1987-088 BUILDING PERMIT
TOWN OF QUEENSBURY No- 87-88
WARREN COUNTY, NEW YOR K o
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Don Read �
PERMISSION is hereby granted to C
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OWNER of property located at end of Brayton Road , Cleverdale Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Addition to dwelling (living area)
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 . OWNEWS Address is Cleverdale , New York. 12820
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2. CONTRACTOR or BUI LDEFt S Name
John P . Matthews
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3. CONTRACTOR or BUILDER'S Address �C
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Lake George , New York
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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}
i x} Wood Frame d } Masonry i ) steel d 1
7. PLANS and Specifications
20 ' x25 ' per plot plan , specifications and application and Var . 1209
No.
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P.
S, Proposed Use
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One—family Dwelling (additional living area) o•
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o . o0 Oct . 1 19 87
PERMIT FEE PAID — THIS PERMIT EXPIRES m
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(if a longer period is required an application for an extension must be made to the Ruilding and Zoning inspector of the i..Y
town of Queensbury before the expiration date.)
On
Dated at the Town of Queensbury this 25th Day of March fg 87
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SIGNED BY "t - own far the T of Queensbury OQ
Building and Zoning Inspect
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TO BE COMPLETED BY BLDG . DEFT .
Application No . I ;,,ror.: ti..3F 0JLZ1N5L.+ur • r'
_foam 01 Queei" 39 dry Permit Issued
BUILDING and ZONING DEPARTMENT Permit Expires
Bay and Hawiland Road, R. D. 1 Box 98 Zoning Designation [1
Oueensbury, New York 12801 variance No . C] 3M AR 2 4
Site Plan Review No .
` - Approv by " ISUILDird4Ga tic CODE DEFT.
APPLICATION FOR Ik A �o
FU I LD I NG 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 .
The owner of this property is : 7)A Ili
P . O_ Address Lo 0 do it gh A L
Tel .
Property Location7! T11A1 +�I Tax Map No . / f
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 I / Tel . No .
Name of builder ,JOeyy A 1KATMIkAd Address ���f r� . � Tel . �q "+.�}s.�y ■
Name of plumber Address Tel . r
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 and indicate all
Other work (describe) * set-back dimensions from praperty 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. * of ,septic disposal area .
COMPLETE INFORMATION REQUIRED BELOW .
Size of property 8 � ft X#70-ft .
* Existing buildIng ( s) Slze�^ft X ft •
PROPOSED BUILDING AND USE : * Existing building ( s ) Use I .�►
Size of new structure 0 X� � ft
Foundation-pier/slab/crawl/partial/full * Proposed building , distance from property line
(circled e ) y - 1 _ _ft
* Front yard 6 ft Rear axd �jr
No . of stories (habitable space) Side yards ft and ft
* �_
Height ( grade to ridge ) _ /ti ft • If on corner , setback from side street ft
If residential , now of families
Now of roams ( excluding baths ) 1 OCCUPANCY INFORMATION
No . of bedrooms
x. PRIMARY BUILDING -
Now of bathrooms 1 / One family dwelling
Primary heating system
Two family dwelling
Type of fuel g2ji.. Multiple dwelling / Number of units
No . of fireplaces to be installed__ Permanent occupancy
Will a wood stove be installed? o0
* Transient occupancy
Central Air condltloning? � Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Other
Ranc Contemporary Log cabin '� 7
If addition , what will use be .
ised ranch Mansion Duplex
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 * {]tk3er
CONSTRUCTION $ ` L, . . . . . . . . . . .
INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED ,
Form BPA 4/86 md-vi
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood ramee , fire safe , etc .
Will any second-hand or ungraded lumber be used? If so , for what ? ��rL
Foundation wall material Thickness 80 R �
Depth of founda �r low grade (to bottom of footing )
Will there be a�`t �'7 -Heats ar unheated? Floor seq. footage 0roV sq £t
Will there be a basement?�`JfAb&LWill 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__ _ '" spacing_ �"o . c . length ''8 ft.
Joists ( floor beams ) lst . floor � "x " spacing �I ►y�"o . c . span -ft .
Joists ( floor reams ) 2nd . floor A'X " spacing "o . c . span ft .
Overlays ( ceiling beams ) "X OF
spacing "o . c . span ft .
Roof rafters i�"X_L_" spacing .IG„ o . c . span
__j _£t .
Roof trusses (pre-engineered) spacing A' o . c . span ft .
Exterior wall finis Yt r S pf what material? �
Interior wall finish ���"`
If a garage is to be attached , d scribe 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? !C�o` Height above roof ft .
Depth of chimney foundation below grade ft .
Depth of fireplace hearth �ft .vme ►i.. n .
Water supply - Municipal or privatewar
SEPTIC SYSTEM i Distance from ANY private well ( includi.ng adjoining properties ft .
(A separate application is necessary for any repair or new installation of septic system)
Town of A F F I D A V I T STATE OF NEW YORK
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Warren
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
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 - • N�
er , owns ' s agent , arcnirect, eontractor -
day of 19 ,� ��
Notary Public , Warren County , N. Y .
* IF * * * * * * * * * * IF * * * * * * * * * * * * IF * * IF * * yr * * * IF * * * aAr * * * * IF IF
SPECIAL CONDITIONS OF THE PERMIT :
BY
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
2 . Type of heat_, &JYA
3 . Is the building mechanically cooled ?
4 . Percentage of area of windows and doors
A . Over 16 % Only
i . U value of gross area of walls , roof/ ceiling and floors
ex sed to ambient conditions
2 . Floor o r heated spaces YES NO
a . Are f ndation walls insulated ? YES NO
1 . If , what is the R v e ? �
3 . Slab on grade S No
a . If YES , what i the value of insulation around
perimeter of flOO
4 . Is basement heat ? YES NO
a . R value o Insulation
5 . Type Of 1 ulation
B . Under 16 % Only
1 . R value of roof and floors exposed to ambient conditions,
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2 . R value Of exterior walls � • Ici
3 . R value of glazed area jy . Zo 3 'Mo
4 . R value of doors 2 • �rj
S . R value of floors over unheated spaces
6 . R value of slab edge insulation - unheated slab
7 . R value of slab insulation - heated slab
Be R value of heated basement/ cellar walls ( above grade )
9 . R value of heated basement/ cellar wallas ( below grade )
10 . Type of insulation
Co 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
C , For Swimming Pool Only
1 . Maximum heating
Telephone No . _ 44ks J
)'g( a plic nt ' s signature )
�0 _.J'vu�n v� �ueenshsere�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D- 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION e
Date/ Permit No a i O
r = APPROVED - YES NO
ooting/Pier Forms
oundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plum bin
Relief Valves
Ext . Porches
Finished Floors
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
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready
Remarks-
;
Building Inspector
6/86 and-vl
BUILDING DEFT. COPY OE APPLICATIONO ON FTHIS wITHLD NCa NEP EW VORKNBOARD OF FIRE UNDERWRITERS.
FIL
TEMP. # DATiE c '
CITY OR > S t COUNTY t �," r),t_,a r
VILLAGE (� F,{ [ ; c TOWNSHIP {
STREET AND NO. OR POLE NO-
ROAD AND POLE NO.
BETWEEN WHAT TWO
CROSS STREETS IS SECTION BLOCK LOT
PREMISE LOCATED?
OCCUPANT'S - OCC BUILDING
CY `� +j r
NAME
OWNER'S NAME TEL. #
AND ADDRESS I f
CU NT �i // ff
SUPPLIED #� 11' :'� # , �.r �,q, }a.4, FROM THEIR G Jr_.�{ ' f f YJ+ r' '" OFFICE
BUILDING f ��,{ WORK DEFECTS
B NEW L�_l OLD ❑ IS NEW ❑ ADDITIONAL ❑ REMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
No, of Flxtures & BRANCH OFFICE USE
NUMBER OF OUTLETS Lamp Receptacles MOTORS HEATERS CIRCUITS ONLY
Lor+
tior Side Attach't E Each No. Eel, No. Gauge INSPECTION
Ceiling Wall Racep'k Switch Pendant Bracket No. TYP•
Out-
side
Sub-
due
Base-
mart
I" FI.
2nd FI.
3rd FI,
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: GO NOT USE THIS SPACE.
This application is intended to cover the abtrye•I isted equipment to be inspected but if at time of impaction there is found add iti"all equipment not above listed.
you are authorized to make the inspecdnn and adjust the fee to Oliver the additional equipment, as Pr"itled ISV the apPIi"ril-
E LECT R IC SO GN TOTAL
SIZE OF FEEDERS LAMPS WATTS
MAINS
CHARACTER EXPOSED GAS TUBE SIGN
CH WORK CONCEALED TRANSFORMERS OF VA
WORK AK Be {NUMBER) {CAPACITYI
57ARYED COMPLETED SIZE OF SIGN
SERVICE OVERHEAD UNOERGROVN6 MAKER
ENTERS 'OF SIGN
BUI La ING
INSPECTION REQUESTED
ON OR AS NEAR AS NEW FO OLD
POSSIBLE
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NAME AND ADDRESS DATE OF
i
NAME OF N
APPLICANT
APPLICATIO
r ,/
STREET ADDRESS � ?`: x..f i ,. . (: .L. : , TELEPHONE # FI'a" r`.+' LICENSE NO.
CITY OR COiDE i t _
f WHEN APPLICABLE
POST OFFICE
4e EL (REV_ aln5) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
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