2012-390 4011111110,,, TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120390 Date Issued: Wednesday, November 07, 2012
This is to certify that work requested to be done as shown by Permit Number P20120390
has been completed.
Location: 268 Lockhart Rd
Tax Map Number: 523400-252-000-0001-036-006-0000
Owner: JAMIE JOHNSON
Applicant: JAMIE JOHNSON
This structure may be occupied as a:
Fireplace By Order of Town Board
Garage Detached TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property
owner of the responsibility for compliance with Site Plan, Variance, or
�a
other issues and conditions as a result of approvals by the Planning Board Director of Building& Code Enforcement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Flay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120390 Application Number: A20120390
Tax Alap No: 523400-252-000-0001-036-006-0000
Permission is hereby granted to: JAMIE JOHNSON
For property located at: 268 Lockhart Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: JAMIE JOHNSON
CELENA ORTEGA Fireplace
268 LOCKHART Rd Garage Detached $30,000.00
LAKE GEORGE,NY 12845-0000 Total value $30,000.00
Contractor or Builders Name/.Address Electrical Inspection Agency
BOB KRAMER
FIREPLACE INSTALLATION
668-0015
84 CORTLAND St
LAKE GEROGE NY 12845-0000
Plans&Specifications
2012-390
Detached Garage 864 sq ft
with living space above garage - 1 fireplace (gas)
$129.60 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,August 10,2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Friday,August 10,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
gliTy 742 Bay Road,Quceusbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT Re 0 s ,
Permit Number: P20120390 Application Number: A20120390
Tax Map No: 523400-252-000-0001-036-006-0000
Permission is hereby granted to: JAMIE JOHNSON
For property located at: 268 Lockhart Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction legs.
Owner Address: JAMIE JOHNSON Fireplace
CELENA ORTEGA Garage Detached $30,000.00
268 LOCKHART Rd Total Value $30,000.00
LAKE GEORGE,NY 12845-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
BOB KRAMER
FIREPLACE INSTALLATION
668-0015
84 CORTLAND St
LAKE GEROGE NY 12845-0000
Plans&Specifications
2012-390
Detached Garage 864 sq ft
with living space above garage- 1 fireplace(gas)
$129.60 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,August 10,2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town o uee bury; rid• •,gust 10, 2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
I $6'). (. � 1
AUG 2D12 Revised 4/14/2010
APPLICATION FOR FUEL URNING APPLIANCE & CHIMNEYS
Application is hereby made to the Building & Codes Office for the issuance of a Building & Use Permit pursuant to the
New York State Fire Prevention & Building Code. The applicant or owner agrees to comply with all applicable laws,
ordinances, regulations, and all conditions that are part of these requirements and also will allow all inspectors to enter
• premises to perform required inspections.
Important Note To Applicant: Rouqh-ln and Final Inspections Are Required:
Owner::
t4 Installer/Builder:
Address: , 4> -- a Address: 861 -I(11/4-Cs
Phone Nos.: 6/__9 Phone Nos.: 6(9B
Location of Property: aPK-36,6411— Subdivision Name:
Location of Proposed Construction and/or Installation: '1-iA-- r4
Contact Person for Building & Codes Compliance:
• Fuel Burning Applicance Wood Coal Pellet Gas Oil •
Information
Stove
Fireplace Insert
Fireplace, factory built*
Fireplace, Masonry
Furnace, (Garage Only)
* If Factory Built, Please Provide: Manufacturer Name: Model No.
Listed By: Number:
Chimney Information BLOCK BRICK STONE
Masonry** Check One/
TILE STEEL SIZE IN
INCHES
Flue Check One ✓
DOUBLE WALL TRIPLE WALL INSULATED DIRECT CHMNEY
VENT LINER
Chimney Material Check One
** If Non-Masonry, please provide: Manufacturer Name: Model No.
ADDITIONAL NOTE: CONSTRUCTION / INSTALLATION MUST CONFORM TO NYS FIRE
PREVENTION & BUILDING CODE AND/OR MANUFACTURER REQUIREMENTS. CONSULT
AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED INSPECTIONS
Town of Queensbury * Community Development Office * 742 Bay Road, Queensbury NY 12804
OFFICE USE ONLY
. .a 001 ; ;
TAX M�� O. —ate. LQpERMIT N0. �_
id i
l
FEE P• • / i BLDG.&CODES APPROVAL LI ,
AUr U 112
0
ACCESSORY STRUCTURE BUILD/NG PERMIT APPLICATION
Use this application for any structure other than the Principal Structure (house) to include, but not limited to:
garage, shed, greenhouse, dock, deck, etc. Refer to Informational Brochure No. 3 entitled Accessory Structures-
Sheds/Fences.
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PERMIT. NO INSPECTIONS WILL BE MADE UNTIL THE APPLICANT HAS RECEIVED-,
A VALID BUILDING PERMIT. p u
OWNER: '4rl l� 11 INSTALLER/BUILDER: JiOti
S
ADDRESS: Z6 LOci)w- 1 t (2_ ADDRESS: C �CDN( k' C S$ •
PHONE NOS. 26 PHONE NOS. 0 ? CJ-
LOCATION OF PROPERTY: SUBDIVISION NAME:
LOCATION OF PROPOSED CONSTRUCTION AND/OR INSTALLATION: glo O d-C C_ ked I�(�
HAS THERE BEEN A SITE PLAN REVIEW;VARIANCE OR SUBDIVISION APPROVAL? 0 YES 0 NO 7Th `�`
IF SO,INDICATE APPLICATION NO.AND DATE OF APPROVAL: lAf `
ESTIMATED COST OF CONSTRUCTION: $ iC- 3C)5 Y OTHER ACCESSORY STRUCTURES ON PROPERTY?
IF YES,PLEASE LIST:
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: PHONE:
1ST FLOOR 2ND FLOOR TOTAL PROPOSED
PROPOSED CONSTRUCTION SQ.FT. SQ.FT. SQ.FT. HEIGHT
FT.&IN.
OPEN PORCH
DECK
3 SEASON,COVERED OR ENCLOSED PORCH'
BOATHOUSE
BOATHOUSE WITH SUNDECK
• DOCK
SHED
PC<tE-$'ARN 86
DETACHED GARAGE(NO.OF CARS: ) / l Spe_e- 4-661-e, ^i'
OTHER ACCESSORY STRUCTURE: 614— # L)
*CONSIDERED FLOOR AREA & MUST COMPLY WITH FAR [FLOOR AREA RATIO].REQUIREMENTS IF THE
STRUCTURE IS LOCATED IN THE WATERFRONT RESIDENTIAL ZONE.
To the best of my knowledge, the statements contained in the 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 Codes, the Zoning Ordinance,
and all other laws pertaining to the proposed work shall be complied with, whether specified or
noted, and that such work is authorized by the owner. Further, it is understood that I/we shall
submit prior to a Certificate of Occupancy or Certificate of Compliance being issued, as requested
by the Zoning Administrator or Director of Building and Codes, an As-Built Survey by a licensed
surveyor, drawn to scale, showing actual location of all new
construction.
QUESTIONS? CALL 761.8256 OR EMAIL
codesaaueensburv.net
I have read. nd,a . to the above.
`�� 646-1Y/I VISIT OUR WEBSITE FOR MORE INFORMATION
Signed �iw Dated: ( U/ Yvww.aueensburv.net
•r5 :):
Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804
Queensbury Building & Code Enforcement - Residential Final Inspection
Office No. (518) 761-8256till' �c�l Arrive: am/ m Depart:/O ( m/pm
Date Inspection request received: i Inspector's Initials:
NAME: 2,44 }% � PERMIT#: Q
d. -3 l
LOCATION: 0L,/(-1<1,0 J� 6 /. I DATE:
TYPE OF STRUCTURE: i � �(1 t ]1c.e, [~!� Ab�Y
�� / �'y1N C. 5)`"`.<< 6 �
J Comments: W
Yes No NIA
4" Building Number Address visible from road
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 18 inches
Roof Complete/Exterior Finish Complete
Platform at all exterior doors
Handrail 4 or more risers
Guards at stairs,decks,patios more than 30 inches above grade
Guard at stairwell at 34 inches or more
Guard at deck, porches 36 inches or more
Handrail Termination at Newell Post or Wall
Interior/Exterior Railings 34 inches to 38 inches
Deck Bracing/Handicapped Ramp Compliant
Grade away from foundation 6 inches with 10 feet
6 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18 inches above grade
Interior privacy/trim/doors I main entrance 36 inches
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells safety glazing
Interior Smoke Detectors/Carbon MonoxidOi etectors
Every level: .J Every Bedroom: V
Outside every bedroo rea:
Inter Connected: Battery backup:
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area
Crawl Spaces 18 inch x 24 inch access, 1 sq.ft.-150 sq.ft.vents _
Bathroom Fans,if no window
Plumbing fixtures
Foundation insulation to floor/Sticker on Panel
Duct work sealed properly/Blower Door Test Certification
Floor truss,draft stopping finished basement 1,000 sq.ft.
Emergency egress below grade
Gas Furnace shut-off within 30 feet or within line of site
Oil Furnace shut-off at entrance to furnace area
Furnace/Hot Water Heater operating
Low water shut-off boiler
Relief Valve(s)installed/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum 1/�"Gypsum
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/3/4 hour fire door I door loser
Gas Logs in Sealed or Glass Enclosure
Final Electrical; Energy Saving Light Bulbs 50%
Final Survey Plot Plan
Arc Fault Breaker Habitable Spaces/Tamper Proof Receptacles
Flex Gas Pipe Bonding
As Built Septic System/Sewer Dept. Inspection Sticker
Site Plan /Variance required l •
Flood Plain Certification, if required
Okay to issue C/C or C I 0[Temporary/Permanent]
L:\Building&Codes Forms\Building&Codes\lnspection Forms\Residential Final Inspection Form_revised_100405.doc;Revised
January 7,2008; Revised 6/26/08; Revised 12/22/10, Revised 04/13/11
Town of Queensbury Fire Marshal 1,( � 6t��!!!�c
742 Ba Road " `�
" . Queensbury,NY 12804
761-8205/761-8206
fax 745-4437
Factory Built Gas Fireplace/ Stove Inspection Report
Notice: New York State requires that all UL Listed,factory built appliances be installed according to the instructions and
specifications contained in the Installation Manual accompanying the appliance. No deviation from the manufacturer's
instructions or specifications is allowed.
Permit# I J 3 C% Schedule Inspection Time " am pm anytime Inspecto
Name I1 i\ t7✓1 Address &:;* g /\004K hear }-111I Rough In Final
Appliance Manufacturer ���1 Model# )11� —`���•��
Direct Vent Factory Built Chimney Flue Size Double Wall Triple Wall Insulated
Yes No N/A Comments
Floor Protection '
f—c\ge t}K.)
Clearances to Combustibles (all sides)
Firestop(s) Vertical Chase
Wall Penetration
Vent Clearances to Combustibles
Vent/Chimney Termination
Chimney height must be 3 feet above roof
penetration;2 feet above any combustible
construction within 10 feet
Gas Shut-Off Valve
Combustion Air
Hearth Extension (if any)
Mantel /
Height above f/p opening
Witness Operation
Tank Placement (if LP)
CO Detection •
CSST Bonding
•
White—Building Dept. Mellon—Cust)mer Pink—Fire Marshal
J Les g "/ D
Rough Plumbing 0 Insulation Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building & Code Enforcement Arrive: am/pm Depart. \ am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: M, I
NAME: J tA✓A S n►� PERMIT #: �3c
LOCATION: au, L-.i C-K (A (\-+r INSPECT ON: 8' -(3./ -/
TYPE OF STRUCTURE: R t-fc t
_ Y N A
Rough Plumbing / Nail Plates
Plumbing Vent t Vents in Place
1 % inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet I change of direction
Pressure Test 1'
Drain /Vent
Air/ Head
5 P.S.I. or 10 ft. above highest connection for 15 minutes
Pressure Test
Water Supply Piping
Air/Head
50 P.S.I for 15 minutes
Insulation /Residential Check I Commercial Check
Tyvek or Similar Exterior Sealant
Proper Vent, Attic Vent
Door/Window Sealed (No Insulation)
Duct I Hot Water Piping Insulation
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly/ No duct tape _
COMMENTS:
Rough Plumbing Insulation Report.revised Nov 17 2003, revised February 15,2005, revised January 7, 2008
to y) 9-ll
Rough Plumbing 0 Insulation Inspectioli Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building & Code Enforcement Arrive: am/p m Depart: --gym/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials:
..,44.1 )
NAME: Dr) f),'1 PERMIT #:
LOCATION: , . ,. r , I1` r1 INSPECT ON: , r?
TYPE OF STRUCTURE: C rc''" e A o��
Y N N/A fl
Rough Plumbing /Nail Plates
Plumbing Vent I Vents in Place
1 % inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/change of direction
Pressure Test
Drain /Vent
Air/Head
5 P.S.I. or 10 ft. above highest connection for 15 minutes
Pressure Test
Water Supply Piping
Air/Head
50 P.S.I for 15 minutes
Insulation / Residential Check/Commercial Check
Tyvek or Similar Exterior Sealant
Proper Vent, Attic Vent 1.7
Door/Window Sealed (No Insulation)
Duct/Hot Water Piping Insulation
If required unheated spaces _
Combustion Air Supply for Furnace
Duct work sealed properly/ No duct tape
COMMENTS: L v
Rough Plumbing Insulation Reportrevised Nov 17 2003, revised February 15,2005, revised January 7,2008
Septic Inspection Report
Office No. (518) 761-8256 Date Ins ction request received:
Queensbury Building &Code Enforcement Arrive: Ili am/ppokb Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: B PERMIT NO.: (2/LOCATION: [.:L 444- 141 Qct INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand Lo Cla
Type of Water: Municipal / Well Water
Waterline separation distance ft.
Well separation distance /4' ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length r /(PO ft.
Length of each trench GJ _ ft.
Depth of trenches " ' / ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank 0' tC
Tank to Distribution Box y1'
Distribution Box to Field/ Pitf 5>p/'c
Opening Sealed: Y N
End Cap Y�N
Inlet/Outlet Pipes &Baffles Y N
Location/ Separations
• Foundation to tank ft.
Foundation to absorption ft. � kb(
Separation of Pits ft.
Conforms as per Plot Plan _Y N
Engineer Report and As-Built /I Y N
Location of System on Property:
Front Rear Left Side Right Sid- Middle Front Middle Rear
System Use St�t,�s:
�/ Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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