88-051 WW1' GE (:.u,:. : ,._,
TO BE COMPLETED BY BLDG. DEPT. { 01;)g 'it=( I
n 8
Application No. U '
_/own of Queensbury Permit Issued 19 FEB 291988 ��
BUILDING and ZONING DEPARTMENT Permit Expires 19 �"�
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation ' BUILDING & CODE DEPT.
Queensbury, New York 12801 Variance No.
(� I Site P1 iew No r 5 -- n" 1,/�
I APPr d..by j
J AL,A) Ci4)
APPLICATION FOR
BUILDING AND ZONING PERMIT I.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *::*
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.
The owner of this property is: Cfr/4tt 5 Q. J C4C/J
P.O. Address D / 3
i &X /66V IA,rE 6co.c ,E NY.• Tel. 792- 5 43
Property Location: /Vl4C/RJ) . ,'Clad Lotrg' Tax Map No. / /
Street number or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
l7A✓E q/LEY RP. 0./ e % 46// L4rE 6604476 72d-6,5'Gj/
Name P.O. Address Tel. No.
Name of builder S..F Address Tel.
Name of plumber Address Tel.
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
Sup/ 2)R•X oir t!!i�ray[-, /kjCi * 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.
* Size of property ft X ft.
* Existing building(s) Size ft X ft.
PROPOSED BUILDING AND USE: * 7)0cKJtTCie t>iin
* Existing building(s) Use ,
Size of new structure ft X ft ' *..
Foundation-pier/slab/crawl/partial/full * Proposed building, distance from property line
(circle one) *
No. of stories (habitable space) * Front yard " ft Rear yard ft
Height (grade to ridge) ft. * Side yards ft and ft
If residential, no. of families * If on corner, setback from side street ft
No. of rooms(excluding baths) * OCCUPANCY INFORMATION
No. of bedrooms *
* PRIMARY BUILDING -
No. of bathrooms * One family dwelling
Primary heating system * Two family dwelling
Type of fuel
No. of fireplaces to be installed * Multiple dwelling / Number of units
Will a wood stove be installed? * Permanent occupancy
* Transient occupancy
Central Air conditioning?
Business
*
BUILDING STYLE, PRIMARY STRUCTURE * industrial
Ranch Contemporary Log cabin * Other ' -2=10 C
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 ) * Attached garage/one car/ two car/ car
* * * * * * * * * * * * * * * * * * ' Private storage building
ESTIMATED MARKET VALUE OF * Other —POGO._
CONSTRUCTION
$
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form r4PA 4/86 and-vl .
BUILDING PERMIT APPLICATION CONTINUED •
BUILDING SPECIFICATIONS: •
Type of construction, wood frame, fire safe,etc. WX'1.
Will any second-hand or ungraded lumber be used? If so, for what? A/o
Foundation wall material JAkit -Pc c t Thickness 'fOY9
Depth of foundation below grade (to bottom of footing)
Will there be a cellar? WO Heated or unheated? N O Floor sq. footage sq ft
Will there be a basement? A/G Will any portion be used as living space? NO
(If so, what portion? sq.ft. Type of use?
Type of roof - sloped/flat/shed/other,C47 Material of roof pC yitwD4,
Size, wood studs o'. "X Ej " spacing Zsf"o.c. length /2- ft.
Joists(floor beams) 1st. floor "X " spacing "o.c: span ft. •
Joists (floor beams) 2nd. floor "X " spacing "o.c. span ft.
Overlays(ceiling beams) "X " spacing "o.c. span ft.
Roof rafters "X " spacing o.c. span ft.
Roof trusses(pre-engineered) spacing "o.c. span ft.
Exterior wall finish Of what material?
Interior wall finish
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
Is there to be an opening between garage and dwelling? If so will a Fire-rated
door, enclosure, and self-closing device beprovided?
Will a flue-lined chimney be installed? Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well
SEPTIC SYSTEM Distance from ANY private well(including adjoining properties ft.
(A separate application is necessary for any repair or new installation of septic system)
Town of Queensbury AFFIDAVIT STATE OF NEW YORK
County of Warren
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 Sig - _ LL
Owner, owner's - - ,t,arcnitect,contractor
a day of frj - 1941B IF
•
Notary Public, Warren County, N.Y.
SPECIAL CONDITIONS OF THE PERMIT; •
•
•
•
By
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12804.
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME /6ICI .-
LOCATIONI� 7ef t _v
DATE '� ' v PERMIT
y ) ,�e APPROVED
G.fXr �%� YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING L�
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
//CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING v�
SIDING
EXTERNAL PORCHES/STEPS
STAIRS-CLEARANCE & RAILS
PLUMBING FIXTURES/RELIEF VALVE
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER(S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
SIGNED CERTIFICATE OF OCCUPANCY MUST BE
)BTAINED FROM THE BUILDING DEPARTMENT BEFORE
PHESE PREMISES ARE OCCUPIED!
2EMARKS:
INSPECTOR
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REVISIONS
I, NO' DATE REMARKS DWN. CHK'D. APPV'D. - s
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THI,PROPERTY OF NELES INC.NEITHER THIS DRAWING OR ANY DATA ,
OR INFORMATION THEREIfi SHALL BE COPIED OR REPRODUCED IN ANY MANNER,'LOANED OR
UNLESS OTHERWISE SPECIFIED-
TOLERANCES: X=±.05; ,XX=t.01; XXX=+.003; ` + ! GLENS FALLS, N.Y.
OTHERWISE DISPOSED OF OR USED FOR ANY PURPOSE WHATSOEVER WITHOUT THE PRIOR 1 LEY (gi-r—h/ b! [
WRITTEN PERMISSION OF fIELES INC.IF THIS DRAWING IS LOANED BY OR WITH AUTHORITY OF Xs =±.5° °; FINISH
r NELES INC.THE BORROWEP,IN CONSIDERATION OF SUCH LOAN,AGREES TO THE FOREGOING REMOVE SHARP OUTSIDE EDGES AND CORNERS TO DRAWN SCALE - DATE
CONDITIONS AND TO RETURN THIS DRAWING UPON REQUEST. .02-.03RADIUSOR CHAMFER.DIMENSIONS ININCHES.
CHECKED APPV'D. REF.
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NOTE -D I �� S U N t,C •, "
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THIS DRAWING 1 H PR �!S E PROPERTY OF NELES INC.NEITHER THIS DRAWING OR ANY DATA
R UNLESS OTHERWISE SPECIFIED
O INFORMATION THEE IN SHALL BE COPIED OR REPRODUCED IN ANY MANNER LOANED, O ED OR _+ _ �} _ ri
TOLERANCES. X _.05; XX=t.01; - .XXX-t.003,
OTHERWISE DISPOSED OF, OR USED FOR ANY PURPOSE WHATSOEVER WITHOUT THE PRIOR - � GLENS FALLS, N.Y.
_, G R\ lr C}V E I CE / �«nl 14 KE
WRITTEN PERMISSION i F NELES iNC.IFTHIS DRAWING IS LOANED BY OR WITH AUTHORITY O XS -t_5 ,. , FINISH
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REMOVE SHARP OUTSIDE EDGES AND CORNERS TO oAawN scALE = DATE
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CONDITIONS AND TO ITURN THIS DRAWING UPON REQUEST. .02 .03 RADIUSOR CHAMFER.DIMENSION5IN INCHES.
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