2014-603 TOWN OF QUEENSBURY
F4TO742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20140603 Date Issued: Monday, March 23, 2015
This is to certify that work requested to be done as shown by Permit Number P20140603
has been completed.
Location: 178 HUDSON POINTE Blvd
Tax Map Number: 523400-315-007-0002-082-000-0000
Owner: GEORGE & ANNE MATHEWSON
Applicant: GEORGE & ANNE MATHEWSON
This structure may be occupied as a:
Residential Addition By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property 4
Idtct.
owner of the responsibility for compliance with Site Plan, Variance, or
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 Bay Road,Queensbury,NY 12804-5902 (St 8)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140603 Application Number: A20140603
Tax Map No: 523400-315-007-0002-082-000-0000
Permission is hereby granted to: GEORGE & ANNE MATHEWSON
For property located at: 178 HUDSON POINTE Blvd
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: GEORGE &ANNE MATHEWSON
178 HUDSON POINTE Blvd Residential Addition $70,000.00
QUEENSBURY,NY 12804-0000 Total Value $70,000.00
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014-603
Res. Addition 345 sq.ft.
$100.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, November 24,2015
(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 f Quee sbutyf / M aoxember 24,2014
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
DATE IVCsU2r116.er 1 q c20(y Received
2 Tax Map ID _
TAX MAP ID 3/c ' 7- - Permit No. i LZ f r2
Permit Fee X71
ZONING Rec Fee V
NOV 19 2014site Plan#
HISTORIC SITE Yes No Subdivision#
SUBDIVISION NAME Lot#
TOWN BD. RESOLUTION 86-2013: $850 RECREATION FEE FOR NEW DWELLING UNITS, INCLUDING SINGLE FAMILY DWELLINGS,
DUPLEXES OR TWO FAMILY DWELLINGS, MULTIPLE FAMILY DWELLINGS, APARTMENTS, CONDOMINIUMS, TOWNHOUSES, AND/OR
MANUFACTURED&MODULAR HOMES, BUT NOT MOBILE HOMES. THIS IS IN ADDITION TO THE PERMIT FEE.
APPLICANT 1 1 I t 1 Cr C,n� I'Ll.df(On OWNER Ccrqe
IR ;4-
ADDRESS 1 (1 (IC>10 k y I?C d ADDRESS ) 7g' o d5o Fn e g j u J
I CE.(k Ny L LLe e as b i-c ry
1,88
i ra / 'y
PHONE/E-MAIL q ( - 'J.3 C1 (a75 C- VL' PHONE/E-MAIL _P`S - 9-26 /Q`a"
T
CONTRACTOR1-L(� e-- COST OF CONSTRUCTION(ESTIMATED): $ /D 00 C�
ADDRESS: BUILDING ADDRESS: 1 7g- J 1 '�t�+SUn IE' n le / 'd.
PHONE/E-MAIL ` f } r�
CONTACT PERSON FOR BUILDING& CODES COMPLIANCE: I �' �� A I \� ( e (' 11 I PHONd et-? /C y
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
New Addition Alteration 15t floor sq.ft. 2' floor sq.ft. Total sq. ft. Height
Single Family 3q3-- — ,3 VS l y '
Two-Family
Multi-Family
(#of units
Townhouse
Business Office
Retail - Mercantile
Factory- Industrial
Attached Garage
(#of
Other
1
Town of Queensbury Building&Codes Principal Structure Application July 2014
If commercial or industrial indicate name of business
Proposed use of building or addition r,--)ed i oc-t,', / )ct` I 1
Source of heat (circle one) Gas) Oil Propane Solar Other
Fireplace: complete a separate application for Fuel Burning Appliances &
Chimneys nch
Are there structures not shown on plot plan? rl C
Are there easements on the property? fl C
Site Information
a. Dimensions or acreage of lot
b. Is this a corner lot?
c. Will the grade be changed as a result of construction Yes No
d. Public water or Private well
e. Sewer or Private Septic System
Value of all work to be performed (labor or materials) $
DECLARATION:
1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period.
2. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and
department approval.
3. 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.
4. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy.
5. 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
I have read and agree to the above: PRINT NAME: C1 n cf.y S R f b gee.(y4 DATE II- 19 - iv
SIGNATURE: 24 (.0 L � i:t DATE
,_.-CAL4,(
FOR OFFICE USE ONLY
Operating Permit Issued: Yes No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
2
Town of Queensbury Building&Codes Principal Structure Application July 2014
SEPTIC DISPOSAL PERMIT
/
Al I i Office Use Only
DATE ,Y ve��'l�'e►2 I CI ,?C/y Received
t ' _� -
�� Tax Map ID
TAX MAP ID Permit No. — .1'C 1
'7? HLLa5o') ,�O I .�. L t Permit Fee ,
LOCATlONOFINSTALLATlON I r0 �1 t � Approvals�.,`w 1 9 _)uiii
APPLICANT -H.I II I L Co(\ t1 - - 1 PHONE/E-MAIL 79 ° I& Q l[,7�2 75-
ADDRESS `5 I C r2O L..�ley ROS s fiLtdSosn �CL I15 L CUP1
1NSTALLERBUILDER: PHONE/E-MAIL
ADDRESS: p
OWNER 6-)
LaO(-E C I I I CL:1-1).e . • )011 PHONE/E-MAIL C I S `) .Qe) -I0.,7y
Address I 71? dSon Poi ole 61(id, ✓✓✓
CONTACT PERSON FOR BUILDING& CODES COMPLIANCE: /Gm 19/13 reFA PHONE 4aN 17e51
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed _Y /N
1981-1991 Spa or Hot Tub installed _Y ' N
1992-Present 5 l / C, 5-(
PARCEL INFORMATION
/
Topography _Flat rolling Steep slope %slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious Material At what depth? non -e-
Domestic Water Supply ✓ Municipal Well (if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: I—.S per minute per inch (test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CQN TRUCTION -1-�
x t rjil 6--
P-CQ C( f?'f -+ '0 /1hG f'
Tank Size /OCC gallons(minimum size 1,000 gallons,add 250 gallom toi#e f.Qr!ach garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length 5 ft.; Each trench x
Seepage Pit with#3 stone How many: 110 Il '_ ;size
Alternative System Bed or other type? X
Holding Tank System Total required capacity? -X....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 material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations
and agree to abide y,these and all reRuirements of the Town of Queensbury Sanitary Sewage.Disposal Ordinance.
Print Name: I v,ciA( • e I b re c h-I-- Date: //–/l- /V
Signature: �-c%i . ('t. 7,-t_,e--r-1' " Date:
Town of Queensbury Building Codes Septic Disposal Permit July 2014
Queensbury Building & Code Enforcement - Residential Fir - r spection
Office No. (518) 761-8256 Arrive: 2--P-7i) a' I. . I-; • •
: �,_ a prr
Date Inspection request received: 317.- 115 Inspector's Initialsar
NAME: P. IT#: i\- OD')
LOCATION: D• 'E: 3 12'',
TYPE OF STRUCTURE: sC—�
Comments:
Yes No NIA
4" Building Number Address visible from road
Chimney Height/"B"Vent/Direct Vent Location `-G`11
Fresh Air Intake (�
3 inch Plumbing Vent through roof minimum 18 inches ✓/
Roof Complete I Exterior Finish Complete V
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 '1 `Vth
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: Eery Bedroom: v/
Outside every bedroo area: ___
Inter Connected: j 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 W Gypsum
Basement stairs closed rise>4 inches )/
Garage Floor Pitched
Garage fireproofing/3/,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 1712 V Lam'
Site Plan /Variance required d
Flood Plain Certification, if required Q
Okay to issue C/C or C/O[Temporary/Permanent]
r u ss s teaD..D 15 A-r- R e. r-
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
de,
Town of Queensbury Building &Code Enforcement 1 U )v" 12--
Office No. (518)761-8256
Rough Plumbing I Insulation Inspection Report
Inspection request received: ' 17-- `i 5
Name: N'11`-r Jy\I Q'Yl Inspected on: 3l F->I 1 5
Location: I b -A-t, , "Q'\vk-) Arrive: \ '''' .. 8.
R� m.
Permit No.: 11— bCa Inspector's Initials: Alik
Type of Structure: S �
'' ‘ 13 17,� =1 ) > COMMENTS
Y N NA
Plumbing under slab --i-\1\ -\-CT
Rough Plumbing/ Nail Plates
Plumbing Vent/Vents in Place j_ Oj
1 1/2 inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/change of direction
Pressure Test
Drain/Vent
Air i 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 t� ��i AA / W @ fsi-. oSZ__
2 ndow Sealing
Tyvek or Similar Exterior Sealant � 'z1 ,��Au-`i
Proper Vent, Attic Vent chi L‘►.x 7
Door I Window Sealed (No Insulation)
Duct/ Hot Water Piping Insulation IA)\r 17 .-L9
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly/No duct tape
Blower Door Test
Air Sealing
Rough Plumbing/Insulation Inspection Report0
--1-4,cA Hwy
Rough Plumbing / Insulation Inspection Report
Office No. (518) 761-8256 Date Insctian r, quest received: P-/I Is J v l
Queensbury Building & Code Enforcement Arrive:
742 Bay Road, Queensbury, NY 12804 Inspector,'s4nitib1
NAME: 41,I-1306a( { Pkig6�J�2r` PERMIT#: ` 4 -&O
LOCATION: F r7 �0 [7 INSPECT ON: _ S
TYPE OF STRUCTURE: TeA
Y N N/A
Plumbing under slab
•
ough Plumbing /Nail Plates- t- -C kL U '
Plumbing Vent/Vents in Place
11/2 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. for 10 ft. above highest connection for 15 minutes
Pressure Test
Water Supply Piping
Air/ Head
50 P.S.I. for for 15 minutes
Insulation / Residential Check/Commercial Check
Window Sealing r`
Tyvek or Similar Exterior Sealant
Proper Vent, Attic Vent
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
Blower Door Test
Air Sealing •
1 � � 1 V
tt
COMMENTS: ! n '' ` v .'
t I
Rough Plumbing_Insulation Inspection_02 05 13
Towneensbury Building & Code Enforcement
Office No. (518) 761-8256
d
Framing I Firestopping Inspection Report
Inspection request received: /â_O i 5 o vI
Name: 14+✓Cl (0,,.. 1--
o,� Inspected on: ''-';' I►
Location: 1 "— en- P .6l✓ci---• Arrive: •gfillf a.m. ' •.m.
Permit No.: ) Iq---1(.2C7 3 Inspector's Initials: .15F^
w
TYPE OF STRUCTURE: P/J /t
j
1.�—t ��0-D� DOLS
V N N/A COMMENTS:
Framin C RZY-1 AL
Attic Access 22"x 30"minimum �+�� �(
j C�Jack Studs/Headers
I -(54,i,,\'g
/ .1(‘'n<<n . a-7 I S
Truss Specification Provided C..)1^-
Bracing
y`Bracing/Bridging // /
/ /� (,,c�c
V
Joist hangers G'.-- ?5 g .!'e:' cX d FE •
Jack Posts 1 Main Beams -YqLk._Exterior sheeting nailed properly��� r7 /^�°�iA Fr_d_rzival
12"O.C.
Headroom 6 ft.8 in.
Stairwells 36 in.or more K3 EE t) LL T CO is-AVETE
Exterior Deck Bracing 1 CD -�.\7 0 F V p.rN A` tom.
Headroom 6 ft.8 in.
VC-1v�t * '( F_1�� -�
Notches!Holes I Bearing Walls
Metal Strapping for Notches Top Plate
1 1/2(w) 16 gauge(8) 16D nails each side
Draft stopping 1,000 sq.ft.floor trusses
Anchor Bolts 6 ft.or less on center
Ice and water shield 24 inches from wall
Fire separation 1,2,3 hour ��10 1 ‘
1.. v L' O�
Fire wall 2,3,4 hour J �_ \ \---4\-VE ,
Firestopping 4
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation _
House side 1/2 inch or 5/8 inch Type X 03 ,�� �
� Lc\ V'" ,`.,' x'�
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space/Bedrooms
24 in.(H)
20 in.(W)
5.7 sf above/below grade
5.0 sf grade
Design Professional Sign-off,if required
Framing/ Firestopping Inspection Report r
v`
Town of Queensbury Building & Code Enforcement F- l O am
Office No. (518) 761-8256
n,
Framing I Firestopping Inspection Report 4-lerliel' V-'"t A)0/-3 Man
Inspection request received: ( ( -(sl�I3;iS nNa-
Name: .li ,' U . ..:/... ... �l•-- Inspected on: I - 7 o1.D 1.
Location: (.7g— 1141^44S o v, d i 43I14% Arrive: .oisf llIP a. .I p.m.
Permit No.: C`'1''(/0 3 ` Inspector's Initials /`
TYPE OF STRUCTURE: �. d.
ea # M4.44w
Y N NIA COMMENTS:
ming
Attic Access 22"x 30"minimum
Jack Studs/Headers
Truss Specification Provided ' ""
Bracing/Bridging
Joist hangers
1
Jack Posts I Main Beams . EL-1
-_
t �Exterior sheeting nailed properly
12"O.C.
Headroom 6 ft.8 in.
Stairwells 36 in.or more
Exterior Deck Bracing
Headroom 6 ft.8 in. 4 —
Notches I Holes I Bearing Walls
Metal Strapping for Notches Top Plate
1 1/2(w) 16 gauge(8) 16D nails each side
(—)Draft stopping 1,000 sq.ft.floor trusses 7 i
\J chor Bolts 6 ft.or less on center
e and water shield 24 inches from wall
Fire separation 1,2, 3 hour
Fire wall 2,3,4 hour
Firestopping
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
---2:-&-:". ....,
House side 1/2 inch or 5/8 inch Type X ' 1?e L \ wit`z
Garage side 5/8 inch Type X P‘V‘ _\
Ceiling/wall
Windows Habitable Space/Bedrooms / 'b
24 in. (H)
20 in. (W)
5.7 sf above 1 below grade
5.0 sf grade
Design Professional Sign-off, if required
Framing / Firestopping Inspection Report
1066A .
Foundation Inspection Report
Office No. (518)761-8256 Date Inspection request received: I d-e I
Queensbury Building&Code Enforcement Arrive: am/pm Depart:i Gm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initial
NAME: - 7lEtZpic.t1 /_`eCtienMPA4 PERMIT#: ! -(o O 3
LOCATION: t o PF 1 SPECT ON: ll-7/c)-61c
TYPE OF STRUCTURE: lAlQ(
1-16)-1(L
Comments
N N/A ,
Footings
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
Foundation/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in placeCfK.C14- "C-- /
dation Dampproofmg
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
fimil fbz et areas under slab
� kfill Approv�L_�►
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 fl.
L:\Building &Codes Forms\Building &Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/9/2014
p(z_
Foundation Inspection Report
Office No. (518)761-8256 Date Inspection request received: i/(o/Jits1
Queensbury Building&Code Enforcement Arrive: am/pm Depart:4.66 am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:/4 � ,, 6/
NAME: U 47p 6K-C RMIT#: /% [ 2- 0 3
LOCATION: � J — .r y� ( t d. / SPECT ON: //(P/fir
`
TYPE OF STRUCTURE: 4 G�r4.6 ! "" -"--.7-Q4c41(y
"MSSF
Comments
Order -
N N/A /' i 7[6)/9C ‘547
C �---
Footings /�
Piers �J
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
this ose on site.
Foundation/Wall o
Reinforcement in Place '2-_ `Zc- p-u-<-->- -)
Footing Dowels or Keyway in place
Foundation Dampproofmg
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building &Codes Forms\Building &Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/9/2014
Town of Queensbury Building & Code Enforcement / ,��
Office No. (518) 761-8256 �`'
Septic Inspection Report
Inspection request received:
Name: Ner-it-4 ALLI OA Inspected on:
Location: I 1/ C 4S c,n Pi' Arrive: a.m.I p.m.
Permit No.: f 'y-- to 03 Inspector's Initials:
Comments and/or diagram
Soil Type San Loam/Clay
Type of a er: Municipal/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+I- Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft. Ok_V 4g G
Length of each trench ft.
Depth of trenches ft.
Size of Stone .�,� �
Seepage Pits: NumberA.\\%"—Z-) C7--)Z.)
Size: x 6 C\
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed:
/7 N
End Cap _N ,,��(,�
Inlet/Outlet Pipes&Baffles N I ./t ,çE
C
Manholes 12"or less below grade
[provide extension collar if Yes] Y N
i
Location/Separations —1
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits f ft.
Conforms as per Plot Plan N
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y N
Location of Syste on P perty:
Front Re Left Side Right Side Middle Front Middle Rear
S stem Use Statu-.
Approved
'artial Al.-.ved and needs to be re-inspected, please call the Building&Codes Office
:..roved
Septic Inspection Report