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2005-598 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 4z Community Development- Building &Codes (518) 761-8256 CERTIFICATE (--NArE7 OCCUPANCY Permit Number. P20050598 Date Issued: Friday, April 02, 2010 This is to certify that work requested to be done as shown by Permit Number P20050598 has been completed. Location: 57 ELLSWORTH Ln Tax Map Number. 523400-265-000-0001-007-000-0000 Owner. ROBERT & ROBERTA ELLSWORTH Applicant: ROBERT & ROBERTA ELLSWORTH This structure maybe occupied as a: Residential Addition 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. Permit N Building&Codes Office-Department of Community Develogm ( ,1own of Queensbury Fee 742 Bay Road,Queensbury,NY 128044)I" ReCre Dave Hatin,Director codes@aueensburv.net Phone: (518) 761-8256 FAX: (518) 745-4437 Principal Struchke—Builc ng Permit Application Application & Plans subject to review before issuance of a valid permit for construction Instructions: A permit must be obtained before beginning construction. No inspections will be made until the applicant has received a valid building permit. All applicants' spaces on this application must be completed and must appear on the application form. Applicant/Builder /►� le7d64; ;n6l _ Owner: Address: lao7 j2 Address: STllSt�tH, / � yC lysy 5- Home Phone: :Z 9' -U i SU Home Phone: S/ 8' 79 Z2-UfSo Email Address: Email Address: Cell Phone: Cell Phone: FAX Phone: `7f - V9419 FAX Phone: '7 " -c/.'e/? Person responsible for supervision of work with respect to building and codes compliance: Name: Address: Phone Location of proposed construction: Lot No. Legal Address:T�f (it P, + Q t e— Tax Map Number: Estimated Cost of Construction: $ Proposed construction for: :ZResidential Use _Commercial Use Name of Business: If proposed construction is an addition,what will use of new addition be? 03 New Addition Alteration Proposed Construction 1.t Floor 2nd floor Other Total Proposed structure (Occupancy Type) Sq. Ft. sq.ff. Sq.Ft. Square feet Height Ft.&In. Single-Fa l Dwelling Two-Family Dwelling Townhouse Multifamily Dwelling Number of Units: Office Mercantile Manufacturing Other: X ' Attached Garage 1, 2, 3 � •4� Type of Heating System: Electri Oi), Gas, Wood, Forced Hot Air, Baseboard, Other: Is a fireplace and/or woodstove being installed, please refer to a separate application. —Yes :!No Applications are subject to Zoning Administrator, Code Compliance, and Structural Plan review. The Building and Codes Office will allow commencement of your proposed project only after issuance of your permit. Declaration: Please sign below after you have carefully read the statement: To the best of my knowledge, the statements contained in the 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 Codes, the Zoning Ordinance, and all other laws pertaining to the proposed work shall be complied with,whether 'pecified or noted, and that such work is authorized by the owner. Further, it is understood that I/we shall submi 'or to a Certificate of Occupancy or Certificate of Compliance being issued, as requested by the Zonin dministrator or Director of Building and Codes, an As-Built Survey by a licensed surveyor, drawn to scale, s ing actual location of all w construction. Date: pplicant/Builder Signature: G The application of dated is hereby approved and permission granted for the construction, reconstruction or alter tion of a building/and or accessory structure as set forth above. Date: Authorized Signature: L:\Sue Hemingway\Building.Permit.FORMS\Principal Structure Permit Application,doc V:12/14/04 a 3 � �xs� �Ns C\©Sze C1CGsc� } t e 1 ©� Poo c3 r � k 3 ��` f NOTICE FOAM INSULATION MUST EL C BY A 15 MINUTE THERMAL FBA. NOTICE rr KRAFT PAPER INSULATION MUST F COVERED BY NON$COMOUST;r'[_n. ,ul . �tor G3�G T`" BUS +� &j�= EPT ON !/ s Lv\NCfit. yr1Kdow { a FILE COPY 1 rr r� i i 5' i r 10 qu_ v_ r o L—L Q � t t } / t } I S9S JI I ' ► t t t ► '� s , E w r � s CL 4— � n 71 CC) Nk- LA x 1 d S' ' s y; N Ih 4 �' ,x X. A 1 -lo Ic U � n c r COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 176 Doe Run Road-Manheim,PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL lermit No...... .. . Cert. N2 10061 Cut-in Card No..................................... )wner........X1...... ................................................................................................... ,ocation... .......&-X. .7— ristallation Consisting of... ........................... A...../P....Pz-..7'0x ..aA ................................................................I......................................................................................................... ristalledBy..................................e...... 7. ...Lic.No................................................... The conditions following governed the issuance of this certificate,and any certificate previously issued is ancelled:- This certificate only covers the electrical equipment and installation conditions as of date. Upon the itroduction of additional equipment or alterations,application shall be promptly made for inspection. Inspectors of this Company shall have the privilege of making inspections at any time, and if its i ules are violated,the Company shall have the right to reyake s rt)r Ic ate. )ate.... ............. INSPECTOR Queensbury Building & Code Enforcement - Reside Final Inspection Office No. (518)761-8256 Arrive: z�, amlpm rt: am/pm Date inspection request received: inspector's initials: NAME: Is LJ6 PERMIT#: LOCATION: DATE: TYPE OF STRUCTURE: Comments: Yoo No W 4' Building Number Address visible from road 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 atios 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 Bracin /Handicapped Ramp Compliant Grade mmy 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 Sa lain /Window in stairwells safety glazing Interior Smoke Detectors I Carbon Monoxide Detectors Every level: Every Bedroom: Outside every bedroom area: Inter Connected: Batte backu Attic access 30 inches x 22 inches x 30 inches(height)in accessible area Crawl Spaces 18 inch x 24 inch access, 1 N.ftA 50 sq.ft.vents Bathroom Fans,if no window Plumbina fixtures Foundation insulation i 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 Furnace shut-off at entrance to furnace area Fumace/Hot Water Heater op±rating Low water shut-off boiler Relief Valves installed/Heat Trapt Water Temp 110 Enclosed Stairs Sheetrock Underside minimum W Gypsum Basement stairs dosed rise>4 inches Garage Floor Pitched Garage fireproofing/%hour fire door/door closer Duct work Sealed rt Gas Lolls in Sealed or Glass End re Final Electrical Final Survey Plot Plan Arc Fault Breaker in Bedrooms Flex Gas Pipe Bonding As Built Seoc System I Sewer Dept. In ction Sticker Site Plan /Variance required Flood Plain Certification,if re aired Okay to issue C/C or C 10 1 Temporary/Permanent L:1Buibding&Codes FormslBuilding&Codesllnspection FormslResidential Final Inspection Forrri_revtse0_100405.doc;Revised January 7,2008;Revised 6/26/08 Rough Plumbing I Insulation Inspec ion Report Office No. (518) 761-8256 Date Inspection request received: C� q,3 c Queensbury Building & Code Enforcement Arrive: am/P Dart: am/pm 742 Bay Road, Queensbury, NY 12804 Inspector's Initials: 1421 �� � �-�--t .��'''ram- NAME: PERMIT #. v����� LOCATION: INSPECT ON. �C TYPE OF STRUCTURE: i� -,_ Y N N/A Rough Plumbing / Nail Plates \Id Plumbing Vent/ Vents in Place 1 1/2 inch minimum Drain Size Washing Machine Drain 2 inch minimum Cleanout every 100 feet/ change of direction Pressure Test Drain / Vent Air / Head � � r 5 P.S.I. or 10 ft. above highest connection for 15 minutes Pressure Test Water Supply Piping 61-1 3� Air/ Head .I for 15 minutes Insulatio 1,-ZAesidential Check/ Commercial Check Proper Vent Attic Vent Duct/ Hot Water Piping Insulation If required unheated spaces Combustion Air Supply for Furnace Duct work sealed properly / No duct tape COMMENTS: LAPam Whiting\Building&CodesUnspection Forms\Rougb Plumbing Insulation Report.revised Nov 17 2003.doe Revised February 15,2005 Framing / Firestopping Inspection Report / Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ Depart: m/pm 742 Bay Road, Queensbury,NY 12804 Inspector's Initials NAME: C%-5 G,Joe%F( PERMIT#: �J LOCATION: INSPECT ON: Z TYPE OF STRUCTURE: Y N N/A COMMENTS Framing Attic Access 22"x 30"minimum Jack 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 Headroom 6 ft. 8 in. Notches/Holes/Bearing Walls Metal Strapping for Notches Top Plate 1 '/2 w 16 gauge 8) 16D nails each side Draft stopping 1,000 sq. ft. floor trusses Anchor Bolts 6 ft. or less on center Ice and water shield 24 inches from wall Fire separation 1,2, 3 hour F e wall 2, 3,4 hour Firestopping Penetration sealed 16 inch insulation in cavity min. Garage Fire Separation House side Yz 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 Framing / Firestopping Inspection Repo C Office No.(518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pRn� Depart: a pm _ �} 742 Bay Road,Queensbury,NY 12804 Inspector's Initials: NAME: PERMIT#: LOCATION: — S 'C SPECT ON: TYPE OF STRUCTURE: Y N N/A COMMENTS Framing Attic Access 22"x 30"minimum S t'r Jack Studs/Headers ���_!�' IJ Gam'Ij 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 Headroom 6 ft. 8 in. Notches/Holes/Bearing Walls Metal Strapping fo Notches Top Plate I %2 w 16 gauge 8) 16D nails each side Draft stopping 1,000 sq. ft. floor trusses Anchor Bolts 6 ft. or less on center Ice and water shield 24 inches from wall Fire separation 1, 2, 3 hour Fire wall 2, 3,4 hour / Firestopping Penetration sealed 16 inch insulation in cavity min. '\ Garage Fire Separation House side '/2 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 I r ELLSWORIH� f t Too T_ 4 LOCAl1fJVV MAP SCALE: f" 1 W& m � c v 0 CAPPED IRON ROD FOUND NOW OR FORMERLY NOW OR FORMERLY LANDS OF LANDS OF TRACY B. STEVENSON CHARLES & SHIRLEY STEVENSON LIBER 1332, PAGE 185 USER 44A PAGE 591 TAX MAP: 265.00-1-10 � TAX MAP: 265.00-1-11 1 20' WIDE RIGHT OF WAY FOR INGRESS & EGRESS AND FOR U71LI71ES, - WOODED AS DESCRIBED IN DEED DIET CAPPED IRON TO ELLSWORTH IN USER ROAD IRON RAD FOUND CAPPED #RAN 1414 AT PAGE 74 RODS 8356 44 E 1744.32' NONNI S 8276 48•E ROD FOUND ATV : CAPPED ERAN ��_ —— r- S 8226W E IRA& RAD FWAO CAPPED NM 4so.�� ............. - —— •• - FOUND ,• �`�� — _ I _ — — ..... _ 875.01 � ................ ROQ Np &GARAGE \ �� 20.5 04' EXCAVATED �. — \ \\ UM PACE 'S`pin - _ POrE d yAREA / \ NM 6 b J1 •' - OvERHEAD wtREs NM 6 NWOODED GIRT `DRI BA57N / YYT 2712 GtTCN / \ BASS u ` u NOW OR FORME7?L2 STORY \ \ UXL PaEWOOO FRAME HOUSE 1 / / �-� 1 � CULVERT _� LANDS OF Q LANDS OF L (UNDER CONSIRUC170N) EE£CTRIC I / �, \ r (ELECTRIC i ROBERT A. ELLSWORTH 4E _ LIBER 653, PAGE 877 1 �' ° NOW OR FORMERLY / P� � ? BARN V I (11/5104) 7RAN51�ORAfER� / 3 �. uN0ERQ40uN0) z RUBEN W. & DANA J. ELLSWORTH � � � _ ,/ :+r . _ �!j \ / \ TAX MAP.- 265.00-1-6 o `� .N USER 1414, PAGE 74 � o gsPyALT — — — / ,� o LANDS OF r -- —— _ i J c • POLE 5 ! =RI�LWAY / a/LVERTJ `t ROBERT A. ELLSWORTH '� — — — r ix A O N { 1 TAX MAP: 265.00-1-9 — J A LIBER 1033, PAGE 293 GARAGE M j• �'��.^� iy�� TAX MAP: 265.00-1-8 I NOW OR FORMERLY � RAO FOUnow CAPPED ND i Wf 14. 19 ACRESf ti ROBERT A. ELLSWORTH NM 5 LANDS OF CAPPED IRON _ Oun: POLE A00 romoD :z WOODED LIBER 653, PAGE 877 O TAX MAP: 265.00-1-7 NOW LANDS OR FORMERLY • 12"MAPLE - 9"MAPLEAWN C. OAND & JANET JENKINS i w/ WIRE W/ WREI.E W/WIRE Foum USER 513 PAGE 441 2 I Ej w dCrLN1RE FENCE .�� TAX MAP: 265.00-1-5 STAKE er N 83 40'08" W f283 02' 5*05 '» — 6 �.. 375.32' ° STONES �_ N 85Y1532 W N 86 42'3#" W �' LINES AS SHOW4 ON MAP REFERENCE NO. 1 I a I NOW OR FORMERLY `/�\!//lflXl• TNDS OF �"F��`d`.� A'��i O 9 ZUOS SCO SPELLBURG UBER 1217, PAGE 86 TAX MAP: 265.00-1-2 I HEREBY CER77FY TO: RUBEN W. ELLSWORTH AND DANA J. ELLSWOR77-1, HSBC MORTGAGE CORPORA77CK (USA), ITS SUCCESSORS AND/OR ASSIGNS AND 57EWART TIRE INSURANCE COMPANY, THAT THIS MAP WAS PREPARED FROM AN ACTUAL FIELD SURVEY PERFORMED ON 774E SUBJECT PREMISES AND THAT THE SITE IMPROVEMENTS SHOWN WERE NOTES MAP ROOM WE DEED REFERENCE LOCATED DURING THE SAID FIELD SURVEY, AND ARE AS SHOWN HEREON. 1) FIELD SURVEY PERFORMED ON NOV. 5, 2004. 1) MAP ENTRED: IMAP OF A SURVEY MADE FOR DANA NORTON", ROBERT A. ELLSWORTH NOV. 5, 2004 e �- MADE BY VAN DUSEN & S7EVES, DA TED JUL Y 15, 2002 AND TO 2) THIS MAP IS SUBJECT TO WNA7EVER FACTS MAY BE LAST REUSED ON DECEMBER 12, 2002, RUBEN W. ELLSWORTH & DATE DONALD L. PI EON REVEALED BY AN UP-TO-DATE 77TLE REPORT OR DANA J. ELLSWORIN N.Y.S. LTC. NO. 50 7 ABSTRACT OF 77T7-E. DID. SEP7FMBER 9, 2004 3) SUBJECT TO ALL RIGHTS PRIVILEGES, RESTRICTIONS, LIBER 1414, PAGE 74 COVENANTS AND EASEMENTS OF RECORD. TAX Y)P ICE 4) ONLY COPIES MADE FROM THE ORIGINAL OF THIS SURVEY SECTION 265.00, BLOCK 1, PARCEL 9 MAP WHICH ARE MARKED WITH AN ORIGINAL OF THE LAND SURVEYORS SEAL AND BEARING 774E SURVEYORS ORIGINAL SIGNATURE IN RED INK, SHALL BE CONSIDERED TO BE VALID AND TRUE COPIES. 5) UNAUTHORIZED ALTER4TION OR ADD177ON TO A SURVEY SURVEY & MAP MAPOFMAP BEARING A LICENSED LAND SURVEYORS SEAL IS A SURVEY SHOWING SITE IMPROVEMENTS A VIOLATION OF SEC17ON 7209, SUBDMSION 2, OF NE BY THE NEW YORK STATE EDUCATION LAW. . .d Q is P� DONALD L. Plt7GEURf, Jr. PREPARED FOR LICENSED LAND SURVEYOR RUBEN W. & DANA J. ELLSWORTH o N.Y.S. LICENSE NO. 50372 1 I HA L ROAD SITUATED IN' s la c E , 5031'L FORT EDWARD, NEW YORK 12M TOWN OF QUEENSBURY, WARREN COUNTY, NEW YORK LAND ,. . (518) 792-4146 SCALE. I" = 100' NOVEMBER 5, 2004