2001-846 TOWN OF QUEENSBURY
•
742 Ba Road, eensb ,NY 12804-5902 518 761-8201
Y Qu �Y � ) /
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20010846 Date Issued: Tuesday, September 03, 2002
This is to certify that work requested to be done as shown by Permit Number P20010846
has been completed.
Tax Map Number. 523400-290-000-0001-064-000-0000
Location: 25 BROOKFIELD Run
Owner. MARK& MELISSA DUNBAR
Applicant: SCHERMERHORN PROPERTIES INC
This structure may be occupied as a:
By Order of Town Board
Fireplace TOWN OF QUEENSBURY
Garage - 2 Cars Attached
Single Family Dwelling
Director of Building&Code Enforcement
1
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010846 Application Number: A20010846
Tax Map No: 523400-290-000-0001-064-000-0000
Permission is hereby granted to: SCHERMERHORN PROPERTIES INC
For property located at: 25 BROOKFIELD Run
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: SCHERMERHORN PROPERTIES IN Single Family Dwelling 205,000.00
15F BIRDIE Dr Garage-2 Cars Attached
QUEENSBURY,NY 12804 Fireplace
Total Value 205,000.00
Contractor or Builder's Name/ Address Electrical Inspection Agency
SCHERMERHORN PROPERTIES INC
15F BIRDIE Dr
OUEENSBURY,NY 12804
Plans & Specifications
2001-846 25 BROOKFIELD RUN
3347 SQ FT SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE AS PER PLOT PLAN
SPECIFICATIONS
$476.68 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday,November 14,2002
(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 th T Zi44 f Q n ury fr dnesday,November 14,2001
SIGNED BY ` for the Town of Queensbury.
Director of Building&Code Enforcement
•
. C1) /__9)-1
• /� == ENERGY CODE
— _-��_ COMPLIANCE APPLICATION
K' �_� TOWN OF QUEENSBURY� WARREN COUNTY
=�3- 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)
PART 4* Design by Component Performance
• Commercial Buildings-Hi Rise Residential
*Recruires submission of worksheets
APPLICANT' S NAME: / PROPERTY LOCATION:
•_Cc 4 eiV tv /Ovh re.., c/c4y 0L., Z S PIr0t3 1.<74' f(/
t
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
•
1 . Gross Floor Area - 3 -/-/ 7 scruare feet .
•
2 . Tv e of Heat - Electric Oil Gas x Other
3 . Is building mechanidally cooled? Yes X- No •
4 . Percentage of area of windows and doors Over 17% Under 17%
5 . R-V_`-_LUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS
S=O'rrN ON PLANS SUBMITTED:
a . Roof R ID
b . Exterior wails • R / q
c . Glazed areas R z_r
d . Exterior doors R /3
e . Floors over unheated spaces R N/1
Edge of slab on grade (heated building) R '__
c.. Basement/cellar walls (above grade) R jv
h . Basement/cellar walls (below grade) R /0
- . Heating/cooling-ducts-piping in unheated space R A//64_
6 . Service (domestic) hot water heati nc device
Conforms to minimum efficiency per code Yes No
TEMPERATURE CONTROL MAXIMUM SETTING 1400 - WILL NOT BE EXCEEDED
• App i c � ' Si nature Da=e Phone Number
G/-va •0
INSPECTOR' S REMARKS:
/ l • F,
a
Fire \larshal's Office Town of Queensbury, 742 Bay Road,Queensbury, N'
(518) 761-8205
Application for Fuel Burning Appliances & Chimneys :
applicable to solid fuel & vented gas appliances
Date // 20 0 f Permit No6/ g1
Application is hereby made to the Building & Codes Of/ice lbr the issuance of cr 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, iYigttlations, and all conditions that are part of
these requirements and also will allow all inspectors to enter premises to perform required inspections.
NOTE to applicant: Rough-in and Final Inspections are required.
Applicant Information , Fuel Burning Appliarnce Information
• (circle appropriate words)
Name: ver ,et?-. g,�i i. 14 a toIn e-n igiAllt.%, Stove: wood coal pellet gas
•
Fireplace insert
Address: .ir } 1 i k,di `,. Pt. - Fireplace, factory-built: wood gas
Fireplace, masonry: wood gas
• Furnace: ` wood gas oil
Phone: —7 i y •- A, ' •
(1
If non-masonary applicance, please provide
Owner: e. 'e t--- a et-_. i �,,A., i"h't,) Manufacturer Name: .
Address: i' t G. , f Model Number: . . _
Chimney Information
Phone: X` "Al ' �, Q�, �S , ..l: (circle appropriate words)
Masonry block brick stone
f{/L= rf( ` i Flue tile E.`te size: , inches
Exact Address: c� I'.. isIt
` �" .
of construction or installation • Factory-Built
N Vic „{ , / . Manufacturer name: ,.:,e s 41c.
pSIB/.: I c .,.-- 1, , Model Number: '
Note: `..
Listed By: Number:
Construction /Installation must •
conform to NYS Fire Prevention & Building Indicate (circle) chimney Material: '
Code. Consult available Towit of Queensbury
Handouts regarding required inspections. Double nail ! Triple wall / Insulated / Direct renting .
•
Chimney Liner
i 40.a.rs3bit ar',e:Depaurtarriemt—2" w,z col'Qtrzeez$.sbzzz-y, �v'e r Y'oz-fir
Fire Marshal Code# S Collected S Refi
mde d ''Re cc'ieed/ro»r)trc fioided to): Q. t .)c'` e, er-- ,i.,„_.,:c , .
s�
address:
4 173 3389 (190) Public Safety c 3 — — — — ---
.4 233 2655 (230)Minor Sales
W 5)+-'' ,,,,, :. r;
i l 3 r1.a wL6 —�Tww Ve„..4NL 62 Daysa
Whitel(Applicant) ; Green(Fire Marshal) / Yellow(Bldg. Dept.) Pink�:Goldenrod(Cashier's Dept.)
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: 20 4— 2. Y 't.00 t<-t`J-c fU Kw, ��Q _y q '
Fil '=,sip i Tax Map No. / / LIVED
/ Fee Paid
Owner's Name: SL 4G +�c o— Lov 6s 41+4--_ Noy....1. .....204.1
Address: 1 1= i a i-qt. 0v TOWN OF QUEENSBURY
BUILDING AND CODE
•
2. INSTALLER'S NAME : SG ti r/i1 c v o ��,S y. PHONE NO. 706—6 6 71
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/bdrm =
1980— 1991 x 130 gal/bdrm =
1991 —present 4 x 110 gal/bdrm = 4
Garbage Grinder Installed yes / no >4
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
cei at((III depth at wh t depth mt ..icipal
oiling loam (t) �.,feet f(fl/�feet 111,
Steep slope p clay if well; water supply
slope other from any septic-system
depth: absorption is /O6 ft.
other
Percolation Test: (To be completed Eby 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: /2 oo gallon (min. size 1,000 gal) �n y, ,
Tile Field: each trench TO ft. Total System Length: -
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # Z / 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 regulations with respect to this application and agree to abide by these and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
fr% 2._.
/.
Signature of responsible person D e
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.c -O 1 - O 91p
No inspection will be made until applicant has received a Fee Paid $ Vc-
valid building permit. All ap.licants'_,.w: ,4n- .•_ ii, Rec. Fee Paid
application must be complete x�!s s: li :s`o't_:- Reviewed By.
application form.
/ /_ NOV i 2001
Applicant: . Sc. c,1,- L-,c h A 1--, ( `-)s-43- r Qwner: Cc-4 L ,v 4�o f. G®ti J 1,-,„Li,,
Address: Z s- 0�00`��►''' ,,� ' ��t;t;ti�SBU(2I Address: I.� F Q r,o>'i c. ►Pmt
pt.Qvc c�1� e,V .l /11 CODE QucLc,i 4.v,,_ IUD/ lard
Phone# ( ) • - Phone# ( ) 7 g/1l. - 66 7�F
U
Property Location: Lot Number: Z S-/ House Numbe 2 s / Is Ic �4-r ` -G-,--..._.
Subdivision Name: {'-oo K icr 1 A ap Number:. . —/ — 3 y
A New Building: esidenc= /commercial Estimated Market Value'of Construc ion: $ A 05 o,o
❑ Addition: rest.ence/ commercial If an Addition, what will use of new addition be?
o Alteration: residence/ commercial
❑ No change to exterior size: residence/com'l
❑ Other work(describe )
Check Occupancylnformation 15`Floor , 2nd Floor •Other floor Total
Below sq.ft. sq.ft. sq.ft. Square Feet
IG,A-
C( '-
/\ �, Single family dwelling l g z / / c Z c /3 3 7
VV 0 Two family dwelling f
❑ Townhouse •
o Multifamily dwelling
#of units
o Office
4.1
7 (1tl ❑ Mercantile
❑ Manufacturing
❑ 1 car detached garage
�� ❑ 2 car detached garage _
o 3 car detached garage
❑ 1 car attached garage .
2 car attached garage 77 g /
❑ 3 car attached garage
o Storage building-
commercial
❑ Storage building-
residential
O Other
What is the proposed height of the structure 3 Z feet inches
// Will any second-hand or ungraded lumber be used? If so, for what?
/ Type of Heatirtg System�lectric/ oil / gas/wood / orced hot a' baseboard/other:
.l umber of Firepl es to be installed / Number of Woodstoves to be installed
List the person(s)responsible for supervision of work as regards to building codes:
Name Address Phone Number
Builder ScC, c._r- ti�r./,oL-i-, - Qvcahs 6v,-,,i 71V-067 (74
Plumber Cc/Z s c_ — j=o`f 4,4 gi
Mason 4,f6- -- — — -,-✓f r-r.v, /lc 26o— 107 el Z
Electrician /'r h� ,� -. Qvc.-1 c-vJ C v. 7 60 - r 4/.36
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
j submit,prior to a Certificate of Occupancy or Certificate of Compliance being issued,as requested by the Zoning
Administrator or Director of Building and Codes,an As Built Survey by a licensed surveyor;drawn to scale,showing actual
location of all ew onstruction.
Signature: �'LL, owner,owner's agent,architect,contractor
ONOTOWN OF QUEENSBURY
�w BUILDING & CODE ENFORCEMENT
1 742 BAY ROAD
Nv-/'� QUEENSBURY NY 12804
(1 (518) 761-8256
ARRIVE: - DEPART: INSP• (J`j
FINAL INSPECTION REPORT - RESIDETTIaL
DATE SPECTIONN �
/REQUEST RECEIVED: 3 O
NAME
LOCATION _I� 1� 2u �(
DATE q 162-- PER VI/l�" !l�TYPE OF STTURE
FOOTINGS FOUNDATION`"`--BACKFILL FRAMING _
ROUGH PLUMBING _,ASEPTIC INSULATION
FINAL ELECTRIC ``WOODSTOVE OR'F'IREPLACE
// N/A YES NO
CHIMNEY HF1 GHT/B VENT/HEIGHT 7
PLUMBING/VENT
/j
ROOFING/ 1
EXTERIOR` FINISH /'
DECK/POACH/STEPS/RAILINGS i/
RELIEF V`LVES 't
FURNACE/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY DOORS 'I
FINISH FLOORS
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE /
OTHER FLOORS CAR ETED/ I
STAIR CLEARANCE/RAI NGS /
SMOKE DETECTORS
BATHROOM FANS //
PLUMBING FIXTURES /
FOUNDATION INSULATION /
GARAGE FIRE PROOFING
DOOR CLOSERS /
\\\\ . .
FINAL ELECTRICAL /
SITE PLAN/VARIANCE/ REQ. /�
FINAL SURVEY PLOfi' PLAN `A
OK TO ISSUE C/O/OR C/C
MAP REFERENCE:
PHASE it
BROOKFIELD ESTATES
DATED DECEMBER 7, 1987
LAST REVISED JUNE 7, 1988
BY VAN DUSEN & STEVES
LAND SURVEYORS
LOT 25
1.53 acres
f 42,00F
i HEREBY CERTIFY THAT THIS MAP WAS PREPARED
FROM AN ACTUAL_ FELD SURVEY.
THIS CERTIFICATION SHALL RUN ONLY TO THE PERSONS
FOR WHOM THE SURVEY WAS PREPARED. AND ON THEIR
BEHALF TO THE TMI COMPANY. GOVERNMENTAL AGENCY
AND LENDING INSTITUTION LISTED HEREON.
CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL
INSTITUTIONS OR SUBSEQUENT OWNERS.
CERTIFIED TO, MARK A. + l`=SSA M. DUNBAR
CHARTER ONE BANK. F S.B
223.77'
S03'24-- p
IT'S SUCCESSORS AND/OR ASSIGNS "
FIRST AMERIGAN TITLE INSURANCE COMPANY OF NEW YORK . < ��piE ®F�' .
CERTIFIED BYE y-!
MATTHEW G. STEVES. LLS NYS 50135
DATED DECEMBER G. 2001
MAY 5. 2002
N06-T3 32"E
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Steves
Land Surveyors, LLC
169 Haviland Road Queensb ury, New York 12804
(518) 792-8474 New York Lie. No. 50135
P W-A W A ""WI LA °R WIVE" SM IS A
MAP �AItlOO A CTIONl7 lN0 l-OM C1R5 fE1l 6 A
VIOLATION OF EECr10N 7408. EIS-0M910N 7, OF T£
NEW YM STATE EDUCA710H LAW
dLLYCOM mm TW ORIGINAL IDI'M SURVN
WAM YMM AN O"WHALOr Tm LAW SURVEYOR!
%0"FYunaNs NOICAM MUMON MMY THAT
WLV,ALLK M"AMINWSMIED TO �"�° �
EN ING C WAS M"AM Ri ALAW SNQ TRIM 1Hf
oasn�o coGE a rNncncE rae LAW auRveYGRs AOGrtEn
TOTMNEWr FOIRW , MWRWY "°��`
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ON HIS I MAEf TO 7ME TTU COWANT; GOVERNL1ENTAL
MTIC 5IG ftOr RfSTIOWW MO "RE`R"'ED
ro,YmAGr,Y,E1„D.,GRY�YEMYEDN•
1
Map of a Survey made for
Mark A. &Melissa M. Dunbar
Town of Queensbury, Warren County, New York
1
Date: DECEMBER 6, 2001
Scale 1" 30'
�TIOFI
2
6-05-02
FINAL SURVEY
1
1-02-02 .
CHANGE TITLE COMPANY
DUNBAR
DWG. NO. 8GG71-25
r NO.
DATE
DESCRIPTION
•
FIRE MARSHAL
TOWN OF QUEENSBURY
`# QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUES ECEIVED PERMIT#( f
NAME c n
LOCATION Le.-T
SCHEDULE INSPECTION ON c �—
`�__ YTIME
APPROVED
N/A YES I NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTIN 1
FIRE EXTINGUISHERS
FIRE ALARM SYSTEM S
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION SYSTEM'
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNI S
REQUIRED SIGNAGE
CHIMNEY
WOOD STOVE
FIREPLACE-MASONRY
FIREPLACE-FACTORY BUILT 6
F\tJil�
REMARKS: ❑ OK TO THIS DATE
Pub
� 1
INSPSLIP.PUB INSPECTO
RESIDENTIAL FINAL INSPECTION REPORT r ?
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement
Dept.of Community Development Arrive.!?(-a p D pa� ai -re
Town of Queensbury spector's Or _...,.----
742 Bay Road
Queensbury,New York 12804 Q l
NAME r Q-s(` ?trn _ `` V PERMIT#O I `U �`O
LOCATION z.P\ DATE -U -
TYPE OF STRUCTURE ,Sc )
N/A YES NO COMMENTS
Chimney HeightP'B"Vent/Direct Vent Location J '
Fresh Air Intake
Plumb Vent through roof fi
Roof Complete ,//
Exterior Finish Complete ,//
Interior/Exterior Railings 30"to 36" /
Exterior Handrails,balconies,landing 18 in. o ore .�
Interior Handrails stairs both sides 3 or more,•se
Grade 2%away from foundation if
if 8"clearance to sill plate
Gas Valve shut-off exposed/regulator 18"abo - grade
Gas Furnace shut-off within 30 feet or within 1. • of site
Oil Furnace shut-off at entrance to furnace area
Furnace/Hot Water Heater operating ` ✓/
Relief Valve(s)installed ✓
Headroom,6 ft.6 in.on stairs I •I/
Basement stairs,6 ft.4 in. i f
Handrail exterior stairs both sides more than 3 risers II
Interior privacy/trim/doors/main entrance 36" / 1/
Floor Finish / 1/
Bathroom/Kitchen watertight / ..
Interior Handrails Balconies/Landing 18 in.or more .
Railing across window in stairwells /
Smoke Detectors: f/
every level %//
every bedroom _ ./,/
outside every bedroom
inter connected -I f f
Bathroom fans
Plumbing fixtures ►, ti r Pj u eJ�. 0 AT-1-112-r...C•irik f
Foundation insulation
3/4 hour fire door/door closer ✓/
Garage fireproofing
Garage penetrations sealed
Furnace in separate room protected(in garage) •,/ J
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)_ I
Okay to issue permanent C/O(Certif.of Occupancy)
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC,:)
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL cy 1 i,
Permit No. ' Cert. O 7 3 4 8 4 Cut-in Card No. 1
Owner .5G14L7Ly . /2/a &��'!
Location r2--C-. 0/2 '0
Installation Consisting of�D / WIC to 7/2/6E/81; G 41 L` '7175
....±.4,A.l.. .P 66 f.-D2Ve72-, 7°6t-'+-P 7, -it—) c=�
Installed By Y •'" 6't4eIb( 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 maki spections at any time, and if its
rules are violated,the Company shall have the right o r voke_th' c rtifica .
Date -2-4/ ' INSPECTOR
Member N.F.P.A.,I.A.E.I.
•
�T �y ' Office Use
GENERAL INSPECTION REPORT 1 Inspector:
v
Town of Queensbury
Ready at time:
Dept. of Community Development Request received: Meet:
Building& Code Enforcement At time:
742 Bay Road
Queensbury, NY 12804 ARRIVE 1 L=7,Da »a: - C 'RT I otes:
(518) 761-8256 Inspector's Ini ial
NAME: `i�f'5�1�( 11 n. L,.' PERMIT# O I ^ g>1-71
LOCATION: 5 lJ OO��
IE� Ac\____ Vim- INSPECT ON(date): �'� ` L VL
TYPE OF STRUCTURE:_s`� C
RECHECK
N/A YES 0 COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete. en,
Materials for this purpose on site ' ' \ ��-E'er_- ��� �0l rn�Foundation/Wallpour _
Reinforcement in Place 1 -6
Foundation/Dampproofing k R""
Backfill Approval V-V$N \X�a k 1 1 l E�6i—
Plumbing Under Slab _
Plumbin!,Vent/Vents in Place t �'� � �� �'"� �1 �
Roug r 'lumbing _6\ 'J e-�? W`7 - f .-- s
He a ng Rough-In
/
sulation -\ - �� \,i(ilc-L-k, cSV__ L_�
Foundation Walls Interior R-
Foundation Walls Exterior R- \---'e A..9 - L M-I
Floors R- �"�►� � 1�
Walls R- ka s4
Ceiling R- 1)O v
Duct work or piping in a'
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
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
•
Office Use
GENERAL INSPECTION REPORT Inspector:
Town of Queensbury Ready at time:
Dept. of Community Development Request received: Meet:
Building& Code Enforcement At time:
742 Bay Road ` 01)
Queensbury, IVY 12804 ARRIVE am/pm: DEPART C am/pm Notes:
(518) 761-8256 Inspector's Initials d/
NAME: G���� C Rae.A) PERMIT# U I 6;#)
LOCATION: �� 2�-'I� � L--O INSPECT ON(date): /1�6 2�
TYPE OF STRUCTURE: //f
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsibl for
providing protection from fre zing
for 48 hours following the pla emen
of the concrete.
Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place
Foundati o n/D amppr o o fang
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 Ovarkte r piping in `
unheated spaces R- _ 4;Z6--
ramingP oper Vent,Attic Vent / i �jL�/1 C— _ —g7� "`���YYYJJJI �T
Jack Studs/Headers
Bracing/Bridging SAC ��,� W} k
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
Office Use
GENERAL INSPECTION REPORT €)a ti Inspector:
Town of Queensbury
U
Ready at time:
Dept. of Community Development Request received: Meet:
Building& Code Enforcement At time:
742 Bay Road
Queensbury, NY 12804 ARRIVE am/pm: DEPART�.$2Jam/pm otes: .�,
(518) 761-8256 Inspector's Initials L_---- ' "'"
NAME:S \QS\ WAVY- `� J`'\c) 1 PERMIT# CD/— /
LOCATION: �-� S
��'C��� a l eAC)�C)r\ INSPECT ON(date): 3r1
LI ---Oc71_______
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers N
Monolithic Pour Form \ \
Reinforcement in Place \ \
The contractor is responsible\for '
providing protection from freezing
for 48 hours following the pla*men
of the concrete.
Materials for this purpose on site '' •
Foundation/Wallpour_ \ /
Reinforcement in Place V
Foundation/Dampproofing A
Backfill Approval 1
Plumbing Under Slab \ /
Plumbing Vent/Vents in in ace
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-
ro ent,Attic Vent
4Fr•arning . fl ) , .
;ck Studs/Headers f, / f
v racingBridging T.; v0 0)6O �/
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour_
Penetration Sealed
Fire a112 4 hour
F sopp' -
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
FIRE MARSHAL
TOWN OF QUEENSBURY
sj QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST RECEIVED PERMIT# 0( C� (p
NAME ;l{C-f2 Gia r1/4_ 1
LOCATION g kekilk =ig-c-0 a
SCHEDULE INSPECTION ON 3 I l 162.—
AM PM ANYTIME
APPROVED
N/A YES NO
EXITS
AISLE WIDT S
EXIT SIGNS
EMERGENCY LI HTING
FIRE EXTINGUISHE S
FIRE ALARM SYSTEM
FIRE SPRINKLER SY
FIRE SUPPRESSION SYST M
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKL RS
CLEARANCE TO HEATING NITS
REQUIRED SIGNAGE
CHIMNEY D126-e-:1- 1IC4 i
WOOD STOVE
FIREPLACE-MASONRY
FIR PLACE-FACTORY BUILT E-( 1 Ai
j/lA-hke t)G 36 6 Nig RP
REmARKs4P-012.,./74q. V OK TO THIS DATE
I
un.s ; ` 5i
} �1 — FL1z.
INSPsuP.Pua INSPECTOR
•
FIRE MARSHAL
> TOWN OF QUEENSBURY
c vorp-k' • QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST RECEIVED PERMIT# 0/,U 7 .b
NAME S c'Mn'AkZ•-fe-R0p2i)
LOCATION La 7- Z5- lefe,46=l&z,6 /v )
SCHEDULE INSPECTION ON Al /62—
AM PM ANYTIME
APPROVED
N/A YES I NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHT! G \
FIRE EXTINGUISHER'
FIRE ALARM SYSTEM
FIRE SPRINKLER SYS M
FIRE SUPPRESSION SY'T
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SP."INKLERS
CLEARANCE TO HE'.TING UNITS
REQUIRED SIGNAGE
CHIMNEY
WOOD TOVE
FI LACE-MASONRY
REPLACE-FACTORY BUILT 6•(- ✓
REMARKS OK TO THIS DATE
0.4)ei VV - "80 . . (2/4/?96/2
JP(--
INSPSUP.PUB INSPECTOR
Office Use
GENERAL INSPECTION REPORT Inspector:
-2.0 .6
Ready at time: ) PCB;I'
Town of Queensbuiy `�
Dept. of Community Development Request received: Meet: u
Building& Code Enforcement At time:
742 Bay Road f L\
Ary
Notes: ( /" ,Queensbury, NY 12804 ARRIVE am/pm: DEPART' am/pm I
(518) 761-8256 Inspector's Initials
NAME: C�I_ CPERMIT# r-L '— g L
LOCATION: e) YU CT1 e t0 g)V1 INSPECT ON(date): 4P 3 /1 c OO--
TYPE OF STRUCTURE: 5
RECHECK
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is respo .ble for
providing protection om b eezing
for 48 hours following the pl. ement
of the concrete.
Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place
Foundation/D amppro o fing
Backfill Approval
Plumbing Under Slab _
VOLP1 'b ing Vent/Vents in ' t ✓ '-
' �gh l iumbing2—
ating Rough.-Inn
Insulation
Foundation Walls Interior "-
Foundation Walls Exterior '-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Proppe ent,Attic Vent f
ack Stu is/Headers V'
Bracing/Bridgingti7�IZOUlt)C— (RUO AR.1C. 1 A (S jA) 1 D ,
Joist Hangers /" ✓ _
/ Jac - osts/Main Beam__ ,/ , _
f Atr In ltratiU azrier.:, ✓ CItu bOL 1E a U/ Cflt CE G �6 7
Penetration Sealed
Fire Wall 2, ,4 hours. /,. _
•1 Firestoppmg 1 A14(/kc.c. F,l 6 C A ItC,Q`� ?e 4t '- �'x
k oLk6 uCS
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
TOWN OF QUEENSBURY eC?C Uj
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name (.')'\ frcio krnQIcai_ Sn
Location � rYr` g C ,;k) :\,
Date \ —1(Q'O?V Permit # Q)_ S
LI
SOIL TYPE: and Loam-Clay-
Results of Percolation Test-
(if applicable) R.te-Minute/Inch /
TYPE OF SYSTEM:
ABSORPTION FIELD: Tot.1 Leng h C
Length of each t ench (eO
Depth of trenche , Z
Size of stone ,• v
SEEPAGE PITS: u ber-
Size - ft. x ft.
Stone size
PIPING: Size Type( j
Bldg. to Tank If"
`z' T
Tank to Dist. Box w o+ 2"
Dist. Box to Field/PO yr A
Openings Sealed? No Partial
LOCATION/SEPARATION .
Foundation to Tank / feet
Foundation to Absorption _7.0 feet .
Separation of Pits , feet �_,
Conforms as per Plot )1 an Ad No C
LOCATION OF SYSTEM 0 ' 'OPER �� UIL.
(circle one) r
Front - Rear - Left ide Right Side
Middle Front - - ' -ar
COMMENTS:
•
GUC 4,% n2r—
SYSTEM Oaf O
.USE APPROVED: YES NO
Arrived:
Departed: 'b ; (.
Building Inspector
ICIP1
TOWN OF QUEENSBURY = 4
BUILDING & CODE ENFORCEMENT A 742 Bay Road flt ,
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name -(2C iM--7- 1-04--r , ClY'S
Location LOT o- S 15-00lL]`;x l(l
Date 14+' -rmi t # PI —S*
SOIL TY' Sand-Loam-Clay-
Results of '- . ati. Test-
(if applicable) Rat .-M,r uteA Inch
TYPE OF SYSTEM: 10 j N tilL4 c 1
ABSORPTION FIELD: .tal ength c.. 6660
Length of each tren hi .r / J '44
Depth of trenc h
Size of stone
SEEPAGE PITS: Numb:r
Size - ft. ft.
Stone size .4
PIPING: We Type � >
Bldg. to Tank I` Sty, ' O
Tank to Dist. Box i' c4 2zc?7
Dist. Box to Field/ i„ /,‘
Openings Sealed? Y-s No Partial
LOCATION/SEPARATIO
Foundation to Tank 4:2,Xfeet
Foundation to Absorpti .n C) feet . .
Separation of Pits eet 4��=--
Conforms as per Plot Plan —770 Nq V6,�4
LOCATION OF SYSTEM ON P'OPERZY.__., n5
(circle one)
Front - Rear - Left Side - flight Sid
Middle Front - Middle Rear
COMMENTS:
f L,s-i E l `t--
c A-6c , ,z c i cf-a'
SYSTEM USE APPROVED: YES NO
Arrived: ,,
Departed: 47(.--
Building Inspector
NOV . 08 2001 12: 34PM HP LRSERJET 3200 ' p• 1
•
1 . 3 8 acres
/:_i!„v,,,.,...ii .
J , "I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc., -
7t3 r 745" shown on ment. I aiso rep resent that I have
•
�+rsonally measured
docu the distances set forth on the diagram.' •
///? 4 -- .
.� ; NATURE i -
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GENERAL INSPECTION REPORT
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received: j()/,)1)
Building&Code Enforcement IJ
742 Bay Road 62
Queensbury,NY 12804 Arrive am/pm Depart( am/
Inspector's Initials V L`
NAME: PERMIT# 0 l 1 _
LOCATION: �j r<7�? ��{� v DATE : ) a-
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 from freezing
for 48 hours following the pla ent
of the concrete.
Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place
Foun ' n/Dampproofing
11 Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior
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
4:fk //6�
GENERAL INSPECTION REPORT
( 518 ) 761-8256
Town of Queensbury
Dept. of Community Development Date inspection request received: Ll �� ' d/
Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive\,:,) apart'
spector's Init �-
NAME: 51( er-A, -A or PERMIT# l
LOCATION: a j aisvk.G(.t2 gL DATE : fffi I , J/
TYPE OF STRUCTURE: ___( ,t
RECHECK
N/A YESO COMMENTS
.00tings/Pi ��p rZ �� ^� //(
Monolithic Pour Form
Reinforcement in Place
The contractor is respon.ible for
providing protection froi freezing
for 48 hours following the .laceme t
of the concrete.
Materials for this purpose on s e
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampprgofi 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
?; ,
(111; 'ildr-
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 nOm
Inspector's Init l3•.
NAME: Pf:. (-UQ A b d2i1/4.) RCA)
PERMIT# D( '-/ 6
LOCATION: 2 6-�j ,eab(� F/ r0 `MCA) DATE : i t 7-O
TYPE OF STRUCTURE:
RECHECK
i ,„.;,-7 r ,r , N/A O COMMENTS
M nohthic Pour Form
Reinforcement in Place 1 /
-
The contractor is responsib e for
providing protectio from f eezi
for 48 hours folio 'ng the . ace, ent
of the concrete.
Materials for this pu .se on s',: _
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofi 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-
oper Vent, Attic Vent j�/�,1e/ ��
i_ Fraznang //CU f/ P61 �J �PC-e-
Jac Studs adcrs L
Bracing/Bridging i
Joist Hangers Z-2- ( 1� `jp4 i)
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
NOV 08 2001 12: 34PM HP LRSERJET 3200 p. 1
• 1438 acr.. e.s
.1:_______d : . ./ocz. s_.: .
"I have seen or observed, or believe I saw evidence of,
ail objects such as houses, wells, trees, fences, etc.,
7`/3-- 1,M,- ,,3 shown on this document. I also represent that I have
personally measured the distances set forth on the diagram.'
era—
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