2001-263 OUEENSBURY
TOWNaF
742 Bay Road,Queensburq,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
CEDTIFIr I TE OF OCCUpANry
Permit Number P20010263 Date Issued: Monday, Deeember 03,2001
This is to certify that work requested to be done as shown by Permit Number P20010263
has been completed.
Tax Map Number: 523400-289-019.0001.009-002-0000
Location: 5 BLACKBERRY Ln
Owner: KIMBERLEE POLUNCI
Applicant: KI IBERLEE POLUNCI
This structure may be occupied as a:
By Order of Town Board
Single Family Dwelling 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) 76.1-8256
BUILDING PERMIT
Permit Number: P20010263 Application Number: A20010263
Tax Map No: 523400-060-000-0007-022-002-0000
Permission is hereby granted to: KIMBERLEE POLUNCI
For property located at: BLACKBERRY 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: KIMBERLEE POLUNCI Single Family Dwelling 71,000.00
9 CHERRY St Total Value 71,000.00
GLENS FALLS,NY 12801
Contractor or Builder's Name/ Address Electrical Inspection Agency
RICHARD SCHEIDEGGER.
25 ALGONOUIN
NY
Plans &Specifications
2001-263
1280 SQ FT SINGLE FAMILY DWELLING AS PER PLOT PLAN SPECIFCATIONS
$153.60 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,May 14,2003
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town en.bup Monday,May 14,2001
SIGNED BY for the Town of Queensbury.
Director of Building&C�6 e�Ercement
Building Permit Application
kl QlVr=i OJF QLLE'E'12Sbui y - Dept. of Corninuld y Development, 742 Brij.Rock!, Queelrsburv', NY 12804 [761-8256]
NOTICE BUILDING & . CODE ENFORC:EM-ENT
Requirements prior to issuance
A permit must be obtained before of this permit: PERMIT FILE NO. �6_17�
beginning-construction. No inspections PERMIT FEE PAID$ � eo.a
will be made until applicant has received Zonf7t d Action P
a VA
,I,M BUILDING PERNIIT. Ali . LJ r:, Qd
applicants' ::70NtFEPAID $pp + spacers on this application . ,.
MUST be completed acid•the signature � ``3
Plannin Board Action <VIEWED I3Y.
of the applicant must appear on the - SPR ubdivision Other
BtdGling Int�eclnr
lieation form. �. ( Y3 eatto ee ayment
llc_��i
Address: G ile- Address:
Phone # / _ _}��L - � 'v_-�� Phone # {SLR'_) �lS�- c7�} _ ✓' r�' '�%�I
Property Location: 5-.-��tc�tG�i�y' f��.�. � -
Tax IVIap Number
Subdivision Name: —
Section Block- Tot
4` NATURE OF PROPOSED WORK: OF TT
�3 �
New CONSTCT
Buil �sidenc j commercial
Addition o Building:
residence j commercial OCCUPANCY INFORMATION:
Alteration to Building: Primary-, Building -
residence, / commercial ' Single Family Dwelling
Residence / Commercial Two Family Dwelling
no change to exterior size Family Dwelling
Office
Other Work (describe below)i Mercantile
":htaniifacturing
" ' y Other
GROSS AREA OF PROPOSED STRUCTURE: / S
3f ADDITION-, what will use
lst .Floor. . . . . . . sq. ft". ,mil of new, addition be? .
2nd .Floor. . ... . . . . 'fit.. '
Other Fluvf
(not unfinished cell�r O.X!fasement)
x` ACCESSORY BUILDINGS:
De ched Garage . �ar
TOTAL FLOOR AREA: ��2 (✓ SQ• FT. !Oeh
ttac d G e 1, 2 car
riva orage Building
SIZE OF NEW SmRTrc mTr1zF: rcial age Building
FEET X "7o • FEET er
oundation Type: o( 'C'.A Will any second-hand or ungraded
Number of Stories : • lumber be used? If so, for what?
(habitable space orvly) ;4/
Height (grade to ridge) : feet TYPE OF HEATING SYSTEM:
Number of fireplace" and/or woodstove (circle all which plies)
to be installed:_ ;,- Electric / Oil Gas. / Wood
Qorced Hot Air / Baseboard / Other
Person responsible "for supervision of-snro=k a� `regards to"-building -- - - - -
codes is: CC4>M Jam-�tuy<:JJ Zza`1 tt/' �XA 62rayltldi'1/f_ C<
Name Addre ss Phone
/Builder: H rrh�t'Ul e e. ��
Plumber: ta�or�` LuwcC '' ,rr c. cti Y - YC�s
Mason: r Y Sr t,r.t tv� vy! o Z
Electrician: �, o1e-ne � <-ale f��
DECLARATION.- Please sign belmv after'le' you have cane,fully 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 llwe shall submit prior to a
Certificate of Occupancy'or Certificate of Compliance being issued, an AS.BUILT PLOT PLAN by
a licensed surveyor; drawn to le, showing actual location of project on premises.
t,�--•2..C,-vim,� �//clJ
Signature: / 7 �/ /re 9
(owner, owner's agent, architect, c retractor)
Application for Peruimit Septic Disposal System
' s Town ofQueensbury 742 Bay Road Queensbury,NY 12804 018)"761-8256
1.- OWNER INFORMATION:
.....................:.............................................................................................................
,
Office Use
Location of installation: S /3(�kckRe.-V c�y
Tax Map No.
r File Permit No. j
��� -�I f /�.�. I
Owner's Name: ✓� - jW)z l" Fee Paid
f
................................................................................................
Address:_3 G'G.c,v r
2. INSTALLER'S NAME ®��,;,� (� 2{a�r�$ �W f i a c, PHONE NO. Tel`1,0c7t
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 4 bedroom(s) and multiply# of
bedrooms With applicable gallons per bedroom to equal total dailyflow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdrm =
1980-,1991 x 130 gal/bdrm =
1991 -present ,3 x 110 gal/bdrm = 3C3 G-y /3,8
Garbage Grinder Installed __yes-�
Spa or Whirlpool Installed yes _ / no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
Tonoaratiliv, S iI Na t r Ground Water Bedrock or Impervious Material Domestic Water Supply
I7a sand COB81CS at what depth at what depth municipal
Rolling oam feet feet well
Steep slope clay T well; water supply
slope other from any septic-system
depth: absorption is 160 ft:
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: 01 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 septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub:
Septic Tank: 1,cao6 gallon (min. size ],000 gal.)
Tile Field: each trench ft; Total System Length: 1 3S, ft.
Seepage Pit(s): number of size ofeach: ft. by ft.
Size of Stone to be used: It / depth or thickness feet
Bed System Size: x
Alternative System: length and/or size
C-i;Wk��tJ��s At3c -�7o.�a SYs; 1`2 Div/-tc 'eYSrFt
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
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 respect to this application and agree to abide by these and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person bate
TOWN OF QUEENSBURY Fee Paid
BUILDING & CODES DEPARTME
PORCHE DEg Permit # l
APPLICATION FOR: - KS-
DOCKS & PS' S Est. Cost ®[
- A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. PLEASE ANSWER ALL OF THE FOLLOWING:
The undersigned hereby applies for a Building Permit to do the following work which will be
done in accordance with the description, plans and speclf ft ations .submitted, and such special
conditions as may be indicated on the permit. TWO SETS OF STRUCTURAL PLANS S"ALL BE SUBMITTED
WITH THIS APPLICATION.
Owner of Property: r {Q e �rO {
P.Q. Address 3erY 57- ('( S `S /oZ$ Phone #
Property Location r ✓ Tax Map # e,o 2
Subdivision Name (If applicable)
PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS 'REGARDS TO BUILDING CODES:
Name: U'�'r c_ t��I�v�� Address e-0 "r, ranc�4116 /C//VPhone#_ 1,2
BUILDING SPECIFICATIONS:
i
Type of work to be done: Porch ec ock Boathouse `(Circle one)
v
Size of Structure to be- built (squa�te Dotage) :
`S` `• ,- Foundation Mate ria-1 : Width. 3p G Thickness 1 ��
Depth of Footing, below grade:
i
Size of Posts or Studs: _ L( x x Long
Size of Floor Joists: x _ x �/� Span
Decking or Flooring Material :
How will Porch or Deck be fastened to building? �wr
If Roof Will Be Installed, Answer Following Questions:
Size of Posts or Studs: x is Long
Roof Rafters: x Spacing Span
Roof Trusses (pre-engineered spacing): Span -
Type of Roof: Sloped Flat Shed Other (Circle one)
1
Material of Roof:
ZONING INFORMATION:
TWO PLOT PLANS MUST BE PREPARED AND SUBMITTED, drawn reasonably to scale and attached
hereto, showing clearly and distinctly all buildings,, whether existing or proposed and
indicate all set back dimensions from property lines. Show location of water supply and
location and configuration of septic disposal area.
--- Size of Property: ft. x ft. � -
Existing building(s) : Size ft. x ft.
Size ft. x ft.
Use of Existing -building(s):
Proposed structure, distance from property line:
Front yard /o v ft. Rear yard 2 v ft-.
Side yards I zo ft. and qa-1 ft. �'/I�
If on corner, setback from side treet: ��I ft.
DECLARATION
To the best of my knowledge and belief 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
Bune
ding Code, the Zoning Ordinance, and all other laws pertaining to the proposed work
sh 'be complied with, whether specified or not, and that such work is authorized by the
o r. C� �csvJ( G'
1/DATE: J ?A IS 3
_ �`7 G.i� � ��..c: r;' 0 SIGNATURE � �! yi,+-,..1.z.;
'1 l Owner, Own r s Agency, Architect, Contractor
REVIEWED 'BY CODE ENFORCEMENT OFFICER, DATE SIGNATURE
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY
9000 HEATING DEGREE DAYS
Comoliar-ce Methods: PART 5 Acceptable Practice method
1&2 Family Dwellings (only)
PART 6 Thermal Rating - Component Trade Offs
1&2 Fdmily Dwellings; Multi-Family
Dwellings (3 stories or less)
PART 4 Design by Component Performance
Commercial Buildings-Hi Rise Residential
*Requires submission of worksheets
APPLIC.A-N. T S NAME: PROPERTY LOCATION:
64cAc 4e-xry /-a o e--
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1 Gross Floor Area scTuare f et Ck
2 . Type of Heat - Electric 0 11 Gas Other
3 . Is building mechanidally cooled? Yes L1.40
4 . Percentage of area of windows and doors Over 17% Under 17%
5 . R- -V=, , UES FOR INSULATION,GIVEN BELOW MUST CORRESPOND TO R-V.'rl--rUES AS
&HO-W-IN ON PLANS SUBMITTED:
;= . Roof R
b . Exterior walls R
C - Glazed areas R
d. Exterior doors R
e . Floors over unheated spaces R 2
7dcre of slab on arade (heated building) ;2- R
C. Basement/cel ar wal (above grade)
Basement/cellar walls (below grade R
Heating/cooling-ducts-piping ir- unheated space R
6 . Service (domestic) hot water heating device
Co .forms to min"i-num efficiency per code Yes No
I —7k--
TEMPERATURE CONTROL MAXIMUM SETTING 1400 WILL NOT BE EXCEEDED
A D )j / s
L:)P, Ca= sighatq_re Date PhoneNU.rkW' er
dL
!NSP=-'!-'-'-rO-RIS REMARKS:
BLDG. PERMIT'NO. 2 0 01-2 6.3
APPLICATION FOR A TEMPORARY CERTIFICATE OF OCCUPANCY
A TEMPORARY CERTIFICATE OF OCCUPANCY is hereby requested for the property.
located'at;� 5 Blackberry Drive , Kimberlee Polunci
for the following uses: Single Family DVjellixig
Octcxber 30, 2001
DATE SIGNATURE OF APPLICANT
TEMPORARY CERTIFICATE OF OCCUPANCY`
The TEMPORARY CERTIFICATE OF OCCUPANCY is hereby ( )APPROVED ,:•
( )DISAPPROVED
with the"following conditions: Certii"cafe of Qc.cupancy toe sued
upon completioh:nof:
1 ) Stain ,or seal siding
2 ) Ins-tall relief valve"
3) Complete insulation @ box
4) Complete L.P. Gas Tank installation
5) Submit Survey '
TEMPORARY CERTIFICATE OF,OCCUPAN F : O$ WOO DEPO I i ( 4100,00
received on Gctyber 30, 2001
Date of Issuance Director of Bldg. & ode forcement
I'll IS TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES 30 ' DAYS
FROM THE DATE`OF ISSUANCE:
NOTE: This-Certificate is NOT VALID unless signed by the Director of Bldg. & Code
Enforcement or his designee.
RESIDENTIAL FINAL INSPECTION REPORT
Office No. (518)761-8256 Date inspection request received:
Building& Code]Enforcement
Dept. of Community Development Arrive ,1;iMn/pm Depart am/pm
Town of Queensbury Inspector's Initials
742 Buy Road
Queensbury,New York 12804
NAME 1 c�/0,T*9 t PERMIT# f
LOCATION f3lo-41 DATE f LAX,
TYPE OF STRUCTURE
N/A YES NO CONRVIENTS
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 foundation
8"clearance to sill plate
Gas Valve shut-off exposed/reg for 18"above grade
Gas Furnace shut-off within 30 f t or within line of site
Oil Furnace shut-off at entrance furnace area
Furnace/Hot Water Heater opera
Relief Valve(s)installed
Headroom,6 ft.6 in. on stairs
Basement stairs,6 ft.4 in.
Handrail exterior stairs sides ore than 3 risers
Interior privacy/trisu� rs/main trance 36"
Floor Finish
Bathroom/Kitchen watertight
Interior Handrails Balconies/Landa g 18 in. or more
Railing across window in stairwell
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
Okay to issue CIC(Certif.of Compliance)
Okay to issue temp. C/O(Certif.of Occupancy) 00,
Okay to issue permanent C/O(Certif. of Occupancy)
RESIDENTIAL FINAL INSPECTION REPORT
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement
Dept.of Community Development Arrive jl o am/pm Depart am/pm
Town of Queensbury Inspector's Initials
742 Bay Road
Queensbury,New York•12804 / J NAME (� ` �+� r ` PERMIT#! I—�67-3—
LOCATION DATEl
TYPE OF STRUCTURE
N/A YES NO COMMENTS
Chimney HeightPB"Vent/D' ect ent Location `' r.d`. �p C 4UQ t 7'
Fresh Air Intake
Plumb Vent through roof
Roof Complete A
xterior Finish Complete 1
Interior/Exterior Railings 30"
Exterior Handrails,balconies,I ding 1` in.or more �oeh-
Interior Handrails stairs both si es 3 or ore risers
Grade 2%away from foundatio
8"clearance to sill plate
Gras Valve shut-off osed/re ' at 18"above grade
Furnace shut-off or within line of site
it Furnace shut-off at entrance o furnace area
�ace/Hot Water Heater opera' g .P. iN f
ef Valve(s)installed !
Headroom,6 ft.6 in.on stairs
Basement stairs,6 ft.4 in.
Handrail exterior stairs both side more than 3 risers
Interior privacy/trim/doors/main trance 36" Y-'
Floor Finish
Bathroom/Kitchen watertight
Interior Handrails Balcomes/Lan i g 18 in.or more
Railing across window b stairwe s
Smoke Detectors:
every level
every bedroom 1
outside every bedroom
inter connected
Bathroom fans
bing fixtures
N/Foundation insulation 6
'14 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
to PlanlVariance required
final Survey Plot Plan D C
As Built Septic System layouf 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)
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MAP REFEREMCE:
MAP OF LANDS OF
MARION B. NEWTON
BY KESTNER ENGINEERS, P.C.
DATED AUGUST 27, 1987
REVISED 8-11-98
BY VAN DUSEN & STEVES
LAND SURVEYORS, LLC
DEED REFERENCE:
M ARI ON B. NEWTON
TO
WILLIAM & MARY LEE GOSLINE
DATED DECEMBER 31, 1987
IN BOOK 701 PAGE 603
LANDS N\F OF
LITTLE
BOOK 584 PAGE 1077
S83059'43"E
377.36
30' SETBACK
AREA
3.00 acres
1 STORY
HOIJ R
GRAVEL DRIVE
-_1
50' SETBACK- -
LANDS N\F OF
LITTLE
BOOK 648 PAGE 538
Rece, 0)
p01
NpV 13 2
N OF Q�E DNGpO Y
I08 1A011A AN
N83'59'43"W
aD u s
ZED AL7MTM Olt ADDITION TO A 11AMY
MAP NEAFM A LXXIM LAND 9XVIENM aEx 13 A
Q ,.
SANK OF � »�- a. OF lK
Kv Yw STATE IDumm tAw*
Q�
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YAM " A11 DR=& OF 1E WO 0U111E"M
Stbv s
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AT
•RRAPICAATIDNs NOIGTED NpDfIDH flW111Y RIAT
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LC
vs sU w as memo 0 ACCpID " WIN"wwa THE
° '°°°°Ea" 'm "`�"°
sY 111E NEII NDrI STATE AssOCIA1HM1 a p11pFF,sYCNAL
a"
SNIYEYgIs. sAq fFA1lIGWT WN1
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AID A
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M
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169 Haviland Road
IlalE1.�TAl
wkrCw a WM mum wo A we
(518) 792-8474 Queeusbuu, New
Ork 12804
>AE "�`A"" °N'�
m 1K A a �1N01'
V..Ynrk Lie.
o. 50135
LANDS OF
SCHERMERHORN
I
PROPANE
TANK 0
oI
HEREBY CERTIFY THAT THIS MAP WAS PREPARED
M
FROM AN ACTUAL FIELD SURVEY.
THIS CERTIFICATION SHALL RUN ONLY TO THE PERSONS
M
FOR WHOM THE SURVEY WAS PREPARED, AND ON THEIR
O
BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY
V)
AND LENDING INSTITUTION LISTED HEREON.
CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL
INSTITUTIONS OR SUBSEQUENT OWNERS.
CERTIFIED TO: KIMBERLEE P. G. POLUNCI
M do T MORTGAGE CORPORATION.
IrS SUCCESSORS AND/OR ASSIGNS
FIDEUTY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK
Map of a Survey made for
KIMBERLFE P. G. POLUNCI
isbury, Warren County, New York
Town of Queen
CERTIFIED BY:
MATTHEW C. STEVES, LLS NYS 50135
DATED: MARCH 30, 2001
NOVEMBER 9. 2001
BE�LRY
B1,p,.Ci�
1 11-09-01
NO. DATE
tANt
HOUSE LOCATION
DESCRIPTION
C.
a�
Dater MARCH 30, 20'
Scale 1'=50'
S-1
%lwr1OF1
POLUNCI
DWG. NO. 98049C
C-436
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COMMONWEALTH ELECTRICAL INSFECHUN SERVILE9 INUe
Main Office 176 Igoe Run Road If Manhelm, PA 17545
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The conditions following governed the issuance of this certificate, and any certificate previously issued is
cancelled: -
This certificate onlycovers the clectrical equipment and installation conditions as of date, Upon the
� inspection.
introduction of additional a ui ment or alterations, application shall be promptly made for
Inspectors of this Company shall have the privilege of making inspections at any time, and if its
p py p
rules are violated, the Company shall have the-right to re oke this certificates
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COMMONWEALTH ELECTRICAL INSPECTION SERVICE, INC,
001
Main Office 17b Doe Run Road - Manheim, PA 17545 �
MUNICIPAL CERTIFICATE -i ELECTRICAL APPROVAL �
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The conditions following governed the issuance of this certificate, and any certificate previously issued is
cancelled: -
This certificate only covers the electrical equipment and installation conditions as of date, Upon the
introduction of additional equipment or alterations, application shall be promptly made for inspection,
Inspectors of this Company shall have the privilege of making inspections at any time, and if its
rules are violated, the Company shall have the right to revoke this certificate.
Date ,,soil,It01#4l4 it lr;, :, ,#,,,,#„44f, INSPECTOR , , e. . ##,#,1oil14#441
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Y
RESIDENTIAL FINAL INSPECTION REPORT
Office No.(518)761-8256 Date inspection request received.
Building&Code Enforcement
Dept.of Community Development Arrive am/pm Depart- I pm
Town of Queensbury Inspector's Initials
742 Bay Road
Queenomq,.New York,12804
NAME , PERMIT 4
LOCATION �( DATE 7 r
TYPE OF STRUC ,� in
• N/A YES NO COMMENTS
Chimney HeightP B"Vent/Direct Vent Location
Fresh Air Intake
Plumb Vent through roof
Roof Complete V A
Exterior Finish Completejs�ide
Interior/Exterior RailingsExterior Handrails,balco18' or moreInterior Handrails stairs b mo a risers
Grade 2%away from fou
8"clearance to sill plate
Gas Valve shut-off oxposed/regale or I8"above grade
Gas Furnace shut-off within 30 fee or 'n line of site
Oil Furnace shut-off at entrance to cc area
Furnace/Hot Water Heater opera
Relief Valve(s)installed
Headroom,6 ft.6 in.on stairs
Basement stairs,6 ft.4 in.
Handrail exterior stairs both sides nore than 3 risers.
Interior privacy(trim/doors/main er trance 36"
Floor Finish
Bathroom/Kitchen watertight
Interior Handrails Balconies/Landi ig 18 in.or more
Railing across window in stairwell
Smoke Detectors;
every level
every bedroom
outside every bedroom
inter connected ,
Bathroom fans j (�
Plumbing fixtures dy;� �
Foundation insulation _
av
1/4 hour fire door/door closer tt �{ jK
Garage fireproofing
Garage penetrations sealed ply i:ft'GL 1 l 0/)
Furnace in separate room protected(in garage)
Light ventilation per room
Safety glazing 18"or 1 sti o floor
Final Electrical v � b 1
Site Plan/Variance re aired
Final Survey Plot Plan
As Built Septic System layout required
`�ZOk to issue C/C(Certif.of Compliance)_ p
y to issue temp.C/O(Certif:of Occupancy '{ �c� 1��i C.r .A -
Okay to issue permanent C/O(Certif.of Occupancy)
7141
TOWN OF QUEENSBURY
BUILDING CODE ENFORCEMENT
Ba_y Road
Qut--4ens;buv-_y MY X2864
(SIS) -7451-82-545
SEPTIC DISPOSAL SYSTEM rNSPEC-rION
Name
Luca 4-i on
Date 4 Permit #C31
4 -axn—/
Solt- -Ty Sa -m-C I a_y-
S ' - m-C
Re-sul -ts 0-f Pier, o�� a-ti a Test-
{ 1 -F applicable ) Rate-ta- - nu-te/ Inch
e ! T,
"TYPE OF SYSTEM
I
ABSORP-TION FIE1-D: To-tal Long-th
- -F i9 I
let
Length of each c h lt r� nch
0
e
Dep-th o-f
Size of stone
SEEPAGE PI Numb
Size - - 11< -F-t
Stone size
PIPING_ Size -F_vpo
Bldg - to Tank I-A
Tank to Dist - Box
Dis-t - Box to Field/plt-
Openirigs Sealed ? es No : Partial
ILOC-A-VI CMZSEPARAIFI ONS
Founda *tion to Tank k C� feet
Founda-tion to 'Absar-p -tican -Foe-t ,
Sepav-a-tion of-�' - P! -ts Ffeet
Con-farTns as per Plot. Plan
LOCATION OF - -SYS-UEM ON PRO K I
( ci ,rclt-- one )
Front - Rear Lt---f_7t_ 1:111uh-t Side
Middle f:- r-on -t -t-dcf I e Rear
COpv4EN-rS
SYSTIE14 USE APPROVED = YE 0
,p a
wu-f I a-f I;fg I -t-"ir
GENERAL INSPECTION REPORT
(518)761-8256
Town of Queensbury _
Dept.of Community Development Date inspection request received: V Ais)
Building&Code Enforcement T
742 Bay Road
Queensbury,NY 12804 Arrive am/pm DepaInInspector's Ini
NAME: QPERMIT#
LOCATIO DATE f
TYPE OF STRU
RECHECK
N/A YE/No COMMENTS
otin s/Pier L
Monoli 'c P ur Form
Reinforce nt in Place
The contractor is re ible for
providing protecuo fro freezing
for 48 hours followi g e placement
of the concrete.
Materials for this purpa on site
Foundation/Wallpour
Reinforcement in PIa
Foundation/Dampproo
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in tce
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interio R-
Foundation Walls Exterior -
Floors R
Walls R
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent,Attic Vent
Framin
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
Firestoppin
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 12844 Arrive am/pm Den-1
Inspector's Idals
NAME: paunr_.; PERMIT
LOCATI N: DATE, pj�
TYPE OF STRUCTURE: S
RECHECK
N/A YES-NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection fro zing
for 48 hours following a pla ent
of the concrete.
Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofin
Bac Approval
Pluunb Sla
Plumbing Vent/Vents in P ce
Rou tumbing -
He e g Rom n
Foundation Walls Interi R-
Foundation Walls Exteri r R
Floors
Walls -
Ceiling
Duct work or piping in
unheated spaces R-
o r Vent,Attic Vent
gamin �..
StudslHeaders ra racinglBridging
Joist Hangers L
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
",U
GENERAL VVSPECTION 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 am/pm Depart[ o
Inspector's Initials
NAME: Lk o PERMIT 0
L ATII DAM:
OCATI10
TYPE OF STRUCTURE:
RECHECK
N/A.YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is respon ible for
I it 0
providing protection fro fteezin
for 48 hours following placem
of the concrete.
o Materials for this purpose
i site
Foundation/Wallpour_
Reinforcement in Place
Foundati on//D roofin
Backfill Approval
Plumbing Under Slab_
Plumbing-Vent(Vents. PI_ in ac
Hearing Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Pro F C Vent
k Studs/Headers
Bracmg1Bridgmg_ A
Joist Han ✓ � -A-V—
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
ire opallmil,4 hour
� ,3 �
GENERAL MSPEC'TXON REPORT
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development .Date inspection request received:
Building&Code Enforcement
742 Bay Rbad
Queensbury,NY 12804 Arrive `, ' Da19poectoes
pa -t�7a
Initi
NAME: 9a)y�o 1 PERMIT# O jv
LOCATION: DATE: Q
TYPE OF STR TORE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Pla
The contractor is sponsibl for
providing protecti n from fr zing
for 48 hours fo110 'ng the p acement
of the concrete.
Materials for this pu se on site
Foundation/Wallpour
Reinforcement in Place
Fo ation/Dampproofi
k ill Approves
lumbing Under Slab
Plumbing VentlVents in P ce
Rough Plumbing
H ting Rough-In
V, lation '
Foundation Walls Interior �=v+
Foundation Walls Exterior - � ��� �i_-
��
Floors R- J 0�
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent, Attic Vent
Framin
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
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 am/pm Depart am/pm
Inspector's Initials
NAME:
LOCATION: 4-
DATE :
TYPE OF STRUCTURE:
RECHECK
N/A YES��O, COMMENTS
F otings/Piers V 1 I r ��� �, A•..�4—
onolithic Pour Form 1" r
Reinforcement in Place / r1
The contrak
s res nsible or ��' `'~'v�J 7
providing tion om free ing
for 48 houowi g the pla went
of the conc
Materials foru se on site
Foundation/ our
Reinforcemela
Foundation/Dproo ngBacl�ill AppPlumbing UnlabPlumbing Vent . laceRough Plumb
Heating Rough-In
Insulation
Foundation Walls Interior
Foundation Walls Exterior
Floors R-
Walls R-
Celing R-
IDuct 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 I,2, 3,hour
Penetration Sealed
Fire Wall 2, 3,4 hour
Firestopping
LATC
GENERAL INSPECTION REPORT
(51.$ )761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive am/pm Depart In
Inspector's Initials
e-
NAME: , J C �,G t V— „.V\6-Y PERMIT# C.U( '"02
LOCATION: i q c." - DATE : S G AA
TYPE OF STRUCTURE:
RECHECK
N/A YES O COMMENTS
IfFootings/Piers !
Monolithic Pour Fna2
Reinforcement in PThe contractor isi a for
providing protec don from eezing
for 48 hours foll wing the Iacement
of the concrete.
Materials for this r arpose o site
Foundation/Wallpc ur
Reinforcement in e
FoundatioAUnd
roofing
Backfill A
Plumbing b
Plumbingin Place
Rough Plu
Heating R
Insulation
Foundls terior R-
Foundls E terior R-
FloorsR-
WallsR-
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
Firestopping
742 Bay Road
QuOensburY,NY 12804-5902
Re: John and Kim polunci,Blackberry Lane,Queensbury
Dear W Hatin:
We examined the deep excavation and made a percolation test on Wednesday
afternoon(5/09/()1)at the above building site. The soils are dry and granular with a broad
distribution of stones and cobbles.There is no evidence of bedrock,impervious strata,
groundwater Or mottling to a depth of at least eight feet.
A percolation test shows that soils are well drained with a stabilized rate after
presoak of some 2 V2 minutes per inch.The wastewater sYsten,design should be based on
the current five-minute rate of 1.2 omu.
Sincerely,
SCUDDER Associates
Consulting Engineers
Charles H. Scudder,PP,
Principal
P.O.Box 792 • Glens Falls, Newyork 12801 (518)793-1475 FAx(518)798-3747 • e-mail:ctouds@global2000.net
TOTAL P.01
L
MAP REFERENCE: DEED REFERENCE:
MAP OF LANDS OF MARION B. NEWTON
TO
MARION B. NEWTON
BY KESTNER ENGINEERS, P.C. WILLIAM & MARY LEE GOSLINE
DATED AUGUST 27, 1987 DATED DECEMBER 31, 1987
IN BOOK 701 PAGE 603
S83'59'43"E
377.36
I I
LANDS N\F OF o M I LITTLE ►�
BOOK 584 PAPE 1077 r (o I�
z
vo
I
I
-._ 3.
6o TO BE-
KIWW4ZLEE
70
LANDS N\F OF
LITTLE
BOOK 648 PAGE 538
NOTES:
1. PROPERTY LINE INFORMATION AS PER MAP REFERENCE.
AND EDIMENT CONTROL SHALL BE IN ACCORDANCE
�. EROSIONTATE GUIDELINES FOR URBAN EROSION AND
WITH NEW YORK
SEDIMENT CONTROL GRADING SHALL CONFORM TO SECTION A183-25
ON REGULATIONS OF THE TOWN OF QUEENSBURY.
3. INDIVIDUAL LOT
OF THE suBDlvisl OCATED WITHIN THE QUEENSBURY UNION FREE
4. PROPERTY IS LAND THE BAY RIDGE FIRE PROTECTION DISTRICT.
SCHOOL DISTRICT
`.
ooq
- ,'
} g' M r o
"1 70 (A
/0y, \
'
i
i 9 -
90
i'
i
80
6?d
LANDS N\F OF
SCHEZMERHORN
S83'59'43"E
�- 212.49'
AREA
23399.19 sq ft +
0.54 acres >> 9
x
�� �•��• / _•' TRAIL �_ -- �A'�3F
� x
250.03' -,• - �� X 372.49' +
S83'S 49 3"E
FENCING
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B�CKBERRY
lot
6.30 acres
LANDS TO BE RETAINED BY
WILLIAM & MARY LEE GOSLINE
N83'59'43" W
655.21
243.43'
864.95
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