1987-216 BUILDING PERMIT
TOWN OF QUEENSBURY No. 87_216
WARREN COUNTY, NEW YORK
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PERN9lSSlpT+f is hereby granted to Albert Randall Q.
m
Street, Road or Ave. i
OWNER of property located at 12 Crownwood Lane
Addition to dwelling (family room)
in the Town of Queensbury, To Construct or place a
at the above location in accordance to application together with plot plans and other information hereto filed and A
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. w
1 . OWNER'S Address is 12 Crownwood Lane
Queensbury , New York. 12801
2, CONTRACTOR ar BUILDERS Name
r-
.aim Davis N
n
re
a
3. CONTRACTOR or BUILDER'S Address '
Pitcher Road a
Queensbury , New York 12801 ory
4_ ARCHITECT'S Name
m
5. ARCHITECTS Address
6. TYPE of Construction — (Please indicate by X)
( x) wood Frame ( ) Masonry ( ) Steel [ 1
7. PLANS and Specifications
12 ' xl8 ' per plot plan , specifications and application submitted .
No. �
F+-
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B. Proposed Use fine-Familyr`
Dwelling ( family roam added) o
0
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m
$ 1 2 I)n PERMIT FEE PAID — THIS PERMIT EXPIRES
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date_)
Dated at the Town of Queensbury this bth Day of May 19
$7 W
N
SIGNED BY at oo for the Town of Queensbury
Building and Zoning Inspector
V
TO BE COMPLETED BY BLDG . DEPT .
�] / Application No .
�lotvn o/ Queeinjh"ry Permit Issued 19 � co i-,
BUILDING and ZONING DEPARTMENT Permit Expires 19
Bay and Havitand Road, R. D. 1 Box 98 Zoning Designation � _ lj
C)ueensbury, New York 12801 Variance No.
Site Plan Review No . APR
p 23
1987
Q C2 - 3 Approved b t
BUILDING 4C )DF�EPT,
APPLICATION FOR ' !fC „ r'�"
f
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 Perm�i.,t,�,. � �,� � /
The-owner of this
_property is : - '� I ■ �i.f I bfiu
P . O. Address IG� -� Tel . WAS " +
Property Location : Tax Map No . / /
Street number or building lot number
Subdivision name ( if applicable)
THE Rs N RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS :
Name
. O . Address tel . No .
Name of builder Address Tel .
Name of plumber ,y Address Tel .
Name of mason M ____Address Tel .
NATURE OF PROPOSED WORK : ZONING INFORMATION :
construction of a new building A PLOT PLAN MUST BE PREPARED AND SUBMITTED .
L/ 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
whether interior or corner lot . Show location
FOR DEMOLITION PERMIT , STATE SIZE AND * of water supply and location and configuration
LOCATION OF STRUCTURES AFFECTED . * of septic disposal area .
w COMPLETE INFORMATION REQUIRED BELOW . ,/r�� ,/�
* size of property 100 ft X GG.d ft .
* Existing building ( s ) Size ft Xft -
PROPOSED BUILDING AND USE : * Existing building ( s ) Use
Size of new structure ,1 ,c. ift x9� ft '"
Foundation-,pier/slab crawl partial/full Proposed building , distance from property line
(circle one ) Front yard ft Rear yard IF7e> ft
No . of stories (habitable space)e) i Side yards �/y �ft and "�� ft
*
Height ( grade to ridge ) _ 14 ft , If on corner , setback from side street ft
If residential , no . of families'^
No . of rooms ( excluding baths ) I OCCUPANCY INFORMATION
No. of bedrooms --•"�—
,� PRI Y BUILDING -
No . of bathrooms * One family dwelling
Primary heating system Two family dwelling
Type of fuel Q� ultiple dwelling / Number of units
No . of fireplaces to be installed �pe,-++,anent occupancy
Will a wood stove be installed?
Transient occupancy
Central Air conditioning? Business
BUILDING STYLE, PRIMARY STRUCTURE Industrial
* Other
Ranch Contemporary Log cabin If addition whit will use be?
Raised ranch Mansion Duplex * �i
Split level Old. style Bungalow
Cape Cod Cottage Other * ACCESSORY BUILDING-
Colonial Row Town House * ��D%tached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) t.�'"Attached garage/one car/ tw,cZcar ^car
Private storage building
ESTIMATED MARKET VALUE OF Other
CONSTRUCTION
INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE BIDE OF THIS SHEETr TO BE COMPLETED ?
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , 5rod fram fire safe , etc .
Will any second-hand or ungraded lumber be used? If so , for what?
Foundation wall material 134.o -i4 Thickness
Depth of foundation below grade (to b0 oting ) F
Will there be a cellar? ---- Heated or unheated? Floor sq. footage sq ft
Will there be a basement? Will any portion be used as living space?
( If so , what portion? _sq . ft . - - Type of use?
ped lat/shed/other Material of roof
Type of roof -Fslo
Size , wood studs X ., spacing_ / "o . c . lengthft .
Joists ( floor beams ) 1st . floor } '1 spacingI —"o . c . span�ft .
Joists ( floor beams ) 2nd . floor "X " spacing "o . c . span ft .
Overlays (ceiling Yaeams ) -"X spacing 'Z,4111o . c . span�_ft .
Roof rafters ^X " spacing o . c . span ft .
Roof trusses (pre-engineer d) spacing "o . c * span ft .
Exterior wall finish 0N �S _� Qf I at material ? d4Tj
Interior wall finish s
If a garage is to be attached , describe materials to be used for FIRE SEPARATIONS
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? 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 f Warren A c F T D A V i T' STATE OF NEW YORK
County of Warren fii f _ 1 V I
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
day of 19 Signature _
[]wn -, owner ' s agent , arcnitect, contractor -
Notary Public , Warren County , N . Y .
SPECIAL CONDITIONS OF THE PERMIT :
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Application far : 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 �X � .
2 . Type of heat A IV- , f
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 f100v ?
4 . is basement heated ? YES NO
a . R value of insulation
5 , Type of insulation r
4 �
B . Under 16 % Only-
IV R value Of rvof . a d floo s exposed to ambient conditions.
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2 . R value of exterior walls ei " � i
3 . R value of glazed 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 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
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
J
Telephone No . —t—"
( applicant ' s signature )
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BUILDING and ZONING DEPARTMENT
Say and 1-iaviland Road. P.D. i Box 98
Queensbury, New York 12801
BUILDING INsPECTCIR. ' S REPORT
NAME.
LOCATION
�+ permit NO
NO
Date V * +
*
APPROVED - YES
ooting/pieT Forms
oundatiOn
Waterproofing
Back.fili
F ranting
Roofing
siding
Masonry Veneer
Rough Plumbing
Relief Valves
Exit , Porches
Finished Floors
Interior Trim
stairs & Railings
Cellar Drain Tile
Concrete Floors
p1b. , Fixtures
Gar . Fireproofing
Door Closers
smoke Detectors
Chimney
INSULATION %
Foundation
Floors
walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APFROV Survey
Final Builcling
Next scheduled inspection (call hen. ready
Remarks- 4XA,
Building 'Inspector
rc>18 , and-VI
BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT. WHEN REOUI RED.
T1711P fl IT 0 t-P
ury DRL Fv.
VILLAGE .� TOWNSHIP COUNTY
STREET AND NO_ OR j �'4 "f r:. 1..1 ! t a� 1 yl^y„ e J1
ROAD&CIO POLE NO # POLE NO.
WO
CETWEEN ROSS STREETS IB +
PREMISES LOCJITEDs SECTION BLOCK LOT
OCCUPANTS � � BUILDING
`.NAME OCCUPANCY
OIYII ERS NAME
AND ADRESS 7TEL.D # L ••�
CURRENT
SUPPLIED FROM THEIR OFFICE
BY *+
ORK DEFECTS
I /ILD/Nl' NEW Yd OLP l_t Is NEW LJ ADDITIONAL y,d` REMOVED ❑
Llft@ELOW ALL EQUIPMENT WHICH YOU INSTALLED
- B BRANCH OFFICE USE
NUMBER OF OUTLETS MOTORS HEATERS CIRCUITS ONLY
Leon
""' Side Ateteh't
G lt "` XP Wrtls AGauge. INSPECTION
atilant ee W.O
OaM
Sutr
bee
7st FI. `
2%d Fl
SnI re.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE,
4
This ep laieetion is inkew to co the ale listed equipmtemt to be Inspected but if at time of irapmtion them is found additional equipment not above listed,
yea. re autlwrked to mNee the uypeeaion end +djtat the fee to cagier Owe additional equipment, M Provided by the applicant.
SIZE OF ELECTRIC SIGN TOTAL
MAINS FEEDERS LAMPS WATTS
CHARACTER - l EXPOSED GAS TUBE SIGN
OF WORK CONCEALED TRANSFORMERS OF VA
WORK TO SE ENUMBERI [CAPACITYI
STARTED COMPLETED ,f� SIZE OF SIGN
!PIBLE
ICE OVERHEAD UNDERGROUND MAKER
RS OF SIGN
DI
CTION REQUESTED
R AS NEAR AS NEsll1 OLD Q
AVOID DELAY BY OIVI NG FULL AND ACCURATE INFORMATION. ALL SPACES DATE OF
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICA ON ;
PRINT NAME AN Q (MOD ESS
NAME OF / .• SIGNATURE !
� �T3_`� C +L+� .f\ OF APPLICA.J llTerf (' >r
APPLICANT ti.. 'TZ'�.�—
^s, tlf/`f� - � },.I7��,�,(.,�+,,
STREET ADOR ESS r "^ � y`� � f"" ""'^^- G "• """' TELEPHONE * I
CITY OR '�,�E l ..rA.,f� .} ,ZIP �I — LICENSE NO.
POSTOFFICE -=''I.. -i'L/E +/�. COPE .L _WHEN APPLICABLE
a6 EL (REV. ,/ec) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
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