1987-330 s
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CERTIFICA.TE +(lF COMPLIANCE �
TOWN OF +QUEENSBURY
WARREN COUNTY. NEW YORK j
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� Date February 12 - 14 . al
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This is to Certify that work requested to be done as shown by Permit No. 87- 130
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has been completed.
This structure may be occupied as a deb k '
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Sullivan Rd . & Sullivan Place , Glen Lake {
L.ocarion
Mildred A . Moore
Owner
By Order Town Board I
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11 'M VN OF +QUEENSBURY
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Director of 'Bldg. & Code Enforcement �
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BUILDING PERMIT
TOWN OF QUEENSBURY
Na. 87-330
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Mildred A . Moore
OWNER of property located at Sullivan Road and Sullivan Place Street, Road or Ave.
Cl ueensbu Addition to dwelling (deck)
in the Town of s�v
ry• To Construct or place a Q.
at the above location in accordance to application together with plot plans and other information hereto filed and 9
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. OM
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1 . OWNER'S Address is
RD #1 Box 1745 �
Lake George , New York
2_ CONTRACTOR or BUILDER'S Name
Tom Kennedy
3. CONTRACTOR or BUILDER'S Address. cn
Greenwich , NY F�
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address G.
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5. TYPE of Construction — {Please indicate by X) p
{ 1 Wood Frame { ) Masonry { I Steel
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?_ PLANS and Specifications tt
30 ' xS ' deck per plot plan , specifications and application
No.
8. Proposed Use
One—Family Dwelling (deck added) a
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$ 10000 PERMIT FEE PAID — THIS PERMIT EXPIRES January 1 19$$ o
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(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the m
town of Queensbury before the expiration date.) F,
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Dated at the Town of Queensbury this 5th Day of June 19 87 ova
SIGNED BY / / vi • t.' for the Town of Queensbury
Building and Zoning Inspector U
TO BE COMPLETED BY BLDG . DEFT .
/ Application No .
_ own o/ Q,ueert36urry TC►VVN OF QUEENSBs av
Permit Issued 19
BUILDING and ZONING DEPARTMENT Permit Expires 19 � n
Bay and Haviland Road, R. D. 1 Box 98 Zoning Designation C3
Clueensbury, New York 12801 variance No . 3
Site Plan Review No . J UN 3 1987
3 Approved byz
APPLICATION FOR BLIILQING & CpI�E DEP f.
P,U I LD I NG 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 clone 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 : iL ■ , Y400dZ
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P. O. Address YL -$� 1 0 Kt r� �� *� ZEZZ: Tel *
Property Location : yZ� _ Tax Map No , f j
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 TOYYJ f jQ J1/J✓{�) , Address aTel
Name of plumber yr • 1 Address �F � I Tel .
Name of mason Address 92, Tel .
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 ,
(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 I d 0 ft X S j ft .
Existing building ( s) Size 5 O ft X 3 2-ft .
x
PROPOSED BUILDING AND USE :
� Existing building ( s ) Use
Size of new structure 3[] ft X ft
Foundation-pier/slab/crawl/partial/full Proposed building , distance from property line
(circle one )
Front yard _S',3ft Rear yard 4 0 ft
No . of stories (habitable space) �, Side yards � ["') ft and ft
Height ( grade to ridge } ft If on corner , setback from side et. }�ft
If residential , no . of families
No . of rooms ( excluding baths ) * OCCUPANCY INFORMATION
Noe of bedrooms
PRIMARY BUILDING -
No . of bathrooms
One family dwelling
Typeof heating system Two family dwelling
Type of fuel
No . of fireplaces to be installed Multiple dwelling j Number of units
Will a wood stove be installed? ,,,_Permanent occupancy
Central Air conditioning? Transient occupancy
* Business
BUILDING STYLE, PRIMARY STRUCTURE Industrial
Ranch Contemporary Log cabin Other
If addition , what will use be?
Raised ranch Mansion 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 ) * Attached garage/one car/ two car/ car
* * * * * * * * * * * * * * * * * * Private storage building
ESTIMATED MARKET VALUE 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 . { K6.5S 'CF-&Will any second-hand or ungraded lumber be used? If so , for what?
Foundation wall material� Fin rr � { (� � Thickness
Depth of foundation below grade (to bottom of footing ) f/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?
Type of roof - sloped/flat/shed/other Material of roof
Size , wood studs rix " spacing '+ "17 . C . length uft .
Joists ( floor beams ) st . floor w� ^'" T�" spacing "o . c . span ft .
.foists ( floor beams) 2nd . floor "'X " spacing .-- "o . c . span ft .
Overlays (ceiling beams ) "x " spacing "o . c . span ft .
Roof rafters "X " spacing o . c . span ft .
Roof trusses (pre-engineered) spacing "o . c . span ft .
EXtera.or wall finish of what material ?
Interior wall finish
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?
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 Queensbury A F F I D A V I T
County of Warren 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 _ VJ
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^y -Owner , owner ' s agent , arcYxi�ect , c[?ntractor
day of 19 d4 /
Notary Public , Warren County, N . Y .
SPECIAL CONDITIONS OF THE PERMIT :
BY
✓ T wN OF 'QUEENSBURY
BUILDING 53 ROAD D SAY DEPARTMENT
QTELEPHONE ( 51r 0
8) 792- 5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME n ` - I
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LOCATION
DATEPERI+IIT
TYPE OF STRUCTURE x
RECHECK S - APPROVED
/A YES NO
FOpTiNGSfPIERS
�..
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESIPONSI LE
FOR PROVIDING PROTECTION
FREEZING FOR 48 HOURS FOLL ING.
THE PLACEMENT OF THE CONCR E .
MATERIALS FOR THIS PURPOSE N S E
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENTIVEN S IN PLACE
PLUMBING UNDER SLAB
FRAMING :
JACK STUD /HEAD£ S
BRACINGfBRIDGING
JOIST HANGERS
JACK POSTSfMAIN B
HEATING ROUGH- IN
INSULATION :
FOUNDATION ALL N E R-
FOUNDATION WALLS EX ERI R R-
FLOORS R-
WALLS R-
CEILING
DUCT WORK R PIPING I UNHE TED
SPACES
REMARKS :
ARRIVE
DEPART '
INS CT
JoVV" Of I�een � bur�
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 No . n 7
Polo
APPCROVE - YES NO
} p'ooting le Forms -�.•��Ij
Foundat '
Watexproofing
Backf i l l
F ranting
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief valves
Ext , Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Brain Tile
Concrete Floors
Plbg . Fixtures
Gar . Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIv'EWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready
Remarks-
AZ
Builng Inspector
6/86 and-vl
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