RC-000263-2015 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
OL Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: RC-000263-2015 Date Issued: Wednesday, November 4, 2015
This is to certify that work requested to be done as shown by Permit Number RC-000263-2015
has been completed.
zJa'�
Tax Map Number: 308.19-1-20 2t\h
Location: 32 DIVISION RD
Owner: Clute Enterprises
Applicant: Clute Enterprises
This structure may be occupied as a:
SFD 1248 sq. ft. By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance 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 Dir6 c ng ode n} cn r
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000263-2015
Tax Map No: 308.19-1-20 REVISED
Permission is hereby granted to: Clute Enterprises
For property located at: 32 DIVISION 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
Owner Address: 6 HOLDEN AVE Single Family-New $125,000.00
Queensbury,NY 12804 Total Value $125,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Clute Enterprises
6 HOLDEN AVE
Queensbury,NY 12804
Plans&Specifications
SFD 1248 sq.fl.
PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,October 29,2016
(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 of Quue rdne tr 4,2015
SIGNED BY: /d/ the Town of Queensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
cow 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150305 Application Number: A20150305
Tax Map No: 523400-308-019-0001-020-000-0000
Permission is hereby granted to: CLUTE ENTERPRISES
CLUTE ENTERPRISES
For property located at: 32 DIVISION 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: CLUTE ENTERPRISES Single Family Dwelling $125,000.00
6 HOLDEN Ave Total Value
QUEENSBURY NY 12804-0000 $125,000.00
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-305
SFD 1248 s.f.
$249.60 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,July 28, 2016
(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 n of eens es my 28,2015
)1SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
DATE 1 r et I .c Received
Tax Map ID 50g, IR-(
TAX MAP ID -; - .20 Permit No. 2,0 - 505 .05
Permit Fee 6-6./
ZONING Rec Fee n/ 41lEf
Site Plan# v 5c�dh
HISTORIC SITE Yes No u it I, JUL 1 0 2015 Subdivision# s"
Li
SUBDIVISION NAME 1 Lot#
TOWN Ba RESOLUTION 86-2013: $850 RECREATION FEE FOR NEW DWELLING UNITS,INCLUDING SINGLE FAMILY DWELLINGS,DUPLEXES
OR TWO FAMILY DWELLINGS, MULTIPLE FAMILY DWELLINGS, APARTMENTS, CONDOMINIUMS, TOWNHOUSES, AND/OR MANUFACTURED &
MODULAR HOMES,BUT NOT MOBILE HOMES. THIS IS IN ADDITION TO THE PERMIT FEE.
APPLICANT `1 A - r= 7 OWNER S"›. c.__
ADDRESS O ADDRESS
PHONE/E-MAIL Ci ) Q aS,NDLL,ie•- max_c ti PHONE/E-MAIL L 3 1x77
CONTRACTOR COST OF CONSTRUCTION(ESTIMATED): $ l "j 0 C)'v
ADDRESS: BUILDING ADDRESS:
.�9 ._ - ��
PHONE/E-MAIL
r — Cot �b
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: - -C - PHONE
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
New 1st 2nd-_� Addition Alteration 1 floor sq.ft. 2 floor sq.ft. Total sq.ft. Height
Single Family - 1
o Family
Multi-Family
(# of units )
Townhouse
Business Office
Retail - Mercantile
Factory- Industrial
Attached Garage
(# of )
Other
1
Town of Queensbury Building&Codes Principal Structure Application July 2014
• If commercial or industrial indicate name of business
Proposed use of building or addition
Source of heat (circle one) Gas Oil Propane Solar Other
Fireplace: complete a separate application for Fuel Burning Appliances &
Chimneys
Are there structures not shown on plot plan?
Are there easements on the property? Lcjz
Site Information
a. Dimensions or acreage of lot VOCPX t c
b. is this a corner lot?
c. Will the grade be changed as a result of construction Yes ?c( No
d. Public water or Private well
e. Sewer or Private Septic System
Value of all work to be performed (labor or materials) $
DECLARATION:
1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period.
2. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and department
approval.
3. 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.
4. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of occupancy.
5. I also understand that I /we are required to provide an as-built surve • - licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupa • .
I have read and agree to the above: PRINT NAME: s 4:_ ' DATE It .s
SIGNATURE: / //L DATE 7/5 16
FOR OFFICE USE ONLY
Operating Permit Issued: Yes No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
2
Town of Queensbury Building&Codes Principal Structure Application July 2014
SEPTIC DISPOSAL PERMIT Office Use Only
DATE 7�c t S Received
Tax Map ID
TAX MAP ID 3:: A9 - ( - -24..% r rryn
�nit No.
{'� Jed ` 1 it Fee
LOCATION OF INSTALLATION ,� (/.1.:7-+'Nt0-- 55}-_ Approvals:
yBf 11l.f,N;.
APPLICANT ,1C_L i _c../ r1 a-✓Nc.._o PHONE/EMAIL -79 Lc 7.) 7
ADDRESS ,. . LO.€ rk s-u • �J -
INSTALLER/BUILDER SP1/41-117- PHONE/E-MAIL
ADDRESS:
OWNERL PHONE/E-MAIL
Address ( ,
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: �-- ,‘,Er-C-7 PHONE SL21 . li
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed Y %N
1981-1991 Spa or Hot Tub installed _Y _KII
1992 Present J t -` F.-r 5
PARCEL INFORMATION
Topography 'Flat rolling Steep slope %slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply 'Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size \ ;z.;.1 gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length 1. (..: ft.;Each trench _J2 x_ _
Seepage Pit with#3 stone How many: ;size
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received&approved. The installed system must match the septic system
layout on file—no exceptions.
DECLARATION: Any permit or a•, oval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fa or circumstanczee k•• I •r'on behalf of an applicant,shall be void. I have read the regulations and
agree to abide by these - d all requirem#it. • t own of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: `. .,s. Date: —715 l i
Signature: iTartaV. Date: 714 (t
6
Town of Que: ••ry Building&Codes Principal Structure Application July 2014
Town of Queensbury Thomas R. Van Ness
Highway Department Highway Superintendent
742 Bay Road, Queensbury, NY 12804 f Home: (518) 745-0929
Phone: (518) 761-8211 JUL 1 0 2015
Fax: (518)745-4466 David DueII
TOWN OF QUEENSBURY Deputy Highway Superintendent
BUILDING& COOPS Home: (518)745-0938
DRIVEWAY PERMIT
Date:
Applicant Name: C\ )se_r r - .
Telephone No.: 7c1 '-1 `77
Address to Be Inspected: "
Return Address: (43d*c -, F45.Je-
Applicant must show exact location and width of driveway(s) to be connected to the highway by
placing stakes at the specified location.
The Superintendent of Highways of the Town of Queensbury has reviewed this application_ The
following action has been taken:
STEP 1: ( ) Preliminary approval
NEED ( ) Slight Swale
( ) Deep Swale
( ) Level with the road
{ ) Level with the top of the paved wing
Size culvert pipe to be used (if necessary)
( ) 12" ( ) 15" ( ) 18" ( )24" ( )36"
Preliminary inspection completed by: Date:
Approval by Highway Supt.: (or) Deputy Supt.:
Upon completion please resubmit this approval permit for a final approval.
STEP 2: ( ) Final Approval ( ) Rejected
Date:
Thomas R. Van Ness, Highway Superintendent David Duell, Deputy Highway Superintendent
7
Town of Queensbury Building&Codes Principal Structure Application July 2014
It \ kk
Rough Plumbing I Insulation Inspection Report
Inspection request received a 1 ,\`2Q,t,S
Name C\\ Inspected on c 3 'LEA 5
Location 32_ 1,\V\S, P r\- Arrive [ tk:30 am pm
Permit No. Inspector's Initials /.1
Type of Structure
COMMENTS
Y N
NALr'1 �_ r4-29 �(OZ)ct
Plumbing under slab
if Rough Plumbing /Nail Plates / 3101— 28 S b Com--11)
Plumbing Vent /Vents in Place J
1 Y2 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
Insulation / Residential Check/ Commercial Check
Window Sealing f
Tyvek or Similar Exterior Sealant ,4
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
Blower Door Test
Air Sealing
Town of Queensbury Building & Code Enforcement Office No. (518) 761-8256
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256 l Z
Framing I Firestopping Inspection Report
Inspection request received: �l l'2QiS
Name: C .k J Inspected on: Q kl
Location: 32 'lv\.s.\QY\ Arrive: - l a.m./p.m.
Permit No.: 45— 305 Inspector's Initials: b
TYPE OF STRUCTURE:
N NIA COMMENTS:
fs Framing yb
Attic Access 22"x 'minimum -
Jack Studs I Headers
Truss Specification Provided 'V e310 _ 2� p (c/LA\)
Bracing/Bridging
Joist hangers � 2
Jack Post- /Main Beams • - V L
Exterior sheeting nal ed properly
12"O.C.
Headroom 6 ft.8 in.
Stairwells 36 in.or more ,
Exterior Deck Bracing
Headroom 6 ft. 8 in. -a� C
Notches/Holes/Bearing Walls
Metal Strapping for Notches Top Plate
1 1/2(w) 16 gauge(8) 16D nails each side
Draft stopping 1,000 sq.ft.floor trusses
Anchor Bolts 6 ft. or less on center ---- • /\+r\fes
Ice and water shield 24 inches from wall 1,2,3 hour ��1 l - `� t eC
Fire separation
Fire wall 2,3,4 hour
pr Firestopping
— U �ng _t 0
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side''/2 inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space/Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above/below grade
5.0 sf grade
Design Professional Sign-off, if required
Framing / Firestopping Inspection Report
Rough Plumbing I Insulation Inspection Report
Inspection request received gi gl4i I Lo-45
Name Inspected on 9 1 1
Location bw4S,,�, Arrive ,')') am/pm
Permit No. t "- CF Inspector's Initials &....—t,L-1"\--) .
Type of Structure
COMMENTS
N NA ME 2-22.— z 01
Plumbing under slab \
Rough Plumbing / Nail Plates
Plumbing Vent /Vents in Place &__A+t-Ok )
1 Y2 inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/change of direction
7/7\ ,
Pressure Test
Drain /Vent
Air / Head
1\______../2
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
Window Sealing
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
Blower Door Test
Air Sealing
Town of Queensbury Building & Code Enforcement Office No. (518) 761-8256
Town of Queensbury Building &Code Enforcement
Office No. (518) 761-8256
Framing I Firestopping Inspection Report
Inspection request received: �,,
_ � 1S
Name: L.����� Inspected on:
Location: '3Z_ I�ts �� Arrive: ! —4 CD p.m.
Permit No.: /5 Inspector's Initials:
TYPE OF STRUCTURE: c-41
N NIA COMMENTS:
Framing 1
Attic Access 22"x 30"minimum
Jack Studs/Headers
Truss Specification Provided
Bracing/Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly rej /
12"O.C.
Headroom 6 ft.8 in. Cc-M(2
Stairwells 36 in.or more
Exterior Deck Bracing
8 in.6 ft.8 in.
Notches/Holes/Bearing Walls 62--A4\/(kM
Metal Strapping for Notches Top Plate VO{L.
1 %(w) 16 gauge(8) 16D nails each side
Draft stopping 1,000 sq.ft.floor trusses
Anchor Bolts 6 ft. or less on center
Ice and water shield 24 inches from wall
Fire separation 1,2, 3 hour
Fire wall 2, 3,4 hour
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/wall
Windows Habitable Space/Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above/below grade
5.0 sf grade
Design Professional Sign-off, if required
Framing / Firestopping Inspection Report
Edward K. LaPoint. PE
8 Ward Lane, PO Box 190
Cleverdale, New York 12820
518-744-4411
eklapointpe(a7gmail.com
August 22, 2015 :.'''
•
Mr. Larry Clute •'
Clute Enterprises
Holden Avenue
Queensbury, New York 12804
vs„
Re: Acceptable Bracing Plan
32 Division Avenue, Queensbury, New York ,�
Dear Mr. Clute:
Regarding the above:
1. The project is a wood framed single story ranch which was framed offsite and
delivered for assembly on the lot.
2. The front and back halves of the roof truss system do not exactly match
along the ridge line. As a result, there is an approximately 2 inch gap along
the ridge line for 15 feet in the center (side to side) of the roof.
3. The gap will eventually be covered with the home's ridge vent.
4. The following additional roof bracing is acceptable and should be installed:
1. Connect a 2x4 brace front to back from the knee cords and nail to the two
vertical center cords.
2. Sister a 2x6 nailing plate between the two mismatched ridge boards
beneath the gap.
Please feel free to contact me if you have any questions or comments.
�feyn
Ed . .rd L;P int. PE
8 Ward Lane, PO Box 190
Cleverdale, New York 12820
518-744-4411
ekiapointpe(7a gmail.com
L•d 9960-£V1-2LS ]1813 dL£ ZOSL £O des
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13
Rough Plumbing I Insulation Inspection Report
Inspection request received 9, 2a�c]
Name ca w--e) Inspected on 11
Location v p,n Arrive (� a /rpr' prr> '
Permit No. l S—&0 Inspector's Initials �/
Type of Structure sc-1 , i
MM NTS
Y N NA
Plumbing under slab
Rough Plumbing /Nail Plates
Plumbing Vent /Vents in Place
1 Y2 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
ater Supply Piping
� ! ,it/ Head
50 P.5.1 for 15 minutes
Ins ation / Residential Check / Commercial Check
ndow Sealing
yvek or Similar Exterior Sealantt//'
P •per Vent, Attic Vent
poor/ 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
Blower Door Test
Air Sealing
Town of Queensbury Building & Code Enforcement Office No. (518) 761-8256
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received: 8 W1A t2a1 S
Name: CI1 ) Inspected on: J. �liti7
c
Location: 2— I,xV 1 &l0'' Z
' Arrive: f i •.m.
Permit No.: 1 '-- Inspector's Initials: 1111FA`
om -ents and/or dia s ram
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 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. . F * ' T
Conforms as per Plot PI N I .
Engineer Report and s-Built Y N
ETU Maintenance provided Y N
Location of Syste i on P r'e
Front 'ear eft Sid- Right Side Middle Front Middle Rear
System Use Sta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Septic Inspection Report
uwn c{Queensbury Building &Code Enforcement
Office No. (518) 761-8256 'C , -'t`,.-`
Septic Inspection Report
Inspection request received:
Name: Inspected on: r_ 2 (.i`
Location: Arrive: y -,'`f m. • . .
Permit No.: Inspector's Initials: (---_,--.94,--A-
----
Comments and/or diagram
Soil Type a;Sandra m.1 Clay
Type of Warr Muriicip_ql/Well Water ' 6 .y--) 1-- Ch
Waterline separation.dstance ` ' ft. }
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N N/A rN 2 A;, _-.
[150'to well required if NO] lam' L� V
Absorption Field: Total length li ~. :, ft. AUG 1 9 2015 .
Length of each trench ' c.. F fL
Depth of trenches .. ft. T BUILoING&EENSBURY
Size of Stone CODES
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank :1 v J-,4 t -_V ,
Tank to Distribution Box t,.4 '
Distribution Box to Field/Pit 1-:‘` , 4,8;#1:405SN". - '�
Opening Sealed: y71'. N '�-'''0C.,..»
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 I Separations • . ,......—
_.__—
Foundation
Foundation to tank ‘-'-2--1,.,- ft. WS33
\`N"-A
Foundation to absorption v (.c ft.
Separation of Pits ft... V'
Conforms as per Plot Plan _Y ,N,-
Engineer
Engineer Report and As-Built _Y J4
ETU Maintenance Contract provided _Y_N
Location of System on Property: _..__._�ti
Front Rear Left Side Right Side Middle Front Middle Rear_—)
System Use Status:
Approved
`Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256
Framing I Firestopping Inspection Report 10° A
Inspection request received:
Name: CLLTE_ T�(� ‘. Inspected on: — 41
Location: �t�'6\p‘'.-3 L5T_ Arrive: -I �u�. .m.
Permit No.: .1/41\ ,7'111/4� @ 2°15 50 5 Inspector's Initials: -��
TYPE OF STRUCTURE: c6C b ,Sc) t.t3bVeC.Tto6 /
Y N NIA COMMENTS:
Framing F.0T R1�
Attic Access 22"x 30"minimum
Jack Studs/Headers
Truss Specification Provided \ \-` ��'E ' #‘ E2I3
Bracing/Bridging �
Joist hangers V -Jt-vJ N t
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 1/2(w) 16 gauge(8)16D nails each side
Draft stopping 1,000 sq.ft.floor trusses
Anchor Bolts 6 ft.or less on center
Ice and water shield 24 inches from wall
Fire separation 1,2,3 hour
Fire wall 2,3,4 hour
Firestopping
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side 1/2 inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space/Bedrooms
24 in.(H)
20 in.(W)
5.7 sf above/below grade
5.0 sf grade
Design Professional Sign-off,if required
Framing / Firestopping Inspection Report
ll
f Queensbury Building & Code Enforcement v",
Office No. (518) 761-8256 dx t'0
Septic Inspection Report
Inspection request received: g I t► 2 �
Name: Inspected on: Vb 12- S.S
Location: '2 Q kV 1 .QX.1 Arrive: dI gri1I� .
Permit No.: I�' Inspector's Initials: ardirir
ments and/or dia s ram
Soil Typegr• ' .... Clay
Type of ►. er: nicis- ►ell Water X �-c51
Waterline sep. ati.• i istance �C 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 15l:, ft.
Length of each trencht.
Depth of trenches z. ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank %‘k .cA t-TO
Tank to Distribution Boxblve-3
Distribution Box to Field/Pit 'k ble,VWt( ��.-�?✓r��'
Opening Sealed: r(Y N VJC --
End Cap ,N
Inlet/Outlet Pipes&Baffles v Y� N
Manholes 12"or less below grade V Y
[provide extension collar if Yes] VN
Y
Location/Separations
Foundation to tank ‘3-10 ft. WS-2- ‘0
Foundation to absorption 7.Q ft.
Separation of Pits jit
Conforms as per Plot Plan
Engineer Report and As-Built Y t/N
ETU Maintenance Contract provided Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Fron iddle Rear
System Use Status:
pproved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
l ^�
Foundation Inspection Report
Office No. (518) 761-8256 Date Inspection request received: -2 l S�
Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: 1/
NAME: C L ' PERMIT#: (l — l 0-S •
LOCATION: ,� \- V t �� � INSPECT ON:
TYPE OF STRUCTURE: ' I j\a1��
Comments
Y N N/A
Footings
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
•Foundation/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofing
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
• ackfill 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 12/9/2014
Foundation Inspection Report
Office No. (518)761-8256 Date Inspection request received: `Z / D(/ S
Queensbury Building&Code Enforcement Arrive: am/pm Depart:3‘ a pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials/ `
NAME: C LIJ�C PERRMMIT#: . 4r-
I S 7
LOCATION: nL V G>" �/ INSPECT ON:
TYPE OF STRUCTURE: I
Comments
Y N N/A
400tings
1
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 / Sfre_ -
Footing Dowels or Keyway in place •�> \J1���, „n
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:\Building &Codes Forms\Building &Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/9/2014
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