1990-123 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
August 13 90
Date 19
• 90-123
This is to certify that work requested t be done as shown by Permit No.
has been completed.
This structure may be occupied as a single family dwelling
Location (Queens Lane
William F. Paulsen
Owner
• By Order Town Board
TOWN OF QUEENSBURY
(a4
• v
Director of Bldg. & Code Enforcement •
•
� � � BUILDING PERMIT
1-3
TOWN OF QUEENSBURY No.
90 193
WARREN COUNTY, NEW YORK
0
PERMISSION is hereby granted to William.F Paulsen
•
OWNER of property located-at 59 p p y Queens Lane Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Single 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. ,.b
1. OWNER'S Address is
59 Bittersweet La
Slingerlands NY 12159
2. CONTRACTOR or BUILDER'S Name
same
3. CONTRACTOR or BUILDER'S Address
cn
4. ARCHITECT'S Name - m
CD
- m
cn
Ul
5. ARCHITECT'S Address •
t
sv
lD
6. TYPE of Construction—(Please indicate by X) -
( Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
Completion of:
No. 36'x60' Single family dwelling as per plot plan, specifications and application.
vg,
(Former Perrnii, 6 7-44a) CD
8. Proposed Use• -'
Single family dwelling
•
Renewal ro
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 30 19 90
aci
(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.)
•
Dated at the Town of Queensbury this Day of . ril • 19 90
• SIGNED BY for the Town of Queensbury
Building and Zoning In pector -
L 1
TOWN OF QUEEY
• REVIEWED BY
,. 1% FEE PAID $ ,� iltioJ
f #4, PERMIT NO.
BUILDING PERMIT APPLICATION .
•
A.PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION: NO INSPECTIONS
WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT.
All applicants spaces on,this application MUST be completed and the signature of the
applicant MUST appear on'the reverse side of this application.
• • • • • • • • • • • • e•jj •////• • • • • • • • • •'. SS • • ,• • • • .• • • • • * • • • •
The owner of this property•is:_,,,fJ LU/1414Q F PpulSeN
41
P.O. Address d9 St n o&,s'w& A, -,v Skive le�l�l6C,r Tel.
l7 !�
Property Location I q uems . UU;v quieelusbureye . Tax Map NO. /_/
Has there been any split of this property since October 1, .1988? /
If yes Planning Board Review is necessary.Ieiqco,1
� yesno
SUBDIVISION NAME, IF APPLICABLE- ROLW LOT NO. (.f? -•
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS :TO BUILDING CODES IS: -
‘1)//4442 FrOara/
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF •
• :
Construction of anew building •
CONSTRUCTION: $ /D�.. .,--
Addition to a building • . COMPLETE INFORMATION REQUIRED BELOW:
• Size of property -- - ft-x
Alteration to a building , * Existing Buildings(3) Size ft. x_ft..
(no change to exterior dimensions) •
coo • Proposed building - distance from property line:
Other work (Describe) a)l�yl pl(p 0�(,y/ • Front yard=ft. Rear yard L,6 ft.
0 X,tS rlN Gii7USt: • Side yards A. ft. and Ir ft.
• If on corner, setback from side street . ft.
GROSS AREA OF PROPOSED STRUCTURE •
1st Floor. `, .: i.')�0 ` .sq. ft • •
"(, • OCCUPANCY INFORMATION
2nd Floor sq. ft. • Primary Building -
'�~f ,One Family Dwelling •
Other Floors 1,(�Q �� t. •
(not cellar or basement) • Two Family Dwelling
'TOTAL FLOOR AREA 16itsq. ft. • Multiple Dwelling/Number of units_
Size of new structureft xft. • _Business
'.Foundation-pier/slab/crawl/partial,full • _Industrial
(circle one) • • Other
•
INo. of stories (habitable space) ON 6
Height (grade to ridge) 4 ft.. • If addition, what will use;be?
If residential, no. of families •.
`No. of rooms(excluding baths) •
Accessory Building
No. of bedrooms, 3 •
No. of bathrooms � Detached_ Garage ONE/TWO Car
•
Primary heating system (ryes Fl • Attached Garage 0 =/TWO ar
'Type of foal hyru, • Private storage building
:No. of fireplaces to be installed PO • • /
Will a wood stove be installed gyp- . . • _Other..._S
mil. ��k' U4 .2-
Central Air conditioning 4i ' •
OV• ER
J
BUILDING PERMIT .APPLICATION CONTINUED -
BUILDING 3PFC[FIC.ATIONS:
•
Type of construction, wood frame, fire safe. etc. (Ood Fo nWe
Will any second-hand or upgraded lumber be used? If so. for what? kb
Foundation wall material ` oOk co ")k,e Thickness
Depth of foundation below grade (to bottom of footing) -(�r6k
Will there be a cellar? Heated or unheated? Floor sq. footage sq ft.
Will there be a basement? u8.$ Will any portion be used as living space? NO
(If so, what portion? sq ft. Type of use? .
Type of roof slope flat/shed/other Material of roof .4siArLitT S'h I,� �
Size, wood studs "x -6 „ spacing Gfp'.' o.c. length ?-(}}t,
Joists (floor beams) 'lst floor "x 10" spacing`/6 "o.c. span J ' ft.
Joist (floor beams) 2nd floor ,Z "x /O"'spacing /4 "o.c. span ft.'
Overlays (ceiling beams) "x " spacing " o.c. span ft.
Roof rafters "x " spacing o.c. span ft.
Roof trusses (pre-engineered) spacing en u" o.c. span u y— ft.
Exterior wall finish ek pbv of what material? Vinyl Dal in?
q2 " �'h,
Interior wall finish , pio,�j 406t 1
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
//, &t •afte-Cr . .
Is there to be an opening between arage and dwelling? la- If so will a Fire-rated door, enclosure,
self-closing device be provided? his
Will a flue-lined chimney be installed? 't�25 Height above roof A N ti ft.
Depth of chimney foundation below grade v' ft.
Depth of fireplace hearth ' L/ft. in,
Water supply - Municipal or private well MO GV t,et4 G1-L.
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)
NAME OF BUILDER wo FiqUiSe ADDRESS(Rti Cie/S'W -tAt EL. NO. 1i� L77
NAME OF PLUMBER ? ADDRESS TEL. NO.
NAME OF MASON ? ADDRESS TEL. NO. .
NAME OF ELECTRICIAN 7
ADDRESS TEL. NO. .'
DECLARATION _
To the best of my lonowledge and belief-the s'atmoiaffz-"c t inmd:in this application, together with the
plans and specification submitted, are a true and complete statement of all proposed work to be done on
the described premises and that all provisiAr.of the BUILDING CODE, THE ZONING ^RDINANCE,.and
all other laws pertaining to the proposed work shall be complied with, whether s rifled or not, and that
such Work is authorized by the owner.
0, C ,
Signature 'V.?
Owner, owner's agent, architect, contractor
SPECIAL CONDITIONS OP THE PERMIT:
B:Y
' TO BE COMPLETED BY BLDG. DEPT.
TOWN C - ;.S' _
�] / Application No. -3 ----,
.. own of Queen3dur y Permit Issued 19 1 J Jj
BUILDING and ZONING DEPARTMENT Permit Expires 19 1 ..
,Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation '/ JUL 2 3 198
Queensbury, New York 12801 Variance No.
. 4, Site P - •eview No. BUILDING& CODE DEPT,
, q _ .
010 , 0-/r
APPLICATION FOR _4..�. " aill/ h>cyK- �� `,°�/ `
IBUILDING AND ZONING . PERMIT - : �/v f�Z`
PP
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 maybe indicated on the Permit.
The owner of this property is: J eE /V2EL/ i d •
P.O. Address /-,I uC,//e Da • /-/vO,foA./ Ai Tel. J -P 7cPS,6
Property Location: ' �7 p-u,v Pm./ - 0.,,eu; . y4%,, al. .--5 / Tax Map No. / /
Street number or building lot number
Subdivision name (if applicable) /"
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
16.13ER l XR G dF • . (Ars,///i •y . 'z.,/33 - 'G y .
Name P.O. Address Tel. No'.
Name of builder lDMM ,E'vr . 'ivc . Address ,//r,,,//e /Ji/ /-/o,,vy .0 Tel. OP,21-71-'5
Name of plumber D. Cl f . - Address W1,134....- ,/ ,-zJW Tel. Z37— 20.: 6
Name of mason JoL� C <1 Address ( /fir-e-/ /. • Tel. ES/- 2 623
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
_Other work (describe) * set-back dimensions from property lines. Give _
* street and number or lot number and indicate
FOR DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot. Show location
LOCATION OF STRUCTURES AFFECTED. * of water supply and location and configuration
* of septic disposal area.
* •
* COMPLETE INFORMATION REQUIRED BELOW.
* Size of property /00 ' ft X c,768 G 7ft.
- * Existing building(s) Size ft X ft.
PROPOSED BUILDING AND USE: * '�'����
. Existing building(s) Use I cy✓-
Size of new structure 3C ft X ‘y ft *
Foundation-pier/slab/crawl/partial/full * Proposed building, distance from property line
*
(circle one) * Front yard 55 ,4/,,,, ft Rear yard /,'O f- ft
No. of stories (habitable space)_ /
Height (grade to ridge) ' /S ft. * Side yards l‘ ft and ,Z Q ' ft
If residential, no. of families / * If on corner, setback from side street ft
No. of rooms(excluding baths) 7 * OCCUPANCY INFORMATION
*
No. of bedrooms _3
No. of bathrooms 7 * PRIMARY BUILDING -
* ine family dwelling
Primary heating system TLc-C. * Two family dwelling
Type of fuel * ._ Multiple dwelling / Number of units
No. of fireplaces to be installed A/c ,-Z —
Will a wood stove be installed? �/o * Permanent occupancy Transient occupancy .
Cei,�.....- __ conditioning? *
* Business
. BUILDING STYLE, PRIMARY STRUCTURE .* Industrial
(nch, Contemporary Log cabin * Other
Raised ranch Mansion Duplex * If addition, what will use be?
Split level Old style • Bungalow * •
Cape Cod - Cottage Other * ACCESSORY BUILDING-
Colonial Row Town House * Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE) * //ttached garage/one car/ two car/ / car
* * * * * * * * * * * * * * * * * * —Private- storage building
ESTIMATED MARKET VALUE OF * Other
CONSTRUCTION *
$ ,4co& ei
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? I£ ,go, for what? 'y0
Foundation wall material- oecp. ac.r.erc Thickness
Depth of foundation below grade (to bottom of footing) -7'
. Will there be a cellar? Heated or unheated? Floor sq. footage .sq ft
Will there be abasement?./,J Will any portion be used as living space? - /fio
(If so, what portion?,-l__sq.ft. - - Type of uses'
Type of roof - sloped/flat/shed/other‘244 Material. of roof i2.f,e2 r
Size, wood studs a2 "X 6 " spacing /6 "o.c. length ft.
Joists(floor beams) 1st. floor 'Z- "X A) " spacing ,/ "o.c. span ft. -
• Joists (floor beams) 2nd. floor "X spacing "o.c. span ft.
Overlays(ceiling beams) . "X . " spacing "oc. span ft._
Roof rafters "X " spacing o.c. span ft. 1-1,44Se4 O'6 -p1'�-'
Roof trusses(pre-engineered) spacin 2 / "o.c. span ft.
Exterior wall finish (J l h y f ,f 1 if+ , ( Of what material? /1X.I .e.rGy .
Interior wall finish 3244enAr4- '
' 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?)4os If so will a Fire-rated
door, enclosure, and self-closing device be provided? ,V-r
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 ,W4,,,,,44
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 AFFIDAVIT •
County of Warren 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 doneLLon 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! _
• O er, wner's age cni ect,contractor
2, 3 day of J 19 g7 ;7 •
Notary Public, Warren County, N.Y. .
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT:
•
•
•
•
•
•
. By.
TOWN OF QUEENSBURY /
BUILDING AND CODES DEPARTMENT e�
BAY & HAyILAND ROADS /�
QUEENSBURY, NEW YORK I280k y
it
TELEPHONE (518) 792-5832
BUILDING INSPECTO 'S REPORT
REQUEST F R INSPECTION RECE VED f/'7,1/Ud
NAME 4 . ��Q/,L ' .r(��_y
'
YI_'
LOCATION r�i///? /,/ r /:kr-C/
DATE 11Q' , () PE :IT # 97)/,?
+ APPROVED
1 YES NO
i
FOOTING/PIER''
MONOLITHIC PQUR FORMS /f
FOUNDATION/D P-PROOFI
BACKFILL APPRVVAL i
ROUGH PLUMBIN If
FRAMING fi
ELECTRICAL ROUGH-IN 4
INSULATION:
FOUNDATION
FLOORS 1. — 11 . . . .
WALLS % . .
CEILING 1I
FINAL INSPECTION:
CHIMNEY HEIGHT 1
ROOFING 1SIDINGEXTERNAL PORCHES/STAIRS-CLEARANCELS '>C
PLUMBING FIXTURES.IRELIEF VALVE h
INTERIOR TRIM/PRIAACY DOORS
FINISHED FLOORS ,�
GARAGE FIREPROOF IN J 1'
DOOR CLOSER(S) , A
SMOKE DETECTORSyj x
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
OK TO ISSUE C/O R .C/C\ /
i
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM T I BUILDI G DEPARTMENT BEFORE
THESE PREMISES RE OCCUP FD!'
REMARKS:
1 (7( '',
i.;/ < -"J'g l" " 'a ',
r— /
ARRIVE 7/
;,4,DEPART / -1 S / z!/
v
INSPECTOR
INFORMATION FOR BUILDING DEPARTMENT •
WE ARE IN THE PROCESS OF ISSUING A CERTIFICATE
OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION
AS COVERED IN AN APPLICATION FILED WITH OUR •
DISTRICT OFFICE.
THE NEW[ YORK BOARD OF FIRE UNDERWRITERS
APPLICATION NO. C ///fi f
Ot-e
•
2/
•
DAT INSPECTOR
FORM IBD(REV. 1/86)
awn o f Queenilury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPEC ION
NAME �f� ,/!� a,,,,,,,,„, •.,
',
LOCAT I ON .37
, GC "4/ , ,, -e-
DATE _�j f/ 7t PERMIT NO. 90 '"/,,•?,_Y
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? /YES - NO
Percolation rate - Min/Inches;_
rt•
:
TYPE of SYSTEM: ''. r�
Absorption field, total length 6L
Length of each trench ' `•',5
Depth of trenches ;: '' 7
Size of gravel `' `} ,
•
SEEPAGE PITS4Number of)
Size- ft. X fa.g
Gravel size , ;
PIPING: i;-Siz ypq
Bldg. to tank V,q `__
Tank to dist. box y /
Dist. box to field/ /4T6
Openings sealed? YE NO Partial
0 'rl
LOCATION/SEPARATIONS: ':y ,`'
Foundation to tank p '�' ' .ft.
h:;
Foundation to absorptbnGft.
Absorption to lot line'. ft.
Separation of pits" ', ----ft.
LOCATIONYSTEM ON ',PROPERTY(circle' one)
Front -top-s
ear Le°ft sidleJRight side -
COMMENT k Fill
-7-0,4V(----..
bx
17'
!l /71
I
i
SYSTEM USE APPROVED YES ;; O
a
Building to pector
01/86 and vl
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1z, '1 0 kA& APPROVED By: DRAWN by
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0, �al RgvtseD
r4 UI DATE: 24
No. 4157%
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