1991-182 --'CERTIFICATE OF COMPLIANCE
TOWN OF Q.UE,ENSBURY
WARREN COUNTY, NEW YORK
Date ✓e4//.Gyi-A -A 19 9/
This is to certify that work requested to be done as shown by Permit No. 91-182
has been completed.
This structure may be occupied as a Deck
Y.nc-ation 3.2 may AnnRoad
Owner Madelyn & Dale White
By. Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-182
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Madelyn & Dale White
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OWNER of property located at 12 Peggy Ann Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Deck
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.
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1. OWNER'S Address is
Same
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2. CONTRACTOR or BUILDER'S Name
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
5. ARCHITECT'S Address 0
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( I Masonry ( )Steel ( )
7. PLANS and Specifications
No. 429 sq ft Deck as per plot plan specifications and application
8. Proposed Use
Deck
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$ 32.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 12, 19 92
(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 12th Dayiof ,April 19 91
SIGNED BY for the Town of Queensbury
Building and Zoning Intspector
'T
TOWN OF QUEENSBURY Fee Paid ��7-3
;1340.•
BUILDING & CODES DEPARTMENT Permit # �}i- 1 go�
APPLICATION FOR: PORCHES-DECKS- Est. Cost�I()U U
DOCKS & BOATHOUSES
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. PLEASE 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 may be indicated on the permit. TWO SETS OF STRUCTURAL PLANS SHALL BE SUBMITTED
WITH THIS APPLICATION.
Owner of Property: H4l% GAJ °< 2/ WH:( 791 -/9 ( 0
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P.O. Address /2 / 2 /' ,4JA / 3J 2 Phone # 7962-5`/
Property Location Tax Map #
Subdivision Name (If applicable)
PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES:
Name:
()j 7 Address Phone#
BUILDING SPECIFICATIONS:
Type of work to be done: Porch Deck Dock Boathouse (Circle one)
Size of Structure to be built (square footage) : L/2 9
Foundation Material : Width /Z Thickness 12_
3 ( TO'-'.:.' OF QUEENSBURY
Depth of Footing, below grade:
Size of Posts or Studs: 7 x g x Long
Size of Floor Joists: x x )Z Span APR 101991
Decking or Flooring Material : .5/y
How will Porch or Deck be fastened to building? /144/6, 0 BLDG. & CODE DEPT.
If Roof Will Be Installed, Answer Following Questions:
Size of Posts or Studs: x x Long
Roof Rafters: x Spacing Span
Roof Trusses (pre-engineered spacing) : Span
Type of Roof: Sloped Flat Shed Other (Circle one)
Material of Roof:
ZONING INFORMATION:
TWO PLOT PLANS MUST BE PREPARED AND SUBMITTED, drawn reasonably to scale and attached
hereto, showing clearly and distinctly all buildings, whether existing or proposed and
indicate all set back dimensions from property lines. Show location of water supply and
location and configuration of septic disposal area.
Size of Property: /( 3 ft. x /20 ft.
Existing building(s): Size 2 V ft. x 7Z ft.
Size ft. x ft.
Use of Existing building(s) : /qpclfr a t 4 /G&
Proposed structure, distance from property line: t,0'
Front yard 7`/ ft. Rear yard -7 1 ft. \`�
Side yards ,2 ft. and r/�Z ft. - u e/
If on corner, setback from side street: ft. , \-\'
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 done on 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. �/ )�
DATE: y�//g/ SIGNATURE
02 �
Owner, Owner's Agen , Ar t Contractor
APPROVED BY CODE ENFORCEMENT OFFICER, DATE 'i NIZ-P1 SIGNATURE /..
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED/
NAME `�44 d e 1 f v �f(/id ffJ 1 %hfC
LOCATION /�' •,�39 / 21?/1_ 4d _
DATE W/%14/ PERMIT # 940'2
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOWING
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE `
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS ,
JACK POSTS/MAIN BEAM
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
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DEPART �j ' (1;;itAe
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