2001-421 TOWN OF QUEENSBURY
Iwo 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE
OF OCCUPANCY
Permit Number: P20010421 Date Issued: Wednesday, October 31, 2001
This is to certify that work requested to be done as shown by Permit Number P20010421
has been completed.
Tax Map Number: 523400-295-010-0001-041-000-0000
Location: 23 JACQUELINE Dr
Owner: GUIDO PASSARELLLI
Applicant: MICHAELS GROUP
This structure may be occupied as a:
By Order of Town Board
Fireplace TOWN OF QUEENSBURY
Garage - 2 Cars Attached
Single Family Dwelling 41.
4
Director.of Building& Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201.
„Sr. 4,
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010421 Application Number: A20010421
Tax Map No: 523400-295-010-0001-041-000-000
Permission is hereby granted to: MICHAELS GROUP
For property located at: 17 JACQUELINE 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: GUIDO PASSARELLLI Single Family Dwelling 155,000.00
465 LAKE Ave Garage-2 Cars Attached
LAKE LUZERNE,NY 12846 Fireplace
Total Value 155,000.00
Contractor or Builder's Name/ Address Electrical Inspection Agency
MICHAELS GROUP NEW YORK BOARD OF FIRE UNDEI
SUITE 1
10 BLACKSMITH Dr
MALTA.NY 12020
Plans &Specifications
2001-421
2014 SQ FT SINGLE FAMILY DWELLING.WITH 2-CAR ATTACHED GARAGE AS PER PLOT PLAN
SPECIFICATIONS
$285.68 . PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,June 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 n of een ry• T 1 ssixagne 21,2001
SIGNED BY ''' for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit - Septic Disposal System
Town of Queensbury 742 Day Road Queensbury, NY 12804 (318) 761-Y2.c6
I, OWNER INFORMATION:
Location of installation: /NUJ �1 \mac �(l) Office Uxc
Tax Map No.
'711 / a / File Permit NoD1` gat
4�E
G� am,`S Cd Fee Paid
Owner's Name: T
Address:
2. INSTALLER'S NAME PHONE NO. CeS2, -'',\�
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate II bedroom(s) and multiply /1 a/'
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/bdrni =
•
1980 - 1991 x 130 gal/bdrni =
199I -present x 110 gal/bdrns = 33�
Garbage Grinder Installed yes / no >K •
Spa or Whirlpool Installed yes / no X
PARCEL INFORMATION; (circle applicable information & indicate measurements)
IQa9i,raphy Soil Nature Ground Water Bedrock or Impervious Material Domestic W3tcr Supply
Eh'lat sand' at what depth at what depth
!lolling loam feet / municipal)
2_ n .lie! y feet
S'teep slope clay
slope other if svcll; water supply
depth: /i vm any septic-system
ab,volpti(n1
Percolation Test: (To he complete.cl by licensed.pra/c architect)engineer or architec Other
Pate: J • minute per inch
S. PROPOSED SYSTEM: For New Construction: Ail 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: - gallon (min. size 1,000 gal.)
Tile Field: each trench fj Total System Length:
Seepage Pit(s): number of size o each;
Size of Stone to be used: II 2_-- / depth ur thickness
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.
1 have read the regulations with respect to this application and agree to abide by these and all
. requirements of th Town of Queensb•,ry Sanitary Sewage Disposal Ordinance.
S gnature of responsible person ate
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.
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: s
application form. `` �a
•
Applicant: M1CV-1c15 l arm Owner: (Yd
Address: p Address: COVED
Phone# ( )BC ( - l031\N Phone#( ) - JUN 1 8 2OU1
TOWN OF QUEENSBURY
BUILDING AND CODE
Property Location: Lot Number: �?j / House Number 03/ A2tir .\Vt jt..00(t .
Subdivision Name: 1 Ar\` tvo 'Esk-ak...0_,, Tax Map Number: }jq fair
1 New Building: residence /commercial Estimated Market Value of Construction: $ 1
❑ Addition: residence/ commercial If an Addition, what will use of new addition be?
❑ Alteration: residence/ commercial
❑ No change to exterior size: residence/com'l
❑ Other work(describe
Check Occupaucylnformation I" Floor 2"`T Floor Other floor Total
Below sq.ft. sq. ft. sq. ft. Square Feet
t Single family dwelling 'e.)9‘9% `Z® 1` -
❑ Two family dwelling
o Townhouse
o Multifamily dwelling
#of units
o Office
a Mercantile
o Manufacturing
o I car detached garage
o 2 car detached garage
❑ 3 car detached garage
❑ 1 car attached garage
p9 2 car attached garage Imo Liao
❑ 3 car attached garage _
❑ Storage building-
commercial
❑ Storage building-
residential
❑ Other
Will any second-hand or ungraded lumber be used? If so, for what? No
Type of I-leating System: electric/ oil wood /forced hot ail baseboard/other:
Number of Fireplaces to be installed CAE Number of IFoodstoves to be installed 0
List below the person(s)responsible for supervision of work as regards to building codes:
Name Address Phone Number
Builder b `�z
Plumber c c Plu%,(Aoikf-Nc ( C 1•;.kSv' Mkcyoivu,A 4S- 2
Mason ?®, ^�x�jA4I ,iE-1vn �T:ri�-. 4-2k— cn(pc)
Electrician �
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 ector of Building anc ;odes,an its Built Sarver by a licensed surveyor;drawn to scale,showing actual
location of all u w onslructio
•
Signature: owner,owner's agent,architect,contractor
•
Fire Marshal's Office Town of Quecnsbury, 742 Ray Road,Queensburv,NY
(518) 761-8205
, Application for Fuel Burning Appliances & Chimneys:.
applicable to solid fuel & vented gas appliances ,
Date 20 CAPermit No. ..... , ' .1 .
Application is hereby made to the Building& Codes Office fOr the issuance ofa 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 ill y)eclor. to enter'premil'es to pelf-Orin required inspections.
NOTE to applicant: Rough-in and Final Inspections are required.
Applicant Information Fuel Burning Appliance Information
(circle appropriate words)
Name: MAL, InkCINZASc j Stove: wood coal pellet' gas
Fireplace insert
Address: 10 :M � .L Fireplace, factory-built: wood g l
-t" ; , C) Fireplace, masonry: wood airs
` Furnace: wood gas oil
Phone: "'( `" t `'
1 If non-masonary applicance, please provide
Owner: %NILO. Manufacturer Name:
-
Address: Model Number:
I,,;-7 •
Chimney Information
Phone: (circle appropriate words)
Masonry blockkick stone.•
Flue . tile tstteel) size. inches
Exact Address: . ,,�. �% &.
of construction o`•installation Factory-Built
v
L T -, t Manufacturer name: -
Model Number:
Note: Listed By: Number:
Construction /Installation must
conform to NYS Fire.Prevention &. Building Indicate (circle) chimney material: -
Code. Consult available Town of Qileensbuiy
• Handouts regarding required inspections. Double wall / Triple wall / Insulated / Direct venting .
Chimney Liner
j cY sshi•e.x" t l0PepEurtmo xit—TaVsy of Queezzigcbizo-y, New Yarirc l
- '� is l ,
( ¢ v.
Fire Marshal Code 4 S Collected S Refunded Received fi•o,n trctunded to): t\ ( C . '.-° ` $ ti t r- 'A
a 173 3389 (190) Public Safety — - --- _ — ---
9 23.3 2655 (230)Minor Sales
r -) 1-
61Sprt.a wL6 — loww 66.44 02 DelJi.Z3,
White(Applicant) ; Green(Fire Marshal) / . Yellow(Bldg. Dept.) i Pink&Goldenrod(Cashier's Dept.)
7 (c
GENERAL INSPECTION REPORT
( 518 ) 761-8256
Town of Queensbury
Dept. of Community Development Date inspection request received:
Building& Code Enforcement
742 Bay Road ,t
Queensbury, NY 12804 Arrive am/pm Depart gm
Inspector's Initials
NAME: \t"-\ Pc-C-c_S C9(2-C- PERMIT# 6 r Lk,
LOCATION: '�-2a cep DATE : /I I/ /b f
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers 1 F I
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection from freezi
for 48 hours following the placen nt
of the concrete.
Materials for this purpose on site
Foundation/Wal Ipour�
Reinforcement in Place
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
Heating Rough-1n
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
P oper Vent, Attic Vent_
Ja k Studs/Hcadcrs
Braci ng/Bridgi ng_
Joist Hangers •
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation I,2, 3, hour
Penetration Scaled
Fire Wall 3 4 hour
✓i estg-_
a
RESIDENTIAL FINAL INSPECTION REPORT
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement -
Dept.of Community Development Arrive am/pm Depart f m
Town of Queensbury Inspector's Initials J
742 Bay Road
Queensbury,New York 12804
NAME U� \G IA, 1/2 60 1 PERMIT# 5 l
LOCATION 'VD 3 QC,-(S tJ C - (!' ( O it DATE 1/..)(73 / /
TYPE OF STRUCTURE l
N/A YES NO COMMENTS
•
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake
Plumb Vent through roof
Roof Complete
Exterior Finish Complet
Interior/Exterior Railing 30"to 6"
Exterior Handrails,bal nies,Ian& g 18 in.or more
Interior Handrails stairs oth sides or more risers
Grade 2%away from fo dation
8"clearance to sill plate 1
Gas Valve shut-off expo ed/regulato 18"above grade
Gas Furnace shut-off wi in 30 feet o within line of site
Oil Furnace shut-off at en ance to ace area
Furnace/Hot Water Heater perating
Relief Valve(s)install d
Headroom,6 ft.6 in.on'n sta' s
Basement stairs,6 ft.4 in.
Handrail exterior stairs both des more than 3 risers
Interior privacy/trim/doors/ma entrance 36"
Floor Finish •
Bathroom/Kitchen watertight
Interior Handrails Balconies/Lan 'ng 18 in.or more
Railing across window in stairwel
Smoke Detectors: I 6
every level of
every bedroom
outside every bedroom
inter connected
Bathroom
fans
Plumbing
Plumng fixtures
iuidation insulation
3/4 hour fire door/door closer �� 14505 „Q
Garage fireproofing l'
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
4 1, TOWN OF QUEENSBURY
4. j QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST RECEIVED RMIT# 0( -4 /
NAME M jQ
LOCATION cfyuaiLL �Y
SCHEDULE INSPECTION ON zz>---3O - o�
AM PM ANYTIME
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
FIRE ALARM SYSTEM
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION SYSTEM
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNI
REQUIRED SIGNAGE //
CHIMNEY
WOOD STOVE
FIREPLACE-MASONRY � ��
FIREPLACE-FACTORY BUILT f l A
REMARKS: 121 OK TO THIS DATE
INSPSLIP.PUB INSPECTOR
Ilk ,
3P))) ....)
RESIDENTIAL FINAL INSPECTION REPORT
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement
Dept.of Community Development Arrive am/pm Depa �
Town of Queensbury Inspector's Initial
742 Bay Road
Queensbury,New York
\ 12804n
NAME I C�h4 Sly PERMIT 4� / 1 �/
LOCATION g\��2C•L.A.,,�1 / DATE r 0—3(T)-c.
TYPE OF STRUCTURE v SS�
N/A YES NO COMMENTS
Chimney HeightP'B"Vent/Dir- t Vent Location
Fresh Air Intake
Plumb Vent through roof1/1
Roof Complete
Exterior Finish Complete
Interior/Exterior Railings 30"to 36"
Exterior Handrails,balconies,Ian.• g 18 in.or more
Interior Handrails stairs both•ides. or more risers c
Grade 2%away from foundati n8"clearance toy'1 plate
Gas Valve shut-off --..sed/r=r ator 18"above grade
Gas Furnace shut-off within 31 feet or within line of site 1/
Oil Furnace shut-off at entrant: to furnace area
Furnace/Hot Water Heater operating _
Relief Valve(s)installed
VZ
Headroom,6 ft.6 in.on stairs Basement stairs,6 ft.4 in. J
Handrail exterior stairs both side more than 3 risers
Interior privacy/trim/doors/main - trance 36"
Floor Finish ;�/
Bathroom/Kitchen watertight yam/
Interior Handrails Balconies/Lan.• tt 18 in.or more ✓
Railing across window in stairwells
Smoke Detectors: /
every level l//
every bedroom i//
outside every bedroom ,/
inter connected
Bathroom fans
Plumbing fixtures
Foundation insulation V'e_,, -I pc _e-a 01 to a o 4-)
3/4 hour fire door/door closer
Garage fireproofing
Garage penetrations sealed L
Furnace in separate room protected(in garage) � /A) rit--LL- / VAj7�{ �(_vCK�
Light ventilation per room r/ •i,5 L_
Safety glazing 18" 1 s�r floor / /
Final Electrical or /I la 01011
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)
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
1 531 BAY ROAD
QUEENSBURY NY 12804
(518)745-4447
./
ARRIVE: DEPART: INSP: �7
FINAL INSPECTION REPORT
adusapeAL NG
DATE I S CTION EQUEST E EIVED
NAME l / 7�611/
LOCAT3
DAT/ c ( O/ PERMIT #
TYPE OF STRUCTURE . 17:-)S P
FOOTINGS BACKFILL FRAMING PLUMBING
INSULATION
N/A YES NO
CHIMNEY/"B" VENT/HEIGHT
PLUMBING VENT/FIXTURES
ROOFING
EXTERIOR FINISH
HEATING/HOT WATER -
RELIEF VALVES
FLOORS
FOUNDATION INSULATION
INTERIOR STAIRS/RAILINGS
STOCKROOM ENCLOSURE
FIRE/DEMISE WALLS PENETRATIO
FIRE DAMPERS
CEILING FIRE STOPPING
FIRE DOORS/CLOSERS
EXIT DOOR HARDWARE
EXIT STAIRS/RAILS
PLATFORM/ELEVATOR
HANDICAPPED ACCESS
HANDICAPPED BATHS
HANDICAPPED PARKING
FINAL ELECTRICAL
SITE PLAN VARIANCE REO.
AL SURVEY PLOT PLAN, IF REO 1
OK TO ISSUE C/O OR C/C
:3 324-- -LV.
N° g ok.
GENERAL INSPECTION REPORT
(•518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road F U
Queensbury,NY 12804 Arrive am/pm Depa( '-- ' m
Inspector's Initials
NAME: CAO ( flQ PERMIT# I
LOCATIOON -��C' 3 DATE : — - 1
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers 71-7
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following th= p ment
of the concrete.
Materials for this purpose o u site
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
He. 'ng Rough-In
`Tlaton
Foun tion Walls Interior R
Foundation Walls Exterior R-
Floors R-
Walls R- lq
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
•-netration Sealed
ire A all 2,3 fi lour
Firestovju _ k(2 .
1:1:: - '''------ --`!ttgf,7-.,,10:4: --, jpag:d.i.t;'`,LtiW___,
) O41/\
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 Departjd
' m/ m
Inspector's Initials
NAME: 1 \) G / PERMIT# -- `- a J
LOCATION: F�3 C A 7& 1� DATE : —7 c )
TYPE OF STRUCTURE: - c (:)"
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsi. e for
providing protection from II -ezin
for 48 hours following the ',lace '-nt
of the concrete.
Materials for this purpose on
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofi
Backfill Approval
Plu bing Under Sl.
Plu bing Vent/V nts in Place f
gh P11mb' .g� ,/
eating"`ugh-_I_x"
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Pr r Vent Atti nt �' '� F�x kG1� �,
- Ong ?7vt)Aa'� �7'+�D .��3� ,\
Jack Studs/Headers
Bracing/Bridging
Joist Hangers 717-6- -
Jack Posts/Mam Beam
-4ir:I�filtration Barrier d� 6 i b w`�`° -
Fire Separation 1,2,3,hour I ��&--4--� K
Penetration S ed
Xstoppine
Wall 2,3 our_ /' V,P1- /1 ,(%�(�-(2 7
FIRE MARSHAL
TOWN OF QUEENSBURY
QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST RECEIVED MIT#0/ c22 I
NAME
LOCATION _sa-3 .SCt G l
SCHEDULE INSPECTION ON — 7- 00 /
/0 • PM ANYTIME
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
FIRE ALARM SYSTEM
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION SYSTEM
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
CHIMNEY —Pi ft \I\C- i
WOOD STOVE _
FIREPLACE-MASONRY
FIREP CE-FAC ORY BUILT
----r
REMARKS: E] OK TO THIS DATE
0uc- ci
INSPSLJP.PUB INSPECTOR
3/27)1
GENERAL INSPECTION REPORT
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building& Code Enforcement
742 Bay Road -7 ' 21
Queensbury,NY 12804 Arrive am/pm Depart . rn/�m
Inspector's Initials J
NAME: 0\' C--V\-OkAL PERMIT I
LOCATION: 3- DATE: O i
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers I. I
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection ro freezing
for 48 hours followir.g the lacement
of the concrete-
, Materials for this purpope on s.to
Foundation/Wallpour
Reinforcement in Place I
Foundation/Dampproofig
Backfill Approval `
Plumbing nder Slab I
Plumbing - . 1 i Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls In - 'or R-
Foundation Walls Ext:,'or R-
Floors R- ,.
Walls R- ,
Ceiling '-
Duct work or piping in
unheated spaces R
Prorim�c _ ant, -�7ent. �c
° 1111flt1g iP :° °" .
p.,‘
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
F' all 2, , ur `%
- estopprngs_��
1
^ // 1
TOWN OF QUEENSBURY L(7 U
r
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 1
Location
�.. J^Date 41 J
� � � P= � it #
SOIL TYPE Sant .am- lay-
Results of Perco .t on :st-
(if applicable) Ra 'e-Minu .e/Inch 0
TYPE OF SYSTEM:
ABSORPTION FIELD: otal Length /aP
Length of each tre ch d. ,/
Depth of trenchqs o
Size of stone PN-1 tCaS jai. '
SEEPAGE PIT • Numb_ir
Size - ft. x ft.
Stone size
PIPING: — Size Type
Bldg. to Tank I / r7�;j✓1. 3.
Tank to Dist. Box u
Dist. Box to Field/P. vi 1,i
Openings Sealed? No Partial
LOCATION/SEPARATION`
Foundation to Tank f d feet
Foundation to Absorution . feet
_
Separation of Pits feet
.—,Conforms as per Plot Plan — en No
ON OFSYSTEM ON PROPER :
(ci cl - one)
Fro Rear - Left Side - Right Side
i ddl e Front - Middle Rear
COMMENTS:
44T4)6/1c:7
SYSTEM.USE APPROVED: (;) NO
Arrived:.
Departed:
Building Inspector
11
I have seen or observed, or bell'9ve I saw evidence of,r 1 2) l
` all objects such as houses, wells,frees, fences, etc., �shown on his document. I also represent that I have
—o. personal , easc r i" .,: . • apt fnrth on the diagram." RECEIVED
II/ d � 6� uuN � 2uo/ 0 _
SIGNA RE DATE TOWN OF QU SBURY
�+ BUILDING D.CODE
[ATES •- S8510'11"E
87 - .! 144.17'
3 1 i
, .
4
1
fi i t, If
/ 1- ~ , / g 3
f _ //
,. is' d
,,- -„L.../„....._____. / G.&
O /, r. Asa /�" 1
o N AR�� U
Z. 21 507 - '
" sq ft I
j 0.49 ocres r
1
• t____L___' ,
LOT' 3k
�in . .
o 1....i litri.a.P +ESP1-7ES
01
,//:-/- - 60(;14erffC �i\
75.00ri �- cO ' lzdzef
N85'10'1( W •
! l ,
SARAH EN DRIVE - 30
--
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 . pm
Inspector's Initials [�
NAME: / PERMIT# � ,—/D
LOCATION: l DATE : —417 — Q
TYPE OF STRUCTURE:
RECHECK
N/A YES-NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Pla
The contractor is r sponsi►,le for
providing protecti.j from --zing
for 48 hours folio ng the .lacement
of the concrete.
Materials for this p ' se on site
Foundation/Wallpour
Reinforcement in Place
Fo tion/Dampproo
11 Approval
Plumbing Under Slab
Plumbing V-n - in ' . -
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interio R-
Foundation Walls Exterio 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
GENERAL INSPECTION REPORT j P
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive Ut3 am/pm Depart m/pm
Inspector's Initial
NAME: QD CarPERMIT LOCATION: 3��_ r i # (DATE : U f
TYPE OF STRUCTURE:
RECHECK
N/A YEES%O COMMENTS
otings/Piers I I
Monolithic Pour Form
Reinforcement in Place 11 1/-C /d%uu5
The contractor is responsible for
providing protection from -ezing
for 48 hours following the ►lacement
of the concrete.
Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproo•ng
Backfill Approval
Plumbing 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
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
c - 0E-.r�IEPLIrJ�rPLIOPErPER_Pc c_PLIEIEPLPErJP c_PLIU r PLIEIcJPPEPrJ��n�n�nrJ@nrJ��r-rJ�r�rJ��l-r�r�r�r�r_PcPc_ PrJP LIMIrrf.i
5 BY THIS CERTIFICATE OF COMPLIANCE THE 5
5 NEW YORK .-BOARD OF FIRE UNDERWRITERS 5
5 BUREAU OF ELECTRICITY C5
5 ,4O FULTON STREET -- NEW YORK, NY 10038 5
5
SCERTIFIES THAT 5
5 5
S , Upon the application of upon premises owned by 5
5 C5,
5 FOREVER ELEC/BOEL ELECT. cOV ).— MICHAELS GROUP [Cj
SCENECTADY, N.Y. 2309, ( QUEEN23 SBURY, NY 12804 5
ULINE
5 �a l 5
5 / C5
5 Located at . -- 23~JACQULINE QUEENSBURY, NY 12804 5
5 5
5 Application Number: 1010179 Certificate Number: 1010179 -0
5 5
Section: Block: Lot: Building Permit: BDC: A239 • :__ S
5
Described as a Residential occupancy,wherein the premises electrical system consisting of
5electrical
devices and wiring, described below, located in/on the premises at: 5
Basement,First Floor,Second Floor,Attached Garage,Outside, 5
was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below,was
found to be in compliance therewith on the 1lth Day of January,2002. 5
5 Name QTY Rate Rating Circuit Type 5
Alarm and Emergency Equipment 5
Sensor 5 0 Smoke 5
5 Appliances and Accessories 5
5 Bell Transformer 1 0 5
a Dish Washer 1 0 F.H.P. 5
C5J' Disposal 1 0 F.H.P. 5
5 Exhaust Fan 5 0 F.H.P. 5
Furnace 1 0 Gas 5
Wiring and Devices 5
5 Fixture 27 0 Incandescent C5
Receptacle 35 0 General Purpose 5
5 fj Switch 39 0 General Purpose 5
Receptacle 5 0 GFCI 5
Outlet 5 0 Telephone - 5
5 Outlet 4 0 CATV _ CCJ
Receptacle 1 0 Dryer i
5 Receptacle 1 0 Range seal C5� Pole/Post Lighting Standard 1 0 Residential
5 Continued on Next Page 1 of 2
5 5 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5
5 5
0P CPCPCCPC-PCrPCPC �rJ LPICIOREEP ESOM E.PcIOPLIErJ�rP LIMPS] LIErJR�EPLIr�rJ�rJ ESOPr EPLIMEIEf El
r.
1 ��[1rarer_raro_rarararararo_rJaro_rJ[.frJ�[J�[J�[1�cromm rior[J�[nrJ�[.nrJr.Pry[n[nr�clrJ ranc[J�ran[J�rJ�rJ�r�rJ�r�rJ�Esour roso�rJp[J�rJ�rJ�[J�[nEDEPE �Erdro
5 BY THIS CERTIFICATE OF COMPLIANCE THE 5
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
5 5
5 BUREAU OF ELECTRICITY 5
5 40 FULTON STREET — NEW YORK, NY 100385
5 CERTIFIES THAT 5
5 5C
5 Upon the application of upon premises owned by 5
5 C5
FOREVER ELEC/BOEL ELECT. MICHAELS GROUP C5
5 SCENECTADY, N.Y.STREET 2309, QU QUEENSBURY, NY 12804 ULINE 5
5 C55
5 5 Located at 23 JACQULINE QUEENSBURY, NY 12804 5
101 179 1010179 5
Application Number: 0 Certificate Number: 5
5 Section: Block: Lot: Building Permit: BDC: A239 5
5
Described as a Residential occupancy,wherein the premises electrical system consisting of
55 electrical devices and wiring, described below, located in/on the premises at: 5
Basement,First Floor, Second Floor,Attached Garage, Outside, S
praU
was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below, was
found to be in compliance therewith on the 11th Day of January,2002. 5
Name QTY Rate Rating Circuit Type '�
5 Service 'e
1 Phase 3W Service Rating 150 Amperes 5
Service Disconnect: 1 150 CB 5
Meters: 1 5
5 5
5 5
5 5
5 5
5 5
5 5
5 5
5 5
5 5
5 seal _ 5
5 5
5 2 of 2 5
5 C5
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5
5 5
arcJardroopccJp cro m puo cJrdmJram pccJc_pc_cpc_ompccJ�mJ�m pccnmJ�mJrgmJraardrmJp r_pdp_pdpcm_pc_ neJsmrmJ�m �r_PLImJP UPPED m.Pcfc.f 0
• ••
• - CONSERVATION CONSTRUC'TION CODE
PART 5 COMPLIANCE FORM CRO6/-6 C)-1
Building Design by Acceptable Practice
ELDING
U n
DDRESS: Ov_k).1-4 DATE
.47tet,(27 . COUNTY: 1J?414Z61j
--0S-E3C0
LRCH1TECT,ENGINEER,OR
X)NTRACTOR_: 111 14161-1A &20UP PHONE: 5 1 8
'ERMIT APPLICANT: 56'116 PHONE:
• HEATING DEGREE DAYS (Table 2-1)
N
BRUILED°INCFGQEUE
[15000-6000 [17000-9000
tIJUN 1. 8 2001
TO
ENSBUR\
BUILDING DESCRIPTION (Pre-qualifying Conditions)*
If the building does not meet all of the following pre-qualifying conditions,
• Part 5 of the Energy Code may not be used.
R Building is residential with-one or two dwelling units.
Building is-less than 5,000 gross square feet
P1 Building is three stories or less in height.
. .
Ratio of glazing area to gross wall area is equal to or less than 17%.
III. PROJECT TYPE
111 New construction [1 Substantial renovation of existing building
0 Addition to existing building [1 Exempt(7810.6c)
of Nat
zo
IV.. HEATING SYSTEM TYPE
.7)- t •-•
1 Gas-fired ri Oil-fired I Heat pump I Electric •
, 4
• c,
Joint Sealing: 7814_10(i)
Joint Location I Sealant Type Specified I Plan/Spec_ Reference
Windows Polycell _ ,
Doors frames I weatherstripping •
Walls at roof/ceiling
Poi vrel 1
Walls at floors/found_ Polycell
Wall paneLs N/A
Utility entrance Weatherstripping 1
Penetrations Polycell
Other
Other _ I
Air Infiltration Barrier: 7814.10(j)
Location Required? , Specified I Plan/Spec.. Reference
Walls yes[no No-Cedar Siding
Other yes/no
Fireplace: 7814.10(k), (m)
Required I Specified Plan/Spec_Reference
Outside combustion Yes-
air duct with damper
Flue damper with max.20 cfm, or damper <20 c_f_nt_
damper and non-combustible doors
•
Gas fireplace ignition No ,
VI. HVAC PERFORMANCE: 7814.11 (Table 5-3)
Equipment Minimum Performance Specified Performance Plan/Spec.Reference
Furnace • 70% AFUE 90%
Boiler
Heat pump
Central air
conditioner i
•
tIVAC GUN t HUL_ 7814.12
Temperature Control
Required 1 Specified 1 Plan/Spec_Reference
Thermostat each Yes
dwelling unit
Shut off at each Yes
terminal unit
Thermostat
Required I Specified Plan/Spec_ Reference
Minimum rang I Yes
45T-85°F 1
Deadband Yes
range >_5°
Automatic - Yes
capability
•
VI I I. DUCT SYSTEMS: 7.814.13
Category Required Provided Plan/Spec.Reference
Duct >_ 1"thick N/A in conditioned space
insulation - R-33 in uncondtioned space
Transverse Sealed YeJ
joints •
IX. VENTILATION SYSTEMS: 7814.14 •
System Type Required Specified Plan/Spec.Reference
Supply Damper at envelope Ye s
Exhaust. Damper at envelope Y e s
Supply on/off switch + v P •
Exhaust on/off switch I
Yes ;
•
PIPING INSULATION: 7814_-15
Piping Type Insulation Provided Plan/Spec_
Required Reference
Heating distribution" >_ 11/2" N/A
Service bot water`` >_ 3/4" I N/A
`Does not apply to runouts_
"Does not apply to piping with a diameter less than or equal to 3/4"inch_
XL SERVICE WATER HEATING: 7814.21 (Table 5-4)
Performance Requirements
Water Heaters Minimum I Specified 1 Plan/Spec.
Performance Performance Reference
Storage g' > _93 -_00132V I > _93
Instantaneous N/A
Pool N/A
•
Controls
Category - Required Control Control Provided Plan/Spec_
• Reference
System automatic control Yes
System temp.-setting range 140 degrees max_ •
Pool heater Lill N/A •
Pool heater on/off switch N/A
Electric water heater • separate switch N/A
Gas/Oil water heater separate valve Yes
XII. ELECTRICAL POWER: 7814.31
Category 1 :Required I Specified - Plan/Spec. Reference
Electric meters I Ea. dwelling unit Yes I 1
•
•
.E.'11.11 S02 WALL
OF/.CUE FRAKED *AIL: vORKSNEE-
R-Value i R-Yaiue
Insulated Construction Framed
Area = Cocoonent
f41 Area
I�f i /HI
1 i
��4
0.68 1rt. fir Film t
�: 0.68
c
.45 1/Ilk
1/2� Ba_ s -45 1 (1 iit !L '-1_ -
011111.-
... Wallboard
19.00
n i V 1 1 t i C n I
l� ---- 2x6 @ 16" o_c_ , 6.87 1� �',
l Studs
.54 1 i 2" ti'afe .54
Sheathing
1
tr.."-illif65
. ...ySi d i n g _65
in
0.17 p
f''- • £xt JCir Film t 0.17 `
) ---..
21_49 R-Total 9_36
U insulated Fraciionw
Fraeea Fraction -
R-Total Insulated +
R-Iotal Frame°
1
. U R5
. .c — ---_. * .15
21.49 9.36- K _056
•
wall Stud Spacing Insulated Fraction
Framed Fraction
12" O.C_ _b3 . . _ 77
16^ 0.C. .85 .
. ]5
:4" 0_C_
_88 _72
'1,
.-:-.
' .
. -
_.. ,
- • .
. -
. .
. . .. .
-. EASEMENT/CELLAR wkiLS: qlORKSHEET
@ stairwells
. . ,R-Value
with Ext. .
' ConetructiOn I with Int. N .
. . ioeuietion Cowoonwnts
" . 1 Inzul ation
0.-17 1 1
-
0.17
0 4 . I.040•
1-4-11 ENonext Air Fi lc ' 0 4- -•
- • -"'
I •
. 1.. 1
• •
. - Exterior -t- °ini ztz :.
1:-(114.4:
‘.• ' i 1....1.
• 8" poured , .-
••
••
-
1,4 Sleet (Concrete) i . ...1—72... ..
. , 0•4•4 .
•
Core Inlulition
LAM • di •1---- ,
•
. ==q4Nir • “f a ny) I . . . '. 4:
•• . - 1-42R--mx . Fri-4 ..--
---1W A - _ Insuliition
.I' - -1.4:
- II*
1•4.-
[1:"7"S: --
/0.go
•' ..
.. " (..t. or i ot. ) , -117'TEMMOMMEMBEWEV .
.-4 . tigummirger•4-
., 1:4W- . - - •
None; O• .inish
4 _
- , •-"--14..4.4 . - a - .4.-- 0.68 .
0.68 1 i .....
t, -Ai r F r:i" I - .__--I •-":
- 1 .
-. R-Totil
:
•
•
. .
4 .
1 1 .
1 tl -, •
• w R-Tot41
•i
.1 . .
w 1 .
-o7•ir v.-.
II .
'' •' w /3737. • - •
, .
• ••
8
• Exposure Above
.......• .. .
• • .1
Dept1-1 Below GrAae - .. - 48
0 ..
•
•
r
EASEH£NT/CELLAR WALLS: pORKSH£ET
. R-Ye1ue = f R-Valet
with Ext. - Coastructioa with tat- .
_ tasuleti.on Cowoonwats - Insulation
1
r0 Ext. Air File • �:.
)4 1 - 1-4711 None - ►♦4
... - - Extericr Fi ni Sh -• 0. . ••.
1 - : r-m
,. 8" Poured +—_ (
••s
►��4 6loct (Concrcte) ; _ -'_L.2 ___
►:�: a S = Core insulation - �4:
• =t ►•4" ; • i (�f any) . - •
4" ♦4
►♦{.
-'►ii - - Viz IH,ui. I. - -•♦1
� insulation —"'tom-, : ��,:
Ift • ►�♦mi - //--Q0 ��_
..,��`< (.ut. or int. ) -{ A
•� � - r__ tatttior Fiaish t1 • 1!... *44.:1.
••_,— 0.68 i 0.68 ti ' •
i3-57
R-Total
•• U
1
- r R-Tota1 -
1
.C74
w Ue 15 .57
8
. Exposure Above Grade
Depth Below Grade 48
OPACUE FRA3{EJ F"r,GP_ ogORKSP.EET
// �i ."t'l ,' �
I 7-17TY Jy/` . .
•
•
R-Value R-Valuc -
Insulated Construction Framed
Arta Ccctonents - - Ar.a .
JJJI 1
' 0.92* 0.92'�
19.00 •
6" Batt ----
• - - - - - _. . . . . . Insulation
__-- 11; 7/8" TJI's @ 24" o_cf.
1 . ... Joists I . .4.84_ ,
I 3/4" waferwood•
7 ' _93 . . . . Sub-Floor .._.,3. 1
- carpet/vinyl 1_ , j
I ..n �:. .. Fin. Floor . Ile ..
1 0.92 0.92
Int. Air Film -
2i_02 ( i .
R-Total 16_86
•
•
U insulated Fraction** Framed fraction** -
. o•
• R-Total Insulated R-Total Framed
- 'v - .95 - .05 ..
0
21.02 16.86 e'_048
* For vented cra,( space, use R - 0.17 for ext. air film.
:t Floor Joist Spacing . (ntulat'ed Fraction Framed Fraction /
12" 0.C. .87 . 13
• 16" 0.C_ _90 . 10 -
I -ti __ h
• ROOF/CEILING :VENTED'; :. 'ORKSIEE .
. .1 -. :\i'../...i: - / - ":/- -A 7!-- ----------------r--------1:-, -
if .ri• CI 8-1 (/' "----------------"'--..\
i R-Ya1ue R-Value • i
I : Insulated ! Construction . Franed -
1
Area i Components l :.cea
- 1
1
• •
1 I 0.17 Ext. fait- Film 0.17 I
' 30_00 1 9" Batt ---- 12_00 Overlap -
tnsulation i -
2x4 bottom chord
---- i @ 24.E oc 1 • 4.35
Joists •
1 .45 1/2" Gypsum Bd. _45
1 I
- .... Kaliboard
f 0_61 0.61
i . Int. Air Film
31_23 I R-Total 17.58
U Insulated Fraction* Flamed Fraction
r
4
R-Total :nsulatad R-Total Framed
. U _93 _07 •
r
. • 31.23 17.58
_034
I
v Roof Joist Spacing Insulated fractio Framed Fraction-
n
12" 0.C. .E7 .73
• 16" O.C. .90 .10
24" O.C_ .93 .07
I
1
i —
"I have seen or observed, or beli4ve I saw evidence of,
all objects such as houses, wells;ftrees, fences, etc., 0 / 'q a.1
shown on this document. I also rOpresent that I have v. ECEIVED
personal eas I the diagram."
6 6( JUN ...ift......110111
Im••••=. . m..
DATE TOWN OF()LI SBURY
S1GNA RE ,
, BUILDING D CODE
FATES
87 , 1
-. 11 144.17'i ,"
/-7
1 ' 41 ,.
A--%•.‘
I'
7 z...NN f i ..4 / / .• i
Il
, ,6
1 /1
! ' ' Z / '
l' \17
1._
I/6/ 61 * "-• '
lL 1'''''' .11 117
--I
i
1 4- ilkte.4
' t
C:74-
1 1
,, : -"'"------...,, l'`b -0 . ,, - -, - •
1., c..., / /-,--A ,, e
, 6....„, i.....,-----,LOT 38 - ' /
-
t C.)
* C•4 , i i ,17s; ....:_ , 1 1
o i
z i . 21,507 sq ft
4 -‹
0.49 acres I
1 I 0,-...b i -
I
I ( 1 __3__________;
______
[ '
i 1 1-71-CA(.4 i.2./4 E. D4
i .
- o
1,07-- 3k
cN, 0
,
0, . i
! , _... _
.. :i 01
i 0
0 1..f 111-4,4 esTh--7-ES
_
0 .1-
i ..
1
/ -774' K ckt AP
1
i A
SARAH JE 2.‘C DRIVE /
._........._„,.............,,,._..„...._.,....,............. ......„.... ..................
MAP REFERENCE:
LEHLAND PARK
BY D.L. DICKINSON ASSOCIATES
FILED NOVEMBER 3, 1987
CABINET A SLIDE 128
Du s en
Steves
Land Surveyors, LLC
169 Haviland Road Queensbury, New York 12804
518) 792-8474 New York Lic. No. 50135
'uM/WaM AJM=N a AOMNON TO A NIMKY
NA► KANMY A NCONM LAW lNrArV= IM N A
WMATNM Or N6C1oN 7m NUN-MN/MI % or w
NW V= STAR 9MMI M LAW
WgiN mmma emorTICWOSLawim
WAl OVAL K OO MM 70 K V" TMK COR,N.'
'00"MAMS NNN{'/1Tm NNMNON NNMNY 1MT
TW IWACY SO MWAM M AOOOAa = MM 19
990M OCO[ OI RA= FM LAND UN1KYM ADOrNN)
Nn Tie MC: WW MAN AMOMAIM Or PWCN IMM
L"m NYNYEVM "Cm wmlm S"L Nw SLY
To Tie Pmw ra w" IK OW&Y M pou"m AND
ON w mw TO m 11E Oo pw. i01N1NNORAL
ANNNOY AND LOOM WnUTM UFM M MUK 00
TOfle MJMmN orle L90M SOMMOK,
SABAH
JEN DRIVE
fi�A �7-t-
�2�1 - Z-(Z I
Map of a Survey made for
JONATHON WARNER & JENNIFER CAPRON
Town of Queensbury, Warren County, New York
HEREBY On"" THAT TINS MAP WAS PREPARED
ntOM AN AGMAL rMD GMEY.
THIS GERTMATM 5HALL RAI ONLY TO THE PERSONS
MR WW M THE SUNff WAS PWMM. AND ON THER
BEHALF' TO THE Tlnf COMPANY. GOVERliMAL AGDJDY
AND LiIDM N5TIM10N USTCD MCRCOK
CERTMAMONS ARE NOT TRANGF RANI TO AWTiO"
NSTiTunms OR SwSEGmmi OWNERS.
iwwar Capron
Trustco Bads. Natkmd Associatiom its mxcessors
aid/or aims
GW4W Titis Mnu-ance Company
CE M= DYA
MATTHEW 0 STV45. LL5 NYS 301M
DATM I October 25. 2002
NO. I DATE
DESCRIPTION
1 M=30'
S-I
OHM 1 OF 1
WARNER/r,AMON
DWG. NO. 69423-36