1987-657 BUILDING PERMIT
TOWN OF QUEENSBURY �
No. 87-657
WARREN COUNTY, NEW YORK o
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PERMISSION is hereby granted to Kathryn L . Barlow �
91 Lot
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OWNER of property located at Dix Ave . Street, Road or Ave. .�
in the Town of Ousensbury, To Construct or place a Alteration - New Roof
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 185 Mott Road
Gansevoort , N . Ya 12831
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2. CONTRACTOR or BUI LDER'S Name
Robert Vandecar r
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3. CONTRACTOR or BUILDER "& Address ib
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RD Guru Springs Road E
Wilton , N . Y .
d. ARCHITECT'S Name
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S. ARCHITECT^S Address r+
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B. TYPE of Construction — (Please indicate by X) X
I I Wood Frame I ) Masonry I I Steal I I
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7. PLANS and Specifications
No. Pitched roof over existing flat roof to commercial building .
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8. Proposed Use m
NxXxxonk New Roof H
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$ 15 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 1 , 19 88 :14
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.) 0
Dated at the Town of Queensbury thIss 29th Day of('� Sept • 1987
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
TO BE COMPLETED BY BLDG . DEPT . i ('3WNI U
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cc�-� ■■ Application No . � lC,
�otvn oeseen36ure� Permit Issued 19 �� U
BUILDING and ZONING DEPARTMENT Permit Expires 19 SEP 25 OV7
Bay and Haviland Road, R. D. 1 Box 98 Zoning Designation
Queensbury, New York 12801 Variance No . DUI ; i . .E ;°_F' T •
w Site Plan Review No . /&O�-
Approved by : �le e
APPLICATION FOR /
BUILDING AND ZONING PERMIT AO 0
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 , 4nd such
special conditions as may be indicated on the Permit ..��. r --' �x�/p✓/'
------------------------------------------------- -- �------_____-______ `
The owner of this property is . / /`} IYf } �U .�G/'g/e"ad G - ----
P . O . Address I fd G'J f �/?� �177+,Lai C7C �� , �Aj Jr .� a/[ �/ Tel . - -
Property Location :_ f� Z� 1� ' �x /F I 11:'� r� Gt G Tax Map No . f /
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 Address Tel '
Name of plumber Address 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 ,
_Alteration to a building * showing clearly and distinctly all buildings ,
(no change to exterior dimensions) * whether existing or .proposed and indicate all
r/ Other work. (describe) �e �QZJ� set-back dimensions from property lines . Give
street and number or lot number and indicate
'� whether interior or corner lot . Show location
FOR DEMOLITION RMIT , ST TE SIZE
AND * of water supply and location and configuration
LOCATION OF STRUCTURES AFFECTED . * of septic disposal area .
*
* COMPLETE INFORMATION REQUIRED BELOW .
Size of property ft X ft .
Existing buildings) Size ft X ft *
*
PROPOSED BUILDING AND USE : * Existing building ( s ) 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) ft and ft
Side yards
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 One family dwelling
Primaryheating system
t3 y �, ..Two family dwelling
Type of fuel * Multiple dwelling / Number of units
No . of fireplaces to be installed * Permanent occupancy
Will a wood stove be installed? Transient occupancy
Central Air conditioning?
* 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 Sun aloes
Cape Cod Cottage he ACCESSORY BUILDING-
Colonial Row Town House '� Detached. garage/one car/ two car/ car
{ CIRCLE ONE PLEASE ) * Attached garage/one car/ two car/ car
* * * * * * * r * w * * * * * Private storage building
ESTIMATED MARKET VALUE OF * '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 material Thickness
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 . use?
Type of roof - sloped/flat/shed/othea r aterial of rao
Size , wood studs �. " X spacin ;eO . c
length � r _fto
Joists ( floor beams ) Ist . floor " X " spacing "o . c , span ft .
Joists ( floor beams ) 2nd . floor "X to spacing "o . c . span ft .
Overlays ( ceiling beams ) "X of spacing "o . c . span ft .
Roof rafters ?_-$I 1 ]_ " spacing �( o . c . span �roo� - .,'. g, t Cw &' C.
Roof trusses (pre-engineered) spacing "o . co span ft .
Exterior wall finish - -- J Of what material? Wr"
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 fto
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 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 _ _ _ _
Owner .
+ day of 19
Notary Public , Warren County , N . y .
* r * * * * r * * * * * * r y r * * r x x x * * * * * It et it
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SPECIAL CONDITIONS OF THE PERMIT :
By---------------------------------------
TOWN Op QUEENS]3URY
BUILDING AND CODES 'DEPARTMENT
BAY & HAVILANU ROADS
QUEENSB'URYr NEW YORX 128ok
TELE`pH04VE (518) 792~5832
BUrLDING INSPECTOR ' S REPORT
REQUEST FOR XNSPECTION RECEIVED
NAME
ZCcATION `7 3 c ?�
DATE /
' c5cs F
APPROVED
P'OOT21VGlpl- S KES NO
MONOLXTHXC POUR .FORMS
FOUNDATION/DAMP-PROOF2NG
BAC"'I APPROVAL
ROUGH PZUMBXNG
F'RAMXNG
ELECTRICAL R[7�VGH-IN
INSULAT'IONr
FOUNDATION
FLOORS,
WALzs
CSXLTNG
FXNAL INSPECT*XON:
CHIMNEY HEXGHT
ROOPXNG
SSD.I'NG
EX2'ERNA L PO?2CHE'S/.STEPS
STATRS-CZEARANCE & RAMS
PLUMB2-JVG FXXTURESfRELI
XN EF LVoTERXOR 2RtM/PRIVACY asp 5
F-rNXS"BD F y R$
GARAGE FIREPROOF XNG
DOOR CLOSER (S) -
SMOKE DETE'CTL:ORS
FINAL ELECTRICAL INSPECT
FXNAL ` ppJ?OVAL OF
ox To zssu� c/'� o�coNSTR N
CTXaN
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A S-I CERTXPXCATE O$ OCCUPANCY MUST
OBTAINED PROM THE BV-T�XNG DEPARTMENT B E
THESE PREMISES ARE
OCCUPXEDI RE
REMARKS:
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XNSPECTpR
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