1986-500 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date October '6 19 4.
87 __.. --
cQ ��i- S�
I 86 500
This is to certify that work requested to be done as shown by Permit..No.
has been completed.
This structure may be occupied as a ADDITION TO DWELLING (PORCH.AND SUN ROOM)
Location FOREST ROAD, ASSEMBLY POINT
GERALD. A. KILLEEN
Owner
By Order Town Board
TOWN OF QUEENSBURY
Building$ Zoning Inspector
,.-� . BUILDING PERMIT
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TOWN OF QUEENSBURY No. 86-500
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Gerald A. Killeen
OWNER of property located at Forest Road, Assembly Point Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Addition to dwelling (sun room/porch)
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 P. 0. Box 1316A
Lake George, New York 1-1
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2. CONTRACTOR or BUILDER'S Name
Leo Galley H.
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3. CONTRACTOR or BUILDER'S Address
Hopewell Road
Marlton, NJ
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( ) Steel ( )
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7. PLANS and SpecificationsH.
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12'x26' per plot plan, specifications and application submitted.
No.
8. Proposed Use
One—Family Dwelling (porch/sun room addition) ,41
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$5.00 C/O rH.
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$ 16.00 PERMIT FEE PAID —THIS PERMIT EXPIRES March 1 19 87 0 oo
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rt
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town of Queensbury before the expiration date.) 'U
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Dated at the Town of Queensbury this 18th Day of August 19 86 v
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SIGNED BY Maxit ._l . rd for the Town of Queensbury °R
Building and Zoning Inspector Cell:41
`O TO BE COMPLETED BY BLDG. DEPT.
• 21 c� Application No.
sown of Queeniurcy Permit ssued 19 TOWN OF QUEE 'B UT<',
BUILDING and ZONING DEPARTMENT - Permit Expires 19 LE WJt� Ls U V (;
Bay and Haviland Road, R.D. 1 Box 98 zoning Designation A..R -' 1•4
Queensbury, New York 12801 Variance No. AUG 8 1
Site Pl.. eview No. f�
A.M. �1 f�b O.
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APProv by 70,13191 }12J112)g', �5jd
APPLICATION FOR < , + e t
94
BUILDING AND ZONING PERMIT
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * # # * * #
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.
(
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The.owner of this property is:6 �� j
P.O. Address f i d, .3lTik 1 -3/L 19" .4.41(0 .6-000VGfl/4,14— f g1StS el. gs-e 77
Property Location:' ft4' S7 i5'/), ,J.�4s0,/yf,QL po,l L Q J.
, Tax Map No. ' / 3 / /
Street number or building lok number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
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Name P.O. Address ,�! Tel. No.
Name of builder 1 Q Q /G�� Address � � r4)12'y �� d,,Tel- ‘a9 - 7 7 64,6;
Name of plumber / Address Tel.
Name of mason Address 1 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
FOR DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot. Show location
*
LOCATION OF STRUCTURES AFFECTED, of water supply and location and configuration
/-----
f�- ' * of septic disposal area.
*
* COMPLETE INFORMATION REQUIRED BELOW.
�� * Size of property 6 ft X (C)Oft.
* Existing building(s) Size ft X kW__ ft.
*
PROPOSED BUILDING AND USE:
* Existing building(s) Use
Size of new s ucture 111_,ft Xt *
Foundatiq er/ lab/crawl/partial/full *. Proposed building, distance from property line
*
(circle one) * Front yard ' -S(� ft Rear yard IC) I ft
No. of stories (habitable space)
Height (grade to ridge) `12--, ft. * Side yards (5 ' ft and r2,` ft
If residential, no. of families * If on corner, setback from side street ft
No. of rooms(excluding baths) * OCCUPANCY INFORMATION
*
No. of bedrooms
No. of bathrooms * PRIMARY BUILDING -
Primary heating system * 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? Transient occupancy
* Business
BUILDING STYLE, PRIMARY STRUCTURE *' Industrial
Ranch Contemporary Log cabin * --Other ' �p
Raised ranch Mansion Duplex * If addition, what will use be? • Ly �!lJ�/POaGIl�
Split level Old style Bungalow *
Cape Cod Cottage Other * ACCESSORY BUILDING-
Colonial Row Town House * ' Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) *" . Attached garage/one car/ two car/ car
* * * * * * * * * * * * * * * * * * Private storage building
ESTIMATED MARKET VAL E OF * Other
CONSTRUCTION $ g000
*
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, wood frame, fire safe,etc. WOOD
Will any second-hand or ungraded lumber be used? If so, for what? 3 O
Foundation wall material P/ Thickness
Depth of foundation below grade (to bottom of footing)
Will there be a cellar? Heated or unheated? Floor sq. footage sq ft
Will there be a basement? a) Will any portion be used as living space?
(If so, what po sq.ft. - - Type of use?
Type of roof - slop-d/fla /shed/other Material. -f roof •
Size, wood studs "X AA " spacing ! P "o.c. length ft.
Joists(floor beams) 1st. floor EXihh ' " spacing "o.c. span ft.
Joists (floor beams) 2nd. floor "X " spacing "o.c, span ft.
Overlays(ceiling beams) "X " p .c acing "o . span ft.
Roof rafters g "X I!, " spacing span J3 ft.
Roof trusses(pre-engineered) spacing Wjk. "o.c. span ft.
Exterior wall finish I V IYL ,S, P`w1e, Of what material?
Interior wall finish ` jL jr 1(LvLt` c� 70M --.
If a garage is to be attached, describe materi is to be used for FIRE SEPARATION:
Is there to be an opening between garage and dwelling? If so will a Fire-rated
door, enclosure, and self-closing device be provided?
Will a fluezlined chimney be installed? Heightababove roof ft.
Depth of chimney founda1tion below grade
Depth of fireplace hearth
Water supply - Municipal or priyte/well
SEPTIC SYSTEM Distance f--om ANY private well(includirigmadjoining properties ft.
(A separate applicatio necessary for any repair or new installation of septic system)
Town of Qbury A F F .'I D A V I T STATE OF NEW YORK
County off 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
provis'ons 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
authorised by the owner.
SWORN TO :EFORE ME ' IS Signature 1/4,
Owner, or's a ent,arcnizect,contractor
day of 19
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Notary P ..lic, W. ren County, N.Y.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SP 'IAL CONDITIONS OF HE PERMIT:
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By
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Jown of Queenibur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR' S REPORT
NAME Kt t—L IS s /�-
LOCATION ,1J ��
7_, 1 o R L—sr i c�.� PO i AJr.
Date -- Permit No.
7 ,fie
* * * * * * * * * * * * * * * * * * * * .* * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing 7
Roofing
Siding
Masonry Ven=-r /
Rough Plumbi 1
Relief Valves
*xt. Porches L 'am
)(Finished Floo` s 'v,' . .
ynterior Tri°
Stairs & Ra,', ings A7% L C c.-
Cellar Drai Tile
Concrete F oors
Plbg. Fixt' res /(/ ! ..
Gar. Firemroofing h,.„ .
Door Clos:-rs 1/
Smoke De Sectors /
Chimney , 1.
j
INSULAT ON: •
Foundat on
Floors I
Walls
Ceiling
FINAL ECTRICAL INSPECTION
xp:IVEWA ',. APPROVAL
nal Building Survey fr i' d/ 1,--"
Next scheduled inspection (call when ready)
Remarks- /t`t R J 1 --".SGti fe 06-1.. +)
PRY E fi--I(C&= .
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`-hiz ef 4-t _,. .__e€1,,p,._ ../
Building Inspector
6/86 and-vl
GERALD A. KILLEEN
50 MILL PARK LANE
MARLTON, NEW JERSEY 08053
June 18, 1987
Mr. Victor Lefebvre
Building Inspector
Town of Queensbury -
Town Office Building
Bay at Haviland
Glens Falls, New York 12801
Dear Mr. Lefebvre:
Attached is a copy of the Building Permit you issued
to me last August. The builder has completed the work.
I have enclosed a key so that you can go to the house
and inspect the job. If you have any questions you can call
me at work (609-227-4106) or at my home (609-983-2602.
My best regards.
Sincerely, /Ake
Gerald A. Killeen
GAK/lrz
Enclosure
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