1987-501 CERTIFICATEC►F' +CUC+CLJI'�N�C'�
TOWN Of QUEENSBURY
WARREN COUNTY, NEW YORK
[]ate Aug u s t 15 19 90
This is to certify that work requested to be done as shown by Permit No. 87- 501
has been completed.
This structure may be occupied so a �3e-larnil Dwellin
Lai: 126 Brookshire Trace BLLdford Close
Loocation
Owner Gary Sistl
By Order Town Board
'MWN OF QUEENSBURY
Building & Z inn inspector
L - BUILDING PERMIT
TOWN OF QUEENSBUR`tt' �
No. 87-5a1
WARREN COUNTY, NEW Y+OiRK �
0
PERMISSION is hereby granted to Gary Sisti r
n7
Lot 126 Brookshire Trace (Bedford Close)
OWNER of property located at Street, Road or Ave.
in the Town of Queensbury, To Construct or place a One-Family Dwelling 4 104 "
wtl ON
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 29 North Church Lane
Glens falls , N . Y .
2. CONTRACTOR or BUILDER'S Name (7
Dave Fuller
rn
au
3. CONTRACTOR or BUILDER'S Address n
Y•
Jerome Ave .
S . Glens Falls , N . Y .
4. ARCHITECT'S Name
C
O
r't
S. ARCHITECT'S Address N
W
ry
0
0
&. TYPE of Construction — (Please indicate by X)
[ Wood Frame ( ) Masonry ( l Steel ( )
H
7. PLANS and Specifications
w
n
No. 24 ' x 76 ' per plot plan , specifications and application including ra
septic system, attached two-car garage .
S. Proposed Use 1
One-Family Dwelling S°
6
Y•
$ 5 . 00 CIO 88 c
$ 164 , 00 PERMIT FEE PAID - THIS PERMIT EXPIRES February 1 , 19 d
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the iD
town of Queensbury before the expiration date.)
iJ
M•
30th July 87
19 OQ
Dated at the Town of Queensbury this y Day of
B 2
SIGNED Y 0 / 4�z " for the Town of Queensbury
Building and Zoning Inspector
/scsy' / - TOVVN OF
:ri il=�i4 3c�
P t; TO BE COMPLETE]] BY BLDG . DEP T .
�] Application No .
�Jnwn a �rteen urt� Permit Issued - 19 JULFt
iCft�
BUILDING and ZONING DEPARTMENT Permit Expires 19 U 9 98T
Bay and Haviland Road, R. D. 1 Box 98 Zoning Designation
Queensbury, New York 12801 Variance No . BUILDING 8c Ct. ,v- - *Ef'I'
Site Plan Review No . 17 _ /S"Yr 4W
1Vq 7 !' d 0
y� Approve y : .eldr Cd '
# J APPLICATION FOR Ga lyd �
PUILDING AND ZONING PERMIT I
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 .
---__ry—L�—f --
----------- ..............
The owner of ---of this property is : - _ !
P . O. Address r 7( IIOro Tel . f�e
Property Location : ille jr7/'QCe Zo I" c 6 �zC. � 'z7 Tax Map No ,Irc�� f
Street number or building tumbe,/r� 1 -7
Subdivision name ( if applicable) e 40j L'' 0SC
THE PERS^ RESPONSI LE FOR SUPERVISION OF WORK AS REGARDS 'BUILDING CODES IS :
Name r P . O. Address Tel . No . r�.
Name of builder (/ee�/F'r Address rP1� '�f' �uf Tel • %/ ✓3CJ
Name of plumber,�+1 "Crrrr t" G _ Address /� J r� �rcA Ze Tel 4
Name of mason I_,; cicrr Address nN rt Tel . � -0 d�
NATURE OF PROPOSED WDRK : 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
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 .
COMPLETE INFORMATION REQUIRED BELOW .
Size of propert ft X ft _
Existing building ( s) S ' ze ft X ft _
PROPOSED BUILDING AND USE : f„ 1VO/2
Y Existing building ( s ) Use
Size of new ructure ft X t
oundation-pie /slab/crawl/partial/full Proposed building , distance from property line
(circle one)
No . of stories (habitable spc x Front yardQ ft Rear yard
: ft
Height ( grade to ridge ) x Side yards �y ft and 3 7 ft
£t ' if on corner , setback from side street ft
If residential , no . of families-�r---
No . of rooms ( excluding baths ) / OCCUPANCY INFORMATION
No . of bedrooms
PRIMARY BUILDING -
No . of bathrooms 5E ko� _Kpne family dwelling
Primary heating system e�c Two family dwelling
Type of fuel 454/- Multiple dwelling / Number of units
No . of fireplaces to be installed * impermanent occupancy
Will a wood stove be installed? IG_ � Transient occupancy
Central Air conditioning? ze - --
�. 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
Ca e d Cottage Other " ACCESSORY ]BUILDING-
Ca Row Town House * Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * Attached garage/one car/ wo car D car
* * * * * * * * * * * * _Private storage building
ESTIMATED MARKET VALUE OF ,Other - ^Yi e-
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 , I
wood frame , fire safe , etc .
Will any second-hand or ungra e lumber be used? If so , for what ?
e
Foundation wall material Aow or e e Thickness
Depth of foundation belowrade (to bot �f footing )
Will there be a cellar? e sated or unheated? Floor sq. footage X 3 ' sq ft
Will there be a basemen ? Will any portion be used as ]Living space? 0
( If so, what port ' sq. ft , - - Type of use? -
Type of roof - sloi
d flat shed/other Material of of S S
Size , wood. studs-„ _"X V spacing �"o , c . length ft .
Joists ( floor beams ) 1st . floor �" X__-�/19 spacing_f�"o . c , span-ft .
joists ( floor beams ) 2nd . floor "X_ �(��`" spacing_ / span..Zol� ft .
Overlays (ceiling b ams ) "X DI spacing "o . c . span ft .
s.
Roof rafter Tr �� spacing Ayo . c . span_ ft .
Roof trusses (pre-engineer. ) spacing O . C ." span ft .
Exterior wall finish � r �� Of what mat erial?
Interior wall finish -
- b
If a garage is to be attached , . scribe materials to be used for FIRE SEPARATION :
Is there to be an opening between garage and dwelling? r/ fib C If so will a Fire-rated
door , enclosure , and self-closing device he provided?
Will a flue-lined chimney be installed? 6:.S Height above roof ft .
Depth of chimney foundation below rade £t .
Depth of fireplace hearth_-_3 ft , Z in .
Water supply - unicipal r private well
SEPTIC SYSTEM _ nce from ANY private well { including adjoining properties ft ,
(A separate application is necessary for any repair or new installation of septic system)
Town of R F F I D R V I T STATE OF NEW YORK
eensbury
Warren County off Warren
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 speci led or t , and that such work is
authorized by the owner . --
SWORN TO BEFORE ME THIS Signature _-- _ -__ _ --------- -------------
'�wI]er , wne)c ' agent , arcnizect , contractor
day of 19 /
Notary Public , Warren County , N . Y .
it
SPECIAL CONDITIONS OF THE PERMIT :
By-------..........----------------_ __--
• TOWN of QUEENSI3011Y
y
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 areaI� �1'CJ cS /rr 1
2 . Type of heat I�62a � aa L A� C loaow
3 . Is the building mechanically cooled ? /11L7
4 . Percentage of area of windows and doors
A . Over 16 % Only
1 . Ua 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 ?
340 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
Under 16 % Only
lot Revalue of roof and floors exposed -to ambient conditions _
2 . R value of exterior walls
3 . R value of glazed area.
4 . R value of doors - - /YrQ'
value of floors over unheated spaces
60 R value of slab edge insulation - unheated slab � N�
7 . R value of slab insulation - heated slab /P
8 . R value of heated basement/ cellar walls ( above grade )
9 . R value of heated basement /cellar walls ( below grade ) MA
10 . Type of insulation SS �" A Dort. n.
Co Controls
1 . Thermostat maximum heat setting $Qs
n . Duct systems
1 . Is duct system installed in unheated spaces ? YES
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 ,V#Pj6
F . Service Water Heating o
1 . Performance efficiency / 3 res
Temporature control setting mdxi. muM !& '
�G . For Swimming Pool Only
1 . Maximum heating
Telephon,% No . � f
( a`F3plic is signature )
t
1
APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE Z / 97
LOCATION OF PROPERTY FOR INSTALLATIONlCX15r+'e " ► tQ/
Owner's Name: _ r7wr 61 r Telephone:
Address: _ ('fir � ifhlo 04 4 g C..?� r
Installer's Name: "' �f} �11Q/`t Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) Q er
Topography: circle one: Flat Rolling Steep Slope % of slope _
Soil Nature: circle one: Loam. Clay Other / Depth: ___ _ feet
Ok
Ground Water: At what depth? _VA feet
Bedrock or Impervious Material: At what depth? _ /V /4 feet
Percolation test: circle one: Cnot :re7quiredequired / rate min, inch.
Domestic water supply: circle one:(:
ne: Municipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM: eptic Tank gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of / Size each >�� €eet by feet
Size of stone to be used # �2 / 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 24 hours before start
of construction and shall include a plot plan showing:
1 . ) the proposed location of the system
Z.) 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, tile fields and/or drywells
B, 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 Sew a Ordiinn"Ce.
Signature of responsible person:
Date: �L5
Town of Queensbury
Building and code Department
Bay at Haviland Road
Queensbury, New York 1Z801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE
TOWN OF +QUEENSBURY
BUILDING AND CODES DEPARTMENT
6:)A
BAY & HAVST�AND GADS
QUEENSBURY, NEW YORK 1280k
TELEPHONE (5I8 792-5832
BUI ING INSPEC TOR ' �REPORT
�REQUED
ES ORPECTION RECEI
NAME '
LOCATIO s
DATE T # ,�•'�, L
APPROVED
YES NO
FOOTING/PIE
MONOLITHIC PGYR FORMS
FOUNDATION/D -PROOFING,
BACKFILL APP AL
ROUGH PLUMBIN
FRAMING
E 'C XCAL RO H-IN
NSULATSON:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTOO ✓
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE /S PS
STAIRS—CLEARANC & RAILS
PLUMBING FIX! / LIEF VALVE
INTERIOR TRIM/P CY DOORS
FINISHED FLOORS
GARAGE FIREPROOF G
DOOR CLOSERS)
SMOKE DETECTORS
FINAL ELECTRICAL I ECTION _
FINAL APPROVAL OF O STRUCTION
OK TO ISSUE C/o OR C C
A SIGNED CERTIF2 E F OCCUPANCY MUST BE
OBTAINED FROM THE UI I1VG DEPARTMENT BEFORE
THESE PREMISES AR OCC PIED.
REMARKS': JL
6L�
f r1
ARR3: VE Lr
DEPART
INSPECTOR
c a
r BUILDING and ,ZONING DEPARTMENT
L4 Bay and Haviland Road, R+ D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME _ w .Flr
LOCATION 0 �
DATE 1'� f j� PERMIT NO. :/�-
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - O
Percolation to - Min/Inch
TYPE of SYSTEM:
Absorption field total
Length of each
Depth o enches
of gravel_
SEEPAGE PITS-4 a of)
Size- —'Aft. X ft
Gravel size
PIPING : Size Type
Bldgm to tank
Tank to dirt _ box
Dist . box to field
Openings sealed? YE NO Partial
LOCATION/SFEPARAT ONS :
Foundation to t k (� ft:}—
Foundation to sorption. _lift .
Absorption to of line f
Separation of its fa 06c`
LOCATION of S STEM ON PROPS (aisle one)
rant - Rear - Left side - Rx ht side
CtPML
INTS9
i
SYSTEM USE APPROVED YES NO
Building In pe or
01/86 and vl
�`� �../nwrr o ueerasi�ur
4
UILDONG and ZONING DEPARTMENT
ay and Havi land Road, R. D. 1 Box 98
Oueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME OV
LOCAT I ON
Datek � / Permit No .
F' APPROVED - 'YES NO
Footing/Pier Farms
Foundation
Waterproofing
Backfitl
&ell ram..ng
Roofing
Siding
sonry Veneer
ugh Pltambing + d l t
Relief Valves
Ext . Porches
Finished Floors
Interior Trim
Stairs & Railing "
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 tad-vl
UILDING and ZONING DEPARTMENT
�
ay .and Haviland Road, R. D. 1 Sox 98
r`
Queensbury. New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
IaKI
L7ate�/ , ._ Permit NO —
* * * * * *
✓ APPROVED - *
oting/pier Farms APPROVED NO
Eackfill
oundation
aterproofing
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 ELE RICAL INSPECTION
DRIVEWAY PROVAL -
Final Su ding Survey
Next schedules! ins'Pection (call when ready)
Remarks-
4'"C./ �o
Building Inspector
6/86 and-vl
RUILD# NG and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury. New York 12801
BUILDING INSPECTOR ' S REPORT
NAMEa '
LOCATION
-7'Feqc. G--
ate Permit No . % r
APPROVED - NO
L. Moting/Pier Forms
Foundation
Waterproofing
8ackfill
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 . Fireproofi
Door Closers
Smoke detect
Chimney
INSULATION
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready )
Rernarks-
A0
Building Inspector
6/86 and-vl
THE NEW YORK BOARD OF FIRE UNDERWRITERSlp le-
BUREAU OF ELECTRICITY �
.Tl 41 STATE STREET. ALBANY. NEW YORK 12207 }
Date `Larch 1 . 1 `j68 RPPlication Yo. an file A 7 L 9 FJy ►AJ
[w � j
THIS CEERTIFIES THAT 0 `' 1 469/d6
only the electrical egesipnsent as described bslaso amd imtraehsced by the applieamt named sus she above appfice[ion mTsmaber in [ pna l
he mieee o S
srxc r �ie:xsy Asti , I1 �3i icic�veZ k0ad LoL 39 , f4u e:t burJ r N.y
in the ollowia location; Q 2nd Ft. Section 1 dock Lot s2 n
f Rl ❑�Boaement C lot FY. Ou to icl
was examined on 4I r u l and found to be in compliance with the requirements of this Board. M
SE
FIXTURE OUTLETSTACUIS SWITCHES RxTi1RE5 RANGES COOKING PECKS OVENS &SH WASHEItS EXHAUST FANS
INC',MhItlt3GtNT FLtJO[[SCpNT AMT. K. W. AMT. K_ W. AMT, K.W. AMR. K. W. AMT, M. P.
a
p1IYER5 FURNACE MOTORS Re
FUTURE APPUANCE FE DIWS SPECIAL REC'hT TUAE CLOCKS n&y UNIT HEATERS A"ATI 3UTUFT pyyll
MEAS
AMT. K. W. di M. P, GAS M, P. AMT. NO. A- W. G. AT. AMP. AMT. AAVS. TRANS- AMT. M, P. SYSTERAS AMT. WATTS
{{ NO. OF PRET
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SERVICE DISWFMIER:T NO, ER S E R VhNET C E
AMP. AMn. I'mE 1' I r sW I JV 3w a Ar aW s s +IW - ycoNo. of cc Como. MI{tG oF'rWw cEe) No. OF NturRALs W..
NEUTRAL
OTHER APPARATUS.
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G:scy Ss rat i
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' 1 ! iirtGkover% P . O . Box 851
BRANCH MANAGER
le
This certificate must not be altered in any mannerr return to the office of the Board if incorrect. Inspectors nmy be identified by their credemiak-
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE T NOT BE ALTERED IN ANY MANNER.
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