2005-869 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20050869 Date Issued: Monday, February 26, 2007
This-is to,.certify.that work requested to be done as shown.by Permit Number P20050869
has been completed.
Tax Map Number. 523400-226-015-0001-011-000-0000
Location: 128 LAKE Pky
Owner. ADAMSON IRREVOCABLE TRUST
Applicant: KATHARINE P ADAMSON
This structure may be 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&Co, nfo ent
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:_. P20050869 Application Number: A20050869
Tax Map No: 523400-226-015-0001-011-000-0000
Permission is hereby granted to: KATHARINE P ADAMSON
For property located at: 128 LAKE Pky
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: KATHARINE P ADAMSON Residential Alteration $25,000.00
35 PARK Ave Total Value $25,000.00
OLD GREENWICH, CT 06870
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-869
FOUNDATION UNDER EXISTING CAMP
$40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,November 30, 2006
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queen before the xpiration date.)
Dated at the To of e 97,
ay,November 30, 2005
SIGNED BY w
for the Town of Queensbury.
Director of Building&Code Enforcement
Permit No.
Building&Codes Office-Department of Community Development-Town of Queensbury Fee Paid , v
742 Bay Road,Queensbury,NY 12804 Recreation Fee
Dave Hatin,Director codes@aueensburv.net
Phone: (518) 761-8256 FAX: (518) 745-4437
Principal Structure Building Permit Application
Application & Plans subiect 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 (;US'6rvt RAvi i5gA�- Owner: In> -- Oi>av Db1
Address: /-9I 10• i'`► O(JOLMeL/ 9D1 Address: i 0A
Home Phone: `IiD � � Home Phone:
Email Address: Email Address:
Cell Phone: Lt PIS_W39 Cell Phone:
FAX Phone: 'I';�-- 39"-_?, FAX Phone:
Person responsible for supervision of work with respect to building and codes compliance:
Name: 'rD ew Sc h(AV07L '
Address: CJ Al�rvatil��✓ r�+� Phone
Location of proposed construction: Lot No. Legal Address:
_a
Tax Map Number: �l q ' 1 5 —1 — ` f Subdivision Name:
Estimated Cost of Construction: $ ,00E 12�,
Proposed construction is for: >CResidential Use _Commercial Use RECEIVEt)
Name of Business: NOV 0 1 2005
If proposed construction is an addition, what will use of new addition be? 7®WN OF ot
DI
New Addition Alteration Proposed Construction 1A Floor 2^d floor Other Total Proposed
structure (Occupancy Type) Sq. Ft. sq.ft. Sq. Ft. Square feet Height
Ft.&in.
Single-Family Dwelling
Two-Family Dwelling
Townhouse
Multifamily Dwelling
Number of Units:
Office
Mercantile
Manufacturing
Other. Ce�WL S? i �,1�fz 1 Jri1X�(L S�r�t C
Attached Garage 1, 2, 3
Type of Heating System: Electric, Oil, 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 specified or noted, and that such work is authorized by the owner.
Further, it is understood-that I/we shall submit prior to a Certificate of Occupancy or Certificate of Compliance
being issued, as requested by the Zoning Administrator or Director of Building and Codes, an As-Built Survey by a
licensed surveyor, drawn to scale,,showing actual location of all w constr ion.
Date: �(�'S�l'D� Applicant/Builder Signature:
The application of dated is hereby approved and
permission granted for the construction, reconstruction or alteration 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
Queensbury Building & Code Enforcement - Reside ' 1 F' Inspection
Office No. (518)761-8256 Arrive: a pm a rt: am/pm
DateInspection request received: Inspector's Initial .
NAME: � ,Q VVI� dam. IT
G.
7
LOCATION: ATE:
TYPE OF STRUCTURE:
Comments
Yes No N/A
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
Guards at stairs,decks,patios 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
Interior Handrails @ stairs 2 or more risers
Grade away 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 C,
Bathroom/Kitchen watertight Z�Zp '� b(,0—Pb&
Safety glazing/Window in stairwells safety glazing
Interior Smoke Detectors:
Every level: Every Bedroom:
Outside every bedroom area:
Inter Connected: Battery backup:
Carbon Monoxide Detector
Attic access 30 inches x 22 inches x 30 inches(hei ht)in accessible area
Crawl Spaces 18 inch x 24 inch access, 1 s .ft.-150 s .ft.vents
Bathroom Fans,if no window
Plumbing fixtures
Foundation insulation
Floor truss,draft stopping finished basement 1,000 s .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
Furnace/Hot Water Heater operating
Low water shut-off boiler
Relief Valve(s)installed/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum%z"Gypsum
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fire roofin /3/a hour fire door/door closer
Duct work Sealed properly
Gas Logs in Sealed or Glass Enclosure
Final Electrical
Final Survey Plot Plan
As Built Septic System/Sewer Dept.Inspection Sticker
Site Plan /Variance required
Flood Plain Certification,if required
Okay to issue C/C or C/®[Temporary/Permanent]
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form—revised-1 00405.doc
Queensbury Building & Code Enforcement - Residential Final Inspection
Office No.(518)761-8256 Arrive: - Os:
p—( wpm
Date Inspection request received: Inspector's Init
NAME: M < 0 PERMIT#:
LOCATION: _ DATE:
TYPE OF STRUCT RE:
7r1 unde Com ents
Yes N® N/A
Buildin Nun b r/Address visible from road r/1 V
I�l
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 6 inches ��)C
Roof Complete/Exterior Finish Complete
Platform at all exterior doors
Guards at stairs,decks,patios 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
Interior Handrails @ stairs 2 or more risers
Grade away from foundation 6 inches with 10 feet
6 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18 inches above grade L t�
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells safety glazing
Interior Smoke Detectors: _
Every level: Every Bedroom:
Outside every bedroom area:
Inter Connected: Battery backup: D 2
Carbon Monoxide Detector
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area
Crawl Spaces 18 inch x 24 inch access, 1 s .ft.-150 s .ft.vents
Bathroom Fans,if no window
Plumbing fixtures
Foundation insulation
Floor truss,draft stopping finished basement 1,000 s .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
Furnace/Hot Water Heater operating
Low water shut-off boiler
Relief Valves installed/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum''/z"Gypsum
Basement stairs closed 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
As Built Septic System/Sewer Dept.Inspection Sticker
Site Plan /Variance required
Flood Plain Certification,if required
Okay to issue C/C or C/O Temporary/Permanent
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form revised 100405.doc