2001-917 ��` TOWN OF QUEENSBURY
low742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 FILE COPY
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010917 Date Issued: Thursday, August 01, 2002
This is to certify that work requested to be done as shown by Permit Number P20010917
has been completed.
Tax Map Number: 523400-295-010-0001-042-000-0000
Location: 21 JACQUELINE Dr
Owner: CLARK &DONNA PERKETT
Applicant: CLARK &DONNA PERKETT
This structure may be occupied as a:
By Order of Town Board
Shed/ Storage Sheds TOWN OF QUEENSBURY
Director o B 7;de :'ts o �C
3
TOWN OF QUEENSBURY
s 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
f�
Community Development- Building& Codes. (518) 761-8256
BUILDING PERMIT
Permit Number: P20010917 Application Number: A20010917
Tax Map No: 523400-295-010-0001-042-000-0000
Permission is hereby granted to: CLARK&DONNA PERKETT
For property located at: 21 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: CLARK&DONNA PERKETT Shed/Storage Sheds 1,200.00
21 JACQUELINE Dr Total Value 1,200.00
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2001-917
120 SQ FT SHED AS PER APPLICATION
$20.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,January 03,2003
(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 thoill of 94 ensbury,• T ursday,January 03,2002
t _
SIGNED B I .% x ' "3 .f�,- • for the Town of Queensbury.
�6i
Director of Bui1g&Code Enforcement
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.
application form.
Applicant: 14r'k tDO h n P
� 4 r k Owner:
Address: l *'-€ Address:
IY) 917-7a 5
Phone#( ) t Phone# ( )
•
Property Location: of Number: — / Huse Numb c72-/ / G'C
Subdivision Namel of C ;_�X ��e ax Map Number:•
❑ New Building: residence /commercial Estimated Market Value of Construction: $
o Addition: residence/ commercial If an Addition,what will use of new addition be?
o Alteration: residence/ commercial
❑ o change to exterior residtnce/com'l
ther work(describe� ��(2✓ )
Check Occupancylnformation 15t Floor 2"Floor Other floor Total
Below sq.ft. sq.ft. sq.ft. Square Feet
❑ Single family dwelling
to Two family dwelling ENE
o Townhouse REC
o Multifamily dwelling DU' 7 2001 1.
#of units
o Office I D
o Mercantile WN OF��J� E
COD
❑ Manufacturing
o 1 car detached garage
o 2 car detached garage
o 3 car detached garage
•
o 1 car attached garage
❑ 2 car attached garage
o 3 car attached garage
❑ Storage building-
commercial
❑ Storage building-
residentia
❑ Other ��� 4.2o
What is the proposed height of the structure feet inches
Will any second-hand or ungraded lumber be used? If so, for what?
Type of Heating System: electric/ oil / gas/wood /forced hot air/ baseboard/other:
Number of Fireplaces to be installed Number of Woodstoves to be installed
•
List below the person(s)responsible for supervision of work as regards to building codes:
Name Address Phone Number
Builder
Plumber
Mason •
•
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 Wall proposed work to be done on the described premises and that all'
provisions of the Building Code,„theZ ning"Ordinance and all other laws pertaining to the proposed work shall be complied
with,whether specified ornoted,:and"that such work is authorized by the owner. Further,it is understood that Uwe shall
submit,prior to a Certificateof Occupancy or Certificate of Compliance being issued,as requested by the Zoning
Administratorfor'Director of Building and Codes,an As Built Survey by a licensed surveyor;drawn to scale,showing actual
location of all new construction.
Signature owner,owner's agent,architect,contractor
7A,L. Tie-4
/�� TOWN OF QUEENSBURY
' 1�w7� BUILDING & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
• (' (518) 761-8256
ARRIVE: DEPART: 14 d INSP: `" k
FINAL INSPECTION REPORT - RESIDENTIAL
DATE INSPECTIO REQUEST RECEIVED:
NAME
LOCAT ION eee .DATE 7 IIII 3/ v PERMIT M 6"/d--C1/7
TYPE OF STRUCTURE
FOOTINGS FOUNDATION BACKFILL • FRAMING ROUGH PLUMBING SEPTIC INSULATION • _
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
R/4 YES NO
CHIMNEY HEIGHT/B VENT/HEIGHT
PLU-MBu ag2
ROOFING_ ✓j
EXTERIOR FINISH
DEMWQRCM/XTEPS/RAILINGS
RE TEF VA VS=
TURNAQE/11QT WAT_-: t:E L:-
INTERIOR TRIM/PR/VAC 'OORS
FINISH FLOORS:
_ PATH/KITCHEN WATERTIOH
OTHER 1rLOORN NWEEPARLE,
OTHER FLOORS CARPETED
NTATR CLEARANCE/RAIL/NOR
fMOKE DETECTORS
BATHROOM FANS
PI,UMRINO FIXTURES
FOUNDATION INSULATION
PARADE FIRE PROOF/NO
POOR CLOSERS J
FINAL ELECTRICAL
R1TS_ PLANIVARTANOE RED,
.SAL SURVEY PLOT PLAN
AK TO ISSUE e/O OR W `
INSPECTOR'S REPORT 0VG\I I
Dept. of Community Development D,O
Building & Code Enforcement
Town of Queensbury (518) 761-8256
742 Bay Road.�
Queensbury, New York 12804 �
Date: 7 Ze/ Q?�
Property Location: NA-CO OC C/4C= 6,2-
Owner/Tenant: C-1. Q(4 l C-PkC7
BUILDING SEWAGE SIGN
1
OTHER
REMARKS: Tax Map No.
J
j Cif, yw 6-e Le:4-770,d-
44 C(4,-.1i6-6- fir- ors/i�4s6
CONTACT THIS OFFICE WITHIN
d jJ
Building Inspector
INSPECTOR'S REPORT 00/ y1
Dept. of Community Development
Building & Code Enforcement
Town of Queensbury (518) 761-8256
742 Bay Road �-> ��'
Queensbury, New York 12804 *!40-
Date: Zl�i /6 _
Property Location: ��G0UC Ocrz
Owner/Tenant:
UILDING SEWAG. SIGN
OTHER
REMARKS: Tax Map No.
lh A)00 /') (is P (' JC_C— .
CONTACT THIS OFFICE WITHIN
�
Building Inspector
�e
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
Queensbury, NY 12804 ARRIVE_--am� DEPART ' a /pm Notes:
(518) 761-8256 zsector's Initials ,)(K/
NAME: CI< G-W, 7' PERMIT# I
LOCATION: -2-1 WO v6;C..1,t)6- Do. INSPECT ON(dat : Z"1\�` Z
TYPE OF STRUCTURE: IA" �-.G
RECHECK
N/A YE O COMMENTS
Footings/Piers /
Monolithic Pour Form L�// 1 C— �k,< i-D/. `� I)Reinforcement in Place El ,--r' (O
The contractor is responsible for
providing protection from freezing /
r
for 48 hours following the placement
of the concrete. /'
Materials for this purpose on site
Foundation/W allpour / nn ''
Reinforcement in Place �� u ✓�V E e 1
HL6 l l (k\
Foundation/Dampproofing •
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- i/
Ceiling R-
Duct work or piping in
unheated spaces R- �,/
Proper Vent,Attic Vent /
Framing
Jack Studs/Headers / .
Bracing/Bridging `'J
Joist HangersN.
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
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