2008-248 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF 0CCUP-A-N- CY
Pernut Number. P20080248 Date Issued: Tuesday, January 05, 2010
This is to certify that work requested to be done as shown by Permit Number P20080248
has been completed.
Location: 22 NORTH Ln
Tax Map Number. 523400-226-019-0001-060-000-0000
Owner. SANDRA POULOS
Applicant: SANDRA POULOS
This structure maybe occupied as a:
Residential Alteration By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board 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: P20080248 Application Number. A20080248
Tax Map No: 523400-226-019-0001-060-000-0000
Permission is hereby granted to: SANDRA POULOS
For property located at: 22 NORTH 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: SANDRA POULOS Residential Alteration $20,000.00
16 WINDY RIDGE Rd Total value $20,000.00
GLENS FALLS, NY 12801-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-248
foundation alteration 710 sq ft
$71.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,June 09,2009
(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 T Quee rr) d June 09,2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
__ _________ ________________ _ _n>r.WE ,
jFEICE USE ONLY -
TAX MAP NO. PERM _ NO.
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FEES- PE�zr,�[T � _ REcREATioN ENvirti=ERiNG j
If applicablei �s i �3UR1;
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. q
APPLICANT/BUILDER: 54it4"Cb Cap-' k��8� OWNER:
ADDRESS: L-1 L Lf 9 6-T_ S6 C1.� 'Sfl l-T ADDRESS: 2 �rZ d AT� C.l � 1 ��
pSSS
PHONENOS. /59--4CL'I(/ " 578L-1 -19Z.3 PHONE NOS.—' 3Z--/2sS'_ rJINT
CONTACT PERSON FOR BUILDING &CODES COMPLIANCE:_C14-I S PHONE:
LOCATION OF PROPERTY:
SUBDIVISION NAME:
I
PLEI WIRED BELOW:
CHECK ALL THAT z
APPLY TO YOUR O ( �� o�-
PROJECT p Q 0 W I V / � co
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SINGLE FAMILY }/ 1
TWO-FAMILY
MULTI-FAMILY(NU.__ i
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TOWNHOUSE -r -
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BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR I
INDUSTRIAL
ATTACHED
GARAGE(4,2,3)
OTHER I
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IF COMMERCIAL OR INDUSTRIAL—NAME OF BUSINESS:
ESTIMATED CONSTRUCTION COST: 2c- "()y 0 FUEL TYPE:
HEAT TYPE? *HOW MANY FIREPLACE(S) AND/OR WOODSTOVES(S):
ZONING CATEGORY: ARE THERE WETLANDS ON THIS SITE? f`f
IS THIS A HISTORIC SITE?
PROPOSED USE OF BUILDING OR ADDITION: '1"�
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? N
ARE THERE EASEMENTS ON PROPERTY? ij o
*please complete a separate iippiiaation{O,
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 1/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.
Signed
Director of BUildinQ &Codes: 761-8256 (for questionsCQUES:TIONS? CALL761-8256OREMAIL
regarding -Building Permits. construction cedes or septices_ aueensbury.netsystems) BSITE FOR MORE INFORMATIONZoning Administrator: 761-8218 (for questions regarding �rv.gueensbury.net
required permits, the permit process, application requirements or to
schedule an appointment)
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'This application I proposed action described J Permission is hereby granted to the above ,
herein is found to be in accordance with the Applicant to erect or after the building described
zoning Laws of the Town of Queensbury. p herein in accordance with said Application:
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ZONING APPROVAL DATE a BUILDING&CODES APPROVAL/ ATE
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OFFICE USE ONLY
PROJECT NAME: LD
STAFF INITIALS
BUILDING PERMIT SUBMISSION DATA
CHECKLIST FOR- _______------______a_._f__.-___s_..
SINGLE FAMILY DWELLING
1. Building Permit Application Completed? YES NO N /A
2 Energy Form or CheckMate Energy Code Compliance
Forms Complete? (2-copies)
.. ......... .
3
Energy Code Inspector's Report from Checkmate
L Program? (2-copies)
..........._......._........ .......... . ._ . ..........._------------ _.__ _
4 Septic application completely filled out?
If applicable)
)_ _---
5. Electrical Inspection Form complete? X
6. Two (2) sets of the plans each of the following: YES NO N !A
_.. _. . _..._...._.. _ _
a. Floor plans (s)? r1
.......... __ _....... .__.. __.. .__....... __.
b. Foundation plan?
C. Cross sections (s)?
d. Elevations?
e. Window and door schedule?
.... __............ .._.. ....... ..... .......
f. Natural Light, Ventilation and Emergency Egress
Requirements?
... ..._
g Plans signed and sealed by registered architect or k
engineer? '
. _ .._. _.. -----------
Two _ .
(2) site plans showing location of the structure to be
7 built, location of well or water lines, location of septic
system or se..
8. Setbacks from property lines to new structure?
._............... ..... ..............._........... _._. ___ ..... ..
Setbacks to neighboring wells and septic systems,
8.
including onsite well and septic systems (if applicable)?
9. Driveway Permit?
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B 12-I,TR 11-05
Queensbury Building & Code Enforcement - Residential Final Inspection
Office No. (518) 761-8256 Arrive: _,or's 25am/Rmn Depart: am/pm
Date Inspection request received: Ins Initials: �1
NAME: PERMIT#:
LOCATION: a DATE: d
TYPE OF STRUCTUR :
Comments'
YesN /A
,V Building Number Address visible from road
Chimney Height/V Vent/Direct Vent Location
Fresh Air intake
3 inch Plumbing Vent through roof minimum 6 inches
Roof Complete/Exterior Finish Complete
Platform at all exterior doors _
Handrail 4 or more risers
Guards at stairs deckspatios 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 Wail
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 erposec/regulator 18 inches above grade
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells saifety glazing
Interior Smoke Detectors/Carbon Monoxide Detectors
Every level: Every Bedroom:
Outside every bedroom area:
Inter Connected: Battery badcu
Attic access 30 inches x 22 inches x 30 inches ht in accessible area
Crawl Spaces 18 inch x 24 inch access 1 N.ft.-150 sq.ft.vents
Bathroom Fans if no window
Plumbing fixtures
Foundation insulation/Insulation Certification
Floor truss,draft stopping finished basement 1,000 sq.ft,
Emergency ress below arade
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 Valves installed/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrodk Underside minimum'A'Gypsum
Basement stairs dosed rise>4 inches
Garage Floor Pitched
Garage fireproofing/%hour fire door/door closer
Duct work Sealed properly
Gas Logs in Sealed or Glass Enclosure
Final Electrical
Final Survey Plot Plan
Arc Fault Breaker in Bedrooms
Flex Gas Pipe Bondin
As Built Septic System/Sewer Dept. Inspection Sticker
Site Plan /Variance required
Flood Plain Ceramcation,if re uired
Okay to issue C/C or C 10 Tem ra /Permanent
UBuilding&Codes FormslBuilding&Codesllnspection FormMesidential Final Inspection Form revised_100405.doc;Revised
January 7,2008;Revised 6/26/08
Foundation Inspection Report
Office No.(518)761-8256 Date Ins do equest received:
Queensbury Building&Code Enforcement Arrive: �2am/pm Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 lnspec s Initials:
NAME: V PERMIT#:
LOCATION: INSPECT ON: —
TYPE OF STRUCTURE:
Comments
Y N N/A
Footings
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/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofmg (�
Foundation Waterproofing
Footing Drain Daylight or Sump Op'a-
Footing Drain Stone:
12 inch width
c above footing
6 mil for wet areas under slab �-��
Backfill A royal
_EjwaKg Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building&Codes Forms\Building&Codes\lnspection Fors\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
Foundation Inspection Report
Office No.(518)761-8256 Date Ins do 1quest received:
Queensbury Building&Code Enforcement Arrive: � ) -km/p,� Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspectors Initials.
NAME: PO 0 L C2`j PERMIT#:
LOCATION: A111f R r ( L INSPECT ON:
TYPE OF STRUCTURE:
Comments
Y N N/A
Footings
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.
Fo dation/Wallpour
e' in Place
Footin we or Keyway in place
Founds n D pproofing
Foundation Waterproofmg
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:\Building&Codes Forms\Building&Codes\Inspection R)ms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection quest received:
Queensbury Building&Code Enforcement Arrive: p Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector s Initials: -
NAME: RUZO I PERMIT#:
LOCATION: INSPECT ON: - F
TYPE OF STRUCTURE:
Comments
Y N N/A
Footings
r
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/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:\Building&Codes Fors\Building&Codes\Inspection Forms\Foundation Inspection Report-doc
Last printed 12/20/2005 9:24:00 AM
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TO'N rid G���,, �� eJ 4�1,1 11:PA ?"ANT
Based on our limited exam nation,
compliance with our comments shall
• not be construed as indicating the
F r�s►�N5 G,4ga� plans and speci`ications are in full
8"wall 4" below grade compliance with the Ouilding Codes of
2x6 PT sill plate w/anchor bolts New York State.
e 4
10"x20" footing
2 courses rebar with upright 4'on center
Anthony and Sandra Poulos
22 North lane
Assembly Point Ny
06/05/2009 06:51 5185870453 SARACO CONSTRUCTION PAGE 02/02
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