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1987-256 y CERTIFIC-ATE OF Q+�+ IJI'Al"�T+ ~Y TOWN OF QUEENSSURY WARREN CCIUNTY, NEW YC1RKt Date JanuaN�7, 6 87-256 'b This is to certify that work requcatcd to e done as shown by Permit No. has been complctcd. 0M Ca ` 3Ikdb, \Y\C) One-Family ing This structure may be pied as a %, rrc� . E 1 '1D Lot 597 Fox ..Hollow Lane S t . No 17 I„ocadon rL7wr►cr� 1� bm eter Bromstad By Carder 'fawn Board TOWN OF QUEENSBURY r� i 1 x Building +6► 4Z0 ing Inspector BUILDING PERMIT s TOWN OF QUEENSBURY No. 87- 256 WARREN COUNTY, NEW YORK rr io n PERMISSION is hereby granted to peter Bromstad ri 0 l o t 59 7 Fox Hollow Lane ( St . No .. 17 ) Street, Road or Ave. OWNER of property located at rril Section 15 Westland t in the Town of Queensbury, To Construct or place a One• Family Dwelling 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. [3- 0000"NTRACTORWNER'S Address is Coolidge Hill Road Lake George , New York ro 0 rt rt r- to a .,c CTRACTOR or BUi LIDEWS Name o x John. Matthews � � X m x m o or BUILDER 5 Address `t t� Y I RD #1 � � Lake George , New York cn W C M cr ro 4. ARCHITECT'S Name cc. C rtrt N^ 4rJ W o z 5. ARCHITECT'S Address y L F7. TYPE of Construction — (please indicate by Xi € Wood Frame € ) 'Masonry ; ) Stool I 1 PLANS and Specifications 64 ' x43 ' per plot plan , specifications and application C No. including sewage system and three-car attached garage . M w D 8, Proposed Use � One-Family Dwelling m Y $ 5 . 00 C/O � 183 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES _ nece +her 1 197, _ (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 . 14th Day of May 19 87 SIGNED BY 4 for the Town of Queensbury Building and Zoning i nspector TO BE COMPLETED BY-BLDG . DEPT . � J Application No . I"/" o/ Queertj " riy Permit Issued 19 € -I-OWN OF QUr ZNSD3�- ._ ` BUILDING and ZONING DEPARTMENT Permit Expires 19 ? [� � � � it � � [0jBay and I-Iaviland Road, R. d. 1 Box 9$ Zoning DesignationM Oueensbury, New York 12801 variance No . APR 16 1987 Site Plan Review No . r� / /7 — `" * ' ! Approved _ --_ BUILDING & CODE DEPT, APPLICATION FOR 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 . �l The-owner-of this-property- is : J� ' -c -c/t / &&22 c P. O. Address me r Tel . Property Location : L,r T tf� J` �j IX2_ S ry + xJ Yam' Tax Map Street number or building lot number Subdivision name ( if applicable) rA LLe THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : Name ,_, P . O. Address Tel . No Name of builder�� /� 1 t x -- `7 Address Tel ------�����A+++Name of plumber f Address Tel . ame of mason { Address Tel . 7" NATURE OF PROPOSED WIORK : ,� ZONING INFORMATION : ►/Construction of a new building A PLOT PLAN MUST BE PREPARED AND SUBMITTEDr _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 whether interior or corner lot . Show location FOR DEMOLITION PERMIT , STATE SIZE AND of water supply and location and configuration LOCATION OF STRUCTURES AFFECTE._.D._-----. * of septic disposal area . COMPLETE INFORMATION REQUIRED BELOW . Size of property 0` `GG1 ft .X ZOO ft . Existing building ( s) Size ft X ft . PROPOSED BUILDING AND USE : Existing building ( s ) Use Size of new structure 4 ft x� Foundation-pier/slab/crawl/partia ful * Proposed building , distance from property Line ( circle one) Front yard 3( , ft Rear yard , y ft No * of stories (habitable space) , 2 " ft and � qp�f ft . � Side yards �_ - _ ,7 Height ( grade to ridge ) r G,l If on corner , sei=]aack from side street ft If residential , no . of families. ,r No * of rooms ( excluding baths ) zo OCCUPANCY INFORMATION No . of bedrooms_ ,F PRIMARY BUILDING - No . of bathrooms � e family dwelling Primary heating system /� if /t * Two family dwelling Type of fuel Multiple dwelling / Number of units No . of fireplaces ea be installed ! permanent occupancy Will a wood stove be installed? A.* .o Transient occupancy Central Air conditioning? v4149 Business BUILDING STYLE PRIMARY STRUCTURE * Industrial Other Ranch Contempo army,. Log cabin If addition , what will use be? Raised ranch Mansion Duplex Split lever Old style Bungalow Cape Cod Cottage other ACCESSORY BUILDING- Colonial Row Town Souse 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 INFORMATION ON BUILDING SPECTFICATIONSr ON REVERSE SIDE OF THIS SHEETr TO BE COMPLETED ) Form BPA 4/86 and-vl 4 BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , (wood frame, fire sa£e , etC . Wilt any second-hand or ungraded lumber be used? If so , for what ? IVL2 Foundation wall material 611,(r," C�.rn.•* .� Thickness Depth of foundation below grade (to bottom of footing ) Will there be a cellar? Hea£ i'I-yrr unheated? Floor Sq . footage Ito �, sq ft Will there be a basement? 311 any portion be used as living space? ( If so , what portion? sq . ft . - - Type of use? Type of roof - slo ed flat/shed/other Material of roof Size , wood stu s _Z`IVX I, spaci.ng_1 /r2 "o . c . length ft . _ Soists ( floor beams) 1st . floor 2 "XLLJ�2_" spacing-}�"o . c . span ra ft . JOi-sts ( floor beams ) 2nd . floor "'X rc5 " spacing �� "o . c . span ! L ft . Overlays (ceiling beams ) 2 "X " spacing '*o . c , span .� ft . Roof rafters NIX spacing o * c . span ft . Roof trusses (pre-engineere acing �2v ^o . c . span_�ft . Exterior wall finish '` r Of what material ? Interior wall finish If a garage is to be attached, describe materials to a use for FIRE SEPARATION :::T4 �� Is there to be an Opening between garage and dwelling? j If so will a Fire-rated door , enclosure , and self-closing device be provided? tl�5 Will a flue-limed chimney be installed? Height Wove roof Depth of chimney foundation below grade—=£t . ft . ,Depth of fireplace hearth ft . n . Water supply / ? ncpr private well SEPTIC SYSTEM rs�tsT a from ANY private well { including adjoining properties ft . (A separate application is necessary for any repair or new installation of septic system) Town of Queensbury County of Warren A F F I D A V I T STATE OF NEW YORK 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 day of lg Own e owner ' s agent , archxr ect, contractor _ Notary Public , Warren County , N . Y . * * * it * * * * * * IF * * * * * * * * * * * * * * At * * * * * * * * * * Ar * * * IF SPECIAL CONDITIONS OF THE PERMIT : Yearn 4( aesw6wy APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE , f 7 / LOCATION OF PROPERTY FOR INSTALLATION _ aK_,&Ld ^' ' Owner's Name: e T_Y a ✓*t `� r� Telephone: Address: ._�& UL. l C L e' g� Installer's Name: L06,4e Z� Telephone: Number of bedrooms (residential only) Total daily flow (compute @ 150 ,gal per bedroom) 4d� Topography: circle one• Flat pRollingSteep Slope °fix of slope Soil Nature: circle one: andClay Other / Depth: feet Ground Water: At what depth? ? feet Bedrock or Impervious Material: At what depth? � feet Percolation test: circle one: not required required / rate min. inch. Domestic water supply: circle one: unicipal Well Other IF domestic water supply is a Weil: Separation: Watersupply from Septic absorption _ feet PROPOSED SYSTEM: Septic Tank { � gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench feet / Total system length feet SEEPAGE PIT(S): Number of / Size each —6 .__ feet by e? feet Size of stone to be used # _02 / Depth or Thickness � ._ feet ae4 � IMPORTANT ...Pl.ease...LJST NEW EQU P"MENT TO BE INSTAI.I.ED (over) Section II Septic System Inspections& A. All applications for septic system installation, alteration or repair, as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building 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. Co An approved copy of the plot plan shall be 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 Queensbury Building Department before further construction, I have read the regulations above and agree to abide by these and all requirements of the "Town of Queensbury Sanitary Sewage Disposal ChN inance. Signature of responsible person: " j - Date: Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-583 2 SE 'rTLEO 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD- PLACE TO LIVE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRiCiTY 41 STATE STREET, ALBANY, NEW YORK 12207 Date ,. I . , ,t rt i ` , Application ., . a7e ile 1 . , I THIS CERTIFIES THAT f •F .:,} n i only the electrical egalpment as described below wad i.atrodaved by It oppllaesst mid ors L/se abrrce EEprpllicarfinra number in the pnemmas of in thefollowing location, •Bsse►rsent �r lst FT. area! Ft. i, Section Slocit F ,Got r was examined an and fauInd to be its compliance with the requirements of this Board, RXTURE FIXTURES I RANGES ICOOKING0ECKS I OVENS DISH WASHERS EXHAUSt PANS CMITLETS EPTACLES SWITCHES NCANbE5CEN7 FlL NT OTHER AM7. I K. W. AMT- K. W. AMT. K.W- MAT. K- W. AMT- N. P. DRYERS FURNACE MOTORS FLOWN APMAPI 111110113MRS SPECIAL RRC"PT TIW KS Rli,l UNIT HEATERS MtJL"4) JTIET OLMhU S wAAT. K. w. Ole R. P. GAS N. P_ AAAT, No. A. W. G- AMT- AMP. AMT. AMPS. TRANS. AMT. N. O. SYSTEMS AMr. WATTS NO. OF FEET SERVICE DISCCMMIECT No. CW S E R Y I C E AM7, AMP. TYPE EOWP. 1 X ?W 1 X SW 3 X ]W 3 X 4W ' GAR COr1a. aP CC,t&Dl mo, Of NI.LEG o -NW- 0- mo- Or NEUrRALS df.W. Co. OTHER APPARATUS; i 1 -. ;. i r • :-. l . ' . , ; r, BRANCH MANAGER Per f: This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by thei cr�redentiols. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME },? , �j` 7 • {f LOCATION Dat Permit No . APPROVED YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofi g Sidin Masonry Veneer Rough PI bing , Melief Val es >Mxt . porche .>Win ished Flo s ,3Cinterior Trim >Stairs & Railin s Cellar Drain Til concrete Floors ^lbg . Fixtures KGar . Fireproofing )<Door Closers )Smoke Detectors Chimney }S,T, N SULATION Foundation Floors Walls Ceiling W INAL ELECT L INSPECTIO'N�� DRIVEWAY APPR AL_� ,dinal Building Survey Next schedule inspection {call whenRemarks- r,,eady ) Ii� Buii ng Inspector 6/86 and-vl CPPI (l1I E _ 0Wl+j 4j Q4ueen3Cru4ry {, BUILDING and ZONING DEPARTMENT G� Bay and Haviland Road, R. D. 1 Box $8 G • �{� Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date / Permit No . ✓ = APPROVED - YES NO Forms Foundation Waterproofing Backfill r rami ng y J Roofing Siding Masonry Veneer F, Kough PliimbingqU Relief Values ) Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbq . Fixtures Gar . Fireproofing 00or Closers Smoke: Detectors Chimney INSULATION - Foun da t ion Flexors Walls Ceiling FINAE ELECTRICA INSPECTION DRIVEWAY APPROV L Final Building Survey Next scheduled inspection (call when ready 0 Of f;ui lding Inspector 6/86 and-vI ��''� _Jnurre o� �cte�nsfiurr� BUILDING and ZONING DEPARTMENT $ y and iland Road. R k D- 1 Box 98 eens q0 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCAT I '!' 4 i.� d/�.rty4,/ n e!! or . DATE ljf7 PERMIT NO. SOIL TYPE - Fst - LX Percolatio ReqN �~ Percolation rate - MTYPE of SYSTEM :Absorption field to Length of each tr c Depth of trenches Size of gravel_ SEEPAGE PITS{Numb of ) _ Size- ft* x t_ Gravel size PIPING : Size Type Bldg . to tank �` y� � Tank to list box —► ; (J, Dist , box t field Openings s led? ES NO Partial LOCATION/ PARATIONS : Foundatio to tank ft. Foundati to absorption t. Absorpti to lot line fil: Separati n of pits fte DOCATI OF SYS P RTY (circle one ) Front - ear Left sid - Right side - CCIMMENTS ' SYSTEM USE APPROVED YES NO Building Inspector 01/86 and vl �--�/r r ✓ wn a/ Qleee I7Ji" dr f� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.t3. I Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME r LOCATION /� Date / / Permit No . ty? �5-(A APPROVED - YES NO 4400bo'oting/Pier • Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer. cough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete floors Plbg . Fixtures Gar . Fireproofing s_ y Doerr Closers Smoke Detectors Chimney INSULATION : Foundation Floors walls Ceiling FINAL ELECTRICAL. INSPECTION DRIVEWAY APPROVAL Final. Building Survey Next scheduled inspecclon ( call when ready ) Remarks- Buildin nspec-to r 6/86 and-vl _ J'own 01 Queenjl"Py BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME— n+�/�J��...Gt �}-U ry+ 43'! �`-'t- --- LOCATION fey Date' �v / Perri t Noft APPROVED - YES hiC�/ ooting/Pier Forms Foundation waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors interior Trim_ ---- Stairs & Railings Cellar Drain Tile concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney IN SUI.ATI ON : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION _. DRIVEWAY APPROVAL, Final Building Survey Next scheduled inspection (call when ready Remy r ks- �0 g L�[�LdaF Building Inspector and-vl BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. Tval II PATE CITY iM VILLAGE ,�. TOIMNSFFIP !.. - COUNTY STREET AND NO. OR ROAD AND POLE NO_ all � Jr BETYIIEEN WHAT TWO P.....c ..s._ CROSSSTREETSIS ►"",�/� Ho CC.+ L-- _ v / PREMISES LOCATED? SECTION r„1 BLOCK /r LOT / OCCUPANT'S BUILDING ... NAME /e m;q Y- 1 AID OCCUPANCY OWNERS NAME AND ADDRESS oe . .y,/ TEL. 4k CURRENT SUPPLIED _ + BY Vtd etA Mwt,4�,,eA, FROM THEIR - ,f{!( OFFICE BUILDING ..1+.�;'�r+ DEFECTS IS NEW `^ etc El rs NEW -I'L ADDITIONAL ❑ REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS Now w1 FLe4rw A BRANCH Luca- LAMP Raeapeaclaa tit6fT014S HEATERS CIRCUITS OFFICE USE tion Sid. . ONLY orate E �e . Gw-G. INSPECTION Gue- alda bon bye Bar- .. mauve aim Fl_ 2nd FI_ Semi FI, REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. This applicalion K intormUd to cover the abnae-listed equipment to be Impacted but it at time of i Yoe "dwwiaed to make the irspection and aWuat the fag to sever the addieioreal rtspioeeron there n fourW +idditi n are onal atpripenent rwt above lislad, e.Onipestent. r Mo+rimiad by the applicant. 512E OF ELECTR IC StGN TOTAL MAINS FEEDER'S t-AMP+' WRTTS CHARACTER EXPOSED GAS TUBE SIGN OF WORK CONCEALED TRANSFORMERS OF VA WORK TO BE INLRi1BERl {CAPACITYI STARTED COMPLETED SIZE OF SIGN ENTE SE OVERHEAD UNDERGROUND MAKER ILDfN OF SIGN INSPECTION REQUESTED ON OR AS NEAR AS �1 POSSIBLE NEN OLD EJ AVOI0 DELAY BY GIVING FULL AND ACCURATE INFOR MATT ON. ALL SPACES PATE OF MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION PRINT NAME Af4D ADDRESS NAME OF SIGNATURE J y / APPLI+CANTY57G r•--` STREET ADDRESS . L5 ?.Z' ,.tom CITY OR ,r ZIP LICENSE NO, POST OFFICE �{�.� / f CODE /-ac !/N WHEN APPLICABLE 46 EL IRE. I/sal A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BU 1 LDING I 2oo. Z%. P LbT PLIW 13ROAl 6-rAb