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
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Building +6► 4Z0 ing Inspector
BUILDING PERMIT s
TOWN OF QUEENSBURY No. 87- 256
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to peter Bromstad
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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
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CTRACTOR or BUi LIDEWS Name o x
John. Matthews � �
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or BUILDER 5 Address `t t�
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RD #1 � �
Lake George , New York
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4. ARCHITECT'S Name cc.
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5. ARCHITECT'S Address
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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
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8, Proposed Use �
One-Family Dwelling
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$ 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
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