1993-534 •
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW PORK
Date May 23 19 95
This is to certify that work requested to be done as shown by Permit No. Q z—c,a n s
has been completed.
This structure may be occupied as a
entrance foyer
116 Meadowbrook Road
Location
Priscilla Roof
Owner
5 9—2— By Order Town' Board
TOWN OF QUEENSBURY
Director of Bldg. 6c Code Enforcement
BUILDING PERMIT 1-3
TOWN OF QUEENSBURY
No. 93-534
WARREN COUNTY, NEW YORK 0
O
PERMISSION is hereby granted to
PRISCILLA ROOF t'-'
N
OWNER of property located at 116 Meadowbrook Road Street, Road or Ave. I
in the Town of Queensbury,To Construct or place a Addition 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.
1. OWNER'S Address is O
O
same
b
2. CONTRACTOR or BUILDER'S Name
H
Plain & Fancy Cont. c�
H
r
3. CONTRACTOR or BUILDER'S Address
80 West St
Lake George NY 12845
4. ARCHITECT'S Name
5. ARCHITECT'S Address
Sy
O
tS'
fi
6. TYPE of Construction—(Please indicate by X) 0
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(X)Wood Frame ( I Masonry ( )Steel ( )
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7. PLANS and Specifications
No. 12 ' x12 ' Addition to dwelling as per plot plan, specifica—
tions and application.
8. Proposed Use
Entrance to house
sz
Iz
rt-
8 . 00 September 10 94
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rt
town of Queensbury before the expiration date.)
, C7
Dated at the Town of Queensbury this h y of�ii eptember 19 93
Z " CD
SIGNED BY ~
for the Town of Queensbury
Building and Zoni nspe or
TOWN OF QUEENSBURY ••'' R',"'�=;: REVIEWED BY:
COMMUNITY DEVELOPMENT DEPARTMENT ,, 1 4��
BUILDING & CODE ENFORCEMENT , ;'r FEE PAID: , a�
531 BAY ROAD ' ,.... .-"'.`
QUEENSBURY, NEW YORK 12804 , ` PERMIT NO.
(518) 745-4447 S67897
BUILDING PERMIT APPLICATI• d!, ` Old
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONS ►•, CTIO NIIN'O I ECTIONS
WILL BE MADE UNTIL APPLICANT HAS RECEIVED A ' , ID '•.' 'I��NI G IT.
All applicants ' spaces on this application MUSr be • : a'' d aR the
signature of the applicant MUST appear on the 4p1iP. ,• pout form°
1, Q►Leensbury I
`�_ Q Bld&uep1. 6��
OWNER OF PROPERTY: Priseill G. _�>i�{,1 ?�— ��� ,�e'L
Mailing Address : //6 s 0�.e�.&'U Jr Zc� taEzZZ
Telephone Number(s ) : Work Home 9% - ther
PROPERTY LOCATION:
Tax Map Number: Section ( ;`/// (/Block /)� Lot
Subdivision Name: Lot No.
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
CONSTRUCTION: $ ,Se-G•I/27
NEW BUILDING:
RESIDENCE/COMMERCIAL OCCUPANCY INFORMATION:
K. ADD S►., TO BUILDING: PRIMA BUILDING -
'.iESID COMMERCIAL Single Family Dwelling
ALTERATION TO BUILDING: Two Family Dwelling
RESIDENCE/COMMERCIAL Family Dwelling
(NO CHANGE TO EXTERIOR SIZE) Office
OTHER WORK (DESCRIBE BELOW) Mercantile
Warehouse
Manufacturing
Other
GROSS AREA OF PRO OSED STRUCTURE:
1ST FLOOR /9fi4 SQ. FT.
IF ADDITION, USE OF NEW ADDITION:
2ND FLOOR N14 SQ, FT. 470b' 7-,0 Al .:
OTHER FLOORS SQ, FT.
(not unfinished cellar qr basement) ACCESSORY BUILDINGS:
" Detached Garage - One/Two Car
TOTAL FLOOR AREA: /�/LI SQ. FT. Attached Garage - One/Two Car
Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building
Other .
/,,,L FEET X 42- FEET
Foundation Type: I IO f ®,J .c/Ce.1 Will any second-hand or ungraded
Number of Stories : lumber be used? If so, for what?
(habitable space only) OOvv
Height (grade to ridge) : /.2 feet Type of Heating System:
Number of fireplaces and/or woodstove (circle all Bch applies)
to be installed: 0 Electric / Oi / Gas / Wood
orced Hot Ale,/ Baseboard / Other
PE SON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
NAME OF BUILDER/ADDRESS/PHONE : ` 46 /-c¢„�,c� ('cm.7 c ff- 1 M 6p4;0, 2J
NAME OF PLUMBER/ADDRESS/PHONE : S"�,��.
NAME OF MASON/ADDRESS/PHONE : - • c'cc-._-�
NAME OF ELECTRICAN/ADDRESS/PHONE : 5:7z-,.�e
DECLARATION
To the best of my knowledge the statements contained in this appli-
cation, 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 noted, and that such work is authorized by the owner.
Further it is understood that I/we shall submit prior to a Certificate of
Occupancy or Certificate of Compliance being issued, an AS BUILT PLOT PLAN
drawn to scale, showing actual location of pr �n pr is .�
Signature ��ff
(Owner, own ' s agent,, architect, contractor)
FOR ANY SPECIAL PROVISIONS - SEE REVERSE SIDE:
ENERGY CODE COMPLIANCE APPLICATION
, r°=- 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
*Requires submission of worksheets
APPLICANT' S NAME: PROPERTY LOCATION:
pr, ikt
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1 . Gross Floo] Area - f uz/ square feet
2 . Type of Heat - Electric Oil Gas Other
3 . Is building mechanically cooled? Yes No
4 . Percentage of area of windows and doors Over 17% Under 17%
5 . R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS
SHOWN ON PLANS SUBMITTED:
a. Roof R �C7
b. Exterior walls R
c. Glazed areas R /9
d. Exterior doors R
e. Floors over unheated spaces R ,1,)f-'
f. Edge of slab on grade (heated building) R
g. Basement/cellar walls (above grade) R
h. Basement/cellar walls (below grade) R
i. Heating/coolifig-ducts-piping in unheated space R
6 . Service (domestic) hot water heating device
Conforms to minimum efficiency per code Yes No
TEMPERATURE CONTROL MAXIMUM SETTING 140° - WILL NOT BE EXCEEDED
CAA i nt' s ign tur 77,95Ph Nu�Ar/
L./4/14 ,� 07 , grl9 0
INSPECTOR' S REMARKS:
/
- MIDDLE DEPARTMENT INSPECTION AGENCY, INC. .
National Headquarters
1337 West Chester Rk-6 etrhosto� PA 19380
.
APPLICANT COMPLETES THIS SECTION Data: '
To�nnrT�wnohi / '/~^�� . Cnunty / ^� /�� � ~ \ State ^*� /
City, �
Location/Address
(|f Located in Rvm| Area Please Attach Directions) po|o #
Owner ponn� #
Occupied As ' Building: Now Old |
Occupant r-
VVoMkAmuiu Building (Floor #,otoJ:
App. for: YN ring| '4~-SopviiooF-1 or: � Roudyfor\��muton� `
Fee Remitted $ dash�1 Check�1 M.O. 1 I � Nbko Payable To: M.D.I.A.
Number of Rough Wiring Outlets Elect. Heat
-,m z� ,� ,� om '� u� x� nm s�
Switches
Amp. Service Surface Unit Dishwasher Range
Lighting Water Heater AirConditionor Dryer Pump
R000ptao|oo
Oven Garbage Disposal Wiring and Controls for Burner
Number of Fixtures
Amp. Roroptao|oo Fractional H.P. Vent Fans
Other Equipment:
MOTORS1/�p1/121/10 z!o' z/o 1/4 1/3 vc 3/4 z 11/2 c n s r* zo z, uv eo oo ^u sv 75 mo
Mark Number
of Each Size
Applicant's ��/�Z � J ' *. ^�` License # Ponnit #
' �[J . '' /;`^ /� ' Utility:'''~ ' — >
' ~� / ''/� ��' ( / �� (mmws) mmc� �uc*/mm
App Address: ~~ ~`^~°-' - ~ '~-_
��) / � /� ���'� ) aJ �' �P) /_��� Service, .
U /
Phnno # Electrician:
N1CUA USE ONLY
DATE nscsmso. DATE /mopsoTEo.
Correct Location: Same am Above F� or:
Red Notice Label F-1 .`
Rough Wiring Outlets Surface Unit . Oven
Switches Range . Garbage Disposal
Rmmptao|oo Water Heater ` __- ' ' Dishwasher
Fixtures Air Conditioner _ Dryer
Amp. Service Equipment Burner, Wiring &Controls for _ Amp. R000ptodo
Amp. Service Conductors Pump Vent Fans
MOTORS H.P. 1/201u2 zuo zm z/o z/^ z/a z/c *4 z z* c 3 s r* zv z, eo cu 30 40 oo rx mo
Mark Number
of Each Size
mo rm ,mm 1250 1500'17502000225" 2500'275" `wo
E|oof.-Heat
nmscr pss p�/o
CERTIFICATIONS ` USE FOR INITIAL VISIT wor �/so m�rs no FEE
| | RVV Progress: Inc. LKD Contractor
F� CFT Violation: Work Comp �] \�� �� �1
�-^ � � CASH
[] L/A D»»»«' Fee CHK **
F-1 L//\ Duo MO #
F-1 IPA Municipal
lNV # `
�J
Date: ��ho,�XdoL� Utility � � Ownor
`
Cu, in Card Temp # Date .
F-] Final # Date INSPECTORS SIGNATURE
^PpuoAnow Fonm wo.uso EL 11/89
i TOWN OF. QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY ROAD
QUEENSBURY NY 12804
'• (518)745-4447
ARRIVE: DEPART: INSP:C
FINAL INSPECTION REPORT — RESIDENTIA
DATE INSPECTION REQUEST RECEIVED:
NAME 1 3:
LOCATION ,116 6/iDOu. rc-32;
J/ 1e.-
DATE Z 5/ 0,S--- PERMIT # Q3'53'V
TYPE OF STRUCTURE 1 '
FOOTINGS FOUNDATI'QN BACKFILL FRAMING
ROUGH PLUMBING SF\PTIC INSULATION •
FINAL ELECTRICAL WOODSTOVE OR FIRroPLACE
1 NA'dA _ YES NO
CHIMNEY HEIGHT/B VENT/H IGHT
PLUMBING VENT 1\ d •
ROOFING \ A
`
EXTERIOR FINISH ! I
DECK/PORCH/STEPS/RAILINGS / ,
RELIEF VALVES
FURNACE/HOT WATER OPERATING\ t'i
INTERIOR TRIM/PRIVACY DOORS //;gg%
FINISH FLOORS: A'd
4 -
BATH/KITCHEN WATERTIGHT M
OTHER FLOORS 'SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS/ \ ____,
SMOKE DETECTORS
if , ..
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING/ ,
ifDOOR CLOSERS
FINAL ELECTRICAL I
SITE PLAN/VARIANCE REQ.
FINAL SURVEY PLOT PLAN J
OK TO ISSUE C/O /OR C/Cn 1. �
17
f'
J
TOWN OF QUEENSBURY
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED AirtiTO ,
NAME (D rr-
LOCATION Mx? k- —Vc JP, V— QV)
DATE ly I 1 [(1/4 PERMIT# � , t4
TYPE OF STRUCTURE if\vvv-c- -A,
RECHECK ,
_FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
_FOOTING FOUNDATION BACKFILL FRAMING
_ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC
_INSULATION __INSULATION
REMARKS
APPROVAL
N/A 'YES NO
CHIMNEY HEIGHT/LOCATION ,....---`
B VENT/LOCATION wo-
PLUMBING VENT t----'•
ROOFING \
SIDING ,
DECK/PORCH/STEPS/RAILNGS 6
RELIEF VALVES Y
FURNACE/HOT WATER OPERATING' 1/
BASEMENT INSULATION/DUCTWQRK .,,/'
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATERTIG T
OTHER FLOORS SWEEPA E \ ti,..-
OTHER FLOORS CARPET D \ ',
STAIR CLEARANCE/RAIL GS
HANDICAPPED ACCESS / \
SMOKE DETECTORS f \
BATHROOM FANS/WHOL HOUSE FANS`,
ALL PLUMBING FIXT RES OPERATING . t'.-
GARAGE FIRE PROOF NG v,i
DOOR CLOSERS
OTHER FIRE SEPARATION �'h
FIRE/DEMISE WALLS 1.,,°"
DUMPS TER $./
SITE PLAN/VARIANCE REQUIREMENTS
S CC C
FINAL ELECTRICAL IIr tys,� OFT.,
OK TO ISSUE C/O OR
COMMENTS:
•
:::
t 1 = .",.-4'"1.., ' 7/7
I NS P TII�`�� �
j ' G'
TOWN OF QUEENSBURY `11
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447 •
BUILDING INSPECTOR'S REPORT /:)-
REQUEST R INSPECTION REC IVED !(: /J3
NAME ! ,;1, S ( �-�_j'��-''Z/
P V q
LOCATION / b 6"�-�-G�e,,, t1 4`-
DATE (� 1 .13 �� PERMIT I q '•6,)
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE I
THE CONTRACTOR IS RESPONSIBLE •
FOR PROVIDING PROTECTION FRO Mi
/
FREEZING FOR 48 HOURS FOLLOW NG
THE PLACEMENT OF THE CONCRET '.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR 1
REINFORCEMENT IN PLACE i
FOUNDATION/DAMPROOFING I 1
BACKFILL APPROVAL I
ROUGH PLUMBING / C
PLUMBING VENT/VENTS I'N PLACE
PLUMBING UNDER SLAB/ 1
FRAMING: /
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN\EAM \
HEATING ROUGH-IN i,
XASULATION: 1,
FOUNDATION WALLS INTERIOR R- \
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-a _
CEILING R- -r>
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
Uk°pu E, ,/��'i4 �,u0 ( f
5 E .).-1 NT--- Ocos.Z.,- ooe,uliti&._
ARRIVE
DEPART %60
r INSP C R
TOWN OF QUEENSBURY l J .
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR I
NSPECTIONREE IVED
NAME G "6o/
LOCATION ///( J44. 4-4 , ,
DATE `d /y S; PERMIT # / j- S 3Y
TYPE OF STRUCTURE / ' X-
RECHECK APPROVED
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
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING /
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
L/FRAMING: $ ?(
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R°-
FOUNDATION WALLS EXTERIOR
R�...
FLOORS R—
WALLS R-
CEILING R-
DUCT WORK OR PIP,.ING IN UNHEATED
SPACES
REMARKS:
ARRIVE e
,6 DEPART ', 1l �_.L 2.
% INSPEC, OR
,tp.,/,
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT /
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUESk- OR INSPECTION RECEIVED f l(mil N
NAME :j---# _.) OQ 61)-61
LOCATION I 1 C. !"lam e-L--% S1'uU-e`--o
DATE vl )(r,�� ERMIT # g s —5 /
TYPE OF STR CTURRRRE lD1 \
RECHECK A ROVED
N/A YES NO
'OOTINGS/PIERS pc
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM ,r'
FREEZING FOR 48 HOURS FOLLOWING/
THE PLACEMENT OF THE CONCRETE. /
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR /
REINFORCEMENT IN PLACE /
FOUNDATION/DAMPROOFING /
BACKFILL APPROVAL /
ROUGH PLUMBING f,
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB ,,�'/
FRAMING: /
JACK STUDS/HEADERS/ ',
BRACING/BRIDGING
JOIST HANGERS / '‘
JACK POSTS/MAIL' BEAM ,
HEATING ROUGH-IN, '1
INSULATION: ;'
FOUNDATION WALLS INTERIOR R
FOUNDATION WALLS EXTERIOR R- !,
FLOORS R-
WALLS I R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED ,
SPACES
•
REMARK(: I(
�C l C ��)0C� C2100 5 re�,0 r
ARRIVE IZi
DEPART 1,1-C3c—
IPTR
- J t c 1
(�c i_"' A"" )0
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