3688 .• • -
C/O Paid
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date
19 - -
toVn h I.
This is to certify that work requested to be done as shown by Permit No.
has been completed.
tTh
This structure may be occupied as a Gh-el. W.11(111\2, 1 ttc:),P (0
Location L0022 MMTIACIICILCAtrifEA
Owner
By. Order Town Board
TOWN OF QUEENSBURY
• ),ri „ ;i
C: ag,)
Building & toning inspector
=
CREATIVE ••INSTA• PRINTING. GLENS FALLS. N Y 12801 (518)793-5658
BUILDING PERMIT
TOWN OF QUEENSBURY No. 3688
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Patri ci a GPi ger
°L7
OWNER of property located at Lnt #1 22 HPi nrink Circle Street, Road or Ave.
F,.
in the Town of Queensbury,To Construct or place a nnP-Family Dwelling n
at the above location in accordance to application together with plot plans and other information hereto filed and Cu
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
m
1. OWNER'S Address is 16 Orville Street
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Martin C. Mosher
3. CONTRACTOR or BUILDER'S Address r'
Upper Sherman Avenue, R. D. #3
Glens Falls, New York F,
N
4. ARCHITECT'S Name N
CD
5. ARCHITECT'S Address ~•
n•
x•.
0 9
6. TYPE of Construction—(Please indicate by X) 0'-
F.;
CD
( Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
24' x 42' per plot plan, specifications and application
No. submitted including sewage system and one-car attached
garage. 1
8. Proposed Use
N•
One-Family Dwelling
d
$5.00 C/O Paid
$ 36.00= . :-. PERMIT FEE PAID—THIS PERMIT EXPIRES March 1 19 76
(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 19th Day of August 1975
SIGNED BY a19 "d" _ / for the Town of Queensbury
Building and Zonin Inspector
TOWN OF QUEENSBURY (Space inside block to Ix filled in by
WARREN COUNTY,9 NEW YORK Building Inspector)
.- Application for Application No.
pP Permit Issued 19.
BUILDING AND ZONING PERMIT Permit Expires. l).
%caning District
\ aloe nl Work,
THREE 13) Copies of a PLOT PLAN, Drawn to scale .\11"""‘(•(1 by
showingthe actual dimensions of the lot to be built Itcmarkt-
upon, Te exact sue, and location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION. •
TOWN OF QUEENSBURY
WORK.a"/ ,. ./. . . / q.-.7,. . .
i f iteg
OBTAINED BEFORE BEGINNING � ,, _
A PERMIT MUST BE � � g ��J5
ANSWER ALL OF THE FOLLOWING. AU .-j
The undersigned hereby applies for a permit to do the following work A.M. C� i P.M.;
which will be done in accordance with the description, plans and specifi- 71819`1011,116 A_2111213141516
cations, and such special conditions as may be indicated on the permit.
The owner-of this propertyis: /� l
_j.�Ca-c..�.rtii ,,Lc...,(, :7- .'c.. . . ./.�a. . . . !�'✓.C/r[-t..-l/ '. v n l, �0,-C/-.a✓ )-) - -
--INA'E) ,• (P.O.A DRESS) '
The person responsible for •supervision of the work insofar as the BuildingA.A,.:4..-,-,,,,,,,,
Code and the Zoning Ordinancen apply s:1
(�/� la, • (-7--,�-�'�_�G�,t-. �L✓ �i . G c�-tom' /ice/. r . .��. . ......., .
✓������� 1._
(NAME) (P.O.AuuRES 1 /
Name of Builder. . . �..u.l+ Address
Name of Plumber. . t.‹-x-r.--�� Address
Nathe of Mason. .c., -(----- Address
Lot Number l • . Unit Estimated value of proposed work$ .1.� . G.e—_.-i' ' ec---Fi
Name of Villag .-:14 t!7-z..'. t.�.A. c'T.�'Cc..tL:,2.:�./L:u..
Name of Street . / . :v f-I-% e �•�� de of street: north 0, east 0, south A. west ❑
/ 2-2 . . . . . . . . . . Ft.
Nearest Cross Street . . . ..�. :tiU ��t• • • • .-�hu•z.c� Distance from this cross street . . . .
Property is north 0,south ❑,east K,west 0 from Cross Street -
If on Corner, which corner, northeast ❑, northwest ❑, southeast 0, southwest
(Designate by marking with an "X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY
��{{ Main %uilding
�l Construction of a new building. One-family dwelling iX
El Addition to a building. ❑
❑ Alteration to a building. Two-family dwelling
-family apartment house El❑ Demolition of a building. Store building 2I.
/ -car attached garage 0
Other:
Accessory Building
- • One-car detached garage ❑
❑ Other work. Describe •
Two •car detached garage ❑
Private chicken house ❑
Private storage building El
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
J /U---C.-L-,ti;(k.-Lc;/-) ���c.--- lluilding(s) in solid line.
Size of property G "� ft. x /�� ft.
Size and use of existing buildings, if any
en
r,
a-
r� m Size of proposed building 7 • f 4� ft•
i.
Height(from grade to ridge) / ft.
Front yard ft.
xSide yards �ft. and . . . t2 ft.
Rear yard 0 ft.
SOUTH If on corner,setback from side street ft.. ..
• Note: All distances are net, es measured from street side
line to nearest part of building.
(OVER)
7-73-M - .
(cont'd.)
BUILDING SPECIFICATIONS.,
Kind of construction: Wood frame, fire safe, etc.?. . . d�i.--.-eL-- 6&^(--
Will any second-hand lumber be used? �h-9 If so, for what? p
Material of foundation walls . .,_ !Ls--e.•� Thickness c. �")`=z-'
Depth of foundation walls below grade . . .� lo -3"��`4G`---- �� � Continuous foundation? . . .
Will there be a cellar? o If so, material of cellar floor . . .LC!Yrt_.�,,.,,�z: ��
Type of roof: Sloped or fl t? . . . —. Material of roof . . .��/ ,T. . . . 1_JA-,l,.�. e
Size,wood studs "x -y ",spacing /4�. . . ."o.c., length.f. . . • ft.
Size, floor beams, 1st floor A "x / D ", spacing . . . . . . /. .. . . ."o.c.,span r� ft.
Size, floor beams, 2nd floor "1 '-10--E..__— ", spacing "o.c., span ft.
Size, ceiling beams
t.-xz � ", spacing "o.c., span ft.
Site, roof rafters or beams L,rt •-6-,' ", spacing "o.c.,span ft.
Exterior finish / ��-• • '-�/1- - With what material? L./.,�-:L,c.�f-,! -c-,
Finish of interior walls ! -2-• . 1-c--i✓ •.\-3 t'ti- --,t✓-)
If garage is to be attached f what material is wall between garage and main building to be constructed?
Is there to be an opening betwe,n garage and building? 1-720
Kind of heating system Li�,. -cam 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? Li2.-,r) Depth of fireplace hearth
Will a toilet be installed?
Will a kitchen sink be installed and connected to wa r supply? ���
Water supply(public water supply or pump). . . . -&--L-t-=r
Distance of cesspool from any private well �, feet
Will drainage system be provided with required traps, cleanouts, and vents? �,yt��
Town of Queensbury AFFIDAVIT (/
County of Warren
State of New York
I swear that to a:-b cg°rof my knowledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, are a true and complete statement of all proposed work to be done on the described premises and that _provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertaini m ang to the proposed work shall be complied with,whether specified or not.,
and that ouch work is authorized by the owner.
Sworn to before me this Signature 4-2�" n ` 7----•'------ -
OWNER.OWNERS AGENT,ARCHITECT.CONTRACTOR
day of 19
NOTARY PUBLIC.WARREN COUNTY. N. Y.
SPECIAL CONDITIONS OF THE PERMIT: _
•
•
By
TOWN OF QUEENSBURY
BUILDING & ZONING DEPARTMENT
QUEENSBURY TOWN OFFICE BUILDING _
BAY & HAVILAND ROADS, R. D. #1
GLENS FALLS, NEW YORK 12801
APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE
A SEWAGE DISPOSAL SYSTEM WITHIN THE TOWN OF QUEENSBURY
OCCUPANT' S NAME 0 �� ` .ADDRESS XL /,
r
TELEPHONE19, -3 0WNER'S
NUMBER OF BEDROOMS ,
GARBAGE GRINDER? '2 (YES OR NO) TOPOGRAPHY: FLAT9 .ROLLING9 STEEP
`'R OPE, .GENTLE SLOPE, OTHER V .fix
NATURE OF SOIL: CLAY, SANDY, LOAM, GRAVEL, ROCK, ETC. . �
"'' PERCOLATION TEST WATER SUPPLY: 09CIPAL„ WELL, OTHER
DIAGRAM OF.: PROPOSED. :SEPTIC SYSTMD
•
•
9
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OTHER PERTINENT INFORMATION
IT IS HEREBY AGREED THAT IF THIS APPLICATION AND PLANS ARE APPROVED,
INSTALLATION OF SEWAGE DISPOSAL FACILITIES WILL BE MADE IN ACCORDANCE
WITH DETAILS SHOWN.
DATE SIGNATURE OF APPLICANT_ e- ,
LAKE GEORGE PARK COMMISSION APPROVAL: _ __-.-
(signature)
(date)
Pc,r. c2-, I! el-
.Ci ..1",t IN „1,e,11,Ga.l.a.V.,IA_.el.a9.1J.4.,N._.9,'•el.e!..J••J_.la••/..1!%a/.a'%- I.J. A.a Gl..l..InA/-- J../;J_••1..9 e4-1:9cE7_..!..J.7/.,?... ..dInek�:cl.),,Ca.C... !.la la cCa/_.A 4...1,.,C_ _.1-1_.._lJ�..0•&A'!.-,
THE NEW YORK BOARD. OF FIRE UNDERWRITERS
'A, 4
-o BUREAU OF ELECTRICITY ,-
41 STATE STREET,ALBANY,NEW YORK 12207 v.
iP Date : .:.. Application No.on file
THIS CERTIFIES THAT 1
only the electrical equipment'ss described below and introduced by the applicant named on the above application number in the premises of
ul `Y•
in the following location; El Basement ❑ 1st Fl. ❑ 2nd Fl. -• •- -- =-' - •• •-• Section J Block Lot r
was examined on I ,� d and found to be in compliance with the requirements of this Board. ;p
1i
►o' FIXTURE ECEPTACLES SWITCHES FIXTURES M¢Rc�Rr RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS ;
ill OUTLETS INCANDESCENT FLUORESCENT VAPOR AMT. K.W. AMT. K.W. AMT. K.W.. AMT. K.W. AMT. H.P.
"C, DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS .r
'AMT. K.W. OIL ' H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET '�'T.- WATTS 'iP. SYSTEMS Y
.
(+ • • . . T
', SERVICE DISCONNECT NO.OF S E R V I C E
` AMT. AMP. TYPE EQUIP 1/if 2W 1,9'3W 3.'3W 9,0'4W NO.OPER%COND. OF CC.COND. NO.OF HI-LEG OF'HI-'LEG NO.OF NEUTRALS OF'NEUTRAL :�
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kOTHER APPARATUS:
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BRANCH MANAGER
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COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
/2` .
TOWN F QUEENSBURY
Building Department
Inspectors Report Date '/ Z! /7 C
Name t=/ Ca/2 P- zos ezio
Location 2--7 J./ i 1 sZ „Z
Permit No. T) La $S Weather
Per Cent - ,�
Complete Ronix ycaa
Excavation
Footing-Forms
•
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding i •
Masonry Veneer
Rough Plbg.
Rough Htg.
Relief Valves
Wall Board
Ext.Porches
Finished Floor
Interior Trim
Stairs&Railings
Cellar Dr.Tile
Concrete Floors
1/> //1\.
Plbg.Fixtures
Gar.Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval , /
A/12
Building Inspector
REMARKS
•
•
•
TOWN OF QUEENSBURY • •
Building Department
Inspectors Report Date
Name.
Location - 01 tai,x4.--
Permit No. 3(3,' Weather l_(�C
Per Cent •
Complete Remarks
Excavation
Footing Forms 1)
Footing & Piers ��[%G"WZ
Foundation
Cement Coat • -
Waterproofing •
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Rough Htg.
Relief Valves
Wall Board
Ext.Porches
Finished Floor
Interior Trim
Stairs&Railings
Cellar Dr.Tile
Concrete Floors
Plhg.Fixtures
Gar.Fireproofing
Door Closers
Chimney •
Water Meter Inst.
Septic Approval
>� 6
Building Inspector
REMARKS
TOWN OF QUEENSBURY
Building Department
Inspectors A2eport Date 7`?/7'
Name 6 c
Location l.,ir
Permit No. 3-(ki Weather
Per Cent
Complete Remarks
Excavation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing 4)'/
Sheathing
Roof Felt
•
Roofing
Siding
Masonry Veneer
Rough Plbg.
Rough Htg.
Relief Valves
Wall Board
Ext.Porches
Finished Floor
Interior Trim
Stairs&Railings
Cellar Dr.Tile
Concrete Floors
Plhg.Fixtures
Gar.Fireproofing v
Door Closers
Chimney
Water Meter Inst.
Septic Approval
ieg4,
Building Inspector
REMARKS
. dzt % 9D
•
TOWN OF QUEENSBU 'Y
Building Department
Inspectors RepRort, Date Y/ 9`J�✓
Name ' [,�i_Aii_-
Location Mi/'&/,1-1 e--* .0e2
Permitms/ F.
L...,, ;,.,,.,.-_ Weather
._JCS Per Cent
Complete Remarks
Excavation -
i Footing Forms 47
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg. 17- 444- P"
'fr
Rough Htg.
Relief Valves
Wall Board
Ext.Porches
Finished Floor
Interior Trim
Stairs&Railings
Cellar Dr.Tile
Concrete Floors
Plhg.Fixtures
Gar.Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval /
•
Building Inspector
REMARKS ,>1
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