1989-296 7`7Y _q[�4?ik'P.'*nc-v.rin . .� i•:; +,�5Y7 ".�'ix'"
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+CERTIFICATE OF OMF'LIAI`�T E
TOWN OF QUEENSSURY k
WARREN COUNTY, NEW YORK
i
Date, Jul— ?{ 198a.
1 � 8911111111296 ,.
'r
This is to certify
that work requested to be done as shown by Permit No*
has been completed,
j Porch
This structure may � occupied as a
19 Heinrick Circle
Location
Mr. Mrs . Re HaIC01"
i Owner
s
By Order Town Hoard
1rowN OF QUEENSBURY
Director of Bldg. & Code Enforcement
1
BUILDING PERMIT
TOWN 4F +QUEENSBURY No Rq�7945
---
WARREN COiUNTY, NEW YORK `$
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PERMISSION is hereby granted to R Nalco
OWNER of property located at _ 19 4lninrirlr AMIN, circl$ Street, Road or Ave.
in the Town of Queensbury„ To Construct or place a Front p"rIr ._.
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
L7
k"S
SAME �
Y
3. CONTRACTOR or BUILDER 'S Name
Marc Connelly
3. CONTRACTOR or SU1LDER 'S Address
RD 3 Box 3431
Lake Gorge , M . Y . 12845
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4. ARCHITECT`S Name
rM
R5
A
S. ARCHITECT'S Address
,7C
ONO
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6_ TYPE of Construction — (Please indicate by X1 M
m
I ] Wood Frame I 1 Masonry ( I Steel ( Y
7. PLANS and Specifications
No_ G ' x 23 ' front parch as per plot plan , specifications , and
application .
a. Proposed Use
Front Porch
T
C/C incl . -'
$ �c np PERMIT FEE PAID — THIS PERMIT EXPIRES hpr t
(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 Oueensbury this Clay of Hav19$�-
SIGNED BY for the Town of Queensbury
Buildi Zoning Inspect r
TOWN OF QUEENSBURY APPI. TCATTON FOR BUTLr) rNG ANT) 70NING PERMIT4 '
�i`��----�
���-`
Fee Fal,d s*AY 10 1M
BUILDING AND CODES Ul :l 'ARTPtENPT Date 7.6.6ued
13A Y and NAVILAN.D ROADS - RD I Box 9a "%L( Q, & 00tM QEPT.
nUE'ENS,BUF'Y, NEW YORK 12804 PeAm-it No .
Tel . (518J 792-5832 Ext 204
• a : : x w 'r • : a . a a . a a a a a . a w : a a w a a a ■ x w w
A PERMIT Ntus*r D11 OBTAINED BEFORE BEGINNING CONSTRUCTION & NO INSPECTIDNS
WILL BF MADE UNTIL APPLICANT HAS Ri: cr. IVr. D A VALID BUILDINC PERMIT .
All applicable spaces on this application must be completed and the
q—; Puature of the applicant must appear on the reverse side of this sheet .
at 7r at * x do at Yc is � ak
'i' he owner of this ,property is : _ NIL , 4- IG1 r c a .1 QQJ= K"L
L' . O , Address TEL . --- *79 5) /
Property location - - klp1r @[ t. IC ! me !ea _jj [ fL , k'j ) TAX MAP NO ,
11as there been any split of this property since October 1 , 1988 ?
yes no
If yes . Planning Board Review is necessary . C / /
UBDIVISION 14AME , IF APPLTCABLE [� frl Gf FY/Yt S LOT NO .
The person responsible for supervision of work as regards Building Codes is :
NAME / PoO . ADDRESS TEL , NO .
[dame o £ builder y9�ddress � / $! .C.y,Ee� &Cg22�k- Tel ye-z3
Name of Plumber /fi .T.ddress Tel if/
Name of Mason / / Address if - - Tel / if
14ATuRE OF PROPOSED 6ORK : ZONING INFORMATION ( Offica use only )
t'ont:; cruction of a rkow building } ZONING DESIGNATION OF PROPERTY
&o!Adaition to a Ijuilairig r PERMITTED PRINCIPAL PERMITTED ACCESSORY
AlLur" LIOn to " LUilding `
( no CIL"Wj. Lo oxc �! rior dimonsion;:, ) * REVIEW REQUIRED - PLANNING BOARD ZONING BOARD
"__Utlser work (Je crisp,.: ) d SITE PLAN REVIEW #I APPROVED DATE
ap
c;HOSS ARL:A QV PROPOSED, STRUCTURE ; VARIANCE # APPROVED DATE
I
lst Floor / .3'� sq ft ,
" Remarks :
' nd F I o o r - �^ sq ft . COmPLLTI: iNf`O [arlh'i'SON 1cLi�Uilcl /D LIL_L [ tw1 . '%�
X
r + [ her Floors _ �~ sq ft , r Size of props rty +�t7 / / tr. t` . rn
rat collar or basement ) „
Lxi�tittij I�uil+li[+•] ( :: ) Si X: +:�C c r t .
JTAL FLOOR AREA 5q ft . 7
� Lxi,: L a;Sg ne i 1�1in�J (:. ! use�
isa iuC new �;Lructure ft K aft
lou. &d;aLio -pier slat,/crawl/l)iarLiwl/ full Nropot;wd builuing , dizicancu front proijurty lino
(Cirrlu one ) ' 40 ft
N.D . of stories (1"b ! "blo :,;pair • rider arils � +0if fL an r yard /
11" ighc ( Ura.dc to ridgL: ) ft , . Side yards * { f t and ! .�" it
If residential , noo of families a' If on corner , ;A bwck from side ::tr" C CL
No . of roots i ( excluding bachal ' OCCUPANCY INFORMATION
tto . of bedrooms
o . of Ya:atttroaan:: „/ PRIMARY fiUILDINC;
L#006nc faatily dwelling
.' rimary ttaaati[uj ::yt:L%a Awe r Two f"m.Lly dwelling
'lyll.: of EUQI Multilal.: .iwc )ling / Nwnbor of units
No . of flrelal ,acuz; to Igo inscall.:d A
Will :, wQQJ SLOVO t. iet:: t:. 11ua ? . Nersnanant occUpat�Cy
LojnGr"l Air c0114. 1tiQnJ iLg ? jr 'i'xwnsiv[tL raacul3:artcy
,,, I3Usinc:s.s
BUiL..DING STYL EO PRIKARY STRUCTURE „ Industrial
1uanch ConcustipQr,,ary Lon cabin .Ochar
it.aiaud ranch ManSic �t qul,lux r It .addition , wh"t will uuu ba:? _.
iplic ltw:vul Old UCyle Uunk.;" 10w `
Lz"jJu Cod Cott"q%a Or. kter " ACCESSORY BUILDING
�alonia I'Low 'INnwtL ]louse " Uescached yara,g4/ona Bear/ two cae/ car
{ CIRCLE 0"1: PLE:A.SC ) r Attuched gcaracju/ona cur/ two c.ar/ cu ['
r : ■ ■ a a a a a a a M a a a a a storage bux.ldx.ng
L:: sorjMATl n. MARKT_'J' VALUE OFi� * �4Other
1r41-,'ORr1ATION ON BUILDINC SPECIFICATIONS , ON REVERSE: SIDE_ OF THIS CHEET, TO BE COMPLETED !
Form BPA 10188 vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction ,ew<God frame fire safe , etc .
Will any second-hand or ungraded lumber be used? If so , for what 's
Foundation wall material , do
Depth of foundation below grade ( to bottom of footing ) r
Will there be a cellar? ?, (, Heated or unheated? _ O/T, Floor sq. footage sq Ft
Will there be a basement? __Al& Will any portion be used as living space? /#w (�
( If so , what portion? sq . ft . - - Type of use?
Type of roof ` o e �yflat/shed/other Material of roof Al S x
Size , wood Stu -"~ " X " spacing " o . c . length ft ,
7oists ( floor beams } lst . floor _'"X ,a spacing/ "o . c . span., £t .
Joists ( floor beams ) 2nd , floor , �.- "` X ��-" spacings . span ft ,
Overlays ( ceiling beams } r' "}{ spacing �'"o . c . span ft .
Roof rafters �2 ", X _ &,_" spacing &,,, o . c . span_ ft .
Roof trusses (pre-eng : : tired) spacing " o . c . span ft .
Exterior wall finis: wO Of w'-,at material ?
Interior wall finis :. ors
If a garage is to b(--- _ tached , describe mate* : _s to be used for FIRE SEPARATION :
Is there to be an opening between garage and dwelling? A�elo If so will a Fire-rated
door , enclosure , and self-closing device beProvided?
Will a flue--lined chimney be installed? Height above root ft .
Depth of chimney foundation below grade ft .
Depth of fireplace hearth in ,
Water supply - Municipal or erivate 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 )
D E C L A R A T 1 0 N
To the best Of my knowledge and belief the statements contained in this
application, together with the plans and spc-ei flea tions 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.
OF
Signature
Owner, o er's a e , &AecKitect7 con actor
SPECIAL CONDITIONS OF THE PERMIT :
.......... _--_ -
CERTIFICATE OF INSURANCE
This is to certify that ® STATE FARM FIRE AN[) CASUALTY COMPANY, Bloomington, Illinois
0 STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
has In force for Connol I Marr 1 DGA Cannel 1 y I S CUStom Construction
Name or PCA Gyhokler
Rh R Rny 3411
A00ress of Poboyhoider
y p
location of operations
the following coverages for the periods anct limits Indicated below.
POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY
felt. exo }
I :
Comprehensive
92 -37 -4[}37 -OF ® General Liability - 1 —8�' 1+7 - 1 -8 El Dual Limits for. BODILY INJURY
Each Occurrence S
Manufacturers' and Aggregate
Contractors' Liability $
Owners', Landlords" and PROPERTY DAMAGE
Tenants' Liability
The above insurance includes Each Occurrence -
(applicable if indicated by ® 1 ❑ PRODUCTS-COMPLETED OPERATIONS Aggregate' S,
OWNERS' OR CONTRACTORS' PROTECTfVE LIABILITY
CONTRACTUAL LIABILITY I ® Combined Single Limit tor: BODILY INJURY AND
BROAD FORM PROPERTY DAMAGE PROPERTY DAMAGE
BROAD FORM COMPREHENSIVE GENERAL LIABILITY Each Occurrence $ 500 , 000
POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD Aggregate $ 500 , 000
(eff-exp.} CONTRACTUAL LIABILITY LIMITS
Watercraft (If different than above) BODILY INJURY
Liabillly Each Occurrence $
PROPERTY DAMAGE
Each Occurrence $
Aggregate Sr
EXCESS LIABILITY I
Combiner] Single Limit for: BODILY INJURY AND
UMBRELLA
PROPERTY DAMAGE
I
0 OTHER Each Occurrence $
{ Aggregate $
W orkmen s?Workers' Com-
!!��II pensation-Coverage A n o 6 Coverage A STATUTORY
92 -37 -- 1247 -2F La EmPloyersLiability 9- 7 -88 to 9- 7 -89 Coverage $ $ inn nnf)
-Coverage B �. -
'Aggregate not applicable if Owners'. Landlords and Tenants Liability Insurance excludes Structural alterations, new construction or demolition.
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS,
EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
NAME AND ADDRESS OF PARTY TO WHOM CERTIFICATE IS ISSUED
Robert Malcolm 5 8
19 Heirlrick Circle Date
QUeefl Sb Ury+ , M1I . Y . 12804 ignalure of Authorized Representative
L _1 Agent
Title
(558) F6.994.6 Printed in U.S-A- Rev. 11M4
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURYo NEW YORK 12809-
TELEPHONE ( 518 ) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME �+� / 9zemme-
LOCATION
�_._�f
DATE / -�fi P�� PERMIT # cF9
_-,_..{{ ' APPROVED
'4 YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS ,:,,
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL _ T
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CE}LI NG Y if
AL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE5fSTEP
STAIRS-CLEARANCE & ILS
PLUMBING FIXTURESfR LIEF VALVE
INTERIOR fiRIM/PRIV Y DOORS
FINISHED FLOORS _
GARAGE FSREPROOFI G
DOOR CLOSERS)
SMOKE DETECTORS _
FINAL ELECTRICAL NSPECTION
FINAL APPROVAL OF CONSTRUCTION
o
A SIGNED CERTIF ATE OF OCCUPANCY MUST BE
OBTAINED FROM T E BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS.
�f
INSPECTOR
TOWN OF (QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURYo NEW YORK 12809-
TELEPHONE (538} 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME ram'
LOCATION
DATE / PERMIT # - r
APPROVED
YES NO
Z,FTXNGIPXERS
MONOLITHIC POUR FORMS_
FOUNDAT-"ON/DAMP—PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING r � �
FRAMING
ELECTRICAL ROUGH—IN
INSULATION. f•'
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION.-
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/S EP
STAIRS—CLEARANCE RAILS
PLUMBING FSXTURE /R£LIEP� VALVE —
INTERIOR TRIM/-*TVACY DO6.(4S
FINISHED FLOOR
GARAGE FIREPRQCIFING
DOOR CLOSER (S)J
SMOKE DETECTy7RS
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
I
A SIGNED CEF;TXFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!'
REMARKS.
INSPECTOR
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