1987-620 .-
CERTIFICATE OF OCCUPANCY
TOWN Of QUEENSBURY
WARREN COUNTY, NEW YORK
Decexnbcr 21 (37
Date 19
'Phis is to certify that work requested to be done as shown by Permit No. 87-620
has been completed.
This structure may be occupied as a Lane-Famiiyr Dwelling
Location 16 hills Drive (Hidden Hi.11s )
Owner Leonard & Nancy Campagiione
By Order Town Board
i`[3V1►N C]F QUEEN URY
w
Building & Zoning I ktor
BUILDING PERMIT
TOWN OF ' QUEENSBURY �
No. S77$20.__
WARREN COUNTY, NEW YORK
40
erg10
PERMISSION is hereby granted to T 'G41111114ASU00w ��
^�., wa
OWNER of property located at 16 � Vr:LV* '(SUM 111111
� Street, Road or Ave.
an
in the Town of Queembury, To Construct or place a Oise--7imily DsaIllua
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 €'
ES �"arlrth st. �Q+
Gle" wall*# no T. 1280E ,y
2. CONTRACTOR or BUILpER"^s Name
M
FlIn ey Tucker
3. CONTRACTOR or BUILDER'S Address
Gyms la7.lea 1[. Y.
4, ARCHITECT^S Name
5. ARCHITECT"S Address r.+
gs P
&. TYPE of Construction — (Please indicate by XI
30 Wood Frame ( I Masonry ( I Steel ( I
7. PLANS and Specifications
No_ 26s x "I per plat plane speaif3.Cstless and App]Acation 1ne7ud1nS
septle system and attaehad one G` r SAwag w
S. Proposed Use
Ell Oa IIFA=117 DrallJ.nX
#5 0 i10 c/o
$ 96.00 PERMIT FEE PAID — THIS PERMIT EXPIRES Apr:U 1e 19 $$
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Cixaaansbury before the expiration date.)
Dated at the Town of Clueensbury this 18th Day of $apt. T9 87
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
TO BE COMPLETED BY BLDG . DEPT ,
/ Application No .
own o Queen3bury Permit Issued 19 tC04YN :iI
BUILDING and ZONING DEPARTMENT Permit Expires 19
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation
Queensbury, New York 12801 variance No . SEP oy Site Plan Review No .
�] ( • �J APAroved 151987
y : UILOINC 8t COD OL.i- t .
✓ 'J APPLICATION FOR
BUILDING AND ZONING PERM I T
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OFF 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 : C �3 i4 v „� r2u ��✓'
P . O. Address y , ac r i fsw -� �/ .4 Tel .
Property Location : G, 92 r / A(- d / / � G`�� ___,..._ / Tax Map No .
Street number or building lot number
Subdivision name ( if applicable) r �� c-! L 1 z� + m> cp ef` �17ey Y yI"
—c
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS :
./1L!' se ac'' • ; ! -eieov �7100'-�p aid'.
Name P . O. Address Tel . No .
Name of builder /��r,.V � �,s,,,� ,� ,, _,.- Address - a'msr �C - ,��' 27 esrs,r �-- _ ._._,
Name of plumber ,� dress Tel .
.jr,c d
Name of mason s^._ Awk/r ,g;,_�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 property lines . Give
* street and number or lot number and indicate
whether interior or corner lot , Show location
FOR DENlQLTTION PERMIT1 . , STATE SIZE AND * of water supply and location and configuration
LOCATION OF STRUCTURES AFFECTED . * of septic disposal area .
sF
* COMPLETE INFORMATION REQUIRED BELOW .
* Size of property ` t� ft X f/ eft .
* Existing buildings) Size ,� ft X ft .
PROPOSED BUILDING AND USE : * Existing buildings ) Use
Size of new structure �ft X 46rft
Foundation-pier/slab/crawl/partial/ * Proposed building , distance from property line
(circle one )
* Front yard ft Rear yard !' - ft
No . of stories (habitable space } :�-
Height ( grade to ridge ) 'J�lr! ft , * Side yards - ft and z r ft
If residential , no . of families * If on corner , setback from side street ft
No . of rooms ( excluding baths ) * OCCUPANCY INFORMATION
No , of bedrooms 3
No , of bathrooms / * PRIMARY BUILDING -
Primary heating system___., S * . '�_Onie family dwelling
* Two family dwelling
Type of fuel ' Multiple dwelling / Number of units
No . of fireplaces to be installed permanent occupancy
Will a wood stove be installed?
—5�— * Transient occupancy
Central Air conditioning? /21/'`nz me Business
BUILDING STYLE, PRIMARY STRUCTURE Industrial
Ranch Contemporary Log cabin * Other
If addition , what will use be?
Raised ranch Mansion Duplex
split level Old style Bungalow
ape Co Cottage Other * ACCESSORY BUILDING-
colonial Row Town House * Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * __Attached garage/one car/ two car/� f car
* * * « r x * * * * * * * * * * * Private storage building
ESTIMATED MARKET VALUE OF * Other
CONSTRUCTION
INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED !
Form BPA 4/86 and-vl
BUILDING PERMIT APPLTCATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe , etc . _ �*-� Q 'V 7_/IZ 4S;r7 t"
Will any second-hand or ungraded lumber be used? If so , for what ? /�(Q...___ � d
Foundation wall material
1��` � G.•�' Thickness
Depth of foundation below grade (to bottom of footing ) 4:Ljrfs
Will there be a cellar?Heated or unheated? !l��1rMr'' Floor sq. footage G sq ft
Will there be a basement . Will any portion be used as living space ?
( i£ so , what portion? sq. ft . - - Type of use? = y- ,c-
Type of roof - sloped/f at/shed/other �aterial . of roof
Size , wood studs- 1�,__" X �°a spacing' �`" o . c , length ft .
Joists ( floor beams ) lst . floor "X y" spacing f C . span__�ft .
Joists ( floor beams ) 2nd . floor -"?i sp�2"acing "o . c _ span
spacing i "o . c . span , ' c- ft .
Overlays (ceiling beams ) 7 "X ft .
Roof rafters--"X �. " spacing.Z�io . c . span ft .
Roof trusses (pre- engineered) spacing "o . c . span ft .
Exterior wall finish of what material ? 4,'l t'
Interior wall finish r lwoe /'
If a garage is to be attached , describe materials to be used for FIRE SEPARATION :
Is the e to be an opening between garage and dwelling? If so will a Fire-rated
door , enclosure , and self-closing device be provided? V c-A
Will a flue-lined chimney be installed? /Uel Height above roof ft .
Depth of chimney foundation below grade �I z t .
Depth of fireplace hearth ft / • n .
Water supply - Municipal o priv e well ;1 . a rah �^.rt2 f
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 County of Warren A F F I D A V I T STATE OF NEW YORiC
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 --- -__� -_� = `M
Q
- wner, owner s -ag�nt , arcninect , contractor
day of 19
Notary Public , Warren County , N . Y .
SPECIAL CONDITIONS OF THE PERMIT :
Sy------ ..-------__....--------------
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 '1 S
3 ., is the building mechanically cooled ? V `
4 . Percentage of area of windows and doors 1,\ i `T
A . Over 16 % Only
1 . UO value of gross area of walls , roof / ceiling and floors
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a . Are foundation walls insulated ? YES NO
1 . If YES , what is the R value ?
30 slab on grade YES NO
a . If YES , what is the R value of insulation around
perimeter of floor ?
4 . Is basement heated ? YES NO
a . R value of insulation
5 _ Type of insulation
Be Under 16 % Only
1 . R value of roof and floors e posed to ambient conditions
V- � a � , —
2 . R value of exterior walls . y�- kf)
3 . R value of glazed area �Z 74 ID
4 . R value of doors I `�ZD
5 . R value of floors over unheated spaces. -� �
6 . R value of slab edge insulation - unheated slab
7 . R value of slab insulation - heated slab
8 . R value of heated basement/ cellar walls ( above grade ) 10
9 . R value of heated basement /cellar walls ( below grade )
10 . 'Type of insulation V�A GeV- C-A1_.o1 > !s
C . Controls .
1 . Thermostat maximum heat setting 2 o ,
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 of
1 . Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulation
F . Service Water Heating q
1 . Performance efficiency CN 2 +�
2 . Temperature control setting maximum 1 U °
G . For Swimming Pool Only
1 . Maximum heating
Telephone No . app
( applican ' s signature )
d( QetAd6WV
APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE
LOCATION OF PROPERTY FOR. INSTALLATION L. d .
Owner's Name : , � t .�cf -?.7cL� Aj..441c%" 'telephone:
Address: _.e•--(•"�• / crr i ,c } ' ��- r'
Installer's Name: f�' / .L! c .yr�%+ - —�' i-~ Telephone:
i
Number of bedrooms (residential only) .3 _
Total daily flow (compute (,a 150 gal per bedroom)
Topography: circle one: Flat Rolling Steep Slope % of slope
Soil Nature: circle one: Sand ) Loam Clay 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 ruin. inch.
Domestic water supply: circle one: uriicipal Well Other
IF domestic water supply is a 'Well: �y
Separation: Watersupply from Septic absorption _ � /� feet
PROPOSED SYSTEM: Septic Tank rf �' 4' gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of _ / Size each (ca feet by 4F feet
Size of stone to be used # , / Depth or Thickness `�-- feet
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
(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.
c. 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 react the regulations above and agree to abide by these and all requirements
of the 'Town of Queensbury Sanitary Sewage Udsposal Ordinance.
Signature of responsible person:-~��- -z_r -�� ` �---�-
Date:
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 GOOD PLACE TO LIVE
�U � Ld' �ourrt o� �rteQn �thur�
BUILDING and ZONING DEPARTMENT
Bay and Haaifand Road , R .D. 1 Box 98
AA/ Queensbury, New York 12801
P 6 k,00&L
BUi LDING NSP�E ^ TOR ' S REPORT
NAME rl +'° /r
LOCATION � {� t
Date r � / _ Permit Now
APPROVED* -*YES* NO
Footing/Pier Forms
Foundation
Waterproofing
I3ack£ i l l
Framing
Roofing
Siding
Masonry eneer
Rough P1 bing
Relief V lves
Ext . Por es
Finished lours
Interior rim
Stairs Q flings
Cellar Drag 'Tile
Concrete Fl ors
rlbg . Fm tur s
Gar . Fireproo i g
Boor Closers
Smoke Detector
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling_ .
FINAL El CT CAL INS ECTION
I)RIVEWAY PPROVAL
nal But ing Survey
Next scheduled inspection (call when ready )
Remarks-
e
I
ldin Spector
6/86 and-vl
own o e�een9bury
BUILD%t4G and ZO{ IN6 C)FOadq D RTME 9
8
Bay and Haw<<and New York ' ' o1
(]ueensbury,
R'EpORT
Bt1IL.QING 1NSp � GI4R ' S
NAMB
LOCATION
-�3_permi4t i3 Date * * * f IN
* * * /* APPROVED* -* yES* NO
Footing/Fier F`ox'ms
Foundation
waterproofing
H ckf3-11
ami.ng
Roofing
siding
Masonry Veneer ..
�aug Pluml�� ng ~-
Relief Valves
'Ext . Porches -�--
Finished Floors
interior Trim
stairs & Railings
Cellar Drain Tile
Concrete Floors
P13 Fixtures
Oar . Fireproofi g
Door Closers
Smoke Detect s
Chimney \
Ij4SU1,PyTT0t3
ro=datio
1
Floors
walls
Ceiling 113SPECTIi7'L3 r--
VINAL EI,EC"TPSCAL
DRIV'EwBu pp OVA
ildin Survey
�---�'
Final
t3ext scheduled insP
ection (call when ready)
itemarks_
Building inspector
E,f 86 and-vl
7otv#1 Of
BLPLOl NG and Zf7Njr4G DEPARTMENT
Bay and Haviland Road, R .D .
1 BOX SIB
oueensbury, New "Fork 1280,
SVPTIC DISpOSAL SYSTFJY INSPECTION
N ME
LOCATION - cvf'
�-PERMIT NO .
GATE /p�I—t fi
w , _ clay
SOIL TYPE Sand YES NO
percolation Test lteq'�3-
percolation rate _ Min/Inch -
TYPE of SYSTBM" total length
P,bsOXpt'on field ,
Length of ea h trench '
_r---
Depth of txen hes
Size of grave of)
S.eBpAGE pITS�N er ft. ---
size- ft, -
Gravel size size Type
pxP ING
V
Bldg - to tank.
ox
Tank. to dirt_ I
1)i.St- box to f ield S NO partial
Openings sealed?
LOCATION./SEPARATIONS
Foundation to tanx
Fo-andaLti..on to sorpt -- - -
Absorption to lot line
ft.
Separation of pits OPE (circle one)
CATION SYST de Ri ht Side
. - eft .
Front _ �f"`--w�"`
CCINIMN ET C�
0 7
�s
SYSTEM USE PaPPROVEO YES
1
psuild
Inspector
01/66 and Vl
`7 ow" of ` meensburV
BUILOiNG and ZpNiNG DEPARTMENT
98
Bay and Raviland 'Road, R.D .
(]ueensbury, New York 1250�
SEPTIC DISPOSAL SYSTEM 1 NSPEC T I()N
fU�1E
LOCAT ION
DATE / J-
Loam - ,Clay
so-IL TYpE Sand YES
Percolation Test Fieq%X'red?
Percolation rate - loin/Inch
TYPE Of SYS total len h
AbsorTstion fie
Len'3tY" of each each
Depth O t
f renche r�
Size Of gravel
SEEPAGE PITS4 of)
ft, x ft
Size- ��- Type
Gravel size .� -- SizelJ �.
BldgldgPIPT, tank
ldc3 to1f .
Tarilt t4 11st . box
fie d/ fi
Dist. box to E 140 Partial
Dp,enings sealed
LC TION/SEP' .PIONS : f f t t,
tank f t .
Foundation o absOrpti.o ftt
FOur►clation +
AbsorPtiO to lot line
Separa�.iO
of pits PR ER {circle One)
-1 Fright side
Front
�AT - 3,e£t ide
- ear
COST
7"J
SYSTEM USE APP,00 V`F YES
..Inspector
gu i lc3 ing
01/86 mck vl
fif F
pslllt fl u6en ik "ry
r) r } B,ILDiNG and Zot4%NG DEPART
98
Bay and Haviland fioad, -G
' ✓ pueensbury, New York i2g0i
10,
INSPECT()€ I S REPt7RT
BUILDING
NAMIEG+L '
LQCAT I ON 1/fY` / �•
t
permi
* * * * * * *Date
* * *,r * APPROVED - YES lap
Footing/Pier Forms
Founaatlon
c� �
�fa.terproof i.ng
gac)Lf it l
Framing
Roofing
Siding
M,asonrY Veneers
'Rough plumbing��
Relief Valves
Ext . -porches
Finished 'Floors
--
Interior Trim
Stairs ru Railings
Cellar Drain Tile
,Concrete Floors
r
Plbg - Fixtures x
Firepro in9r----
Gar .
Door Closer
gmol.0 rsete torsi-� -
Chi.mney
IN SUI AT
Founds on
Floors
Walls
Ceill 49 TRICAL INSPECTIC)N_
FIi3AL ELF.0
DRIVEWAY AFFROV:T - -
Final Building Surveys-��
all when ready
Next scheduled inspection
c
Remarks-
Ru,ildi.ng I Spector
6/86 and-vl
9.ur+e �and OR{t1G DEa1D1LD1NGR D, 1 gox $B
Say and hlaviiand ROW
dyork 12BUti
DueensburY� N
lt4SFFClOR ' S REPORI
r4AM�
UOCAT ION
ApPRU�1ED "* 5 130
*
�QOC,is►5I`Tt'ier Forms
Foundat.ioa
waterproofing
9ac3cf ill
Frau�ns3
goof 109
sldlng
Masonry 'Veneer
Rough 'p3.uVkbia9 �---
Reii,ef Valves
Ext0 Porches
Finished Floors
Interior Trim
Stairs FARat)-ings
Cellar main Tile
Concrete Floors
plbg - Fixtures
Gar , girepro'o n9
Door Closers
smoke Detec rs
Chimney
:Wsutjt'•TION =
Foundation
Floors
ce it laig x135FEC rIM4--r--�
i F Il3A r ELECTRICAL
�R1yVw "'PROV survey
r•
Final guildiu8
tyext scheduled insp
ection (call when ready
Remarks_
Roil
ding Inspector
6/s6 and-vl
i
4mpkv
14
vo
l �
I
r
1
I
.J
^M.
V
i
I