2009-156 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090156 Application Number: a20090156
Tax Map No: 523400-289-020-0001-011-000-0000
Permission is hereby granted to: MICHAEL & JANICE MASSIANO
For property located at: 21 GRAND VIEW Dr
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: MICHAEL & JANICE MASSIANO
9 GREENWOOD Ln Fireplace
QUEENSBURY,NY 12804-0000 Garage Attached
Single Family Dwelling $840,000.00
Total Value $840,000.00
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2009-156
4426 sq ft single family dweliing with 928 sq ft garage and 3 fireplaces
$623.92 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, May 04, 2010
(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 To of ensb Wild , May 04, 2009
SIGNED BY for the Town of Queensbury.
IV-Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
4z Community Development- Building &Codes (518) 761-8256
CEIK".HFICATE (.3"'F77 OCCUPANCY
Permit Number. P20090156 Date Issued: Thursday, April 22, 2010
This is to certify that work requested to be done as shown by Permit Number P20090156
has been completed.
Location: 21 GRAND VIEW Dr
Tax Map Number. 523400-289-020-0001-011-000-0000
Owner. SCHERMERHORN RESIDENTIAL HOLDINGS, L
Applicant: MICHAEL & JANICE MASSIANO
This structure maybe occupied as a:
Fireplace By Order of Town Board
Garage Attached TOWN OF QUEENSBURY
Single Family Dwelling
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
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PRINCIPAL STRUCTURE:
APPLICATION FOR ZONING APPROVAL & BUILDING PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO
REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.
APPLICANT/BUILDERAV,#f l°&),tkhj C11f 1��� 1)C OWNER: I lkz 4-jow,
ADDRESS: inDDRESS: l�lYl W U�d � --
PHONE NOS. `� L{ �{j PHONE NOS.-7q2
CONTACT PERSON FOR BUILDINGE r &CODES COMPLIANC tG�1"C i PHONE
LOCATION OF PROPERTY: r Ld 1. �,i ,, br � 1`1 ��L V~�'r� /`A
HAS THERE BEEN A SITE PLAN REVIEW; VARIANCE OR SUBDIVISION APPROVAL? ❑ YES JAI NO
IF SO, INDICATE APPLICATION NO. AND DATE OF APPROVAL:
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT z
APPLY TO YOUR z
PROJECT
p Q O a O Ujw �
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u_ = F- Ow � o �
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d2ots
SINGLE FAMILY
�.
TWO-FAMILY
MULTI-FAMILY
(NO. of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACHED
GARAGE(1,2,3) y2 O
OTHER
IF COMMERCIAL OR INDUSTRIAL- NAME OF BUSINESS: ��/y
ESTIMATED CONSTR CTION COST 3 �I - -.�
' FUEL TYPE:
HEAT TYPE: I ► } ti-i L. *HOW MANY FIREPLACE(S): AND/ OR WOODSTOVES(S):
ZONING CATEGORY:- _ARE THERE WETLANDS ON THIS SITE?
IS THIS A HISTORIC SITE? �` (0
c
PROPOSED USE OF BUILDING OR ADDITION:
*Please complete a separate Application for"Fuel Burning Appliances& Chimneys"available in our office
Town of Queensbury - Communihj Development Office - 742 Bay Road, Queensbury, NY 12804
B 3-LGL I I-05
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN?IV Q
ARE THERE EASEMENTS ON PROPERTY? v
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans, and supporting materials are a true and
complete state me nt/d escri ptio n 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 a agree to the above.
Signed
Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction
codes or septic systems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
Permission is hereby granted to the above ; This application / proposed action described 1001
ol Applicant to erect or alter the building herein is found to be in accordance with the
described herein in accordance with said zoning Laws of the Town of Queensbury. 00
Application: 11
;
; ; ;
0 ,
11
BUILDING & CODES APPROVAL
lo ZONING APPROVAL
' ;
DATE '
DATE 00
,_----
QUESTIONS? CALL 761-8256 OR EMAIL
codeslakgueensburv.net
Office Use Only V(:] ISIT OUR WEBSITE FOR MORE INFORMATION
Operating Permit Issued: Yes No www.gueensbury.net
Occupancy Type: Construction Classification:
Assembly Occupancy Limit: Special Conditions:
Towtt of Queensbury - Conimiinity Development Office - 742 Bay Road, Queensbury, NY 12804
e
f"erc;3 AlEI1'shaEfS >ff�ce
_i
APPLICATION FOR FUEL BURNING 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: ROUGH-IN AND FINAL INSPECTIONS ARE REQj'UIRED.
OWNER:Rl a �d� � ��� �( �' INSTALLER/BUILDER:1 G V iff 1.:`�'�1�1S�R ✓ l(J I
ADDRESS l✓j i�, ,�'\Glelt�j ✓�GIsY 1.4_--' ADDRESS: !{�`� 1J1��GJr' V V�c-� ' �• �I I
PHONE NOS!DAD j-7GI�v 1 '�" r PHONE NOS. 5 I i ! 44113
LOCATION OF PROPERTY: ' Gk el P V r SUBDIVISION NAME:
LOCATION OF PROPOSED CONSTR CTION A D/OR INSTALLATION:
C�LIt 1
CONTACT PERSON FOR BUILDING&CODES COMPLIANC14--)t)I� klvk J PHONE:
✓ FUEL BURNING APPLIANCE WOOD COAL PELLET GAS OIL
INFORMATION
STOVE
FIREPLACE INSERT
_ FIREPLACE,FACTORY BUILT*
FIREPLACE,MASONRY
FURNACE(GARAGE ONLY)
*IF FACTORY BUILT,PLEASE PROVIDE: MANUFACTURER NAME: 1—$" :fi '.r_ MODEL NO.
LISTED BY: A,: NUMBER:
QUESTIONS?
CALL 7614205 or 761-6206
CHIMNEY INFORMATION BLOCK BRICK STONE OR EMAIL:
fire marshal�2 ueerns ur,,et,
MASONRY** CHECK ONE ✓ VISIT OUR WEEISITE
TILE STEEL SIZE IN FOR MORE INFORMATION
INCHES X,,�' . €ee ssbur`net
FLUE CHECK ONE
DOUBLE TRIPLE WALL INSULATED DIRECT VENT CHIMNEY
WALL LINER
CHIMNEY MATERIAL CHECKONE ✓
**IF NON-MASONRY,PLEASE PROVIDE: MANUFACTURER NAME: MODEL NO.
ADDITIONAL NOTE: CONSTRUCTION/INSTALLATION MUST CONFORM TO NYS FIRE PREVENTION&BUILDING CODE AND/OR
MANUFACTURERS REQUIREMENTS. CONSULT AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED
INSPECTIONS.
1 Listing and Code Approvals
A. Appliance Certification C. BTU Specifications
Models Maximum Minimum Orifice
MODELS: SL-550TR-E, SL-750TR-E, SL-950TR-E U.S. (0-2000 ft.)or Input Input Size
LABORATORY: Underwriters Laboratories, Inc. (UL) Canada(2000-4500 ft.) BTU/h BTU/h (DMS)
TYPE:Direct Vent Gas Appliance Heater SL-550TR-E{NG} U.S. 21,000 15,000 #44
STANDARD:ANSI Z21.88a-2007•CSA 2.33a-2007 SL-550TR-IPI-E(NG) Canada 18,900 13,500 #45
SL-550TRLP-E(LP) U.S. 20,600 14,600 #55
This product is listed to ANSI standards for "Vented Gas SL-550TRLP-IPIE(LP) Canada 18,540 13,140 #56
Appliance Heaters"and applicable sections of"Gas Burn-
ing Heating Appliances for Manufactured Homes and SL-750TR-E(NG) U.S. 24,300 16,900 #42
Recreational Vehicles", and "Gas Fired Appliances for SL-750TR-IPI-E(NG) Canada 21,870 15,210 #43
Use at High Altitudes'. SL-750TRLP-E(LP) U.S. 23,400 17,600 #54
NOTICE: This installation must conform with local codes. SL-750TRLP-IPIE(LP) Canada 21,060 15,840 #55
In the absence of local codes you must comply with the SL-950TR-E(NG) U.S. 30,400 20,900 #37
National Fuel Gas Code, ANSI Z223.I-latest edition in SL-950TR-IPI-E(NG) Canada 27,360 18,810 #38
the U.S.A. and the CAN/CGA B149 Installation Codes in
Canada. SL-950TR-E(LP) U.S. 30,800 23,000 #52
SL-950TR-IPI-E(LP) Canada 27,720 20,700 #53
NOT INTENDED FOR USE AS A PRIMARY HEAT SOURCE.
This appliance is tested and approved as either supplemen- D. High Altitude Installations
tal room heat or as a decorative appliance. It should not be
factored as primary heat in residential heating calculations. NOTICE:If the heating value of the gas has been reduced,
these rules do not apply. Check with your local gas utility
B. Tempered Glass Specifications or authorities having jurisdiction.
Hearth & Home Technologies appliances manufactured When installing above 2000 feet elevation:
with tempered glass may be installed in hazardous loca- • In the USA: Reduce input rate 4% for each 1000 feet
tions such as bathtub enclosures as defined by the Con- above 2000 feet.
sumer Product Safety Commission(CPSC).The tempered . In CANADA: Reduce input rate 10% for elevations
glass has been tested and certified to the requirements between 2000 feet and 4500 feet. Above 4500 feet,
of ANSI Z97.1 and CPSC 16 CFR 1202 (Safety Glazing consult local gas utility.
Certification Council SGCC# 1595 and 1597.Architectur-
al Testing, Inc. Reports 02-31919.01 and 02-31917.01). Check with your local gas utility to determine proper
This statement is in compliance with CPSC 16 CFR Sec- orifice size.
tion 1201.5 "Certification and labeling requirements"
which refers to 15 U.S. Code (USC)2063 stating"...Such
certificate shall accompany the product or shall otherwise
be furnished to any distributor or retailer to whom the
product is delivered."
Some local building codes require the use of tempered
glass with permanent marking in such locations. Glass
meeting this requirement is available from the factory.
Please contact your dealer or distributor to order.
Heat&Glo • SL-550%750/950TR-E • 2118-900 Rev.M - 1/09 7
APPLICATION FOR FUEL BURNING APPLIANCE & CI-IIlAINTYS
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- ROUGH-IN AND FINAL INSPECTIONS_ARE REQUIRED. �1 )y/�
OWNER:01 I (� `- ''�('< � �4tr ' INSTALLER/BUILDERWiffi ��J v�� l l +
ADDRESS: j� t I I V "fir ADDRESS:�6 ' '�� +�,
PHONE NOS
PHONE NOS---) (_� I � L_ -1 4 `u
LOC TION OF PROPERTY:s 1' e7 �it.`n )V L Z vj I SUBDIVISION NAME:
Ue-e V1 S l'3 LA/''vl:), I\► ) (ZIIWYl
LOCATION OF PROPOSED CO STRUCTION AND/OR INSTALLATION:t `, r
t�f4'�l� FvV�Cy �f} ti PHONE:���_l�'`
CONTACT PERSON FOP.BUILDING&CODES COMPLIANCE:i
✓ FUEL BURNING APPLIANCE WOOD COAL PELLET GAS OIL
INFORMATION
STOVE
FIREPLACE INSERT
FIREPLACE,FACTORY BUILT*
FIREPLACE,MASONRY
FURNACE(GARAGE ONLY)
Imo}- C'7t..� MODEL NO.
*IF FACTORY BUILT,PLEASE PROVIDE: MANUFACTURER NAME: �'1AT
LISTED BY: la - ���-' NUMBER:�� I�- ��-��ol QUESTIONS ?
CALL 761-8205 or 761-8206
OR EMAIL
CHIMNEY INFORMATION BLOCK BRICK STONE
MASONRY** (J CHECK ONE ✓ VISIT OUR WEBSITE
SIZE IN FOR MORE INFORMATION
TILE STEEL INCHES
FLUE CHECKONE ✓ I v' 5+�
CHIMNEY
DOUBLE TRIPLE WALL INSULATED DIRECT VENT LINER
WALL
CHIMNEY MATERIAL CHECKONE ✓ Y
**IF NON-MASONRY,PLEASE PROVIDE: MANUFACTURER NAME:
MODEL NOADDIT .
NOTE:ONAL PREVENTION&BUILDING CODE ND/OR
REQUIREMENTS. CONSULT AVAILABLE TOWN OF QUEEN BURY HANDOUTS EGARDING REQUIRED
MANMANUFACTURERS
ANU ACTUR RS
INSPECTIONS.
1 Listing and Code Approvals
A. Appliance Certification
B. Non-Combustible Materials
This fireplace system has been tested and listed in accor-
dance with UL 127 and ULC-S610 standards by Under- Materials which will not ignite and burn, composed of
writers Laboratories Inc. for installation and operation in any combination of the following:
the United States and Canada. - Steel - Iron
This fireplace may be installed in sleeping rooms EX- - Brick - Tile
CEPT in manufactured homes. If installed with a gas log - Concrete - Slate
set, provisions for the National Fuel Gas Code must be - Glass - Plasters
met. Materials reported as passing ASTM E 136, Standard
Test Method for Behavior of Metals,in a Vertical Tube
This fireplace has been tested and listed for use with the Furnace at 7500 C
optional components specified in this manual. These op-
tional components may be purchased separately and in- C. Combustible Materials
stalled at a later date. Installation of an outside air kit will • Materials made of or surfaced with any of the following
require significant reconstruction and is best if installed at materials:
the time of fireplace installation. - Wood - Compressed paper
Heat& Glo is a registered trademark of Hearth & Home - Plant fibers - Plastic
Technologies Inc. • Any material that can ignite and burn; flame proofed or
not, plastered or un-plastered
WARNING!Risk of Fire!Hearth & Home Technologies
disclaims any responsibility for, and the warranty and
agency listing will be voided by the following actions.
DO NOT.•
• install or operate damaged fireplace
• modify fireplace
• install other than as instructed by Hearth & Home
Technologies
• operate the fireplace without fully assembling all
components
• overfire
• install an unvented gas log set
• install any component not approved by Hearth&Home
Technologies
• install parts or components not Listed or approved
Improper installation, adjustment, alteration, service or
maintenance can cause injury or property damage. For
assistance or additional information, consult a qualified
installer, service agency or your dealer.
NOTICE: This fireplace is tested and approved as a
decorative fireplace. It should not be factored as a primary
heat source in residential heating calculations.
6 Heat& Glo • EXCLAIM-36, EXCLAIM-42 •4013-251 Rev D • 03109
APPLICATION FOR FUEL BURNING APPLLANCE & CHIA4AEYS
Application is hereby made to the Building &Codes Office for the issuance of a Building & Use Permit
pursuant to the New York Staie 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: ROUGH IN AND FINAL INSPECTIONS ARE REQUIRED.� � �
vyv
OWNER: Y/ P. INSTALLER/BUILDERW
�
r
S.S (�,�II � �:�;
ADDRESS: ADDRESS: &
�tJ PHONE NOS
PHONE NOS 1.� ,l �j r
/ I � C', IC`1 t ter SUBDIVISION NAME: kit
LOCATION OF PROPERTY: —�
LOCATION OF PROPOSED CON RUCTION AND/OR INSTALLATION:
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE ��1 1,7C�S PHONE
✓ FUEL BURNING APPLIANCE WOOD COAL PELLET GAS OIL
INFORMATION
STOVE
FIREPLACE INSERT
FIREPLACE,FACTORY BUILT*
FIREPLACE,MASONRY
FURNACE(GARAGE ONLY)
MODEL NO. SC5�jO TiZ�
*IF FACTORY BUILT,PLEASE PROVIDE: MANUFACTURER NAME: IA .'T'
E'p
LISTED BY: i 'r 1 NUMBER: QUESTIONS?
CALL 761-8205 or 761-8206
CHIMNEY INFORMATION BLOCK BRICK STONE
OR EMAIL
MASONRY** N CHECK ONE VISIT OUR WEBSITE
SIZE IN FOR MORE INFORMATION
TILE ST�EEL INCHES z�.,�e;� .--`
FLUE CHECKONE ✓ t/ f J
CHIMNEY
DOUBLE TRIPLE WALL INSULATED DIRECT VENT LINER
WALL
CHIMNEY MATERIAL CHECKONE ✓ I v I
**IF NON-MASONRY,PLEASE PROVIDE: MANUFACTURER NAME:
MODEL NO.
NYS FIRE
NG CODE
ADDITIONAL NOTE: CONSTRUCTIONREQUIREMENTS. CJONSULTLATION MUST CONFORM AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING EGARDINIG REQUIRED ND/OR
MANUFACTURERS REQUIREM
INSPECTIONS.
Final Survey Inspection
Dept. of Community Development
Town of Queensbury
742 Bay Road
Queensbury,NY 12804
Date received: 2Z— Ll
NAME:
LOCATION:
PERMIT#: CEA--
Final Survey Plot Plan
Avuroved Denied
The attached final
survey has been
received by the /
Dept.of
Community
Development.
Upon review the
nEey has been:
Craig BrowlrZoning Administrator
Notes:
L:1SueHemingway\Building.Codes.hmpecdon.FORMS\Fina1 Survey
.Zoning Administratordoc
P� 2 /A
Queensbury Building & Code Enforcement - ResidWil`Final Inspection
O r No. (518) 761-8256 Arrive: am/pm Depart: , am/pm
Date Inspection request received: Inspector's Initials:
NAME: CC %�A PERMIT#:
LOCATION: ' DATE:
TYPE OF STRUCTURE:
Comments:
N A
,C Building Number Address visible from road
Chimney Height/V Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 6 inches
Roof Complete/Exterior Finish Complete
Platform at all exterior doors _
Handrail 4 or more risers
Guards at stairs deckspatios 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/Dderior 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/re ulator 18 inches above grade
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight
Safety I /Window in stairwells safety glazing
Interior
nteri Smoke Detttctors/Carbon Monoxide electors
Eve level: _U Every Bedro
Outside every bedroo area:
Inter Connected: Batts backu :
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area ,___..-.---..--..--,.-...---•_�. -_
Crawl Spaces 18 inch x 24 inch access 1 .ft:150 sq.-ft.vents
Bathroom Fans if no window (
Plumbina fixtures ,�^
Foundation insulation/Insulation 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 Valves installed/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum IN Gypsum
Basement stairs dosed rise>4 inches
Garage Floor Pitdhed
Garage fireproofing/%hour fire door/door closer
Duct work Sealed properly
Gas Logo in Sealed or Glass Enclosure
Final Electrical
Final Survey Plot Plan
Arc fault Breaker in Bedrooms
Flex Gas Pipe Bonding
As Built Septic System 1 Sewer Dept. Inspection Sticker
Site Plan /Variance required
Flood Plain Certification,if required
Okay to issue C/C or C 10 Temporary/Permanent
L:1Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Forrn_revise0_100405.doc;Revised
January 7,2008;Revised 6/26/08
Queens�ui��Build`ingl & Code Enforcement - Residential Final Inspection
Office No. (518)761-8256 Arrive: am/pm Depa i am/pm
Date Inspection request received: 0 Inspector's Initials:
NAME: PERMIT*
LOCATION: r �� + ) i- DATE:
TYPE OF STRUCTURE:
Comments:
Yetw
,C Building Number Address visible from road
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 6 inches
Roof Co ete/Exterior Finish Complete
Platform at all exterior doors
Handrail 4 or more risers
Guards at stairs deckspatios more than 30 inches above Irade
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 priM/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight . 4 1
Safety glazing/Wi in stairwells safety
Interior Smoke ors I Carbon noxi Detectors
Every level: Ev Bed
Outside every bedroom 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 .ft.-150 s .ft.vents
Bathroom Fans if no window
Plumbing fixtures
Foundation insulation/Insulation Certification
Floor truss,draft stopping finished basement 1,000 s .ft.
Emergency ress below grade
Gas Furnace shut-off within 30 feet or within line of site NIL
Oil Furnace shut-off at entrance to fumace area
Fumace/Hot Water Heater operating
Low water shut-off boiler
Relief Valves installed/Heat Trap/Water Temp 110
Enclosed Stairs Shestrock Underside minimum W Gypsum
Basement stairs dosed rise>4 inches
Garage Floor Pitched
Gars a fireproofing/%hour fire door/door closer
Duct work Sealed prop2rly
Gas Logs in Sealed or Glass Enclosure
Final Electrical
Final Survey Plot Plan
Are Fault Breaker in Bedrooms
Flex Gas Pipe Bonding,
As Built Septic System/Sewer Dept. Inspection Sticker
Site Plan /Variance required
Flood Plain Certification if required
Okay to issue C/C or C 10 Temporary/Permanent
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form_revised_100405.doc;Revised
January 7,2008;Revised 6/26/08
Town of Queeusbury Ire Marshal
742 Bay Rod
Qwmubwy,NY 12904
761-SM/761-5206
UK 7454437
Factory Built Gas Firmla ce/Stove Inspection Report
Metiee+New York State regoim that all LOLL Iided,fadwy bola appliamm be m aped aoeordisg to the imAmctisms and
spec�anhoas eosuddmed u the lastmlbdm Mammal acompaayisg;the applamm No deviation from the rer's
¢ indsssuieas or specific is some&
# -/,5(p SdmWeWWccems I 2i C� Ti a /•` '� m p. aoytbw Is*cdw� S
Address ` CiLPn,�i/I' ��1 t,�' Noses Isvd
4pp4aoe At adsmer �! Model# [/
lirect Vest p'aciny Benin Ctiisury_,(,�Siae Double Wan Triple Wan Iusulaied
Yes No N/A Cep
door Protection
3eafances to Combustibles(all sides)
?�f"top(s) vertical cbmw.,�
Wan reoeiratisn
Vent CleatmWes to Combustibles
Vent/Chimney Tn mfiufim
,%d.ueiy bcgpt smod be 3 feet above roof
mmeb*i ;2 feet above say combudible
sughlocclom wiliiu to feet
rss Shut-Off Valve
:embustimm Air
Eleafth Extension(deny) AA46kA
Mantel eve--
witness operation �i i2/1j �/ `6ac A;� �tr�141
rank Placement(if UP)
WhMe—DaMMIngD Yam,. r�-
Twa of Qaeea dwy Fine Marshal
742 Bay head 2�V5
Quenabwry,NY 12M4
761-RM/761-5206
fax 7454437
Factory Built Gas Fir eDlace/Stowe Issnection Report
Notice:New York State Wines tiadt as ILL Lined,factory Wit appiiaoces be iasfased according to tre mostroctiom ad
sp contained is the Loa Manual aooaarpaayiag the appiiaaoe.No deviation froan the wardadarcr's
instractiow or specificatiom is asowed.
9arslit# Swcbeeive 4�0 at dM� anytime Iss�
tausie W4 56//7i'J'�(� Address / � �1� �/G Be00 h rant
1pptianoe Mannfaer Model#
ev
Nflect Vest Factory Balk Ctissaey Fire Size Dowble wa Triple wall Iasdated
Yes No N/A Comments
@loor Protection
-leearances to Combustibles(A sides)
Firestop(s) Vertical Chase
was Peacb7Aim
Vent Clearances to Combustibles Ak
Vest/Cbimrtey Tarmination 4t/
�
3i.ney beigbt be 3 feet above resof
woe ratios;2 fed above any
aolghlodim withis to feet
Gas Shut-Off Valve
Combustion Air Volo
Ile[learth Extension(if any) �'- i�S�l� ►a 4�t v4 L
so 5' n"4- 3
Reebt above Up opeaft
Witness Operation
Cann Placement Qf LP)
Wbbe-DWIMMg Dap- Yamw erg-em ear
Town of Queensbury Fire Marshal
742 Day 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. J
Permit# %7 Schedule Inspection 1011 Time pm anytime Inspector P
Name SQ/ U Address Rough lnminal
Appliance Manufacturer —1 y Model# �L �
Direct Vent Factory Built Chimney Flue Size Double Wall Triple Wall Insulated
Yes No NIA Comments
Floor Protection
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) I vt
Mantel
Height above f/p opening
Witness Operation
Tank Placement(if LP)
White—Building Dept- Yellow r Pink—Fire Marshal
.W r Y51 `Y5`'��
• Town of Queensbury Fire Marshal
742 Bay Road
Queensbury,NY 12804
761-82051761-8206
fax 7454437
Factory Built Gas Fireplace/Stove Inspection Resort
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# ��l.S �=C Schedule Inspectionl�/� A Time / a, p�m anytime Inspectoilt l IVZ'. 7
ly Name //5.S J +?/1 Address 72 I ( 5` �1�A zer_J Rough Ind Final
Appliance Manufacturer 1 ''fU' Model#
Direct Vent Factory Built Chimney__ZFl ue Size r Double Wall Triple Wall Insulated
Yes No NIA Comments Floor Protection 9rf" - -14--0,-2 Ib 396-
Sz PRO
Clearances to Combustibles(all sides)
Firestop(s) Vertical Chase
Wall Penetration_,
Vent Clearances to Combustibles �r
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)
White-Buiidiny DepL Yellow r Punk-Fire Marsha!
/0 --/Z /fie
Rough Plumbing / Insulation Inspec ' n Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm art: am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: 47�
NAME: 44&,s5'11-iK. PERMIT #:
LOCATION: INSPECT ON:
TYPE OF STRUCTURE:
Y N NIA
Rough Plumbing/Nail Plates
Plumbing Vent/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
.S. 15 minutes
Insulation/Apsidential Check/Commercial Check
Tyvek or Sjp4lar Exterior Sealant
ent, 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: yj y � � /
Rough Plumbing Insulation Reportrevised Nov 17 2003, revised February 15,2005, revised January 7,2008
1-3 7. .
Rough Plumbing / Insulation In eCtion 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:
NAME: M&,5,5, PERMIT
LOCATION: INSPECT ON: 9'—,��
TYPE OF STRUCTURE:
Y N NIA
Rough Plumbing/Nail Plates
Plumbing Vent/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
MAi
P. .I 15 minutes
Insulation/ftidential Check/Commercial Check
Imilar 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
COMMENTS: V
Rough Plumbing Insulation Report revised Nov 17 2003, revised February 16,2006, revised January 7,2008
Framing 1 Firestopping Inspection Roit
Office No. (518)761-8256 Date Inspection request received: i
Queensbury Building&Code Enforcement Arrive: am/ Depart:L�� m/pm
742 Bay Road, Queensbury, NY 12804 inspector's Initials:
NAME: 1 PERMIT#:
LOCATION: INSPECT ON: .-
TYPE OF STRUCTURE: 5� t
Y N NIA Framing COMMENTS'`Access 22"x 30" minimum
Jadc Studs/Headersh,� ) S ►�
Bracing/Bridging
Joist hangers
Jadc Posts/Main Beams
Exterior sheeting nailed properly
12" O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more nk^
Exterior Deck Bracing
Headroom 6 ft. 8 in.
Notches/Holes/Bearing Walls
Metal Strapping for Notches Top Plate
1 % w 16 gagge 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
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed
16 inch insulation in cay
4 min.
Garage Fire Separation
House side%inch or 5/8 inch Type X
Garage side 518 inch Type X
Ceilingfwall
Windows Habitable Space/Bedrooms
24 in. (H)
20 in. (1N)
5.7 sf above/below grade
5.0 sf grade
L:\BuildW*&Codes Forrn&0W\3uildkV&CodesUnspedion Fomns'Frarn ft Firedopp ft Inspection Report.doc Revisect January 7,2006
Rough Plumbing 1 Insulation Inspection Report
Office No. (518) 761-8256 Date Inspection request received: A0 01
Queensbury Building &Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials:
NAME: PERMIT #:
LOCATION: a 6 % . INSPECT ON: 4AP �l
TYPE OF STRUCTURE:
N N/A
Rough Plumbi / it Plates
ent/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.1 for 15 minutes
Insulation/Residential Check/Commercial Check
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/NoAucttw
t �
COMMENTS:
Rough Plumbing Insulation Report.revised Nov 17 2003, revised February 15,2005, revised.January 7,2008
O - Itl
Framing / Firestopping Ins ' n Report
Office No. (518)761-8256 Date Inspection request received:Queensbury Building&Code Enforcement Arrive: am/ Depart:c: am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: AIN
NAME: PERMIT#:
LOCATION: b INSPECT ON:
TYPE OF STRUCTURE: f
2�!n
Framing
Y N NIA COMMENTS'
'
Attic Access 2T x 31Y minimum n Specl Ao
Jack Studs/Headers
Bracing/Bridging
Joist hangers
Jadc Posts/Main Beams
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.
Notches/Holes/Bearing Walls
Metal Strapping for Notches Top Plate
1 'r4 w 16 gauge 8 16D naas each side
Draft sto 'ng 1,000 sq. ft. floor trusses
Botts 6 or less on center /�
Ice and,waters d 24 inches from wall / _
i radon 1, 2, 3 hour �y
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed 16 inch insulation in cavity min.
Garage Fire Separation
House side%inch or 518 inch Type X
Garage side 518 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
LASulding&codes Forma-=\8ui1ding&CodesUnapecdion FonnsWraming Firestopping inspection Repoitdoc Revised January 7,2006
r
f<
1
Rough Plumbing / Insulation spection Report
Office No. (518) 761-8256 Date Inspection request received:
a
Queensbury Building &Code Enforcement Arrive: am/pm Depart: ) m/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials:A 1 T1
NAME: 114assla o PERMIT #:
LOCATION. INSPECT ON: I
TYPE OF STRUCTURE:
Y N NIA
Rough Plumbing / ail Plates
ents in Place
1 % inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/change of direction
Pressure Test
Drain
Air H
5 P. .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
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:
Rough Plumbing Insubifion Report.revised Nov 17 2003, revised February 15,2005, revised January 7,2008
Foundation Inspection Report
Office No.(518)761-8256 Date InspqctionVequest received:
Queensbury Building&Code Enforcement Arrive: am/pgn Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspec 's Initials:
NAME: / G`t? PERMIT#: `I
LOCATION: INSPECT ON:
TYPE OF STRUCTURE:
Commenb
Y N NA
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 place
Foundation Dampproofing
Foundation Waterproofing
- Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
poly for wet areas under slab
ackfill pproval
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\Inspecdon Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: Lj I am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials*�� ( I tv
NAME: ' PERMIT#:
LOCATION: �.-j INSPECT ON:
TYPE OF STRUCTURE:
Commenb
Y N NA
Footings
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for 0 L-
providing protection from freezing
for 48 hours following the placement �y
of the concrete.
r this purpose on site. )) J
Foundation/ allpour
Re orcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofing '--
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\lnspection Forms\Foundatlon Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
�- � A)
Foundation Inspection Repo
Office No.(518)761-8256 Date InsF's
t' Or-quest received:
Queensbury Building&Code Enforcement Arrive: 5 am/pr� Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 InspectoInitials: 1
NAME: N—zlPERMIT#:
LOCATION: naINSPECT ON:
TYPE OF STRUC r
Commenb
Y N N/A
Footings
iers
Monolithic Slab
Reinforcement in Place 1
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 place
Foundation Dampproofing
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 Fors\Building&Codes\Inspecdon Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM