2003-362 J
TOWN OF QUEENSBURY
742 Bay Road,Queensbm7,NY 12804-5902 (518)761.8201
fj
Community Development-Building&Codes (518)761-8256
DIO OF OCCUPANICY
Permit Number; P2003036Date Issued; Thursday,Jue 03;2004
This is to certify that work requested to be done as s own by Permit Number P20030362
has been completed.
Tax Map Number: 523400-308.014-OOOI.�034-000.0000
Location: 19 AMETHYST Dr.
Owner: D.KIRBY&MARTH A VAN VLEET
Applicant: D.KIRBY&MART VAN VLEET
This structure may be occupied as a:
By Order of Town Board
Residential Addition TOWN OF QUEENSBURY
Director of Building&Code Enforcement
i
F
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761.;8256
BUILDING PERMIT
Permit Number: P20030362 Application Number: A20030362
Tax Map No: 523.400-308-014-0001-034-000-0000
Permission is hereby granted to: . D. KIRBY&MARTHA VAN VLEET
For property located at: 19 AMETHYST 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: D.KIR13Y&MARTHA VAN VLEE Residential Addition .$3,500.00
19 AMETHYST Dr Total Value $3,500.00
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2003-362
24.5 SQ FT RESIDENTIAL ADDITION AS PER PLOT PLAN SPECIFICATIONS -
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,June 13,2004
(If a longer period is required,an application for an extension must be made to the cone Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the T urn of pee of une�13,2003
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Building Permit-Application
-Town of Queensliury-Dept of Community Development,742 Bay Road,Queensbury,NY.
(518)761-8256
A permit must be obtained before beginning construction. Permit File No. tt a
Ii No inspection win be made until applicant has received;a Fee Paid $-25.,2 01WAY
valid.building,permit. All applicants' spaces on this Rec.Fee Paid $ z
:} application must be completed and must appear on the " Reviewed N
y
application form. UILDIN , r
CODE
Applicant: Ki ray VM V V r� Owner: K��b llr+c+�`ter�a 1�'cw. ,l1
i Address: IC1 -i3rnta,-�<4 r- .Address: 1Q
�.u•e�'vzbc.e.v�.t, ►�`t' Lz.S+a�f ,�/ .
Phone#(alb) - ' Phone#( ) 71, -6:76
S): tt s% -q 2v3
Property Location: ;Lot Number: / House`Number L
Subdivision Name: Psvv� Tax Map Number: i Z 5� - 17-2 6
❑ New.Building: :residence t commercial 'Estimated Market Value of Construction:$ -3 •��
<< X Addition: . 'residenc commercial If an.Addition,what will use-of new addition be?
.09
Alteration: esidenc commercial F AecctA e r,
❑ No change to exterior size: residence t com'i
❑ Other work(describe
Check laCcupaAcyInformatfOn 1` FIoor 2° Floor Other floor Total
Below sq.ft, sq.ft. sq.ft. �S,quare Feet
W_ Single family dwelling j--
❑ Two family dwelling
a Townhouse
❑ Multifamily dwelling
#of units
❑ Office ;
ci Mercantile
❑ Manufacturing,
❑ 1 car detached garage
❑ 2 ear detached garage
❑' 3 car detached garage '
❑ 1 car attached garage'
❑ 2 car attached garage
❑, 3;car attached garage
❑ Storage building
commercial
❑ Storage building-
residential
n Other-
.
What is the proposed height of the structure feet inches
Will any second-hand orungraded lumber be used? If so,for what?
"Type of Heating System- electri toil / gas/wood /forced hot air/ aseboar /other:
Number of FBrentaces to,,be installed . Number:of Woodstoves to be installed �?
List below the person(s)responsible for supervision of work as regards to building codes:
Name Address Phone Number
_ -Builder -
Plumber
Mason
Electrician �. ,; 4 •+
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!!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 all new construction.
Signature: .. G Gs Z
owner,owner's agent architect,contractor
�y r fl �aL
ENERGY CODE COWLIANCE APPLICATION
TOWN OF QUEENSBL RY, WARREN COLn1T y t3—3
9000 HEATING DEGREE-DAYSC:CEIVED
Compliance Methods:Part 5 -Acceptable Practice Method - 1&2 Family Dwellings (onl§IY 8 0 2003.
Part 6*-Thermal Rating—_Component trade Offs 1&2 FamilyN- •.
Mulfi=Fam ily Dwellings(3 Stories or less) 0t 0 uEENSBIJRy
Part_`4*-'Design by Component Performance,Commercial Bnil wigs- 't'ADD CQ
Rise Residential
*Requires submission of worksheets r
APPLICANT'S NAME: 'PROPERTY LOCATION.-'
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area square feet
2. Type of heat- Electric . Oil 'Gas Other
3. Is building mechanically cooled? yes X No
4. Percentage of area of windows and doors Over 17% Under.17%
5. R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPONA TO R VALUES AS
SHOWN ON PLANS SUBMITTED:
a: Roof R 3 9
b. Exterior walls R 117
C. Glazed areas R `� �,FtS`;-�� `
d. Exterior doors R IU ` a CI'
e. Floors over unheated spaces R k a
f. Edge of slab on grade(heated building) R
g, Basement/cellar walls(above grade) R --
h. Basernent/cellar walls(below grade) R �--
i. Heating/cooling-ducts-piping in unheated space R —`
6. Service(domestic).hot water heating device.- "°e
Conforms to minimum efficiency per code 4'. Yes No
TEMPERATURE CONTROL-MAXIMUM SE'ITING'140--WILLNOTBE EXEEDED
,A:ppiicanf's Signature Date Phone Number
INSPECTOR'S REMARKS:
i
Project Name: % W
Address: j� � �:I w6�,:�A'v E C
)EIVED
Building Permit Submission SFD
Checklist 2-Family SAY 3 02003
rocs aF QUEEAISBU� '
RU1CGdNG qD
CODS
All items below must be checked either yes,no or not applicable prior to submission of any b
permit to the Town of QueemburyBuilding Department. If any of the below items are lacking,the permit
will not be accepted until such time as the application is deemed complete for submission.
1. Building Permit Application Gompleted ..................................... Dq-yes ❑no O n%a
2. EnerUForm or CheM&te Energy Code Compliance Forms Connplete.. ❑yes ❑no [.n/a
(2 copies)
3. Energy Code Inspector's Report from ChecldOate Program................. ❑yes [:)no (A n/a
(2 copies)
4. Septic application completely filled out Cif applicable).................. ...... ❑yes [:]no ®.n/a
5. Solid Fuel Burning or Gas Appliance Form... ...I..... ...... ...... ......... ... .Oyes Ono Wa
6. Electrical Inspection Form . ... ... ........:................1.......... ........ Oyes Ono ❑n/a
7. Two(2)complete sets of structural drawings.......................... ...... ... .(� ❑no On/a
a)floor plan;b)foundation plan;c)cross sections:d)elevations;
e)window and door schedule
8. Two(2)site plans showing location of the structure to be built,............ ages Ono On/a
location of well or water lines,location of septic system or sewer line.
9. Setbacks from property lines to new structure............... ................. Rks []no Qn/a
10. setbacks to neighboring wells and septic systems,including onsite well.... ❑yes. Ono Hda
and septic systems(if applicable)
11. DrivewayPemnt..................... ......... .............................. ...... Oyes Qno On/a
5�411'9�
Date:
Staff Initial:
L:\SueHemingway\Buildu'g1'ermitFORMS\Generic Cheddist.doc Januag28,2003
Queensbury Building & Code Enforcement - Residential Final Inspection
Office No.(518)761-8256 Arrive: am/pm art:
Date Inspection re Uest received: Inspector's Initials: V1 z
NAME: PERMIT#:
LOCATION: V;1\- Wcm— DATE:
TYPE OF STRUCTURE: C L-V ,
Comments
Y N N/A
Chimney Ht./"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumb Vent through roof minimum 6" V/
Roof Complete/Exterior Finish CoLmpfete X
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 Railings 34 in.to 38 in.
Platform at all exterior doors
Interior Handrails stairs 2 or more risers
Enclosed Stairs Sheetrock Underside minimum '/"
Gypsum
Grade away from foundation 6 in, with 10 ft.
Handrail Termination at Newell Post or Wall
6 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
Fumace/Hot Water Heater operating
Low water shut-off boiler
Relief Valve(s)installed/Heat Trap/Water Temp 110
Interior privacy/trim/doors/main entrance 36 in.
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
Bathroom Fans, if no window
Plumbing fixtures
Foundation insulation
Floor truss, draft stopping finished basement 1,000 sf
Emergency egress below grade
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/1/4 hour fire door/door closer
Duct work Seated properly
Gas Logs in Sealed or Glass Enclosure
Attic access 30 in.x 22 in.x 30 in.(ht.)In accessible area
Crawl Spaces 18"x 24".eccesi, I sq. ft.-150 sq.ft.vents
Buildin No./Address kisil;I1 fro nroams
, I
Final Electrical 't I 4-� ( 0 1 k
Site Plan /Variance Tekluired
Final Survey Plot Plan
As Built Septic System/Sewer Dept.Inspection Sticker
Flood Plain Certification,if required
Okay to issue C/C or C/0 [Temporary/Permanent
L:\PamW\Building&Codes\Insvection Forms\Res. Final Insp. form 2.docLast orinted 2/12/04
Rough Plumbing
h sulat- fl'ns)pec )bn Report
Office No. (518) 761-8256 Date Inspection reque ceived-
Queensbury Building&Code Enforcement Arrive:—a prn ep t: Q a m
742 Bay Road,Queensbury,NY 12804 Inspector's Initia
NAME: YN ej PERMIT#: J j������
LOCATION: 6-, ��M L\>,V(�N INSPECT ON:
TYPE OF STRUCTURE:
Y N N/A
PVC: R-1,R-2,R-3,R-4 Drain 1 Vents
Cast Iron,Copper Drain/Vent 1 Comm.
Plumbing Vent Vents in Place
Rough Plumbing/Nail Plates
Head or Air Supply Test
Dfain and Vents
5 PSI or 10 ft. above highest
Connection for 15 minutes
Water Supply Piping
C: r0o-rn ercial
er,CPV CPN
op?_pC,Pex One &Two Family ol
Ws'u'lation/Residential Cheek/Commercial Check
Proper Vent,Attic Vent
Duct/Hot Water Piping insulation
If required unheated spaces
Combustion Air Supply for Furnace
'Duct Work Sealed Properly
COMMENTS:
-L-.\SueHemingway\Building.Codes.Inspection,FORMS\Rough Plumbing Insulation Report.doc January 28,2003
Framing / Firestopping Inspection Report
Office No. (518) 761-8256, Date Inspection request received:
Queensbury,Building&Code Enforcement Arrive: am/ epart' am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initial
NAME: VCk, rA PERMIT#: (� t0 O'er
LOCATION: INSPECT ON:
TYPE OF STRUCTURE- `
Y N N/A COMMENTS
ming
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 'l2(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 sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side '/2 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
L:\SueHemin-way\Building.Codes_Inspection.FORMS\Framing Firestopping Inspection Report.doc January 28,2003
Rough Plumbing Insulation Inspection Report �r �
Office No. (518)761-8256 Date Inspection request received:7
Queensbury Building&Code Enforcement Arrive:—am/p epart: knVpM
742 Bay Road,Queensbury,NY 12804 Inspector's Initials:
NAME: 0 C, ERMIT#-.
LOCATION: r2SA� L 4INSPECT ON:
t2s� ,
6CI T:)M
TYPE OF STRUCTURE C) 1:)M%
Y N N/A
PVC: R-1,R-2,R-3,R-4 Drain Vents
Cast Iron, Copper Drain/Vent Comm.
Plumbing—Vent Vents in Place
1rough Plumbing/Nail Plates
Head or Air Supply Test
Drain and Vents
5 PSI or 10 ft. above highest
Connection for 15 minutes
Water Supply Piping
Copper Commercial
Copper, CPVC,Pex One&Two Family
Insulation/Residential Check/Commercial Check
Proper Vent,Attic Vent
Duct/Hot Water Piping insulation
If required unheated spaces
Combustion Air Supply for Furnace
.Duct Work Sealed Pr6perly
CONMENTS:
�L:\SueHemingway\13uilding.Codes.ffispection.FORMS\Rougli Plumbing Insulation Report.doc January 28,2003
Framing ifir,estopping Ins ection Report
Office No.-(518) 761-8256 ' . Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: a Depa �am/pm'
742 Bay Road, Queensbury,NY 12804 Inspecior's'Iniiials }
NAME: PERMIT#: 1 L�
LOCATION: . INSPECT ON:
TYPE OF STRUCTURE: `
Framing Y N N/A COMMkNTS
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 t Bearing Walls
Metal Strapping for Notches Top Plate
1 'Is(w) 16 gauge(8) 16D nails each side
Draft stopping 1,000 sq..ft. floor trusses
Anc or Bolts-6 ft.or,less on center
ce and snow 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
House side %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
L:\SueHemingway\Building.godes.Inspection.FORMS\Framing Firestopping Inspection Report.doc January 28,2003
A-1
Foundation Inspection Report
Office No, (5 1*8)761-825 6 Date Inspection request received: 7 Iq /0
Queensbury Building&Code Enforcement Arrive: a��Depart:4?��-IVprmr
742 Bay Rd., Queensbury,NY 12 804 Inspector's Initial
NAME: PERMIT#:
LOCATION: _ �T -CT ON: Zola 7,
TYPE OF STRUCTURE:
'Comments
Y 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
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
Bacicf11 o al
Mer 77�b -
Cast Copper
P/Yr )
rI Ala ion Interior/Exterior
-V to
o
—Rough Grade 6 inch drop within 10 ft.
LASuelierningway\Building.Codes.InspectionSORMSToundation Inspection Report.doc January 28,2003
Foundation Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/p , Depart: , Z,Tn/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: V t'd V,(e(,< PERMIT#: Q 1 �
LOCATION: �,� _bs:C_ 0 rz INSPECT ON: v
TYPE OF STRUCTURE:
Comments
Y 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
Foundation Dampproofing
Foundation/Waterproofing
Type of DampprooEng/Waterproofing —
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Bacldill Approval
Plumbing Under Slab
VC/Cast/Copper
Foundat* Ins layioJn Inte ' r/ ten r
R- !`� �g
Rough rjrade 6 inch drop within 10 ft.
L,\.SueHemingway\Building.Codes,lnspection.FORMS\Foundation?nspection Report.doc January 28,2003