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8248 C C1 CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date ' - �- - `' 19 _ ' .4 r )\ ��- -3 This is to certify that work requested to be done as shown by Permit No. has been completed. n ` f { /� (///�'� /�/� This structure may be occupied as a f� p• ICI ���%�1._ _I. . 1� �-�14}/ �.V �1 • 1OCJQ Vll r Location Lo� �_��1 )-461.)r) ct Owner IqctEN By Order Town Board TOWN OF QUEENSBURY (; Building & Zoning Inspector ' CREATIVE "INSTA" PRINTING. GLENS FALLS. N Y 12801 15181793-3658 1 BUILDING PERMIT TOWN OF QUEENSBURY ` No. 8 248 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Mary 1R1 Pi Shank Lot 93 Dixon Road �' OWNER of property located at Street, Road or Ave. in the Town of Queensbury,To Construct or place a One—Family Dwelling (Modular) bd at the above location in accordance to application together with plot plans and other information hereto filed and N H. approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. cn 0 1. OWNER'S Address is n 595 Dixon Road Glens Falls, New York 2. CONTRACTOR or BUILDER'S Name Dale Granger I� 3. CONTRACTOR or BUILDER'S Address O rt Notre Dame St. Glens Falls, New York w t7 4..ARCHITECT'S Name 5. ARCHITECT'S Address fi 6. TYPE of Construction—(Please indicate by X) K )Wood Frame ( I Masonry ( ) Steel ( 7. PLANS and Specifications 48 'x24 ' per plot plan, specifications and application submitted including sewage system. No. THE ATTACHMENT OF THE TWO PARTS MUST BE APPROVED BY 0 8. Proposed Use A LICENSED PROFESSIONAL ENGINEER. 0 One—Family Dwelling DJ p, H $5. 00 C/O Paid w� 84. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 1 1984 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the I-+ town of Queensbury before the expiration date.) I-1 N. Dated at the Town of Queensbury this 2 8 th Day of November 1983 SIGNED BY Gov 0' (/" • for the Town of Queensbury Building and Zoning Inspector • TOWN OF QUEENSBURY (Space inside block to be filled in by WARREN COUNTY, NEW YORK • Building Inspector) Application for Application No. , l'crmit Issued 19 BUILDING AND ZONING PERMIT l' rmit Expires. 19 Zmiing. District \ illut• mi \v,),1., • THREE (3) Copies of a PLOT PLAN, Drawn to scale •\1)1)""(II by C .. showing the actual dimensions of the lot to be built Rcinzu-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. 9.2 / _ i.5-- f(/ • a//si TOWN OF QUEENSBURY DATE H E 0 E 11 fl A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK ANSWER ALL OF THE FOLLOWING. 111)V L.I. 19tij The undersigned hereby applies for a permit:to do the following work A.M. 1 --/2e- P.M. which will be done in accordance with the description, plans and specifi- 718)911.0)11)12)1M3141516 cations, and such special conditions as may be indicated on the permit. . . e 2,_ • . _ )., . . . / (0 4.11,6 • The owner of/1,1 A R V Atis property is.i.rt 0, , L„, '..-.1 - 3-9 c 19 i X 6AI I) 45 1040,44,4,e . (NA'4E) (P.O.ADDRESS) The person responsible for •supervision of the work insofar as the Building Code and the Zoning Ordinance apply is: (NAME) (P.O ADDRESS) Name of Builder 1DAt- 6RA/46.4k Address NanV 1).4te 6, P II Name of Plumber Address • Narhe of Mason Address Lot Number lik 613 .Unit Estimated value of proposed work S 4'e, ,,,,--0 Name of Village cp txti,v-44,1- Name of Street I)tl Al Ai Ed' Side of street: north 0, east 0, south er.Cest 0 Nearest Cross Street plustle,cr* Distance from this cross street t9 6 Ft. Property is north "south 0,east Li, west El from Cross Street If on Corner, which corner, northeast D, northwest El, southeast D, southwest • (Designate by marking with an "X" in the correct space.) NATURE OF PROPOSED WORK OCCUPANCY • MI/Construction of a new building. Main Building Cies Addition to a building. , - , One-family dwelling . 0 Alteration to a building. Two-family dwelling • 0 0 Demolition of a building. -family apartment house 0 Store building 0 -car attached"garage 0 Other: • Accessory Building • • One-car detached garage 0 0 Other work. Describe- YVil()C (A..144, Two-car detached garage . El .14-.CMAA. Private chicken house El Private storage building 0 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 Nst4 Show proposed building(s) in'dotted line and existing • ---a huilding(s) in solid line. . i 4,6 14 lin Size of property J ft. x ft. L. Size and use of existing buildings, if any U 17) 4441- . 0 iUi Size of proposed building 44 8 ft.x . .P!...... . . . ft. t„),..,vi.eAl ,... .._.1a_. Height(from grade to ridge) r-,,--- a— ft. Front yard . /b ° ft. 0 Side yards / I( ft. and ft. p /t<t) ti R.0 ' Rear yard ft. SOUTH If on corner,setback from side street ft.. . Note: All distances are net, as measured from street side -----T . line to nearest part of building. • (OVER) . . . 7-73—M • • • . . • • (cont'd.) BUILDING SPECIFICATIONS., Kind of construction: Wood frame, fire safe, etc.?. . . . . D. . . . . . .F .A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will any second-hand lumber be used? t(.Q If so, for what? Material of foundation walls °'n Thickness e 0 /Noce 1 '-o C.14. Depth of foundation wallsbelow grade I t /A Continuous foundation? Will there be a cellar? 1 As If so, material of cellar floor Type of roof: Sloped or flat? Material of roof Size, wood studs eR.A. 6 "x �` ", spacing /1 "o.c., length ft. Size, floor beams, 1st floor . . . °�.. .t . . " x ", spacing 1 )!P "o.c., span ft. Size, floor beams, 2nd floor " x ", spacing 1 "o.c., span ft. Size, ceiling beams A >4 11 ' x ', spacing "o.c., span ft. Size, roof rafters or beams "x ", spacing "o.c., span ft. Exterior finish A ' V./41.U. '(ti . 11.1. 4'. . . . . . . With what material? Finish of interior walls. . .P k y. GV n 01 1" .5 H A4-1-J . OA 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 between garage and building? Kind of heating system . . 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? A'!t Depth of fireplace hearth Will a toilet be installed? Will a kitchen sink be installed and connected to water supply? Water supply (public water supply or pump) t1 pi;AtLti p Distance of cesspool from any private well N 0 ' E 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 tt b4 i 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.,.plets 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 ro sed work shall be complied with,whether specified or not, and that such work is authorized by the owner. Sworn to before me this Signature ( � " '�4{t4+ e8 prga g A,tl A� OWN f OWNERS AG NT.ARCHITECT.CONTRACTOR day of 19 V 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: - �J r t�/ 1. Gross floor .•,area l $ ig // • 5 �J 2 . Type of heat G.ec_TV./ 3 .. Is the building mechanically cooled? MO 4 . Percentage of area of windows and doors A. Over 16% Only 1 . U value of gross area of walls, roof/ceiling and floors exposed to ambient conditions 2 . Floor over heated spaces YES NO a. Are foundation wall's insulated? YES le> 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 a. R value of insulation 5• Type of insulation tiA b B. Under 16% Only 1. R value of roof and floors exposed to ambient conditions 9 /Mew. a sdL l Ai to, is' a oft 2 . R value of exterior walls . Fi .'. g Ca L I$ 3 . R value of glazed area 04'P'Roy 0'1.0 4 . R value of. doors 5. R value of floors over unheated spaces Nod_� 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) ./VOA'S 9 . R value of heated basement/cellar walls (below grade) 10 . Type of insulation 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 Telephone No. 79-3 e v -711. 1-ki 4 - (applicant ' s signature) TOWN OF QUEENSBURY BUILDING & ZONING DEPARTMENT SEWAGE DISPOSAL PERMIT APPLICATION 1. Owner' s. Name M A R Y a l.-tE15 1411 c1� Address 5'9.5' p l,.;C 44 Telephone. No. 7 9.3 1 7 elk- 2. Property location Le, r 3'. Name of person or firm responsible for installing system 1)/Pr I- G lQ 11-1,14 t Telephone No. Address J1/O7` e nr3A4 C, s es& A/ i# 4. Number of bedrooms (residential buildings only) S 5. Daily flow Y gallons/day 6. Septic tank capacity gallons 7. Topography: flat, rolling, steep % of slope fie- `ice 8. Nature of soil and depth 5 A- D 9. If ground water, bedrock or impervious material is apparent at what depth does it begin? ft. 10. Percolation test: A is required B is not required C If required what is the rate minutes/inch . 11. .Water . supply: municipal, well, other Cp iSE1 -513014. 12 Type of system, proposed: drywell,. tile field, other DRYt,tl 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 /tirr �gnature. of pplicant. 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 '' 'j _ VILLAGE i•> ,?,=r ,.- t'i i TOWNSHIP COUNTY STREET AND NO.OR . ROAD AND POLE NO. .. �'•�' POLE NO. BETWEEN WHAT TWO • CROSS STREETS IS `S ? r' PREMISES LOCATED? r- }• ` f SECTION BLOCK LOT OCCUPANT'S BUILDING NAME ':%) �-; ` f 3.% v OCCUPANCY OWNER'S NAME AND ADDRESS /t-1 !I P5 /..'.,;a CURRENT SUPPLIED ;;+ , /,j;. �,; .,,y,_; ,,�_, . BY FROM THEIR OFFICE BDEFECTS ISUILDIN. WNEW L OLD❑ REMODELED ❑ SORK NEW ❑ ADDITIONAL❑ REMOVED ❑• LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS No.of Fixtures& MOTORS HEATERS BRANCH LAMPS Lamp Receptacles CIRCUITS Loca- tion Ceiling.. Side Attacph't Switch Pendent Bracket No. Type H'P' No. Watts No. A W.gG' NO. WATTS Wall Rece t'Is Each Each Gau a 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 ENTERS MAKER BUILDING OF SIGN INSPECTION REQUESTED ON OR AS NEAR AS POSSIBLE _ NEW 0 OLD 1-1 AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF DATE OF / J a APPLICANT i.. ! �'t r - APPLICATION ��"' i\ , ."1 n STREET ADDRESS - CITY OR ZIP j'i Hr^_p / LICENSE NO. POST OFFICE ' ;' CODE WHEN APPLICABLE A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING Re or 82 40a Flo re..ff i4_ete. ro OSS •" v LAND l� /, /j du ?)i•CONSULTANTS �� S "ASS®CUTE TheriRO.Bot x 403e Stone Schoolhouse Lane Theriot Avenue Lake George,N.Y.12845 Chestertown,N.Y.12817 Telephone:(518)668-4676 Telephone:(518)494-2532 Dennis L.Dickinson.P.E./L.S. March 2, 19pL TOWN OF QUEENSB1.3RY RECIEAVED Mr. Mack Dean MAN b 1984 Building Inspector - Town of Queensbury km, Queensbury Town Offices 7I8I911g11)12 1213 4 6. Bay and Haviland Roads a ' ' ® ' . ,o. I� , I, Glens Falls, New York 12801 L RE: Bliesheck, 595 Dixon Road Dear Mack: I have inspected Mrs . Bliesheck' s modular home and it has been placed on the foundation within the limits of the necessary requirements. Should you need anything further, please do not hesitate to contact me . Sincerely, Dennis L. Dickinson, P.E./L.S. ag -t- 2, l- . TOWN OF QUEENSBURY Building Department Inspectors Report Date 4/ Name L 6 f S' t�� Locations J' fw, P-23 . Permit No. <F a Weather ?- A.3✓4--- 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 ✓ r Finished Floor Interior Trim Stairs & Railings /atg2/(A , Cellar Dr. Tile / Concrete Floors � Plbg. Fixtures ✓/�() Gar. Fireproofing` IV/ Door Closers V • till Chimney • Water Meter Inst. Septic Approval Floors Insulation Foundation Walls —Ceiling " ' 5711 • Building I spector REMARKS S1'� dKE JL rC6) 0 TOWN OF•QUEENsBURY Building Department Inspectors R Date /2 -�4 -9 G .l Name art Locationpia-14, , .( . Permit No. E A -7L1 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. Septic Approval Floors Insulation FOc2ndation Walls ' Ceiling " ' • B 'lding Inspe for • REMARKS • /are-d —1 26rd LF 1,2f,d7(4 TOWN OF QUEENSBURY Building Department Inspectors Date Name 1� i.S kW-4 Location /�/3t01,1. 3 Permit No. <� Weather Remarks Excavation Footing Forms Footing & Piers ,7 Foundation Cement Coat ✓) VC. Waterproofing Backfill Final Survey Framing Sheathing Roof Felt Roofing Siding Masonry Veneer Rough Plbg. Relief Valves J/ Wall Board Ext. Porches Finished Floor \ Interior, Trim Stairs & Railings Cellar Dr. Tile I Concrete Floors Plbg. Fixtures Gar. Fireproofing Door Closers Chimney Water Meter Inst. Septic Approval Floors Foundation ' Insulation Walls 'Ceilin Pr5re/J Building nspector REMARKS TOWN OF'QUEENS-BURY Building Department Inspectors Report • Date /2 1 83 Name f,e-/..f/ 'r/t Location -Pib(nry /C.(l . Permit No. La`/8 Weather • Remarks Excatia t on Footing Forms ()J/ 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 X \ Concrete Floors Plbg. Fixtures " Gar. Fireproofing Door Closers Chimney Water Meter Inst. Septic Approval Floors Insulation Foundation Walls • •Ceiling " (CAlt- • Building Inspector REMARKS I" o (5c ct e. uS� �qL LT I O tLSe alo --01 e: 1 ,s� , --- _ — • tpe' i ow,ti e Quec,A buwt( Yt1k4 0 'C wa