91-822 Jr t
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date ,VA/or /1 19 2.-
This is to certify that work requested to be done as shown by Permit No. 91-822
has been completed.
Thu structure may be occupied as a Music Room. Utility Room and Additional Living Sp ice
Location Fitzgerald Road
Owner Dr. Al kristensen
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. be Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No. 91-822
WARREN COUNTY, NEW YORK
0
PERMISSION is hereby granted to Dr. Kristensen
OWNER of property located at Fitzgerald Road Street, Road or Ave. ro
cn
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
RD5 Yorkshire Drive
Queensbury, NY 12804 N
e*
2. CONTRACTOR or BUILDER'S Name
Sherwood Acres
3. CONTRACTOR or BUILDER'S Address
231
-11
e+
4. ARCHITECT'S Name
tta
fD
a
5. ARCHITECT'S Address
6. TYPE of Construction-(Please indicate by X) a
(X)Wood Frame ( )Masonry ( )Steel ( )
O
7
7. PLANS and Specifications
eh
No. 784 sq ft Addition to dwelling as per plot plan specifications 0
and application g
8. Proposed Use -r
Music Room, Utility Room and Additional Living Room Space
$ 89.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 21, 19 92
(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 21st Day of November 19 91
SIGNED BY for the Town of Queensbury
Building and Zon ng Inspe or
TOWN OP QUEENSBURY
�� REVIEWED BY: iug
.. !�1
h L.,,i. 4 'F' Q ,fEE lSEIL
l � FEE PAID: t 4-3-ft-
PERMIT NO. : v!1 - g P,.JV ,,.; 1991
'"'.DC. & CODE DEPT.
BUILDING PERMIT APPLICATION
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO INSPECTIONS WILL BE MADE UNTIL
APPLICANT HAS RECEIVED A VALID BUILDING PERMIT.
All applicants spaces on this application MUST be completed and the signature of the
applicant MUST appear on the reverse side of this application.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Owner of Property:
P.O. Address: D S Vp e W S'jf 1 g J 0 -)) PHONE / % 5--,C.)
Property Location: I I Z C¢ e,4L i Tax Map No. +// / / 5 ‘
Has there been any split of this property since October 1, 1988? Yes No
If yes, Planning Board Review is necessary.
Subdivision Name, if applicable: Lot No.
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
N1 Lr ti-)o c'cc , "C,.Lk,o - ci vl {/ 4-/ .(___
NATURE OF PROPOSED WORK: * ESTIMATED MARKET VALUE OF THE
Construction of new building * CONSTRUCTION: $ Isi>� n a-a
'X Addition to building * /
Alteration to building * COMPLETE INFORMATION REQUIRED BELOW:
(no change to exterior dimensions) * Size of Property: ft. x ft.
Other work (describe) * Exis ing Buil ing Size:
* ft. x ft. �6;,'x s,
* Proposed building - distance from
GROSS AREA OF PROPOSED STRUCTURE: * property line:
/� *
1st Floor 5T Sq. Ft. * Front Yard O ft. Rear yard / ?Oft.
* Side Yards 3 y ft. and SY/5 ft.
2nd Floor Sq. Ft. * If on corner, setback from side street-
* ft.
Other Floors �--- Sq. Ft. *
(not cellar or basement) * OCCUPANCY INFORMATION:
TOTAL FLOOR AREA:
D Sq. Ft. * Primary Building -
ss�� * x One Family Dwelling
Size of New Structure: ; nft. x oG ft. * Two Family Dwelling
Foundation: * Multiple Dwelling/No. of Units
Pier/Slab/Crawl/Partial a (Circle One) * Business
No. of stories (Habitable space) / * Industrial* Other
Height (grade to ridge) � ft.
If residential , no. of families: /' * If addition, what will use be?
No. of rooms (excluding baths): .A
No. of bedrooms: _ * — . . .
No. of bathrooms: * Accessory Building:
Primary heating system: }�- U ,*� Detached Garage - One/Two Car
Type of fuel: /- * Attached Garage - One/Two Car
No. of fireplaces to be ins ailed: f* Private Storage Building
Will a woodstove be installed?: e, * Other
Central Air Conditioning: Yes o
(OVER)
BUILDING PERMIT APPLICATION CONTINUED:
BUILDING SPECIFICATIONS:
Type of construction: woo d frame, fire safe, etc.
Will any second-hand or ungraded lumber be used? If so, for what?
/ J v
Foundation Wall Material : i7O_AZas J Thickness:
Depth of Foundation below grade (to bottom of footing) : 7 /
Will there be a cellar? X941_ Heated or Unheated? Floor Sq. Footage:
Will there be a basement? Will any portion be used as living space? NI a
If so, what portion? Sq. Ft. Type of Use?
Type of Roof: Slope Flat/Shed/Other Material of Roof
Size, wood studs " x �� "; spacing fly, " o.c. ; length R- ft.
Joists (floor beams) : 1st Floor L " x /Q spacing j/Q " o.c. ; span / C; ft.
Joists (floor beams): 2nd Floor /U ' x "; spacing " o.c. ; span ft.
Overlays (ceiling beams) : 44-" x "; spacing " o.c. ; span ft.
Roof rafters: " x " ; spacing JCS o.c. ; span IP ft.
Roof trusses (pre-engineered): cin• " o.c. ; span ft.
Exterior Wall Finish: 13, o a hat material ?
Interior Wall Finish: '
i Q �►
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? Wbf so, will a Fire-Rated door,
enclosure, self-closing device be provided?''II ��.
Will a flue-lined chimney be installed? .GViceight above roof ft.
Depth of chimney foundation below grade: ft.
Depth of fireplace hearth: ft.
Water supply - Municipal or private well : (.
SEPTIC SYSTEM: Distance from my. private well (including adjoining properties: -'' ft.
(A separate application is necessary for any repair or new installation of septic system. )
NAME OF BUILDER & ADDRESS: .S Clc C?. PHONE '>q c.? -�
NAME OF PLUMBER & ADDRESS: S' z PHONE
NAME OF MASON & ADDRESS: PHONE
NAME OF ELECTRICIAN & ADDRESS: PHONE
DECLARATION
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 per ining to the proposed work shall
be complied with, whether specified or not, and that such w author d b th wn .
Signature
• Owner, owner's agent, architect
contractor
SPECIAL CONDITIONS OF THE PERMIT:
By:
Code Enforcement Officer
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE DAYS
Compliance Methods: Fr l°, OF QUEENSEa,.
PART 5 - Acceptable Practice Method 1 & 2 Family Dwellings (ONLY)
PART 6 - Thermal Rating - Component Trade Offs - 1 & 2 Family Dwellings; FiV 1991
Multi-Family Dwellings
(3 Stories or Less) T'_DG. & CODE DEPT.
PART 4 - Design By Component Performance - Commercial Buildings - Hi-Rise Residential
PART 4 & 6 - Compliance Methods Require Submission of Worksheets
APPLICANT S NA PROPERTY LOCO If
PART 5 METHOD OF COMPLIANCE°BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - Sq. Ft.
2. Type of Heat - Elec. Base Board Other TT• - _1. �•.�
3. Is Building Mechanically Cooled? YES X NO
4. Percentage of Area of Windows and Doors Over 17% Under 17%
THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND TO REQUIRED
THE R-VALUES SHOWN ON PLANS SUBMITS!
Baseboard
5. Insulation Values: Actual Shown Elec. Heat Other
A. Roof & Floors exposed to ambient temperatures R
B. Exterior Walls R
C. Glazed Area
D. Exterior Doors R ye,
E. Floors over unheated spaces R�
F. Edge of Slab on Grade (Heated Building)
G. Basement/Cellar Walls (Above Grade) R
H. Basement/Cellar Walls (Below Grade) R
I. Heating/Cooling - Ducts - Piping in Unheated Space R
6. Service (Domestic) Hot Water Heating Device
A. Conforms to minimum efficiency per code )( YES NO
TEMPERAIURE CONTROL MAXIMUM SETTING 140* - WILL NOT BE EXCEEDED
APPLI NT'S SIG RE TELEPHON / MBER
INSPECTOR'S REMARKS:
REY I T
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED f//,
NAME 1r;Tl'',
LOCATION (3 '
DATE ////07.2_ PERMIT# y!j7212-
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
AUTO. EXTINGUISHING SYSTEM
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM
ALARM SYSTEM
r
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKLERS '
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
i
CHIMNEY
WOODSTOVE
FIREPLACE-MASONRY
FIREPLACE-FACTORY BUILT
REMARKS: U OK TO THIS DATE
0_
lam' -Y7 - 4l/i
ARRIVE
DEPART
PELT
ELEc-RIGAL!DISPEL;I IONS
DUPLICATE MUNICIPAL RECORD
/— , zZ
Permit No. ' /
Owner rp ks. /f . ! !E; /�: S e Ott
Occupant
Location c / 7-2- t��'+E,-t/1/1Lt_J) y�7✓).
(,-,',lL E etc/J 3 t/f�?y Street
Town or City State
Installation as itemized on reverse side has been visually inspected pursuant to applicable
codes.
Installed by ..__T) iE tf/2 7 77�-
f �f/r � r
e
Date �� /l�� ` 1! IL.k a v,{��..'Zit" (elf- ,111Lspector
MIDDLE DEPARTMENT INSPECTION AGENCY INC.
FORM NO.18 EL. 900 Haddon Ave.,Collingswood,NJ 08108
,, gay
TOWN OF QUEENSBURY
531 BAY ROAD
31 QUEENSBURY, NEW YORK 12804
�' TELEPHONE ' (518) 745-4447
ve
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED 9/219,
NAME 4 / ' 'i !/4.6,, 42.-
LOCATION-� //t%'_ /
DATE / 2- PERMIT# 9//-6UiL
TYPE OF STRUCTURE ei 6
61„,,-4 ,
RECHECK v1-` 4zem yG
FIRE MARSHAL APPROVAL (COMMERICIAL STRUCTURE)
L-FOOTING vFOUNDATION .BACKFILL !-FRAMING
L.ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC
l-NSULATION WOODSTOVE/FIREPLACE
REMARKS �fee_.e_ G -`��p '
i
716 APPROVAL
N/A YES' NO
CHIMNEY HEIGHT/LOCATION ✓
B VENT/LOCATION ✓
PLUMBING VENT f' V
ROOFING L/
SIDING f tom'
DECK/PORCH/STEPS/RAIL NGS,
RELIEF VALVES
FURNACE/HOT WATER OPERATING, %./
INTERIOR TRIM/PRIM Y DOORS ,
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE ✓
OTHER FLOORS CARPETED \. ✓-
STAIR CLEARANCE/RAILINGS '
SMOKE DETECTORS "\..0/'
DOOR CLOSERS I
BATHROOM FANS
ALL PLUMBING F XTURES OPERATING 47
GARAGE FIRE P DOPING ✓
DOOR CLOSERS . ✓_
OTHER FIRE S ARATION t/
FIRE/DEMISE ALLS c/
FINAL ELECTR CAL
OK TO ISSUE 0 OR C/C
COMMENTS:
::
ll�'C re7.dia.
ARRIVE
DEPART
S ECTOR
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4424
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED
NAME Kr1S �S-�ti br . ri9.2
LOCATION ci-t-Z iv e-jCJ /1,
DATE Li )/?/ 9d PERMIT# APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING `,
t°
FIRE EXTINGUISHERS /
/
AUTO. EXTINGUISHING SY TEM f
/
HOOD INSTALLATION /
AUTO. SPRINKLER SYSTEM
ALARM SYSTEM 1
t1
INTERIOR FINISHES / {
STORAGE: /
CLEARANCE TO SPRI KLERS
CLEARANCE T HEAT NG UNITS
REQUIRED SIGN GE
CHIMNEY
WOODSTOVr
FIREPLA► -MASONRY
FIREPL'CE-FACTORY UILT �
,. / �.
RE 'KS:' i OK TO THIS DATE
2/015 1 " INS' - TOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT �f
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
EQUEST FOR INSPECTION RECEIVED , 40", '
�'
LAME 7- /2(:. i c f/ (f-(: )( --7I)
OCAT I ON ,/�,__T_r.`„L�' ,�
c� 'PERMIT #
YPE OF STRUCTURE /47J ey , I/% 7
'.ECHECK APPROVED
N/A YES NO
OOTINGS/PIERS
ONOLITHIC POUR FORM
EINFORCEMENT IN PLACE
'HE CONTRACTOR IS RESPONSIBLE
OR PROVIDING PROTECTION FROM
BREEZING FOR 48 HOURS FOLLOWING
HE PLACEMENT OF THE CONCRETE.
IATERIALS FOR THIS PURPOSE ON SITE
OUNDATION/WALL POUR
EINFORCEMENT IN PLACE
OUNDATION/DAMPROOFING
ACKFILL APPROVAL
OUGH PLUMBING
LUMBING VENT/VENTS IN PLACj
LUMBING UNDER SLAB
RAMING:
JACK STUDS/HEADERS 1
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
IRESTOPPING
WALLS
CEILING ;
IREWALLS
'EATING ROUGH-IN r \
NSULATION:
FOUNDATION WALLS INTERjOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS
CEILING R- d
DUCT WORK OR PIPING IN UNHEATED
SPACES
EMARKS:
u-4)
IRRIVE /1
DEPART /1 _ `„
INSPECTOR
TOWN OF QUEENSBURY fat=
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED _
NAME , (2y44)1,
LOCATION
DATE ,314V9Z PERMIT # 7/</ L'--
TYPE OF STRUCTURE 6d � //,/, �
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_
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 PIPING IN UNHEATED
SPACES
REMARKS:
Iv
ARRIVE ,J
DEPART
INSPECT
TOWN OF QUEENSBURY , Sc) S. `t
BUILDING AND CODES DEPARTMENT
531 BAY ROAD tr..,
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
j�of
NAME I JL ( KALdJ - .6„,
LOCATION Jf tp4 u JA !1
DATE I//?0/?/ PERMIT it 9/—SW„?
TYPE OF STRUCTURE 76 c 1)4a/
RECHECK APPROVED
IN/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 s
PLUMBING VENT/VENTS IN PLACE
(PLUMBING UNDER SLAB ✓
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM \
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUGH-IN ;'
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT r -7�
REQUEST FOR INSPECTION RECEIVED [�/�y>/�//
NAME
LOCATIONS 4; � C
DATE'4Q5) ) PERMIT # `!) o2,
TYPE OF STRUCTURE C`L
)\ h 1 i cr 4v :t-Act (A
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`' tN PLACE
PLUMBING UNDER SLAB`
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUGH-INII
INSULATION:
FOUNDATION WALLS INTERIOR R
FOUNDATION WALLS EXTERIOR R- \
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD qp,),/
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED j '//Q/
NAME �(.- �.,�^
LOCATION IJJ AL .I A'
DATE f l/a`kG j PERMIT # � -
TYPE OF STRUCTURE ( y c G1t�i'�Z✓//J�
RECHECK APPROVED
N/A YES NO
1. 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 .,e
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN /LACE
PLUMBING UNDER SLAB
FRAMING: 11/
JACK STUDS/HEADERS
BRACING/BRIDGING
i.
JOIST HANGERS
JACK POSTS/MAIN BE
FIRESTOPPING
WALLS
CEILING
FIREWALLS a.
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WA LLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
a - ,/
ARRIVE
DEPART
SPECTOR
m I low
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