2002-674 i
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761.8256 E
CERTIFIr ATE OF COMPLIANCE
Permit Number: P20020674 Date Issued: Monday, February 09,2004
This is to certify that work requested to be done as shown by Permit Number P20020674
has been completed,
Tax Map Number: 523400-301-013-0002-035-000-0000
Location: 15 PEGGY ANN Rd
Owner: CARROLL LA PANN
Applicant: CARROLL LA PANN
This structure may be occupied as a:
By Order of Town Board
Residential Alteration . TOWN OF QUEENSBURY
Director o Building&Code once t
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020674 Application Number: A20020674
Tax Map No: 523400-301-013-0002-035-000-0000
Permission is hereby granted to: CARROLL LA PANN
For property located at: 15 PEGGY ANN 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: CARROLL LA PANN Residential Alteration 10,000.00
15 PEGGY ANN Rd Total Value 10,000.00
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
JEFF M LITTLE
92 BULLROCK Rd
TICONDEROGA.NY 12983-0000
Plans&Specifications
2002-674
Roof alteration, 256 sq ft
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,August 13,2003
(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 the Tow ust 13.2002
SIGNED BY u Ju 4 r 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. Z'60Z---b7q
No inspection will be made until applicant has received a Fee Paid $
valid building permit. All applicants' spaces on this Rec.Fee Paid $1
application must be completed and must appear on the Reviewed By:
application form.
Applicant: Owner: U L-0,A7&L,1dAJ
Address: K-0 Address: 'A,
d - 0,-.,, /J-V- /,2pov
Phone# Phone#
Email Address: Email Address:
Property Location: Lot Number: / House Number
Subdivision Name: Tax Map Numb U`0` Q �-�25
0 New Building. residence /commercial Estimated Market Value of Construction: $ 60 C2
C3 Addition: residence/ commercial
Alteration: 6���c"commercial If an Addition,what will use of new addition be?
U No change to exterior size: residence com'l
0 Other work(describe
Check Occupancylnformation 1"Floor 2 Ud Floor Other floor Total
Below sq.ft. sq.ft. sq.ft. Square Feet
JK Single family dwelling
c Two family dwelling
0 Townhouse
U Multifamily dwelling
#of units
C2 Office
0 Mercantile
0 Manufacturing
C3 1 car detached garage
U 2 car detached garage
0 3 car detached garage
U 1 car attached garage
0 2 car attached garage
0 3 car attached garage
0 Storage building-
commercial
d Storage building-
residential
12r Other
What is the proposed heigl�t of�the structure feet inches
Will any second-hand or ungraded lumber be used? If so,for what?
Type of Heating System: electric/ oil / gas/wood /forced hot air baseboard othet:
Number of Fireplaces 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 7— Phone Number
Builder t3fl, 9661- &AV,,,s 9--_ 13,,.LeW-tPd
Plumber
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 1/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 ricVconstruction.
Signature: owner,owner's agent,architect,contractor
L Residential Final Inspection �p
Office No. (518)16 1=8256 Date Inspection request received: r
Queensbury Building.&Code Enforcement Arrive: am/p e am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: �'�, PERMIT#: � Y
LOCATION: DATE: i
TYPE OF STRUCTURE:
Comments
Y N" N/A '
Chimney Ht./"B"Vent/Direct Vent Location 1 1�
Fresh Air Intake
3 inch Plumb-Vent through roof
Roof Co _Complete WU _
Guard 30 in.or more @ stairs,decks,patios
Guard at stairwell at 34 in.or more (:9-0
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
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
Fumace/Hot Water Heater operating
Low water shut'-off boiler
Relief Valves installed
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: i 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
'/a hour fire door/door closer
Garage fireproofing
Duct work Sealed properly
Attic access 30 in.x 24 in,x 30 in.(ht.)In accessible area
Crawl Spaces 18"x 24"access, 1 s .ft,-150 s . ft.vents
Building No./Address visible from road
Final Electrical .
Site Plan /Variance required
Final Survey Plot Plan
As Built Septic S stem/Sewer Dept.Inspection Sticker
Flood Plain Certification,if required
Okay to issue C/C(Cert.Of Co liance)
Okay to-issue TLm2orary C 1 O(Cert.Of Occupancy)
Okay to issue Permanent C J O(Cert. Of Occupancy)
L:1SueHemingway\Bnilding.Codes.Inspection.FORMS\Res.Final Insp.form 2.doc edited January 28,2003
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 Notes:
Queensburj; AT 12804 ARRIVE am/pm: DEPART - m1pm
(518) 761-8256 Inspector's Initials
NAME. PERMIT#
LOCATION: INSPECT ON(date):
X0 ahlnl-
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/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-
Proper Vent,Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridgmig-
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*.\SueHemingwzy\Bxvilding.%'.Odes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
L 40o1&' rNry
F- ,A RECEIVED
AUG o 8 2002
x TOWN OF QUr--r--NSBURY
TOWN OF QUrENS8URY BUILDING DEPARTMENT. TOWN Op-
t— �,
fsasEd on our limited examination, QUE�NJ -RY ✓
compliancewith our comments shall B,u�(..��NG
not he construed as indicating the DE
plans and specifications are in full
compliancQ with the code REVIEWED 8
DATE' Q� .
>:Za� THIS PLAN TO BE ON ,
PROJECT SITE-AT
ALL TIMES.FOR
THE DURATIOU OF
CONSTRUCTION
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