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2003-340 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development Building&Codes (518)761-8256 CEIRT IFIC OF A.TE COMPLIANCE Permit Number: P20030340 Date Issued: Thursday,November 20,2003 This is to certify that work requested to be done as shown by Permit Number . P20030340 has been completed, Tax Map Number: 523400-316-013-0001.003.000-0000 Location: 141 BIG BAY Rd Owner: TODD JORGENSEN Applicant: TODD JORGENSEN This structure may be occupied as a: By Order of Town Board Deck TOWN OF QUEENSBURY Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay.Road,Queensbury;NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030340 Application Number: A20030340 Tax Map No: 523400-316-013-0001-003-000-0000 Permission is hereby granted to: TODD JORGENSF,N For property located at: 141 BIG BAY 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: TODD JORGENSEN. 141 BIG BAY Rd Deck $4;000.00 Total Value $4;000.00 QUEENSBURY,NY 12804-0000 Contractor or Builder's Name[Address Electrical Inspection Agency Plans&Specifications 2003-340 488 SQ FT DECK AS PER PLOT PLAN-SPECIFICATIONS $48.84 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,June 09,2004 (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 eensb ; ne 09,2003 4 SIGNED BY fax the Town of Queensbury. Director of Building&Code.Enforcement Porch, Deck, Dock, or Boathouse 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. No Permit File No. U inspection will be made until applicant has received a valid Fee Paid $ building permit. All applicants'spaces on this application must be Reviewed By: completed and must appear on the application form. Applicant: Owner: Address: Address: Phone#(_) .0 Phone# Email Address: Email Address: Person Responsible for Supervision of Work as Regards to Building Codes: Name Address: Phone Property Location: Lot Number: House Number II Subdivision Name: Tax Map Number:'3/ (0 ) ,-� Estimated Market Value of Construction: $ C>0 0 'Porch Lit"" lleck Li Dock Ei Boathouse 13 Other work(describe Size of structure to be built square feet Submit along with this application: 1. Two plot plans drawn to scale,preferably using a survey map. Indicate proposed structure showing setback dimensions,from all property lines. Show location of water supply and location and configuration of septic disposal area. 2. Two sets of structural drawings. Indicate size of posts or studs, floor joists, decking or flooring material to be used. Show how the porch or deck will be fastened to the building. If a roof will be constructed, indicate the size of posts or studs, roof rafter spacing and span. Indicate type of roof. sloped, flat, shed, or other. Indicate the type of material being used for the roof. 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. Applicant's signature: Date: L:\SueHemingway\Building.Pennit.FORMS\Porch.Porch.Permitdoe 8/13/02 revised per DH EL �} z M(ti i { aU Nw4�+c� H a� ZZO wWa� J>H 009 U) Ewux�N WI� 0 N a y 0, c a H w Z III ]HI " HI H N H 0z z� a I w z N 0 H rH W a s H z z H z 0 w 9 U , A W x�' a ,► +� w ] H H W a H C'? a H a A ZMH (W) H x H H9 a a m w N z W a wua ww a 9 ] N aaa0a00H uH0 •�. a ;x H H w a N a 0 w �C A 0 w x a z 0 w � xU zw xH 0N0a HN HHUHaa440 H 4 W N N a a 4 N 0 0 4 U H + H U m > H $ N z H U 3 a s > !� a H x u Q H x z z w H 4 z N w . 0 .4 W 9 �+ U U : W H H > H W w a a x N D A . 0 > W w m > w 0 �1 z N N W H N w w W w w > 0 a N 0 x 4' 0 X H a w a a H N N w w W z a N N z NH (7 a > H a 0 z 0 0 4 a a � a x N z 0 w 0H z 0 0 u H 0 0 w 0 0 0 H 9 4 4 w N H w H H O z9 W H z H Z w N H a D A z A 0 N 0 u U U > H �a. z0H9HwaDax H w H HHa 40 H W w w HA X Z w w H H 0 z w U w w 14 w H H H 0 A A 4 w 4 H H U H D� ON H a 0 H 4 a 0 0 H 0 a a H a H H z z z z H z p 0 9 0 z x a 0 X w W a 0 z H H H W H X X 4 4 4 H H x Az9AH14H u wwHNwwuNwilW, all xxxwN 0 MAP REFERENCE: MAP OF STONEHURST A SUBDIVISION DEVELOPED BY ydcHarrc �srr CHARLES & BEVERLY MAINE DATED: JULY 15, 1983 REVISED: SEPTEMBER 27, 1983 BY: VAN DUSEN & STEVES I S04053110■W 180.DO' t t 5EPnC SYSTEM A5 PER CONTRACTORS NOTES f f i� } t LOT 15 LOT 16 64,556 sq ft 1.48 acres N � / 109.92' °� 2 STORY LOT 17 ^� �V WOOD FRAME HOUSE s er C \ PORCH �• � 0 03 QO Z Or ry�Y• �v y� Gr 3'440 E 4-247.47 ro 8,450.00k,. f DRI VE . ........... ............ �y Dates 0 03 �, D u .\" 'MA MONAD AL,ERAAON OR AW IOM TO A"%V S c a t e 1'=40' -� a ~J e "P BEAPIM$A UCDAM LAND M*-fONS 1£AL Mi A Map of a Survey made for %M ATION OF SE"ON nft.BUS-WYMM 2,W THE r V YM STAX EDUCATION"W" Steves MILTf.OFlC!TPOIA THE OFTHELMrT6&= AIAPX[D YATM AN ORIGINAL OF TM[UWD 91AZ1tNSAm SEAL W"BE CONSIDERED TD K V"IM OW=* MMM� ITTOICAIW f"ATED MEREON S AM THAT WILLIAM G. & MAU RE E N T. S ARA tM14 SURVEY wA3 As PREPARED w ACCORDANCE WIN THE �! Bar W 1W Yo c STAX ASSMAIM PSOFE341dM& Land Surveyors LAB .mcom" WW""OCY i OONN WS SM TOTE TIM COMPANY.00IE AA" 169 Haviland Road Queensb New York 12804 AOMY N°L`M6.amu 7M US=NMCK ANo Town of Queenebur , Warren County, New York M 1 O 1 ury, TOTMEAOMMMOrTM UNPMM:sMCTRUF M.• 1 12/23/03 SEPTIC SYSTEM MIGHAELS GROUP (518) 792-8474 New York Lie. No. 50135 NO. DATE DESCRIPTION DWG. NO. 53154-IG E C1118 Septic Inspection Report Office No.(518)76,1-8256 Date InspectionereqQueensbury Building&Code Enforcement Arrive: t: am/pm 742 Bay Rd.;Queensbury,NY 12804 Inspector's Initi '' I) �NAME: r '"~'�f qO LOCATION: rr RECHECK: Comments and/or diagram Soil Type: Sand I Loam J Clay Type of Water: Municipal/Well Water Waterline separation distance ft. / . Well separation distance Other wells: ft. 6-(444 Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone -Seepage Pits: Number Size: x Stone Size: Piping Size Type R Building to tank Tank to Distribution Box Distribution Box to Field J Pit Opening Sealed: Y/N/Partial Location/Se"arationg Foundation to tank t. Foundation to absorption. ft. Separation of Pits ft. Conforms as per Plot Plan Y ,N Location of System on Property. - �2 ` Front Rear 'Left Side Right Side Middle Fr nt Middle Rear S stem Use St us: Approved Partial Approved and needs.to be re-inspected,please call the Building&Codes Office Disapproved L:LSueHemiugway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doe January 28,2003 HA Id([ � TOki O s�uh/1i} �d 0o W �q o w v uraoa O A 3snow V 3WV?Jd QOOM ti a lNols Z m C, Li soz W o 0 / Gb'2b sajoo qt-L 11 bs 999'ti9 ST ZOZ 9T Zo7 suau saoiovaiNm aaa sv K&-,AS Dun 00'091 M„Oi,ES,bpS S3A31S V N3sn(I NdA :M £96L 'LZ d38W3ld3S :03SO £96L '9l ),-in:431b'4 Residential Final Inspection Office No. (518)761-8256 Date Inspection reque ecei Queensbury Building&Code Enforcement Arrive: a p ep <p 742 Bay Rd., Queensbury,NY 12804 spector's Initi NAME: V) -Mt am PE IT LOCATION: 5 N C�! E: TYPE OF STRUCTURE: Comments Y j N N/A Chimney Ht./"B"Vent/Direet Vent Location V Fresh Air Intake 3 inch Plumb Vent through roof Roof Complete Guard 30 in. or more @ stairs,decks,patios Guard at stairwell at 34 in. or more Guard at deck,porches 36 in.or more Exterior Finish Complete Interior/Exterior Railifigs 34 in.to 38 in. Platform at all exterior doors Interior Handrails stairs 2 or more risers Grade away from foundation 6 in.with 10 ft. a CA4' Handrail Termination at Newell Post or Wall 8 inch clearance to sill plate Gas Valve shut-off exposed/regulator 18"above grade Gas Furnace shut-off within 30 ft. 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 Interior privacy/trim/doors/main entrance 36 in. v/ Bathroom/Kitchen watertight Safety glazing V/ Window in stairwells safety glazing Interior Smoke Det tors: Every level: EveryBed orp: Outside every bedroom ea: Inter Connected: Battery backup: CA M Bathroom Fans,if no window q7T-1--0V IVA Carbon Monoxide detector Plumbing fixtures Foundation insulation 1A Floor truss,draft stopping finished basement 1,000 sf Emergency egress below grade Basement stairs closed rise>4 inches 3/4hoiir fire door/door closer Garage fireproofing Duct work Sealed pLoZerly \AE- Attic accesC391u—xcgj.�17 30 in.(ht.)In accessible area Crawl Spaces 18"x 24"access, I sq. ft.-150 sq.ft.vents � e Building No./Address visible from road Final Electrical . V Site Plan /Variance reg aired . Final Survey Plot Plan As Built Septic System/Sewer Dept, Inspection Sticker Flood Plain Certification,if required Okay to issue C/C(Cert. Of CorTliance) Okay to issue Temporary C 1 0(Cert. Of Occiipancy) Okay to issue Permanent C 0(Cert. Of Occupancy) L:\SueHen-dngway\Building.Codes.Inspection.FORMS\Res.Final Insp.form 2.doc edited January 28,2003 Town of Quaensbury � Fora Marshal's Office 742 Bay Road Queensbury, NY 12804 Phone (518)761-8205 Fax(518) 745-4437 Firs Marshal's Inspection Report Request SCHEDULE (. Received: Permit# ��'�u � INSPECTION ON: �� ! 1 a Name: �,'��\�c.r��. � ��.�C�� )�-0 AM PM ANYTIME 7-21 APPROVE® MIA YES No --- COMMENTS EXITS AISLE WIDTHS EXIT SIGNS-NORMAL - BATTERY EMERGENCY LIGHTING FIRE EXTINGUISHERS FIRE ALARM SYSTEM FIRE SPRINKLER SYSTEM FIRE SUPPRESSION SYSTEM HOOD INSTALLATION INTERIOR FINISHES .STORAGE - COMPRESSED GAS CLEARANCE TO SPRINKLERS CLEARANCE TO HEATING UNITS CLEARANCE TO ELECTRICAL REQUIRED SIGNAGE EMERGENCY PLAN MAXIMUM OCCUPANCY SIGN _ CHIMNEY MASONRY RQUGHIN FINAL CHIMNEY _ FACTORY BUILT ROUGH IN FINAL WOOD STOVE' 1ROUGH LN FINAL VENTED GAS APPLIANCE ROUGH IN FINAL FIREPLACE MASONRY BOUGH IN OI(THIS M �T FINAL FIREPLACE ` _ FACTORY BUILT ROUGH IN N E B FINAL COMDE WCHRIs.d RD/LET RS2 11FIREwMARSHAi.tNSPECTIONREPs Y1022001!-C�CC4IPANTCd�Pfie~ WHITE-BUILDING DEPARTMENT COPY ` /�Residential Final Inspection Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ rt: 41( am/pm - 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: NAME: l 2 PERMIT#: LOCATION: L-\ DATE: TYPE OF STRUCTURE: Comments Y N N/A Chimney Ht./"B"Vent/Direct Vent Location Fresh Air Intake 3 inch Plumb Vent through roof Roof Complete Guard 30 in. or more @ stairs,decks,patio-s Guard at stairwell at 34 in. or more Guard at deck,porches 36 in.or more Exterior Finish Compl te Interior/Exterior Railifigs 34 in. to 38 in. Platform at all exterior doors Interior Handrails stairs 2 or more risers Grade away from foundation 6 in.with 10 ft. Handrail Termination at Newell Post or Wall 8 inch clearance to sill plate Gas Valve shut-off exposed/regulator 18"above grade Gas Furnace shut-off within 30 ft. 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 Interior privacy/trim/doors I main entrance 36 in. Bathroom/Kitchen watertight Safety glazing Window in stairwells safety glazing Interior Smoke Detectors: Every level: t Every Bedroom: Outside every bedroom area: Inter Connected: Battery backup: Bathroom Fans,if no window Carbon Monoxide detector Plumbing fixtures Foundation insulation Floor truss,draft stopping finished basement 1,000 sf Emergency egress below grade Basement stairs closed rise>4 inches %hour fire door/door closer Garage fireproofing Duct work Scaled properly Attic access 30 in.x 24 in.x 30 in.(ht.)In accessible area Crawl Spaces 18"x 24"access, 1 sq.ft.-150 sq. ft,vents Building No./Address visible from road Final Electrical Site Plan /Variance required Final Survey Plot Plan As Built Septic System/Sewer Dept.Inspection Sticker Flood Plain Certification,if required Okay to issue C/C(Cert. Of Compliance) Okay to issue Temporary C 1 0(Cert.Of Occupancy) Okay to issue Permanent C 0(Cert.,Of Occupancy) L:\SueHen-dn-gNvay\Building.Codes.Inspectioii.FORMS\Res.Final Insp.form 2.doe, edited January 28,2003 Framing / Firestopping Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building& Code Enforcement Arrive: am/ epart:A�dl �pm 742 Bay Road, QUeensbury, NY 12804 Inspector's Initials: PERMIT 3- NAME: T#: qo LOCATION: INSPECT ON: TYPE OF STRU Y N N/A COMMENTS ,Ffaming V Jack Studs/Headers Bracing/Bridging Joist hangers Jack Posts/Main Beams Exterior sheeting nailed properly 12"O.C. Headroom 6 ft. 8 in. Stairwells 36 in. or more Headroom 6 ft. 8 in. Notches/Holes/Bearing Walls Metal Strapping for Notches Top Plate 1 V2(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 snow shield 24 inches from wall Fire separation 1, 2, 3 hour Fire wall 2, 3, 4 hour Firestopping Penetration seqled-. 16 inch insulation in cavity min. Garage Fire Separation House side Y2. inch or 5/8 inch Type 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 LAS tic Ilcmingway\13 U i Id ing.Codes.Inspection.FORM S\Fra min g Firestopping Inspection Report.doc January 28,2003 Foundation Ifispection Report Office No. (51-8)761-8256 Date Inspection request received: 7,Z Queensbury Building&Code Enforcement Arrive: —arn/pxDepart:D_f-`— am/pm 742 Day Rd., Queensbury,NY 12804 Inspector's Initials: NAME: tNo Trw,,� PERmiT#: 03 -39 '-�) LOCATION: , -, �"I� (-'-, ~ C)Q� 6��- INSPECT ON: YLQ TYPE OF STRUCTURE: Comments Y N/A Piers o-nolithic 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 Darapproofing/Waterproof 9 Footing Drain Daylight or Sump/ Footing Drain Stone: 12 inch width 6 inches above f t�/n 6 mil poly for wet a as under slab Backfill Approval Plumbing Under. a PVC/Cast/Copper Foundation Insulation Interior/Exterior R- Rough Grade 6 inch drop within 10 ft. L:\SueHemingway\Building.Codes.Inspection.FORMS\FoundaflonEnspectionRepoi-t.doe January 28,2003 06/12/2003 00:31 518-798=0815 NMS PAGE 01/02 ADIRONDACK1. E11.,A DILITATION kYl.l+W CINE, PLLC DAV ED G.WELCH, M.D. •TODD R.]ORGENSEN, M.D. Shawn P.Jorgensen, M.D, . Michelle E.Antlles, D,o_- Malflng Address: P.O.;13ox 2053,Glens falls, New York 12801 L. Main Office Location: 17 Main Street, Q,ueensbury, New York 12804• Offices at: Saratoga, Saranac take, d.akP Placid Te1_ (518) 798-0761 Fax. (510) 798.0815 E A K tjSMITT'AL DATE: � � D� TO". !� 5�M�wy � -des , FAX., -W5--7-7 ATTN: FROM; DAVID G.-WELCH, Mf7i TODD R. 9QRGENSiwiV, MD �r a MICHELLE E. ANTILES, DO - SHAWN P. 3ORGENSEN, M.D. DO 1Vulmber of pages inclading the cover page. If there are any questions regarding this tran_slinittal, please call us at (519) 798-0767. FAX (518) 798-0815. MESSAGE: w-e led ��. f j.{,,�`,, 'I� �`g, .�L�t,� 'c;,.�2-/%•"LQ� , !1t+ear� /' J d '»�d fe�.��',/h.�'�,.C.,i -- , This Information contained in this facsimile message Is confideintiall Information Intended only- -7 9 e 0-76 for the use of the Indly(dual or entity named above. If the reader of this message is not the Intended recipient or the employee or agent responslbte to.deliver It to the intended recipient, . you are hereby notified that any dissemination,distribution or copying of this communication Is strictly prohibited. if you have received these docutnients by mistake, please notify us Immediately sa that we can arrange for the return of thei orl9inail documents to cis at no-cast to you. 06/12/2003 00:31 518-798-0815 NMS PAGE 02/02 FPLAN VIEW FOR LEVEL I STORE NAME CUSTOMER -- TODD JORGENSEN 123 STREET RD. DATE 06/12/03 REF Oeck03147 CITY, ST (800) 855 1212 W + —. ....----.. -� i a - - a - a a LOAD AND SUPPORT: Your deck will support a 83 PSF live load. Posts have below-ground post support. DECK AND,POST HEIGHT: You selected a height of 06" from the top of decking to level ground. The top of the deck support posts will-therefore be 87.25' above .ground level. Your salesperson can provide-information for uneven of sloped ground, JOISTS: Set joists on top of beams, 16" center to center. NOTE: The design may require knee braces and ),ridging between joists. Your materials list includes the necessary items. The suggested design is not a finished building plan_ You are responsible for all measurements being correct, for verifying that the design (aqd any substitutions or modifications. that you make) meets all local building codes and requirements. To verify that the suggested design, and any substitutions or modifications, is consistent with conditions at the construction site, review the design with your architect. Also consult your architect for proper construction and use of materials in the structure, Be sure to follovy the deck construction detail available from your. store salesperson.