1986-516 BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-516
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Robert and Gerri Middleton
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OWNER of property located at Seeley Road Street, Road or Ave. rt
in the Town of Queensbury,To Construct or place a Addition to dwelling (deck) Q,
at the above location in accordance to application together with plot plans and other information hereto filed and
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approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is Box 297
Cleverdale, New York a'
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2. CONTRACTOR or BUILDER'S Name
same
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3. CONTRACTOR or BUILDER'S Address cc
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4. ARCHITECT'S Name w
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) a
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( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications rt
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5'x20' per plot plan, specifications and application submitted. a,
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8. Proposed Use
Addition to dwelling (deck)
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES March 1 19 87
(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 26th Day of August 19 86
SIGNED BY MaGi J for the Town of Queensbury
Building and Zoning Inspector
TO BE COMPLETED BY BLDG. DEPT. .
�] / Application No.
,Jown of Queenitur y Permit Issued 19 TOWN OF QUEENS E Jfl'�
BUILDING and ZONING DEPARTMENT Permit Expires 19 4 (( (rj [�, I V [ '1
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation L`� It L�, �/ C IL I.
Queensbury, New York 12801 Variance No. I !� J ' , I - L)
/6 _ j — o, 3 Site Plan Review No 1 ��
Approve -.by• A.M. V C .
• . . 7I M1;O)1111 ' #3)4 5j
APPLICATION FOR - , ram'
• BUILDING AND ZONING PERMIT
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
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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: ��� ' ,1'a (.:~/. //&76)7f7 ,
P.O. AddresQ0X 177 (1%jo',e2,1� !tel, (-' Tel6:3 7?e5-,1/
Property Location: S- , ,6-11, `,-E 09/)-0-- a4 /0bn_ ia --- Tax Map No. , . / / .
Street number or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
Name P.O. Address Tel. No.
Name of builder O/ C(`7u[&e.___ -_ Address Tel
Name of plumber Address Tel.
Name of mason Address 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,
X 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
* of septic disposal area.
/ / • / *
* COMPLETE INFORMATION REQUIRED BELOW.
' / * Size of property ft X ft.
/ // � '/ * Existing building(s) Size ft X ..ft.
* . . . . . . .
PROPOSED BUILDING AND USE: * Existing building(s) Use
Size of new structure Z' ft X2j) ft * 5 /4._r)Ai4 rwr i p-i,(f"
Foundation ier slab/crawl/partial/full *. Proposed building, distance from property line
(circle ne) * ee , `
* Fro : 4 S TY`A/ 6t mar yard 75.-P ft
No. of stori s (habitab a space)
* Side yards d/1 A ` /; f L
Height (gra e to ridge ft. * - r
If residen /
ial, no. o families / "
If on cor r tback f s e st e ft
No. of ro ms(excludi g baths) 7 ' * OCCUPANCY INFORMATION •
No. of brooms / *
No. of athrooms / / * PRIMARY BUILDING -
Prima heating stem /. . . *' X One family dwelling
Type f fuel / * ___Two family dwelling
No. f fireplac, s to be installed * Multiple dwelling I. Number of units
Wil�a wood strive be instaaled? * Permanent occupancy
Central Air conditioning? * Transient occupancy
* • Business
BUILDING STYLE, PRIMARY STRUCTURE - Industrial
Ranch Contemporary Log cabin * Other
Raised ranch Mansion Duplex * If addition, what will use be?
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 VALUE OF *"_Other 1j(f(�p0 0 113 .
CONSTRUCTION $ 40,2 *
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INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
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BUILDING SPECIFICATIONS: '
Type of construction, wood frame, fire safe,etc. ii/eVO- %fZ..jT
Will any second-hand or ungraded lumber be used? If so, for what? - se
Foundation wall material, ' CaciCALG-! 6 Thickness d Q 0 C Z go tic_
Depth of foundation below grade (to bottom of footing) 7—e- 2-�� to G-/2--o C/c—
Will there be a cell r? Heated or unhe. ed? Floer =-q.__footage sq ft
Will there be a bas ent? Will any portion be used as li•ing space?
(If so, what porti ? sq.ft. - - ' ;pe of use?
Type of roof - sl ed/flat/shed/other Material• of roof
Size, wood studs "X " spacing ' "o.c. length ft.
, Joists(floor be ) 1st. floor " " spacing ' o.c. span ft. •
`Joists (floor be s) 2nd. floor " spacing "o.c. span ft. •
Overlays(ceili g beams) "X " spacing "o.c. s.an ft.
Roof rafters "X " spacing o.c. span ft
Roof trusses pre-engineered) ' ..spacing , ."o.c. span ft.
Exterior wa 1 finish Of what material? •
. Interior w. 1 finish .
If a garag- is to be attached, .-scribe ,materials to be used for FIRE S"PARATION:
Is there to be an opening betty en garage and dwell'.ng? If so wi 1 a Fire-rated
door, e losure, and self-clo ing device be provi.ed? •
Will a lue-lined chimney be installed? H- ght above roof ft.
Depth .f chimney foundation below grade ft.
Depth .f fireplace hearth ft. in. /
Water supply - Municipal o private well
SEPTI SYSTEM Distance from ANY private well(including adjoining properties ft.
(A s-parate application is necessary for any repair or new installation of septic system)
Town of Queensbury AFFIDAVIT STATE OF NEW YORK
County of Warren
.Z 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 Signatures ,
Owner, owner's agent,arcnitect,contractor
day f 19
Notary Pub1'c, War en County, N.Y.
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SPECIAL CONDITIONS OF THE PERMIT:
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�own Queenibur,
BUILDING and ZONING DEPARTMENT (1`—
Bay and Haviland Road, R.D. 1 Box 98 C1/}i`a1-1-
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAMET1��-
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LOCAT ION
Date 9/ J Permit -
✓ = APPROVED - NO
• •oting/`ier Forms dd
Foun.a ion
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors1/ (\-\
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- -
P&P- ./ vL 6 (JI°j2`Cf
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Buil ing Inspe' tor
6/86 and-vl
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