2014-465 9.1A1°11_ TOWN OF QUEENSBURY
FijiFN 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20140465 Date Issued: Monday, September 29, 2014
This is to certify that work requested to be done as shown by Permit Number P20140465
has been completed.
Location: 56 DREAM LAKE Rd
Tax Map Number: 523400-279-013-0001-014-000-0000
Owner: ALLAN & DEBORAH MUMFORD
Applicant: ALLAN &DEBORAH MUMFORD
This structure may be occupied as a:
Residential Alteration By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property C� rs/ W
owner of the responsibility for compliance with Site Plan, Variance, or n Y
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
f1 Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140465 Application Number. A20140465
Tax Map No: 523400-279-013-0001-014-000-0000
Permission is hereby granted to: ALLAN & DEBORAH MUMFORD
For property located at: 56 DREAM LAKE 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: ALLAN &DEBORAH MUMFORD Residential Alteration $1,500.00
7 SUGAR HILL Rd Total Value $1,500.00
NORTH SALEM NY 10560-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014-465
Res. Alterations -replace garage door with patio doors
$60.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday, September 29,2015
(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 To of Q nsb ;4 i i ' t,A r tember 29, 2014
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION "Office U \\\\
DATE
DATE q- zL Received It�
`Tax M�a• lD2�.0 L trZib9' \(
TAX MAP ID �Permli No. RY��`TIx
PermiYFee 'AS
ZONING Rec Feel.Ut (=poi
• Site Plan It
HISTORIC SITE Yes ✓ No Subdivision #
SUBDIVISION NAME Lot it
TOWN SD_RESOLUTION 86-2013: $850 RECREATION FEE FOR NEW DWELLING UNITS,INCLUDING SINGLE FAMILY DWEWNGS,DUPLEXES
OR TWO FAMILY DWELLINGS, MULTIPLE FAMILY DWELLINGS, APARTMENTS, CONDOMINIUMS, TOWNHOUSES, AND/OR MANUFACTURED &
MODULAR HOMES, BUT NOT MOBILE HOMES. THIS IS INADDmOON TO THE PERMIT FEES, r/
APPLICANT 11 A- .Z {{-114 K Li. r°lu Nt+�C OWNER -+' k. •�d A/�4II`' W 114 -
ADDRESS ADDRESS 5G �a rv. Lca KL A>f
LW_ lir-U,z e AJJ - (ZS'4_;
PHONE/E-MAIL PHONE/E-MAIL Yn(kyvt I G ao1• GnK.
—cel(- 91 $ 8'>` S
CONTRACTOR �� Tr— COST OF
CONSTRUCTION(ESTIMATED): $ •
ADDRESS: - BUILDING ADDRESS:
&
Peream
n` Vic (-ect C%/I d"h fAc �/ e✓ ?G 4-Co
cldW SHt2ce.
Check all that apply Please indicate measurements as required below
New Addition Alteration 1 S'floor sq.ft. 2"d floor sq.ft. Total sq.ft Height
Single Family
Two-Family
Multi-Family
(# of units
Townhouse
Business Office
Retail - Mercantile
Factory- Industrial
Attached Garage
(# of )
Other
1
Town of Queensbury Building&Codes Principal Structure Application July 2014
If commercial or industrial indicate name of business
Proposed use of building or addition
Source of heat (circle one) Gas Oil Propane Solar Other
Fireplace: complete a separate application for Fuel Burning Appliances &
Chimneys
Are there structures not shown on plot plan?
Are there easements on the property?
Site Information
a. Dimensions or acreage of lot
b. Is this a corner lot?
c. Will the grade be changed as a result of construction _Yes No
d. Public water or Private well
e. Sewer or Private Septic System
Value of all work to be performed (labor or materials) $
DECLARATION:
1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period.
2. If work is not complete by the 1 year expiration date the permit may be renewed,subject to fees and department
approval.
3. I certify that the application, plans and supporting materials are a true and complete statement/ descriptiort 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.
4. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of occupancy.
5. 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. l,����
I have read and agree to the above: PRINT NAME: A A .MA
4„ rl _ D/TE r' /
rah//q
15/SIGNATURE: s!... QL/_�� DATE /1/44 /
FOR OFFICE USE ONLY
Operating Permit Issued: Yes _No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
2
Town of Queensbury Building&Codes Principal Structure Application July 2014
Queensbury Building & Code Enforcement - Residential Final Inspection
Office No. (518)761-8256 Arrive: 3 4t4) a Depart: am/pm
Date Inspection request received: Inspector's Initials:
NAME: [ G `-ciA PERMIT#: 4-
LOCATION: Orion nn ��,, Ka Rd DATE:
RAl
!
TYPE OF STRUCTURE:
eccs f
Comments:
Yes No_N/A
4" Building Number Address visible from road
Chimney Height PIT'Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 18 inches
Roof Complete/Exterior Finish Complete
Platform at all exterior doors
Handrail 4 or more risers
Guards at stairs,decks,patios more than 30 inches above grade
Guard at stairwell at 34 inches or more
Guard at deck,porches 36 inches or more
Handrail Termination at Newell Post or Wall
Interior/Exterior Railings 34 inches to 38 inches
Deck Bracing/Handicapped Ramp Compliant
Grade away from foundation 6 inches with 10 feet
6 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18 inches above grade
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells safety glazing
Interior Smoke Detectors/Carbon Monoxide Detectors
Every level: Every Bedroom:
Outside every bedroom area: _
Inter Connected: Battery backup:
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area
Crawl Spaces 18 inch x 24 inch access, 1 sq.11.-150 sq.ft.vents
Bathroom Fans,if no window
Plumbing fixtures
Foundation insulation to floor/Sticker on Panel
Duct work sealed properly/Blower Door Test Certification
Floor truss,draft stopping finished basement 1,000 sq.ft.
Emergency egress below grade
Gas Furnace shut-off within 30 feet 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/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum W Gypsum
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/V.hour fire door/door closer
Gas Logs in Sealed or Glass Enclosure
Final Electrical; Energy Saving Light Bulbs 50%
Final Survey Plot Plan
Arc Fault Breaker Habitable Spaces/Tamper Proof Receptacles
Flex Gas Pipe Bonding
As Built Septic System/Sewer Dept. Inspection Sticker
Site Plan /Variance
Flood Plain Certification,if required I//
Okay to issue C l C or C/0[Temporary/Permanent)
L1Building&Codes FormslBuilding&Codes\Inspection Forms\Residential Final Inspection Form_revised_100405.doc; Revised
January 7,2008;Revised 6/26/08; Revised 12/22/10,Revised 04/13/11