1986-775 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
October 26 ' 87
Date
240gq -1
This is to certify that,work requested to be done as shown by Permit No. 86-775
has been completed.
This structure may be occupied as a One—Family DKellir9
Location R(405 Route 9L east of Cloverdale Road
•
Donald G. Pensel
Owner
By Order Town Board
TOWN OF QUEENSBURY
•
• / /-- _
Building & Zoning Inspector
•
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 86-775
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Donald G. Pensel
OWNER of property located at Route 9L approximately 600 ft. east of Street, Road or Ave.
Cleverdale Road
in the Town of Queensbury,To Construct or place a One—Family Dwelling w
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.
1. OWNER'S Address is Star Route 'b
Glens Falls, NY
2. CONTRACTOR or BUILDER'S Name
P. J. Enterprises
3. CONTRACTOR or BUILDER'S Address 22 Lincoln St.
Hudson Falls, New York
ro
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( I Wood Frame ( ) Masonry ( ).Steel (x) logs
7. PLANS and Specifications
28'x36' per plot plan, specifications and application
No. submitted including sewage system. co
8. Proposed Use
I1
One—Family Dwelling
CD
CD
$5.00 C/O
$ 91.00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 1 19 87
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the OQ
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 6th Day of November 19 86
SIGNED BY 1 for the Town of Queensbury
Cri l Building and Zoni Inspector 6
e
TO BE COMPLETED BY BLDG. DEPT.
a�] r Application No. I ' Q'-3 s �ti! (
wn o� ueeitJ /ury Permit Issued 19 i
BUILDING and ZONING DEPARTMENT Permit Expires 19 f s• . v a ga a , u : ¢
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation I-_ te-)A__ r gitiE {il 61
Queensbury, New York 12801 Variance No. m'dCLO•w, qr P
Site P1 Review t. • 986b P f! ,10
Appro� b
APPLICATION FOR .1 w '/ . ,-(_-,__---01
3 ` 3 0 1 g
BUILDING AND ZONING PERMIT _ . :�..,..,. ... .__.
41, 4 * * * * * * * 41. # 4P # * # * # * * # * # 4k # # 4 41. 4P * 4E # # # 4 * 4i• #
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. •
•
The owner of this property is: :%)�GLi(J�L fl C / F N'S?E L •
P.O. Address ,•,jj),G%Y/GL, 1)...Z Z. / ��.--2I/, , 4 / - Tel. 67r,� .9W 95
Property Location: •
Tax Map No. /0 / / / /4/
Street number or building lot number
Subdivision name (if applicable) --
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS: •
•
- Name - F.O. Address _- -_ - Tel. No.- /
Name of builder /- (27 L`/vi-E R/'/�/,Sf.sddress 27,,n1'.,,,,, J 1,, / ,_%. , !l ,L Tel. 71 /O 7 2.-7 7
Name of plumbers,/ -, Address Tel.
Name of mason t.''' /0* ,47 Address Tel.
r
NATURE OF PROPOSED WORK: * ZONING INFORMATION:
x Construction of anew building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
Addition to a building * drawn reasonably to scale and attached hereto,
---Alteration
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 ST UCTURES FELTED. � * of water supply and location and configuration
/R / 7 of septic disposal area.
* COMPLETE INFORMATION REQUIRED BELOW.
S6-6 PL®T®Li,1r
/ 7 / * Size of property A i/3A- ft X ft.
/ i .7 * Existing building(s) Size ft X ft.
•
PROPOSED BUILDING AND USE: * Existing building(s) Use .
Size of new structure 2, e!ft X "3 6 ft * •
Foundation-pier/slab/crawl/partial/full * Proposed building, distance from property line
(circle one) :' Front yard • tOo' ' ft Rear yard 20-4p' ft-I-
No. of stories (habitable space)
,, * Side yards ' ' 4-'.- . ft and ft
Height (grade to. ridge) ff ft. * If on corner, setback from side street ft
If residential, no. of families 7 /
No. of rooms(excluding baths) * OCCUPANCY INFORMATION
No. of bedrooms -j *
•
* PRIMARY BUILDING -
No. of bathrooms * X One family dwelling
Primary heating system (2,2� , ,
Type of fuel' * Two family dwelling
No. of fireplaces to be installed ;:7--Multiple dwelling / Number of units
Will a wood stove be installed? .1.-.7.1) * X Permanent occupancy
Central Air conditioning? "� * Transient occupancy
* 7—Business
BUILDING STYLE, PRIMARY STRUCTURE � ' ' Industrial
" -'� Other
Ranch Contemporary Log cabi
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/ two car/ car
* * * * * * * * * * * * * * * * * * Private storage building
ESTIMATED MARKET VALUE OF * Other
CONSTRUCTION $ 70000
*
7
\INNFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
\rm BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED - •
BUILDING SPECIFICATIONS: !
Type of construction; wood frame, fire safe,etc. �; , (--- ,6 J/.l!
Will any second-hand or ungraded lumber be used? .If so, for what?, a—
Foundation wall material 2f73 k.,2_ Thickness ./Qn .
Depth of foundation below grade (to bottom of footing) fr --`"
Will there be a cellar? Heated or unheated? Floor sq. footage /6 sq ft
Will there be a basement. Will any portion be used as living space? /2-4,,,-
(If so, what portion? sq.ft. - - Type of use? .
Type of roof - sloped/flat/shed/other, Material,•of: roof
Size, wood studs ;Z V"X 4 " spacing / "o.c. length 7' 9 ft. •
Joists(floor beams) 1st. floor ___2 "X /d " spacing /6 "o.c. span // ft. .
Joists (floor beams) 2nd. floor a_ '"X )6, " spacing / / 'io.c. span //'41t. •
Overlays(ceiling beams) "X G " spacing Z- "o.c. span.q- ft. /. / 7 6
Roof rafters 7 "X " spacing 2L o.c. span l ft'.
Roof trusses(pre-engineered) spacing "o.c. span ft. •
• Exterior wall finish 717j_, Of what material? 27, 0/�
Interior wall finish. '/,/� _�6 J . .
If a garage is to.be attached, describe materials to be used for FIRE SEPARATION:c I7 .-y,'L .
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? Vo Height above roof ft.
Depth of chimney foundation below grade ft..
Depth of fireplace hearth ft. in.
Water supply - Municipal o priva_te ell
SEPTIC SYSTEM _ Distance from AN rivate well(including adjoining properties / 7 5-I--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
.1 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-7TOW BE.KO --ME THIS Signature_e _) _��di7LP ��1` . •
Owner, owner's agent,arcnizect,contractor
A 2 (i. 3 day of —_ 19 �
ivnsyuiz3_i�, isiar.an-ivuxiy,=iv 's . - - -
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT: .
•
•
By .
,i
• .
•
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 / 0
• /
•
2 . Type of heat /
• ,/23 . Is the building mechanically cooled?
• ' 4, ' Percentage of area of windows and doors
A. Over 16% Only
. .
1, U 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?
••-s
• T. Slab on grade NO
a. If YES , what is the R value of insulation around
perimeter of glOor? •
4 . Is basement heated? (57;i ' NO •
a. R value of insulation
• 5. Type of insulation /-
_
J
B. Under 16% Only
1 , R value of roof and floors exposed to ambientkonditions
• --
-3
•
2 . R value of exterior walls
3 . R value of glazed areag----.- .16
4 . R v4lue of doors
•
. _
. . 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 c liar walls (above grade) E —
• 9. R value o heated basement cellar . Walls (below grade) / 07
10 . Type of insulation
• C. Controls e .
1. Thermostat maximum heat setting 75 ••
•
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 7
F. Service Water Heating
1. Performance efficiency
2. Temperature control setting maximum
• G. For Swimming Pool Only
1 . Maximum heating
lrelephonYe No.
'---(applicant ' s signature)
•
544 Cif QM ore 41.1 J.A'
APPLICATION FOR SEPTIC DISPO
SAL PERMIT
BUILDING and ZONING DEPARTMENT
®ay anc Havilanrl RO3d. R.D. '1 Box OS
Oueeri bury, Nevt Ycrh i2a01 :. :..DATE 110 i UAL
LOCAL JON OF PROPERTY FOR INSTILLATION 5 p .; ` ± `
OWNER'S NAME7 /1 (1-•I /V.5'
ADDRESS `5 7 9/i NJ—
INSTALLER' S NAME
Number of bedrooms (resident•i al only) „.
Total daily f is w (compute @ 150 gal per bedroom) (Jc ,
Topography: Flat Rolling Steed:{ slop , ®(circle one) % of sloge^ 22._
Soil naturean..;®(io - Clay - Other Depth,�..�..rft.
Ground water -At what depth's' 7 ft.
Bed-rock or impervious material - At what depth? ft.
Percolation test ... Not required - Required - -Rate _,�,, ,� ss► n@in�b.
Domestic water supply - Municipal ' Wel - Other
Separation - 6►atersuppiy(if well) from Septic absorption _DC ft.
Proposed System: Septic tank 1000 gal. ( N.inimun size, 1000 gal. )
Tile r'= Fld m Each trench „k •'t. Total system legnth � ft.
• • Seepage pit (s) Number of . Size each ft X ft
Size of stone to ,be used °(:' Depth or thickness ft.
IMPORTANT 1 !
On s separate piece of paper, submit a diagram of the proposed system
with all dimensions shown; including distance from any structure,
distance from property lines end from ANY DOMESTIC WATER SUPPLY or
shore-line of -lake, strew i.,•pond or et -lar,sat." Include all dimensions, of
the system, itF•edf.
* 1. ! d A SS 4 f+ ^S 0 ft d M * •i 0 ft U 0 Ll 'G: * 9 ft 9 q G 4 ffi 9 C d 14 A $ °h *
1. ;:(' ? A ':t i _^� G): I ;:C (-;:Cie of t ;:is Ekcct an2 agpce•
to c iee tkopc and 072 rocuirerent: cf •Th` Town of Cue l.S Dr
Sanitary Scu'aoc t npcsc7 Ord anc•c ,
77c/ ,,:;17,77#
.fi7nr,ot2,r( n1' r,; ,-onFtt,Zt rrr;or
05/66 and/va
BUILDING DEPT.COPY OF APPLICATION FORM 46-EL,NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED.
(TEMP.# (DATE
- CITY OR
VILLAGE raeverda?o Queensbur �rarren
TOWNSHIP y COUNTY
STREET AND NO.OR te , I : .t`1 5
ROAD AND POLE NO. T POLE NO.
BETWEEN WHAT TWO
CROSS STREETS IS C.geverda`..e' road and t ilot '. hob '.lv i j-
PREMISES LOCATED? StCTION / (-? BLOCK/ LOT !'
OCCUPANT'S 11. BUILDING
NAME George P•en:ieY OCCUPANCY .- .
.
OWNER'S NAME TOnagd G. lien:eIf :.4. ,'tt,e r 222A. G. 1? 12801 TEL.#
AND ADDRESS v ' r
CURRENT
SUPPLIED f1 r
BY FROM THEIR OFFICE
BUILDING WORK DEFECTS
IS NEW 0 OLD❑ IS NEW Q ADDITIONAL❑ REMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
No. Fixtures&
NUMBER OF OUTLETS LampfReceptacles MOTORS HEATERS BRANCH CIRCUITS OFFICE USE
Lots- ' ONLY
tion Side Attach't H.P. Watts A.W.G.
Ceiling Wall Recep'Is Switch Pendant Bracket No. Type Each No. Each No. Gauge INSPECTION
Out-
side
Sub-
base
Base-
ment
1st Fl.
2nd Fl.
3rd Fl.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE.
This application is intended to cover the above-listed equipment to be inspected but if at time of inspection there is found additional equipment not above listed,
you are authorized to make the inspection and adjust the fee to cover the additional equipment,as provided by the applicant.
SIZE OF ELECTRIC SIGN TOTAL
MAINS FEEDERS LAMPS WATTS
CHARACTER EXPOSED GAS TUBE SIGN
OF WORK CONCEALED TRANSFORMERS OF VA
WORK TO BE (NUMBER) (CAPACITY)
STARTED COMPLETED SIZE OF SIGN
•
SERVICE OVERHEAD UNDERGROUND MAKER
ENTERS
BUILDING OF SIGN
INSPECTION REQUESTED
ON OR AS NEAR AS
POSSIBLE - - NEW El OLD Fl , .
AVOID DELAY BY GIVING.FULL-AND ACCURATE INFORMATION.ALL SPACES DATE OF -
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION
PRINT NAME AND ADDRESS -
: NAME OF Dona,d C r, r, t SIGNATURE - i
' APPLICANT r z P n`t! " 0%OF APPLICANT 'r. •" (-/ '
•
STREET ADDRESS Star jute 222A TELEPHONE# 656 7_695
CITY OR G is I.,,, rak q ci- }< r ZIP 22801 LICENSE NO.
POST OFFICE.' J - CODE WHEN APPLICABLE -
46 EL (REV. 1/86) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
60c c ( z l
_town of Queeniurcy
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR' S REPORT
NAME—
ki
LOCATION •
. Date //pf1g7 Permit No. 1p -
!� = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofin•,
Backfill
Framing
Roofing
Siding
Masonry Vene=r
• Rough Plumbin•
Relief Valves
y-Ext. Porches 1/
5C-Finished Floors 642.7G!•
541,nterior Trim ✓�/^
.6tairs & Railings - •
Cellar Drain Tile
Concrete Floors
)lbg. Fixtures !/
Gar. Fireproofing NW'
Door Closers
Smoke Detectors •
Chimney A/41 i
INSULATION:
Foundation
Floors
Walls
Ceiling •
INAL ELECT*ICAL INSPECTION
DRIVEWAY APPROVAL
(Final Building Survey
Next scheduled inspection (call when ready)
Remarks- 1 - Celj t3f„: 5'
coXx, �1� 'onek, L;I'VI1JdL t'�
Builing Inspector
6/86 and-vl
ea(/ /a3ie
cc 7 �. ��
awn of 7ueen3hurty
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME �dh 4,/,l Pen,,*-e/
LOCAT I ON �bw�-C /Z-
Da t e 6/a3 /Y7 _ Permit No. 63"6
* * * * * * * * * * * * * * * * * * * * * * *
b/ = APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
yRough 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 ir
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks- -7n7 � '' /49,06=7e 6 //tr
5 6:e e:74.1 s
n nsp
ector
sp tor
6/86 and-vl
7 /0:4'C�It
awn o/ Queenitury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR' S REPORT
NAME Pe;4758-Z
LOCATION � , 7 Rt.
Date 08/87' Permit No. , 6 - 77�
* * * * * * * * * * * * * * * * * * * * .* * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
) naming
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
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks- /0/0"/ 4 .y
�vc1D�C��2-- 5 /e7-7
G'/�
Building Inspector
6/86 and-vl
G etli, 401 51,i7 y; 3' j
JOU/01 of Queeniurj
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME toh Gild Pell ,5-C/
LOCATION f a,,,-,Te j L , e5;c1 C e
„ .-
Date /77//5 47 _ Permit No. Rv-- 773
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
)(Foundation
yaterproofing
Backfill
Framing
Roofing
Siding •
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings s v
/Kellar Drain Tile
Concrete Floors
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 when ready)
Remarks-
csG�G G��A%%
B ilding Inspector
6/86 and-vl
cc�L G `�5 Gt-/?\
__Awn o Queeniturj
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME 16,6,06e,
�sWv'1
LOCATION C1
Date •B /c)--13 Permit No. g/ 7 7.5
* * * * * * * * * * * * * * * * * * * * * * *
!�> V = APPROVED - YES / NO///'''
`Footing/Pier Forms /
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim �E
Stairs & Railings 1f 6
Cellar Drain Tile tj
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers V
Smoke Detectors \
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
eed
Bui ing Inspector
6/86 and-vl
_loom o/ c.u?enibur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME (-P
LOCATION l a L
DATE ,6/ / PERMIT NO. )(jr .— #771;
SOIL TYPE - n Loam Clay -
Percolation Test ' ed? YES (ISO
Percolation rate - Min/Inch 4+ ,3---:
TYPE of SYSTEM:
Absorption field, total length 5Z��,'1
Length of each trench '�tf7'4.-- 40E-
Depth of trenches /Z,'%' •— `8 `z .
Size of gravel ' 3 /,c17 3 (f's/4rJJ
SEEPAGE PITS{Number of)
Size- ft. X ft.
Gravel si e
PIPING: Size Type
Bldg. to tan -'.''' 54--,61 o 'fU
Tank to dist. ox - "."? 5 =1-e io 4.,--c
Dist. box t fi d/pit /r` /'ye. /Soo
Openings s led? NO Partial
LOCATION ,SEPARATIONS:
Foundation to tank ,W ft.
Foundation to absorption 6— ft.
Absorption to lot line ,W4 ft.
Separation of pits /f/' ft.
LOCATION OF SYSTEM ON PROP RTY(circle one)
Front - ear - Left side - Right side -
COMMENTS:
•
SYSTEM USE APPROVED OP NO
7-;'‘,,,,70244./ti.
Bding Inspector
gf
01/86 and vl
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