97-191 CLI�,`I'IFIC OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date .:,,,-,a r 19 4,47
A I WI
This is to certify that work requested to be done as shown by Permit No. 9719±
has been completed.
This structure may be used as a y4 ARN
Location 122 MUD POND RD.
Owner VAN GUILDER, ALLEN to Angel
By Order of Town Board
TAX MAP NO. 52 . 1--12 , a TOWN OF QUE B RY
/)a,
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 1200 TOWN_ OF QUEENSBURY No 97191
TAX MAP NO. 52 . -1-12 . 2 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to VAN GUILDER, ALLEN &
OWNER of property located at 122 MUD POND RD. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a 12 ' X 24 ' POKE BARN
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
ANGEL 122 MUD POND RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name -
VAN GUILDER, ALLEN
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
POLE BARN
( 1 Wood Frame I ) Masonry ( 1 Steel (
7. PLANS and Specifications
288NB.q ft POLE BARN AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
12 ' X 24 ' POLE BARN
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES May 2 19 99
(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 2 Day of May 19 97
SIGNED BY for the Town of Queensbury
Duil�Zoning Inspector
Building Permit Application .
Town of Queensbury - Dept. of Conununity Development, 742 Bay Road, Queensbury, NY 12804 [761-82561
.l BUILDING & . CODE ENFORCEMENT
_ NOTICE Requirements prior to issuance P G
A permit must be obtained before
1 of this permit: •; �� l l 1
W.
beginning construction. No inspections R ..C 1'/F O
will be made until applicant has received E Zoning Board Action PERMIT F PAID$ ,j tl
a VALID BUILDING PERMIT. All Area /Use M l Y 0 2r
applicants' spaces on this application REC ON FE ' • D
MUST be completed and.the signature Board Action TOWi' OF OUE`HS3URY
of the applicant must appear on the. Planning BUILDIN(. Ptlefi>ll i.Y
._.
SPR / Subdivision /Other / Building Inspector
application form. 7hank you. . J Recreation Fee Payment
Q�� 7_, 'APPlicant: J n/ �/1/ � �//✓b/1 �dCA Owner: �ii/D-0 ra J .U:tu. .i
• Address: / A f on /aNJD 'U aAy Address: / ,q Z' ig--if Y 4.Q , J, yS. i7
Phone # ( at ) /7 9 3 ZEy /� Phone # (5.. gL-) - 17 9 6 ass
Property Location: 1/if fl PO I O 2O *,S-, - l p
--Tax Map Number - -
/
Subdivision Name: — Section Block Lot
NATURE OF PROPOSED WORK: _lA--
ESTIMATED MARKET VALUE OF THE
New Building: CONSTRUCTION: $lc.t(j ,
residence / commercial
Addition to Building:
.--
residence. / commercial OCCUPANCY INFORMATION:
Alteration to Building: Primary Building -
residence / commercial Single Family Dwelling
Residence / Commercial Two Family Dwelling
no change to exterior size . Family Dwelling
Office
Other Work (describe below) Mercantile
Manufacturing .
Other
GROSS AREA OF PROPOSED STRUCTURE:
If ADDITION, what will use
1st Floor sq. ft. of new addition be? :
2nd .Floor sq. ft.
Other Floors sq. ft.
(not unfinished cellar or basement) ACCESSORY BUILDINGS:
• Detached Garage 1, 2 car
TOTAL FLOOR AREA: 4" SQ. FT. Attached Garage 1, 2 car
X Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building
Other
FEET X FEET
lax of Po) _ •13A-eAl
Foundation Type: Will any second-hand or ungraded
Number of Stories: 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 // ood
Forced Hot Air / Baseboard / Other
•
Person respon ibL f /sup�{iris n of work as regards to building
codes is : >i~ �a - ✓aw) Jut
Nam Addresss Phone
Builder: •
Plumber:
. Mason:
Electrician:
DECLARATION: Please sign below aier you have carefully read the statement.
To the best of my knowledge 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 noted, and
that such work is authorized by the owner. Further, it is understood that Uwe shall submit prior to a
Certificate of Occupancyor Certificate of Compliance being issued, an AS BUILT PLOT PLAN by
a licensed surveyor; drawn to scale, showing actual location of project on premises.
Signature: ((IS I‘AD 416 &f'f
(owner, o er's agent, architect, contractor)
-7.:Eietle, N‘y)
TOWN OF QUEENSBURY
rBUILDING & CODE ENFORCEMENT
742 BAY ROAD
' � QUEENSBURY NY 12804
(518) 761-8256
a//9
ARRIVE: /4 0 DEPART: J/,v v INSP: -v
FINAL. INSPECTION REPORT - RES DENTIAL f 0.I
DATE INSPE 1 TION UEST ECEIVED: w
NAME CA/1 \ S �1\1l % ��1
LOCATION 1 as O 3 (\(1
DATE 0^ n PERMIT �9 /-19 )
TYPE OF STRUCTUREQ -. �-' (.tn,___
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING_ SEPTIC INSULATION
FINAL ELECTRICAL _ WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT/B VE IGHT . ///
PLUMBING VEN
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/;2AILINGS
RELIEF VALVES
FURNACE/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS 'SWEEPABLE
OTHER FLOORS CARPETED •
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS d
FINAL ELECTRICAL 1
SITE PLAN/VARIANCE REO. - Ji
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O 0ro
1
ft• TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
S 742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256
ARRIVE: 114; DEPART:. P-• NSP: V1_
FINAL INSPECTION REPORT - RESIDENTIAL
DATE INSPECTION REQUESTREC9VED: ( 7 ( 7
NAME 'mil. ., 01 l
� R` Pr--
LOCATION /c 2- .MG,c1 P.,:d ^ J�/.�O}`�
DATE b .DS 9 7 JJ� jPEERMIT i q/ ( f
TYPE OF S RUCTURE `1:LC� l�i'1L/3
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING-_ SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
- N/A YES NO
CHIMNEY HEIGHT/B VENT/IEIGHT
PLUMBING VENT
ROOFING /6/4
EXTERIOR FINISH VI
DECK/PORCH/STEPS/RAILI G
RELIEF VALVES
FURNACE/HOT WATER OPERAT NG
INTERIOR TRIM/PRIVACY DO RS
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS 'SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
SITE PLAN/VARIANCE REO.
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR(C/C
L.,kCa a p- t Hzo �jv�c ,, - B LOu4
�0 A - Pc'sr 5
(518) 761-8256
,,trt
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR�' 'DEPARTI` a')INT ✓
REQUEST17 INSPEC N RE EIVED:
NAME An. d
LOCATION / m Qom)
DATE 5 e��`�11MAT A s C
TYPE OF STRUCTURE: 66 y )
REC ECK _ APPROVE
N/A YE NO
00 GS P ERS
)MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR S RESPONSIBLE FOR
PROVIDING PROTE ION FROM FREEZING
FOR 48 HOURS FO WING THE PLACE-
MENT OF THE CO TE.
MATERIALS FOR THI PURPOSE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB
•
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
4
AIR INFILTRATION BARRIER
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 R-
F?Pel
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, • 1997
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