1986-271 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
1 pate October 10 19 Br� /�\ -12
Theis to certify that work requestedtobe done asshown by Permit No. 36-271
has been completed.
One-Family Dwelling
This structure may be occupied asa
Location Lot 564 Fox Hollow Lane (St. No. 41)
Brian Custer
Owner
By Order Town Board
TOWN OF QUEENSBURY
leete4L( ii!, Zee',
Building & Zoning Inspector
it
1. BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-271
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Brian Custer
OWNER of property located at Lot 564 Fox Hollow Lane (St.{I41) Street, Road or Ave.
in the Town of Queensbury,To Construct or place a
One-Family Dwelling m
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.
t. OWNER'S Address is 10 Hummingbird Lane er
Glens Falls, New York ro
2. CONTRACTOR or BUILDER'S Name
Whalen Const.
r
-o
rt
3. CONTRACTOR or BUILDER5Address rn
West Fort Ann, N. Y.
0
4. ARCHITECTS Name
O
5. ARCHITECTS Address It
cnn•
rt
6. TYPE of Construction-(Please indicate by XI
oa
14 Wood Frame ( 1 Masonry ( )Steel ( )
7. PLANS and Specifications ._.
601x34r per plot plan, specifications and application submitted
No. including two-car attached garage and sewage system.
m
8. Proposed Use One-Family Dwelling g
w
4
$5.00 C/O Paid
171.00 PERMIT FEE PAID -THIS PERMIT EXPIRES January 1 19 87 r
a. h
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the 7
town of Queensbury
ry before the expiration date.) coo
Y IC
Dated at the Town of Queensbury this'7,yt 3rd June 86
Day of/� 9 19
SIGNED BY )�7 � f.La for the Town of Queensbury
Building and Zoning Inspector
5 if' 0 TO BE COMPLETED BY BLDG. DEPT.
C7 // _Application No.
✓Own of gQueendbury Permit Issued 19
BUILDING and ZONING DEPARTMENT permit Expires 19 �TO1W(�N OF(� QUEENSBU.T'
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation d LL LS l� (j V' Ie: (�-1
Oueensbury, New York 12801 Variance No. c:, tl IY Lo U
-7 —1 3/ Site Plan Review No. � /7� .� L � ��y�"�Q�
/ ! — /"- I Approved by: AM Pdry�yR��f.�91171. 4 .PM
APPLICATION FOR 7I3191? L11121314I5Ie
h'
BUILDING AND ZONING PERMIT —
* * * * • a * * * * • • • ♦ * * * * * * * * * * * a * * w * * r ♦ ♦ n * 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 indicateda� on the Permit. /Q
The owner of this property� yI is: tr P*" VAQ $ 'e \(a � 45f'ea-
P.o. Address 10 1TIAVNwP, nJ'142✓ Laps-L 9 Tel. 7q - I2-K0
Property LocationrLR Fo)( 140LLw o 1--lJ ' mar S414 Tax Map No. 77 / / / L 31
Street number or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE TOR SUPERVISI?pN OF WORK AS RFrARDS BUILDING CODES IS:
(A/InaLeN 1 c s+ lit- F)- A- 73, Pica . la3-.507 %
Name II /I P.O. Address . I Tel. No.
Name of builder ((11!10Li 1-, /xlc1?5 F Address Wr F1- A .}, Tel. '14 3 - so-n
Name of plumber 7j Gl� G,oT- 1'(.' Address Cokafp y0(, ,� e... Tel.
Name of mason LA", &)1 „Jir7 Address Oh I N A/ Tel.
NATURE OF PROPOSED WORK: ZONING INFORMATION:
X 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
FOR DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot. Show location
of water supply and location and configuration
LOCATION OF STRUCTURES AFFECTED. *
of septic disposal area.
*
* COMPLETE INFORMATION REQUIRED BELOW.
* Size of property /sqx apt ft XJ(1,O p)3ft.
* Existing building(s) Size ft X ft.
*
PROPOSED BUILDING AND USE:
p „ * Existing building(s) Use 620,r( $ 28 e
S' - - : . .-w structure 6D,O' ft X *
Foundatio, pier/slab/crawl/partia f* Proposed building, distance from property line
(circle one)
No. of stories (habitable space) 2 *• Front yard 30 ft Rear yard /Q� ft
Height (grade to ridge) a 6 / ft. * Side yards 5-0 ft and J ft
* If on corner, setback from side street NJ4- ft
If residential, no. of families
No. of rooms(excluding ba,t.hs) /f * OCCUPANCY INFORMATION
No. of bedrooms rf *
No. of bathrooms 3 * PR14ARY BUILDING -
Primary heating system G/15 I4/CT hynott * 1' -"-e family dwelling
of fuel * Two family dwelling
Type4-s Multiple dwelling / Number of units
No. of fireplaces to be installed I * Permanent occupancy
Will a wood stove be installed? ('(D *
** _Transient occupancy
Central Air conditioning? N Business
BUILDING STYLE, PRIMARY STRUCTURE * _Industrial
Ranch Contemporary Log cabin * Other
* If addition, what will use be?
Raised ranch Mansion Duplex
Split level Old style Bungalow *
Ca•- d Cottage Other * ACCESSORY BUILDING-
Row Town House * Detached garage/one car/ t.,• car
CIRCLE ONE PLEASE ) * ✓Attached garage/one car/
/ car
* * * * * * * * * * * * * * * * * * _Private storage building
ESTIMATED MARKET I7ALUE O * Other
CONSTRUCTION $.. /gth��
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, .od frame fire safe,etc.
Will any second-hand or ungraded lumber be used? If so, for what?
100
Foundation wall material 10 T3�.[r.K Thickness to''
Depth of foundation below grade (to bottom of footing) Fa"
Will there be a cellar?*s Heated or unheated? /00 Floor sq. footage 024W sq ft
Will there be a basement? (.40 Will any portion be used as living space? 1J0
(If so, what portion? sq.ft. - - Type of use? I II Type of roof - ope flat/shed/other Material of roof F�6cp G[icc Sh ihy bre
Size, wood studs "X 4 " spacing IL, "o.c. length Q ft. �i
Joists(floor beams) 1st. Floor ,2 "x 10 " spacing 1 (, "o.c. span (3'"/ ft.
Joists (floor beams) 2nd. floor E "X in " spacing /(, ' "o.c. spanT5F47Tft.
Overlays(ceiling beams) "X " spacing "o.c. span ft.
Roof rafters L '•X� " spacing o.c. span ft.
trusses(pre-en ineered s L
` f 4 pacing q'�C� "o.c. span(, ft.
txters.,s wu11 nish 4 A L 10-
,v-L Of what material? 7,1\,-e_-
Interior wall finish )1(7-
If a garage is to be attaphed, degcrl)F materials to be used for FIRE SEPARATION:
sls" Y1 .c_
Is there to be an opening between garage and dwelling? yts If so will a Fire-rated
door, enclosure, and self-closing device be provided? U.s
Will a flue-lined chimney be installed? '?es Height above roof Z ft.
Depth of chimney foundation below grade gjd ft.
Depth of fireplace he h A ft.,2(, in.
Water supply - unicipal or private well
SEPTIC SYSTEM Distance from ANY private well(including adjoining properties (p0 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 YORX
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 MW ,n/CQ La- 14 lE/ —'
Owner, owner's agent,arcnirect,contractor
/.S day of „5 19 8V
Notary Public, Warren County, N.Y.
* * * * * * * * * * * * * * * • * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT:
By L '3
Jown of Qufenslury APPLICATION FOR SEPTIC DISPOSAL PERMIT
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98 /-
Oueensbury, New York 12801 DATE s//�/ lc&
LOCATION OF PROPERTY FOR INSTALLATION �1.0 fox rfCYGoct2
I„
OWNER'S NAME m k MArs �jro-,.I ( fi S'1'er CC`�
ADDRESS /O {�wm MI Ali 134 J q TEL 3/ 3 '4? fto
INSTALLER' S NAME j4,; 5 TEL TEL -iN)!
Number of bedrooms(residential only) I Total daily flow(compute @ 150 gal per bedroom) Goa
Topography: Rolling - Steep slope - (circle one) % of slope_
Soil nature- - Loam - Clay - Other Depth_ ft.
Ground water -At what depth? 4I+ ft.
Bed-rock or imperviou at rial - At what depth? .1.0 ft.
Percolation test - Not require - Required - -Rate min-inch.
Domestic water supply Municipal Well - Other
Separation - Watersupply(if well) from Septic absorption /01) ft.
Proposed System: Septic tank /ttO gal. ( Minimun size, 1000 gal. )
Tile Field - Each trench $D ft. Total system legnth ;.,y - ft.
Seepage pit(s) Number of _pp- . Size each Affkft Xft /
Size of stone to be used # Depth or thickness - ft.
h
IMPORTANT ! ! *4 *
On a separate piece of paper, submit a diagram of the proposed system
with all dimensions shown; including distance from any structure ,
distance from property lines and from ANY DOMESTIC WATER SUPPLY or
shore-line of lake, stream,pond or wet-lands . Include all dimensions of
the system, itself .* # * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
I have read the regulations on the reverse side of this sheet and agree
to abide by these and all requirements of The Town of aueensbury
Sanitary Sewage Disposal OrdinanceT �1,, � k/'
Signature of responsible person y_�"`�(� LA-44 '^'
Date S/IS/“,
05/86 and/vl
Section II Septic System Inspections:
A. All applications for septic system installation,
alteration or repair, as required by the Town of
Oueensbury Sanitary Sewage Ordinance, shall be
submitted to the Buildina 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 Oueensbury Building
Department before further construction.
TOWN OF QUEENSBURY
• WARREN COUNTY , NEW YORK
i
1 Application for : BUILDING PERMIT IN COMPLIANCE UITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work.
ANSWER ALL of the following: //,,
1 . Gross floor area GVEd
2 . Type of heat /y/}5 • 4/ (,JQ T[✓e ;?:/ '
3 . Is the building mechanically cooled? NO
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 _
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
R - a }
2 . R value of exterior walls �1R -Ti
3 . R value of glazed area 2 , 9(
4. R value of doors /I 1 5 . R value of floors over unheated spaces k - II
6. R value of slab edge insulation - unheated slab (Z - II
7 . R value of slab insulation - heated slab 114
8. R value of heated basement/cellar walls (above grade) /1-/3
9 . R value of heated basement/cellar walls (below grade) Q •Il
10. Type of insulation (L(n(r((D/ cimtf GLtfs
C. Controls / p
1 . Thermostat maximum heat setting 53S
D. Duct Systems
1. Is duct system installed in unheated spaces? NO
a. If YES , R value of duct installation 1(
b. R value of duct in other areas team,
E . Piping Insulation 1
1 . Size of hot water or cooling carrying agent pipe 3
2 . R value of pipe insulation 12' 1 /
F. Service Water Heating
1 . Performance efficiency
2. Temperature control setting maximum Pi So
C. For Swimming Pool Only
1 . Maximum7 - % �(/
heating nnJ/!�// II
Telephone No. -?"1// ' 71,iSk Wi ---
(applicant ' s signature)
7 ;iIQQ
eregiaKW° // "
Yw �own of Qeensbury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R.D.
Oueensbury, New Yo12801
Re; rise ectlb.h ft/..
BUILDING INSPECTOR' S REPORT
CA Cr<
NAME rl (
LOCATION Lp"r At o Ho /a W h„.„
,
Dao '„ /�_ Permit No.2.(� . —
* * - * * * x + * * * ** * * * * x * * - YES NO
* * * �/ = APPROVED
Footing/Pier Forms i
Foundation _
Waterproofing 111111_
FBraming
_
Framing _
Roofing _
Siding _
Masonry Pluming
Rough Plumbing
11111
Relief Vrch _
K Ext. hed Fl
0111
es
Fnnerior Floors .
Interior Trim
MPS
`(Cell 6 Railings
Cellar Drain Tile Mill
Concrete Floors _
Fixtures aI .
Gar. Fireproofing yDoor Closersoke yetectoChimney
INundaTIOI
Fo
undationFloors
Walls
INAL CAL INSPECTION
Iwo
FINAL ELECTRildiI Survey..
Building
� leX ection(call when ready)
Next scheduled Insp
Remarks- -
Heed EL. ^ ` ,
Building Inspect
6/B6 and-v1
41/lldG a � '"
down o Quee„s6u,y
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
C/a jns,pcerldh
BUILDING INSPECTOR'S REPORT
NAME /- (,r'n CUS16-
LOCATIONwi`e
Datej2 fib. Permit No. G "a 2
* * * * * * * * * * *= * * * * * * * * * * *
V/ = APPROVED - YES NO
Footing/Pier Forms I
Foundation
Waterproofing
Backfill
' Framing 1121
Roofing
Siding _
Masonry Veneer _
Rough Plumbing rI
Relief Valves _
Ext. Porches IMPFinished Floors w_
Interior Trim _
Stairs & Railings _
Cellar Drain Tile _
Concrete Floors plbg. Fixtures __
Gar. Fireproofing _
Door Closers
Smoke Detectors =:
Chimney
INSULATION:
Foundation _�=
Floors
Walls —=_
Ceiling
FINAL ELECTRICAL INSPECTION _
Final Building Survey
Next scheduled Inspection(call when ready)
Remarks- -
No 5-rea15- ger T-10 °ooK-
I3L-hrc Ooolt
CtriAGG Oo0K,
Bui ding maps for
6/86 and-vl
1Ib
4'
Jown of Queenilury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R.D. 1 Box 98
Oueensbury, New York 12801
BUILDING INSPECTOR' S REPORT
NAME Cuirc
LOCATION rustl401/ew
Datej. /2AL_ permit No. `L /
* * * * * * * * * * * * * * * * * * * * * * *
1/ v APPROVED - YES NO
Footing/Pier Forms _
Foundation
Waterproofing _
Backfill ��
✓Framing f'}���1' +�M
Roofing
Siding
M$sonry Veneer
✓ ough Plumbing i�vtnig1iall=
Relief Valves _
Ext. Porches
Finished Floors _
Interior Trim _
Stairs 5 Railings _
Cellar Drain Tile _
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing _-
Door Closers
Smoke Detectors 111110
Chimney WM
INSULATION:
Foundation
=;-
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION _
Final Building Survey
Next scheduled Inspection(call when ready)
Remarks- - J f n _ .
Building Inspector
6/86 and-vl
c7
Jown of W(ueenaury
BUILDING and ZONING DEPARTMENT Ili
Bay and Haviland Road, R.D. 1 Box 98 I
Dueensbwy, New York 12801 I
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME aOr F // STtinD —
LOCATION
DATE t_l___134
SanPERMIT N0. QGSCILE - Sand - Loam - Clay -_
Percolation Test Required? YES - NO
Percolation rate - Min/Inch _
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches�-
Size of gravel_
SEEPAGE PITSENumber of) _�-
Size- ft. X __ft. — ____---
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box __
Dist. box to field/pit __
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS: ft.
Foundation to tank —ft
Foundation to absorption f
Absorption to lot line t.
Separation of pits
LOCATION OF SYSTEM ON PROPER ')circle rcle Clue-1-
Front - Rear - Left side - ' 9
-
CCMIENTS: a,,e,/�/j -
A
U ; /
NO
SYSTEM USE APPRO i `
Building Inspector
01/86 and vl
lib
' h -flown of Queenalury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME t1 1/1--,i/ (c) 5
LOCAT I ONE LC Q v /-
DATE / PERMIT NO. A (Y �J
SOIL TYPE - Sand - Loam - Clay -_
Percolation Test Required? YES - NO
Percolation rate - Min/Inch -
TYPE of SYSTEM: r
Absorption field, total length- —
Length of each trench clor
Depth of trenches
Size of gravel_
SEEPAGE PITS{Number of) ______—
Size- _ft- X _—ft-
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS: ft.
Foundation to tank ft.
Foundation to absorptio ft.
Absorption to lot line ft.
Separation of pits
LOCATION OF SYSTEM ON ROPERTY(Circle one)
Front - Rear - Left side - Right side -
COMMENTS:,4 6n—
a_ 6e/ pim
recr—
SYSTEM USE APPROVED YES N/
Building Inspector
01/86 and vl
/6a9
TOWN OF QUEENSBURY
Building Department
Specters Report
Date 6/3/0
Name Cu57-E12_ 2y
Location my ADOL(/aM)
Permit No. 4(0 - & i Weather
Remarks
Excavation
Footin• Forms
Footin. & Piers Ad /
Foundation
Cement Coat
Water.roofin•
Backfill
Final Surve
Framin•
'.. Sheathin.
Roof Felt VIM
_
Siding -
Masonr Veneer
Rou•h P1.•.
Relief Valves
Wall Board
Ext. Porches
Finished Floor
Interior Trim
Stairs & Raili •s 4
Cellar Dr. Tile
Concrete Floors
Pl.. . Fixtures
Gar. Fire.roofin,
Door Closers
Chimne
Water Meter Inst.
Se tic A royal
Floors
Foundation
Insulation Walls
Ceiling
Building Inspector
REMARKS
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