2000-838 .1,4% TOWN OF QUEENSBURY
BayQueensbury, 12804-5902 (518) 761-8201
� � 742 Road,Q urv,
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20000838 Date Issued: Tuesday, March 26, 2002
This is to certify that work requested to be done as shown by Permit Number P20000838
has been completed.
Tax Map Number: 523400-289-010-0001-031-000-0000
Location: 9 HEMLOCK Rd
Owner: MICHAEL & HOLLY DANSBURY
Applicant: MICHAEL & HOLLY DANSBURY
This structure may be occupied as a:
By Order of Town Board
Residential Alteration TOWN OF QUEENSBURY
(--- a,„9 4
Director of Building& Code Enforcement
TOWN OF QUEENSBURY
too 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20000838 Application Number: A20000838
Tax Map No: 523400-043-000-0002-019-000-0000
Permission is hereby granted to: MICHAEL &HOLLY DANSBURY
For property located at: 9 HEMLOCK 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: MICHAEL & HOLLY DANSBURY Residential Alteration 5,000.00
380 SOUTH POST Rd Total Value 5,000.00
WEST WINDSOR,NJ 08550
Contractor or Builder's Name/ Address Electrical Inspection Agency
HAAKENSON, PHILIP
RR3 BOX 3604
FT ANN.NY
Plans &Specifications
2000-838
48 SQ FT RESIDENTIAL ALTERATION (DORMER)AS PER APPLICATION
$4.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,March 28,2003
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Tow ensb ; iWed. 1;y,March 28,2001
SIGNED BY ( . i'\ for the Town of Queensbury.
Director of Building&Code En orcement
Building Permit Application
Town of Queensbury - Dept. of Community Development, 742 Bay Road, Queensbury, NY 12804 [761-82561
BUILDING & CODE ENFORCEMENT
NOTICERequirements prior to issuance r
A permit must be obtained before , of this permit: PERMIT FILE NO.
beginning construction. No inspections PERMIT FEE PAID$ Li will be made until applicant has received pi Zoning Board Action ,
a VALID BUILDING PERMIT. All Area /Use RECREATION FEE PAID$
applicants spaces on this application
MUST be completed and the signature Planning Board Action REVIEWED BY:
,c)1(-)
of the applicant must appear on the SPR / Subdivision /Other
Building Inspector
application form. Thank you. Recreation Fee Payment J
Applicant: t'4,le .J. Nictrr goc/ oAl Owner: Ai c ao,,,, 4.d,y
' Address: 137 3 Z-o 44 la, {�.t ,*-t /1" Address:
(5 ) t 114'3 -
Phone # &.Y - ., , Ceti Phone # ( )
Property Loca AC?dew Loc..7� Or ce"..1,Ce.-, L47,Co
Subdivision Name: Tax Map Number_ /
Section Block T of
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
ca— New Building: CONSTRUCTION: $ 3 r2? - ''
residence / commercial
' Addition to Building:
residence / commercial OCCUPANCY INFORMATION:
i— Alteration to Building: Primary Buildin
residence / commercial 2,-- Single Fami Jc ED
Residence / Commercial Two Family Dwellingg
no change to exterior size Family D � ll�ntg2o0o
Office
Other Work (describe below) Mercantile�OWh10F(�UFENSBUp
Manufactu LDWG qCQ
Other
GROSS AREA OF PROPOSED STRUCTURE:
If ADDITION, what will use
1st Floor sq. ft.
of new addition be? :
2nd .Froar. . .,. . . . . 2/5 sq. ft.
Other Flouts sq. ft.
(not unfinished cellar or basement) ACCESSORY BUILDINGS:
Detached Garage 1, 2 car
TOTAL FLOOR AREA: L/ g SQ. FT. Attached Garage 1, 2 car
Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building
g FEET X C FEET Other
Foundation Type: ;K,st-K.. Will any second-hand or ungraded
' Number of Stories : , lumber be used? If so, for what?
(habitable space onily) Jlfa
Height (grade to ri.dge) : feet TYPE OF HEATING SYSTEM:
Number of fireplaCes and/or woodstove (circle all which applies)
to be installed: lectri Oil / Gas / Wood
ed Hot Air / aseboar3 Other
Person responsible for supervision of work as regards to building
codes is: f, /, -, J - �a 43, �r., Q/v I373 &,., G-` /4, ,--y'470 576`--‘ ' � �9-- � -�
Name Addresss Phone
Builder: �-, --�
Plumber:
Mason:
Electrician: ,�1-.L
DECLARATION: Please sign below after you have carefully read the statement.
To the best of my knowledge the statements contained in this application, together with the plans
and specifications submitted, are a true and complete statement of all proposed work to be done on
the described premises and that all provisions of the Building Code, the Zoning Ordinance and all
other laws pertaining to the proposed work shall be complied with, whether specified or noted, and
that such work is authorized by the owner. Further, it is understood that Uwe shall submit prior to a
Certificate of Occupancy or Certificate of Compliance being issued, an AS BUILT PLOT PLAN by
a licensed surveyor; drawn to scale, showing actual location of project on premises.
�f
Signature: . � Lt'.- ,, f,/�%,'/
(owner, ' er's agent, architect, contractor)
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
_ Location of installation:
/ (� File Permit No. / —536
43,
Tax Map No. ���, /
Owner's Name: kite e k - 61.7,,,,,t.�goe } Fee Paid
Address: 7 46 LO CIS '',3 ,
2. INSTALLER'S NAME : PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate #bedroom(s)and multiply N of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No, of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdnn = i-6--
1980— 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes— / no
Spa or Whirlpool Installed yes_- / no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements) •
TQD•, :• i 4 G_
. a: .re rVun Water_ Bc rock or lmperviQ is MatQrial Domestic Watcr_Supply
sand at what depth at what depth n rl
Rolling feet feet well
ope clay l; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. 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 An
field for each Garbage Grinder, Spa or Whirlpool Tub. .
Septic Tank: ,/1 U 5 gallon (min. size 1,000 gal.)
Tile Field: each trench Jt. Total System Length: it �C& 6.2716 L9 5/ /J
Seepage Pit(s): number of size of each: Jt. by Jt.
Size of Stone to be used: ll / depth or thickness JCct
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON (please read)
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 by these and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
V
Signature of responsible person Date
it i wiiY LODE APPLICATIONS
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY
9000 HEATING DEGREE DAYS
- a
Compliance hods : PART 5 - Acceptable Practice Method -
1&2 Family Dwellings (only) .
PART 6* - Thermal Rating - Component Trade Offs
1&2 Family Dwellings; Multi-Family
Dwellings (3 stories or less)
PART 4* - Design by Component Performance
Commercial Buildings-Hi Rise Residential
*Requires submission of worksheets
APPLICANT' S NAME : PROPERTY LOCATION:
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1 . Gross Floor Area - square feet
2 . Type of Heat - I- Electric Oil Gas Other
3 . Is building mechanically cooled? Yes A- No
4 . Percentage of area of windows and doors Over 17% L Under 17%
5 . R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS
SHOWN ON PLANS SUBMITTED:
a. Roof R 3 ' '
b. Exterior walls R l9
c . Glazed areas R 2.. 3
d. Exterior doors R
e . Floors over unheated spaces R
f . Edge of slab on grade (heated building)• R
g. Basement/cellar walls (above grade) R
h. Basement/cellar walls (below grade) R
i . Heating/cooling-ducts-piping in unheated space R
6 . Service (domestic) hot water heating device
Conforms to minimum efficiency per code Yes No
TEMPERATURE CONTROL MAXIMUM SETTING 140° - WILL NOT BE EXCEEDED
Applicant ' s Signature Date Phone Number
3 - 2-S -a ( ‘.39- 1765-‘
INSPECTOR' S REMARKS :
ctco A\
RESIDENTIAL FINAL INSPECTION REPORT
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement
Dept.of Community Development Arrive• TV• Depart CIPIIFTown of Queensbury •= tor's Ini ':
742 Bay Road J'
Queensbury,New York 12804
NAME \�\ �( PERMIT# - g
LOCATION ` � e, ` DATE 3 - 2ln—f1Z
TYPE OF STRUCTURE
N/A YES NO COMMENTS
Chimney Height/'3"Vent/Direct Vent Location
Fresh Air Intake
Plumb Vent through roof J,
Roof Complete
Exterior Finish Complete
Interior/Exterior Railings 31"to 36"
Exterior Handrails,balconi::,landing 1: in.or more
Interior Handrails stairs bo sides 3 or ore risers
Grade 2%away from foun. 'on
8"clearance to sill plate
Gas Valve shut-off exposed/ -gulator :"above grade
Gas Furnace shut-off within 3► feet o "thin line of site
Oil Furnace shut-off at entran S. to P. ,:ce area
Furnace/Hot Water Hea - g
Relief Valve(s)installed
Headroom,6 ft.6 in.on stairs
Basement stairs,6 ft.4 in.
Handrail exterior stairs both side-more than 3 risers
Interior privacy/trim/doors/main - trance 36"
Floor Finish
Bathroom/Kitchen watertight
Interior Handrails Balconies/Lan.'. 18 in.or more
Railing across window in stairwells
Smoke Detectors:
every level
every bedroom
outside every bedroom
inter connected
Bathroom fans
Plumbing fixtures
Foundation insulation
3/4 hour fire door/door closer
Garage fireproofing
Garage penetrations sealed
Furnace in separate room protected(in garage)
Light ventilation per room
Safety glazing 18"or less from floor
Final Electrical
Site Plan/Variance required
Final Survey Plot Plan
As Built Septic System layout required
Okay to issue C/C(Certif.of Compliance)
Okay to issue temp.C/O(Certif of Occupancy)_
Okay to issue permanent C/O(Certif.of Occupancy)
p.
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name V)A�� V)eA
Location AA)
Date q-j — 1(Qa-p' Permi t #2��10- 3?
SOIL TV and- oam-Clay-
Results of Percolation Test-
(if applicable) Rate-M' • to/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: 'Fetal Le gth J4tj
Length of each tren h zry
Depth of trenches
Size of stone (_, , 'AC).
SEEPAGE PITS: Numb-r-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank 1-1-11 k _, 6Cik-V.
Tank to Dist. Box " _hC-\
Dist. Box to Field/Pit " E6
Openings Sealed? No artia
LOCATION/SEPARATI+ .
Foundation to Tank v�r— feet
Foundation to Absorption , ..feet
Separation of Pits feet
Conforms as per Plot Plan ;estlo.
LOCATION OF SYSTEM ON PROPER
(circle
Front - Rea - - Side - 'i .ht Sid-
Middle - Middle Rear
COMMENTS: F
SYSTEM USE APPROVED: IWO°
0
Arriv- , .
Dep. ed: Ti
1:4 444
Ming di ng rector
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5EC11ON 45,C31ACK 2,PARCH-19 ° • • • " " • . TOWN 0� Ql EN5C3L11ZY,WPC N COUNTY, NEW YOLK
•° /' < 6 I" - 20' FEI3P.V Y 8, 2001
°, ' I; ;� 1�VI5PI2: FV1312UAKY 20, 2001
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SCL212E!ASSOCIATES
+ ti��`.�''�r•4 • CONS LTING ENGINEEPS
a) ..-- 6-5E5 . 4' • -c
•• • " . • ' GLEN5 FAU.S,IOW Y0112501
TI,: 515-795-I475
FAX: 518-798-3741
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL C?,�,
Panel Board No Cert. N2 7 0 8 9 2 Cut-in Card No. �.1
AA
Dwner „(1 (f r �1 �-• , /
Location -6 . (i a Cc,
Installation Consisting of rf 1 Q e -919., ..9t
Installed By Y`• ~ ,''d dci 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 promptly made for inspection.
Inspectors of this Company shall have the privilege of makin:�AP
at any time, and if its
rules are violated, [ Ir the Company shall have the right to e oke th ate
/j Date ` " d` ' Q INSPECTOR...., e
Member N.F.P.A.,I.A E.I.
to A/
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GENERAL INSPECTION REPORT
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive\ me Depart , 40111°
pector's Initials ems, - • •�=
NAME: C PERMIT# GZf _83
LOCATION: L DATE : / 9 c3e� i
TYPE OF STRUCTURE: _ RUD AL a—Q-•
RECHECK
N/A YES NO COMMENTS
Footings/Piers [
Monolithic Pour Form
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
Foundation/Dampproofing
Backfill Approval 2
Plumbing Under Slab
Plumbing Vent/Vents in Placer'
Rou Plumbing T,
He ing Rough-In
lation
Foundation Walls Inteor R-
Foundation Walls Exrior R-
Floors R-
Walls R-
Ceiling / R-
Duct work or piing in
unheated s s R-
Proper Vent, Atti Vent
Framing
Jack Stu rs
Bracing/B • ging
Joist Han rs
Jack Post in Beam
Air Infiltra • n Barrier
Fire Separa on 1,2, 3,hour
Penetration led
Fire Wall 2, , hour
Firestopping
GENERAL INSPECTION REPORT
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive?: , ep
spector's Initial
NAME: \ PERMIT# 0
LOCATION: DATE : - ? i
TYPE OF STRUC Q\\.(2..n,-0, G- c -r-rx Y)
RECHECK
N/A YES NO COMMENTS
Footings/Piers L
Monolithic Pour Form
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/Walipour
Reinforcement in Place
.r"
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct w•rk or piping in
u i •Bated spaces R-
Pro, Vent, Attic Vent
�.. .:ming R
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2 3,hour
Penetration Sealed
Fire Wall 2, 3,4 hour
p-Firestopping W !7
GENERAL INSPECTION REPORT
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement LI
742 Bay RoadQueensbury,NY 12804 Arrive am/pm DepartInspector's Initials
NAME: u Q-CS) PERMIT#
LOCATION: A,6,y.,-- C f r �` DATE: 'Q G
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsi• •
providing protection fro freezin
for 48 hours following e placem; t
of the concrete.
Materials for this • •• on site
Foundation/Wallpour
Reinforcement\tiqlaf•
Foundation/Damppr•$fing
Backfill Approval
Plumbing Under Sla
Plumbing Vent/Ven'. in Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Wal s Interior R-
Foundation Wal s Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
r Vent, A Vent
naming 'rR j I
Jack Studs/Headers
Bing/Bridging
v /
oist Hangers "
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
7 f 2\
GENERAL INSPECTION REPORT 010✓/ /Ala-
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive am/pm Depart 1 '
Inspector's Initialls�� �
NAME: 4w ;J r2 PERMIT# _ _v
1 "
LOCATION: ' �"^ i.D G lL C_ DATE: 4
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers E
Monolithic Pour Fo
Reinforcement in P ace
The contractor'. re •• 'b1e for
providing pro - ion •, freezing
for 48 hours fo owing e placement
of the concrete.
Materials for this • .•:- on site
Foundation/Wall••u
Reinforcement in ' ace
Foundatio�_ 1 . •,roofing
Back ill Approval
Plumbing Under SI,•
Plumbing Vent/Ve i, in Place
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AA � - ✓ l;)/4)44T1-u- �rd�� /1'? ) & A
Foundation Walls Interior R-
Foundation Walls xterior R-
Floors R-
Walls R- i
Ceiling R-
r ct work or piping in
unheated spaces R-oper Vent,Attic Vent o/ TALL MO�a , 5U p/CM/ 6x7,
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Jack Studs/Headers / 149-4.-C
Bracing/Bridging 7."" l41 9t/1-(C- 4 D o t l�o 4-c- 14F
Joist Hangers / 5 v eak 7-5
Jack Posts/Main Beam c tis- ,�e L 5 4 � oEL
Air Infiltration Barrier
Fire Separation 1,2, 3,hour Fv L y /4) /tLc_ i_14,0 662 5
Penetration Sealed
rWall2. ,4 hour
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SEC11ON�fi3,BLOCK 2,PARCEL 19 . . " ((r�pQ" • • TOWN Of QLEN51319Y,WAfN COUNTY, NW YOI;K
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`�`� , }t r."6 1" - 20' FEI3t;UARY 8, 2001
• `'4 t ;i^ ' REVISEn: FWRUARY 20, 2001
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TEL: 518-795-I475
FAX: 518-798-5747