8121 •
C/C Paid
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Dec. 29 19 83 - '
This is to certify that work requested to be done as shown by Permit No. 8121
has been completed.
This structure may be occupied as a One—Family Dwelling
Location Lot 16 Pine Wood Follow Road
Owner C. G. Woodbury (DeMuzio)
By Order Town Board
TOWN OF QUEENSBURY
•
Building & Zoning Inspector
CREATIVE "INSTA" PRINTING. GLENS FALLS. N Y 12801 15181793-5658 •
TEMPORARY
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW. YORK
Date December 16 083
This is to certify that work requested to be done as shown by Permit No. 8121
has been completed.
This structure may be occupied as a One—Family Dwelling
Location Lot 16 Pine Wood Hollow Road.
C.G. Woodbury
Owner
THIS IS A TEMPORARY CERTIFICATE OF
OCCUPANCY FOR 30 DAYS PENDING By Order Town Board
FINAL ELECTRICAL. TOWN OF QUEENSBURY
L . 9ilding & Zoning Inspector
CREATIVE "INSTA" PRINTING, GLENS FALLS. N Y 12801 15181793-5658
• BUILDING PERMIT -
TOWN OF QUEENSBURY
No. 8121
WARREN COUNTY, NEW YORK •
PERMISSION is hereby granted to C. G. Woodbury (DeMuzio) .?
St'. 1id. /7 G�
OWNER of property located at Lot 16 Pine Wood Hollow Road Street, Road or Ave. •
in the Town of Queensbury,To Construct or place a One-Family Dwelling
- O
at the above location in accordance to application together with plot plans and other information hereto filed and g'
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'SAddressis 679 Upper Glen Street
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name F-'-
O
Same
3. CONTRACTOR or BUILDER'S Address
Same
- r
0
rt
4. ARCHITECT'S Name •
-
f--'
ro
5. ARCHITECT'S Address
6
O
iZ
6. TYPE of Construction—(Please indicate by X)
O
H
(x)Wood Frame ( ) Masonry ( )Steel ( ) ~'
O
7. PLANS and Specifications ,d
26'x50' per plot plan, specifications and
No. application submitted including two-car attached
garage and sewage system.
8. Proposed Use
One-Family Dwelling
$5. 00 C/O Paid o
$ 136. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 1 1984
ro
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the p�
town of Queensbury before the expiration date.)
1-1
Dated at the Town of Queensbury this 23rd Day of September 1983
�^
SIGNED BY //1 Liid , dam for the Town of Queensbury
• Building and Zoning Inspector (e4 li
•
• BUILDING DEPT.COPY OF APPLICATION FORM 46-EL.NEW YORKBOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT.WHEN.REQUIRED.
CITY OR //,-..� - - /)
VILLAGE \ )���c ? lP TOWNSHIP COUNTY\ �C — v
STREET AND N .OR �/ •
ROAD AND POLE NO. Q( 'J }s. .-- H\fl,.� +s,� vim.. -i POLE NO. - •
BETWEEN WHAT TWO
CROSS STREETS IS //� '
PREMISES LOCATED? • SECTION'. BLOCK LOT
OCCUPANT'S BUILDING . •
NAME - OCCUPANCY
OWNER'S NAME rP
AND ADDRESS 1�
\ + _� ��� i� �JY�_. - .
CURRENT
SUPPLIED -i' ''1 t ^�
BY } �•�\ �/` FROM THEIR OFFICE
BISUILDING •NE> OLD'❑ REMODELED ❑ WORK NE ADDITIONAL❑ REMOVED DEFECTS ❑
-LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
No.of Fixtures& I BRANCH
NUMBER OF OUTLETS Lamp Receptacles MOTORS HEATERS CIRCUITS LAMPS
Loca-
tion
Ceiling Side Attach't Switch Pendent Bracket No. Type H.P, No. Watts No. A.W.G. NO. WATTS
Wall Recept'Is EachEach GaugeEACH
Out-
side .
Sub-
base
Base- -
ment .
1st Fl.
•
2nd Fl.
3rd Fl.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE.THIS SPACE.
•
This application is intended to cover the above-listed equipment to be inspected but if at time of inspection there is found additional equipment not above listed,
you are authorized to make th'e inspection and adjust the fee to cover the additional equipment,as provided by the applicant. -
SIZE OF - ELECTRIC SIGN TOTAL
MAINS FEEDERS LAMPS WATTS
CHARACTER EXPOSED GAS TUBE SIGN
OF WORK CONCEALED TRANSFORMERS OF VA _
WORK TO BE (NUMBER) (CAPACITY)
-- STARTED - COMPLETED SIZE OF SIGN
'SERVICE MAKER
ENTERS
BUILDING OF SIGN -
INSPECTION REQUESTED -
ON OR AS NEAR AS (�j
POSSIBLE NEW I I OLD
•
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
NAME OF _� 1�7 tom'`i7$\7Y DATE OF -- _�
_ APPLICANT ' '^. - APPLICATION
CRESS 1 i `�) 0 j7.� -� 'J -Jr�(�
� LICENSE NO.
�.J-
ZIP t✓✓COD / WHEN APPLICABLE - -
?PARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING.: -
maBpAnmm All/*Lm Aim not m JaRAWLm issIstwnwngkmitnivntivnivAcmnuccmm' V ;an ratikrscmmmmmm)c _
1 k: `'..`47) .'n _ THE NEW YORK BOARD. OF FIRE UNDERWRITERS
c � BUREAU OF ELECTRICITY
IT:* 41 STATE STREET,ALBANY,NEW YORK 12207. 0 -
^ C Date A� .(;::.Ell3C?.e 11.E8.':i Application No.on file t '.)(r''.r�' ,3 ' e 1 ` `�' ^
- �. THIS CERTIFIES"THAT /� �r �} T
c only the electrical equipment'as described below and introduced by the applicant named on the above applicationp number in the premises of 0
V.:1 )0(1_A1Q.'Y271 1.?.ra.�s�E C2L �(.rn ?.1 T. 31 4.� 01.C'--•'1 )Y, n `i .t��:r_.`..,}`.a S 7 t' ' !.;:e,'_i: ....
.-
y�'-�_'� i.LLB .,' v i 0
k" in the following location; 0 Basement 0 1st Fl. ❑ 2nd Fl. Section Block Lot --
was examined on +ra 1 w g;_;,3 and found to be in compliance with the requirements'of this Board.
--' FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
to RECEPTACLES SWITCHES INCANDESCENT OUTLETS INCANDESC�FE�NT FLUORESCENT My . AMT. K.W. AMT. K.W. AMT. K.W.. AMT. K.W. AMT. H.P:
li
c DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS 0
SYSTEMS
i 'AMT. K.W. OIL ' H.P. GAS H.P. AMT. , NO. A.IW.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET .AMT.- WATTS
n . µme :. G - 4 -_
C•. SERVICE DISCONNECT NO. S E R V I C E I
AMT. AMP. TYPE EOUIP. 1.'2W 1.B'3W 3 2 3W 3,fc 4W NO,OFFECCC..COND. OF CC COND. NO.OF HI-LEG OF'HI'LEG NO.OF NEUTRALS OF NEUGRAL
l�- r'j; a��L a i' v., ,,l;?,jl
» OTHER APPARATUS:, 4
'! -� -,y�,.7:-C ^-1'I ry, �; o �- `,a n 5. i 9 a—1 s1 c$ 2 L1. •� ii . ^ '1 w
—
�' d's it�l_r'Js h_`%.G..1:.� L-i_�• �;v1 '�a C': .0 _._ �„ n�.. _ L.,J eJ 4
': ?..71( s.— -4.--a—l--,—,-,—(1 -1--
BRANCH MANAGER 0
0
Per `-. 0 .
f Y�Yv.-4Y7,4?-4-riv-4,(v YiY-4Y4YYvrYvrYiCY,YYvY,Y4YY:rYiY isi-4 ® ® rtimittirm ® ® 0 0
COPY FOR BUILDING DEPARTMENT.THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY'MANNER.
r <:::)'-- _
TOWN OF QUEENSBURY (Space inside block to )x filled in by
WARREN COUNTY, NEW YORK Building Inspector)
Application for Application No. .
PM Permit Issued 19. .
.BUILDING AND ZONING PERMIT Permit Expires. 1f1.
7. w11,;2. District
\ ;due of work,$
THREE (3) Copies of a PLOT PLAN, Drawn to scale •\1'111."`c•cl bY
showing the actual dimensions of the lot to be built Kc'm:1rks"
upon, The exact size, and location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
7, I
TOWN OF QUEENSBURY
\ - ' ( - 3 REG [IVE .--
ow -45 e's *7 -5.--KP DATE .
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK St=V 2 0 1983
ANSWER ALL OF THE FOLLOWING. A.M. -( `l= �€{ (' p�M
The undersigned hereby applies fore permit to do the following work 718)911O11)12)1)2)3)41516
which will be done in accordance with the description, plans and specifi-
cations, and such special conditions as may be indicated on the permit. " .q,„,a ; r1L
The owner of this property is: ( ()--sfr-, p
INA''E1 (P.O.ADDRES )
Thy e tpersoon res is b��r +supervision of the work insofar as the Building Code and the Zoning Ordinance arply is:
(NAME) (P.a.ADDRESS)
'
Name of Builder. .. .u _ )\`' ' •!• • • • .Address _
Name of Plumber. .'TUL 1 p :"' Q 1�-S Address �$.... F • . •n
Nae of Mason. . . e. n.�t•�.. . .. , ``mil • • . . • • • . . •Address \ 1
m
Lot N -f- r.„._,
umber. . .C. o Unit Estimated value of proposed work S7 I\ ' t/
Name of Village 2? tJ
Name of Stree0l N \")` . ' .1° \ -'-t .\ Side of street: north, east ❑, south 0. west 0
Nearest Cross Street\'-- \1— F N --, Distance from this cross street �� Ft.
Property is north El,south east i i, west 0 from Cross Street
If on Corner, which corner, northeast ❑, northwest ❑, southeast D. southwest
(Designate by marking with an"X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY
'El Construction of a new building. Main Building �;
❑ Addition to a building. . . . One-family dwelling.. ❑
,
ElTwo family dwelling Alteration to a building. -family apartment house D.
El of a building.
Store)building El
-car attached garage X
Other:
• Accessory Building
One-car detached garage ❑
❑ Other work. Describe Two-car •detached garage ❑
Private chicken house ❑
Private storage building ❑
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 buildings) in dotted line and existing
• building(s) in solid line.
Size of property ft. x ft.
• Size and use of existing buildings, if any
N
0 m Size of proposed building ///^ ft.x � ft.
Height(from grade to ridge)
r ft.
Front yard • ft.
Side yards ft. and ft.
Rear yard . ft.
SOUTH If on corner,setback from side street ft.. .
Note: All distances are net, as measured from street side
. line to nearest part of building.
(OVER)
7-73—M
(coned.)
BUILDING SPECIFICATIONS.,
\r„) ,._A.__.21
Kind of construction: Wood frame, fire safe, etc.?. . . • . ... . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . • • • •
Will any second-hand lumber be used? C) If so, for what %i1
Material of foundation walls . . . . . . .' .......•' • 1 ThicknessN1,1'.,.
Depth of foundation walls below grade I Continuous foundation? . . . . �. .
Will there be a cellar? If so, material of cellar floor C r ��
Type of roof: Sloped or flat?.. ... . . . _ °:' . . Material of roof . . .Cti . ... . -.(1.
Size, wood studs 'n--" " x • • •iLp ", spacing . . . .(. .f "o.c., length. e • ft.
Size, floor beams, 1st floor '�— " x 71 ", spacing r17:10, "o.c., span 1_ ft.
Size, floor beams, 2nd floor „ x .1 ", spacing . . . Ci "o.c. span i ft.
Size, ceiling beams 1-r• " x ", spacing ,� "o.c., span . . .1 r'. . ft.
Size, roof rafters or beams . 17. c c.,—"ix \ ", spacing . .1. -.,.j. . . ."o.c., span ft.
Exterior finish j--' ' T With what material?
Finish of interior walls. . . . . �• •T ...\~ .• . . . . . • • • • • • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •
If garage is to be attached, of what material is s11 between/garage and main building to be constructed?
Is there to be an opening between Farage and building? I
Kind of heating system e Oil burner or coal?
Will a flue-lined chimney be provided? Depth of chimney foundation below grade
Height of chimney above roof yrl i
Will there be a fireplace? - ,. . .-.--• • Depth of fireplace hearth
Will a toilet be installed • f�� ) �'
Will a kitchen sink be installed and connected to water supply? . .,t ) ��� tom,
Water supply (public water supply or pump)
Distance of cesspool from any private well ,- ,- feet
Will drainage system be provided with required traps, cleanouts, and vents? -` �.
Town of Queensbury AFFIDAVIT
County of Warren
State of New York
I swear that to tt bc,1 of my knowledge and belief the statements contained in this appli 'on,together with the plane and specifications sub-
mitted, are a true and co,,.�lete statement of all proposed work be done on the d ribed p times that all provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pe ining to the repo work hall comp' with,whether specified or not,
and that such work is authorized by the owner.
Sworn to before me this Signature
OWNER.OWNER'S AGENT,AREGT,CONTRACTOR
day of 19
NOTARY PUBLIC, WARREN COUNTY, N. Y.
SPECIAL CONDITIONS:OF THE PERMIT:
•
•
By .
TOWN OF .QUEENSBURY
BUILDING & ZONING DEPARTMENT
SEWAGE DISPOSAL PERMIT APPLICATION
C 3- '''71 R �,
1. Owner ' s Name PC
Address. G
. -7 Fr
.. Telephone No. .3 -)---L-Ft.
2. Property location Cri -� 'c '®c '`7 t`6\kZr\i\-)
3 . Name of person or firm responsible for installing system
G I < 7K - Ve Telephone No.
Address / 7P/t-Q
•
4. Number of bedrooms (residential buildings only)
5. Daily flow gallons/day
6. Septic tank capacity f b ,7 gallons
7. Topography: %IP
rolling, steep
. . slope. -
8. Nature .of soil and depth 9�
9. If ground water, bedrock or impervious materialis apparent at wh'at
depth does it begin? ft.
10.. Percolation. test: A is required
B is not required
C If required what is the rate minutes/inch
11. Water supply- municipal, ell, other ' .
12. Type of system proposed: drywell, tile field, other
Any contractor, corporation, individual, etc. engaged in the construction -
of a sanitary sewage disposal system who covers the same before inspection,
does not have an approved permit, or varies from the approved application
will be subject to a penalty of $250 a provided fo - - 1 -Section 6 . 010 of. the
Queensbury Sanitary Sewage Ordinance.
Date " ') -) __ . .,,,,_)- (-----Z)
signature of applicant
On separate sheet of paper submit:a diagram of the .proposed septic system
with all dimensions, including distance from any structure, distance from
property line and domestic water supply, etc. Include all dimensions of
the system itself.
Form 3-82
` O
-TOWN F "QUEENSBURY
WARREN COUN"TY , NEWYORK
A lication for : BUILDING PERMIT INCOMPLIANCEE .N
WITH THE , EW YORK
pp STATE ENERGY CONSERVATION
,
A. permit must be obtained before beginning . work .
ANSWER ALL of the "following:
1. Gross floor area
• ' t 71 ' ._S .F- - . _
2 , Type of heat 'd �.�
3 , Is .the building
mechanically coo.led7 ,•
4 , Percentage of area of windows -and doors I 4'
A, Over 16% Only roof/ceiling and floors
1 . Uo value of gross- area of walls ,
exposed to ambient conditions
2
,. Floor over heated sp
aces . : YES NO
a. Are 'foundation walls insulated? YES
NO.
1 , If YES , what is the R value?
•
a", If YES , what. is 'the
grade YES NO
3 . Slab onR value of insulation around
perimeter of floor?
4 , . Is •basementheated?" YES NO
a. R' value of insulation
5. Type •of insulation
B. Under 16.% Only
1. R value of. roofpand floors exposed to ambient: conditions
2 . -R value of exterior walls ,l �
3 . - R value of g
lazed area. " v _ �
4 , R value of doors -
__� _..,._-___� ..:_ .- aces (`�'� -
5, R .value of" floors over unheated sp q�
6 . R value of slab edge insulation
- unheated slab "�'`�^
7 . R value of slab insulation heated slab
' - - . 8. R value of heated basement/cellar walls (above grade)
- 9 , -R value of -heated basement/cellar walls (below: grade)
10 . Type of insulation
C. Controls , - -
- - 1 , Thermostat maximum heat; setting
D. Duct Systems • YES NO
1. Is duct system installed -in unheated spaces?: -
a. . If YES , R value of duct installation
b. R value of duct in - other areas
E, Piping _Insulation a ent Pipe
1, Size of hot water or cooling carrying g
2 R - value of pipe insulation
F. Service Water Heating . . ' . . ,
1. Performance efficiency} .T,aximum
2 ,. Temperature control setting ma-
-
G. For Swimming Pool Only
1. Maximum .heating
Telephone No.
(applicant ' s signature)
TOWN OT QUEENSBURY
Building Department
Inspectors R.. , � Date `2 1S-13
Name ' (
",_
Location _ 1�I tI n O
. Permit No. I ).-1 Weather
Remarks
Excavation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board
Ext. Porches i a
Finished Floor
Interior Trim O
Stairs & Railings 0
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofin
Door Closers
Chimney
Water Meter Inst.
Septic Approval
-Floors
• Insulation Foundation
Walls
' 'Ceiling - •
19 7ui ding In pector
REMARKS •
TOWN OF QUEENSBURY
Building Department
In ipectars R Date/ -
Name //��.�'/2O L,
Location / )7j( 7 P/ er) P Permit No. 'I a 1 Weather
Remarks
Excavation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
Siding \
Masonry Veneer
Rough Plbg.
Relief Valves A
Wall Board /
Ext. Porches /
Finished Floor /
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst. F/
Septic Approval (�L'
Floors
Insulation Foundation '
Walls
Ceiling
0/(ir
Building Inspector
REMARKS ��