1989-021 r. r 1F
1.
+ L�`RTIFI+CATE f C + TJI'A1TC,Y
TOWN OF QUMENSBURY
WARREN COUNTY, NEW YORK
Deft October 5 ... 19 89
This is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure maY be occupied as a Pole
{{ Structure
Location _ Labe George R. V. Perk
Owner Victor King r
By Order Town Board
7IOWN OF QUEENSSURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 89-21
WARREN COUNTY, NEW YORK rb
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PERMISSION is hereby granted to
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I
OWNER of property located at xz +a 149 -`
Street, Road or Ave. ,!
t.�
in the Town of Queensbury, To Construct or place a � - Ell yjA
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.
t . OWNER'S Address is
Rte 149 BOX 3227 x
Lake George, N.Y. 12845 rP
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2- CONTRACTOR or BUI LDE R'S Name t]
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Same
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3. CONTRACTOR or BUILDER 'S Address
"17
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x
4. ARCHITECT'S Name
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S. ARCHITECTSAddrom
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Co
S. TYPE of Construction — (Please indicate by x)
( } Wood Frame i ) Masonry 1 } Steel ( I
7. PLANS and Specifications
No. 40 x 120' Pole structure as per plot plan, specifications and application. a
ri
B. Proposed use Ca
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Pale Structure to be used for Campers as shelter while at park
$50. 00 c/o
$ 480A0 PERMIT FEE PAIL? — THIS PERMIT EXPIRES October 1 19 gg
(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 7 Day of March gy
SIGNED BY for the Town of Queensbury
Buiwi Zoning n or
i�4LVAT OF QUEENSBURY I APPLICATTON FOR BUILDING AND ' ZONTNc, PER-MIT
l'u.te= oa
><±GciCvetf l/
Rev ' ed .3 7
��ix•. F� �v4•�
Fee Pab firs . .G3
WILDING AND CODES Lll :1'ARTP1ENT Pate Ts,eued 3 --7_ 21
13AY and IIAVXLAND ROADS RD I Box 9S
PUEENSBURYY, NEW YORK 12804 Penln.(.t
Tot . (5I8) 7D2-S832 Ext •204
* ti t • ik * * 1F r * t * yr * * * * * * w It It w w It * ■ w w x w- w w w M Y r
A PERMIT MUST BIB OBTA1NED BEFORE BEGINNING CONSTRUCTION . NO INSPLCTi6NS
- WILL BE h1ADE* UNTIL APPLICANIT HAS RECEIVED A VALID BUILDINC PERMIT .
All applicable spaces on this application lnust be conkpleted and the
s •l ,nkuaturc of the * app * i : ant *must appear * on the reverse side * of this sheet .
'1' lte owner of this property is : 4AKe CLyoi ex R, � , ]� aAr .. - - -
P . O . Address 1� dUT'i:- I 't�2 1. ox i 'k - zz:z TEL . ,>-- - 3 ? 5
Property 14Gation 1?0u i F l 9 ,BOJr 442 -7 TAX MAP Now
llas there been any split of this property since October 1 , 19eB4? / ✓
If yes , Planning Board Review is necessary , yes n4
SUBDIVISION NAME , IF APPLICABLE LOT No .
The person responsible for supervision of work as regards Building Codes is :
]L[..4=
� ag 1j. L1A1•Cyr your` /4Z l (3oX32- ?7 _o 7173 - 416FC1 t
NAME P . O . ADDRESS TEL . Now
name of builder_ ��� C� �y/ l� �, Address T. �S<� j5 o X 3.Z 21 7 Tel 3 4f9r3 f
14aine of Plumber Address Tel
Name of Mason Addross Tel
(4ATuRC OF PROPOSED W ll%K : � ZONING It+IFC3RW.TION ( Office use only )
✓ Ct7n=iCruGCiort of :a na:w building ZONING DESSICNATION OF PROPERTY
Ad.Yition to a building # PERMITTED PRINCIPAL PERMITTED ACCESSORY
�Altur4Lion to a l;uilding " •
� (no ClkttrkCJv to .:xcarior dimonsions) " REVIEW REQUIRED -* PLANNING BOARLr ZONING 60ARD_
Cltller work Cdae.crilua:) +` SITE PLAN REVIEW # APPROVED DATE
GkOSS AREA OP PROPOSED, S 'l' ItUCTUR2 # VARIANCE APPROVED DATE
1st Floor p sq ft . * Remarks :
+-f
ar
3 nd Floor sq f to w COt•il'L)_T4 IPPOl 4ATION 1tI:r1UI )tED 111 1.0 W .
Other Floors sq Eta, + Size of prolturty I01� ACRES ft X fC .
( not cellar or basQment )
" L:xiutlnej )5uilaiitM+] { ; ) 5i :mu fc X ec .
'DOTAL FLOOR AREA 0 sq ft . :
r j 1::xiz4:tinrl bW1Li l"ifkg (t.; )
�' ic.: trr" now s ructura = z o ft Xjaa_ 3 ft
Vow4d:ation pie / ::laL/crawl/palrtial/ full " Vropo; :.vd builuing , discancu frowt L+roijc:rty lirkcs
{Circle one: ) +' t'
NO , 4f nC4rie.w
A • (Ykabit:ably ..slaacc) # Front y urd CU hear yard f t
Side
.krd:: ft :and rt
ltuiclh, c (tirade to ridga: l 2 22 - ft . Si ycc,rna:r :;t Cbaa:1C from skit :;cr- tfLt ft
If rouiduntial , no . , of faunilies •
No . of rootn 3 (excluding batViu 1 " OCCUPANCY 'I NFMMAT I ON
slo . 4f bedroonks
Now of batlkrooma . l'R• 1Y BUILDING ma P
k+risrury hu ati$4uj :y«bta +n . ono ,fancily dwelling
Type cif fua:l * 11^wo f aukily dwullinal
NO . of firej'iplacu4 to Ira installed �► e.ultiplo Jwttllinrl / Humber of units
1'cYLnskfiGtlL OCCupaJkCy
Will :. w4a]a) : tUVk: La iikse:alluri? 'rr"n::ia:fkt rat cu b.aftG•
L'uritr:al Air cosLaitioning:a r i ' J
Dasinuss
BUILDING STYLC, PRIKAAY STRUCTuR1 „ ' aaaaaaaaalnclustrial
1::ttkGlk CoriCaruil:[sa':ary L.C,n cakbiri " Oth"'r
luissud ranch ti:bn:.�ic.,tr 13ui�ltx
w It "dditi0n , wltut will uuax bu?
:Jplic 14:Vo1 Old ucyla Uutka ..slow `
C.AJ40 Cod Cott:aqo r Oct " ACCLSSQTtY BUTLDING-
Col oil i:al lto►+f 0wrk house U.atachad y:arago/ono car/ two „car/ Gar
{ CIRCLE CHL,% PLEASE: ) " Acrachud rl;ar.arje:/orta: car/ two czar/ c:aa•
"� w ■ w N ■ * • w w w r x w w w •' Vriv`atct storage building
LM '1' xMA9'lif] MARKPT VALUE OF " �—OcYxar
C oN `.T j40 U C'r I (a)" $ y� r
INFOrI161APTON ON AUTLDTNC .9prcIi,%rcATIONs , ON REVERSE-: SIDG OF This CIIEET, 'ro LAC COMPLC'1'LA !
Form DPA 10/88 vl
}siJ 1L 7ING YL'HMxT APPLICATION CONTINUED
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe ' etc . Wb Or-
Will any second-hand or ungraded lumber be used? If so , for what?
Foundation wall material Thickness
Depth of foundation below grade ( to bottom of footing )Will there be a cellar7_�tj ^Heated or unheated? [).& F}7 'loor�sq • fooYa c��sg ft
-T
Will there be a basement? Z ,TWill any portion be used as Living space? Nf7
( If so, what portion? -sq . f t . - Type of use?
Type of roof ope flat/shed/other Material of Xoof
IIJ L1 5
Sizee wood stu s " X '" spacing "o , c . length ft .
Joists ( floor beams) 1st . .floor "X „ spacing "O . c . span ft .
.joists ( floor beams) 2nd . floor "x '" spacing "o . c . span ft .
Overlays ( ceiling beams ) '"X "• spacing "o . c . span ft .
Roof rafters "" X `" spacing �7_ 11f o . c . span�3 ft .
Roof trusses (pre--engineered) spacing o . c . span."
Exterior wall finish of what material? 'T J�`19N"Z N
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? ft .
Will a flue-lined chimney be installed? _ io Height above roof
Depth of chimney foundation below grade ft .
Depth of fireplace hearth ft . in.
Water supply - Municipal or private wel — ft ,
SEPTIC SYSTEM _ Distance from ANY private well (including adjoining Properties
(A separate application is necessary for any repair or new installation of septic system)
D E C L A R A T I O N
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, acid that such work, is nuthurie:ed by tiie owneV
Signature
Owner, owner's irgent , chitect, contractor
If
SPECIAL C.`ONMITIONS OF THE PERMIT ;
if
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
41 STATE STREET, ALBANY, NEW YORK 12207
Date ApPtication Ne. on file
THIS CERTIFIES THAT
only the electrical equipment a described below and introduced by the applicant namM on the above application number in the promises of
POLE BAILN
in the following location; L1 Basement ❑ tat Fl. ❑ 2nd Ft. Section Stack Lot
was eramined on and found to be in compliance with the requirements of this Board.
""Ue! FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS /TAt t1MITCIiES INCANDUaN4 FWMSCENr I OTHER MST. 1 K.W. AMt. K,W. AMT, K-W, AMT. t, W, AMT. H.P.
DRYERS FURNACE MOTORS FUTtM! AF}UANCE t�ERS VMW 111011 TIME CLOCKS Out UNIT HEATERS MULT14UTIU DWiMERS
AMT, K.W. Cwl H.P. GAS H,P, AMT, No. A w. o. Anti. AMP. AMT, Am TRANS. AMT. H. P. N,OF FW AMt. WATTS
SERVICE DISCONNECT NO.OF S E R Y I c E
AAsr. AMP, irPE i s zw I x sw s >w s r ew Na MR ScoNo. OF cc COND. Na.of H��Ec OF Hi•10 No-of NtunlALs of 4UT iAt
OTHER AFPAGTUS;
�T
BRANCH MANAGER
Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
YOU ARE HERESY REQUESTED TO
INSPECT AND ISSUE CERTIFICATES
FOR THE FOLLOWING ELECTRICAL
EQUIPMENT TO BE INSTALLED BY
THE UNDERSIGNED I
TEMP. If DATE )
CITY OR VILLAGE TOWNSHIP - COUNTY t
{JI ! ` AJ K V I� / 4T1IC11\fS C 1++
POLE NUMBER
STREET AND NO OR ROAD
ri o v!74 1o;' 1 Lea 3 2 x -1
(BETWEEN WHM TWO GROSS STREETS 15 PREMISES LOCiN'EOT MOTION BLOCK LOT
OOCUPANTS NAME BUILDING OCCUPANCY jr J HOME TELEPHONE NUMBER
O'HNE 'S NAME AND A REBS
�^ _ +G is
CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUM�ft
' '
BUILDING IS
NEW � OLD ❑ Y'A:JIFNC LS NEW ADDITIONAL Q DEFECTS REMOVED ❑
LIST BELIJtN ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS No. of Fixtures & MCTOF1S HEATERS BRANCH OFFICE USE
LOOK- Lamp Receptacles CIRCUITS ONLY
"on Side Attach't B`vM11 Pendent Bracket No Type �h NIa Each No. INSPECTION
Ceiling Wall Recep'Is
Ol1T-
SIQE
sue
BASE
BASE-
MENT �y
7 M
FL. V
2nd
FL.
3rd
FL.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE:
THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED. BUT IF AT TIME OF INSPECTION, THERE IS
FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED, YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER
THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT.5QE OF MAINS FEEDERS ELEC:IRIC SIGN5ILAM PS TDTA.L NY.TTS
IaJU �`
CHARACTER OF WOM ,°GIBED GAS TUBE SM.NRRANSFOFIMERS OF
Q CONCEALED
°ATE VA)RK TO BE STARTED E COMPLETED SIZE OF SIGN INUMRER) CAPACITY
`t e �1 s I
SERVICE ENTERS BUILOINO ,..,..,/'' MANUFACTURER OF SKiN
L'J WERHEAD ❑ UNMAGRDUND y
DATE INSPECTION REOUESTED ON IOR AS NEAR AD POS MUST ENTE.R'APPLWJMM"�
5
r WENTl�IpAT1DN NUMBERI I
pbKHD MAYS BY INQ FUao AM ACCURATE IN TlC1Il1. ALL SPACES BE FILLED IN OR APPL19&TH.31N MAY WE RETURNED.
PRINT NAME AND ADDRESS
DA7 AP N
NAME O APPLICANT F P
IF RE ` l
--
STREET ADbRESS ' TE ON NO.
tsu7F 4y f7 CO
OE - v !
CITY OR POST OFFICE ZIP G4E LICENSE NCI- WHEN APPLICABLE
❑ 85 Jahn Street O 41 State Str et 584 Delaware Avenue 217 Lake Avenue ❑ 202 Arterial Road
NEW YORK, NY 10038 ALBANY, NY 12207 El
BUFFALO, NY 14202 � ROCHESTER, NY 14608 ` SYRACUSE, NY 13206
I THE NEW YORK BOARD OF FIRE UNDERWRITERS
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK I2804-
TELEPHONE (528) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED _
NAME --
LOCATION
,PATE /�� �`O� ^ PERMIT #
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR F S
FOUNDATION/DAMP-PR FXNG
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
*�CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SILTING
EXTERNAL PORCHES/ TEPS
STAIRS-CLEARANCE & RAX
PLUMBING FIXTUR SIRELIE VALVE
INTERIOR TRIM/ RIVACY RS
FINISHED FLOO S
GARAGE FIRED FING
DOOR CLOSERf )
SMOKE DETEC ORS
FINAL ELECTR CAL INSPECTION
FINAL APPRO L OF CONSTRUCTIO
A SIGNED CERTIFXCATE OF OCCUPANCY ST BE
OBTAINED FROM THE BUILDING DEPARTME BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS :
i
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVXLAND ROADS f
QUEENSBURYr NEW YORK 12804-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION
DATE PERMIT #
r APPROVED
p YES O
I..-i*`OOT.IA�Gf P2ERS
MONOLI HXC POUR FORMS
FOUNDA ON/DAMP-PROOFING
BACKFXLL APPROVAL
ROUGH P BIG
FRAMING
ELECTRICAL OUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/S E
STAIRS-CLEARANCE RA
PLUMBING FIXTURES R7 VALVE
INTERIOR TRIM/PR VACY D
FINISHED FLOORS
GARAGE FIREPROO ING
DOOR CLOSERS)
SMOKE DETECTO
FINAL ELECTRICA INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST B
OBTAINED FROM THE BUILDING DEPARTMENT SEFO
THESE PREMISES ARE OCCUPIED!
REMARKS:
10
INSP TOR
w
LAKE GEORGE R.V. PARK, INC.
ROUTE 149, BOX 3223
LAKE GEORGE, M.Y. 12845
(518) 792-3775
March 7 , 1989
Richard Gijanto
Town of Queensbury
Building Inspector
Queensbury , NY
Dear Mr . Gijanto ,
Regarding your request via our phone conversation , the
following is an explanation of the anticipated uses of the
pole building proposed in my application for a building
permit , Feb _ 6 , 19891
This structure will provide shelter and be a gathering place
for campers as they engage in activities such as ; game
playing , square dancing , group meetings , crafts , card
playing etc .
In an attempt to extend our shoulder season , now open April
1 . - Nov . 30 , we feel the addition of a structure of this
type is necessary ,
This shelter is intended for the exclusive use of campers
and registered guests in this recreational vehicle park .
Sincerely ,
Victor J . King
Lake George R . V . Park