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F (]1ViPLIAN+CE
CERTIFICATE O
i
TOWN Of QUEENSSURY
{ WARREN COUNTY. NEW YORK
I
Date F fsruarbe A l4 _91
TFiis i��s/ to certiffy t at work requested to be done as shown by Permit Nn._ f39- 8f18
has been completed.
This structure may bw occupied as a Pn1 Rare R St ran 1 �� i 1 rl ; ng
f Location
i
k
OwnerIrving Martindale
By Order Town Board
s 'TOWN of QUEENSBURY
Director of Bldg. do Code Enforcement
i
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{
+y
BUILDING PERMIT
TOWN OF QUEENSBURY
No. $$ Qnsl
WARREN COUNTY, NEW YORK 00
rn
PERMISSION is hereby granted to Irving Martindale 's=
OWNER of property located at Route 149 Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Alterations & Addition
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.
F2CONTF't�ACTOR
OWNER S Address is
I
H
RD#3 Box 3238
Lake George , N . Y . 12845 �
or SUI LDER S Name .—
t
to
3. CONTRACTOR or l3U:1 L E R^S Address
4. ARCHITECT'S Name
ci
5_ ARCHITECT'S Address M
r
6. TYPE of construction — (Please indidte by X)
( ) Wood Frame I 1 Masonry ( ) Stael I 1
r7, PL:ANS and Specifications18 ' x 17 ' Alterations , and 21 ' x 17 ' Addition to bldg . XXX as per
plot plan and application , and specifications .oposed use
Alterations & Addition
$ qq n PERMIT FEE PAID -- THIS PERMIT EXPIRES —�May L
0f 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 16th Day of _ D tnher 19_$9___
SIGNED BY for the Town of Queensbury
uilding and Zo Inspector
TOWN OF QUM NSBURY
REVTEWED BY
FEE PAID $ y'
PERMIT NO.
BUILDING PERMIT APPLICATION _
I _ 11 i�Ncl
W
a CODE DEPT.
A PERKrr MUST BE OBTAINED BEFORE BEGINNING CONSTRUC`I7ON. NO INSPECTIONS
WILL BE MADE UNTM 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.
* w * a a * * a * * * * * * * * * * * # * * * * * * a * * * a * * a a # * * * a *
The owner of this property is: �� r-tz i 'h ar Ar 'f-f- , ►r e+� .w Jr`s�
P.O. Address 9 . ; r,/�'.A �� � rs , �N` el. _ 7 9P.2 - ,o l 5
Property Locations ca slL At / yam Tax Map No. -VCPI / I �
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:
`,IATURE OF PROPOSED WORK : ESr,MATED MARKET VALUE OF
Construction of a new building
# CONSTRUCTION: S 7erO
Addition to a building " COMPLETE INFORMATION REQUIRED BELOW:
* Size of property ezg� ft x ft.
Alteration to a building * Existing Buildings( 3 ) Size ft. x ft.
(no change to exterior dim�ns) «
Proposed building - distance from property line.
Other work (Describe) " Front yard fta Rear yard ft.
* Side yards ft, and ft.
GROSS AREA OF PROPOSE,DSTUCTURE , If on corner, setback from side street ft.
g
1st Floor Ic"S X / �sq. ftet'C ' rofi * OCCUPANCY INFORMATION
2nd Floor sq. ft. * Primary Building
Other Floors sq. ft* * One Family Dwelling
(not cellar or basement # Two Family Dwelling
TOTAL FLOOR AREA sqe ft, • Multiple Dwelling/Number of units
r7 •
Size of new structure _ft x I I ft. f Business
� Industrial
Foundation-pier/slab/crawl/partial/full Other 'fi_Q� j
(circle one) • ,.,n ,
No* of stories (habitable space) •
Height {grade to ridge) ft. If addition, what will use bets��.�_.
if residential, no. of famllles •
No. of rooms(excluding baths) * Accessory Building
No. of bedrooms " Detached Garap ONE/TWO Car
No* of bathrooms •
Primary heating system
,. ��_Attached Garage ONE/Two Car
Type of fuel " )[� Private storage building
Nom or fireplaces to be installed '
Will a wood stove be installed Other
Central Air conditioning
O V* ER
l
BL- ILDINC PER %IIT APPLIC _aTiON CONTINUED
BUILDING 3OPFC' IFIC .ATIO '4S:
Type of construction, wood frame, fire safe. etc. �N1
will any second--hand or upgraded ltirn ?}erbe 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 ft .
Will there be a basement ? Will an ortiori yQ
y P t>e used as living space ?
(If so, what portion ? sq ft . Type of use?
Type of roof - sloped/flat /shed/other Material of roof
Size, wood studs—4Lr"x49L'" spacing / V "" o. c. length _ft.
Joists ( floor beams ) 1st floor '"x "" spacing '"o,c. span ft.
Joist (floor beams) 2nd floor Pr of
" spacing ""o. c, span ft,
Overlays (ceiling beams ) Fix " spacing " o. ca span ft.
Roof rafters ''x_�`" spacing_12 V 000, span g2 ft.
Roof trusses (pre-engineered) spacing o. c. 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 by an opening between garage and dwelling? If so will a Fire-rated door, enclosure,
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)
NAME OF BUILDER ADDRESS TEL. NO.
NAME OF PLUMBER ADDRESS TEL. NO.
NAME OF MASON ADDRESS TEL. NO.
NAME OF ELECTRICIAN _ _ADDRESS TEL. NO.
DEC LA RATION
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 ail proposed work to be done on
the described premises and that all provisions of the BUILDING CODE, THE ZONING Q or a b doIEg and
'ell other laws pertaining to the propnsed work shall be complied with, whether sNINC ed or not, and that
such work is authorised by the owner.
Signature
Owner, owner's agOnt: architect, contractor
SPECIAL CONDMONS OF THE PERMIT:
BY
lip
TOWN OF Q[3EENS ;4
BUILDING AND CODESS DEPARTMENT
OADS
BAV 6 HAVILANNEW VORX I2809-
QvEENSBURyr 518 ) 792- 5832
TELEPHONE f
y 11 }]INC, INSPECTOR' S REPORT
REQUEST FOR �NSPECTI N REC IV
NAME
�r
LOCATION G a tr=fi'
PERMIT #
DATE _ APPROVER
/ *YES NO
G' 1
FOOTI'NGlplER.S'UR FORMS
MONOLITHIC � � _PpROOFING`_
FOUNDATION/
BACKFILL APPROVAL _.---
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH N�_�--
INSULATIONs !
FOUNDATION
FLOORS
WALLS
p CEILING
/ NAL INSPECTION : s ------�'
([• ""' CHIMNEY HEIGHT _--
ROOFING
SIDING S� STEPS_�_1--
EXTERNAL PORC RAILS"
STAIRS—CLEARA CE & RA _ -----^�`-
RES/RELIEF VALVE
PLUMBING FIX
INTERIOR TR /'PRIVACY DOOR ,
FINISHED F RS
GARAGE FIR PROOFING__.__—_--�—'�
DOOR CLOSE (ORS —�—`-
SMOKE DET
FINAL ELECT ICAL INSPECTION
FINAL APPRO AL OF CONSTRUCTION
UPANCY
BE
A SIGNED FROM,ERTTTHE BUT
DEPAR7,M,N,1'TSE RE
OBTAINED
THESE PREMISES ARE OCCUPIED !'
REMARKS :
r
~f CTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT `
BAY & HA V.I LAND ROADS - L
QUF.EN.SBURYr NEW YORK 1.280&� a
TELEPHONE (538) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECE VED
NAME 1 1/ - I ,y
LOCATION
DATE � �G e RMXT # � /7
APPROVED
zi YES NO
f FOOTING/PIERS
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. PORCH (STEPS
STAIRS—CLEARA CE & RAILS_ _
PLUMBING FI URES/RELIEF VALVE
INTERIOR T M/PRIVACY DOORS
FINISHED RS -
GARAGE F EPROOFING
DOOR C ER (S)
SMOKE TECTORS _
FINAL E CTRICAL INSPECTION.
FINAL A PI2OVAL OF CONSTRUCT-TON.
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
INSPECTOR
t. Y of
17 '
TOWN OF QUEENSBURY
Zoning Administrat r
Date -4;
7My11%�
r
0%40001
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