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2002-024 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: P20020024 Date'lssued: Tuesday,May 24,2005 This is-to certify that work requeste&to be-done as shown by Permit Number P20020024 has been completed. Tax Map Number: 523400-239-012.0002-066-000-0000 Location: 25 BRAYTON Ln Owner: BRUCE&COLLEEN HALSE Applicant: BRUCE&COLLEEN HALSE 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&Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBUR.Y 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020024 Application Number: A20020024 Tax Map No: 523400-239-012-0002-066-000-0000 Permission is hereby granted to: BRUCE& COLLEEN HALSE For property located at: 27' BRAYTON Ln 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: BRUCE& COLLEEN HALSE 4 FOX CHASE Dr Residential Alteration 15,000.00 COMES,NY 12047 Total Value 15,000.00 Contractor or Builder's Name j.Address Electrical Inspection Agency JOSEPH ROULIER - PO BOX 301 CLEVERDALE.NY 12820 Plans &Specifications 2002-024 408 SQ FT RESIDENTIAL ALTERATION AS PER APPLICATION AV 97-2001 ZBA approved Dec. 13, 2001 Board of Health Septic Variance approval Resolution No. 55, 2001 1 $40.80 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,January 16,2003 (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 Ore—ToWn o b ednesday,January 16,2002 SIGNED BY for the Town of Queensbury. Code Enforcement Director of Building Building Permit' Application Town of Queensbury-Dept of Community Development,742 Bay Road,Queensbury,NY (518)761-8256 A permit must,be obtained before.beginning construction. Permit File No o No inspectionwill be made until applicant has received a Fee Paid $ valid building permit. All applicants' spaces on this ' Rec. Fee Paid application.rnust be completed and must appear on the Reviewed B application form. ,p Applicant: Owner: Address. ? Address: Phone .yy Phone# (_s 2�r -7 Property Location: Lot Number: / House Number _et_> -/ /3 K, �Q,, �,, s�,,,��1,. .�i < t'• Subdivision Name: Tax Map Number:. d. New Building: residence t commercial Estimated Market.Value'of Construction:$ ❑ Addition: residence/ commercial If an Addition,what will use of new addition be? [V Alteration: -residence commercial ❑ No change to exterxor_stze: residence t com'1 ❑ Other work.(describe - Check OccupancyInformation 15t Floor 2"d Floor Other floor .Total Below sq.ft. sq.ft. sq.ft. Square Feet 1411 J ' Single family dwelling , ❑ Two family dwelling ❑ Townhouse ❑ Multifamily dwelling #of units unr- 0 Office ❑ Mercantile U Manufabflur s- - - - O, 1 car detached garage `�. ❑ 2 car detached garage' . r ` ❑ 3 car detached garage' '` ❑ 1 car attached garage, ❑ 2 car.attached-garage " ❑ 3 car attached garage ❑ Storage.building- commercial ❑ Storage-building- residential ❑ Other What is the proposed height of-the structure feet d inches Will any second-hand or ungraded lumber be used?,If so, for what? !L� Type of Heating Syste lectric e oil / gas 1 wood /forced hot air baseboard they: Number of Fireplaces to,be installed - d Number of Woodstoves to"be installed O List below the person(s)responsible for supervision of work as regards to building codes: Name Address Phone Number Builder 6 Ile- Plumber Mason Electrician t, - 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 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 new construction. Signature r- � owner,owner'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:�� � �� D�L� File Permit No, ' 1 Tax Map No, Fee Paid Owner's Name:Z- �q e. 1 Address: 2. INSTALLER'S NAB G�5,...�LC ��� �� -� PHONE NO. 3. RESIDENCE INFORMATION: (circle,year of dwelling, indicate 9 bedroom(s) and multiply# 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/bdrm = 1980-1991 _3 x 130 gal/bdrm = -3 90 1991 -present x 110 gal/bdrm = Garbage Grinder Installed yes / no Spa or Whirlpool Installed yes / no 4. PARCELRqFORMATION: (circle applicable information&indicate measurements) Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply Flat sand at what depth at what depth municipal Rolling loam feet feet well Steep slope clay if well; water supply %slope other from any septic-system depth: absorption is-fit other -_ - Percolation.Test: (To-be ^or.-pleted:by.lirensed pr-ofessional_engineer o.r 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 zc/T) .c tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Sepank: gallon (min. size 1,000 gal.) Tile Field: each trench ft. Total System Length: fl- Seepage Pit(s): number of size of each: ft. by ft Size of Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length andlor size 6. HOLDING TANK SYSTEM: (if required) ­ec Number of tanks:,_3 / Size of each gallons /TOTAL Capacity:-. o egallons Note: Alarm System and associated ca rk must be inspected by a Town approved electrical inspection agency yes 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 resp ect to this application and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Signatur�of espo �sibleperson Date Septic Inspection Report Office No.(518)761-8256 Date Inspection re u t re Queensbury Building&Code Enforcement Arrive: pm ep art:- 742 Bay Rd., Queensbury,NY 12804 Report req epar�- Inspector's Initia NAME: IF P IT NO.: in 7--oz--4 LOCATION: PECT ON: RECHECK: Comments and/or diagram Soil Type: Sand Loam Clay Type of Water: Municipal/Well Water Waterline separation distance Well separation distance ft. Other wells: ft. Abso!ption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Pi in Size Type Building to tank Tank to Distribution Box Distribution Box to Field Pit _2pening Sealed., Y/NI Partial Location/Separations Foundation to tank Foundation to absorption Separation of Pits ft. Conforms as.per Plot Plan Y_N Location of System on Property: Front Rear Left Side ,Right Side Middle Front Middle Rear S stem Use St us: ;ipproved .Partial Approved and needs to be re-inspected,please call the'Building&Codes Office .......................Disapproved L:iSueHetningway\Building.Codes.Inspection.FORMS\Sepdc Inspection Report.doc, January 28,2003 r•. .�.;, ..• .,.•, ::_•t to-.n. .,: .. �p,•r, :f. 41• 1 .•,.'L ..rJ,. ��•�;st•,'•,f'�.�ti;Ylsi ,ar.y,• '�:� t,r,.•,? i . •.t•r•• .g'.�t� . r,• .i`•$:_ .a_> :d,'rr +ty :,, .r., �, :.„ a `a + •,•i KJ` •i,.•.J' .. •t•I ,•.. 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't'; .'t•tit;:: :i 'r ,t 'L �r ,M�twt`yt•j•.t. �t' 't• J`::•:� :a:;..t= ,rf+ ,,r 'I�d ..;•„Lwo,�N� ..t ,. ,'r • • , • ' +,•• •yl::Ir+••�.•r,f, .,I,q•. r ••w• •�t,�t, •',t•,FY•1•sr`+t••'. +• P O r.: .+•f."64r CI •• • .ti� ti i '::•}a .r:-'J.'+t',l' Lr+ " a r`'•jr77/ •'�'•` r i .� .,• ' /rij Wo lama -sm-saw. 42 w • r ' • «y•wrww: , r+Aarrwwr�r+► �w.• •,+�►rR• w�t.ht yi.rtt +► w ' b�ere t ssw evident off Zs e . �Iro�,► trees,ie , � •r,, � •�asrrent.l aitio • � d� • s. � lmd d �► .� Wx- anda' c va ating, Inc. 63 Woodchuck Hill Rd. Lake George,NY 12845 .... . ..............-_ -- — MW Bill To Roulier Construction Co. .....-....... ---.- . ..._...__..........._........_..._.._..............___..._.._..- P.O.Box 301 DATE INVOICE# JOB Cloverdale,NY 12820 2/28/2005 _72 cl Zoe �pG S� DATE DESCRIPTION 2/17/2005 Hauled in fill,#2 stone, 1000 gal.septic tank,frame and cover,loaded dirt .onto truck and hauled•away;dug and.set-septic..tank ... . .. ...... -..___...._.�_._.. Trackhoe Trucking Gabor 2 Ids.of Fill l Id.of#2 Crushed Stone 3 1000 Gal Septic Tank,frame and cover,riser and pipes 2/18/2005 Hauled in fill,loaded dirt onto truck and hauled away,set new riser,dug around old risers patched and backfilled Trackhoe Trucking Labor t Id.of Fill Hydro cement Sales Tax DUE UPON RECEIPT. A finance charge of 20A per month will be Total charged upon unnaid balances.. Customerarsrees:to n_Av_ all and collection fees if necessary. w Septic Inspection Report Office No.(518)761-8256 Date Inspection reques c"d: Queensbury Building&Code Enforcement Arrive: a p Vepart7Ba� 742 Bay Rd.,Queensbury,NY 12804 Inspector's In itial it ial . NAME: IT NO.: 60a— LOCATION: INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Munici al/Well Water Waterline separation distance ft. Well separation distance Other wells: Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone V5 0 Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field Pit Opening Sealed: Y/NI Partial End Cap* Location/Separations Foundation to tank Foundation to absorption ft. Separation of Pits Conforms as per Plot Plan Y D Engineer Report and As-Built Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Stag Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved Last revised 1/6/05 RESIDENTIAL FINAL INSPECTION REPORT Office No.(518)761-8256 Date inspection request received: Building&Code Enforcement Dept.of Community Development Arrive epart n/ m Town of Queensbury I or s Iriiti 742 Bay Road Queensbury,New York'12804 NAME — PERMIT# C3Ca`y7 tJ LOCATION '2.R P,ft%JT 0 L A io — DATE Z 0 TYPE OF STRUCTURE N/A YES NO COMMENTS Chimney Height/"B"Vent/Direct Vent Location Fresh Air Intake Plumb Vent through roof Roof Complete Exterior Finish Complete Interior/Exterior Railings 30"to 36" ' Exterior Handrails,balconies,landing 18 in.or more Interior Handrails stairs both sides 3 or more risers Grade 2%away from foundati 8"clearance to sill plate Gas Valve shut-off exposed/r gulator 18' hove grade Gas Furnace shut-off within 3 feet or wi line of site Oil Furnace shut-off at entranc e to furnace Furnace/Hot Water Heater ope atin Relief Valve(s)installed Headroom,6 ft.6 in.on stairs r Basement stairs,6 ft.4 in. Handrail exterior stairs both sid s mor than 3 risers Interior privacy/tnm/doorslmain ce 36" Floor Finish Bathroom/Kitchen watertight Interior Handrails s/Lao 18 in.or more Railing across window m stainvel 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 JUPCPtaC t-lOL�1L�C� Tr'�i4� Okay to issue C/C(Cer f.of Compliance) Okay to issue temp.C/O(Certif.of Occupancy)_ Okay to issue permanent C/O(Certif.of Occupancy) r . RESIDENTIAL FINAL INSPECTION REPORT Office No.(518)761-8256 Date inspection request received: ' Building&Code Enforcement f Dept.of Community Development Arrive Depart a2 Town of Queensbury spector-s Init als 742 Bay Road Queensbury,New York 12804 NAME hY.�'L PERMIT c -4 LOCATION rC DATE 1 � TYPE OF STRUCTURE r A YES NO CONMIENTS 1 Chimney Heightf V'Vent/Direct Vent Location Fresh Air Intake Plumb Vent through roof Roof Complete Exterior Finish Completet. .,.�` '� t � ����? Interior/Exterior Railings 3 "t 36" . Exterior Handrails,balcom s,1 ding 18 in.or more Interior Handrails stairs bo side 3 or more risers Grade 2%away from founds'on 8"clearance to sill plate Gas Valve shut-off expose dl gulat r 18"above grade Gas Furnace shut-off within 3 feet r within line of site Oil Furnace shut-off at entranc to ace area Furnace/Hot Water Heater oper t g Relief Valve(s)installed Headroom,6 ft.6 in.on stairs Basement stairs,6 ft.14 in. Handrail exterior stair oth sides ore than 3 risers Interior privacy/trim/doors/main en ce 36" 'Floor Finish Bathroom/Kitchen watertight Interior Handrails BalconieslLanding 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 doorldoor 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) a GENERAL INSPECTION REPORT ( 518) 761-8256 Town of Queensbury ; Dept.of Community Development Date inspection request received: Building&Code Enforcement 1 � 742 Bay Road , Queensbury,NY 12804 Arriv Dep rt spector's itlts NAME: 1 .c - PERMIT# — y- LOCATION: _ Z_ RE ��' DATE : 7=W—dZ TYPE OF STRUCTURE: 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 f Plumbing Under Slab Plumbing VenttVents in Place Rough Plumbing 1� _- Heating Rough-In !' Insulation 1 Foundation Walls Interior R- / Foundation Walls Exterior R- Floors R- --Walls R- / —Ceiling L-41-lOV) R Ell/ - Duct work or piping in unheated spaces R- Proper Vent,Attic Vent Framing 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 Firestopping ti • 'F <o� Office Use GENERAL, INSPECTION REP F� � ��# �: � Inspect ' Town of Queensbury Ready at time' Dept. of Community Development Request received: C L t O�'�� Meet: Building& Code Enforcement ' At time: 742 Bay Road Queensbury, NY 12804 ARRIVE RT Notes: (518) 761-8256 Inspector's 1hitia�lls NAME: PERMIT# c-) LOCATION: INSPECT ON(date): TYPE OF STRUCTURE: RECHECK N/A YES NO/NMIM Footings/PiersMonolithic Pour Form Reinforcement in Place The contractor is responsible for providing protection from freezing for 4&hours following the placement of the concrete.Materials for this purpose on site Foundation/Wallpour Reinforcement in Place, Foundation/Dampproofmg Backfrll Approval Plumbing Under Slab Plumbing Vent/Vents in Place Rough Plumbing Heating Rough-In Insulation Foundation Walls Interior R- Foundation Wails Exterior R- , Floors R- Walls R- Ceiling R- / Duct work or piping in unheated spaces Proper Vent,Attic Vent Framing Jack Studs/Headers BracingBridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1,2,3,hour Penetration Sealed 4FiLe Wall 2,3,4 hour re opping - L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc GENERAL MSPECTION REPORT (518 ) 761-8256 Town of Queensbury Dept.of Community Development Date inspection request received: Building&Code Enforcement 742 Bay Road Queensbury,NY 12804 Ar ri� �epart HVC5-,�p s e kppeclor��Initi NAME: PERMIT# ZIA LOCATION: DATE : 1,-7 TYPE OF STRUCTURE: EQ�D X ek'20- RIO M�?D 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 p S -7 7-rN I e1j Z-11 of the concrete. Materials for this purpose on site Foundation/Wallpour Reinforcement in Place Foundation/Dampproofing_ Backfill Approval Plumbing Under Slab Plumbing Vent/Vents in Place Rough Plumbing eating Rough-In VInsulation WA 12 77 Foundation Walls Interior R- Foundation Walls Exterior R- Aoors R- V alls R- \/Ceiling Duct work or piping in 5�-\—V3 unheated spaces R- Proper Vent,Attic Vent-=Z/ Framing Jack Studs/Headers Bracing/Bridging ,�. Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1,2,3,hour Penetration Seated Fire Wall 2, 3,4 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 1 a;l �; Depart Inspector's lnni al NAME: VW�� PERMIT# LOCATION: DATE : TYPE OF STRUCTURE: 14 RECHECK N/A YES NO COMMENTS Footings/Piers f Monolithic Pour Form Reinforcement in Place The contractor is responsible far providing protection from freezi g for 48 hours following the place ent of the concrete. Materials for this purpose on site Foundation/Wallpour Reinforcement in Place Foundation/Dampproofin Backlill Approval _ lumbing 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 work or piping in heated spaces R- Pro r Vent,Attic Vent Fr ming Jack Studs/Headers BracingBridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1,2, 3,hour Penetration Sealed Fire Wall 2,3,4 hour Firestopping iy t • -C� ED TO OF CO gUl DING AND -D rx/e7cts� �ep�n ' o srn,enc.x a SNL/J IV// X/////// ♦ /�a �� lose' 01 OKI.. _ /l�i2C•eaR2C0 /�6,¢ C01--l't/ + CCORJC6 0YAAS,9 �QiPAYTa,V A4Md ASSC8764Y foi- AIZ*,"JOSSO V.dOiNG Ti9Ar!{ .ExP/�A/Sio.til _ _'1%6PH.CfO 19Y: 'Jo4 /OF7- "I have seen or observed,or believe I saw evidence of, all objects such as houses;wells,trees,fences, etc., shown on this document. I also represent-that I have personall easured the distances set forthatheram.. :.. SIGNATURE