87-848 •
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
This is to certify that work requested to be done as shown by Permit No. 87-848
has been completed.
This structure may be occupied as a One Family Dwelling
LocationHillman Rd. , Cleverdale
Dr. & Douglas Provost
Owner
By Order Town Board
TOWN OF QUEENSBURY
Building & Zoning Inspector
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 87-848
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Dr. and Douglas Provost
OWNER of property located at Hillman Rd. Cleverdale Street, Road or Ave.
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in the Town of Queensbury,To Construct or place a Alteration to one family
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 7 Horicon Ave
Glens Falls, N. Y. 12801
2. CONTRACTOR or BUILDER'S Name
John Mason ty
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3. CONTRACTOR or BUILDER'S Address
P.O. Box 86
Cleverdale, N.Y. o
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4. ARCHITECT'S Name to
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications
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No. 24' x 32' as per plot plan, specifications and application.
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8. Proposed Use Alteration to inside of one family dwelling (converting attic into . H
loft and bath)
$5.00 C/O
$ 40.00 PERMIT FEE PAID —THIS PERMIT EXPIRES July 1, 19 88 n
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rt
town of Queensbury before the expiration date.) t-•
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Dated at the Town of Queensbury this 9th Day of December 19 87 0
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SIGNED BY Q� —�%
\ CD/ ���� Zt./1/ for the Town of Queensb ry ,
Building and Zoning Inspector /(„re,
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TO BE COMPLETED BY BLDG. DEPT.
Application No. rom; Or QUEEN,p`; -
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�]own of Queeniurf/ Permit Issued 19 ,-- - -bli
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BUILDING and ZONING DEPARTMENT Permit Expires 19 u 1Yj L L
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation f f1?-//9
Queensbury, New York 12801 Variance No. /1✓//4 C 9 19
nn Site Plan Review No. /y//3
g- j - 1, V Approved by: I;PLI (NG & CODE l7EP
APPLICATION FOR
BUILDING AND: ZONING PERMIT ALL � �a
* * * * * * * * * .* * * * * * * * *. * * * * * * * * .*. # * * .a. * * * * * * *:,*.
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: Dr. and Douglas Provost
P.O. Address 7 Horicon Avenue Glens Falls , N.Y. 12801 Tel. 793-8220
Property Location: Hillman Road Cleverdale Tax Map No. 11 / 1/• 1 . 10
Street number or building lot number
Subdivision name (if applicable) Takundewide
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
John A. Mason P.O. Box 86 Cleverdale, NY 656-9956
Name P.O. Address Tel. No.
Name of builder Sunsoval, Inc Address P.O. Box 86 Cleverdalwel. 656-9956
Name of plumber T. Address Tel.
Name of mason II 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,
XAlteration 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.
* Size of property See Enclof&dX ft.
* Existing building(s) Size 24 ft X 32 ft.
*..
PROPOSED BUILDING AND USE: * Existing building(s) Use S .F.R.
Size of new structure 24 ft X 32ft *
Foundation-pier/slab crawl partial/full * Proposed building, distance from property line
(circle one) *
* Front yard ft Rear yard ft
No. of stories (habitable space) 2
* Side yards ft and ft
Height (grade to ft.ridge) 22 * If on corner, setback from side street ft
If residential, no. of families 1
No. of rooms(excluding baths) " " 7 * OCCUPANCY INFORMATION
No. of bedrooms 3 *
No. of bathrooms 2 * PRIMARY BUILDING -
Primary heating system electric * X One family dwelling
Type of fuel - * Two family dwelling
No. of fireplaces to be installed - * Multiple dwelling / Number of units
Will a wood stove be installed? - * Permanent occupancy
Central Air conditioning? no: * X Transient occupancy
Business*
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
, ._ * ' Other . .
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc. wood frame
Will any second-hand or ungraded lumber be used? If so, for what? No
Foundation wall material cement blocks Thickness 10"
Depth of foundation below grade (to bottom of footing) 4 ' 0"
Will there be a cellar? No Heated or unheated? - Floor sq. footage - sq.ft
Will there be a basement? No Will any portion be used as living space? -
(If so, what portion? sq.ft. - - Type of use?
Type of roof - sloped/flat/shed/other Material of roof asphalt shingles
Size, wood studs 2 "X 4 " spacing 16 "o.c. length 8 ft.
Joists(floor beams) 1st. floor 2 "X 10" spacing 16 "o.c. span 12 ft.
Joists (floor beams) 2nd. floor 2 "X 1P" spacing 16 "o.c. span 12 ft.
Overlays(ceiling beams) 2 'X 8 " spacing 16 "o.c. span 12 ft..
Roof rafters 2 "X 8 " spacing 16 o.c. span 12 ft.
Roof trusses(pre-engineered) spacing - "o.c. span - ft.
Exterior wall finish siding Of what material? vinyl
Interior wall finish sheetrock
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? No If so will a Fire-rated
door, enclosure, and self-closing device be provided?Will a flue-lined chimney be installed? yes Height above roof 2 ft. 6"
Depth of chimney foundation below grade - ft.
Depth of fireplace hearth - ft. - in.
Water supply - Municipal or private well Lake George
SEPTIC SYSTEM _ Distance from ANY privatewell(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.
e etSWORN TO BEFORE ME THIS Signature
Owned!, owner's agent,arcnitect,contractor
I day of 1C.C 19 7
Notary Public, Warren County, N.Y.
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SPECIAL CONDITIONS OF THE PERMIT: