2008-492 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
4E Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20080492 Date Issued: Thursday, July 02, 2009
This is to certify that work requested to be done as shown by Permit Number P20080492
has been completed.
Location: 303 CLEVERDALE Rd
Tax Map Number. 523400-226-012-0001-007-000-0000
Owner. DOUGLAS & SUSAN LIVINGSTON
Applicant: DOUGLAS & SUSAN LIVINGSTON
This structure maybe occupied as a:
Single Family Dwelling By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the (�
owner of the responsibility for compliance with Site Plan
property P tY P ,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code E orCement
Planning Board or Zoning Board of Appeals.
------ ____ ______________________________________, r-......._. ...........
FICE USE ONLY ; ;
1 � f
TAX MAP NO. PERMIT NO.
FEES: PERMIT ��3� RECREATION ENGINEERING ; ;
...........................................
(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` a ier OWNER: ov ♦vi••• s/
ADDRESS: l�Ge.. ���,4��� /tom y,� 1�"zo ADDRESS: ec.� .��� ./✓ /a2�'za
PHONE NOS. _3G/ -.3-z C-ee-C. PHONE NOS. N "�
CONTACT PERSON FOR BUILDING &CODE•S COMPLIANCE: a e lam: PHONE: . 01C
LOCATION OF PROPERTY: �
SUBDIVISION NAME:
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT Zcc o F-
APPLY TO YOUR z rx o a a U)LU F- w
PROJECT O 1- W Q CL = U
z ¢ ¢ Nd Ou~. 0U- n. 2oiS
SINGLE FAMILY i
S r�..c♦ .tM
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:
f
ESTIMATED CONSTRUCTION COST: 904a-�-a ._ FUEL TYPE: f✓ 4
HEAT TYPE: "HOW MANY FIREPLACE(S): n✓ AND/ OR WOODSTOVES(S):
ZONING CATEGORY:4Ze1-,—ARE THERE WETLANDS ON THIS SITE?
IS THIS A HISTORIC SITE? Z ve
PROPOSED USE OF BUILDING OR ADDITION: .S' .a A
`Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in o r office B 3-LGL 11-05
QTown of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN?
ARE THERE EASEMENTS ON PROPERTY? /l/a
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 state me nt/d escri ptio n 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.
Signed
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
o described herein in accordance with said ; zoning Laws of the Town of Queensbury. 11
10 Application:
01
' '
EE3KOJr6VALDIG & COD AP ZONING APPROVAL 11
,
10
DAfF
DATE 00
s '
QUESTIONS? CALL 761-8256 OR EMAIL
codes(M-gueens bury.net
Office Use Only VISIT OUR WEBSITE FOR MORE INFORMATION
www.gueensbury.net
Operating Permit Issued: Yes No
Occupancy Type: 21 PE is�t 1,A L.
Construction Classification: Tlr. -
Assembly Occupancy Limit:
Special Conditions:
QTown of Queensburyl • Community Development Office • 742 Bay Road, Queensburyy, NY 12804
..........................................
OFFICE USE ONLY +
TAX MAP NO. PERMIT NO. `e rj RMIT FEE + ;
APPROVALS: ZONING
r TOWN CLERK_ , ,
:. ;
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT)
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. ,
OWNER: a
�'" -s /�•-' INSTALLER:
® t
��eZ �e._..cqo ee
ADDRESS: �__,�c� ,��� �t/. Y /��72 o ADDRESS: /t/.
PHONE NOS.__ 'S ✓�^ G a�G AW r�i'.? PHONE NOS. j G / — 3.2 7 t _
LOCATION OF INSTALLATION: -.26-3 ��a�c �AI Iz��f�&' ,� Y
} .............................................. :.................................. , RESIDENCE INFORMATION:
YEAR BUILT N0.OF I X COMPUTATION- 1 _ TOTAL DAILY FLOW '
BEDROOMS
............ .. .,.... ....................................;.........................,,..........................,................,.,..........14........... ................................................................... I GARBAGE
{ 1980 or older I X 150 allon er bedroom i = IN qo
(......................� .......;.............................................. 9 P I INSTALLED Rmot/
{ i.......... 1...........l..........................................................................:
......................._..........
X 130 gallon per bedroom = i
i..... ................-..................D
...........................1....... SPA OR HOT TUB
1992-present I X 110 gallon per bedroom j = .3INSTALLED?.............._... .......... .........................,..........................................................................;...........;..........................................................................
EL INFORMATION: /
✓ TOPOGRAPHY: FLAT ROLLING V STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM f CLAY V' OTHER
✓ GROUNDWATER: AT WHAT DEPTH? 'Y BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION ISA FT. )/
✓ PERCOLATION TEST: RATE IS ^' 9 PER MIINUTE PER INCH (TEST TO BE
COMPLETED BY A LICENSED PROFESSIONAL ENGINEER OR ARCHITECT)
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.
M/"a✓ SEPTIC TANK: GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
��A ✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
s.-/ ✓ SIZE OF EACH FT. X FT.
N�A ✓ SIZE OF STONE TO BE USED: # I DEPTH OR THICKNESS FT.
.���► ✓ BED SYSTEM SIZE: X
A ✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(if required) NO. OF TANKS: -3 /SIZE OF EACHNI-ee o
✓ GALLONS./TOTAL CAPACITY: o c GAL.
.................................................. ....:.:.:.:........:...........................................::........:...::...:.:...:...:.:.::.:...:...:.:..:...:.::.....:....................:...:....:.:..:.::..:..:...::.........:..... . ...:
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
..:..::.N,.,
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 b these and all requirements of the Town of QUESTIONS? CALL nsbur . OR EMAIL
g Y G Codes�aueensburv.net
Queensbury Sanitary Sewage Disposal Ordinance.
VISIT OUR WEBSITE FOR MORE INFORMATION
c A & ueensbun net
Signature of Perso Responsible Date
l - Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804
TOWN OF QUEENSBURY
742 Bay Road,Qwensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080492 Application Number. A20080492
Tax Map No: 523400-226-012-0001-007-000-0000
Permission is hereby granted to: DOUGLAS & SUSAN LIVINGSTON
For property located at: 303 CLEVERDALE 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. Tyne of Construction Value
Owner Address: DOUGLAS & SUSAN LIVINGSTO
5340 BALFOR Dr Single Family Dwelling $90,000.00
VIRGINIA BEACH, VA 23464 Total value $90,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-492
838.34 SQ FT 1 ST FLOOR& 357.21 SQ FT 2ND FLOOR SINGLE FAMILY DWELLING
$143.52 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, September 24, 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 ~°i' r of e ns�ury;��t f?�V esday, September 24, 2008
SIGNED E f ` `� " r%' for the Town of Queensbury.
Director of Building&Code Enforcement
PROJECT NAME: OFFICE USE ONLY -;
STAFF INITIALS:
BUILDING PERMIT SUBMISSION DATE: ;
CHECKLIST FOR:
------------------------------------
SINGLE FAMILY DWELLING
1. Building Permit Application Completed? YES NO N /A
_ ..... __......__..............
_............................
......................._.........................._..:-.................
........................._.._. .............
......
2 Energy Form or CheckMate Energy Code Compliance
Forms Complete? -copies)._.-_...-.._..._.... _._._._.----.____.............
.._._._. _ .____..._..........__
3 Energy Code Inspector's Report from Checkmate
Program? (2-copies
. )
4 Septic application completely filled out?
_ 1 (If applicable)
---._ .. ._.......------------ -- -.. _._-..._ _. __. J
5 ; Electrical Inspection Form complete?
... .. ... ........... ..
__._...
. _. _.
6. Two (2) sets of the plans each of the following: YES NO N /A
.................._...__................._..... ..-._._.____....._._._ ..._-...___._---.._._._._.....__._._._._...._._--_............_....;.._._....__._._..._...._ ;.....__._........_._____.._ ____.....__..-
a. Floor plans (s)?
- ...
b. Foundation plan?
....__...
c. Cross sections (s)?
d. Elevations?
__._... --------_.._-......__..........._........................_.
e. Window and door schedule?
.......... . --- . ---- .._ .- ........ - ..... . .............._ .. .. _.. ___.
f. Natural Light, Ventilation and Emergency Egress
-Requirements? 1/
_ _.. _ .. -..._. .. -. . _ ,. ....... . ...............
I g. Plans signed and sealed by registered architect or ✓
en ineer?
..._._..1._._._g__
- _ 1_....... _-........................_1
Two (2) site plans showing location of the structure to be
7. built, location of well or water lines, location of septic
system or sewer line?
.._....-..............._._.._._._._.-........_..-_._...____...__...._-__...._.____._. _...................._......_..............__................____.....
8. I Setbacks from property lines to new structure?
i
--....._.._;._._.__._...-.__. ..-_........._.._._......._......._......._....._......................................_.__._.-_.._...... _ ._..__...._.................._.............._....._...._.. ................................ ...........
......_.._....................................................._................................;.._...._.... _...._.........-_.._
i Setbacks to neighboring wells and septic systems, /
8' including onsite well and septic systems (if applicable)?
_..
9. ! Driveway Permit?
_..._ ___ _ --- ._- ______ _.-.- _ .. . _........... .... ___-................... ..
Town of Queensbury • Community Development Office • 742 Bay Road, Q.ceensbury, NY 12804
B 12-LTR I1-05
Check Residential Plan Review: One& Two Family Dwellings
Y/N/N/
(2)Full sets of plans
Over 1,500 sq. ft.—Stamped
j' Design Loads On Plans: 90 Wind Floor Loads 40 psf
�./ 50 Ground Snow Load Sleeping Areas and Attics 30 psf
Calculations:
Window Schedule With Glass Size
Door Schedule/Main Entrance 36"Door
Emergency Escape Or Bedrooms and Habitable Space
Above/Below grade,5.7 sq. ft.
Grade,5.0 sq. ft.
24"(h)x 20"(w)min.
44"Max.Height above floor
Residential Check Paperwork Compliance and Inspectors Checklist: OK
Dampproofing/Waterproofmg Materials On Plans
I[ Foundation Drainage On Plans,if required
6"Drop in 10' Exterior Grade
Framing Cross Section For Each Roof Line,Vertical Fire Stopping Every 10' Where
Required
Ice and Snow shield 24"Inside Exterior Wall/24"Inside Knee Walls
Platforms At Exterior Doors
Stairway Headroom 6' 8' All Stairs 36"Width
Stair Run and Rise
Winder Run and Rise
Spiral Not.Allowed From 2nd Story
Smoke Detectors Battery Backup and Proper Location
Bathroom Fixtures Proper Clearance
Hall Width,36"min.
Handrails More Than Four Risers On Open Sides
Railing and Guards>30"/Basement Stairs Included/Closed Risers More Than 4"in Ht.
Safety Glazing Notes For Required Areas
Garage Fire Separation
Garage Floor Sloped
Attic Access
Roof over 30"—22"x 30"/Crawl Spaces 18"x 24"Access
Carbon Monoxide Detector Outside Lowest Sleeping Area,On Every Level&
Interconnected
Soil Test Results,if required
Septic To Well Or Water Line Separation
All Paperwork Signed
Queensbury Building & Code Enforcement - Resideqal Final Inspection
O M No. (518) 761-8256 Arrive: am/pm Depart-),'0 am/pm
Date Inspection request received: Inspector's Initials:
NAME: r V-- PERMIT#: �n j—q
LOCATION: DATE:
TYPE OF STRUCTURE: A la �. A 42
Comments:
Y N WA
4' Building Number Address visible from road —:7
Chimney.Height/"B"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 decks ios 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 silt plate
Gas Valve shut-off exposed t regulator 18 inches above arade
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitcr®n waterti ht
Safe Pain /Wi in stairwells safetv alizing
Interior Smoke ectors/Carbon onoxid Detectors
Every level: V E ry Bed om:
Outside every bedroo area:
Inter Connected: Battery backup:
Attic access 30 inches x 22 inches x 30 inches eight in accessible area
Crawl Spaces 18 inch x 24 inch access, 1 .ft:150 sq.ft.vents
Bathroom Fans,if no window
Plumbin fixtures
Foundation insulation/Insulation 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 FumW
u at entrance to furnace area
Fumaat eater o ratin
Low wat -off boiler
Relief Valve(s)installed/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum'r4"G sum
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/%hour fire door/door closer
Duct work Sealed prqp@r1y
Gas Logo in Sealed or Glass Enclosureoe
Final Electrical Z.
Final Survey Plot Plan
Are Fault Breaker in Bedrooms
Flex Gas Pipe Bonding
As Built Septic System/Sewer Dept. Inspection Sticker
Site Plan /Variance required
Flood Plain Certification,if required
Okay to issue C I C or C 10 1 Temporary/Permanent
LABuilding&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form_revise0_100405.doc;Revised
January 7,2008;Revised 6/26/08
162-12
ppppppp --
Septic Inspection Report
Office No. (518) 761-8256 Date InspectioVequest received:
Queensbury Building &Code Enforcement Arrive: ` am/prp epart: am/pm
742 Bay Rd., Queensbury, NY 12804 Ins s Initials:
NAME: D(� Z
PERMIT NO.:
LOCATION: 36 RECHECK: INSPECT ON:
�
_Comments and/or diagram
Soil Ty : Sand M?Itiv
ClaT of Water: Munici Ie ater '
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + - Y N_N/A
Absorption Field: Total length ft. ��
Length of each trench ft.
Depth of trenches ft. L L
Size of Stone (fJ o PC- Kv
Seepage Pits: Number K
Size: x
Stone Size:
Piping Size T pe
Building to tank to
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: Y N
End Ca Y N
Inlet/Outlet Pipes &Baffles _Y_N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N 44 � IN A,�
Engineer Report and As-Built Y N
Location of System on Property:
Front Rea Left Side Right Side Middle Front Middle Rear
System Use S t
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
/ - C5
Rough Plumbing / Insulation Insp ction Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: m/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials:
NAME: PERMIT #:
LOCATIO INSPECT ON:
TYPE OF STRUCTURE: ak �f-
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.1. or 10 ft. above highest connection for 15 minutes
Pressure Test
er ly Piping
Air/Head
50 P.S.1 f 15 minutes
Insulatio Residential Check/Commercial Check
-TyydCor 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 toe
COMMENTS:
Rough Plumbing Insulation Reportrevised Nov 17 2003, revised February 15,2005, revised January 7,2008
30 �-�
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: i" am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: ke r� PERMIT#:
LOCATION: INSPECT ON:
TYPE OF STRUCTURE:
` Commeab
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 te.
'als for se on site.
Foundation/Wallpo
Reinforcemen ace � 1
Footing Dowels or Keyway in place
Foundation Dampproofing �..-- --
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:\Buliding&Codes Forms\Building&Codes\Inspection forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
be Ile r ) ff, -- / '�' /I-16Aj im--/
Framing / Firestopping Inspection Report
Office No. (518)761-8256 Date Ins o5,*uest received:
Queensbury Building &Code Enforcement Arrive: am/ rt: am/pm
742 Bay Road, Queensbury, NY 12804 Inspecto s I itials:
NAME: 'i�t c` fC'�^� PERMIT
LOCATION: , j r INSPECT ON: 77) 77'
TYPE OF STRUCTURE:
Y . N NIA FramingCOMMENTS
ccess 220 x 30° minimum
Jack
a 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/Holes/Bearing Walls
Metal Strapping for Notches Top Plate
1 % w 16 gauge 8 16D nails each side
Draft sto ' 1,000 sq. ft. floor trusses '
r- ee
chor Bolts 6 or less on center
and water Id 24 inches from wall
Pke-wpgr—ation 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
LABuilding&Codes Forms-OMBuilding&Codesllnspection FormsTraming Firestopping Inspec ion RepoRdoc Revised January 7,2008
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