1986-404 r'
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date January 14 19 87
�� , -�- 3t_P f1
This is to certify that work requested to be done as shown by Permit No. 86 •U�''
has been completed.
This structure may be occupied as a One-Family Dwelling
I.Mation \ 1 ' Hunter Lane
Owner John and Suzanne Kubricky
By Order Town Board .
TOWN OF QUEENSBURY
fBuilding & Zoning Inspector •
BUILDING PERMIT
k. ~
TOWN OF QUEENSBURY No. 86-404
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to John and Suzanne Kubricky
OWNER of property located at Hunter Lane Street, Road or Ave.
in the Town of Queensbury,To Construct or place a One—Family Dwelling o
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. a.
cn
1. OWNER'S Address is
Ridge Road
Glens Falls, New York
2. CONTRACTOR or BUI LDER'S Name o'
rt
AJS Enterprises 1-'
3. CONTRACTOR or BUILDER'S Address
4 Amy Lane
Glens Falls, New York
4. ARCHITECT'S Name
C
0
mrr
5. ARCHITECT'S Address
w
C
6. TYPE of Construction—(Please indicate by X)
(g)Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. 54'x27' per plot plan, specifications and application submitted m
including one—car attached garage and sewage system. Ft
8. Proposed Use See Var. 1020 and Site Plan 20-85 1-6
One—Family Dwelling
$5.00 C/O Paid
$ 122.00 PERMIT FEE PAID —THIS PERMIT EXPIRES Feb. 1 19 87CrQ
(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.)
Dated at the Town of.Queensbury this 14th Day of July 19 86
SIGNED BY �4� &. /v for the Town of Queensbury
Building and Zoning Inspector e
" Cc'']]- TO BE COMPLETED BY BLDG. DEPT.
rJown ol Queen ituri, Application No..
Permit Issued 19
BUILDING and ZONING DEPARTMENT Permit Expires ' 19
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation OWN OF Q`I` NUF'Y
Queensbury, New York 12801 Variance No. . /U a_a [,Thi.' E 0 :E ti V TI
E r Site Plari Review No. r -5'rii ,,i
`
Approved by: e p •
a
APPLICATION FOR /L.(A�3 Cwr" A.M.AM
BUILDING AND ZONING PERMIT • � �g�����0,�.14�j��121314i �. �`
* * * * * * * * * * * * * * * * * * * * * * * * * * * *. * * * * * * * * * * :.*
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.
•
.-----F
The owner of this property is: ®/. ✓ * ) d I F,/✓ Al;1 /60e.e.Y/
P.O. Address // . Pia, . 4/,o +-f .9`46,r r "110 d>>
el/e`c�Cf Tel. 1› 3
Property Location: M 6.1, f1- `.4,-,.//47 .. 04 4_f) 4,, ,p ,,py 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:
Name P.O. Address Tel. No.
Name of builder fa?..s,;77!,rimiewr Address /_J t, / Z,C/t-..f1r.r r�.;- Tel. 7 ,?..7,$C`, /
Name of plumber ?..„7 /s>�i ti 4,,e64ef 1- Address AJies'i2.., -..�,:t.r Tel.
Name of mason .6,4. G,..,x v_4-.4.i Address 510 La j , _'-.?..,.,; /'Y r1..!•( Tel.
NATURE OF PROPOSED WORK: * ZONING INFORMATION:
' TU Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
Addition to a building * drawn reasonably to scale and attached hereto,
Alteration to a building * showing clearly and distinctly all bviildings,
(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 " y'pe' ft X G oD ft.
* Existing building(s) Size ft X ft.
* . . .
PROPOSED BUILDING AND USE:sY
* Existing building(s) Use
Size of new structure ag_ft XZ(,Sft *
•
Foundation-pier/slab/crawl/partial_ llm * Proposed building, distance from property line
(circle one)
No. of stories (habitable space). / Z * Front yard/^�}�"} ft Rear yard C 7,3 ft
Height (grade to ridge) /2 ft. * Side yards •�/ ft and �+' ;� ft
* If on corner, 'setback from side street If residential, no. of families / ft
No. of rooms(excluding baths) (p * OCCUPANCY INFORMATION
No. of bedrooms 3 *
No. of bathrooms 2%/T- * PRIMARY BUILDING -
Primary heating system * V one family dwelling
lCi�/� Two family of fuel * dwelling
No. of fireplaces to be installed / * Multiple dwelling / Number of units
Will a wood stove be installed? "1./0 * Permanent occupancy
Central Air conditioning? /vjj * Transient occupancy
* Business
BUILDING STYLE, PRIMARY STRUCTURE • * Industrial
* Other
Ranch Contemporary Log cabin * If addition, what will use be?
Raised ranch Mansio Duplex
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 ) * veAttached garage/one car/ two car/ car
* * * * * * * * * .* * * * * * * * * Private storage building
ESTIMATED MARKET VALUE OF * Other
--
CONSTRUCTION $ *
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. , BOO , �
Will any second-hand or ungraded lumber be used? If so, for what? Sn/®
Foundation wall material 6)ti*G/'ifrf7_s'"` ?6,10c /4S/ Thickness Ar
Depth of foundation below grade (to bottom of footing)
Will there be' a cellar? '/±, c Heated or €'reheated? • Floor sq. footage /04.0 sq ft
Will there be a basement!? _F" Will any .portion be used as living space? ,"t)
(If so, what portion? sq.ft. - - Type of use?
Type of roof - slope/flat/shed/other •Material. of roof
Size, wood studs 9"X C.0 " spacing //A "o.c. length - ft.
Joists(floor beams) 1st. floor "X /0 "• spacing , , "o.c. span /3 ft.
Joists (floor beams) 2nd. floor "X 7' " spacing j , "o.c. span / Aft.
Overlays(ceiling beams) '7 "X " spacing / "o.c. span ft.
Roof rafters "X ,Q' " spacing p o.c. span ft.
Roof trusses (pre-engineered) spacing, LI "o.c. span " , ft. er,4.1a
Exterior wall finish / ;, A9. _,,,,/) Of what material? .-t'lJejc
• Interior wall finish 145/. -,f, 4,1‘,
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
�f c',/x't .7, 'i r E)rJ tfr
Is there to be an opening between garage and dwelling? 9, -c If so will a Fire-rated
door, enclosure, and self-closing device be provided? - F lac •
Will a flue-lined chimney be installed? Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well % -/ ex-
SEPTIC SYSTEM Distance from ANY private well{including adjoini4.
ng properties -, t 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 specified or not, and that such work is
authorized by the owner.
SWORN TO BEFORE ME THIS . Signature
er, owner's gent,architect,contractor
if f day of ;:- _19 u4
Notary Public, Warren County, N.Y.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT:
•
•
•
By /.01<3
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 / r
2 . Type of heat 6�,o4./j1G
3 . Is the building mechanically cooled? f -
4. Percentage of area of windows and doors ; 0210z %p
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 - t
B. Under 16% Only
1. R vat e 9f roof and floors exposed to ambient conditions
J `
/ 77 30, 09
2 . R value . of ex,terio.r._..walls a d, _rce
1 3 . R value of glazed area
4 . R value of doors /. ; /5
5. R value of floors over unheated spaces 42 07.D/
6. R value of slab edge insulation - unheated slab 9.6
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) %.0(P
10. Type of insulation 67q.J d q� �tl� n�� -3
C. Controls i1
1. Thermostat maximum heat setting 0C30
•
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 �n
1. Performance efficiency G*240,713
. . 4S/171,'AE f ,,.,, 641,)-d 90
2. Temperature control setting maximum ltomg /Ys°
G. For Swimming Pool Only
1. Maximum heating
/7 Telephone No. 79 2 -�j$p
( pplicant ' s ignature)
_own. of Queenilury
• BUILDING end ZONING DEPARTMENT
Bay and Haviland Road. R.D. 1 Box 98
dueensbury, New York 12801
SEPTIC -DISPOSAL PERMIT APPLICATION .
.4--
Owner ' s Name -� tJ ' v- Fib' CrAz ,�,� ` eveilziG. Tel. �9��2
Address .°�/0 1 120 � 4-�'�1 ..a1 "7k 4. .5% 'V` / C�/
Person/Firm installing system 14.( ‘,/?4- A '1
Number of bedrooms (residential only) 2
•
Total daily flow: (compute @ 150 aal.per bedroom per day) ,4 _
Topography: f a - rolling - steep - (circle one) Degree of slope %
Nature of soils: a - 'o -clay- other- Depth ft.
• Groundwater-- at what depth? Hp._ ft.
Bedrock or impervious material--at what depth? N ft.
•Percola
tion Test - Not required f Required -Rate min/inch.
Domestic Water Supply - Municipal Other
4:10°
IMPORTANT!
On a separate piece of paper, submit a diagram of the proposed septic
system with all dimensions; including distance from any structure,
distance from property lines and distances from aax domestic water -
supply or shore-line of lake, stream, pondor• wetlands. Include all
dimensions of the system itself.
•
Description of proposed system: •
. Septic tank size/o1, gal.
Tile .field- Length of each. trench ft. . Total field ? -ft.
Size of stone .
Seepage Pit (s) Num er • / Size ftX -ft. Size of stonet
Any contractor, corporation, individual,Etc. , engaged in the
_ • construction of a Sanitary Sewage Disposal System, who covers the
same before inspection, does not have an approved Permit, or varies
from the approved application, will be subject to a Penalty of $250
as provided for in Section 6. 010 of the Town of Queensbury Sanitary
Sewage Ordinance.
• S gnature 6-f/y�
Applicant Date
•
01/86 and/vl •
Jown o f Queensbur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
co lt/v u
LOCATION 1 y
Date j//5/ 7 Permit No. e6 - CA(
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
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 I 'N
Gar. Fireproofing 1 \
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
. FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Xinal Building Survey
Next scheduled inspection (call when ready)
Remarks-
.
Building Inspector
ector
6/86 and-vl
IQ/f /a / / 9, WAin
awn of Queen jtur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
G/D / ,
BUILDING INSPECTOR ' S REPORT
NAME -J OA h l� (A )0 I'
LOCATION
! t! ,i_
Date f 2//a / 1G Permit No. - 7'c./f
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer C
Rough Plumbing tr
Relief Valves \ /
xt. Porches
-Finished, Floors /\
nterior Trim - -- / \,
)(Stairs & Railings — / \
Cellar Drain Tile /
-Concrete Floors /
)CPlbg. Fixtures '
mar. Fireproofing
50oor,Closers i \ /1
XEmoke Detectors /
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
k.r/eC/1StEtZ f��/G/►1/4'6 111�� Cowl `-
(nat. P. c/c
Building Inspector
6/86 and-vl
fLf O /0/.?c
0°N-4 _loom of° Queenibur/
BUILDING and ZONING DEPARTMENT
r/Dr 1C �(V Bay and Haviland Road, R.D. 1 Box 98
PJ). °5) Queensbury, New York 12801
P°
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME /U\AA
LOCATION ()
ib PERMIT NO. i-6_ )L/
SOIL TYPE Sand - Loam - Clay -
Percolation e tRequired? YES - NO
Percolation rate - Min/Inch ( - 5
TYPE of SYSTEM:
Absorption field, total length p 126,
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS{Number of)
Size- -- ft. X- ft.
Gravel size --
PIPING: Size Type
Bldg. to tank Lc' L/(J
Tank to dist. box ,J I
Dist. box to field/pit t ( rt
Openings sealed? LYE) NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ( 1' ft.
Foundation to absorption /b ' ft.
Absorption to lot line I ft.
Separation of pits K ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front -(g Left side - Right side -
COMMENTS:
1�1
SYSTEM USE APPROVED YES) NO
atd./VI
Building Inspector '
01/86 and vl
/ id / /$D -3 P71
�� awn o/ Queenilury
cc BUILDING and ZONING DEPARTMENT
�� (J Bay and Haviland Road, R.D. 1 Box 98
I ,� Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME hObi K(_/
LOCATION O c•T�� { (iL/'1
DATE /O/i ' PERMIT NO. Va - 04
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS-(Number of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS:
ems.
SYSTEM USE APPROVED YES NO
Building Inspector
01/86 and vl
C a 11- 6( II b'7o ) a / 6 / ' 5' ///-11
--i)
Jown of Qut'eniur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME —T d b h K b
LOCATION 2,0 /fa/ A
Date /d4L/1‘ Permit No. 3 6 --bfd
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding /
Masonry Veneer \ are
Rough Plumbing
Relief Valves \ ,'
Ext. Porches
Finished Floors q' \
Interior Trim I \
Stairs & Railings 1 \
Cellar Drain Tile
Concrete Floors I
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors •
Chimney
INSULATION:
Foundation
Floors �,
yWalls af�
)(Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
(4/11/e
Building Inspector
6/86 and-vl
awn o/ Queenit ur,
BUILDING and ZONING DEPARTMENT •
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME Kalt:1-Ly
LOCATION ./1 0l / ZII
,�1
Date��/��/ Permit No. — 1'f C
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation •
Waterproofing
Backfill
• Roofing
Siding
Masonry Veneer
£ o gh Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings .
Cellar Drain Tile •
Concrete Floors `e
Plbg. Fixtures `
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call wh n ready)
Remarks-
Building Inspector„
6/86 and-vl
Jouin o f Queeniurcy
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME ak(!et re-f Cg
LOCATION
Date 2 Permit No.
* * * * * * * * * * * * * * * * * * * * * * *
APPROVED - Yr/ NO
Footing Pier Forms
1-I.V(o S OJlIL3e
.Wegiai 7 &c,K To 8
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures \:/?\ 's
Gar.. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
Final Building Survey
►JA/0/f170,J d-WA-TC-leP o c1/1162 —
Next scheduled Inspection(call when ready)
Remarks- -
��C( 6 1tfOO T(A 'S 01/2&-g00
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