2006-567 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20060567 Date Issued: Monday, October 22, 2007
This is to certify that work requested to be done as shown by Permit Number P20060567
has been completed.
Location: 165 PILOT KNOB Rd
Tax Map Number. 523400-227-014-0001-024-000-0000
Owner: DONNA ROSEN
Applicant: DONNA ROSEN
This structure may be occupied as a:
Fireplace By Order of Town Board
Single Family Dwelling TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the ` >
nPro
property owner of the responsibility for compliance with Site Plan,Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
��� TOWN OF QUEENSBURY
w
` 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060567 Application Number. A20060567
Tax Map No: 523400-227-014-0001-024-000-0000
Permission is hereby granted to: DONNA ROSEN
For property located at: 165 PILOT KNOB Rd
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 Queens bury Zoning
Ordinance. Type of Construction Value
Owner Address: DONNA ROSEN
10 PASTURE GATE Ln Fireplace
DELMAR, NY 12054-0000 Single Family Dwelling $40,000.00
Total Value $40,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2006-567
1797 SQ FT SINGLE FAMILY DWELLING WITH 1 FIREPLACE
$213.16 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, September 12, 2007
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To of nsb Tjr :d , , September 12, 2006
SIGNED BY '41 for the Town of Queensbury.
Director of Building&Code E 'orcement
Permit No. -567
Building&Codes Office-Department of Community Development-Town of Queensbury Fee Paid
742 Bay Road, Queensbury,NY 12804 Recreation Fee
Dave Hahn,Director codes(q1aucensburv.net
Phone: (518) 761-8256 FAX: (518) 745-4437
Principal Structure Building Permit Application
Application & Plans subject to review before issuance of a valid permit for construction.
Instructions: A permit must be obtained before beginning construction. No inspections will be made until the
applicant has received a valid building permit. All applicants' spaces on this application must be completed and
must appear on the application form.
Applicant/Builder (,,i c016e14 Owner: awniA g
Address: �j GoM 't GJr'.�CaP Address: 3- - t 4 Ui
laor,l`( N ' 122v? &.t,ephl`f 14`( 122.01
Home Phone: 4-34-2. )q Home Phone: 4 4-.- 21,1'
Email Address: Email Address:
Cell Phone: Cell Phone:
FAX Phone: 44- (p1' 1 FAX Phone: 434-00 l "-7
Person responsible for supervision of work with respect to building and codes compliance:
Name: NSll l' A 1.0t1 .A.1.04n)
Address: •J' �! �<� • - ' • TO
.rte _• ' `'Phone 518'600/ b5
!Ti
Location of proposed construction: Lot No. Legal Address: t(e) 'F1L V-NOB go
Tax Map Number: 22'1. 4-- I - 24- Subdivision Name:
Estimated Cost of Construction: $ 40,coo
Proposed construction is for: )Residential Use Commercial Use
Name of Business:
If proposed construction is an addition,what will use of new addition be?
New Addition Alteration Proposed Construction 111 Floor 2nd floor Other Total Proposed
structure (Occupancy Type) Sq. Ft. sq.ft. Sq. Ft. Square feet Height
F Ff.&in.
Single-Family Dwelling 6 130 229 1 1�9 7 27 j 9 H
Two-Family Dwelling
Townhouse
Multifamily Dwelling
Number of Units: !
Office
Mercantile
Manufacturing
Other:
Attached Garage 1, 2, 3
Type of Heating System: Electric, Oil, Gas, Wood, Forced Hot Air, Baseboard, Other:
If a fireplace and/or woodstove are being installed, please refer to a separate application.
Applications are subject to Zoning Administrator, Code Compliance, and Structural Plan review.
The Building and Codes Office will allow commencement of your proposed project only after
issuance of your permit.
Declaration: Please sign below after you have carefully read the statement:
To the best of my knowledge, the statements contained in the application, together with 'he 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 Codes, the Zoning Ordinance, and all other laws pertaining to-the
proposed work shall be complied with, whether specified or noted, and that such work is authorized by the owner.
Further, it is understood that I/we shall submit prior to a Certificate of Occupancy or Certificate of Compliance
being issued, as requested by the Zoning Administrator or Director of Building and Codes, an As-Built Survey by a
licensed surveyor, drawn to scale, showing actual location off all new struction.
Date: ! Au& 2a* Applicant/Builder Signature: 4 Al 4°40W —A6g5W �
?1/e A ��✓T.
The application of dated is hereby approved and
permission granted for th on truction, reconstruction or alt ratio a 'din and or accessory structure as set
forth above. r
Date: b Authorized Signature
L:\Sue Hemingway\Building. ermit.FORMS\Principal Structure Permit Application.doc v:12/14/04
1 �
OFFICE USE ONLY
TAX MAP NO. PERMIT NO. PERMIT FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: �d INSTALLER:
ADDRESS: . '27 ^ ��-.L.� S , ADDRESS:
61-111
PHONE NOS. '3 — /5— 7 ,e4.10/5 /e0
NOS.
LOCATION OF INSTALLATION: / 5 �C or /ee0
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older i 1 X y 150 gallon per bedroom = INSTALLED?
1981 -1991 11 X 130 gallon per bedroom j = SPA OR HOT TUB
1992-present ''7� I X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION: � Y 5 7-74) > 5-'57z---1A=--. c--c- /4106/770✓v�C—
, �2GJ CJ2/� v e
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH (TEST TO BE
COMPLETED BY A LICENSED PROFESSIONAL ENGINEER OR ARCHITECT)
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: GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
i! APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. •
•
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 QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codes@queensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
Signature of Person Responsible Date
• Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
Fire Marshal's Office Town of Queensbury,742 Bay Road,Queensbury,NY
(518)761-8205
Application for Fuel Burning Appliances & Chimneys
applicable to solid fuel & vented gaslppiiances
Date ! AtIlit , 201�?�l E,:. ; Permit No. 10_6 —567
TO
Application is hereby made to the BuilIirig& Codes.Office for the issuance of a Building and Use
Permit pursuant to the New York State Fire Prevention and Building Code. The applicant or owner
agrees to comply with all applicable laws, ordinances, regulations, and all conditions that are part of
these requirements and also will allow all inspectors to enter premises to perform required inspections.
NOTE to applicant: Rough-in and Final Inspections are required.
Applicant Information Fuel Burning Appliance Information
(circle appropriate words)
Name:_ i70S Stove: wood coal pellet gas
Fireplace insert
Address: Fireplace, factory-built: wood _as
,Ar4-1' M( MAY-7 Fireplace, masonry: wood gas
Furnace: wood Op oil
Phone: 434 ' ?JJ 161
If non-masonary applicance,please provide
Owner: cOIJN p JC Manufacturer Name: alaq124--
Address: -C- AAIJI SSU ithe Model Number: ai- 32 o1GetR•
4L ( 14`( 1224/
Chimney Information
Phone: -�y� �� (circle appropriate words)
Masonry block brick stone
Flue tile Mb size: 6, inches
Exact Address: ►( Ptt,t?T7 . M
of construction or installation Factory-Built
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 Queenshury
Handouts regarding required inspections. Double wall / Triple wall / Insulated / Direct ventin;
Chimney Liner
Casi.hier'a D pear tmtea rat--2'ovarzi of Qzzee xiab ' •, . ew
'
jr
Fire Marshal Code# $Collected Refolded Received from u�dc ):
cull '.s+.
Ae
^-
.9 173 3389 (190) Public Safety ',
A 233 2655 (230)Minor Sales
DATE:
yi�wca�cv66- Dera.
y.
White(Applicant) / Gre: (Fire Marshal) / 111 ellow(Bldg.7,015. / Pii k&Goldenrod(Cashier's Dept.)
•
Queensbury Building & Code Enforcement - Reside .'al 1 Inspection
Office No. (518)761-8256 Arrive: an . P s : am/pm
Date Inspection request received: Inspector's Initials•
NAME: •SIT#:
LOCATION: /6 5— ! , /a'f" i l , Reif I • E:
TYPE OF STRUCTURE:
Comments
Yes No N/Ae>op c7, l f k�-7
Building Number/Address visible from road / 7
Chimney Height/"B"Vent/Direct Vent Location `J ` _'
Fresh Air Intake �`'
3 inch Plumbing Vent through roof minimum 6 inches j D�
Roof Complete/Exterior Finish Complete _ / lr- �� / /459°7
Platform at all exterior doors
Guards at stairs,decks,patios more than 30 inches above grade
Guard at stairwell at 34 inches or more
Guard at deck,porches 36 inches or more
Handrail Termination at Newell Post or Wall
Interior/Exterior Railings 34 inches to 38 inches
Interior Handrails @ stairs 2 or more risers
Grade away from foundation 6 inches with 10 feet
6 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18 inches above grade
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells safety glazing
Interior Smoke Detectors:
Every level: Every Bedroom:
Outside every bedroom area:
Inter Connected: Battery backup:
Carbon Monoxide Detector
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area
Crawl Spaces 18 inch x 24 inch access, 1 sq. ft.-150 sq.ft. vents
Bathroom Fans,if no window
Plumbing fixtures
Foundation insulation
Floor truss,draft stopping finished basement 1,000 sq. ft.
Emergency egress below grade
Gas Furnace shut-off within 30 feet or within line of site
Oil Furnace shut-off at entrance to furnace area
Furnace/Hot Water Heater operating
Low water shut-off boiler
Relief Valve(s)installed/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum'/2"Gypsum
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/3/4 hour fire door/door closer
Duct work Sealed properly
Gas Logs in Sealed or Glass Enclosure
Final Electrical
Final Survey Plot Plan
As Built Septic System/Sewer Dept.Inspection Sticker
Site Plan /Variance required
Flood Plain Certification,if required
Okay to issue C/C or C/0 [T nporary/Permanent]
L:\Building&Codes Forms\Building&Codes\Inspection Fonns\Residential Final Inspection Form revised_100405.doc
—y /C D4 /26 lo`Z
Queensbury Building & Code Enforcement - Residential Final Inspection
/
Office No. (518)761-8256 Arrive: 2L r"1 a m art: i"- am rp
Date Inspection request received: Inspector's Initials:
NAME: 0,`;''. _ PERMIT#: kr
LOCATION: r 7ir/ ., DATE: MCI
TYPE OF STRUCTURE:
Comments
Yes' No N/A
Building Number/Address visible from road Jj c. 11\:.) k.----
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake 4%7 t=-1 Q. l\t-E-
3 inch Plumbing Vent through roof minimum 6 inches ./
Roof Complete/Exterior Finish Complete
3r=
Platform at all exterior doors i
Guards at stairs,decks,patios more than 30 inches above grade ,J 1•---th--4 1 1Q
Guard at stairwell at 34 inches or more
Guard at deck,porches 36 inches or more .,J V? (S � cz:
0 :1
Handrail Termination at Newell Post or Wall i
Interior/Exterior Railings 34 inches to 38 inches ;/ '�=(_T 6rA 2
Interior Handrails @ stairs 2 or more risers
Grade away from foundation 6 inches with 10 feet ✓/
6 inch clearance to sill plate J
Gas Valve shut-off exposed/regulator 18 inches above grade '
Interior privacy/trim/doors/main entrance 36 inches ,,/
Bathroom/Kitchen watertight V i
Safety glazing/Window in stairwells safety glazing f
Interior Smoke De ctors:
Every level: Every Bedroom: i
Outside every bedroom a a: .j
Inter Connected: Battery backup: /
Carbon Monoxide Detector J`
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area ✓ /
Crawl Spaces 18 inch x 24 inch access, 1 sq.ft.-150 sq.ft. vents j
Bathroom Fans,if no window 4
Plumbing fixtures v!,
Foundation insulation J
Floor truss,draft stopping finished basement 1,000 sq. ft. /
Emergency egress below grade r' i
Gas Furnace shut-off within 30 feet or within line of site ✓
Oil Furnace shut-off at entrance to furnace area ,/
Furnace/Hot Water Heater operating
Low water shut-off boiler
Relief Valve(s)installed/Heat Trap/Water Temp 110 .. r l
Enclosed Stairs Sheetrock Underside minimum 1/2"Gypsum / / N6 {
Basement stairs closed rise>4 inches -,� p i L
Garage Floor Pitched \� �VGarage fireproofing/3/4 hour fire door/door closer `p /I/
t I'-) i�;
Duct work Sealed properly ✓ / ;
Gas Logs in Sealed or Glass Enclosure - �`.i�-‘
Final Electrical r" � �
Final Survey Plot PlanUf --\ /
As Built Septic System/Sewer Dept. Inspection Sticker trl.c1f u.I',0j /
Site Plan /Variance required
Flood Plain Certification, if required /
Okay to issue C/C or C/0 [Temporary/Permanent
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form revised 100405.doc
Final Survey Inspection
Dept. of Community Development
Town of Queensbury
742 Bay Road
Queensbury, NY 12804
Date received: 6Q 7-7
NAME: 1'\01?E�
LOCATION: tb5 V% `j vz *,
PERMIT#: tt_Q-,5-Lc`7
Final Survey Plot Plan
Approved Denied
The attached final
survey has been
received by the .-7
Dept. of
Community
Development.
Upon review the
survey has 'Jell:
1 /
1
Crai: : own, Zoning Administrator
Notes:
L:\SueFlemingway\Building.Codes.Inspection.FORMSWinal Survey
Zoning Administrator.doc
�--- — L`bes
.... pae�Utl1Tty
--
I HEREBY CERTIFY T0:
UNAUTHORIZED ALTERATION OR
ADDITION TO THIS DOCUMENT IS
11CLATION OF SECTION 7209,
1.) DYON A. RUSEN
STATE EDUCATION LAW.
2. CTITLE INSURANCE COMPANY
THAT AP WA PREPAR FROM AN ACTUAL FIELD SURVEY MADE
IN ACC RD CE WI H THE E I ING CODE OF PRACTICEADOPTEDBY
THE N W Y RK ST TE ASSO TION OF PROFESSIONAL L D SURVEYORS.
PA L . OMM _ .LS. C. N0. 4919
MAP REFERENCES:
MAPd0
1) SURVEYMDED
Np4 t�F
Lake George
DATEDNJUNE 8, 990,"MAPOLA T REVISEDA EMBERFORBTY 9,T1991 MADELLIABYMVAN DUS NH.R AND
E0p1tD „
STEVES,` AND FILED IN THE WARREN. COUNTY CLERK'S OFFICE. ON FEBRUARY 13,
a Warner
Bay"
'1992; IN PLAT CABINET "A", AS MAP NO. 1-182 AND IN THE WASHINGTON COUNTY
0
CLERK'S OFFIE ON FEBRUARY 5, 1992, IN MAP DRAWER 23B, AS MAP NO. 39.
tt1,Z
./
2.) MAP ENTILTED "BOUNDARY LINE BETWEEN TOWNS OF QUEENSBURY ANDFORT ANN,
q
�•'ot
otof
WARREN AND WASHINGTON COUNTIES, STATE OF NEW YORK SHEET 11 OF 11", MADE
BY C.T. MALE ASSOCIATES, DATED MAY 25, 1965 AND FILED IN THE WARREN
"QUEENSBURY-FORT
COUNTY CLERKS OFFICE ON APRIL 12, 1966 IN DRAWER TITLED
/
ANN BOUNDARY LINE". ALSO FILED IN THE WASHINGTON COUNTY CLERKS OFFICE, ON
a 632
DECEMBER 10, 1968, IN MAP DRAWER N0. 13.
Uro Found Iron I
'a ,eke Pipe On
3.) ` MAP ENTILTED "SURVEY OF LANDS OF WALTER GOODWIN AND. SONYA GOOD WN (BOOK
Property Line
E
487 OF DEEDS, .PAGE 781) PILOT KNOB ROAD (COUNTY ROAD N0. 32)," MADE BY
JULY 29, 2002.
26
PAUL F. TOMMELL, L.S., P.C., DATED
p1;p2
� afar
P1an9 E
NOTES:
_
... ..Ed4e-6f--Water on-Au9u-A-1212802 ..
.... .... .... ....
•" "'• g3}
1.) TOGETHER WITH ALL THE RIGHT, TITLE AND INTEREST IN AND TO THE SHORE
Found Iron
Pipe on
b1-.—
',y Lan1ts
3.5't
OF LAKE GEORGE.
Found Iron Pipe N Ol
Property Line N
DOTlnd A. ROSeri °j
2.) SUBJECT TO THE RIGHTS OF THE TRAVELING PUBLIC TO THE LAND BETWEEN THE
Area = 0,244± Acres
CENTERLINE OF PILOT KNOB ROAD AND THE WESTERLY LINE OF SAID ROAD.
Warren County Tar, Map No. 82.00-2-28o
Ps E�ca NO'ed
Book 1281 of Deeds, mage 273 Warren County'
Co°OtyMoP Rei�a<,
See
Concreteegy4b'I'b'('�
Steps
2 Story HouseOf
No. 167
�i t P,00Cky,
FO
O
Stone Retaining Wall.
N �,�ry pf
JOI
Wood 0
/DOgI'YL
Steps
p,,tre'n'
o 0
� Found Iron Pin
/
vi oWshv"gtOT
0 0.?'t South of
/
_
Property Line
26.1'
..
-_.. •� ;, .
'
Now or Formerly~ of
o Covered Porch With 2 3f
Story h "
.:
.... ...
<. ,;. -.
,,Londs .:
Michael Stevens
« a
o
Book 503 of Deeds, Page 565 - Washington County
2s. i / o m N '-
'
Lands } orFormerlyof
Book 666 of Deeds, Page 178 Warren County
/ 3 a
0'
Har
Harold Smith
/ Wood
steps.
a
s
Book 878 of Deeds, Page 225 - Washington County
1' Wide
^
Book 1194. of Deeds, Page 328 Warren County
GhimneY. v Two House Story cni
-
nY e•nsbti,
g /
AO
" Found 4" Iron Pipe
Llne
it 0f op O,^t
ElectricOn Property
�.._ 4.2�d:
To
trg To
'7.7 Propane
Gp.ty� ,-,
Tank (1
el
VUI
a7 t Cp,,yryty
ed 1}r tO'ry
12.0'± 78.4' rd Conct ate Septic
s ♦;etobtplo 1 / O.51y'b'YI�
P ce / is Found Irol Pin
T9fik Cover
o
ReteTen 0.4t South of
Go a
Covered
Brick
-
as Property Line
Sas
StoopWalk
,
ConcreteI
App
bf Sanitary Beall
4 Wolk
o Washington Coun
y Tax"^;Map No. 82.00-2-28
o
D '
e°
F;
*' Book 914 of Deeds
Page 212 -1 Washington County W
z ,_'
Well m
„>
O(Covered)
y.
-_-_--�
e
Concrete
.y
Steps.
Power Pole ,'!�
(Utilities are
Underground to House)
Stone Retaining Woll
Conc..nBlock
R g Wall ly
i
Found Iron Pin ca
0.2't South of
Gravel Parking Area '•
i •
Property Line a'i Right of Way
�'i
1R
Power Pole--
S25'55'58"W 67.95
NM g299
�_
i...
A
Found Buried Pipe pl
) /.�''�
Survey of Lands of
�rn
Drywall-/�-
�_
Donna A. Rosen
(Sse Note No. 2)
Jcee
ti,Vti
r---
5'65'
SA45' 68 Q0
2, }h
b
�
_Pilot nQb(r�a� °�;�
Deed Llne
- ,i
of New
SCALL:
1 20
TOWN OF FORT ANN
WA511INGTON COUNTY, AND
R YOr. TOWN OF QUEEN5EURY
° WARREN COUNTY, NEW YORE
..r
' l OMMELL # A550CIATE5 JUNE 22, 2007
2 GILBEIRF ROAD
L 5ARATOGA SPRINGS, NY 12666 MA? NO. 2000O89G
49,192 PH: 518.587.3149 FA:516.567.7251
_.— .__.._.._.. - - �, «.,n.�-.�..�. ,,.m., _ ,.nwsUiMmS••• •,•two""h1, II ...ia J Yf6Lx, t.'s.�.
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--------------
NM #298
UNAUTHORIZED ALTERATION OR
ADDITION TO THIS DOCUMENT IS
11CLATION OF SECTION 7209,
SUBDIVISION 2, Or NEW YORK
STATE EDUCATION LAW.
1 20
TOWN OF FORT ANN
WA511INGTON COUNTY, AND
R YOr. TOWN OF QUEEN5EURY
° WARREN COUNTY, NEW YORE
..r
' l OMMELL # A550CIATE5 JUNE 22, 2007
2 GILBEIRF ROAD
L 5ARATOGA SPRINGS, NY 12666 MA? NO. 2000O89G
49,192 PH: 518.587.3149 FA:516.567.7251
_.— .__.._.._.. - - �, «.,n.�-.�..�. ,,.m., _ ,.nwsUiMmS••• •,•two""h1, II ...ia J Yf6Lx, t.'s.�.
y-4' lz-6 /Y7
, Queensbury Building & Code Enforcement - Residential Final Inspection
Office No. (518)761-8256 Arrive: 2',0 aiii part: Z-,-,9)anima
Date Inspection request received: — Inspector's Initials:
NAME: Ro 5- "ti • PERMIT#: a .r 1K
LOCATION: .. — P A A _I DATE: ...ow...i'llfrialn i
TYPE OF STRUCTURE:
Comments
Yep 1�2 N/A
Building Number/Address visible from road ,J/ 10t`-----
_Chimney Height/"B"Vent/Direct Vent Location J Q� F 1 Q `� '� c
Fresh Air Intake IAc.E
3 inch Plumbing Vent through roof minimum 6 inches J--
Roof Complete/Exterior Finish Complete J/
Platform all exterior doors ✓
GuardsJ �1 ,-1 C9 L��
at stairs,decks,patios more than 30 inches above grade
Guard at stairwell at 34 inches or more 4 �,V--V--- ___T- J���
Guard at deck,porches 36 inches or more f
Handrail Termination at Newell Post or Wall Li
Interior/Exterior Railings 34 inches to 38 inches %/`r A
Interior Handrails @ stairs 2 or more risers
Grade away from foundation 6 inches with 10 feet 4
6 inch clearance to sill plate J
Gas Valve shut-off exposed/regulator 18 inches above grade
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight ,�j
Safety glazing/Window in stairwells safety glazing f
Y atOS9
Interior Smoke D ectors: //
Every level: Eve Bedro V
Outside every bedroom a a: /
i
Inter Connected: ;/ Batterybackup: ,/
/ V.t.Carbon Monoxide Detector �/`
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area -✓
/
Crawl Spaces 18 inch x 24 inch access, 1 sq. ft.-150 sq.ft. vents
Bathroom Fans, if no window 4
Plumbing fixtures ,/�
Foundation insulation
Floor truss,draft stopping finished basement 1,000 sq.ft. /
Emergency egress below grade / ,/
Gas Furnace shut-off within 30 feet or within line of site ✓ /
Oil Furnace shut-off at entrance to furnace area / ,/
Furnace/Hot Water Heater operating f
Low water shut-off boiler
Relief Valve(s) installed/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum/2"Gypsum
/ \ ...,.-"\-
Basement stairs closed rise>4 inches ,./ 7: \rjJ`
Garage Floor Pitched 7 �1�
Garage fireproofing/3/4 hour fire door/door closer t
Duct work Sealed properly ‘
Gas Logs in Sealed or Glass Enclosure N�
Final Electrical
Final Survey Plot Plan ti f V-
System
As Built Septic /Sewer Dept.Inspection Sticker
���v�
Site Plan /Variance required
Flood Plain Certification,if required
Okay to issue C/C or C/0 [Temporary/Permanent)
L:1Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form_revised_100405.doc
, ,. ._ Li
f 6/%24 /0-7/ .
Queensbury Building & Codicment - R esi. • ial Final Inspection
Office No. 518 761-8256
( ) Arrive: i a •Z �- �
Date Inspection request received: — Inspector's In '. .�_�►�
NAME: I Se /PERMIT#: a - r
LOCATION: / -_ 0t- �,6 _ DATE: _ •ir
TYPE OF STRUCTLfRE:
Comments
Yes No N/A
Building Number/Address visible from road _ 1'35T aL T -TT" NA►
Chimney Height/"B"Vent/Direct Vent Location 9V_ Raj ' 17 to
Fresh Air Intake 1 _
3 inch Plumbing Vent through roof minimum 6 inches J �� 1�
Roof Complete/Exterior Finish Complete / - t .J Rt.-1..._ T \--V\Platform at all exterior doors
Guards at stairs,decks,patios more than 30 inches above grade '�gvC- ���o
Guard at stairwell at 34 inches or more 410///
'-f\U� .‘5i N Jt `,
Guard at deck,porches 36 inches or more L `
OM 1 1-21\v.)3.%Handrail Termination at Newell Post or Wall
Interior/Exterior Railings 34 inches to 38 inches / - k. 6 <<=-L C-0 L
Mt i"3 Tr
Interior Handrails @ stairs 2 or more risers C3e-t0 '-j f\t cs>� -Th
Grade away from foundation 6 inches with 10 feet ✓ �v b .,'V____
6 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18 inches above grade y l vs R L� t
Interior privacy/trim/doors/main entrance 36 inches %4tp�
?cc- Ft.i1r---k-
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells safety gla ing / C-°"-V1.. .\-E_ t`k. . ‘0Pa.
Interior Smoke Dete rs: �Z O/c- SMA
Every level: Every edroo . - RaP 1��` FGP�.6
Outside every bedroom ar : Lit-- -
Inter Connected: Battery backup: ,/ _ � � vU E
Carbon Monoxide Detector Q gA11-13 --T-�-
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area �p �1 ��,
Crawl Spaces 18 inch x 24 inch access, 1 sq.ft.-150 sq. ft.vents Z-,-(,._04-07-:
ti/i ,g - -K-�
— i
Bathroom Fans,if no window
1jvQ�1F_
Plumbing fixtures
Foundation insulation _ 7-61.-. .1;;;, G L-0.47
Floor truss,draft stopping finished basement 1,000 sq. ft. eoR-T0 L►�ttJ�i�
Emergency egress below grade L]
Gas Furnace shut-off within 30 feet or within line of site iJ M X..1 T-c, %.-‘p�E�
Oil Furnace shut-off at entrance to furnace area GCO p a cTz�J �>
Furnace/Hot Water Heater operating
Low water shut-off boiler 20katrtikki
J / t-LD � k!�`C!v al
Relief Valve(s)installed/Heat Trap/Water Temp 110 t 4t7. �`
Enclosed Stairs Sheetrock Underside minimum 1/2"Gypsum Jg-} ‘kp
Basement stairs closed rise>4 inches / t�1, ,1
Garage Floor Pitched �// 1 �l
Garage fireproofing/3/4 hour fire door/door closer /' ✓ b 1 0- tJ �- u3C` tI
Duct work Sealed properly ✓
Gas Logs in Sealed or Glass Enclosure
Final Electrical t a iNt_k._ R s-- `.ovEia__
Final Survey Plot PlaniS !
As Built Septic System/Sewer Dept. Inspection Sticker Alli V ' \ T I? \ - V AL L TM 3V
Site Plan /Variance required Q \ QPAF\-
Flood Plain Certification,if required / ,�������� `
Okay to issue C/C or C/0 [Temporary/Permanent] lZ`<
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form_revised_100405.doc
11•c\\_ 1t attpi car
&4\S �etz_FP‘- T___
COMMONWEALTH ELECTRICAL INSPECTION SMVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No.. ----- N2- 94552 Cut-in Card No.....................................
.. . ........, ..........
---I--- �
Owner........ e -- .-A...... ................ ...............................
A.I.-I, / )........ ..'0
Location................n....:. �I.* .. ...
0... ................................
InstallationConsisting of.................................................................. .... . ..... .........................................
.......................................................................................................4 1.........................................
...............
......................... ./........./ ./...........................................
InstalledB ......�j ........... Lic.No...................................................
The conditions following go, rued the issuance of this certificate,and any certificate previously issued is
cancelled:- 7
This certificate only covers the electrical equipment an} installation conditions as of date. Upon the
introduction of additional equipment or alterations,applic "on shall be promptly made for inspection.
Inspectors of this Company shall have the privile of ni mg inspections rat any time, and if its
rules are violated,the Company shall have the right t, evoke is certifi te.��_
Date<......- ........... INSPECTOR
ember NA
2 -4/ 5--/7/M
Foundation Inspection Re art
Office No. (518) 761-8256 Date Ins tion r-' est rec- ed:
Queensbury Building&Code Enforcement Arrive: `;I� :4,1 . 1 I - '4epart: . td.
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi. •
NAME: C) i' — 'ERMIT 11: 1 alp -
LOCATION: o' , INSPECT ON: Ill -
TYPE OF STRUCTURE:
Comments
•
Op N/A e
Footings _01. „_,
)Ris•
Monolithic Slab
Reinforcement in Place \ J �
The contractor is responsible for tel*)
providing protection from freezing �'�—`�
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
Foundation/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofmg
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
Foundation Inspection Report
Office No. (518)761-8256 Date Ins tion requ-: rece' =I:
Queensbury Building&Code Enforcement Arrive: 2 , pm 'epart: m'i'r ��ep
742 Bay Rd.,Queensbury,NY 12804 Inspector's Ini • •:
NAME: 2 SA'\ " RMIT#: (7(') 7
LOCATION: l 6 5- ; / o j V n R e) • INSPECT ON: "V/ Vo7TYPE OF STRUCTURE:
Comments
Y N N/A
%Footings 0Yk 1 Vt�
Piers
Monolithic Slab
Reinforcement in Place ‘ 0
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/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofmg
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundatlon Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
Foundation Inspection Report —/ `
Office No.(518)761-8256 Date Ins t' n request received: 112) /G)-7
Queensbury Building&Code Enforcement Arrive: am/pgi Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspect° s Initials:
NAME: I`C)4PERMIT#: a ` �7
LOCATION: I ( ' l i I 0 T V o i� �L INSPECT ON: 1/1!.!.
TYPE OF STRUCTURE: j
Comments
Y N N/A
Footings
Piers
Monolithic Slab
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/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampprooftng
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing /
6 mil poly for wet areas under slab 1,f
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
Rough Plumbing / Insulation Inspection Report
Office No. (518) 761-8256 Date Inspection requ s e
Queensbury Building & Code Enforcement Arrive: ALV,f t a ' m D art: 11i".;'V 691m
742 Bay Road, Queensbury, NY 12804 Inspector's Initials.
�
I
NAME: o_6E1. PERMIT #: DLQ,---(67
LOCATION: i t P\t.�i KiJer, KO INSPECT ON: ,i)\-�_Nt>-i
TYPE OF STRUCTURE:
\ �` \ 2-->
C,\,,)/ Yiii4 N N/A
Rough Plumbing / Nail Plates Vf.,A- •z.io ?, M,v___ c,,ti__))
Plumbing Vent / Vents in Place J
1 1/2 inch minimum Drain Size -✓
Washing Machine Drain 2 inch minimum
eanout every 100 feet/ change of direction
Pressure Test
Drain / Vent
Air / Head
5 P.S.I. or 10 ft. above highest connection for 15 minutes
Pressure Test
Water Supply Piping
Air / Head
P.S.I for 15 minutes
n
v Insulation / Residential Check / Commercial Check %1V ��.
p
Pro er Vent, Attic Vent " `"'.
Duct / Hot Water Piping Insulation
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly / No duct tape
COMMENTS:
L:\Pam Whiting\Building&Codes\lnspection Forms\Rough Plumbing Insulation Report.revised Nov 17 2003.doc Revised February 15,2005
• / 1/0e4tesda/
Framing / Firestopping Inspection Report
Office No. (518) 761-8256 Date In fction req sfr; =i -d•
Queensbury Building&Code Enforcement Arrive: /UV a p n I- .• : am/o
742 Bay Road, Queensbury,NY 12804 Inspector s Initia .
/, r.
NAME: • � � • / PERMIT#: /6 — •
l�
LOCATION: INSPECT ON: �'
TYPE OF STRUCTURE:
t Oz.?
Y N NIA COMMENTS
ill Framing h7. 4. 1`
1lNiLiccesst 22"x-30"�mum
Jack Studs/HeadersL
Bracing/Bridging j (�( �,r1
Joist hangers43," `�`^�-�,
Jack Posts/Main Beams
Exterior sheeting nailed properly ✓
12"O.C. /
Headroom 6 ft. 8 in. ✓✓
Stairwells 36 in. or more
Headroom 6 ft. 8 in.
Notches/Holes/Bearing Walls
Metal Strapping for Notches Top Plate
1 '/2(w) 16 gauge(8) 16D nails each side
Draft stopping 1,000 sq. ft. floor trusses
Anchor Bolts 6 ft. or less on center
Ice and water shield 24 inches from wall
Fire separation 1, 2, 3 hour
Fire wall2, 3,4 hour
irestoppm
Penetration sealed
16 inch insulation in cavity min. _
Garage Fire Separation
House side %2 inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space/Bedrooms %//:
24 in. (H)
20 in. (W)
5.7 sf above/below grade
5.0 sf grade �.
fi/brja
/3 • /
.1, 3/2 4 t 1/0 7
Fra ing / Firestopping Inspectio ' eport
Office No. (518) 761-8256 Date Inspection requ %. eiv:..
Queensbury Building&Code Enforcement Arrive: /= a �lmop; p. • : z...:66.--a pm
742 Bay Road, Queensbury,NY 12804 Inspectors Initials.
NAME: Ra_., 1--___). PERMIT#: 0‘Il L'�.
LOCATION: P7i KO Rci_ INSPECT ON: --.2_.&,.-07
TYPE OF STRUCTURE:
-2____ ki ___c___-\---i.D3
Y N /A COMMEN
4ttiTcFraming •
,1\b-C41-t)9 qts)\ 1 /
cess 22" x 30" `minimum `� V
Jack Studs/Headers /
Bracing/Bridging 'J ' F X5
Joist hangers f� „,, D R -
Jack Posts/Main Beams �� ��-- ,_
Exterior sheeting nailed properly
//:" VI .tyt \-- � __6j V(21Jw
12"O.C. 1J C-- -kV,
Headroom 6 ft. 8 in. 71 �n�� ��� .
Stairwells 36 in. or more 7Y17/
1_ ,,,,,,,13 __S:`:-..V � )tk'\R-L2 , �Z.c
Headroom 6 ft. 8 in.
Notches/Holes/Bearing Walls 7! I � � V \�F_R
I
Metal Strapping for Notches Top Plate
1 ''A(w) 16 gauge (8) 16D nails each side
Draft stopping 1,000 sq. ft. floor trusses
Anchor Bolts 6 ft. or less on center
Ice and water shield 24 inches from wall
Fire separation 1, 2, 3 hour
Fire wall 2, 3,4 hour
4
Firestopping i ----> '-‘-01
v�✓7 - )3
L
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side `'A inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space/Bedrooms /
24 in. (H)
V--20 in. (W) / - , '_
5.7 sf above/below grade ✓ T�. �`� V' J ?\\)-1
. �\('
5.0 sf graded D� Q�l��
daiV . •
Framing / Firestopping Inspection Report
Office No. (518)761-8256 Date Inspection request-received:
Queensbury Building&Code Enforcement Arrive:XL•�`;;l�,a_ m Depart:
742 Bay Road, Queensbury,NY 12804 Inspector's Initi •
s
/
NAME: • PERMIT#:
LOCATION: j n/ INSPECT ON:
TYPE OF STRUCT ' :
TT Y N /A
Framing ���; y`U�/1n
COMMENTS
ss 22"x 30"minimum 'Yr-- / /
L�
Jack Studs/Headers Lvb t�W15
�CZv55 tA. t1
Bracing/Bridging _ y,
Joist hangers :1—t)
Jack Posts/Main Beams
Exterior sheeting nailed properly
12"O.C. I ``3��� ?
Headroom 6 ft. 8 in.
Stairwells 36 in. or more i �•�•- j"\ (\1,; fFit
Headroom 6 ft. 8 in. h Y�
Notches/Holes/Bearing Walls i�_,-
Metal Strapping for Notches Top Plate ? V2?-.
1 /z(w) 16 gauge(8) 16D nails each side
1,000 sq. � �d
Draft stopping ft. floor trusses -
Anchor Bolts 6 ft. or less on center
Ice and water shield 24 inches from wall
Fire separation 1,2, 3 hour
Fire wall 2,3,4 hour
Firestopping
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side 1/2 inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space/Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above/below grade
5.0 sf grade
1 - 3 . liw(3d ,//sby ._
Foundation Inspection Report
Pe P
Office No. (518)761-8256 Date Inspectio equest received:
Queensbury Building&Code Enforcement Arrive:/ pyrk, Depart: am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: }- /IPERMIT ti: C/C? — s�7 v' . .
LOCATION: r() i'1 7 ]V�`% .' INSPECT ON:
TYPE OF STRUCTURE:
Comments
Y N N/A
Footings
Piers
Monolithic Slab
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/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofing
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
-/ /
12 inch width / if
6 inches,above footing V/ /e /i-
C
6 aril poly for wet areas raider slab _Iv
Ba�IEfApproval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Repart.doc
Last printed 12/20/2005 9:24:00 AM
7Th ors
Foundation Inspection Report
1Z/2 -
Office No. (518)761-8256 Date Inspecti n request received: 1. 7 Q r
Queensbury Building&Code Enforcement Arrive: . '0 am/p ( Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:./
NAME: PERMIT#: 067-5-C7
LOCATION: / nL k/1"6 g INSPECT ON: _ ; d-AL o 6
TYPE OF STRUCTURE: /
Comments f d-F/()(,
VII N/AFootings (A A
t77-'
(Piers
Monolithic Slab
Reinforcement in Place '2 4( V
The contractor is respodsibleTor
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
Foundation/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofing
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 milpoly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
/H3T.= 7-/-0,- d_d_i //'°
Foundation Inspection Report
Office No. (518) 761-8256 Date Inspectio quest received:
Queensbury Building&Code Enforcement Arrive: l'- Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: JI '
NAME: -c� 1 k„ ee.„-5 -_-,0 PERMIT#: (22 SCS 7
LOCATION: ' / r r c± N►,�in .INSPECT ON:
TYPE OF STRUCTURE:
Comments
Y N N/A
Footings
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of.the_concrete. _
Materials dor this purpose on site.
Foundation/Wallpour
em o" 'n-Pl�
Foo ' g Dowe - or Keyway in place
Fo tion I : pproofing
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Reportdoc
Last printed 12/20/2005 9:24:00 AM