1986-573 BUILDING PERMIT
TOWN OF QUEENSBURY No 86-573
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Lewis A. Cooley
OWNER of property located atl Birdsall Road, Glen Lake Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Alterations to dwelling (dormer)
at the above location in accordance to application together with plot plans and other information hereto filed and cn
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is n
RD #2 °o
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
same
3. CONTRACTOR or BUILDER'S Address
same n
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( I Masonry ( )Steel ( )
7. PLANS and Specifications
No. alterations to dwelling - dormer per specifications and rt
application submitted.
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8. Proposed Use rt
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One-family dwelling - dormer added
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 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.) p
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Dated at the Town of Queensbury this 15th Day of September 19 86 P.
SIGNED BY ?ileaa for the Town of Queensbury ri
Building and Zoning Inspector
! TO BE COMPLETED BY BLDG. DEPT.
c�77 // Application No.
..' Jouwn of Quee#iurtj
Permit Issued 19 TOWN or Q, EI, �,.. j,
BUILDING and ZONING DEPARTMENT Permit Expires 19 ��? ,�I,
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation - E-e 'u u , i
Queensbury, New York.12801 Variance No. ilgl1 ��
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Site Plan ev'ew No. � L,i-L) 1 lf_�a
qo _ 1--a %Approve /<Y �-�.m, 516
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APPLICATION FOR ,�ts, ;n • n .a n r 1 e d e a I s
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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.
The owner of this property is: „((:‘,/, i ,.. 6614r
P.O. Address . P,2 , . p r/ f 11 ie. ci- C f.e,,,fty^� /4 7; Tel./ 3-7"C -9,2
Property Location: ,�, _r2 f/ / t',.q' . Tax Map No. / /
Street number or building lot number
Subdivision name (if applicable)
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THE PERSON RESPO SIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
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'N--r5 i/c 117� 4/
Name / P.O. Address Tel. No.
Name of builder,ip y* (‘44 Address , Tel. 7 f 1 -7f1. -
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,
_Alteration to a building• * showing clearly and distinctly all buildings,
(no change to exterior dimensions) * whether existing or proposed andlindicate all
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Other work (describe) * set-back dimensions from property lines. Give
U (?l p� * 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 ft X ft *'
' Foundation-pier/slab/crawl/partial/full * Proposed building, distance from property line
(circle one) *
No. of stories (habitable space) * Front yard ft Rear yard ft
* Side yards ft and ft
Height (grade to ridge) ft. * If on corner, setback from side street ft
L. If residential, no. of families
No. of rooms(excluding baths) • * OCCUPANCY INFORMATION
No. of bedrooms *
* PRI*NRY BUILDING -
No. of bathrooms * One family dwelling
Primary heating systet«
* Two family dwelling
`Type of fuel
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
Raised ranch Mansion Duplex * If addition, what will use be?
Split level Old style Bungalow * _ .C`�X T6 /3 %7� 'Of
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
CONSTRUCTION ra �`' * ---
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, •TO BE COMPLETED!
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED - 1
BUILDING SPECIFICATIONS:
Type of construction; wood frame, fire safe,etc. /2//0-6 c -~ co •
Will any second-hand or ungraded lumber be used? If so, for what? "v 4)
Foundation wall material 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? Will any portion be used as living space?
(If so, what portion? sq.ft. - - Type of use?
Type of roof sloped/flat/shed/other Material. of roof
Size, wood studs "X ,�/ " spacing .re. "o.c. length f ft. �
Joists(floor beams) 1st. floor "X " spacing 74, "o.c. span /Z ft.
Joists (floor beams) 2nd. floor ,. "X ,'' " spacing /G "o.c. span /2- ft.
Overlays(ceiling beams) , "X e( " spacing /6"o.c. span .‘- ft.
Roof rafters "X C " spacing /4 o.c. span/eft.
Roof trusses(pre-engineered) spacing /'a "o.c. span"jf ft.
Exterior wall finish%?x%/_, / 432 fj- „ Of what material?
Interior wall finish �� Q / .
If a garage is to be attached, describe materials 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 flue-lined chimney be installed? Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well
SEPTIC SYSTEM _ Distance from ANY private well(includiny adjoining properties ft.
(A separate application is necessary for any repair or new installation of septic system)
'Down of Queensbury A F F I D A V I T STATE OF NEW YORK
County of Warr„pn
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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 pecified or not, and that such work is
authorized by the owner.
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SWORN TO BEFORE ME THIS Signature_
Owner, owner's agent,arcnite ,contractor
day of 19
Notary Public, Warren County, N.Y.
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SPECIAL CONDITIONS OF THE PERMIT:
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By
a 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:
1. Gross floor area
7 65 '
2 . Type of heat p/ / / 'Q
3 . Is the building mechanically cooled? `(/p
4 . Percentage of area of windows and doors
A. Over 16% Only ti
1 . Uo value of gross area of walls , roof/ceiling and floors
exposed to ambient conditions
2 . Floor over heated spaces 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
d
B. Under 16% Only
1. R value of roof and floors exposed to ambient conditions
2 . R value of exterior walls / ?- Z
3 . R value of glazed area
4 . R value of doors
5 . R value of floors over unheated spaces
6. R value of slab edge insulation - unheated slab
7. R value of slab insulation - heated slab
8. R value of heated basement/cellar walls (above grade)
9 . R value of heated basement/cellar walls (below grade)
10. Type of insulation
C. Controls
1 . Thermostat maximum heat setting
D. Duct Systems
1 . Is duct system installed in unheated spaces? YES NO
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
2 . R value of pipe insulation
F. Service Water Heating
1. Performance efficiency
2 . Temperature control setting maximum
G. For Swimming Pool Only
1 . Maximum heating
Telephone No. _
(applicant ' s signature)
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