2000-378 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804.5902 (518)761-8201
Commu'ty Development-Building&Codes (518)761.8256
WrIFIr ATE F 0 CCUP. AINCY
Permit Number. 2000378 Date Issued: Friday,April 04,2003
This is to certify that work requested to be done as shown by Permit Number 2000378
has been completed:
Tax Map Number, 523400'-290-017-0001-018-000-0000
Location: 5 MASTERS COMMON SOUTH
Owner. MICHAELS GROUP LLC THE F
Applicant- MICHAELS GROUP
This structure may be occupied as a:
By Order of Town Board
Single Family Dwelling TOWN OF QUEENSBURY
Director of Building&Code nforc .ent
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518)761-8256
- VALUE $ 230000 Building Permit No. 7000278
TAX MAP NO. 46 . -7-26
Permission is hereby granted to MICHAELS GROUP
Owner of properly located 45 MASTERS COMMON SnTJTN
in the Town of Queensbury,to construct or place a,; rT0 T,E P A M T T,v nT TP'T T ING
at the above location in accordance to 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.
Owner's Address:
10 BLACKSMITH DRIVE
ALTA, NY 12020
Contractor or Builder's Name:
MICHAELS GROUP, INC.
Contractor or Builder's Address:
JIM CHANDLER, PROJECT MGR 10 BALCKSMITH DR
MALTA, NY 12020
Electrical Inspection Agency:
NEW YORK BOARD
NEW YORK BOARD OF FIRE UNDERWRITERS.
Type of Construction:
SINGLE FAMILY DWELLING
Plans and Specifications:
3142 sq It SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE
AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
SINGLE FAMILY DWELLING
S3 8 7 PERMIT FEE PAID—THIS PERMIT ENP1RES June 9 2 0 0 2
(If a longer period is required,an application for an extension must be made to the Cade Enforcement
Officer of the Town of Queensbury before the expiration date.)
Dated at the f Queenshury this 9 June 2000
%,2 SIGNE B for the T of eensbury
ode ce t
Building Permit .1pplicat' ion
Town of Queensbury - Dept. of Community DeveloPniem, 742 Bay Road, Queeiisbury, NY 12804 1761-82561
BUILDING & . CC?DE ENFORCEMENT
Requirements.prior to issuance
A permit must be obtained before of this permit: PERMIT FILE NO.
beginning construction. No inspections PERMIT FEG PAID h � � S
will be made until applicant has received fining Board Action
a VAIrID BUILDING PERMIT. All Area /Use RECREATION PEE 'A $
applicants' spaces on this application
MUST,be completed acid•the signature Q Planning Board Action REVIEWED BY.. !J
(apikation
e applicant-must appear on the SPR / Subdivision /Other Building Gccpectnr
form. nor. , _J t Recreation Fee Payment
Applicant: ME tm1GY1bc° % Ln'Rl���p Owner:
Address: ��, �2 Address:
Phone # {S� _) gtC� _ �t__ I'hoitc # -
Property Location ?_fd/�4�'h'dCPnry�yt � aht ^. k S { -----) ----- -------Tax Map Number
Subdivision Name:
/—;7
Section Block 1 r)t
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
c New Building: CONSTRUCTION: $ a2jood
residence / commercial
Addition to Building:
residence / commercial OCCUPANCY INFORMATION:
Alteration -to Building: Primary Building -
residence / commercial _� Single Family Dwel-lincr
Residence / Commercial Two Family Dwei IVE"
no change to exterior size, Family Dwelling
office MAY 3 1 2000
Other Work (describe below) Mercantile '
Ma nu f a c t u r i nVDW,1j OF OUEEENSSBURY
Other BUdi Dli�lO AND COIF
GROSS AREA OF PROPOSED STRUCTURE: ,
1st Floor. . . . , . . 7 sq.-
ADDITION, what will use
2nd .Floor. . . . . . . .� f If sq. ft. S~ of new addition be? :
Other Floors . . . . . sq. t.
(not unfinished ce•i ar. or basem� ACCESSORY BUILDINGS:
�t 7f U� Detached' Garage 1, 2 car
TOTAL FLOOR AREA: �l�z SQ. Attached Garage 1, 2 car
Private Storage Bui.l ing
SIZE OF NEW STRUCTURE: Commercial Storage Building
T0t act it Other
FEET X :55 FEET
Foundation Type: 4�',i2'E'C:�> Will any second-hand or ungraded
Number of Stories : 2- lumber be used? If so, for what?
(habitable space only) 'A a
Height (grade to ridge) : .34f feet TYPE OF HEATING SYSTEM:
Number of fireplaces and/or woo stove (circle all which a plies
to be installed: f Electric / Oil / as / Wood
Forced Hot Air / Baseboard / ' Other
Person responsible for supervision of work as regards- to building '
codes i s : �-AtNk V_z m1c ey-* C.'SR g�Bata ,a l�rz�
Na'• e A dre s -- Phone
Builder: O ti�
Plumber: 'Z CQ ..ZA-Cor
Mason: l t
Electrician: b 2 Z
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 Occupancyor Certificate of Compliance being issued, an AS BUILT PLOT PLAN by
a licensed stu-vey sa�ale, showing actual location of project on premises.
Signature: 'A
(owner, owner's agent, architect, contractor)
Application for Permit— Septic Disposal System
7'osvii c?f Qmf_msb111:y 742 73qj,1?(;qd Quvan.vbul- 2 04 (.5/8) 761- 2 6
1. OWNER INFORMATION:
011-1ce We
Location of installation:
Tax Map No. File P I ernlit No.
T� Fee Paid
Owner's Name: A
.................... ............................ .....................
Address: k(��)
2., INSTALLER'S NAME vnx PHONE
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate iq bedrooni(v) and multiply 11 of
bedrooms with applicable gallons per bedroom to equal total dail))flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdnn =
1980— 1991 x 130 gal/bdrin
1991 —present x 110 gal/bdrin =
722 q 0
Garbage Grinder Installed yes— no EIVF7u
Spa or Whirlpool Installed yes no -9-7 . mEC
MAY 3
4. PARCEL INFORMATION: (circle applicable information & indicate-1.1&4V,4jldllbn)�ENSBiIP'-'
T BUILDING AND CODE
o o rra h oil tire round Water. Bedrock or Impervious Material Domestic Water SLIP_Ply
Mat at what depth at what depth -__1?1?117iC1p171_
Rolling loam fe
et fee! 1
Steep slope 0 ay
%slope other
J;'0177 0nVX(1/J1iC-s)1.Vt01??
g;T i I
depth:
abso17-W011 is
Percolation Test: rro be compluied by licensed proI&xsiol lei/engineer or archilecl)
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 installcd in Plunning Board approved subdivision). Add 250 gallons to tli*csiv.c
of(lie Septic tank an leach field for each Garbage
age Grinder, Spa or Whirlpool Tub.
Septic Tank: gallon (min. size 1,000 gal.)
Total Length:tai S 2Tile Field: each trench.
Seepage Pit(s): number of size, oj*each: by A
____J1.
Size of Stone to be used: # depth or thickness --.feet
Bed System Size: X
Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required)
Number of tanks: N./y,_ / 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 ofan 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 Sanitat-Y Sewage Disposal Ordinance.
Signature ofresponsible'.person IDat6
Fire A1,11,S11,111"office
Town of,QUCC115hury, 742 INN- Road,Queensbury,N N'
_5 -8205
Application for Fuel Burhing Appliance's & Chimneys
applicable to solid fu, & vented gas appliances
Date 0 2 0 AP
Permit No. 3)
Application e is hereby made it) the Building& Codes pi.1 issliance�?f a Building andanduse
PP I je.ft)
Permit pursuant to the Nett York State Fire Preve(I 16011 alld Building Code. 771eqj)jVicajjo1-owner.
agrees tocolillily ivith all applicable laivs, ordilla Ices, (111(/4111 coliditions that are pal-i-of
these iWfilirefiiei,ils and also ivill allow all iii to enter-pr&lnises to pet/oj-in I-eqitii-e
j;
NOT to applicant: Rough-in and Final Inspect'
ions are,,reqUIl .pd-,
Applicant Informatio'n
Fuel BurnhwAppliance 111iol"'M.,f"fi"66"
(circle�appropriate words)
Name: i4A�J4 -
Stove: wood coal
)je
Fireplace insert
Address: Fireplace, factory-built: IV06d
cr
I OLO Fireplace, masonry
wood glis
Furnac
e: wood -as
911 (ON I -)(I oil
Phone:
If non-masonary applicarice, please provide
Owner:
PvlallUlfactUrer Name: V If r..
Address: Model Number:
Phone: Chimney Information
(eircle appropriate words)
Masonry block brick stone
Flue file .--steel' size: inches
Exact Address: qus-sk% 404*00 :&A
ofConstructioll 01.installatioll Factory-Built
Manufacturer narrie:7i.
f, ,V
Ivote: Model NUrriber: m
Listed By:
Number:
Construction lhistallati6n must
C0111ornz to NYS Fire Prevention c Building Indicate (circle') chininey material:
Cocle-'Consult available Toi ttn of Queensbury
Handouts regarding required inspections. Double icjal Ti-iple vafl 1 111sillate(I
Direct veiltilla
Q 111,11112el!LI'll(III
-V-I IWA--V W-V 400-R-IC
Fire Aleirshal Code
S Collected S Ref iinded Receii-e(j Ind'd to), i.
00 adih-ess.:
..4 173 3389 (190) Public Sqfeti- C�15"
4 23-3 2655 (230)Minor Saley
J\
7ow-
White(Applicant) Green Wire Marshal) Yello (131d,,. Dept.) Pink&, Goideiii-od(Casliiet-'sDcl)t.)
Residential Final Inspection
Office No. (518)761-8256 Date Inspection request received:
a m
Queensbury Building&Code Enforcement Arrive: Dart rn,.oD C1%.r6o part,
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initial
4�0, ,-15r5 t 7
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
Roof Coniplete
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
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 wiffiffi 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
Interior privacy/trim/doors/main entrance 36 in.
Bathroom/Kitchen watertight
Safe lazing
Window in stairwells safety glazing
I terior Smoke Detectors'
Every level: Every Bedroom:
Outside every bedroom area:
Inter Connected: —./ Battery backup:
Bathroom Fans,if no window
Carbon Monoxide detector
um bin fixtures
%..00 Foundation insulation
Floor truss,draft stopping finished basement 1,000 sf
Emergency eFess below grade
j9asement stairs closed rise>4 inches
N 3/4hour fire door/door closer
Garage firepyoofing
Duct work Sealed properly
Attic access 30 in.x 24 in.x 30 in.(ht.)In accessible area
Crawl Spaces 18"x 24"access, I sq.ft.-150 sq.ft.vents
Building No./Address visible from road
Final Electrical
Site Plan /Variance required
Final Survey Plot Plan
As Built Septic System/Sewer Dept.Inspection Sticker
Flood Plain Certification,if required 4117 d
Okay to issue C/C(Cert. Of Compliance)
Okay to issue Temporag C 0(Cert. Of Occupancy)
Okay to issue Permanent C 0(Cert. Of Occupanc
L:\SucHemifi�vay\Building.Codes.Inspection.FORMS\Res.Final Insp.form 2.doc edited January 28,2003
y Town of Queensbury Fire Marshal
742 Bay Road
Queensbury,NY 12804
761-8205/761-8206
fax 745-4437
Factory Built Wood Burning Fireplace 1 Stove Inspection Report
Notice: New`Bork State requires that all UL Listed,factory built appliances be installed according to the instructions and
specifications contained in the Installation Manual accompanying the appliance.No deviation from the manufacturer's
instructions Ar ecifications is allowed. e
Permit# � r Schedule Inspection A/� Time am pm anytime Inspector J
NameAddress Rough I naFil_00,
Appliance Manufacturer Model#
Masonry Chimney Factory Built Chimney Flue Size Double Wall Triple Wall Insulated,_
Yes No N/A Comments
Floor Protection,j C • t��
Clearances to Combustibles (all sides)
Safety Strip Installation (fireplaces only)
Firestop(s) vertical chase
Wall Penetration
Chimney Clearances to Combustibles
Chimney Termination
3 feet above roof penetration;2 feet above
any combustible construction within 10 feet
Combustion Air
Hearth Extension
Mantel(height above f/p opening)
Fireplace Doors 1 Screen (required)
White---Building Dept. Yen+Cust onier Pink—Bre Marshal
Residential Final Inspection
'. Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/p Depart: f r
'742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: ��'�
NAME: a-,
- --,
r" PERMIT#: �,,�_
LOCATION: r-. DATE: 44
TYPE OF STRUCTURE:
Comments
Y N NIA
Chimne Ht.I"B"Vent/Direct Vent Location `
Fresh Air Intake
3 inch Plumb Vent through roof,
Roof Complete
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 Bailin s.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 ode-,
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 Valve(s)installed
Interior privacy/trim/doors/main entrance 36 in.
Bathroom/Kitchen watertight
Safety glazing
Window in-stairwells safety glaaing
Interior Smoke Detectors: ��f �(�- /.,�&tev/
Every level; / Every Bedroom: /� &, -
Outside every bedroom area: �G'd f
'Inter Conrieeted: / Battery backup:
Bathroom Fans,if no window
Carbon Monoxide detector
Plumbing fixtures
Foundation insulation � t t Ot �_(
Floor truss,draft stopping finished basement 1,000 sf
Emer enc a ess below:grade
Basement stairs closed rise>4 inches A
3/hour fire door/door closer E� A) r s
Garage fire roofin I
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 sq.ft.-150 s .ft.vents:
Buildin No./AddresivisilAe from d
Final Electrical
Site Plan 1 Variance re u'red
Final Survey Plot Plan
As Built Septic System/Sewer De t,Ins ection Sticker
Flood Plain Certification,if required
Okay to issue C/C(Cert.Of Compliance)
Okay to issue Temporary C/O(Cert.Of Occiu arc
Okay to issue Permanent C/O(Cert. Of Occupancy)
L:\SueHemingway\Building.Codes.Inspection.FORMS\Res.Final Insp.form 2.doc, edited January 28,2003
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MAP REFERENCE:
MASTER'S COMMON SOUTH
DATED: AUGUST 26, 1987
BY: VAN DUSEN & STEVES
FILED: MARCH 10, 1988
DRAWER 17 FOLDER 1
LOT 25
LOT 19
u� }
MASTERS COMMON SOUTH
N07'30'50"E
UnurlEs 148.84'
a
35.4!
PORCH
IisHOUSE
00
f�� I
04
00
I
au S
�.�
'UNAU11iOI1gD ALTERATION OR ADDITION TO A SURVEY
IMP BEARING A U(fi)W LAND SUROEM SEAL IS A
NOLAMON OF SECTION 7200, SIB-gNSKIN Z. OF THE
NEW OORK STAR WUQl0N LAW.'
'ONLY CORES OF ,HIS SURVEY
THERAL
S
NARKED YA7H AN ORgNAI OF THE LAND SURVEYORS
M OF THE
SEAL SHALL TI CONSIDERED TO BE YAUO COPIES'
SIGNIFY
'CEft11FIU SIOWFY THAT
ECARED
WS PR IN ADCI THE
THIS SLYIVEY MMS PRAcl ED N LAND SUNI E VAI'OR AD
DOST1tW 000E OF PRACTNI FOR LAND SURYE'lORS ADCNim
Land
Sur,'
BY THE NEVI YDiK STATE ASSOCIAIICN OF PROFESSONAL
LAND SURVEYORS SAID CER71F ATIONS SHALL RUN ONLY
vIt y o r s , LL C TO TH: PERSON FOR WHOM iNE SURVEY IS KPARED, AND
169 Haviland Road ON � TAM L TD,I,E T<TLE COLPU OOVREON. TAL
AMID
AOENGY AM LB�S10 RB'R1Ut110N LJSiFD NaEON, AND
Queensbury, New York 12804 To THE mwEB OF,NE LEN= INSTlux#.'
;518) 792-8474
New York Lie. No. 50136
LOT 26
30,072.15 sq. ft.1
v
m
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i
i
-.-.-.-._-
i
164.73'
S08'58'50"W
LOT 18
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Map of a Survey made for
THE MICHAELS GROUP
Town of QueenPury, Warren County, New York
A
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NO, I DA TE
DESCRIPTION
RECEIVE®
NOVkN.S
p
TOWN QBURY
BUILDING AND C®DE
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MICHAELS
DWG. NO. MCS-26
G LNERAL&SPECTION 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. Depar
Inspector's Initial \
aliti ld
r- 7
NAME: 4, PERMIT 4
C,
LOCATION: DATE:
TYPE OF STRUCTURE:
RECHECK
NI ",YES 0 COMMENTS
ootin ers
s ers�Monol 0*crForm_
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
Foundatio ur
Reinforcement in Place
Foundation/Dampproofing_
Backfill Approval
Plumbing Under Slab •
Plumbing Vent/Vents in Place
Rough
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/Bridging
Joist Bangers�_
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
Penetration Seated
Fire Wall 2,3,4 hour
Firestopping_
GENERAL 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 In
Inspector's Initials
NAME: ���( t�l�liy'-�' PERMIT# � ` 37
LOCATION: XM,I�, 1(!�i . DATE
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers 1 1
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete. F-
Materials for this pu se on site
Foundation/Wallpour
Reinforcement in Place ti
Foundation/Dampproofin�
Backfill Approval
Plumbing Under Slab
Plumbing VenttVents 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/Bridging
oist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
r a2)
GENERAL REPORT
(518) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road l ?
e
Queensbury,NY 12804, Arrive am/pm Depart , n/
Inspector's Initials
;JPf
V
NAME: k W ,s PERMIT#x- CeR -�t
LOCATION: ill DATE qlfm,(-
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
Foundatio, Ur
Reinforcement in Place A
Foundation/Dampproofing_k
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
R o..u/
h Plumbing ,ing
6ingRQU
,
nsuIation Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
sated spacesR-
Attic Vent�
V g�ent'
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
jPe
e tration Sealed
Wall 2,3,4 hour
9
GENERAL MSPE+C'TION.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 Dej i m
Inspector's Init"Is i
NAME: PER1v1IT# 0��
LOCATION: DATE: —� C>
TYPE OF STRUCTURE:
RECHECK �—
N/A\YES NO COMMENTS
Footings/Piers 1
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 i
Backfill Approval
Plumbing Under Slab f
P bing Vent/Vents in Place p
y Rough Plumbing' lur7f ��Ry7
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-
Pro r Tent tticrent
F. miiig" �
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air hifiltration Barrier
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2 3 4 hour n
/firestopping V
FIFUE M^I:;?.'SH^i
-T-(DWN OF ClUaEEN.'3E3UF;,"Y
(:aUE=-ElNSE3UFZ-V-, NY 12804
(518) 7E51-8205,
FIRE MARSHAL INSPECTION REPORT
REQUEST RECEIVED jU
NAME
LOCATION ft!)'ERMIT #
SCHEDULE INSPECTION. ON c7 e-1
AM PM
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS.
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
FIRE At-ARM SYSTEM
FIRE SPRINKLER 9 (STEM
FIRE SUPPRESSION* SYSTEM
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIONAGiE
CHIMNEY
WOOD STOVE
tpK-FIREPLACE = MASONRY r5CFACTO BLT.
>5;f-ROUGH-IN
FINAL
REMARKS: 0 TO THIS DATE
c,
SO
INSPSLIP.PUB INSPVCTOR
F=IF::?.V-= MARSHAL
TOWN CIF CZUE!aN,SE3UF:?,"*e
QUF-:E!N,SE3UFz?.-Y', NY 12804
(518) 761-8205
FIRE M^kSHAL INSPECTION REPORT
REQUEST RECEIVED
NAME
LOCATION
SCHEDULE INSPECTION ON
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING.
FIREEXTINGUISHERS
FIRE ALARM SYSTEM
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION SYSTEM
1-10100 INSTALLATION
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPF;,'IN LERS
CLEARANCE TO HEATING UNITS
REQUIRED SI(3NAC3E
CHIMNEY
WOOD STOVE
FIREPLACE E--1 MASONRY 0<.FACTORY BLT-
R(DUG;H-lN
E�~FINAL
REMARKS: OK TO THIS DATE
lb c) t4 f2, INJ
Q tAA+-
INSPSLIP.PUB IN CTOR
GENERAL INSPECTION REPORT ,• _ =��,�'=
(518) 761-8256
Town of Queensbury o
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804. Arrive am/pm Depart ± /at p
Inspector's Initials��
NAME: 0A ; C(` ,b'�'�z=_'0 Lf PERMIT# -2,0 U 0' U
LOCATION: '!�- C on SD •DATE: '
TYPE OF STRUCTURE:
RECHECK
a. N/A YES,,NO COMMENTS
FootingsMers
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 �i
Backfill Approval
Plumbing Under Slab
lumbing VentlVents in Place
Heating Rough In ' 1
Insulation .
Foundation Walls Interior R
Foundation Walls Exterior R !
Floors R
Walls R-
Ceiling R
Duct work or piping in
unheated spaces R- 1
Proper VentPu
Framing
Jack Studs/Hea ers G
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam %14
-Air-Inf'iltration.Barrier-
Fire Separation=1;2-,-3-hour
Penetration Sealed
ire Wall 2,3,4 hour
Firestopliirig 1A!`lrAtL �0(140
i
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 £4M11
Inspector's Initials
NAME: PERMIT# 96M-
LOCATION: VATE:
TYPE OF STRUCTURE:
RECHECK
N/A NO COMMENTS
otings/Piers i
Monolithic Pour Form
Reinforcement in Place
The contractor is responsibl Oltt
providing protection from f ezing
for 48 hours following the acem6 t
of the concrete.
Materials for this purpose on ite
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofing
Backfill Approval
Plumbing Under S
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/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
Town of Queensbury Fire Marshal
742 Ray Road
Queensbury,NY 12804
761-8205/761-8206
fax 745-4437
Factory Built Gas Fireplace/Stove Inspection RelDort
Notice:New York State requires that all UL Listed,factory built appliances be installed according to the instru 'ons and
specifications contained in the Installation Manual accompanying the appliance.No deviation from E W man acturer's
instructions or specifications is allowed.
Permit# Schedule Inspection Time am pm anytim Spector ��/"
Name ��� 1r1rn 11r7 Address S MG SX �aSYI tn �' Rough In Final
Appliance Manufacturer Model#
Direct Vent Factory Built Chimney Flue Size double Wall Triple!Fall Insulated
Yes No N/A Comments
Floor Protection
Clearances to Combustibles (all sides)
Firestop(s) Vertical Chase
/ Wall Penetration
Vent Clearances to Combustibles
Vent/Chimney Termination
Chimney height must he 3 feet above roof
penetration;2 feet above any combustible
construction within 10 feet
Gas Shut-Off Valve
Combustion Air
Hearth Extension(if any)
Mantel
Height above f/p opening
Witness Operation
'Wank.Placement(if LP)
White—Building Dept i Yellow Mast er Pink—Tire Marshal
Town of Queensbury Dire Marshal
742 Bay Road
Queensbury,NY 12804
761-8205/761-8206
fax 745-4437
Factory Built Gas Fireplace/Stave Inspection Report
Notice:New York State requires that all UL Listed,factory built appliances be installed according to the instructions and
specifications contained in the Installation Manual accompanying the appliance.No deviation from the manufacturer's
instructions or specifications is allowed.
Permit# Schedule Inspection Time am pm anytime Inspector. \ `0
Name i c r\ n C Address ��i �'� �� Rough In Final
1
Appliance Manufacturer Model#
Direct Vent Factory Built Chimney Flue Size Rouble Wall Triple Wall Insulated
Yes No N/A Comments �-
Floor Protection � r,-- �� G — A-)6
Clearances to Combustibles (all sides) 0A L J /v�(
Firestop(s) Vertical Chase
Wall Penetration
Vent Clearances to Combustibles
Vent/Chimney Termination
Chimney height must be 3 feet above roof
penetration;2 feet above any combustible
construction within 10 feet
Gas Shut-Off Valve
Combustion Air
Hearth Extension (if any)
Mantel
Height above f/p opening
Witness Operation
Tank Placement(if LP)
White—110dingDept. Yellow Cust r Pink—Fire Marshal
vt, J fi 1
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