1987-347 ER.TIFICA.TE CIF +Q��LTI'Al''�+�Y
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK � � Sri ,
Gate 1" � ►U gg 1 3 > 19 87
87-347
This is to certify that work requested to be done as shown by Permit No.
has been completed. ]' r)-P (' n i ' '3- u A'\1
(hje- Flansil.y Dwel. na
Fid
This structure tray be occu d as�a ,,��^�J � � �+ 1
t `y' 1 c nctiil s j 't �*� S Y 9 tk3 cl3en kii 13 Sukr .
Location
WTI Scherrxere Orn �V T
Owner
By Order Town. Board
TOWN C)F QUEENSBURY
Building & Zoning Inspector
BUILDING PERMIT
TOWN OF QUEENSBURY �
No. $7-347
WARREN COUNTY, NEW YORK
z
0
Rich Schermerhorn
PERMISSION is hereby granted to w
w
OWNER of property Vacated at Lot 9 Hidden Hills Drive ( St . #9) Street, Road or Ave.
in the Town of Queensbury, To Construct or place a One-Family Dwellin
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 1 Windsor Ct .
a'
Gansevoort , New York 12831
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2. CONTRACTOR or BUILDER'S Name same
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3. CONTRACTOR or BUILDER'S Address
same
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d. ARCHITECT'S Name
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5_ ARCHITECT'S Address CD
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6. TYPE of Construction — (Please indicate by X)
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( 34 Wood Frame ( ) Masonry ( Steel ( }
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7, PLANS and Specifications
50rx26t per plot plan , specifications and application submitted a
No. including sewage system and one car attached garage .
S. Proposed Use p
Clete-Family Dwelling m
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$5 . 00 C/O µ
$ 117 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES January 1 1988
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Qusensbury before the expiration date.?
N•
Dated at the Town of Queensbury this 15tt 4h Day of .tune 19 87 00
/ ,,,
SIGNED BY c s l 4 for the Town of Queensbury
Building and Zoning InsQector
TO BE COMPLETED BY BLDG . DEFT .
� 7 Application No . TOWN QF' QUEt.�NSBi =ry
_../,porn O/ Queen i g"r y. Permit Issued 19
BUILDING and ZONING DEPARTMENT Permit Expires 19 J u� f I^ lyr
Bay and Haviland Road, R. D. 1 Box 98 Zoning Designation FI� I F
Queensbury, New York 12801 variance No . JUN987
Site Plan Review No *
- „Jf ci [ iBU1L.I3IVG 8c CUDE DEBT.
! Approved by -.
APPLICATION FOR
��
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 conditionsas may beon the- - - - ............ ________________
The owner of this property is : i C' k) �.LAe_ C( O'n e . ( ' 'rNO !" *y
P . O. Address ct ti3 ,7 + . Y, � Z $ Tel . 7' `i3 " 7 [34
Property Location ; hlidde Adl _g )4L IL Gc�`f 9 (ST �Ow-V Tax Map
Street number or ,building lot number
Subdivision name ( if applicable) Pl as 6ez t 4
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS :
Name P. O . Address Tel . No .
Name of builder RIC1% 5cjr1rrw� -ess J W: ncl5o " Tel .
Name of plumber �� , f, o f Address cy { V,S : l u.IIC. }�►- Tel .
Address* - ' }- t aC J4 OVAZ
Name of mason b ,,v Am # wr Lae �YSC'e��
NATURE OF PROPOSED WORK : * ZONING INFORMATION :
( `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 buildings ,
i (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 DFZIOLITION PERMIT , STATE SIZE AND of water supply and location and configuration
LOCATION OF STRUCTURES AFFECTED . * of septic disposal area .
COMPLETE INFORMATION REQUIRED BEL�
Sic a
* Size of property / 0 -ft X, . ft .
* Existing building ( s) Size ft X ft _
*
PROPOSER BUILDING AND USE : * Existing buildings ) Use
Size of new structure Q ft XZ(� f
Foundation-•pier/slab/crawl,/part ti- full Proposed building , distance from property line
(circle one ) Front yard ��— ft Rear yard�-��ft
No . of stories (habitable space ) —�- - Side yards �2 f ft
ft . * � <j £t and
Height ( grade to ridge ) If on corner , setback from side street ft
If residential , no , o£ families � '"
No . of rooms ( excluding baths ) °f * OCCUPANCY INFORMATION
No. of bedrooms_
* PRIMARY BUILDING -
No . of bathrooms ,. 2 * v One family dwelling
Primary heating system J�`Ltsw C`i,C * Two family dwelling
Type of fuel_ C� x , G * Multiple dwelling f Number of units
No . of fireplaces to be installed 0 Permanent occupancy
Will a wood stove be installed? MI)
* Transient occupancy
Central Air conditioning?— * Business
BUILDING STYLE, PRIMARY STRUCTURE Industrial
* Other
Ranch Contemporary Log cabin If addition , what will use be?
Raised ranch Mansion Duplex
Split level Old style Bungalow
Cape Cod Cottage Other * ACCESSORY BIJILDING-
0 onia Row Town House * Detached garage/one car/ two car/-- —car
( CIRCLE ONE PLEASE ) * t7Attached garage/one car/ two car/ / j, -car
* * * * * * * * * * * * * Private storage building
ESTIMATED MARKET VALUE OF * Other
CONSTRUCTION
$ _. _ S�,, note _ _ _ _ - - - _ -
INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED !
Form BPA 4/86 md--vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe , etc . woodA
Will any second-hand or ungraded lumber be used? If so , for what ? AID
Foundation wall material _Thickness /0 *"
Depth of foundation below grade (to bottom of footing )
V� Will there be a cellar? Heated or unheated? ye�ke.At edA Floor s+q. footage sq ft
Will there be a basement? Till any portion be used as living space? w/�
( If so , what portion?� sqo ft . _ _ Type. of use?
Type of roof - sloped/flat/shed/other_ $ 4j Material of roof Y o 11�7 _ph—i 4. rio 14v
Size , wood studs__2_"X6 ___'• spacing_Lj0 . o . c . length ditm i7t'� zsiC
.joists ( floor beams ) 1st . floor "X " spacing L� ,2p vl " 3tA i n I C 5
_ I1— p g /(s, — o , c . span-1-� f t . X
joists ( floor beams) . 2nd . floor ."X�" spacing_"o . c . span fir+ '+ft . AM � tr ve }
Overlays ( ceiling beams ) ,�, "X " spacing: _"o . c . span ft .
Roof rafters "X ,• s cing�_o . c 0 span dddd' +eft .
Roof trussed{pre-engineered.] spacing, + l� "o . c . span. ft .
Exterior wall finish QL rd Of what material ?
Interior wall finish Z• L7G If a garage is to be attached , describe materials to be used for FIRE SEPARATION :
Is there to be an opening between garage and dwelling? `" /�! If so will a Fire-rated
door , enclosure , and self-closing device be provided? ye_doc
Will a flue-lined chimney be installed? X� Height above roof ( ft .
.Depth of chimney foundation below grade-,-.V _ft . r
Depth of fireplace hearth_.- ft , in .
Water supply - Municipal or private well f rj it r'(' _ i D of E
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 County of warren A F F I D A V I T 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 nott and th t such work is
authorized by the owner . r
SWORN TO BEFORE ME THIS Si nature _
/ i"dddd`7
day of 19 Owner , owner ' s agent , arctxitect, contractor _
Notary Public , Warren County, N . Y .
SPECIAL CONDITIONS OF THE PERMIT :
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 wont .
ANSWER ALL of the following : y
1 . Gross floor area 30 1:0
2 . Type of heat ,I & ,4r,..
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 insu ated ? 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
B . Under 16 % Only
1 . R value of roof and floors exposed to ambient conditions`
r004F Z.
2 , R value Ot exterior wal is
�l 3 , R value Of glazed area �Lq
4 , R value of doors R 13
5 , R value of floors over unheated spaces 12 app �-7
6 . R value of slab edge insulation - unheated slab
f7 . R value of slab insulation - heated slab �l /� I �
as * R value of heated basement/ cellar walls ( above grade )� a
•+ 9 . R value of heated basement / cellar walls ( below grade )1 � 10
10 . Type of insulationT - -
C , Controls
1 . Thermostat maximum heat setting
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 a ent pipe e "J y
2 . R value of pipe insulation P.
F , Service Water Heating O /
1 . Performance efficiency.
2 . Temperature control setting maximum_ ( �"}
G . For Swimming Pool Only
10 Maximum heating
Telephone No .
{ applicant ' s signature )
APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE — f
LOCATION OF PROPERTY FOR INSTALLATION i,:AA e /1.l i %X 5 --}
Owner's Name: }� iC.�"1 Telephones
Address: _ ►/� r'!t^3 O ,T !� ,._
Installer's Name: 1 �`t �I z3 �# C} t Telephone:
Number of bedrooms (residential only)
Total daily* flow (compute a 150 gal per bedroom)
Torpographya circle one: Flat Rolling Steep Slope % of slope
Sail Nature: circle one** ( Sand Loam Clay Other / Depth: feet
Gtround Water: At what depth? ( feet
Bedrock. or Impervious Material: At what depth? � feet
Percolation test: circle one: not irequireSp required / rate Q._ min. inch,
Domestic water supply, circle one: Municipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption l feet
PROPOSED SYSTEM: Septic Tank � / ADO D gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench Ep feet / Total system length _ Qi feet
SEEPAGE PIT(S) : Number of / Size each feet by -- feet
Size of stone to be used # / Depth or Thickness _ feet
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
(over)
Section II Septic System Inspections:
A. All applications for septic system installation, alteration or repair, as
required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to the Building Department at least Z4 hours before start
of construction and shall include a plot plan showing:
1.) the proposed location of the system
2.) location and distance to lot lines
3.) location and distance to structures
4.) location and distance to any water supply
5.) size and dimensions of all tanks, distribution
boxes, the fields and/or drywells
Be No system shall be covered before inspection and approval by the building
Inspector. Failure to comply with this requirement may result in the
uncovering of the system by the installer and a fine of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person:
40
Dates
Town of Queensbury
Building and Code Department
Fay at Haviland Road
Queensbury, New York 1Z801
(518) 792-5832
SE -rTLED 1763 HOME OF NATURAL BEAUTY A GOOD- PLACE TO LIVE
J'veuse 0 +ee�se3 � etrt�
i BUILDING and ZONING DEPARTMENT
` Bay and Haviiand Road, R.D. 1 Box 98
U Queensbury, New York 12801
� y
BUILDING INSPECTOR ' S REPORT
NAME /Y . j ae
LOCATION e� Ga�'�G�*�
Date0/ Z. �Permit- No .
APPROVED YES NO
Footing/Pier Forms
Founda ' on
Waterpr fing
Backfill
Framing
Roofing
Siding
Masonry Venee
Rough Plumbing '
LFtel ie f Valves
4wExt . Porches r`
Finished Floors
Interior Trim
stairs & Raili s
Cellar Drain T e
Concrete Flov s
Plbg . Fixtur s
400gla�r . Firepr fing
L000r Close
Smoke Det tors
Chimney
IN SU LAT I
Foundat ' n
Floors
Walls
Ceiling
lofrINAL ELECTRICAL INSPECTION F._ ..
DRIVEWAY APPROiVb1-
Final Building Survey
Next scheduled inspection (call when ready
Remarks
'00er
Bui ing Inspector
6/86 and-vl
!�l n 13UILDING and ZOr41NG DEPARTMENT
v Bay and Havifand Road, R.D. 1 Box 96
Q y ✓ QueenSbury, New York 12801
ILA / SPECTOR ' S REPORT
AME J1 ,iGvi�i', �'1TGAi -3L
LOCATIONOW 9d�
Permit No
* * * * * * * * * y,•* * APPROVED - YES NO
Footing/Pier ozms
Foundation
waterproofing
Backfill
F ralming
tolftoof ing
CS"iding
Masonry Veneer
Etough Plumbing �l2 tom.
VReli.ef Valves
4-�Ext . Porches ,,o,
finished Floors
L�rffterior Trim
Ges tairs & Railing
Cellar Drain Ti
Concrete Floor
Plbg . Fixture
VGEar . Fireproo Ing ,
Lp6or Closers
G5moke Detec rs
Chimney
NS C3 LAT I ON
goundation
~1''loo rs
Wa11s
Ceiling
FINAL EL TRICAL INSPECTION��
DRIVEWAY PPROV Final Building Survey
Next scheduled lnsp
action (call when ready
Remarks- A(e Zeaj
t
� ^Building Inspector
6/86 and-vl
co down 0/ Qmieenik"ry
BUILDING and ZONING DEPARTMENT
i Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILD�IQNG� INSPE[CTOR * S REPORT
NAI~"IE+^ i1. �G ell~ rr+ r=1rYEVYH
LOCATION
rot e 71 / Sel Perrnit No . $ 7 - �7
APPROVED YES NO
Footing/Pier Forms
Foundation
waterproofing
Backf i l l
Framing
Roof ing
Siding
Masonry Veneer
)L 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 INSP'ECTION�
DRIVEWAY APPROV
Final Building Survey
"Next scheduled inspection (call when ready
Remarks-
T
Tiding ns ector
6/86 and-vl
r awn n/ Queen36ury
BUILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R. D. 1 Box 98
Queensbury, New York 12801
SEPT-IC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
DATE Ir �l PERMIT NO .
SOIL 'TYPE - Sand - Loam - Clay
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SY:aC
T
Absorptionf Id , total le h +
Length of trench
.Depth of tren es
Size of gravel T
SEEPAGE PITS{N er oo! f ) _
Size- ft. X ft_
Gravel size '
PIPING : Si e Type
Bldg . to tank �f vc
Tank to dirt . x V
Dist.. box t field/ J
openings s led? E NO Partial
LOCATION EPARATIONS :
Foundat n to tank 1� Z. ft.
Founds on to absorption ft.
Absor ion to lot line ft_
Sepa do pits ft«
LOCATION S TEM ON PROPERTY (circle one )
Front - ar Left side - Right side -
CC)MMEN
1
SYSTEM USE APPROVED YES NO
Building Inspsector
01/86 and v1
_ town o f Queen J '"'V
BUILDING and ZONING DEPARTMENT
Day and Haviland Road, R-D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATIONT -
Date/ __ Permit No . /
APPROVED* -* YES* NO
Footing/pier Forms
Foundation
Waterproofing
Backf ill
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 INSPEC"SIOI3
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready )
Remarks-
nu lding Inspector
6/86 and-vl
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R.D. 1 Box 98
oueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAIVE J 'C f7 �'r �'' E?r
� !�
LOCATI vie), 74
FYi4 [ 7Pmit
Date G�1
Noa ;?'2- 3-
APPRDVED - YES 140
Footing/Pier Forms
Foundation
waterproofing
Backfill
;K F ram.i ng
Roofing
siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext , Parches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg , Fixtures
Gar , Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION
Foundation
Floors ,
�twalls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAi _
Final Building Survey
Next scheduled inspection (call when ready
Remarks-
.. , r
B iiding Inspe for
6/86 and-vl
_,J'o n a� �eeeeres6urc�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME , .
LOCATION
Date& Permit Now
✓ APPROVED - 'YES NO
F ing/Pier Forms
elation
VWaterproofing
�ackfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext . Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbsg . Fixtures
Gar . Fireproofing
Door Closers
Smoke 'Detectors
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSP ''TION
DRIVEWAY APPROVAL
Final 'Building Survey
Next scheduled inspection (call when ready
Remarks-
Building inspector
6/86 and-vl
LP 10 aLtl1! O! Q"eerilI "ry
• BUILDING and ZONING DEPARTMENT
Bay and Hawiland Road, R.D. 1 Box 98
Ciueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME ie
LOCATION `� /A
Date.iG -- ' "7 3 "� -i
Permit No
"PROVED - S NO
Footing;/Pier Forms Rf a it
Foundation
Waterproofing
Backfill
Framing
Roofing
x Siding
Masonry 'Veneer
Rough Plumbing
Relief Valves
Ext . Porches
Finished F1 s
Interior Trim
Stairs & Railin
Cellar Drain Tile
Concrete Floors
Plbg . Fixtures
Gar . Fireproo ng
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-
Bui ding Inspector
.s6 and-vl
awn G/ �ueensbur�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
r1� Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME /7 i J� CA
Er 1-n Y h a YYi
� TION
)y dOfedo, A14f Its
Permit No . 74 7,,i �-
✓ I APPROVED - YES No
4/ 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
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-
Building Inspector
6/86 and-vl
t
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DATE - APPROVED BY
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DRAWLN/G� NUM"M
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KOG ARCHITECTS' STANDARD FORM