95-202 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Januo L y 31 19 97
This is to certify that work requested to be done as shown by Permit No. 95202
has been completed.
754 SQ. FT. ALTERATION TO RESIDENCE
This structure may be occupied as a
84 C'LE VERDALE RD.
Location
Owner BROCK, JOHN A.
TAX liAP NO. 13 . -3--18
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
VALUE $ 5000 TOWN OF QUEENSBURY 95202
TAX NAP NO. 13. .. No.
WARREN COUNTY, NEW YORK
a,-j 0
BROCK, JOHN A.
PERMISSION is hereby granted to
CLEVERDALE RD.
OWNER of property located at Street, Road or Ave.
754 SQ. FT. ALTERATION TO RESIDENCE
in the Town of Queensbury,To Construct or place a
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
P.O. BOX 84
CLEVERDALE. NY 12820 ..
2. CONTRACTOR or BUILDER'S Name
BROCK, JOHN A.
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
RESIDENTIAL ALTERATIONS
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
754 SW, FT. ALTERATION TO RESIDENCE -�EER- P IF}T VAX -
SPECIFICATIONB=t, ,,a,,
8. Proposed Use
754 SQ. FT. ALTERATION—TO - I tEEES= -=
$ 32 PERMIT PEE PAID -THIS PERMIT EXPIRES April 24 19 97
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this f� y a May 19 95
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
Department of Community Development . Reviewed By:
Building & Code Enforcement i !� 13ui1din, Inspector
, Town o f Qcieensbury i � rci
742 Bay Road c/
Queensbccry, New York 128U4 �i�
(518) 745-4447 Building Permit Appl q pp ENSBURY
•
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONS` AND E PECTIONS
WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT.
All applicants ' spaces on this application MUST be completed and the
signature of the applicant MUST appear on the application form.
Applicant: _.'r , 1 4, f7 t'e / -- Owner: ..22//- .C-, fo,i. 'e- fr
Address: 4-[n--' -//P 4 44'. If Address: C L "�' - F"d ; f �j 0
Ct z`t-5,'/9J. C.)e., A. I
Phone # L `S " 4, t mac Phone # _/ ) 6,57 G - 2'.z.
Property Location: C/-/ 1' /.?.5Cr � /7� 2 j,� 7e, ./'c-`e's '"' ','
lax Map Number / 3 / - / i
Subdivision Name: Section Block Lot
NATURE OF PROPOSED WORK.: ESTIMATED MARKET VALUE OF THE
New Building: CONSTRUCTION: $ 6-
residence / Commercial
Addition to Building:
residence / commercial OCCUPANCY INFORMATION:
X Alters . • • -.• Building: Primary Building -
esiden - / commercial x Single Family Dwelling
A Resid- .r- / Commercial Two Family Dwelling
no change to exterior size _ Family Dwelling
Office
Other Work (describe below) Mercantile
Manufacturing
Other
GROSS AREA OF PROPOSED STRUCTURE:
.if ADDITION, what will use
1st Floor sq• ft • of new. addition be? :
2nd .Floor 76y sq. ft . —
Other Floors sq. ft . --
(not unfinished cellar or basement) ACCESSORY BUILDINGS :
Detached Garage 1 , 2 car
TOTAL FLOOR AREA: 7S-y SQ. FT. Attached Garage 1 , 2 car
Private Storage Building
SIZE OF NEW STRUCTURE : Commercial Storage Building
Other
FEET X FEET
Foundation Type : Will any second-hand or. ungraded
Number of Stories : lumber be used? If so, for what?
( habitable space only) /C
Height (grade to ridge): feet TYPE OF HEATING SYSTEM:
Number of fireplaces and/or woodstove (circle all which applies )
to be installed: Electric / Oil / Gas / Wood .
Forced Hot Air / Baseboard / Other
Person responsible for supervision of work as regards to building --
codes is : ._ , ,. /rt.. : ✓ e7 rt
Name Addresss Phone
Builder: QLJi=4," --
Plumber:Mason:
Electrician:
DECLARATION
To the best of my knowledge the statements contained in this appli-
cation, 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 Code, 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, an AS BUILT PLOT PLAN
drawn to scale, showing actual location of ,project on premises .
Signature : -'ff tf ,le'; %` .� '«� .:-- -'
'"owner., owner s agent, architect, contractor)
TOWN OF QUEENSBURY
.. 11 BUILDING & CODE ENFORCEMENT
3� 742 BAY ROAD
QUEENSBURY NY 12804
0 (518) 761-8256
ARRIVE: DEPART: INSP:
FINAL INSPECTION REPORT - RES DENTIAL
DATE INSPECTION REQUEST RECEIVED: ' I ( - 9
NAME Y\_
LOCATION - C__
DATE l PERMIT
TYPE OF STRUCTURE ' CRe�
FOOTINGS__ FOUNDATION BACKFILL _ FRAMING
ROUGH PLUMBING _ SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT/B VENT/HEIGHT
PLUMBING VENT
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/RAILING:
RELIEF VALVES
FURNACE/HOT WATER OPERATING
INTERIOR TRIM/PI-XVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED _
STAIR CLEARANCE/RAILINGS _
SMOKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES •
FOUNDATION INSULATION _
GARAGE FIRE PROOFING
DOOR CLOSERS
.FINAL ELECTRICAL
SITE PLAN/VARIANCE REO•
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C/C
t'‘)/ C4/1/-e- es°l
%�. J
(518) 761-8256
TOWN OF QUEENSBURY (011/
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR DEPART INT
REQUEST FOR INSPECTION RECEIV > t
NAME _ INDC)Y ;�� C' I' of ,,O �,siy1, ,
LOCATION v
DATE ' s `9 PERMIT A �'�o O�
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLO NG THE PLACE-
MENT OF THE CONCRET: .
MATERIALS FOR THIS PiAti ON SITE
FOUNDATION WALLPOU A . _
REINFORCEMENT I AIR■
FOUNDATION/D., •PROOFING1 _
BACKFILL ' •ROVAL V
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB
!
FRAMING: �/
JACK STUDS/HEADERS !/
BRACING/BRIDGINGtoj
JOIST HANGERS /
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R- _
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
O'( / x' '
TOWN OF QUEENSBURY
L t�� BUILDING & CODE ENFORCEMENT__
� 742 BAY ROAD12
QUEENSBURY NY 12604
(518)745-4447
ARRIVE: 11,0 DEPART: _ INSP:
FINAL INSPECTION REPORT - RESIDENTIAL
(7/
DATE INSPECTION REQUEST RECEIVED: '/- / /. ! `. /‘
\ l
NAME ^f 4 -
(
LOCATION LJ �.��},`r
DATE 1 1 — / f 7 Lam' PERMIT { ) i,��.'\
I ?
TYPE OF STRUCTURE --)1
FOOTINGS FOUNDATION BACKFILL _ FRAMING _
ROUGH PLUMBING _ SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT/B VENT/HEIGHT ice/
PLUMBING VENT
ROOFING
Ve"
EXTERIOR FINISH J�
DECK/PORCH/STEPS/RAILI S V
RELIEF VALVES
FURNACE/HOT WATER OPERAT
INTERIOR TRIM/PRIVACY D
FINISH FLOORS: P
BATH/KITCHEN W ERTIGHT 1
OTHER FLOORS SWEEPABLE
46/•
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS /
BATHROOM FANS
PLUMBING FIXTURES t�
FOUNDATION INSULATION - X
GARAGE FIRE PROOFING ✓✓t
DOOR CLOSERS
FINAL ELECTRICAL
SITE PLAN/VARIANCE REO.
FINAL SURVEY PLOT PLAN V/
OK TO ISSUE C/O OR C/C
eele-C )ix-4 l geeir7c€,,,
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY RD., QUEENSBURY� NY 12804 �'
INSPECTOR'S REPORT: ARR,I,J Z1 DEPARTGRAINTOC
REQUEST FOR INSPE I R EIVED:
�/NAME t//1 `f raGi 1
LOCATION - C/,, rd/ R.0
DATE / / J PERM 1' # _!c -020 2-
TYPE OF STRUCTUR. :
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR F0•
REINFORCEMENT IN PL'CEJ/
THE CONTRACTOR IS R:?.P.NSIBLE FOR
PROVIDING PROTE TIO ROM FREEZING
FOR 48 HOURS FOLLOW' ', THE PLACE-
MENT OF THE CONCRETE _
MATERIALS FOR THIS 'POSE ON SITE
FOUNDATION/WALLPOU•
REINFORCEMENT IN ACE
FOUNDATION/DAMPP',•OFINI
BACKFILL APPROV,.
PLUMBING VENT V NTS IN 'LACE
ROUGH PLUMBING
PLUMBING UNDE• SLAB
3
FRAMING:
JACK STUDS/HEADER
BRAC NG/BRIDGING
JOI HANGERS
JAC POSTS/MAIN BE,
AIR INFILT• 'TION BARRIER
HEATING RO GH-IN
INSULATION:
FOUNDA ION WALLS INTERIOR R
FOUNDATION WALLS EXTERIOR R-
FLOOR R_ --
WALLS R-
CEILI0G R_
DUCT ORK OR PIPING IN
UNHE' ED SPACES R-
V
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY RD. , QUEENSBU Y NY 12804 r
J� w 14e
INSPECTOR'S REPORT: ARR ASO INT (1./
REQUEST FOR INSP N RECEIVED:
NAME rQc /
LOCATION q //JJ eja,d(C a G
DATE 246 J PERMIT # q- e,30 o2
TYPE OF STRUCTURE:
RECHECK APPROVED
/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSI E FOR
PROVIDING PROTE TION FROM F EEZIN
FOR 48 HOURS FOLLOWING THE LACE
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON S TE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING J/
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLAC
ROUGH PLUMBING
(
„PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADE S
BRACING/BRIDGIN _
JOIST HANGERS
JACK POSTS/MAI BEAM
AIR INFILTRATION BARR R
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALL INTERIOR R-
FOUNDATION WALL EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY RD., QUEENSBURY NY 12804 "" .
INSPECTOR'S REPORT: ARR//3i' DEPART 4/ti3 INT Ca
REQUEST FOR INSPE IO RECE ED:
NAME ' rJ�
LOCATION 1 Nr�
DATE 4/‘;
PERMIT # q0. y 0
TYPE OF STRUCTUR :
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLAC:
THE CONTRACTOR IS RESP•NSIBLE FOR
PROVIDING PROTE, TION F'OM FREEZING
FOR 48 HOURS FOP OWING THE PLACE-
MENT OF THE CONC• TE.
MATERIALS FOR THIS PURP'SE ON SITE
FOUNDATION/WALLPOU'
REINFORCEMENT IN PLA E
FOUNDATION/DAMPPROOFINt
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLA E
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BE,
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
INSULATION: j
FOUNDATION WALLS INTERIOR '-
FOUNDATION WALLS EXTERIOR R- -
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
21-1647 -(2)r
-4,dui sd�`
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY RD., QUEENSBURY NY 12804 '`
INSPECTOR'S REPORT: ARR 41624 DEPART//I0 INT
REQUEST FOO INSPECTION RECEIVED:
NAME -04-1
T
LOCATION can I _ .
DATE l Zr 3 nPE' IT # �
TYPE OF STRUCTUR, : _ 4- � 9S 404)
RECHECK JJJJ I
APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FO'4
REINFORCEMENT IN PLA E
THE CONTRACTOR IS RES'O'SIBLE FOR
PROVIDING PROTE TION •M FREEZING
FOR 48 HOURS FOLLOWING+THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PU'PO•E ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLC
FOUNDATION/DAMPPRO., NG
BACKFILL APPROVAL Lam,
/PLUMBING VENT/VEN 'S IN PLACE
"ROUGH PLUMBING
PLUMBING UNDER SLAt
/FRAMING: t
JACK STUD [HEADERS
BRACING B IDGING
JOIST HAN ERS
JACK POST MAIN BEAM
AIR INFILTRATION ARRIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION W LS INTERIOR R-
FOUNDATION W LLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R_
DUCT WORK OR IPING IN
UNHEATED SPA S R-
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY RD., QUEENSBURY NY 12804 i
INSPECTOR'S REPORT: ARR/3r DEPART/( INa
REQUEST FOR INSPECTION '` CEIVED: /q�/pf
NAME 914-30 .0•4.,
LOCATION J -
DATE 40/5/9s n PE' IT # 'T E a n k
TYPE OF STRUCTURE:
RECHECK AP•ROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATIONLALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB
gRAMING: -
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS •
JACK POSTS/MAIN BrAM
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS IN,ERIOR R-
FOUNDATION WALLS E . ERIOR R-1
FLOORS R-
WALLS -
R_
CEILING 1 R_
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR S1JDEPART 9•'LJ INT :AC
REQUEST FOR INSPECTION • CEIVED:
NAME 4 �r ,r
LOCATION4
DATE ®J- PERMIT M
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES _ NO
•
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEME T IN PLACE
THE CONTRACTO IS RESPONSIBLE FOR
PROVIDING PRO TION FROM FREEZING
FOR 48 HOURS FO LOWING THE PLACE-
MENT OF THE CON TE.
MATERIALS FOR THIS\PURPSE ON SITE
FOUNDATION/WALLPOUR '\
REINFORCEMENT IN PLACE,
FOUNDATION/DAMPPROOFIN \\
BACKFILL APPROVAL
PLUMBING VENT/VENTS I7 PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB I
FRAMING: 7
JACK STUDS(H ADERS y/
BRACING/BRI ING
JOIST HANGS S
JACK POSTS/ AIN BEAM
AIR INFILTRATION BA RIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN �-
UNHEATED SPACES R-
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R MAY 0 21995
BUILDINGt
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RECEIVED
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MAY -0 2 1995 1-`
TOWN.CY'•QuharkiSBUFiY
BUILDING AND CODE
'
,
2 .7441r 457
( }-3491-