1987-542 i
CER.TIFIC- rM 0, F +�'�CC�. 3I'',E�► 1'�TC�'
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YORK
I
Date ITS
� 87-542
'This is to certify that work requested to be done as shown by Permit No.
' has been completed*
j one—Fam31y Dwelling
This structure may be occupied as a
Loeation
Lot �#67 Wil.' ow Road (St. . #34 )
�iarilxx ifcxrSl±4:r
Owner
By Order Town Board
TOWN OF QUEENSBi]RY
1
Building & Zoning Inspector
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BUILDING PERMIT
TOWN OF QrUEENSBURY No. 87-542
a
WARREN COUNTY, NEW YORK '
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PERMISSION is hereby granted to Martin Mosher
rn
OWNER of property located at Lot #67 willow Rd . ( St • No . 34) Street, Road or Ave.
e Fines of Queensbury
in the Town of Oueensbury, To Construct or place a One—Family Dwelling
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 Oueensbury Building and Zoning Ordinance.
*s
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t. OWNER'S Address is FJ'
26 Sugar Pine Rd .
Queensbury , N . Y . o
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2. CONTRACTOR or BUILDERS Name
Same
3. CONTRACTOR or BUILDER'S Address ' O
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4_ ARCHITECT'S Name rn Y•
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5. ARCHITECT'S Address CD «
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6. TYPE of Construction — (Please indicate by X)
( x} Wood Frame I } Masonry i } Steel ( }
7. PLANS and Specifications
No. 28 ' x 62 ' per plot plan , specifications and application including
septic system, attached two-car garage and driveway permit . ru
S. Proposed Use r
>l�
One-Family Dwelling N
$5aOO
$ 192 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES March 1 , lg 88
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Clueensbury before the expiration date_)
Dated at the Town of Oueensbury this 18th Day of August 19 87
SIGNED BY 40 /G/...�.CTi� for the Town of Oueensbury
Building and Zoning I nspector ei
TO BE COMPLETED BY BLDG. DEPT .
�] / Application No .
� lG►Wn t? (30e'" en � hEtrR Permit Issued 19
BUILDING and .ZONING DEPARTMENT Permit Expires
Bay and Haviland Road, R. D. 1 Box 98 Zoning Designation i'i
Queensbury, New York 12801 Variance No . t AUG 13 1987
Site Plan Review No . {i
iF f Approved by : 1 BUILDLNG & CODE DEPT
q0 f APPLICATION FOR 9 ��
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 Permit .
The'owner-of`this property is : rq 2.!? T:-,;
P . O . Address Pr' L��; '
?s 1.ed�r, ! Tel "7 5R.-7 -
Property Location : )M & ?' " � Ct xt "� Z2 � 1�t-�•- �. � 0`16 'T'ax Map No .
Street number or building lot number k-c.c.+ �..Ls. t.y +'r y ✓ ��
Subdivision name ( if applicable) ti� -
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS :
Name P . O. Address Tel . No .
Name of builder. t� C , s.ad. , Address Tel .
Name of plumber _ _, Address Tel .
Name of mason �y.,, _ Address Tel .
NATURE OF PROPOSED WORK : ZONING INFORMATION :
Ve� 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 property f `7� G} ft X l 70 ft .
* Existing buildings) Size ft X ft .
PROPOSED BUILDING AND USE : Existi.ng building ( s ) Use
Size of new structur�ft X� ft
Foundation-pier/slab raw partlalT
fulL Proposed building , distance from property line
(circle one ) CA.4.<,.t � �-
r2,r. Front and ` -� ft Rear yard ?f! ft
No . of stories (habitable spaced QQ' y t` A -. -u X~ - ft and � 7 ft
* Si e yards .3 O
Height ( grade to ridge ) -3 fto If on corner , setback from side street ft
If residential , no . of families /
No . of rooms ( excluding baths ) g OCCUPANCY INFORMATION
No. of bedrooms
f z PRIMARY BUILDING -
No . of bathrooms _ ( tc * One family dwelling
Primary heating system
Type of fuelj� �� ,� n Two family dwelling
� Multiple dwelling / Number of units
No . of fireplaces to be installed r
� Permanent occupancy
Will a wood stove be installed? &4, �
� Transient occupancy
Central Air conditioning? Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Ranch Contemporary Log cabin Other
Raised ranch Mansion Duplex if addition , what will use be?
Split level Old style Bungalow
Cap_e__CQ�d Cottage Other ACCESSORY BUILDING-
r " Colonial Row Town House * Detached garage/one car/ two car/ car
{ CIRCLE ONE PLEASE ) '" Attached garage/one car/ two car/ 1 .
car
* * * * * * * * * * * * * * * _Private storage building
ESTIMATED MARKET VALUE OF t 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 .
Will any second-hand or ungraded lumber be used? If so , for what?Foundation wall wall material //Z? � � Thickness
Depth of foundation below rade (to bottom of footing ) 6 ',p
Will there be a cellar?Heated or unheated?-) Floor sq. footage '* ?OeFo 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 - sloLe flat/shed/other Material of roof
Size , wood studs "X spacing, �'"o _ c , length ep £t , "
Joists ( floor beams ) 1st . floorZoo
-ti "X .IA7 or spacing ,I "o , c , span / f ft .
Joists ( floor beams ) 2nd . floor �7 '"X / Gr r 0spacing "o . c . span. ft . G '
overlays (ceiling beams ) fttt a. .."'X " spacing a 4{ "o , c . span ft ,
Roof rafters,-,;r "X Is spacing .2 ' o . c , span ft .
Roof trusses (pre-engineered) spacing " o . c . span ft ,
Exterior wall finish 1/t ,x do 0` 4 ._ Of what material?
Interior wall finish //4.
If a garage
age is to be attached , describe materials to be used for FIRE SEPARATION -
Is there to be a we ing I so willa lre-ra e
enclosure , and self-closing device be provided?
1 a flue-lined chimneyt
Depth of chimney foundation below grade t7 "' ft,
Depth of fireplace hearth ft , in .
Water supply - �,„ , ; r � 1or private well
SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties Jf�ft .
(A separate application is necessary for any repair or new installation of septic system)
Town of Queensbury
County of Warren R F F I D R }V'` I T STATE OF NEW YORK
I swear thatt 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 __�'�e�✓___
Uwner , Owner ' s agent . arcriiuect�, contractor
day of d19
Notary Public , Warren County , N , Y ,
* * * * * * * * * * * * * * * * * * * * * * * * * * * * Or * * * * * *
SPECIAL CONDITIONS OF THE PERMIT :
r_r-i.ti*S "S c3 .�r�Krr.� 5 LA40 W vc :> 2 td/5 � - +C&)5t A)
TOWN OF QUEENSbURY
WARREN CGUNTY , NFW YORK
Application far : BUILDING PERMIT IN COMF' T. IANCE WITH THE NEW YORK
STATE ENERGY . CONSERVATION CODE
A permit must be obtained before beginning work .
A1l4SMXR ALL of the followings c
1 . Gross floor aria 1 - Z2 �� ?
2 . Type of heat _ �. 1 �-, lr- 3zTXYZ
3 . Is the building mechanically cogled ? [,[�
4 . Percentage of area of window* and doors ,
A . Over 1Gt Only
1 . Z7o value of gross area of walls , roof / ceiling and floors
exposed to ambient conditions
2e Floor c -,; er heated spaceg YES NO
a . Ara foundation walls insulated ? YES NO
le If YES , what is the R value ?
3 , Slab can grade YES NO
a . if YES , what is the R value of insulation around
perimeter of floor ?
4 . Is }casement heated ? YES NO
a . R value Of insulation
5e Type of insulation
Be Under 16 % Only
1 . R value 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
5 . R value of floors over heated spaces
6 . R value of slab edge insulation - unheated slab —
7 . R value of slab insulation - iteated slab _ �r
B . R value of heated } aaoment / cellar wills ( above grade ) t2- /0
9 . R values of heate (3 basement / cellar walls ( below grade ) j2-0
10 . Type of insulation �� c a =
C . Controls
1 . Thermostat maximum heat nettinv W . C�
D . Duct sxstem_s
1 . Is duct systl: m installed in unheat � d apaees7 Y1 S t: C`
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 cal ryinq agent pipe ---
2 . R value of gripe insulation
F . Service water lleat _in !i
1 . Performance efficiency -
2 . 'temperature control settinq maximum � �cQ
G . For Swimrninel Pool_ Only
1 . Maximum heating , _,Jjrm�_
Tee ], ephan � Na . -
s ( a.l; plicant s signature )
£3.ij i 0,A1
Tin "S VU Uj `,►r ,]�t2�.�k LUv f At.S vG '4
r4tu own oQ &Wy
APPLICATION FOR SEPTIC DISPOSAL PERMIT
BATE
t�' r
LOCATION OF PROPERTY FOR INSTALLATION 07
Owner's Name: Telephone:
Address: _
Installer's Name: G 2 ,� �' , � w Telephone: _!Z 199,5 -e
Number of bedrooms (residential only) _ `T T
Total daily flow ('compute @ IS 0 gal per bedroom)
Topography: circle one: Fla Roiling Steep Slope % of slope
Soil Nature: circle one: Sand Loam Clay Other / Depth: feet
Ground Water: At what depth? } feet
Bedrock or Impervious Material: At what depth? feet
Percolation test: circle one: t regtix'red 1required / rate 0 - 5' min. inch.
Domestic water supplyx circle one. Municipal Well Other 2 £.L. { -}
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption /per feet
PROPOSED SYSTEM : Septic 'Tank /F J�v 0.0 _ gal. (minimum size: 1 ,000 gal.)
TILE FIELD . Each Trench _ s feet / 'Total system length �7, .5 9 feet
SEEPAGE PIT(S) : Number of / Size each feet by feet
Size of stone to be used # / Depth or Thickness l feet
IMPORTANT
ewvPleaseo.oLIST 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.
l have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Maposal Ordinance.
Signature of responsible persona
Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-583Z
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE
BUILDING and ZONING DEPARTMENT
Bay and Havifand Road, R. D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME -
LOCATION 'err 4 '7 /`� fif_ el-4 3�
L?ate - Permit
✓ = APPROVED - 'YES NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
)CRelief Valves
TCExt . Porch
es
,XF'inished Floors
/interior Trim
A tairs & Railings
Cellar Drain Tile
Concrete Floors
A, lbg . Fixtures
tXar . Fireproofing
)Poor Closers
}tmoke Detectors
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
rIIVAL ELECTRIC L INSPECTIONRIVEWAY APPRf7 AI
Final Buildin Survey
Next schedule inspection (call wkien ready )
Remarks--
Building Inspe or
6/86 and-vl
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'�j yf nwn o Queenizury
{ �►r BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. Q. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SY TEM INSPECTION
NAME 4o14 fL�/c�.
4
LOCAT I,yON
DATEt/ Z PERMIT NO . p ��
SOIL 'TYPE - Sand - Loam - Clay
Percolation Test Required? YES - N
Percolation rate - Min/Inch
TYPE of SYSTEMW
Absorption fie d , total 1eng
Length of each ench '
Depth of trench s '
Size of graveI
SEEPAGE PITS#N er of
size- ft. X f
Gravel size
PIPING : Size TyIDe
Bldg . to tank f 41fI
Tank to disc . bo &
Dist . box to f i ld/
Openings Seale 7 E NO Partial
LOCATION/'SEP RATIONS :
Foundation o tank ft.
Foundation to absorption '. ft.
jSeparatio
bsorptio to lot line ft.
of pits
T OF SYSTEM ON PROPERTY ircle one )
r ear - Left side - Right side -
SYSTEM USE APPROVED�QE NO
Building Inspector
01/86 and vl
BUiLDfNG and ZONING DEPARTMENT
' Bay and Hauiland Road, R. D. i Box 88
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
< r
LOCATION /
L7ate-z� `' f ,7 ^ Permit No .
✓ = -
Fr>otingfPier Forms APPROVED YES NO
Foundation
waterproofing
Backfill
�aming
Roofing
Siding
M�onry Veneer -
L040ugh Plumbing
Relief valves
Ext . Porches
Finished Floors
Interior "Prim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg . Fixtures
Gar , E'ireproofin
Door Closers
Smoke Detector
Chimney
INSULATION
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection ( call when ready )
Remarks~
k3uz dIing Inspector
6ft36 and-vl
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.� wn vl �u �en36rsrt� ` 13
13UILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R. D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
.y�
NAME
LOCATION ! C � r' f11 cr Rce
Date 9 Permit No . ? 7y L5y �
✓ = APPROVED - NO
noting}Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Venee
Rough Plumbing
Relief Valves
Ext . Porches
Finished Floors
Interior Trim_
Stairs & Railin
Cellar brain Ti e - -
Concrete floor _
Plbg . Fixture
Gar . Firepro lngL.
Door Closers
Smoke Detec rs
Chimney
INSULATION
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL`_
Final Building Survey
Next scheduled inspection (call when ready
Remarks- _/f � &z, ,-el
Buildin c r
6/86 and-vl
proo
�?Owry o/ Quees� sbulrr�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. Di 1 Box 98
Queensbury, New York 12801
Bl1I LD ING INSPECTOR ' S REPORT
NAME
LOCATION
Date: /_ Permit No . /" •
// APP - Y NO
Vooting/Pier Fes
Foundation OF
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer.
Rough Plumbing
Relief Valves
Ext . Porches
Finished Flours
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg . Fixtures
Gar . Fireproo ng
Door Closers
Smoke Detec rs
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL 'ELECTRICAL INSPECTION
DRIVEWAY APPROV
Final Building Survey
Next scheduled inspection (call when ready )
Remarks-
Building Inspector
6/86 and-vl
BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED,
TEMP. 1t DATE
CITY OR -7
VILLAGE TOWNSHIP42 44e� F„4� COUNTY ,...
STREET AND NO. OR ,r 7 r
ROAD AND POLE NO a�/�� 6p / lie �[, 1r' � �"�,�,,,.,�� /�"r POLE NO
BETWEEN WHAT TWO + r
CROSSSTREETS IS .�. /,/' f
PREMISES LOCATED? h..L'7' ,,.rF'rY.�.I SECTION ',/r i BLOCK LOT /
OCCUPANT'S BUILDING
NAME OCCUPANCY �r '
OWNER'S NAME
AND ADDRESS yr) rir„ TEL. #
SUPPLIED '.L�. '
BY FROM THEIR Of FiCE
BUILDING WORK DEFECTS
IS NEW OLD ❑ IS NEW ADDITIONAL ❑ REMOVED
LIST BELOW ALL EQUIPMENT WHICH YOU NSTALLED
of NUMBER OF OUTLETS LNamp Receptacles MOTORS HEATERS CIRCUITS OFFICE USE
Loco- ONLY
Non Side Attach'[ H.P. Watts A.W.G.
Coiling Wall Racep'Is Switch Pendant Bracket No. Typo Each No. Each No. Gauge INSPECTION
Out-
sides
Slawns!
Mont
mer.t
1st Fl.
2nd Fl.
3rd Ft,
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE.
This application +s intendad to cover the above-listed equipment to be inspected but if at time of inspection thorn is found additional equipment not above listed,
you are authorized to make the inspection and adjust the fee to cover the additional equipment, as provided by the applicant.
SIZE OF ELECTRIC SIGN TOTAL
MAINS FEEDERS LAMPS WATTS
CHARACTER £%POSED GAS TUBE SIGN
OF WORK CONCEALED TRANSFORMERS OF VA
WORK TO BE iNUMBERI ICAPACITYI
STARTED COMPLETED SIZE OF SIGN
SERVICE OVERHEAD UNDERGROUND MAKER
ENTERS
BUILDING OF SIGN
INSPECTION REQUESTED
ON OR AS NEAR AS
POSSIBLE NEW � OLD
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED,
PRINT NAME AN ADDRESS
NAME OF DATE OF
APPLICANT J�
-p
STREETADDRESS / Rol. e TELEPHONE
CITY OR zip LICENSE NO.
POST OFFICE CODE WHEN APPLICABLE
46 EL (REM. 1/R5) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
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