2002-024 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: P20020024 Date'lssued: Tuesday,May 24,2005
This is-to certify that work requeste&to be-done as shown by Permit Number P20020024
has been completed.
Tax Map Number: 523400-239-012.0002-066-000-0000
Location: 25 BRAYTON Ln
Owner: BRUCE&COLLEEN HALSE
Applicant: BRUCE&COLLEEN HALSE
This structure may be occupied as a:
Residential Alteration By Order 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 QUEENSBUR.Y
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020024 Application Number: A20020024
Tax Map No: 523400-239-012-0002-066-000-0000
Permission is hereby granted to: BRUCE& COLLEEN HALSE
For property located at: 27' BRAYTON Ln
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: BRUCE& COLLEEN HALSE
4 FOX CHASE Dr Residential Alteration 15,000.00
COMES,NY 12047 Total Value 15,000.00
Contractor or Builder's Name j.Address Electrical Inspection Agency
JOSEPH ROULIER -
PO BOX 301
CLEVERDALE.NY 12820
Plans &Specifications
2002-024
408 SQ FT RESIDENTIAL ALTERATION AS PER APPLICATION
AV 97-2001 ZBA approved Dec. 13, 2001
Board of Health Septic Variance approval Resolution No. 55, 2001 1
$40.80 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,January 16,2003
(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 Ore—ToWn o b ednesday,January 16,2002
SIGNED BY for the Town of Queensbury.
Code Enforcement
Director of Building
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 o
No inspectionwill be made until applicant has received a Fee Paid $
valid building permit. All applicants' spaces on this ' Rec. Fee Paid
application.rnust be completed and must appear on the Reviewed B
application form.
,p
Applicant: Owner:
Address. ? Address:
Phone .yy Phone# (_s 2�r -7
Property Location: Lot Number: / House Number _et_> -/ /3 K, �Q,, �,, s�,,,��1,. .�i < t'•
Subdivision Name: Tax Map Number:.
d. New Building: residence t commercial Estimated Market.Value'of Construction:$
❑ Addition: residence/ commercial If an Addition,what will use of new addition be?
[V Alteration: -residence commercial
❑ No change to exterxor_stze: residence t com'1
❑ Other work.(describe -
Check OccupancyInformation 15t Floor 2"d Floor Other floor .Total
Below sq.ft. sq.ft. sq.ft. Square Feet
1411 J '
Single family dwelling ,
❑ Two family dwelling
❑ Townhouse
❑ Multifamily dwelling
#of units
unr-
0 Office
❑ Mercantile
U Manufabflur s- - - -
O, 1 car detached garage
`�. ❑ 2 car detached garage' . r `
❑ 3 car detached garage' '`
❑ 1 car attached garage,
❑ 2 car.attached-garage "
❑ 3 car attached garage
❑ Storage.building-
commercial
❑ Storage-building-
residential
❑ Other
What is the proposed height of-the structure feet d inches
Will any second-hand or ungraded lumber be used?,If so, for what? !L�
Type of Heating Syste lectric e oil / gas 1 wood /forced hot air baseboard they:
Number of Fireplaces to,be installed - d Number of Woodstoves to"be installed O
List below the person(s)responsible for supervision of work as regards to building codes:
Name Address Phone Number
Builder 6 Ile-
Plumber
Mason
Electrician t, -
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 all new construction.
Signature r- � owner,owner's agent,architect,contractor
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: ........_........................................._..."..............................-.._."...._....................._._..,
Office
Use
Location of installation:�� � �� D�L�
File Permit No, ' 1
Tax Map No,
Fee Paid
Owner's Name:Z- �q e. 1
Address:
2. INSTALLER'S NAB G�5,...�LC ��� �� -� PHONE NO.
3. RESIDENCE INFORMATION: (circle,year of dwelling, indicate 9 bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No of Bedrooms x Computation = Total Daily_Flow
1980 or older x 150 gal/bdrm =
1980-1991 _3 x 130 gal/bdrm = -3 90
1991 -present x 110 gal/bdrm =
Garbage Grinder Installed yes / no
Spa or Whirlpool Installed yes / no
4. PARCELRqFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat sand at what depth at what depth municipal
Rolling loam feet feet well
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is-fit
other
-_ - Percolation.Test: (To-be ^or.-pleted:by.lirensed pr-ofessional_engineer o.r architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect(unless installed in a-Planning Board approved subdivision). Add 250 gallons to the size
of the zc/T)
.c tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Sepank: gallon (min. size 1,000 gal.)
Tile Field: each trench ft. Total System Length: fl-
Seepage Pit(s): number of size of each: ft. by ft
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: length andlor size
6. HOLDING TANK SYSTEM: (if required)
ec
Number of tanks:,_3 / Size of each gallons /TOTAL Capacity:-. o egallons
Note: Alarm System and associated ca rk must be inspected by a Town approved
electrical inspection agency yes
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
For your protection,please note that pursuant to Section 136-29 of the Code of the Town
of Queensbury, any permit or approval granted which is based upon or is granted in
reliance upon any material misrepresentation or failure to make a material fact or
circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with resp ect to this application and agree to abide by these and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signatur�of espo �sibleperson Date
Septic Inspection Report
Office No.(518)761-8256 Date Inspection re u t re
Queensbury Building&Code Enforcement Arrive: pm ep art:-
742 Bay Rd., Queensbury,NY 12804
Report
req
epar�-
Inspector's Initia
NAME: IF P IT NO.: in 7--oz--4
LOCATION: PECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand Loam Clay
Type of Water: Municipal/Well Water
Waterline separation distance
Well separation distance ft.
Other wells: ft.
Abso!ption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Pi in Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field Pit
_2pening Sealed., Y/NI Partial
Location/Separations
Foundation to tank
Foundation to absorption
Separation of Pits ft.
Conforms as.per Plot Plan Y_N
Location of System on Property:
Front Rear Left Side ,Right Side
Middle Front Middle Rear
S stem Use St us:
;ipproved
.Partial Approved and needs to be re-inspected,please call the'Building&Codes Office
.......................Disapproved
L:iSueHetningway\Building.Codes.Inspection.FORMS\Sepdc Inspection Report.doc, January 28,2003
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va ating, Inc.
63 Woodchuck Hill Rd.
Lake George,NY 12845
.... . ..............-_ -- —
MW
Bill To
Roulier Construction Co. .....-....... ---.- . ..._...__..........._........_..._.._..............___..._.._..-
P.O.Box 301 DATE INVOICE# JOB
Cloverdale,NY 12820 2/28/2005 _72 cl Zoe
�pG S�
DATE DESCRIPTION
2/17/2005 Hauled in fill,#2 stone, 1000 gal.septic tank,frame and cover,loaded dirt
.onto truck and hauled•away;dug and.set-septic..tank ... . .. ...... -..___...._.�_._..
Trackhoe
Trucking
Gabor
2 Ids.of Fill
l Id.of#2 Crushed Stone
3 1000 Gal Septic Tank,frame and cover,riser and pipes
2/18/2005 Hauled in fill,loaded dirt onto truck and hauled away,set new riser,dug
around old risers patched and backfilled
Trackhoe
Trucking
Labor
t Id.of Fill
Hydro cement
Sales Tax
DUE UPON RECEIPT. A finance charge of 20A per month will be Total
charged upon unnaid balances.. Customerarsrees:to n_Av_ all
and collection fees if necessary.
w
Septic Inspection Report
Office No.(518)761-8256 Date Inspection reques c"d:
Queensbury Building&Code Enforcement Arrive: a p Vepart7Ba�
742 Bay Rd.,Queensbury,NY 12804 Inspector's In
itial it
ial .
NAME: IT NO.: 60a—
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Munici al/Well Water
Waterline separation distance ft.
Well separation distance
Other wells:
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone V5 0
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: Y/NI Partial
End Cap*
Location/Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits
Conforms as per Plot Plan Y D
Engineer Report and As-Built
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use Stag
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
RESIDENTIAL FINAL INSPECTION REPORT
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement
Dept.of Community Development Arrive epart n/ m
Town of Queensbury I or s Iriiti
742 Bay Road
Queensbury,New York'12804
NAME — PERMIT# C3Ca`y7 tJ
LOCATION '2.R P,ft%JT 0 L A io — DATE Z 0
TYPE OF STRUCTURE
N/A YES NO COMMENTS
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake
Plumb Vent through roof
Roof Complete
Exterior Finish Complete
Interior/Exterior Railings 30"to 36" '
Exterior Handrails,balconies,landing 18 in.or more
Interior Handrails stairs both sides 3 or more risers
Grade 2%away from foundati
8"clearance to sill plate
Gas Valve shut-off exposed/r gulator 18' hove grade
Gas Furnace shut-off within 3 feet or wi line of site
Oil Furnace shut-off at entranc e to furnace
Furnace/Hot Water Heater ope atin
Relief Valve(s)installed
Headroom,6 ft.6 in.on stairs r
Basement stairs,6 ft.4 in.
Handrail exterior stairs both sid s mor than 3 risers
Interior privacy/tnm/doorslmain ce 36"
Floor Finish
Bathroom/Kitchen watertight
Interior Handrails s/Lao 18 in.or more
Railing across window m stainvel
Smoke Detectors:
every level
every bedroom
outside every bedroom
inter connected
Bathroom fans
Plumbing fixtures
Foundation insulation
3/4 hour fire door/door closer
Garage fireproofing
Garage penetrations sealed
Furnace in separate room protected in garage)
Light ventilation per room
Safety glazing 18"or less from floor
Final Electrical
Site Plan/Variance required
Final Survey Plot Plan
As Built Septic System layout required JUPCPtaC t-lOL�1L�C� Tr'�i4�
Okay to issue C/C(Cer f.of Compliance)
Okay to issue temp.C/O(Certif.of Occupancy)_
Okay to issue permanent C/O(Certif.of Occupancy)
r .
RESIDENTIAL FINAL INSPECTION REPORT
Office No.(518)761-8256 Date inspection request received: '
Building&Code Enforcement f
Dept.of Community Development Arrive Depart a2
Town of Queensbury spector-s Init als
742 Bay Road
Queensbury,New York 12804
NAME hY.�'L PERMIT c -4
LOCATION rC DATE 1 �
TYPE OF STRUCTURE
r
A YES NO CONMIENTS
1 Chimney Heightf V'Vent/Direct Vent Location
Fresh Air Intake
Plumb Vent through roof
Roof Complete
Exterior Finish Completet. .,.�` '� t � ����?
Interior/Exterior Railings 3 "t 36" .
Exterior Handrails,balcom s,1 ding 18 in.or more
Interior Handrails stairs bo side 3 or more risers
Grade 2%away from founds'on
8"clearance to sill plate
Gas Valve shut-off expose dl gulat r 18"above grade
Gas Furnace shut-off within 3 feet r within line of site
Oil Furnace shut-off at entranc to ace area
Furnace/Hot Water Heater oper t g
Relief Valve(s)installed
Headroom,6 ft.6 in.on stairs
Basement stairs,6 ft.14 in.
Handrail exterior stair oth sides ore than 3 risers
Interior privacy/trim/doors/main en ce 36"
'Floor Finish
Bathroom/Kitchen watertight
Interior Handrails BalconieslLanding 18 in.or more
Railing across window in stairwells
Smoke Detectors:
every level
every bedroom
outside every bedroom
inter connected
Bathroom fans
Plumbing fixtures
Foundation insulation
3/4 hour fire doorldoor closer
Garage fireproofing
Garage penetrations sealed
Furnace in separate room protected(in garage)
Light ventilation per room
Safety glazing 18"or less from floor
Final Electrical
Site Plan/Variance required
Final Survey Plot Plan
As Built Septic System layout required
Okay to issue C/C(Certif.of Compliance)
Okay to issue temp.C/O(Certif.of Occupancy)
Okay to issue permanent C/O(Certif.of Occupancy)
a
GENERAL INSPECTION REPORT
( 518) 761-8256
Town of Queensbury ;
Dept.of Community Development Date inspection request received:
Building&Code Enforcement 1 �
742 Bay Road ,
Queensbury,NY 12804 Arriv Dep rt
spector's itlts
NAME: 1 .c - PERMIT# — y-
LOCATION: _ Z_ RE ��' DATE : 7=W—dZ
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
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
Backfill Approval f
Plumbing Under Slab
Plumbing VenttVents in Place
Rough Plumbing 1� _-
Heating Rough-In !'
Insulation 1
Foundation Walls Interior R- /
Foundation Walls Exterior R-
Floors R-
--Walls R- /
—Ceiling L-41-lOV) R Ell/
-
Duct work or piping in
unheated spaces R-
Proper Vent,Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
ti
• 'F <o� Office Use
GENERAL, INSPECTION REP F� � ��# �: �
Inspect '
Town of Queensbury Ready at time'
Dept. of Community Development Request received: C L t O�'�� Meet:
Building& Code Enforcement ' At time:
742 Bay Road
Queensbury, NY 12804 ARRIVE RT Notes:
(518) 761-8256 Inspector's 1hitia�lls
NAME: PERMIT# c-)
LOCATION: INSPECT ON(date):
TYPE OF STRUCTURE:
RECHECK
N/A YES NO/NMIM Footings/PiersMonolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 4&hours following the placement
of the concrete.Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place,
Foundation/Dampproofmg
Backfrll Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Wails Exterior R- ,
Floors R-
Walls R-
Ceiling R- /
Duct work or piping in
unheated spaces
Proper Vent,Attic Vent
Framing
Jack Studs/Headers
BracingBridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
4FiLe Wall 2,3,4 hour
re opping -
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
GENERAL MSPECTION REPORT
(518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804 Ar ri� �epart
HVC5-,�p s
e kppeclor��Initi
NAME: PERMIT# ZIA
LOCATION: DATE : 1,-7
TYPE OF STRUCTURE: EQ�D X ek'20- RIO M�?D
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
p
S -7
7-rN I e1j
Z-11
of the concrete.
Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofing_
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
eating Rough-In
VInsulation WA 12 77
Foundation Walls Interior R-
Foundation Walls Exterior R-
Aoors R-
V alls R-
\/Ceiling
Duct work or piping in 5�-\—V3
unheated spaces R-
Proper Vent,Attic Vent-=Z/
Framing
Jack Studs/Headers
Bracing/Bridging ,�.
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Seated
Fire Wall 2, 3,4 hour
Firestopping
GENERAL INSPECTION REPORT
( 518 ) 761-8256
Town of Queensbury
Dept.of Community(Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive 1 a;l �; Depart
Inspector's lnni al
NAME: VW�� PERMIT#
LOCATION: DATE :
TYPE OF STRUCTURE: 14
RECHECK
N/A YES NO COMMENTS
Footings/Piers f
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible far
providing protection from freezi g
for 48 hours following the place ent
of the concrete.
Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofin
Backlill Approval _
lumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R
Walls R-
Ceiling R-
Duct work or piping in
heated spaces R-
Pro r Vent,Attic Vent
Fr ming
Jack Studs/Headers
BracingBridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2,3,4 hour Firestopping iy t
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"I have seen or observed,or believe I saw evidence of,
all objects such as houses;wells,trees,fences, etc.,
shown on this document. I also represent-that I have
personall easured the distances set forthatheram..
:.. SIGNATURE