93-169 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Da to Apr i 1 1 19 --3$
This is to certify that work requested to be done as shown by Permit No. 93169
has been completed.
This structure may be used as a REPLACE DETERIORATED FOUNDATION
Location ROUTE 9L
Owner
MATTHEWS, JOHN P
By Order of Town Board
TAX MAP NO. 2 . -1-9 -- TOWN OF QU S R Y
Director of Building & Code Enforcement
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BUILDING PERMIT
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TOWN OF QUEENSBURY c
No. 93-169
WARREN COUNTY, NEW YORK IN
PERMISSION is hereby granted to JOHN P. MATTHEWS
OWNER of property located at Rowe 9L Street,Road or Ave.
in the Town of Queensbury,To Construct or place a Replace detmionated Round bt on
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 n I
Box 1154 RD#1
Lake Geonge NY 12845
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2. CONTRACTOR or BUI LDER'S Name
Isame
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame (x) Masonry ( )Steel ( )
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7. PLANS and Specifications
No. Replace deteAiok ted 6oundati.on as petL plot plan, zpeci6icat:onz
and apptica Lion. Iz
B. Proposed Use
Foundation to dweU ng
44.00 MAV6 94
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19 0
(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.) £Z
Dated at the Town of Queensbury this Day of 19q�_
SIGNED BY - for the Town of Queensbury
Building and Zoning In or
TOWN OF QUEENSBURY F QOE IEWED BY: -5 �fq3
COMMUNITY DEVELOPMENT DEPARTMENT C�(uE �-
BUILDING & CODE ENFORCEMENT FEE PAID: ��
531 BAY ROAD
QUEENSBURY, NEW YORK 12804 19,"RMIT NO.
(518) 745-4447
BUILDING PERMIT$W&IQATIION
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A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO INSPECTIONS
WILL BE MADE UNTIL APPLICANT HAS REGEIVED A VALID BUILDING PERMIT.
All applicants ' spaces on this application MUST be completed and the
signature of the applicant MUST appear on the application form.
OWNER OF PROPERTY: 4' a,.lfa&j&ti
Mailing Address : ,2a1 EQ�s.r 5, ` S
Telephone Number(s) : Work dome Other
PROPERTY LOCATION:
Tax Map Number: Section �_ Block I_ Lot
Subdivision Name: ILot No.
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
CONSTRUCTION: $ 3 NEW BUILDING:
RESIDENCE/COMMERCIAL OCCUPANCY INFORMATION:
ADDITION TO BUILDING: PRIMARY BUILDING -
RESIDENCE/COMMERCIAL t/ Single Family Dwelling
ALTERATION TO BUILDING: Two Family Dwelling
RESIDENCE/COMMERCIAL Family Dwelling
(NO CHANGE TO EXTERIOR SIZE) Office
tI/ OTHER WORK (DESCRIBE� BELOW) Mercantile
Tc;. ¢ `s iTrsill i�� cc��C�'lt�/ Warehouse ..
Manufacturing
Other
GROSS AREA OF PROPOSED STRUCTURE:
1ST FLOOR SQ. FT.
IF ADDITION, USE OF NEW ADDITION:
2ND FLOOR SQ. FT.
OTHER FLOORS SQ. FT.
(not unfinished cellar or basement) ACCESSORY BUILDINGS:
Detached Garage - One/Two Car
TOTAL FLOOR AREA: SQ. FT. Attached Garage - One/Two Car
Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building
Other
FEET X FEET
Foundation Type: Will any second-hand or ungraded
Number of Stories : —T lumber be used? If so, for what?
(habitable space only)
Height (grade to ridge) : feet Type of Heating System:
Number of fireplaces and/or woodstove (circle all which applies)
to be installed: Electric / Oil / Gas / Wood
Forced Hot Air / Baseboard / Other
' PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
NAME OF BUILDER/ADDRESS/PHONE: �Jhw �.3t7�l �S
NAME OF PLUMBER/ADDRESS/PHONE:
NAME OF MASON/ADDRESS/PHONE: f/
NAME OF ELECTRICAN/ADDRESS/PHONE:
DECLARATION
To the best of my knowledge the statements contained in this appli-
cation, 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 -noted, and that such work is authorized by the owner.
Further it is understood that I/we shall submit prior to a Certificate of
Occupancy or Certificate of Compliance being issued, an AS BUILT PLOT PLAN
drawn to scale, showing actual location of of n pr ises .
Signature
(Owner, owne s hgen , architect, contractor)
FOR ANY SPECIAL PROVISIONS - SEE REVERSE SIDE:
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TOWN OF QUEENSBURY
BUILDING 6 CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
(! (518) 761-8256
ARRIVE: DEPART: • INS :y
FINAL INSPECTION REPORT - RESIDENT {C
DATE INSPECTION REQUEST RECEIVED:
NAME
LOCATION
DATE LA —I -95- PERMIT #
TYPE OF STRUCTURE gy-Q�4 �E\g. o
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
NIA TES NO---
CHIMNEY HEIGHT B VENT/HEIGHT
PLUMBING ENT
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/RAILINGS
LIEF VALVES
RNA E HOT WATER OPERATING
INTERIOR RIM PRIVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATER IGH
OTHER FLOORS SWEEPAB E
OTHER FLOORS CARPETED
STAIR CLEARANCE RAILINGS
F
SMOKE DETECTORS
BATHROOMFANS
PLUMBING FIXTURES
FOUNDATION NSULATION
GARAGE FIRE PROOFING
DOOR LO RS
FINAL EL CTR CAL
SITE PLAN VARIANCE RE .
INAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C C
TOWN OF QUEENSBURY
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION lJL
DATE PERMIT#
TYPE OF STRUCTURE= le�i'..�
RE£f1E£'K' ,/ '
FIRE MARSHAL AP ROVAL ( MMERCIAL STRUCTURE)
—FOOTING FOUNDATION BACKFILL FRAMING
_ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC
INSULATION WOQDSTOVE/FIREPLACE
REMARKS
APPROVAL
N/A YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VEI4T
ROOFING
SIDING
DECK/PORCH/STEPS/RAILI S
RELIEF VALVES ?
FURNACE/HOT WATER OPERATING
BASEMENT INSULATION/DUCTWORK_
INTERIOR TRIM/PRIVACY DQORS
FINISH FLOORS: /
BATH/KITCHEN WATEgTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS
SMOKE DETECTORS
BATHROOM FANS/WHOLEHOUSE FANS
ALL PLUMBING FIXTURES OPERATING
GARAGE FIRE PROOFING
DOOR CLOSERS
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
DUMPSTER
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS:
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ARRIVE „ • ?
DEPART f
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSS/PECTION RECEIVED
NAMEhf / { % r.�l
LOCATION L DATE (v J PERMIT # t Q
3-146�7
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YES
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/ EADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS�MAIN BEAM
HEATING ROUGH-IN
INSULATION:
FOUNDATIOh WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WO K OR PIPING IN UNHEATED
SPACES `
REMARKS:
ARRIVE
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DEPART /
I PECTOR
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RECEIVED
i',,AY _ 1993
& CODE DEPT
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TOWN OF QUEENSBURY BUILDIN W"TMENT 'Y
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compliance wft our commeft Ad
nd be ax&ued as Ind'aft the
plans and speffabons are in fuH
compliance with the Code, DATE
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