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1985-390 ----mimoplmw� CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW Y+ORK to Nate [9 This is to certify that work requested to be done as shown by Permit No. has been completed. ME�DlM1, �UI�GI'+� This structure may be occupied as a r �, - T ar� > 7 S T n'to c• n Z nx._r ] 1 i n cr Location w 7 ' ; C t' ,F, i T ; C}�wtaer �. r c �r 1T - By Order Town Board TOWN OF QUEENSBURY �: //',I/✓ i „�, err;. ,l '`' "` _ .�Y-��2„�'�i�-�...____�' Building & Zoning Inspector CREATIVE •'INETA" rRIRTIMG 6LEMS FALLS. N V 12941 15161955-5550 , BUILDING PERMIT TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Nancy J . Tellier pF OWNER of property located at Pinewood Road Street, Road or Ave. fa �C in the Town of Queensbury, To Construct or place a One—Family Modular Dwellings at the above location in accordance to application together with plot plans and other information hereto filed and *3 approved and in compliance with the Town of Queensbury Building and .Zoning Ordinance, � F� F-' 1 . OWNE R•S Address is 770 Ridge Road (D Glens Falls , New York �t 2. CONTRACTOR or BUILDER'S Name Assembly Developers & Tectonics ro r 3_ CONTRACTOR or BUILDER 'S Address � tD 20 Saratoga Ave . O South Glens Falls, New York 0 4. ARCHITECT'S Name �y 0 ru ID+ 5. ARCHITECT'S Address 6_ TYPE of Construction — (Please indicate by X) (X) wood Frame { ) Masonry ( ) Stool ( 1 0 7, PLANS and Specifications 1152 sqo ft . modular dwelling per plot plan No, specifications and application submitted including sewage system . r B` Proposed THE ATTACHMENT OF THE TWO PARTS MUST BE APPROVED BY "C A LICENSED PROFESSIONAL ENGINEER.. One-Family Modular Dwelling o f� ti✓ $ 5 . 00 C/O Paid ly $ $ 4 ' 00 PERMIT FEE PAID - THIS PERMIT EXPIRES February l 19 86 � Ilf a longer period is required an application for an extension must be made to the Building and Zoning inspector of the t7 town of Queensbury before the expiration date_) f£D F­1 F-+ Dated at the Town of Queensbury this 2 9th /D,ay of July 19 $ 5 � j� '�t�SIGNED BY for the Town of Queensbury Building and Zoning Inspector TOWN OF QUEENSBURY [Space inside 'black to lx& fiilc•d in b} WARREN COUNTY% NEW YORK Building Insprcu:r} Application for •{PU VIIILuti"rI, ttic,. BUILDING AND ZONING PERMIT r"1116; \ A44c + i! It's "rl THREE f31 Copies of a PLOT PLAN, Drawn to scale t} y +"'+ "ys [1 showing the actual dimensions of the lot to be built upon, The exact sire, and location an the lot of the building to be erected or altered MUST BE SUB- MITTED WITH THIS /APPLICATION. hAie///�{7 ( /Rrl �y� /+� /� } �p■ ■ . . . . . �.!. x: —, i +) 1✓TFi11� Vl�,t/1��KYf��.Nr V f'�{iYy►� A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK rL'�rYr: ANSWER ALL OF THE FOLLOWING. 3 U L The undersigned hereby applies for a permit to do the following work Al#. ,�e' +�RiDhiit ."0 P.M* which will be done in accordance with the description, plans and specifi- .CIS 911CUIII 11218141516_ cations, and such special conditions as may be indicated on the permit. OW The owner of this property is. T t]dc'D Nanny . J , Felber,,. . . . . . 7.70 , RXi Ige . Rd . ., . Glens. Falls. , .N . Y. . 12801. . . . . . . . . . . . . - . . INA"AC) IP d ^E>DRESSS The person responsibie for supervision of the work insofar as the Building Code and the Zoning Ordinance apply is. Join .G. . w�l.sli . F#SSernbky. .Dc�velapers . &. -Tectonics . -- En,q pnee�i — ,Department . . . . . . . . . . . . . . (NAM£I Name of Builder Assembly move lopers - & Tectoni-cs Address . 20 Saratoga - Ave . . South , Glens . Fa.l.ls , N. Y. Name of Plumber Assembly. . 1)eye,.jQpers. .& . bectcanics . . . . Address 'no. . Saratoga - Ave w , . South . Glens . Falls , N . Y. Narise of Mason Kenneth F3aldwin - - - - Address .] en _ Lake . Rd , .,. Nest, Fort: - perm " . NiiY .. - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lot Number . . . . . . . . . . . . Unit . . . . . . . . . Estimated value of proposed work S 32 . 000 Nameof Village . . . . . . . . . . . . . . . . : . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Street -I?ine.w;CtQsl . Road . . . . . . . . . . . . . . . . . . . . . . . . . . Side of street: north [3 , east 0 , south f3l. west 0 Nearest Cross Street . . Luzerne Road Distance from this ^Toss street . . - . . . .400 . . . . . . . . Ft. Property is north 0 , south 0 , east , west El from Cross Street If on Corner, which corner, northeast �i , northwest C1 . southeast Fl . southwest (Designate by marking with an "X'* in the correct space.) NATURE OF PROPOSED WORK OCCUPANCY Construction of a new building. Main Btutding C) Addition to a building. One-family dwelling © Alteration. to a building. Two-farni-f dwelling © Demolition of a building. -family apartment house Score building � - -car attached garage L� Other: . . . . . . . . . . . . . . . . . . . . . . . . . Accessory Building One-car detached garage r C] Other work. Describe: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Two-car detached garage � C � Private chicken house Private storage building . . . . . . . . . . Othey: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ZONING SPECIFICATIONS. Fill in for new building, or addition to existing building, or a change of occupancy. Indicate on the plot plan street names, the location and size of the property, the location, size and setbacks of pro- NORTH posed buildings, and the locatic►tt of all existing buildings. Show proposed building(s) in dotted line and existing Luzerne Road lauilding(s) in solid line. m Size of property . . _ . . . 13.5 . . . . . ft. x . .1.49 . 55. . . , ft. ro Size and use of existing buildings, if any . .Npne. - - v ►- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Size of proposed building . . . . 24 . . . . ft. x . . 4.8 . . . . . ft. 0 Q) Height {from grade to ridge) . . , . � f3. . .4" CIA Front yard . . . . .30 . . . . . . . . . . , . . . . . . . . . . . . . . . . . ft- Side yards . . . . . . . - . . . . ft. and . . . . . . . 5. . . , , . , ft- Rear yard . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . . . ft. sou-r" If on corner, setback from side street . . . . . . . • • • • . . . . ft. Corinth Road Note : All distances are net, as measured from street side line to nearest part of building. (qV ERi 7- 73 -M BUILDING SPECIFICATIONS., Kind of construction : Wood frame, fire safe, etc.? , . . . . . . W. . . . Frame Will any second-hand lumber be used? . . . N-0 . . . . . . . . . If so. for what? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Material of foundation walls . . .Cement , Block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Thickness , . , . 10„ Depth of foundation walls below grade . . . .S'1, '. . - . .6... . . . . . . . . . . . . . . . . , . . . . . . . Continuous foundation? . Yes. , Will there be a cellar? . . Xe$ . . - . . • . . . If so, material of cellar floor . . . . . Cement . . . , , . . . . . . . . . . . . . . . . . . . . . Type of roof: Sloped or flat? _Sloped. . . , , . . _ Material of roof . Shingles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Size, wood studs . . . . . . . . . . . . . . . . 2. . . "' x . . 4. . . . . . . . . . . . ", spacing - . . . , . 16 . . . . . "o.c., length . . , . . . . . . I . . £t. Size, floor beams, Ist floor . . . . . . . . 2. . . " x . . $ . . . . . , _ , , _ _ . "', spacing . . . . . . 16 . . . . . .•"o.c., span . . . . . . . . . . . . . . ft, Size, floor beams, 2nd floor . . . . . . . . . . . " x " spacing . . . . . . . . . . . . . . "o.c., span . . . . . . _ . . . . . . . ft. Size, ceiling beams . - - - d . . . . . . _ _ . 2 . . ^ x . . 6 . _ . . . . . . . . . . ", spacing . . . . , . 24 _ . . . . . "a_c-, span . . . . . . . . . . . . . . ft. Size, roof rafters or beams . . , . - . . . 2. . . " x . . 6 . . . . . . . . . . . ", spacing . . . . . . 24 . . . . . . ''o.c., span . . . . . . . . . Exterior finish Vinyl Siding, . . . . . . . . . . . . . With what material? . . . . ,V"Y.1 Finish of interior walls . . . . 'f" Sheetrocls, , . , . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , . . , . . . . . . . . . . . . . . . . . , . . If garage is to be attached, of what material is wall between garage and main building to be constructed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Is there to be an opening between garage and building? . . . . . N.Oo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kind of heating system . . , . . _ . . . Electr i•c • . . . . . . . . . . . . . . Oil bunter or coal? . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . Will a flue-fined chimney be provided? . . . . .I` QC _ . - _ . Depth of chimney foundation below grade . . . . . . . 1 . . Height of chimney above roof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will there be a fireplace? . . . . . NP. . . . . . . . . . . . . . . . . . Depth of fireplace hearth . . . . . . . . . . . . . . . . , , . . . , . Will a toilet be installed? . . . . ,Xes . . . . . . . . . . . . . . . . `. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will a kitchen sink be installed and connected to water supply? . , . . . . Yes . . . . . . . . . . . . . . . . . . . , _ . . , . . . . . . . _ . . . . . , Water supply (public water supply or pump) l uh)llc. - • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Distance of cesspool from any private well . A . . . . . . . I None. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . feet Will drainage system be provided with required traps, cleanouts, and vents? . . - -Xes . . . . . . . . . . . . . . . . . . . . . . . . . . . . Town of Queensbury AFFIDAVIT -County of Warren State of New York I swear that to tr, lacm`fof my knww,ledge and belief the statements contained in this application, together with t$c clans and spacif Ations au6- miG Care a true and IN [O statement of allnd ll oth etf work rt he done on the descosed wor premtsesry a whfi,an wheth r sp the cified BUILD- ING CODE, THE 2(7NINi� ORDINANCE, and all Other laws pertaini w � proposed work ebr l be wftit w sgsraf and that such work is authorized by the owner. Sworn to before me tltia Signature .. t-� !liz f WNER, OWNER'S AGENT, ARCHITECT, CONTRACTOR 11 day Of. . . ... . . . . . .. ... . . . . . . . .. . . .. . .. . . .. .. . ... . . 19 . . . f440TARY PUe LtC. WARREN COUNTY, N, Y. SPECIAL CONDITIONS OF THE PERMIT; By . . . .. . . . .. . . .. ... . . . . ... . . . .. . . . . .. .. . . . . .. .. . . . ... . . . . .. .. .... .... .. . ... . . ` TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . ANSWER ALL of the fallowing : 1 . Grass floor area 1152 2 . Type of heat Electric 3 . Is the building mechanically cooled ? No 4 . Percentage of area of windows and doors 10 % A . Over 16 % Only 1 . Uo value of gross area of walls , roof/ ceiling and floors exposed to ambient conditions Ce ; l i nq - _ 06 Flnxnrs + Wal l c - 09 2 . Floor over heated spaces YES NO a . Are foundation walls insulated ? YES NO 10 if YES , what is the R value ? 3 . Slab on grade YES NO a , If YES , what is the R value of insulation around perimeter of floor ? 4 . Is basement heated ? YES NO a . R value of insulation 5 . Type of insulation Polyurethane Be under 16 % Only 1 . R value of roof and floors exposed to ambient conditions_ 19 2 . R value of exterior walls 13 3 . R value of glazed area _ 69 4 . R value of doors 15 5 . R value of floors over unheated spaces 13 6 . R value of slab edge insulation - unheated slab 8R 7 . R value of slab insulation - heated slab 8 . R value of heated basement/ cellar walls ( above grade ) SR 9 . R value of heated basement /cellar walls ( below grade ) 2 ' - 8R Ica Type of insulation- � Fiberglass C . Controls 1 . Thermostat maximum heat setting 800 D . Duct Systems 1 _ is duct system installed in unheated spaces ? YES NO a . if YES , R value of duct installation be R value of duct in other areas E . Piping Insulation -No 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating 1 . Performance efficiency Yes 2 _ Temperature Control setting maximum 160 G . For Swimming Pool Only 1 . Maximum heating Telephone No . 793-8513 ( appli n signature TOWN OF QUFENSBURY BUILDING & ZONING DEPARTMENT SE4+.'AGF DISPOSAL PERMIT ,APPLICATION 1 . Owner ' s Name Nancy J . Tellier Address 770 Ridge Road Glens Falls , N . Y . 12801 Telephone No . 798- 8513 2 . Property location Pinewood Rd . , Glens Falls , N . Y . 3 . Name of person or firm responsible for installing system Dick Lee Telephone No . 793- 2363 Address Broad St . , Glens Falls , N . Y . 4 . Number of bedrooms ( residential buildings only ) 3 56 Daily flow 450 cgallons/day 6 . Septic tank capacity 1000 gallons 7 . Topography : flat , rolling , steep % of slope Flat 86 Nature of soil and depth Sand - 10 9 . If ground water , bedrock or impervious material is apparent at what- depth does it begin? None ft . 10 . Percolation test : A is required S x is not required C If required what is the rate minutes/inch 11 . Water supply : municipal , well , other 12 . Type of system proposed : drywel l , the field , other Seepage Pit Any contractor , corporation , individual , etc . engaged in the construction of a sanitary sewage disposal system who covers the same before inspection , does not have an approved permit , or varies from the approved application will be subject to a penalty of $ 250 as provided for in Section 6 . 010 of the Que+ensbury Sanitary Sewage Ordinance . Date 7- 16- 85 /.�/Jlz!r.%1 sign a�t ,,Ar"f appilcant on separate sheet of paper submit a diagram of the proposed septic system with all dimensions , including distance from any structure , distance from property line and domestic water supply , etc . Include all dimensions of the system itself . Form 3 - 82 TOWN OF QUEENSrBURY Building Department Pewmit, No. WeRtb" &xcatYa tl.an Footing Forms- -Footing & Piers Foundation Cement Coat Water roofin Sacicfill Final Survey r.randngr Sheathing Roof Felt Roo€i Siding Masonry Veneer Rough Pl Relief Valves VA Wall Board Sxt . Porches Pinished Floor Interior Trim Stairs & Railin s Collar Pr . Tile g, x Concrete Floors pp . Fixtures Gar . Fire rvofinrf Door Closers ON Chimne Water Meter Inst . Septic A royal Floors Ynsulation Found& eiAzt wal3s Ceiling R� Building Tnspector REMARKS 00 Qom" - 5>, K . .- - t TOWN OF CCU EENSBU RY Building Departmeut Iospeetaes Matta VAI - NAUND it Parses Nw i �"� Weather . s Remarks 8xcatYa t on Foo ti.n Farms Pootingr & Piers Foundation Cement Coat waterproofing BaClcfil2 Final Survey Framing sheathing Roof Feat Roofin Siding Masonry Veneer Rough Plbgo Relief Valves wall Hoard L•xt . Parches Finished Floor Snterior Trim stairs & Railings Cellar Dr . Tile Concrete Floors P2 Fixtures Gar . Fire roofin -- Door Closers Chimne Water Meter Snst . WIN Se tic Approval I Floors _ Foundation Insulation walls _ ceiling lie Building Inspector REMARKS TOWN OF QUEENSBUR'Y Building Department inapeoors Report Date ld Name_ Permin. No. ;?-6-- a _ Weather ExcatYa Lion FoatinCT Forms Footin & Piers Foundation Cement Coat waterproofing_ Bacxfill Final surve Framin aheathin Roof Fel t Rovfin siding Masons veneer Rou h Plb . Relief valves Wail Board F.xt . perches Finished Floor Tnt+er%or Trim ,Stairs & Railin Is Cellar Dr . Tile concrete Floors plba4 Fixtures Gar . Fire roofin Door Closers Chimne Water Meter Inst . Se tic A xoval 41 Floor's _ Foundation _...._ Insulation Walls ' _ Cei lire 13nildin5r Inspector REMARKS „[ TOWN OF QUEENSBURY Building DewL:tme lat insprebws Repert Date I �-' Namm ' permit Na. - 62Weather Rezarks Excaoatson Footin Forms Footin & Piers Foundation Cement Coat Water roofin Backfill Final survey Framin Sheathin ,Roof Felt Roofin Sidin Masonry Veneer Ftou h Pl Relief Valves Aiall Board xxt . Porches Finished Floor .Interior Trim Stairs & Railin s Cellar Dr . Tiles Concrete Floors pl Fixtures Gar . Fire xaofin ,Door Closers Chione Water Meter Inst . T Se tic A roval FZOU1's �-- Founda Lion _.�... insulation galls - Ceilin23 ...._^ Bvx rIinyr .ems REMARKS TOWN OF QUEENSSURY Building Department mom. Report Date //f rI S' N+amrr AoIP 8uf r G 1 C.,� L,oea�tio�a „��- S ^5 Pr.�r+l�,-wc�err.► PernriR Na. r� L- --- :=� �`a"G7 Wewti►er Remarks ExcatYa t an Footin Forms Footing S Piers Foundation Cement Coat Water ro©fin Ba.c7cfill Final survey Framin Sheathin Roof Felt Roofin Sidin Masonry veneer Rou Th PI Relief Valves wall Board ExtII, Parches Finished Floor Interior Trim Stairs & Railings Cellar Dr . Tile Concrete Floors PI . Fixtures Gar . Fire roofin Door Closers Chimney Water Meter Inst . Se tic Apozaval Floors Foundation Insulation Walls Cei13 uila i g Inspeata REMARKS ,508 Hie �- T THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY Fr 41 STATE STREET. ALBANY, NEW YORK 12207 Date October lO r 19tS5 Application No. onfile 069231.�85 /� �+ �* 'ry THIS CERTIFIES THAT 649667 9 Gi 6 ! r only the electrical aquipment as described bet0w snd intradnced by thug applicant named ors the aLoae `application number its the pt>,gmises of .. rw P arxr-'Y T011-i.ert I lrkawA x3 RCad, Que nsbury, New York in the folhowing hocation; outside .:,liaaensent � lst FT. 0 Tnd Fl. Sec#ion Black Lot _... arcs esamined on �2Z 3 and found to be in compliance with the requirements of this $card. Fl%TUER1 ACI,ES SYY7TCHB FIXTURES RANGESCOOKING DECKS OVENS DISH WASHERS EXHAUST FANS OLhTLETS NCANDESCENT RESC PUIOENT Y ANT, K. W. AMT. K. W_ AMT. f K.W. I ANT. r K - w, ANT. N, P. r, DRYERS FURNACE MOTORS FUTURE AFFUANCE FEEDERS Isracm WC'" Timm CLOCKS "U, UNIT HEATERS YMULT94X" ET DIMMERS 'AMT. K. W. ca H- P. GAS I NO. A. W. G. ANT. AMP, I ANT. AMPS, TRANS. j ANT. I p. P. SYSTEMS .ANT.- WATTS No. or. FEET SERVICE DISCONNECT No, OF S E R V 1 C E AMT. AMP. YYPE i .,W 2W 1 M 1W 3 IY 9W 3 X IW NO: +DP CC. COND. A. W. G. NO. OF i14YEC. A. W. G. NG, dF NEUTRALS A. W. G. V PER lY OF CC.CONO- OP HId1EG OF NEUTRAA. 2i] Cr 1. x ] 4/C1 I 2/0 OTHER AFFARATUS: I.1`ISPECU01V FEE PA Tn Nancy qxAaallier 770 Ridge RDad Glen;t Frilas , New York 12£301 239 BRANCH MANAGER COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. � ceps TOWN OF QUEENSBURY Building Depertmaen,t hupedtom Report Data 3 Name ..1?, T6+L+c.r ,mac. Lawht m ecAor toot7C2 W+FaTS10AL Perot No. �B 4'4 Weather Remarks Mimi ExcatYation Footing Forms Footing & Piers Foundation cement Coat Water roofin Eackfill Final Survey Frami n Sheathzrnff Roof Felt Roofi.n SIdIngr Masonry Veneer Rough P3 Relief Valves Wall .Board Ext . Porches Finished Floor Interior Trim stairs & Railings Cellar Dr . Tile concrete Floors PJbg . Fixtures Gar . Fire roofin Door closers Chimney — Water Meter Inst . Se tic Approval Floors Foundation —— Insulat.ion , Ceiling Bul di Inspector REMARKS J��.►' d�.hc--t7► urw'- �cs�,[1 qGEORGE KUROSAKA JR.. P.E. 13UILDLNG SYSTEMS CONSULTANT POuT OFFIGS BOX NO, 660 GLENU ,FALLS NEW YORK 12eOI (518) 702-1522 13 ARBUTUS DRIVE OUEENSBURY. N.Y- 12001 .�P-H^oNC SIB 792 - iS22 BUMDIND 1N SPF�L OR Town of Queensbury re : Factory Man actured Home Town Hall Tnstallation Certification. Queensbury , New York. 12801 Attention. Mack Dean Dear sir , This is to certify that I have observed and inspected the Installation of a "Factory Manufactured Home"" ; as defined by the New York State Uniform Fire Prevention and Building Code , Chapter D - MANUFACTURED HOUSING , Article 2 - FACTORY MANUFACTURED HCMES , as applicable to your local building regulations ; there appeared to be no apparent structural damage to the units , due to or attributable to the transportation or loading/unloading of the units , herein- after described as follows : ,rr _� Date of Installation : 054r''�'�'��00=j� Site Locatlon : Community : Town of Clueensbury County : Warren.-� Manufacturer/Supplier : e' ri" -�,�y. ,O/ Address : , 5' Insignia Serial No . JEE f 'J"d7 !i Plan Approval No . -,00 !>/ ,pG, S Manuf actuver ' s Model/Component No. : Date of Manufacture : 77/2�.^�'' r Installer/Supplier : I have also examined the approved P �& Specificatjons for the abovementioned ""Factory Manufactured Home" , and to the best of my knowledge and belief , this "Home" has been installed in accordance with these approved Plans & Specifications , and all other applicable laws codes , ordinances , standards &/Or z-egulat!Ons . KVROSNje �f' Res tfull s mit edf IL roe e z _`• m GEORGE KUROSAKA J"R . , P . E. NYS PE Lic . No . 35869 r U. S. DE PAR TUE HT OF HOUSING ANO UR"N DE VE L OPM E HT FEDERAL MOUSING AAMINISTRATION "HA Pam 2005 For accurate resister of carbon copies, form Fors Approved ✓A Farm 26-1952 may be separated aionF above fold. Staple CIMS No. 63—ROOSS Zev. 2/75 completed sheets together in original order. Proposed Construction DESCRIPTION OF MATERIALS Now fTo be iascrtcd by FHA or VA) Under Construction 30roperty address PINEWOOD ROAD City GLENS FALLS . Stafe N . Y , Vortgagor or Sponsor {t�iamrt tAcklrrasf Antractor or Builder ASSEMBLY DEVELOPERS & TECTONICS INC. 20 SARATOGA AVE . , SO, GLENS FAILS r NY I Vame) {Atklrcssl INSTRUCTIONS 1 . For additional information an how this form is to be submitted, number required, than the minimum acceptable will be ussumed. Work exceeding f copies, etc., see the instructions applicable to the FHA Application for minimum requirements cannot be considered unless specifically described. lortgagr Insurance or VA Request for Determination of Reasonable Value, as 4# include no alternates, "or equal" phrases, or contradictory items, he case may be, 2. Describe all materials and equipment to be used, whether or not shown meat(Consideration of c request For acceptance of substitute materials or equip- ent is not thara6y precluded,) n the drawings,called marking each X in each appropriate sceis check-box and entering 5. Include signatures required at the end of this Farm. 'rr information called for in each spore. if space is inadequate, enter 'See misc." and describe under item 27 or an an attached theist, THE USE 6. The construction shall be completed in compliance with the related 1F PAINT CONTAINING MORE THAN ONE HALF OF ONE PERCENT drawings and specifications , as ome'ndad during processing. The specifi- .EAD BY WEIGHT IS PROHIBITED, cations include this Description of Materials and the applicable Minimum 3. Work not spec;Fi ca l ly described or shown will not be considered unless Property Standards. 1 . EXCAVATION: Bearing soil, type - SAND 2. FOUNDATIONS: Footings. concrete mix ; strength psi 3000 lbs . Reinforcing 3 # 4 STEEL BARS Foundation wall. material CONCRETE BLOCK Reinforcing DURAWALL Interior foundation wall: material CONCRETE BLOCK Party foundation wall Columns: material and sizes STEEL 3" D PIPE Piers. material and reinforcing Girder: material and sizes 4 — 2 x 1.2 WOOD Sills: material SILL SEALER — WOOD PLATE Basement entrance areaway Window areaways CORREGATED METAL Waterproofing TAR Footing drains I"'ermite protection TREATED SILL WOOD Sasementless apace: ground cover ; insulation foundation vents Special foundations Additional iunformatiaon: 3. CHIMNEYS: Material Prefabricated (make and size) Flue lining: material Heater flue size Fireplace flue size Vents (material and sire): gas or oil heater water heater Additional information; 4. FIREPLACES: 'Type: ❑ solid fuel; ❑ gas-burning; ❑ circulator (make and size) Ash dump and clean-out Fireplace: facing lining ; hearth mantel Additional information; 5. EXTERIOR WALLS: Wood frame: wood grade, and species STUD GRADE SPF ❑ Corner bracing. Building paper or felt Sheathing RUFFDEC thickness 3/8 " ; width 48 " [N p spaced o, c.; ❑ diagonal: solid; Siding --VTNYT• grade ; type HOR LAP ; size DBL . 4" ••.. STAPLED expoauro fastening Shingles ; grade type ; size ; exposure . "; fastening Stucco ; thicktuss "; Lath ; weight ib. Masonry veneer Sills Lintels Base gashing Masonry: ❑ solid ❑ faced ❑ stuccoed; total wall thickness facing thickness "; facing material Backup material thickness "; bonding Door sills Window sills Lintels Base Hashing Interior surfaces: dampproofing, coats of ; Furring Additional information: Exterior painting. material ; number of coats Gable wall construction: Q same as main walls; ® other construction ND TNSUIT.Ar]`ION TN TIPPER C.ART.F'. RNDq 6. FLOOR FRA INGt 12" BOLTS @ Joists: wood, grade. and species A 2 RTR - SYR - ; other -2X8 ' S 24 O . C . ; bridging anchors 4 . 0 " , .o . C _ Concrete slab: ❑ basement floor; ❑ first floor; Q ground supported, ❑ self-supporting; mix thickness '•, reinforcing ; insulation ; membrane: Fill under scab: material thickness Additional information: FLOQR INSULATED TO 74 SUBFLOORING: (Describe underflocring for special floors under item 21 .) 4x8 Material: grade and species COMB . SUB FL.l.10R,/[,JNDERT.AYMF.N'P P ; size --3,/'40" ; type `"TYP PLYWOOD Laid: ❑ first door ; ❑ second floor; ❑ attic sq. ft.; 0 diagonal; ❑+ right angles. Additional information• Q-TAIED Fr NATTi,En r1Q R}1h r_ AT FiT T t^r F.C; RY] JOTS'TS P TnTNTS gt AGr4ERED A I WN 8. FINISH FLOORING: (Wood only. Describe other finish flooring under item 27.) LocATscrN Rooms GRADE SPEcrra TNrcx+rsss WIDTH I BLDG. pwrca FINISH First floor Second floor Attic floor . MI. ft. Additional information: HA Farm 2005 1 DESCRIPTION OF MATERIALS 1A Fortes 26-1852 DESCRIPTION OF MATERIALS 9- PARTITION FRANKING: Studs: wood, grade, and species STUD GRADE SPF size and spacing 2 X 4 24" O.C.r Other Additional information: 10. CEILING FRAMING. joists: wood, grade, and species Other Bridging Additional information: 11 , ROOF FRAMING; ABC TRUSS FILE M6480 SHEET #DS6381M FOR 57 P . S . F @ 24 " O . C . Rafters: wood, grade, and species Roof trusses (see detail): grade and species Additional information: 13. ROOFING; Sheathing: wood, grade, and species STD 32/16 _ EXTERIOR FIR ❑ solid; 17 spaced " O.C. Roofing ASP . SHINGLES grade: 235# T ; size 7 2X36 type Underlay DBe 15# ASPHALT SATURATED FELT weight or thickness-150 size ; fastening STAPTED Built-up roofing N/A ; number of plies ; surfacing material Flashing: material GLAV. DRIP EL.(,E_ ; gage or weight 28 CIA ; ❑ gravel stops; O snow guards Additional information: 13. GUTTERS AND DOWNSPOUTS; Gutters: material ; gage or weight ; size ; shape Downspouts: material ; gage or weight ; size ; shape number. Downspouts connected to: Storm sewer; ❑ sanitary sewer; ❑ dry-well. ❑ Splash blocks: material and size Additional information: 14. LATH AND PLASTER Lath ❑ walls, ❑ ceilings: material ; weight or thickness Plaster: coats ; finish Dry-wall ❑ walls, ❑ ceilings: material CWPqtTM thickness hi" finish PAINT Joint treatment TAPE , BED & FINISH 15, DECORATING: (Paint, waffpaper, etc.) Roans WALL Ft"taw MATERIAL AND ArrLICATtoN CE11ANG FINISH MATERIAL ANo ArrucATicw Kitchen LATEX PAINT LATEX J!AINT Bath LATEX PAINT Other LATEX PAINT Additional information: 16, INTERIOR DOORS AND TRIM: Doors: type HOLLOW CORE „ , ; material MASON1JrF: thickness 3/8" Door trim: type TEARDROP material PINE Base: type . .. TEARDROP - material ETPjF ; size 21s'"- Finish: doors WHITE LACQUER SPRAY trim ITTE LACQUER :SPRAY Other trim (ileiti. J� and location) LACQUER- -_ Additional information: ALL NAILS SETS HOTMES PrrT"TTrn is 12AjNrrrr3 17. WINDOWS; Windows: type DBE , HUNG ; make MALTA ; material �''}3�ATED PINE ; sash thickness 1 3/8" Glass: grade I ; Cl sash weights; %] balances, type SPRING CAM _ ; head !lashing - 024 ALUM 9F Trim: type TEARDROP ; material PINE paint LACQUER SPRAY number coats 2 Weatherstripping: type material Storm sash, number Screens: [21 full ; ❑ half; type number -ALL screen cloth material _ALUM , MESH Basement windows: type material -- ; screens, number. ; Storm sash, number . Special windows Additional information: WINDOW WITH SCREEN ALL. ONE L'rhT_IT rL-O _ 47 ,_,•_„. ,.•�___ 18. ENTRANCES AND EXTERIOR DETAIL; Main entrance door: material TNSUL . STEEL ; width - 16" thickness 3 4 ", Frame: material PINE thickness 5 4 Other entrance doors: material INSUL • STEEL ; width 32"" thickness 3 4 Frame: material PINE. thickness ' Brad flashing . 024 ALUMINUM Weatherstripping: type VINYL (MAGNETIC) : saddles ALUM * Screen doors: thickness '; number ; screen cloth material Storm doors: thickness "; number Combination storm and screen doors: thickness "; number. ; screen cloth material Shutters: ❑ hinged; C2F fixed- Railings IRON POST , Attic louvers Exterior millwork: grade and species 'Faint ; number coats Additional information: — . _ 10 3/4 " ALUMINUM SOFFIT (CONTINUOUS PERFORATED @ EAVE ) 19. CABINETS AND INTERIOR DETAIL; NO. Kitchen cabinets, wall units: material FORS OAK STILES ;"M feet of shelves 55 MlAheif width J ZiWL Base units: material SEL , OAK{ ; counter top HIGH PRESS ] y LAM. edging ROLLED EDGE _T Back and end splash PLASTIC LAM . Finish of cabinets number coats N/A Medicine cabinets: make TRIANGLE PRODUCTS OR EQUAL model NORMALLY 54446-4,1-.52., Other cabinets and built-in furniture 24 " VANITY CABINET Additional information: 20. STAIRS; TRF.ios RmiL" ST&wus HANUAAR, BALusTsks $TACx Materiat Thickness Material Thickness Material Size Material Size Material Size Basement FIR 2" " " Main Attic Disappearing: make and model number Additional information: 2 to` , 1• Y 11 . SPECIAL FLOORS AND WAINSCOT[ LAr.ATGpM RAZZ, tJ1�DfRPLOQR MATEaw Cocoa, ]BaRosa, Stze+r GAo& Erc. 7'"RXsHPY n WAR a RAZZ, MAreRtn.L MATEALAL MAreRI.AL Kitchen CUSHION VINYL MEMBRANE PINE PLYWOOD Bath CUSHION VINYL MEMBRANE PINE PLYWOOD CLOSETS CUSHION VINYL MEMBRANE PINE PLYWOOD BALANCE CARPET & PAD UM- 44C PINE PLYWOOD LQCATION MAT9:RIALr CO-..Oa, B6JRn'r.Rr 'A/. $ISL7r GAGES ETC. } HEIGHT 14UGHT m SHQWF U;EIGHT OVER. �rvw (FROM FL 03t) Bath Bathroom accessories: El Recessed; material ; number. ❑ Attached; material number Additional information. 22. PLUMSINGt FIXTURS 1Ku4ace L40Ca.TSCM MAIte Mre'P FIxTVRE 1DLwrsricArtoX No. Size CouoR Sink S Lavatory Water closet BATH AM . STANTIARD . ___ __ PLRBj9 Bathtub Shower over tubes H Stall showerd Laundry trays ❑ Cksrtain rod ©[2f Door ❑ Shower part; material Water supply. ® public; ❑ community system; t] individual (private) system.* Sewa deiGs osal: ❑ public; ❑ community system; KNindividual (private) system.* *Shaw and describe rndrrndual system in complete detail rn wpa€ale drawings and sperifiratsons acwrdrslg to requrromemts. House drain (inside): ❑ cast iron; ❑ tile; M othcrPVC House sewer (outside): ❑ cast iron; ❑ Lite,' ® other PVC Water piping: ❑ galvanized steel; Ucopper tubing; ❑ other Sill cocks, number 1 Domestic water heater: type F. IjECTRI ; make and model . MOR PLO 7,—HER42f)3& heating capacity gph. 100` rise. Storage tank: material GLASS LINED ,... .. . ; capacity gallons. Gas service: ❑ utility company; ❑ liq. pet. gas; ❑ other Gas piping: ❑ cooking; ❑ 'house heating. Footing drains connected to: ❑ storm sewer; ❑ sanitary sewer. ❑ dry well. Sump pump; make and model ; capacity : discharges into 23. HEATING. ❑ Hot water. ❑ Steam. ❑ Vapor. ❑ One-pipe system. ❑ Two-pipe system_ ❑ Radiators. ❑ Convectors. ❑ Baseboard radiation. Make and model Radiant panel: ❑ floor; C3 wall; ❑ ceiling. Panel call: material ❑ Circulator. ❑ Return pump. Make and model capacity gpm. Boiler: make and model Output Btuh.; net rating Btuh_ Additional information: Warm air: [I Gravity. ❑ Forced. Type of system Duct material: supply ; return Insulation ., thickness ❑ Outside air intake. Furnace: make and model Input Btuh.; output Btuh. Additional information: ❑ Space heater; ❑ floor furnace; ❑ wall heater. Input Btuh.; output Btuh.; number units Make, model Additional information- Controls: make and types Additional information: Fuel: ❑ Coal; ❑ oil; ❑ gas; [] fsq. pet. gas; ❑ electric; ❑ other storage capacity Additional information; Firing equipment furnished separately: ❑ Gas burner, conversion type. ❑ Stuker: hopper feed ❑; bin feed ❑ Oil burster: ❑ pressure atomizing; ❑ vaporizing Make and model Control Additional information: Electric heating system: type PI BC 2D Input 250 watts 24(l volts' output Rri j Btu)-/FT Additional information: AT.'[. ROOMS HAVE. INDIVIDUAL WATT, 1NMt1ITMrPRD TUFRMOSTATS Ventilating equipment: attic fan, make and model ; capacity cfm. kitchen exhaust fan. make and model Other heating, ventilating. or cooling equipment 13ROAM 4130 DI 160 C. $ram,_ OR EO BATH FAN BROAN 678 50 [_ . F. M . OR Eft 24. ELECTRIC WIRING: Service: ❑ overhead; ❑ underground. Panel. ❑ fuse box; circuit-breaker; make ca. E . AMP"s 20[3 NO. circuits 40 Wiring: ❑ conduit. ❑ armored cable; ® nonmetallic cable; ❑ knob and tube; ❑ other Special outlets: tX range; M water heater; ❑ other WASMF.R ® Doorbell. ❑ Chimer. Push-button locations � FRONT _DOOR Additional information: GF-[ 25. LIGHTING FIXTURES. Total number of fixtures S Total allowance for fixtures, typical installation, S. Nontypical installation Additional information: ------------------ s DESCRIPTION OF MATERIALS DESCRIPTION OF MATERIALS 26. INSULATION: L.cxv Ym:)", 71»ctcrress MwTaatmt Txrs, P.No Mrmoo Of lmwkts ATION V^roa BAartIRR Roof Ceiling 12"" FIBERGLASS — FORCE FIT R- 38 Wall 3 5 B"" FIBERGLASS STAPLED TO STUDS — 1" DOW BOARD R- 19 Floor 3 5 B" FIBERGLASS STAPLED TO JOISTS R- 13 27. MISCELLANEOUS: (Describe any main dwelling materials, equipment, or construction items not shown elsewhere, or use to provide additional information where the space provided was inadequate. Always reference by item number to corresppond to numbering used on this form.) ATTIC. UPPER GABLE END LOUVERS SHIPLOOSE FOR SITE INSTALLATION �2" x 18 " 1 79 SO E'T FREE AIR SPACE EA Fi HARDWARE: (make, moli&6 1, and ilnish.) FRONT & REAR DOOR LOCKSr KWICKSETj KEYED ALIKE . BEDROOM AND BATH DOORS ARE DARAVAN C- 3 WITH PRIVACY FEATURE . SPECIAL EQUIPMENT: (State material or make, model and quantity. Include only equipment and appliances which are accept- able by local law, custom and applicable FHA standards. Do not include items which, by established custom, are supplied by occupant and removed when he vacates premises or chottles prohibited by law from becoming realty.) PORCHES: TERRACES: GARAGES: WALKS AND DRIVEWAYS: Driveway: width 20 ; bast material RUBBLE ; thickness "; surfacing materiel thickness Front walk: width material thickness '". Service walk: width ; material thickneaa Steps: material ; treads risen " . Cheek walls OTHER ONSITE IMPROVEMENTS: (Sped aft tweriar ansete improvements +roe described rfsemRtn, incfsiding ittnar such as unusual grading, drainage structures, retaining walls,fence, railings, and aecrssdry structures.) LANDSCAPING, PLANTING, AND FINISH GRADING: Topsoil." thick: ❑ front yard: [3 side yards; ❑ rear yand to feet behind main building. Lawns (seeded: sodded, or sprigged): M front yard ar.r ; ® side yards r r.r rear yard 30 , Planting: ❑ as specified and shown on drawings, ❑ as follows: Shade trees, deciduous, " caliper. Evergreen trees. to ". B do B. Low flowering trees, deciduous, to Evergreen shrubs, ' to ", 8 Ik B. High-growing shrubs, deciduous, ' to Vines, 2-year Medium-growing shrubs, deciduous, ' w Low-growing shrubs, deciduous, . to IDRI'MFICATION.—This exhibit shall be identified by the signature of the builder, or sponsor. and/or the proposed mortgagor if the latter is known at the time of application Date Signature Signature FHA Foam 20DS VA Form 26-1832 li GPO : 1976 0 - 210.069 I