2002-167 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: P20020167 Date Issued: Friday,March 05,2004
This is to cent that work requested to be done as shown by Permit Number P20020167
has been completed.
Tax Map Number: 523400-266=003-0001.065-000.0000
Location: 30,CLEMENTS Rd
r
Owner: ROBERT.&JACQUELINE KOCH
Applicant: ROBERT&JACQUELINE KOCH
This structure may be occupied as a:
-BY.-Order of Town Board -
Garage-2 Cars Attached TOWN OF QUEENSBORY
Director of Building&Code En£oteement
i
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020167 Application Number: A20020167
Tax Map No: 523400-266-003-0001-065-000-0000
Permission is'liereby granted to: ROBERT& JACOUELINE KOCH
For property i.ocated at: 30 CLEMENTS Rd
in the Town 6f 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 Unifonn Building Codes and the Queensbury Zoning
Ordinance. , Type of Construction Value
Owner Address: ROBERT& JACQUELINE KOCH Garage-2 Cars Attached 12,000.00
30 CLEMENTS Rd Total Value 12,000.00
QUEENSBURY,NY 12804
Contractor or:Buildei's Name/ Address Electrical Inspection Agency
HEATH, JOHN JR
RD I BOX 1219
WHITEHALL,NY
Plans &Specifications
2002-167
672 SQ FT 2-CAR ATTACHED GARAGE AS PER PLOT PLAN SPECIFICATIONS
$67.20: PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday,March 27,2003
(If a longer period is required,an application for an extension must be madeto the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at th Tow 0 Q- n day,ay,March 27,2002
SIGNED BY� for the Town of Queensbury.
Director of Building&Code Enforcement
f 1
/ Building Permit Application
Town of Queens_bury-Dept of Community Development,742 Bay Road,Queensbury,NY
(518)761-8256
A permit must be obtained before beginning construction. Permit File No 2_
No inspection will be trade until applicant has received a Fee Paid" $
valid building permit. All applicants' spaces on this Rec.Fee Paid
application must be completed and must appear on the Reviewed
application form, t / ,
Applicant: C3fl"-r fC 0cii Owner: $Ej[Tj pG
Address: 30 C 1. IG M C,WES VZ Address: G�iGhE►ar
Phone#("____) -6_ Phone#
Property Location: Lot Number: / House Number CuFaielaTs'r�M, 0UEE��B
Subdivision Name: Tax Map Nurnber•. .Z(n(�,.3 i'.:•tfa a AAI CC)De
❑ New Building: residence /commercial Estimated Market Value of.Construction:$
.'14 Addition: I<Emge>commercial If an Addition,what will use of new addition be?
❑ Alteration: residence/ commercial
change to exterior size: residence t com'1
❑ No','
❑. Other work(describe )
s Check OccupancyInformation 1"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
2 car attached garage 7 2
❑ 3 car attached garage
❑- Storage building-
commercial
❑ Storage building-
residential
❑ Other
,I
What is the proposed height of the structure �9 feet Q inches
Will any second-hand or ungraded lumber be used? If so,for what?
Tpe of Heating System: electric/ oil / gas!wood. /forced hot air/ baseboard/other:_��,8f.1 G
Number of Fireplaces.to be installed 0 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 Ibirk,4 tJ6 1"il 6 y 2- - 138 2-
Plurhber
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 Surveyby a licensed surveyor;drawn to scale,showing actual
location of all new cowtiuction.
1` Signature: V CJ!!i'►lJt+l�[. ` 6.�� owner,owner's agent;architect,contractor
Office Use
GENERAL INSPECTION REPORT Inspector:
Toivn of Queensbury Ready at time:
Dept. of Community Development Request received: Meet:
Building& Code Enforcement At time:
742 Bay Road
Queensbury, NY 12804 ARRIVE am/pm: DEPART/6,11amlpm
� Notes:
(518) 761-8256 Inspector's Initials
NAME: V0 PERMIT# (9 7
LOCATION: INSPECT ON(date):
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/'vVaRpour
Reinforcement in Place
Foundation/Dampproofmg_
Backfill Approval
Plumbing 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
unheated spaces R-
vkpP per Vent,Attic Vent
arpn' V/T
Jack Studs/Headers
Bracing/Bridgmg
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping_
L-\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
Office Use
GENERAL INSPECTION REPORT Inspector:
Town of Queensbury Ready at time:
Dept. of Community Development Request received: Meet:
Building& Code Enforcement At time:
.742 Bay Road
Queensbuiy, AT 12804 ARRIVE am/pm: DEPARam/pm Notes:
(518) 761-8256 Inspector's Initials`�
NAME: PERMIT#
LOCATION INSPECT ON(date): u --2k
TYPE OF STRUCTURE:
RECHECK
N/A YES COMMENTS
tings/Piers
Monolithic Pour
Reinforcement in lace
u
'in r
0 la
�tings
lace p 'bl,The contractor is res ble,fb�
I1po providing protect n.from freezing
11
for 48 hours'follo ing the lacement
of the concrete.
s purp on
Materials for this 7puirpse on ite
this
Foundation/Wallf
Reinforcement in Place
Foundation/Damp proof_ g_
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in P ce
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interio R-
Foundation Walls Exteri R-
Floors
Walls R-
Ceiling R-
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
Firestoppig-
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAI,INSPECTION REPORT.doc
Queensbury, Building & Code Enforcement - Residential Final Inspection
\V-1 6Office No. (518)761-8256 Arrive: am/pm, Dep rt: L,/4ar)Jpm
Date Inspection request received: Inspector's Initials: f
NAME: PERMIT#:
LOCATION: 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 minimum 6"
Roof Complete/Exterior Finish Co m lete
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 rade
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 Valves installed/Heat Trap/Water Temp, 110
Interior privacy/trim/doors/main entrance 36 in.
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells safety lazin
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/3/o hour fire door/door closer
Duct work Sealed 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"acce s, 1 s . ft.-150 s . ft.vents
Building No./Addresi visi e from road
Final Electrical Q
Site Plan /Varian re u' ed
Final Survey Plot Plan
As Built Septic System/Sewer De t. Inspection Sticker
Flood Plain Certification,if required
Okay to issue C/C or C/Cl Tem orar /Permanent]
L:1PamWlBuildinp,&Codes\Iruspection FormslRes, Final Insp. form 2.docLast printed 2/12/04
MAP REFERENCE:
MAP OF A DE FOR
BETTT-y VEYBATCHEDER
MALCOLM & B 19g4
DATED: JUNE 31 1994
REVIFILED* AMAPU GUS#223
PLAT CABINET A--1, SLIDE 197
BY: VANDUSEN & STEVES
LEGEND:
o IRF = IRON ROD FOUND
FENCE LINE
l UTILITY POLE
ELECTRIC TRANSFORMER
_ WELL
LANDS gANNON
F OF
DAVID
LANDS N /F OF
ALENE BROWN
SEE SUBDIVISION MAP OF LA MC
O OF CORMACK
ALENE M. BROWN SY COULTER MARCH 27, 1991
APPROVED JAN 22' 1991. FILED
N 05'2 '2 30"E
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3: waRK
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125.96
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PROPANE O
TANK
121,039 sq.ft.
2.78 acres
Dus en
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rve ors LL
Land su York 12801
Glens Falls, New 50135
37 Chester Street New York moo• No.
(518) 792-5474
S01'4! 0"E
70 wTVATO 11 >
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I.R.F.
YAWTIDA — •--
688' + /- TO NEW YORK STATE ROUTE 9L
t.R.F 705.89'
CRUSHED STONE DRIVE
418.34'
S05'22'37W
LANDS N /F OF M ALCOLM BATCHELDER
DGE OF WATER AS OF 2-1-9
s
POND
LANDS N/F OF SEVERANCE
Map of a Survey made for
LINE KOCH
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�,pEERT & 3AQTj
ueeusbury, Warren County, New York
Torre of Q
TAX MAP N0. 27-3-1.3
N0. , DATE
44" M APLEW
48" MAPLE Zo
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HOUSE V
DESCRIPTION
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DWG. No. 92321-3