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5640 CERTIFICATE OF CSC UPAN CY I TOWN OF QUEENSSURY WARREN COUNTY, NEW YORK Date February 16 19 93 This is to certify that work requested to be dome as shown by Permit No. 5640 ( 1978 ) has been completed. This structure may be occupied as a apartment ( one only ) Location Hewitt Road C:1«t+er Richard and Dorothy Kubricky 50- 1- 5 By Order Town Board TOWN OF QU88NS$URY f • Director of Bldg. & Code Enforcement r BUILDING PERMIT TOWN OF QUEENSSURY No. 5640 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Richard and Dorothy Kubricky Hewitt Road Street, Road or Ave. :z OWNER of property located at Pi in the Town of Queensbury, To Constructor place a Convert dwg . to 4 apts . and 2 car det . gar . PA at the above location in accordance to application together with plot plans and other information hereto filed and p� approved and in compliance with the Town of Queensbury Building and Zoning Ordinance- I� t. OWNER'S Address is R . D . # 1 0 F`4 Glens Falls , New York o *e 2. CONTRACTOR or BUI LDER'S Name C Same �t r- c� 3. CONTRACTOR or BUILDER'S Address ` Same 4. ARCHITECT'S Name 5. ARCHITECT'S Address x fD 6. TYPE of Construction — Mlease indicate by XI E F+- rt E 1 wood Frame i I Masonry i I steel f 1 rt 1 p 7. PLANS and Specifications Pli Convert dwelling to 4 apartments and two -car detached 0i No. garage per plot plan , specifications and application t submitted and Variance # 586 granted 10 -18 -78 . S. Proposed Use 4 Apartment Building a o 0 � $ 5 . 00 C/O Paid ( per Variance # 586 ) S 44 _ CIO PERMIT FEE PAID — TEAS PERMIT EXPIRES January 1 19 85 (if a longer period is required an application for an extension most be made to the Building and Zoning inspector of the ¢ town of Queensbury before the expiration date.} CD :3 :C rt & (D Dated at the Town of Queensbury this 2 8 t h Day of December 1978 0 � N SIGNED 'BYlt' '"v�� �( - °�i Qj �� �.._for the Town of Queensbury � � Building and anirp Inspector 1v 0 ' 64 13143. . 3C�fGe m e.�d"P h '�l 2. �5 A tD TOWN OF QUEENSBURY (Space inside block tit) be fitled in b% WARREN COUN"Ti y. NEW YORK Building InzrXW1orl Application for 1filmlatii,t, it S'c•rl,stt S �,tu�r1 19 BUILDING AND ZONING PERMIT t', , ,,, it I .74flCC'e4 Irl i� +tut, Sli+.triYrt $ \ i ryf II +I'+ +4 l',� t71' THREE ( 3 ) Copies of a PLOT PLAN, Drawn to scale showangg the actual dimensions of the lot to be built upon. The exact size. and location on the lot of the . . building to be erected or altered MUST BE SUB- MITTED WITH THIS APPLICATION. TC., . l OF QUEENS;PURY aFEZ 5G' r,qtr A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK i; u �, .� 1�J /8 ANSWER ALL OF THE FOLLOWING, AJf. �,Ce,J? P.M. The undersigned hereby applies for a permit to do the following work 718y91*1. 111!5} 1 a ` :I { ' a which will be done in accordance with the (description, plans and specifi. � cations, and such special conditions as may be indicated on the permit. Th wner of this c! rt is: 1�.+r✓� L? Jt.. 'a'."J./f�-o L a:. ✓- `"'ee (r+ 0i ADDRESS) ;*e _1 The/ neon res nsthie Jfar r��su a ision of the work i s+,far as the Sx„icElatg Code and the Zoning Ordinance apply i%: . . l G,e , 'y'/P+Y•!Y!J, lY_...G?,6� �I'l�atC.t �s . . . . - . �.,I - ...<+rs` G-.�. . �""1 {,NAME1 // W b AO bFtESSI Name of Builder , . . . . . Address . . . . . . . . . . . . . . A-r Address Name of Plumber . . . . , _ . Name of Mason . , . . . . '.t. . . . . . . . . . . . . - - . . Address . Unit Estimated value of proposed work 4 �� f , " ?. . . . . . . . . . . . . Lot Number , . p ' Name of Village . . . . . . . . . I . I . . . . I . . . . . . . . . . . . . . Name of Street r r. . Cc' e• '%`''Side of street : north ❑, rase � south ❑ , west 0 Nearest Cross Street / r s �t:;.4.v �-�,.-A �r . .,,,rC, d� �-:1�. . . 3]istance frr:=,+ lTii ; •-ross street - . Property is north south 'iJ , east L J , west 0 from Gross Street If on Corner, which corner, northeast Ct , northwest Q . southeast Q �cutf,cxt-5t (Designate by marking with an "X " in the correct space.) NATURE OF PROPOSED WORK OCCUPANCY © Main $>tiiding Construction of a new building. _ One-family dwelling u Addition to a building. Two_Camifv dwelling Alteration to a building. / family apartment house © Demolition of a building. Stor`r building -car attached garage L7 ,! -..c.�! f/ wl�rr✓-..z'Ym -74�76U '& Other . . . . . . . . . . . . . . . . . Accessory Building - r)ne-car detached garage Other work. Describe. / .Gc ! ca. . . J'wo-car detached garage Private chicken house Private storage building Ln Other : . , ZONING SPECIFICATIONS. Fill in for new building, or addition to existing building, or a change of occupancy. Indicate on the plot plan street names, the location and size of the property, the location, site and setbacks of pro- posed buildings, and the location of all existing buildings. wtonT►t Show proposed building(s) in dotted line and existing huilding( s) in solid line. size of property ft. x . . . . . . . . . . . . it. J&2;r r i.� wOL­e " . . . . . . . . . Size and use of existing buildings, if any . ou Size of proposed building . . . . ft. x • • . . . . . ft- I l eight (from grade to ridge) . . . . . . . . . . . . . . . . . . . . . ft. Front yard ft. . . . . . . . . . . . . Side vards . . . . . . . . . . . . . . , ft. and . . . . . . . . . . . . . . . ft. Rear yard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ft. sOUTN Lf on corner, setback from side street . . - ft. . ,(Vole. All distances are nee, as maasured frown street side line to nearest ,(part of building. toveftl 7 -73-M (coni'd.) BUILDING SPECIFICATIONS4 Kind of construction: Wood frame, fire safe, etc.? . 4��' e7"> .4v Will any second-hand lumber be used? . . . . . /� . . . . . If so, for what? . . . . . . . . . . . . . . . . . . . . . . . . .=.. . . , . . . . . . Material of foundation walls , 4�7&_Aoee"x-.2" . , �,< -o�/Ic . . _ . . . . . . . . . . . . . , . Thickness Depth of foundation walls below grade . . . rC'% foundation? . . . . . . . . . . • • . - Continuous foundation. Will there be a cellar? ,�+-'T- , , , , . , If so, material of cellar floor . C. g- A �. Type of roof: Sloped o . .ate . . 4f�o �� , . . . . Material of roof Size, wood studs . . . . . . . . " IY.. . . . ."?� . . . . . x . . . . . . . . . . . . . . . spacing , _ . . �[: . . . . , "o.c., len � �� . . . . . ft. Size, floor beams, 1st floor . . ", spacing , . . . ..e ' . , , . . "'o.c., span . . . ./. �' . . . . . . ft. Size, floor beams, 2nd floor $ " spacing �i ,u ° 1' g .!+G _ _ . . . "a.c., span . . . . . . . . . . . . . . ft. Size, ceiling beams . . . . . . . . . . . . . . . . . . " x . . . . . , , . . . .d, spacing . . . . . _ . . . . . "o.c., span . . . . . . t. Site, roof rafters or beams . . . , , . ,?. . . . " x . . . . _� . . . . . . ", spacing . - . . ��. . . . . - "o.c., span . . . . . . . . . . . . . . ft. Exterior finish 'c�4�c+7 .1'4 F0lr!Pk'K---,, . . . . . . - . . . . . . . . With what material ? ,�`�'r�`�F Finish of interior walls . . . .a-L'C C . . . ....". .� /mac,, . . If garage is to be attached, of what material is wall between garage and main building to be constructed? Is there to be an opening between garage and building? . . . . . . . . . . . . . . . . . . . . . Kind of heating system . . . >,,�,,� -- ?c . . . , . _ . . . . . . Oil burner or coal. Will a flue-lined chimney be provided? Depth of chimney foundation below grade . . +"-", R7_ Height of chimney above roof. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will there be a fireplace? � . . . . . . . . . . . . . . . Depth of fireplace hearth r. ►` . . , . . , . . . . . . . . . . _ Will a toilet be installed? , . i '' 7 . . . . . . . . . . . . . . . . . . . . . . - . . - . . - . . . . . . . . . . Will a kitchen sink be installed and connected to water supply? -_. 'f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Water supply (public water supply or pumps . . . . ,c ► . � � . . . , , Distance of cesspool from any private well . . . . Ar%>-'. . . . feet Will drainage system be provided with required traps, cleanouts, and vents? . . . . L` ! f�'.l . , , . . . . - . Town of Queensbury AFFIDAVIT County of Warren State of New York I swear that to it pwpof my know edge and belief the statements contained in this application, together with the plans and specifications sttb- mitted, are a true and co.m.p lete statement of all proposed work to be done on the described premises and that aQ Ve ions of the BUILD- ING CODE, THE ZONING ORDINANCE, and ait other laws pertains ro wed work shall be complied with, whether specified or not, and that such worst is authorised by the owner. Sworn to before me this Signature .. OWANER. AGENT, ARC TECT, 6&I RACTOR dayof.. . . . . .. . . .. . . . ... . . .. . . . . . .. . . .. . . .. .. ... . .. 14. . .. .. . . NOTARY PUBLIC, WARREN COUNTY. N. Y_ SPECIAL CONDITIONS OF THE PERMIT., By . . . .. ..... . . .... .. .. .. .. .. . . . . . .. . . . . ... .. . ... . . . .... . . .. ... . . ... .. .... TOWN OF QUEENSBU1ZY REVIEWED �BY � FEE PAID ^• PERMIT NO. BUILDING PERMIT APPLICATION A PERMIT MUST BE OBTAI ED 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. The owner of this property is: /Z1 P.O. Address 5 I .• 7"� /� •rJ' - t'� � ? s{ :70;r� od32, Property Location r ,�� .-�^7' ./ dOV Tax Map No. Has there been any split of this property since October 1 . 1988 ? / If yes Planning Board Review is necessary& yes no SUBDIVISION NAME, IF APPLICABLE LOT NO. THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS: r MATURE OF PROPOSED WORK : ESr:MATED MARKET VALUE OF * Construction of a new building * CONSTRUCTION; $ ,I Z S 000 Addition to a building " COMPLETE INFORMATION REQUIRED BELOW: * Size of property i,� J' ft x Zeta ft. Alteration to a building �► Existing Buildings( 3) Size ft. x J. k x ft. (no change to exterior dimensions) Proposed building - distance from property line: Other work (Describe) * Front yard ft. Rear yard , ft. * Side yards� Sr ft, and 1C74 ft& GROSS AREA OF PROPOSED STRUCTURE If an career, setback from side street ft. 1st Floor 6 C) sq. ft. OCCUPANCY INFORMATION 2nd Floor je sq. ft. * Primary 'Building Other Floors sq. ft. „ One Family Dwelling (not cellar or basement * Two Family Dwelling TOTAL FLOOR AREA sq. ft, " Multiple Dwelling/Number of units Site of new structure ft x / + Business Foundation-pi+er/slab/crawl/parti 1/full " Industrial (circle one) " Other * No. of stories (habitable space) Height (grade to ridge) 2 Zor ? 'o/ ft, * If addition, what will use be? If residential, no. of families .. No. of rooms(excluding baths) / * Accessory Building No. of bedrooms . • Detached Garage ON W Car No4 of bathrooms � + Primary heating system{ dot ,r7 Ge.►.In + Attached Garage ONE/TWO Car Type of fuel Private storage building No. of fireplaces to be installed ,ram * ether WiU a wood stove be installed�i � w 4 Central Air conditioning R .d .p OV• ER r BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS: Type of construction, wood frame, fire safe, etc. Wi11 any second-hand or upgraded Iumber be used? If so, for what ? Foundation wall material <Z c. Thickness _ Depth of foundation below,,e Arade (to bottom of footing) Will there be a cellar ? ooc-Ad4W Heated or unheated? Z64a� Floor sq. footage f 0 ,9Z _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 - loped/ at/shed/other. Material of roof j Size, wood studs"x�_" spacing '" o.c. length ft . Joists (floor beams) 1st floor _ '"xqr ^ spacing "o.c. span —ft. Joist (floor beams) 2nd floor ffx_ „ spacing "o. c. span ! (r ft. Overlays (ceiling beams)_ x _"" spacing" O.C. span /C ft. Roof rafters -"x— ` " spacingo. c, span ft. ~ Roof trusses (pre-engineered) spacing-_�:L."' o.c. span ft. Exterior wail finish rSiOVj41_ ea _` o what material? (:nsr oo� Interior wall finish If a garage is to be attached, describe materials to be used for FIRE SEPARATION: Is there to he an opening between garage and dwelling? If so will a Fire-rated door, enclosure, self-closing device be provided? Will aflue-lined chimney be installed?� 1EE Height above roof. ft. Depth of chimney foundation below gr de „�z ft. Depth of fireplace hearth,.,C ft. in. Water supply - Municipal or private well r SEPTIC SYSTEM Distance from ANY private well (including adjoining properties C>0 ft. (A separation application is necessary for any repair or new installation of septic system) NAME OF BUILDER rXA,,>A-j&V[ ADDRESS TEL, NO. NAME OF PLUMBER ADDRESS TEL. NO. NAME OF MASON ADDRESS TEL. NO. NAME OF ELECTRICIAN ADDRESS TEL. NO. DECLARATION 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 clone on the described premises and that a.0 provisions of the BUILDING CODE, THE ZONING ORDINANCE, and ell other laws pertaining to the proposed work shall be complied with, whether specified or. not, and that cuch work is authorized by the owner. Signature Owner, owner's t, arc itect, tractor SPECIAL CONDMONS OF THE PERMIT: BY ENSgURY 531 BAY ROAD QUEENSBURY , 'NEW YORK 1 804 TELEPHONE ( 518) 447 BUILDING INSPECTOR' S REPORT FINAL INSPECTION REQUEST FOR ,INSPECTI%ON RECEIYEO 11 Ile i 1 NAME,------- — LOCATION: OCAT ION /,.� ry DATE .��� PERfM1IT# TYPE OF STRUCTURE RECHECK 'FIRE MARSHANG L APPI (CBACKFILLL STRUCTURE -`ROUGH PLUNlBINGWOOUSTOVE/FIREPLACEL �gEPTIC INSULATION REMARKS APPROVAL NIA YES NO CHIMNEY HEIGHT/LOCATION B VENT/LOCATION PLUMBING VENT ROOFING SIDING" 'DECK/PORCH/STE S/RAI INGS RELIEF VALVES -- FURNACE/HOT W RA ING� BASEMENT INSULATION/DUCTWORK_ INTERIOR TRIM/PRIVA Y DOORS FINISH FLOORS : BATH/KITCHEN WATER IGHT OTHER FLOORS SWEEP LE OTHER FLOORS CARPET 0 STAIR CLEARANCE/RAILI S HANDICAPPED ACCESS SMOKE DETECTORS BATHROOM FANS/W O S FANS ALL PLUMBING FIXTUREESS ATING w GARAGE FIRE PROOFING d DOOR CLOSERS OTHER FIRE SEP A FIRE/DEMISE WALLS IO DUMPSTER AN E EQUIREMEN SITE PLAN/V FINAL ELEC AL }C OK TO ISSU C/ 0 C/C -jgpT + Kjcat COWMEN S :� A& T- C p �+t P 111 ro 0� � ARRIVE — DEPART �1, = IN TOWN OF QUEENSSURY ]RUelding Dopartmeent Report Dater_ -- . r Namewi 0 wiG.alt3ld' pit No. Rema rkS ' SxcatYation I'i Footin Forms Footin & Piers Foundation cement Coat Water raofin Backfill Final SurVe Frami.n sheath-in Roof Felt 'Roofin Siding Masonr veneer Rau h P1 Relief Valves Wall Board Ext . porches Fi.ni shed Floor Interior Trim Stairs & Rai.lin s cellar Dr . Tile Concrete Floors Pl. Fixtures Gar . Fire roofin - voor closers --�-�� chimne -- Water Meter Inst . septic A roval Floors Foundation XnsulatiOn p7'al_is --�--�^� ceil�� line Building Inspector REIKARKS TOWN OF QUEENSBURY $,stildia,�' DePa.rtmcs�nt ,r Permit No. Remarks excatm t.i on Poo tin Forms Footin & Piers FoundstiOn Cement Coat Water roofin g,acKfi l l Final Suave Frame-n Shea thi n Roo Felt ,Roofin Si d i.ng Masonr veneer Rou h Plb . Relief Valves Wall ;goard Sat . Porches Finished Floor Interior Trim Stairs 6 Railin s Cellar Dre 'Tile concrete Floors Pl , Fixtures Gar . Fire roofi r Closers C hiiune ----- Water Meter Tnst * septic A royal Floors Foundation insulation walls ' . Cei 1.1 In BLj.x ing Tnsgector REMARKS YA R . S� 86 Rj CA 4 )P%d pdwl/yx tei A Hj44pvt=ky TOWN OF QUE ENSBURY N O V 1984 A.M. P. M4 7I1$VL0 " 1131116 44z�&, � LA4 .; ► �.' woeow � 1 ,, 6 �ee,r, tJ�eoen a (I a VaAiance. an V a be y 1� _r ' fi,� n i axia r k on �3rJ++ R49"i o °•,=M di..rcuAAed #�a n elide n •r# Va L r �7ad. , fee zegaL 4,4444z d #J a-t the pAcopeAr4 iA Land Lo,c and a The duxwiLL 6e we n&nnaL na r ' a nd pe AmneiLt the R -OCwy wLL auxiethrat Town andlon County &C"Zc" n - i wea1.,. f;�rr uw , w No one andx" A d *A cA t nn. �OPPa `on" The T 1 La own nn.iny? Boaaed app4W e e af"PI : der.,onded. r ode motion to aPpAeove the app�n. OA- KceAroxafxa .�-- 72 - 4 - �2icluzaed Ku6n.%cha�G ,,q eAraitt R oac (Van" z• Co. 6oaAedJ DAaw ng& and p •rf� +C /� IL a A1 4 pR { oA a uAle L Vn�' r,ra d- to r�vonfa d ner � �yc .satated that fee P� tAe pAwpeA+.tg be one #h.e ZonZng L F S pal Afl +�h feauAle. d..d #ht paopeAetya ,i..a. the AA--3:e. a $ Lotas cvm6ened. The. � ne The u.,ot (4) &ep 'Pahl w.ath .urine ,,ejliAi.o to divide ireto �" �lJAe,, KuhAyicf.•yF 'as P<"a- 6e ino.@,►uied a.As ttn. inr cO a ctnd . :rho oAr. , it a a the Locate on off° °' ' �waan a the width o the Town Road PoAL �ar�a�a � c n {G�.Lawwd. 1�Aeas• 12icJ on iAr� about the mZnimum $ ram' 9t wsza. Hated 6� kuh w ; y f& a pant`"P� u+ZL.L be We,LL Wen. �* AeovaL fAeom aLL but 4 o the 6,,kyc p,u,v ded the BoaAd with w,�l"An aPP eAeAxon and 3 urdzvaiLabLe.. g 4: Lot owne.�.�.; the. 4 cone off° a deceased P l n f►lge aAd ,�'►l` CAa'&Leas P hejp.d and '� '�`,n,#ipa�y 111n. and /�,1. Adin +�el�-�L�c+f�y 1:rcrfi_yn. l�Lt.. peA &onar.,Lly .a.taiP-d theyt weAe�e .cn L°avoae o ° the °PP 140&d the �� �uLd. be managed by � awn. 7 he Town ' luren �n 4°Pux+e.d the. app 1 :r.y fZo n not e_nq jf u "As noi° ,in Ae -Pink wc.th pLann'jtg of an 7AE Caunty A La AZAg Board appAeoved the appl-zc+zli.on. Ro►va the appL jcai-on with cz .�e,ecnnww-nda- +u r; aa madeby l b n, S icaAd to app in a mLka Second by e 6 pzL#L a srnwSnn o ' MA • kubAZaky 4comnend l3ui n ed JL.e,& pAe&e jar u»n. 1 ... ..._._.nh.tAa' and thoreoeWA P&. yi " �f v i 1 � ram,/v3 'g`k[� ,AiAT- Wj Lwc. I,uU0 c. V c .vi f�'r .4L l�'/•�'sd L�eT-ro+,v J Ar s 47 6<,-r 10AJ . : � �, ,-F 1�J' � '� �-s�-�.c. U,.�v ,�c..t�.. - ��[�c:.�•+� t.�,�+� u... �3 � 1 ul�'e�+�t i �"' ca v f�-v roc. " c.d+� 7+�-+ c` - r A'5 r � 13