87-122 BUILDING PERMIT
TOWN OF QUEENSBURY No. 87-122
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Donald W. Miller
OWNER of property located at Jay Road, Glen Lake Street, Road or Ave.
in the Town of Queensbury,To Construct orplace a Addition to dwelling (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.
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1. OWNER'S Address is RR #1 Box 1692
Lake George, New York
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2. CONTRACTOR or BUILDER'S Name
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name O
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5. ARCHITECT'S Address 0
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( 1 Masonry ( )Steel (
7. PLANS and Specifications
No. 22'x12' per plot, specifications and application submitted.
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8. Proposed Use rt
One—Family Dwelling (deck added) 1-4
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES Nov. 1 19 87 N
(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.) (IQ
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Dated at the Town of Queensbury this 6th Day of April 19 87
SIGNED BY 14YI l.{, ,e7 for the Town of Queensbury
Building and Zoning Inspectorf e
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• .. TO BE COMPLETED BY BLDG. DEPT.
// Application No.
own o f Queeniurq Permit Issued 19 TOWN OF QUEENSBURY
BUILDING and ZONING DEPARTMENT Permit Expires 19 r.
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Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation r (I, tVi i_r,
Queensbury, New York 12801 Variance No. p
Site Plan Review No. ' (-
n fir R 6 1987
I/ 3 - / , Approved by: p BUILDING & CODE DEPT.
APPLICATION FOR C'1777I f % /1/12
BUILDING AND ZONING PERMIT f9r• a
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.
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The owner of this property is: j01�9 e, J �,4). 2 / /,: , .5 ) /� /
P.O. Address le, ` e i / 9� &AK'/2, l /,�� L Tel.j`� •� f <
Property Location: J Tax Map No. / /
tre t number or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
9 14{ULGL As i 1 U t , v
Name P.O. Address Tel. No.
Name of builder S,1,f)eJ ?, Address S,,r?/L t, Tel.
Name of plumber Address Tel.
Name of mason 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
Other work (describe) D i{ * set-back dimensions from property lines. Give
* 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.
* Size of property / I) ft X Q ft.
* Existing building(s) Size / 7ft X 7, ft.
*
PROPOSED BUILDING AND USE: lL/ �
* Existing building(s) Use e Wit'/, ,
Size of new structure ft X,�1,4 ft *
Foundation-pier/slab/crawl/partial/full * Proposed building, distance from property line
*
(circle one) * Front yard 3 ft Rear yard ft
No. of stories (habitable space) * Side yards ft and ft
Height (grade to ridge) ft. * If on corner, setback from side street ft
If residential, no. of families
No. of rooms(excluding baths) * OCCUPANCY INFORMATION
No. of bedrooms *
No. of bathrooms * PRIMARY BUILDING -
Primary heating system * �` One family dwelling
Type of fuel * 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 style 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
CONSTRUCTION $ --/: D0 )• *
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc. l 1 1) #kid eXtriPD
Will any second-hand or ungraded lumber be used? If so, for what? G
Foundation wall material * Thickness / - f`
Depth of foundation below grade (to bottom of footing) r
Will there be a cellar?/ Heated or unheated? Floor sq. footage sq ft
Will there be a basement? 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 ,Z "X er. " spacing ,r / "o.c. length 4 ft.
Joists(floor beams) 1st. floor "X " spacing "o.c. span ft.
Joists (floor beams) 2nd. floor "X " spacing "o.c. span ft.
Overlays(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
SEPTIC 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 Qbury AFFIDAVIT STATE OF NEW YORK
County off 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___ leS7( -- -� f a 2
Own , owner's agent,ar nitect,contractor
day of 19
Notary Public, Warren County, N.Y.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT:
By
_Town o f Queen i ur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME LOCATION ,try ,g,„4
Date J-11ly / 1 Permit No. X7-12_Z.
* * * * * * * * * * * * * * * * * * * * *
� ✓ APPROVED =Y / NO
Footing , 'ier Forms (
Foundation 1
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 ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
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Building Inspector
6/86 and-vl
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DA - VIA IT7-
ZONX a 8M CODES DEPT. 3)t
_ TOWN Of QUEE,NSBURY
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APPROVE
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DATED
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(�o�JAL�_ it) Yyl)-izi-' _ - ZONING &BLDG CODES DEPT.
TOM OF QUEENSBURY
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