2010-334 ��` TOWN OF QUEENSBURY
`JO742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
X"
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100334 Application Number. A20100334
Tax Map No: 523400-308-006-0001-053-000-0000
Permission is hereby granted to: SAMUEL&VIOLA WAHNON JR
For property located at: 17 WARREN Ln
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: SAMUEL&VIOLA WAHNON JR
1304 ROUTE 9 Single Family Dwelling $152,000.00
GANSEVOORT,NY 12831-0000 Total Value $152,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-334
1680 sq ft single family dwelling
$201.60 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,July 15, 2011
(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 Queep,sbury; Thursday,July 15,2010
SIGNED BY - for the Town of Queensbury.
Director of Builduune&Co'Enforcement
1
r..• ..srr1nio
YO8 '/' OFFICE USE ONLY
TAX MAP --NO. � PERMIT NO. /D 332/
FEES: PERMIT,O/ RECREATION ENGINEERING
(If applicable)
PRINCIPAL STRUCTURE: APPLICATION FOR ZONING APPROVAL & BUILDING
PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO REVIEW
BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.
APPLICANT/BUILDER: Loki PA PACE 0----' OWNER:
ADDRESS: 3q.,� C v i ,.Vq,c. 12 ,,ADDRESS:
PHONE NOS. 9.226 ^Q'1 O PHONE NOS.
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE:�-�k1 I WOI4iii9AJPHONE: RIr2O 1
LOCATION OF PROPERTY: 11 (1 )� iC L4Me (;`bt�ioI - s 1u a\- !V 1 -
HAS THERE BEEN A SITE PLAN REVIEW;VARIANCE OR SUBDIVISION APPROVAL? YES ❑ NO
IF SO, INDICATE APPLICATION NO.AND DATE OF APPROVAL: QIP' ZV )O 1-1"-"2-:)------1 0
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT z
APPLY TO YOUR z cO O O 0) a LL•w
PROJECT O O O = _
W
o- C7
V W L Q U
LU 0 � � d °z d F- - O ~ � wZ
Z Q Q B co N UJ O LL H LL 0.. 1 ea
SINGLE FAMILY (c .-o i/ft- �_ lc
TWO-FAMILY
MULTI-FAMILY
(NO.of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACHED
GARAGE(1,2,3)
OTHER
Town of Queensbury * Community Development Office * 742 Bay Road, Queensbury NY 12804
Revised 4/14/2010
IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS: /V//7
ESTIMATED CONSTRUCTION COST: /3 2OGS O,b FUEL TYPE: Sh
n �q tt11
HEAT TYPE: [161 )/Z J/Z *HOW MANY FIREPLACE(S): NQ)6'e AND/OR WOODSTOVES(S): /v Ok\
ZONING CATEGORY: . r ARE THERE WETLANDS ON THIS SITE? /`-' (7
IS THIS A HISTORIC SITE? N
PROPOSED USE OF BUILDING OR ADDITION: P@5 \ c Q N Tit 4
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? l' c
ARE THERE EASEMENTS ON PROPERTY? ye3
*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
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 above.
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)
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 761-8256 OR EMAIL
codes(' ciueensburv.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
Revised 4/14/2010
OFFICE USE ONLY
TAX MAP NO. —" ^ �� PERMIT NO. /0 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. 1
OWNER: L Li P M y2p -' INSTALLER: U 1, 1� E-•T l ' 'E x
ADDRESS: 2 k c /Cc Id1,o_t.) P-1 S v2- _ ADDRESS: 1,364] �1 t v c-1-4)\c
PHONE NOS. 1 f-ty�'7`i t� v �fe JET�/ PHONE NOS. f'7-2 r /
LOCATION OF INSTALLATION: 17 IA)f-Lecrd 140.9e 61.4.01,K.1.56tAiLy
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED? A/b
1981 -1991 X 130 = SPA OR HOT TUB
1992-present 3 X 110 = INSTALLED? /t) 0
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING t/ STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND ✓ LOAM CLAY OTHER
±
✓ GROUNDWATER: AT WHAT DEPTH? ae, r
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? gift-
✓ DOMESTIC WATER SUPLY: MUNICIPAL j WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS A)4- PER MIINUTE PER INCH[mpi]
(Test to be com leted 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: i Hipp 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
CI ABSORPTION FIELD(WITH NO.2 STONE) Total length � {f ft. Each trench X
❑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 Disp sal Ordinance. codes@queensburv.net
yL
(A 7-7-10 VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www.aueensburv.net
Town of Queensbury * Community Development Office * 742 Bay Road, Queensbury NY 12804
Queensbury Building & Code Enforcement— Manufactured / Modular Final Inspection
Office No.(518)761-8256 Arrive: am/pm Depart 10 Aram/pm
Date Inspection request received: Inspector's Initials: MI)
NAME: teCK) PERMIT it: 2c \D
LOCATION: VI WCZf,1.. \ 7 A'P- & DATE:
Manufactured Home V
Modular Home
Footings_ Foundation_ Backfill, Framing_
Comments:
Yes No WA
Foundation support,pier spacing,
Per manufacturer ,Y/
Anchoring per manufacturer 2'from ends ✓
Water line shut off V
Sewer line support @ 4 feet
Heating Crossover[doublewide}off grd. / /
Dryer vented outside , /
Skirting ventilated 1 sa.ft.ner 1.500 sa.ft. YY /
Hot water relief valve piping outside f
Deck,porches,steps,railing V
Fumace/hot water operating ✓
Garage Fire proofing ' kK,
Fire Door/Door losers
Plumbing Fixture/3"Vent through roof[Modular] 7
Foundation insulation[if applicable] V
Smoke/Carbon Monoxide Detectors/Interconnected !,/
Final Electrical
Variance required f
Data Plate okay !
Manufactured HUD seal okay yf
Warranty Seal after January 1,2006
Installers Warranty Sealij
18"x 24"access or 22'x 30"attic access V
Vapor retarder under home 6 mil poly or otherN7
911 Street number f
Okay to issue CIC or CIO[Temp./Perm.]
Model# Serial#
Manufacturer
Date of Manufacturer
L:IPam Whiting120101Building Codes Forms\Manufactured Modular Final Inspection 03 04 10.doc
Final Survey Inspection
Dept. of Community Development
Town of Queensbury
742 Bay Road
Queensbury,NY 12804
Date received: 1 ( 2't (b
NAME: O h
LOCATION: \ W AC/41._% a LN
PERMIT#: i 0 — ' 1
Final Survey Plot Plan
Approved Denied
The attached final
survey has been
received by the
Dept. of
Community
Development.
Upon review the
survey •been:
0
.i,
Cr.. : :rown,Zoning Administrator
Notes:
L:\SueHemingway\Building.Codes.inspection.FORMS\Final Survey
Zoning Administrator.doc
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t7" R i I / 7Ast4/✓f/ensbury Building & Code Enforcement— Manufa«, red / Modul rFinal Inst tion
No.(518)761-8256 Arrive: am/pm Depart am/pm
pate Inspection request received: Inspector's Initials: . ,
C .b
NAME: /i k&o v... PERMIT#: (-i .._.�
LOCATION: / 1--)0"0(1n,., t i't DATE: , . -3/%/0
Manufactured Home
Modular Home
Footings_ Foundation. Backfill_ Framing_
Comments:
Yea No NA
Foundation support,pier spacing,
Per manufacturer
Anchoring per manufacturer 2'from ends
Water line shut off
Sewer line support ) 4 feet ' '\'�' k..-Ict
Heating Crossover[doublewide)off grd. .. "1/4.4"....;
Dryer vented outside
Skirting ventilated 1 sq.ft.Der 1.500 sa.ft. j
Hot water relief valve piping outside ' c c‘ %v'iZ `'L (
Deck,porches,steps,railing //* ..( 5
Furnace/hot water operating ��—��'' 1, `-
m
Garage Fire proofing • I,/ i (2.1. ' 6
Fire Door/Door closers �.
Plumbing Fixture/3"Vent through roof[Modular] W
Foundation insulation[rf applicable] / ------------,
Smoke/Carbon Monoxide Detectors/Interconnected ,l
Final Electrical rrj` A\C
V /
Variance required \ l
Data Plate okay
Manufactured HUD seal okay j.
Warranty Seal after January 1,2006 V
Installers Warranty Seal iit ''S, j{,i
`
18"x 24"access or 22"x 30"attic access v40,-K/
Vapor retarder under home 6 mil poly or other / ��
V
911 Street number
Okay to issue CIC or CIO[Temp./Penn.] C..\45:V/15
Model# Serial# 6,4 0 V1./1 AM
Manufacturer 1\' l P\ t K1 L
Date of Manufacturer
L:1Pam Whiting12010\Building Codes Forms Manufactured Modular Fine Inspection 03 04 10.doc
11\1 7//te)-
Septic Inspection Ree•it
Office No. (518)761-8256 Date Ins 1-•I•n =,i""�
Queensbury Building&Cale Enforcement Arrive: � Oak of
art: -11124-(-61)W
742 Bay Rd., Queensb ry NY 12804 Inspector's In • _
NAME: /d/Ui C% P �IT NO.:
LOCATION: / /_t". I ON: ` _ c)
RECHECK:
Comments and/or diagram
Soil Type: rte-." ..rg/ Clay
Type of Water: • . ell 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 .
Depth of trenches ft.
Size of Stone 2/
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank y" 5c '-kt
Tank to Distribution Box k `
Distribution Box to Field/ Pit r k"
Opening Sealed: Vlk. N
End Cap Ali' N
Inlet/Outlet Pipes&Baffles _N
Manholes 12"or less below grade Y_N
[provide extension colla(ifOAes] Y N
Location/Separations
Foundation to tank \L ft. S BUILT
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _N
Engineer Report ands-Built. Y—N
ETU Maintenance Contract Y+N
provided
Location of System o• •roperty:
Front Rear .. Side Right Side Middle Front Middle
stem - S . s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Fomis\Septic Inspection Report_03 29 10.doc
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection u- eived•
Queensbury Building&Code Enforcement Arrive: J--i-�, amd alio-v' rt: a /pm_
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: _
NAME: W W 01..__ RMIT NO.:
LOCATION: 17- L. )Q ( INSPECT ON: • — -- D
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal/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.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: _Y T N
End Cap Y N
Inlet/Outlet Pipes&Baffles Y,^N
Manholes 12"or less below grade _Y!N
[provide extension collar if Yes] Y N
Location/ Separations )\—
Foundation to tank ft. '
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _Y
Engineer Report and As-Built _Y -'IV
ETU Maintenance Contract _Y N
provided
Location of System on Property.
Front Rear -ft Side Right Side Middle Front Middle Rear
System Use SSatus•
7.7. 74(p0roved
P. '.1 Approved and needs to be re-inspected, please call the Building &Codes Office
sapproved
L:\Pa Whi .< 010\Building Codes Forms\Inspection Forms\Septic Inspection Repor .03 29 10.doc
ss---// /11 i4
Foundation Inspection Report 0
Office No.(518)761-8256
Queensbury Building&Code Enforcement Date :j •• "uestxi\received:
742 Bay Rd.,Queensbury, I spect ' p am/pm
NY 12804 Insspecto s`Initials: � :
NAME: �LOCATION: PERMIT#: 0 - 3
ji - _ -- INSPECT ON: agr ►s
TYPE OF STRUCTURE:
Footings Y N N A
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
M: `, . •se on site.
Fo - • :'ion/Wallpour
Re'#1 - ,i a, •,
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:\BuHding&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
j — ( a, ---
Foundation Inspection Report / n)./ T
Office No.(518)761-8256 Date Inspection request received: C)
Queensbury Building&Code Enforcement Arrive: am/pm Depart:1erspm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: LM A tJ ON 37. PERMIT#: I - -; -
LOCATION: I `7 L2 fJ L,rc.J`Q INSPECT ON: V5-/116)
TYPE OF STRUCTURE:
Comments
Y N ,N,LA
4-ootings
Piers 1
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 Waterproofmg
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
/0 5d
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection request received: ��t��
Queensbury Building&Code Enforcement Arrive: am/pm Depart: L J' cam/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: 611
9
NAME: 'Vtk,I'° PERMIT#: /-3
LOCATION: `J r'- C _I� INSPECT ON: VAMP"
TYPE OF STRUCTURE: f40\-1‘&T 'L:
Comment
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
7
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
Cin i ;: above footing
6 mil pol or wet areas under slab �� / 4
Backfill App i val . /... "
Plumbing der Slab —
PVC/Cast/Copper -i. Toa.kp--
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 v- Al-)°11
Office No.(518)761-8256 Date Inspection request received: ?/a-§4-0 /D
Queensbury Building&Code Enforcement Arrive: am/pm Depart:
_ pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials
k9
NAME: n PERMIT#: 0 � -3_
LOCATION: I IidO,rr-f INSPECT ON: _ .# /D
TYPE OF STRUCTURE: r
Comments
Y N N/A
Footings
Piers
Monolithic Slab
Re's .: ment in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the . _ . ent
of the concrete.
: or this purpose on site.
't) Foundation/WaLlpour
Reinforcement in Place !� t
Footing Dowels or Keyway in place
Foundation Dampproofing
5s>, A
Foundation Waterproofing
Footing Drain Daylight or Sump (- 4 'i
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:\Bullding&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
(TX 30) 10- / Z /kmites
Foundation Inspection Report
Office No.(518)7614256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart:"�� am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:etz§9 `—
NAME: /lJ(� 6'1 L--- PERMIT#: I 3 •
LOCATION: r INSPECT ON:
TYPE OF STRUCTURE: kk t31 —. ,, L
Comments
Y N N/A
Footings
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 —7-62Dq' --
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\Inspectlon Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM