8732 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 8732
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Henry Naqamatsu
OWNER of property located at Rockhurst Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Alteration to dwelling (foundation)
at the above location in accordance to application together with plot plans and other information hereto filed and A�
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is
104.6 Cornelius Ave. `t
Schenectady, New York
2. CONTRACTOR or BUILDER'S Name
John Mason
3. CONTRACTOR or BUILDER'S Address
P. O. Box 86
Cleverdale, New York
4. ARCHITECT'S Name
Fi
in
rt
O
5. ARCHITECT'S Address A./
6. TYPE of Construction—(Please indicate by X)
( I Wood Frame ( ) Masonry ( ) Steel ( ) -
7. PLANS and Specifications
install 24.'x3 6' continuous foundation per specifications ._ H
No. and application submitted. o K
8. Proposed Use
A� H-
One-Family Dwelling (foundation) -
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rt-
..... 0
10. 00
$ PERMIT FEE PAID —THIS PERMIT EXPIRES Marcr. 1 19 85
(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.)
Dated at the Town of Queensbury this 28th Day of August 19 84
`IM
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
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® � �� �E NSBUR� (Space inside block to Whiled in by
WARREN COUNTY, NCW• YOF21C . -'' Building Inspec•tot•) ..
.\iiplication No.
Applicaf000 for Permit Issued l�.•.
BUILDING AND ZONING PERMIT . - 1'c•rmit Expires ; - • •
%c,liint:. l)istri(t 1 .
\'Am. (it work .
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THREE (31 Copies of a PLOT PLAN, Drawn to scale A
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showingg.the actual dimensions of the lot.to be built a lien):ii 3 - • -
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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 O(F QUEENSBURY':
5 _ z :Aug, . .27,,,..1.9.$4. iiii l5 Uu I 1'J I1 flJ I ' 1
ICU U 2 1 1Y84
A PERMIT. MUST BE OBTAINED BEFORE'6EGINNING WORK a n a.t
ANSWER ALL OF THE FOLLOWING. : 7181911011J.112)11213141516 :
The undersigned hereby 'applies for:a permit to do the following work H , . ' ' '
which will be done in accordance with the description, plans: and specifi- • .
cations, and.such special conditions as may be indicated on the permit.
The owner of this property is: f
Mr. and Mrs . Henry.-Nagamatsu 1046 Cornelius Ave'., Schenectady., ; N.Y. :
(NA`4F) '(Po AbdRESSI -
• The person responsible for supervision of the work instifaras the Building Code and the Zoning'Ordinance apply is: , ,
,John A.:,Mason P.O. Box 86 Cleverdale, N.Y. 12820
• (NAME) . (P 0 ADDRESS(
Naive of Builder. . .7ohirl. A, . Mas ort• ' Address . .P.-.0:. ,Bo.x. •86. . .C1evex ddle,NY. :.
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Name of Plumber • Address
II . „ II.
Name of Mason Address .
Lot Number • Unit . Estimated value of proposed work S .3 0.0 0...0 0 ..
Name of Village . .'...Caevezdale •
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Name of Street Rockhurst Road . Side of street: rigrth 0, east ❑, south ❑, west
Nearest Cross Street Clever d 4,,I,e Road.. a.d.. . ... . ... . . . . ..:. Distance from thus cross street . .,. .2 0 0 0 Ft.
• Property is north 0;South,. E,east r.i west ❑from Cross Street 4:
If on Corner, which corner, northeast ❑, northwest 0, southeast 0. southwest '
• (Designate by marking with an "X" in the correct space.)
. NATURE OF PROPOSED WORK .. OCCUPANCY .
❑ Cdnstruction of a new building. Main Building.❑ Addition to a building. One-family dwelling
0 Alteration to a building. Two-family dwelling ❑
0 Demolition of a building.' -family apartment house . ❑
• Store building .. ❑
-car attached garage ❑
Other:
. Accessory Building `
One-car detached garage
a Other work. Describe:.I n s t•411 .a. .2 4.1.‹.3:6 ' Two car'detached garage," 0
continuous: .f ouzl.dat.i.an. .out. .of. .10" .
Private chicken house 0
re, htrv, ea,(,(T 11 Private storage building ❑
concrete blocks 4':0" ie n depth. Other:
ZONING SPECIFICATIONS. Fill in for new building, or addition to existing building,or a change of occupancy.
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Indicate on the plot plan street names, thei location and
size of the property, the location, size and setbacks of pro-
posed.buildings,and the location of.all existing buildings.
NORrro Show proposed buildings) in dotted line and. existing
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• huilding(s)-in solid line. '
. Size of property , ft. x ft.
SEE ENCLOSED Size and use of,existing buildings, if any
II
n • W . Size of proposed building , ' ft.x ft.
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• Height,.(from grade to ridge) . ft.
Front yard' ft.
Side yards • • - B. and • ' ft.
Rear,yard it.
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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;
(OVERT
7—1 3 -M -
(cont'd.) ,.
BUILDING SPECIFICATIONS., q GU 1
n truction: Wood frame, fire safe, etc.) _
---
Kind of cos
Will any second-hand lumber be used?, -If"so for what)
Material of foundation walls . .Co.ne�et.e. 131s Thickness . 10; .
Depth of foundation'walls below grade 4 ' Cr' Continuous foundation? Yes
. Will there be a cellar? Yes If so, material of cellar floor . .`.4. , c.oncrete. :S dab
Type of roof: Sloped or flat? - Material of roof . . . . .:.':—
Size,wood studs — "x ' spacing — "o.c., length _ ft.
Size, floor beams, 1st floor "x ", spacing "o.c., span ft.
Size, floor beams, 2nd floor " x ", spacing.. . . . . . . . . . ..."o.c.; span ft.
Size, ceiling beams "x :. . , ", spacing "o.c., span ft.
Site, roof rafters or beams "x ", spacing "o.c., span ft.
Exterior finish With what material?
Finish of interior walls. . .". . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 Oil burner or coal?
Will a flue-lined chimney be provided? No Depth of chimney foundation below grade
Height of chimney above roof
. Will there be a fireplace? . . . . N4 Depth of fireplace hearth
Will a'toilet be installed) . No .
Will a kitchen sink be installed and connected to water supply? No
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 bei r of my knowledge and belief the statements contained in this application,together with the plane and specifications sub-
mitted, are a true and co.a.plete statement of all proposed work to,be done on the described premises and that all provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertaining to the proposed work shall be complied with,whether specified or not,
and that such work is authorized by the owner. �_
Sworn to before me this Signature �� S
OWNER.OWNER'S AGENT.ARCHIT CT,CONTRACTOR
Z� — day of �`� 19 C (----
NOTARY PUBLIC, WARREN COUNTY, N. Y. - I �
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SPECIAL CONDITIONS OF THE PERMIT:
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By
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14-12-2(6/81) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION?,
NOTIFICATION OF AVAILABILITY FOR REVIEW ECE V Q OCT 1984
INITIATING UNIT: g'titi leli ry A Cfairs Contact: lu) ke_ klh�t�
OTHER# DATE ISSUED c)/a/"41
OTHER# DATE DUE. /egg--
OTHER'#.' DEC# .5-0 -$'f-ne-t5 3
PURPOSE FOR NOTIFICATION/REVIEW AUTHORITY:- Ar-c-/e /_�
APPLICANT: c hn' Mason ( ,- N0z5421)14 ;ts�c) P.O Rox • ; fi/sf f08, 1?
PROJECT NAME/DESCRIPTION:. //2Stn..// capper- Wa/sc I,ne 1-0 4 der Cc `¢
in kale Ceram
PROJECT LOCATION:
City/Village GI 2 V�+�dGZIe Town: cU eer)S bLx.r�-
County: VNa,rr�+'l USGS Quad:
(Attach a location map)
REMARKS:
DISTRIBUTION: �d 2; I�% eC�%(��� t
no comments 0- - comments attached-0.
RESPONDING UNIT:.
BY:
(name/unit/date)
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NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPLICATION . FOR PERMIT
ALBANY,NEW YORK 12233 APPLICATION NO.
Read instructions on back before completing this application. Please type or print clearly in ink. Use separate
addenda and exhibits to provide all required data and explanations for which space on the form is inadequate.
❑ARTICLE 15, TITLE 3(CONTROL OF AQUATIC INSECTS, WEEDS, OR UNDESIRABLE FISH)
[�ARTICLE 15, TITLE 5(PROTECTION OF WATERS)
� 7,-L 'l �
❑ For the construction, reconstruction, or repair of a DAM or other impoundment structure. ; °I
❑ For the construction, reconstruction,or repair of any permanent DOCK,pier, or wharf;and any d c piZrr, or tocl
s
wharf, built on openwork supports, which has a top surface area of more than 200 square feet. StP. L U l")`' ' -
❑ For the disturbance of a STREAM BED or excavation in or fill of navigable waters:. r„ ��� IJN i
❑ARTICLE 15, TITLE 15 0 WATER SUPPLY 0 LONG ISLAND WELL REGUI—Al'
0 ARTICLE 24(FRESHWATER WETLANDS) Permitr'G 5.
0
0Letter of Permission : .� ��t;]Q� �r
0 ARTICLE 25(TIDAL WETLANDS) `RSSL� �+�• °'
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1. NAME OF APPLICANT: _ .
___________"_____JohnA. Mason v
2. APPLICANT IS A/AN ZI Individual 0 Partnership 0 Association 0 Corporation 0 Municipality ❑Governmental Agency
3. NAME&TITLE OF .
OFFICIAL SIGNING APPLICATION ,lohn A. Mason-, Agent ;`PHONE. 656-9956
STREET ADDRESS _
ORP. O. BOX P.O., Box 86 POST OFFICE Cleverdale • STATE N.Y. ZIP CODE 1.2820
4. NAME &ADDRESS OF OWNER •
(If not applicant) Mr. Henry T. Naqamatsu PHONE 377-2827
- STREET ADDRESS •
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OR P.O.BOX 1 046 Cornelius- Ave POST OFFICE Schenectady STATE . N.Y. ZIP CODE 12305
...- - 6. WILL PROJECT UTILIZE
5. PROJECT LOCATION: STATE OWNED LAND?
a).City or Village of Cleverdale NAME OF STREAM OR OTHER WATER BODY: .. - -
(If appropriate; if un-named, show on ;Yes 0 No
Town of XakXXGXXXI4X Queensbury map-See Item 5b)
County of Warren Lake George . .
b) Specific project site or area is marked on U.S.G.S.or equivalent map, attached as Exhibit.No.
7. PROPOSED USE: 51911 Private 8. PROPOSED STARTING DATE: 9. APPROXIMATE COMPLETION DATE . 10. FEE OF S ENCLOSED
0 Public ErCOmmercial
9/7/84 9/7/85 .
11.. PROJECT DESCRIPTION: (Feet of rip-rap new channel;cubic yards of material to be removed; draining,dredging,
filling, and location of disposal sites; type of structure to be installed;height of dam; size of impoundment;
capacities of proposed.water sources; extent of distribution system; etc.) -
To install a• 1" copper waterline to' a depth of 4 ° 0 .
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12. This project will require the following additional permits, applications for which are the responsibility of others:
❑DAM 0 DOCK ❑ STREAM DISTURBANCE 0 SPDES/NPDES ❑WATER SUPPLY 0 L. I.WELLS ❑ FRESHWATER WETLANDS 0 TIDAL WETLANDS
13. NAME AND ADDRESS OF OFFICIAL NEWSPAPER OF LOCALITY WHERE PROPOSED WORKS ARE LOCATED: .
The Post Star -
Lawrence & Cooper Sts .
Glens Falls , N.Y. 12801
14. IS ANY PORTION OF THE ACTIVITY FOR WHICH A PERMIT IS SOUGHT NOW BEGUN OR COMPLETE? ❑Yes No
If "YES", explain in addenda, giving reasons and dates, and show existing work on drawings or map. .
15. CERTIFICATION:
I hereby affirm under penalty of perjury that information provided on this form and all attachments submitted here-_
with is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A
misdemeanor pursuant to Section 210.45 of the Penal Law. As a condition to the issuance of a permit, the applicant
accepts full legal responsibility for all damage,direct or indirect, of whatever nature, and by whomever suffered,
arising out of the project described herein and agrees to indemnify and save harmless the State from suits, actions, • .
damages and costs of every name and description resulting from the said project. -
DATE - ;` i SIGNATURE
95-19-2(4/Rn' —SEE REVERSE clr)F—
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TOWN OF'QUEENS-BURY
Building Department
Inspectors Report Date / o /4//81
Name a- vk,-{ a q G.WI Sii(
Location k o c k h 1,1,v..ST R.6 a-4.
Permit No. Sf'7 3 "7i Weather
Remarks
Excatia t. on ,,��77
Footing Forms r- O/
Footing & Piers
Foundation
Cement Coat
Waterproofing /1/51 7,-,
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
r v( v.L
Building Inspector
REMARKS
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REGULATION UNIT
REGION 5
WARRSE3URG, N. Y. -