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1989-172 y CERTIFICATE CIF COMPLI. ►.NCE TOWN OF QUEENSSURY WARREN COUNTY. NEW YORK Date, August 4 19 S9 89 - Z72 This is to certify that work requested to be done as shown by Permit No., has been completed. This structure may be occupied as a neck Location 10 a csmore Drive Owner klat thew Y r By Order Town Hoard TOWN OF QUEEr4SSURY 71 Director of Bldg. BSc Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No. WARREN COUNTY, NEW YORK 0 1 PERMISSION is hereby granted to Clark CO l Street, Road or Ave. OWNER of property located at Za Sg tttr; ye - -.0 in the Town of Queensbury, To Construct or place a 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. EARCHITECTwS ress is Same qa R or SUI LDEWS Name " Self R or BtJILQER S Address Salme *V" S NameS Address O CFI MC S. TYPE of Construction — (Please indicate by %1 �] 1 I Wood Frame I ) Masonry i Y Steel i 1 r'b C�q 7. PLANS and Specifications No- 24 ' x sp+ecificatioos , and 19 ' deck as per plot plan , application _ tt" la. Proposed Use Deck 10 . 00 c /c 416 . pp PERMIT FEE PAYS THIS PERMIT EXPIRES _ NOv ber 1 19., $9 M (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.) Day of _ .. A ril —19_$9_ Dated at the Town of C3ueensbury this h p for the Town of aueensbury SIGNED BY Building and Zoning I ctor TO BE COMPLETED BY BLDG * DEPT . LDG� cc�� Application No , (�I BURY lawn of ueen s uref Permit Issuedl �,19 BUILDING and ZONING DEPARTMENT Permit Expires 19 Bay and Haviland Road, R.D. I BOX 98 Zoning Designation8Queensbury, New York "128d1 Variance No .Site Plan Review No ,Approved y DEPT. APPLICATION FOR BUILDING AND ZONING PERMIT A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING . The undersined hereby applies for a Building Permit to do the following work which will g be done in accordance with the description , plans and specifications submitted , and such special conditions as may be indicated on the Permit . _______ __ ______ The lowner Tof this Property is : M Ci " Tel 7`(16 ` 34c'S� P . O. Address Tax Map Property Location : Street number or building lot number Subdivision name ( if applicable) P I N �-_s THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : — � -� I 1 11Tel . No . Name P . U . Address Tel . Name of builder +>u-" N12 Address Address Tel . Name of plumber Tel . Name of mason Address NATURE OF PROPOSED WRK : ZONING INFORMATION : _Construction of a new building " A PLOT PLAN MUST BE PREPARED AND SUBMITTED , _Addition to a building drawn reasonably to scale and attached hereto . Alteration to a building showing clearly and distinctly all buildings , ( ) whether existing or proposed and in no change to exterior dimensions al * set-back dimensions from property lines . Give ✓Other work (describe) FIBE-fz street and number or lot number and indicate * whether interior or corner lot . Show location FOR DEMOLITION PERMIT , STATE SIZE AND * of water supply and location and configuration LOCATION OF STRUCTURES AFFECTED . * of septic disposal area . * COMPLETE INFORMATION REQUIRED BELOW - Size of property Igo ft X 17 L., ft . Existing building ( s) Size 2-$ ft X 4$ ft . * PROPOSED BUILDING AND USE : * Existing buildings } Use Size of new structure 2 �( ft X ft * w i r- l"r '6—Foundatiot�p / slab/crawl/partial/full Proposed building , distance from property line * and ft (circle one ) Front yard 7�'`�f 1 ft Rear y ft No . of stories (habitable space) Side yards tj ft and ft _ ft Height (grade to ridge ) If on corner , setback from side street If residential , no . of families OCCUPANCY INFORMATION No . of ludin bath s) hs) No * of No _ of beddroomsooms � Yr%If * PRIMARY BUILDING * 4.. -fjne family dwelling Primary heating system * Two family dwelling Multiple dwelling / Number of units Type of fuel No . of fireplaces to be installed * Permanent occupancy Will a wood stove be installed'? * Transient occupancy Central Air conditioni.ng' Business BUILDING STYLE, PRIMARY STRUCTURE * Industrial G * Other ]- Ranch Contemporary Log cabin If addition , what will use be? Raised ranch Mansion Duplex * Split level old style Bungalow * ACCESSORY BUILDING- Ca e . Codu Cottage Other oloni Row Town House Detached garage/one car/ two car/ car car CIRCLE ONE PLEASE ( ) * Attached garage/one car/ two car/ * * * * * * * * * * * Private storage building ESTIMATED MARKET VALUE OF Other CONSTRUCTION $ INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED ! Form BPA 4/66 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS * Type of construction , od f a e; fire safe etc . A-" Lfooi1 15 To61-- Will any second-hand or raded lumber be used? if so , for what ? 1dc> Foundation wall material Thickness Depth of foundation below grade (to bottom of footing ) �� SIX C� I-- PAnS -Will there be a cellar? Heated or unheated? Floor sq. footage s ft Will there be a basement? Will an - `I y 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 , woad studs "X " spacing "o . c . length ft . Joists ( floor beams ) 1st . floor 2. "X $ " spacing J "o . c . span706� ft . Joists ( floor beams) 2nd . floor �41x�rvspacing "o . c . span ft . Overlays (ceiling beams ) "X spacing Ft Roof rafters span ft . " " X spacing o . c . span ft . Roof trusses (pre-engineered) spacing 11 span ft . Exterior wall finish Of what material ? 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 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 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 _ day of 19v , o r� Owner , ' s -agent , arcnscect , contractor ,� / 2-� Notary Public , Warren County, N. Y . * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * SPECIAL CONDITIONS OF THE PERMIT : By BUTIFN QUEEl3S$URY BUILDINGNG AND CODES DEPARTMENT BAY & HAVILAN ADSYORK I2804 QUEENSB NEW 792-5832 TELEPHONE (518 ) BUILDING INSPECTOR' S P�EPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION PERMIT 1 DATE APPROVED YES NO FOOTING.I"PIERS NOP70L' HIC POUR FORM FOUNDA SON/DAMP-PROOFING�_� BACKFI APPROVAL ROUGH P MBING FRAMING ELECTRICA ROUGH-IN INSULATION: FOUNDATIO FLOORS WALLS C ILING NAL INSPECTIO CHIMNEY HEIGHT ROOFING SIDING S EXTERNAL PORCHES/S ILS STAIRS-CLEARANCE 6L F VALVE FIXTURES/ CV RS INTERIOR TRIM/PRI FINISHED FLOORS GARAGE FIREPROOF NG DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL O CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY T BE OBTAINED FROM THE BUILDING DEPARTMEN BEFORE THESE PREMISES ARE OCCUPIED ? REMARKS : �r ----------- INSPECTOR TOWN OF QUEENSBURY � BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12801 TELEPHONE ( 51.8) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION S' C G DATES/,sue q RMIT #� APPROVED YES NO FOOTINGIPIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP--PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ST S STAIRS-CLEARANCE & ILS PLUMBING FIXTURES/ �ELTEF VALVE INTERIOR TRIM1PRI CY DOORS FINISHED FLOORS GARAGE FIREPROOF G DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL NSPECTION FINAL APPROVAL O CONSTRUCTIONS A SIGNED CERTIFI ATE OF OCCUPANCY MUST BE OBTAINED FROM TH BUILDING DEPARTMENT BEFORE THESE PREMISES A E OCCUPIED! REMARKS : s 4 f�, � A,-�r ►mot yf rs ,j � . INSPECTOR S fc INA n 9 l D R I V F: fir „ SY,r- 1,t r.r1c�RF: n �� FILE COPY FILE COPY U E � N S B U p y p zvwtv of ©u n�se�uRY OD REVIEWED BY ,Zoning Adm;t►` #ra�� ►r t fez � I 3�� x 6 D �� INfi G1RpfiR - p F 'IP ; K Pit) i i I � r r ' � FOFix ;5`3v- J i ON i t