1992-234 OMNI
x
BUILDING PERMIT �
TOWN OF QUEENSSURY No. 92-234
WARREN COUNTY O NEW YOR C �+
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PEA MISSION is hereby granted to Wayne A Mi chel 1 e Yi 11 i afin5
OWNER of property located at $eel1/ Rd Cleverdale Street, Road or Ave_
lic
in the Town of Queensbury. To Construct or place a
Addition to dMpllina
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.
In
Y
t. OWNER'S Address is
Box 241
Cleverdaleg NY 12820 �
films
2. CONTRACTOR or BUILDER 'S Name 3C
Same
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3. CONTRACTOR or BUILDER'S Address (a
con
4, ARCHITECT'S Name
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CL
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S. ARCHITECT'S Address
CO)
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6. TYPE. of Construction — (Please indicate by K)
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(xi ) Wood Frame [ ) Masonry I 1 Steel { 1 M
F
Specifications
216 sq ft Addition to Dwelling as per plot plan specifications
plication CL
Qe Room
e�
Q
$ 16_00 PERMIT FEE PAID — THIS PERMIT EXPIRES May 20 , 01992
J
(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.)
i0
Dated at the Town of Queensbury this 20th Day of MaIY 19 92
r
SIGNED Byfor the Town of Queensbury
Building Zoning I or
4 '
T0W19 OF QUEENSBURY
REVIEWED BY :
aw
OWN OF QUEENSBUH L
A041
FEE PAID : � { - RECEIVED #
PERMIT N0 . : q " - MAY 14- 1992
BLDCi. 8► CODE DEPT.
BUILDING PERMIT APPLICATION
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 .
Owner of Property : , ! ME
P . O . Address : BOX CL 45V46 '�'�' ,G , rA � / Z Ir2 d PHO,rNNE_f�5 ��"a �35 '7
Property Location : /�G. /CCU L� r� .^� �E _Tax Map No - �
}{as there been any split of this property since October I , 1988? Yes
No
if yes , Planning Board Review is necessary .
_ Subdivision Name , if applicable :
Lot No .
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS :
NATURE OF PROPOSED WORK : * ESTIMATED MARKET VALUE OF THE
Construction of new building * CONSTRUCTION :
Addition to building
Alteration to building * COMPLETE INFORMATION REQUIRED BELOW :
( no change to exterior dimensions ) * Size of Property : nz9'C! ft . x 130 ft .
* Existing BuildingSize :
Other work ( describe ) * y ft . x ft .
* Proposed building - distance from
GROSS AREA OF PROPOSED STRUCTURE : property line :
* Front Yard /rPSf ft . Rear yard �v d ft .
1st Floor / �/ Sq . Ft ' * Side Yards ft . and ft .
2nd Floor Sq . Ft . * If on corner , setback from side street-
* ft .
Other Floors Sq ' Ft ` * OCCUPANCY INFORMATION :
( not cellar or basement ,+��
TOTAL FLOOR AREA : `4 Sq . Ft . * Primary Building -
* A, One Family Dwelling
Size of New Structure : ! ft . x / 41. 5' ft . * Two Family Dwelling
Foundation : _ Multiple Dwelling/No . of Units
Pier/ Slab/Crawl /Partin /Full ( Circle One ) * Business
* Industrial
No , of stories ( Habitable space ) * Other
*
Height ( grade to ridge ) ft ' If addition , what will use be?
If residential , no . of families : �[ * d dl
No . of rooms ( excluding baths ) : R
No . of bedrooms : * Accessory Building :
No , of bathrooms : * K Detached Garage One Two Car
Primary heating system : r~�-,�- _r fe 114o Ate' * Attached Garage - /Two Car
Type of fuel : Private Storage Building
No . of fireplaces to be installed : * Other
Will a woodstove be installed? :
Central Air Conditioning : Yes X No
( OVER )
BUILDING PERMIT APPLICATION CONTINUED :
BUILDING SPECIFICATIONS :
Type of construction : wood frame , fire safe , etc .
Will any second- hand or ungraded lumber be used ? If so , for what ?
Foundation Wall Material : .�SL.dC_/� Thickness : le "
Depth of Foundation below grade ( to bottom of footing ) : or
Will there be a cellar? - Heated or Unheated ? 40'o54yr. —,r,:,:r—/) Floor Sq . Footage :
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 45PY4 A:nFx> Maternal of Roof
Size , wood studs c;2- x '" ; spacing Jam " Q . C . ; length ft .
Joists ( floor beams ) : Ist Floor — "' x Al '" ; spacin '"
g � o . c . ; span ft .
Joists ( 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 ) a . c . ; span ft .
Exterior Wall Finish : pypypew
500 A16� of what material ?
Interior Wall Finish : �sdC.�" ---
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 , serf- closing device be provided ?
Will a flue- lined chimney be installed ? "eight 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 A ADDRESS :
NAME OF PLUMBER A ADDRESS : PHONE
NAME OF MASON & ADDRESS : PHONE
NAME OF ELECTRICIAN & ADDRESS : PHONE
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 .
Signature � �
Owne , owner s agent , architect
contractor
SPECIAL C N ITI NS OF E P RMIT :
By :
Code nforcement Off cer
ENERGY CODE COMPLIANCE APPLICATION
TOM OF OUEENSBURY , WARREN CatNTY 40 9000 HEATING DEGREE ILIUM OF RECEIVE�NBUI�
Cowl iance Methods: MAY 14 1992
PART 5 - Acceptable Practice Method - I b 2 Family Dwellings ( ONLY ) BLDG. d► GQpE pEpT,
PART 6 - Thermal Rating - Component Trade Offs - I b 2 Family Dwellings ;
Multi - Family Dwellings
( 3 Stories or Less )
PART 4 - Design By Component Performance - Commercial Buildings - Hi - Rise Residential
PART 4 6 - Compliance Methods Require Submission of Worksheets
APPLZCANT@S NAME P OPA17 L I M
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE .
1 , Gross Floor Area on 04-Z> r/ fQ 5q . Ft , . ',°� " � / <<' 4- ,
oo,
2 . Type of Heat - Elec . Base Board Other L �`7�' r ,�<v�- ,q,,Ae
3 , Is Building Mechanically Cooled ? ,' ( YES NO
4 , Percentage of Area of Windows and Doors Over 17% _Under 17 %
THE "ALLIES GIVEN ON THIS SHEET MUST CORRESPOND TO
THE R-VALUES SH" ON PLANS SUB14ITTMI R_ E O U I R E 0
5 . Insulation Values : Baseboard
Actual Shown Elec . Heat Other
A . Roof & Floors exposed to ambient temperatures R 33 .�
8 . Exterior Walls R 3 3
C . Glazed Area
D . Exterior Doors R
E . Floors over unheated spaces R_
F . Edge of Slab on Grade ( Pleated Building ) R
G. Basement/Collar Walls (Above Grade ) R
H. Basement/Cellar Wails ( Below Grade ) R
T . Heating/Cooling on, Ducts - Piping in !Unheated Space 'R��
6 . Service (Domestic ) Not Dater Heating Device
A . Conforms to Mi ni=jm efficiency per code A YES NO
1'ElIERATURE CONTROL MAXIM N SETTING 1400 on, WILL MOT BE EXCEEM
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INSPECTOR ' S REMARKS
' TOWN OF QUEENSBURY
RUILDING & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12BO4
(518) 761-8256
ARRIVE : DEPART : INSPr
FINAL INSPECTION REPORT — RESIDENTIAL
DATE' INSPECTION REQUEST RECEIVED :
NAME /1._. ._ .4--1f'-�►' [� ,-, ^
LOCATION ^/_ '�'--3 � I-L3AV")
DATE - -. ."g_ PERMIT 0
TYPE OF STRUCTURE
FOOTINGS FOUNDATION BACHFILL FRAMING
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
CHIMNEY 1iEiGi�,T1B VENTlifElGfiT
,'�IUMBI G VENT
ROOFING
EXTERIQft FINISH
E K PClRCH STE S N ,
E I F VALV S
FURNACE HO W T O ERA G
NT RIOR TRIM IVACY O S
.FINIS O S :
BATHlKI .'CHEN WATER.TI�HT _
OTHER FL40QRS WEEPABLE
t7'THFeFt _F S CA PETER
S A R C N E RAIL,IN S
S O E T CTOR
BATHRO M FANS
U B NG F XTUJESA
I O
GARA FIRE PROJILGI
DOOR O E S
A CTRICAL11
Si E N A I N E R
FT A V Y P P
"" T U C 0
6 .357'31
4a TOWN of QUEENSsuRY IRA
SAY ROAD
QUEENSBURY , NEW YORK 12604
TELEPHONE ( 5I8) 745- 4447
BUILDING INSPECTOR' S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTIfNI RECEIVED_ e tp_lH
NAME
LOCATION 'ter P l lj I= PM
DATE.�"7 1
- PERMIT/ ` tZ_Z.3_q
TYPE OF sTR uc RE o 't"t2 nualerz
RECHEC
F RE MARSHAL APPROVAL (CO, PMERCIAL STJ!V�JCTURE )
yAeOOTING FOUNDATION VSACKFILL NeTRAMING
.ROUGH PLURSING FINAL:ELECTRICAL' SEPTIC
SULATION �W0005STOVE/FIREPLACE
REMARKS F� oA►_ may [ „a
APPROVAL
CHIMNEY HEIGHT/LOCATION N/A YES INC
S VENT/LOCATION "^
PLUMBING VENT
ROOFING
SIDING
DECK/P RCH/S EPS/RAILINGS
RELIEF VALVES
FURNACE/HOT WATER OPERATING
BASEMENT INSULATION/DUCTWORK
INTERIOR TRIMlPR VACY DOORS
FINISH FLOORS :
BATH/KITCHEN WA RTIGHT
OTHER FLOORS SWE ABLE
OTHER FLOORS CARP TEE
STAIR CLEARAPICE/RAIL G
HANDICAPPED ACCESS
SMOKE DETECTORS
BATHROOM FANS/WH L US AN'
ALL PLUMBING FIXTURES PE TI
GARAGE FIRE PROOFING
DOOR CLOSERS
OTHER FIRE SEP RA I N
FIRE/D£MISE WALLS
DUMPSTER
SITE PLAN/VARMICE RE OI EM N
FINAL ELECTRICAL
OK TO ISSUE C/O O/Rr�,C+lC
r/ 4r.
ARRIVE fJ' /�''
DEPART
�__
TOWN OF QUEENSBURY 45
BUILDING AND CODES DEPARTMENT z/o
531 BAY ROAD
QUEENSBURY9 NEW YORK 12804
TELEPHONE (518 ) 745- 4447
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
LOCATION
DATE 46X,�11 1 / PERMIT OF
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YES NO
FOOT ING /PIER
MONOLITHIC POUR F M - --
REINFORCEMENT IN PLACE
THE CONTRACTOR 15 RESPONSIDUE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 YOURS FOLLOWING
THE PLACE14ENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR ?'
REINFORCEMENT IN PLA £
FOUNDATION/DAMPROOFIf G — '��- '
BACKFILL APPROVAL_ i
ROUGH PLUMBING
PLUMBING VENT/VW S 16KPLACE
PLUMBING UNDER SLAB
FRAMING :
JACK S' /JB / S
N �RIH
BRACT G JOIST HANGS
JACK POSTS IN BEAM
HEATING ROU - IN
INSULATIO
FOUNDA N ALL INTERIOR R-
FOU N {ON WALLS EXTERIOR R-
FLOS R
WA S R-
C ING
DUCT WORK OR PIPING IN UNHEATED
SPACES
REIMARKS
ARRIVE
DEPART
INSPECTOR
TOWN OF EEP9S6� /
BUILDING AND CODES DEPARTMENT
531 SAY ROAD
QUEENSBURY9 NEW YORK 12804
TELEPHONE (518 ) 745- 4447
BUILDING INSPECTORS REPORT
REQUEST FOR INSPECTION RECEIVED
MANE
LOCATION
DATE2z �f`' PERNIT f# �J'�.w .c,32/
TYPE OF STRUCTURE
RECHECK APPROVED
N A YES NO
FOOTINGS/ PIERS
MONOLITHIC POUR F
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPOK BLE
FOR PROM I DI NG PROTECTION FROM
FREEZING FOR 48 HOU FOLLOWING
THE PLACEKE OF THE - CONCRETE.
MATERIALS FO THIS RJRPOSE ON SITE
FOUNDATION/0 LL PO
REINFORCEMENIN PAC€
FOUNDATION/DAePRO ING
BACKFILL APPRO,YA
ROUGH PLUMBING -,+� —
PLUMBING VENT V 5 IN PLACE.
PLUMBING UNDER B
j( FRAMING :
1� JACK 5 0 AD
BRACING/BRI GING
JOIST HANG S
JACK POST MAIN h BEA
HEATING ROU — IN `
INSULATION :
FOUNDATI }P LC NTERI
FOUNDATI N MALLS EXTERIU R R—
FLOORS R—
WALLS I R—
CEILING
DUCT W K OR PIPING IN UNHEATED
SPACES
ARRIVE
DEPART
_ 11t14
INSPECTOR
TOM OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY , NEW YORK 12804
TELEPHONE ( 518 ) 745- 4447
BUILDING INSPECTOR ' S REPORT �1
REQUEST FOR INSPECTION RECEIVED (0, d
NAME �.'�a_d �5 ► 1T�CN V �.�3
LOCATION
DATE PERMIT f
TYPE OF STRUCTURE
RECHECK APPROY
N/A YESI N0
FOOTINGS/PIERS
MONOLITHIC POUR FORM f _
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RES SII
FOR PROVIDING PROTECT ON F
FREEZING FOR 48 HOURS FOLLNG
THE PLACEMENT OF THE ONCR
MATERIALS FOR THIS PU POSESITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLAC
FOUNDATION/DAMPROOFIN
?(BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS INTPwACE
PLUMBING UNDER SLAB 17
FRAMING :
JACKS D /HEADER
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BE
HEATING ROUGH- IN
INSULATION .
FOUNDATION WALLS R-
FOUNDATION WALLS/NTERIOX
XTERIO %-
FLOORS -
WALLS
CEILING R-
DUCT WORK OR P ING IN UNHEAT
SPACES
REMARKS :
VE 4rA)
T
NS CTOR
Tfl1iN OF QUEENSBURY
BUILDING AND CURES DEPARTMENT
531 BAY ROAD
Q � NEW 0 TELEPHONE ( 518 ) 745- 4447
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED I,;&elfez
NAME�y�/'� sp
LOCATIONI �,•.L �
DATE PERMIT t gee t
TYPE OF STRUCTURE. Ir �
RECHECK APPROVED
N/A YES NO,
FOOTINGS/PIERS ✓
MONOLITHIC POUR FORM t
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONS B E
FOR PROVIDING PROTECTION FR
FREEZING FOR 48 iftWRS FOLLO NG
THE PLACEMENT OF THE COHCR E_
MATERIALS FOR THIS PURPOS ON SITE
FOUNDATION/'WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOF'ING
BACKFILL APPROVAL i
ROUGH PLUMBING
PLUMBING VENT/VENTSzrV PLACE
PLUMBING UNDER SLA
FRAMING :
JACK S DS/HEA E
BRACING/BRIDGZWG _
JOIST BANGER
JACK POSTS/WIN BEAM y
HEATING ROUG IN
INSULATION :
FOUNDATIO WILLS INTERIOR
FOUNDATI N WALLS EXTERIOR
FLOORS R-
WALLS
CEILIN R-
DUCT W RK OR PIPING IN UNHEATED
SPACES',
REMARKS :
J yy f j
f
S ! C
ARRIVE
DEPART
f �I PECTOR
YOU ARE HERESY REQUESTED TO
INS,pCT AND ISSUE CERTIFFCATES
FOR E H FOLLO460ING ELECTRICAL
EQJJPNIENT To SE INSTALLED SY
THE UNDERSIGNED
4 tpyJfJSNs* y� �a.� �
` G1Tv aR V l yc il It
/y
4u..AG,E 1� R iu qv r "'"p_�',� � �✓
BTREET AND IJO OR
N
WNM TWO GLOB"STREErs M PREMI3 + �!e I� �°"•
BE-r�vE-E'N �..- BuiLau�orc+.m,�Nm+'
NAME"' FsPlio nuMaBR s:a
OC.T:1a 1 r �
i 0�1'rt�ER'R NAME AND AOaRESS CWFIVE Yak TELEPHONE N maER
TNEVi
OIriREAN gLIPPLI r� DEFEOTS REMCNED CJ
4l{ NEW Q ADOtnONAL Ll�
WORK IS
BunDING is oun ( '- gRANCri OFFICE USE
NEW ❑ LlI BEL<71N ALL 'EC]LFIP'ME.NT tPlHIGH Yt7V IN ONLY
No. of Fixtures & Ml}TCyF1S HE�gTERS CIRCUITS
UMBER OF OUT Lame H.P.Re0eptacleB No. GSLISte Gau �N
N ��
Luca- jnl B •t Pondsnt Bracket No. TYPs Each Na Each
tlon Coming 1M11B I pmoc p•ls '
OI.IT-
siOE
SUB-
BASE
BASE-
MENT
Tst
FL_
2nd
FL.
FL-
FL_
REMAR%S� LIST OTHER ELECTFNCAL 9EV4CES NOT SET FORTH ABOVE.
THE IrilSPEy IF A AND ADJUST THE FEE TO COVER
E IS
ENT NOT ABG't1E LISTEQ 'MQU4ARE AUTHOR TO MAKE TOTAL PaTTS
TH45 APPLICATION IS INT PMDED 'IO GOVER THE. A80VE USTE.t? EQUIPMENT TO BE KE THTED. 8UT It` AT TI1NE OF 4N'SPECiION. THER
FOUNO ADDIT4ONAL EQUIPMENT pROV IDSD BY THE Al
THE AOD4T%O AL EQU4PMENT, AS FEE Rs ELEOT711C s1GNsn_AMPa
812E OF Mill S.�a.►"� 1 I E C+A+TUBE SIC1,W11-RAM'nAQFIMERS
Jl' ❑ csPwln
GNARAGiER OF WORK ./] C] GC EA`LSO E1l OF SIGN CNUMBERI
DAM WORK TO BE uTARrEO �y VV V' MIWUFAS:TlJRE'f1 OF SIGN
,SFJc,'cE ENTERS suit W3
o CA'ERtlEAa ►� -. y . . � l l 1 l 1
ON(OR AS NEAR AS POSS'aLE �Ti • � �'(1} D.
DATE W`3PP-f�r1DT1 RE�?1'IESTEO
1
4
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OF/4PPLI
1]A.TE CON F .
PRINT NAME AND ADDRESS - r TELE.PH'm"tiE
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NAME OF APPLICANT
7IP COPE LICENSE NCL WHEN APPLICABLE
l STREET ADDRESS . I - • ,
_ 202 Arterial Roed
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CITY OR POSY OFFICE I.�li;i I t'�~ 217 Lake Avenue i SYFACtJSE. NY 1320$
4i State Street } 570 Delaware Avenue i [� ROCHESTIM NY t d6O8 l at 5) 463-8562
85 Jorin Street AL9ANY, NY 12207 y SUFFAL01 NY 14202 1l (716) 264-0141 lii
NEW YORK NY i 1>038 (518) 463-'2122 ` (718) 884t 155
(212) 227-3700
THE NEWyp'RK BOARD OF SIRE UNDERWRITERS
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