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1987-610 i I iI F CERTIFICATE OF OCCUPANCY TOWN OF QUEEN59URY � - I WARREN COUNTY, NEW YORK Date December S ;g < � I $7—ti 1 Cl E This is to certify that work requested to be done as shown by Permit No. has been completed. This an-ucture may be occupied as a Qne—Family IJwelling 3.,ot #3 Briggs Court ( St . No . 22) Queensbury Forest Subdlviziion Location ,NWsullo Brothers Inc . Owner By Order Town Board TOWN OF QUEENSBURY Building & Zoning Inspector i Y BUILDING PERMIT TOWN OF QUEENSBURY No 87-610 1 WARREN COUNTY, NEW YORK r PERMISSION is hereby granted to iuLssullo Brothers Inc . 1 OWNER of property located at Lot #3 Briggs Court ( St . No . 22) Street, Road or Ave. ueens ury o es u 3-VTS on in the Town of Queensbury, To Construct or place a One—Family Dwelling 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 W 3049 Broadway c Schenectady , N . Y . � tx� .e 2. CONTRACTOR or BUI LDER'S Name o r'+ Same ro P1 m 3. CONTRACTOR or BUILDER'S Address C Y ra. SD H 07 4. ARCHITECT'S Name f'} 5. ARCHITECT'S Address r-r 4 ro n m B. TYPE of Construction — (Please indicate by X) a w i XI wood Frame i ) Masonry I I Steel o CIq Kl !ta 7. PLAINS and Specifications m n No. 34 ' x 48 ' per plot plan , specifications and application including R septic system and two car attached garage . r�r B. Proposed Use One—Family dwelling w 0 ro $5 . 00 157 . 00 April 1 , 88 PERMIT FEE PAID — THIS PERMIT EXPIRES 19 w (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the G town of Clues nsbury before the expiration date.l 15th . 19 Sept 87 1 Dated at the Town of Queensbury this ©ay of }� N• ao SIGNED BY a for the Town of Queensbury Building and Zoning Inspector � ' TOWN OF Application No . ., fou►n o of y iseel�36�tr t Permit Issued 19 out LOING and ZONING DEPARTMENT Permit Expires 19 ©ay and Haviland Road, R.D. 1 'Box 98 zoning Designation S E P Queensbury. New York 12801 - variance Noe Site Plan Review No. 13UIR ^? raG � POOE DEPT, y ' APPLICATION FOR BUILDING AND ZONING PERMIT 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 tha Permit , �r•l�.l � 9� ���w�w,MwtilMY.,����.�.��.�.�.�.�..YlMww �N�� �� �� �w �� ................ The owner of this property is : Masullo $rotbera builders Inc P. O. Address 5ly 7'el . l7r] ( 5R Property Location: Lot # '� �e +�- �`�• ►" "i �- "ax Map No. Street numbber or building lot number - Subdivision r name (if applicable) SIfJLe:.RlE)7iSy aXggt! THE PERSON RESPONSIBLE FOR- SUPERVISION OF WORK AS PJar:nrtM BUILDING CODES IS : Name P. O. Address Tel . No . N411 of builder Same Address Same as Abobe Tel . Sams Name'' of plumberIMB Plus' Address 88 cep „r;bWsy,N_Y_ Tel .459�-58I1 -- Name or maso,nM lies, &M, &t4id,.e+� Adds •: _ Tel same�., -� NATURE OF PROPOSED WORK: 1(l! a ?N 31+EF')Ff*lfaTION a Construction of a new buil.c v ing * A PXA-, PL:a.N MUST BE PREPARED AND SUBMITTED , Addition to a building * drawn reasonably to scale and attached hereto, Aiexation -to a building ' showing clearly and distinctly all. buildings * (no , change 'to exterior dimensions) '� whether existing or proposed and indicate all Other work (describe) L L * set back dimensions from property lines . Give * street and number or lot number and indicate ION PERMIT STATE SIZE AND FOR DEMOLITION * whether interior or corner lot . Show location LOCATION IT STRUCTURES AFFECTED. * of water supply and location and configuration of septic disposal area . * * COMPLETE INFORMATION REQUIRED BELOW . * size of property Led t X '& f t . * Existing building ( s) Size ft X�ft . * � PROPOSED BUILDING AND USE : '+ Existing building (s) Use Size of new structure jj�ft Foundation- ier,/sab/c.raw part�f ull * Proposed bui�llddin�,distance from roper p g property line (circle ) * Front yard plan ft Rear yard ft Now of stories (habitable space) 2 Haight (grade to 3ridge) 23' ft_ * Side yards ft and ft If residential, no. of families i » 1 on corner, setback from side street_ 343 _ft No. of roams (excluding baths) * OCCUPANCY INFORMATION No* of bedrooms A 4 Id .*r PRIMARY BUILDING Noe of bathrooms � _ *, family dwelling em Primary heating sys em * _ One OneTwo family dwelling Noe of fireplaces t Types of fuel Pier-rrto be installed * Y Multiple dwelling / Number of units �� , � Will a wood stove be installed? Permanent occupancy ---� - * 'Transient occupancy Central Air conditioning? yen Business * BUILDING STYLE, PRIMARY STRUCTURE * Industrial Ranch Contemporary Log cabin * Other Raised .ranch Mansion Duplex * If addition, what will use be _ Bplit level Old style Bungalow Ca a Cod Cottage Other * ACCESSORY BUILDING- nia Row Town House * Detached garage/one car,/ two car/ scar ( CIRCLE ONE PLEASE ) * X Attached garage/one car/ two car/ r ^car * * • • * * * + * * * * * * * * * * _Private storage building ESTIMATED MARKET VALUE OF * Other CONSTRUCTION INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED ! Worn BPA 4/86 and-vl BUILDING PERMIT APPLICATION .,CONTI=ED - BUILDING SPECIFICATIONS : Type of construction, wood frame, fire safe■ etc . ibod Frame will any second-hand or ungraded lumber be used? If so, for what? ND Foundation wall material rlo a 2wourA ______ Thickness W' S 1011 Depth of foundation below grade (to 'bottom of footing ) 7+0►' Will there be a ceilax? WS Heated or unheated? Floor sq. footage0e6240W sq ft W41 there be a basement? Nd will any portion be used as living space? 1VO (If so, what portion? sq. ft. - - Type of use? Type of . roof - sloped/flat,/shed/other material, of roof lksahalt Sire , wood studs 2 "X.� spacing_"o . c . length eft. Joists ( floor beams)lot . floor 2 _"X^.'A&_" spacing. ,�, "o . c . span lh ft . Joists ( floor beams) 2nd . floor 2 '"X 10 " spacing IG "o . c . span tb -f to Overlays (ceiling beams ) "X spacing "o. c. span ft . Roof rafters "X " spacing a . c . span ft. Roof trusses (pre-engineered) spacing0000 "o . co span ft . Exterior wall finish Aluo in= Of what material? Interior wall finish 4" dWA&Wdk= fts ed If a garage is to be attached , describe materials to be used for FIRE SEPARATION : . �"' FixeL7ode Is there to be an opening between garage and dwelling? Yes If so will a Fire-rated door, enclosure, and self-closing device be provided? 'Yes will a flue-lined c'himney7be installed? yvg Height above roof. op ft . Depth of chimney foundation below grade fto Depth of fireplace hearth ' Water supply — Municipal or private well MMICI=d SEPTIC SYSTEM Moo, 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 A F 3 D A V I T County of Warren STATE OF NEW YC?RK I swear that tq, the best of my knowledge and belief the statements contained in I<his application, together with the plans and specifications submitted , are a true and comps ete _ aft4tement of all proposed work to be done Pon the described premises and that all provisions, ,of the BUILDING CODE . THE ZONING ORDINANCE, and all other laws pertaining to the propo#pd work shall be Complied with, whether specified or not, and that such. .work is authorised- by the owner_ _SWORM TO BEFOR.B ME THIS *Signalur Owner, owner ` s agent , arcnirect, contractor day of 19 Notary Public , warren County, N. Y . • * • * * x • * * * * * * w * • * * s * * * * * +► * * * * : * r * * re * * * * ,e # + yr + * a SPECIAL CONDITIONS OF THE PERMITz TOWN of ¢UEENSBURY 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 alQir? _ 2 . Type of h e a t MLectri.c Heat Pump 3 . Is the building mechanically cooled ? YES 4 . Percentage of area of windows and doors 1470 A . Over 16 % Only 1 _ Uo value of gross area of walls , roof /ceiling and floors exposed to ambient conditions See Att ebgd _ 2 . Floor over heated spaces YES NO a . Are foundation walls insulated ? <iiD NO 1 . If YES , what is the R value ? it13 3 , Slab on grade YES ae 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 Fiberglass H . Under 16 % only 1 . R value of roof and floors exposed to ambient conditions_ 2 . R value of exterior walls 3 . R value of glazed area 4 . R value of doors 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 so R value of heated basement/ cellar walls ( above grade ) 9 , R value of heated basement/cellar walls ( below grade ) 100 Type of insulation C . Controls 1 . Thermostat maximum heat setting 9& 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 . PIpInSE insulation i. size of hot water or cooling carrying agent pipe Cooper 2 . R value of pipe insulation Fe Service Water Heating 1 . Performance efficiency 2 . Temperature control setting maximum G . For Swimming Pool Only 1 _ Maximum heating c— Telephone No . 370-1058 applicant ' signature ) APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE LOCATION OF PROPERTY FOR INSTALLAUON Owner's Name: ln Sy l& frifta S nu l kx[ s Telephone: Address: '?6 $4R 8rdadffGrA �SC ,ho�w..Lc^� .AO�.l�r' +M,/ • Installer's Name: S 19ArC Telephone: Number of bedrooms (residential only) Total daily flow (compute @ 150 gal per bedroom) �d O Topography: circle one<S;D Rolling Steep Slope % of slope Soil Natuues circle one Sand Loam Clay Other / 17epth: feet Ground Water: At what depth? rVIA feet Bedrock or Impervious Material: At what depth? ��f of _ feet Percolation test: circle one: not require required / rate min. inch. Domestic water supply- circle one: ( unicipal Well Other IF domestic water supply is a Weil: Separations Watersupply from Septic absorption _ feet PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench SO feet / Total system length 256 feet SEEPAGE PIT(S) : Number of / Size each feet by feet Size of stone to be used # jf4v3 / 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 30 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 dryweils 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 $250.00. c. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system , a new proposal must be submitted to the Queensbury Building Department before further construction. I have read the regulations above and agree to abide by these and all requirements of the 'Town of Queensbury Sanitary Sewage Disposal Orwdinance. c Signature of responsible person• Date: yeo / '� a Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE THE NEW YORK BOARD OF FIRE UNDERWRITERS i BUREAU OF ELECTRICITY 41 STATE STREET, ALBANY, NEW YORK 12207 Application ,Va.1on file T ..,. �.. ;a ..; ;, •;r :; •1 } Date } ,i- r }' 'El' 1:.1� ir, i ' " � � [ ' � t b HIS CERTIFIES THAT watt the eleetrical equiprneraR ar derac+"rberZ baloRs a+Rd irstrodaaced by the applicant nefned Oft, the aboae syepliestiow nurssber s`n the prenaiees of ; '�' -� s'� ;' T r:�i ' (• '} '` } }:. ', �'. , in thejollowing location, Q Basement �.; tat Fl. 2" Fl. ;- 1 T`j � Section i , IBlocic i Lot } was ,examined an '; }. 1 T! } le 1 , 1 . .4 1:1' '-' and found to be in coanpliance with the requirements of this Board. FIXTURE FIXTURES RAMOES gDOKINo DECKS 011EN5 DtSN WASNRRS EX}IAUST FAME CUTLETS ErTACUM SWITCHES INCANDE$CENT FuXWESCENr OYHER AMT, K. W. AMT- K. W. AMT. K.W- AMT. K. W. AMT- FF. P. Up DRYERS FURNAC! MOTORS FUTURE AlFLIANCR FEEORRS SMCLAL RRC"tPT TIME CLOCLCS L UwIT XRATERS M�Tt ��T T SYSTRINS AMT, K. W. dL R. P- GA9 N- P. AIAT. 140. SERVICE 1GE DI A. W. G. AMT. AAV. AMr. A,ws. TRANS. AMT. R, F, wo• OF I$T AMT. WAT'r5 r+++...e.^•r wC. CF S R R V t C E S..... INETRR No. crF ce. [oPrD. A w. U Pro.aF NL.LEG A,W. G- Nf}. e?F NEUTRALS A. W.4. AMT. AMP. TYPE &QUIN'. 1 .AX 2W 1 0 3W $ # $v+ $.A' 4W PER # OF CC. CCNJD. aF HI-LEG OF NEUrRwi I i o OTNER A"ARATM • [;' ,�� �-- . •;. '31 } ' { E ' }� l BRAMiCH MANAGGIN This certificate must not be ahered in any manner; return to the office of the Board if incarrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER, ` �{ }r BuiuD1NG and ZONING DEPARTMENT " N Bay and Haviland Road, R.D_ 1 Box 98 Queensbury, New York 12801 l SEPTIC DISPOSAL SYSTEM INSPECTION NAME ' S LOCATION DATE ,4 /efz PERMIT PNO . SOIL TYPE - Sand - Loam - Clay - Percolation 'rest Required? YES - NO Percolation rate - Min/Inch TYPE of SYST Absorption fiewd " total lengt Length of each trench Depth of trenc s Size of gravel SEEPAGE PITS er of) Size- t. X f Gra size PIPING : Size Type Bldgv to tank Tank to diet. box Dist. box to fie d/ Openings sealer? E NO Partial r LOCATION/SEPA TIONS : Foundation t tank ft. Foundation o absorption ft* Absorption to lot line ft. Separatio of pits ft. LOCATION SYSTEM ON PROPER (circle one) Front - ea - eft si - R1 t side CCMMENT 5 T t =� (q k_ �5 a � ►� - SYSTEM USE APPROVEAi.1djIng NO Bns ctor 01/86 and vl ✓n u+n o� '�tt e¢ez 3 +b►.t r t�f BUILDING and ZONING DEPARTMENT Bay and Havifand Road, R.D. 1 Sox 98 Queensbury, New York 12801 SEPTIC �D�fISPOSAL /SYSTEM INSPECTION NAME LOCAT ION r7 j v r s [rdZ, a BATE / PEi2M IT NO . ( 0 SOIL TYPE L n - oam - Clay - Percolation Required? YES Percolation rate - Min/Inch TYPE of SY TEM: Absorption field , total length Length of ea h trench Depth of tre ches Size of grav _ -- SEEPAGE PITS4 umber of) Size- Gravel size PIPING : Size Type Bldgm to tank Tank to dlst. box Dist. box to fief pit _ Openings sealed? ES I3O Partial LOCATION/SEPA. Ions Foundation to ank ft, Foundation to absorpti n ft . Absorption It lot line ft. separation a pits ft. LOCATION OF SYSTEM ON pR PERTY (circle one) Front - Re - Left side Right. side CCb1MENTS : A)-OT [ I� Do to Ar SYSTEM USE APPROVE4ng Bct r 01/86 and vl i ! J BUILDING and ZONING DEPARTMENT ! - Bay and Hauiland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INS ,P�7EC' TOR ' S REPORT NAME LOCATION Date-L� —� Permit No . ✓ = APPROVED - Y S NO Footing/pier Forms Foundation Waterproofing I3ackfill Framing Roofing Siding Masonry Veneer t_..r Aqh Plumbing Relief Valves Ext , Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION Foundation Floors i Walls Ceiling_ FINAL EI ECTRI AL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- Building Inspect r 6/86 and-vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HA VILAND ROADS QUEENSBUIRY, NEW YORK 12801 TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR IyNSPECTIO�N' RECEIVED_/- j NAME LOCATION DATE r RMIT #_ 9-7— APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—PROOFING BACKFSLL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN INSULATION: FOUNDATION FLOORS WALLS CEILING AL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHE /STEY?S STAIRS—CLEARAN E & RA)CLS PLUMBING FIX RES/REL F VALVE INTERIOR TR /PRIVACYORS FINISHED F RS GARAGE FI PROOFING DOOR CLO R (S) b4 SMOKE D ECTORS FINAL ELE T 'ICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A .SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS : IN ECTOR TOWN OF Q BUILDING ANDD CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12801 TELEPHONE (5I8) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED �i NAME LOCATION / DATE f PERMIT # APPROVED YES INO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATIONID P-PROOFING BACKFXZL APP AL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH N & ULATION. FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH /STEPS STAIRS-CLEARAN E & RAILS ...._ ....... PLUMBING FIX RES/RELIEF LVE INTERIOR TRI /PRIVACY DOO FINISHED F RS GARAGE FIR ROOFING DOOR CLOS {S) SMOKE DET CTORS FINAL ELEC ICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUS BE OBTAINED FROM THE BUILDING DEPARTMENT FORE THESE PREMISES ARE OCCUPIED? REMARKS . rZ l INSPEC R of �ueerrsburc�t BUILDING and ZONING DEPARTMENT Bay and Haviland 'Road. FI. D. 1 Box 98 Queensbury, New York 12BOl BUILDING INSPECTO /6 RE RT NAME LOCATION Date,'r!� �' / 1A_} 7Perm i t Na . APPROVED* -*)IES * NO Footing/Pier Forms Foundation Waterproofing Backfill Framing XRoof Siding Masonry Veneer Rough Plumbing Relief Valves Ext , Porches Finished Floors Interior Trim Stairs & Railings cellar Drain 'Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke DetectOrs Chimney IN 8U LAT I UPI : Foundation Floors Walls Ceiling FINAL ELEC CAL INSPECTION DRIVEWAY APPROVAL . Final Building Survey _ Next scheduled inspection ( call when ready ) Remarks- Bui ding Inspector 6/86 and-vl 10,07,wn of 110 4 0 BUILDING and Zc)NING crEP,aRTeneNTT } ' Bay and Haviland Road, R-0. 1 Box 98 ueensbury, New York 12801 +� BU1L ING INSPECTOR ' S REPORT LOCATION C �0. Z c Date /4 / Permit. Now APPROVED - YES No Footing/Pier Forms ,y,�k'oundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbs-ng Reline £ Va1Ves Ext . porches Finished Floors interior Trim Stairs & Railings Cellar Drain Til Concrete Floors Pl. bg . Fixtures Gar . Fireprao Ing Door Closers Smoke Deter rs Chimney I N SU I.AT I ON Foundatio Floors Wallas Ceiling FINAL ELEC RICAL INSpECTID DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- Building nspector 6/86 and-vl _ !titan a uQpny6udr SUjL_ 111VG and ZONING DEPARTMENT (lay and Haviland Road, R.D. i Sox 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME �*r LOCATION �` " Permit No . Date * APP ROV EL] YFs NO Footing/Pier Forms Loo roundation waterproofing 04MckfiII Framing Roof ing siding Masonry Veneer Rough Plumbing Relief '`valves Ext . Porches Finished Floors Interior Trim Stairs & Filings Cellar Drain Tile Concrete Floors .1bg . Fixtures �- Gar . Fireproofing Door closers smoke Detectors chimney INSUl.ATION - Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION, DRIVEWAY APYROV Final g, jjdlng Survey Next scheduled inspect (call when ready ? Remarks- Rui ding Inspector 6/86 and-vl V oklc:�) I (' I BUILDING and ZONING DEPARTMENT Bay and Haviiand Road, R.D. 1 Box 98 J Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date �� /� Permit No . ! " �/C? * rt * w * k * * * ✓ �* * * * * *ED -* YES NO �ooti.r►g/Pier Forms rr � L Foundation waterproofing Backfill Framing Roof In Siding Masonry veneer Rough Plumbing Relief valves Ext . porches Finished Floors interior Trim stairs & Railings Cellar Drain Tile concrete Floors plbg . Fixtures ,Gar . Fireproofin Door closers Smoke Detectors Chimne]r INSULATION : Foundation Floors walls ceiling FINAL ELECTRICAL ILVSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready Remarks- �Ld Xvt` zz Building inspector 6/86 and-vl * Type of Fireplace: El Pre-tab Masonry © Modular SLAB HOLLOW CHIMNEY SWEEP • No. of Stories: '2 3 4 • No. of Fireplaces: 1 2 3 4 P.O, Box 77 Middle Road • Woodstove : I__l Insert LI Free Standing C1 Pellet CROWN POINT, NEW YORK 12928 (518) 597-3640 + Type of Wood Used: C_J Soft F) Hard L-1 Wet F I dry • Last Cleaned: Years) Ago C] Never Number of cords burned per season: _ Customer_,� o Flue Size: FA 8" xa" 0 8"x 13" 3" x 13" LI 8" x 17„ Address ,V.OV g�YW.5 ...�. ` / ��, — O 13"'x 17" ❑ 8" Bound L1 6" Round (A to City "'� � State,01v 2ila - .r,`_o" • Outside Chimney bimensions:... X Pho - - - „ r Time + Fireplace opening Size: " x Date d - - • How did you hear about us? Cl Referral CI Yellow Pages LJ Media-TV, Newspaper l Direct Mail C� Other CONDITION � � - REPORT 5 t6 d CCJMMENTS : dr CHIMNEY �,`yYl f'+ ry Ire ["t) }� .SVC7 • c' 1 , Height y; 2. Chimney Cap /Spark Arrestor F M nut 3. Crown / Wash uR P5. _ Brickwork / Mortar Flashing Flue Tiles. Moisture Resistance CUSTOMER VERIFICATION FIREPLACE sriltrE I have read this form and now understdn which areas of my woodburning system appear to be satisfact ry and which areas 8. Smoke Chamber °ANMR dd are not satis y. _ Signed -- Date 9. Damper 10_ Firebox / Grate LkITEi NEXT SERVICING RECOMMENDED 11 , A'sh Container rnt�ISIIItII—" 12. Spark Screen / boors ASH LIMP El montF a3 Y Vpar The fireplace and chimney should be inspected yearly for any 13. Tools / Gloves V W n structural faults. 14. Hearth Protection Sweep's or Mason's Signature 15. Misc.: WOODSTOVE OR FIREPLACE INSERT RECEIPT 1 INVOICE 16, Stovepipe Condition (woodstove) DESCRIPTION PRICE 17. NFPA Approved Flue Connection (insert) 18. Installation / Thimble / Clearances OTHER SAFETY CONSIDERATIONS 19. Fire Extinguisher / Smoke Detectors 20. Gas Furnace Flue Liner SUBTOTAL 21 . Fire Escape Plan Note: This sheet is the result of a visual inspection done at the time of deaninq. If is DATE COMPLETIE0 TOTAL intended as a convenience to our customer, not as Gedificafion of lire worthiness or safety. Since conditions of use and hidden construction defecls are beyond our control, we make r, s9s.9 coppPlhPld rommney Sipmly. Inr. no warranty of the safety er function of any appliance and none is to be implied. �r1 t TA 4 dl /00 Ot J !• Now s L�fr�04 ia' _ tj oil ..r- 7 NEW YQ R I;r%,. STATE ENERGY CONSERVATION CONSTRUCTION CODE PART 6 WORKSHEET THERMAL RATING rAETHOD OKIE- AND Tl� Ol FAMILY BUILDINGS BUILDING & -'"3 C,70-~ GROSS FLOOR AREA ADDRESS NUMBER OF STORIES DEGREE DAYS ' ' 1 CO11TRAC T OR , ARCHITECT OR ENG114EER TELEPHONE ? x the huildir.e do=s not meet the follcoe:tira -pre-qualifying conditions . Part 6 of the Energy Code may not be used . YES 140 ✓S/ Building is one-- or t.v:e-fGrily residential . V i Building is detached . Building is less than 5 . 000 gross square feet . Building is three stories or less in height . Entrance doors have a storm door or certified U value of . 40 or less . Glazing area /gross wall area is equal to or Mess than : 24k if 5, 000 degree days 232 if 6 , 000 degree days 202 if 7 . 000 degree days 18Z if 8. 000 degree days 162 if 9 , 000 degree days If all of the above conditions are not met, either PART 3 . PART 4 or PART 5 of the Energy Code must be used . r DIRECTIONS: For each component of the proposed building design enter the design information requested such as Areas. "U" or "R" Values . Additional lines are provided for designs with more than one component construction type . Obtain thermal ratings for each item by consulting the appropriate Tables . A. ROOF/CEILING Obtain Thermal Ratings from Table 6ewl , 6-2. 6-1E or 6-2E depending upon degree days and heating type, A Area: U-Value: 4 q��t. herma Rating Area•. U-Value : Square Thermal Rating Be NET MALLS Obtain Thermal Ratings from Table 6-1 . or 6-1E depending upon heating type . Area: G� 4 U-Value: qu� t. Thermal Rating Area: U-Value : Square FtV Thermal Rating Note: Met Wall Area = . Gross wall Area minus Basement/Cellar Walls. Glazing ' Areas and Door Areas . C. GLAZING Obtain Thermal Ratings from Table 6-3 or 6-3E depending upon heating type . WINDOWS Area of Glazing . ^ Isw � U-Value: *'r .3 ( J .,�quareM. Thermal Rating Area of Glazing : U-Value: Square FE. Thermal Rating SKYLIGHTS Area of Glazing : U-Value r Square Ft. hermal Rating Dle FLOORS Obtain Thermal Ratings from Table 6-1 . 6�1E or 6s-4E depending upon degree days . and heating type . Floor Area : iJ-Value : ,�IVA, ____ Sq� - hT erma7 Rating Dz . BASEMENT/CELLAR MALLS Obtain Thermal . Ratings from Table 6-4 . 6- 5 , 6-6 or 6-- 5E depending upon degree days and heating type . Wall Perimeter: Linear Feet Exposure Above Grade: Feet U-Value of Nall : Depth of j-'al l U-Value Below Grader Inches Thermal Rating Note : Use the above grade U-Value of the wall . The Thermal Rating Tables have been designed to take into account the insulating effect of the earth . D3 , SLAB INSULATION Obtain Thermal Ratings from Table 6-7 or 6-6E depending upon heating type . Slab Perimeters Linear Feet Insulation R-Value : �^ Thermal Rating E . INFILTRATION CONTROL Obtain Thermal Ratings from Table 6-8 or 6-7E depending upon heating type . If the building does not meet the following conditions , enter NA (Nct Applicable ) for Thermal Rating , YES NO All windows have an air leakage rate of 0. 35 cfm or less per linear foot of operable sash crack ; All net wall areas have an infiltration barrier ; and A heat recovery ventilator, which transfers heat between the outgoing airstream and the airstream entering from the outside . is installed . Conditioned Floor Area : ( Shall not include qu�areFt . herT mai " Rating basement/ cellar floor area ) F . SOUTH FACING GLAZING Obtain Thermal Ratings from Table 6-9 or 6-8E depending upon heating type . If the building does nct meet the fol ; oiairzg- conditions , enter NA ( Not Applicable ) for Thermal Rating. YES 140 The building is no less than 1 . 250 square feet in conditioned floor area; At least 45 percent of al-1 glazing faces within 30 degrees of true south ; All glazed areas in buildings are no more than U(glazing ) = 0 . 58 : South facing glazed areas are free of any site - obstructions during . the heating season ; and An area of four-inch thick concrete or masonry is exposed to direct sunlight from south facing glazing . The area of this concrete or masonry shall be no less than three times the area of south facing glazing , Conditioned South Glass/Total Glass : 2 Floor Area : Square Ft . Glass Area/Gross Wall Area : �( See Above ) Therms Rating SUWiMveARRY OF TOTAL `F'HERMAL. RATING If the - Total Thermal Rating is zero (0 ) or greater, the proposed design for the building envelope complies with the Energy Code , THER14AL TABLE AREA U—VALUE RATING USED A . ROOF/ CEILING Type 1 rb T . 033 44 6-2 Type 2 [ B . 14ET WALLS Type. 1 '2 064 -+ 4) 1 Type 2 Co GLAZING d Window Type 1 Window Type 2 Skylights _ D1 . FLOORS D2 . BASE 14E14T/CELLAR WALLS Ball Perimeter 134 Feet Exposure A.bdve Grade '^'r^ Feet - Wall U—Value Depth of Wall U—Value � 9*1Qw Grade { - - Inches . D3 . SLAB INSULATION Slab Perimeter Feet Insulation R—Value E . INFILTRATION CONTROL Conditioned Floor Area Sq. Ft. - F . SOUTH FACING GLAZING South Glass/Total Glass Percent G1 . Area/Gross Wall Area Percent Conditioned Floor Area Sq. Ft. TOTAL THERMAL RATING -4