8930 TOWN OF QUEENSBURY (Space inside block to be filled in by
WARREN COUNTY, NEW YORK Building Inspector)
PPIication for Application No. .
Permit Issued 19.
BUILDING AND ZONING PERMIT Permit Expire`. • Ig.
%(niinL District
• \ aline nl Work ,% ��
THREE (31 Copies of a PLOT PLAN, Drawn to scale '\pprm c! by ��"'JL /' v►I�
Nr •
', showing the actual dimensions of the lot to be built Ilc'imii•KS
\� upon, The exact size, and location on the lot of the •
-4. building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
`
3 . 0 ' — ' (G ii ! 1�! `y (DATE T®Wl�l OF G� EE[\isJ17a01�Y
I
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK R E 0 E 1 E D
ANSWER ALL OF THE FOLLOWING.
The undersigned hereby applies for a permit to do the following work
which �9�— C.D-
whieh will be done in accordance with the description, plans and specifi- - 0:-, ne,c- 1-F,m _r j ,
cations, and such special conditions as may be indicated on the permit. i,.WL. l'-' 11iX �2p3I4� P.M
7�31911P 1
The owner of this,propert is: f r— ,
3.Awe BnR A A CArtAAV//ati L/ �a X 03., f�4,u• 1-Al/f-. /V 7
• INA`:E) (P.O.ADDRESSI
The person responsible for supervision of the work insofar as the Building Code and the Zoning Ordinance apply is:
Noe.4.¢.v o c"a=r/re.h/-E' 2 L 44— i t/ . 4%.trr ia(/r, rt/y,
(NAME) • IP.0 ADDRESS)
Name of Builder /704C'ry N v`e/s- t Address e i
Name of Plumber e ' Address
Name of Mason " Address
WG>sT mT. ray K, �r?QOt7
Lot Number 4 . . . . Unit Estimated value of proposed work s
Name of Village v.4Elt!,S41 uLy
Name of Street . . . . /gQJ2/Eh/vl/f4. • • . �� Side of street: north gl, east 0, south 0. west 0
Nearest Cross Street fi.(�St //4.0"i1/////N 4L3 Distance from this cross street ,52?O Ft.
Property is north • 0,south ❑,east IX, west ❑from Cross Street
If on Corner, which corner, northeast ❑, northwest ❑, southeast Q. southwest
(Designate by marking with an "X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY
Construction of a new building. Main Building CZ
Addition to a building. • . One-family dwelling
Two-family dwelling
El Alteration to a building. -family apartment house ❑
❑ Demolition of a building.
Store building ccnde,- ❑
• . . J -car attached garage ❑
Other:
• Accessory Building
One-car detached garage
❑ Other work. Describe• Two-car detached garage El
Private chicken house ❑
Private storage building ❑
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, size and setbacks of pro-
. posed buildings,and the location of all existing buildings.
NORTH Show proposed building(s) in dotted line and existing
l uilding(s) in solid line.
Size of property /0 0 ft. x / , 7 ft.
• Size and use of existing buildings, if any
F
in in
i m Size of proposed building . . . ..5. . . ft.x . . .1/Q. . . . ft.
Height(from grade to ridge) / ft.
Front yard . 5-0 ft.
Side yards Z S ft. and 35 ft.
• Rear yard q Z • ft.
SOUTH _If on corner,setback from side street ft..
Note: All distances are net, as measured from street side
. line to nearest part of building.
(OVER)
7-73-TMt
(cont'd.)
BUILDING SPECIFICATIONS.,
Kind of construction: Wood frame, fire safe, etc.?. . . . •,G4.4. .! 4 n . . . . . . . . . . . . . . . . . . . . . . . . • • •
Will any second-hand lumber be used? . . . . /0). . . . . . . If so, for what2 ��
Material of foundation walls . . . . . .��°/%a.Qr�.7`/r'. . .z Bloc/( Thickness /0
Depth of foundation walls be19 grade y Continuous foundation?
Will there be a cellar? If so, material of cellar floor . . . .fie r+!C.R.F.T. /E
Type of roof: Sloped or flat? Material of roof
Size,wood studs A " x 6 ", spacing . . . .,; "o.c., length ft.
Size, floor beams, 1st floor .�--- "x / p ", spacing / <i "o.c., span /2 - ft.
Size, floor beams, 2nd floor . . . .12 " x l.0 ", spacing . . . . ..... . . . . ...o.c., span . . . .! 2, Y` ft.
Size, ceiling beams " x^ ", spacing "o.c., span ft.
Size, roof rafters or beams . . .U_rx�S ", spacing Z Y "o.c., span 2 i ft.
Exterior finish /r=v.'= E`' B /4 w • With what material? Pie v'I O'V
Finish of interior walls. . ..SI Y 46'er
If garage is to be attached, of what materiaL is wall between gangs and main building to be constructed?
e . . . /•ram �d.o . .—. . . . ?C C4
Is there to be an opening between garage and,building?
Kind of heating system E/e-c-Aeic Oil burner or coal?
Will a flue-lined chimney be provided? . Depth of chimney foundation below grade
Height of chimney above roof
Will there be a fireplace? Depth of fireplace hearth
Will a toilet be installed? . '‘/ . S
Will a kitchen sink be installed and connected to water supply? L( .•
Water supply (public water supply or pump) Ptrt3lt
Distance of cesspool from any private well feet
Will drainage system be provided with required traps, cleanouts, and vents?
Town of Queensbury AFFIDAVIT
County of Warren
State of New York
I swear that to tt bei i of my knowledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, area true and co.i. lete statement of all proposed work to 'be done on the described premt and that all provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws perta to the proposed work sha mplied with,whether specified or not,
and that such work is authorized by the owner.
Sworn to before me this Signature
OWNER,OWNER'S AGENT,ARCHITECT.CONTRACTOR
day of 19
NOTARY PUBLIC. WARREN COUNTY. N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
•
By
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Application. for: BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work.
ANSWER ALL of the following:
1. Gross floor area /77 L•
2 . Type of heat Eci"/ c
3 . Is the building mechanically cooled? A/o
4 . Percentage of area of windows and doors •
A. Over 16% Only
1 . Uo value of gross area of walls , roof/ceiling and floors
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a. Are foundation walls insulated? YES NO
1. If YES , what is the R value?
3 . Slab on grade YES NO
a. If YES, what is the R value of insulation around
perimeter of floor?
4. Is basement heated? YES N.O
a. R value of insulation
5. Type of insulation
B. Under 16% Only
1. R value of roof and floors exposed to ambient conditions_
2 . R value of exterior walls )fi/ 9
3 . R value of glazed area K2-
4 . R value of doors �8
5. R value of floors over unheated spaces X � ?
6. R value of slab edge insulation - unheated slab
7 . R value of slab insulation - heated slab R/St
8. R value of heated basement/cellar walls (above grade) 7l7i
9 . R value of heated basement/cellar walls (below grade) ii " K
10 . Type of insulation f-7-s�6-ecn,gyp A,444
C. Controls ^a
1 . Thermostat maximum heat setting 7 J
D. Duct Systems
1. Is duct system installed in unheated spaces? YES NO
a. If YES , R value of duct installation
b. R value of duct in other areas
E. Piping Insulation
1. Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulation
F. Service Water Heating
1 . Performance efficiency Ai '' -42O90
2. Temperature control setting maximum /Z
G. For Swimming Pool Only
1 . Maximum heating
Telephone No. 79F- QS/p
(applicant ' s signature)
TOWN OF. QUFENSBURY
BUILDING & ZONING DEPARTMENT
SEWAGF DISPOSAL PERMIT APPLICATION
1. Owner ' s Name ( /-r/L4/1- / -/4 StG`(& j
''
• Address `-1 GGX ,"n, 0A1,4s ,,97_/7s /1,,,�/,
Telephone No. 7
2. Property location
3 . Name of person or firm responsible for installing system ,4J 2,71 noi (�y7-
Telephone No. n — b. I O
Address
4. Number of bedrooms (residential buildings only) 7
5. Daily flow L/S c7
gallons/day
6. Septic tank capacity (, O J gallons
7. Topography: flat, rolling, steep
% of slope i-7/ -
8 . Nature of soil and depth 4;z —( c s
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? ft.
10. Percolation test: A is required
B - is not required
C If required what is the rate minutes/inch
11. Water supply: municipal, well, other
•
12 . Type of system proposed: drywell, tile field, other
Any contractor, corporation, individual, etc. engaged in the construction
of a sanitary sewage disposal system who covers the same before inspection,
does not have an approved permit, or varies from the approved application
will be subject to a penalty of $250 as provided for in Section 6 . 010 of the
Queensbur Sanitary Sewage Ordinance.
Date l 5//J '/19 -1---- J-- Q-4'O
•
4 signature
/ applicant
On separate sheet of submit a diagram of the proposed septic system
with all dimensions, including distance from any structure, distance from
property line and domestic water supply, etc. Include all dimensions of
the system itself .
1() (07- p ( ci re,J, „,,&
<_._....._______„....__
Form 3-82
TOWN OF QUFFNSBURY
BUILDING & ZONING DEPARTMENT
SEWAGF DISPOSAL PERMIT APPLICATION
1. Owner ' s Name 4e'iti, / C-09-4 /¢,v
Address z/A"-ivi ,PD., ca/ ,/ //r. 4/y
Telephone No.
2. Property location 6 Apple h/o v re L4 v16"
3 . Name of person or firm responsible for installing system
/&e.in/qN Cas.licWe' Telephone No. 7y8_ as.1-/o
Address zg :Lsl,!/ Adam'., /E,✓_c //,f /1/,!
4. Number of bedrooms (residential buildings only) 3
5. Daily flow gallons/day
6. Septic tank capacity /vo O gallons
7. Topography: flat, rolling, steep
% of slope
8 . Nature of soil and depth SAND
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? ft.
10. Percolation test: A is recuired
B ✓ is not required
C If required what is the rate minutes/inch
11. Water supply: �nunicipai) well, other -
12. Type of system proposed: drywell, e field other
Any contractor,. corporation, individual, etc. engaged in the construction
of a sanitary sewage disposal system who covers the same before inspection,
does not have an approved permit, or varies from the approved application
will be subject to a penalty of $250 as provided for in Section' 6 . 010 of the
Queensbury Sanitary Sewage Ordinance.
Date /2-/..9444
signature of applicant
On separate sheet of paper submit a diagram of the proposed septic system
with all dimensions, including distance from any structure, distance from
property line and domestic water supply, etc. Include all dimensions of
the system itself.
Form 3-82
BUILDING DEPT.COPY OF APPLICATION FORM 46-EL,NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED.
TEMP•# DATE b , .� ,,._
CITY OR J �
VILLAGE 6-k. /.;f I7//`I f TOWNSHIP f_j/(J/_:/l/(cif//-/ COUNTY 4(/4l/Z,�JE/J
STREET AND NO.OR _
ROAD AND POLE NO. ,c-. /)PJ)/4- /-66if. G d/(e-, POLE NO.
BETWEEN WHAT TWO
CROSS STREETS IS
PREMISES LOCATED? SECTION BLOCK LOT
OCCUPANT'S BUILDING NAME OCCUPANCY tom, )) _ - i ri 0 . I` i l):,I 1 Ji .
OWNER'S NAME / r
AND ADDRESS �J4 f=t/a.LJf:,rI �'LI-S/ �1C1 Al ��d X /�tJ -`�/�i / >`�f TEL.# --](/3 " 9/ fJ
CURRENT
SUPPLIED j - �'lr 1 Cl !!i. /
BY 1�� : •n`,1 n.. r. r)') �� .J r, I:i�. e, FROM THEIR C/.ice... 1 /-- "j f!S - OFFICE
BUILDING may/ WORK DEFECTS
IS NEW L� OLD El IS NEW ❑ ADDITIONAL❑ REMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
No.of Fixtures& BRANCH OFFICE USE
NUMBER OF OUTLETS Lamp Receptacles MOTORS HEATERS CIRCUITS
Loca- - - ONLY
Lion Side Attaeh't H.P.•, Watts A.W.G.
Ceiling Wall Retep'Is Switch Pendant Bracket No. Type Eech No. Each No. Gauge INSPECTION
Out-
side
Sub-
base
Base-
ment
1st Fl.
2nd Fl.
3rd Fl. •
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE.
This application is intended to cover the above-listed equipment to be inspected but if at time of inspection there is found additional equipment not above listed,
you are authorized to make the inspection and adjust the fee to cover the additional equipment,as provided by the applicant.
SIZE OF ELECTRIC SIGN TOTAL
MAINS FEEDERS LAMPS WATTS
•
CHARACTER - EXPOSED GAS TUBE SIGN
OF WORK CONCEALED TRANSFORMERS OF VA
WORK TO BE - •
(NUMBER) (CAPACITY)
STARTED COMPLETED SIZE OF SIGN
SERVICE OVERHEAD UNDERGROUND MAKER
ENTERS
BUILDING OF SIGN
INSPECTION REQUESTED
ON OR AS NEAR AS
POSSIBLE e NEW OLD 1-1
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NAME AND ADDRESSNAME OF• / /,/
APPLICANT /%i71/i///�i'" /1 C r/—//U/./ APPLICATION �f�' 's/J'S(
c,�' ''. ' ( .> C' l
STREET ADDRESS /. '46X �,• -� TELEPHONE# '/J
CITY OR i �' /L{ L/ ZIP LICENSE NO.
POST OFFICE CI IL`r;f "//S / 5/ / COD ��/ WHEN APPLICABLE
c
46 EL(REV.t) ,e4) - A:SEP( RATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
• K
,05
TOWN- OF QU•EENSBuRY
Building Department
Inspectors Repot Date _ f`
Name S ��- — a �'
' Location w-
' Pe unit No. c1•.3 0. Weather
:=175!c, Remarks
Exca>ation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing _
Sheathing J -~'
Roof Felt I /
Roofing /
Siding I ''/'
Masonry Veneer
Rough Plbg.
Relief Valves (I� lam_ Y
Wall Board lei
Ext. Porches ✓' (- //`
Finished Floor :y' t1
Interior Trim
Stairs & Railings ,J a
Cellar Dr. Tile
Concrete Floors
P1bg. Fixtures Y�
Gar. Fireproofing • _ A
Door Closers
Chimney
Water Meter Inst.
•1 Septic Approval •
Floors
Insulation Foundation
Walls '
Ceiling L590./gt9
•
Building Inspector
REMARKS
ne 7cc- i
TOWN OF QUEENSBURY
Building Dpartment
•
huvedtara Report ®ate! . j,ir
Name A}42, 04 le rh i t I
Location Le /47510/..-e_11.DJSC
Permit No. Weather
Remarks
Exca,ation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing •
Sheathing
,Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board _
Ext. Porches-
Finished Floor
Interior Trim
Stairs & Railings `f
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst. -
Septic Approval i— // :%'
Floors •
Insulation FOUndatibn
Walls
Ceiling
Building Inspector
REMARKS
4(�b j01a „o/PVC •
jf °
TOWN OF QUEENSBURY
Building- Department
•
•
•
Insects Report • Date 2-I3 S
Naive /lC'i?W -,---1 i_dolUSA
' Location `ZZ- VC i.nruz
Permit No. 3 ! S y 31 Weather
Remarks
ExcaVation-
Footing Forms
Footing-& Piers
Foundation
Cement Coat
Waterproofing
Backfill •
Final Survey
Framing
Sheathing •
• Roof Felt
Roofing
i d ing
,
Masonry Veneer
Rough Plbg.
Relief Valves •
•
Wall Board 1/lS1' �
Ext. Porches 4 (t
Finished Floor
Interior-Trim
Stairs & Railings
Cellar Dr. Tile'
Concrete Floors
Plbg. Fixtures
Gar. 'Fireproofing
Door Closers .
Chimney
Water Meter Inst.
Septic Approval
Floors • ✓•
Insulation Foundation-- & — .
Walls •
Ceiling (
Bui ,d�nspector
•
REMARKS
om '
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date / `/ c7j"
• Name_ / ,q1__ c2
Location /J/- 41 SL -C22
. Permit No. I c3c13 Weather
Remarks
Excatra tion
Footing Forms •
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey A
Framing ✓ IT/( •
Sheathing v
Roof Felt `.
Roofing t/('✓{-�
Siding
' Masonry Veneer .,
Rough Plbg. V N i/
Relief Valves
Wall Board
Ext. Porches
Finished Floor
Interior Trim •
Stairs & Railings
Cellar Dr. Tile
• \\\(:,,\\\
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Floors '
Insulation Foundation
Walls
Ceiling
•
Building Inspector
• REMARKS
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date 1/4) ;' 0 4. '
Name rU O-'ram,1 n we %r/ C4-3 / nen/,y
Location 7p-/e/- ,r.y / r)
Permit No. Weather_.___
8 7 3® Remarks
Excavation r
Footing Forms e---1 ., A_�f-.
Footing & Piers (/- ,f i
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
R ugh Plb g. LV �i�
Iief Valves l(
Wal 1 hoard
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
7
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Floors
Foundatio
Insulation n
Walls
Ceiling
icc --
4.,,..-----1 _i__ 6' vc\-\
Building Inspector
REMARKS
•
•
TOWN OF QUEENSBURY
Building Department r
Inspectors Report Date r2 /,'-W
Name . /��_GcEZ:).4/
Location
. Permit No. Weather
7 3® Remarks
Excavation
Footing Forms t. ,/� :�
Footing & Piers {{{ •
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg. / �.
Relief Valves
Wall Board •
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Floors
Insulation
Foundation '
Walls
"Ceilin
Building Insp ctor
REMARKS
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