1986-387 i
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
This is to certify hat work requested to be done as shown by Permit No. 86-387
has been completed.
This structure may be occupied as a Addition to one family dwelling
(living area/two car garage).
Location Rockhurst Road/Lake George
Owner Nathan Dickinson, Jr.
By Order Town Board
TOWN OF QUEENSBURY
Building & Zoning Inspector
it
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 86-387
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Nathan Dickinson, Jr.
OWNER of property located at Rockhurst Road/Lake George Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Addition to dwelling
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.
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1. OWNER'S Address is 241 Vaughn Road
Hudson Falls, New York
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2. CONTRACTOR or BUILDER'S Name 0
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John Graham
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3. CONTRACTOR or BUILDER'S Address
Stone Schoolhouse Road
Hudson Falls, New York
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction-(Please indicate by X) 0i
a.
(x)Wood Frame ( ) Masonry ( )Steel ( ) t-''
7. PLANS and Specifications G)
367x28' per plot plan, specifications and application submitted
No. and Variance No. 1081 granted 5-21-86.
8. Proposed Use
One-Family Dwelling (living area and two-car attached garage )
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$5.00 C/O Paid ,97-` i i� rt
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$ 44.00 PERMIT FEE PAID -THIS PERMIT EXPIRES February 1 19 87 w1-1
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the m
town of Queensbury before the expiration date.) W
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Dated at the Town of Queensbury this . lOth Day of July 19 86 a
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SIGNED BY `/'(a a /U_ for the Town of Queensbury
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Building and Zoning Inspector
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CFR
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iti TO BE COMPLETED BY BLDG. DEPT.
Application No.
own of Queen iur y Permit Issued 19 TOWN OF QUEENSBURY
BUILDING and ZONING DEPARTMENT Permit Expires 19 RECEIVE Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation
Queensbury, New York 12801 Variance No. O I JULSite P1 Review N U 9196,
/5- i _ 2 3 Approve b CK' /e ro°
71b19110}1x1912I3I41566
APPLICATION FOR e 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.
-5 The owner of this property is: ') c!' L c 41-. L '
P.O. Address �/ ���k � /1 OCe.12 1 2. —G!-e � �j 1- Tel. 7"" V P6
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Property Location: C_,!? /f Tax Map No. / /
Street number or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR ERVISION OF WORK AS REGARDS BUILDING CODES IS:
?IL ,& _c a y),-, ,,kA,,oa-�/ _ i // �= /1�y , 7 7— J'�
Name P.O. Address Tel. No.
Name of builder 64 414-14Pvn Address e lci,['/ 41 Tel. 7 S!_? -�J -e
Name of plumbe 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,
I- 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
• * 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. rr��
* Size of property 4-0 ft X 7 S1 ft.
* Existing building(s) Size 73 ft X 3;2_ ft.
* . . . . . . . . . . . . . . . . . .
PROPOSED BUILDING AND USE: � * Existing building(s) Use
Size of new.stru, e . 6ft XLby ft *
Foundation-pier/MP/crawl/partial/full * Proposed building, distance from property line
(circle one) *
* Front yard ' ..i",'7 ft Rear yard ft
No. of stories (habitable space) * Side yards s ft and "; ram ft
Height (grade to ridge) ...- ft. ---
If residential, no. of families * If on corner, setback from side street ft
No. of rooms(excluding baths) * OCCUPANCY INFORMATION
No. of bedrooms ca=1
*
M, PRIMARY BUILDING -
No. of bathrooms ,/�
Primary heating system ac�,�-C/u-c� * One family dwelling
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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
Contemporary Log cabin * Other. '
Raised ranch Mansion Duplex
* If addition, what will use be. ,2 , .edQ ��
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 ) * '16gE tached garage/one car/fo ca car
* * * * * * * * * * * * * * * * * * " &"Private storage building
ESTIMATED MARKET VALUE OF * -Other
CONSTRUCTION c�
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
a;r
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe etc. �' � )447-1-!- -- .
Will any second-hand or ungraded lumber be used? If so, for what? 112)
Foundation wall material -. Thickness
Depth of foundation below grade _(to bottom of footing) ,g -
Will there be a cellar? -ZU Heated or unheated? Floor' sq. °footage sq ft
Will there be a basement? 72c, Will any portion be used as living space?
(If so, what po __ ? sq.ft. - - Type of use? -
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Type of roof -`sloed lat/shed/other Material• of roof G2. z Q .
Size, wood studs "X 0 " spacing "o.c. length g 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 " ;Facing "o.c. span' ft.
Roof rafters "X 4; " spacing o.c. . span,qif f t'.
Roof trusses(pre-engineered) spacing "o.c. span ft.
A-- .Exterior wall finish. Of what material?
Interior wall finish
If a garage is to be attached, des be materials to be used for FIRE SEPARATION: '
Is there to be an opening between garage and dwelling? '7t� If so will a Fire-rated
door, enclosure, and self-closing device be.'provided?
Will a flue-lined chimney be installed? 7t—, 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 PORK
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,_, areatrue..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 C 12_ _ -' 7
er, owner's agent,arcnitect,contracto
ay of 1
Notar Publ c, W rren C ty, N.Y.
* * * * * * * "* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF T PERMIT:
•
•
•
•
By
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:
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�`�1. Gross floor area �� . pp f'j[0N C �`��lr�� ( J����~
2 . Type of heat CC6. 0 r�
3 . Is the building mechanically cooled? %z,0--
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
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Under 16% Only
1. R value of roof and f).00rs exposed to ambient conditions
2 . R value of exterior walls G, !'
3 . R value of glazed area ,-7 , .3 v
4. R value of doors l
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)
9. R value of heated basement/cellar walls (below grade)
10 . Type of insulation -
C. Controls
1 . Thermostat maximum heat setting 4/2/AN
D. Duct Systems 1. Is duct system installed in unheated spaces? 7r4 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 max mum
G. For Swimming Pool Only ��
1 . Maximum heating
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Telephone N o. 7 / 7 ../S/C� �j . - `,„`7 l � ram,-
• - ((applicant ' s signature) f
_bean of Queen iur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCAT I ON_ e. 1—, .5�
Date 2.//�.(97 Permit No. g6 -3 7
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing 8err)
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
Smoke Detectors
Chimney
INSULATION:
Foundation R1r11/ R— eo-
Floors — 19' ' ✓
—walls •- /7 G�
Ceiling 666
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL •
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
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Building Inspector r.Z�y
6/86 and-vl
gown of Queeniurcy
0()/
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME 1J1 WS()
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LOCATION AC/01-(112ST—
Date .216--/ Permit No. gra 5gf?
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
X.Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing /i/
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings \\I
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures /
Gar. Fireproofing /
Door Closers /
Smoke Detectors /
Chimney I
INSULATION:
Foundation e9
Floors
Walls L-
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
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Buildi g Inspector
6/86 and-vl
Down of Queeni ur 1 •
BUILDING and ZONING DEPARTMENT .
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR' S REPORT
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NAME 141/6;& 414,-4.4 ) ,
LOCATION pad
Date 1/a,er, / v(p Permit No. 8(0,- mi •
P' = APPROVED - YES / NO
/iooting/Pier Forms H . Otte
Foundation
Waterproofing •
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 •
Smoke Detectors
Chimney .
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION •
Final Building Survey
Next scheduled Inspection(call when ready)
Remarks- - 7 6.v.,
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