2008-495 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
(zt Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20080495 Date Issued: Thursday, January 22, 2009
This is to certify that work requested to be done as shown by Permit Number P20080495
has been completed.
Tax Map Number. 523400-296-015-0001-006-000-0000
Location: 65 COUNTRY CLUB Rd
Owner. STEVEN & LISA JACKOSKI
Applicant EVA MAE JONES HALL LE
This structure may be occupied as a:
Demolition
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance 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: P20080495 Application Number. A20080495
Tax Map No: 523400-296-015-0001-006-000-0000
Permission is hereby granted to: EVA MAE JONES HALL LE
For property located at: 65 COUNTRY CLUB 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: EVA MAE JONES HALL LE
DANIEL & DENNIS HALL Demolition
44 GRAND St Total value
GLENS FALLS,NY 12801-0000
Contractor or Builders Name/Address Electrical Inspection Agency
Plans &Specifications
2008-495
demolition of residence
$20.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, September 17, 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 Tp Queer j f fWV nesday, September 17, 2008
SIGNED BY ±� -,`° for the Town of Queensbury.
Director of Building&Code nforcement
ffOFFICE USE ONLYTAX MA PERMIT NO. a ' t +°, FEE PAI ( .` ' +
Permission is hereby granted to the above named Applicant to demolish the buildingps)
described herein as set forth in the Application below.
+ Director of Building&Codes Date + ;
APPLICATION FOR DEMOLITION PERMIT:
Fill in applicable spaces and submit two(2) plot plans, drawn to scale,showing lot boundaries with
dimensions and adjacent roads/streets. Show all existing structures on the property and indicate which
are to be demolished. Indicate on the plot plan the location of all utilities.
Hs rRv(KrNG, LL� 5 !J. L�sA. m_ JAckvSkz
APPLICANT/BUILDER: c/o 57Ev6 -JAcKoSK.T OWNER:
ADDRESS: I I .1J Y ,STATE IT- NJ EdT RNN A1Y ADDRESS: 113
PHONE NOS. S 13 - 3(J 43 1 Ia y)L PHONE: 519- 37� -3 t`? f
PERSON RESPONSIBLE FOR WORK: J<C-stl " 9/- -S PHONE: 'S 19 —3 G r'Y3 TI
LOCATION OF DEMOLITION: C D U/1J-f�� C - t- Q D�d 4.6
WHERE WILL DEMOLITION MATERIAL BE DISPOSED?4ft rL t= CAATTA)ts- S C1,U:i=CC
ASBESTOS INFORMATION: T- I q 5 Fb(-T A N Y I -8-k-7
✓ Is there any asbestos within the building to be demolished? YES NO
✓ If YES, our office needs the following information:
o Name of firm removing the asbestos:
o License number of firm:
o Indicate where the asbestos material will be disposed:
NOTE: A copy of Asbestos Removal Report must be filed with our office before demolition begins.
STRUCTURE INFORMATION:
✓ Indicate which structure(s)will be demolished: RESIDENCE GARAGE BUSINESS
I / STORAGE BLDG.� OTHER
✓ Size of structure:Q I- X 3 -7 '�q
✓ Number of stories: 1
✓ Foundation type: FULL CELLAR CRAWL SPACE SLAB
✓ Foundation: WILL BE REPLACED WILL NOT BE REPLACED 7�
✓ Structures(s): WILL BE REPLACED WILL NOT BE REPLACED
UTILITIES INFORMATION:
✓ Indicate utilities for this structure: GAS) ELECTRIC �0 PROPANE PUBLIC WATER
ONSITE WELL-WATER PUMP PUBLIC SEWER
IV,
Have you notified the Town Water Dept. for public water and public sewer disconnect? YES NO I,
Have all utilities bee disconnected: YES NO
QUESTIONS? CALL 761-8256 OR EMAIL
PA codesAaueensburv.net
SIGNATURE OF APPLICANT VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensburv.net
,:; Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
Queensbury Building & Code Enforcement - Residential Fin I spection
Office No. (518)761-8256 Arrive: a t#: /
am/pm
Date Inspection request received: Inspector's Initials:
NAME: S PE
LOCATION: D Z
TYPE OF STRUC IRE:
Comments,
Y No NIA `
4• Building Number Address visible from road
Chimney Height/'B°Vent/Direct Vent Location m
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 6 inches Roof Complete Com lete/Exterior Finish Complete �� !
Platform at all exterior doors
Handrail 4 or more risers
Guards at stairs decks,patios more than 30 inches above grade
Guam 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 awayfrom foundation 6 inches with 10 feet
6 inch clearance to sill plate
Gas Valve shut-off ex sed/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.ft:150 s .ft.vents
Bathroom Fans,if no window
Plumbing fixtures
Foundation insulation/Insulation Certification
Floor truss,draft stopping finished basement 1,000 s .ft.
Emergency ress 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 J.
Relief Valves installed/Heat Trap/Water Temp 110 C7
Enclosed Stairs Sheetrock Underside minimum IN Gypsum
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/%hour fire door/door closer
Duct work Sealed properly
Gas Loge in Sealed or Glass Enclosure
Final Electrical
Final Survey Plot Plan
Arc Fault Breaker in Bedrooms
Flex Gas Pipe Bond in
As Built Septic System/Sewer Dept. Ins ction Sticker
Site Plan /Variance required
Flood Plain Certification,if required
Okay to issue C I C or C 10 Temporary I Permanent
LABuilding&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Fonn_revised_100405.doc;Revised
January 7,2008;Revised 6/26/08
MAP REFERENCES
MAP OF A SURVEY MADE FOR
BRIAN J. & STACY A. ALLEN
BY: VAN DUSEN & STEVES
DATED: JANUARY 25, 2003
LAST REVISED: MAY 30, 2003
MAP OF A SURVEY MADE FOR
BARRY & LILLIAN EGGLESTON
BY: VAN DUSEN & STEVES
DATED: SEPTEMBER 13, 2001
LANDS N/f OF
EGGLESTON
GIRF
M S81°04' 13„E �a
475'51, a
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70, 127. 18 sq. ft. -
1.61 acres CI
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EICMF = CONCRETE MONUMENT FOUND
OIRF = ]RON ROD FOUND
OIRS = IRON ROD SET / TO BE 5ET
= UTILITY POLE
—o a— = WOODEN FENCE LINE
l�
Date: June 20, 2008
IDi ■ .UNAUTHORIZED ALTERATION OR ADDITION To A SURVEY Map of a Survey made for Scale 1'=40'
-�IM1• MAP BEARING A UCFNS72 LAND SURVEYORS SEAL H A
i•�' � V10LAn0N OF SECTION 7209,SUB-DIVISION 2.OF THE
NEW YORK STATE EDUCATION LAW.'
'ONLY COPIES FROM NA ORIGINAL OF THIS SURVEY (' ('�
SteVesMARKED WLT}I AN ORIGINAL OF THE LAND SURVEYORS '/`\\J/J//.��� \ S�.
SEAL SHAU.BE CONSIDERED 70 BE VALID TRUE COPIES.' Dan H a 11 ✓ • C ) K-T, S
"CERTIFICATIONS INDICATED HEREON SIGNIFY THAT
THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE
Land S u r v e y o r s EXIST E CODE OF PRACTICE TAA FOR LAND SURVEYORS ADOPTED / c 0 t p n C
BY THE NEW PORK STATE ASFOR LAND of SURVEYORS
OP J\ V/� �
LAND SURVEYORS.SAID CERTIFICATIONS SHALL RUN ONLY SHEET 1
To THE PERSON FOR WHOM THE SURVEY IS PREPARED,AND
ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL Warren Count New York
169 Haviland Road QuE ensbury, New York 12804 AGENCY AND LENDING ITHE LENDING
LISTED HEREON,AND Town Of Queensbury, �,
TO THE ASSIGNEES
OF THE IENDINC INSTITUTION.' Hall C2274
(518) 792-8474 New York Lic. No. 50135 - NO. DATE DESCRIPTION DWG. NO. 0807G
96. -6 / 6 - -G