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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. P20040937 Date Issued: Monday, May 15, 2006
This is to certify that work requested to be done as shown by Permit Number P20040937
has been completed.
Tax Map Number. 523400-301-006-0001-052-000-0000
Location: 20 SUGAR PINE Rd
Owner. MICHAEL & MARY ROMANOWSKI
Applicant: MICHAEL & MARY ROMANOWSKI
This structure maybe occupied as a:
Garage Attached By Oder of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040937 Application Number: A20040937
Tax Map No: 523400-301-006-0001-052-000-0000
Permission is hereby granted to: MICHAEL&MARY ROMANOWSKT
For property located at: 20 SUGAR PINE 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: MICHAEL&MARY ROMANOWSK
20 SUGAR PINE Rd Garage Attached $16,000.00
Total Value
QUEENSBURY, NY 12804 $16,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
HILLTOP CONSTRUCTION
47 WILLIAM STREET
H[TDSON FALLS. NY
Plans&Specifications
2004-93 7
80 SQ FT GARAGE ADDITION
$30.00 PERMIT FEE PAID -THIS PERMIT.EXPIRES: Thursday, December 15, 2005
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To ueens a esday,'December 15, 2004
SIGNED BY for the Town of Queensbury.
.Director of Building&Code Enforcement
Building Permit'Application
Town of Queensbury—Dept of Community Development,742 Bay Road,Queensbury,NY
(518)761-8256
A permit must be obtained before beginning construction. Permit File No. -
No inspection will be made until applicant has received a Fee Paid
valid building permit. All applicants'spaces on this Rec.Fee Pai PP muo q
application must be completed and must appear on the Reviewed Br i` 4 t
application for . (/ t
Applicant: �1� ll�l Owner: mlCYta oma-noe3sk �Ep5GrJU��
Address: 20 W Address: u,LenS ' n /a�fd y gN�CO�F�j^
Phone#(,TLq):7�ff-AQ3_3-7 Phone#( )Y_Z3-33 Y o
Email Address: Email Address: n v
Property Location:. Lot Number: / House Number/ G a R Pl n�e /�Gf
Subdivision Name: Tax Map Number:
❑ New Building: residence /commercial Estimated Market Value of Construction:$ d�
Addition: esidence commercial
If an Addition what will us of n w addition be?
❑ m
Alteration: residence/ comercial. a ' 9, (
❑ No change to exterior size: residence/com'l
❑ Other work(describe )
Check Occupancylnformation I"Floor 2° Floor Other floor Total
Below sq.ft. sq.ft. sq.ft. Square Feet
❑ Single family dwelling
❑ Two family dwelling
❑ Townhouse
❑ Multifamily dwelling
#of units
❑ Office
❑ Mercantile
❑ Manufacturing
❑ 1 car detached garage
❑ 2 car detached garage
❑ 3 car detached garage
❑ 1 car attached garage /
>f, 2 car attached garage Q
❑ 3 car attached garage
❑ Storage building-
commercial I `�
❑ Storage building- g
residential
o Other
What is the proposed height of the structure_ feet inches
Will any second-hand or ungraded lumber be used? If so,for what? no
Type of Heating System: electric/ oil / gas/wood /forced hot air/ baseboard/othet: �
Number of Fireplaces to be installed Y Ill l l`L Number of Woodsioves to be installed V
AQ n`e-
List below the person(s)responsible for supervision of work as regards to building codes:
Name Address Phone Number
Builder
Plumber I n °% �►�-y`�
Mason
Electrician
Declaration: please sign below after you have carefully read the statement:
To the best of my knowledge the statements contained in this application,together with the plans and specifications
submitted,are a true and complete statement of all proposed work to be done on the described premises and that all
provisions of the Building 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,as requested by the Zoning
Administrator or Director of Building and Codes,an As Built Survey by a licensed surveyor;drawn to scale,showing actual
location of a t w construction
�i / �, D i
Sienature: /��r owner,owner's agent,architect,contractor
Queensbury Building & Code Enforcement - Reside in Inspection
Office No. (518)761-8256 Arrive: ', 6 a m e rt: am/pm
Date Inspection request received: L Inspector's Initials:
NAME: P, IT#: ZOO937
LOCATION: 7 p Q =,Fl (tom R DATE:
TYPE OF STRUCTURE:
Comments
Yes No N/A
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 Complete/Exterior Finish Complete
Platform at all exterior doors
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
Interior Handrails @ stairs 2 or more risers
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:
Every level: Every Bedroom:
Outside every bedroom area:
Inter Connected: Battery backup:
Carbon Monoxide Detector
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area
Crawl Spaces 18 inch x 24 inch access, 1 s .ft.-150 s .ft. vents
Bathroom Fans,if no window
Plumbing fixtures
Foundation insulation
Floor truss,draft stopping finished basement 1,000 s .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''/z"Gypsum
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage firs roofin /3/4 hour fire door/door closer
Duct work Sealed properly
Gas Logs in Sealed or Glass Enclosure
Final Electrical
Final Survey Plot Plan
As Built Septic System/Sewer Dept.Inspection Sticker
Site Plan /Variance required
Flood Plain Certification,if required
Okay to issue C/C or C/0 [Tempor Permanent
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form revised 100405.doc
Foundation Inspection Report
P P �1
Office No. (518) 761-8256 Date Inspection re est r ceiv
Queensbury Building&Code Enforcement Arrive: p Depart: ����V
742 Bay Rd., Queensbury, NY 12804 Inspector's Initi Is:
NAME: ^,�� S �('—�
� "�-� RMIT#: _
R7
LOCATION: S� `(�,�G (\_ _. INSPECT ON:
TYPE OF STRUCTURE:
Comments
Y N N/A
o ings
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
Foundation Dampproofing
Foundation/Waterproofing
Type of Dampproofing/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:1SueHemingway\Buil ding.Codes.Inspection.FORMSToundation Inspection Report.doc January 28,2003
Foundation Inspection Report
Office No. (518) 761-8256 Date Inspectioi�equ e eiv
Queensbury Building&Code Enforcement Arrive: h a hm epart: main,' m
742 Bay Rd., Queensbury,NY 12804 Inspector s Initials
t.1 V .
j 7
NAME: ��,'�� 3`�J� PERMIT#:
LOCATION: n SPECT ON: -
TYPE OF STRUCTURE:
Comments
-- Y N N/A
ootings
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
Foundation Dampproofing
Foundation/Waterproofing ,
Type of Dampproofing/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•Sldb
l ;,
PVC/Cast/;cpbper
Foundation'Iiisulation Interior/Exterior
R-
Rough,Grade 6 inch drop within 10 ft.
LASueHerningway\Buii ding.Codes.Inspection.FORMSToundation Inspection Report.doc January 28,2003
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