1987-454 BUILDING PERMIT H
TOWN OF QUEENSBURY 87-454
No.
WARREN COUNTY, NEW YORK •
0
PERMISSION is hereby granted to Wilma Cleveland/Sandra Lorensen
00
I
OWNER of property located at Corner Bay & Moon Hill Rd. Street,Road or Ave. w
in the Town of Queensbury,To Construct or place a
Addition-Deck
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
P.O. Box 833
Glens Falls, N. Y. 12801
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2. CONTRACTOR or BUILDER'S Name
Harry Otten
Glen Rd.
Ft. Edward, N_ Y_ C
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECTS Name p.
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5. ARCHITECT'S Address CD
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6. TYPE of Construction—(Please indicate by X)
(X)Wood Frame ( ► Masonry ( )Steel 1 1
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7. PLANS and Specifications 0
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No. 12' x 13' addition to 2 family dwelling as per plot plan and to
application.
8. Proposed Use rr
Addition Two—Family dwelling °o
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10.00
$ PERMIT FEE PAID —THIS PERMIT EXPIRES February 1, 1g 88
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the a.
town of Queensbury before the expiration date.) p,
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Dated at the Town of Queensbury this 16th Day of July 19 87 o
y � ��,
SIGNED BY -- /lC.... for the Town of Queensbury o
Building and Zoning Inspector
TO BE COMPLETED BY BLDG. DEPT.
Application No.
own of Queenitur1 Permit Issued 19 a --
BUILDING and ZONING DEPARTMENT Permit Expires 19 ! Q
Bay and Haviland Road, R.D. 1 Box 98 zoning Designation 1111
Queensbury, New York 12801 Variance No.
Site Plan Review No.
. QDE DEPT
$ JUL 141987
i, U v Approved by: 1 BUILDING tic
`"t �' APPLICATION FOR G�%�
FUILDING AND ZONING PERMIT #,
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. ANSWER ALL OF THE FOLLOWING.
The undersigned hereby applies for a Building Permit to do the following work which will
be done in accordance with the description, plans and specifications submitted, and such
special conditions as may be indicated on the Permit.
The owner of this property is: Sa.na/ a. fl. LOA,enserj / )i/n-ia X Cl16velan4
P.O. Address re), ,icyx 8"33 , 6/",,s //s / /11 Y /a t I Tel. fiq?'1/7y
Property Location: C.pan ct.„/ 4_ 19766rl I./t n /',/S Tax Map No. / /
Street number or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
73-LaidgP- --<2.124--....--ea,_..er
Name P.O. Address Tel. No.
Name of builder rr y QWf�or AddressG/Fn fa44 e
, L AY Tel 7 y9 9 ) c$'
Name of plumber /k ¢ Address / Tel.
Name of mason ^(tryty._. Address Tel.
NATURE OF PROPOSED WORK: * ZONING INFORMATION:
Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
_
_Addition to a building * drawn reasonably to scale and attached hereto,
Alteration to a building * showing clearly and distinctly all buildings,
(no change to exterior dimensions) * whether existing or proposed and indicate all
1/Other work (describe) DE)GK * set-back dimensions from property lines. Give
ei(/S -i j j3u , id, n� * street and number or lot number and indicate
*
FOR DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot. Show location
LOCATION OF STRUCTURES AFFECTED. of water supply and location and configuration
* of septic disposal area.
*
* COMPLETE INFORMATION REQUIRED BELOW.
a30
* Size of property )Q 8' ,Y a (oO ft X i-iev' ft.
* Existing building(s) Size ft X ft.
*
PROPOSED BUILDING AND USE:
* Existing building(s) Use ,?& „/„, ,...,6/, /6iy7
Size of new structure /A ft X /3 ft * /
Foundatio , - 'slab/crawl/partial/full * Proposed building, distance from property line
(circle one) * / J
No. of stories (habitable space) * Front yard s ft Rear yard ft
Height (grade to ridge) ft. * Side yards c 6 ft and , 1 ft
If residential, no. of families * If on corner, setback from side street ft
No. of boomrooms(excluding baths) * OCCUPANCY INFORMATION
No. of oms bedro * PRIMARY BUILDING -
No. of bathrooms
Primary heating system * One family dwelling
Type of fuel .-- —� v/ Two family dwelling
No. of fireplaces to be installed * Multiple dwelling / Number of units
Will a wood stove be installed? * Permanent occupancy
Central Air conditioning? - * Transient occupancy
* Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Ranch Contemporary Log cabin * Other
Raised ranch Mansion Duplex If addition, what will use be?
Split level Old styr!) Bungalow *
Cape Cod Cottage Other * ACCESSORY BUILDING-
Colonial Row Town House * Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * Attached garage/one car/ two car/ car
* * * * * * * * * * * * * * * * * * Private storage building
ESTIMATED MARKET VALUE OF * Other
,rNSTRUCTION *
$ ,a6
ilkATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED' -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc. 0-0 00-
Will any second-hand or ungraded lumber be used? If so, for what? /t/ 12
Foundation wall material Ze7te7Thickness
Depth of foundation below grade (to bottom of footing) (i!
Will there be a cellar? AM Heated or unheated? Floor sq. footage sq ft
Will there be a basement? rob Will any portion be used as living space?
(If so, what portion? sq.ft. - - Type of use?
Type of roof - sloped/flat/shed/other Material of roof
Size, wood studs "X " spacing "o.c. length ft.
Joists(floor beams) 1st. floor 2. "X I " spacing /(, "o.c. span l/2- ft.
Joists (floor beams) 2nd. floor "X " spacing "o.c. span ft.
•verlays(ceiling beams) "X " spacing "o.c. span ft.
Roof rafters "X " spacing o.c. span ft.
Roof trusses(pre-engineered) spacing "o.c. span ft.
Exterior wall finish Of what material?
Interior wall finish
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
Is there to be an opening between garage and dwelling? If so will a Fire-rated
door, enclosure, and self-closing device be provided?
Will a flue-lined chimney be installed? Height above. roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well
.EPTIC SYSTEM Distance from ANY private well(including adjoining properties ft.
(A `separate application is necessary for any repair or new installation of septic system)
Town of Queensbury AFFIDAVIT STATE OF NEW YORK
County of Warren
I swear that to the best of my knowledge and belief the statements contained
in this application, 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 not, and that such work is
authorized by the owner.
SWORN TO BEFORE ME THIS Signature ,5?;'
Owner, owner's agent,arcnitect,contractor
day of 19
Notary Public, Warren County, N.Y.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT:
By
V!44
� awn of Queeni1ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR'S REPORT
NAME /
4 47 6'/4
LOCATION �� d Ou,., / //
•
Date 7/Z / ; Permit No.
* * * *' * * * * * * * * * * * * * * * * * * *
✓APPROVED - / NO
noting/Pier Forms r /�K
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECT'ICAL INSPECTION
DRIVEWAY AP.'ROVAL
Final Building Survey
Next scheduled inspection (call ready)
Remarks- , _/
/6611(4
Bui ding Inspector
6/86 and-vl
I -awno� Queeniburc�
gJc BUILDING and ZONING DEPARTMENT
111 Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
70BUILDING INSPECTOR' S REPORT
NAME Gi/4 7ildffec,zeoet,
LOCATION WV'
/-'7 / / �` /1,�/ ,,a/J
.((may��
Date � /SI Permit No. 1/�/ /i'
"
* * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED „' YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproof g
Door Closers
Smoke Detecto s
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
/anal Building Survey
l �
Next scheduled inspection (call when ready)
Remarks-
((/'
-
Building pec or
6/86 and-vl
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