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1987-508 4 � I CERTIFICATE C)F OCCUPANCY TOWN OF +QUEENSBURY WARREN COUNTY, NEW YORK 2 <9 9 f Date_ Jecento r L , 19 67 This is to certify that work requested to be bone as shown by Permit No. 87-- 5C8 ' has been completed. This structure tray be oc�cu a ONE- FA, 1II Y DWELLING CHESTNUT RIDGE , & 09UNTY LINE Location + _ GA PEDERSON C]wner By Order Town Board TOWr4 OF QUEENSBURY r Building & Zoning Inspector 1 TEMP 0 R A R Y CERTIFICATE OF O CCUPAM... ' TOWN OF +QUEENSBURY t WARREN COUNTY, NEW YORK I Data Nov . 30 , 14 87 f This is to certify that work requested to be dune as shown by Permit No, 87-508 i has been cotnpieted. F One-Famil Dwelling 3 This structure may be occupied as a y f Location Chestnut Ridge & County Line Owner Derek & Gail Pederson TEMPORARY 30 DAY C /O ISSUED By Order Town Board PENDING FINAL ELECTRICAL TOWN OF QUEENSOURY i building & Zoning Inspector 1i BUILDING PERMIT a AV TOWN OF QUEENSBUR'Y No. 87-508 � WARREN COUNTY, NEW YORK a PERMISSION is hereby granted to Derek & Gail Pederson OWNER of property located at Chestnut Ridge & County Line Street, Road or Ave. r.a in the Town of Queensbury, To Construct or place a Ony Earn$ 1 y Dwel ling 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. 1 . OWNER'S Address is RD 1 Box 526A Glens Falls , N . Y . 12801 2. CONTRACTOR or BUILDER'S Name Bill Herlihy H 3. CONTRACTOR or BUILDER 'S Address ray ty7 1 Dartmore Dr . M Glens Falls , N . Y . o 4. ARCHITECT'S Name 5. ARCHITECT'S Address C"7 rs9 cry H 6. TYPE of Construction — (Please indicate by XI H ( x{WWood Frame ( ) Masonry I I Steel I I G7 7. PLANS and Specifications No. 74 ' x 28 ' per plat plan , specifications and application including o attached two-car garage and septic system. C= 8_ Proposed Use One-Family Dwelling rr� r� $5 . 00 C/o + $ 171 . DO PERMIT FEE PAID - THIS PERMIT EXPIRES March 1 ' 19 $8 �' (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the � rn town of 4.wensbury before the expiration date.] 1 Dated at the Town of Queensbury this 7th dayof August 19 87 r SIGNED BY x / e for the Town of Queensbury Building and Zoning Inspector ;Oz N r.7 TO BE COMPLETED BY BLDG . DEPT . Application No . own a Queenigury Permit Issued 19r. - BUILDING and ZONING DEPARTMENT Permit Expires 19 bi Bay and Haviland Road, R. D. 1 Box 98 zoning DesignationQueensbury, �1ew York 12801 variance No . 4i Site Plan Review No . JUL 3 ���� t f/ Approved y �-i �j �UILD,I�'�Ca i9c COC1E, C]Ef"T APPLICATION FOR D /�iC iJ/ I g� ( ': ' 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 . The owner of this property is : gg 6AAJ I L �CLt-3/11. 7 p P . O. Address ! IJG7X � � C�y �}�Tr � lI YG7 � Tel . t rJ� f e�J� Property Location : � � � 1 4L02 !Zy 4*1d4 lA!F- 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 OILL i �EP(-J tkf Address IG( ? Tel Name of plumber .4(�K EAVAc Address Tel . Name of mason'T &2E LE)' ti/,I�^�� -IWS Address (,. VAW RD. Tel * NATURE OF PROPOSED WORK : ZONING INFORMATION : Vlo onstruction 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 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 AFFECTED . * of septic disposal area . COMPLETE INFORMATION REQUIRED BELOW . Size of property aC>"PD ft x 3C� ft . Existing building ( s ) Slze '747�ft X�.t3 ft . PROPOSED BUILL71NG AND USE : * Existing building ( s ) Use Size of new structure -711 ft x j ft Foundation-pier/slab/crawl/partial ull * Proposed building},_ distance from property line (circle one ) * Front yard-? + ! ft Rear yard 1,04, ! ft No . of stories (habitable space) * Side yards 3 r ft and .¢ � ft Height ( grade to ridge) 23 y 6 ! ft . If on corner , setback from side street ¢., ' ft If residential , no . of families No . of rooms ( excluding baths )_` _._ '� OCCUPANCY INFORMATION No . of bedrooms PY BUILDING - No . of bathrooms 4ne family dwelling Primary heating system...1:10:E:AALAT . Type of fuel L, Two family dwelling No . of fireplaces to be installed i MultI. ple dwelling / Number of units Will a wood stove be installed? * Permanent occupancy Central Air conditioning? rJC� 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 Cod Cottage Other " ACCESSORY BUILDING-� olonia Row Town House Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE ) '" Attached garage/one Car/ wo car Car Private storage building ESTIMATED MARKET VALUE OF _Other CONSTRUCTION 67 !7 INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED ! Form BPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . 7i`] E-12 rri/L 7 Will any second-hand or ungraded lumber be used? If so , for what ? _ 4)ej �- Foundation wall material 5:j�y Thickness _ r� Depth of foundation below grade (to bottom of footing ) lel Will there be a cellar?Heated or unheated? U�-+iLC` ;C Floor sq. footage q ft Will there be a basement? c_D� Will any portion be used as living space?_ / Jn ( If so , what portion? sq . ft . - - Type of use? Type of roof - sloped/flat/shed/other. ��Material of woof ,CSA5P ` � 1t! Size , wood studs X _ spacing_.L6 o . c . length " ft . Joists ( floor beams ) lst . floor r' „X [C� " spacing _"'o . c , span Jam { ft . Joists ( floor beams ) 2nd . floor ,'X ^ " spacincl__ L�"o . c . span - L4 ft . Overlays ( ceiling beams ) _ "X " spacing "o . c . span ft . Roof rafters "' xP4spacing o . c . span ft . Roof trusses (pre-engineered) spacing_Z4_ 1Oo . c . span ft . Exterior wall finish Of what material? 5 11) j 146r Interior wall finish "�- I.f a arage i d.s to be attached , describe materials to be use for FIRE SEPARATION: S�f3 rr 7�Yfa� ,sf Is there there to be an opening between garage and dwelling? 'CGS 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_2t,: ft .A�2.in . Water supply - Municipal or private well SEPTIC SYSTEM _ Distance 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 A C C r '�' County of Warren A i f !q 1 Y,l 1 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 ORLANCE , and all other laws pertaining to the proposed work shall be complied with, whetfie o ot , and that such work is authorized by the owner . SWORN TO BEFORE ME THIS Signature __�. r, ________ er , owner ' s agent , archlLect ,L"g3ri tractor day of 19 Notary Public , Warren County, N . Y . * * * * * * If * * * * * * * * * * * * * If * If If If * * * * * * * w 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 0&. 3 * is the building mechanically cooled ? . A )d 4 , Percentage of area of windows and doors _ ��, e A . over 16 % Only 1 . U value of gross area of walls , roof / ceiling and floors o exposed to ambient conditions 29 Floor over heated spaces YES NO a . Are foundation walls insulated ? — ES NO 1 , if YES , what is the R value ? 3 . Slab on grade YES Q a . If YES , what is the R value of insulation around perimeter of floor ? 4 . Is basement heated ? YES NQ a . R value of insulation 5 , Type of insulation B . Under 16 % only 1 , R value of roof and floors exposed to ambient conditions_ 2 . R value of exterior walls / 3 . R value of glazed area r 4 , R value of doors 5 . R value of floors over unheated spaces Z37o 6 . R value of slab edge insulation - unheated slab 7 , R value of slab insulation - heated slab . ­ so R value of heated basement/ cellar walls ( above grade ) �. g . R value of heated basement /cellar walls ( below grade ) �7 10 . Type of insulation --- C . Controlse 1 . Thermostat maximum heat setting Do Duct Systems 1 . Is duct system installed in unheated spacer ? YL: S 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 E) ipe 20 R value of pipe insulation� 'Oej;�2 _ F , service Water Heating 1 . Performance efficiency, 2 . Temperature control setting maximum G , For Swimming 'Pool Only 1 . Maximum heating Telephone No . 723 ..67 57 ( applicant ' s : igr: aturO ) APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE ( I /' LOCATION OF PROPERTY FOR INSTALLATION C4 �5+�� �( _ -� a Cj"�K A[ ? `�" L/AD:F� Owner's Name: 1? _✓ � P{r'y,R.) Telephone: (�j --62 Address: L�'� f G} +�__- .�1' /�. � - F;44�,� ,�s� K.), ` ` f Installer's Name: -T)A. JF EiC2 s,�. - - Telephone: 1 i ( E Number of bedrooms (residential only) T� _ Total daily flow (compute (9? 150 gal per bedroom) (� Topography: circle one: Flat Rolling Steep Slope $Ii of slope Soil Nature: circle one: Sand Loam fClay 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: Muni.cipa W el Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption i6Q feet PROPOSED SYSTEM : Septic Tank 1&'0 _ gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench feet / Total system length c �r.+� Y feet SEEPAGE PIT(S) : Number of / Size each feet by feet Size of stone to be used # ,2 / Depth or Thickness _ s� feet I M P O R T A N T ._.Please.._I..IST NEW EQUIPMENT TO BE INSTALLED (over) r. .. l 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 Di Ordinance. Signature of responsible person: Date: ez Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . HOME OF NATURAL BEAUTY . A GOOO. PLACE TO LIVE r � l ` f0ivr+ og ee „ 3 ur BUILDING and ZONING DEPARTMENT Bay and Haviiand Road. R. D. 1 Box 98 OueensoMr4t44ew York 12801 d BUILD INSPECTOR ' S REPORT NAME LOCAT I ON � sct' - Dane !j / permit No . e!' APPRCIV)i;D* -�*YES* *1'1O . Footing/pier Forms Foundation Waterproofing Backfill framing Roofing Siding Masonry Veneer Rough Plumbing Re3 fief Valves {.,EEC . porches in , floors eri.or Trim fairs & Railings cellar Drain Tile Concrete Floors "bg Fixtures L.Gy Fireproofing "Nono r Closers make Detectors ChimneY INSULATION : Foundation Floors Walls Ceiling L,r ~NAL ELE RSCAL INSPECTION DRIVEWAY PROVAL Final Building Survey Next scheduled inspection (call when ready Remarks- tee '~ Bui ing Inspector 6l86 and-vl 1 _ - own o/ Quee" JI"r y 0 ILDING and ZONING DEPARTMENT Bay and Naviland Road, R. D. 1 Box 98 Cueensbury, New York 12801 SEPTIC PISPOSAL SYSTEM INSPECTION NAME jovTore LOCATION f f tj p DATE 11_41_L�__ PERMIT NO.----L ✓ �CL-_____ SOIL TYPE - Sand - Loam - Clay Percolation Test Required? YES - NQ Percolation rate - Min/Inch - TYPE of SYSTEM:. Absorption field , total leng % �r Length of a ch trench s Depth of tr nches Size of gra el --- SEEPAGE PITS Number of) Size- ft- X _ f Gravel size Bldg , to tank 1 !� Tank to di st _ b Lf Dist. box to fi d/Openings Seale ? YES Partial LOCATION/SE P RATI S : Foundation v tank Foundation a abso ti.onft • Absorption to lot li a ft - Separatio of pits ft_ ON SYSTEM ON ROPERTY (circle one) Front - ear - Left si - Right side TS SYSTEM USE APPROVED YES NO f Building Inspector 01/86 and vl "` [ f � � `./+vu/►e �7� �+esec'nit3bEtr'e� BUILDING and ZONING DEPARTMENT Bay and Hawiiand Road, Ft-D. 1 'Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR. ' $ REPORT NAME �Cih• / �{ LOCATION "/ r Date / permit No . APPROVED YES NO Footing/Pier Forms Foundation water rooting Ba ill raming Roof ing Siding Ma ftry Veneer ugh Plumbing Relief Valves Ext , porch Finished Fl ra Interior Tri Stairs & nail gs Cellar Drain T e Concrete Floors Plbg . Fixtures Gar . Fireproof ' g Door Closers Smoke Detecto s Chimney IN SU LAT ION Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION ,DRIVgWAY APPRO'VAI- Final Building Sur;Yey �1 Next sc duled inspec ion (call when ready Remarks- , Bu ding Inspector 6/86 and-vl +y � �.1'ourr► o�' �u ee n s e� O1 �i SUILCDING and ZONING DEPARTMENT ��,I,�R7 / Bay and Haviland Road. R.D. I Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION "�� � gee Permit NO APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill L,�r'raming Roofing Siding Masonry Veneer r ugh P1umb:Lng 1- Relief valves Ext . Porches Finished Floors Interior Trim Stairs & Railin Cellar Drain Til Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSTMATI ON Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final 13ulldi.ng Survey _ P� Next scheduled inspection ((call wh/en/ ready ) Remarks.- F. C) ��� 1 r�.b� t"1 �► � [f� i � S Building I p Ctor 6/86 and-vl awn 01 Queenshur� � Ji BUILDING and ZONING DEPARTMENT C7I Say and Haviland Road, R.D. 1 'Box 88 C Queensbury, New York 12801 ya, BUILDING INSPECTOR ' S REPORT l � NAME /e Ole /� Sr' /1� re LOCATIONi� 1//7i9r Datq�7 �/ r Permit No . gd V D - YE NO ' XFoti.ng/Pier Forms Y datlon � terproofing Backfill Framing Roofing siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors 1 Interior Trim stairs & Railings Cellar Drain Tile Concrete Floors -- Plbg . Fixtures Gar . Fireproof-In Door Closers Smoke Detector Chimney INSULATION Foundation j Floors !� Walls Ceiling FINAL ELECTRICAL INSPECTION^ DRIVEWAY APPROVAL, Final Building Survey* I NexC scheduled inspection (call when ready Remarks- OF � ,- 3 r Building Inspector 6/86 and-vl down o� ueerrsur BUILDING and ZONING DEPARTMENT Bay and Haviland Road* S.D. i Box 98 Oueensbury, New York 12801 BUILDING INSPECTORtS REPORT NAME LOCATION I]ate �! /� permii No . * * * * * * * * * �✓* * APFRC3VED* -* * * NO L"Orooting/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 . Fireproofi Door Closers Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAT .-- Final Building Survey Next scheduled inaPeCtion { call when ready Remarks- Building Inspector 6/86 and-vl BUILDING DEPT_ COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. TEMP. tl DATE . CITY OR VILLAGE ;OWNHIP- COUNTY STREET AND MO. OR • - - ROAD AND POI.!'NO. POLE NO. BETVYEEN WHAT TWO I _ .- CROSS E LOCAEETS IS �f E 55T& �" k1 r TION BLOCK LOT PREMISE T;*S ,�^ NAcLIPANr s ' +� } BUILDING ANNCv 5 NAME +' OWNERS NAME AND ADDRESSCURRENT / TE L. # SUPPLIEDfff BUILDING ,.,/"' ��r fir' FROM THEIR ."",/ '�y�''-j' � ' OFFICE DEFECTS IS dYG NEW Imo' OLD 0 is NEW 1=.1 ADDITIONAL © REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED Na of Flxslne 6 BRANCH NUMBER OF OUTLETS Lwnp Reeeptedw MOTORS HEATE RB CIRCUITS OFFICE USE Lem I ONLY bast M" AtaccWt M.P. Watte A.W.O. DniilBnnp tbslt Re •b Switedn Pendant Bracket No- Type Each No. leach No. Geuw INSPECTION CHAV side Sub- how Baer srrant Irt Fl. 2nd Ff. 9rd Fl. REMARKS:. LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. This application is intended to cover the abw lismd equipment to be inspected but it at tuna of {nrfwction there is, found additional equipment not above listed, yr are Authorized to make the inspection and adjust the fee to aver the additional equipmerrl, as provided by the applicant. ${ZE OF 1 K- ELECTRIC SIGN TOTAL MAINS : . FEEDERS / ' " LAMPS WATTS CHARACTER EXPOSED 4 , GAS TUBE SIGN OF WORK :L - .r CONCEALED TRANSFORMERS OF VA WORN TO BE ]] j iNUMBERI ICAPACITYF STARTED r"f '.`' -"" COMPLETED ,: [ SIZE OF SIGN SENT ER OVER U HEAD UNDERGROUND MAKER iLOIN OF SIGN INSPECTION REQUESTED ���/ CON OR POSSIBLE NEAR AS !�"�I�/ / 1' �1' f NEW EI'" OLD AVOID DELAY BY GI VI NO FULL AND ACCURATE INFORMATION. ALL SPACES BATE OF +' MUST BE FILLED IN Oft APPLICATION MAY BE RETURNED. PRINT NAME AgibRESS �% APPLICATlL7N ,,r / G/^�/ �/ SIGNATURE APPLICANT ,.? f- raj.;"E: V tt x Of APPLICANT�� "'•l: r� '. . r +��.. STREET ADDRESS TELEPHONE # �' CITY OR {; ZIP LICENSE NO. POST OFFICE -_ I (^, 1 _ i CODE WHEN APPLICABLE sy 46 EL (FWV- 1/86) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING J b f ` /k MM ; € ICA Or z. ) '•, ; v1 �d�z�i1�5'�cr,,�i' sue%,B�i �" � a 4L - _ r