1986-221 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 86-221
WARRENN�COUNTY, NEW YORK
PERMISSION is he rntedlo v Derek A.Clark
OWNER of property located at Lot 157 Peggy Ann Road
Street,Road or Ave.
in the Town of Oueensbury,To Construct or places Addition to dwelling (porch)
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.
I. OWNERS Address is RD #2 Box 179B
Glens Falls, New York Cd
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2. CONTRACTOR or BUILDERS Name
same
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3. CONTRACTOR or BUILDERS Address
same
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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8. TYPE of Construction—(Please indicate by%I
(Ix)Wood Frame ( )Masonry ( I Steel ( ) p
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7. PLANS and Specifications
No. 14'x12' per plot plan, specifications and application submitted.
8. Proposed Use
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One-Family Dwelling (porch addition) H.
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$ 10.00 PERMIT FEE PAID-THIS PERMIT EXPIRES December 1 ig 86
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
F`
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Dated at the Town of Queensbury15th this Day of May ig 86
SIGNED BY t (�
a - n(/��to for the Town of Queensbury
Building and Zoning InInspectorn
TO BE COMPLETED BY BLDG. DEPT.
Application No.
own O� Queenitury Permit Issued 19 TOWN OF QyEEMF F'
BUILDING and ZONING DEPARTMENT Permit Expires 19 tI M
Bay and Haviland Road. R.D. 1 Box 98 Zoning Designation _ ID) E C E U �Y I`
Queensbury, New York 12801 Variance No. I IL),.
Site Plan Review No. AY yyid` .ryD�`
Approved by: RW N �[/ "'
APPLICATION FOR 4 7/ 7f" ,t !, C, 71819040412 0iIg.•.
BUILDING AND ZONING PERMIT
* * * * * * * * * * * * * * * * * * * * * * * * * * * *• * * * * * * * * * *::*
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CCNSTRUCTION. 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: TE/Zeit /9. (L.9ir/t
P.O. Address 20 2/_J £ownn/79.0 (,//.*s its , /v- Y- Tel. 79z-$
Property Location: ere669 /r"V^. 2✓ for 75-7 Tax Map No../ all / / in
Street number or building lot number/J
Subdivision name (if applicable) / � ClpevEC
THE PERSON RESPONSIBLEE FOR SUPERVISION OF WORK AS REGARDS}/BU,ILDING CODES IS:
DFn /
c,t ! .2/a e_ J20a u3ser/-1 AV (�/r<FA[<s 7552 S3S Z
Name P.O. Address Tel. No.
Name of builder S1,w Address F,p<v az ('/*<FAu<,,v Y Tel. 75 3- 96✓.3
Name of plumber Address Tel.
Name of mason Address Tel.
NATURE OF PROPOSED WORK: * ZONING INFORMATICN:
Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
✓Iddition to a building Pa-& * 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.
* Size of property /7f ft X /2.5 ft.
* Existing building(s) Size 6i, ft X zL ft.
PROPOSED BUILDING AND USE: * Existing building(s) Use .4,., e_
Size of new structure /9 ft X /2- ft
Foundatio a slab/crawl/partial/full * Proposed building, distance from property line
(circle one) * Front yard ft Rear yard ft
No. of stories (habitable space) / * Side yards as ft and ft
Height (grade to ridge) 8 ft. * If on corner, setback from side street ft
If residential, no. of families
No. of rooms(excluding baths) / * OCCUPANCY INFORMATION
No. of bedrooms *
No. of bathrooms * PRIMARY BUILDING -
7.
Primary heating system A/m+t . ' One family dwelling
4.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? * _Transient occupancy
* Business
BUILDING STYLE, PRIMARY STRUCTURE Industrial
Ranch r ContemporarDLog 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 ) * 'Attached garage/one car/ wo car car
* * * * * * * * * * * * * * * * * Private storage building
ESTIMATED MARKET VALUE OF Other
CONSTRUCTION
$- f100 . 00
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. c�/a✓ fim=e.
will any second-hand or ungraded lumber/be used? If so, for what? A/0
Foundation wall material //✓r/ ✓ },.�q�/,7 rmp ...4J) Thickness
Depth of foundation below grade (to bottom of footing)
Will there be a cellar? ,VD Heated or unheated? Floor sq. footage sq ft
Will there be a basement? ,(/p will any portion be used as living space?
(If so, what portion? sq.ft. - - Type of use? /
Type of roof - sloped/flat/shed/other,s/�✓r„/ Material of roof f/i•®,(,,,w„/,S , ., .,2�s'" �464/
Size, wood studs "X '{ " spacing '40 "o.c. length `a ft. JJ
Joists(floor beams) 1st. floor o2 "X B " spacing /6 "D.c. span /2- ft.
Joists (floor beams) 2nd. floor "X " spacing "o.c. span ft.
Overlays(ceiling beams) e2 "X 6 " spacing /b "o.c. span /z ft.
Roof rafters . "X L " spacing /6 o.c. span ft.
Roof trusses(pre-engineered) spacing "o.c. span ft.
Exterior wall finish 7-/// . Sfa:n„/ Of what material?
Interior wall finish None-
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 be provided?
Will a flue-lined chimney be installed? Ave Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well j,,.,.. !Uc>(r
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
County of Warren AFFIDAVIT 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 spe 'fied or not, and that such work is
authorized by the owner. �)
SWORN TO BEFORE ME THIS Signature C7. �_,Fy
_ Owner owner's agent,arcnitect,contractor
* day of au/ 194
I
Notary Public, Warren County, N.Y.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT:
By
Tluuo.
TOWN OF QUEENSBURY
Building Department
Importers Report pate ,-, ��� 560
ne
Name '.! diyy 6QnAi7-
Location
Pent No. P/f Weather
d G _ 2 I Remarks
Excairation
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
Foundation
Insulation Walls
Ceiling
1
Building Inspector
REMARKS
13
TOWN OF QUEENSBURY
Building Department
Inspectors NaasOB Date Ci Ot'?°RHO
LocationWWe�"�''��� �y,.� , 14-,
Permit No. arty Weather
(Y6 - a a1 Remarks
Excavation
Footing Forms f 0 r
Footing a 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 Foundation.
Walls
/-ynnhC^eilin�n/g
/'
Building Inspector
REMARKS
P J
FROM WEST CONSTRUCTION Proposal --,;, , ;/ Proposal No.
•
10 EASY STREET rr t Sheet No.
GLENS FALLS, N. Y. 12801
793.4643 Data
Proposal Submitted To Work To Be Performed At
�DsnL.cC
Name +-z _Ca(A(C, 1
Street_Ferj5 L.' Ay, (Z ^ City Street
City G)lee3 ccits C(it st%c'\ Dote State_. ._
ale of Plans
Slate_ _ Architect
Telephone Number —
We hereby propose to furnish all the materials and perform all the lobar necessary for the completion of A t i X 19
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P'AT ',cif a xA 1`irnr ,Se'all, IN;Irra M M.... fin' re4k,., 3. " Ta r Sub4100/-
1T1:1-eket(. v4 1" Fet-Vevr% -T 5\44.r,lr .1% 4 .ST 4A twee LIs e... lb " ran....t- s.s ` r, 2 ' „?Ac 6,4.,
31" no..-ti,t.a ins Choi > It EA bset-1.t., a0. a._!- .2r to nee.' 1 1 (s rr rns /L�' r. . t..r
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p . < cr,_'e.- y10a u.. /u/.' --/e Z.-el red JTrr? / hauls
Teri. /c/Atew ' A'Stn i a pew-et/4 - ,
All material is guoranleed to be as specified, and the above work to be performed in accordance with the drawings
and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of
Dollars IS 02(sY3. !(c I.
with payments to be made as follows; r
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Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will
become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our
control. Owner to carry fire, tornado and other necessary,insurance upon above work. Workmen's Compensation and Public
Liability Insurance on above work to be token out by ! )el.T
Respectfully submitted �Iecr ' 1/.), 4
Per
Note—This proposal may be withdrawn by us if not accepted within 30 days
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions ore satisfactory and are hereby accepted. You are authorized to do the work as
specified. Payment will be made as outlined above. lor.e47 /+ �/�Accepted_ +yamSignature GA. L-C�...e
Date ///tis s /9®6 Signature
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