2014-104 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20140104 Date Issued: Wednesday, September 16, 2015
This is to certify that work requested to be done as shown by Permit Number P20140104
has been completed.
Location: 85 HANNEFORD Rd
Tax Map Number: 523400-227-018-0001-030-000-0000
Owner: ADIRONDACK MTN RIDGE EST., LLC
Applicant: ADIRONDACK MTN RIDGE EST., LLC
This structure may be occupied as a:
Single Family Dwelling By Order of Town Board
-� TOWN OF QUEENSBURY
/
Issuance of this Certificate of Occupancy DOES NOT relieve the property f ,\ I
of the responsibility for compliance with Site Plan,Variance, or /Y1�Y Y-it-
owner
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement
or Zoning Board of Appeals.
I
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140104 Application Number: A20140104
Tax Map No: 523400-227-018-0001-030-000-0000
Permission is hereby granted to: ADIRONDACK MTN RIDGE EST.. LLC
For property located at 85 HANNEFORD 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: ADIRONDACK MTN RIDGE EST., Single Family Dwelling
136 STONE SCHOOLHOUSE Rd Total Value
LAKE GEORGE NY 12845-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans &Specifications
2014-104
SFD 1,000 Sq ft.
cross ref. Pere Test BP 13-575 & BOH Septic Variance 4-2014
$200.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,April 15, 2015
(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 : r ; sburyi Tue • y,• pril 15,2014
SIGNED BY for the Town of Queensbury.
Director of Building&Co.e Enfosement
SEPTIC DISPOSAL PERMIT1 / C [,
D�iiE $ /S ! ecL
RQU 2' lapl.:
TAX MAP ID 22 ./6 -r �3
TOW OF QUEE No.
LOCATION OFINSTALLATION 78-SIHLtf- _ _ art. :w fINO&C0Ae&TlitF=-
- -- - Approvals: y
APPLICANT 4c0(1. Alin. 1� PHONE/E-MAIL 36t` 86Z
ADDRESS /74 51-4.-..eScke/4&/FC' A". l 14lee- tc--rle Ay J7�'YS
INSTALLER/BUILDER: R Di, vtt-v-/� � PHONE/E-MAIL 6 Y 6 /`" 379 t(
ADDRESS: < G 1
OWNER Sil^•le_ c' r0 It R-n+ PHONE/E-MAIL
Address J ' / j� �
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: (y O l y 71/ 4bI7 (/
vS PHONE 36/-O
/ �7)N 7er✓cAS, JM
RESIDENCE INFORMATION L
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed _Y 4 N
1981-1991
Spa or Hot Tub installed _Y a N
1992-Present 3 //-L; 33 0
PARCEL INFORMATION
Topography X Flat rolling Steep slope %slope
Soil Nature Sand )C) Loam Clay Other
Groundwater At what depth? /if " 45- /Pen to. QU(
Bedrock/Impervious Material At what depth? •Nen/Er: SEPTIC VtiR. r
Re.3
Domestic Water Supply Municipal X Well(if well,water supply from any septic system absorption is 7-I ft.)
Percolation Test Rate: .`3-n/Os per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size /0 0 0 gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length ft.;Each trench x
Seepage Pit with#3 stone How many: ;size
Alternative System Bed or other type? t/j e.-1 R-9-4
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received& approved. The installed system must match the septic system
layout on file-no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any .terial representation or
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be vs id. I ave read the regulations
and agree to abide byi.es• and all requirements of the Town of Q -ensbury Sanitary Sewa.e .ispos=I Ordinance.
Print Name: y/ • �w CAI'a Date:
Signature: --- -Date:
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
Town of Queensbury Building & Codes Office Use Only
Received:
PRINCIPAL STRUCTURE APPLICATION Tax Map ID: ad-7. «-/ -36
Permit No.: /y
A
permit must be obtained before beginning construction $/��
Permit Fee:
Please read: 'TB resolution 86-2013(1-28-2013): $850 recreation fee for new dwelling *Rec Fee: $
units,including single-family dwellings,duplexes or two-family dwellings, multiple family ite lap �or�
dwellings, apartments, condominiums, townhouses, and/or manufactured and modular • !u onS,"04,1 LI V t
homes,but not including mobile homes. This is in additio e permit fee. v' o c
Date 3' 2 `T lU, ! e null AM I0 -j ��
Applicant
Tax Map ID 223. l fj - / 3 U TOL-v.Or UUtENSBURY
Address -i s ,, o _ _
Zoning W fZ –
I Phone/E-mail
Property Owner /t')ov n+a' 1 ? d trick Contractor/Agent
Address / 3 6 :i7c S va/4owsc P4. Address
�1-rt 6ectje / N'y 1289-5–
Phone/E-mail
28ySPhone/E-mail 34/ -&C2 Phone I E-mail
Contact Person for Building&Code Compliance: 6 47 y ?Cr VC S Day Phone: 36/- 162 I/
Building Street Address: 85 Haig-trio/4 [Z4.
Subdivision Name: wil- Lot#: Historic Site: _Yes X No
Estimated cost of construction: $ $ /8A–
Type
8kType of Construction:
Check all that apply —Please indicate measurements as required below:
aC
0 a
F 254 1st Floor _Mind Floor) Other Total Height
v
Ar 111:4
Single Family 'Y/1 ,000 ,5F
p,24., o • , 0 /g e?
� I
Two-Family „air '^ J�
Multi-Family(#of 1 bl/
units_)
Townhouse
Business Office
Retail-Mercantile
Factory-Industrial
Attached Garages(# )
Other
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
If commercial or industrial indicate name of business
Proposed use of building or addition �AS;(te-14244cI
Source of heat(circle one) Gas Oil Propane Solar Other 4Jc ./-
Fireplace-complete a separate application for"Fuel Burning Appliances&Chimneys _Yes /r No
Are there structures not shown on plot plan? D e c1-C
Are their easements on the property? EaSc.h c.r,-f- o' -c etc,5+-.=r j
Site Information
a. Dimensions or acreage of lot O, 2 ti 1• a c.
b. Is this a comer lot? .tj c
c. Will the grade be changed as a result of construction: _Yes X No
d. Public water or Private well ?/-t v al P uj ad
e. Sewer or Private Septic System
Value of all work to be performed(labor and materials) $ /8 a
Declaration: I acknowledge no construction activities shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and
department approval. I certify that the application, plans,and supporting materials are a true and complete statement/description of the
work proposed,that all work will be performed in accordance with the NY State Building Codes,local building laws and ordinances, and
in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a
certificate of occupancy. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above.-
Print Name: Ge.y 6 $ervaS
Signature: Date: /2 6//y •
-
FOR OFFICE USE ONLY:
Operating Permit Issued: _Yes _No
Occupancy Type:
Construction Classification:
Assembly Occupancy Limit:
Special Conditions:
Town of Queensbury Building&Codes Principal Structure Packet 518-7614256
Please include two (2) sets of the following documentation with the submission of a Completed application for a
Building&Zoning Permit
1. Principal Structure Application
2. Plot plan drawn to scale with the use of a survey map, if possible'[40 scale-1 inch=40 feet[engineering scale]:
• Indicate proposed structure, showing setback dimensions from all surveyed property lines
• Show location of all existing structures on the property
• Show location of water supply(well or water lines)
• Show location and configuration of septic disposal system or sewer line
3. Structural Drawings to include:
• Floor Plan
• Foundation Plan
• Cross Sections
• Elevations
• Window and Door Schedule—see attachment
• Calculation Sheet for Natural Light, Ventilation&Emergency Egress—see attachment
4. Registered Architect or Engineer's Stamp(signed&sealed)under the following circumstances:
• Residential addition or alterations with construction costs over$20,000
• Single Family Dwelling 1,500 sq.ft. or greater
• Any commercial construction
5. Checklist for single family or multiple dwelling or commercial project
6. REScheck or COMcheck signed &stamped: Downloadable version-www.energycodes.gov.
7. Fireplace and/or woodstove solid fuel burning application (if applicable)
8. Septic Disposal Permit(if applicable)
9. Electrical Inspection Agency-Please see"Certified Electrical Form"on the Town's website
10. Driveway permit(if applicable)
11. Fee
Notes:
Certificate of Occupancy: Before a certificate of occupancy is issued for a new residential or commercial structure, an as-
built survey[plot plan]certified NYS licensed surveyor must be filed with our office.
Changes to Plan: Any changes prior to or during construction will require submittal of amended plans[review and re-
approval are necessary].
Withdrawn Permits: 20%of the initial fee is retainable by the Town of Queensbury. No fee is refundable after 1 year from
initial application date.
Additional Review: All Applications are subject to Zoning Administrator, Code Compliance,and Structural plan review
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
Checklist - Single family dwelling or Multiple dwelling / Commercial project -
SINGLE FAMILY DWELLING PROJECT cHECKLIST •
PROJECT NAME: 55 kJ-Wig eyf #-cf Tc(.
•
Please include two(2)sets of the following documentation: Yes No N/A
1. Building Permit Application Completed • "C
2. Energy Code Inspector's Report from ResCheck
3. Septic application(if applicable) •
4: Solid Fuel Burning or Gas Appliance Form(if applicable) x
5. Driveway Permit
6. Structural Drawings
Floor plan(s) X
Foundation plan
Cross Sections
Elevations
Window and door schedule X
Natural Light,Ventilation and Emergency Egress Requirements X
Plans signed and sealed by registered architect or engineer X
7. Plot Plans-Indicate proposed structure,showing setback dimensions from all surveyed property lines; 7G
Show location of all existing structures on the property; x
Show location of water supply(well or water lines);
Show location and configuration of septic disposal system or sewer line
8. Electrical Inspection agency selected
MULTIPLE DWELLING OR COMMERCIAL PROJECT CHECKLIST
PROJECT NAME:
Please include two(2)sets of the following documentation: Yes No NIA
1. Building Permit Application Completed
2. Energy Code ComCheck and Inspector's Report Form
3. Septic application completely filled out(if applicable)
4. Solid Fuel Burning or Gas Appliance Form(if applicable)
5. Driveway Permit
6. Structural Drawings
Floor plan(s)
Foundation plan •
Cross Sections
Elevations -
Design loads including floor,snow load and wind load
Seismic design(required after January 2003)
Plans signed and sealed by registered architect or engineer
Window and door schedule
7. Plot plan: Indicate proposed structure,showing setback dimensions from all surveyed property lines
Show location of all existing structures on the property
Show location of water supply(well or water lines)
Show location and configuration of septic disposal system or sewer line
8. Electrical inspection agency selected
Town of Queensbury Building 8 Codes Principal Structure Packet 518-761-8256
WINDOW SCHEDULE
CALCULATION SHEET
JOB SITE ADDRESS: 8.5 Ha-,.', , / r‘1 Rce-
DATE: 3/2,6/it
OWNER: /vtouneo:-t PL-d,,e t)/c-/co S
APPLICATION NO.:
Window#or Letter Window Manuf. Window Unit or Stock# Rough Rough Sq.Ft.Vent Sq.ft.egress I Clear opening Clear opening Special hardware or
on Plan Name Model Type Call size Opening Width Opening clear opening width in inches height in Instructions
Height inches
r 5 t
e ..,.m:�m.k-S flit - _ ._ ns.netar�
r ... ..-- i . r . 5
•
C 4 a,
7/6 A 3//a 38 re . k 4 /Y* '1,24 4-z.6 32. 3/4 1 ? //6
1�,. it ., /uc i° 32/2 261 `l " it i '/N' z a 2 .0 2° 3/6 /C rd
�' a C a o 3/ 7L 1/86 iv e H
4 44vse� S�lowGx 3/y a S/0 do IR L(o ✓f/Z 6 .55— 6.553 36 ?/I6 Z6 sho
B F - 3141 X6/0 . 80 - 6'DVZ 6- sS 1-575- 36 %6 Za 06
•
•
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
•
NATURAL LIGHT, VENTILATION, AND EMERGENCY EGRESS REQUIREMENTS
CALCULATION SHEET
JOB SITE ADDRESS: 3 ) I La z e 7‘.r Re"
DATE: 3/26 // if
OWNER: P 1-y t5/4,-)
APPLICATION NO.:
NATURAL LIGHT, VENTILATION, AND EMERGENCY EGRESS REQUIREMENTS
Habitable Room Area of Room Required light Actual light square footage Required ventilation Actual Ventilation Square Footage Square Foot Opening for Egress Remarks
In Square Feet 8%of room area 4%of room area
Master jK0 (I, Z SF 20.63 5F g. 6 SP /0 -Si cr �. SS
RED 1 9z 7, 3651" 10.43 3. 68 Sr AL- S 6. sr—
BED a 33. 3 6 -6 6 zsr 3- 3 3 /3 . /
N1. BATH ?Ori' 5-66 8 . 13 2.-33 H, 217
BAtli 74.2 . 62- ' 5. 61 2. 8 ( 249S
titiN6/flrj yH 9 X5. 9 53, 82 1: -1 /6 26 . 1�-
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
- Ott ( n
1 r U ., a „use-Joni,
►-eceived:
Town of Queensbury Building & Cc s' " �a lj
Permit No.:
SEPTIC DISPOSAL PERMIT F tP�blitfi=€ $L� ISfk�W� '
A permit must be obtained before beginning cor structionBUILOIN' ,r,,,?!..S t' i .•
Applicant: r Jk. MJ JZ_ iy {vS InstallerlBuilder I tLv II V IE 1
E( Address: /96 5?cn c �Y1 (�a, P•4 Address 1 � . ,
D" ,
14.c e Cco c ,t/y /28 ys !'I'
l) I
Phone: 578 -367- %Z ct Phone j
r Owner. S 4,n Location of Installation TOWN OF QUEENSBURY
Address: - =ES
�j J(v �`.A44la/ /
Phone
Contact Person for Building&Code Compliance: Get7 ?en/14S Day Phone: 7C/-862 if
Residence Information:
i Year Built
1980 or older #of Bedrooms x Gallons per bedroom =Total Daily Flow
x 150 = Garbage Grinder installed? °Q'
I
1981-1991 x 130 Spa or Hot Tub Installed? NO
! 1992-Present 3 x 110 = 330
Parcel Information:
Topography Flat Rolling _Steep Slope _%Slope
Soil Nature Sand Loam _Clay _Other
1 Groundwater At what depth? /"°�/��
Bedrock/Impervious Material At what depth? �7
1 Domestic Water Supply _Municipal x Well(if well,water supply from any septic system absorption is loo ft)
Rate
Percolation Test - 3„As per minute per inch(Test to be completed by a licensed professional engineer or
architect)
Proposed System for New Construction: All individual sewage disposal systems must be designed by a licensed professional engineer or
architect(unless installed in a Planning Board approved subdivision).
Tank size ri c ot •gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or
4..whirlpool tub
r
I System Type: Absorption Field(with#2 stone) Total length ft. Each trench X
Seepage Pit(S)(with#3 stone) How many? Size?
Alternative System Bed or other type? E(j en ?e4
1 Holding Tank System Total required capacity? Tank size? #of tanks?
I
i NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified
Electrical form on Town website;2)Effective as of March 23,2006 Septic System-As Built Plot Plan: The Building Department will no longer
allow systems to be covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed
system must match the septic system layout on file. There will be no exceptions.
II For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval granted
which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or circumstance known
by or on behalf of an applicant,shall be void.
✓I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbury
Sanitary Sewage Disposal Ordinance.
Print Name: 66V7 fVad 7rt. Date: /8/y /
Signature: /4 - Date:
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
Residential Final Inspection 07,4
Inspection request received 9/l40/5V- a _ nj
Name 61//1/2pus 3N4775& &' ervas Inspected on 9 Location "ter Wann Arrive am/pm
Permit No. a/0/446i Inspector's Initials
Type of Structure s�
Ye'No N/A Bathroom Fans,if no window
4" Building Number Address visible from road �/ Plumbing fixtures
Chimney Height/"B" Vent/Direct Vent Foundation insulation to floor/Sticker on Panel
Location
Duct work sealed properly/ Blower Door Test
Fresh Air Intake Certification
3" Plumbing Vent through roof minimum 18" Floor truss,draft stopping finished basement
Roof Complete/ Exterior Finish Complete 1,000 sq.ft.
Platform at all exterior doors Emergency egress below grade
Handrail 4 or more risers Gas Furnace shut-off within 30 ft.or within line
Guards at stairs, decks, patios more than 30" of site
above grade Oil Furnace shut-off at entrance to furnace area
Guard at stairwell at 34"or more Furnace/Hot Water Heater operating
Guard at deck, porches 36 "or more Low water shut-off boiler
Handrail Termination at Newell Post or Wall Relief Valve(s)installed/Heat Trap/Water
Interior/Exterior Railings 34 "to 38" Temp 110
Deck Bracing/Handicapped Ramp Compliant Enclosed Stairs Sheetrock Underside minimum
'A Gypsum
Grade away from foundation 6" with 10 feet Basement stairs closed rise•4 inches
6"clearance to sill plate Garage Floor Pitched
Gas
g adealve shut-off exposed /regulator 18"above Garage fireproofing/ Y hour fire door/door
closer
Interior privacy/trim/doors/main entrance Gas Lo s in Sealed or Glass Enclosure
36 " g
Bathroom /Kitchen watertight Final Electrical;Energy Saving Light Bulbs 50%
Safety glazing/Window in stairwells safety Final Survey Plot Plan
glazing Arc Fault Breaker Habitable Spaces/Tamper
Interior Smoke Detectors /Carbon Monoxide
Proof Receptacles
Detectors ✓ Flex Gas Pipe Bonding
Every level: ✓ Every Bedroor / As Built Septic System/Sewer Dept. Inspection
Outside every bedroom area: ✓ Sticker
Inter Connected: / Site Plan /Variance required
Battery backup: ✓ Flood Plain Certification, if required
Attic access 30"x 22"x 30"(height)in Okay to Issue Temporary/Permanent
accessible area Certificate of Occupancy OR
Crawl Spaces 18" x 24" access,l sq.ft.-150 sq. Certificate of Compliance
ft. vents P
Yes No N/A
Comments:
Town of Queensbury Building& Code Enforcement Office No. (518)761-8256
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
Inspections per Permit
Permit# P20140104
Inspection Date Inspection Type
Approved/Denied Comments Permit Type Person Responsible
05/30/2014 Pressure Test Supply Single Family Dwelling CHARLES DYER Staff
Approved 2014-104
05/30/2014 Pressure Test Vent Single Family Dwelling CHARLES DYER Staff
Approved 2014-104
05/30/2014 Rough Plumbing Single Family Dwelling CHARLES DYER Staff
Approved 2014-104
05/30/2014 Fire Stopping Single Family Dwelling CHARLES DYER Staff
Denied 2014-104
provide fire blocking and fire stopping where indicated
07/07/2014 Septic Single Family Dwelling DAVID HATIN Staff
Partial 2014-104
-Provide engineer insp letter and change at pump station tank
-Need to inspect pump line sieve
07/08/2014 Septic Single Family Dwelling DAVID RATIN Staff
Partial 2014-104
OK to cover sleeved 2"pipe in 4" SDR
-Need to inspect pump station and final electrical inspection
-Need engineer sign-off and as-built
07/25/2014 Septic Single Family Dwelling DAVID HATIN Staff
Partial 2014-104
Need to inspect pump station and alarm system
Final Electrical Insp.
OW TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
f Community Development- Building&Codes (518) 761-8256
Inspections per Permit
Permit# P20140104
Inspection Date Inspection Type
Approved/Denied Comments Permit Type YP Person Responsible
Fire Stopping Single Family Dwelling CHARLES DYER Staff
Approved 2014-104
D4/11/2014 Miscellaneous Single Family Dwelling STAFF
Misc 2014-104
Permit app reed&entered
)5/21/2014 Pressure Test Supply Single Family Dwelling CHARLES DYER Staff
Denied 2014-104
not ready
5/21/2014 Pressure Test Vent Single Family Dwelling CHARLES DYER Staff
)enied 2014-104
not ready
5/21/2014 Rough Plumbing Single Family Dwelling CHARLES DYER Staff
)enied 2014-104
not ready
5/21/2014 Framing Single Family Dwelling CHARLES DYER Staff
,pproved 2014-104
W30/2014 Plumbing Vents Single Family Dwelling CHARLES DYER Staff
Denied 2014-104
TOWN OF QUEENSBURY
A 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
Inspections per Permit
Permit# P20140104
Inspection Date Inspection Type
Approved/Denied Comments Permit Type yp Person Responsible
10/30/2014 Final Inspection Single Family Dwelling DAVID HATIN Staff
Denied 2014-104
Property must have water and all landscaping complete before final CO is issued
04/17/2015 Final Electric Single Family Dwelling MIDDLE DEPARTMENT
Approved 2014-104
07/20/2015 Septic Single Family Dwelling DAVID HATIN Staff
Approved 2014-104
final electrical ok
07/20/2015 Final Inspection Single Family Dwelling DAVID HATIN Staff
Denied 2014-104
install bldg#
need to have inner connect: smoke,co detectors
Town of Queensbury Building &Code Enforcement
Office No. (518) 761-8256
3:ou
Septic Inspection Report
Inspection request received: 7 2 cs r !— //
Name: 7/44 ( MA L72 ALL Inspected on: 20 /S
Y
Location: e5 al.zcz(le/ Arrive: 2,60 a.m.lp.m.
Permit No.: /P/' /GS' Inspector's Initials: 0,
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/ ell Wate)
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO) .-,
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone I
Seepage Pits: Number •
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed: _Y__N
End Cap _Y_N
Inlet/Outlet Pipes&Baffles _Y_N
Manholes 12°or less below grade _Y N
[provide extension collar if Yes] _Y_N
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft. /
Conforms as per Plot Plan X/Y__N �:� Ale:4151
Engineer Report and As-Built }O Y N
ETU Maintenance Contract provided _Y_N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Stat :
Approved .
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report (11
Queensbury Building & Code Enforcement - Residential Final Inspection
Office No. (518) 761-8256 Arrive: 31e--' am/pm Depart: am/pm
Date Inspection request received: Inspector's Initials: Pt,
NAME: />?0.ucc%`tJ jr6 41 PERMIT#: /�y�t7Y
LOCATION: A*" c,6,,,e 4 / DATE: //za tr—
TYPE OF STRUCTURE: /
Comments:
Yes No ,�N/A_
4" Building Number Address visible from road f/
Chimney Height/"B"Vent/Direct Vent Location t/ ry j k 3/i
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 r/ ,.
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 8 inches with 10 feet
6 inch clearance to sill plate ✓
Gas Valve shut-off exposed/regulator 18 inches above grade l//
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight 1/
Window Safety glazing I in stairwells safety glazing
Interior Smoke Detectors/Carbon Monoxide Detectors
Every level: Every Bedroom: /
n/ /
Outside every bedroom area: _ / / f 7� Z,,e / e cons
-
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.R-150 sq.ft.vents V
Bathroom Fans,if no window ✓
Plumbing fixtures tV ,
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. 1//
Emergency egress below grade t/ ,
Gas Furnace shut-off within 30 feet or within line of site ///
Oil Furnace shut ince to furnace area / v
Fumace/Hot lAratericleciteroperating V
Low water shut-off boiler ✓
/
Relief Valve(s)installed I Heat Trap/Water Temp 110 V
Enclosed Stairs Sheetrock Underside minimum W Gypsum ✓j
Basement stairs closed rise>4 inches V
Garage Floor Pitched V
Garage fireproofing/'/.hour fire door/door closer ✓/
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 Bun Septic System/Sewer Dept. Inspection Sticker x/
Site Plan /Variance required /
Flood Plain Certification,if required t//
Okay to issue C/C or C 1 O[Temporary!Permanent]
L:tBuilding&Codes Forms1Building&Codesllnspekzion Forms1Residential Anal Inspection Form_revised_100405.doc;Revised
January 7,2008;Revised 6!26!08; Revised 12!22/10,Revised 04/13/11
Queensbury Building & Code.Enforcement - Residential Final Inspection
Office No. (518) 761-8256 Arrive: am/pm Depart am/pm
Date Inspection request received: Inspector's Initials:
NAME P iK t(\+y, R c ea. PERMIT#: /1-1 4121LOCATION: $ 5 kim n n o f /aaiI DATE: I v—
TYPE OF STRUCTURE:
Comments:
Yes No N/A_
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/main entrance 36 inches
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells safety glazing �.
Interior Smoke Detectors/Carbon Monoxide Detectors
Every level: _ Every Bedroom:
Outside every bedroom area:
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
Fumace/Hot Water Heater operating
Low water shut-off boiler
Relief Valve(s)installed/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum W Gypsum
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/%hour fire door/door closer
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 n / L`�e �` f
SRe Plan /Variance required /V� /r)o /1 /t
Flood Plain Certification, if required /
Okay to issue C/C or C/O[Temporary/Permanent] 9 � // L4 4 «�% 674e
•
Mere_ 7;f</ Co ,s thfuCO
L:1Building&Codes Forms\Building&Codes\nspection FornslResidential Final Inspection Form_revised_100405.doc;Revised
January 7,2008;Revised 6/26/08;Revised 12f22/10,Revised 04/13/11
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
F 4y Community Development-Building& Codes (518) 761-8256
Inspections per Permit
Permit# P20140104
Inspection Date Inspection Type
Approved/Denied Comments Permit Type YP Person Responsible
Fire Stopping Single Family Dwelling CHARLES DYER Staff
Approved 2014-104
04/11/2014 Miscellaneous Single Family Dwelling STAFF
Misc 2014-104
Permit app reed&entered
05/21/2014 Pressure Test Supply Single Family Dwelling CHARLES DYER Staff
Denied 2014-104
not ready
05/21/2014 Pressure Test Vent Single Family Dwelling CHARLES DYER Staff
Denied 2014-104
not ready
05/21/2014 Rough Plumbing Single Family Dwelling CHARLES DYER Staff
Denied 2014-104
not ready
D5/21/2014 Framing Single Family Dwelling CHARLES DYER Staff
Approved 2014-104
15/30/2014 Plumbing Vents Single Family Dwelling CHARLES DYER Staff
Denied 2014-104
,fl TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
f.
Community Development-Building&Codes (518) 761-8256
iiirr Inspections per Permit
Permit# P20140104
Inspection Date Inspection Type Person Responsible
Approved/Denied Comments Permit Type
05/30/2014 Pressure Test Supply Single Family Dwelling CHARLES DYER Staff
Approved 2014-104
05/30/2014 Pressure Test Vent Single Family Dwelling CHARLES DYER Staff
Approved 2014-104
05/30/2014 Rough Plumbing Single Family Dwelling CHARLES DYER Staff
Approved 2014-104
05/30/2014 Fire Stopping Single Family Dwelling CHARLES DYER Staff
Denied 2014-104
provide fire blocking and fire stopping where indicated
07/07/2014 Septic Single Family Dwelling DAVID RATIN Staff
Partial 2014-104
-Provide engineer insp letter and change at pump station tank
-Need to inspect pump line sieve
07/08/2014 Septic Single Family Dwelling DAVID HATIN Staff
Partial 2014-104
OK to cover sleeved 2"pipe in 4" SDR
-Need to inspect pump station and final electrical inspection
-Need engineer sign-off and as-built
07/25/2014 Septic Single Family Dwelling DAVID RATIN Staff
Partial 2014-104
Need to inspect pump station and alarm system
Final Electrical Insp.
j X001_ W_ _55tba ck
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SILT FENCE
god , Stairs
(see sheet 2 fordetails)
f
Mill I lil'iI '
i
1 4" PVC Gr: vii
Lin From Hu
o
�I Proposed IG)O ga.
Plastic Septi Ton
�C
Q).
Ston 5tep5 Path
Capped Rod et -- --- -- _ 6r,—
Tall Iron Pipe Found
o - Tall Iron P e Found °
36,
-s
/C I
ITE MAP — SCALE: 1" =_1500'+
KNOBIROAD
r 51 TE
om' , ipe Found - ----
i
Iron Pipe foun
10.5/ -,
PORCH I I
Back Fi�l Effluen I Line
I I
CO to Accommodate Drain hack �\
j , _ / I PARING
Propo ed 10' Strip a pavement
ffl t l Ex osure
SILT FENCE t U 1
(see sheet 2 for details)
Iron Pipe Found i
Map Reference
Map of...
Alfred E. � Alice J. Schuman
By: D.L. Dlckln5on A`;5oclate5
Date: 5 Au u5t 201 sDaooaonuaiina
g anesN__ no jo Nm01
JJS�Z-A
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va rrJl 'r°-�
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,� 6x6 PT Landscape Timber
44 �� Retaining Wall.
3�1 i Height = 36"+
#1
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eb
SILT FENCE
god , Stairs
(see sheet 2 fordetails)
f
Mill I lil'iI '
i
1 4" PVC Gr: vii
Lin From Hu
o
�I Proposed IG)O ga.
Plastic Septi Ton
�C
Q).
Ston 5tep5 Path
Capped Rod et -- --- -- _ 6r,—
Tall Iron Pipe Found
o - Tall Iron P e Found °
36,
-s
/C I
ITE MAP — SCALE: 1" =_1500'+
KNOBIROAD
r 51 TE
om' , ipe Found - ----
i
Iron Pipe foun
10.5/ -,
PORCH I I
Back Fi�l Effluen I Line
I I
CO to Accommodate Drain hack �\
j , _ / I PARING
Propo ed 10' Strip a pavement
ffl t l Ex osure
SILT FENCE t U 1
(see sheet 2 for details)
Iron Pipe Found i
Map Reference
Map of...
Alfred E. � Alice J. Schuman
By: D.L. Dlckln5on A`;5oclate5
Date: 5 Au u5t 201 sDaooaonuaiina
g anesN__ no jo Nm01
JJS�Z-A
Ib W
va rrJl 'r°-�
._) 1,
U,
2.0; Capped Rod Set
,� 6x6 PT Landscape Timber
44 �� Retaining Wall.
3�1 i Height = 36"+
#1
otect E uen iIt p11)
7
u F ,.
i I I�U�L r>SC ;,� nd Sl
/ r 1 �w eeve P #1 � fi
° ' � o o °
Past Parking Q U U)
Sleeve
I Proposed (16) Module Eljen
�r
i / 1 1/2' PVC Pressure I B43 Filter Absorption Bed
\ Effluent Line1 _j
10.0 - t 10.0' x 34.7' = 347+ SF
- - - 10.0 -
' 1 Effiluerat the r - -' -TY� e �OunG� -
\ 11000 gal. Plastic ' / r /L ��allroa plke Set 10.0'z4W c�
Pump Station-
/ O x
ry
L
SILT FEhLC)i
r of way over the exl5tin lane. ` go , — , w14. U w
NC ETE y 9 1 I _
Drilled Well ,; „
Broken Iron Pip Found Also, 5ubJect to the rlght5 of others. I +' r,
o-
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FIREPLACE I }� 0
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en w
Variance Table;o
r 0 U
I Disposal Field to Property Line: z
LLJI
Required 10i'
� :D •
Proposed 2 (as .shown)rV
`� w
u}ter'-' w
LU
Effluent Line t use.- Ho z
h
ca —
Required 10�' ���� z
Proposed 1 (as shown) �0`-
NOTE: If effluent line is below the c
' grade of the crawl space, no
variance 1s needed.
i Cz
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Adk. Mtn. Ridge Estates 2014-104
1
85 Hanneford Rd.
SFD 227.18-1 30
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Past Parking Q U U)
Sleeve
I Proposed (16) Module Eljen
�r
i / 1 1/2' PVC Pressure I B43 Filter Absorption Bed
\ Effluent Line1 _j
10.0 - t 10.0' x 34.7' = 347+ SF
- - - 10.0 -
' 1 Effiluerat the r - -' -TY� e �OunG� -
\ 11000 gal. Plastic ' / r /L ��allroa plke Set 10.0'z4W c�
Pump Station-
/ O x
ry
L
SILT FEhLC)i
r of way over the exl5tin lane. ` go , — , w14. U w
NC ETE y 9 1 I _
Drilled Well ,; „
Broken Iron Pip Found Also, 5ubJect to the rlght5 of others. I +' r,
o-
��
"", C 64il CFIUF ._7
iF K m ,
f '
FIREPLACE I }� 0
t'� W7:, 8
Over C,3`' DDM o�
r 2
=u°.Ixiacam 4 a3
i , y C7o as y m "{{' d
OZ
V-1 l4'i �� E. E d c _j z
rr� t"_3 Om oo
Cijm-`+✓'1"3
en w
Variance Table;o
r 0 U
I Disposal Field to Property Line: z
LLJI
Required 10i'
� :D •
Proposed 2 (as .shown)rV
`� w
u}ter'-' w
LU
Effluent Line t use.- Ho z
h
ca —
Required 10�' ���� z
Proposed 1 (as shown) �0`-
NOTE: If effluent line is below the c
' grade of the crawl space, no
variance 1s needed.
i Cz
I
{{ / �n
•
Adk. Mtn. Ridge Estates 2014-104
1
85 Hanneford Rd.
SFD 227.18-1 30
,. ...a, .... ,,,. '
Jas "�M`
..
,..,,.�:.�.uar,.. .. _n- .t ui t: ` z'+"`'
II III Ili liry 6.Y:y _. -tr _ ^�'a w. r
rr.� � �' i t�#�Hd