2001-571 FIILE COPY
TOWN OF QUE ENSBURY
2 1 1 20 74 Bay Road,Queensbury,NY 12804-5902 (5 8) 76 8 1
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20010571 Date Issued: Monday, December 17, 2001
This is to certify that work requested to be done as shown by Permit Number P20010571
has been completed.
Tax Map Number. 523400-308-018-0002-034-000-0000
Location: 24 KIMBERLY Ln
Owner. ROBERT MC DONALD
Applicant: MICHAELS GROUP
This structure may be occupied as a:
By Order of Town Board
Single Family Dwelling TOWN OF QUEENSBURY
Garage - 2 Cars Attached
Fireplace
Director of mg&Co e E ennt
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
ET
Community Development- Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010571 Application Number: A20010571
Tax Map No: 523400-308-018-0002-034-000-0000
Permission is hereby granted to: MICHAELS GROUP
For property located at: KIMBERLY 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: ROBERT MC DONALD Single Family Dwelling 156,000.00
C/O THE MICHAELS GROUP, LLC Garage-2 Cars Attached
10 BLACKSMITH Dr Fireplace
SUITE 1 Total Value 156,000.00
MALTA,NY 12020
Contractor or Builder's Name/ Address Electrical Inspection Agency
MICHAELS GROUP NEW YORK BOARD OF FIRE UNDEI
10 BLACK SMITH DR
MALTA.NY
Plans &Specifications
2001-571
1633 SQ FT SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE AS PER PLOT PLAN
SPECIFICATIONS
$238.76 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,August 09,2002
(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 Town of Quee bury; T r day,August 09,2001
SIGNED BY ! 0 l for the Town of Queensbury.
• Director of Building Co. Enforcement
Application for Permit — Septic Disposal System
Town of Qu sbitl y 742 Boy Roar/Quecvrshw;y, NY 12804 (5/8) 761.3 2.6
1. OWNER INFORMATION:
,Z- \<.c4 Office use
Location of installation: �, •
File Permit No. d_OO11 "‘0 '2J
Tax Map No• / /
i I
` 11 Fee Paid
Owner's Name: �4-1�C IGY cam,\3 • •I. ..... . ......
y ` 1 .
Address: �� ��,''C�S\'Y\ � \� , \c�t1� VCC�
2. INSTALLER'S NAME : �? vYY� PHONE NO. (4,--2 -),1Cf�j
3, RESIDENCE INFORMATION: (circle year of dwelling, indicate II bedroom(s) and multiply 11 o/'
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/bdrrn = .
1980 - 1991 x 130 gal/bdrsn _
I991 -present ____ x 110 gal/bdnn = 330
Garbage Grinder Installed yes / no X
Spa or Whirlpool Installed yes / no X •
PARCEL INFORMATION: (circle applicable information & indicate measurements)
TQloi,r'aphy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supper
l later (sand- ') at what depth at what depth nnuricipa/�
Rolling loam �fc'et t--
Steep slope clay if well; water supply
_ %slope other front any septic-system
depth: absorption is
other
Percolption Test: (To he completed by/icensed.pro/esslwral engineer or architect) _ .._..
7
per-inch —
S. 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 silt
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub,
Septic Tank: I gallon (min. size 1,000 gal,)
Tile Field: each trench � ft Total System Length: _ U.D72-
Seepage Pit(s): number of size of each; fi, by
Size-of Stone to be used: Il 2 / depth or thickness _Jew
Bed System Size: x
•
•
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: NA, / Size of each: gallons /TOTAL Capacity: gallons
Note. Alarm System and associated electrical work must be inspected by_a Town appro_vcd__
eiectrical inspection agency,7. -
SIGNATURE & INFORMATION FOR RESPONSIBLE PERSON (please read)
For your protection, please note that pursuant to Section 136-29 oldie Code of the Town
of Qucensbury, 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 respect to this application and agree to abide by these and all
. requirements of the own f Queens Sanitary Sewage Disposal Ordinance,
X, •
Slgnature of responsible person Date
Building Permit Application
Town of'Qucensbury-Dept of Community Development, 742 Bay Road, Queensbury,NY
(518) 761-8256
•
A permit must be obtained before beginning construction. Permit File No.- O. / -52/
No inspection will be made until applicant has received a Fee Paid -7(P
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:THE c ee_\c- Owner: Somme.
Address: Address:
Phone# (51 )8�� - (v3i I Phone# (_) -
Property Location: Lot Number: 2r7 / House Number / \('( A�
Subdivision Name: ( Tax Map Number:
XNew Building: residence /commercial Estimated Market Value of Construction: $ 5(g:DCSLO
• ❑ Addition: residence/ commercial Ilan Addition, what will use of new addition be?
o Alteration: residence/ commercial
•
❑ No change to exterior size: residence/com'I
❑ Other work(describe )
Check Occupancyluformation t" Floor 2"'r Floor Other floor Total
Below sq. ft. sq. ft. sq. ft. Square Feet
r, Single family dwelling
❑ Two family dwelling
o Townhouse
❑ Multi family dwelling
#of units — - - -
❑ Office
o Mercantile
o Manufacturing
o 1 car detached garage
❑ 2 car detached garage
❑ 3 car detached garage
❑ I car attached garage
)1. 2 car attached garage 4-'Ace)
❑ 3 car attached garage
❑ Storage building-
commercial
❑ Storage building-
residential
❑ Other
Will any second-hand or ungraded lumber be used? If so, for what? 1,1,3\ .
Type of Heating System: electric/ oil /a) wood /forced hot air/ baseboard/other:
Number of Fireplaces,to be installed 6t J?. Number of 1Voodstones to be installed N) ,
• List below the person(s) responsible for supervision of work as regards to building codes:
Name Address Phone Number
Builder MtE ehzas stni-t AA—AV- \ - - ---
• Plumber CcA C %N-y\ k\m3k . Ask\ rk,.\ 465 -ZA-
Mason e � 1`�e�,,nr-�a p ,;5WS G` c 4'2t— �9
Electrician FFc:=CLek)kx- vtq.L�A,,��L ())272-
•
Declaration: please sign below after you have carefully read the statement:
'1'o 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 and that all
provisions of the Building Code, the Zoning Ordinance and all other laws pertaining to the proposed work shall he 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 Dir• or of Build'n' id odes,an As Built Surrey by a licensed surveyor;drawn to scale,showing actual
lo: ::t1
ati _ ` owner,owner's agent,architect,contractor
Fire Marshal's Office Town of Queensbury. 742 Bay Road,Queenshui-v, NY
(518) 761-8205
Application for Fuel Burning Appliances & Chimneys
applicable to solid fuel & vented gas appliances
sR
7/
Date ', 20 (91 ' Permit No. ..Y .
•
Application is hereby made to the Building : Codes O//ir.•c'for the issuance()fa Building and Use
Permit pursuant to the New )'orlc State Fire Prevention and Building Code. The applicant or owner •
agrees to comply with all applicable laws, ordinancesregulations, and all conditions that are part of
these requirements and also will(allow all inspectors to eater premises to per/brin required in.peciioii.r.
° NOTE to applicant: Rough-in and Final Inspections are req uired. .
Applicant Information Fuel Burning Appliance Information
- (circle appropriate words)
OName:IriN.LAAK VC Stove: wood coal pellet gas
t ' � ' Fireplace insert
Address: tOCi' ,1 Fireplace, factory-built: wood was
(' 1,° " . 14, k 0 )10 Fireplace, masonry: wood gas
Furnace: wood gas oil
- Phone: 9 l it
If non-masonary applicance, please provide
Owner: ",;j,,,+ Manufacturer Name:
•
. Address: , Model Number:
l
Chimney Information
Phone: (circle appropriate words)
Masonry block b -ick stone
�'
-{ Flue tile size: inches.
Exact Address: 5 >C i( -
of construction or installation ,ii.Factory-Built '
4Cr , 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 Queensbury
. Handouts regarding required inspections. Double wall .r Triple wall / Insulated / Direct venting
' Chimney Liner
Catschiler'et 1:10 .1pEt tatxearit®TOI�Sr22>t of Qzzeexx€braiiitimunsimmimmexamit. raey, Ne�rr Yoz9k
I l
Fire zti-lars'lrat Code# , ' •
S Collected S Reiiincled . Received from trefin ded'OE l C g ro'A. ; t( i,:.�l..
• . - address:
f 173 3389 (190) Public Safety _ — -- -----_
.4 ?33 2655 (230)Minor Sales - r:^
414,
IV) 1.../. /"'„I")
D5ly-Awr,6 -'/pw (/JL L!j.(G 02 !/Gpw1 J•
White(Applicant) Green(Fire Marshal) / . Yellow(Bldg. Dept.) I Pink&Goldenrod(Cashier:s Dept.)
TOWN OF QUEENSBURY
A'a .N. ate. BUILDING & CODE ENFORCEMENT
!lyr vM,s,it 742 BAY ROAD
s,- ,. QUEENSBURY NY 12804
s'1,,,v` (518) 761-8256
ARRIVE: DEPART: INSP:
FINAL INSPECTION REPORT
Ctfmpromc-fAL P1 RM NO
(hotel, motel, apt. complex)
DATE INSPECTION REQUEST RECEIVE
NAME c\(\1 Cr�C_.P X/� .5Yi61
LOCATION V L \ IN.-\, I oll`�__
DATE/ ^� �c O(� PERMIT II1 —57/
TYPE OF STRUCTURE
FOOTINGS BACKFILL_ FRAMING_ PLUMBING_
INSULATION
11 N/A YES NO
CHIMNEY/"B" VENT/HEIGI1T _
PLUMBING VENT/FIXTURESIi
t
ROOFING
EXTERIOR FINISH \\
HEATING/HOT WATER
Ih +
RELIEF VALVES
FLOORS
1
FOUNDATION INSULATION 1
INTERIOR STAIRS/RAILINGS
STOCKROOM ENCLO URE I
FIRE/DEMISE WALLS PENETRATION
FIRE DAMPERS 1
CEILING FIRE STOPPING
FIRE DOORS/CLOSERS
EXIT DOOR HARDWARE
EXIT STAIRS/RAILS
PLATFORM/ELEVATOR 1
i
HANDICAPPED ACCESS
I
HANDICAPPED BATHS
HANDICAPPED PARKING
FINAL ELECTRICAL
SITE PLAN/VARIANCE REO.
NAL SURVEY PLOT PLAN, IF REO 0
OK TO ISSUE C/O OR C/C
r'Who
i
FIRE MARSHAL
TOWN OF QUEENSBURY
40Ej QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST RECEIVED /2p/0/PERMIT# 2oe(-17(
NAME )14 , 6-414-f(S Qyusc e
LOCATION - LI (
SCHEDULE INSPECTION ON _ )`Z f l 7_40(
AM M ANYTIME
ti,
\ APPROVED
\ N/A YES I NO
EXITS
AISLE WIDTHS \
EXIT SIGNS
EMERGENCY LIG TING
FIRE EXTINGUISHER
FIRE ALARM SYSTEM
FIRE SPRINKLER SY/ST M
FIRE SUPPRESS91 SYSTEM
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SP INKLERS
CLEARANCE TO HEA ING UNITS
REQUIRED SIGNAGE
CHIMNEY
WOOD STOVE
FIREPLACE-MASONRY
FIREPLACE-FACTORY BUILT i 1/J
/ ,
REMARKS: E] OK TO THIS DATE
�J-
INSPSLIP.PUB INSPECTOR
'✓0C
•
RESIDENTIAL FINAL INSPECTION REPORT ((..)
Office No.(518)761-8256 Date inspection request received: V./A�'( t
Building&Code Enforcement
-
Dept.of Community Development Arrive am/pm Depart '/ tt /pm�
Town of Queensbury Inspector's Initials -Iu��
742 Bay Road
Queensbury,New York 12804 NAME in i G6-..14 C,f S G-r-o, PERMIT# ZGrJ(_S /l I
LOCATION `7 —\ 1 kit,N tom` W( ` )C. DATE r7i J l']/cf( ' '�"_ t
TYPE OF STRUCTURE (
N/A YE,VNO COMMENTS
Chimney Height/"B"Vent/Direct Vent Location ✓
Fresh Air Intake ✓
Plumb Vent through roof V/2
Roof CompleteExterior Finish Complete A
Interior/Exterior Railings 0"to 36"
Exterior Handrails,balco 'es,landing 1: in.or more ✓Interior Handrails stairs bo sides 3 or lore risers /,
Grade 2%away from foun tion ✓/
8"clearance to sill plate ✓ /
Gas Valve shut-off expose egulato•18"above grade //
Gas Furnace shut-off within I fee ir within line of site / ✓
Oil Furnace shu off at entail(• . furnace area /Furnace/Hot Wat- .-. - ..a ating /�
Relief Valve(s)installed //
Headroom,6 ft.6 in.on stairs r/
Basement stairs,6 ft.4 in. ,/
Handrail exterior stairs both side.more than 3 risers
Interior privacy/trim/doors/main zi trance 36" //
Floor Finish
Bathroom/Kitchen watertight J
Interior Handrails Balconies/Lan.' g 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 door/door closer //
Garage fireproofmg ✓/
Garage penetrations sealed
Furnace in separate room protected(in garage)
Light ventilation per room
Safety glazing 18"or esss m floo,r� ✓✓✓
Final Electrical / /2f 01 l-e- f� V-
Site Plan/Variancerqu ed
Final Survey Plot Plan �j Ut �LV� ✓U6'2 U"/
As Built Septic System layout required
Okay to issue C/C(Certif.of Compliance)
Okay to issue temp.C/O(Certif.of Occupancy)_ /
�J U��,G,
Okay to issue permanent C/O(Certif.of Occupancy) by
c ..._ i
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-�Zy am/ Depart -,ba
Inspector's LIM s
, ------
NAME: �r� t V,,-) C__. --1\01_,-)1P PERMIT# 7 )
LOCATION. \",�4 DATE.
TYPE OF STRITC
RECHECK
N/A YES NO COMMENTS
Footings/Piers 1-7-1
Monolithic Pour Form
Reinforcement in Place
The contractor is re .• 'ble for
providing protection om , eezing
for 48 hours followin_ the p acement
of the concrete.
Materials for this purpose on sit:
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofin
Backfill Ap�roval r
Plumbing Under-Sla:
Plumbing Vent/Vents in Pla e
Rough Plumbing
Heati Rough-In_
I lation lh•t , / F2
Foundation Walls Interior R-
Foundation Walls Exterio i R-
Floors •
Walls kr I/
Ceiling "- --3 V
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
,. IN_ (--y/
,_,,,g,...-: , -- _-- \ n -- - ). 0,? 1-
- .1,,e44.74w.:2 ,...,..,,, Act
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 y`4Dam/ I➢epart a i ��
\ Inspector's Initial
NAME: Gra PERMIT#d -, 7 /
LOCATION: K, W'CQ.• DATE : J
TYPE OF STRUCTURE:
RECHECK
I4/A YES NO COMMENTS
Footings/Piers I I I 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 o' site ii
Foundation/Wallpour _ ' c!-�
Reinforcement in Place
''\''S
Foundation/Dampproofing
Backfill Approval / '
Plumbing Under Slab "0°° \\ �,
P1 - sing Vent/Vents in Place
ough Plumbing /
F�
Heating Rough-In �,\tee'►
Insulation J�t., `1
'Foundation Walls Interior R- te " ��
Foundation Walls Exterior R- l DV
Floors R-
Walls R- �' ��
Ceiling R- D
Duct work or piping in
unheated spaces R-
Pr7,-r Vent,Attic Vent
•` aming ki,2-?1,- ;t Z t t�0 .//
Jack Studs/HeadersI �/
Bracing/Bridging . _
Joist Hangers •ef
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour Y
Penetration Sealed
Fire 12,3,4 hour
topping
/., TOWN OF QUEENSBURY q 14
BUILDING & CODE ENFORCEMENT ev-4
742Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name MrcAy\zao (17717-iyilx10
Location / /<iiik 'y/ A fir'
Datt--L -'&. Permit # /'
SOIL TYP:: Sand Loam-Clay-
Res •
ults of Percolatllon Test-
(if applicable) Rate--Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tdita. Len t ,Co6_
Length of each trench 1 .
Depth of trenches
Size of stone , 4t2—
SEEPAGE PITS: um r-
Size - . x 1 ft.
Stone size _
PIPING: 1 Si- e Type
Bldg. to Tank ,I_ '?o ,/O
Tank to Dist. Box } .
Dist. Box to Field/P. : y " •
Openings Sealed? es ; No Partial
LOCATION/SEPARATIO '. :I
Foundation to Tank .i ) feet
Foundation to Absorp .ion . — e feet . .
Separation of Pits _ feet
Conforms as per Plo Plan _ aft No
LOCATION OF SYSTEM tN PROPER
(circle
Front - 'e. -'Side - Right Side
Middle Front - Middle Rear
COMMENTS:
•
SYSTEM.USE APPROVED: • YES NO
Arrived:
Departed.. tj�
Building Inspector
GENERAL INSPECTION REPORT
( 518 )761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received: L/
Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive am/pm Depart I r -��
// Inspector's Initials
NAME: ,/`/�(1,04S PERMIT# /"es/7/
LOCATION: DATE : `///a--er'7
TYPE OF STRUCTURE: / d
RECHECK
N/A YES NO COMMENTS
Footings/Piers 1
Monolithic Pour Form
Reinforceme f. 'i 'lace
The con .ctor is esponsible for
providing • otecti•n from freezing
for 48 hou folio • g the placement
of the conc -te.
Materials for t''s pu ••se on site
Foundation/Wa' pour
Reinforcement i i Ph ce
F..nda i•ilk. u •ofing
:. kfill •ire,:i
Plumbing 6 der 'ab
Plumbing VentlVe is in Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls I tenor R-
Foundation Walls E erior R- •
Floors R
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces '-
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 -3 i247)
( 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: \ CSC) PERMIT L ( `S
LOCATION:p9, 9 1 m,\4kr- k-N DATE: O,
TYPE OF STRUCTURE:
RECHECK
N/A Y INO COMMENTS
ootings/Piers t// I
Monolithic Pour Form
/
Reinforcement in Place n y f C6-6Joof
The contractor is responsible for O'--
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/Ve in Place
Rough Plumbing
Heatg Rou
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls y 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
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive 'y'am/pm Depart am/pm
Inspector's Initials ,�/f
NAME: 7„,41,,..4 s0 PERMIT# 0/-5-2/
LOCATION: ...Di "�tAr• �-29 DATE:
TYPE OF STRUCTURE:
RECHECK
N/A YES NO/ COMMENTS
Footings/Piers V
Monolithic Pour Form /
Reinforcement in Place ,4 'F te..a4
The contractor is respons_ble f r
providing protection from free ing
for 48 hours following the pla went
of the concrete.
Materials for this urpose o s'te
Foundation/Wall r
Reinforcement in Pla I
Foundation/Dampproofing 1
Backflll Approval 1
Plumbing Under Slab 1
Plumbing Vent/Vents in Plac�.le
Rough Plumbing
Heating Rough-In 1
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
THE NEW YORK BOARD OF FIRE UNDERWRITERS CERTIFICATE NO.
DO NOT WRITE HERE-FOR OFFICE USE ONLY -
BUILDING PERMIT NO.
TEMP.i DATE ^-- ) --,.• e 3
(o�22(0,
CITY OR VILLAGE 7.P CODE TOWNSHIP COUNTY
\). f S \ZQ - l�-z.,rc J h
STREET AND NO OR R rAD POLE NUMBER
AAt- \1rn ` Nv,
BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOpATED, SECTION BLOCK LOT
Z //
OCCUPANTS NAME BUILDING OCCUPANCY
T �\LV\c s C{dccs o,
OWNER'S NAME AND ADDR HOME TELEPHONE NUMBER
CURRENT SUPP IEDBY FROM THEIR OFFICE WORK TELEPHONE NUMBER
\1
BUILDING IS �I
NEWl OLD ❑ I WORK IS NEW.IX ADDITIONAL❑ DEFECTS REMOVED❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS No.of FixturdS& MOTORS HEATERS BRANCH OFFICE USE
Loca- Lamp Receptacles CIRCUITS ONLY
[Ion Side ASach't H P Watts A.W.G.
Ceiling Wall Recep'Is Switch Pendant Bracket No Type Each NO Each No Gauge INSPECTION
OUT-
SIDE
SUB
BASE
BASE-
MENT
1st
FL.
2nd
FL.
3rd
FL
REMARKS LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE.
co,- k aoc.
THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED,BUT IF AT TIME OF INSPECTION,THERE IS
FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER
THE ADDITIONAL EQUIPMENT,AS PROVIDED BY THE APPLICANT.
SIZE OF MAINS 1��. `' FEEDERSApplicant affirms that there is not an application for electrical
CHARACTER OF WORK ❑EXPOSED
❑CONCEALED inspection pending with a qualified electrical inspection
DATE WORK TO BE STARTED DATE COMPLETED authority, for the installation listed herein.
This application is valid for a period not exceeding one year
SERVICE ENTERS BUILDING from the date received by the Board.
❑ OVERHEAD ❑ UNDERGROUND
DATE INSPECTION REQUESTED ON(OR AS NEAR AS POSSIBLE) MUST ENTER APPLICANTS I I O I r] I I I (alI
IDENTIFICATION NUMBER> . (
AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NAME AND ADDRESS
NAME OF APPLICANT `` � � DATE OF APPLICATION ,SIGNATURE OF APPLICANT
eWar TkOC"ce X
STREET ADDRESS TELEPHONELE NO G{`^�C Z
CITY OR POST OFFIIC � ��y[Te�--� 12ZIPCODE LICE��O WHEN9607
APPLICABLE
❑40 Fulton Street ��11Washinglon Ave. ❑ 3291 Lake Shore Road ❑ 803 West Avenue ❑ 202 Arterial Road
NEW YORK, NY 10038 SUITE 704 BUFFALO, NY 14219 SUITE 106 SYRACUSE, NY 13206
(212)227-3700 ALBANY, NY 12210 (716)827-1155 ROCHESTER,NY 14611 (315)463-8552
(518)463.2122 (716)436-4460
THE NEW YORK BOARD OF FIRE UNDERWRITERS
ONS E R-nT.AA` ION CONSTRUMON CODE
,9-00 /
PART 5 COMPLIANCE FORM
Building Design by Acceptable Practice
Dom:__ � DATE: JunAl.
Or
�So QU �i�y COUNTY
44
RCHIIEG'r,ENGINEER,OR S 18
ON TRACTOR: THE /1161.0 7 G2ooP PHONE: I 11L 0 2001 •
ERMIT APPLICANT: ShrJe PHONE TOWN OF BUILDING p,CODE
`Y
- HEATING DEGREE DAYS (Table 2-1)
n 5000-6000 n 7000—9000
•
I. 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.
Building is residential with-one or two dwelling units. _FA Building Building is-less than 5,000 gross square feet
[3 Building is three stories or less in height.. •
Ratio of glazing area to gross wall area is equal to or less than 17%_
I[I:PROJECT TYPE - -
'X New construction n Substantial renovation of existing building
❑ Addition to existing building n Exempt(7810.6c) riS
k • A `Q�r
"gf '`•-k
IV. HEATING SYSTEM TYPE :'� •
Gas-fired �; Oil-fired [ I Heat pump I Electric t h_ - ? f
f
•
Joint Sealing_ 7814_10(i)
Joint Location I Sealant Type Specified I Plan/Spec. Reference
Windows I Polycell I .
Doors frames I Weatherstripping I
Walls at roof/ceiling
Pol vre1 I
Walls at floors/found. Polycell - _
Wall panels N/A
Utility entrance Weatherstripping 1
Penetrations Polycell
Other
Other ....
I I .
Air Infiltration Barrier: 7814.10(j)
Location Required? I Specified , Plan/Spec.. Reference
Walls yes[no No-Cedar Siding y
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_m_
damper and non-combustible doors -
Gas fireplace ignition - too
VI. HVAC PERFORMANCE: 7814.11 (Table 5-3) ".
1
Equipment Minimum.Performance Specified Performance Plan/Spec.Reference
Furnace' 70% AFUE 90%
Boiler
Heat pump _
Central air
conditioner i I
J
1
•
vtt_ tiVAG t..;uI\I t 7814_12
Temperature Control
Required 1 Specified I Plan/Spec_Reference
•
Thermosi2t e2cb yes
dwelling unit •
Shut off at each Yes
terminal unit
Thermostat
Required I Specified 1 Plan/Spec.Reference
Minimum range I Yes
45°F 85°F 1
Deadband Yes •
range
Automatic - Yes
capability
VIII. DUCT SYSTEMS: 7.814.13
Category 1 Required Provided Plan/Spec.Reference
Duct z I"thick N/A in conditioned space
insulation - R-33 in uncondtioned space
Transverse Sealed Yes
joints -
IX. VENTILATION SYSTEMS: 7814.14
System Type Required I Specified Plan/Spec_Reference
Supply Damper at envelope Ye s
Exhaust Damper at envelope Ye s
Supply on/off switch '
YQG
IExhaust - on/off switch Yes
X: P.I P 1N G INSULATION: 78 14.1 S
Piping Typc Insulation Provided Plan/Spec.
Required Reference
Heating distribution' >— 11/2"
Service hot 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
Wacer Heaters Minimum Specified 1 Plan/Spec.
Performance Performance Reference
Storage Er- > .93 —_00132V I > _93
Instantaneous N/A
Pool N/A
•
Controls
Category I Required Control I Control Provided Plan/Spec_
• Reference
System automatic control Yes
System temp.-setting range 140 degrees max.
Pool heater II' WA
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 I _Required ' Specified - 1 Plan/Spec. Reference 1
Electric meters I Ea_ dwelling unit `"e_= 1
. £t i El IOR t-,T1L
OP/.CUE FRAKED *ALL: •ORKSt_E£-
•
R-Value 1 1 R—Y41ue
lnaulatad Construction Fracao
. �� Area - Coeoonent ! Area
1 s . , ,! 1 1 y
' 4 0.68 (ct. Air Films 0.68 lit i 1/ {
.45 1/2" Gypsum Bd. : _45 1111 1 If.. •..�: .
13 tailboard
! 19.00 . __ E'niulaticn .
[fly
-
2x6 @ 16" o_c. , 6_87 ,� 1 �
�?-- ---- . --. studs •.`
j ''
clafeswoo3 • .54
II �\
17-` .... Sheathing
- . 1 (0) :
{� _65 .VYiding _65
1-41 :):
. 0.]7 Ext, AirF:lm t 0.17
• 21.49 R-Total 9_36
(! insulated Fraction" Framed Friction-r
'�R
•
R-Total insulated R-total Fraceo
U - _RS _15.
21_49 - � 9.36 K .056
r 1Ya11 Stud Spacing I lntuleted Fraction l Frames Friction I
72" O.C_ .83 .77
1
16" O.C. .E5 _15
:A" 0.C_ _68 , _72
•
EASEHE!'T/CELLAR KFLLS_ KORKSH££_
@ stairwells
R-Velue c R-Vatcc
with Ext. Construction .l with Int. N
Insulation Coaoonents t In:ulat{on
0-17 ( 1 0.17 - /
�.. Id]
Ext. Air Fi 1 c . ►��_
a t ! ; None
1
�.`
► • : ! !! ': Exterior -rinish • l��
►.... ; 1".
)) I.f i 8" Poured . . ( 'MA:
124 - i 81oct (Concrete) : __.172.— -
♦♦ : . . .4
4.4 • . Core (nsuiation •t �4:
— S� . i • ! ti'f cny) 1 cif • �.:c� . Id::
�.
,.:., j]f 2,�tR-max Pro-4 - -0 :
Insulation d- --I�'-
-710�- (ext. or i nt_) 1 /0-Sfl -il�tt 2041
-1;4 j .- : :: ;::
er Finish -- 1:
41
;71• ►�4 - -'— 0.68 0.68 _1/ :� 0 • + F:1et -I :-
s.
I
R-Tots 1 I
13 -37
1 -
U -. -
Iv R-Tota1
v .. 1 K -07Y
.1 /3-37- _
•
8 .<
Expoturc Above Gredc K
Depth Below Gracie 48
EAS£HElli/CELLAR KALLS: tioRKSHEE:
•
R-Valve = R-Valcc
with Ext_ ft Constructioa with int. '
Inaul4ti.on + Coatoonents i insulation
. . 1 .-�• 0.17 0.17 - �
�.�! Ext_ Air Filc . �. • 1•♦!
2;2 = : None - .. •
♦♦♦ " � Exterior finish ° - L�l.� rii-1 8.. Poured . . _ _1 ♦!.,
• ♦�♦� Sloct (Concrete) _ -_3-.Z--- 4, �♦
♦4 4 ,I, - Core (n 4
♦.( insulation --t o.1 -..40
I ♦44 (axt_ or int. ) - ,;�!-
E 4 4�. : •
- .,__ None - - It....:j .'���-
►♦♦♦ - - ` . interior Finist: . _ - 1!% V « •
: =♦10 . -- _ - t tot, l.ir Piz., --t i .
13.57
R-Total -
•
i 1 • -
•
- .c R-Total • -•
• -• 1
Uiv m 13 .57 ft .C74 .
•
8 «
Expo:are Above Crade -
•
•
48
Depth Sel o.c Gracie f •
OPACUE FR/J<E F. OP_ fORKSH.EET
de/ �i "f/--e'1T! j
TAT•,-7z . r .
. A V /1( i t / ci-i_s.- 2 : ill :
4 1 1..,ii j .
" .....:15:::'+'*'*‹ /7/<;5
IL
i R-Value R-Value
( ' _ _
i Insulated Construction Fracec
' Area Ccrtcnents Area -
' , , : •
1 0_92t i 0.92t
IFxt_ Air Film ,
6" Batt
19_00. .. . . . . . Insulation - ----
. --_- ; 11 7/8" TJI`s @ 24" •
io_c� _ _
`
I 1 .... Joists 14.84
i _93 3/4" waferwood ' i
i . ... Sub-Floor .._:33. , ;
negl.... tFiIn. Floor _n 1_. I
1 0.92 0.92 1
Int. Air Film
21.02 R-Total ! 16.86 •
U Insulated Fraction*R u
Framed Fractionve -
• o
• R-Total Insulated R-Total Framed
•U - .95 + - .05
0
21.02 16.86 e';''_048
* For vented crawl space, use R w 0.17 for ext. air film.
•
i f** Floor Joist Spacing (nsulat'td Fraction Fraceo Fractionl
i ttt
12" 0.C. .87 73
16" 0.C. _90 ' _ 10
•
ROOF/C£1LIKG ZVEKIEC: 'ORKSK£E:
- -j Ili { ` 1.
Y�f t ` err . f
r-----------.._____......-
Z • e i
R-Value _ R-Value = i
1 insulated - Construction i . Fraaed -
i Area i '
Components 1 .aret`
.1 ' 0_17 Ext. Air Filc 0.17 ' i
30_00 9 Batt ! ---- 12.00 Overlap -
. insulation t
2x4 bottom chord'
--- @ 24" cc f 4.35
Joists 4
i • :45 1/2" Gyps= Bd.. _45
. .... Wallboard
1 0.61 0.61
•
Int. Air Filar
31_23 1 17.58 .
R-Total
tnsulated Fraction* Flamed Fraction
r e
R-Total Insulated R-Total Framed
U _93 .07
r ` _034 •
- 31.23 17.58
Roof .foist Spacing Insulated Fraction framed Fraction-
- 12" O.C . .E7 .73
• 16" O.C. .90 .10
24" O.C. ..93 .07
.
are . ;.. -.
` y
?12 /.4
��:F,)4 1 "I have seen or observed, or believe I saw evidence of,
K(to o+z,•4 e--g t all objects such as houses, wells,trees, fences, etd.,
shown on this document, I als¢irsent that I hive • ' ,
0 ( 02 7 personally m,, sured e4 ist� s t forth on th� dia am." .
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