8119 •
C/iD Paid
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW..YORK
Date Ja.n. 26 10
•
This is to certify that work requested to be done as shown by Permit No. 811¶
has been completed. •
This structure may be occupied as a One—Family Dwelling
Location Lot 1 7 Pi Tip Wood Hollow Roa
Owner Ca G. CW'oorlbury (Fitzsimmons) . -
By Order Town Board
TOWN OF QUEENSBURY
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I Buii'd n & Zoning Inspector
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CREATIVE •INSTA'• PRINTING. GLENS FALLS. N Y 12801 1518)793-5658
TEMPORARY
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date December 21 198.
This.is to certify that work requested to be done as shown by Permit No. 8119
has been completed.
This structure may be occupied as a One-Family Dwelling
LocationLot 17 Pine Wood ITollow Road
Owner Co Go . [Woodbury (Fitzsimmons)
Temporary Certificate of Occupancy By Order Town Board
for 30 days
TOWN OF QUEENSBURY
`mil_.. rBuilding & Zo ning Inspector
CREATIVE "INSTA" PRINTING. GLENS FALLS,-N Y. 12801 IS18)793-3658-
,
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. 8119 CD
WARREN COUNTY, NEW YORK
GD
PERMISSION is hereby granted to C. G. Woodbury (Fitzsimmons) ;s
O
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OWNER of property located at Lot 17 Pine Wood Hollow Road Street, Road or Ave. b'
/7
in the Town of Queensbury,To Construct or place a One-Family flwel 1 i ng 1-C
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. 1-11
ri-
1. OWNER'S Address is 679 Upper Glen St. m
Glens Falls, New York
0
2. CONTRACTOR or BUILDER'S Name co
Same
3. CONTRACTOR or BUILDER'S Address
Same
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4. ARCHITECT'S Name • ~
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H-
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5. ARCHITECT'S Address
0
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6. TYPE of Construction—(Please indicate by X) O
•
0-
(X)Wood Frame ( ) Masonry ( ) Steel (
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7. PLANS and Specifications 28 'x 54 ' per plot plan, specifications and
No.
application submitted including two-car attached
garage and sewage system.
8. Proposed Use
One-Family Dwelling
0
m
$5. 00 C/O Paid
ro
$108. 00 PERMIT FEE PAID -THIS PERMIT EXPIRES April 1 1984
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the uF'
town of Queensbury before the expiration date.) f
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Dated at the Town of Queensbury this 22nd Day of September-- 19 83
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SIGNED BY „G� (.�. if./�
/� �Ce„✓✓ �, for the Town of Queensbury -
Building and Zoning Inspector L I-'
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-i THE NEW' YORK BOARD. OF FIRE UNDERWRITERS T. t
- y
k BUREAU OF ELECTRICITY : '
F; 41 STATE STREET,ALBANY;NEW YORK 12207
Date L '->%I'1:'7 , ) '�.:' :�, Application No.on file �b 9,.J:� .'v /tt n r; 'Ot` 6'' ''
A l r
_< THIS CERTIFIES THAT r
-t-t only the electrical equipment'as described below and introduced by the applicant named on the above application number in the premises of
— j '_5011b1_ .7 La_, bL:i, C C?„ 9 -=1 .:'0..e _ 110 1...`l: ..Sc: j ? .. f , ::L 4:.1-P,E: Z,.;,,- y r
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{ in the following location; ❑ Basement ❑ 1st Fl. ❑ 2nd Fl. Section Block Lot y
' was examined on t!..: and found to be in compliance with the requirements of this Board. r .
— 1 r ;
- FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS ''
t OUTLETS RECEPTACLES SWITCHES INCANDESCENT FLUORESCENT MERCURY AMT. K.W. AMT. K.W. AMT. K.W.. AMT. K.W. AMT. H.P:
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-( DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MUSYSTEMLTI-OUTLETS DIMMERS
'AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET 'AMT.. .WATTS Y
N TL'L`- ' ;'ni i
C a �t .
M
j SERVICE DISCONNECT NO.OF •� ' "�'- `:S''' �. E R V I C E r -
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AMT. AMP. TYPE EQUIP 7�9'2W 1,4.3W 3,B'3W 30 4W NO,OPERC.gCOND. OF CC.COND. Na OF HI-LEG OF'HI IEG Na OF NEUTRALS OF N UTRAL �' -
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1 OTHER APPARATUS: T
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T` .< BRANCH MANAGER
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' COPY FOR BUILDING DEPARTMENT.THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
TOWN OF QUEFNSBURY
BUILDING & ZONING DEPARTMENT
SEWAGF DISPOSAL PERMIT APPLICATION
1. Owner ' s Name (7, Cr ,\\v-) JV(
Address )5 !A,
Telephone No. 7
2. Property location el
3 . Name of person or firm responsible for installing system
Telephone No.
Address
4. Number of bedrooms (residential buildings only) -�
5. Daily flow gallons/day
6. Septic tank capacity f L1 -t---"Z77 gallons
7 . Topography: hat' oiling, steep
% of slope
8 . Nature of soil and depth f -Ill
9. If ground water, bedrock or impervious material is apparent. at what
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, well, other ) ] ►,
12. Type of system proposed: drywell, tile field, other
Any contractor,, corporation, individual, . 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 as provided r in Section 6 . 010 of the
Queensbury Sanitary Sewage Ordinance:
Date 9 ~ J ^
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
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK :
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work.
ANSWER ALL of the following:
1. Gross floor area I ) ( _� , i
2 . Type of heat r� -,
3 . Is the building mechanically cooled? , v
4. Percentage of area of windows and doors
A. Over 16% Only
a . U value of gross area of walls , roof/ceiling and floors
o
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a. Are foundation walls insulated? YES NO
1. If YES , what ' is the R value?
{ • 3 . Slab on grade YES NO
a. If YES , what is the R value of insulation around. ;•
perimeter of floor?
4 . Is basement heated? YES NO
a. R value of insulation
5. Type of insulation
B. Under 16% Only •
1 . R value of woof and floors exposed to ambient conditions
2 . R value of exterior walls �
3 . R value of glazed area C ��IT
,/ j
4 . R value of doors �
1-1.-
5 .
R value of floors over unheated spaces � �� ^
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 . Thermos
tat maximum heat setting
D. Duct Systems
1. Is duct system installed in unheated spaces? YES NO
a. . If YES , R value of duct installation
b. R value of duct in other areas
E. Piping Insulation •
1. Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulation
F . Service Water Heating � '
1 . Performance efficiency j
2 . Temperature control setting maximum
C7 1—
G. For Swimming Pool Only
1 . Maximum heating
9 --t \- --,_:__ . -\,./vG,- 0,_-1:.. ,,,, ,_ ,
Telephone
i
(applicant 's signature) ,,
7 TOWN OF QUEENSBURY (Space inside block to be filled in by
WARREN COUNTY. NEW YORK Building Inspector)
Application for Application No. :
�� Permit Issued 19-
BUILDING AND ZONING PERMIT Permit Expires. 19.
%„nine District
. \ olucfd Work$ I
THREE (3) Copies of a PLOT PLAN, Drawn to scale rG '/c.,
showing the actual dimensions of the lot to be built item irKf
upon, The exact size, and location on the lot of the
building to`be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION. .
9'i —5 - 7q. TOWN IOF_ QUEEN�►SBURY
��� �� DATE HEl nn E [I �� _U
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK
5EP ? 01983
ANSWER ALL OF THE FOLLOWING. �a) d
r -� P.M.
The undersigned hereby applies for a permit:to do ,the following work 8 9 1I11 1 2 3 4 5 6
which will be done in accordance with the description, plans and specifi- 71. 1 .1 I - F�a 1 ) 1' I I .
cations, end such special conditions as. may be indicated ,on the permit. 1 -
`e i el,.o
The owner of this property is: .
C# &, t � ^7�. . .3_C 1&1 r', Z / c4z z') !--i T,z s/hi 07 v:,s
(NA"E) (P.O.ADDRESS
The person respon bie for supervision of the work insofar as the Building Code and thhZoning Ordinance apply is:
\ k , CAL-1 �'H 1 -_3 V`� (-'7 --2- ) Ij-''
(NAME) 70 AD ESS) ,
Name of Builder
^ ,\1`3 �✓`/ � �rR''�t ... . . . .Address ' 9
Name of Plumber. . �).VAP . : . .fC.-..-'1Q•)< �S Address
Name of Mason.4. .t n .171 --_ .LA11107- Address \ '�' )"7
Lot Number ( -1 Unit Estimated value of proposed work 3 A. .�'j. T�
Name of Village V '_
Name of Street -- t ' ;'f' �"� it'P�" Side of street: north Xeast ❑, south O. west 0
Nearest Cross Street t, S c/? � �\ f ��.i Distance from this cross street 1 —� Ft.
Property is north 0,southeast ., 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 ` •
XConstruction of a new building. . Main Building
❑ Addition to a building. . . . One-family dwelling •
❑ Alteration to a building. Two-family dwelling ❑
❑ Demolition of a building. -family apartment house ❑
Store building ❑,
car attached garage •K
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, sire and setbacks of pro-
posed buildings,and the location of all existing buildings.
NORTH Show proposed buildings) in dotted line and existing
• . huilding(s) in solid line.
Size of property ft. x ft.
Size and use of existing buildings, if any
:�
x W Size of proposed building ft.x \i ft.
Height(from grade to ridge) f'.3 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-'K
(cont'd.)
BUILDING SPECIFICATIONS.,
Kind of construction: Wood frame, fire safe, etc.?.
Will any second-hand lumber be used? '3 1 If so, for what 1 r
Material of foundation walls . . . ,��.�✓�f ,' Thickness
Depth of foundation walls below grade i Continuous foundation? . . . I.t i.
Will there be a cellar? If so, material of cellar floor �" 1
Type of roof: Sloped or flat? ... .-`.c-rY l 'Material of roof
Size, wood studs � ", spacing ) "o.c., span .(
" x � ", spacing . �`. . "o.c., length • ft.
. . .
Size, floor beams, 1st floor "x �'3-
ft.
Q
Size, floor beams, 2nd floor " x , ", spacing �— "o.c., span / ft.
Size, ceiling beams . . " x , ", spacing "o.c., span ft.
Size, roof rafters or beams 'x ", spacing 1c0 "o.c., span ft.
Exterior finish . . . . . . With what material?
Finish of interior walls. . . . . . . . . ,7.�/� ��,�' � �
If garage is to be attached, of what mate ial is wall between garage and main buf<1Qing to be constructed?
Is there to be an opening between_garage and building?
Kind of heating system . . . Oil burner or coal?
Will a flue-lined chimney be provided? . . . • Depth of chimney foundation below grade
Height of chimney above roof
Will there be a fireplace? Depth of fireplace hearth
Will a toilet be installed? 3
Will a kitchen sink be installed and connected to water supply? . . . . .
Water supply (public water supply or pump) - v L-A
Distance of cesspool from any private well .. / feet
Will drainage system be provided with required traps, cleanouts, and vents? l S
Town of Queensbury AFFIDAVIT
County of Warren
State of New York
I swear that to tr. boa j of my knowledge and belief the statements contained in this ap ' tion,together with the plane and specifications sub-
mitted, are a true and coa.p lete statement of all proposed work be done on the d ri premises/a at all provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pe ining to a propo wor shall pe complt with,whether specified or not,
and that such work is authorized by the owner.
Sworn to before me this Signature ....... ....
OWNER.OWNER'S AGENT,A C CT.CONTRACTOR
day of 19
NOTARY PUBLIC. WARREN COUNTY. N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
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By
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BUILDING DEPT.COPY OF APPLICATION FORM 46-EL.NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED.
CITY •
OR (' � j C .,` � TOWNSHIP _ COUNTY "�\� �`�-r
V '�. •
VILLAGE
AGE / + �/�/�
ROADSTREET AND LE NO .> �i C�sS , // POLE NO.
ROAD AND POLE NO�I i�.l�'\ 1 1�V�'-�-V W "`
BETWEEN WHAT TWO
CROSS STREETS IS
PREMISES LOCATED? SECTION BLOCK LOT
OCCUPANT'S BUILDING
NAME /�,,� OCCUPANCY.
OWNER'S NAME V AND ADDRESS
'CURRENT
SUPPLIED -N( ' (,� \ FROM THEIR OFFICE
BY � •
BSUILDING WNEW OLD❑ REMODELED ❑ IS
NEWT ADDITIONAL❑ REMOVED DEFECTS ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NNUMBER OF OUTLETS Lamp of eceptas a MOTORS HEATERS CIBRCUIT LAMPS
Receptacles CIRCUITS
Loca-
tion Side Attach't H.P. Watts A.W.G. WATTS
Ceiling Wall Recept'Is Switch Pendent Bracket No. Type Each No. Each No. Gauge NO. EACH
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 the 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
POSSIBLE NEW D. OLD 1-1
•
AVOID DELAY BY rGIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION.MAY BE RETURNED.
NAM
E OF �+ ( -1 �� - DATE OF C-1 " 1 A^—
N
1, APPLICATION
I CAT I O N
STREET ADDRESS • r `
•
' ZIP
LICENSE NO.
POST OFFICE `�� > Ff CODE L WHEN APPLICABLE
A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date /
Name /4 ,{5 cJ
Location (.;r "f'� Arvpr,z"e . 2 C J
Permit No: /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
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers \\
Chimney
Water Meter Inst
Septic Approval
Floors
Insulation Foundation
Walls
Ceiling
a„p4it i ng 1"n(P ector
9
REMARKS
m'e-d rl."CerAL 17674
/2d 3,k' L ( e
ro
TOWN OF'QUEENSBURY •
Building Department
Inspectors Report Da
Name S'!61 5. nn tmiv �. ityl�
Location 1 Nf 1i1/ 0
b
. Permit No. 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 ra'- - 46411, 441.4,
Finished Floor /7S
g7
Interior Trim j
Stairs & Railings 1
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures :///'' ('J
Gar. Fireproofing;
Door Closers ki 0 4—
Chimney
Water Meter Inst.
Septic Approval
Floors
Insulation / Foundation
• Walls
• 'Ceiling
• Bui1 ing Inspe for
•
REMARKS
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