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2003-645
TO" OF QUEENSBURY 742 BayRoA Queensbury NY 12804.5902 (518)761.8201 Community Development=Building&Codes (518)761.8256 fir - rE CY U.'ft"'I'I F I C. OCCuPAN Permit Number. P20030645 Date Issued; Thursday,December,06, 2007 This is to certify that work requested to be done as shown by Permit Number P20030645 has been completed. Location. 60 RAINBOW Trl Tax Map Number. 523400-279-015-0001.059-000-0000 Owner, GREGORY&PAMELA VALASTRO Applicant: GREGORY&PAMELA VALASTRO This structure maybe occupied as a: Fireplace By Order of Town Board Garage-2 Cars Attached TOWN OF QUEENSBURY Residential Addition, Issuance of this Certificate of Occupancy DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, �` G 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. TOVN OF QUEENSBURY 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building-&Codes (5 61-8256 BUILDING PERMIT Permit Number: P20030645 Application Number. A 0030645 Tax Map No: 523400-279-015-0001-059-0.00-0000 Permission is hereby granted to: GREGORY &PAMELA VALASTRO For property located at: 60 RAINBOW TrI Umber: A in the Town of Queensbury,to construc rlace plic 59 0 tIM at the above location in accordance w�h applicatio together,'with plot plans and o r hereto filed U2and approved and in compliancevio the NYS ,d the Que b Zoning Ordinance. Type of Constructi Value Owner Address: GRE9ORY&PAMELA VALASTR INBOW Trl Fireplace 10 Garage-2 ttached QIU ENSBURZY,NY 12804 ftial 4Ad E Resid n $13,000.00 Total lue $13,000.00 Contractor or Builder's Name Ad. s,, Electrical Inspection jFncy Plans &Specifications 2003-645 692 SQ FT RESIDENTIAL ADDITION AND 658 SQ FT 2-CAR ATTACHED GARAGE AS PER PLOT PLAN SPECIFICATIONS $140.84 PERMIT FEE PAID- THIS PERMIT'EXPIRES: Wednesday,August 22, 2007 (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.) 0pl Dated at the To of ens ugust 12,2003 SIGNED BY *1 for the Town of Queensbury. Director of Building&Code Enforcement f . TOWN OF QUEENSBURYY 742 Bay Road,.Queensbury, i 12804-5902 (518)76178201 Community Development=Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030645 Application Number: .: A20030645 Tax Map No: 523400-279-015-0001-059-000-0000 Permission is hereby granted to: CTRECiORY&PAMELA VALASTRD For property located at: 60 RAINBOW; TrI 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.Uni£orm Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: GREGORY&PAMELA VALASTR 60 RAINBOW Trl Garage-2 Cars Attached NY 12804 Residential Addition $13,000.00 QUEEN5BURY Total Value $13,000.00 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2003-645 692 SQ FT RESIDENTIAL ADDITION AND 658 SQ FT 2-CAR ATTACHED GARAGE AS PER PLOT PLAN SPECIFICATIONS 1 $140.84 PERMIT FEE,PAID-THIS PERMIYEXPIRES: Monday,August 22, 2005 (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 th ow, f Que sb ; F iday,August 22,2003 SIGNED BY for the Town of Queensbury. Director of Building&Co e Enforcement Building Pe*rmit Application Town of Queensbury-Dept of Community Development,742 Bay Road, Queensbury,NY (5 18)761-8256 A permit must be obtained before beginning construction. Permit File No,,:74�0_3 —(Q1 No inspection will be made until applicant has received a Fee Paid $ valid building permit. All applicants' spaces on this Rec. Fee Paid application must be completed and must appear on the Reviewed By: , application form. Applicant: �,cecvjfu �.�nq�JrAasAY6 Owner: Ift%vow" �Q Qmckco Address: GO Address: ()&a- kyul JaW Phone Phone# Email Address:� VR\ ess:keiN CQ'ft) Email Property Location: Lot Number: House Number Subdivision Name: T ax M ap Aumber -7 L3 New Building: residence /commercial Estimated Market Value of Construction: $ Addition: e--r-es-i—de-fi--ce�> commercial "-fe3tde-n-c`e/ commercial If an Addition,what will use of new addition be? 13 Alteration: U No change to exterior size: residence com'l C3 Other work(describe Check OccupancyInformation 15'Floor 21d Floor Other floor Total 0 Beh w sq.ft. sq.ft. sq.ft. Square Feet UK Single family dwelling &MM (r,Iq 72y- 0 Two family dwelling 0 Townhouse C3 Multifamily dwelling #of units U Office 0 Mercantile U Manufacturing U 1 car detached garage U 2 car detached garage E3 3 car detached garage— 0,010 =Waft 0 1 car attached-garage__ attached g4Ka,;Ed- 2 car A ❑ -3-dar-attached garage t*"9 U Storage building- commercial ai U Storage building- residential C3 Other What is the proposed height of the structure feet inches Will any second-hand or ungraded lumber be used? If so, for what? Type of Heating System: electric/(bi t gas/wood for ced hot air baseboard t other: Number of Fireplaces to be installed Number of Woodstoves to be installed List below the person(s)responsible for supervision of work as regards to building codes: Name Address Phone Number Builder Q•m e,Aw,�h �I ak' U Fi -7 q 5-�Vp I Plumber i\1ni A,-A Mason vetnrl. S'2 G Electrician MA MC,—Fj (tc, S%Q k Declaration: please sign below after you have carefully read the,statement; To the best of my knowledge the statements contained in this application,together witli 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 I/we shall submit,prior to a Certificate of Occupancy or Certificate of CompliancQ 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 new construction. 21 3L V,Signature: 1 er wrier's agent,architect,contractor d, ENERGY CODE COMPLIANCE APPLICATION TOWN OF QUEENSBURY, WARREN COUNTY 9000 HEATING DEGREE DAYS Compliance Methods:Part 5 -Acceptable Practice Method— 1&2 Family Dwellings(only) Part 6*-Thermal Rating—Component trade Offs 1&2 Family.Dwelling; Multi-Farriily 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: f 1. Gross Floor Area"- --- square feet 2.. Type of heat- Electric_ Oil Gas Other 3. Is building mechanically cooled? yes 1/ . No 4. Percentage of area of windows and doors 4 Over 17% Under 1'7% S. R VALUES FOR INSULATION GIVEN BELOW MUST CORRESPONDS TO R VALUES AS , SHOWN ON PLANS SUBMITTED: a: Roof " R b. Exterior walls C. Glazed areas �l- b d. Exterior doors RD .2 v e. Floors over unheated spaces R f. Edge of slab on grade(heated.building), R g. Basement/cellar walls-(above grade) R n, h. Basement/cellar walls(below.grade). R i. Heating/cooling-ducts-piping in unheated space R 6. Service(domestic)hot water heating device V"Yis Conforms to minimum efficiency per code No TEMPERATURE CONTROL MAXIMUM SETTING 140—WILL NOT BE EXEEDED Applicant's Signature Date Phone Number INSPECTOR'S REMARKS: Fire Marshal'$Office 'Town of Queensbury,742 Bay Road,Quecz;sbury,NY (518)761-8205 Application for Fuel Burning Appliances & Chimneys applicable to solid fuel & vented gas appliances ;,µr Permit No, �- " Date ( a 20 —�� 5 Application is hereby made to the Building& Codes Office for the issuance of a Building and Use Permit pursuant to the.New York State Fire.Prevention and Building Code. The applicant or owner agrees to comply with all applicable laws, ordinances, regulations, and all conditions that are part of these requirements and also will allow all inspectors to enter premises to perform required inspections. NOTE to applicant: Rough-in and Final Inspections are required. Applicant Information Fuel Burning Appliance Information (circle appropriate words) Stove: wood coal pellet gas Name: { t' r Fireplace insert i. Fireplace, factory-built: wood; gas Address 1,'' ? r)r, i�= .:.{> l 1r'1. Fireplace, masonry: wood gas Furnace: wood gas oil l Phone: provide If non-masonary applicance, please p `' -�.1 ttRi Manufacturer Name: Owner: t. Address: _ Model Number: Chimney Information Phone: 'j 1`I` (circle appropriate words) ( t Masonry block 1. brick stone Flue the steel Vim} size: inches i 4 � r Exact Address: 191*'- ¢ t't , t _<_ t4 of construction or histallation Factory-Built Manufacturer name: Model Number: Note: Listed By: Number. Construction/.Installation inust core orrn to NY�S Fire Prevention &Building Indicate(circle) chimney material: Code. Consult available Torun of Queensbuo, Handouts regarding required inspections. Double wall / Triple wall / Insulated / Direct venting Chimney Liner C�>�h�[ is Depaa me t=-Tp��rr, ;o„f Q een�rbuz-y, New 7[norA: Fire Marshal Code# $Collected $Refunded Received fi onr (refunded tl3):� ."t♦___.,�tc'� address: 3 A 173 3389 (190) Public Safety - A 233 2.655 (230)Minor Sales _ r V t DATE. White(Applicant) / Green(Fire Marshal) / Yellow(Bldg.Dept.) / Pink&.Goldenrod(Cashier's Dept.) Q14eensbury Building & Code Enforcement Resi ial Final Inspection Office No.(518)761-8256 Arrive: D Date Inspection request received: Inspector's Initi NAME: P IT M LOCATION: -7 TE: TYPE OF STRUCTURE: Comments Yes, No N/A Building Number/Address visible from road V, Chimney Height/"B"Vent/Direct Vent Location Fresh Air Intake 3 inch Plumbing Vent through roof minimum 6 inches Roof Coalete/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 V 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 V Interior privacy/trim/doors/main entrance 36 inches IV A Bathroom/Kitchen watertight V/ 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(height)in accessible area Crawl Spaces 18 inch x 24 inch access, I sq.ft.-150 sq.ft.vents Bathroom Fans,if no window Plumbing fixtures Foundation insulation 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 urn Water Heater operating ow watershut-off boiler Relief Valve(s)installed/Heat Trap/Water Temp 110 Enclosed Stairs Sheetrock Underside minimum Y2"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/0[Temporary/Permanent L:\Building&Codes Forms\Building&Codes\Inspection Fonns\kesidential Final Inspection Form revised 100405.doc Towel of Queensbury Fire Marshal 742 Bay Road Queensbury,NY 12804 761-8205/761-8206 fax 7454437 Factory Built Wood Burning Fireplace/Move Insnection Report Notice:New York State requires that all UL Listed,factory built appliances be installed according to the instructions and specifications contained in the Installation Manual accompanying the appliance.No deviation from the manufacturer's 1 instructions tor specifications is allowed. ? Permit# (�`V� Schedule Inspection l``i u-Oq Time a , pain nytime Inspector 5 U Name alfl Address (01 1 Vl (}Z� a Rough In Finap� Appliance Manufacturer GX j' � Model# 0121y A F Masonry Chimney Factory Built Chimney Flue Size Double Wall Triple Wall Insulated Yes No N/A Comments Floor Protection Clearances to Combustibles (all sides) S �4 t (/� f d`Li c�►11 Safe Strip Installation(fireplaces only) SN V�'PO ji; CtJl ty P ( y) � L ['�tze-A � 11,11 Firestop(s) vertical Chase Wall Penetration Chimney Clearances to Combustibles Chimney Termination 3 feet above roof penetration;2 feet above any combustible construction within 10 feet Combustion Air 4VX401 Hearth Extension 9', i-teT,- 2 Mantel(height above f1p opening) �i Ve c)F Fireplace Doors/Screen (required) V White—Building Dept. Ye114 Cust n►er fink—Fire mar.'M R 1 COMMONWEALTH ELECTRICAL INSPECTION SERVICE, INC. Main Once 176 Doe Run Road -Manheim, PA 17545 i w MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL 4 PeffC t No, , site # 1#6I#I1Iof list11itr1trttt e l 0 3 16 8 Cut-in Card No'�rlliri1rr11•H/ilrlRttf�rrr�tf•rIf# 3 0 j}+►� aim' �i VQ'� "/ N +tillftiffirffrti#Irr#I�er#tIr#ter # 44I00ri1 fff!••e• r# i IiN11ri1E11.1i►f1•If#•fii•i•!••if1••!if!••riffif#!•f tr#e i#IIiiN#f•••#rR•# ••r� ##IiI I11.1iH / /61 Location/ter• #tet/iNiiNDO 11 iisoilffifl#.r1oilsee/1i1i1e1lre#N##lilt#I11#N#ilsttl#it•I••ttittitt111111ftit#I tils#1i1iN1ll#i!t7'tilalltlli#Iir#t1 Installation Consisting of,,, f .lfe ..•r•tr.rr.ii#Ire r# rin#rrall#lillleliliiltl#IIi•►•ff•N•••!t•eer•rfrr•I#ri##It#s##11#•N!#•!I.leeefal•rwfneM i /V ' IIifees••R••rReN•NIUIeii1.111ri1#NoilfII1RI H i• fir •fse•f•fR•Irit#1IIIHINi#s#isflll##I#1e##llitfiii•iss#uf••i••lffipiR•lrfrrt�6116L� N tf#q/Nlfftfr#titiitliHi ire#tol of#f#ift ltttt l too ofrlrfrltil#!too l too lMNti to#•f4 t•o##ff to Ito##16#01•oo#li too!!#r off M I sil lid Ito#sif too of!$/Ito It##i•f II!nifrfr#Ito I11rr1#406 test A Malta 1211#••11e••r•r6 14By,,,,, t Installed •#e•f1fNr••#leelell#Iir#sit!#eisees!1fi!•1i1le11ifoss•fleftrrf•ri1#•ef1•Ifrft•#rRlrrf ice No. ff1#.#fIf•1111tf tlt•t1i#1II111#IfeM##ff1###tt1l11 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 makl inspections at any time, and if its rules are violated, the Company shall have the right t ,re ke- 'is rtif is I t '�*t li1•r1#►1#tf#oNt••f1R••1R1 1lleeifofifffff!•••111 INSPECTOR•#ii•# I i Ito 1 too I.1momef see eft#•e•t•Iu1n•fllli16Nl�#••Nslu•soft 61111110816#114i Member NAPeA1,1AIJ1t• r v Queensbury Building & Code Enfofrcement- Resi I Final Inspection '-jRe Si "Yfice No.(5 18)761-8256 Arrive: M Date Inspection request c ived: it Is Inspector's Initials. NAME: IT#: LOCATION: IrE.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 thrq�ugh 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 Well Interior/Exterior RailingKI 4AT6es t9�es V, Interior Handrails @ stairs 2 or mor6-ffisers 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 Bathroom/Kitchen watertight V\ S*ty glazing/Window in stairwells safety glazing Interior Smoke Detectors: Every level: _ Every Bedroom: Outside every bedroom area: Tt�,AQ Inter Connected: Batterybackup: Y 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, I sq.ft.-150 sq.ft.venti Bathroom Fans,if no window Plumbing fixtures Foundation insulation Floor truss,draft s!oging finished basement 1,000 sq.ft. Emergency egress below grade Pl— 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 Relief Valve(s)installed/Heat Trap/Water Temp 110 —7— Enclosed Stairs Sheetrock Underside minimum 0 Gypsum Basement stairs closed rise>4 inches Garage Floor Pitched ai I -gHage fireproofing/1/4 hour fire door/door closer Duct work Sealed properly Gas Logs in Sealed or Glass Enclosure Final Electrical Final Survey Plot Plan V�k As Built Septic Sy stern/Sewer Dept.Inspection Sticker_ Site Plan /Variance requiredn .Flood Plain Certification, ' re ire_&1' Okay to issue C/C 6rO/_q,:r;Kemporary Xir—Manent L1__`1_ L-1-0001, L:\Building&Codes Forms\Building&Codes\Inspection Forrhs\Residential Final Inspection Form revised 100405.doc Framing /Firestopping Inspection Report /T Office No. (518) 761-8256 Date Inspection request received: 1 Queensbury Building&Code Enforcement Arrive: —am/ ep rt: U pm 742 Bay Road, Queensbury,NY 12804 Inspector's Initial -7�/ 3 NAME: PERMIT#: 0 - LOCATION: -INSPECTON: /0=a2—P3 TYPE OF STRUCTURE: Y N N/A COMMENTS Framing \)s-—Sg� Jack Studs/Headers Bracing/Bridging Joist hangers Jack Posts/Main Beams Exterior sheeting nailed properly 12"O.C. Headroom 6 ft. 8 in. Stairwells 3 6 in. or more Headroom 6 ft. 8 in. Notches/Holes/Bearing Walls Metal Strapping for Notches Top Plate 1 V2(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 snow 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 V2inch 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 L-.\SueHemingway\Building.Codes.Inspection.FORMS\FramingFirestopping Inspection Report.doc January 28,2003 V Town of Queensbury Fire Marshal 742 Bay Road Queensbury,NY 12804 761-8205/761-8206 fax 745-4437 Factory Built Wood Darning Fireplace/Stove Inspection Report Notice: New York State requires that all UL Listed,factory built appliances be installed according to the instructions and specifications contained in the Installation Manual accompanying the appliance.No deviation from the manufacturer's instructions }or specifications is allowed. F �3 �lS 1 / Inspector. 3- K� e � Schedule Ins echon Time m anytime p p y Name Address t o o �/!t 'Y y�J i % Rough InX Final Appliance Manufacturer j - U Model# 1Masonry Chimney Factory Built Chimney.X Flue Size Double Wall/-Triple Wall Insulated, Yes No N/A Comments Floor Protection Ijo Coco fA&V6/J Ge Clearances to Combustibles all id � e& o AOAI-OR ,� Safety Strip Installation(firepizces only) l 1 kw4 I- rOyj 4 Firest6lp(S) Vertical Chase Wall Penetration Chimney Clearances to Combustibles � DK ' G 6, Chimney Termination �� � el 3 feet above roof penetration;2 feet above any combustible construction within 10 feet II Combustion Air R Hearth Extension IK A j IV -�� Mantel(height above f/ opening)� g p p � A40-f � 1 Fireplace Doors/Screen {required 7� White—Building Dept. YeIlo —C mer /Pink— Marshal UQ� ` (� Ce, ��� � 1 p 1 -tJ ` � 4 . Foundation Inspection Deport ,3 Office No. (518)761-8256 Date Inspection request received: ill Queensbury Building&Code Enforcement Arrive: am/ Depart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: NAME: PERMIT#: LOCATION: _ ) INSPECT ON: -,1- 3 TYPE OF STRUCTURE: Comments Y N NIA otings Piers Monolithic Slab 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 Foundation/Waterproofing Type of Dampproofmg/Waterproofing Footing Drain Daylight or Sump. Footing Drain Stone: 1.2 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:1SueHemingway\Building.Codes.Inspection.FORMS\Foundation Inspection Report.doe January 28,2003 Rough Plumbing Insuiation Inspection Report `', Office No. (518)761-8256 Date Ths ection req cei Arrive;Queensbury Building&Code Enforcement a m 742 Bay Road,Queensbuiy,NY 12804 Inspec s Init* I PERMIT#: 2 NAME: LOCATION: n C)'le-A C"t -v-fA r INSPECT ON: TYPE OF STRUCTURE: U Y N N/A PVC: R-1,R-2,R-3,R-4 Drain Vents Cast Iron,Copper Drain/Vent Comm. Plumbing Vent/Vents in Place Rough Plumbing/Nail Plates Head or Air Supply Test Drain and Vents 5 PSI or 10 ft. above highest Connection for 15 minutes Water Supply Piping Copper Commercial Copper, CPVC,Pex One&Two Family VInsulation/Residential Check/Commercial Check Proper Vent,Attic Vent _AZ Duct/Hot Water Piping Insulation If required unheated spaces Combustion Air Supply for Furnace Duct Work Sealed Properly COMMENTS: �L.-\Suel-lemin6-%vay\Building.Cades.Inspection.FORMS\Rough Plumbing Insulation Report.doc January 28,2003 Z/ � Framing / Firestopping Inspection Report Office No. (518) 761-8256 Date Inspection req rece* ed 0 Queensbury Building&Code Enforcement Arrive: a p e rt: i a pm 742 Bay Road, Queensbury, NY 12804 Inspector's Initia NAME: PERMIT#: LOCATION: 6'o INSPECT ON: TYPE OF STRUCTURE: Y N N/A Framing COMMENTS 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 snow shield 24 inches from wall Fire separation 1, 2, 3 hour Fire wall 2, 3, 4 hour Penetration sealed 16 inch insulation in cavity min. Garage Fire Separation House side V2 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 L:\Suel-lemingway\Building.Codes.Inspection.FQRMS\Framing Firestopping Inspection Report.doc January 28,2003 Framing / Firestopping Inspection Report Office No. (518) 761-8256 Date Inspection req I iv Queensbury Building&Code Enforcement Arrive: p part: am/pm 742 Bay Road, Queensbury, NY 12804 Inspector's Initi NAME: N& A-45-T-Q-0 - PERMIT#: _L4�7 LOCATION: INSPECT ON: 2. TYPE OF STRUCTURE: Framing Y N N/A COMMENTS 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 I Y2(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 snow 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 1/2 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 L:\SueHemingway\Buildin-..Codes.Inspection.FORMS\Framin.-Firestopping Inspection Report.doc January 28,2003 06/NY2004 TUE 9;38 FAX 15188282368 UFP-327 Design 9001/005 { .r 4 P&R TRUSS #327 11 FALLS INDUSTRIAL PARK RD HUDSON, NEW YORK 12534 PHONE(518)828 2888 FAX(518)828-2891 A UNIVERSAL FOREST PRODUCTS CO. FAX TRA14SMI.TTAL TO: 1 COMPANY ' FROM: TIM =SNYD18R V DATE (0 /� J 04 TIME 1 PM r . NUMBER OF PAGES INCLt7DING COVER SHEET - r' COMMENTS: d 4 i 061M/2004 T 9:38 FAI 151,88282368 UFP-327 Design �002/005 L . M iTekO MiTek Inds.istries, Inc. 14515 North Outer Forty Drive suilte 300 Chesterfield,MO 63017-5746 - Telephane 3141434-1200 Rc: O3h4783 Fax 3141434-53A3 s The truss drawing(s)referenced below.hive been prepared by MiTck Industries,Inc_under my direct supervision based on the parameters provided by P&R Hudson. Ta;es or sheets covered by this seal: J67-37661 tliru 16737602- My license renewal elate for the State orNew York is June 30,2005. Hof NEty � GGA�q�`fy Q,A� r Cr K� Uj to '� Z NQ•08 ) June 21,2004 Garcia,Juan The seal on these drawings indicate acceptance of profcssional engineering responsibility.solely for the truss components Shown_ The suitability and use of this component for any�particular building is the responsibility or the building designer,per ANSVIN--2002 Chapter 2. 06/21/2004 TUE ' 9:39 FAX 15188282368 UFP-327 Des'ign &03/005 COMMON To Truss Type Ply 167376611 03H47 EL3 ll Job Truss Job Rofiamninz,(option.il) Universal Forest Products Inc.,Hudson NY 1253;f,'Tim Snyder 5.100 a Jul 8 2073 Mil-ek Industries,Inc. Mori Jun 21 15145!52 2004 Page F 1.13.0i 7.:i4 i 144)-0 20-8-12 1 2M.0 FR" last 7.2-A 6-8-12 6.8-12 7-34 1-0-0 1:511,11 e.00 P-2 5 4x8,:* 2.5 IN a 2 Bab 12 4X5= 394- 4Y5- i 2"4 8-11.11 ('18 Ile Offsets(X.Y): [2:0-1-8 d7rl� I . ............ LOADING SPACING 210-0 CST OEFL in (loc) Vdofl L/d PLATES GRIP TCLL 53.9 Plates Increase 1.00 TC 0,85 VrA(I.I.) -0.1810-12 1999 360 M1120 1971144 TCDL 10.0 Lvrr !rIncruant! 1.00 BC 612 VerI(TQ -0.38 10-12 :-877 SCLL 0,0 Rep Stress Incr NO WB OALI Hofz(TL) 0.09 8 n/a n1a BC-.r3L 10.0 Code IBC20001ANSIBS (SIMP[Mad) Weight 121 lb LUMBER BRACING I TOP CHORD 2X 6 SPF 1650E 11.5E TOP CHORD Sheathed cr.3-1 1-0 cc purlins. DOT CHORD 2 X4 SPF 21001'1 Z ROT CHORD Rigid calling directly applied or 10-0-0 cc br.,fring. WEBS 2 X 4 SPF Slud "EKcurll' !l12 2 X 4 SPF Nc,2,5-10 2 X 4 SPF No,2 REACTIONS (lb/size) 2=Z192/05-8,8=214710.5.fl Max Horz,2155((Cad case 8) Max Uplift2=-315(load case 7),6315(ldad=e a) Max GravZ--2444(load case 2),8=2444(foad case 3) FORCES (lb)-First Load Case Only TOP CHORD 801-CHORD 2-12=2802,11-12=1937,10-11=1937,8,10-2802 WEBS 3-12--702,5-12-914,5-1 D=91 A.7-1 0=702 NOTES 1)This truss has been checked for uniform roar liva load only,except es noted. 2)Wind:ASCE 7-128;90rnph;h=3W TCDL--6.DDsf:BCDL=6.0psf:Category 11;Exp 0,partially;MWFKS interior zone;cantilever left and right exposed;and varliral I&I end right exposed,porch left and right exposed;Lumbstr DOL=1.15 plzric:grip DOL-1-15. 3)TCLI._1 ASCE:7-98;Pg=70.0 psf(ground show);Galtallory It;Fxp R;Partially Exp.:C11-1.1.Unobstructed slippery surface 4)lJnba1anr:pd!;ricw load,~;have been considered forthis design. 6)This truss has been designed for 1,00 limes flat rcuf loud ol'519 patch overhangs non-wricurrent with other live lwidr;. bV NE 6)Thin lru--s has been designed for a 10.0 psf bottom chord live load nonconcorrunil with anyother liveloads perTable 1607.1 of IBC-00. 7)Provide mechanical connection(by others)of frurm to Nulling plate capable 01[withstanding 315 lb uplift at joint 2 end 315 lb uplift stjoint GA LOAD CASE($)Standard CC 0 0. 8 ssjovx Juno 21,2004 14tlb N.Outer Flyly. suit.#300 Lie!iqn�lid for uwn ONY-ill,IArlL"M 'rKK ClArign is band only upon OctcMelels SnOW0.and is for V,3 illlfilh 11,11 buildinp cornporl�r. Ch=u,"nid.11110531377 AP-70cabilty of dcslpn poramentca,3nd propv hColPrQf0J;.t,,j4%:u, Ill not irlroderior.w. ,or on- I%for lateral vupport of individual web merott4t only.Additional hraring to Inswun Vablilly dvrinq corutntclioll is I"fMPQn,4n*,MrY nr Ina ,ZF�7","cio, Atkiistorml pArmanAnI t3factno of thoomoo structure L flie tespandtffilyof'Ile For MITek 06/22/2004 TUE 9:40 FAX 15188282368 UFP-327 Design my Fly Job 15737W. 03H4763 �---------- COMMON Job Me ITrer"T'p" M Lk -UM"Sof Fo"I'Mi1witi Ina.Mdwe)NY 125M 5209 pion 14-0-0 1.0-0 14.M 14-0-0 1.0-D Scale 1:53.1. Sx:5 6.0D 12- 8 2XIS If 2.6 11 1xS 11 RICH 6 Rita "x" if 5 12 76 25 24 n 4 21 2D 19 13 17 16 3X5 I-S" 11 1.5x4 11 1.SY4 I I 1.Sxd 11 1.5.4 11 6x5- I.5X4 II i.W II 1.sx4 II 1,!5x4 11 13Y4 It 213-0-0 28-D-0 LOADING(psf) SPACING 243.0 CSI OEM In 1100) Udag Up! PLA'rps GRIP TOLL M10 Flat"lncma%Q 1.00 10 0.21 Vort(ILL) File . ohl 999 M1120 1971la4 TOOL 10.0 Lumbar Inamnsm 1.00 ac 0.08 Vatt(TL) 0.01 15 "99 180 DOLL 0.0 RnPSUA"Mar NO Via 0.2s mma:(l L) UO 14 1118 "/a ECOL ID.0 Goan IHC2Q(MIAN';Im. (raotnx) Walgirt:A44 Ib BRACING TOP CHORD z x 6%PF I WIMF 1 51, TOP CHORD Shum(hod OFO-G-0 Do Plinins BOT CHORD 2 X 4 1,RPF 2.10OF I RF 1301 CrIORL3 Rigid soling directly by0iod of 10-411-0 w-braclag. 'OTHCRS 2 X4 SPF S(ttd REACTIONS (ItWcm) M MaxUpI61 1*1x SOM27-1 .1 so a wo d2-19(ftead carmd).14-33(IDUA careft '4(load ease 7).251=42(tond cnso7),21%--100Jjpd cane 7),20:-23(road rasa 8),19=64qaad "as"8). case 13),1(3-98(tcdd�8) Max caso2),21-262(load cam 1),22-406goad mu&Z),23=4Mo9d c9an2). 20-403(loadc:aso catm3),17-251(latid OwO3),16=760(foAd nng-3) FoRCn'S (in) maximum comprinsslonnifnidinum Tonnbn TOP CHORD 1-2--0/6,q. 12_5-ES-1191144 6.11--.11111115,7-11-117/192,64-117/188,9-10=1171163,"10,11=4191104, BOT ctioqD 7,7r?=nIiio,zws--01113.24-7�,umo. 19-20-01112.1a-19=O1112.'I7-1B=aMO9' 16-17=01109'14-16--011101) wca$ 8-21=2WO,7-n=-Wf.1A.6-23=-888f,98.5-74--w2vs, 3,26--w1tI35,9.20-304tv,10-19-368187,11-18-37279. 13-16-45611134 NOTES I)W rod:ASCr 7-95;90mph;fi-30rt-,TCDL-6.0;n;[;BCDL-5.G0tf,catogL4yII;Exp B;"ftfqnT.MWI-R8gnwQ and z .cintacivet-loft and right efiuubd',end vertical loft and right exposed;perch"and right exposed;LumbeeOOL-1.15 plate gill,VDIX-11-15. 2)Truing 4ASIgnarl forWind londp In the piano of the truss only. Far studs axposed to vvind(normal Vi the 60-14 MITAk-JAWAM Gnbiat kna betair a)I CLLz MCI:7-98;Pq-70.0 paf(ground snow);Category 11:Exp 8;Partially Exp.;CI=1.1;Unobtarur.lad slippaTy surface 4)Unbalanced snow load-have boon considered forthiv design. 5)Trig ftvA;;tms boon agglgrigil for 1.00 Ilmos flat roof load of-si3.9 prfor;overhangs With allerIlva tonals; e)Tfir,brigshas bean dasignad far R 10.0 psf bottom chord two load nonconcurrentwith any other five(Dada per Tsble 113n71 At IFIC-00. 7)CANA mq �ul continuous bottom chord bearing, NE 8)Goble ctuaa 5rw,-cl At 2-0-0 on. 0 9)Provide n1eChAniral aannaatiAn(ny omara)at trvsz to bearing pL1ro aapaWo of wltM.tamm�g 191b uplift at pint 2,33Ib uplr(n!plan[1a,SD m uplm At)wnrz;e,Uz � ,1,} /„,� M uplift(it joint 7:4,S'.4 2)uplift tit joint 24,12 ib uplift At joint 2b,100111 uplift at joint 26,23 M;uplift tit 10ifi(ZD,64 ID Uplift At joint it),0 in uplift at joint 18,32 b uplift st folit 17 And OR lb uplift at joint iG. LOADCASE(S)S-Laridtittl 0.080 "N June 21,2004 14515 N.Oulw F011Y. DAZ��n--AUd f(w utooAly with MTck connoctor.lhl�.design is bosed only upon paitinceleis 51so,-.i;ietel i;low on Individual building cornporsepl. Chesterfield,W)0017 XpPliCabitily of detio- 1^11 upp.i lion of 1s r(rporsIoMly of bulldttvp 14 evIonef-r,vf KM d"Zio"m-Nt-7f#(1 silOwn is for 1welulsvppotl ori'.Y.Viduo-11(ownhAtionly. 7woctc,L Addiflonal pofmonent broictrig of treaverczI STIUCIUre is i-ijaing awiptior.Fat pencioliquoiance'evictoing M Safely loomen.in awnaolo from Ifu=note I,aIAte.,%tVJ D'rjr.ffia,Oft-,M,.gli W1 53719. a 1,6k Symbols Numbering System Q General Safety Notes PLATE LOCATION AND ORIENTATION : Failure to Follow Could Cause Propetly 13/° 'Center plate on joint un'essx,y Damage or Personal Injury 4 offsets are indicated, 6 4 8 dimensions sE avin in R*in-slxteenlhs Dimensions are in it-in-sixteenths, 1. Additional stab'lity bracing for truss system,e.g. Apply plotes to both sides of truss diagonal orX-b.,acing,is always required.See BCSII, 1 ond securely soot. 2, ,ever exceed the design loading shown and never Q.l�b 1 2 3 stack malerials on inadequately braced trusses. TOP CHORDS 1 provide copies of this truss design to The building designer,erec lion supervisor.property owner and a WEBS , 4 oil other inlerested parties. i 0 0 4, Cut members to bear tightly ogaM each other, `For 4 x 2 orientation,locate U �bA r z plates C'ia'from outside L '� 0 5, Place plotes on each face of truss at each edge of kuss, 0 s �� 0 joint and embed full�j,Knots and wane at joint BOTTOM CHORDS locations are regulated by ANSI f TP11, _ This symbol indicates the 8 7 6 5 6. Design assumes trusses will be suitably protected from I required dlrect,on of Jots in the environment in accord with ANSI/IPl1. connector p'ates. 7, Unless othar4e noted,moisture content of lumber «plate location details available In Mirek 20/20 shall not exceed 19%at time of fabricafion, software or upon request, JOINTS ARE GENERALLY NUMBERED/LETTERED CLOCKWISE AROUND THETItUSS STARTING ATTNE JOINT FARTHEST TO $. Unless expressly Holed,this design is not applicable for •� PLATE SIIb THE LEFT, use with fire retardant or preservative heated lumber. CHORDSANDIVEBS ARE IDENTIFIED BY END JOINT 9. Comberis a non struclurol consideration and is the Q A perpendicular arsi dimension is fheMcilh NUMIIERSlEET1ERS, responsibility of trussfabricator,General practce is to X i .�} to slats.Second camber for dead load det1ection, i dimension is the length parallel to slots. i 10.Plate type,s-ze,orientation and locofon dimensions CONNECTOR PLATE CODE APPROVALS shown indicate minimum rating requirements, LATERAL BRACING 00 11.Lumber usedshc I be of the species and size,and Indicated by symbol shown and/or BOCA 96.31,93,43,96 2D-1,96-67,84.32 in all respects,equal to or better than that by text in the bracing secl..on of the specified. output. Use T,I or Eliminator bracing i ICBO 4922,524-3,5363,3907 12.Top chords must be sheathed or purlins provided at «a if indcated. i spacingshosvn on design. r--4 BEARING SBCCI 9667,9730,9604R,9511,9432A M ( 13.Bottom chords require lateral bracing at IC it.spacing, B or less,if no ce`ing is installed,unless ofh6Wse noted. Indicates location whye bearings Is, (supports)occur.Icons vary but 14.Connections Rat shown are I11eresponsibil1y of others. reaction sect;an indicates joint �.r numoer where bearings occur, ��� 15.Do not cut or oiler Truss member or plate-,vithoui p1or approval of a professional engineer. 16.Install and land ve lcallyunless'nd'coled olhemise. IndushyStandards: Mi ek ANSYTPll: ,National Design Specification for Molal ` Plate Connected Wood Truss Construction. DSH9: Design Standard for Bracing. i o p' BCSI% Building Component Safety Information, Guide to Good practice for Handling, Insfall'ng&Bracing of Metal Plate Connected Hood Trusses. MRek Engineering Reference Sheet:MII.7473 0 2004 MR0 c Framing / Firestopping Inspection Report Office No. (518) 761-8256 Date Inspection req I eceived: IoL 1 f�-�h� Queensbury Building& Code Enforcement Arrive: p art: azr 742 Bay Road, Queensbury, NY 12804 Inspector's Initi NAME: 'VA 4 ov o PERMIT#: Z 31 - LOCATION: )L rd INSPECT ON: TYPE OF STRUCTURE: *W Y N V— fJackrFami:n�g N/A COMMENTS r Studs S ci Jack Studs tj-e�� Bracin'�el�-B�ridging Joist han( 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 I Y2(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 snow shield 24 inches from wall Fire separation 1,2,3hour Fire wall 2, 3,4 hour Firestopping Penetration sealed 16 inch insulation in cavity min. Garage Fire Separation House side Y2 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 L:\SueHemingway\Building.Codes.Inspection.FORMSTraming Firestopping Inspection Report.doc January 28,2003 I- 4 Framing/Firestopping Inspection Report Office No. (518)761-8256 Date Inspection r ques rece' d: �4 Queensbury Building&Code Enforcement Arrive: am/p part: 742 Bay_Road,Queensbury,NY 12804 Inspector's In' ial NAME: PERmrr#: LOCATION: INSPECT ON: TYPE OF STRUCTURE: QIA- Y 1V N/A COMMENTS Framing . Jack Studs/He Bracing ridgy Joist han 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 snow shield 24 inches from wall C 4kI- �JiF-� 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 %z 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 L.\SucHemingway%uilding.Codes,Inspection.FORMS\Framing Firestapping Inspection Report.doc January 28,2003 1 Project Name:--C ((� �B{`A BP# .Address: Build` Permit Submission a �zn`g array zng Checklist All items below must be checked either yes,no or not applicable prior to submission of any building permit to the Town of QueensburyBuilding Department. If any of the below items are lacking,the permit will not be accepted until such time as the application is deemed complete for submission. 1. Building Permit Application Completed ... ... yes ❑ no ❑ 2. Energy Form or CheckMate Energy Code Compliance Forms Gomplete.. S,yes ❑no ❑n/a 3. Energy Code Inspector's Report from C heckMate Program..... ... ... ... .. VLyes ❑no ❑n/a 4. Septic application completely filled out(if applicable)............ ... ... ... ... ❑yes ❑no 5�n/a 5. Solid Fuel Burning or Gas Appliance Form... ... ... ... ...... ... ...... ... ... ... .Qyes [:]no Qn/.,a 6. Electrical Inspection Form... ... ......... ... ... ... ... ... ...... ... ... ... ... ... ... .. yes Qno ❑n/a 7. Two (2)complete sets of structural drawings... .. ... ... ...... ...... ... ... ... ... . Myes Qno ❑n/a a) floor plan;b)foundation plan;c) cross sections:d) elevations; e)window and door schedule t ' 8. Two (2)site plans showing location of the structure to be built.... ...... ... ©yes Qno [—]n/a location of well or water lines,location of septic system or sewer line. 9. Setbacks from property lines to new structure... ... ... ...... ... ... ...... ... .. Nyes ❑no ❑n/a 10. Setbacks to neighboring wells and septic systems,including onsite well... . Myes Qno nn/a and septic systems (if applicable) 11. DrivewayPermit... ... ... ...... ...... ... ......... ... ... ... ...... ...... ... ... ... ... Qyes ❑no Rn/a Date: Staff Initial: L..\SueFkn ingway\Bading.Pennit.FORMS\Generic Checkhst.doc / C opt - Permit Number REScheck Compliance Certificate Checked By/Date New York State Energy Conservation Construction Code RES checkSoftware Version 3.5 Release I d Data filename: C:\Prograin Files\Check\REScheck\Valastro.rck PROJECT TITLE:Valastro COUNTY:Warren STATE:New York HDD:7635 CONSTRUCTION TYPE:Detached 1 or 2 Family BEATING TYPE:.Non-Electric DATE: 07/22/03 DATE OF PLANS: 10/02/02 PROJECT DESCRIPTION: Addition COMPLIANCE:Passes Maximum UA= 128 Your Home UA= 106 17.2%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 692 30.0 0.0 24 Wall 1:Wood Frame, 16" o.c. - 160 19.0 0.0 9 Window 1:Vinyl Frame:Double Pane 8 0.280 2 Window 2:Vinyl Frame:Double Pane 8 0.280 2 Wall 2:Wood Frame, 16"o.c. 66 19.0 0.0 3 Door 1: Solid 18 0.230 4 Wall 3:Wood Frame, 16" o.c. 27 19.0 0.0 2 Wall 4:Wood Frame, 16" o.c. 224 19.0 0.0 12 Window 3:Vinyl Frame:Double Pane 8 0.280 2 Window 4:Vinyl Frame:Double Pane 8 0.280 2 Wall 5:Wood Frame, 16" o.c. 56 19.0 0.0 3 Window 5:Vinyl Frame:Double Pane 8 0.280 2 Wall 6:Wood Frame, 16" o.c. 56 19.0 0.0 ' 3 Window 6:Vinyl Frame:Double Pane 8 0.280 2 Wall 7:Wood Frame, 16"o.c. 104 19.0 0.0 5 Window 7:Vinyl Frame:Double Pane 24 0.280 7 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 668 30.0 0.0 22 COMPLIANCE STATEMENT: The proposed building represented in this document is consistent with the building plans, specifications,and other calculations submitted with this permit application. The proposed systems have been designed to meet the New York State Energy Conservation Construction Code requirements. When a Registered Design Professional has stamped and signed this page,they are attesting that to the best of his/her knowledge,belief,and professional judgment, such plans or specifications are in compliance with this Code. ' Builder/Designer Date ' 1�P 5 t