1999-100 a()(1 ,1A1
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 4000. No. 99100
TAX MAP NO. 55.—1-18 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to LEWIS, KARL & DEBORAH
OWNER of property located at 12 HICKS RD. Street.Road or Ave.
in the Town of Queensbury,To Construct or place a CH)
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
12 HICKS RD.
QUEENSBURY,NY_.... 12804;
2. CONTRACTOR or BUILDERS Name
LEWIS. CONSTRUCTION
3. CONTRACTOR or BUILDERS Address
12 HICKS .ROAD
QUEENSBURY, :NY . :.12.804
4. ARCHITECT'S Name
COMMONWEALTH ELECTRICAL AGENCY
5. ARCHITECT'S Address
PO BOX 70.6 .
HAGUE, NY 12836
6. TYPE of Construction—(Please indicate by X)
RESIDENTIAL ADDITION
1 1 Wood Frame ( )Masonry ( )Steel ( 1
- 7. PLANS and Specifications.,
300NSQ. FT RESIDENTIAL ADDITION. (3. SEASON PORCH) AS PER PLOT
PLAN SPECIFICATIONS
8. Proposed Use
RESIDENTIAL. ADDITION:. (3. SEASON PORCH)
$ 24 2001
PERMIT FEE PAID —THIS PERMIT EXPIRES April 7 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
Dated at the Town of Queensbury this 7 Day of Apr i 1 . 19 1999
•
SIGNED BY 1� for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development •Permit No. •qv!' 06
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
Location of property for installation: /2-- me--to 5 /2,..L._ _
Property Owner's Name: Aa-z, L - t�/� -
Property Owner's Mailing Address: $'A /f, </W S /2
Installer's Name: Rip-Li - /.�1�Gr��.5 Phone # 2 5' Z -2--/o
Number of bedrooms (if residential): 3 Total daily flow: -,j C.)
(residential -compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
• Soil Nature: sand, <loam, clay, other /depth:
Ground water: at what depth? / feet / Bedrock or Impervious Material: at what depth? feet
Percolation test:P not required, required [rate min. per inch j
Domestic water supply: municipal, X well, other
If domestic water supply is a WFT T, water supply from any septic absorption is el,- feet. •
PROPOSED SYSTEM
• Y /0&0
Septic tank- gallon (minimum size: I,D00 al.)
30 2
Tile field: each trench 010 feet / Total system length: feet
•
Seepage pit(s): number of 4//y� / size each: . ft.by ft.
Size of stone to be used: # . / depth or thiclmess , feet
•
•
HOLDING TANK SYSTEM: (if required)
Number of tanks: : Size of each: gallons
CA.arm system and associated electrical work to be inspected by a certified agency.J
For yotz protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or
approval granted which is based upon or is granted is reliance upon any rn t.:rial r isrepresentabon or failure to make a
material fact or circumstance known by or on behsdf of an applicant, chs It be void.
I have read the regulations with respect to this application and agree to bide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: Date: ��
. ' 4 , ,,,0.6
9
_/ : _ ENERGY CODE COMPLIANCE APPLICATION
0.041A�jW TOWN OF QUEENSBURY, WARREN COUNTY
9000 HEATING DEGREE DAYS
Compliance Methods: PART 5 - Acceptable Practice Method -
1&2 Family Dwellings (only)
• PART 6* - Thermal Rating - Component Trade Offs
1&2 Family Dwellings; Multi-Family
Dwellings (3 stories or less)
PART 4* Design by Component Performance
• Commercial Buildings-Hi Rise Residential
*Requires submission of worksheets
APPLICANT' S NAME: PROPERTY LOCATION:
' � 1_ �� �s
I / L ,Y C-ic 12G, '
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1 . Gross Floor Area - j o ° square feet
2 . Tvoe of Heat '0 - -Electric Oil Gas Other
3 . Is building mechanically cooled? Yes k No
4 . Percentage of area of windows and doors V Over 17% Under 17%
5 . R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS
SHOWN ON PLANS SUBMITTED:
a . Roof R 3 Y.
b . Exterior walls R / `"
c . Glazed areas R -3
d . Exterior doors R �3_____.
e . Floors over unheated spaces R _e_
f . Edge of slab on grade (heated building) R .•.e
g. Basement/cellar walls (above grade) R A
h . Basement/cellar walls (below grade) R
i . Heating/cooling-ducts-piping in unheated space R a, f�
6 . Service (domestic) hot water heating device
Conforms to minimum efficiency per code Yes )D No
TEMPERATURE CONTROL MAXIMUM SETTING 140° - WILL NOT BE EXCEEDED
Apply :.t' s Signa re Date Phone Number
INSPECTOR' S REMARKS:
Building Permit Application
Town of Queensbury - Dept. of Community Development, 742 Bay Road, Queensbury, NY 12804 1761-82561
. ° • BUILDING & CODE ENFORCEMENT
NOTICE Requirements prior to issuance r /
A permit must be obtained before of this permit: PERMIT FILE NO. 99 - (1(..-1
beginning construction. No inspections 6
will be made until applicant has received n Zoning Board Action PERMIT FEE PAID$
a VALID BUILDING PERMIT. All Area /Use
applicants' spaces on this application RECREATION FEE Al $
• MUST be completed arid•the signature n Planning Board Action REVIEWED BY.of the applicant must appear an the
SPR / Subdivision /Other in ding Inspector
plication form. nma�,. Recreation Fee Payment
Applicant: l9A- 2- /e GtJ .5
. • Address: /(92 / CRS /7,G/ Address:
Phone # (57 ) 29_z - ,z/o tJ Phone # ( ) _
Property Location: / ,/ C-/es /Ze ( ,6-75---/ • y�
• Tax Map Number ,, / �:
Subdivision Nanie: ..•. Sect. / lIm e t„t
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
New Building: CONSTRUCTION: $ J caw 0
`f residence / commercial
1( Addi o 2 ilding:
•
•
Lresidenpe-y commercial OCCUPANCY INFORMATION:
Alteration to Building: Primary Building -
residence / commercial -Vs Single Family Dwelling
Residence / Commercial Two Family Dwel r . r--�����
no change to exterior size . Family Dwi .'.
Office
Other Work (describe below) Mercantile APR 02 1999
Manufacturing
—
• Other TOWN OF t5UEENSBURY
—
GROSS AREA OF PROPOSED STRUCTURE: • BUILDING AND CODE
• 1st Floor 3 00 sq. ft. If ADDITION, what will use
of ne
2nd .Floor sq. ft. w addition be7 :
Other Floors sq. ft. 3S-+--.4seo Al /00ri
(not unfinished cellar or basement) ACCESSORY BUILDINGS•
•
• Detached Garage 1, 2 car
TOTAL FLOOR AREA: SQ. FT. Attached age 1, 2 car
Private ge Building
SIZE OF NEW STRUCTURE: Commercial forage Building
FEET X AO FEET Other
Foundation Type: • 8 afU/4/ Will any second-hand or ungraded
' Number of Stories : / lumber be used? If so, for what? �fi'c:
(habitable space only) •
Height (grade to ridge) : feet TYPE OF HEATING SYSTEM:
Number of fireplaces a d/or d wOostove (circle all which applies)
to be installed: d}/ k Electric / Oil / Gas / Wood 'e2 .-
Forced Mot Air / Baseboard / Other
Person responsible for supervision of work as regards to building
codes is : LI a vi •
•
Ntiine ) Addresss Phone
Builder: J7iq`,L o2 Z%/�r�/- S 2?'X - 2- I a V
Plumber: A///
• Mason: jf /1.-c. - -/ ' ..
Electrician: Afiln L `�� f 5 •
DECLARATION: Please sign below after you have carefully read the statement.
To the best of my knowledge the statements contained in this application, together with the plans
and specifications submitted, arc a true and complete statement of all proposed work to be done on
the described premises and that all provisions of the Building Ccxle, the Zoning Ordinance and all
other laws pertaining to the proposed work shall be complied with, whether specified or noted, and
that such work is authorized by the owner. Further, it is understood that I/we shall submit prior to a
Certificate of Occupancyor Certificate of Com lance being issued, an AS BUILT PLOT PLAN by
a licensed surveyor; drawn to scale, showing's ual location of project on premises.
1/4
Signature: �.2'
-
(owner, owner's agent, ar hitect, contractor)
> _ �. .1 ♦.. N tip...- - .J Y- i 1 .• ,. ..- - - a r-!-"V ."Y •- x
Fire Marshal's Office • • . Town of Quecnsbury,742 Bay Road,Queensbury,NY
(518)761-8205
. Application for Fuel Burning Appliances & Chimneys
applicable to solid fuel & vented gas appliances .
I 20 Permit No. f lv
• Date1 • , C,C I
•
Application is hereby made to the Building& Codes Office for the issuance of a Building and Use-
Permit pursuant to the New York State Fire Prevention and Building Code. The applicant or owner
agrees to comply with all applicable laws, ordinances, regulations, and all conditions that are part of
these requirements and also will allow all inspectors to enter premises to perform required inspections.
NOTE to applicant: Rough-in and Final Inspections are required.
Applicant\Information Fuel Burning Appliance Information
�, - (circle appropriate words)
Name: ;'.•!4: ‘, K= .IStove: wood coal pellet
\�. Fireplace insert
Fireplace, factory-built; wood gas,; '
Address 1 $> ,. T_
.;, Fireplace, masonry: wood gas f"
.
t Ni Furnace: wood gas oil
Phone: 2. ,. - 2 ;t -1 t .
\ If non-masonary applicance,please provide'
•
Owner: =:1 :-;,, 6 Manufacturer•Name: LSz„1., l , ,
Address: Model Number:
- Chimney Information, .
Phone: 7 G - 2 c {7' (circle appropriate words) "
Masonry block brick stone ,
f Flue tile steel size: . inches
d J,
Exact Address: fd ,. -t .-.4;$ . �/ Jd?/ -c2c . L`.... r
• -of construction or installation Factory-Built '
Manufacturer name: ,
Model Number: ' . •
- Note: Listed By: - Number:
• Construction/Installation must
conform to NYS Fire Prevention &Building Indicate(circle) chimney material:
Code. Consult available Town of Queensbury ,. --,...kp_
•
Handouts regarding required inspections. Double wall,l Triple wal / Insulated / Direct venting
A,
. Chimney Liner '°""""�
•
CYigaii.ie e',s.Degartmerrct—To of Queezi bury, New W mk
Fire Marshal Code# $Collected $Refunded Received_from (refunded to):T _
' address:
. _
A 173 3389 (190) Public Safety a--•
• A 233 2655 (230)Minor Sales
t
DATE: • ) t1. �� t ) - 1 ,-\Pw •0
-r') .....
i $ 44*-14✓.2c w — /On. 6424 2 D ,
White(Applicant) / Green(Fire Marshal) / Yellow(Bldg.Dept.) IPink&Goldenrod(Cashier's Dept.) O
. /I
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL'CERTIFICATE - ELECTRICAL APPROVAL ,/Od
Permit No. Cert. No 75887 Cut-in Card No
Owner , L'-2.e)
l
/ cam ._S /� , /,/_ ,v..
Location f� � G.����r
Installation Consisting of..5- w" raf 6 /-6-6 rJ 5 4'I 7 Si l/4I'J
Installed By 44 v Lic.No.
The conditions following governed the issuance of'this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall b omptly made for inspection.
Inspectors of this Company shall have the privileg- .f mak' g ins ctions at any time, and if its
rules are
��77violated,
Jthe Company shall have the right to ,•v.ke th' certi cate.
•
Date...h �`� i' d, w,/ INSPECTO'/. ....
/ Member N.F.P.A.,I.A.E.I.
via"
q 14y.)--\_
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION C0
Name yC.PAL L.- -
Location 0,, (-{tic(4s 2_
Date 1
It I Permit # y c1—1UU
SOIL TYPE: Sand-Loam-Clay
Results of Percolation Test-
(if applicable) Rate-Mi ute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tota Length ' L; (f)
Length of each trench t)\Q_At_h
Depth of trenches al
Size of stone
SEEPAGE PITS: Numb- -
Size - ft. ft.
Stone size
PIPING: Size Type
Bldg. to Tank �.�,Ib�‘6(r,
Tank to Dist. Box kill
Dist. Box to Fiel ,�/e:2: 4ff
t' Qt1i� To ctS
Openings Sealed? o Partial
LOCATION/SEPARAT ON
Foundation to T. k ems; feet
Foundation to At sorpti on = - .feet . .
Separation of P 'ts fe-
Conforms as pe Plot Plan Yes o/
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear -ft Side - eight Side
Middle Front ,. Middle Rear
COMMENTS: V
I'�j.`•
>
r- . w q� �
SYSTEM. 6 USE APPROVED: 1 ! 0
Arri =d: / `„
,)
,,i 4 ! AO/.i v3D
ir 'tii' di g Ins. 'tor
\
1 \\
FIRE MARSHAL
TOWN OF QUEENSBURY
QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST RECEIVED PERMIT 9rl OD
NAME ,LkQ, oL. .) i 5
LOCATION )01- Hi(`-KS O
SCHEDULE INSPECTION ON �— / 2_AB()1
NI AM I6 ANYTIME
APPROVED
NIA YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHT;dG
FIRE EXTINGUIS
FIRE ALARM SYSTEM
FIRE SPRINKLER SYS EM
FIRE SUPPRESSION S STEM
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE:
CLEARANCE 0 SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
CHIMNEY
WOOD STOVE
FIREPLACE-MASONRY
FIREPLACE-FACTORY BUILT LI
REMARKS: icAOK TO THIS DATE
Vve Lire
c5F S V k.k 631/41:46(S
INSPSLIP.PUB ,INS CT
Z ' ' 013
,0
GENERAL INSPECTION REPORT
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive7;a an Depart
Inspector's I ' i
NAME: ��tO\) PERMIT#
LOCATION: !-k t RDBODATE : Lf-C
TYPE OF STRUCTURE: POp)C't-k-
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsi3le for
providing protection from freezing
for 48 hours following the placemen
of the concrete.
Materials for this purpose on site
Foundation/Wall ur
Reinforcement in Place
Foundation/Dampproofi ng
Backfill Approval
Plumbing Under Slab
Plumbing VenUVents in Pl* e
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interi r R- 1 \ c tiler iZV_
Foundation Walls Exteri r R-
Floors -
Walls R- ._19
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1, 2, 3, hour
Penetration Sealed
Fire Wall 2, 3,4 hour
Firestopping
GENERAL INSPECTION REPORT �!
Town of Queensbury
Dept. of Community Development Date inspection request received:
Building& Code Enforcement . 1
742 Bay Road
Queensbury,NY 12804 Arrive \7:,v- d�i
pm Depart / j
spector's Initials
ofor
NAME: Lew' 1 PERMIT# � c
LOCATION: �jLc
i 2 c 49 DATE : z GeV
TYPE OF STRUCTURE: firel
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place\ j
The contractor is re •• ible ;s r
providing protection fro
for 48 hours following the p1.cement
of the concrete.
Materials for this purpose on s'.-
Foundation/Wallpour t
Reinforcement in Place
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in P1
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent, Attic Vent f,
`Framing F
Jack Studs/Headers
Bracing/Bridging
Joist Hangers 55: tc5 v‘
Jack Posts/Main Beam l �Ti Air Infiltration Barrier `1 EAN, 1
Fire Separation 1, 2, 3, hour
Penetration Sealed
Fire Wall 2, 3, 4 hour
Firestopping
GENERAL INSPECTION REPORT
Town of Queensbury
Dept. of Community Development Date inspection request received:
Buildi rig& Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive = ''. - Depart _ __ sm
Inspector's Initi+f�
NAME: ASi-/ PERMIT# %l—
LOCATION: /2c1 DATE :
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection from freeziing
for 48 hours following the placement
of the concrete.
Materials for this purpose on ite
Foundation/Wallpour
Reinforcement in P
Foundation/Dampproofin
yBackfill Approval
Plumbing Under Slab
Plumbing Vent/Vents i Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1, 2, 3, hour
Penetration Sealed
Fire Wall 2, 3, 4 hour
Firestopping
GENERAL INSPECTION REPORT
Town of Queensbury
Dept. of Community Development Date inspection request received:
Building& Code Enforcement
742 ;,•ay Road
Queensbury,NY 12804 Arrive? k-b. 'epart
Inspector's Initi
NAME: i�'�NC`� \ € *,C� PERMIT#
LOCATION: c,K DATE : i--
TYPE OF STRUCTURE: `�c� li`c-1
RECHECK
N/A YES1O COMMENTS
ootings/Piers
Monolithic Pour Form
Reinforcement in Place Z- 1,j •
The contractor i responsible fo•
providing protect h n from Ping
for 48 hours folio . g the pl.cement
of the concrete.
Materials for this purpose ,n to
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab- - -
Plumbing Vent/Vents in 'lace
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1, 2, 3, hour
Penetration Sealed
Fire Wall 2, 3, 4 hour
Firestopping