1986-266 i
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date September gb
This is to certify that work requested to be done as shown by Permit No. 86-266
______________.
has been completed.
This structure may be occupied as a One-Family Dwelling
Location Lot 4 ant Acres - Pickle hill Road
OwnerPaul and Deborah Davidson
By Order Town Board
'') TOWN OF QUEENSB RY
Building & Zoning Ins for
BUILDING PERMIT
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK NO' 86-266
PERMISSION is hereby granted to Paul and Deborah Davidson
OWNER of property located at Lot 4 Grant Acres - Pickle Hill Road Street,Road or Ave.
in the Town of Queensbury.To Construct or place a One-Family Dwelling
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. ro
I. OWNERS Address is
48 Canal St.
Fort Edward, New York 12828
0
2. CONTRACTOR or BUILDERS Name
tY
William Davidson
m
t7
3. CONTRACTOR or BUILDERS Addressm
197 Sherman ave.
Glens Falls, New York
4. ARCHITECT'S Name
r
ro °
n
5. ARCHITECTS AddressA' c
m 0
xw
W rf •
Y rt
6. TYPE of Construttion—IPlees indicate by XI .NY n
o
Ixl Wood Frame ( 1 Masonry 11 Steal ( I a m
7. PLANS and Specifications
28'x54' per plot plan, specifications and application submitted
No. including one-car attached garage and sewage system.
B. Proposed Use m
One-Family Dwelling 1D
$5.00 C/0 Paid
$ 110.00 PERMIT FEE PAID-THIS PERMIT EXPIRES December 1
Ora longer period is19 86 m
required anhe ationfor an extension must be made to the Building and Zoning inspector of the p'
town of Oueensbury before the expiration date.)
Dated at the Town of Queensbury this 28th Day of May [9 86 cc
SIGNED BY 7Os/ K Ne
ac I for the Town of Queensbury
Building and Zoning nwector
glieffile NW TO BE COMPLETED BY BLDG. DEPT.
Application No.
.7own of Queenshury Permit Issued 19
BUILDING and ZONING DEPARTMENT Permit Expires 19 TOWN OF QUEENSRUIRY
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation (� I' i�' U t E rl
Oeeensbury, New York 12801 Variance No. W c El
,, // Site Plan Review No. MAY 1 9 198O
a —7 — T — 4+ Approved by: A.M. /� �4��--� !a P.M.
APPLICATION FOR 71819r10 '911213141516
BUILDING AND ZONING PERMIT
* * * * * * r • r • a • * * * * * r ♦ * * * * * * * * i • * r • r • * w ♦ •::r
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.
(1-?*The owner of this property is: ``/'` L . `/% Be(1-?* ick c),/a ,./ ,C..Xj
P.O. Address 4 CA .a AC- � 'fir,.
G r
T. . �S , T S-A\.-.e.- J:'.ID I ' I, Tel. t�1 42.�F
,
Property Location: L07Y 4 , Gcwa7 ) "c ' Q.Lkks. V-ViV Tip; GF, t•-r:1 , Tax Map No. / /
Street number or building lot number
Subdivision name (if applicable) (-Jt.+,..a- Af,,1-i
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS p BUILDING CODES IS:
` J J`'- 1 G ctf-to ks J'.4. 19'y'J • 5y 14
W'.kl ul. Lea Y ,i)'.; J ` l� � �tir...-0
Name P.O. Address 1 Tel. No.
Name of builder ` . v.iic -.) b..+iT• Address )1-1 a-el-IN-Mat I Li- C:F Tel. 1r11)'337-A
Name of plumber Address Tel.
Name of mason U4.a ' C 4&a Address SH`.nn..n Aut , r;. F • 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) * set-back dimensions from property lines. Give
* street and number or lot number and indicate
* whether interior or corner lot. Show location
FOR DEMOLITION PERMIT, STATE SIZE AND * of water supply and location and configuration
LOCATION OF STRUCTURES AFFECTED.N I M * of septic disposal area.
* COMPLETE INFORMATION REQUIRED BELOW.
* Size of property 2 a ft X 20`l� ft.
* Existing building(s) Size ft X ft.
* !Jp•o C_
PROPOSED BUILDING AND USE:
* Existing building(s) Use
Size of new structure 24 ft X )aft * 1J o'a S
Foundation-pier/slab/crawl/Partial/full * Proposed building, distance from property line
(circle one) * Front yard I pQ ft Rear yard (fr g ft
No. of stories (habitable space) * Side yards /pp ft and / 3�J ft
Height (grade to ridge) _)C %r ft. * If on corner, setback from side street ft
If residential, no. of amilies
No. of rooms(excluding baths) * OCCUPANCY INFORMATION
No. of bedrooms *
* PRIMARY BUILDING -
No. of bathrooms / %2 * ,/One family dwelling
Primary heating system F/iEG- * Two family dwelling
Type of fuel * Multiple dwelling / Number of units
No. of fireplaces to be installed j * permanent occupancy
Will a wood stove be installed? !v o _Transient occupancy
Central Air conditioning? IV J ** Business
BUILDING STYLE, PRIMARY STRUCTURE * _Industrial
Other
Ranch Contemporary Log cabin * If addition, what will use be?
Raised ranch Mansion Duplex
Split level Old style Bungalow *
(tape Cod ) Cottage Other * ACCESSORY BUILDING-
Colohial Row Town House Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * Attached garage/one ca two car/ car
* * * * * * * * * * * * * * * * * _Private storage building
ESTIMATED MARKET VALUE OF Other
CONSTRUCTION $ is *
tied
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
..r WOO
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc.
O w hat?e�..LE.
Will any second-hand or ungraded lumber be used? If so, forr what?
NU
Foundation wall material Ca 1..)C 2 ('? �I
Thickness 3
Depth of foundation below grade (to bottom of footing) 11- p .
Will there be a cellar?y tS Heated or unheated? Floor sq. footage (45{4. sq ft
Will there be a basement? Will any portion be used as living space? 1JU(If so, what portion? sq.ft. - - Type of use?
Type of roof - sloped/flat/shed/othersLuf[ Il Material of roof 4t"40114'1*.,... *'Fill I Ik144u-ir
Size, wood studs ` "X to "o.
" spacing c. length g' ft.
Joists(floor beams) 1st. floor ''K-�"cvz�
Z. "X y() " spacing o.c. span 2�'/ft.
Joists (floor beams) 2 floor "X /n spacing "o.c. span ft.
Overlayg(ceiling beams) Z "X At
spacing I "o.c. span ft.
Roof rafters 'L "X /o " spacing J(' o.c. span ft.
Roof trusses(pre-engine ed) spacing "o.c. span ft q �� ...��,�/ �
Exterior wall finish CD,n Of what material? r'1 Woot% 5.140 lvttsUa
Interior wall finish -bey L 3k( 1
If a garages to be attached,
(describe maateri�alls�to be used for FIRE SEPARATION:
7t if
Is there to be an opening g Between garage dwelling? (br If so will a Fire-rated
door, enclosure, and self-closing device be provided? /_J (�c
Will a flue-lined chimney be installed? Height above of of ft.
Depth of chimney foundation below grade ft. v„-v -w " Ak4 �_
Depth of fireplace hearth ft. in. E�ti‘-ttd,_i
Water supply - Municipal or private well ?n w 6Vt ‘-(--"A‘
SEPTIC SYSTEM Distance from ANY private well(including adjoining properties (11: ' F ft.
(A separate application is necessary for any repair or new installation of septic system)
Town of Queensbury
County of Warren AFFIDAVIT STATE OF NEW YOAK
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 �-,S19,S ^_ `1 Li Q.t.. ICI .
Owner, owner's agent,arcni ect,contractor
day of 19
Notary Public, Warren County, N.Y.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT:
1
By
awn of Queenilury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL PERMIT APPLICATION
Owner' s Name VA.�l- G. -ptF. '1-4W I/11JkIN\---) Tel. 141- 42.04-
Address 4`b CS-3 '. h-T- , tT„T ft -WI " D t qJ>A,
Person/Firm installing system .Q.5.06 i4ow Ant) LXCAv .., 4i.r D 4o..) la kk\ (J*
Number of bedrooms(residential only) 3 A
Total daily flow: (compute @ 150 gal.per bedroom per day)_ 4-S D
Topography: flat - rolling - steep - (circle one) Degree of slope y
Nature of soils: sand loam-clay other- Deptha_,20 ft.
Ground water-- at what depth? KA ft.
Bedrock or impervious material--at what depth? t' ft.
Percolation Test - Not required f Re• 'red S q - 'O min/inch.
Domestic Water Supply - Municipal 0- Other
IMPORTANT!
On a separate piece of paper, submit a diagram of the proposed septic
system with all dimensions; including distance from any structure,
distance from property lines and distances from any domestic water
supply or shore-line of lake, stream, pond or wetlands. Include all
dimensions of the system itself.
Description of proposed system:
Septic tank size /044 gal.
Tile field- Lengt of each trench_ 5 ft. Total field..23D ft.
Size of stone 9
Seepage Pit (s) Number /F{A-/ Size ftX _ft. Size of stone#
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 Town of Queensbury Sanitary
Sewage Ordinance.
" - In .----1
Signature of Appl ant Date
TA !), D St __, Oti s j rw •_-c-N•->
01/86 and/vl
Septic System Inspections:
A. All applicationd for septic system installation,
alteration or repair, as required by the Town of
Oueensbury Sanitary Sewage Ordinance, shall be
submitted to the Building Department at least
24 hours before start of construction and shall
include a plot plan showing:
1) the proposed location of the system
2) location and distance to lot lines
3) location and distance to structures
4) location and distance to any water supply
5) size and dimensions of all tanks, distribution
boxes, tile fields and/or drywells
B. No system shall be covered before inspection and
approval by the Building Inspector. Failure to
comply with this requirement may result in the
uncovering of the system by the ,installer and a
fine of up to $250.00.
C. An approved copy of the plot plan shall he
available•on the construction site. Failure
to produce said plot plan at time of inspection
may result in an immediate work stoppage.
D. Should unforeseen problems during construction
prevent proper installation, alteration or
repair of an approved system, a new proposal
must be submitted to the pueensbury Building
Department before further construction ,
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 following: nip, /
1. Gross floor area ! ) p ]
2. Type of heat QL•L.C'rn+c.
3 . Is the building mechanically cooled? 1‘.-) U
4. Percentage of area of windows and doors
A. Over 16% Only
1. Uo value of gross area of walls , roof/ceiling and floors
exposed to ambient conditions
2. Floor over heated spaces YES NO
a. Are foundation walls insulated? YES NO
1. 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
B. Under 16% Only
1. R value of roof and floors exposed to ambient conditions
2%
0 �1 " W1k ,c. eF-`-
2 . R value of exterior walls 1I1A , Lu Fe,,C-nn'3 iT t Z )A•` Ito\y
3 . R value of glazed area 9. e
4 . R value of doors /y Y
5. R value of floors over unheated spaces a -a
6. R value of slab edge insulation - unheated slab NO
7. R value of slab insulation - heated slab
8. R value of heated basement/cellar walls (above grade) r
9. R value of heated basement/cellar/ walls (below grade) 24)/
10. Type of insulation f.-VAAY / 'PISEQ6LASf
C. Controls ( p
1. Thermostat maximum heat setting qs
D. Duct Systems
1. Is duct system installed in unheated spaces? YES m
a. If YES, R value of duct installation
b. R value of duct in other areas
E. Piping Insulation �
1. Size of hot water or cooling carrying agent pipe '-j'
2. R value of pipe insulation Q ' a
F. Service Water Heating
1 . Performance efficiency
2 . Temperature control setting maximum Iys o
G. For Swimming Pool Only
1 . Maximum heating N 'Ca
y I 11
Telephone No. ��13 S 3 LA_ . , \�1�1-�-.?.•-• L lJ `(applicant ' s sature)
/ THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
polg / 41 STATE STREET.ALBANY.NEW YORK 12207
gAiri116, 1937 Application No.an file 012755/06 A 682967
THIS C'RTIFIES THAT
only thbelow en
d equipment as described below introduced by the applicant named on the above application number in the premien of =
'l Paul Davidson, Pickle Rill Road, Queeusbury, New York
in Pitfollowing beatn ,SBasement E 1st F1. El 2ndFt. Outside Section Block Lot
ties ea'omined on � .. ondfou.sd to be in compliance with the requirements of this Board. ,
FIXTURE E[QrthOEf EWITCNES FIXTURES wwpry RANGES COOEINGO[CR, OVENS DISH WASHERS EXHAUST FANS
E.
OURRS IIKaMCfXEM fIUOREXFm ynp MM.. [.W. chef. [.W. W.I. [.W. .W.I. L W.' .W.T. M.R —
26 47 21 24 2 \ 3 4
DRYERS FURNACE MOTORS NINO AIRIANCE NWUIIS SPECIAL RECer RMEC/OCRS aW UNIT HUMS MISInTOIDIET , commis
_
Ml. [.W. Olt H.e. PAS H.r. MU. NO. ♦.w o. WT. M1r Wr MPS. TEANE. Wr. H.r. yp.a�T Wr M'Am
1 Kange li6 1 =
1 Dryer il1U =_
- SIRVIC DISCONNECT NO.01 1 IIWT S B10 e R ``�� V I C E \
MT. AM. ! ME tour.. 111W I I'M' 113W SpeW Ho'6ficoto. Of CGCp1a. NO OF HI.ISG ai X4o NO.Of*Muss \eltarnM
1 200 CO 1 x 1 4/0 1 2/4)
OD ER AMILOUE \ E.
\ —
1- CPC I. r1
1- Smoke /03[ectar ,J
Electric/',Eater's:3- 2.0 KW
4- 1.5 KW
i 4- 1.0 KW =
_ 3- .75 KW ,J
- William F. Davideen M (� / I
_ 197 Sharon Avmu.t a/
glens Fails, New lurk 12801 / le
BRANCH MANAGER
PE
I X j IQ/
! Per ,% I
This/certificate must not be altered in any manner;return to the office of the Board if incorrect. Inspectors may be identiRid by,..their credeMiah.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALI tRED IN ANY MANNtN,
. own of Queene1ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
'/'n Oueensbury, New York 12801
_
/t'vf
BUILDING INSPECTOR' S REPORT
NAME T1 —(�7/r//J
LOCATION 4r .G ��"'
Date .23/ DY' permit No. bV- add
140,
* * * * * * * * * * * * * * * * * *
!�` ✓ = APPROVED - YES NO Footing/Pier Forms ' _
Foundation
Waterproofing
Backfill
raining
-
frog
iding _
Masonry Veneer _
111111 ugh Plumbing Vallief Valves ISM
t. Porches �a
iMaiF fished Floors
trior Trim tairs a Railings —
Cellar Drain Tile _
Qoncrete Floors -=G..a
�'V/7�lbg. Fixtures
r. Fireproofing
or Closers __MS
Smoke Detectors
Chimney
'-fundation:
o IMMO
Floors
Walls _
ding
L/FINAL ELECTRICAL INSPECTION 672,7y
Final Building Survey r
Next scheduled Inspection(call when ready)
Remarks- -
l a , 9/) . Tb
4
Building Inspector
6/86 and-vl
\V3B J cc77 own of Queendtury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 CI eensbury. New York 12 01Bo 98
SEPTIC DISPOSAL SYSTEM INSPECTION
NoME.
LOCATION
/ PERMIT NO. 3In-2�n�
DATE Gkl)
SLoam - Clay -
PeIcLolt - S Required? YES
Percolation est
Percolation rate - Min/Inch _________
TYPE of SYSTEM: total length n
Absorption field, �.g
Length of each trench
Depth of trenches__ _________
Size of gravel_
SEEPAGE PITS{Number of) _____-----
Size- ft. X ft.
Gravel size Size Type
PIPING: r. e
Bldg. to tank
Tank to diet. box r
Dist. box to field° NO Partial
Openings sealed? J/
LOCATION/SEPARATIONS: f
Foundation to tank `fib fit•
Foundation to absorption '
Absorption to lot line ft
Separation of pits
LOCATION SYSTEM ON PROPERTY(circle one)
Front
ear - Left side - Right side -
DS •
O a
6-2A-LA" dt" tit:a jaisr_
trje
SYSTEM USE APPROVED Y
O
N-CA
Build ng In ector
01/86 and vl
awn of Queendbury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
BUILDING INSPECTOR' S REPORT
NAME b- �Sc
to rY6 ra"x Or.--.)
LOCATION P i c
Date 7/ )/ /b4 Permit No. $'t
* * * * * * * * * * * * * * *
* • * * •
✓ = APPROVED - YES NO
Footing/Pier Forms
Foundation _
waterproofing _
Backfill nr7
✓Framing Roofing _
Siding _
Masonry Veneer
y Rough Plumbing
Relief Valves _Ext. Porches _
Finished Floors _
Interior Rai I
Stairs & Railings
Cellar Drain Tile -1111111
-=' Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door ClosersaS
Smoke Detectors
Chimney ■
' INSULATION:
Foundation
Floors _
Walls _
Ceiling _
FINAL ELECTRICAL INSPECTION
Final Building Survey
Next scheduled Inspection(call when ready)
Remarks- -
I A/I/tl ' 1wA
Bui ding Inspector
6/86 and-vl
TOWN OF QUEENSBURY
Building Department /
Inspectors Report Date s4o7B6
Name �1�V1'D56N
' Location fr,p X •S ,4 <,'Qb
' Permit No. SG- -766
Remarks
Excavation
Footin• Forms
Footin• S Piers
Foundation i
Cement Coat '�,=
Water•roofin•
Backfill
Final Surve
Framin•
Sheathin•
Roof Felt
Roofin.
Sidin•
Nasonr Veneer
Rou•h P1•• .
Relief Valves
Wall Board
Ext. Porches =r
Finished Floor
Interior Trim Stairs S Railin•s
�-
Cellar Dr. Tile
Concrete Floors .—
Pl.. . Fixtures
Gar. Fire•roofin•
Door Closers
Chimne
Water Meter Inst.
Se.tic A• •roval
Floots
Foundation
Insulation Walls
Ceilin
Building Inspector
REMARKS
o®f ,e O
TOWN OF QUEENSBURY
Building Department
Impedes Report Date 3=a 3
Name
art Sn
• location hid L, /nn
' Permit No. A - 26 G Weather
Remarks
Exca(fation
Footing Forms (/ [/, K t
Footing s Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Floors
Insulation Foundation
Walls
Ceiling
Building Inspector
REMARKS