8118 C/O Paid
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date , 19
This is to certify that work requested to be done as shown by Permit No. 118
has been completed. •
This structure may be occupied as a One—Family Dwelling
Lot 12 Pine wood Hollow Road
Location
Owner Co G. Woodbury (Stamper)
By Order Town Board
TOWN OF QUEENSBURy_
. .1-
•*;
1. Building & Zoning Inspector
CREATIVE ••INSTA'• PRINTING. GLENS FALLS. N Y '2801 15181793-5658
BUILDING PERMIT
TOWN OF QUEENSBURY " .
No. . 8118 ,
• WARREN COUNTY, NEW-YORK O
or
PERMISSION is hereby granted to C. G. Woodbury (Stamper)
ST. 116. /a. 1.4
OWNER of property located at Lot 12 Pine Wood Hollow Road Street, Road or Ave.
rt
in the Town of Queensbury,To Construct or place a One-Family Dwelling
at the above location in accordance to application together with plot plans and other information hereto filed and 'Z1
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
679 Upper Glen Street
Glens Falls, New York
1-I
0
rr
2. CONTRACTOR or BUILDER'S Name
same H
3. CONTRACTOR or BUILDER'S Address
ID
same
0
0
4. ARCHITECT'S Name
0
N
0
5. ARCHITECT'S Address
tb
O.
W
6. TYPE of Construction—(Please indicate by X)
•
(x)Wood Frame . ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
28 'x62 ' per plot plan, specifications and
No. application submitted including two-car attached .
garage and sewage system.
8. Proposed Use
N
One-Family Dwelling
ro
$5. 00 C/O Paid ~'
$ 94 . 00 PERMIT FEE PAID -THIS PERMIT EXPIRES April 1 - 1994
(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.) N
1-'
Dated at the Town of Queensbury this 21st Day of September 19 83
SIGNED BY '7 i ad. for the Town of Queensbury
Building and Zoning Inspector
,p_t.C,1, '.4,A AAA AA) ) A_:,,,..J_.).AA AA.CJ..CA AA A).AA AA AA A).AA AA/.a-1 J..1.-1,A A.IJ..IJ.kJ./.,..0_,,Il l/-Atl•A,C)...AA J.J AA.i. ..9•IJJ.CA.I.J_9% 9!.a/.a)..1,9/.�_-./-a l,.,‘,_la/.a/.a.!-4' _
THE NEW YORK BOARD. OF FIRE UNDERWRITERS -
BUREAU OF ELECTRICITY _-
P(v . _
� 41 STATE STREET,ALBANY,NEW YORK 12207 • v . -
�.� (=:i ryjij fe y' 71 11�Ci 4jl( r'e i:JE' C'u r, ,f� r-
pP f k. .,`L:].� 1',�- �.:I A 61 7 7 Y
Date D Application No.on file
THIS CERTIFIES THAT —
only the electrical equipment'as described below and introduced by the applicant named on the above application number in the premises of
-7;'a`yPd.)7.v•N'( f+t �,i' -,ii'-I _ Eil T7 n'1 }!a- r'?, •-.; .D I-rt..?e.u:t1�_° "r1`: .�D �.�:���C^,_'.f.a
.. - �,� 1% :� ":1t��t-�ry -.1.: -.6 � ._ -L•=`V`_Y F�1 L, J`.,l JG, y
, 'tisl V
in the following location; r
❑ Basement ❑ 1st Fl. ❑ 2nd Fl. Section Block Lot
°�1 T1 fJ Flr dr.:r
was examined on 2-/.�°j f °-.1 and found to be in compliance with the requirements of this Board.
k6.
R FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS -
OUTLETSUT 'ECEPTACLES SWITCHES WRCURY
INCANDESCENT FLUORESCENT ap8 AMT. K.W. AMT. K.W. AMT. K.W.KW . AMT. K.W. AMT. H-P.
r .r
its _ ii �! u ❑ �■
— DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS I-
SELL SYSTEMS
'AMT. K.W. OIL H.P. GAS H.P. Al51T. -1,NO..-.+r. A.`W,;cG-.1 AMT. AMP. AMT., AMPS. TRANS. AMT. H.P. NO.OF FEET MAT.- WATTS
di :':':' .. `
li iC-^:� "l fl
SERVICE DISCONNECT NO.OF u - S' "-- E R V I C E •
AMT. AMP. TYPE METER mull,. ,H'2W 1,B'3W 3,B'3W 3,0•IW NO,OF CC.COND. A.W.G. NO.OF HI-LEG A.W.G. NO.OF NEUTRALS A.W.G-
EQUIP. PER A' OF CC.COND. OF HI-LEG Of NEUTRAL
OTHER APPARATUS:
1:'h l -q s: -^ 1 i _ -1 e f 2 1.l 9 1�,E^ : 2 1. ,L, i.°�Z'r 1� •;� `_i_1
]I f_,.:rt.' -.+e L''�L'i':. .�.L'. [..L., �l y e..s Ld- ..u.h o u D
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v '.1.1.--. Z-il`. k'.:. yj;a tet'-'�it Oi
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C
— !had:'•Orin. S iii:?;Cv 'Z.:
- 6' ;i}e '_1 n •! ^ 1 , K >J t'r:_-.. 1122.01 BRANCH MANAGER
1 Per . =
fY'y-Y-Y-Y-Y-Y-Y-Y-Y-Y-Y-Y Y Y YY•i YYY�YY QY YY�YY YYYYYY'YYYY YY YY Y%YY YYY"V“'i-i rY ri-i-i iY YY'YY f-%r'i r'i YY-%Y'irY rY Y9 YY i9 Y'i 1i Y9 Y' �_
COPY FOR BUILDING DEPARTMENT.THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
( %ram
TOWN OF QUEENSBURY (Space inside block to lie filled in by
WARREN COUNTY, NEW YORK • Building Inspector)
Application for Application
No. '
pP Permit Issued 19.
BUILDING AND ZONING PERMIT Permit Expires. . 11.
Zoning District
. \ :due of Work i ff"-- ,
S
THREE (3) Copies of a PLOT PLAN, Drawn to scale .\1�1�i.n\ecl by . ,��1 .,/l�f i�'/� �'
showing the actual dimensions of the lot to be built ►l�'m ��'Kf v
upon, The exact size, and location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
; TOWN OF QUEE as�ui~�(
G O - - ' Imo/f'.-€:2. -V ��� ��C� ,,��( ATE rEG UVa
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK SEir' G 0 983 ,.,!I
ANSWER ALL OF THE FOLLOWING. I a� FeP. KThe undersigned hereby applies for a permit•to do the following work M.
which will be done in accordance with the description, plans and specifi- 1 1?,11U)11'1, 1 .1 . . . i6
cations, and such special conditions as may be indicated on the permit. /
The owner of this property is: M 0,D i iic
•
�� l
(NAME) (P.O.ADDRESS)
The person responsil'e for 2 supervision of the work insofar as the Building Code and the Zoning Ordinance apply is:
1 ^ � - � , , , 1 —� � I.
(NAME) (P 0 ADDRESS)
Name of Builder ' L` r/ f � ' 1'a�� 1 Address (r't
' �.j 1 ' . . .Address &, •Name of Plumber. .�. � • • -•�v• • • �•ti^• � • d•"-'� • • • • • r� � �.-�J�
Name of Masorf fl' / 1 4 --\f Ste,' ) Address < t"-' "� Cps""^
Lot Number. . . . )... Unit;,
Estimated value of proposed work 3 � ) `) (/ 17
Name of Village . ``� • � A
ame of {' + • °'��✓�f If s -� Side of street: north 0, east 0, south 0. west
Nearest Cross Street \'^y'-^- 1 V41(i'PC''' 1�-5- Distance from this cross street Ft.
Property is north El,south ❑,east i 1, west 0 from Cross Street
If on Corner, which corner, northeast ❑, northwest ❑, southeast 0, southwest
(Designate by marking with an "X" in the correct space.)
NATURE OF PROPOSED WORK •. OCCUPANCY •
Construction of a new building. Main Building
❑ Addition to a building. . . One-family dwelling
Two-family dwelling ❑
❑ Alteration to a building. -family apartment house ❑
❑ Demolition of a building.
Store building ■
. . . . -car attached garage NI
1
Other:
• Accessory Building
• . . One-car detached garage El
❑ Other work. Describe Two-car •detached garage ❑
Private chicken house El
• 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 building(s) in`dotted line and existing
huilding(s) in solid line. .
Size of property ft. x ft.
Size and use of existing:buildings, if any
I-N `
i w Size •of proposed building k o. . . )x • • ft.
Height(from grade to ridge) 1' ft.
Front.yard . —4 •d 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 .
(cont'd.)
BUILDING SPECIFICATIONS.,
�
Kind of construction: Wood frame, fire safe, etc.. . . . . . f
. . . . . . . . . . . . . . . .
�
Will any second-hand lumber be used? 1 f--- If so, for what' V
Material of foundation walls '' �t Thickness . . . . . .
Depth of foundation walls below grade
i _ Continuous foundation? �. .
..
Will there be a_cellar
'� .. If so, material of cellar floor � `�-�)�'
Type of roof: Sloped or flat? . . .F • Material of roof . . i :57 '�' 1—'f (i*
Size, wood studs �--� "x • • ", spacing 9 "o.c., length. .,Is� • ft.
Size, floor beams, 1st floor "x • • r• .17• • • • • - •", spacing ( 40 "o.c., span ( ''+— ft.
Size, floor beams, 2nd floor " x ", spacing "o.c., span ft.
Size, ceiling beams �, " x�,-7 ` ,l : • .. . ', spacing "o.c., span �, cy ft.
Size, roof rafters or beams
"° "x .I . .'�J. .3.\: ',', spacing rl�' , "o.c., span ft.
Exterior finish . . . .'\,,_,/- . • • • • With what material? . -
. . . . . �/.�1:'J Qnt..
Finish of interior walls. . . . . . . . . .. � • • • - • - - • • • - • • - • • • • • - • • • • • • • • • • • . . . . . . . . . . . .
If garage is to be attached, of what material is wall between garage and main bui<1ding to be constructed?
- 'V j-, -, �, , v erg
Is there to be an opening between gam *
e and building? 1it2'
Kind of heating system . . . . .:_. -._ L.-f1 , Oil burner or coal?
Will a flue-lined chimney be provided? '---9---0. Depth of chimney foundation below grade
Height of chimney above roof
Will there be a fireplace? 7-4 U Depth of fireplace hearth
Will a toilet be installed? - l '
Will a kitchen sink be installed and connected to water supply?
Water supply (public water supply or pump) . . . . . . ?�)
Distance of cesspool from any private well 1. 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 b, r of my knowledge and belief the statements contained in this applica '•• together with the plans and specifications sub-
mitted, area true and coa.p lete statement of all proposed work be done on the di.: .•, p m,ses and that an provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pe ining to the pro•.sed work al 'lied with,whether specified or not,
and that such work is authorized by the owner. l (\
Sworn to before me this Signature
OWNER.OWNERS AGEN .ARCHITECT.CONTRACTOR
( day of 19.. -
NOTARY PUBLIC, WARREN COUNTY, N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
•
By -
/V/ TOWN OF QUEENSBURY :
BUILDING & ZONING DEPARTMENT
SEWAGE DISPOSAL PERMIT APPLICATION ..
1. Owner' s Name C , 6- x..74 ,9-5 k3l(,'y.
•
Address} 4=Z; 1 ;\
7 1 -, :S,v_"- Telephone No. ,
2. Property location ; i y �' .. - 11'`-7Q,-°y
3 . Name. of person or firm responsible for installing system
E5-40- 4` . c '-'°.="77�_��, Telephone No. .
Address t— f (_.-----1"--C-:-.- mow(&
4. Number of bedrooms (residential" buildings only) 7
5. Daily flow gallons/day
"6. Septic tank capacity I �' �/ L.---" gallons_
7 . Topography: 4110Prolling, steep
% of slope
8 . ' Nature of soil and- depth j
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: ' unicipal, w=11, other
12. Type of system proposed: drywell, t ' e fi ,ef 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 as provided f 'n Section 6 . 010 of, the
Queensbury' Sanitary Sewage Ordinance.
CV---' p c
Date / _1 ��'
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 17� F , - . .
. . . ,.. :
.. .
. . . .,
2 . Type of heat , � � . . .
3 . Is the building mechanically cooled? —17 '
4. Percentage of area of . windows and doors • / 44 • - . :
- A. Over 16% Only- . .
l . - Uo value of gross area of walls , roof/ceiling and floors
•. exposed to ambient conditions
2 . Floor over heated space's YES NO
' a. Are• founddtion 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,,//roof and floors exposed to ambient conditions_
• i� ��. / -. .
2 . R value ,of exterior walls � -
•
3 . R value of glazed area >�
4 R value of doors r (,,,—' ! �'
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 ( -1( �-'' •-S
C. 'Controls
- ' 1. Thermostat 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 A �� , .2 . Temperature control setting maximum 1
• G. For Swimming Pool Only
1. Maximum heating
Via+
Telephone No. 1 �
•
(applicant ' s signature)
i
BUILDING DEPT.COPY OF APPLICATION FORM 46-EL.NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED.
CITY OR t A
VILLAGE t1 1 ] L y TOWNSHIP COUNTY "
STREET AND NO.OR r _
ROAD AND POLE NO. V�,�/�1` i\k-Ak, Y '� — V 4 d i POLE NO.
BETWEEN WHAT TWO
CROSS STREETS IS •A
PREMISES LOCATED? SECTION BLOCK LOT
OCCUPANT'S BUILDING
NAME OCCUPANCY
OWNER'S NAME t"' / \
AND ADDRESS �� ��1
CURRENT
BYSUPPLIED �1,�
FROM THEIR OFFICEB �l
DEFECTS
ISUILDING NEW14: OLD El REMODELED El IS
NEWy- ADDITIONAL REMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS No.of Fixtures& MOTORS HEATERS BRANCH LAMPS
Lamp 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 n
POSSIBLE NEW I I OLD ri
• AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
NAME OF Imo` `l+`j�` I, DATE OFF
APPLICANT APPLICATION
STREET ADDRESS
CITY OR ��', r CODE WHEN APPLICABLE
ZIP \ LICENSE NO.
POST OFFICE tt
A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date f I -Z -Cf�
Name I,vO 6 Y) b `- C64AY
Location Lei— !2 -
Permit No. 73 t I 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 1/
J)
Finished Floor
Interior Trim / dye_!L
Stairs & Railings\) . 0 V`
Cellar Dr. Tile
Concrete Floors ,/
Plbg. Fixtures `/ / 0
Gar. Fireproofing\/
Door Closers / C
Chimney
Water Meter Inst.
Septic Approval
Floors
Insulation Foundation
Walls
"Ceiling "
CriP
Biding Inspector
REMARKS
--- O K
•
TOWN OF QUEENSBURY
Building Department
Inspectors Report • Date,42`'*2•-J93
Name Ze- If)
Location 2 ;1:>1AJ 6 62-7 . *f /cif
. Permit No. SC l I Wea lmw
Remarks
Excat,a tion
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 Gam _
Floors
Insulation Foundation
Walls
Ceilin
10/f
Buil ing Inspector
•
REMARKS
C •
•
TOWN OF QUEENSBURY
Building Department
InspectorsAeport Date ?'-'��
• Name -0 er5f>��n�'
Location (, ,'2._ vl'IU5 G J i> n /% /
Permit No. Si 1 I ,X Weather
�0� Remarks
ExcaOation
Footing Forms
Footing & Piers
Foundation , /'Dd f7-
Cement Coat
Waterproofing
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
Siding
‘4\ ci
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
Buiing Inspector
REMARKS