2011-479 `� TOWN OF QUEENSBURY
yrs742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20110479 Date Issued: Monday, December 12, 2011
This is to certify that work requested to be done as shown by Permit Number P20110479
has been completed.
Location: 145 MONTRAY Rd
Tax Map Number: 523400-296-013-0001-054-000-0000
Owner: RUTH KOUBA
Applicant: RUTH KOUBA
This structure may be occupied as a:
Fireplace By Order of Town Board
Garage Attached TOWN OF QUEENSBURY
SingleFamily Dwelling
Issuance
off this Certificate of Occupancy DOES NOT relieve the property < :Davp �
owner of the responsibility for compliance with Site Plan,Variance, or ;c4/5Zt
other issues and conditions as a result of approvals by the Planning Board
Director of Building&Code Enforcement
or Zoning Board of Appeals.
SiTOWN OF QUEENSBURY
' � 742 Bay Road.Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110479 Application Number. A20110479
Tax Map No: 523400-296-013-0001-054-000-0000
Permission is hereby granted to: RUTH KOUBA
For property located at 145 MONTRAY Rd
r
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: RUTH KOUBA
145 MONTRAY Rd Fireplace
QUEENSBURY NY 12804-0000 Garage Attached
Single Family Dwelling $125,000.00
Total Value $125,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2011-479
828 sq ft single family dwelling with 290 sq ft garage with 1 fireplace
$209.10 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, September 28,2012
(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.)
n
Dated at the T of ee sbdry e • :y, September 28,2011
,M! ,:
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
i •
s r--J sv-0.fn1p
FFICE USE ONLY J �---� � 2 lylR// {�
TAX MAP NO. AP'11—I PERMIT NO. !' ! D �,,,� (� �tl/ LS II
ii
FEES: PERMIT I� RECREl O ENGINEERING_ SCP 2 2 2011
#t f/f et- g Jo (If applicable)
�VSf � TOWN OF QUEENSBURY
PRINCIPAL STRUCTURE: APPLICATION FOR ZONING APPRO L &;i:U WNGODES
PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO REVIEW
BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION. ,�1
APPLICANT/BUILDE�R:,�a KCU�• OWNER: eU '�i iztJsP
G
ADDRESS: VA opc-40:,o 0 -• (is1/4( ADDRESS: 3Q_ aztowcoo'/ /�- {�i!
_
PHONE NOS. 79g- 7$2(0 PHONE NOS. 2Q6- 782(0
3�Abl-
CONTACT PERSON FOR BUILDING&CODESE �C}O�M�PLIANCE: pu w 14% PHONE: ' _ -'
LOCATION OF PROPERTY: Yfl( ,A l ASyt{"fiJSe1Al2 �
HAS THERE BEEN A SITE PLAN REVIEW;VARIANCE OR SUBDIVISION APPROVAL? 0 YES E NO
IF SO, INDICATE APPLICATION NO.AND DATE OF APPROVAL: N JP
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT
APPLY TO YOUR Z p p U) d w
PROJECT d0F OF ce _, 0I- _
ll.l JLL U_ 1-1- W Q �. C7U �.A/
W O J roll- i d I-- H O ~ la
W — I/ l �l/�
2 Q Q ' fA NU) OLL I— LL LLIa6 !V//)
SINGLE FAMILY �( SZg — g� go' ,i.t
TWO-FAMILY ,'` LV
MULTI-FAMILY
(NO.of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL„ATTACHED
�j ) 1+5.3.i
GARAGE�,3) X ��O -- Zq o /&i d lit
OTHER
Town of Queensbury' Community Development Office*742 Bay Road, Queensbury NY 12804
-4-
V ,
Revised 4/14/2010
IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS:_ 14/A__
ESTIMATED CONSTRUCTION COST: $ 125,taae FUEL TYPE: /Ytt Ste ,/
HEAT TYPE:_ P42- `HOW MANY FIREPLACE(S):_ I AND/OR WOODSTOVES(S): So
ZONING CATEGORY: MOO- ARE THERE WETLANDS ON THIS SITE? �d
IS THIS A HISTORIC SITE? )40
PROPOSED USE OF BUILDING OR ADDITION: Sila
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? No
ARE THERE EASEMENTS ON PROPERTY? 140 t � V-OOL
*Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in our office
• 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
xonfomlance-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 id ag e tt tt above.
Signed �� r'v yL2W17 9�OMrfC
i ��ULien/T
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)
Town of Queensbury*Community Development Office*742 Bay Road, Queensbury NY 12804
Revised 4/14/2010
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
QUESTIONS? CALL 7614256 OR EMAIL
codesftueensburv.net
Office Use Only - VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
Operating Permit Issued: Yes No
Occupancy Type: Construction Classification:
Assembly Occupancy Limit: Special Conditions:
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
fiECEllvEri
-vise. '•/1-�
APPLICATION FOR FUEL BURNING APPLIANCE & CHI � SSEP 2 2 2011
Application is hereby made to the Building &Codes Office for the issuance of a Building & Us Pe • a.,f e
New York State Fire Prevention & Building Code. The applicant or owner agrees to comply 'th all ,I I�Fv�NSBURY
ordinances, regulations, and all conditions that are part of these requirements and also will allo ' �� t&O ES
premises to perform required inspections.
Important Note To Applicant: Rouqh-In and Final Inspections Are Required:
Owner: FU1IU Q,P Installer/Builder: JF91)825191)825Address: 31 /, , eCcO t- ( f Address: WU ?OuM �N glp
Phone Nos.: -7;1g-"MVP Phone Nos.: 796- 1
Location of Property: l` 5 rnankt 120 Subdivision Name: #4S09/9
Location of Proposed Construction and/or Installations .-!viivb /ZOOM
Contact Person for Building &Codes Compliance: 01/Ais NA1. - 12UUA1.&/ h4a 410/
Fuel Burning Applicance Wood Coal Pellet Gas Oil
Information
Stove
Fireplace Insert
Fireplace,factory built* X
Fireplace, Masonry
Furnace, (Garage Only) rr
* If Factory Built, Please Provide: Manufacturer Name: fafia°-H' /��Model No. e V-32 O/L 152,1/41.—
Listed
UjOLListed By: Number:
Chimney Information BLOCK BRICK STONE
Masonry** Check One,/
TILE STEEL SIZE IN
INCHES
Flue Check One ✓ �it
DOUBLE WALL TRIPLE WALL INSULATED DIRECT CHMNEY
VENT LINER
Chimney Material Check One✓ ✓
** If NorhMasonry, please provide: Manufacturer Name: Model No.
ADDITIONAL NOTE: CONSTRUCTION I 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
Il?/ eJised4/1 q
OFFICE USE ONLY In)
TAX MAP NO. PERMIT NO._ PERMIT FEE " " �EF PO�' I
APPROVALS: ZONING _ TOWN CLERK TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PER DUILDINOB aE� _, )
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID�PERMIT. �/ ;NAIL/Dees
'.
OWNER: �^W�uese..�.�y� �.•y� �•.Q�� INSTALLER: _)f t .?LAI iC .'5
ADDRESS: al Ce0AQ41: 0 1/W• Geri( ADDRESS: 'jy'^/'�`1 _I 1 Sair
PHONE NOS '740 - I U L��IIb ,..p� PHONE NOS. 8- '1
LOCATION OF INSTALLATION' 14'S m0N 1`FG'/ 9400, 061
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED? MO
1981-1991 X 130 = SPA OR HOT TUB
1992-present O X 110 It Z20 a20 INSTALLED? MA
PARCEL INFORMATION:
1 TOPOGRAPHY: FLAT ROLLING A. STEEP SLOPE %SLOPE
I SOIL NATURE: SAND S LOAM CLAY OTHER L
I GROUNDWATER: AT WHAT DEPTH? 4- IMM
//--
I BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?''(�I r
I DOMESTIC WATER SUPLY: MUNICIPAL X WELL (If well:water suppy from any septic system absorption is ft)
1 PERCOLATION TEST: RATE IS 2'.30 PER MIINUTE PER INCH[mp]
(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: 4000 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: I
%ABSORPTION FIELD(WITH NO.2 STONE) Total length /20 ft. Each trench 2 X 4bl
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
o ALTERNATIVE SYSTEM Bed or other type?
o 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 7614256 OR EMAIL
Sanitary ge Dis I ce
!�•yy�- cadeslaldueensburv.net
2/ 6,077 4.# VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www.queensburv.net
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
. 9 ll c
L--Queensbury Building & Code Enforcement - Residential Final Inspection /&aA
Office No. (518) 761-8256 / Arrive: am/p� Depart ' ( ` m/pm
Date Inspection request received: (d/ 4�J91� Inspector's Initials: /1e�(�t�
NAME KO IN 56- t PERMIT#: O// 499
LOCATION: /4'C ,f fo nice d-'/ DATE: y/p �jo
TYPE OF STRUCTURE:
Comments:
Ty No N/A_ /Fir
4" Building Number Address visible from road lJ v
Chimney Height/13"Vent/Direct Vent Location N
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 18 inches / /
Roof Complete/Exterior Finish Complete tJ Si-� Pec`e
Platformanat r more
doors ��//� A7—k( o
Handrail 4 or more risers
Guards at stairs,decks,patios more than 30 inches above grade •
Guard at stairwell at 34 inches or more r i/
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
Gas Valve shut-off exposed/regulator 18 inches above grade
Interior privacy/him/doors/main entrance 36 inches //
Bathroom/Kitchen watertight V
Safetyerglazin / in stairwells safety 9 9
Interior Smoke Oe v/ Bed Mpnoxd Ve ors
Everylevel: EveryBed
Outside every bedroom ag a:
Inter Connected: Lf Battery backup:
Attic arncc 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/Insulation Certification/Sticker on Panel 4/ /
Floor truss,draft stopping finished basement 1,000 sq.ft. / �/
Emergency egress below grade
Gas Furnace shut-off within 30 feet or within fine of site
Oil Furnace shut-off at entrance to furnace areaZ.
Fumace/Hot Water Heater operating
Low water shut-off boiler
Relief Valve(s)installed!Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum''b"Gypsum
Basement stairs closed rise>4 inches /
Garage Floor Pitched V�
Garage fireproofing 1%hour fire door/door closer
Duct work Sealed properly •
Gas Logs in Sealed or Glass Enclosure r-
Anal Electrical
Anal Survey Plot Plan V`
Arc Fault Breaker Habitable Spaces/Tamper Proof Receptacles
Flex Gas Pipe Bonding Vd/
As Built Septic System/Sewer Dept Inspection Sticker
Site Plan /Variance required
elOkadolissee /CorCation,'drequeedOkay to issue C!C or C/O[Temporary/Permanent]
L:Wulding&Codes Forms\Bulding&CodesVnspection Fonts Residential Final Inspection Form_revised 100405.doc;Revised
January 7,2008; Revised 6/26/08;Revised 12/22/10
9 11 /-,
Queensbury Building & Code Enforcement - Residential Final Inspectionon /&A-A--
Office
a-�
Office No. (518) 761-8256 r X-�Y
/ Arrive: am/p De art: 1 1 `(( Ilam/pm
Date Inspection requestesreceived: /d� 9/-06 Inspector's Initials: {- �
NAME: �1 O/^6 e l PERMIT#: O//— 49 9
LOCATION: /4/S.- it104/` zI�/� DATE: y7a o I /��4
TYPE OF STRUCTURE:
Comments:
Yea/ No N/A 60(��
4" Building Number Address visible from road
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 18 inches ,/
Roof Complete/Exterior Finish Complete ✓/ Fla" �J+^ a�
( Fres Qec'd
Platform at all exterior doors -
Handrail 4 or more risers 11 /
Guards at stairs, decks, patios more than 30 inches above grade ✓/
Guard at stairwell at 34 inches or more % kV
Guard at deck,porches 36 inches or more ✓
Handrail Termination at Newell Post or Wall `/
Interior/Exterior Railings 34 inches to 38 inches
Deck Bracing/Handicapped Ramp Compliant
Grade away from foundation 6 inches with 10 feet
6 inch clearance to sill plate ikKf
Gas Valve shut-off exposed/regulator 18 inches above grade V
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight
Safety glazin /Win " in stairwells safety g�ng
Interior Smoke De ors/Carbon Mpnoxide electors
Every level: Every Bedroo$n w /
Outside every bedroom a a: >/
Inter Connected: Battery backup: if
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.fL vents kl
Bathroom Fans, if no window W
Plumbing fixtures t
Foundation insulation/Insulation Certification/Sticker on Panel ,,/
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 V ✓
Oil Furnace shut-off at entrance to furnace area
Fumace/Hot Water Heater operating
Low water shut-off boiler
Relief Valve(s)installed/Heat Trap/Water Temp 110 /
Enclosed Stairs Sheetrock Underside minimum%"Gypsum V 1
Basement stairs closed rise>4 inches
Garage Floor Pitched tC
Garage fireproofing/%,hour fire door/door closer /e
Ductwork Sealed properly V/j
Gas Logs in Sealed or Glass Enclosure V
Final Electrical
Final Survey Plot Plan V
Arc Fault Breaker Habitable Spaces/Tamper Proof Receptacles �
Flex Gas Pipe Bonding 7
As Built Septic System/Sewer Dept. Inspection Sticker
Site Plan /Variance required
FloodOkay Plain CC/C or Cif required
Okay to issue C/C or /0[Temporary/Permanent I0
L:1Building&Codes Forms\Building&Codes1Inspection Forms\Residential Final Inspection Form revised_100405.doc; Revised
January 7,2008; Revised 6/26/08; Revised 12/22/10
410 kaalt
s Town of se nsbary Musial
742 Bay Road
Query,NY 12804
7614205/76141206 C�
fax 7454437
Factory Built Gas Fireplace/Stove Inspection Report
Notice: New York State riven that all UL Listed,factory bait appliances be installed a tmtg to the iasiructioas and
ape iW:atioss contained in the Installation Maunal a000mpanyiag the apples=No deviation from the aaadaelarer's
instruction or��speaTmeations p/ Mowed.
owed.
Permit# r)-o/1-r7 9 Schedule Inspection /01/,-)A,,/01/,-)A,,/// Tin eg 4/S as pa anytime Inpeetu/+t )
Name 1.6/t 5 Q Address /q S'Lj� � � � Rough In Fanat c
•
Appliance Maeatacterer V Met# Sri&`3 S c f&S - U'
Direct Vent Ys.. Factory Balt Cbiaaey Fite Size__ Doable Wall Triple Wal Instated
Yes No N/A Cam
Floor Protection •
Clearances to Combustibles(all sides) 1/
Firestop(s) vatic' at Chase
WSI P c/
Vent Clearances to Combustibles V
Vent/Chimney Termination
aiasey hit mast be 3 feet above mat
pe.aration-2 feet above any can6ntibte
esntrnetion within 10 tat
Gas Shut-Off Valve .f
Combustion Mr
Hearth Extension(if any) (/
hlantd J
Heil*Aim OP OWNS*
Witness Operation
Tank Placement Of 12)
W-anta•s na•- Yum,.-Cum.., Pik-rte
Final Survey Inspection
Dept. of Community Development
Town of Queensbury
742 Bay Road
Queensbury, NY 12804/
Date received: / ISYji4
NAME: KQlith C
LOCATION: /II( 410417)„ /° ----
PERMIT #: 0208"V 7,
Final Survey Plot Plan
Approved Denied
The attached final
survey has been
received by the
Dept. of /
Community
Development.
Upon review the
survey has been:
Craig Zoning Administrator
Notes:
L.NSueHemingway\Budding.Codes.Inspection.FORMSTinal Survey
Zoning Administrator doe
.• X
(a1 r,F u f 5
y3, i ..
X. V17tlt�a
>?R�i F#S( tyspi'• a. �1
2, � :`�` � �_ 1t r �y,r•��'v
• yr i +, Y �vG�/s' "� �` 1"...-:
_ a , may, s
;. i'r •sRsij,s,a Ati,l Co �t4 4 Sjf'ya1 �"iC- 1 S 1
--7 ` a Y/_hr's "T �' 4 � l �i � r 'a fy J. 1 -M �: � r 5 � • '� a
=t k�';s � yS,c� '. 1 .`i ..I'�� '� �F,; J. t /, ' xAt�. � .� �• � r � S � ,
✓, xn _ r • �i t 7 i .. •:�s5` 54`t 5
� 'may*7 'e ^I •. �#'•yip t., _'T ,7
'i.i i j 1� :`'i,; SeP':-. :fl •,y S',4f !} r•t '.
�i"W� A- r J.yy f� }fir: N� tx,i1• y
'rt'". �i. t�+t.•:v > .\ r�, d - ' tts a c{ « 3�i ..J +: II : N�. 1
s Jyl`,,+� ((ggg�4gp'}�f r ; 1`^f 1,4-:- � %„ • Y -a �VI`
r x- > .'
sa - e.ST i�ArJ/'y''rl):'
IL
@? yf f - i• h. �.. - r `+( ( c) r h 1
yt,,�%'`� .yam•'{;-, ;�r: .' ^i �
igf ?fE�tro7 J , a '.fi., ✓ 1.; MI5`
�.( 1 J( <•r� •}' ''+ V i �.� ,� � �1 I r,rr :.tee • I� � - ". ��' S• t '
,.t fi•j� the
N
Y6 Ji", 1 • r� ��'`-,F, .r�'A ! ; - (- 91 r � -:. x,�"`�+, t ;'�:., R � (1011
•r v 1 TT
ar �t 7, t e J a r. • t ... k•-ik
*�r �a� z j pIt3
'i'+ r;�lt ' �.� .' f ,.!'.'_� '_ `�� G� t;�Jr fr i t rt,J JF G •k;,
�." rs f .+ y •' - Y y� .iZA-� Zvi } �•
•_� r i , r `r lid
�N�`�r.. • � Ai t tt�'�+« c� ��s� :. v'��,, s �',� �
r.
r s-/ i'1�S�t35.4U11 �z II
• y"
� j ?
t. I µtx�
(;url•ItshU1;Y!4c it� +.
� [rlcen3hury � '• n
� �- H11;h ;/cls;;:; �'*� � �. � �' _'� r'y38� ..� �" ;ti 4'Z Yi '�1 rk•� ��f1 �r ti::
J i s i'• 1 •ay r ? t <�
s ; } ,:'ia .--'�'V .L -_wit•• ` '.+. r { t t `N s it � � - � ....' 4 � �"f`i�l` 's Ir • c•� •
~
",', ��wxt�'tt ,i';t i�9,�!�i, Y o�• !'M yr 4
SITE LOCATION MAP
CERTIFICATION.•
I HEREBY CERTIFY TO:
1) RUTH KOUBA
2) STEWART TITLE INSURANCE COMPANY
THAT THIS MAP WAS PREPARED FROM AN ACTUAL FIELD
SURVEY COMPLETED UNDER MY DIRECT SUPERVISION.
THIS SURVEY AND THE CERTIFICATIONS HEREON SHALL BE
VAUD ONLY TO THE PARTY OR PARTIES HEREON NAMED AND
ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR
SUBSEQUENT OWNERS, OTHER THAN AS MAY BE OR EXPRESSLY
STATED HEREON.
raj
RUSSELL E. HO ARD NYSPL 050540
DATE: 10/18/11
DEED REFERENCE:
1) MILO J. KACIAK, TRUSTEE OF THE WILLIAM KACIAK TRUST TO JOHN ARNOLD
AND KIM ARNOLD, FILED IN THE OFFICE OF THE WARREN COUNTY CLERK IN
BOOK 3710 AT PAGE 212, DATED FEBRUARY 02, 2009.
MAP REFERENCE:
1) "MONTRAY HEIGHTS" DATED JUNE 17, 1920,
PREPARED BY ROSWELL S. BAYLIS, C.E.
catch
basin
o
vs IPF
o �
� 11
a N
� 11
1�
1�
\G
2TEw>E
Lands n/f i S"
Stewart's Shops Corp.
L" 3966 P. 159 ).
o,
NOTES:
1) BASE MAP PREPARED FROM AN AUGUST & OCTOBER 2011 FIELD SURVEY.
2) NORTH ORIENTATION IS BASED ON DEED REFERENCE 1.
3) THIS SURVEY WAS PREPARED WITHOUT THE BENEFIT OF AN ABSTRACT OF TITLE AND
IS THEREFORE SUBJECT TO ANY EASEMENTS, COVENANTS OR RESTRICTIONS OF RECORD
ANY STATEMENT OF FACTS SUCH DOCUMENT WOULD DISCLOSE.
4) SUBJECT TO APPLICABLE LAWS AND APPROVALS OF THE TOWN, COUNTY, AND STATE
REGARDING THE DEVELOPMENT OF LAND.
5) UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING A LICENSED LAND
SURVEYORS SEAL IS A VIOLATION OF SECTION 7209, SUBDIVISION 2, OF THE
NEW YORK STATE EDUCATION LAW.
6) ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY MARKED WITH AN ORIGINAL OF THE
LAND SURVEYORS SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES.
7) UNDERGROUND UTILITIES, STRUCTURES AND FACILITIES HAVE BEEN SHOWN FROM
SURFACE LOCATIONS AND MEASUREMENTS OBTAINED FROM A FIELD SURVEY.
THERE MAY BE OTHER UTILITIES WHICH THE EXISTENCE OF ARE NOT KNOWN. SIZE,
TYPE AND LOCATION OF ALL UTILITIES AND STRUCTURES MUST BE VERIFIED BY
PROPER AUTHORITIES PRIOR TO ANY AND ALL CONSTRUCTION. CALL DIG SAFE PRIOR
TO ANY EXCAVATION.
IRF
30
\66�
LEGEND
o IRF
tl
o IPF
IRON PIPE FOUND
�1
IRON ROD SET
CO,
11
oao
STONE WALL
Itd
WIRE FENCE
o
1b
11
WOOD FENCE
Ib
POINT
F.P.
FENCE POST
-ohw
OVf=RHEAD WIRES
11
NOW OR FORMERLY
LOT NUMBER PER
1 6 7
light
111
post
I'll
IPF
it
tl
ii
„
,t
11
n
n
,
n
n
n
u
IRF
30
\66�
LEGEND
o IRF
IRON ROD FOUND
o IPF
IRON PIPE FOUND
o IRS
IRON ROD SET
CO,
UTILITY POLE
oao
STONE WALL
X
WIRE FENCE
o
CHAIN LINK FENCE
11
WOOD FENCE
G
POINT
F.P.
FENCE POST
-ohw
OVf=RHEAD WIRES
n/(
NOW OR FORMERLY
LOT NUMBER PER
1 6 7
MA:' REFERENCE 1
� V /
/
Lands n/f
Ronald F. Smith &
Stephanie K. Smith
L. 3873 P. 086
3A,1
25.
AREA =
0.59-± ACRES
\67/ .54,9r
571.
1 68
/
GRAPHIC' SCALE
15 30 60
( W FEET )
1 inch = 30 ft.
Lands n/f
Jennifer Mead
L. 4149 P. 300
IPF
/
5.4
IPF
044
0A 0001)
DRjvE
ohw
cath
y basin
w• Ir 1
� o
f
�^ a
d
54.6'
OA
4
IPF f
01,
o�
O i
� 1
� c
0
6
/
NAIL
41,
Ri
Ec i
DEC 0 9-2011
DING & CODES
CONCRETE G 1 �� �Q/17�
MONUMENT n
_ MAP OF A SURVEY MADE FOR
O NF�Y
tM TFyo RU., x� .�OUBA
n O Town of Queensbury County of Warren State of New York
120 OS054,° vQ,BOLSTER AND ASSOCIATES
LAPROFESSIONAL LAND SURVEYORS
342 Main Street, Hudson Falls, New York 12839
Russell E. Howard, PLS N.Y.S. Lic. No. 50540 Date: 08/29/11 Tax Map #:296.13-1-54
Date Sealed: /O /9 ,- Scale: 1 inch = 30 feet Revised: 10/18/11 Drawing #: 11053A
ti0'
Y
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart:3.n\ am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: J '�"
)
NAME: c-a PERMIT NO.: L•—I
LOCATION: 14c-Mohs RioqINSPECT ON: CI
RECHECK: /
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal/ Well Water _
Waterline ; •.ration distance ft.
Well .:ration distance ft
Other wells: ft.
Well Casing -n• , 50'+/- _Y_NN/A
[150'to •-II -•, fired IfNO]
Absorption ield: To-I lengthft.
Lea hof ea. trench i ft
Depth oft = ches ft.Size of e f c— fLQ
See...e Pits: Nu r
S• - x
Stone S•• -
/
Piping ize Type / ✓C
Build g to tank /
, 6....----
Tank to Distil• ion Box /
Distribution Box to ield/ Pit / / f
Openin4 Sealed: Y_ r
ndCap Y ' ��
Inlet/Outlet Pipes& files Y N
Manholes 12"eorn lessn colow rade _Y N /
[provide extension collar ' Yes Y N
L
Location/ Separa • /
Foundation to ft.
Foundation to absorpti. ift
Separation of Pits / ft
Conforms as per Plot Plan ,_,.,•,Y N
Engineer Report and As-Built _Y_N
ETU Maintenance Contract Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
system Use S G
Appro
Approved and needs to be re-Inspected, please call the Building &Codes Office
Disapproved
L-\Pam Whiting\2010\Building Codes Fonns\IrspectIon Form Septic Inspection Report_03 2910.doc
a...r
7
RUCINSKI HALL ARCHITECTURE a P��t
Ronald Richard Rucinski ` J
Ethan Peter Hall gE G'S
111 627 Maple Avenue iiiii•
2011 N) c,,
Saratoga Springs NY 12866 `per
-.
TOWN OF E:ASBURY
Voice 518 580 1905 BUILDING . CODE_ S J
Fax 518 584 5012
Email ephall@nycap.rr.com
Septic As-built for Kouba Residence
4 November, 2011
Charles Dyer—Town of Queensbury Building Department
742 Bay Road -
Queensbury NY-'12804 � c
Re: Septic As-built forJ45 Montray Road
Charlie,
At the above referenced project location I observed the installation of the sewage disposal system
including the septic tank, distribution box and tile field laterals prior to back fill. All items appear to
be installed in accordance with the construction documents and are acceptable to this office.
If there are any additional questions please call to discuss.
Regards, ,o� , '4
"di
11/1
Ethan P\,4:
7•oktArchitec
Cc: Ruth Kouba -Owner
JPG Construction - Builder V
Y:UCouba\PaperworkVztter 4 Nov 20 I I.doc 1
In-/zto
Rough Plumbing / Insulation Knape ion Report
Office No. (518) 761-8258 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm I : .art: m/pm
742 Bay Road, QueeJAB
nsbury, NY 12804 Inspector's Initials: „
NAME: ti&) hot_ PERMIT #: //_4 7,
LOCATION: /45" Mob.,¢r 6-7- INSPECT ON: /1- 7 -//
TYPE OF STRUCTURE: Qp
Y N N/A J Bks (1' eve'
Rough Plumbing /Nail Plates (t pp one /15
Plumbing Vent/Vents in Place
1 h inch minimum Drain Size `s
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
• V
- 1 '.S.l fo 5 minutes
nsulation/R: idential Check/Commercial Check
. = . ,. ' der Exterior Sealant
Proper Vent, Attic Vent VZ
Door/Window Sealed (No Insulation)
Duct/ Hot Water Piping Insulation
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly/No duct tape
COMMENTS:
'2\
Rough Plumbing Insulation Report.revised Nov 17 2003, revised February 15,2005, revised January 7,2008
2 -4( li <e
Rough Plumbing I Insulation Inspector* Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm
�Depart:nfj—i)r�am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials/' l
NAME: iroubo„ PERMIT#: 11l1/77
LOCATION: /JIS filov61rgi •
INSPECT ON: if2-//.
TYPE OF STRUCTURE: t >
Y N N/A
Rout Plumbing/ ail Plates
Plu •'ng Ve Vents in Place V
1 % inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/change of direction
Pressure Test 1\7 )
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/Commercial Check
Tyvek or Similar Exterior Sealant
Proper Vent, Attic Vent
Door/Window Sealed (No Insulation)
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
lik . . .
3
Septic Inspection Report //
Office No. (518) 761-8256 Date Inspection request received: l0 12 /l l
Queensbury Building&Code Enforcement Arrive: am/pm '-'art: am/pm
742 Bay Rd., QNY 12804 Inspectors Initials:
•
NAME: U�dU I5A PERMIT NO.: 1 , - tr7,'
LOCATION: 1 "/5e i✓I an-1W--A-7(laFl� INSPECT ON: D - /
RECHECK:
L_ Comments and/or diagram
Soil Type: �jr ] Loam / Clay
Type of Water: M d / Well Water
Waterline separation distance ft. rtdV
A-A C
Well separation distance R.
Other wells: _R. AS,'-1-2) ,
ir
Well Casing Length 50' +/ - „^Y N N/A
Absorption Field: Total length / )‘• ft.
Length of each trench ' 50 R.
Depth of trenches e2.- R.
Sizeof Stone vin
1-1)
Seepage Pits:: Number iv � —
Size:
Stone Size:
Piping Size Type
Building to tank �� `j.2..
Tank to Distribution Box ' ` 9u.4-
Distribution Box to Field Pit I `
Opening Sealed: 712 N7
End Cap _N
Inlet/Outlet Pipes&Baffles Y N -
Location/ Separations
• Foundation to tank 1"L R.
Foundation to absorption 2:1-t- R.
Separation of Pits
Conforms as per Plot Plan Y�, / N
Engineer Report and As Built Y N
--------------
Location of System - • 'petty:
Front Rear Left Side Right Side Middle Front Middle Rear
act:ii - •
,'Approved
,r1Tf Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forrns-OLD\Building&Codes\Inspection Fonns\Septic Inspection Report.doc
Framing / Firestopping Inspection Report 1 -
Office No. (518)761-8256 Date Inspection request received: / 6f�7! 11
Queensbury Building&Code Enforcement Arrive: t am/pm Depart am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: e //1 c
NAME: O V (j I�� PERMIT#
LOCATION: ] r n Arcr1 i fLa tq_b INSPECT ON: J1 I
TYPE OF STRUCTURE:
N NIA COMMENTS:
Framing �w
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 %(w) 16 gauge (8) 16D nage each aide
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, Z 3 hour
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed
16 inch emulation in cavity min.
Garage Fire Separation
House side 3 inch or 98 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:1Buibhg&Codes Forms-OlDl6 JMmQ&Codes\nspedion Fennel/Framing Firestopping inspection Reportdoc Revised January 7,2008
jecs
Framing / Firestoppingrose
Date ae Innsspp�lo Repo
Office No.Queensbury Building&Code Enforcement Arrive: I %,o,. ` ► rt ) a ' pm ,
742 Bay Road, Queensbury, NY 12804 Inspector's Initia)=/
NAME: VVIC/� ,. i1 -ERMIT#: 77.
LOCATION: 'S II itice., , . INSPECT ON:
TYPE OF STRUCTURE:
Y JrUA 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 %(w) 16 gauge (8) 16D nails each side
Draft stopping 1,000 sq. ft.floor trusses
IOItB 8 ft. less on center
Ice and water shield 4 inches from wall
mese , , 3 hour
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side 34 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
I.ABufdtng&Codes Forms-OIDiSulldi g&CodesUnspedion Fonn&Fruning Firestoppine Inspection Reportdoc Revised January 7,2008
(ear/ter) 2l0 o-
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: , am/pm Depart{o `-cam/pm
742 Bay Rd.,Queensbury,NY12804 Inspector's Initials: L^T
(J �'
NAME: a oh PERMIT#: Y1
LOCATION: /� �_ INSPECT ON: fj �7 /
TYPE OF STRUCTURE: tier
,
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 Dampproofmg
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
• 1 •es above footing
mil ',sly for wet areas under slab
iE Backfi -.royal 7
rsg nderSlab A. �h
vfits2ac1 t F ( -b
Foundation Insulation Interior/Exterior A—C
R-
Rough Grade 6 inch drop within 10 ft.
L•\Building&Codes Forms\Building&Codes\Inspection Fonns\Foundation Insperoon Report.doc
Last printed 12/2W2005 9:24:0D AM
Foundation Inspection Report
Office No.(518)7614256 Date Inspection u> :,
Queensbury Building&Code Enforcement Arrive: "1 rpm ,i , -per: Wait, pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Im, �,
NAME: If /1ERMTT#: / .
LOCATION: D f ,� t ' INSPECT ON:
TYPE OF STRUCTURE: 0 — /l `
Comments
Y N
Footings,-
Monolithic
ootingsMonolithic 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 Doirals or Keyway in place
Foundation DamI proofing
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:1BuRdIng&Codes Forms\Building&CodesgnspeWon Forms\foundation Inspection Reportdoc
Last printed 12/20/2005 9:24:00 AM