2012-334 ..41" TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
oN 5Q r5>
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120334 Date Issued: Wednesday, November 02, 2016
This is to certify that work requested to be done as shown by Permit Number P20120334
has been completed.
Location: 122 MUD POND Rd
Tax Map Number: 523400-279-015-0001-018-000-0000
Owner: ALLEN & ANGEL VAN GUILDER
Applicant: ALLEN & ANGEL VAN GUILDER
This structure may be occupied as a:
Residential Addition By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property (7.1),J 4 ,g/t---
owner of the responsibility for compliance with Site Plan, Variance, or
other issues and conditions as a result of approvals by the Planning Board Director of Building& Code Enforcement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120334 Application Number: a20120334
Tax Map No: 523400-279-015-0001-018-000-0000
Permission is hereby granted to: ALLEN&ANGEL VAN GUILDER
For property located at 122 MUD POND 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: ALLEN&ANGEL VAN GUILDER Residential Addition $12,000.00
122 MUD POND Rd Total Value
QUEENSBURY, NY 12804 $12,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
JIM HODGES
JIM HODGES 361-1007
60 MAPLE St
HUDSON FALLS NY 12839-0000
Plans&Specifications
2012-334
4 season porch 192 sq ft
$100.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,July 25,2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town Que sbury We► •s .y, July 25, 2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY 2
TAX MAP NO. a 15 1-1 g PERMIT NO. 1 -33 Da,t e
FEES: PERMIT # /01 WRECREATION
ENGINEERING J(lS tara „`
(If applicable)
PRINCIPAL STRUCTURE:
APPLICATION FOR ZONING APPROVAL & BUILDING PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO REVIEW
BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.
APPLICANT/BUILDER: \m
'A- \COWNER: Rn 1 kkci
ADDRESS: ( , -a)sADDRESS: I�� m� Pub
i.-�..
PHONE NOS.L-`J�CS-) 3L t - I ail PHONE NOS. ( i$) ri qI&- ,38ej -501-" age
[e ore
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE: 3 .(-y-\ \\- 1Qc, PHONE: (p t - CU
LOCATION OF PROPERTY: \aa
HAS THERE BEEN A SITE PLAN REVIEW; VARIANCE OR SUBDIVISION APPROVAL? 0
YES 0 NO
IF SO, INDICATE APPLICATION NO.AND DATE OF APPROVAL:
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT z
APPLY TO YOUR z (j o I-
PROJECT 0 • 0 �- w
O O
= Oz
1- E a = ozs
SINGLE FAMILY
TWO-FAMILY
MULTI-FAMILY
(NO.of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACHED
GARAGE(1,2,3)
OTHER
IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS:
ESTIMATED CONSTRUCTION COST: 19 CC ,LO FUEL TYPE: '-VP
HEAT TYPE:fl{ \ucz-k( .Piue *HOW MANY FIREPLACE(S): 1 AND/OR WOODSTOVES(S): ( l
ZONING CATEGORY: ARE THERE WETLANDS ON THIS SITE? qt-)
IS THIS A HISTORIC SITE? '� U
PROPOSED USE OF BUILDING OR ADDITION: 44 v2 inc'., .e")(Ck
*Please complete a separate Application for"Fuel Burning Appliances& Chimneys"available In our office
B 3-LGL 11-05
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? 1, I '
ARE THERE EASEMENTS ON PROPERTY? (\,'\3
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans, and supporting materials are a true and
complete statement/description of the work proposed, that all work will be performed in
accordance with the NY State Building Codes, local building laws and ordinances, and in
conformance with local zoning regulations. I acknowledge that prior to occupying the
facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand
that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above.
Signed1/7�
L
Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction codes
or septic systems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
Permission is hereby granted to the above This application / proposed action described
Applicant to erect or alter the building herein is found to be in accordance with the
described herein in accordance with said zoning Laws of the Town of Queensbury.
Application:
BUILDING & CODES APPROVAL ZONING APPROVAL
DATE DATE
J
QUESTIONS? CALL 761-8256 OR EMAIL
codes(a queensbury.net
Office Use Only
VISIT OUR WEBSITE FOR MORE INFORMATION
Operating Permit Issued: Yes No www.queensbury,net
Occupancy Type: Construction Classification:
Assembly Occupancy Limit: Special Conditions:
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No..141.;'...3 .� Cert. N2 28570
Cut-in Card No....................................
Owner... r t' .. / -
Location ....................................
_ ...............
Installation Consisting of f:.. ................. ................................
I'!`.✓ .C.::. ...........................................................................
..........
Installed By *1..:... ,1�. .. ...............................Lic.No.........................
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 romptly made for inspection.
Inspectors of this Company shall have the privilege of makin inspe 'ons at any time, and if its
rules are violated,the Company shall have the right to v this i rcate.
Date.ze 2-1 1
................... INSPECTOR....°...... if
'...r .............................................
Member N.RP.A.,I.A.E.I.
Wed 77 cLc \ I._3 ( 2 )
Rough Plumbing I Insulation Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building & Code Enforcement Arrive: am/pm Depart:?ict am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initialsat_
NAME: 44-b� G3 PERMIT ##: 1,;) 3 3
LOCATION: AAA i, j, Pro d _ INSPECT ON: d --/.)
TYPE OF STRUCTURE:
Y N N/A
Rough Plumbing /Nail Plates
Plumbing Vent/Vents in Place
1 %inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/change of direction
Pressure Test
Drain /Vent
Air/Head
5 P.S.I. or 10 ft. above highest connection for 15 minutes
Pressure Test
Water Supply Piping
Air/Head
50 P.S.1 for 15 minutes
Insulation/Residential Check/Commercial Check
Tyvek or Similar Exterior Sealant
Proper Vent, Attic Vent
Door/Window Sealed (No Insulation)
Duct/ Hot Water Piping Insulation
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly/No duct tape
COMMENTS:
Rough Plumbing Insulation Report.revised Nov 17 2003, revised February 15,2005, revised January 7,2008
Rough Plumbing / Insulation Ina eetion Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Departam/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: )'h
NAME: :412 G 3 - PERMIT ##: % 33 <1
LOCATION: .A Al 14 p „ r� d INSPECT ON:
TYPE OF STRUCTURE:
Y N N/A
Rough Plumbing /Nail Plates
Plumbing Vent/Vents in Place .
1 % inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet I change of direction
Pressure Test
Drain /Vent
Air/Head
5 P.S.I. or 10 ft. above highest connection for 15 minutes
Pressure Test
Water Supply Piping
Air/Head
50 P.S.I for 15 minutes
Insulation/Residential Check/Commercial Check
Tyvek or Similar Exterior Sealant
Proper Vent, Attic Vent \.$7
Door/Window Sealed (No Insulation)
Duct I Hot Water Piping Insulation
If required unheated spaces _
Combustion Air Supply for Furnace
Duct work sealed properly/ No duct tape
COMMENTS:
11-L
Rough Plumbing insulation Report.revised Nov 17 2003, revised February 15,2005, revised January 7,2008
Framing / Firestopping Inspection Report ,.,
Office NI (516) 761-8256 Date Inspection request received:
Queensbury Building & Code Enforcement Arrive: a m Q part( am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials 1'"LA k i
z- ( 12 • �>
NAME: `!��'� C �'� �C� � PERMIT#:
LOCATION: ' 6 .‘1 INSPECT ON: ;o//
TYPE OF STRUCTURE: 7I= /
Y N NIA COMMENTS:
raming >./
Attic Access 22" x 30" minimum V
Jack Studs I Headers
Bracing /Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12" O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Exterior Deck Bracing
Headroom 6 ft. 8 in. •
Notches I Holes I Bearing Walls
Metal Strapping for Notches Top Plate
1 %(w) 16 gauge (8) 16D nails each side
Draft stopping 1,000 sq. ft. floor trusses
Anchor Bolts 6 ft. or less on center
Ice and water shield 24 inches from wall
Fire separation 1, 2, 3 hour
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side %2 inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space I Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above/ below grade
5.0 sf grade —
L:1Building&Codes Fomes-OLD\Buildinq&Code;Unspection Fomts\Framing Firestopping Inspection Report.doc Revised January 7,2008
9X7;
Q0
Framing / Firestopping Inspection Report tJ 6c1
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/ Depart: i .-Q am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: j
� J
NAME: V O CrC321 1 d-N r PERMIT#: I r 3J
LOCATION: / a IY) Lt ,'c1 INSPECT ON: i
TYPE OF STRUCTURE:
Y_ N NIA COMMENTS:
Framing
Attic Access 22" x 30" minimum
Jack Studs/ Headers
Bracing/ Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12" O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Exterior Deck Bracing
Headroom 6 ft. 8 in. •
Notches 1 Holes/ Bearing Walls
Metal Strapping for Notches Top Plate
1 ' (w) 16 gauge (8) 16D nails each side
Draft stopping 1,000 sq. ft. floor trusses
Anchor Bolts 6 ft. or less on center
Ice and water shield 24 inches from wall
Fire separation 1, 2, 3 hour
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side ' inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space / Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above/ below grade
5.0 sf grade
L:1Bui}ding&Codes Fomes-OLD18uilding&CodesUnspeciion Fern \Framing Firestopping Inspection Report.doc Revised January 7,2008
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Dep am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:64..A..n
NAME: V(zf `,--(,t t t d C: /`' PERMIT#: / a -33 `-/
LOCATION: /' a A f(1( Poi
i INSPECT ON:
TYPE OF STRUCTURE:
Comments
N N/A
Footings
It/C11
Piers
Monolithic Slab
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 I Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofmg
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
•
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Buiiding&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM