1985-568 CERTIr TE OF OCCUPANCY
TOWN OF QUEENSSURY
WARREN COUNTY. NEW YORK `
gnu
Date 1� 19
This is to certify that work requested to be done as shown by Permit No.
has been completed. Ii f 1 �
t
This atrucrurr may be CwcIpse as x y^�
Lvcation 1"f 43 . . • , r,_ _ : : . ; . ` i
Owner
By Order Town. Board
TOWN OF QUEEMSBURy
Building & Zoning Inspector _
C*KAT1Y[ "INSTw ' ►XIHTX6, OLCNS ILLS X v It♦tUY fPts�)P)-�SSS
BUILDING PERMIT
TOWN OF QUEENSBURY No 85- 568
WARREN COUNTY, NEW PORK n
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PERMISSIClN is hereby granted to Richard and Linda Falkouski CA
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OWNER of property located at West Mountain Road
Street, Road or Ave_ hi
iy
Addition to dwellin F"'
in the Town of Queensbury, To Construct or place a '4 t �- �-'wing area ) yV
at the above location in accordance to application together with plot plans and other information hereto filed and 0
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. &n
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t . OWNER'S Address is
RD # 2 Box 314
Glens Falls , New York
2. CONTRACTOR or BUILDERS Name
Adam Sc hweikert
Adamaran Industries , Inc .
3. CONTRACTOR cr BUILDERS Address
RD # 1
Glens Falls , New York
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4_ ARCHITECT'S Name 1•t
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5, ARCHITECT'S Address �
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B. TYPE of Construction — {Please indicate by XI 04
iK ) Wood Frame I I Masonry I } Steel I I
7, PLANS and Specifications
No. 201x441 per specifications and application submitted ,
S. Proposed Use p,
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One—Familyt Dwelling - additional living area added o
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84 , f70
$ PERMIT FEE PAID — THIS PERMIT EXPIRES May 19 86 t-Q o,
(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.) Di lD
fD �
Dated at the Town of Queensbury this 2nc3 Day of Octoer b 19 W H-
_�- `-
SIGNED BY for the Town of Queensbury
Building and Zoning I nspecto
TOWN OF QUEENSSURY
( Space inside: block tea lx• gilled ire bit
WARREN COUNTY. NEW YORK Building lrlsrm or)
Application for t+pplicatioll No.
Pt-l- ,, ,r I,_.uc•tl 19
BUILDING AND ZONING PERMIT I'r l ll, il 1:,1,; ,
J.l ,r1ire . Disirir'1
THREE 131 Copies of a PLOT FLAN. Drawn to scale tile! 1113. (-(1 bV
sltawin��++�� the actual dimensions of the lot to be built lt,•,,,;,, )I�r~
upon, Tlta exact site. and location on the lot of the
building to be erected or altered MUST BE SUB_
MITTED WITH THIS APPLICATION.
DATE:r,a $. . gi
�/O F 1l�OUI�If1EE{}�Ijfti�ESOU IRYY{ '
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORD UUJ
ANSWER ALL OF THE FOLLOWING. I. r l
The undersigned hereby applies for a permit to do the followingwork A I*A. P .
which will be done in accordance with the description, plans and secifi- 4:34 t0 r
cations. and such special conditions as may be indicated on the ,permit. 71819JIO" 11213141 s 16
The owner f this- property is:
. . ��C/. . .
iP O. ADDRESS3
The person responsibie for supervision of the work insofar as the Building Code and the Zoning Ordinance apply is:
fpi '. . . . . 5 .8�s . . rvr '�rac
(NAME) IP O AGOR£SS.i
Name of Builder . .�1�?,�'/we5x/C'*41 . �iG'G?�i �9�.�'/�-'`. . . -_ . Address _JeOl . . . I /G aa,.
Name of Plumber . . . . . . Address
Name of Maso Address . .
Lot Number . � e. . . . Un .,}`t . . . � . . Estimated value of proposed work 5 . . . . rock 4 C?ip. . . . . . .
Name of .7az ceM - J::7j t ,
Name of Street _ rYj{dGt. e. .I�� . . . . . . . . . . . . . . . Side of street: north ❑ . east 0 , south 0 . west }�
Nearest Cross Street ."! Awe , .4 1 _. . . . . . , . . - . - Distance from this gross street . . . . . . . . . . - ./�P,d. - Ft.
Property is north W south 0 , east i i , west ❑ from Cross Street
If on Corner, which corner, northeast C 1 , northwest 0 , southeast � , southwest
{Designate by marking with an "X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY
El Construction of a new building. Main B09ding
Addition to a building. One-family dwelling 2�r
ED Alteration to a building. Two-family dwelling 0
Demolition of a building. . . . . -family apartment house g�]'
Store building; LA
-car attached garage
Other:
. . . . . . . . . . . . . . . . . . . . . . . . Accessory Building
C Other work. Describe: One-car detached garage La} . . . . . . . . . . . . . . . . . . . . . . . . . , . , . Two-car detached garage 0
Private chicken house fl
Private storage building [�
. . . . . . . . . . . . . . . . . . . . . . Other! . . . . . . . . . .
ZONING SPECIFICATIONS. Fill in for new building, or addition to existing building, or a change of occupancy.
Indicate on the plot plan street names. the location and
size of the property, the location, site and setbacks of pro-
NORTH posed buildings, and the location of all existing buildings.
Show proposed buildingis) in dotted line and existing
S ,O'erwa
l;uilding(s) in solid line.
Size of property . . . . . . . fir? 5 ft. x . . -��.s?:" ? . . ft.
Size and use of existing buildings, if any
3 W Size of proposed building , . . . . "+'�
Height (from grade to ridge) . . . . . . . . . . . . . w2 %�. . . . ft.
Front yard . . . . . . . . . Lv.S , Y' . . _ . . ft.
Side yards ft. and . . . . . r , G??%? . . , ft.
Rear yard . . . . . . . . . . . . 5 d. . . ft.
SOUTH If on corner, setback from side stl� . ,lC ' + ft.
Note: All distances are net, as measured from street side
fff line to nearest par
t f of building.
[OVER}
7-73-M
(cont'd.)
BUILDING SPECIFICATIONS.,
Kind of construction: 'Wood frame, fire safe, etc.? . . . �
Will any second-hand lumber be used? Q . . . . . . I so, far what? . . . .'or : . . : .
'T`hickness • • 1 D �� . . . . . . . . - -
Material of foundation walls 1 •/, d, • . • , �. .� . . . • , , . Continuous foundation?
Depth of foundation walls below grade . . . . . . •�-- -- . . . . . . . ,
Will there be a cellar? Q . . so. material of cellar floor ��
Material of roof . . ri ' . . . , . . . . . . . . . . . .
'Type of roof: Sloped or flat? . . spacing . . . 1'�9.' , . "o.c.. length . . _ . . . . . . cQ . . ft.
Size, wood studs , , , . . . . .-Gl . . . . . " x . . . . �+ .�W . . . . . . ' . p g
x . . , spacing , . . . . . :+?6. . . . ."o.c., span . . . . . . . . /'.!'7. . . ft.
Size. floor beams, 1st floor . . . . - r' +2 ,:� .2 ft.
x N4:' z4. . . ' . spacing . . . . . . . . ."o.c., span . . . . _ . .
Size, floor beams, 2nd floor . . . . Y R • ing tVc., span . �" '�. . . . ' ft.
aspacing - . , . . . .
Size, ceiling beams �{ ' . . "cs.c., s an f _ !.? - ft.
/gip: , , " x .�*,�. . . . . ' , spacing
Side, roof rafters or beams I �r With what nnateriai ? G .
' . . . _
Exterior finish . . . . . . OA�". A
Finish of interior walls . . . . . . . . . . . . . . /' `/'If garage is to be attached, of what material is wall between garage and main building to be constructed?
. .
Is there to be an ripening between ge and > ilding. 6 oil burner or coal? . . . . . 'y' ` . . . . .
Kind of heating system �.Y
Will a flue-lined chimney be provi ed? • • - Ilepth of chimney foundation below grade .
Height of chimney above roof , r."~' Depth of fireplace hearth . . . . . . . . . . . . . . . . . . . . . . . . .
Will there be a fireplace? rr,� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . , . . . . . . . . . . _ . . . . . . . .
Will a toilet be installed? . . . . ,!�2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Will a kitchen sink be installed and connected to water sup ly? • - ' . . . .
y or pump)
Water supply (Public water suppl -`�
� ��}} t<e? i feet
Distance of cesspool from any private well . . .
Will drainage system be provided with required traps, cleanouts, and vents? . .
AFFIDAVIT
Town of Queensliury
County of Warren
State of New York with the to and specifications sstL
<-oi m knowledge and belief the statements contained in this application, ta�etlier
I swear that to sr, bda r Y work to be done on the described pre"as" and that a loin of
misted, are a true and eo.L. fete siatemeat of all proposed p sed work ll be oom0i wi , wheth led
ING CODE, THE ZONIN� ORDINANCE, and all other laws persain
and that such work is authorized by the owner-
and ' '
Sworn to hcfare me this S>gnattire OWNER. OW N£R'S AG T, n F11 EC7. CONTRACTOR
day of. - _ . . - _ 19
N OYAttY pU8t.1 G. WARREN COUNTY. N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
. . . . . ... . ... .. . . ...
TOWN Oki QUEE: NSBURY
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 followings
1 , Gross floor areai
2 , Type of heat 6e / 4
3 , Is the building mechanically cooled ? 41
40 Percentage of area of windows and doors �j ,ra
A . Over 16 % bnly -
1 . UO value of gross area of walls , roof/ celltng and floors
exposed to ambient conditions , ' , p
io cn _.,._....__...._..
2 . ' Flaar aver heated spaces c� YES. NO
a . Are foundation walls insulated ? ;,, YES , NO
1 , If YES , what is the R value ?,
=;; � + A,au..-s %o a /f
3 . Slab on grade C- 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 u i F°
d ti
Under 16 % Only
1 . R .Value" of roof and floors exposed to ambient conditions
2 . R value ' o.f exterior" wails
3 , R value of grazed area
4 . R . value of doors
5 . R value of floors over-,unheated spaces
6 . . R value of slab edge insulation - unheated slab
7 . R value of slag insulation - h`eated slab
R . 'R value of heated basement/cellar walls ( above grade )
S . ' R value of heated basement/cellar wa11a --jbeIow grade )
100 Type of Insulation
c . Controls
1 , Thermostat maximum heat setting_
Do Duct Systems -
] Is duet 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 414
20 R value of pipe insulation
F Service Water HHeatin
1 , Performance efficiency ,
2 . Temperature control aettlng maximum
G . For Swimming Pool Only f /
1 . Maximum heating_ � .
Telephone NO .
- '
( applicant ' s s ' gnature ) '
r
TOWN OF "QUEENSBURY
Building Department
Name
Location
i'ermit No. Wcatltar
AI / W57)17 Remarks
ExcaQa ti on _._..._._..
PootIng Forms
Footing & Piers
Foundation
Cement Coat
Water roofin
Bacicfi 13
Final survey
Frami.
Shea thin
Roof Felt
Roofin
Siding
Masonry Veneer
Rough Pl
Relief Valves
Wall Board
Ext . Porches
Finished Floor ILhe /
Interior Trim
Stairs & Railings
Cellar Dr , Tile
Concrete Floors
Plbg. Fixtures
Gar . Fire roofin
Door Closers
chimney
Water Meter Ins t .
Se tic Approval
Floors G +�
tionnda
Insulation Fou
Wall s
ceilin
Building Inspector
REMARKS
SPAZ,G= mush I3 �✓su� 4 �- c
TOWN QF - QUEENSBURY
BuIlI dins- Departmaut
pon aft Na.
Remaxks
Exca0pa is an
Pootingr Forms
Foatin & Piers
Founda tion
Cement Ccaa t
Waterpmoo.f.inqr
Bach€.i11
Final Serve
Pramingr
Sheathing
Roo€ Felt
Roo.f.ing
,Sidin
Masonr Veneer
Rough Pl ba
Roll e.F valves
Wall Board
Sxt . Porches
Finished Floor
Interior Trim
Stairs & RallingA
Cellar Dr . Tizel
Concrete Floor
PLL5Z. Fixture -
Gax . Fire rp in -
Door Closers -
chimne -
Water Meter Inst .
3e tic Approval
Floors '
Insulation Foundation _
Walls
eflinv
7
Bu l ing Inspector
REMARKS
TOWN OF Q►UEENSBURY
Building Dep &rtment
hz%w ctw a Report Date
Locatiaft
PannitNa, Weewt}acr
Remy z-ks
Exca0at on
Footing Fcxrms
Footing & Piers
Foundation
Cement Coa t
Water roofxn
Bacicf ill
Final Surve
Framin
Sheathin
Roof Pei t
..Roo.fIng
SIdIng
M&SOnrY Veneer
Rough Pi
Relief valves
Wall Board
Ext . Porches
Finished FloorNk
Intee.rf or Trim
Stairs & Railings
Cellar Dr . Tile
Concrete Floors
P.Zbg. Fixtures
Gar. Fire roofin
Door Closers
Chimne
Wa ter Meter Inst .
Se tic APPZova2
Fl c ozs
Xnsulatlean Foundation
Wa11s
Ceilin
S' .x ding Inspector
REMARKS
i� TOvi C�
� eUIASBU RY
�r partme�,t
Imoe ,Rrepwt Data
Location Itri(� sr •�tr_ J2
Perm p4m `t e— 'Weather
Rema z-xs
sxca c}a tion
Footina Forms tC IJDiC
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Surve
Pr6uning
. Sheathingr
Roof Felt
Roo.fingr
Sidin
Masonxg Veneer
Rough Plbqe
Relief Valves
Wall ,board
Ext . Porches OOF
Finished Floor
Xnterior Trim
Stairs & Rallingb
Cellar Ur . Tit
Concrete Floor
P.Ibg. Fixture
Gar. Fire roofln
Door Closers
Chimney
Water Meter Xnst .
Septic Approval
Floors
.tnsula tion Founda tian
Aia22s —
Ceilin
Bus Bing Inspector
-M
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REKS
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