2011-406 TOWN OFQ UEENSBURY
ivo742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20110406 Date Issued: Friday, April 20, 2012
This is to certify that work requested to be done as shown by Permit Number P20110406
has been completed.
Location: 24 PERSHING Rd
Tax Map Number: 523400-302-014-0001-062-000-0000
Owner: HOWARD & KRISTINE LA ROSE II
Applicant: HOWARD & KRISTINE LA ROSE II
This structure may be occupied as a:
Fireplace By Order of Town Board
Garage Attached TOWN OF QUEENSBURY
Single Family Dwelling
Issuance of this Certificate of Occupancy DOES NOT relieve the property
owner of the responsibility for compliance with Site Plan,Variance, or '
other issues and conditions as a result of approvals by the Planning Board
Director of Building&Code Enforcement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
F41 rA,
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110406 Application Number: A20110406
Tax Map No: 523400-302-014-0001-062-000-0000
Permission is hereby granted to: HOWARD &KRISTINE LA ROSE II
For property located at: 24 PERSHING 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 Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: HOWARD &KRISTINE LA ROSE Il
KRISTINE Fireplace
2Garage Attached
4 PERSHING Rd
Single Family Dwelling $250,000.00
QUEENSBURY,NY 12804 Total Value $250,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
CIFONE CONSTRUCTION CO.
792-9242
P.O. BOX 684
GLENS FALLS NY 12804-0000
Plans&Specifications
2011-406
1752 sq ft 783 sq ft garage& 1 fireplace
$467.85 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, September 07,2012
(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 o sbury; 4We I I s i/, ptember 07,2011
SIGNED BY c*-4 4 for the Town of Queensbury.
Director of Building&Code Enforcement
30z. .14 -1-62_ OFFICE USE ONLY '
TAX MAP NO. , PERMIT NO. — Lia o E y It_,I
FEES: PERMIT ° ' RECREATION � ' ,c.,,, '7, 7:�"7 'I;
ENGINEERING ' `
-- -/ - oG (If applicable) : ; ;�eA I : ` i L i f
PRINCIPAL STRUCTUR .1. 1 ' r'r 1`='- i Y
.iiill_i:ilNr", , ,-;0i)t s
APPLICATION FOR ZONING APPROVAL & BUILD r G�O
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO REVIEW
BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.
APPLICANT/BUILDER: Ck SSb h c eeo v\A-v�C t0)" OWNER: k"i 0 4)0-v4 ;; ',<\f L7 1 IV\ CA-Pa.P C
ADDRESS: P, 0 04- G8!- , 1ea.l hlb ;makY ADDRESS: 2-14 9e>rs - \` `.C•
PHONE NOS. 51 8 " 9 2,.I-4t , PHONE NOS.
CONTACT PERSON FOR BUILDING &CODES COMPLIANCE: Mci--- PHONE: 3c. I-0(.2.6,
LOCATION OF PROPERTY: 2 Li Pe.vS A\ --,r, \RCA & JcC t,+:b\J Y 'Y 1 '`'~r' -
HAS THERE BEEN A SITE PLAN REVIEW;VARIANCE OR SUBDIVISION APPROVAL? 0 YES 0 NO
IF SO, INDICATE APPLICATION NO.AND DATE OF APPROVAL:
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT z
APPLY TO YOUR z 0 cc cc g d w F- co
PROJECT g p O • W -J OF' _
LU 0 -~i r,U. 0 ° a I=- I- O � Z
z < ¢ �- cn Ncn Ori 12 a%-
SINGLE FAMILYK I _
�`?�_ C7 Z- O 1,75 2_ .-' 1-1-6TWO-FAMILY �` 9`
7
MULTI-FAMILY
(NO.of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL ---`'
ATTACHED L f (161,
>
GARAGE(1,2,3)
OTHER
IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS:
ESTIMATED CONSTRUCTION COST: il 25 b 00 0 PE: Nlcd u 10- (mo
� G-0-c
HEAT TYPE:14o+ 14 t't *HOW MANY FIPPPI A _ !C1• I L Aan I no InInnneTrnicei ‘.
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? N t�
ARE THERE EASEMENTS ON PROPERTY? N o
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans, and supporting materials are a true and
complete statement/description of the work proposed, that all work will be performed in
accordance with the NY State Building Codes, local building laws and ordinances, and in
conformance with local zoning regulations. I acknowledge that prior to occupying the
facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand
that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the a•ove.
Signed
Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction codes
or septic systems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
Permission is hereby granted to the above This application / proposed action described
Applicant to erect or alter the building herein is found to be in accordance with the
described herein in accordance with said zoning Laws of the Town of Queensbury.
Application:
BUILDING & CODES APPROVAL ZONING APPROVAL
DATE DATE
� J
QUESTIONS? CALL 761-8256 OR EMAIL
codesOqueensburv.net
Office Use Only VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
Clncr,finn Dnrmi4 Icc. e.a• v.... �i�
C el1 /2010
APPLICATION FOR FUEL BURNING APP ' I • CE & CHIMNEY'
AUG 1 1 2011 I1
Application is hereby made to the Building&Codes Office for the issuanc• of a.:uilding& Use Permit p suan to the
New York State Fire Prevention & Building Code. The applicant or own:r ag =+: : 14 1.: is+ .,~, i abl laws,
ordinances, regulations,and all conditions that are part of these requirem:;nts andBOt pyla T., :4 -eeec ors t enter
premises to perform required inspections. """•"
Important Note To Applicant: Rouqh-In and Final Inspections Are Required:
Owner:: Ic .04c'"6.. �ARoSE Installer/Builder: k" A .- - C0. ..L •
Address: 24 ?ex-5\AI nc Tri• QSby Address: a9 5 1 LA-1 5 c? t t• Lrer
(JoSS�-3oa`'C�
Phone Nos.: Phone Nos.: LADS� 'C(3 O U
Location of Property: ' 1 evv►t- Subdivision Name:
Location of Proposed Construction and/or Installation: 'a 4 1)e..c.b\ei,vtcj 1Zal• Qvee r>slq
t-
Contact Person for Building &Codes Compliance:
- Fuel Burning Applicance Wood Coal Pellet Gas Oil
Information
Stove
Fireplace Insert
X, Fireplace,factory built* X
Fireplace, Masonry
Furnace, (Garage Only)
* If Factory Built, Please Provide: Manufacturer Name: P1/4.05e.cs zf-- Model No. 5 Go 1'J kB t
Listed By: Number:
Chimney Information BLOCK BRICK STONE
Masonry** Check One/
TILE STEEL A/ SIZE IN
INCHES
Flue Check One ✓
DOUBLE WALL TRIPLE WALL INSULATED DIRECT CHMNEY
VENT LINER
Chimney Material Check One/
** If Non-Masonry, please provide: Manufacturer Name: N3e5'C‘r-- Model No. Soo Dv ci,.4
ADDITIONAL NOTE: CONSTRUCTION / INSTALLATION MUST CONFORM TO NYS FIRE
PREVENTION & BUILDING CODE AND/OR MANUFACTURER REQUIREMENTS. CONSULT
AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED INSPECTIONS
Town of Queensbury*Community Development Office*742 Bay Road, Queensbury NY 12804
g
..
� C r'i i ��t-.��1' ii'
OFFICE USE ONLY //II
TAX MAP NO. PERMIT NO. aPERMIT FEE AUG 1 12011
11
APPROVALS: ZONING TOWN CLERK TOWi e a _
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PER •
BUILDING & CODES
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PERMIT.
OWNER: IA 0 J C1/4—N' -\K ' � 1 Y1 I-R13c e, INSTALLER: pC%c70 `< Co ,S
ADDRESS: a'-1 ��,v S 1� d ADDRESS: 1 , () 3,5* (.28 c t i ' 4'\'
p
PHONE NOS. PHONE NOS. -> 18 >�' -- 7��"f •
LOCATION OF INSTALLATION: 2 Lt Pc"43' \` Q._Q
RESIDENCE INFORMATION:
YEAR BUILT
NO. X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED?
1981-1991 X 130 = SPA OR HOT TUB
1992-present 3 X 110 = 330 INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE • %SLOPE
✓ SOIL NATURE: SAND -X LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? )•14-Nc,
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? NA
✓ DOMESTIC WATER SUPLY: MUNICIPAL v( WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS otr:,, N PER MIINUTE PER INCH[mpi]
(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).
TANK SIZE: `cXJ GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder,spa or whirlpool tub.
SYSTEM TYPE:
ABSORPTION FIELD(WITH NO.2 STONE) Total length 15 50 ft. Each trench 2.1- 0 X 18' o 2� w
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
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 Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sewage Q]sposa dinance. codes(i?queensburv.net
1
C' T') 1 k 11 VISIT OUR WEBSITE FOR MORE INFORMATION
ti
Signature of Person Responsible Date www.queensburv.net
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
Final Survey Inspection
Dept. of Community Development
Town of Queensbury
742 Bay Road
Queensbury,NY 12804
Date received: 1 Ica '.
NAME:•
LOCATION: 24 W-rtsAkak
PERMIT#: '2.0-11-40tp
Final Survey Plot Plan
_AR nroved Denied
The attached final
survey has been
received by the
Dept.of
Community
Development.
Upon review the
survey has been:
OK-j
Craig Brown, Zoning Administrator
Notes:
L:\SueHemingway\Buildmg.Codes.Inspection.FORMS\Final Survey
Zoning Administrator.doc
Queensbury Building & Code Enforcement- Residential FIM Inspection
Office No. (518)761-8256 Arrive: am/p Depa - ' am/ m
Date Inspectionrequestp
received: �f G,� � Inspectors Initials:
NAME: kat ReeLe__-, PERMIT#: // — 1C),
LOCATION: , 4-1A k;, N DATE: y—/ g fa,
TYPE OF STRUCTURE: ' S F'
Comments:
Yetv.No N/A
4" Building Number Address visible from road
Chimney Height/13"Vent/Direct Vent Location 17;
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 18 inches
Roof Complete/Exterior Finish Complete
Platform at all exterior doors 1�
Handrail 4 or more risers
Guards at stairs,decks,patios more than 30 inches above grade
Guard at stairwell at 34 inches or more V
Guard at deck,porches 36 inches or more
Handrail Termination at Newell Post or Wall
Interior/Exterior Railings 34 inches to 38 inches V /
Deck Bracing/Handicapped Ramp Compliant _ /' � ��
Grade away from foundation 6 inches with 10 feet
6 inch clearance to sill plate C"
Gas Valve shut-off exposed/regulator 18 inches above grade
Interior privacy/trim/doors/main entrance 36 inches //-
Interior
Bathroom/Kitchen watertightSafety glazing/W dow in stairwellsafety ing Smoketectors/ arbor oxic Detectors
Every level: Ev Bedrk J /
Outside every bedroom rea: YY
Inter Connected: Battery backup:
Attic access 30 inches x 22 inches x 30 inches(heig�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 to floor/Sticker on Panel /
Duct work sealed properly I Blower Door Test Certification �/
Floor truss,draft stopping finished basement 1,000 sq.ft.
Emergency egress below grade /r
Gas Furnace shut-off within 30 feet or within line of site i/
Oil Furnace shut-off at entrance to furnace area /
Fumace/Hot Water Heater operating 1
Low water shut-off boiler
Relief Vahre(s)installed/Heat Trap/Water Temp 110 //
Enclosed Stairs Sheetrock Underside minimum W Gypsum
Basement stairs closed rise>4 inches V
Garage Floor Pitched
Garage fireproofing/'/hour fire door_i_door closer CTt—c...:9 .S9
Gas Logs in Seal mvi€Light Bu� U"� .S9-.7k-
Gas
Final Electrical. nergy Saving Light Bulbs 50 ,t%n �l��
Final Survey Plo �`
Arc Fault Breaker Habitable Spaces/Tamper Proof Receptades
r4-111315)
Flex Gas Pipe Bonding
As Built Septic System I Sewer Dept. Inspection Sticker
Site Plan /Variance required
Flood Plain Certification,if required 1 3,i /
Okay to issue C/C or C I 0 f Temporary/Permanent] r J'
L:1Buiiding&Codes Forms\Building&Codesllnspection Forms\Residential Final Inspection Form_revised_100405.doc;Revised
January 7,2008;Revised 6/26/08;Revised 12/22/10,Revised 04/13/11
-
Queensbury Building & Code Enforcement - Resi entiaFinal Inspection
Office No. (518)761-8256 Arrive: am/p Depart: I 'i 'am/pm
Date Inspection request received: J -/1-/ ,A Inspector's Initials:
NAME: 'n(7`->G PERMIT#: /J VI)6,
LOCATION: f P ./,-- N-, R4 DATE: Al-/a-%A
TYPE OF STRUCTURE:
Comments:
Yes No N/A
4" Building Number Address visible from road /
Chimney Height/13"Vent/Direct Vent Location >// )*‘1 do-m ' ` i"1'"
Fresh Air Intake ✓✓
3 inch Plumbing Vent through roof minimum 18 inches
Roof Complete/Exterior Finish Complete 1/ C'Q
r Cp - S �_rac
Platform at all exterior doors
Handrail 4 or more risers 5" 7 —
Guards at stairs,decks,patios more than 30 inches above grade g.), �� �� -a2il`�
Guard at stairwell at 34 inches or more
Guard at deck,porches 36 inches or more / - V w-t t ar2A-2
Handrail Termination at Newell Post or Wail if
Interior/Exterior Railings 34 inches to 38 inches t� / -1 .,--'es-Q._-
Deck
1� _Deck Bracing/Handicapped Ramp Compliant t/ °7 .,*C-4--.
���
Grade away from foundation 6 inches with 10 feet ✓� (
6 inch clearance to sill plate h/,
Gas Valve shut-off exposed/regulator 18 inches above grade ✓' 0 cL _
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight /
Safety glazing/Window in stairwells safety gl= 'ng t/
Interior Smoke Dete�tiors/Carbon Monoxid- •etectors
Every level: �/ Every Bed7
Outside every bedroom rea:
Inter Connected: Battery backup: %/.
/
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 k/ .
Foundation insulation to floor/Sticker on Panel t"1446
Duct work sealed properly I Blower Door Test Certification 1/ �,_W‘1.. ` , ec5+-t
Floor truss,draft stopping finished basement 1,000 sq.ft.
Emergency egress below grade / / i ��� MN 1A-Let)
Gas Furnace shut-off within 30 feet or within line of site ✓ • / � --(Z 1)-11-3C
Oil Furnace shut-off at entrance to furnace area /' Y
Furnace/Hot Water Heater operating ✓ /
Low water shut-off boiler •/ 171��-L�� f��
Relief Valve(s)installed/Heat Trap/Water Temp 110 /
Enclosed Stairs Sheetrock Underside minimum W Gypsum ! / �2� i -�L'' .
Basement stairs closed rise>4 inches yam/" it
Garage Floor Pitched t//
Garage fireproofing 1%hour fire door/door closer t.//' CV`S).-CX>Cf2l)Gas Logs in Seal or Gla •//
Final Electri nergy Sa r g Light Bulbs �� _/ -4i�
Final Survey PlofPla f
Arc Fault Breaker Habitable Spaces/Tamper Proof Receptacles
Flex Gas Pipe Bonding /
As Built Septic System/Sewer Dept. Inspection Sticker 1/ /
Site Plan /Variance required ,J/
Flood Plain Certification,if required0 ✓
Okay to issue C/C or C/0[Temporary/Permanent]
L:1Building&Codes Forms\Building&Codes\Inspection Fomhs\Residential Final Inspection Form_revised_100405.doc;Revised
January 7,2008;Revised 6/26/08;Revised 12/22/10,Revised 04/13/11
tiebok
Queensbury Building & Code Enforcement Re nttiiatFin Ia Inspection
Office No. (518)761-8256 Arrive: am/p Depart 'L `�'am/pm
Date Inspection request received: q -II--` Inspector's Initials: �/"-'
NAME: �Nfi C. PERMIT#: ii—V)Ca
LOCATION: I 0r1$ ' DATE: '/-/a-AA
TYPE OF STRUCTURE:
Comments:
Yee No NIA
4" Building Number Address visible from road
Chimney Height/'B'Vent/Direct Vent Location V/ 14`S \5k
Fresh Air Intake ✓
3 inch Plumbing Vent through roof minimum 18 inches —
Roof Complete/Exterior Finish Complete ✓ if
/��. -PS . -�}
Platform at all exterior doorslam'
Handrail 4 or more risers % / ._
Guards at stairs,decks,patios more than 30 inches above grade t/
Guard at stairwell at 34 inches or more e "`?��� �?t,, ?-�
Guard at deck,porches 36 inches or more of . V t <
Handrail Termination at Newell Post or Wall
Interior/Exterior Railings 34 inches to 38 inches -1) f2--
Deck Bracing/Handicapped Ramp Compliant
Grade away from foundation 6 inches with 10 feet ‘./..• '�� Li q-- s
6 inch clearance to sill plate ‹/
Gas Valve shut-off exposed I regulator 18 inches above grade 0c- -
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight �/
Safety glazing/Window in stairwells safety . = , �/
Interior Smoke yrs/Carbon
i'. o = •: ,•
Every level: bDi Every Beds/ 7
Outside every room�rea:
Inter Connected: Battery backup:
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 to floor I Sticker on Panel ✓/ t9ia 'a;
- 6144c-5
Duct work sealed properly I Blower Door Test Certification 1 / c- 1 -.2f2.-C -%
44:st-i.
Floor truss,draft stopping finished basement 1,000 sq.ft. t/
Emergency egress below grade / v/ � - Nil
Gas Furnace shut-off within 30 feet or within line of site ✓ / C?" Z-
Oil Furnace shut-off at entrance to furnace area /'
Fumace/Hot Water Heater operating ✓
Low water shut-off boileaped ✓ ^— L- - ���
Relief Valve(s)installed/Heat Trap/Water Temp 110 / � ��f Z
Enclosed Stairs Sheetrock Underside minimum'A"Gypsum • c2r� i‘r.. cy y'�
Basement stairs closed rise>4 inches / 1 !°"
Garage Floor Pitched ✓/ ( ��►-"
Garage fireproofing 1%hour fire door/door doses }//'
Gas Logs�In�S�e�nt or Gla Ise .� d/
Final Eledu'mrEnergy`Sa r g Light Bulbs 4134->-----____
Final Survey Plot Plan / f
Arc Fault Breaker Habitable Spaces/Tamper Proof Receptacles 1
Flex Gas Pipe Bonding /
As Built Septic System/Sewer Dept.Inspection Sticker V
Site Plan /Variance required //
Flood Plain Certification,if required
Okay to issue C/C or C/O j Temporary/Permanent] 0 ti
L:1Buiiding&Codes Forms\Building&Codesunspection FormsRResidentiai Final Inspection Form revised 100405.doc;Revised
January 7,2008;Revised 6/26108;Revised 12/22/10,Revised 04/13/11
Town of Queensbury Fire Marshal
742 Bay Road
Queensbury,NY 12804
761-8205/761-8206
fax 745-4437
Factory Built Gas Fireplace/Stove Inspection Report
Notice: New York State requires that all UL Listed,factory built appliances be installed according to the instructions and
specifications contained in the Installation Manual accompanying the appliance.No deviation from the manufacturer's
i instructions or specifications is allowed. �tn"-t0Permit# I L4O(f/ Schedule Inspection 14111 1i * Time 4.3--4.3-- am p� ytime Inspector ' '
Name L A .6&• Address(9."1 02 S n'(%.&' Rough In_Final '
Appliance Manufacturer STI CModel# DV c Ni
t_i'
Direct Vent Factory Built Chimney Flue Size t? Double Wall Triple Wall Insulated
Yes No N/A Comments
Floor Protection
Clearances to Combustibles (all sides)
Firestop(s) Vertical Chase
Wall Penetration
Vent Clearances to Combustibles
Vent/Chimney Termination
Chimney height must be 3 feet above roof
penetration;2 feet above any combustible
construction within 10 feet
Gas Shut-Off Valve
Combustion Air
Hearth Extension (if any)
Mantel G v,,,--32c-tic.,..., )U 'S fl&' t-
Height above f/p opening
X ,
Witness Operation
Tank Placement(if LP)
CO Detection
CSST Bonding
White—Building Dept. Yellow—Cust Amer Pink—Fire Marshal
Rough Plumbing I Insulation Inspection Report
Office No. (518) 761-8256 Date Inspection request received: / p
Queensbury Building &Code Enforcement Arrive:///Yr am/ Depart: am/pm
742 Bay Road, Queensbury, NY 12804 inspector's Initials:O/ 414 C-4)44
NAME: graft_ '0�-- PERMIT#: _ - -
LOCATION: Lo/'- qfv ' INSPECT ON:
TYPE OF STRUCTURE: �s f
N N/A
Rough Plumbing/Nail Plates
Plumbing Vent/Vents in Place r '
1 %inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet I change of direction
Pressure Test
Drain/Vent
Air/Head
5 P.S.I. or 10 ft. above hi'hest connection for 15 minutes
Pressure Test
Water Supply Piping
Air/Head
50 P.S.1 for 15 minutes
nsulati �f Residential Check/ConVercial Check 1/
or Similar Exterior Sealant
Proper Vent, Attic Vent
Door/Window Sealed (No Insu . )
Duct/Hot Water Piping Insulan
If required unheated space
Combustion Air Supply for:tiimace
Duct work sealed proper/No duct tape
COMMENTS:
Rough Plumbing Insulation Reportrevised Nov 17 2003, revised February 15,2005, revised January 7,2008
Rough Plumbing I Insulation Inspection Repoit
Office No. (518)761-8256 Date Ins n `
p�cUo request received:
Queensbury Building &Code Enforcement Arrive: am/a�m•• Depart: am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's initials:- Yfr
NAME: PERMIT#: c7Qar '/ 6
LOCATION: o91-1 f er A(h PINSPECT ON: _ I1-
9
TYPE OF STRUCTURE: l��/fry
N N/A
Rough Plumbing/Nail Plates
Plumbing Vent/Vents in Place
1 %inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/change of direction
Pressure Test
Drain/Vent
Air/Head
5 P.S.I. or 10 ft. above h'•hest connection J•r 15 minutes
Pressure Test
Water Supply Piping
Air/Head
P.S.1 for 15 minutes / /14,44
Insu Residential Check/ • ' mercial Check v '`
Tyvek or Similar Exterior Seale re,i►s
Proper Vent,Attic Vent
Door/Window Sealed (No I -ulation) 1aeof
Duct/Hot Water Piping In cation
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly/No duct tape
COMMENTS:
Rough Plumbing insulation Report.revised Nov 17 2003,revised February 15,2005, revised January 7,2008
0 GT 47e7
eft, Town of Queensbury Fire Marshal
742 Bay Road
� ` Queensbury,NY 12804
761-8205/761-8206
fax 745-4437
Factory Built Gas Fireplace/Stove Inspection Report
Notice:New York State requires that all UL Listed,factory built appliances be installed according to the instructions and
specifications contained in the Installation Manual accompanying the appliance.No deviation from the manufacturer's
instructions or specifications is allowed.
Permit# g°11 Cr(9 Schedule Inspection 7/1 '/ / `'4)�tn Time 1/ pm anytime Inspector 6�`
I+
Name 1,A C- E Ss'' Address 2 t PeirLc L 1,4) Rough Iq/ Final__
Appliance Manufacturer }f, '41Model# .,570-1)60 i.4
Direct Vent Factory Built Chimney Flue Size 6// Double Wall Triple Wall Insulated
Yes No N/A Comments
Floor Protection r \/
Clearances to Combustibles (all sides) X
Firestop(s) Vertical Chase
Wall Penetration
/\C
x
Vent Clearances to Combustibles
Vent/Chimney Termination
Chimney height must be 3 feet above roof
penetration;2 feet above any combustible
construction within 10 feet Cta:.p
Gas Shut-Off ValveXj
Combustion Air A
Hearth Extension(if any)
Mantel I r milt-41e-1e - iv,5 441(ec 5 /0-14/4 `'
Height above f/p opening
X v r 5 feel >-/,‘, 14.1 u=i
Witness OperationX \ 4:2? l t•
Katav• 47) I) 2 /
Tank Placement(if LP) /\'/.
CO Detection A
CSST BondingA/ ,CAL1 414411 !`614411./
White—Building Dept. Yellow—Customer Pink—Fire Marshal
Rough Plumbing / Insulation Inspection Reot gy-
p,
Office No. (518)761-8256 Date Inspection request received: i [ t 140k
Queensbury Building &Code Enforcement Arrive: am/pm Depart. arn/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials:titAct
NAME: 'G 1C> S d c15-c�6" 5`f PERMIT#: 026/(-46(4'
LOCATION: r. 6 t INSPECT ON: (1[rev
I
TYPE OF STRUCTURE:
Y N N/A
Rough _U)bbird/Nail Plates
Plumbing Vent I Vents in Place
1 %inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout eve 100 feet t chane a 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
50 P.S.I for 15 minutes
Insulation/Residential Check/Comm Cial Check
Tyvek or Similar Exterior Sealant
Proper Vent, Attic Vent
Door/Window Sealed (No Insuiaon)
Duct/Hot Water Piping Insuiativh
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly/:IIlo duct tape
—
COMMENTS: /
(51,- -- 5 1J-,-7 -cc- tifJ--c3))
Rough Plumbing Insulation Report-revised Nov 17 2003,revised February 15,2005, revised January 7,2008
- 5
Rough Plumbing / Insulation Inspection Report
Office No. (518) 761-8256 Date Insp,ctjon request received: 1 /� / Z.--
QueensburyBuilding &Code Enforcement Arrive: l I{/1 am/pm Depart: a pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: I/i
NAME: r• PERMIT #: ' . 06
LOCATION: 94 , INSPECT ON: /®
TYPE OF STRUCTURE:
Y N NIA
Rough Plumbing /Nail Plates
Plumbing Vent/Vents in Place
1 %inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout 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
50 P.S.I for 15 minutes t l
%Insulation/Residential Check I Commercial Check i/ �1� if 1'' /
l h
Tyvek or Similar Exterior Sealant Side,a �
Proper Vent, Attic Vent
Door/Window Sealed (No Insuiationj
Duct/Hot Water Piping Insulation
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly/No duct tape
COMMENTS:
Rough Plumbing Insulation Reportrevised Nov 17 2003, revised February 15,2005, revised January 7,2008
r-/Q tr,a' .
Framing / Firestopping InspectionKeport
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart ' am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's initials:
NAME: /6‘. RCS's PERMIT#: =
LOCATION: 24 ��,�-c/�, INSPECT ON: A[. 11
TYPE OF STRUCTURE:
Framing ti AukCOMMENTS:
as22"x30"minimum J./
Jack Studs/Headers V/
Bracing/Bridging V
Joist hangers �
Jack Posts/Main Beams
Exterior sheeting nailed properly
12"O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Exterior Deck Bracing
Headroom 6 ft. 8 in.
•
Notches/Holes/Bearing Walls
Metal Strapping for Notches Top Plate
1 %(w) 16 gauge(8) 16D nails each site
Draft stopping 1,000 sq. ft. floor trusses
Anchor Bolts 6 ft. or lesson 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%inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wal
Windows Habitable Space/Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above/below grade
5.0 sf grade
L:1Building&Codes Forms OLXBuNding&Codeslin specfion Forms Framing Firestopping Inspection Reportdoc Revised January 7,2006
Framing / Firestopping Inspection Report
Office No. (518)761-8256 Date irsspecti•n_m
Queensbury Building&Code Enforcement Arrive: Z-'3S = �,�"�1�
742 Bay /r
Road, Queensbury, NY 12804 Inspector's Initia -. .>�
NAME: C I V c"\ PERMIT#: Z — 1-106
LOCATION: QS:7 INSPECT ON:
TYPE OF STRUCTURE:
Y Ifla COMMENTS:
Framing
Attic Access 22"x 30" minimum
Jack Studs/Headers
Bracing/Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12"O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Exterior Deck Bracing
Headroom 6 ft. 8 in.
Notches/Holes/Bearing Walls
' Metal Strapping for Notches Top Plate
1 'A(w) 16 gauge(8) 16D nails each side Q �
Draft stopping 1,000 sq. ft.floor trusses v u
Anchor Bolts 6 ft or less on center
Ice and water shield 24 inches from wail OP
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'A 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
L:1Building&Codes Forms-OLC Building&Codes\Inspection Foims1Frsming Firestopping Inspection Report.doc Revised January 7,2008
Framing / Firestopping Inspection R- •
Office No. (518) 761-8256 Date Inspection -•.• ed:
Queensbury Building&Code Enforcement Arrive: Z'C a' 0 • -part: -,\O a
742 Bay Road, Queensbury, NY 12804 Inspector's Initial Ir//
NAME: C\ PnL = PERMIT#:
LOCATION: 7 PERNl-A k( a7 INSPECT ON: -• -
TYPE OF STRUCTURE:
Y N N/A COMMENTS:
Framing
Attic Access 22" x 30" minimum
Jack Studs/Headers
Bracing/Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12"O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Exterior Deck Bracing
Headroom 6 ft. 8 in.
Notches/Holes/Bearing Walls
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 Bofts 6 ft. or less on center
/Ice and water shield 24 inches from wall PtCV-----
Fire separation 1, 2, 3 hour
Fire wall 2, 3, 4 hour Ef
Firestopping
Penetration sealed
16 inch insulation in cavity min. �\ i�tD•)1- AM -
Garage Fire Separation `
House side%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
L:\Building&Codes Forms-OLD\Building&CodesMnspection Forms\Framing Firestopping Inspection Reportdoc Revised January 7,2008
� TelSei7,
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: TO
- _ , PERMIT#: —4/C) •
LOCATION: ,Z411111WAI, 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 Sumpinq *Ck2)—(PON1
Footing Drain Stone: i\K-0q45-4'140-1\
12 inch width
• .es above footing
mil ' ly for wet areas under slab
Bo(cicfdl • , 'royal V)Iik-6/1Z, Ct4^-'L //1
g Under Slab
PVC/Cast/Copper J
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Buliding&Codes Forms\Buiiding&Codes\Inspedion Forms\Foindadon Inspection Reportdoc
Last printed 12/20/2005 9:24:00 AM
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection request received: 9 i t
Queensbury Building&Code Enforcement Arrive: am/pm Dep: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: 6A) 0
NAME: LPERMIT#: 2t i.4.-- .
LOCATION: `2„4 ( INSPECT ON: </tat ( I
TYPE OF STRUCTURE: s l
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.
9 Materials for this purpose on site.
oundation/Wallpour
Reinforcement in Place
//_:'
2_ `ZS Ac¶cM-Footing Dowels or Keyway in place ,
Foundation Dampproofing 1, RtA-o-CZA:1,-,icRIV
Foundation Waterproofing 1'N
Footing Drain Daylight or Sump l 17.—t-i-N-‘-' t+ikx .-
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\Inspectlon FormsWoundatbn Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
1
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart:p3cam/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: J(
C�9.
NAME:
- C_") - � 1 PERMIT#:
LOCATION: MINIM II INSPECT ON: AP?:--
TYPE OF STRUCTURE:
Comment'
Footings
Y .
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
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:\Buliding&Codes Forms\Building&Codes\Inspectlon Forms\Foundatlon Inspection Reportdoc
Last printed 12/20/2005 9:24:00 AM
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: )2‹ am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:(LAD
NAME: PERMIT NO.: _c%L ' (9G,
LOCATION: '24 '�'12ST t 'L INSPECT ON: 6W
RECHECK:
Comments and/or diagram
Soil Type: Loam/Clay
Type of Water: /Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench ft.
t
Depth of trenches l` r ft.
Size of Stone ' .
Seepage Pits: Number
Size:
Stone Size:
Piping zeType
Building to tank 1"-
Tank to Distribution Box `' ..TDR.1C
Distribution Box to Field/ Pit 7.-e7 -TpLf
Opening Sealed: V_N
End Cap 3LY N
Inlet/Outlet Pipes&Baffles �Y N
Manholes 12"or less below grade Y_N eq-
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank ✓ 1 ft.
Foundation to absorption 31 ft. It)
Separation of Pits ft.
Conforms as per Plot Plan N
Engineer Report and As-Built _ _N
ETU Maintenance Contract Y N
provided
Location of Syst- . •roperty:
Front Rear Left Side Right Side Middle Front Middle Rear
7..-m S s:
pproved
pproved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Buiiding Codes Forms\Inspectlon Fonns\Septic Inspection Report_03 29 10.doc
MAP REFERENCE:
MAP OF FIRST SUBDIVISION OF
BROAD ACRES
FILED IN THE WARREN COUNTY
CLERK'S OFFICE ON 6-10-1930
LEGEND:
IPF = IRON PIPE FOUND
IRF = IRON ROD FOUND
IRS = IRON ROD SET -
`Q -a- = UTILITY POLE
t = LIGHT POLE
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AREA OF LOT LINE ADJUSTMENT
109.89 sq. ft.
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/ AREA OF LOT LINE ADJUSTMENT
109.89 sq. ft.
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(407-
DusUNAUTHORIZED
OL��
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and Surveyors
Q V 7
1 B9 A8VZ1aIId Road Queensbury, New York 12804
(518) 792-8474 New York Lie. No. 50135
ALTERATION OR ADD17M TO A SURVEY
MAP BEARING A LICENSED LAND SURVEYORS SEAL IS A
VIOLATION OF SECTION 7209. SUB -DIVISION 2, OF THE
NEW YORK STATE EDUCATION LAW.'
'ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY
MARKED 'ATTH AN ORIGINAL OF THE LAND SURVEYORS
SEAL SHAM BE CONSIDERED TO BE VAUD TRUE CONES•
RECARED HEREON SIGNIFY THAT
*CERTIFICATIONSSURVEY KITH THE
THIS ING CO WAS PRACTICE 9r LAND SURVEYORS
E>aS71NG CODE OF PRACTICE FOR LAND SURVEYORS ADOPTED
BY THE NEW VE YORK STATE RMCATR@N OF LL RUN
TO LAND SHALL NUN ONLY
PERSON SAID CERT HE SURVEIONSY
TO THE PERSON FOR NTIOM 7IiE 51RVEY IS PREPARED, .AND
ON HIS BEHALF TO THE 71TLE COMPANY, GOVERNMENTAL
AGENCY AND LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF 7HE LENDING INSTIIUTTON.'
Map of a Survey made for
. .
Howard & Kristine L a R o s e
Town of Queensbury, Warren Count New York
Q y' y'
tiaze, RrKil li, cuil
Scale 1'=20'
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S 1 OF 1
4
4/16/12
HOUSE LOCATION
3
6/1 /11
PROPOSED LOT LINE
2
5/23/11
PROPOSED LOT LINE
1
5/9/11
CORRECT SPELLING OF NAME
LAROSE C-2466
DWG. NO. 11031
NO.
DATE
DESCRIPTION
302.14-1-62
cNo
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