1986-372 CERTIFICATE OF OCCUPANCY
-TOWN OF QUEENSBURY •.
WARREN COUNTY, NEW YORK
Date 19 _
a. l
This is to certify that work requested to be done as shown by Permit No. 86-372
has been completed.
This structure may be occupied as a Addition to one family dwelling.
Grant Avenue Ext.
Location ..
Owner Bruce Lundgren
By Order Town Board
TOWN OF QUEENSBURY
Building & Zoning Inspector
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 86-372
WARREN COUNTY, NEW YORK
P MISSION is hereby granted to Bruce Lundgren
OWNER of property located at Grant Avenue Ext. Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Addition to dwelling (family room)
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.
CD
1. OWNER'S Address is Grant Avenue Ext.
Glens Falls, New York
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2. CONTRACTOR or BUILDER'S Name
Ruggles Const.
3. CONTRACTOR or BUILDER'S Address
5 Wincrest Drive w
Glens Falls, New Yorkrr
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction— (Please indicate by X)
(X) Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. 20'x30' per plot plan, specifications and application submitted
including sewage system. a
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8. Proposed Use
One—Family Dwelling (family room addition) o
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$5.00 C/O Paid a
$ 90.00 PERMIT FEE PAID —THIS PERMIT EXPIRES February 1 19 87 co
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
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town of Queensbury before the expiration date.) 0
Dated at the Town of Queensbury this 2nd Day of July 19 86
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SIGNED BY for the Town of Queensbury
Building and Zoning Inspector �� ri
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TO .;.,i COMPLE9`L. BY' BLDL. ,,r;PT.
/ Application No.
Own Ol Queenilur y Permit Issued 19 OWN 0 C41Ii. S R.
BUILDING and ZONING DEPARTMENT �`��t� "`"`gi`
Permit Expires 19 ) IC Cr
two ((�i�
Bay and Haviland Road, R.D. 1 Box Zoning Designation I L �� J 'J
Queensbury, New York 12801 Variance No.
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l;( �r� _J 1 Site Pla �e�view I.O.� Jf ;'j s
J J v V Approv y•1 • ,,.+ 's'. �.Se •0---- .
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z18619.i .1.1)M2I:f 3l 5 i 6
APPLICATION FOR iv,. a.„- ° s : 1�-.„_e a!s a
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BUILDING AND ZONING PERMIT .
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
' 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. �y pL,t
4/
The owner of this property is: ,^h:cc LT1 l_o A) r>dl otl .
P.O. Address 4 0-, 4—yx .r 1, jt . t- - Tel.
Property Location: �-4 Hi � 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:
gi ) • 1v Ls-4 L -s ' .
• Name P.O. Address Tel. No.
Name of builder I R L &3 S fy,address c' 6.)/ A0(',{ ,S1 17 ' Tel. '7 L} Petra 6
Name ofplumber � /
e4-1, j,vi,-.Kr Address Tel.
Name of mason .1 '�,l e, Address Tel.
NATURE OF PROPOSED WORK: * ZONING INFORMATION: -
Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
� ition 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
* 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 / 14� ft X �.� ft.
* Existing building(s Size „AA_ ft X -7 37- ft.
* . . .
PROPOSED BUILDING AND USE: * Existing building(s) 'Use - ,
Size of new structure ft X25J ft
Foundation-pier/slab/crawl/partial/full * Proposed building, distance from proper y line
(circle one)
* Front yard " 6 ft Rear yard j 1-, ,-' ft
No. of stories (habitable space) f * Side yards ft and --+ ft
Height (grade to ridge) f ft. * If on corner Attack from side streetr ft
If residential, no. of fadilies
No. of rooms(excluding baths) • /' * OCCUPANCY INFORMATION
No. of bedrooms *
No. of bathrooms * PRIMne BUILDING Primary -
heatings stem * OOne family dwelling
y � Ae * Two family dwelling
Type of fuel X/Fe
No. of fireplaces to be installed J * Multiple dwelling / Number of units
Will a wood stove be installed? ?— * Permanent occupancy
Central Air conditioning? .A/ ,£ * Transient occupancy
* Business
BUILDING STYLE, PRIMARY STRUCTURE ,t• Industrial
Ranch . Contemporary Log cabin * Other . . . . .
If addition, what will use be?
Raised- ranch Mansion Duplex * . .
Split level Old style . Bungalow * f'l"i?j
+
Cape Cod Cottage Other * ACCESSORY BUILfING-
Colonial Row Town House * ' Detached�� garage/one car/ two car/ Oar
( CIRCLE ONE PLEASE ) * ,PIttached garage/one car/ two car/ a/ car
* * * * * * * * * * • * * * * * * * * ' Private storage building
ESTIMATED MARKET VALUE OF * Other •
CONSTRUCTION $ *
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form BP,I /1-1 ma-vl •
BUILDING PERMIT APPLICATION CONTINUED - ,
BUILDING SPECIFICATIONS:
Type of construction, od frame, fire safe,etc. .
Will any second-hand o lumber be used? If so, for what? , 0.4,
Foundation wall material lnl� , L �' Thickness
Depth of foundation below grade (to bo tom of footing 4.-j9 6
Will there be a cellar? Heated or unheated? ,�Floor sq. footage j sq ft
Will there be a basemenY2 Will a port on e used as living space?
(If so, what portion? sq.ft. - - Type of use?
Type of roof sloped flat/shed/other Material...of roof 's*-44-L-
Size, wood stu 'X " spacing )4, "o.c. length q ft.
Joists(floor beams)�1st. floor 7, "if 6 " spacing A,, "o.c. span J,J ft.
Joists (floor beams) 2nd. floor "X " spacing "o.c. span ft.
Overlays(ceiling beams) "X .�- " spacing Z+/"o.c. span ji ft.
Roof rafters "T "X 4' ,spacing �5eo.c. span A,J ft.
Roof trusses(pre-engineered) spacing Z "o.c. span 20 ft.
Exterior wall finish G Z4,4 nfn 2I? 'Of what material? 440 1.9,
Interior wall finish 4 - 6
If a garage is to be attached, descri a 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? f� � Height above roof ' a) t, ft.
Depth of chimney foundation below grade ` ,,��ft.
Depth of fireplac earth ) ft. 0 in. -L
Water supply - unici al or private well
SEPTIC SYSTEM _ Distance from ANY private well(including adjoining properties ) az 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_ 4. .tn e .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 Signature_ 1
Own r owner's agent,arc ct,contractor _
day of 19
Notary Public, Warren County, N.Y.
.
* * * * * * * * * * * * * * * * * * .* * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS. OF THE PERMIT: ,
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By
awn o/ Queensbury APPLICATION FOR SEPTIC DISPOSAL PERMIT
BUILDING and ZONING DEPARTMENT
Bay a d.Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801 DATE, / 2/744
LOCATION OF PROPERTY FOR INSTALLATION
OWNER' S NAME 64t7t4
ADDRESS L TEL
INSTALLER' S NAMEJA,4 TEL
Number of bedrooms (residential only)
Total daily flow(compute @ 150 gal per bedroom)
Topography: XIII - Rolling - Steep slope - (circle one) % of slope
Soil nature: Sand - Loam - Clay - Other Depth 40 ft.
Ground water -At what depth? ft.
Bed-rock or impervious material - At what depth? )2. ft.
Percolation test - Not required - Required - -Rate min-inch.
Domestic water supply j Municipal(- Well - Other
Separation - Watersupply(if well) from Septic absorption ft.
Proposed System: Septic tan ) gal. ( Minimun size, 1000 gal. )
Tile Field - Each trench ft. Total system legnth7)6 ft.
Seepage pit(s) Number of . Size each " ' ft X ft
)
Size of stone to be used # Depth or thickness ft.
IMPORTANT! !
On a separate piece of paper, submit a diagram of the proposed system
with all dimensions shown; including distance from any structure,
distance from property lines and from ANY DOMESTIC WATER SUPPLY or
shore-line of lake, stream,pond or wet-lands. Include all dimensions of
the system, itself.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
I .have read the regulations on the reverse side of this sheet and agree
to abide by these and all requirements of The Town of Queensbury
Sanitary Sewage Disposal Ordinance.
Signature of responsible person
Date
05/86 and/vl
Section II Septic System Inspections:
A. All. applicationa for septic system installation,
alteration or repair, as required by the Town of
Queensbury Sanitary Sewage Ordinance, shall be
submitted to the Building Department at least
24 hours before start of construction and shall
include a' plot plan showing:
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• 1) the proposed location of the system
2) location and distance to lot lines
3) .location and distance to structures
4) location and distance to any water supply
5) size and dimensions of all tanks, distribution
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boxes, tile fields and/or drywells
B. No system shall be covered before inspection and '
approval by the Building Inspector. Failure to •
comply with this requirement may result- in. the
uncovering of the system by the ,installer and a
fine of up to $250.00.
C. An approved copy of the plot plan shall' be
available on the construction site.. Failure •
. to produce said plot plan at time of inspection'
. may result in an immediate work stoppage.
. D. Should unforeseen problems during construction
prevent proper installation, alteration or
.. repair of an approved system, a new proposal
must be submitted to the Queensbury Building
Department before further construction.
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:
1 . Gross floor area {d
2 . Type of heat �sl�il�i.vCi
3 . Is the building mechanically cooled? /, /%
4 . Percentage of area of windows and doors
A. Over 16% Only
1 . Uo value of gross area of walls , roof/ceiling and floors
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a. Are foundation walls insulated? YES NO
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 NO
a. R value of insulation
5. Type of insulation
B. Under 16% Only
1. R value of roof and floors exposed to ambient conditions
2 . R value of exterior walls
3 . R value of glazed area
4 ., R value of doors g•- .: 3"
5 . R value of floors over unheated spaces
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) - R
9 . R value of heated basement/cellar walls (below grade)1
10 . Type of insulation t7 ) Lk ) T7 • 0,zJ Pt 4 6
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. 742;j) �
(applicant ' s signal e)
_/own of Queniur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
L-oho 6 axr-
BUILDING INSPECTOR ' S REPORT
NAME C671N-Arr AAA& 4-AA/11,3 Ci-C.,&
LOCATION FQA-Vr- Av& .�
ry/�
Date i, �g/ bla Permit No. p � y �i),
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches V-
Finished Floors ✓�
Interior Trim
Stairs & Railings - -
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors f
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
OMMWBuilding Survey
Next scheduled inspection (call when ready)
Remarks-
R4I4 Pk - IO/V 911O V 6--
6rz_. - J--0 V a
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BuInspec r
6/86 and-vl
awn o/ Queeniurry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME L.,
W G
LOCATION— i /L„6" ---)CT-"
Date e- 24/ Qc a Permit No. 3'(g- 372-
* * * * * * * * * * * * * * * * * * * * * * *
APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
B. fill
'oo ing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors \
Interior Trim /
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar.. Fireproofing
Door Closers
Smoke Detectors
Chimney
ULATION:
Foundation 461,4/6- ;�,/
"-
Floors .�/0Af L �" vv
Walls Oi - To CLoS V P
Ceiling 04- 70 CCo5L- Up
FINAL ELECTRICAL INSPECTION
Final Building Survey _
Next scheduled Inspection(call when ready)
Remarks- -
*AO 0 30I5( I JAV 6164.5 R 15 5 ,t4,6,0
Sor >✓; (76A/rs --G u- U&Air= O --
Li
Building In ec r
6/86 and-vl
Jown o/ Queeni ur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
' NAME V% C3 Nr 1C._12.
LOCATION GIrtg..031 RI-LIC P +-
DATE 7 /a PERMIT NO. iffref-372,
SOIL TYPE - Sa - Loam - Clay -
Percolation Test Required? YES -
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length 7-, 00
Length of each trench SO
Depth of trenches ' 2 t 60
Size of gravel Aiti,
SEEPAGE PITS*Number of)
Size- ft. X ft.
Gravel size '
PIPING: /Size Type
Bldg. tank % -04 Sect , -�
Tank to .st. box / 4_ 4 LI 41
Dist. box field/pit .44 7113
Openings sea -,d? ,q YES NO-'-Partial
LOCATION/SEPARAT'.ONS: 1
Foundation to tank Z ft.
Foundation to absor. ion 1ft.
Absorption to ;lot lin_ *weft.
Separation of/pits ft.
LOCATION OF SYSTEM ON PR• ERTY(circle one)
Front - Rear/- Left side - Right side -
COMMENTS: /
fi
-61
0 /VaTS . 7-AVfL !
/0dC c -t
i3 T-, 6 OK
A—s .A--'2ov -
SYSTEM USE APPROVED YES 0
Building Inspec r
01/86 and vl
,4wt.cc��
Jown of Queenihury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME .►-ttce. L my, cl q v e 1,1
LOCATION J
(7va4 E
Date 7/// /LC _ Permit No. (1-6- 37L
✓ = APP) OVED - YES / NO
1,- Footing/Pier Forms
Foundation
Waterproofing 6 .
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors . ,
Interior Trim
Stairs & Railings \ /
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar.. Fireproofing / ,
Door Closers I
Smoke Detectors
Chimney j
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
Final Building Survey .
Next scheduled Inspection(call when ready)
Remarks- -
/o
Building epector
6/86 and-vl