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2000-615 TOWN OF QUEENSBURY 742 Bap Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761=8256 CERTIFICATE OF OCCUPANCY Pernut Number: P20000615 Date Issued; Friday, January 26, 2001 This is to certify that work requested to be done as shown by Permit Number P20000615 has been completed. Tax Map Number: 523400-054-000=0005=006-512=0000 Location; 6 CLEARVIEW Ln Owner: ROBERT & JEANNETTE JENSEN III Applicant: ROBERT & JEANNETTE JENSEN III This structure may be occupied as a: By Order of Town Board Single Family Dwelling TOWN OF QUEENSBURY r )jW k' I Director of Building & Code Enforcement TOWN OF +QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 QL Community Development - Building & Codes (518) 761-8256 BUILDING PER.MIT Permit Number: P20000615 Application Number: A20000615 Tax Map No: 523400-054-000-OOO5mOO6-512-0000 Permission is hereby granted to: ROBERT & JEANNETTE JENSEN III Owner of property located at: CLEARVIEW Ln in the Town of Queensbury, to construct or place a Single Family Dwelling 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. Owner Address: ROBERT & JEANNETTE JENSEN III 10-210 REUENCY Park QUEENSBURY, NY 12804 Contractor or Builder's Name f Address Electrical Inspection Agency COTTRELL HAJECK, INC. MIDDLE DEPARTME 582 SECOND Ave TROY, NY 12182 Type of Construction : Single Family Dwelling Value : S 9090000000 Plans & Specifications 2000-615 1008 SQ FT SINGLE FAMILY DWELLING AS PER PLOT PLAN SPECIFICATIONS $126,00 PERMIT FEE PAID - THIS PERMIT EXr] RES: Wednesday, August 28, 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 f Que s'bu and y August 28, 2000 SIGNED BY 'p for the Town of Queensbury. Director of Building & C de E rcement . Building .Permit .Application Town O ueens�`7Gi - De x. o C(Nninunity Develu Nuent, 742 Bav Rexu! ' � � � 1 f 1 Quccaasfaaerv, f'V2! I2804 /761-8256/ o�� BUI DING & CODE ENFORCEMENT Requirements prior to issuance rApermit must be obtained before of this permit: FPERMITILE NO. ��uung construction. Na inspections EE PRlL7 $e made until applicant has received Zoning Board Action a VAI, D BUILDING PERMIT, All Amu f Use ON FEEPrtfD $ applicants' span" can this application MUST be completed and the signature Q Plunning BoardAcdon REVIEWED BY.- r [ ( of the applicant must appear an the 5Pt2 / Subdivision / Other BuildingInspecror � ' " Recreation Fee Payment Builder : PPlicant: Owner,, Robert E . & Jeannette Jensen , II Cottrell Hajeclt: , INC , 10- 210 Regency Parr Address-. 582 C:d •c +•,t7 n=»•,,,� Address: Troy , NY 12182- 2532 f]Queensbury , NY 12804 Flxane # 1$_) 3Z_3IZ4 Phone # Property Location, Lot 02 Clearview Lane Subdivision Name: Clear _view Estates tax Map Number ra_ / ri- 16 - 512 Section Block tAit NATURE OF PROPOSED WORK : ES` 114ATED MARKET VALUE OF THE XXXXXNew auildincx : CONSTRUCTION : $ 901t goo _ 00 esidenc�/ commercial Addition ui lding : residence J commercial OCCUPANCY INFORMATION :Alteration to to Building : Primary Building residence / commercial XXX Single Family Dwelling Residence } Commercial Two Famil Dwelling no change to exterior size Family Dwellg IG 1 8 2000 Office . ,. . Other Work ( describe below ) Mercantile Manufacturing - = ---.. .._.... . . Other GROSS AREA OF PROPOSED STRUCTURE : If ADDITIOPI , what will use 1st Floor . . . 1 t 008 sq . ft . .,� / of new addition be ? 2nd .F1'ogr . . . !�4' . . sq . ft . Other Fluots . . . . Ad _ sq . ft . { not unfinished cellar or basement ) ACCESSORY BUILDINGS : Detached Garage 1 , 2 car TOTAL FLOOR AREA : 1 , 052 SQ , FT , Attached Garage 1 , 2 car Private _ Storage Building SIZE OF NEW STRUCTURE : Commercial Storage Building 2A_ FEET X 42 FEET Other Foundation Type : Poured Concrete Will any second- hand or ungraded Number of Stories : nnE• lumber be used ? If so , for what ? ( habitable space or �ly ) No Height ( grade to rxdge ) : feet TYPE OF HEATING SYSTEM : Number of fireplacet and/or woo stove { circle all ��,,hA ch applies ) to be installed ._ Electric / � / Gas Wood Forced Hot Air ! aseboar / Other Person responsible for supervision of work as regards to building codes is : Randall SA2 cf�nri nrl AXt?'rt1 gp Trny 2 *42- 5374 Name Addresss Phone Builder ' Cgottrall H,ajP[`k * 1nr! SR2 trtn ,nr3 Assr�niyL� r 't'rn:VtNY 121n2- 2532 ( 518 ) 237- Plumber : 1s,€--b�aa>i > 5324 Mason : tznuP Electrician : by hlaiLder DEGTARA7TON.• 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 Stich 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, an AS BUILT PLOT PLANT by a licensed surveyor; drawn to scale, showing actual location of project on premises. Builder : Co�jltre Rajeck , Inc Signature: / ►rl R *&, 6 nler's agent, architect, contractor) Application for Permit -- Septic Disposal System TOW" of QQueenSbury 742 Bay Road Queensberry; NY 12804 (518) 761-8256 1 . ONVNER INFORMATION; _ .................... Location of installation; Lot#2 Clearvlew Lane Office Use Tax Map No. '54/ 5- / 6 _ 51 2 File Permit No. © 5 Owner's Name: Robert E _ g Jeannette Jensen; II Fee Paid ... .. ................... ... . ............................................................._..,w.,___.......... Bui der , Cottrell Haj +eck , Inc . Address: 582 Second. Avenue , Troy , NY 1 21 82- 2532 518- 237- 5324 2. INSTALLER'S NAME : Cottrell Ha.jeck , Inc . PHONE NO. 237- 5324 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 + vmputation = Total Daily Flow 1980 or older x 150 gal/bdrm = 1980 - 1991 x 130 gal/bdrm = 1991 - present 2 x 110 gal/bdrm = 220 Garbage Grinder Installed yes ` / no xx Spa or Whirlpool Installed yes _ / no _jm_ 4. PARCEL INFORMATION: (circle applicable information & ,indicate measurements) Tgpogrrapjsy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply Flat olnr T at what depth at what depth municipal oling as _3to7 feet 3 tom► 7 fe+et well ti teep s ope clay j ifwell; water supply slope other from any septic-system depth 3 ' to ' absorption is 1 10 other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: 14 t-n 2 5 minute per inch 5. PROPOSED SYSTEM: FF rr 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: 1 , 000 gallon (min. size 1, 000 gal.) Tile Field: each trench 55 fl: Total System Length: _ 275 . Seepage Pit(s): number of size of each: ft, by fJ. Size of Stone to be used: # 3 / 4'• / depth or thickness 1 2 feet Bed System Size: 24 x 55 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 inspections 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. 01 ,�1 August 1 6 , 2000 Signature of Oesponsible person Date ENERGY CODE COMPLIANCE APPLICATION TOWN OF QUEENSBi3RY , WARREN COUNTY 9000 HEATING DEGREE DAYS Comte iar_ ce Methods : P;LRT 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 -Him Rise Residential *Reauires subraission of worksheets ,A._1DPI. IC.A.NL T ' S NAMI E : PROPERTY LOCATION * Cottrell Haj +eck . Inc . Lot # 2 Clearview Lane , Clearvlew Estates 582 Second Avenue Queensbury , NY 12804 Troy , NY - 518- 237- 5324 PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE : 1 . Cross Floor Area - 11052 scrua.re feet 2 . Tv—oe of Heat - Electric xxxx 011 Gas Other 3 . Is building mecaaaidally cooled ? Yes xxx No 4 . ? e=centace of area of wir_dows and doors Over 77 % xxxxUnder 17 % 5 . R-V�?.i.,UES FOR INSULAT1 IONF GIVEN BLOW MUST CORRESPOND TO R-V_ALUES A5 S OIKN ON PLA,'QS SLBirlTTEa'? : 30 a . Roof R b _ Exterior. walls R 19 CM Glazed areas R 1 7 do Exterior doors R _ _i in e . Floors ove= unheated spaces R .19 Edge of slab on grade ( heat. ed bulIlding ) R g . Basement / cellar walls ( above g-ade ) R i g ?s . Basement / cellar. walls ( below grade ) R � n Heating/ cooling-ducts -piping in unheated space R 6 . S a =vice ( domes `. _c ) hot water heat .-Inc device Co -.=' orms to sri-imum efficiency per code xxxYes No TEMPERATURE CONTROL MAXIMUM SETTING 1400 - WILL NOT BE EXCEEDED Apo c - 5 ig.^_at re Data = one Number Ajiaust 16 . 2000 516- 237- 5324 _ I =vSP _ _ ;CR. " S RE`?.RKS . BLDG, KEPT. COPY MIDDLE DE PARTMF.N14INSPEC`I"ION AGFNCY, INC. Gate Jan . 30 , 2001 Certifies that the electrical wiring to the electrical equipment listed below has been examined and is approved as being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date noted above and is issued subject to the fotlowing conditions. Owner: Jensen -, ., / Occupancy: Dwelling m � � C Sam e 4z Tn:s cation ate applies only a tho a ntrt noted dale to the ens a visual eq drupe ct i listed o wantonly and the is 6 Clear-view Zra ne Install a[ion inspected as the above noted date based on a visual insl?eGl ion. No warranty is (r7GCupaRt; ll e .S L2 r * . ' ,� . expresses or impiied as to the mectiancsi salefy, efficiency or faness of Ine equipment for any pa rUcurar pu r pose. This cend icala shal I be valid 1 or a pe riod of one year f rem this above nosed date $Lot.ild the electrical system to which this ceniflcate applies be allered its any way. Including bu Location: not limited to. the ini roducuon of additional oiectr" eq uipmanl anmor the replacement of any o the o moon an is inst a Red as at tha above noted date, this can ihcata shall be immediately null and OVER �. voic. This Geri iticata applies only to the use, uG:Upain cy and owners hp as led sated herein. Upon SEE V V a ch an ye in the use, occupancy or ownership of the property indicated above.Aft is can ilicate shall be mrredialely null and void. In the event that this condicate becomes invalid based upon the above condsions, this oadificate may be nwalidaied upon reinspeclion by Middle Department In- r spectlon Agency, inc. An applicarlun Tor irxpeclion must be submitted to Middle Department C o-t-t r e 1 1 H a.j e ck , Inc Inspection Agency, Inc. to initiate the inspec i on and revalidation process. A Fee wi14 be charged Applicant: 582 Second Ave . for this servico_ LN . 'Troy , N . Y . 12182 J No- 14 - 97551 MAW Form No, 704 7-94 200 Amp . Service Equipment 4/ ) 16 - Switches 29 - Rec : ptacles 13 - Fixt, ures 1 -Water heater 1 - Burnr_ x , Wiring x Con troxs fDr Al 1 -Well Pump 1 - Dishwasher 1 - Dryer I. -Washer Reck. dtac ._ e 1 - Vent Fan 4- Smoke DetectorE ------------ RESIIIENTIAL FINAL INSPECTION REPORT Office No. (518) 761-8256 Date inspection request received: w " Building & Code Enforcement Dept. of Community Development Arrive am/pm Depart Town. of Queensburry Inspector's Initialsk' 742 Bay Road Queensbury, New York 12MM NAME P1 R11II`1_-�E 5�! W LOCA- 0 rr TYPE of STRiS BATE NIA YES INTO COMMENTS Chimney HeightPITN Vent/Direct Vent Location Fresh Air intake Plumb Vent through roof Roof Complete Exterior Finish Complete ,Tnterior/Exterior Railings 30" to Exterior Handrails, balconies, 1 0 18 ' or more Interior Handmils stairs both si 3 or ma. . risers Grade 2% sway from. foumulati _ 8" clearance to sill plate Gas Valve shut-off exposed/re for l above grade_ — — Gas Furnace shut-off witJ 30 eet o thin line of site Oil Furnace shut-off at en to aroa Furnacefflot Water Heater Relief Valve(s) installed Headroom, 6 ft. 6 in. on stairs Basernent stairs, 6 ft. 4 in. jAndrail exterior stairs both si more than 3 risers Intc!TiOr rivacy/trinVdoors/:Hein trance 36„ Floor Finish Bathrooitm tchen watertight Interior Handrails Bal 18 in. or more Railing across window in stairwells Smoke Detectors_ every level every bedroom �{ G+ L outside every bedroom inter connected Bathsaorn fans / Cf Plumbing ftxtares Foundation insulation 3f4 hour are door/door closer Garage fireproofing Garage penetrations sealed Furnace in separate root. protected (in garage) Light ventilation per room Safety glazing I W" or less from floor Final Electrical Site PIanfVariance required Final Survey Plot Plan As Built Septic System layout required Okay to issue C/C (Certif of compliance)_ Okay to issue temp. CIO (Cettif. of Oo¢upancy)_ Okay to issue permanent C/o (Cer". of Occupz--G7 TOWN OF QUWRNSBURY BUILDING S CODE ENFORCEMENT 742. BAY ROAD QUEENSHURY NY 12804 { (518) 761-8256 ARRIVE : 'DEPART : INSP : rimAL INSPECTION REPORT - RBSIDENTZAL DATE INSPKC=ON REQUEST RECEIVED : x LOCATION L1ATE •� .� "'� d-C'.] L,�r � PERMIT M -1" TYPE OF STRUCTURE { S FOOTINGS FOUNDATION BACKFILL FRAMING ROUGH PLUMBIN40 SEPTIC INSULATION FINAL ELECTRICAL WOODSTOVE OR FIREPLACE H A YES no CHIMNEY HiEIGHT,/B VENT/HETGH'I'_,_ PLUMBING VENT ROOFING EXTERT R FINISH DECK OR S LINGS RELIEF VALVES -- FURNACEIHOT WATEA OPERAT G INTERIOR TRIM TRIMIPRI ACY RS WISH F S BATH K ' eHEN WAIRTIGHT OTHER FLOORS SWE PABL OTHER FLOORS CARITED STAIR CL ARAN S RAi ING S OKE PETECTORS _ iB NG IXTU ES OU II ON I 10 GARAGE FIRE PRQUFING DOOR CLeQSERS ECT CAL E VARIA CE RE _ rr L SU V Y PLOT= PLAN TO ISSUE C O R C MACADAM PARKING LOT E' I 1 S TOR Y BRICK I BUILDING I NOW OR FORMERL Y CHURCH OF LATTER DAY SAINTS 5271230 TAX MAP: 54-5-19.2 MACADAM PARKING LOT CAPPED \� IRON ROD FOUND 0 J O o N 2 a 0 Q A �V N O Z 0 W CAPPED IRON ROO FOUND MAP REFERENCE 1) MAP EN77TLED 'CLEAR14EW ESTA7ES, OWNED BY RONALD & MAR RAVNOR' MADE BY NOR 7H£AST LAND SURVEY & LAND DEVELOPMENT CONSUL TAN7S P.C., DATED OCTOBER 22, 1991 AND RL£D IN THE WARREN COUNTY CLERK'S OFFICE ON APRIL 13, 1992, IN PLAT CAB. A-1, SLIDE 182. DEED REFERENCE CHAD M. RA YNOR TO ROBERT E. "SEN, Il & JEANNETTE JENSEN DTD. MAY 15, 1997 BK. 1024, PC 130 NOTT-• TW ALW MS PREPARED *MfOUT a94917r OF AN LP-M-DATE TIRE RID O r OR AB3fl r ar "TIE AAID RS SL L#rr 77 * MyrM? FACTS My BE REWAM BY SLID DOCUMENTS ONLY COPES MADE FROM THE ORICNUL OF THIS SURVEY MAP WHICH ARE MARKED WITH AN OTK.M OF THE L*IO SURVEYORS EMMOSSED SEAL AND BEARNO THE SURVEYORS ORNGdAL SIGNATURE IN RED INK. SWILL BE COMSOERED TO BE VALID AND TRUE COPES. UAU`THOAI= ALTERA71001 OR ADDITION TO A SURVEY MAP BEARNNG A UCENSED LAND SURVEYORS SEAL IS A VIOLATION OF SECTION 720E SUBDIVISION 2. OF THE NEW YOW STATE EDUCAMN LAW. NOW OR FORMERLY BERNARD C. & BEVERL Y ROGGE 1134120 TAX MAP. 54-5-6.52 IAA MA/': LOT (D CLEARVIEW ESTA TES (VACANT PARCEL) NOTES• 1) RESTRICTIVE DEED COVENANTS 5HOULD BE CAREFULLY EXAMINED BEFORE C0NS7RUC77ON TAKES PLACE ON THIS PARCEL. 2) REFER TO MAP REFERENCE NO. 1 FOR 07HER SU8D/VIS70N N07ES AND FEA 1URES. ZONING INFORMA 77ON ZONE.• SR- lA, ONE ACRE MIN. SINGLE- FAMILY DWELLING LOT WID7H: 150' FRONT YARD SETBACK. 30' 57D£ YARD SETBACK • 30' OR MORE WITH A 10' MIN. REAR YARD SETBACK: 20' PERMEABLE AREA: 50X MIN. BUILDING HEIGHT- 40' MAX. I HEREBY CER77FY TO: ROBERT E. JENSEN, If AND EANNET 7E ,ENSE•N, AND M & T MORTGAGE CORPORA 770V, THA T 7HIS MAP WAS PREPARED FROM AN ACTUAL ON THE GROUND SURVEY, ACCORDING TO RECORD DESCRIPTIONS. OCTOBER 25, 2000 DA TE DONALD I P/DGE N. Y. S LICENSE NO. 503 POLE NMJ NYTJ IRON ROD FOUND (BEN T) A MO N 3 A N IRON ROD FOUND (BENT) a 0 0 f PALE NMI N YTI Q J NOW OR FORMERLY MICHAEL R. & JANICE L BARD/N 9241222 LOT O CLEAR NEW £STATES TAX MAP.- 54-5-6.1 DRILLED O," WELL NOW OR FORMERLY .IUD/TH FREIBERGE"R 7221155 TAX MAP.- 54-5-6.7 MAP P"FI ED JAN 2 4 2001 OF LANDS OF TOWN OF QUEENSBURY BUIIDiNG AND CODE ROBER T E. JENSEN, H AND JEANNETTE JENSEN BEING LOT NO. 2, CLEARVIEW ES TA TES S17UA TED IN TOWN OF QUEENSBURY, WARREN COUNTY, NEW YORK SCALE.- 1" = 30' OCTOBER 25, 2000 SURVEY & MAP BY DONALD L. PIDGEON, Jr. LICENSED LAND SURVEYOR N. Y. S. LICENSE NO. 50372 16 MICHAEL ROAD FORT EDWARD, NEW PORK 12828 518— 792— 4146 RESIDENTIAL. FINAL INSPECTION REPORT Oflice No. (518) 76148256 Date inspection request received: �d Building & +Code Enforcement Dept. of Community Development A s-rihve : "t rarnH m5�epart Town of Queensbury � In p tor's hi " 742 Say Road Queensbury, New York 12WW NAME � r��tJ CGS/� } l 1`iEa TE �LOCATION ',�,� ���.�'L�_`� TYPE OF STRUC:TURF, NIA YES NO COMMENTS Chimney Hcight/"13" Vent/Direct Vent Location Fresh Air Intake Plumb Vent through roof Roof Complete Exterior Finish Complete Interior/Exterior Railings 30" to 36" Exterior Handrails, balconies, lauding. 18 in. or more � �\��� Interior N;andrails stairs both sides 3 gbgpl -, Grade 2% away from fbun='n 8 ' clearance to sill plate + L Gas Valve shut-off exposed/regulator above Gas Furnace shut-off within 30 feet or wi line o 'site C -ti— _ ?�— Oil Furnace shut-off at entrance to furnace Furnace/Hot Water Heater operating �` • F— Relief Valve(s) installed Headroom, 6 ft. 6 in_ on stairs Basement stairs, 6 ft. 4 in. Handrail exterior stairs both sides more sers Interior privacy/trim/doors/awin an 6" - Floor Finish Plathmom/Kitchen watertight Interior Handrails Balcomes/Landing 18 in. or rn L Railing across window in stairwells Smoke Detectors: every level every bedroom outside every bedroom inter connected Bathroom. fans Plumbing fixtures Foundation insulation 1/4 hour fire door/door closer Garage fireproofing Garage penetrations sealed Furnace in separate room protected (in garage) Light ventilation per room. Safety glazing 18" or less from floor Final Electrical Site Plan/Variance required Final Survey Plot Plan �` 7 j (�^ L ".yam 4J '�it 1f� As Built Septic system layout required Okay to issue C/C (Certif. of Compliance) T Okay to issue temp. C/O (Certif. of Occupancy)_ Okay to issue permanent C/O (Certif ofOccupanwj) zy �rC'ENERAL INSFE+C7'IC1N REPORT ( 518 ) 761 - 8256 Town of Queensbury Dept. of Community Development Date insp+e+cd ou request received: Building & +Code Enforcement 742 Bay Road �7 Queensbury, NY 12804 Arrive andpm Den Inspector's Initials I NAME: PERMIT # ` bop l LOCATI DATE : TYPE OF STRUCTURE: RECHECK N/A YES NO COMMENTS Footings/Piers Monolithic Pour Form _ Reinforcement in Place The contractor is responsible for ,providing protection from free g for 48 hours following the ent Of the concrete. Materials for this porno on site Foundation/Wallpour Reinforcement in Place Foundation/Dampproofin Racid"ill Approval Plumbing Lander Slab ng VentlVents i Place Plumbin h l v c Heat' gRo ugh-In Iti Foudation Walls 'Interior R Foundation Walls Exterior R- Floors R- W,alls R- Ceiling, R- Duct work or piping in unheated spaces R- r 'V'ent, Attic Vent V Frhnting Jack Studs/Headers Bracing/Bridging, Joist :Hangers JackPosts/Main Beam. Air Infiltration Barrier Fire Separation 1, 2, 3, hour ktion Sealed ire Wall 2, 3, 4 hour. Fir estopptnn AYV\ ENEKAL INSPECTION REPIJRT c 518 » 61 - 8256 Town of Queensbury Dept. of Community Development Date inspection request received: Building & Code Enforcement 742 Bay Rbad Queensbury, NY 12804 Arrive am/pm Depart �7� n Inspector's Initials NAME: � +ci rce 5�✓� PERMIT # LOCATION, � ' 1� rc\1\ f'� +�fir. ��._„_ BATE : ��-e�L�L� TYPE OF STRUCTURE: RECHECK N/A YES NO COMMENTS F'ootingwToiers Monolithic Pour Form Reinforcement in Place The contractor is responsible for providing protection from freezin for 48 hours following the placement 1�Jj 1.' A) of the concrete. Materials for this purpose on site FoundationlWaillpour Reinforcement in Place Found ation/Dantpproofing Backfill Approval Plumbing Under Slab Pt PPluma vent/Vents in Place ,r A11+1 L t J*-r?f` g Rough- nsulawdon I C- Foundation Wails Interior R- Foundation Wails Exterior R- Floors R- Walls R- Ceiling R- Duct work or piping in unheated spaces R- _ e , Attic V t F miAg Jack StudwIleaders Bracing/Bridginja Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1, 2, 3, hour Penetration Scaled F,�' Wall 2, 3, 4 hour, =-� r�irestoppin 1 < TOWN OF QUEENSBURY BUILDING CODE ENFORCEMENT 742 Say Road Queensbury _NY Z_2804 j (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name J CIA) i Location _ Date — Permi t # SOIL TYPE : Sand- Loam-Clay- j i Results of Percolation Tes - ( if applicable ) Rate-Mina a/ Inch TYPE OF SYSTEMft ABSORPTION FIELD: Total Length i Length of each trench Depth of trenches Size of stone SEEPAGE PITS : Numbe - Size - ft . ft . Stone size f PIPING : Size Type Bldg . to Tank Tank to Dist . Box Dist . Sox to Fief /Pit Openings Sealed ? Yes�T� o 'cart a� � LOCATION/SEPARAT OHS : Foundation to T nk feet Foundation to A sorption feet Separation of its feet Conforms as pe Plot Plan �- es No LOCATION OF SY TEM ON PROPERTY: ( circle one ) Front - Rear Left Side - Right Side Middle Front Middle Rear COMMENTS : SYSTEM USE APPROVED : EYES NO Arrived : Departed : Building Inspector Tow of QUEENSBURY � BUILDING S CODE ENFDRCENEN,4' I 742 Bay Road queensbury NYI�8O4 csxs> 761-9256 SEPTIC DISPOSAL SYSTEM INSPECTION Name SU� n �'V l �°ts Location r ' 'Cate /OL Permit # SAIL TYPE: nd- Loa -Clay- Results of Percol a t i on est- ( if applicable ) Rate- note/ Inch TYPE OF SYSTEM: / ABSORPTION FIELD : 7 a1 Lengthf 'Jac; 1 Length of each tre h p Depth of trenches ° Size of stone SEEPAGE PITS : berm Size - t . x ft . Stone size PIPING: Size ype Bldg . to Tanis Tank to Dist Box Dist . Box to Field/P Openings Se led ? Yes No artxa LOCATION/SE ARATI Foundation to Tank feet Foundation to Absorption feet Separation of Pits feet Conforms S per Plot Plan a No LOCATION F SYSTEM ON PROPER ( circle o e ) Front - ar _ Left Sid - Right Side Middle F ant - N4441vwoKear COMMENTS SYSTEM USE APPROVED : YES 00) Arrived: Departed: Building Inspector i ,u r _ R► 34 LP r OF I %arm 0,"5?5:,3t.yd I I I CI i 71 h�t' {,� }�+,j�+ �,/ slp 0 r 5 JL:tZ ' EPTo Y TOWN OF QUEENSBURY1 . BUILDING A CODE ENFORCL.,y, cl 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPEC Dame Location ` - [ 1 .� Date Permit # SOIL TYPE: ',Sand- LOAm-Cl ay- Resul is of Percolation Test- ( if applicable ) Rate-Minute/ Inch TYPE OF S. ABSORPTION FIELD: Total Lejagth � / S�C) � Length of each trench Depth of trenctes 2- Size of stone �Z,_ SEEPAGE PITS : umber- Size - ,t . x Stone size PIPING: i ype i Bldg. to Tank Tank to Dist . Box �j Dist . Box to Fiel pit r � : Openings Sealed? Yes o 15artial LOCATION/SEPARATI Foundation to Tan Ta f �% feet Foundation to Abso ti n feet Separation of ? its feet Conforms as per Pl of Ian es No LOCATION OF SYSTEM PROPER . - ( circle one Front - Rea - Le f Si - fight Side Middle Front a ar COMMENTS : cry--ilC�-t_- SYSTEM US APPROVED( YES NO Arrived: Departedo . uIl ing Inspector GENERAL INSPECTION REPORT ( 518 ) 761 - 8256 Town of Queensbury J -qo C) Dept. of Community Development Date inspection request received: ! Building & Code Enforcement 742 Bay Road I Queensbury, NY 12804 Arrive andprn Depart ,� Inspector's Initials NAME: - S ` `� o 6Z l PERMIT iY ciG —" rra 5 LOCATIC1Nf✓ DATE : U0 F }� TYPE OF STRUCTURE: RECHECK NIA YES NO COMMENTS Faotings/Piers � ^-� — I Monolithic Pour Form Reinforcement in Place The contractor is responsible for providing protection from freezing for 48 hours following the placement of the concrete. Materials for this purpose on site Foundation/WaRpour Reinforcement in Place Foundati0I1/Dsttn Backfill Apprroval .Plumbing Under Stab �rml ng Venl/Vents in Place gh I'luxnl�in r�s seating Rough"In �r 'GV ir.7 ' k, �9 f G3 ♦ 1 Insulation Foundation Walls lnteriar Foundation Walls Exterior - Floors R _ Watts - Ceiling - Duct woL iping in unheaaces R- r Ventc entrams Cx-� Jack Studs/Headers Bracing/Bridgin J0 II.'#YtgerS / Jack Posts/h+Iain Air hifritration Ba r Fire Separation 1. 3, hour Penetration Sealed re 'watt 2, 3, 4 hour .r'Firestoppin � r GENERAL INSPECTION RE .R'T ( 518 ) 761 -8256 Town of Queensbury Dept. of Community Development Date inspection request received: Building & Code Enforcement 742 Bay Road /� r Queensbury, NY 12844 Arrive am/pnn Deparat Inspector's mitiats NAME- �j PERMIT 0 LAO CATION: 4 r DATE : 4?C2a6_... J"7'1 o w T"Y. M Of STRUCTURE: 5,97") t RECHECK NIA YES NO CO MMENTS Footings/Piers i Monolithic Pour Form Reinforcement in Place The contractor i5 'ae providln�g protection ng for 48 hours follo the p nt of the concrete. Materials for this on site Foundation/Wallpou Reinforcement in Place ( O4oundationMa.rnpproo tg, _ Backfill Approval Plumbing Under Stab Plumbing VentlVents in 'lace Rough Plumbing Heating Rough-In Insulation Foundation Walls rior R- Foundation Walls xterior 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 Firestoppin GENERAL INSPECTI NN REPORT ( 518 ) 761 -8256 Town of Queensbury Dept, of Community Development Date inspection request received: Building & Code Enforcement 742 Bay Road Queensbury, NY 12844 Arrive am/pm Depart Inspectaar's Initials NAME: Ita A PERMIT 4 i r4� f LOCATION: 4f .tcuJ DATE TYPE OF STRUCTURE: RECHECK �' OHO"6.- .i c- ( G NIA YES N COX4MENTS tings/Piers c ur Form J Reinforcement in Place /t 4'� � [ -Ai The contractor is responsible for providing protection fsotn for 48 hours following the ceme t of the concrete. Materials for this on to Foundation/Wall ;see Reinforcement in PlFoundation/Damppr Backfdt Approval Plumbing Under Slab _ Plumbing, Vent/Vents in lace____. Rough Plumbin Heating Rough-In Insulation Foundation Walls =or R- Foundation Walls or R- Floors R Walls R- Ceilin,g R- Duct work or pipin4 in unheated spaces ' R- _ Proper Vent, Attic Vent Frami Jack StudsCHeaders BracinglBn Joist Hangers Jack Posts/Main. Beam Air Infiltration Barrier Fire Separation 1, 2, 3, hour Penetration Sealed_ Fire Wall 2, 3, 4 hour. Firestoppin GEC ERAL ZMSPEC 70V REPORT ( 518 ) 761. 8256 Town of Queensbury Dept. of Community Development Date inspection request received. Building & Code Enforcement 742 Bay Road L Queensbury, NY 12804 Arrive am/pm Depard Inspector's Initials r NAME: E' ti <f PJ PERMIT 4 LOCATION: DATE : G' 3 M TYPE OF STRUCTURE: RECHECK NIA YE NO COMMENTS VFoo ers Vt Monolithic Your Form Reinforcement in Place The contractor is responsi�for providing protection from'f its for 48 hours Following the place ent of the concrete. Materials for this purpose on site Foundation/Wallpour Reinforcement in Place Foundation/Damp aoo€u�g BackEll Approval Plumbing Under Slab Plumbing Ventf Vents in Place Rough Plumbing_, Heating Rough-In Insulation Foundation walls Interior - Foundation Walls Exterior Floors R- r - wall$ R- I Ceiling R- Duct work or piping in unheated spaces Rw Proper Vent, Attic Vent Framing Jack Studs/Headers BracinglBridging Joist Hangers Jack PostslMain Beam Air Infiltration Barrier Fire Separation I, 2, 3, hour Penetration Sealed Fire Wall 2, 31 4 hour Firestoppin C COTTRELL HAJECK, INC . n 682 SECOND AVENUE TRANSMITTAL LETTER NORTH TROY, NEW YORK 12182-2532 (518) 237-6324 PROJECT: Jensen Residence Lot# 2 Clearview Lane PROJECT NO.: TO: DATE: August 1 7 , 2 0 0 0 Building & Code Enforcement RE: Town of Queensbury 742 Bay Road TRANSMITTED: Queensbury , NY 12804 $X herewith ❑ under separate cover REASON TRANSMITTED: VIA: courier ❑ approved U revise and resubmit Q for response ❑ approved as noted 1Xx for approval ❑ for file ❑ not approved ❑ for Information ❑ as requested Akx COPIES DATE DEscl:lPnorl 1 8- 16- 00 Building Permit Application 1 8- 16- 00 Septic Disposal System Permit Application 1 8- 16- 00 Driveway Permit Application 1 8- 16- 00 Energy Code Compliance Application 1 8- 16- 00 MDIA Electrical Inspection Application 8- 2- 00 Plot Plan 2 8- 2- 00 BuildingPlans ; Elevations , Foundation , Ploor Plans , 5ecti n - 17- 20 Check 8+693 Permit Fee REMARKS CC)PIES TC3: (with enclosures) Co#rel I H eck, Inc. 0 Bye Il Randall iffajeck O Project Manager If enclosures are not as noled, please notify us at once. MIDDLE DEPARTMENT INSPECTION AGENCY, INC. National Headquarters 1337 West Chester Pike, West Chester„ PA 1.8382-6422 >x . . . COMPLETESTHIS a Date: i-1G." City, Town or Township County State Location/Address sie &2 ZAAMt clear'!u `� ambdsvislan (If Located in Rural Area - Please Attach Directions) Pole # _ _ Owner Permit # � O*cupied As 04 'lift P+MiiiiIIIII2 Building: New= OldO Occupant �" _ Work Area in Buildin Floor #, etc.) .m for: Wiring [:] Service 0 or: Ready for Inspection . Fee Remitted - $ Cash o Check M.O.1"0 120a 1500 I?50 ocammalm 2000 2250 250a : rj1& Make Payable To: M.D. I.A. oaa Number of Rough Wiring Outlets Elect, Heat 5a0 7Sa Switches Lighting XfW Amp- Service Surface Unit Dishwasher t[ Range Receptacles Water Heater Air Conditioner Ir Dryer Y Pump Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner Amp. Receptacles X Fractional H.P. Vent Fans Other Equipment- r MOTORS H.P. 1/2 111 1/10 1/a 1/6 1/4 /3 1/2 3/4 1 1Yz 2 3 �'i ].,0' _39, Mark Number of Each Size ` Applicant's Signature ksdf >� +. i tialMliit License # Permit # T/A � D Utility. KS Applicant's Address: W111 NA2 ff;+imerrrl! �...��+. ; bF WFF CRE T 90 CMA Tr Off (City) q - M (State) O (Zip) 1121 rlr11-3 2 Service Request # rR',drN0t,.. Electrician, DATE RECEIVED; DATE INSPECTED: ion : Same as Above ED or: abelough Wiring Outlets Surface Unit Oven witches Range Garbage Disposal Receptacles Water Heater Dishwasher Fixtures Air Conditioner Dryer Amp. Service Equipment Burner, Wiring & Controls for Amp. Receptacle Amp, Service Conductors Pump Vent Fans MOTORS H.P. i/20 1/12 1/1Q i/a 1/6 1/4 1/3 1/2 3/4 1 1>6 . 2 3 5 JYz 10 15 2Q 25 3Q 40 S0 75 1QQ Mark Number of Each Site Eject. Heat soo 1.750 1000 also 1WO 1ts0 20aa 22so 2sa0 2Tao 3aaa 0 RW Progress: Inc. Q LKD 0 Contractor 0 CPT Violation : Work Comp. [] Inc. 0 L/A Owner CASH ED L/A Fee CHIC # # [] IPA Municipal Due MO INV # Date: Other Side Utility pplicant Owner Cut in Card © Temp # Date w Q Final # Date IHSPeCT4t)RS SIGNATURE APPLICATION FORM NO. 250 EL 5194