8400 • C/O Paid
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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. 8400
has been completed.
This structure may be occupied as a One—Family Dwelling
Location West Drive
Winona Wood
Owner
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By Order Town Board
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TOWN OF QUEENSBURY
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Building & Zoning Inspector
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"CREATIVE "INSTA" PRINTING. GLENS FALLS. N-Y 12801 (518)793-5658
BUILDING PERMIT
TOWN OF QUEENSBURY No 8400
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Winona Wood
OWNER of property located at West Drive Street, Road or Ave.
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 O
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is RR +n O
i O
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Larry Wood
3. CONTRACTOR or BUILDER'S Address
RR *4 Box 398
Glens Falls, New York
rt
4. ARCHITECT'S Name
K
m
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
(x)Wood Frame ( ) Masonry ( )Steel (
7. PLANS and Specifications 24 'x40 ' per plot plan, specifications and application
No. submitted including sewage system. O
Demolition of older dwelling when new dwelling completed.
mm
8. Proposed Use p zJ
I—, CD
One-Family Dwelling - Demolition old dwelling rt••
o �
$5. 00 C/O Paid
t7
$ 70. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 1 19 84 o,
~
(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•
(D 4
Dated at the Town of Queensbury this 19th Day of April 19 84
SIGNED BY -mad a for the Town of Queensbury `Q
Building and Zoning Inspector
TOWN OF QUEENSBURY (Space inside block to be filled in by
WARREN COUNTY, NEW YORK ' Building Inspector)
Application for Application No. .
�p Permit Issued 19.
BUILDING AND ZONING PERMIT Permit Expires. 19
%cinin District
\ ilia. nl work$ /7
THREE (3) Copi®: of a PLOT PLAN, Drawn to scale y l'i� ,d ,_ i
showing the actual dimensions of the lot to be built 1t�i,,:i�Kf z (` e
upon, The exact size, and location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
A�.�.y7 o� TOWN OF QUEENS URY
'1 / pg7E I,
A PER
MIT MUST BE OBTAINED BEFORE BEGINNING WORK
H E 0 EVIE -,j
ANSWER ALL OF THE FOLLOWING. h 'I'i 1. 2:N84,
The undersigned hereby applies for a permit.-to do the following work 75Gt7 P. ,
A.M.n�.
which will be done in accordance with the description, plans and specifi-
cations, and such special conditions as may be indicated on the permit. e e e e a e
The owner of this property� / is: . .
. .( U/JA. . ./ilee. - .
(NA'•1E) (P.O.ADDRESS)
The person responsible for supervision of the work'insofar as the Building Code and the Zoning Ordinance apply is:
,�f9��y (,J. �J d� e Y 6d 9 ' /�.�r��,�. <� �� ?iO7 . .
(NAME) (P.O.ADDRESS) � �1 / /
Name of Builder. . L/QA R/ � ' s" Addres //� r�;
lei Address ��0�re-- " I"
Name of Plumber.-. . . / , f
Name of Mason. . . �.. :41-Gi.().GL). ./. . �.,.r.570 r,<.(.� . . . . . ... . . .Address '/Oiti (4.96 :>. . ei
Lot Number J Unit ,Tr Estin{ated value of proposed work 5 .j��,.CJU''h "" / df�0
Name of Village . . .,�i�(!? C-fe,J e //Y •
Name of Street . .CG,O.e,/ CA', `"�-°" F Side of street: north east 0, south 0. west ❑
Nearest Cross Street . . .L 2-Qt' N Rd t Distance from this cross street Ka Ft.
Property is north Xi,south ❑,east i 1, west ❑from Cross Street
If on Corner, which corner, northeast ❑, northwest ❑, southeast ❑, southwest
(Designate by marking with an "X'• in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY .
_ '2 Construction of a new building. Main Building
❑ Addition to a building. . One-family dwelling i
0 Alteration to a building. Two-family dwelling
K] Demolition of a building. -family apartment house ❑
Store building ❑
•
-car attached garage ❑
��/f ,,✓✓ / Other:
140,n/ .4.1 a¢. 71. . . .aeef i E .i.'G' /✓.l letC,. ,,,- Accessory Building ❑
One-car detached garage
0• 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, site and setbacks of pro-
posed buildings,and the location of all existing buildings.
NORTH - Show proposed building(s) in dotted line and existing
ev �' �, >;uilding(s) in solid line. .
.ti, '..a__... � � Size of property 'i/d ft. x ,
�'id ft.
i,
jr' Gfil'e
c , i Size and use of exiissting.buildin s, if any.._ . :: • . •j; . .
W C W
_ Size of proposed building .t: ft.x ft.
B
\J "" • et�, Height(from grade to ridge) . . . . . . . /1P ft.
Front yard a ft.
Side yards " '. ft. and ./e
e ft.
,7 e.i_IN �� e • Rear yard 2- . / 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.,
r'1
tmr. - -, '�Ol1w�'
Kind of construction: Wood frame, fire safe etc.? re . ,'IP,-t'^'c-�:. • • au CI1i).,. 0.1 '4d 1- 1 to '"
Will any second-hand lumber be used? 7ree_g� If so, for what'
Material of foundation walls . . .£-'p CA'' ''' Thickness . . . /#.
Depth of foundation walls below grade ,Y# Conn sinuous foundation? ye-5-
Will there be a cellar? . ./:`C'z.3 If so, material of cellar floor .
Type of roof: Sloped or flat? .�,D�'r-�` • •6/#/t3Z. Material of roof .,Qr.G../ii.c/: .f�''.ct'?�?;,'�'�,' . , r�'s.t .,�v .c, ��f ,.d
" x spacing "o.c., length P.
Size,wood studs . . . . . . . /�o ft.
Size, floor beams, 1st floor ,2,. . ."x cP ", spacing :''6 "o.c., span /oZ_- ft.
Size, floor beams, 2nd floor — " x y ", spacing "o.c., span ft.
Size, ceiling beams • • • " x e.P ", spacing /6 "o.c., span /�, ft.
Size, roof rafters or beams c2 Co.,. . . "x • // ", spacing /t'S "o.c., span Au ft.
Exterior finish . . ./X•/2 C o0s'f
• • an;.�cih4 • fy• 6/C, With what material? f'/ifs
Finish of interior walls. . . .7�,?. . .(`-4 e.,?.=. u e'c-/<
If garage is to be attached, of what material is wall between garage and main building to be constructed?
Is there to be an opening between garage and building?
Kind of heating system . . . r Oil burner or coal? . . .Qi/ e3 t.e/Vete
Will a flue-lined chimney be provided? eL5' Depth of chimney foundation below grade
Height of chimney above roof ,
Will there be a fireplace? . . t�� Depth of fireplace hearth . . ....0 �`% '
Will a toilet be installed? - e e r
Will a kitchen sink be installed and connected to water supply? 7e,
Water supply (public water supply or pump) ettssbc�'`" '-fr• • • •(.(.2�7�•`'( .'1
Distance of cesspool from any private well . . . . 025'... 2,44 , feet
Will drainage system be provided with required traps, cleanouts, and vents? ie,:
Town of Queensbury AFFIDAVIT
County of Warren
State of New York
I swear that to.tt-bey c of my knowledge and belief the statements contained in 'a application,together with the plans and specifications sub-
mitted, area true and co.,.p lete statement of all proposed work to be done on described premises an that all provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertaining to the posed wor shall be plied with,whether specified or not,
and that such work is authorized by the owner.
Sw rn to f e e this/ ? Signature
/a day of #1467( • 1 _Q
OWN R.OWNER'S AGENT.ARCHITECT.CONTRACTOR
NOTARY PUBLIC. WARREN COUNTY,N.Y. 2�
SPECIAL CONDITIONS OF THE PERMIT:
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By
TOWN OF QUFENSBURY
BUILDING & ZONING DEPARTMENT
SEWAGE' DISPOSAL PERMIT APPLICATION
1. Owner ' s Name 4 ,4 7 'l cty
Address 44,S:/ 1 /.y. ��-!" 4
Telephone No. ,75l
2. Property location ` ' .' `�` t“?.
3 . Name of person or firm responsible for installing system
( -I(acL, Telephone No. -
Address
4. Number of bedrooms (residential buildings only) 7
5. Daily flow 300 gallons/day
6. Septic tank capacity / O ` gallons
7. Topography: flat, rolling, step')
% of slope G:
8. Nature of soil and depth _Aa.11.4d zo ` -
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 O -5- minutes/inch
r
11. Water supply: municipa , well, other
12.. Type of system proposed: .drywel , 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 as provided for in Section 6.010 \of the
Queensbury Sanitaryta Sewage Ordinance..
Date 0/ 1F�"/ ‘,'./eL�G mac° ,� 2-7/
"
/ ( 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.
too 4°
Form 3-82
rd2e /8 - Zf! " 5�
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 9 ()
2 . Type of heat � r,Tk/r, I,(.2 ?) �Ge./e/M- .e_
3 . Is the building mechanically cooled? z d,
4. Percentage of area of windows and doors /s' )_--
A. Over 16% Only
1. Uo value ,of gross area of walls , roof/ceiling and floors
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a. Are f'oundation 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
/>�S= 1. R value of roof and floors exposed to ambient conditions_
fe0 2 . R value of exterior walls
3 . R value of glazed area Nen,ti.)A #-11e_ T . t/+cs / 9
e���� 4 . R value of doors
e/9 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 . 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 '
2 . Temperature control setting maximum
G. For Swimming Pool Only
1. Maximum heating •
Telephone No. 7,'5e/6'/ ,��2��fi�'",T,,f .� ' '-,
(applicant ' s signature)
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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. F`/`(Od
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CITY OR/
VILLAGEi/, i,.:�s-yl= =s- TOWNSHIP r U!'kF. •-1‘,'-- ,". /r COUNTY
STREET AND NO.OR -z- • . -i 1' 4 -
ROAD AND POLE NO:, '�; j,`" i ,%;r �`Y� POLE NO.
BETWEEN WHAT TWO
CROSS STREETS IS 1G>'
PREMISES LOCATED? I Si SECTION BLOCK LOT
'T - ' /7 iJ. •—a ? ����''J--�
OCCUPANT'S / BUILDING � , -
NAME . tA, �i,lvt ;� rr. (.'�/)CJ`�r. OCCUPANCY t�(/t�C //(�'f7
OWNER'S NAME r - -
f'-
AND ADDRESS fli;,'t(1 i%k/'� '::_ ✓� J(J� C''r-. ✓,.:)('s :
CURRENT
SUPPLIEDBY /77 / /Ii � FROM THEIR • OFFICE
IS NEW W
DEFECTS
_ #J
BUILDING .�/ OLD El REMODELED IS NEW XI ADDITIONAL❑ REMOVED ❑❑ •
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED •
•
No.of Fixtures& BRANCH
NUMBER OF OUTLETS Lamp Receptacles MOTORS HEATERS CIRCUITS LAMPS
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.
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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 POSSIBLE NEAR AS /� /�`� �+'4/ l '- NEW f OLD.
( f�
El
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
f, f
NAME OF J DATE OF (/ i
APPLICANT /`�/% ,ii��'�/ /! ° �P APPLICATION ! �/STREET ADDRESS ' � "-� 4.
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CITY OR %/J t" ,i; ZIP /7; � LICENSE NO.
POST OFFICE i i /�" t . - CODE/•"-" WHEN APPLICABLE
A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
TOWN OF QUEENSBuRY
Building Department
Inspectors Report Date `i/�Y/'c
Name (A//N 0/11,1 Gtwo o()
Location Liz ,f i ,aZ-
Permit No. 1 Yc5-0-- Weather
Remarks
Excavation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Ba ckfi ll
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 J.%
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Fl rs
Insulation Foundation
Walls
Ceiling
Building Inspector
REMARKS
- x E
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date S3 /9(i
Name n _ a /!
Location IA)L ST a 12-
Permit No. IOC) Weather
Remarks
Excavation
Footing Forms
Footing & Piers Js
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
Building Inspector
REMARKS
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date /2-
Name
Location /:{ )/:._7- 7--
. Permit No. 4 Q o Weather
Remarks
Exca)ation
Footing Forms / T
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
•
c-- -r966ed
Building Inspector
REMARKS