1987-517 i
CERTIFICATE C]F C7CCUPAN(`,�Y
TOWN OF iQUEENSSURY
WARREN COUNTY, NEW Y+ORK
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Date DecF•mber `' 8 , 19 87
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This is to certify that work requested to be done as shown by Permit No. 18 1 i S
has been completed.
This structure may be occupied as a Ors e- Tr am i ] y 1Twe ll irs
Location 12 Greenway- North
GordQa Poole & Pasne3a A-nderson
Owner
By Order Town Board
_------- 70VVN 4F QUEENSBURY
let
Suildinif & zoning ! for
BUILDING PERMIT
TOWN OF QUEENSBUR'Y No. 87_517 A �
WARREN COUNTY, NEW YORK z
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PERMISSION is hereby granted to Gordon Poole & Pamela Anderson
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OWNER of property located at 12 Greenway Borth Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Alteration to One—Family
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. o
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t . OWNER'S Address is 0
12 Greenway North rj
Queensbury , N . Y . 12801
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2. CONTRACTOR or BUILDERS Name ny
Same
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address r�r
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6. TYPE of Construction — (Please indicate by X) 'Z
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I >9 Wood Frame ( ) Masonry ( I Steel I ) rt
7. PLANS and Specifications
No. Convert Existing Garage to Dining Room, per plot plan , specifications
and application .
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B. Proposed Use rt
One—Family Dwelling
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$5 . 00 C/O F*
$ i n na PERMIT FEE PAID - THIS PERMIT EXPIRES Mnrr•h i 79 Rf3
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Gueensbury before the expiration date.) ro
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loth August 87
Dated at the Town of Queensbury this Day of 19 N•
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SIGNED BY Z/ / �+ .�/ for the Town of Queensbury
Building and Zoning Inspector ,.t,,,7
TO BE COMPLETED BY BLDG . DEPT .
/ Application No .
OWI7 t7t[ES►t36fe►�laf Permit Issued 19
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BUILDING and ZONING DEPARTMENT Permit Expires 19 � � � j-� y ; � � ,, , a
Bay and Haviland Road, R. D. 1 Box 98 Zoning Designation L` U i
Queensbury. New York 12801 Variance No .
L } v o Site ;P/lalRe ewNo RUG Idd0- f� AApr3aY BUILDING & Cope D&:p '_
APPLICATION FOR
PUILDING 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 Permit .
------_a__--------- ----------------------- -------
11
The owner-of this property is : .......
- - {�-- G7 1. `�fr - cT
P:&. Address LA 1 Gj62 - Tel . / � - �3cyZCJ
Property Location : � ' de / Tax Map No . / /
street number or building lot number
Subdivision name ( if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK. AS REGARDS BUILDING CODES IS :B
��Vame ,r �+t� P . O . Address rr i ++ Tel . No . r ,r
Name of builder E' lf)r/ : �l Address /{�"� ! �cJ c,11:4r+/ I Te1 .� &0
Name of plumber c-wg- Address — Tel .
Name of mason evdxv I Address 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 ,
k/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) setback dimensions from property lines . Give
street and number or lot number and indicate
whether interior or corner lot . Show location
FOR 3�F"MQLL PEP
TE * of water supply and location and configuration
of septic disposal area .
tica COMPLETE INFORMATION REQUIRED BELOW .
Size of property ft X ft .
Existing building ( s ) Size ft X ft *
PROPOSEDBUILDING AND USE : * Existing buildings ) Use
Size of .new structure ft X ft _
Foundation-pier/slab/crawl/partial/full Proposed building , distance from property line
(circle one )
* Front yard. ft Rear yard ft
No . of stories (habitable space ) Side yards ft and ft
Height { grade to ridge } ft . * If on corner , setback from side street ft
If residential , no . of families
No . of rooms ( excluding baths ) * OCCUPANCY INFORMATION
No . of bedrooms
PRIMARY BUILDING -
No , of bathrooms '7�.,pne family dwelling
Primary heating system -fTwo family dwelling
Type of fuel
N * Multiple dwelling / Number of units
o . of fireplaces to be installed
,� Permanent occupancy
Will a wood stove be .installed? Transient occupancy
Central Air conditioning?
* Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
RaEsed
-� Contemporary Log cabin * Other
* If addition , what will use
Ranch
ranch Mansion Duplex
Split level Old style Bungalow
Cape Cad 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
CONSTRUCTION7.` - r"Yrti ' - - - - - - _
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 . f)
Will any second-hand or ungraded, lumber be used? If so , for what ? / ;y CJ
Foundation wall material ,��. I . -.. 1'3iick.ness �fp Q
Depth of foundation below grade (to bottom" of footing )
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 "" X '" spacing ""o . c . length ft .
Joists ( floor beams ) lst . floor ""X '" spacing "'o . c . span ft .
Joists ( 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 .
Exterior wall finish Of what material ?
Interior wall finish
If a garage is to be attached , describe materials to be used for TIRE 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 F I) A If 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 T BEFORE THIS Signature _- (7_ •°�
Owner , wner " s age arcn�rect , contractor
d of 19
Notary Pvbli , : amen County, N. Y .
SPECIAL C NDITIONS F THE PERMIT :.
By_T____________ ________----------
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 40 S !
2 . Type of heat (22 9 A
3w 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 7 S � NO
a . If YES , what is the R value of insulation around
perimeter of floor ? - i !j
4 . Is basement heated ? YES NO
a . R value of insulation ) (�
5 . Type of insulation !�E� F +'4" G�`-�
B . Under 16 % Only
1 . R value of roof and f-l -q&Drs exposed to ambient conditions.
2 . R value of exterior walls '- / f
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 wails ( below grade )
109 Type of insulation
co Controls
1 . Thermostat maximum heat setting
D . Duct Systems ,
10 is duct system installed in unheated spaces ? YES f 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 . Max/ imum hee Ja/t l n� g
2
Telephone No . 1 / ~ J �] [mil _ C
( app cant ' s signature )
as ate..: 01 Queenilury
Ili , BUILDING and ZONING DEPARTMENT
"f gay and Hauiland Road, R. D. 1 Box 98
oe- oueensbury, New York 12801
l �
BUS L/D" ING INSPECTOR ' S REPORT
NAMET
LOCATION
i7ate=/ 11L—.� permit No . / f /
APPROVED YES NO
)'oc,tinq/Pier Forms
roundat.lon
waterproofing
"ackfill
Framing
Roofing
Siding
Masonry Venee
Rough Plvmbin
Relief Valves
Ext . Porches
rinished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg , Fixtures
Gar . Fireproof ! g
Door Closers
Smoke Detector
Chimney
I N SU LAT I ON
Foundation
Floors
Walls
Ceiling_
FINAL EI.E RICAL INSPECTION _
DRIVEWAY APPROVAL
nal Building Survey
Next scheduled inspection ( call when resdY )
Remarks-
CV/1
Buildi Inspector
6/86 and-vl
BUILDING and ZONING DEPARTMENT
( Bay and Havikand Road, R. D. 1 Box 98
Glueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCAT I ON Z, 4� �%�".�l
Date,&I ;F 7 Permit No .
✓ = APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
B ckfill
raming
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext , Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg . Fixtures
Gar . Fireproof in
Door Closers
Smoke Detector
Chimney.
INSULATION
Foundation
Floors
Walls
Ceiling
FINAL ELECT CAL INSPECTION _
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready
Remarks-
5/ 4' �`�----
Building Inspector
6/86 and-vl
L ,% OlL/I1 +PfI BE �? .ff�PLt
tr / BUILDING and ZONING DEPARTMENT
v [I Bay and Haviland Road, R.D. 1 Box 98
Oueensiaury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION
Date _ ��
f � Permit No . �v._,,�
✓ = APPROVED - "YES NO
Footing/Pier Forms
Foundation
Waterproofinfilg
Br Ing l
t_-.�`'raming
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Values
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 {ca13 _w�fhen really )
Remarks- Ale
6/86 and-vI Building Inspector
BUILt]ING DEPT• COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT. WHEN y REQUIRED_
t
y^ k + TEMP. AlCIS GIP� J- / fiall �
STREET AND ND, on - - TOtM1iYSHIP t -at' .t : ( r.1 t \'l r c xmry 1..
ROAD AND POLE pill f .,wi i_ � . : t C'N N�U� r,. CJ f I �1
CROSS 11111iESNRtIH£IEAT T C> F J pn ii I , nI P61'E
NAME ANT$ f.� '."; "� y� { SECTION BLOCK LQT '`•
^J 7 (•] f' I BUILDING
OBINE l i NAME 3 41� ^NCV .A17.
A17
AND ADDRESS 1- } C7fys d7 r•
SUPP F lid =!" f Alf l ��f �/ f�-:r TEL. iw`
BSUYPPLI£D Ilill ; %x rOL fY� �-,cc w Ill
T r
BUILDING _ WORK
NEW FROM
OLD THEIR. R {' �,�/ j -, �1p.• DEFECTS
+L7. IS NEW ElID ADITIONAL .�7+. DEFTS
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
MOVED
NUNBER OF OUTLETS No. of Fbtbues s
l LalelP Repples�ly MOTORS HEATERS ppC�u ll OFFICE USE
Skit Attal ONLY
Y a n Reece to SeeltGy I lesdent Bree;eet Na Tl E� Nlo Eat N°- A.W.G. INSPECTION
�.
elide
Al
bl
Brr
lot Fill.
wt.ec
Ft sa
s.d Ft.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE.:
OQ NOT USE THIS SPACE.
Th motion is intended m cnvee the ibO lieted ecIu'Pmsnt to li iosoll but it :t Ill of i
vllwsize OF ll to melt* the ie�ti4n wed al die fey to n w tie additill OquWam"l. w pforided by efts KipPd�einl.011ilmnd MWiiialYY 'ItPliPnssnl tw1 aboe. listed.
MAINS FEEDERS ELECTRIC SIGN TOTAL
CHARACTER LAMPS WATTS
OF WORK EXPOSECGIfeCEAL E8 GAS TRANSFORMERS OF
IIIORK TO Be VA
STiLRTED COMPLETED INIJRI ICAPACITYI
SERVICE OVERHEAD 512E 4FMBE SIGN
ENTERS - UNDERGROUND
1 1 MAKER
INSP ECTt4N REQUESTED y 4F SIGN
I�AS NEAR AS
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES NEW � OLD
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. DATE OF
PRINT NAM NO AE OFTRE $ { APPLICATION _
NFL K:ANT -"'s!"s F f 1 r-" .=L 'I {,_, 1/ SIGNATUREI S
OF APPLICANT
STREET ADDRESS f .� �' Ir - 1, `f 1.Lr !i ' f )c r
CITY
OR
OFFICE •-. E`•' .-= [ I`f TELEPHONE
P
CaDE fi LICENSE NO
I THEN APPLICABL E
46 EL (REV. 1/6p6) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING