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1987-639 y ` ~ YI • ` I CATE OF I TOWN OF +QUEENSSURY i WARREN COUNTY, NEW YORK 1 i Date March 3 , 19 19 83 I 1 0 CA 87 -639 This is to certify that virnxlc 'requested to be done as rhown by Permit Na. has been completed. I G'�ie•-Family L�wel2. i�-�� i This structure may be occupied as a Locatson .ZW Mcnitray Rand Ruth Kouba C hvner By Order Town Board j 7oWN OF QUEENSBURY i i Building & Zoning Inspector i I Vr BUILDING PERMIT TOWN OF +QUEENSBURY � No. 87-639 0' WARREN COUNTYr NEW YORK ` Muth Kouba PERMISSION is hereby granted to N 1 _ w 25 Montray Rd a Street, Road or Ave. an OWNER of property located at 4 in the Town of Queensbury, To Construct or place a Move 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 Queensbury Building and Zoning Ordinance. r2. :C:O:N:TRACTOR R'S Address is 35 Sweet Road c CT Glens Falls , N . Y . 12801 a a or BUILDERS Name Larmon W 3. CONTRACTOR or BUILDER'S Address. Schuylerville , No Y . N 431 4. ARCHITECT'S NaffW O r M r{ O'+ `C 5. ARCHITECT'S Address 6. TYPE of Construction — (Please indicate by X) i ) Wand Frame t ) Masonry ( ) Steel ( I a d 7. PLANS and Specifications W No. 20 ' x 41 ' per plot plan , specifications , and application including septic system � a _ 8. Proposed Use Moving of one family dwelling ao m rti rf 0 EI $5a00 cIo April 1 , 19 $$ rt $ 10600 PERMIT FEE PAID — THIS PERMIT' EXPIRES M to (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 data.) .Se t 87 Dated at the Town of Queensbury this 22nd Day of P 79 SIGNED BY for the Town of Queensbury Bui ding d zoning Inspector TO BE COMPLETED BY SLUG . DEFT . Cj+Jdr y 4+f "-1 + sw: Km_ ti 3:• ' / Application No * j r L pu/►Z p �L�E'@►t� b[tMR�f Permit Issued 19 lJ BUILDING and ZONING DEPARTMENT Permit Expires 19 Bay and Haviiand Road, R. D. 1 Sax 98 Zoning Designation� � "i2 - SEP 221987 Clueensbury, New York 128U1 Variance No , Site P1 e ' ew N . ApprO U l Q 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 conditions as may be indicated on the Permit . ___________ The owner of this property is : Tel . fS P . O . Address � � r Tax Map Now ��' / � /� Property Location : t number Street number or uilding Subdivision name ( if applicable) THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : Name P . O . Address Tel . No . u� i ,. -- 'r� S.sSr. � �\'_1 ,J. /, r fir. yl Name of ���-ram Address �-- Tel . Name of plumber Addressy Tel . Name of mason 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 ' * showing clearly and distinctly all buildings , Alteration to a building � (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 .r- whether interior or corner lot , Show location VOR 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 100 ft X l �f' r (+ 6_ft _ buildings ) Size 2<C3 ft X ft . PROPOSED BUILDING AND USE : Existing buildings ) Use Size of new structure ft X f property line Foundation-pier/slab/crawl/partial full * Proposed building , distance from prop Y * .i ft (circle one) Front yard 7J 5 ft Rear yard No . of stories (habitable space) * Side yards �ft and 39 ft Height ( grade to ridge ) i.„ ft ' if on corner : setback from side street ft If residential , no . of families J * OCCUPANCY INFORMATION Now of rooms ( excluding baths ) No . of bedrooms cl- * PRIMARY BUILDING - No . of bathrooms * ✓ne family dwelling primaryheating system �- Two family dwelling Type, of fuel e"'I`, C � Multiple dwelling / Number of units No . of fireplaces to be installed * permanent occupancy Will a wood stove be installed? * Transient occupancy Central Air conditioning? `�n_ih * Business BUILDING STYLE, PRIMARY STRUCTURE Industrial Other Ranch Contemporary Log cabin If addition , what will use be? Raised ranch Mansion Duplex * Split level Old stvle Bungalow * ACCESSORY BUILDING- Cape Cod Cottage Other car Town House Detached garage/one car/ two car/ Colonial Row * two car/ calm ( CIRCLE ONE PLEASE ) Attached garage/one car/ _Private storage building ESTIMATED MARKET 'VALUE A�mmmmmmmOFF � Other CONSTRUCTION $ C' 0ae)0 ?f x - - 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 . Will any second-hand or ungraded lumber be used? If so , for what ? Foundation wall material Thickness e Thick CJ Depth of foundation below grade (to bottom of footing ) „ Will there be a cellar?Heated or unheated? - '� v _.� Floor sq. footage Ih j �, sq ft Will there be a basement . , t- 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 ti ' ;I c v Size , wood studs FIX PIspacing "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 a _ c . span ft , Roof trusses (pre- engine ed) spacing Is span ft . Exterior wall finish Of what material? [ c y Interior wall finish w 6 C ,• 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? kkAAT Height above: roof : . ft . Depth of chimney foundation below grade y _ft . � - { Depth of fireplace hearth -� t�n _ fT + / Water supply - Municipal or private well [ r : �w1 ' • ,s' srtti.t:, SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties ft . (A separate application is necessary for any repair or new .installation of se c 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 not , and that such work is authorized by the owner , SWORN TO BEFORE ME THIS Signature _ ---- clay of 19 _Owner , owner ' s agent , arcnirect , contractor - Notary Public , Warren county, N . Y . * * * * * * * * * . * * * * * * * IF * * * * * * * * * * * * * * * * * * Ar SPECIAL CONDITIONS OF THE PERMIT ; i By • 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 : , l , Gross floor area V gig 2 , Type of heat CLx 3 . Is the building mechanically cooled ? 4 * percentage of area of windows and doors A . Over 16 % only 10 U value of gross area of walls , roof / ceiling and floors exposed to ambient conditions 2 , Floor over heated spaces YES NO N a , Are foundation walls insulated ? YES :- 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 fN0 a . R value of insulation 50 Type of insulation B . Under 16 % Only FaR ue of roof and floors exposed to ambient conditions _ x1 ? .T-- ; I �oue of exterior walls I� 1 ue of glazed area ue of doors 5 . R value of floors over unheated spaces 60 R value of slab edge insulation - unheated slab 7 , R value of slab insulation - heated slab _ $ . R value of heated basement/ cellar walls ( above grade ) 7t 91 R value of heated basement / cellar walls ( below grade ) 10 Type of insulation h err G ( ,A C , Controls 1 . Thermostat maximum heat setting D . 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 agent pipe 2 , R value of pipe Insulation F , Service Water Heating 1 . Performance efficiency 2 . Temperature control setting maximum G . For Swimming Fool Onlyv_^ 1 . Maximum heating Telephone No . ' -'° l .v[ ` �.•f rc`; ( applicant ' s signature ) APPLICATION FOR. SEPTIC DISPOSAL PERMIT DATE / 4;37-7 LOCATION OF PROPERTY FOR INSTALLATION Owner's Name: „/� 1. . -c� . Telephone: Address: Installer's Name: I � Telephoner Number of bedrooms (residential only) ___ Total daily flow (compute @ 150 gal per bedroom) Topography: circle one: WIaRoiling Steep Slope `"b 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: rnoflrequirerequired / rate min. inch. Domestic water supply: circle one: Municip Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption feet PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1 ,000 ,gal.) TILE FIELD: Each Trench feet j Total system length ^,/ Z( feet SEEPAGE PIT(S) : Number of / Size each feet by feet Size of stone to be used # / � {f / Depth or Thickness � y � feet IMPORTANT .,.Please...LIST NEW EQUIPMENT TO BE INSTALLED (over) Section Il 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 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 B. No system shall be covered before inspection and approval by the ?wilding 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. Co 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. 1 have read the regulations above and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Elimposal Ordinance. Signature of responsible person: Date: Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . HOME OF NATURAL BEAUTY A GOOD PLACE To LIVE r_ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU CIF ELECTRICITY NLG dt STATE STREET. ALBANY. NEW YCRK 12207 Date APRIL 22 , 1938 Application No. onfife 0 2 7 364 / 87 A 'I THAS CERTIFIES THAT away the olectrical egcsiRment an describes) below and introducedby she applicant named on the shows apVAUvOtion no'mber in the premises of RUTH K.OUBA , KOIr'TRAY ROADi GLE 14S FALLS , NEW YCiRK in the following Location; ❑JBasement 0 1st Fa. ❑ Bnd Fl. OUTSIDE section 70 Block 2 Lot 3I. was examined on 3,/ 9 /b' fi and forswd to be in compliance with the r"uirements of this Board. FIXTURE ACLES SWITCHES FIXTURES RANGES 000I[Ittt�T DECKS OVEFIS dSH WASHERS EXFIAUST VANS OUTIETS PHICEPTINCANDESCENT F{UOKESCENT YA AMT. K. W. DRYERS FURNACE MOTORS FUTURE /IFFLIAhMCE FEEDERS SPECIAL REC'FT TIRRE CU7CISS E� UNIT HEATERS MNETI o1fTEET DIMMERS AMT_ K. W. Olt H. V. GAS H. P. AAA7. NO. A. w. G. AMT. AA4P. A1AT. AMPS- TRANS_ AAu_ rl, *. SYSTEMS AMT. wwTTS Nd. QF FEET 1 IN i r er fir1Ci SERVICE DISCONNECT ND. OF S is Y I C E AI AMP. TYPE lic"P. 1 X 2w 1 0 SW 9 AF 3w t/ Aw NO. CC-,C{1ND. OF cc. CgND. NO. OP HI.IEG CJF M itG NO_ CK WEUTRAIS OF ►EUTRM 1 15 Q Cks 1 x k 2 / OTHER APPARATUS: + " INSPEMON FEE PAW .f5 :.i1:EET H.OA1l �► GLENS %A.LT S , NE-94 YORK 12801 239 BRANCH MANAGER Per This certificate must not be akereci in any manner, return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN AI MANNER. �* M1DOLE, DEPiA1R'�'�II "T• NUPE"1U11! A EN Y, ING. National Headquarters Ow Haddon Ave.. Collingswood, NA 08108 Date; /6f /P. City, Town or Township lodoey't L County 0/, )r V .,eemL Location/Address MA6 o G< JA Located in Jh at Arm - Please Attach Directions) Pale # Owner Permit # Occupied,As ur +p vc..I 4 t C' Buildi NewC Oi Occupant ' 11Work Area in Bu i I di no IFloor # ) : for: WiringE2., Service or: Read far ! eeitian: Fee Remitted - $ Cash Check W.10. Make lba able To: i1A.D. 1.A. Number of Rough Wirinj Outlets Elect. Heat Switches Lighting Amp. Servife 5urfEandit! Unit Dishwasher Range Receptacles Water Heater _Air r Dryer pump Number of Fix ur 'Oven Gar D- al Wiring and Contrbis for - Burner Arilp. Receptacles rctional H.P. Vent Fans Other Equipment' MOTORS H_P. 1/ 1{1 1/10 1/a 1 1 1/4 1/3 1/2 3/4 1 1+/x 2 3 5 kz 1e) 15 20 25 3p rr 40 5O, 75 1V0 Mark Number of Each Sire r_. . Applicant's Signature 'F ICBnS6 # Pe # T/A Utility: N ME (OFFICE CATIONS Applic t Address: !j (City) (State) A41 oe 6i ,f-Cy r Service Request# ." Phone # Electrician:. DATE RECEIVED: I DATE INSPECTED/0 Correct Location : Same as Above or; Red Notice Label [] Rough Wiri ;Eq ets rface it OveR Switches an Gar Disposal Receptacles Water Heater Dishwasher #,--` Fixtures ., Air o ibn Dr er Amp. Servic ment - P Burner, iring to trols for I ece tacle Amp. Servicuctors Pum Vent Fans MOTORSH,P, 1/24P 1/8 1/et 4 1/3 1/2 3/4 1 1 life 2 3 7% 10 15 20 25 30 40 50 75 1[fU Mark Number .� of Each Size ` elect. Heat 5w 7 x OO 125e 1S 000 2250 ;SOo 27a0 3ooa E] RW Progress: Inc. 0 LKD O Contractor FT Violation: Work Comp. F Inc. [:I Owner CASH F1 L/A ee CHIC # ED IPA ue Mil # Mun icipa$.. . . I N V # Ili��lrr Daze: Other Slde .E] ' ' Utility Applicant Owner. Cut in rd 0 Temp # Date f , l �] Final #r Date fNSP C S SIGN-A°i UREs'� APPLICATION FORM "0. 256 EL 1I'/84 - - - - - - ��.•J/ ..,_lo u/n o/ Qu ee n j "r y BUILDING and ZONING DEPARTMENT Bay and Hauiland Road, R. D. 1 Box 98 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LIQ? — /� LOCATION 4L DATE IC a �T /5 PERMIT NO . SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: 1 Absorpti. n field , total length Z Length o each trench Depth of enches ' Size of gr vel SEEPAGE PIT 4Number of) Size- ft x _ ft_ Gravel size PIPING : ize Type Bldg . to tank Tank to dist . box Dist. box to field t openings sealed? NO Partial I.00ATICIN/SEPARAT ONS Foundation to t k ft. Foundation to sorption ft. Absorption to lot line ft . Separation o pits ft, LOCATION of YSTEM ON PR.OPE (circle one) Front - Rea - Left side - Rx ht side - CC HMENTS : /^ /t to CIS LF" '+t`-T , ! L aA4 f Al otro Tb T-c�ro 173 � csT 13� 1e p� �o c._ F 'C'� �E F==rl���'► . 1� f 1�' N T'C7 cfi f+aV rk h� d .�` AAD SYSTEM USE APPROVED Y Bu 1 ing In or 01/86 and vl ]] 7 1 c / i V _Down O/ QUCe473tate ► y BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 'I Box 98 (� t Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION DATEZ PERMIT NO , C!/ SOIL TYPE - and - Loam - Clay - Percolation Test Required? YE Percolation rate - Min/Inch TYPE of SYSTEM : Absorption field , total ength_�r `1"� Length of each trench Depth of trenches Size of gra el 4Ntu SEEPAGE PIT nber f) _ Size- ft X _ ft. Gravel size PIPING : Size Type Bldg . to tank �✓�- - Tank to dist . x Dist_ box to f ' ld/pit Openings wale YES WO martial — LOCATION/SEP TI S : Foundation t tank ftM-4j/K:--- Foundation absorp ' on ft►-t7jL Absorption o lot line --Wft4 Separation f pits ft . LOCATION OF SYSTEM CN3 PRO RTY (circle one ) Front - Re -- Left side - ght side - CCMMErNTiS : W-Z Jai C 1 4 t L I,rw ! .a(.' SP.r —c 'fir 0.4/ SYSTEM USE APPROVED YES` NU Building Inspe or 01/86 and V1 o/ Q"eenshury gUNLDING and ZONING DEPARTMENT Bay and Maviland Road, R.D. 1 Box 98 ueensbury, New York 12801 BUILDING INSPECTOR " S REPORT NAKE� 1 f1 +F LOCATION Bate / Permit No o fp ✓ Y APPROVED - YES NO L,,r!'ooting/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- . Id Buildin nspector 6/86 and-vl BUILDING DEPT. COPY OF APPLICATION FORM 46-ELo NEW YORK BOARD OF FIRE UNDERWRITERS. r FILE THIS COPY WITH BUILDING DEPT, WHEN REQUIRED. TEMIE lI gwrE CITY YQR VILLAGE � '+- OUNTY F'.�+I'-s.... STREET AND NO. OR TOWNSHIP C ROAD AND POLE NO, BETWEEN WHAT TWO LE NO. CROSS STREETS IS PREMIS ;S.L TEOT OCCUPANTOS NAMEBUILDING OT OWNER'S NAME OCCUPANCY AND ANDA .r AbpRESS f � U TEL. SUPPLIED �rf#' � �+�,� "_�� (�;� �✓1. BY %F OM THEIR T -F+'�..v J BUILDING FR OFFICE IS NEW OLD (WORK NEW lC7f DEFECTS L�l ADDITIONAL ❑ REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS No. of Pictures a Love Lamp Recaplaclea MOTORS HEATERS CIRCUITS"off OFFICE USE Slaw, A, . .t ONLY WaH ROMOU Bwilei Pandant Bracket No. Type H.P. Water A.W..G. E*ph No. Each No' Gauge INSPECTION Ou! eke Sob y� baN Bra aswrt Ist Fl, tad Fl. ��- REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE.- DO NOT USE THIS SPACE. This application is intafidad to cower the aboire-listed 0swiptnant to 6a inypec led but if at time of i Yo++ are authpriaetl W make thr iflspectien and a naPlotion there is sound additional eOuipmens not above listed, adjust the }ea to cower the additional squipn�eml, as Pr kftd by the aPplicanl. 512E OF MgfNS FEEDERS ELECTRICSIGN TOTAL CHARACTER LAMPS WATTS OF WORK EXPOSED GAS TUBE SIGN CONCEALED TRANSFORMERS OF WORK TO BE VA STARTED COMPLETED INUMBERi (CAPACITYI SIZE OF SIGN SERVICE ENTERS OVERHEAD UNDERGROUND IL ING MAKER INSPECTION REQUESTED OF SIGN ON OR AS NEAR AS POSSIBLE NE�If ❑ AVOID DELAY BY Owl NO FULL AND ACCURATE INFORMATION. ALL SPACES OLD MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF DATE OF PRINT NAME ANDPP DR S r,. APPLICATION f/•[ APPLICANT .G'7U SIGNATURE �! OF APPLICANT STR E ET ADOR ESS .-�...] .s'" � +• (',[:t . CITY OR. TELEPHONE POST OFFICE �[ C p � '� CODE _ L62 ■III Nt APPLICABLE 46 EL (wk`v. 1/ee) A SEPARATE APPLICATION. M ST BE FILED FOR EACH SEPARATE BUILDING