HomeMy WebLinkAbout2914_1_001_178.52-2-19.1_313_JEFFERSON STREET_NA . . •
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CERTIFICATE OF OCCUPANCY N° 4 2 08
CITY OF SARATOGA SPRINGS, NEW YORK •
Building Permit No. i 5 9 9 s Date Issued I �..I.. '.I 9
Owner j Ifl MG AL.C.Ivr .�'G'
Address .3I 3 TEF-PErzsc t S 7i7 •
Fax Map I.D.Number •
This is ro certify that the NL ^'L 6- 'i= eD 3 t ,0fl i N&
named above" is in compliance with applicable codes, ordinances, and approvals, and is ready for
• occupancy as a tom- t l ACI GO FAH RE SI OeQC 4
The JOIlowing items are conditions on issuance of he certificate:
ASV?'
Date 8l, t Building Inspector
CITY OF SARATOGA SPRINGS
BUILDING DEPARTMENT (518)587-3550
INSPECTOR REPORT
Job Site 3 ) 3 3*E19% s% 51 Permit# S C3 (‘'cd.{ File# Zci L(
Footings Foundation Insulation
before before Rough Rough before Septic Other
Concrete Backfill Framing Plumbing Sheetrock
PV47, C-.0-
(Passed Reinspection Failed
Required Stop Work
Inspection Date eilidl Inspector T3'(3. 1 C k EY
CITY OF SARATOGA SPRINGS
BUILDING DEPARTMENT (518) 587-3550
INSPECTOR REPORT
Job Site 3 3 0.1:er-FCPa S-r-Eiso Permit# f V` File# c;-i i 4f
Footings Foundation Insulation
before before Rough Rough before Septic Other Final
Concrete Backfill Framing Plumbing Sheetrock
— '0 Lat.6T ?(C `) Fr i C( 5o t 00-11_ D i S
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Passed Reinspection Failed
• Required Stop Work
Inspection Date 0 c iuc.G25 t Inspector fc4-v'-1L c t
CITY OF SARATOGA SPRINGS
- BUILDING DEPARTMENT (518)587-3550
INSPECTOR REPORT
Job Site 3/3 3 'ee--54►-' 37 Permit# ) 8 19— File# Z -1L-1
Footings Foundation Insulation
before before Rough Rough before Septic Other 45
Concrete Backfill Framing Plumbing Sheetrock
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Passed Reinspection Failed
Required Stop Work
Inspection Date J 1(o I(. 1
Inspector 133 14 t cfG zy
ex
Engineering America Company Quick Letter
P Y—
23 Church Street
Saratoga Springs, NY 12866
(518) 587-1340 Phone
(518) 580-9783 Fax
georgey0?nycap.rr.con►e-mail •
August 3, 2001
Mr. Mike Biffer
Building Inspector
City of Saratoga Springs
I Saratoga Springs,NY 12866
Re: McAllister Residence
Jefferson Street
Dear Mr. Buffer:
This letter is to certify that the pilasters built into this foundation are structurally sufficient and, in
this case, do not have to go all the way to the top of the foundation. The attached sketch shows
that the pilasters go to grade level— in this case that is sufficient.
If you have any questions concerning this change please give me a call.
Sincerely
.Q
• .:<• "-z (k,,,,, , ,
•,. -0,,...:t.6,7/
kir:-.- ez'i ..:,,,-;...i,,, 5 r; A
George Y enc ,PE,,NSPEr
P .y.} f: h fj1
Cc: McAllister
Mc 4-/A,fize ,
(g-AOP
1 025"'I( )
B4.ece ce/I-41-
fiu
rao
t CITY OF SARATOGA SPRINGS
BUILDING DEPARTMENT (518) 587-3550
INSPECTOR REPORT
Job Site 5/...... ;/�i - O/v —. Permit# ti v
9 �
/63 914 ,C/0 7'--.
Footings Foundation Insulation
before before Rough Rough before Septic Other Final
Concrete. Backfill Framing Plumbing Sheetrock
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Passed Reinspection Failed ,
Required Stop Work
Inspection Date C7 K42. e::,,. .) Inspector . .- , �...,��F e
1CITYOF SARATOGA SPRINGS
BUILDING DEPARTMENT (518)587-3550
INSPECTOR REPORT
Job Site X? =7FIzUi Permit# t"c... 5 File# it
Footings Foundation Insulation
before before Rough Rough before Septic Other Final
Concrete Backfill Framing Plumbing Sheetrock
, 1
61 4- t oe,Ot,ccriSe k%-s-1--t -C.) ipr-4 c2g --`1:7r--.
411rPassedA. 0211r.s, Reinspection Failed
Required Stop Work
Inspection Date ) .`'L000 • Inspector .Le.isok4 ata, tr 41-1.-
/4
p.ti1 .-/4
CITY OF SARATOGA SPRINGS J
BUILDING DEPARTMENT (518)587-3550 /
INSPECTOR REPORT
Job Site S4� - 2�,� 'Sr Permit# 115:15 File# jit 14
Footings Foundation / Insulation
before before Rough" Rough before Septic Other Final
ncrete Backfill Framing Plumbing Sheetrock
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Passed Reinspection Failed
Required Stop Work
Inspection Date /�(°0o Inspector nntit4 1-L/�L.:.'
CITY OF SARATOGA SPRINGS �.
BUILDING DEPARTMENT (518)587-3550
INSPECTOR REPORT
Job Site r- Jrr s c .) -r Permit# 'Efr S File# 2tzt
Footings Foundation Insulation
before before gh 4'ough before Septic Other Final
Concrete " Backfill Framing Plumbing Sheetrock
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Passed Reinspection Failed 7 .
Required Stop Wor
Inspection Date i1 Inspector ` 6 >+4tpyL.1. 2 5b'?I
• CITY OF SARATOGA SPRINGS
BUILDING DEPARTMENT (518)587-3550
INSPECTOR REPORT
Job Site 3 1 3 .S Lz t_w,s,i./ S'T Permit# 7' 1' File# 2131/
Footings Foundation — Insulation
before before oughRough before Septic Other Final
Concrete Backfill Framing Plumbing Sheetrock
ME2c -?'(2,•-)S 5 C- T( f ti
71445 l J./S PC: r(t,
Passed Reinspection Failed
Required y Stop Work
Inspection Date 512,1 00 Inspector
1�
CITY OF SARATOGA SPRINGS
BUILDING DEPARTMENT (518) 587-3550
INSPECTOR REPORT
Job Site 3 1 jisFec,2S J sTruArrPermit# C ??7, 7S File# ;9/ (fr
Footing Foundation Insulation
before before Rough Rough before Septic Other Final
Concrete. Backfill Framing Plumbing Sheetrock
I D ` .Dt tP044-(5). rn Svt Tixt3 6s w-/ 6'( Fe-D-7- eivAvs
e _ i p pm
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Passed Reinspection Failed
Required Stop Work
Inspection Date 14 /G'fl Inspector 'atLS
CITY OF SARATOGA SPRINGS /
BUILDING DEPARTMENT (518)587-3550
INSPECTOR REPORT
Job Site 3 3 -1 1-r: ��s1Q.5C Situtrer Permit# 1? ! I c File# /
Footings Foundation Insulation
before before Rough Rough before Septic Other Final
Concrete Backfi Framing Plumbing Sheetrock
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Okis Passed "1-1-kECIfFNG6. Reinspection Failed
3. A flit--or-4 F J Vf4TLex.) Required • Stop Work
Inspection Date I I 1 a c 4,a Inspector ` ,
-:ii / , CITY OF SARATOGA SPRINGS
BUILDING DEPARTMENT (518)587-3550
INSPECTOR REPORT
Job Site 3 1 3 3 E .5so ) 5I Permit# 1 8 c 5 File# 71"451k L,
ootings Foundation Insulation
before before Rough Rough before Septic Other Final
C. cret- Backfill Framing Plumbing Sheetrock
l0 1c, .4 L i `-F
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Paed Reinspection Failed
Required a Stop Work
Inspection Date z, g �I Inspector gre-(0 ���,,.;e9.,c„
r
APPLICATION FOR PERMIT FOR
INSTALLATION OF A PRIVATE SEWAGE DISPOSAL SYSTEM
8357 _ -
Building Department, Department of Public Safety 091 L
APP. NO. City Hall, Saratoga Springs, New York 12866 - (518) 587-3550
FILE NO.
FOR OFFICE USE ONLY .
APPLICATION DATE q Z q Y N _ SOIL DISTURBANCE ACTIVITY PERMIT
PERMIT NUMBER ji - • Y _ N _ FLOOD HAZARD DEVELOPMENT PERMIT
• PERMIT DATE
CONDITIONS n Y _ N D.E.C. PERMIT
Y N --7 STATE HEALTH DEPARTMENT PERMIT
Y _ N — OTHER
Application is hereby made to the Building Ins
installation of a private sewage disposal s Pmector for the issuance of a permit for the
stem
property in the City of Saratoga Springs, Y (including any part thereof) on a private
of the City of SCty a apursuant to Chapter 97, Article III, of the Code
09 Springs. The owner, applicant, and contractor agree to comply with
all applicable State and Local Regulations and. Ordinances, and all conditions expressed on
this application, and will allow all inspectors to enter the premises for the required
inspections. The following regulations shall also!apply:
A. This application must be filled in completely and submitted to the Building Inspector.
B. The application must be accompanied by:
1. A plot plan, to scale, showing: lot configuration and dimensions; all buildings or
structures on the lot and their distances to one another and to the lot lines; --arid
including a detailed sketch and description of thero
location of and distance to any existing and ro p Posed sewage disposal sys't'em;
y �a, etc. on this site or on contiguous sites. P posed wells, any waterways, ponds,
2. A permit fee of sale; make check payable to "City of Saratoga Springs".
:„ ...y 3. Proof of the contractor's liability insurance, specifying
• less that $1,000,000, with the City as "AdditionaInsured"; OR proof ofimits of aanlowner's
and contractor's protective liability'
liability not less than $500,000 each o currenceance both foY rlpecif inglimits of
bodily injuryand ro
damage, and with the City as "Named Insured". P perty
4. Results of percolation tests and deep hole tests.
C. Construction of the proposed system shall not commenceprior to
D. Any deviation from the approvedpanpermit issuance.
subject to the same procedure esabl shed for must bthee uexaminatdionyoftithe original
E. The BuildingInspectorBuilding Inspector,
is authorized to inspect thef col plan.r
and in any event, work at any stage of construction,
gent, the permit applicant shall notify the Building
work is ready for final inspection and before an underground Inspector when the
backfilled. Inspection of the system shall be made a within forty-eight
are covered or
notification to the Building Inspector of the need for inspection.eight hours of proper
F. In accordance with Section 97 - 11, the owner shall o
in the
sewage disposal facilities in a sanitary manner' at ally ate t mes,a � at malnoaexpen e t ovthe
City.
G. In accordance with Section 97 - 10, at such time as a public sewer becomes available to
this property, a direct connection shall be made. to the
applicable City Codes, and this private sewage disposal
Public sewer in .compliance with
filled with suitable material, in accordance with generally accepted ractices.
system shall be abandoned and
JOB SITE 3133'4FER3oN 617
SYSTEM COST 2.4.000 . dslr,
NUMBER OF BEDROOMS
GARBAGE DISPOSAL - YES NO -e_.,_" _
OWNER Proves kc- A i 51•
ADDRESS off i!,_ ii sod Rd PHONE ( 732) 30—pi�{
SIGNATURE -bSt IVe-Y
Pl'
� rJ . 0 "r&
DATEI Ci q C�
APPLICANT •
7
ADDRESS PHONE ( )
SIGNATURE
DATE
CONTRACTOR PC- L•lcn .• L CCA-%/ rt(Tvc,
ADDRESS • PHONE ( ) 3 t44
SIGNATURE
DATE
ENGINEERie ilSePCH/
LICENSE # PHONE
/�UC�L°ie/icj&'/7160/ (�l`� ) 5E37'1310,
023 �f �, • y i���� /a8 "
ADDRESS ( ,
l
0
TABLE
5
REQUIRED LENGTH OF ABSORPTION TRENCH
` (based upon 2 ft. wide trench)
i
Flow Rate (Gals/Day)
Percolation
Rate 2 bedrooms 3 bedrooms 4 bedrooms 5 bedrooms 6 bedrooms
Min./Inch
220 260 i 300 330 I 390 1 450 440 i 520 I 600 550 1 650 1 750 660 I 780 I 900
1 - 5 92 108 125 138 162 187 184 216 250 230 270 312 275 325 374
6 - 7 110 130 150 165 195 225 220 260 300 275 325 375 330 390 450
cu
-0 8 - 10 123 145 167 184 217 250 245 290 333 306 360 417 367 433 500
co
11 - 15 138 162 188 207 244 281 275 325 375 344 406 469 413 488 I 563
0 16 - 20 158 186 214 236 279 321 315 372 429 393 464
536 472 - 557 643
21 - 30 184 217 250 275 325 375 367 433 500 459 542 625
550 650 750
31 - 45 220 260 300 330 390 450 440 520 600 550 650 750 660 780 900
46 - 60 245 290 333 367 433 500 489 578 667 612 722 833 734 867 1000*
Dosing Not Required Dosing or Alternate Design Required
•
*Greater than 1,000 ft. of trench requires Alternate Dosing
,
3
50GA'S
y
"4,
ti C tit of 5arain a Syringe
'fi y c PLANNING BOARD
CITY HALL
474 BROADWAY
SARATOGA SPRINGS, NY 12866
TELEPHONE 518-587-3550
MEMORANDUM
TO: Michael Biffer, Building Inspector 477 3
orksJoseph O'Neill, Director of Public W
FROM: Geoff Bornemann, City Planner U
3'_Z
DATE: 3-1-n
• SUBJECT: Approval Planning Board Plan
Attached for your files is a . copy of the plans approved by the
Planning Board and signe by the chai an for:
Project Name: Aak
6G' ��`"/
Address: c // dkriVS 67
Project Type: . 2 (27-
(-c%/vGl/YOfXj
This approval of the plans indicates that the necessary financial
guarantee (letter of credit) , unless waived, is in place.
Please note this project will require:
Building Permit:
Street Opening Permit
Utilities: v/
Other Improvements in ROW:
DPW Construction Inspection:
City Engineering Office
Construction Inspections: l/
If you have any questions, please contact me.
GB/r
P. Male, City Engineer
ENGINEERING AMERICA 5185873367 P. 01
I
4c� i
g •
January
4
2000
i 11
w Attn': Mr. Mike Biffer ! ,
t r Building Inspector • ,
i, '��► W City of Saratoga Springs Building Dept.
'• �' _ City Hall,474 Broadway
23 Church St. Saratoga Springs,NY 12866
Sarat a Springs
�
New York, 12866 Re: McAllister Residence Foundation
Jefferson St., Saratoga Springs,NY
! Dear Mike,
Engineering America Co. has been asked to review a construction
change made to the McAllister residence foundation. The following details
the revision and my professional opinion of that revision:
According to the contractor, a 10"block wall was installed instead of
the 8"poured wall originally specified on the P.E, certified construction plans.
A 10"x 20"footer was installed, instead of the 8"x16" footer specified for the
poured wall,and was inspected and approved by the City of Saratoga building
• department.
It is my professional opinion that a 10"block wall placed on a
10"x 20"footer is a local industry standard for residential construction and is
structurally sufficient when constructed properly, including the required
anchor bolts, rebar and pilasters.
This letter should be attached to the construction plans as a permanent
addendum. Please contact our office with any additional questions or
}
comments about the construction of this residence.
Sincerely,
l " j
George liYasenchak, P.E.
GMY/tly
Cc: I McAllister
. j
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File No.___121.11__
q(
APPLICATIONFOR BUILDING PERMIT -- CITY OF SARATOGA SPRINGS
• Building Department, Department .of Public Safety
City Hall, Saratoga Springs, New York' 12866 -- [518] 587-3550
Application is hereby made to the Building Department for the issuance of a Building
• Permit pursuant to the N.Y. State Uniform Fire Prevention and Bulding Code for the
construction of buildings, additions or alterations, or for removal or demolition, as
herein described. The applicant or owner :agrees to comply with all applicable laws,
ordinances, regulations and all conditions expressed on this application which are part of
these requirements, and also will allow all Inspectors to enter the premises for the
required inspections. The following regulations shall apply:
A. Application must be filled in completely and submitted to' the Building Department..
B. Application must be accompanied by:
1 . Plot plan showing lot dimensions; buildings on the lot and their distances to one
another and to the lot lines; and a detailed description of the layout of the
property.
2. Complete set of plans showing proposed construction and a complete set of
specifications.
3. Appropriate permit fee.
C. Work covered by this application shall not commence prior to permit issuance.
D. Occupancy of a building or premises to which this application applies shall not occur
prior to the issuance of a Certificate of Occupancyby this Department.
E. Any deviation from approved plans must be authorized by the approval of revised plans
subject to the same procedure established for the examination of the original plans.
F. Building Department shall' be notified _
in advance
to the required schedule of inspections, whichmshall'notice includehbut snot limited]toccording
1 . Foundation footing before pouring concrete ,
2. Foundation before backfill
3. Secure surveyor's location of foundation and submit to Building Department
4. Plumbing, heating; framing, electrical and insulation before closing in of work.
5. Prior to occupancy, final inspection for Certificate of Occupancy.
G. All electrical work needs inspections by and a certificate of compliance from an
approved inspection agency.
H. The building .permit is effective for one year from the date of issuance u�
conditioned for r, lesser period of time. Mess
' For office use Zoning Informations
Application No. 31354, Zoning District (,t
Permit No, g 2 Sect-Blk-Lot/fig 5a a
Date Applied ' > Lot Width 1'63'67" 0z QC,Pe4
=��r � Lot Area
Issue/deny dat- rip. r- No. of Bedrooms .
Permit type, E{�N 1�1 1st Floor Area o
Permit fee J3 No. of Stories
2nd Floor Area ®,
Bldg. Height • /7 ----- � �y/
p Basement Area
Job Site./J •�'e cx0S--, Yard Dimensionsfor Principal Building
Front • Rear Left
�, Right
+ Owner ✓ rl_A% Al k accessory Buildin
_ Distance To
Address , �vmspru`�p Principal building Left lot line
Address
Rear lot line
i Right lot line
Phone 732 l�ly•_ _9
�, Is ob site in a floodplain?
+ Applicant j yes_ no
Address Is job site in a historic district? yes no
Phone
owtf Construction Costs
+ Or�27Basic Improvement '±
Address __ Y 9 Electrical
Ave 7�7 $
�o tea,. / r Plumbing
Heating
Phone _.3_§..5. 1 �3 Other
Comp. Carrier TOTAL COST
s -- roc- .
Policy No
•
4 - _
PAGE 2
SPECIFICATIONS & MATERIALS CHART
r --
.GENERAL SIZE MATERIAL SPECIFICATIONS OTHERsh
FOOTINGS / X Q
1(
�l0 �J CoNC(ze' 3ooD• psi
DRAIN
going to: ---
SLAB /-1,I 6O0cze? . 2 ry�y�
FOUNDATION WALL (/(/� psi
u 'i xeD eatwee ._ 3DDa Psi
InnA3Pi4 f}Lr-
WATERPROOFING
seAteg_
VENT
"�v AVDe22iu 203
COLUMNS, PIERS
/0 a 3Parlige, eo,vel ere. 3Poapsi
GIRDERS
3) V/O SPS
EXTERIOR WALL STUD
otX 6 5PF / ,I o.c.
INTERIOR WALL STUD
.7)11
SPr. /60 o.c.
FLOOR JOIST, 1st FLOOR
FLOOR JOIST, 2nd FLOOR
CEILING JOIST __ _
ROOF RAFTER _- O,vir
COLLAR TIES _
o.c. /
o.c.
RIDGE
—
FLOOR SHEATHING Aie Pt/
WALL SHEATHING yZ k
ROOF SHEATHING O^ A" W OL r
INSULATION SIZE
MATERIAL I VAPOR BARRIER
R-FACTOR
FOUNDATION - OUTSIDE
FOUNDATION - INSIDE yoiriv
/d
UNDER SLAB J/z _� J-�OLy
I
EXTERIOR WALLS a n.
Pile/filIfS15, 249
CEILING/ROOF r
, meteeitsS _ R-3D
FINISH WORK SIZE '
MATERIALUNDERLAY
_..__... -- ... _...._ ..... _ ..... .__. OTHER
EXTERIOR WALLS
SBD wA yL S./D,,U6
INTERIOR WALLS /''
. . ..W i
FLOOR _
Aw/ g
CEILING ��'rt
ROOF `3✓��
/-1�,A-55
MISCELLANEOUS ����
SIZE MATERIAL
__---__
L
•
/ ,
Page 3
HEATING SYSTEM PLUMBING - .# UNITS & VENT SIZE
TYPE OIL i' "- FUEL �.
SINKS LAVORATORIES io:2d.
VENT-MATERIAL SIZE .
TOILETS__ TUB/SHOWER oZ
SEWER - TYPE - CITY 41111)
/.41�eoeNto SP�rl�° ' rTp�
DESCRIBE (DRAW ON SITE PLAN)
WATER SUPPLY - ITY n1e ,4 Sio.____5 PRIVATE
CHIMNEY AND/OR FIREPLACE : MATERIAL /114-
.
�gie FLUE SIZE
GARAGE TYPE : ATTACHED DETACHED
1._ UNDER NO. CARS of:2-
GARAGE/DWELLING SEPARATION : Door Type
Hr. Fire Rating
' Materials:
/ � Hr. Fire Rating
PORCH: FOOTING _%9 'dO, An7e SII,U/ FOU ,
. NDATION
• ADDITIONAL INFORMATION:
STATE OF NEW YORK
County of fs-- as:
being duly sworn deposes and says that he is
the applicant previously named. He is he
o
owner or
and is duly authorized to perform or have performed the saidfwork dand to make and
file this application; that all statements contained in this application are true
to the best of his knowledge and belief, and that the work will be perfolmed in the
manner set forth in the application and in the plans and specifications filed there-
with.
Sworn to before me
G
This day of a
uoe 19.1 .4 /
Not- 4 , yr ' gat____ _ k + Sign�a�4 re o ._,.r
c County L'�
:nat a o Applicant
PAGE #4
Date Location �Pc�rmit/F iJ.o No.
LOCATE MAIN BUILDING, ACCESSORY BUILDINGS, AND ANY ADDITIONS,
GIVING ALL PERTINENT YARD DIMENSIONS.
•
•
REAR LOT LINE ft
A
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REAR .
YARRto
73t .
.
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LOT RIGHT
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lq� ,ft _ LOT
ReAok LINE
oeeK • T /9i=3 ft
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5661
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MAIN YARD --- J _4 r--- RIGHTf
crimpy:- BUILDING
)- YARD.
5(n'o"
ti ?oeol=t7' 1
oveRM a&,
FRONT
Dr
V
FRONT LOT LINE/03' ft
F i
JOB LOCATION: I3 ciiFFEf50,1 y
4-gm-To 643 9f r
LICENSED PROFESSIONAL ENGINEER OR REGISTERED ARCHITECT:
NAME: )45eA,C1/4-g-16-06-/Peeie//)& , ei q
ADDRESS: 0? 3 f fe7N ST,, /Ul/
PHONE: ,57 g/5- J,/3 l
OWNER:
NAME: //17 /ne.,,4///sTe1
ADDRESS: 021 e-Z'r-nsan /Edi Zit& S /l/i iQ, <vJ 07739
PHONE: 4 73 / 3e) 0/W
THE UNDERSIGNED HEREBY CERTIFIES THAT HE
HAS PREPARED AND/OR REVIEWED AND MODIFIED
THE ATTACHED PLANS AND SPECIFICATIONS
FOR SUBJECT BUILDING AND CERTIFIES
THEY ARE IN COMPLIANCE WITH THE
NEW YORK STATE
ENERGY CONSERVATION CONSTRUCTION CODE.
•4 revf
SEAL AND SIGN UI3. REGISTERED: ARCHITECT
OR LICENSED �ROiESSIONAL'°ENGINEER
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Building&
A a ,' PUBLIC SAFETY DEPARTMENT
Plumbing
, CITY HALL Codes
•c�APWi4i C0 5
Saratoga Springs, New York 12866 Zoning
Telephone 518-587-3550
THOMAS J.CURLEY MICHAEL J.BIFFER
Commissioner Fax 518-587-1068 Building Inspector
ROBERT G.KING ROBERT W.HICKEY
Deputy Commissioner Asst. Bldg. Inspector
October 25, 1999
Mr. James McAllister
21 Rumson Road
Little Silver, NJ 07739
RE: 313 JEFFERSON STREET
Dear Sir:
I have reviewed your application for a building permit for the property referenced above. In order to issue
your permits, the following items will be needed:
o✓ 1. A survey prepared by a licensed surveyor showing the proposed location of the
building, etc.;
'2. A building permit fee of$286.56 payable to the Commissioner of Finance;
L-3. A septic system permit fee of$100, also payable to the Commissioner of Finance;
I.4. The amount of construction costs for building permit and septic system will be
needed;
5. And, your contractor's liability insurance and worker's compensation coverage.
(Please contact this office regarding these coverages.)
Once the above items are received I will be able to issue your permits. Please note that your plumber who
needs to be licensed will also need a permit for his work.
Yours truly, •
12,LA-
Robert W. Hickey
Assistant Building Inspector
RWH/jb
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4029 Application for Exemption To be filed in duplicate
way.January 1579) from Tax on Self-Employment Income �
evenue Unice
MDuarussal iami AMMO kMWwith the Internal
a,O Oand Waiver of Benefits
Nome of ,8olal security or number
X96 G45
. .
f_. 1 _ 0.11E0_ -
•
'Nu - and street or rural route -` 0 s
Chir
or town.state,end ZIP code / S O
• Caution: Form 4029 is not proof of the right to an exempt ion from Federal income tax withholding or social security -
tax on employees.
.
Before you file this form, please read Instruction A, Who May File.
1 certify that 1 am and continuously have been a member of. .� a'•'= d. =.:
�(Nama or nualp�ie Group)
�, ,e- gam :---....e.,e-i-v+•M
.._-t itaCr �..o- tl rr misted and beadan)
f .Iqedand as.8 fnllowec.ottbe4 haved.teachlaesatsrat growl_1 .co"- - i
i'' Since oel) atone)) peen
in the event
' • scientiously opposed to accepting benefits of any private or public Insurance which makes payments
of death, disability, old-age, or retirement or makes payments toward the cost of, or provides services for, me`di•
• cat care (including the benefits of any insurance system established by the Social Security Act).
payingself-employment tax on my earnings from seif•employment,•
fromP
I request that I be exempted
under section 1402(g)of the Internal Revenue Code.
I waive all rights to any social security payment or benefit under Titles 11 and XVIII of the Social Security
Act. I understand and agree that no benefits or other payments of any kind under Titles Ii and XVIII of the Social
Security Act will be paid based on my wages and self•employment income to any other person. I certify that
I have never received benefits or payments under the above Titles, nor has anyone else received these bene,`
• fits based on my earnings. •
I agree to notify the Internal Revenue Service within 60 days of any occurrence which results in my no longer
' being a member of the religious group described above, or in my no longer following the established teachings
of this group. .• rOtl• s
y r,
Furthermore, I understand that if any tax exemption under section 1402(g) °�f;the l'itegrsa( RetrgflurGode
ceases to be effective, this waiver will also cease to be effective, but only to the a)iteht that't en fits'tett.be
•
• payable only on the basis of my self•employment income for and after the first taxable year in which the exemp-
tion ceases to be effective, and my wages for and after the calendar year beginning in or with the beginning of
•
• such taxable year.
• 4;aii 20198
The first year I became subject to self•emptoyment tax was (Show"NONE"_if you were never
subject to this tax). ar'an L:.: Ph:L As A;,
Under penalties of perjury. I declare that I have examined this application and waiver and to the bestpfmy knowledge and '
• belief it Is true end correct. :
• ed r. 1 I. " _fl/,..OV Dated .. 19 . rL
Icertiythat ._. -5., a member of .1�'4r"�a.r� �:7 ,
, (Name or Taxpayer) (Na Ilre group)
r
/ �.
en
• Name Of Authorized Representative%=/ _ � t--
G�ti^a , /� a N►ddreW
r
Moisture el Authorized RaVresentative _...._._ ..
• (Tit � (D.t.d)
For Internal Revenue Service Use aproved for exemption from seif•empioyment tax(see Caution above) COPY B
c13( proved for exemption tr self•emp�y t tax
To be Returned
OLa��-.i By to Taxpayer
• (Director's sinters) (Oats)
Farm 4029 (Rev. 1-79)
1st WOOdUlCoh,
.‘ Ark,
111!. .....
. - 11_8331B I ! 03 03 '
1644 Georgetown Rd. • Christiana, PA 17509
rbmac / 02 - a5
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550 APPLICATION FOR PERMIT FOR
INSTALLATION OF PLUMBING
(�C,-'"�9/
APP.NO.
Building Department, Department of Public Safety FILE NO.
City Hall, Saratoga Springs, New York 12866 - (518) 587-3550
C 1FOR OFFICE USE ONLY
APPLICATION DATE -1 `-� PERMIT NO. cj l5`�
T PERMIT DATE A!._±„.3:1
CONDITIONS
PERMIT FEE IAL{2,5o
Application is hereby made to the Building Ins
of a
permit for the installation, alteration, or repair ofctr r a the plumbinge system
(including any part thereof) within a building or structure onprivate property
in the City of Saratoga Springs, pursuant to Chapter 83, ArticleIII of heode
of the City of Saratoga Springs. The owner and contractor agree to comply with
all applicable State •and Local Regulations and Ordinances including all
applicable provisions of the New York State Uniform Fire Prevention and Building
Code and all conditions expressed in this application and will allow all
inspectors to enter the premises-for the required inspections. The following
regulations shall also apply:
A. This application must be completed and submitted to the Buildin Ins
B. This application must be accompanied by : 9 pector.
1 - As needed - plans and/or schematics of the proposed plumbing system(s) .
2 - Copies of the master plumber's license and his current registration.
3 - Proof of the master plumbers liability insurance, specifying limits of
liability not less than $1,000,000 with the City as "Additional Insured";
or proof of an owner's and contractor's protective liability insurance
policy, specifying limits of liability not less than $500,000 each
a currrenncceiboth
edfor bodily injury and property damage, and with the City
4 - The appropriate fee as calculated on the reverse side of this form.
• C. Plumbing work for which this permit application is made shall not commence
prior to permit issuance. Minimum 24 hr. notice required for all inspections.
D. Required inspections may include but are not limited to:
1 - A pressure test on piping of the potable water supply system
prior
to
covering or concealment; test pressure shall be equal to at least the
maximum pressure at which the piping is to serve.
2 - Water pressure tests) on building, drains, drainage and vent piping,
prior to covering or concealment; test pressure shall be equal to at
least a 10-foot column of water.
4 JOB SITE 5/3 \ • //
' fl*4"` - COST OF PLUMBING WO -�
p7S
OWNER Q� , PHONE ( 7 3,Z) 5 3 L,
ADDRESS 3 I i /
:, � �{
SIGNATURE 'i'f GLS/ ���► l
DA, E
•MASTER; PLUMBER
PHONE ( 571- ) S��(-q13
ADDRESS °� AL.
SIGNATURE (..1
DATE yr7
CALCULATION OF
PERMIT FEE FOR INSTALLATION OF PLUMBING WORK
BASIC CHARGE BY OCCUPANCY TYPE:
(a) PENT - NO. OF DWELLING UNITS : t X $15 PER UNIT = /5 (a)
(b) TRANSIENT - NO. OF SLEEPING ROOMS : X $15 PER ROOM =
(c) COMMERCIAL - NO. OF TENANT SPACES (b)
: X $30 PER TENANT = (c)
(d) ALL OTHER - NO. OF BUILDINGS X $30 PER BUILDING =
(d)
INDICATE QUANTITIES OF EACH FIXTURE AND/OR PLUMBING COMPONENT BELOW TO DETERMINE
FEES IN ADDITION TO THE BASIC CHARGES:
- WATER CLOSET r
- BIDET
- URINAL
- LAVATORY
- BATHTUB (WITH OR WITHOUT SHOWER) I
- SHOWER STALL /'
- SHOWERS (GROUP) - PER HEAD `
- SERVICE SINK
- KITCHEN SINK 1
-. LAUNDRY TRAY
- DISHWASHER
- HOSE BIBB
- DENTAL UNIT
- DENTAL LAVATORY
- DRINKING FOUNTAIN
- FLOOR DRAIN
- WASHING MACHINE CONNECTION l
- HOT WATER TANK 6
- HOT TUB OR JACUZZI
- ROOF DRAIN
-.OTHER
(e)v TOTAL -`
NO. OF FIXTURES AND/OR COMPONENTS : /I Cyd
L t X 42:50,EACH ITEM = -(e)
ADD ALL DOLLAR AMOUNTS IN THE FAR RIGHT COLUMN
FOR a,b,c,d, AND e ENTRIES: TOTAL FEE AMOUNT = ya
%: ^ ' MAKE CBECKS PAYABLE TO "THE CITY OF SARATOGA, SPRINGS")
FROM : {n PHONE NO. : 908+530+0338 Dec. 14 1998 03:42PM P01
1-98 P.03/04 JOH f
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