2001-108 ., hi TOWN OF QUEENSBURY
742 Ba Road ueensb NY 12804-5902 518 761-8201
��� Y , Q �Y, � )
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20010108 Date Issued: Tuesday, July 03, 2001
This is to certify that work requested to be done as shown by Permit Number P20010108
has been completed.
Tax Map Number: 523400-301-013-0002-065-000-0000
Location: 16 ALGONQUIN Dr
Owner: LARRY CLUTE
Applicant: LARRY CLU 1'E
This structure may be occupied as a:
By Order of Town Board
Single Family Dwelling TOWN OF QUEENSBURY
Garage - 2 Cars Attached
Director of Building& Code Enforcement
TOWN OF QUEENSBURY
ji-2" 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010108 Application Number: A20010108
Tax Map No: 523400-121-000-0008-120-000-0000
Permission is hereby granted to: LARRY CLUTE
For property located at: 16 ALGONQUIN Dr
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: LARRY CLUTE Single Family Dwelling 140,000.00
13 DAWN Rd Garage-2 Cars Attached
QUEENSBURY,NY 12804 Total Value 140,000.00
•
Contractor or Builder's Name/ Address Electrical Inspection Agency
CLUTE ENTERPRISES COMMONWEALTH ELECTRICAL A(
13 DAWN Rd
OUEENSBURY,NY 12804
PO BOX 706
HAGUE.NY
Plans &Specifications
2001-108
2064 SQ FT SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE AS PER PLOT PLAN
SPECIFICATIONS
$274.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,March 21,2003
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To' • •-c- .eensb ; We s y,March 21,2001
SIGNED BY c ( for the Town of Queensbury.
Director of Building& ode nforcement
- Building- Permit Application
Town of Queensbury - Dept. of Community Development, 742 Bay Road, Queensbury, NY 12804 /761-8256/
-0 BUILDING & CODE ENFORCEMENT
NOTICERequirements prior to issuance ( • )
r of this permit: PERMIT FILE NO. l l�g
. A permit must be obtained before
beginning construction. No inspections [ b
Zonin Board Action PERMIT FEE PAID$ .
will be made until applicant has received n g
a VALID BUILDING PERMIT. All Area /Use RECREATION FEE PAID$
applicants' spaces on this application n
MUST be completed and.the signature 0 Planting Board Action REVIEWED BY: \/
of the applicant must appear on the SPR / Subdivision /Oilier Building Inspector
iipplication form. nv.�l,..., i J Recreation Fee Payment -�
Applicant: 1__C i-A-V� e .Owner: C—._(L
. ' Address: \.- ` -1- .-NQ\ 0 'NA=i..t5 ddress:
Phone # ( ) `7c13- ` 7D717 Phone # ( ) -
Property Location: cc;r- - r- l lu , �,,.f t...DVN.� ,may �-k,.• _
• 'I'a Mi p Number \ ( / ' / t3Q
Subdivision Name: �t.,.�v�e-���c;c��, c'v-j; . ,-,.K►-- -
.. _ Section Block I nt
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
New Building: CONSTRUCTION: $ V-40 ccDo
residence / commercial
Addition to Building:
residence / commercial OCCUPANCY INFORMATION:
Alteration to Building: Pr many Building -
residence / commercial Single Family Dwelling
Residence / Commercial Two Family Dwelling.
no change to exterior size . Family Dwell
'
Office
Other Work (describe below) Mercantile MAR 1 6 2001
Manufacturing
Other TOWN OF QUEENSBURI
GROSS AREA OF PROPOSED STRUCTURE/ L BUILDING AND D_ CODE
If ADDITION, what will use
1st Floor "SD SD sq. ft . of new addition be? :
2nd .Floor. . ., cttD ft., s
Other Flour's sq.
(not unfinished cellar or basement ACCESSORY BUILDINGS:
„_" Detached Garage 1, 2 car
TOTAL FLOOR AREA: 'a(=`-f SQ. FT. Attached Garage 1, 2 car)
Private Storage Buil Trig
SIZE OF NEW STRUCTURE: Commercial Storage Building
LI FEET X SO FEET Other
Foundation Type: pG,,,,t- , - Will any second-hand or ungraded
Number of Stories : alumber be used? If so, for what?
(habitable space oryly)
Height (grade to rLdge) : p.( 3 feet TYPE OF HEATING SYSTEM:
Number of fireplacepI �a d/or woodstove (circle all whic lies)
to be installed Elec ric Oil Gas / Wood
orced Iiot Ai ' / aseboard / Other
Person responsible for supervision of work as regards to building
codes is : \ cLA-t—ki C t ,Se . -77"77
Name Addresss Phone
Builder:
Plumber:
Mason: CJ ...,:___‘eElectrician: \ �� � c ��.
DECLARATION: Please sign below after you have carefidly read the statement. •
To the best of my knowledge the statements contained in this application, together with the plans
and specifications submitted, arc a true and complete statement of all proposed work to be done on
the described premises iat . provisions of the Building Code, the Zoning Ordinance and all •
other laws pertainm to the propos d work shall be complied • whether specified or noted, and
that such work ►1s authorized by th owner. Further, i l understo I that I/we shall submit prior to a
Certificate dOccupancy'or Cer ' f Compli ce being issu d, an AS BUILT PLOT PLAN by
a licen surveyor; drawn le, sho •ng a al location of oject on premises.
Si ature:
(owne , ner's a i t, architect, contractor)
Application for Permit—Septic Disposal System
Town of Queensbury 742..Ba Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: •
Office Use
Location of installation. ` - --,,.� �J/�
Tax Map No. I�-1 / / l
,v.e.-5 File Permit NQ�'"��
• Fee Paid
Owner's Name:
Address: \
2. INSTALLER'S NAME CJe PHONE NO. '79 7 -7 7
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#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/bdnn
1980— 1991 x 130 gal/bdrm =
1991 —present Li x 110 gal/bdrm = L-(L-
Garbage Grinder Installed yes— / no ?�
Spa or Whirlpool Installed yes_ ./ no X
4. PARCEL INFORMATION: (circle applicable information&indicate measurements) •
r it r mound Water Bedrock_•orimpervigcs Material Dom: ' ater Supply
at sand at what depth at what depth diglifileffiR
Rolling loam fret feet well
Steep slope clay if well; 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 leach field for each Garbage Grinder, Spa or Whirlpool Tub. _
Septic Tank: \000 gallon(min. size 1,000 gal.)
Tile Field: each trench 50 ft. Total System Length: Do° ft.
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: II / depth or thickness _ feet
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 lations 'th respect to th'. a p plication and agree to abide by these and all
requiremen : of the Town o Queensbury .ani .ry Sewage Disposal Ordinance.
`iiggift 3) t510t
Signature • responsible person Date
BLDG. PERMIT NO. 2001-108
APPLICATION FOR A TEMPORARY CERTIFICATE OF OCCUPANCY
A TEMPORARY CERTIFICATE OF OCCUPANCY is hereby requested for the property.
located at; 16 Algonquin Drive
for the following uses: *Single. Family Dwelling
June '28k 2001 '
DATE - SIG ATURIE OF APPLICANT
TEMPORARY CERTIFICATE OF OCCUPANCY
The TEMPORARY CERTIFICATE OF OCCUPANCY is hereby (v)APPROVED
( )DISAPPROVED
with the following conditions: Certificate of Occupancy to be
issued upon completion of:
1 ) Install Rail@ Porches
2 ) installation., of Gas
3 ) Final Fireplace Inspection
TEMPORARY CERTIFICATE OF OCCUPANCY FEE: ( )$10.00 DEPOSIT: ( 4100.00
received on June 28 , 2001
Date of Issuance Director of Bldg. & Code Enforcement
TIIIS TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES 30 DAYS
FROM THE DATE OF ISSUANCE.
NOTE: This Certificate is NOT VALI_D unless signed by the Director of Bldg. & Code -
Enforcement or his designee.' - '
Inspector's No.
Date 20
COMMONWEALTH ELECTRICAL INSPECTION SERVICE INC.
(Consulting and Fire Inspection Services)
(Incorporated in the states of Maryland,New York,Pennsylvania,Delaware and West Virginia)
Desiring Certification of Approval, application is made for inspection of electrical installation in the premises
described below.On demand,applicant agrees to pay for inspection service in accord with schedule of charges.
PLEASE PRINT
-.-- '-• ' '-, Type Bldg. El DWG 0 Other Owner , - "•�
, I
Occupant Building Permit No.
Job Location (--:Or ,,. , ,.- 's- --- ;'"' 'City - ; , State '.;. ......
County Twp. M/C# Swimming Pool —New El Old El
Directions to Job Site ,:;.. s:; -.
I
%,
Application For Rough Wiring El Fixtures El SetVice.El or
Work New Q.' Additional 0 Bldg. —New l Old El Ready for Inspection
x
APPLICANT'S SIGNATURE - - LICENSE N PERMIT a
-
PLEASE. , �� PHONE p
PRINT NAME ":--: • . _
APPLICANT'S i _ I' NAME.OF
ADDRESS ), ^ n. _ UTILITY
OFFICE TO
CITY ' ' _ - STATE . ZIP CODE 1; . ' BE NOTIFIED
ROUGH WIRING SPACE BELOW FOR USE OF INSPECTORS ONLY
OUTLETS AMP SERVICE PUMP
EQUIPMENT
SWITCHES HEAT OVEN
PUMP
RECEPTACLES SURFACE GARBAGE
UNIT DISPOSAL UNIT
MEDIUM BASE RANGE DISHWASHER
FIXTURES
MOGUL BASE WATER DRYER
FIXTURES HEATER
FLUORESCENT AIR AMP. RECEPTACLES
FIXTURES CONDITIONER
MERCURY VAPOR OR WIRING&CONTROLS FOR BURNER FRAG.H.P.
QUARTZ FIXTURES _ VENT FANS
MOTORS:H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1-1/2I 2 3 5 7-1/2 10 15 20 25 30 40 50 75 100
MARK NUMBER
OF EACH SIZE
Inspector's Comments:
OFFICE USE ONLY WORK INSPECTED REPOR- o 0
NOTIFIED TED cc 4 a FEE PAID
U
SERVICE DATE CON- TOTAL $
Date Received: TRACTOR TOTAL $
R.W,DATE OWNER CHECK NO.
FINAL DATE OCCUPANT CHARGE
Certificate No.:
CERTIFICATE NEEDED AGENT CASH
Date Sent: DYES ❑DUP ELEC.
LT.CO.
INSPECTOR
Progress 0
THIS APPLICATION EXPIRES ONE YEAR FROM DATE MAKE ALL FEES PAYABLE TO C.E.I.S.INC.
WHITE/OFFICE PINK/INSPECTOR YELLOW/OFFICER GOLD/CUSTOMER
•
fir i
ri Fire Marshal's Office "I'o'rn Of Quecnsbur}. 742 Bad' Road,Qucensburv,N1
(518) 761-8205
Application for Fuel Burning Appliances & Chimneys
applicable to solid fuel .& vented gas appliances
Date Ct__________ 20 OA Permit No. tie i-j . e
,..
Application is hereby made to the Building ct Codes Of/ice for the issuance of a Building and Use
Permit pursuant to the New York State Fire Prevention and 13uilfling Code. 77te applicant or owner
agrees to comply with all applicable!rms., ordurance` ;a t gulatt(Si3; atul all‘conditions that are part of
these requirements and also will allow all insfectb)=s to eider premise:; t4e,fortn required inspections.
p NOTE to applicant: Rough-in and Final Inspectionszare required.
Applicant Information Fuel Burning Appliance Information
(circle appropriate words)
Name: •.yr.-(...,, r . —XCI Stove: wood coal pellet gas
Fireplace insert
Address: k - ,, .,,. C S Fireplace, factory-built: wood cis
e...,.,: L.--) 4.--,1 L, Fireplace, masonry: wood ,gtts
iI Furnace: wood gas oil
,
Phone: .7., —131+°
If non-masonary applicance, please provide
Owner: ��,,,# Manufacturer Name: f�,,�,,ti. ,µ,, , _
Address: . Model Number: `I C ,
' iy' Chimney Information
Phone: ,_; , , ' .• (circle appropriate words)
Masonry block brick stone •
Flue tile steel size: inches
Exact Address: '( ei „,. Cie--
of consrructio)t or installation Factory-Built '
Manufacturer name: � eSivi `_
Model Number: V a 36
Note: Listed By: Number: •
Construction/Installation must
conform to NYS Fire Prevention & Building Indicate(circle) chimney material:
Code. Consult available Town of Queensbtuy ,� -h
Handouts regarding required inspections. Double wall / Triple wall I. Insulate(// Direct renting
Chimney Liner
•
•
•
j CASa tier',rst De)ps,a-tmeiit—710 wiz cf Qxz4e4ezaata,bury, _Mew Yox-.13c
Fire Marshal Code# SCollected 5 Refunded Received fi-oot (/`efunded to):,..:.{- t' ` ;' `L ', + :
-'.A „i(,) address.- .._
.4 I73 3389 (190) Public.Safety c - ,''' — — — --
.4 233.655 (230) Minor Sales
• r
. ° CJ'W,,.. 11 v,,.-o-,42,„,a,`'-.t'h ..
04.7.e�wta — /oww (i ce 02 `vayo.5,
White(Applicant) 1 Green(Fire Marshal) / Yellow(Bldg. Dept.) Rink& Goldenrod(Cashier's Dept.)
' _ - gOO(-1O
�� ENERGY CODE COMPLIANCE APPLICATION
3 :'' 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 Dwellings; Multi-Family
Dwellings (3 stories or less) -
PPRT 4* = Design by Component Performance
• Commercial Buildings-Hi Rise Residential
*Recuires submission of worksheets
APPLICANT' S NAME: PROPER Y__LOCATION:
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE: t ,.
1 . Gross Floor Area - eD(v41 square feet .
2 . r.r'Je of neat - E1=''-r?c Oil K Gas Other
3 . Is building mec_ani dal lv cooled? Yes y No
4 . P e_centage of area of windows and doors Over 17% . Under 17%
5 . ?-VALJES FOR INS::�=TION GIVEN BELOW MUST CORRESPOND TO R-VALTES AS
S-=Oc•TN ON PLANS S SM i TT_D:
a . Roof R 3c,
b . Exterior wails R (y
c . Glazed areas R 5
d . Exterior doors R D.
e . Floors over unheated spaces R ►y
. Edge of slan on grade (heated bu_ldi nc) R --
c . 3as ement/cellar wails (above c=ade) R
b . 3asement/c="=,- walls (below grade) R
- . __eating/coC_-nC-c c=s-piD1:c in unheated space R Li.
6 . Service (domestic) hot water heating device, /
Ccio--.i� to minimum efficiency pe= code )G, Yes No
RA �RE ccarao MA: Mt.TM SETTING 1400 - WILL NOT BE EXCEEDED
S- - ,R' S REMARKS:
30/k
RESIDENTIAL FINAL INSPECTI®N REPORT
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement
Dept.of Community Development Arrive am/pm Depar —''•` alp/pm
Town of Queensbury Inspector's Initials V !-/
742 Bay Road _ / Q
C >Queensbury,New York 12804
NAME ( .\C\kik PERMIT 4 �� /����
LOCATION 11114 l l I C ��1 DATEi�
TYPE OF STRUC
N/A YES NO COMMENTS
Chimney HeightP'B"Vent/Direct Vent Location �s�C—ut,d`1)S JL
Fresh Air Intake
Plumb Vent through roof p 11
Roof Complete kook s 17 I L A) C) 1'l LC--
Exterior Finish Comp et•
Interior/Exterior Rai •A gs 0"to 36"
i/Exterior Handrails, ..'comes,landing 18 in.or more
Interior Handrails stair both sides 3 or more risers
Grade 2%away from ft :dation
8//"clearance to sill plat-
17.7
VGas Valve shut-off expo.eld/regulator 18"above grade
Gas Furnace shut-off wi n 30 feet or within line of site
0)1 Furnace shut-off at e i n ance to furnace area
vFurnace/Hot Water He: • operating
Relief Valve(s)instal ••
Headroom,6 ft:6 i .on s .0
Basement stairs,6 ft.4 in.
Handrail exterior stairs bo sides more than 3 risers
Interior privacy/trim/doors/ ain entrance 36"
Floor Finish
Bathroom/Kitchen waterti, t •
Interior Handrails Balconie anding 18 in.or more
Railing across window in s ells _
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)
FIRE MARSHAL
111:14 TOWN OF QUEENSBURY
QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST RECEIVED PERMIT# a(--/m
NAME C1 C0 7
LOCATION GG°/)aU IA)
SCHEDULE INSPECTION ON
( I AM PM ANYTIME
APPROVED
N/A YES NO
EXITS I
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
FIRE ALARM SYSTEM
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION SYSTEM
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINK ERS
CLEARANCE TO HEATING. UNITS
REQUIRED SIGNAGE
CHIMNEY
WOOD STOVE
FIREPLACE-MASONRY _
FIREPLACE-FACTORY BUILT rl,�/�
REMARKS: EOK TO THIS DATE
iNsasi iP,Pua INSPECTOR
.. ,Q\\‘(-"
RESIDENTIAL FINAL INSPECTION REPORT .
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement
Dept. of Community Development Arrive am/pm Depart! T p
Town of Queensbury Inspector's Initial
742 Bay Road
Queensbury,New York 12804
NAME J-421,"ClOCi5- PERMIT .--/
1 F
LOCATION rt,t A DATE iTYPE OF STRUCTURE` �—� r
N/A 7/No COMMENTSnChimney Heightf"B"Vent/Direct Vent Location I ' 4 u k� r\ "i 4 � Pc_�'LJ
Fresh Air Intake t// fe l c2,4g_ -- 0•/J -/C C
Plumb Vent through roof i//✓
Roof Complete i/
Exterior Finish Complete ✓
Interior/Exterior Railings 30"to 3:' .� (� R6 RC jtC
Exterior Handrails,balconies,Iand. g 8 in.or more / lJ ft1 J A-GL� R {t-
Interior Handrails stairs both sides or A.ore risers
Grade 2%away from foundation V
8"clearance to sill plate
Gas Valve shut-off exposed/regulat.� 18' above grade / c'sf Ybr /�1, 7 / f)
Gas Furnace shut-off within 30 feet. wi 'n line of site / ii/ -s�
Oil Furnace shut-off at entrance to ac r area v r�c/ /—
,FtintiteeiHot Water Heater operating (t/ -�D r� • FA,A-C
Relief Valve(s)installed ✓&-
Headroom,6 ft.6 in.on stairs
Basement stairs,6 ft.4 in. 1 ✓
Handrail exterior stairs both sides Ono than 3 risers V'
Interior privacy/trim/doors/main entr ce 36" V f
Floor Finish �//
Bathroom/Kitchen watertight ✓/
Interior Handrails Balconies/Landing 11 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 t//
3/4 hour fire door/door closer / t/l
Garage fireproofing J/ V
Garage penetrations sealed
Furnace in separate room protected(in garage) >.'
Light ventilation pe room
Safety glazing 1 " r less om floor
Final Electrica Z.S 0/ 6
Site PlanNarianc requ' ed L.
Final Survey Plot Plan
As Built Septic System layout required
Okay to issue C/C(Certif.of Compliance) J/ a „ i. r f j t •Z o 4/3-7 Pi-
Okay to issue temp.C/O(Certif.of. Occupancy), l� I b�j 7�
Okay to issue permanent C/O(Certif.of Occupancy)
/• TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
0t � 1 742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256
ARRIVE: DEPART: INSP:
FINAL INSPECTION REPORT - RESIDENTIAL
DATE INSPECTION REQUEST RECEIVE :
NAME a
LOCATION DAT PERMIT OX)/In
TYPE OF STRUCTURE
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING _ SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT/B VENT/HEIGHT
PLUMBING VENT
ROOFING
' EXTERIOR FINISH /
DECK/PORCH/STEPS/ ^SLINGS
RELIEF VALVES
FURNACE/HOT WATER O FRAYING
INTERIOR TRIM/PRIVACY ORS
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
SITN/VARIANCE REQ.
L AL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C/C
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545 20
MUNICIPAL CERTIFICATE ELECTRICAL APPROVAL 0?
Panel Board No Cert. N2 69339 Cut-in Card No./4
Oj..3../.G...
Owner 1-Z4 r2 `/ L ctrer
Location 14.1,.Cr-ll Y2 td 1yk (3t4./.C% .r4 b u
Installation Consisting of..o QA.I. ...U.Ct— , e RV..) -}....G.O. P.C C• .ci
1-{ G 1-4 S3.....1 .. 9. ..�...I IC YJ .hw as he a.)..CAa... .4 c J2...J'%
Ca.J3�.cR1 . .l!.o)'e- OeT
Installed By...UW/4.4,11 Tt l.C.e9 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 making inspections at any time, and if its
rules are violated,the Company shall have the right to revoke this certificate.
Date G.-a.Li -01 INSPECTOR„4 L...........
((// Member N.F.P.A.,LA E.I.
C '
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 am/pm Depar& a / n
Inspector's Initials (-'----
NAME: L u C PERMIT# b 1 -- O/
LOCATION: A-LC�a�G2v1ki 13 DATE : 6 /5 a '
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers I
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 1
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place R-6-Q
(�Rough Plumbing \\6 '(5 ".L kit)
g gHeatin Rou h-In U l
Insulation nn - ��x G 4
Foundation Walls Interior R- ✓�(. `A)(2 G k. / �4)
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
/ unheated spaces R-
V
JProper Vent, Attic Vent _
dd Framing
Jack Studs/Headers
facing/Bridging
• oist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
110
0—P)(\ir
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 am/pm Depart, ln/
Inspector's Initials
NAME: d--(7``t X- PERMIT# () /' 10 g
LOCATION: J � �oe nC t,t_ DATE: S- 111—apyrs 1
TYPE OF STRUCTURE: UU
RECHECK
N/A YES NO COMMENTS
Footings/Piers I
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 l' �/ � �.� , K
Backfill Approval 0(4 ()
Plumbing Under Slab
Plu bin Vent/yents in Place
ough?lu binge
Beall ough-In /
"'ration rf
� ndation Walls Interior R-
Foundation Walls Exterior -
Floors
Walls R- R /
Ceiling R- •
Duct work or piping in
unheated spaces R- ✓/
Eroper Vent, Attic Vent
Jack Studs/Headers
Bracing/Bridging
Joist Hangers t i✓�y/'A,L �r��"GG PLzt y 111f k56
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
Pe etration Sealed
Wall 2.3,4 hour
/Ire
irestoppmg .o
a---?- I Q R ECT—A—-\ ". )4 1=A\P C 1
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\•9
lb am/ 1t Depart 00
Inspector's Init'"'1!
NAME: PERMIT# L L/
DATE : l JU LOCATION: _ r
TYPE OF STRUCTURE: . '
RECHECK
N/A YES NO COMMENTS
Footings/Piers I I
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for 'tS, V.4
"
providing protection from freezing A\L1
for 48 hours following the p . ement ���
of the concrete. �`
Materials for this purpose on .
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofing
Backfill Approval
Plumbi _Under Slab I 1 ,5
Plu' gh Plumbing;mg Vent/VentsinPlac= \ �S -��,• �J .�-. 3 1.-
eating Rough-In «C__0P)1 --
Insulation
Foundation Walls Interior R-
Foundation Walls Exterio R-
Floors '-
Walls '-
Ceiling I-
Duct work or piping in
un ed spaces '-
Pro ent, Attic Vent
—� ming
Jack Studs/HeadersVI li
Bracing/Bridging t 0 t-W1.-ETE_ r‘ 6
Joist Hangers — FI tvi 1 { t\U
J k Posts/Main Beam V Infiltration Barrier �� V� � 1
ire Separation 1,2, 3,hour TU� ThiV Penetra • n Sealed g PI��[v b` ` ; ���
Fire all 2, 3,4 hour y Ek 4 i,� ��PI L�
`
�� estopping _
WI ..------
Vim,
1))TOWN OF Q UEENSBURY .
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 4j
Location VQ NN (' u_N„
Date L\-(916--),06}Permi t o)-/(J
SOIL TYPE: Sand-Loam-Clay-
Results of Perco atiOq Test-
(if applicable) "ate-i4i,nute/Inch
TYPE OF SYST M:
ABSORPTION F ELD: Total Length 7j'DI
Length of ea h tr-nch 4 c,�56
Depth of tre ches - �) - 7, '
Size of sto e 2-
SEEPAGE T : Nu Der,',‘
Size - ft. x' ft.
Stone size /
PIPING: Size Type
Bldg. to Tank Lii�7W1:::"
-Tank to Dist. Box_ __. 11
Dist. Box to Field P' t" .
Openings Sealed? No Partial
LOCATION/SEPARATIO .
Foundation to Tank IC feet
Foundation to Abso spti on 70 .feet
Separation of Pits fe
Conforms as per P1 t Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Lef Side - Right Side
( Middle Front)- Middle Rear
COMMENTS:
OEED (4._ V)0►T 3 P11C_
Ptroi qPi
•
SYSTEM USE APPROVED: YES NO
Arrive• °At
Dep A` s C
JAMIle Iiii(ALL
Ailiji
uilding In:. Itor
\\ C-1-AC62
lqiis
GENERAL INSPECTION REPORT , ill
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive3 1,21 al p Depart,Depart,V9 a
ector's Initaaa s . !.y..
NAME: / PERMIT# 0l:/ / O
LOCATION: �C b DATE : LI _ 1c\a'a(. e
TYPE OF STR CTURE: ��
RECHECK
N/A`YES O COMMENTS
Footing./Piers pQA I
Monoli ' cur Form
Reinforcement in Place J2,-
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete. �'j ��
Materials for this purpose on site �v�
Foundation/Wailpour :i'
Reinfo cement in Place
Fo dation/Dampproofing k
ackfill Approval 1V
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing 1
Heating Rough-In
Insulation
Foundation Walls Interior R- i
Foundation Walls Exterior R- r'
Floors R- 1
Walls R-
Ceiling R- I' ",
Duct work or piping in ,``
unheated spaces RJR. `;
Proper Vent, Attic Vent
Framing i F,
Jack Studs/Headers / ',
Bracing/Bridging /, c
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier \
Fire Separation 1,2,0,hour
Penetration Sealed <.
Fire Wall 2,3,4 hour
Firestopping
GENERAL INSPECTION REPORT
( 518 ) 761-8256 , 3
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive 1440 a ie epart a
Inspector's Initi
NAME: PERMIT#
LOCATIO : lQ DATE : / — p
TYPE OF STRUC • c
RECHECK
N/A YES NO COMMENTS
Footings/Piers I
Monolithic Pour Form
Reinforcement in Place
The contractor is respo r sible for
providing protection from freezing
for 48 hours following he placeme
of the concrete.
Materials for this purpos.on site
Foundation/Wallpour
Reinforcement in Place
Fo ation/D'amp.roo.
ackfill Approval \� e
Plumbing Under Slab
Plumbing Vent/Vents in Plat e
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterio, R-
Floors '-
Walls
Ceiling
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
Q_
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 am/pm Depart" �am/p
Inspector's Initials \jp✓
NAME: kxr.�-..� LS( ��� PERMIT#.)1— I U
LOCATION: 1(,p ( lA-((i)(' DATE : —/J T>J
TYPE OF STRUCTURE: U U (�
RECHECK
N/A YEO COMMENTS
ootings/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
Plumbing Under Slab
Plumbing Vent/Vents in Place /
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls I' or R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling R-
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
J 1 1 J I I. 1 ► .1
6 _ _ '-1 1. . of
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MAP REFERENCE:
MAP OF SECTION NO. 5
LAND 0' PINES
DATED: FEBRUARY 23, 1984
FILED: DECEMBER 18, 1984
BY: COULTER & McCORMACK
—` C 1Alj U'K �
------0------- —0
S83'15 00"E w"
160.00'
CIRF
� ry
a
1 0
119 4L% Q
LEGEND: ` F01
120
O CIRF = CAPPED IRON ROD FOUND r
= HYDRANT
Ln cower ° CIRF
I� - ~
Q GRF
7629' I O 3
3 4L70' Cr
W ('0 00
O uc ap
9-4
01)
O a GRAVEL DRIVE N
CRF /
RECEIVED
ururEs
JUN 2 6 2001
109.94' °
°O�DL TOWN OF QUEENSSURY
N83'1500W R�1�I ! 5 MAP WAS PREFAM
CEF FROM AN ACTUAL FIELD SURVEY.
THIS CERTIFICATION SHALL RUN ONLY TO THE PERSONS
ISPERINGFOR WHOM THE 5MVEY WAS PREPARED. AND ON THM
BEHALF TO THE ME COMPANY. GOVERNMENTAL AGENCY
AND LENDNG INSTITUTION TRAM HEREON.
PINES 'WAY
CERTrIGATIONS ARE NOT TRANSFERABLE TO ADDITIONAL
I F NSTIMI0145 OR SWSECAJrNT OWNERS.
GERTPED TO, KENT & EVELYN M. DIXON
CHARTER ONE BANK, F.S.B., its successors
and/or assigns
CHICAGO TITLE INSURANCE COMPANY
e'f NEW
Al
.� .
MATTHEW G. STEWS. LLS NY5 501W
't �r DATED JUNE 15, 2001
D
ateL 4,
2001
,NAU4,OgffD AtTExAuON OR ADDITE]N ,� � "�
�.n u 's MAP REAwtNo A ucE+RmAN LD �REAL N A Map of a Survey made for Scale 1'=30'rM
D. 'n �unw of Ana r^ Rib-WMW % a W
Gam. WW V= STATE EIM1LA710141 LAM.'
Steves K&NARRO rTm AN aRowL a WLAW nnYEYOM�
WIALL ME
I"'"'MINW KENT & EVELYN M. DIXON S-1
TH! wRvcY MAS PRFP'AIMD M AOOOIIDANCE MT1 R1E
Land Surveyors, LLC BYTM°O°`"R"EM""'°A°°P°
w 1NE NEW Msx srATE A9RDOIATNIN a MOPERIIONAL
LAID SURYMM SAID OFNiIFICAM6 86" RLM OILY
W THE PERSON FOR V*= THE 904T R; PREPARED, AND
ON NO RMALF YO W TIM OtlIrW SOVEUNNHRK � t OF 1
169 HavUand Road Queensbury, New York 12801 Ao� A"' `m o PC La°" "M6 NE"°' "'° Town of Queensbury, Marren County, New York
To m AiiYJQ6 a M �oR: nann�rsL•
DIXON C491
1(518) 792-8474 New York Lie. No. 50135 NO. DATE DESCRIPTION DWG. NO. 01141