. R value of heated basement/cellar walls (below grade)
10. Type of insulation 4110
e` ) CGS(
C. Controls
1 . Thermostat maximum heat setting
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 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
2 . Temperature control setting maximum
G. For Swimming Pool Only
1. Maximum heating l
Telephone No. 79 "7i S D. ,(/a``
(applicant ' s signatu e
awn of Queendtury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. I Box 9B
Oueensbury, New York 12801
SEPTTIC DISPOSAL PERMIT APPLICATION
Owner' s Name fl1 - IC .• c_L, ca.. g Tel. 79d, - S3 �
Address 3 i In/e5+ Qcr 1'ue G(enst-tj\ S N-y iagol
Person/Firm installing system f\e ct' \ t r Sere ce
Number of bedrooms(residential only) .�
Total daily flow: (compute @ 150 gal.per bedroom per day)_ 4/5 d
Tcpographv:(ila1)- rolling - steep - (circle one) Degree of slope —y
Nature of soils:w1 loam-clay- other- Depth ft.
Ground water-- at what depth? — ft.
Bedrock or impervious material--at what depth? - ft.
Percolation Test - Not required / Required -Rate min/inch.
Domestic Water Supply -CMunicipal)- Well - Other
IMPORTANT!
on a separate piece of paper , submit a diagram of the proposed septic
system with all dimensions; including distance from any structure,
distance from property lines and distances from any domestic water
supply or shore-line of lake, stream, pond or wetlands. Include all
dimensions of the system itself.
Description of proposed system:
Septic tank size /00O gal.
Tile field- Length of each trench ft. Total field ft.
Size of stone % 3
Seepage Pit (s) Number / Size E ftX_ S ft. Size of stone%
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 Town of Queensbury Sanitary
Sewage Ordinance.
1 >r:cl uh . s• 1706/ e6
Signature of Applied' Date
01/86 and/vl
Septic System Inspections:
A. All applications for septic system installation,
alteration or repair, as required by the Town of
Oueensbury Sanitary Sewage Ordinance, shall be
submitted to the Buildina Department at least
24 hours before start of construction and shall
include a plot plan showing:
1) the proposed location of the system
2) location and distance to lot lines
3) location and distance to structures
4) location and distance to any water supply
5) size and dimensions of all tanks, distribution
boxes, tile fields and/or drywells
B. No system shall be covered before inspection and
approval by the Building Inspector. Failure to
comply with this requirement may result in the
uncovering of the system by the ,installer and a
fine of up to $250.00.
C. An approved copy of the plot plan shall he
available•on the construction site. Failure
to produce said plot plan at time of inspection
may result in an immediate work stoppage.
D. Should unforeseen problems during construction
prevent proper installation, alteration or
repair of an approved system, a new proposal
must be submitted to the Queensbury Building
Department before further construction.
'''' ov 30 2011 2:35P \e",I4DIA, Watervl let, NYvy\iay. ' v .,?ny>vi;vw) •y'vitv;tvNO OS12P 6/6��ip;p .
MIDDLE DEPARTMENT INSPECTION AGENCY, INC. NI.
`4204,63 that the electrical wiring to the electrical equipment listed below has been examined and is approved as i}:en being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date FyO
i noted below and is issued subject to the following conditions. `fl
Owner. Judy Evans Date: 10/27/2011 £S Z/L) 11.
Occupant Same Location:l5 Tina Lane
Oau en Queensbury,Warren Co. NY
,,,
p cy:Single Family Dwg. 0 '.
s V
Applicant:
'
Judy Evans ra ,a-^pT a t xy I
17 Tina Lane . sF° 6C �' eJ�! et "''!" rr,
Queensbury, NY 12§ e ` o-•`� ,- 4 s 1' octi 'r o-'sz ` ''
L ,5b. . ' � .. v : , o.
Richard Moon / ba ;';M� �q ,may i y#"'t ,jt t 1
No. 918,04 Y f0.k s . °`;S • 1 y
,y ri fit• :` e > E n f 411
Equipment: •6 .ivosr j
1 -50 Amp GFCI, 1 GFCI'ecep4, lee1 -¢�'actlon 'T• • 1 kit <�."^ ,<r7L.y, 1
v4 `'
IN
s, 11; a ,R - 3 n r°�
et r c
% +any ' asb"l'.D' q!!L''1 N.
.6 t ?Cr u v 3 r
} •`rt X _yy
mt s "31444, < I.
•'yn., ry 1411g Al11 i .o'^ri 3s 11,4 NA a • yn;,
lA' �i 1 ei 1. •e:,'n d4 4.,, / I 4. EYE i ri ?.. K n
agdB
This cenillcate applies tothe electrical wring to the elaelecsl equipment Need immediately nun and void. Thiscertificate applies only la the use,ono/penny end' :.;,i
above end the ns4tialloo Inspected as ol the above noted date based on a visual ownership as Indicated henln. Upon a change In the use,oc tpency or ownership 'S;
Inspection. No wlnlnty is smartened or implied Se to the mechanical safety,OM of the property indicated Wove,this caall, aale shall be immediately null and void. of:
nanny or Wens ol the equipment for any pa,cular purpose. The certificate WWI In the event that this certificate becomes invaild Weed upon the above conditions, t: ;
be valid for a period ol one year horn Its move noted dab. Should the electrical this certificate may be r.vdidated upon reinspeclion by Middle eepanment
system to which Ilse ttdificele epples W Meted in any way,including but not knit. Inspection Agency,Inc. An application for inspection must be submitted to Meddle it!,t
, ed to,the introduction of additional electrical equipment and/or the replacement of DepedmeM Inspection Agency, Inc, to Iniliete the inspection and revallatlon li?I
any of the component;Installed as of the above noted dale,We certificate shall be process. A lee will be changed for t isseMco. )j,
f Y..
30F. l7 - / -- 43
dr
• down of Queensdury
BUILDING and ZONING DEPARTMENTO
Bay and Haviland Road, R.D.
x 98
Dueensbury, New York 12801
BUILDING INSPECTOR' S REPORT
NAME
LOCATION (.(� O
Permit No. o� -a��—
Date // / * *
* f * f * * * * *
*/f * ^* '�a * * * * APPROVED - YES NO
>''oo my a orms
Foundation 111111
Waterproofing I
Backf
Frami g
Framing _
Roofing Masonry Veneer _
siding _
Rough ValvesEPorchesf _
Finished Floors =—=
Interior Trim
Stairsa6 Railings •—=
Cellar a Flo Trsle �_
Concrete Floors _
ploy, Fixtures �
Gar. Fireproofing
LaS ok Closers S_
Smoke Detectors ■
111.1
Chimney
oyaration•
1
ails ,��
Ceiling �� �,,=='
FINAL ELECTRICAL INSPECTION �)
DRIVEWAY APPROVSurvey —
Final Building
Next scheduled inspection (call when ready)
Remarks-
Build ng Inspector
6/86 and-vl
Or
• Jown of Queenddury
/ BUILDING and ZONING DEPARTMENT
/fib,A Bay and Haviland Road. R.
'\ \r` Oueensbury.New York 12801
BUILDING INSPECTOR' S REPORT
NAME
LOCATION ja 2
No. �- �15-
Permit * * * *
Date * * * * * * * *
* * * +A *.a ��*Q* �e = APPROVED - YES NO
• Footing/Pier E'6z'msMIMI
Foundation III.Frami
Waterproofing IIIII
Backfill
Framingg
Woofing OS
Masonry
• ng
UM
Mosgh P umbi Veneer IMO
Rough Plumbing ER
.�• O b
t4lief Valves D pe ran
• Porches , Q !
1�'nished Floors V$taiVrra
IPtaiterior Trim
�. re & Ridings _
Cellar Drain Tile �
Crete Floors ■+r•�
mlbq. Fixtures
, Fireproofing � � ,
or Closers '81 V i•
lbmoke Detectors
ro
imney III
IN SULPL
V I(dundati0N: 22 � EMI
Foundation !� •
nieooillrS
W �� i
11111
ceiling DAL ELECTRICAL INSPECTION -�
D; EWAY APPROVALSurvey
art •
Building
Next scheduled inspection (call When ready)
Remarks-
/
Building Inspector
6/86 and-vl
awn o f Queenetury
BUILDING and ZONING
DEPARTMENT
DE RTME T
Bayand ndeD 8
pueenSbUry, NWYork12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NNAE.
LOCATIONS - 5
OE
/� PERMIT
SOIL
N0.
RI � f
D
_ Loam - Clay
-
Percolation t Required? YES r
- Min/Inch
Percolation rate
TYPE of SYSTEM: total length
Absorption field,
Length of each trench
Depth of trenches
Size of gravel_
SEEPAGE PIT51NEUmthe of) _
�ft. X tQft. --�_
Grzv-
Gravel size
PIPING: $yye Tye PIPI u
Bldg. to tank
Tank to dist. box
Dist. box to field NO Partial
Openings sealed?
LOCATION/SEPARATIONS: eft.
Foundation to tank jft.
Foundation to absorption eft.
Absorption to lot line
-.sPERTY(circle one)
Separation of pits
LOCATION OF SYS�- eft side Right side
Front - Rear
COMMENTS:
SYSTEM USE APPROVED • NO
InspectorBuilding Insp
01/86 and vl
l,_..yl g II
Jorun of Queenabury
BUILDING and ZONING DEPARTMENT
98
Bay and Haviland Road, R.O.
1 Box aueensbury,New York 12801
BUILDING INSPECTOR' S REPORT
NAME
LOCATION 7IN G �
//2{7 Permit No.
Date # * e * * * ✓*_ ppPROVED«_YES* *N� *
tilFooting/Piet Forms '
Foundation 11111
Fr
Waterproofing 11111
ai gl
Framing _
Roofing 11111
Siding
MMg�sonrP Veneer Wm
y¢ough Plumbing �_
Wm
Relief Valves _
Ext. Porches _
Finished Floors
Stairs
RaTrilm ==
CellarSel &Drain __
ncr a Flo Trsle __
Concrete Floors �_
Gab., Fixtures _
Gar. Fireproofing _
Door Closers _
Smoke Detectors ■
Chimney
INSULATION:
Foundation
Floors 11111
I
WallsCilingINSPECTION .
FINAL ELECTBuilding L Survey
Final Building
Next scheduled Insp
ection(call when ready)
Remarks- -
Building Inspector
6/86 and-vl
slit
c� 6
Jown o f Q ueena urg
BUILDING and ZONING DEPA R.D.RTME 98
T
Bay and sbund New York 12801
1 Box
pueeflensbrY,
BUILDING INSPECTOR'S REPORT
1
NAME A
LOCATION np
Permit No. b
Date-�_/* * * * * * x * * * x « * *
* * x x + x * *✓*_ APPROVED - YES NO
Footing/Pier Forms ' 11111
Foundation _
Waterproofing 11111
Baaming -��i�
IIMS
✓Foaming _
Roofing _
Siding _
Masonry Plumbing V bng _
RoughVals _
Relief Porches
IL •
Fin, Ped FloFinished FloorsTrimBellaB D ainlTile colcre Da Flo TIsleConcrete FloorsCar. iFreproofesGar. Fieproofinpoor Closers
Smoke Detectors I
Chimney
INSULATION[ !Foundation
Floors _
Neils _
FINAL _
FINAL ELECTRICAL INSPECTION
Final Building Survey
Next scheduled Inspection(call when ready)
, ,
} Berner - Zter 64
Building Inspector
6/86 and-vl
,_r_
TOWN OF QUEENSBURY
Building Department
ln1peeterx Aepert�---a
Name j n f -cv^,✓
�tiun o 2 �_ 1— Wather��..
Permit No.
.�RemLarks
EXca#ation ��if�F1
Foots
Footin• Forms
Footin• s Piers
Foundation
Cement Coat
Water•roofin•
Backfill
Final Survey
?remind
Sheathin•
Roof Felt
Roofin•
Siding
Mason Veneer
Rou•h Plb• •
Relief Valves S
Ext. Porches
Finished Floor
Interior Trim
Stairs Railin•s
Cellar Dr. Tile
Concrete Floors
Irak
P1•• • Fixtures
Gar. Fire•roofin•
Door Closers
Chismwater Inst.Se.tic Meter
Floors
Foundation
Insulation Walls
Ceiling,
Building Inspector
REMARKS
UJL002,r, e. Q dun- ' 1
/j o-y ora
aed�
X fYotiy
STATE OF NEW YORK
DEPARTMENT OF HEALTH `= OFFICE OF PUBLIC HEALTH
DISTRICT OFFICE • 21 BAY STREET • GLENS FALLS, N.V. 12801 • TEL. (518) 7933893
DAVID AXELROD,N.D. Lan T. Loudon, N.D. ; D.P.H.
cannn;..;on.. Regional Health Director pr
Albany Region -Uisntri8tFB3irector
May 8, 1986
TOWNTO OF QUEENSBU7'1
Mr. Vic LaFave IiJI �' �ry
Building Department IYf'YYl
Town of Queensbury MAY 8 1986
Bay And Haviland Roads
Queensbury, New York 12801 71819 121112131416.M
Dear Mr. LaFave:
RE: Lot #2, Tina Lane
Lands of Brandt, Queensbury (T)
This letter will serve to authorize a substitute of seepage pit for
tile fields on the above lot. It is proposed to install two eight foot by
six foot seepage pits with one foot of crushed stone around them. This is
equivalent to the design on the approved subdivision map.
Very truly yours,
Brian S. Fear, P.E.
District Health Director
BSF:ns
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