1987-621 BUILDING PERMIT
TOWN OF �
QUEENSBURY
WARREN COUNTY, NEW YORK No. !]<T-521
PERMISSION is hereby granted to Sr
Q"atassbatrT Vol 1►'3.ra1 17aptr
OWNER of property loratetf at Dix Ave.
Street. Road or Ave. i
in the Town of Queensbu �—ry, 7o Construct or place a 1"s731' .#.tslsa �
at the above location in accordance to application
aPPro+ued and in compliancetogether with plot plans and other information hereto filed and
with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Addross is
DIX Avu a Ae
Q11110110mabu:r ►e so to 12801
2. CONTRACTOR or 9Ul LOER S Name
a CONTRACTOR or B V I LI7E R 5 Address �q�
43 Va Notrar Dome S[a
G1leesar lraell ele 8a Yw 12801
4. ARCHITECT'S ,Name '!?
r
5, ARCHITECT$ gddrg�
6. TYPE of Conatructian _ fPlaese indicate by 7i(} to
(Jilk,Wood Frame { ) Masonry ( ) steel { }
T. PLANS and Specifications
No. 52 s .. ,50, pier pl&t pl.sa a1
e p&Cif1cat10ll1ss and aip"P2i+estiolis..
8. Proposed Use
+iI
s+
pW
i7
16000 PERMIT FEE PAID — THIS PERMIT EXPIRES April is
(if a longer Period is required an application for an extension must be
town of Oueensbury before the explrstion date.) made to the Building and Zoning nspecter of the
Elated at the Town of QUOGnsburyr this 16CbI
[lay of Sept" 19 87
SIGNED 8Y
Building and Zoning Inspector for the Town Of QUeensbury
TO BE COMPLETED BY BLDG , DEPT ,
c- Application No .
�7own O/ Quee 't9t/� "ry Permit Issued 19
BUILDING and ZONING DEPARTMENT Permit Expires l9 SEIP 0 7
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation JL
Queensbury, New York 12801 variance No , i3UJLUING -�k COOF, OIYf"1`
Site Plan Review No .
Approve by :
.-..�_^,..-
APPLICATION FOR r
BUILDING AND ZONING PERMIT
at � aE # at � ar � � # # # ar ar ar � � # � aE .� of � � * � # �' � � at ,� # � * � * .t ::• �
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 : Tel ,
n
P . O . Address
Tax Map No .
Property Location : lot number
Street number or building
Subdivision name { if applicable}
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : —
Tel * Now
P . O . Address
Name Tel .
Name of builder Address Tel .
Name of plumber Address Tel .
Name of mason Address
NATURE OF PROPOSED WORK :
* ZONING INFORMATION :
* A PLOT PLAN MUST BE PREPARED AND SUBMITTED ,
Construction of a new building * drawn reasonably to scale and attached hereto ,
Addition to a building * showing clearly and distinctly all buildings ,
Alteration to a building and indicate all
whether existing or proposed arty lines . Give
{no change to exterior dimensions} * Set-back dimensions from property
Other work {describe} * 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 REQUIRE ._ gfjiO {
4" � ft X £t .
* Size of property
Size ft X ft .
* Existing building ( s)
—
*
PROPOSED BUILDING AND USE : * Existing buaZding ( s ) Use
*
Zft X ft * distance from property line
Size of new ructure — Proposed building ,
Foundation- ie slab/crawl/partial/full * ft
(circle one) * Front yard ft Rear yard ft
No . of stories (habitable spice) * Side yards ft and ft
Height {grade to ridge) ft * If on corner , setback from side street
if residential , no . of families * OCCUPANCY INFORMATION
No . of rooms ( excluding baths)
No. of bedrooms * PRIMARY BUILDING -
one family dwelling
No . of bathrooms
Primary heating system * Two family dwelling Number of units
Type of fuel Multiple dwelling /
Noe of fireplaces to be installed * Permanent occupancy
Will a wood stove be installed? * Transient occupancy
Central Air conditioning? Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Other
Ranch Contemporary Log cabin * If addition , what will use be?
Raised ranch Mansion Duplex
,r
Split level Old style Mwn
ow
1110 fill, ACCESSORY BUILDING- car
Cottage
Cape Cod * Detached garage/one car/ two car/^�_�_
Colonial Row ouse Attached garage/one one car/ two car/ car
*
(CIRCLE ONE PLEASE } * * Private storage building
* * * * * * * * * * * * Other
ESTIMATED MARKET VALUE OF * -•- -
CONSTRUCTION $
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 franc fire safe , etc .
Will any second-hand or ungraded lumber be used.? If so , for what ? Q
Foundation wall material � gdo R $ ,t rk
A' I Z t _r�"� y Thickness
Depth Of foundation below grade (to bottom Ling )
Will there be a cellar? Q Heated or sated?
will there be a basement? Floor sq. footage '2^ !nt� } sq ft
'ti Will e used as living space?
( If so , what portion'> s ft . - - Type of use?
Type of roof - sloped/flat/ he other Material of r of
ize , W46d studs__ ? - 42 spacin �" a . c . len9 + ft .
Joists { floor beams ) 1st . Floor Q —�k�.�"_�f spacing- � span�..ft .Joists ( fI oor beams ) 2nd . floor
Overlays (ceiling beams ) "X „s spacing "o . c . span ft ,
spacing o . co span ft .
Roof rafters "'X " spacing o . c . span ft *
elf trusses (pre-engineered) s acing '•o . c . span ft .
Exterior wall finish 1112 (OR 'nrqtj/ , Of what material?
Interior wall finish
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
Depth of chimney foundation below grade ft , ft .
Depth of fireplace hearth ft . 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 T
County of Warren A F F I D A V I T STATE OF NEW YORX
I swear that to the best of my knowledge and. belief the statements contained
in this applicatione together with the plans and specifications submitted , are a true and
complete statement of all, proposed work to be done an the de cribed premises and that all
provisions of the BUILDING CODE , THE ZONING ORDINANCE , and a 1 other Taws pertaining to
the proposed work shall be complied with, whet specified r not , and that such work is
authorized by the owner .
1
SWORN TO BEFORE ME THIS � 4
Signature _ __ _ ___ _
Owner , owne '
day of s agent , arcnutect, contractor ~
lg
Notary public , Warren County , N . Y .
It * * * * * * * * . * * IT * * * * * * * * * * * * * * * * * * * * * * * * * * * * It * * * At
SPECIAL CONDITIONS OF THE PERMIT :
F low /Z /;/
By
TCIUN OF QUEE13SBURY
BUILDING AND CODES FEPARTMENT
SAY & HAVILAND ROADS 1280&
QuEENSBURY � NET^1 YORK( 57 $ ) 7925832
TELEPHONE "
BUIUDING -iNSPECTop" S REPORT
RECExvED�„r '~
�R xNSPEN . ,.
REQUEST .'✓r�'.�. ,
o _
NAME
LOCATION
PERMIT
APPROVED
DATE 'YES NO
FOOTING/PIERS
MONOLITHIC POUR �PROOFI7dG
BACICFI --� �-�
FOUNDA LL APPROVAL
ROUGH PLUMBING
FRAMING OUCH—ls
ELECTRICAL R
INSULATION'
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING pgRCHES/STEPS__
EXTERNA CLEARAiVCE & RASLS_�
STAIRS~ FIXTURFSIRELIEF VALVE
PLUMBING IXTU ESIRE Y DODRs�r
INTERIOR
Fx1x5HEF FLOOj FIND
GARAGE FIREPROO
FOOR CLOSER (S )
SMOKE DETECTORS
FINAL TRIC
ELECAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
CUPANCY MUST SE
OF iDEPARTMENT BEFORE
A }SIGNED CERTIFICAHETE BUILDING
OBTAINED FROM T
THESE PREMISES ARE OCCUPIED
REMARKS : /
INSPECTOR
0 0 70uvn of Qeaee" J i"rry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME -tore � J` ►`
LOCATION f2 �. -
Date � /I�i"' /�
Permit 13a .
* C*
/� *rr" APPROVED NO N
,ISooting,/`Pier Forms
,/ Fo`�undation
Waterproofing
Backfill
Framing
Roofing
siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext , Porches
Finished Floors
Interior Trim
Stairs & Mailings
Cellar Drain Tile
Concrete Floors
plbg . Fixtures
Gar _ Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL ELECT CAL INSPECTION
DRIVEWAY APPROVA3._ -
Final Building Survey
Next scheduled inspection (call when ready
Remarks--
Buildi g inspector
tor
and-VI
b
99 EXISTING W00[7 FENCE
XISTING FOUN9g,MN
o
97
EXISTING BACKSTOP
I j
FIRE HOUSE
R.O.W. 150.
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TOWN OF QUEENSBURY
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Title
SOUTH QUEEIVSBI,iRY VM. FIRE DEPARTMENT PAWILUON
DETAILS
MORSE ENGINEERING
QUAKER VILLAGE
GLENS FALLS NY 12801
Designed: Checked: Scale: Sheet of Drawing No.
J.R.H. R.S.M. AS NOTED Sheets
Drawn: Dole: Project No. A
J.C.M.