1991-390 •
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
-WARREN COUNTY,. NEW YORK
Date /1r/AL . , 19 of
This is to certify that work requested to be done as shown by Permit No. 91-390
has been completed.
This structure may be occupied as a _ Gaffe Roam
LocationCourt House Estates, 67 Nelson Road
Owner Dr. & firs. Richard Anderson
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 91-390
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Dr. & Mrs. Richard Anderson
OWNER of property located at Court House Estates Street, Road or Ave. 6.4
in the Town of Queensbury,To Construct or place a Interior Alterations
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at the above location in accordance to application together with plot plans and other information hereto filed and R,
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is
67 Nelson r?
RR3 Box 3177
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2. CONTRACTOR or BUILDER'S Name C"
Hafner Construction
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3. CONTRACTOR or BUILDER'S Address 0
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4. ARCHITECT'S Name c+
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5. ARCHITECT'S Address Ill
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6. TYPE of Construction- (Please indicate by X)
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( )Wood Frame ( ) Masonry ( ) Steel ( ) CCD
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7. PLANS and Specifications 1
No. 800 sq ft Interior Alterations as per plot plan specifications
and application a
8. Proposed Use a ct•
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Game Room y
$ 32.00 PERMIT FEE PAID -THIS PERMIT EXPIRES June 6, 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 6th Day of / / June 19 91
SIGNED BY EGG/ I-„ - =✓ for the Town of Queensbury
Building and Zoning-'I nspctor
TOWN OF QUEENSBURY
REVIEWED B
411.1b11 FEE PAID $ TOWN OF/G?U N;DI1HY
g 41 PERMIT NO. giin3%� CEivE1.,
BUILDING PERMIT APPLICATION JUN 41991
BLDG. & CODE DEPT.
A PERMIT MUST BE OBTAINED 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.
• • • • * • • * • • • * * * * * * • * * * a * • * * • • a • • • * • • * * • * • *
The owner of this property is: Dikl{ Vi Rdeladt 1) ^,)e4a.yet ei
P.O. Address 61 7 10e.Men•N, "" RR 3 Qo 307 Tel. 71 - SA-a)
Property Location CaLitat 44 801% P. ` rstedd. ', Tax Map No. / /
Has there been any split of this property since October 1, 1988? / 1/
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:
Cain .
*
NATURE OF PROPOSED WORK: * ESI'IMATED MARKET VALUE OF •
Construction of a new building * CONSTRUCTION: $ a,ol inn
Addition to a building • COMPLETE INFORMATION REQUIRED BELOW:
* Size of property ft x ft.
Alteration to a building . *
(no change to exterior dimensions) •
Existing Buildings(3) Size ft. x ft.
,� * Proposed building - distance from property line:
Other work (Describe) r •* Front yard ft. Rear yard ft.
F;1 ), A P,q r:., ;i f /`_,i Side yards ft. and ft.
GROSS AREA OF PROPOSED STRUCTURE a If on corner, setback from side street ft.
*
1st Floor sq. ft.
OCCUPANCY INFORMATION
*
2nd Floor sq. ft. * - Primary Building -
Other Floors * , One Family Dwelling
sq. ft. 6
(not cellar or base tt Two Family Dwelling
TOTAL FLOOR AREA ( 0 a sq. ft. • Multiple Dwelling/Number of units
Size of new structure s _y ft x ft. * Business
Foundation-pier/slab/c2,::.;:,' rtiai/full * Industrial
(circle w.;ti,, a —Other tQtto- ---Y't ----
•
No. of stories (habitable space) •
Height (grade to ridge)_. ft. • If addition, what Will use be?
If residential, no..of.families 1 ' *
No. of rooms(excluding baths) • Accessory Building
No. of bedrooms ' __Detached Garage ONE/TWO Car
No. of bathrooms *.
Primary heating system . —__Attached Garage ONE/TWO Car
Type of fuel * _Private storage building
No. of fireplaces to be installed *
* Other
Will a wood stove be installed
•
Central Air conditioning
OV* ER
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe, etc.
Will any second-hand or upgraded lumber be 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 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 - sloped/flat/shed/other Material of roof
Size, wood studs "x " spacing " o.c. length ft.
Joists (floor beams) 1st floor "x " spacing "o.c. span ft.
Joist (floor beams) 2nd floor "x " spacing "o.c. span ft.
Overlays (ceiling beams) "x " spacing " o.c. span ft.
Roof rafters "x " spacing o.c. span 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 be 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- - a
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 CdfADDRESS /-4,10/2-A/ TEL. O. l e?"-`3 `
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 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 wit hether specified or not, and that
such work is authorized by the owner.
Signature
Owner, owne agent, architect, contractor
SPECIAL CONDITIONS OF THE PERMIT:
BY
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE DAYS
To�zll. OF Qu`CNsu�1
Compliance Methods: RECE1V ECro
PART 5 - Acceptable Practice Method - 1 & 2 Family Dwellings (ONLY) J U�
41991
PART 6 - Thermal Rating - Component Trade Offs - 1 & 2 Family Dwellings;
Multi-Family Dwell . & CODE DEFT
(3 Stories or Less)
PART 4 - Design By Component Performance - Commercial Buildings - Hi-Rise Residential
PART 4 & 6 - Compliance Methods Require Submission of Worksheets
APPLIC NT'SfNAPE ' PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - Sq. Ft.
2. Type of Heat - Elec. Base Board Other ho E7ec -'G
3. Is Building Mechanically Cooled? YES NO
4. Percentage of Area of Windows and Doors Over 17% ✓ Under 17%
THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND TO REQUIRED
THE R-VALUES SHOWN ON PLANS SUBMITTED!
Baseboard
5. Insulation Values: Actual Shown Elec. Heat Other
A. Roof & Floors exposed to ambient temperatures R
B. Exterior Walls R 41L)
C. Glazed Area R
D. Exterior Doors R
E. Floors over unheated spaces R
F. Edge of Slab on Grade (Heated Building) R
G. Basement/Cellar Walls (Above Grade) R
H. Basement/Cellar Walls (Below Grade) R /1 109-
I. Heating/Cooling - Ducts - Piping in Unheated Space R
6. Service (Domestic) Hot Water Heating Device
A. Conforms to minimum efficiency per code YES NO
TEMPERATURE CONTROL MAXIMUM SETTING 140* - WILL NOT BE EXCEEDED
COnStk—&di:0311 6A-(i/W 58C9\C?
APPLICANT'S SIGNATURE(4471_, �� -ZATE TELEPHONE NUMBER'ap _
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INSPECTOR'S REMARKS :
./1/046//
REVI D BY
(ii41 MIDDLE DEPARTMNT INSPECTION AGENCY, INC.
National Headquarters
1337 West Chester Pike,West Chester, PA 19380
APPLICANT COMPLETES THIS SECTION
Date: f. 9 ;.,1
City, Town or Township ), 2 e ..-7 5,4 v a) /�J County '-1%�.^- ^ .State ,r
Location/Address , ,7 �7�-C ,d*i`7 ie:...-//1
_ (If Located in Rural Area - Please Attach Directions) Pole #
Owner c i f i�'L. t 7...,,,x0,..d_.,- ' Permit # _` r•' -'
Occupied As i - Building: Newn� Old. 1�
• !'Occupant . -
Work Area in Building (Floor #,etc.):
App. for: Wiring❑ Service n or: Ready for Inspection: .., r • r.=.5`.c' ,
Fee Remitted-$ Cash n Check in M.O. n Make Payable To: M.D.I.A.
500 750 1000 1250 1500 1750 2000 2250 2500'2750 3000
Number of Rough Wiring Outlets Elect. Heat
Switches
Lighting Amp. Service Surface Unit Dishwasher Range
Water Heater Air Conditioner Dryer Pump
Receptacles
Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner
Amp. Receptacles Fractional H.P. Vent Fans
• Other Equipment:
MOTORS H.P. 1/201/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 11/2 2 3 5 742 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size ., -
Applicant's 7:,--- i
Signature - License # Permit #
T/A Utility:
(NAME) (OFFICE LOCATION)
Applicant's Address:
(City) (State) (Zip) Service Request #
Phone # . • ' ."-/ Electrician: .
MDIA USE ONLY DATE RECEIVED: DATE INSPECTED:
Correct Location: Same as Above n or: •
Red Notice Label n
Rough Wiring Outlets Surface Unit Oven
Switches Range Garbage Disposal
Receptacles Water Heater Dishwasher
Fixtures Air Conditioner Dryer
Amp. Service Equipment Burner, Wiring &Controls for Amp. Receptacle
Amp. Service Conductors Pump Vent Fans
MOTORS H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 11/2 2 3 5 71/2 10 15 20 25 30 40 50 75 100
Mark Number •
of Each Size
500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Elect: Heat
•
•
CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CO RECT FEE PAID
❑ RW Progress: Inc.❑ LKD❑ Contractor
❑ CFT Violation: Work Comp.❑ Inc. ❑ CASH ❑
n L/A Owner
Fee CHK #
❑ L/A Due MO #
n IPA V Municipal
INV #
Date: Other Side El Utility Applicant ❑Owner
Cut in Card n Temp # Date
n Final # Date INSPECTORS SIGNATURE
APPLICATION FORM NO.250 EL 11/89
TOWN OF QUEENSBURY
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED ' D
PME 0, a 1 21e2 iebd—
LOCATIOU Co 7 e.621_LA
GATE / 4g/ PERPIIT#
TYPE OF STRUCTUREQQ -4QB-j(,4.)
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL VRAMING
ROUGH PLUMBING FINAL ELECTRICAL SEPTIC
_INSULATION WOODSTOVE/FIREPLACE
REMARKS Qft/imu, . JLJ
c/''/1i C v "
//9, ri APPROVAL
/1'97" IN/A 9 YES NO
CHIMNEY HEIGHT/LOCATION / L/
B VENT/LOCATION ' ✓
PLUMBING VENT 1' ✓
ROOFING / ✓
SIDING
DECK/PORCH/STEPS/RAILINGS``
RELIEF VALVES 1 �/
FURNACE/HOT WATER OPE AT,ING
BASEMENT INSULATION/DUCTWORK • ✓
INTERIOR TRIM/PRIVA cY DOORS ✓
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT:
OTHER FLOORS SWEEPABLE �✓
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS \. ✓
SMOKE DETECTORS
BATHROOM FANS/WHOLEHOUSE FANS
ALL PLUMBING FIXTURES OPERATING u't
GARAGE FIRE PROOFING ' , ✓
DOOR CLOSERS '‘tr.
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
DUMPSTER
SITE PLAN/VARIANCE REQUIREMENTS ✓ <:_
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C �✓ .
COMMENTS:
A.
ARRIVE 3•' /
DEPART ' ate'
I _ T
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD /)7
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION
RECEIVED
NAME /M .
LOCATION �' ,(;a .
DATE �j/(7 // PERMIT # g/— 9 )
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 f'
JOIST HANGERS
JACK POSTS/MAIN BEAM ` .
FIRESTOPPING a'
WALLS
CEILING
FIREWALLS
�IEATING ROUGH—IN I
NSULATION:
FOUNDATION WALLS INTERIOR R—I /1 X.
FOUNDATION WALLS EXTERIOR R-1
FLOORS
WALLS 1 R-1
CEILING
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS: �.
/I()
j
ARRIVE V DEPART 1 --r—�--
r~' NS PEC TOR
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 &l%C3l Gj/
NAME,,, D-'\() C
LOCATION CO N
DATE Ce' /3 11 PERMIT I 9 J 3ci (�
TYPE OF STRUCTURE J_f T I crr �I-��✓Gi�l lS
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 SITES/
FOUNDATION/WALL POUR \ /
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING ti /
BACKFILL APPROVAL % /
ROUGH PLUMBING /"
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB /'1,
FRAMING: /
JACK STUDS/HEADERS /'
BRACING/BRIDGING /
JOIST HANGERS
JACK POSTS/MAIN BEM a.
HEATING ROUGH-IN
INSULATION: / k
FOUNDATION WALL INTERIOR R- `t
FOUNDATION WALLS EXTERIOR R-
FLOORS �' R-
WALLS / R-
CEILING R-
DUCT WORK Q'R PIPING IN UNHEATED
SPACES /
REMARKS: L-
ARRIVE ��
DEPART fc) YX(�
INSPECTOR
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MMID�IIIi1M�irM
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GIPSANO1**#*-I*
JUN 41991
BLDG, & CODE DEPT.
TOWN OF QUIEE.�,�`SBURY
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