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87-848 • CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date 19 This is to certify that work requested to be done as shown by Permit No. 87-848 has been completed. This structure may be occupied as a One Family Dwelling LocationHillman Rd. , Cleverdale Dr. & Douglas Provost Owner By Order Town Board TOWN OF QUEENSBURY Building & Zoning Inspector BUILDING PERMIT TOWN OF QUEENSBURY No. 87-848 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Dr. and Douglas Provost OWNER of property located at Hillman Rd. Cleverdale Street, Road or Ave. • in the Town of Queensbury,To Construct or place a Alteration to one family 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 7 Horicon Ave Glens Falls, N. Y. 12801 2. CONTRACTOR or BUILDER'S Name John Mason ty 0 3. CONTRACTOR or BUILDER'S Address P.O. Box 86 Cleverdale, N.Y. o 0 4. ARCHITECT'S Name to rt 5. ARCHITECT'S Address H 6. TYPE of Construction—(Please indicate by X) 0 ( )Wood Frame ( ) Masonry ( )Steel ( ) • 7. PLANS and Specifications (") N No. 24' x 32' as per plot plan, specifications and application. CD n 8. Proposed Use Alteration to inside of one family dwelling (converting attic into . H loft and bath) $5.00 C/O $ 40.00 PERMIT FEE PAID —THIS PERMIT EXPIRES July 1, 19 88 n (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rt town of Queensbury before the expiration date.) t-• ( p Dated at the Town of Queensbury this 9th Day of December 19 87 0 N 0 +. SIGNED BY Q� —�% \ CD/ ���� Zt./1/ for the Town of Queensb ry , Building and Zoning Inspector /(„re, N TO BE COMPLETED BY BLDG. DEPT. Application No. rom; Or QUEEN,p`; - _J �]own of Queeniurf/ Permit Issued 19 ,-- - -bli l BUILDING and ZONING DEPARTMENT Permit Expires 19 u 1Yj L L Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation f f1?-//9 Queensbury, New York 12801 Variance No. /1✓//4 C 9 19 nn Site Plan Review No. /y//3 g- j - 1, V Approved by: I;PLI (NG & CODE l7EP APPLICATION FOR BUILDING AND: ZONING PERMIT ALL � �a * * * * * * * * * .* * * * * * * * *. * * * * * * * * .*. # * * .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. The owner of this property is: Dr. and Douglas Provost P.O. Address 7 Horicon Avenue Glens Falls , N.Y. 12801 Tel. 793-8220 Property Location: Hillman Road Cleverdale Tax Map No. 11 / 1/• 1 . 10 Street number or building lot number Subdivision name (if applicable) Takundewide THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS: John A. Mason P.O. Box 86 Cleverdale, NY 656-9956 Name P.O. Address Tel. No. Name of builder Sunsoval, Inc Address P.O. Box 86 Cleverdalwel. 656-9956 Name of plumber T. Address Tel. Name of mason II 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, XAlteration to a building * showing clearly and distinctly all buildings, (no change to exterior dimensions) * whether existing or proposed and indicate all Other work (describe) * 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 See Enclof&dX ft. * Existing building(s) Size 24 ft X 32 ft. *.. PROPOSED BUILDING AND USE: * Existing building(s) Use S .F.R. Size of new structure 24 ft X 32ft * Foundation-pier/slab crawl partial/full * Proposed building, distance from property line (circle one) * * Front yard ft Rear yard ft No. of stories (habitable space) 2 * Side yards ft and ft Height (grade to ft.ridge) 22 * If on corner, setback from side street ft If residential, no. of families 1 No. of rooms(excluding baths) " " 7 * OCCUPANCY INFORMATION No. of bedrooms 3 * No. of bathrooms 2 * PRIMARY BUILDING - Primary heating system electric * X 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? no: * X Transient occupancy Business* BUILDING STYLE, PRIMARY STRUCTURE * Industrial , ._ * ' Other . . BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS: Type of construction, wood frame, fire safe,etc. wood frame Will any second-hand or ungraded lumber be used? If so, for what? No Foundation wall material cement blocks Thickness 10" Depth of foundation below grade (to bottom of footing) 4 ' 0" Will there be a cellar? No Heated or unheated? - Floor sq. footage - sq.ft Will there be a basement? No 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 asphalt shingles Size, wood studs 2 "X 4 " spacing 16 "o.c. length 8 ft. Joists(floor beams) 1st. floor 2 "X 10" spacing 16 "o.c. span 12 ft. Joists (floor beams) 2nd. floor 2 "X 1P" spacing 16 "o.c. span 12 ft. Overlays(ceiling beams) 2 'X 8 " spacing 16 "o.c. span 12 ft.. Roof rafters 2 "X 8 " spacing 16 o.c. span 12 ft. Roof trusses(pre-engineered) spacing - "o.c. span - ft. Exterior wall finish siding Of what material? vinyl Interior wall finish sheetrock 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? No If so will a Fire-rated door, enclosure, and self-closing device be provided?Will a flue-lined chimney be installed? yes Height above roof 2 ft. 6" Depth of chimney foundation below grade - ft. Depth of fireplace hearth - ft. - in. Water supply - Municipal or private well Lake George SEPTIC SYSTEM _ Distance from ANY privatewell(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. e etSWORN TO BEFORE ME THIS Signature Owned!, owner's agent,arcnitect,contractor I day of 1C.C 19 7 Notary Public, Warren County, N.Y. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * SPECIAL CONDITIONS OF THE PERMIT: