1991-788 5-'t y-
ERTIFICATE ,i F OCCUPANCY
-TOWN O QUEENSBURY
WARREN COUNTY, NEW YORK
Date otoAth. 19 -
aqt; curl '
This is to certify that work requested to be done as shown by Permit No.
91-7
has been completed.
This structure may be occupied as a Addition/Wl teaati on to Dwelling (Bedrooms)
i nation - test Mtn Rd
Owner Donald A Johannah Ross
By Order Town Board
TOWN OF QUEENSBURY
V
Director of Bldg. do Code Enforcement
BUILDING PERMIT
.
x
TOWN OF QUEENSBURY
No. 91-788
WARREN COUNTY, NEW YORK
0
h.
PERMISSION is hereby granted to Donald & Johannah Ross .n
OWNER of property located at RR5 320 West Mtn Rd Street, Road or Ave. N
in the Town of Queensbury,To Construct or place a Addition/Alteration to Dwelling
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.
0
1. OWNER'S Address is H
Same
0
tv
2. CONTRACTOR or BUILDER'S Name -
Bill Trombley a
c./
0
3. CONTRACTOR or BUILDER'S Address
West Mtn Rd
a
Queensbury 0•
4. ARCHITECT'S Name
ro
N
5. ARCHITECT'S Address c+
e+
3
0.
6. TYPE of Construction—(Please indicate by X)
( X Wood Frame ( ) Masonry ( )Steel ( ) -
n.
7. PLANS and Specifications G.
No. 1,920 sq ft Addition/Alteration to Dwelling as per plot plan c
specifications and application
8. Proposed Use i
r
CD
Bedrooms
0
$ 104.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 4, 19 92 c
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the E
town of Queensbury before the expiration date.)
ro
Dated at the Town of Queensbury this D y o ember 19 91
SIGNED BY • Uh• _ / for the Town of Queensbury
Buil.ing and Zoninginspector
•
TOWN-OP QUEENSBURY
4111bREVIEWED BY: i- •
" 0, FEE PAID: h r°
PERMIT NO. : CI I
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: ioNALb. W U-ol-(qNNAI-t i5
P.O. Address: 2-R.S- 8oK. 32a £LEST IT kb PHONE 7cid-g3ya
Property Location: WEi MT
• Tax Map No. `7�/ / / "?7
Has there been any split of this property since October 1, 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:
_ /( I ion 6/ems
NATURE OF-PROPOSED WORK: / * ESTIMATED MARKET VALUE OF TH
E
Construction of new building ° �`� o
9 * CONSTRUCTION: $ Z (
+� Addition to building
✓� Alteration to building * COMPLETE INFORMATION REQUIRED BELOW:
(no change to exterior dimensions) * Size of Property: NO ft. x gAD4p ft.
Other work (describe) * Existing Building Size:
* att ft. x 4 ft.
* Proposed building - distance from
GROSS AREA OF PROPOSED STRUCTURE: yyy111h, / * property line:
*
1st Floor "-- �S Ft. 2 C/
q Front Yard G,i ft. Rear yard /Zv ft.
44 * Side, Yards(i ;ft. and
2nd Floor (�O Sq. Ft: . &°/2fl * i' If on corner setback from side.ft.
Other Other Floors Sq. Ft.
(not cellar or basement) • * OCCUPANCY INFORMATION:
TOTAL FLOOR AREA: /926 Sq. Ft. * Primary Building -
I/ ,/ * ✓ One Family Dwelling
Size of New Structure: a T ft. x `/O ft. * Two Family Dwelling
-Foundation: * Multiple Dwelling/No. ,of Units
Pier/Slab/Crawl/Partial/Full (Circle One) * Business
tri
* Indusal.
No. of stories (Habitable space) * Other
Height (grade to ridge) ft. *
If residential , no. of families: / * If addition, what will use be?
No. of rooms (excluding_ baths):. ,
tiS
No. of bedrooms:. * — ��
No. of bathrooms: , ., a%z * Access y Building:
Primary heating system:. �s (,oi At2 * Detached Garage - One/Two Car
Type of fuel: Grls * Attached Garage - One/Two Car
No. of fireplaces to be installed: --- * Private Storage Building
Will a woodstove be installed?: * Other
Central Air Conditioning: Yes Na ✓ *
(OVER)
BUILDING PERMIT APPLICATION CONTINUED:
BUILDING SPECIFICATIONS:
Type of construction: wood frame, fire safe, etc. WOOD t"ZAMf- :
Will any second-hand or ungraded lumber be used? If so, for what? /IIO
Foundation Wall Material : Thickness:
Depth of Foundation below grade (to bottom of footing) :
Will there be a cellar? Heated or Unheated? -1 Floor Sq.. Footage: 960
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 SLoPEb Material .of Roof /SP(/4-L 1
Size, wood studs c.t. " x / " ; spacing /(p " o.c. ; length ft. _ -
Joists (floor beams) : 1st Floor " x — "; spacing -- " o.c. ;_ span - ft.
Joists (floor beams) : 2nd Floor o. " x /0 spacing - / , ' " o.c: ; span /0. ft.
Overlays (ceiling beams) : " x "; spacing " o.c. ;' span ft.
Roof rafters: " x " ; spacing o.c. ; span ft.
Roof trusses (pre-engineered) : spacing a " o.c. ; span 02 ft.
Exterior Wall Finish: CEbA 2 ,ScD g 3G of what material ?
Interior Wall Finish: )kE c��ock
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
Is thereto 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? go Height above roof ft.
Depth of chimney foundation below grade: ft.
Depth of fireplace hearth: ft. in.
Water supply - Municipal or private well : tittiOtCAPAL
SEPTI SYSTEM: Distance from Arix private well (including adjoining properties: ft..
(A eparate application is necessary for any repair or new installation of--septi.c system. )
NAME OF BUILDER & ADDRESS: .41141-00A181A1 WEST Mr gb 06/ PHONE tna a(v-J3
NAME OF PLUMBER & ADDRESS: du) )c7-t. PHONE
NAME OF MASON & ADDRESS: PHONE
NAME OF ELECTRICIAN & ADDRESS: 0(41,40 _ PHONE
DECLARATION
To the best of my knowledge and belief the statements contained in thisapplication,
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 propos- • work shall
ii
be complied with, whether specified or not, and that such work is a horize by t - owner.
Signature ' / l U/ / 4
• Ow 'er, owner's agent, architect
contractor
SPECIAL CONDITIONS OF THE PERMIT:
By:
' Code Enforcement Officer
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE DAYS
Compliance Methods:
PART 5 - Acceptable Practice Method - 1 & 2 Family Dwellings (ONLY)
PART 6 - Thermal Rating - Component Trade Offs - 1 & 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
f ,jJ 4 !•� n afEsT f1 T ieb
DI�A�-.l� �J� An��iA N Ass
APPLICANT'S NAME PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - 966 Sq. Ft.2. Type of Heat - Elec. Base Board Other c t 5 1"o2CCa grA/2
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 30
B. Exterior Walls R,/4
C. Glazed Area R 3,o3
D. Exterior Doors R .r
7 E. Floors over unheated spaces R -0 .
F. Edge of ,Slab on Grade (Heated Building) 11.41
G. Basement/Cellar Walls (Above Grade) • R --
H. Basement/Cellar Walls (Below Grade) R
I. Heating/Cooling - Ducts - Piping in Unheated Space R 2,5r
6. Service (Domestic) Hot Water Heating Device
A. Conforms to minimum efficiency per code VYES NO
TEMPERATURE CONTROL MAXIMUM SETTING 140° - WILL NOT BE EXCEEDED
//70 LE T HONE NUMBER -
APPLICANT'S SIGNATURE DAE E
INSPECTOR'S REMARKS: 01/
ED BY
3bZ
°'r'''p.r .,r'4
'" MIDDLE-DEPARTMENT INSPECTION AGENCY, INC.
m........ i National Headquarters
1337 West Chester Pike,West Chester, PA 19380 .
APPLICANT COMPLETES THIS SECTION Date:
City, Town or Township � 1\iS6U r County VjAi2IG k\ State psi,'
Location/Address RP c 1 to 1✓``�Tik.1r pi)
(If Located in Rural Area- Please Attach Directions) Pole #
—�
Owner ( 7,—,Al/it.-.Eb tee ". 3 pt-In N►N r\N Pe„3`.› Permit #
Occupied As ( /-Sat, {'.f1PI , / 1 Building: New Old❑
Occupant ‹A ^c,.. A'c., ("Y-43 A)t- 1—
Work Area in Building (Floor #,etc.):
App. for: Wiring Service D or: Ready for Inspection:
Fee Remitted-$ Cash n Check n 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 11h 2 3 5 7'/2 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size
Applicant's
Signature License # Permit #
T/A Utility:
Applicant's Address: (NAME) (OFFICE LOCATION)
(City) (State) (Zip) Service Request # -
Phone # Electrician:
MDIA USE ONLY DATE RECEIVED: .DATE INSPECTED:
Correct Location: Same as Above[ or:
Red Notice Label 1 I - "
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 1'/2 2 3 5 71/2 10 1 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 CORRECTFEE FEE PAID
RW Progress: Inc.❑ LKD❑ Contractor
'CFT Violation: Work Comp.❑ Inc. ❑
L/A Owner CASH [1]
Fee
\_/A Due CHK #
'oA Municipal MO #
` INV #
}' Other Side ElUtility Applicant
111
• Owner
and n Temp # Date
[ Final # Date INSPECTORS SIGNATURE
1
ELECTRICAL INSPECTIONS
DUPLICATE MUNICIPAL RECORD
Permit No. 9 7 FI
Owner b2 nl S
Occupant y`
Location W' /r1 TN/ • F.O.
„e,r Street
Town or City State
Installation as itemized on reverse side has been visually inspected pursuant to applicable
codes.
Installed by
e
Date l®'11 Z am.d� e -- ----- ns ector
MIDDLE DEPARTMENT INSPECTION AGENCY INC.
FORM No_18 EL 900 Haddon Ave.,Collingswood,NJ 08108
r[vuVn nIK11YV Vu1LCIJ n.Y.HIK I.v INLJI IVCK
/ (� OUZ EXS +'s , /�', WIRING &CONTROLS FOR 6,4'S BURNER
2.3 RECEPTACLES4 V �tr r _H.P.PUMP
J FIXTURES K.W.OVEN
Z,rjlvAMP.SERVICE EQUIPMENT H.P.GARBAGE DISPOSAL UNIT
(/,DAMP.SERVICE CONDUCTORS K.W. DISHWASHER
K.W.SURFACE UNIT K.W. DRYER
K.W. RANGE AMP. RECEPTACLE
K.W.WATER HEATER 3 FRAC. H.P.VENT FANS
•
)TORS N.P. 1/20'1/12 I/10 MIA% IA y 5. 1 11/2 2 3 5 7% 10 15 '20 25 30 40 50 75 100
iRK NUMBER
EACH SIZE
PPARATUS
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 0/3'0 l
NAME k C� V Z5,SS
LOCATION We "" 'SIN `C l �[ ��O
DATE J /3 a cc! PERMIT # ' 1-' 8
TYPE OF STRUCTURE 7c.-), It :,
RECHECK APPROVED d
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 ;7
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
A-0UGH PLUMBING /
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN B M
FIRESTOPPING
WALLS i
CEILING fv
FIREWALLS e/ 1
HEATING ROUGU IN
INSULATION:,
FOUNDATI,ON WALLS INTERIOR; -
FOUNDATION WALLS EXTERIOR'R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
3.
ARRIVE /� `-
447
DEPART // 4I/NfrPEC314'4--R
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT n
REQUEST FOR INSPECTION R� IVED l�/� � (�('
NAME a I a o s
LOCATION \,}eSA 1 r` Vz()
DATE /0/03I 9I,) PERMIT I q ( ' ga
TYPE OF STRUCTURE ))VA14- - t)t),)01 (
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS-
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIB E
FOR PROVIDING PROTECTION F
FREEZING FOR 48 HOURS FOLL WING
THE PLACEMENT OF THE CONC E.
MATERIALS FOR THIS PURPOS ON SIT '
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE ,e
FOUNDATION/DAMPROOFING ,7
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VE TS<N LACE
PLUMBING UNDE LAB _
FRAMING:
JACK,,-S* DS/HEADERS
BRACING/BRIDGING i
•JOIST HANGERS
JACK POSTS/MAIN BEM
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-/,CEILING R- 3g c/ _
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART
INSP CTOR
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 4�'4 �� 94 'lltiv??44/
LOCATION b YI1/fJ `LY t .2D
DATE ///�j//q/ PERl9IT # J/-1d"P
TYPE OF STRUCTURE 7}d-/obt tt1/Plee,a29
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM j
FREEZING FOR 48 HOURS FOLLOWING /
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR I
REINFORCEMENT IN PLACE I ,"
FOUNDATION/DAMPROOFING I /
BACKFILL APPROVAL 1 /
ROUGH PLUMBING ti '
PLUMBING VENT/VENTS IN PBAC -
PLUMBING UNDER SLAB
(FRAMING• �9
/` JACK STUDS/HEADERS h
BRACING/BRIDGING 1/
JOIST HANGERS I t
JACK POSTS/MAIN BEAM /
FIRESTOPPING J 1
WALLS /
CEILING / t.
FIREWALLS I
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR P PING IN UNHEATED
SPACES
REMARKS:
J S
ARRIVE J /
DEPART •)
INSPEC R
Jown o� Queensbury P
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box9,8
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME I,' ! ' t _
LOCATION /> ! / �(
DATE ///r / � PERMIT NO. Q�l , /T
.
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch 1?
- r
{
TYPE of SYSTEM:
Absorption field, total length/
Length of each trench' 56 , �f
Depth of trenches '31/ y'
Size of gravel_
SEEPAGE PITS{Number of) ' j
Size- ft. X ft. 4'
Gravel size , f
PIPING: Size Type
Bldg. to tank !' t/C
Tank to dist. box c�°(
_Dist. box to field/pit ,0// G
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank (i/eft.
Foundation to absorpti nJOO��"ft. •
Absorption to lot lin „Itoft.
is
Separation of pits ti-"- ft.
LOCATION OF SYSTEM 0 PROPERTY(circle one)
Front - Rear - Left . ide -Right side -
COMMENTS: jD--60 n
•
{00xl) \\ 9
o•
pc .
SYSTEM USE APPROVED 4320 NO
4-Ltr. d/
Buf ding Ins""ector
01/86 and vl
44., 3.`J cS /ern,
TOWN OF QUEENSBURY
_/ 531 BAY ROAD
QUEENSBURY a NEW YORK 12804
;� .• TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION _
REQUEST FOR
INSPECTION RECEIVED
NAME f tr_r 4 Xf-c1
LOCATION 26 1✓_�-sr7/'0
41
DATE /O/V Z- PERMIT/ _ 0'%)/-71
TYPE OF STRUCTURE & dl'- ru1---FP
RECHECK -,
FIRE MARSHAL APPROVAL (COMMERICIAL SCTURE)
FOQOTING FOUNDATION BACKFILL 44RAMING
cADUGH PLUMBING FINAL ELECTRICAL SEPTIC
'/INSULATION WOODSTOVE/FIREPLACE —
REMARKS I I
I by APPROVAL
r N/A ES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION t /
PLUMBING VENT %
ROOFING 1, 1
SIDING U, t
DECK/PORCH/STEPS/RA+ LINGS
RELIEF VALVES i /
FURNACE/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY DOORS ✓
FINISH FLOORS: ��:j�
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPWLE
OTHER FLOORS CARPETED c/
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS I
DOOR CLOSERS ,F A ✓
BATHROOM FANS t
ALL PLUMBING FIXTURES OPERATING
GARAGE FIRE PROOFING ✓
DOOR CLOSERS 1 '\..
OTHER FIRE SEPARATION ✓
FIRE/DEMISE WALLS ✓
FINAL ELECTRICAL'
OK TO ISSUE C/O L,OR C/C 't
COMMENTS: tj
4
ARRIVE I
DEPART
IV INSPECTOR
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