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1989-452 d . . .. vwT; Krc .' ¢ . .•..,t,. .:XaA.::'Klrl'^. ». X'^al3=.. .r^ r•?. .. ;�. .. 1 CERTIFICATE OF OCCUPANCY r TOWN OF QU'EENSBURY 'i WARREN COUNTY, NEW YORK Date Segtember _2g -Ma. I 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 Addition to Sing 7 a Fai 1 )r k Location 15 Sycamore Tony SZmul Owner By Order Town 'Board TOWN 4F QUEENSSURY Building 6 Zoning Impactor I x BUILDING PERMIT y TOWN OF QUEENSBURY No. WARREN COUNTY, NEW YORK ,D Cr c� cs� PERMISSION is hereby granted to Tony Semul OWNER of property located at 15 Sys mo_ a Drive Street, Road or Ave. in the Town of Queensbury, To Construct or place a Addition to Singl.cb Family 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. � fi 1 . OWNER'S Address is Same 2. CONTRACTOR or BUI LDERS Name `l Peter Sluck 3. CONTRACTOR or BUILDER'S Address RD# 1 Box 1152 Fort Edward , H . Y . 12828 4. ARCHITECT'S Name ►-� CZ) -C c'a 5. ARCHITECTS Address O m a A 6- TYPE of Construction — (Please indicate by XI r" ( ) Wood Frame I ! Masonry I Steel [ 1 7. PLANS and Specifications 25 No- 12 ' 6 " x 15 ' addition to single family dwelling as per plot plan , specifications , and application , 8. Proposed use _ cj 0 C Addition to Single Family Dwelling cn z $ 16 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES January 1 19_4� m I I f a longer period is required an application for an extension must be made to the Building and Zoning inspector of the -rt town of Queensbury before the expiration date.y r Dated at the Town of Queensbury this, th Day of June _ 19 89 - SIGNED BY for the Town of Queensbury Building and ton( nsp+actor TOWN OF QUEENSBURY APPI. TCATTON FOR BUILDING ANT) ZONING PERMIT f 7 i ■.i ec i Cv ell r, 1Rev i ewed Fee AcLid t/ VTR"" W I LD I NC ARID CODES ul TARTA ENT paste I b 4 ued ��Q�• & C`,G1QE D 3AY and ItAVILAND ROADS-- RD 1 BOX 98 ,PUEENSBURY, NEitl YORE 12804 Pit No • _ Tel ( 518) 792-5832 Ext 204 * * * ■ ■ * i* * 1 * * * * * a * * t* * . all ■ ■ ■ * * w a . a ■ A PERTIIT MUST Dn OBTAINFD BEFORE LEGINI-( ING CONSTRUCTION . NO INSPI: C'f IONS WILL BE, MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDINC PERMIT . All applicable spaces on tftis application must be completed and the Kinuature of the applicant must appear on the reverse sick of this sheet * 1' 1te owner of this Property is : -TC+tszr� v ty . O . Address 1 S �� Ah] , r TEL . r7 y 5 ~ troperty location TAIL MAP NO . f / Has there been any split of this property since October 1 , 1988 ' / yes no If yes , Planning Board Review is necessary , SUBDIVISION NAMED IF APPLICABLE LOT NO ne person responsible for supervision of work as regards Building Codes is : NAME P . O . ADDRESS N 61 NO . [dame of builder C!' �\ , cti� Address ( C r� x - r C ' el ft3-------- td:ame of Plumber 14dress Tel [dame of Mason Address Tel 14ATuRE OF PROPOSED WORK : ZONING INFORMATION ( Orfica use only ) - Con :: cructian of :a stew building) '" ZONING DL:SICNATION OF PROPERTY yr nddicion to a builain47 PERMITTED PRINCIPAL PERMITTED ACCESSORY �Aituc:. Gion to a Luilding ( rto cfr..[i�]u tG t:xC � riOr ClitnCn �' i4 '� REVIEW REQUIRED - PLANNING BOARD ZONING BOARD Ucl,er wort: (d' e.cril,o1 `e "A # SITE PLAN REVIEW # APPROVED DATE_ C: itOSS ARL'A Ol' YROPOSCD, !3TrCUCTURE * VARIANCE # APPROVED DATE r 1st door / sq ft . Remarks ? n d Floor s q f t . „ Cod'tPLL:'1't;: jpjyoI:MATJON 54LLQU IICED ud: L.UW . Ssii,: o f prolaerty f t X f t . other Floors sq ft . r LaGi::tiatcl l�uit+lia,�] t :: 3 5i : ,: i' c % rt . ( not cellar or basi: ment ) TOTAL FLOOR AREA sq f t buila .Lnq ( ;; ) Us.: - ..: izu of new utruatur.: 12�j f t X 15 / f ' l uw ,d:acicrn-pier/ �lal+/CC.awl/)raxti:al ful " NraLioaaci building , di :icancu iron, propurty lino (circle one ) Front yard ft Roar yard ft No . of storiea (hab !"blo :space ) / f t :and r' t „ Side yards Yluight ( grade to ridgL.: ) jL{ ft • If on corner , iuc.b"cic .froln siclu 2rruct rt It' rs:: iduntial , now of familicti tic , of rootn:a ( a=xcludinr3 baths ) / ' OCCUPANI:Y INFOWvATION tdo , of budroomu PRIMARY LUILDING NO4 of bathrooui : one family dwelling i'ri[WAry Ituatiny sy :tun, IFca' r �w�o . 'Swo t:+u�i] y dwu3.liny i A l Multi d jsl.4* welling / Number of units f u,.. i n of flrujliacU4 to ]u.: ln::t;allud t/ 13@Y1n:anCttt occupturcy . 11 4 wood L" OVO Lj lnut:allud f {1 + ► 01`r:ansi4jnt occup;anc:y L'untr:al Air cOculitiuning'1 O ylusincsss BUILDING :TYLEO PRIMARY STRUCTURE . Industrial Other lunch Conterr,f:ar..ry Lc,�? cabin * if "ddiLion , wilt will u::,: bui' t;.aisud ranch rsansic.,rt !7ulsl ,`x :Jplit Old stylo Urank1.. loW r4 .�se Cod Cotter{ate Ocher ACCESSORY UUILDIt+iC— Cotoni.. l law Arowtt douse * i:+staehac! y ,rargclon4 cur/ two czar/ ear ( CIRCLE CaNli PL>hA-`.0 ) W AttPachud g ariagw/Orin Car/ two c:44C/ CULL . . * a ■ 4 * . . ■ a ■ w * * • •' priv" tC storage building L: -". 'C1KA'k`CD MARKET VALUE of * Ocher INFOr4tA'TION ON nUILDTNC sprcrFICATIONS ■ ON REVERSE sID0 OF THIS SHL•'ET '1'0 13C COKPL1ETC01 Form DPA 10/80 VI BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc , c _ � n nc < C_ Will any second-hand or ungraded lumber be u .. cd? If so , for what ? ilk C7 Foundation wall material y ,. . c c- ,c_ Thickness Depth of foundation below grade ( to bottom of footing ) _ ' Will there be a cellar? <r r Heated or unheated ? yNc,a � �{ Floor sq . footage 's . :C, �sq ft Will there be a basemen 4eS Will any portion be used as living space? ( If so , what portion? �J sq . ft , - - Type of use? C- 1. � r Type of roof - sloped/ flatfshed/other SLGGr` Material of roof Size , woad studs , -�2 " X � " spacing__d_![,._"o , c . length ZF ft . 3oists ( floor beams ) 1st . floor '" K Yi " spacing ( "o . c . span' ft . JoIsts ( floor beams ) 2nd . floor " X " spacing "o , c , span ft , Overlays ( ceiling beams ) "X " spacing " o . c . spanl -A ft . Roof rafters Z "X g spacing__L6�_ o . c . any £t . Roof trusses (,pre-engineered) spacing " c span ft , Exterior wall finish ! r ti Oft material ? Interior wall finish },,?_ _______ If a garage is to be attached , describe water -.als to be used for .FIRE SEPARATION Is -re 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 he installed? Height above roof ft , Depth of chimney foundation below grade ft , Depth of fireplace hearth ft , in . Water supply - Municipal or private well SEPTIC SYSTEM _ Distance from ANY private well ( i_ncluding adjoining properties ft . (A separate application is necessary for any repair or new installation of septic system) DECLA. RATI0N 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. r r Signatu e `� dp .G s Ca ,Owner, owpi s agent, architect , contractor 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 fallowing : 1 . Gross floor area 2 . Type of heat 3 . Is the building mechanically cooled ? gys! 4 . Percentage of area of windows and doors ' A . Over 16 % Only 1 . Uo value of gross area of walls , roof / ceiling and floors exposed to ambient conditions y - 19 K �Cra tJsY �\ 2 . Floor over heated spaces YES a . Are foundation walls insulated ? YES NO 1 . If YES , what is the R value ? 3 . Slab on grade YES NO a . If YES , what is the value of insulation around perimeter of floor ? 4 . Is basement heated ? L NO a . R value of Insulati- on 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 rrc_ 3 . R value of glazed area ^ a_ ;__,r « s o 4 , R value of doors ,A pjb7� c sof. t : _• rL %' 5 . R value of floors over unheated spaces ¢ : R value of slab edge insulation - unheated slab `J f?. R value of slab insulation - heated slab ' /� . R value of heated basement / cellar walls ( above grade ) R value of heated basement / cellar walls ( below grade ) w 10 . Type of insulation CJwIThJ ".1.r C . Controls I . Thermostat maximum heat setting D . Duct Systems i . 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 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating 1 . Performance efficiency 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating �r oe or Telephone No . ! (r 2 4ft3 ��/ ( app1. nt signature ] At-BANY 12241 BINGHAMTON 13901 BUFFALO 14203 HEMPSTEAD 11550 NEW YORK 10047 ROCHESTER 14614 state OfiilSEEl1 ding 202 100 Broadway State Office Building State Office Building MenandS Hawley Street 125 Main Street 175 Fulton Avenue Two World Trade Genter 155 Main Street W. East Washington St. STATE OF NEW YORK t, WORKERS' COMPENSATION BOARD .. .,.� THIS AGENCY EMPLOYS AND SERVES THE HANDICAPPED rl i! WITHOUT DISCRIMfNATION, ' OFFICE AT ROBERT STEINGVT STATEMENT THAT APPLICANT DOES NOT REQUIRE CHAIRMAN WORKERS ' COMPENSATION OR DISABILITY BENEFITS COVERAGE (Ref : Sec . 57 , WC Law ; Sec . 220 , Subd . 8 , DB Law) Applicant ' s Name � t �t� -� - e- +o. R. Now Address x.;� k Office At �_- C� i ► Q h 5 ( Cp Business or Trade Name , if Different From Above The above named applicant for permit subject to restriction under Section 57 of the Workers ' Compensation Law , and Section 220 , Subd . 8 , of the Disability Benefits Law , makes the following statement for the purpose_ of establishing that he/ she does not require coverage under these laws . 1 . Location of work 2 . Exact work to be performed 3 . Number of workers C7 4 . Date work is to be (a ) commenced (b ) completed I have workers ' compensation insurance ( certificate attached) . R"I do not need workers ' compensation insurance because status is Individual owner or partner with no employees and not a corporation . I do not need workers ' compensation insurance because : [] I have disability benefits insurance (certificate attached) . [yam' do not need disability benefits insurance because status is Individual owner or partner with no employees and not a corporation . 0 I do not need disability benefits insurance because : I hereby affirm, under the penalties of perjury , that I am the above named applicant for permit subject to restriction under Section 57 of the Workers ' Compensation Law and Section 220 , Subd . 8 , of the Disability Benefits Law and that the foregoing statements are true . / Date Signed (Q y .f'7` 19 _L gnature of Applicant Telephone No . - Title TO STATE OR MUNICIPAL DEPARTMENT , BOARD , COMMISSION OR OFFICE REQUIRING CERTIFICATE OF WORKERS ' COMPENSATION INSURANCE UNDER SECTION 57 OF THE WORKERS ' COMPENSATION LAW AND UNDER SECTION 220 , SUED , 80 OF THE DISABILITY BENEFITS LAW Based on the foregoing statements made by the above applicant : ❑ The Board has no objections , at this time , to the issuance of the permit requested . 0 The applicant will be required to have a Disability Benefits insurance policy effective not later than four (4 ) weeks after the employment of one or more employees on each of at least 30 days in any calendar year . It is to be understood , however , that the Board reserves the right to request revoca- tion of the permit if , after investigation , it is found that the applicant is required to have workers ' compensation and/or disability benefits coverage for the work referred to in the above application . WORKERS ' COMPENSATION BOARD By Date : (District Administrator or Supervisor of W . C . Enforcement ) �. C- 105 . 21 ( 7-83) TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT SAV & HAVILAND ROADS I2804- QUEENSBURY, NEWT ORIC TELEPHONE ( 51.8 ) 79211111115832 BUILDING INSPECTOR' S REPORT REQUEST FpR INSPECTION RECEIVED NAME Z,OCATION � _ �-�-��FSRMST # DATE _ APPROVED YES 1 NO FOOTXNGIPXERS MONOJgTHIC POUR FORMS �- FOUNDA XONIDAMPIIIIIIIPROOFING BACKFI APPROVAL ROUGH PL BING FRAMING ELECTRICAL OL1GH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING f, IIIIII INSPECTION: CHIMNEY HEIGHT ROOFING SIDING STEP EXTERNAL PORCH / ,STAIRS-CLEARANOB & RAI PLUMBING FXXTU6RESIREZ -r VALVE�� INTERIOR TR'f4f PRIVACY DOO FINISHED FLOORS GARAGE ,FXREPAOOFING_�� _ DOOR CLOSER JS) SMOKE DETEC RS FINAL ELECTR AL INSPECTION FINAL APPROV L OF CONSTRUCTION A SIGNED CAR OF OCCUPANCY MUST BE S14GNED FROM THE BUILDINGOB DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED. IIIIIIIIII REMARKS : INSPECTOR TOWN OF QUE,ENSBURY BUILDING AND CODES DEPARTMENT �. ! BAY & HAVILAN OARSYORK ] 28[7 QUEENSBURY, 792-�� �� TELEPHONE (518 ) BUI113ING INSPECTOR' S REPORT - REQUEST FOR INSPECTION RECEIVED `r ' - - NAME LOCATION - 1PERMIT #�-�S---- DATE ---`-= APPROVED i YES NO 4 FOOTING/PIERS MOUND TIO AMP-PROOFING FORMS FOUNDATION/ BACKFILL APPRCIVAL�_ �� - ROUGH PLUMBING . t,,,•FRAMING ELECTRICAL ROUGH-IN INSULATION-* FOUNDATION �- FI.GOR S WALLS CEILING FINAL INSPECTION- CHIMNEY HEIGHT ROOFING SILTING EXTERNAL. PORCHE61STEPS - STAIRS-CLEARANCV & RAILS PLUMBING FIXTURESIPELIEF VALVE INTERIOR TRINIPRIVACY DOORS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION 11 A SIGN CERTIFICATE OFF OCCUPANCY MUST ED SE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED ! REMARKS: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENS.BURY, NEW YORK I280k TELEPHONE (5I8 ) 792-5832 Bu I LDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVEDJ� b NAME LOCATION DATE `si PERMIT # APPROVED YES NO FOOTINGIPIERS MONOLITHIC POUR FORMS FO NDATIONIDAMP-PROOFING I ACKFILL APP OVAL ROUGH PLUMBS G FRAMING ELECTRICAL RO H-IN INSULATION: FOUNDATION FLOORS WA.L LS CEILING FINAL INSPECT ON: CHIMNEY HE, GHT ROOFING SIDING EXTERNAL PORCHESIST S STAIRS-C EARANCE & ILS PLUMBIN FIXTURESIREL EF VALVE INTERIO TRIMIPRIVACY RS FINISHE FLOORS E GEIREPROOFI CSER (S) E D TECTORS FINAL ELE TRICAL .INSPECTION FINAL. APT' OVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE ,BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED ! REMARKS: INSPECTOR atvn 0/ Queenzllury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 96 Queensbury, New York 12801 BUILDING IN PECTOR ' S REPORT NAME LOCATION owOL" 40f/,.-cv Date Y�� I �� Permit Noe fir'° APPROVED - YES NO ,Footing/Pier Forms V Foundation aterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Chain Tile -- Concrete Floors _ Plbg . Fixtures — Gar . Fireproofing Door Closers Smoke Detectors .! Chimney INSULATION . Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVA1. Final Building Survey Next scheduled inspection (call when ready ) Remarks- Building Ins ector 6/86 and-vl TOW BUILDING i N F AND COD BURY -J B,T,rLLDING AND CODES DEPARTMENT BAY 6 HAVILAND ROADS OLTEENSSURY NEW Y 0eL TELEPHONEr (5 8) 792-5832 BUILDING INSPECTOR' S REPORT 1 REQUEST FOR INSPECTIONECEIVED NAME LOCATr N DATE Uc3 c PERMIT #� — � APPROVED ' ES I NO L/FOOTING/PIERS MC?NOLITHIC pOUR FORMS FOUNDATION/DAMP—PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN INSULATION: FOUNDATION FLOORS r WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING 1 SIDING EXTERNAL PORCHES/STEP STAIRS—CLEARANCE PLUMBING FIXTURES/RE IEF VA E INTERIOR TRIM/PRIVA DOORS _ FINISHED FLOORS GARAGE FIREPROOFIN DOER CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL IN PECTION� � FINAL APPROVAL OF NSTRUCTION A SIGNED CERT.TFICA [ E OF OCCUPANCY MUST BE OBTAINED FROM THE USLDING DEPARTMENT BEFORE THESE PREMISES ARE"%yOCCUPIED r IIIII REMARKS: f O yq �-, i ' rNSPECTOR SELECT 43USINESS FORMS i6091 948-5203 f APPLICATION FOR ELECTRICAL INSPECTION I PLEASE BEAR DOWN YOU ARE. MAKING (4) COPIES MIDDLE DEPARTMENT INSPECTION AGENCY, INC. ` - � National Headquarters - 900 Haddon Ave., Collingswood, N.J. 08108 COMPLETESAPPLICANT Date : City, Town or Township County State / r Location/Address �s (1f Located in Rural Area - Please Attach Directions) pale =a `e # Owner rn ' 7 - _ Permit # Occupied As Building: NewO Old = Occupant Work Area in Building Floor #, etc_ ) : App. for : Wirin %® Service 0 or: Readv for inspection : Fee Remitted - $ Cash Q Check M.Q. Make Payable To: M.D. I.A. 5cD 750 1D00 1250 1504 i750 2000 2250 25D0 2F50 300D Number of Rough Wiring Outlets Elect, Heat Switches J ,Amp. 'Service Surface Unit Dishwasher Flange Lighting Water Heater Air Conditioner Dryer Pump Receptacles Oven Garbage Disposal Wiring and Controls for Burner Number of Fixtures Amp. Receptacles Fractional H.P. Vent Fans Other Equipment: MOTORS H.P. 1/2 1/12 1/10 1/S 1 1/6 1/4 1/3 1/2 3/4 1, 1 11/2 1 2 1 3 1 5 1 7V2 1 10 1 15 1 20 25 1 30 40 50 75 lOD Mark Number of Each Size T7 App I ica ignatur License # Permit # /A Utility : INAME (OFFICE LOCATION) Applicant's Address _ (City) (State) (Zip) Service Request # Phone # Electrician: MDIA USE ONLY DATE RECEIVED: DATE INSPECTED: Correct Location : Same as 7bove Cj or: Red Notice Label Rough Wiring Outlets Surface Unit 'Oven Switches Range Garbage Disposal Receptacles Water Heater Dishwasher Fixtures Air Conditioner Dryer Amp, Service Equipment Burner, Wiring & Controls for Amp. Receptacle Amp. Service Conductors Pump Vent Fans MOTORS H.P. 1/20 1/12 IJle 1/a lf6 3 /4 I/3 1/2 3/4 1 1+lz 2 3 5 TVr 101572rO2 L3C L40 107, 5 100 Mark Number of Ea^" coo 5D0 r5o 1006 1250 1500 1150 2000 225D 25D0 2F50 3000 Putrick Daslanaw t. Heat lEudsan all �� 12�39 J i,; �Tltil ^A; INSFECiOR CERTIFICATIONS ' U" FOR INITIAL VISIT;CWLY ` s NOTIFIED DATE. CORRECT IR6E PAID RW Progress : Inc. 0 LKD Contractor CFT Violation : Work Comp. Inc_ F-1 CASH El �f L/A Owner Fee CH K t* Due PA Municipal INQV# Applicant Date : Other Sided Utility Owner Cut in Card Q Temp # Date i F t w v k u t f►.ll i c�l F�r� A�•,:"��` +' CAL' . jUl 44 no y 4 z c cio SN 3: N 03 od H(Aow r r1 t `t 3ntpjq r%31 lwY ��