8691 BUILDING PERMIT
TOWN OF QUEENSBURY No. 8691 •
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Roland .Surprenant
•
OWNER of property located at Lot 80 West Mountain Road Street, Road or Ave.
Section 4 Land O'Pines Subdivision
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
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
0
1. OWNER'S Address is 64 2 Dixon Road
Glens Falls, New York
•
2. CONTRACTOR or BUILDER'S Name ri
Tim Chase Construction Co.
rD
3. CONTRACTOR or BUILDER'S Address
ct
Lake George Road
Glens Falls, New York
4. ARCHITECT'S Name cn 11
(DO
0 rF
rl-
N•co
6o
5. ARCHITECT'S Address
(D
rt
nn11
W
6. TYPE of Construction—(Please indicate by X) •
rl-
(x)Wood Frame ( ) Masonry ( )Steel ( 1 O
7. PLANS and Specifications
56 'x26 ' per plot plan, specifications and CD
No. application submitted including two—car attached o
garage and sewage system. ¢'
8. Proposed Use
N.
One—Family Dwelling
lam-
cn
$5. 00 C/O Paid O
$ 108 . 00 PERMIT FEE PAID —THIS PERMIT EXPIRES March 1 19 85 tD
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the �J
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 14th Day of August 19 84
C7
SIGNED BY ec ?. �� for the Town of Queensbury
(D
Building and Zoning Ins I--I
W
TOWN OF QUEENSBURY (Space inside block to Ix filled in by
WARREN COUNTY, NEW YORK • Building Inspector)
Applicationfor for Application No.
Permit Issued • 19.
BUILDING AND ZONING PERMIT permit r:xpires. lq.
%„nin. District
•
\ ,iluc. „t Work Pt"� -!'1'��'�%C�ifS�
THREE (3) Copies of a PLOT PLAN, Drawn to scale •\1'I""`` I l'Y
showing the actual dimensions of the lot to be built ' RemarKS'
upon, The exact size, and location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
J; / — y YL' \ V�• cb 1D g irr
TOWN OF QUEENSBURY
S®URY
DATE RECE: VE
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK AU6 11o4ANSWER ALL OF THE FOLLOWING. •. -
The undersigned hereby applies for a permit to do .the following work ^'�'�'�s/" oAvY P.M.
ands ecifi- g_ Il it �e• • I�3�4�516,which will be done in accordance with the description, plans p .e_ acations, and such special conditions as may be indicated on the permit.
The owner of this property is: .\W" ��S- 14.oLP�1� SU PSP.C%hw 64 bw".% NNE., GLNS. .mA.„.S.l. 14...,. .
(NA•.1E) (P.O.ADDRESS)
The person responsible for su rvision of the work insofar as the Building Code and the Zoning Ordinance ply is:
7114.% CM"6- IASd1LVc�‘®g4. G . 1tt.k`k.,.Eif-G6.9-otol' G'LCKv. MI.lbz,.N '`Q,
(NAME) (P.O.ADDRESS)
- Name of Builder .SiorSk. Address S(►
•Name of Plumber CA.rs.�,. , Address s-A P+�._
Name of Mason SA M1 Address -4 l'ne
Lot Number. . .5 o. . • . . Unit 'I Estimated value of proposed work 3 51 O O®
Name of Village . . .LAryb. .DI. . R 1 5 c-V 6la\‘.)t4 MO
Name of Street Side of street: north 0, east X, south 0. west ❑
Nearest Cross Street .5vv—( rio04.NV6Y3,U.t Distance from this cross street . . N.50.0 Ft.
Property is north a,south ❑,east i i, west. 0 from Cross Street
If on Corner, which corner, northeast 0, northwest ❑, southeast Q, 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 ❑
❑ Alteration to a building. Two-family dwelling
❑ Demolition of a building. -family apartment house ❑
Store building ❑
• 2. .-car attached garage °®.
Other:
Accessory Building
• One-car detached garage
Other work. Describe Two-car •detached garage ❑
Private chicken house ❑
Private storage building ' (il
• 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
luilding(s) in solid line. . AA
Size of property 1 2-5 ft. x 1%` - ft.
CSC ��t44,6D
Size and use of existing buildings, if any
11- 1—
W s\` A Q1..�� 4 W 2� ft.
Ilt Size of proposed building . . .5..Ca • . . ft.x
Height (from grade to ridge) 22. ft.
Front yard A'5 ft.
Side yards 3 a ft. and 4® ft.
Rear yard ®Z, ( ) 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.,
hop
Kind of construction: Wood frame, fire safe, etc.?. . . . . .w. . . . . . . . . .r RASE
Will any second-hand lumber be used? N 4 If so, for what2
Material of foundation walls COW— 41C- d3 LOC:VS. .®'lZ. .��? �D. .(v4 �'Thickness Iv" Jr• 0 00401)
Depth of foundation walls below grade `.I—OZ)t% Continuous foundation? . .�.
Will there be a cellar? . •' E4 If so, material of cellar floor CSAK—.9.4c6..
Type of roof: Slo d or flat? S1-� D Material of roof f l 6 6 A-W ASS. .5.y1. !�Les
Size, wood studs .(4t 4,04'"$1 r • " x ", spacing ) b "o.c., length • ft.
Size, floor beams, 1st floor ' . "x 10 ", spacing 112 "o.c., span 12,ley ft.
Size, floor beams, 2nd floor . " x l® ", spacing 14.1Q."o.c., span . . . .)a.(�el . . . . ft.
Size, ceiling beams " x ", spacing "o.c., span ft.
Size, roof rafters or beams "x ", spacing ) 6 "o.c., span . . . .)ALOE ft.
Exterior finish "r(t �� L 1�" t•Sleet• •�•�� With what material? F' ' ��• L_�Vab
Finish of interior walls. . . .Vo.:.‘.'�'$.• 9P\14,g t` \gs)Cx.
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? . . . .7. . . .Io . .l.M a At . AT). .DAM
Kind of heating system . .4.1.-�s,`` .6.454 saAsz Oil burner or coal?
Will a flue-lined chimney be provideti? id R . Depth of chimney foundation below grade
Height of chimney above roof. /. . ri'
Will there be a fireplace? 4 4.5 Depth of fireplace hearth I bts th 3 •
Will a toilet be installed?
Will a kitchen sink be installed and connected to water ssuply? 6--
Water supply (public water supply or pump) IICC
Distance of cesspool from any private well �s 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, ba.jof my know,ledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, area true and co.,.p•lete 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, they specified or ..t,
and that such work is authorized by the owner. ` a f G• �� �� •
Sworn to before me this Signature 6
`V �� �...•` l e
OWNER.OWNER'S AGENT,ARCHITECT.CONTRALTO
day of • 19
NOTARY PUBLIC. WARREN COUNTY, N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
•
•
•
By
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 `4-1O SQ .
2 . Type of heat C.Lee- BpSE6al0.D
3 . Is the building mechanically cooled? C)
4 . Percentage of area of windows and doors ) 1 • 1b¢ W
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 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 roof and floors exposed to ambient conditions
Roof— {z- 3 O .
2 . R value of exterior walls 9,— 20
3 . R value of glazed area 1+" a • 65
4 . R value of doors R.— , � •2.
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) Q."
10 . Type of insulation Fi6�R pSS Ills f ge) c. -c W pas - VAG1D F+AM)
'.SR. wPA-LS.
C. Controls 5q G .
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 P69- MAh10f• SOCC'.S'
2 . Temperature control setting maximum Iibo o F.
G. For Swimming Pool Only
1 . Maximum heating
Telephone No.
(applicant ' s signature)
' g•.
N
TOWN OF .QUEENSBURY
BUILDING & ZONING DEPARTMENT
SEWAGF DISPOSAL PERMIT APPLICATION
1. Owner' s Name (Z. i RS. go)..1,3„z Sv94pRANAt1l
Address b�J2 D‘XtN OPD.j GL5lJS ELLS, N . .
Telephone No. -1 9.3®1 .5°J°-1
E I
2. Property location ' S L� ^�", L�, .D..O P
Lt7 40 1W415 SU(3bkv
3 .. Name of person or firm responsible for installing system
,,
1 1 M � 1/4�SE Co% S1 4 Telephone No. / 93'"4.46"
Address LAk6 GEOcL“ OAQi GLEt�1S FALLS ) N •� .
4. Number of bedrooms (residential buildings only) 3
5. Daily flow v`c0 gallons/day
6. Septic tank capacity gallons
7. Topography: rolling, steep
IRCIO
% of slope
8. Nature of soil and depth SA $bl LOpM=V t,tLt4o0t4 b6P`V\
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: municipa] well, other
12. Type of system proposed: drywei 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 Sanitary Sewage Ordinance. ��"'
Date 161C ' ,
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 domes is water supply, etc. Include all dimensions of
the system- itself. SEA
OX4D g R4 Li:1)
Form 3-82 .
BUILDING DEPT.COPY OF APPLICATION FORM 46-EL.NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH'BUILDING DEPT.WHEN REQUIRED. _
CITY OR
VILLAGE \) C. ,.( t.aUV�� TOWNSHIP •
- COUNTY (\\�
STREET AND NO.OR I
ROAD AND POLE NO. \}� t: S�i�L7\�1�` �,,\a Ti C){!� POLE NO.
BETWEEN WHAT CROSS STREETS SWO g� ` .
PREMISES LOCATED' �)-f >l`.�� �V •} rS E CMG �iy T��l ,t).• SECTION ` BLOCK/ LOT
OCCUPANT'S \''i, I I 1 ,,• 2,c*,. N0 �U t {? 1'r INS, 1°� .OCCUPANCY ., n•.G�7 ! \may C C•
NAME �I '_ t ha '
OWNER'S NAME . y�
AND ADDRESS is '� �� \ �C-\ %1 S)VXG VZ, ')QI\.\J 1\.5A..�c.V,S " I��..�)f ‘ - _1
CURRENT
SUPPLIED \.\ ! I'l\0 FROM THEIR C'• • V
BY OFFICE •IS
W
DEFECTS
V.BUILDING NEW OLD El REMODELED ❑ IS
NEW NR ADDITIONAL El REMOV D ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS No.of Fixtures e 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.
i
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 OF SIGN
BUILDING ' '
INSPECTION REQUESTED
ON OR AS NEAR AS
POSSIBLE NEW OLD 1-1
• AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
NAME OF I`1c\\N\.,' \.1,A)1\1L\ (\` 1::, - -C3 DATE OF �1 C` ) j \ ‘-1�1
APPLICANT APPLICATION
STREET ADDRESS
y' -
POST OFFICE � -(= 1 �..-�5 \�'a-. CODE I ''' 1 WHEN APPLICABLE -
A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
TOWN 00 QUEENSBURY
Building Department
Inspectors Report Date "-too/3 7
5(
Name //Lf/i e.iJnN i 7i2-0Ui.A.)0
Location L.e 1 -O L til -( :n-i.T s
Permit No. '2,6 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
Finished Floor
Interior Trim is
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing {„ ,_._
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Floors
•Insulation Foundation
Walls
Ceiling
g.�
€.3-0'eK;
Building Inspector
REMARKS
•
TOWN OF QUEENS URY
Building Department
Inspectors Repeat Date /Z/1
Name 77 n-) (7/gy p_ l ScJP,n2� 9- C—
L,ocation LDS7`' _ (�ei1 ,4i
Permit No. Weather
Remarks
ExcalYa tion / �� �i i- -
Cy /
Footing Forms / C J
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
•
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board -- C9-4
Ext. Porches c -
Finished Floor -
Interior Trim - L
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing -]
Door Closers cal;. ,
Chimne
Water Meter Inst. ____T__
Se tic A roval •
Floors
Insulation Foundation
Walls
Ceiling
Building Inspector
REMARKS
���v \ /1-e7CC 7 Q2 - 6J�
Y 7-j
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date I/o /'V
Name i
Location L'�dF 7 j
Permit No. ?. (q ct/ 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 a
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst. (r9 /
Septic Approval �iii/4L
Floors '
Insulation Foundation
Walls
Ceiling
Build' nspector
REMARKS
lC 04-yi4✓/
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date /D/4 6 h
Name //%i c U
Location r ,"7 A?.
Permit No. 5 j Weather
Remarks
Excavation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt j
Roofing
Siding 1
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
��/U� / (A/ 7 )
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date
Name /C o 14itro f � ' ,✓
Location Lam "go
Permit No. '3Q y Weather
Remarks
Excatra t on
Footing Forms
Footing & Piers /1G
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
r
LOT 81
_ 3ot
�'LEc. slRVt<E
I:�TR• t. riLTIC0. �
4��
cvut+.et�c . sn.
SLRViCC '
1FltS1 f #4oM
UTtL . CO. POLL
i
4%tAKPC, EE
125, iGat
Lc7 8o
N OUSE aat Ste' s.
-
57vw
4w - 2a i
c.R.• RflcNl
t
i
DrSTR. f�oX,
SffPTisTw4K
LA
00
3-9m wxt-l. X5 r;• tmvp
ofZ
3
cults bm(/MTT *fk 10
125. oo�
\V#4TER MAIN
W M S7- M0,0 11-4T k 11J R 4 DATED
BUILDING & �ZNING INSPECTOR
_pWp► OF QUEENSSURY
1T pI, N SurPreto awr
vEsca,,PTioN : \ Is Ld 0' Fines . 5e4,rfalr. Ld
LoT 80 rjF 5 tc`3N No.'s
of LptJt) of PlwV-%i Sll'eo vislow t
TOWN OF 4QUSINS!!L 54 1,1; WkRREr t
colise", WNW
LOT l.R)✓ A. -23,� io3.Z Sq•F')
Vr
M fR S. L. to 1,i D R IZ P r, tN N T i
OW WEST oUNTAIN P,0.AD, tN 1,kl,0 c' P i N r
4u��N5 F3URY� N_'`l'. �3on
BY -t5 P Ic vt51cr)N S
A ptyiSloN dF T.t�l,`t�t�.t.L'�`R. ja55aeiJlTL�S, ��c•
UPffR 8Y Ro1.c5 P a BoX 99b , Gigs u:5 F,i+-LS,, N Y,12tdi.'7'7�,..ct�9i�