1997-270 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date October 2 19 _
This is to certify that work requested to be done as shown by Permit No. 97270
has been completed.
SINGLE FAMILY DWELLING
This structure may be occupied as a
BARBER AVE.
Location
Owner SCELLEN, MARK
TAX MAP NO. 115. -1-9 By Order Town Board
TOWN OF QUEENSBURY
f 5 S• s I m •""
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 135000 No. 97270
TAX MAP NO. 115 . —1-9 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to RCFLLE-N, MARK
OWNER of property located at 9 RABRFR AVE. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SINCLE FAMILY DWELLING
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
122 E . HUNTER ST
GLENS FALLS , NY 12801
2. CONTRACTOR or BUILDER'S Name
MARTIN, TODD
3. CONTRACTOR or BUILDER'S Address
28 FIFTH ST
GLENS FALLS , NY 12801
4. ARCHITECT'S Name
COMMONWEALTH ELECTRICAL AGENCY
5. ARCHITECT'S Address
PO BOX 706
HAGUE , NY 12836
6. TYPE of Construction—(Please indicate by X) '
SINGLE FAMILY DWELLING
( )Wood Frame ( ) Masonry ( )Steel
7. PLANS and Specifications
22t°2 SQ FT SINGLE FAMILY DWELLING WITH 2—CAR ATTACHED GARAGE
AS PER PLOT PLAN SPECIFICATTn)R
8. Proposed Use
SINGLE FAMILY DWELLING
$ 279 PERMIT FEE PAID —THIS PERMIT EXPIRES June 10 19 99
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 10Day of June 19 97
SIGNED BY OCC1) -h-
sz, for the Town of Queensbury
Building and Zoning Inspector
IiuivaingApplicationPermit
Town of Queensbury - Dept. of Community Development, 742 Bay Road, Queensbury, NY 12804 1761-8256
'O BUILDING & CODE ENFORCEMENT 1
NOTICER uirementsprior to issuancerl -,, of this permit: PERMIT FILE NO. J-XA permit must be obtained before5
beginning construction. No inspections /]
a' 10
will be made until applicant has received Zoning Board Action PERMIT FEE PAID$•.9 I f V.
a VALID BUILDING PERMIT. All Area /Use
applicants' spaces on this application RECREATION FEF PAID$
MUST be completed and.the signature
L-
ot'the applicant must appear on the � 1 Planning Board Action REVIEWED BY: ; `
�pplieation form. n you. SPR / Subdivision /Other
Building Inspector
J Recreation Fee Payment
Applicant: ST'-)rn IT: bVl ?,v Owner: t`4, ►A-€--K Sc ELL
t
Address: v..) ) c •F Address: fD E 14s N ,L S' <. r,
Phone # (5 n) ) -,F t8i4 1 Phone # ( i C' ) *m ei - St ?
I'Il1IttiI'IV I llI'flhIiIll1 6'"FFP tiuFi
`I'nx 9 ,
Mn 1 Nutuibdr / I ' l
Subdivlslun Nlti►Iu: I __
Section Block Tnt
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
New Building: `Qc?' CONSTRUCTION:
residence / commercial $ 3�f`�oo 00
Addition to Building: -
residence / commercial ; OCCUPANCY INFORMATION:
Alteration to Building: Primary Building -
residence / commerci 1 ) 7 V Single Family Dwelling
Residence / Commercial S Two Family Dwelling
no change to exterior siz�c Family Dwelling
Office
Other Work (describe below) Mercantile
Manufacturing •
Other
GROSS AREA OF PROPOSED STRUCTURE:
1st Floor If ADDITION, what will use
2nd .Floor 1st
3 sq.q. ft. of new addition be? :
Other Floors ' o o sq. ft.
(not unfinished cellar or basement) ACCESSORY BUILDINGS:
Detached Garage 1, 2 car
TOTAL FLOOR AREA:- 4. ,9 Li SQ. FT. Attached Garage 1,
' Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building
°' Other
5 FEET X 31 -' t FEET
Foundation Type: Poi e� CO JCpE z Will any second-hand or ungraded
Number of Stories : lumber be used? If so, for what?
(habitable space only)
Height (grade to ridge) : feet TYPE OF HEATING SYSTEM:
Number of fireplaces and/or woodstove (circle all whichappli s)
to be installed: ON) E , , c tst Electric / Oil / d
- Forced Hot Air / Board / Other
Person responsible for supervision of work as regards to building
codes is : -To 17-) i' Ae;i kr a8 -�v <;, F - 7ct8- 48 ,f 1
Name Addresss Phone
Builder: •
Plumber: 5 A ,„ 11 s to cR
Mason:
Electrician:
DECLARATION: Please sign below after you have carefully read the statement.
To the best of my knowledge the statements contained in this application, together with the plans
and specifications submitted, are a true and complete statement of all proposed work to be done on
the described premises and that all provisions of the Building Code, the Zoning Ordinance and all
other laws pertaining to the proposed work shall be complied with, whether specified or noted, and
that such work is authorized by the owner. Further, it is understood that Uwe shall submit prior to a
Certificate of Occupancy'or Certificate of Compliance being issued, an AS BUILT PLOT PLAN by
a licensed surveyor; drawn to scale, showing actual location of project on premises.
Signature: t • C :&
(owner, owner's agent, architect, contractor)
Application for SEPTIC DISPOSAL PERMIT
r
Town of Queensbury Permit No.
Dept. of Community Development
= Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
Location of property for installation: E A\i EI
Property Owner's Name: t
Property Owner's Mailing Address: E
Installer's Name: Phone #
Number of bedrooms (if residential): 3 Total daily flow: '45 C)
(residential - compute @ 150 gal./bdrrn.)
Topography: /flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: not required, required rate min. per inch
� � �
Domestic water supply: V"municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank: /000 gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: _ feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # � / depth or thickness /•=t .
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
r
Alarm system and associated electrical work to be inspected by a certified agency.
� J
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 ve read the regulations with respect to this application and agree to abide by these and all requirements of the Town of
bury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: / (0.Jvti4 Date:
- {-, "I have seen or observed.or Wove t sew evidence of
all ob' such es houses,weN;bees,fences,et.
APPROVEDR sho on this docwsent I siso represent that i bve
Application oily measured the set h d1s on the sm."
.lN � 9 199 u.��
SIGNATURE TE
if ' illIir i
��� ` PLOT PLAN
SEPTIC SYSTEM
Notice: The following statement must be "stamped" on your plot
plan. This sheet of paper may be used for purposes of drawing your
plot plan. After drawing such plot plan, please read the statement
and sign it. If you choose to use other paper for your plot plan,
the office will stamp those plans for your signature.
P
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76 `44
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Ti N OF QUEENS URY
742 Bay Rd., Queensbury, NY 12804
APPLICATION FOR SOLID FUEL BURNING APPLIANCES AND CHIMNEYS
Date ,19 Permit No. 1 / l
APPLICATION IS HEREBY MADE to the Building Dept. for the issuance of a Building and Use Permit
pursuant to the New York State Fire Prevention and Building Code. The applicant or owner agrees to comply with
all applicable laws, ordinances, regulations, and all conditions that are part of these requirements and also will allow
all inspectors to enter premises to perform required inspections.
Please fill out additional form if more than one appliance and/or chimney.
Applicant APPLIANCE (check appropriate boxes)
Address • ❑ STOVE: ❑Wood o Coal o Pellet o Gas
❑ FIREPLACE INSERT
Zip ❑ FIREPLACE, FACTORY-BUILT:
❑ Wood ❑ Gas
Phone ? FIREPLACE, MASONRY:
❑ Wood .tEt Gas
Owner ,: 0 FURNACE: ❑ Wood ❑ Gas ❑ Oil
Address c IF NON-MASONRY APPLIANCE:
Manufacturer:
Zip Model:
Phone ' �J
CHIMNEY (check appropriate boxes)
*EXACT ADDRESS of proposed construction
❑ MASONRY: 0 Block 0 Brick 0 Stone
4 FLUE: ❑ Tile ❑ Steel
Size: inches
CONSTRUCTION / INSTALLATION MUST 0 FACTORY-BUILT:
CONFORM TO NYS FIRE PREVENTION & Manufacturer: Model:
BUILDING CODE. CONSULT AVAILABLE Listed By: Number:
TOWN OF QUEENSBURY HANDOUTS o Double Wall ❑Triple Wall
REGARDING REQUIRED INSPECTIONS. 0 Insulated m Direct Venting
❑ Chimney Liner
Cashier's Department Town of Queensbury, New York
Dept: Fire Marshal Amount Collected Amount Refunded
Code Number Title -; ya-
A 173 3389 (190) Public Safety -7/
A 233 2655 (230) Minor Sales
Fee Collected From or Refunded to: or) a 1\O. _ /<
Address:
Dated:' r Town Clerk or Deputy: ' � ;
White: Applicant Green: Fire Marshal Yellow: Bldg. Dept. Pink & Goldenrod: Cashier's Dept.
RESIDENTIAL FINAL ,INSPECTION REPORT
Office No. (518) 761-8256
Building & Code Enforcment Arrive: 7* Insp
Dept. of Community Development
Town of Queensbury Date Inspection Request Rec ed:
742 Bay Road
Queensbury, NY 12804
NAME �'� A 6 C LL PERMIT NO. �1
LOCATION cp)Plec2.3 ._ A' s _ DATE i cm\*7\c‘,7
TYPE OF STRUCTURE 4-)1A.)
N/A YES NO COMMENTS
Chimney Height/"B" Vent/Direct Vent Location
Fresh Air Intake _
Plumb Vent Through Roof
Roof Complete
Exterior Finish Complete
Interior/Exterior Railings`=;30" to 36"
Exterior Handrails, Balcor,e , Landing 18 in. or more
Interior Handrails Stairs Bo Sides 3 or More Risers
Grade 2% Away From Fo 4on
8" Clearance To Sill Plate
Gas Valve Shut-Off Expos digulator 18" Above Grade
Gas Furnace Shut-Off wi 3 Fee or within Line of Site
Oil Furnace Shut-Off at E tranc o Furnace Area
Furnace/Hot Water Heatef Ope r ting
Relief Valve(s) Installed
Headroom 6 ft. 6 in. OrStairs
Basement Stairs 6 ft. 4 in.
Handrail Exterior Stairs Both Sides More Than 3 Risers
Interior Privacy/Trim/Doors/Main Entrance 36"
Floor Finish
Bathroom/Kitchen Watertight J/,
Interior Handrails Balconies/Landing 18 in. or more
Railing Across Window in Stairwells
Smoke Detectors:
every level V
every bedroom
outside every bedroom
inter connected
Bathroom Fans
Plumbing Fixtures
Foundation Insulation
3/4 Hour Fire Door/Door Closer �.
Garage Fireproofing
Garage Penetrations Sealed
Furnace In Separate Room Protected In Garage)pa ( g )
Light Ventilation Per Room
Safety Glazing 18" or Less From Floor
Final Electrical
Site Plan/Variance Required
Final Survey Plot Plan
As Built Septic System Layout Req.
Okay to Issue litiorcto
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED __044,____
NAME `J Ce/424
LOCATION ? Za4:(7)-4)(7eJ
DATE PERMIT # Wi7 . 7- 27 c)
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS °;
EXIT SIGNS ``
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
AUTO. EXTINGUISHING SYST
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM
ALARM SYSTEM
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
CHIMNEY
WOODSTOVE
FIREPLACE - MASONRY
FIREPLACE - FACTQRY BUILT
Jt-'./r/1' 0W 1/2..2/
REMARKS: OK TO THIS DATE
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INSPSUP.PUB INSPECTOR
TOWN OF QUEENSBURY
110.0gi, BUILDING & CODE ENFORCEMENT
;;;;NOY 742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256
ARRIVE: `L`5i DEPART: 1 'INS L
FINAL INSPECTION REPORT — RESIDENT L
DATE INSPECTION REQUEST RECEIVED:
NAME
LOCATION BIPAD4 /` vF__
DATE \3\cti PERMIT # TT-?- `
TYPE OF STRUCTURE ip l T) CAS C1
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT/B VENT/HE GHT ; V
PLUMBING VENT i _ i
ROOFING 1 1
EXTERIOR FINIS t
PECK/PORCHTEPS �IGS "1?-
RELIEF VALVES \_ 1/
FURNACE/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY DOORS lye/
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT /
OTHER FLOORS SWEEPABLE Y
OTHER FLOORS CARPETED \\:////://
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS
DATHROOM FANS
'LUMBING FIXTURES
(I
FOUNDATION INSULATION ,
GARAGE FIRE PROOFING
DOOR CLOSERS
.,1;
FINAL ELECTRICAL
SITE PLAN/VARIANCE REQ. t
FINALURVEYYPVT PLAN INAV
CO
OK TO ISSUE C70 ORR C
` ► :-lE__.. \1:V r k cili
t `0 t %.
TOWN OF QUEENSBURY
IrtglABUILDING & CODE ENFORCEMENT -.\
742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256
ARRIVE: .C50 DEPART: II -�j INS
FINAL INSPECTION REPORT - RESID TIA
DATE INSPECTION REQUEST RECEIVED:
NAME ,��
LOCATION B WE V F
DATE .S -7 97 PERMIT # ¶VrrO
TYPE OF STRUCTURE -4FQ ciNe GAS
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES J NO
CHIMNEY HEIGHT/B VENT/HEIGHT
PLUMBING VENT f)
ROOFING
EXTERIOR FINISH
PECK/PORCH/STEPS/RAILINGS
RELIEF VALVES
FURNACE/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS
$ATHROOM FANS
PLUMBING FIXTURES /
FOUNDATION INSUL ION
GARAGE FIRE PRO FING
DOOR CLOSERS / _
FINAL ELECTRICAL
SITE PLAN/VARIANCE REQ.
FINAL SURVEY PLOT PLAN
1
OK TO ISSUE C/O OR C/C
‘-""-)3 \
k\ *C.5--C--
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256
ARRIVE: 212)C; DEPART: 2..Y L46 INSP•
FINAL INSPECTION REPORT - RESID TI L
DATE INSPECTION REQUEST RECEIVED:
NAME c
LOCATION RABBF R A'J F
DATE "Z ' PERMIT # 97- 7cj
TYPE OF STRUCTURE a,3 F r) tic, 7, CAP) (3044
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A 1 YES NO
CHIMNEY HEIGHT/B VENT/HEIGHT
.:/;//( N(//'
PLUMBING VENT
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/RAILIN
RELIEF VALVESN/j/:
FURNACE/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS: //11r///
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED
STAIR -CLEARANCE/RAILINGS
SMOKE DETECTORS -4///'
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
N)//1144:://(1//
FINAL ELECTRICAL
SITE PLAN/VARIANCE REQ.
FINAL SURVEY PLOT PLAN
)(/'
OK TO ISSUE C/O OR C/C
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%.,vinivivill vvntudIrl ni.x.t.,I KILAL iiNirrit.,I'thy r_diVILE,1INL.
Main Office 357 Elwyn Terrace — Manheim,PA 17545 q 7.. a 7 0
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Panel Board No Cert. N° 4 9 9 7 0 Cut-in Card No.
Owner A.A. 5C6Se---e—A)
Occupant /.)
Location 7 6/4/2,e6-72 n06,7, attee , Liy-
c6'cui 6 s- ci r-6-- --
Installi ion Consisting of i 7-c/-/-t reece-P 3
t,P Ce 1 C 1 RY 672 i 41VIS
i J I
c,.-C2 0 /9- :5 rietile-t
Installed By. 7—: in ft' -f7it) Lic #
The conditions following governed the issuance of this certificate,and any certificate previously
issued is cancelled:—
This certificate only covers the electrical equipment and installation conditions as of date. Upon
the introduction of additional equipment or alterations, application shall be promptly made for
inspection.
Inspectors of this Company shall have the privilege of making inspec . at any time, and if its
rules are violated,the Company shall have the right to revoke th. certific te.
Date g-7 i.--- ci 2 INSPECTOR
Member N_F_P_A__I.A_F_I_
- rrr v ``-J a I f
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TOWN OF QUEENSBURY )"
k r 1
.. BUILDING & CODE ENFORCEMENT
� �' 742 BAY ROAD ?�
QUEENSBURY NY 12804
(518) 761-8256
ifi
ARRIVE: -IA DEPART: „c INSP•
FINAI INSPECTION REPORT - RE
111,
DATE INSPECT ON REQUEST RECEIVED: -1 1
NAME S
�� �✓ ` 1 MCA( lir 't
LOCATION ��QfV g
DATE -- V ---9 PERM / CV-1`D----X
TYPE OF STRUCT RE 73
FOOTINGS FOU DATION BACKFI FRAMING
ROUGH PLUMBING SEPTIC INS,LATION
FINAL ELECTRICAg WOODSTOVE 0 FIREPLACE
- N/A YES NO
CHIMNEY HEIGHT/B ENT/HEIGHT
PLUMBING VENT
ROOFING
'( ► A b\'
EXTERIOR FINISH \\1;
DECK/PORCH/STEPS/RAI INGS
-
RELIEF VALVES
FURNACE/HOT WATER OPE•4.T G I
INTERIOR TRIM/PRIVACY +tlRS
FINISH FLOORS:
BATH/KITCHEN WATERTI H N:4/1////
OTHER FLOORS 'SWEEPA.LE
OTHER FLOORS CARPE ED
STAIR CLEARANCE/RAI INGS
SMOKE DETECTORS
BATHROOM FANS /
PLUMBING FIXTURES:'' ,
FOUNDATION INSUL TIION
GARAGEI1 FINJIII-
DOOR CLOSERS 1`j E._TWo*F--
FINAL ELECTRICAL V
SITE PLAN/VARIANCE REQ. _
FINAL SURVEY PLOT PLAN
t
OK TO ISSUE CO OR C/C
l -1) (518) 761-8256
4) \
TOWN OF QUEENSBURYal
UILDING & CODE ENFORCEMENT ,'1'
742 BAY RD., QUEENSBURY NY 12804Air
INSPECTOR'S REPORT: ARR,,aCC)DEPAR'**. )
REQUEST FOR INSPECTION RECEIVED: i
NAME - P ELLEOt M W /:
LOCATION 1 BRRC3F57-)_ A
DATE 'Cr' Z (�a7 PERMIT II 91- 0
TYPE OF STR CTURE: 6F D U.1 , x Il CC
RECHECK APP:•VED_
N/A YES NO
•OTINGS PI R. A
MONOLITHIC PO R FORM
REINFORCEMENT 'N PLACE
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROT' TION FROM FREEZING
FOR 48 HOURS FO LOWING THE PLACE-
MENT OF THE CON.RETE. ,
MATERIALS FOR TH S PURPOSE ON E -
FOUNDATION WALLPOR
REINFORCEMENT IN P ACE
FOUNDATIONIDAMPPRAIIIII, _
BACKFILL APPROVAL 111111r '..
IP, v
PLUMBING VENT/VENTS I` ' 'C _
•
ROUGH PLUMBING _
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS H:ADER`
BRACING I:ihl7t$11:[ __k R -\//
JOIST HANGE:S
JACK POSTS ,IN B
)6)/(
1111
- 31 i
AIR INFILTRATION : RRIER
HEATING ROUGH-INA/a _
INSULATION:
2,-`••`+ I LLS INTERIOR R- V
F ON _.
FOUNDATION ALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED -PACES R- .
i
(518) 761-8256
TOWN OF QUEENSBURY 6111*
f
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804 41t4/
4 IN
INSPECTOR'S REPORT: ARR)tDEPART '�
REQUEST FOR INSPECTI' EIVED:
NAME S , It 11°
J �►
LOCATION + Ary
DATE g-(, f"C 7 PERMIT 97-a70
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.'
MATERIALS FOR THIS PURPQSE ON SI ,�r�
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE 1
FOUNDATION/DAMPPROOFING _
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING:k
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
HEAT NG ROUGH-IN
INSULATION: `'v - Ot L - Y
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R- _
WALLS it A- R-
CEILING A L 1 ' R=' 1
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
OF NEII,
e'Pp KE.1Tyc y0,2
( 4'495 August 1997 VI• 4:t
1.
w
A °6675`� fir'
Mr. Todd Martin 'ToF �1oNP�
28 Fifth Street �s�
Glens Falls, New York 12801
Re: Single Family Residence
Garlinghouse Design #34825
Sealed 5/22/97
Dear Mr. Martin:
Regarding the above referenced project, the following structural changes are
acceptable:
1) On Sheet #8, eliminate the ceiling joist to create a cathedral ceiling
over the master bedroom.
2) On sheet#2, a 1 1/2" x 1" x 2" notch cut out of the flush LVL beam
to accommodate plumbing.
Please feel free to contact me if you have any questions or comments.
Sincerely,.
c 640
Edward ' . -Point, P.E.
22 Brookshire Trace
Queensbury, New York 12804
518-798-3654
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD. , QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR1°25 DEPARTk' I f
REQUEST FOR INSPEC • 'ECEIVED: � r
NAME _ � n.
LOCATION � 1� _ ` P'u-
DATE ~3 - (7 -9- - PERMIT f c\--i' !
TYPE OF STRUCTURE: SC -0
RECHECK APPROVED
N/A_ YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE _
THE CONTRACTOR IS RES#ONSIBLE FOR
PROVIDING PROTE ION ROM FREEZING
FOR 48 HOURS FOL WIN THE PLACE-
MENT OF THE CONCRE
MATERIALS FOR THIS PUR OSE ON SITE - -
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUM ING UNDER LAB
ING:
JACK STUDS/HEA E
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM r _
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R- _
FLOORS R-
WALLS R-
CEILING R- - -
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
` L.A_:r-
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT J
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR EPART 49
REQUEST FOR INSPECTION RECEIVED: �I
NAME - 1�
LOCATION t pi c�E...R /k E
DATE ] CA 1 PERMIT * LA- -2-1c
TYPE OF STRUCTURE: - 1t (LA
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
4 � s
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE (2)
FOUNDATION/DAMPPROOFING
- 7
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING j
PLUMBING UNDER SLAB _
FRAMING: .,
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS —�
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS ..R-
WALLS R -av�LAR y7---
-
CEILING t< e� ' -'
� ,
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT l�
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARRV - DEPAR - •= T�
ipor
REQUEST FO INSPECT N CEIVED: i .i��ii'
NAME C �� ,m K
LOCATION \ CY 'r'�✓
DATE4% ✓! , PERMIT # ( -D [ c3
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES , NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLL.�'' G THE PLACE-
MENT OF THE CONC'
MATERIALS F*' THI.
OSE ON SITE,-
FOUNDATION/WALLPO
REINFORCEMENT IN PLACE _
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING 31% \ k;L= _
PLUMBING UNDER SLAB_
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR NFILTRATION BARRIER
HE ING ROUGH-IN
NSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R- `�
WALLS 1 R-'
CEILING 'i. r:A1110
DUCT WORK OR PIPING I
UNHEATED SPACES R-
z
EA 1L-t
P c c C -, =
tit _ ��O�► ► WYNi
4":11
(518) 761-8256
TOWN OF QUEENSBURYOA df
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR >-I DEPAR ,
REQUEST FOR INSPE TION RECEIVED: 4
NAME Rar - 5ee(lec)
LOCATION 9 &(- 1- -
DATE 74?'?1.011 'i PERMIT I 9 -',927?)
TYPE OF ' RUSTURE: 5r1")
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS _
MONOLITHIC PQUR FO
REINFORCEMENT LACE _
THE CONTRACTOR IS RE IBLE FOR
PROVIDING PROTE T N FROM FREEZING
FOR 48 HOURS FOLLO ING THE PLACE-
MENT OF THE CONCRE E. _
MATERIALS FOR THIS PURPOSE ON SITE _
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE _
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/V NTS IN PLACE Y
ROUGH PLUMBING ` I!.3 t...-"t ���///
PLUMBING UNDER SLAB _
AMING: 0, 0 f` _ A
JACK U /IlEADZBS( 4
BRACIN I N --
JOIST HANGERS (3)
JACK POSTS/MAIN BEAM ) ,.l\
AIR INFILTRATION BARRIER "
HEATING ROUGH-IN • e- ---Id
rce) ih c`
' ...- v
e to ct.L:f, „ ..,c,4 N
INSULATION: s `
FOUNDATION WALLS INTERIOR R
1;-01. .c...
FOUNDATION WALLS EXTERIOR R-
FLOORS R- `".7� P`
WALLS R-
01 17
CEILING R- 'r v0 hi
DUCT WORK OR PIPING IN 0 `�,` F
UNHEATED SPACES R-
.ii Tikc -_ 1- oV)) v iiV '-k IN
1) �Nk..._. F'`A-%v Fov_ Q�\(. R k'
t EU, t\GAOF_Z C._)t-k-
t3 tb .. 0 Pt L C� AN16 16 C '
Ts,1 t L—r:.`'►,_
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date : . 7 q7 Permit # 77- 27C
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number
Size - ft. x f .
Stone size
PIPING: .ze Type
Bldg. to Tank _
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption — feet
Separation o,= Pits a feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
t"--4--T 14,064 afFF66.--
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Jcif-Y
11
Building Inspector
{518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD. , QUEENSBURY NY 12804
v
INSPECTOR'S REPORT: ARR DEPART l AIJINigfr
REQUEST FOR INSPECTION RECEIVED:
/NAME 5C6C-4.1
LOCATION /9 t3
DATE PERMIT I 77-
TYPE OF STRUCTURE:
RECHECK APPROVEI
N/A YE7 NO
FFOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE _
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE _
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING _
JOIST HANGERS
JACK POSTS MAIN BEAM
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING K-
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
54,62, //P 'Ot1 O' ) f-.L
OF NEtN
kr to
30 June 1997 os6152
Mr. Todd Martin
28 Fifth Street
Glens Falls, New York 12801
Re: Single FamilyResidence JUL 01 1997
g
Garlinghouse Design #34825
Sealed 5/22/97 ,
Dear Mr. Martin:
Regarding the above referenced project, the following foundation change is
acceptable:
1) 16" continuous concrete footings with 2 - #4 rebars.
Please feel free to contact me if you have any questions or comments.
Sincerely, 011,
ift
Edward K. La'oint, P.E.
22 Brookshire Trace
Queensbury, New York 12804
518-798-3654
, , ' -icarJ At JCR)
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT �SY�
742 Bay Road )A-�
Queensbury NY 12804 419--
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name \CkX
Locatione::: \;:).W4VQ
kgZ__,
Date (9—,36-CO Perm t 49 1-2 -270
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length (<i17,f6
Length of each trench
Depth of trenches
Size of stone /'
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: S1" T Pe
Bldg. to Tank ' <%
Tank to Dist. Box
Dist. Box to Field/P'
Openings Sealed? , ' Yes No Partial
LOCATION/SEPARATI
Foundation to Tank o '7 feet
Foundation to Absorption _ feet
Separation oi= Pits ! feet
Conforms as per Plot P1 an Yes No
LOCATION YSTEM ON PROPERTY:
(circle.
Front ReasA Left Side - Right Side
Middle ofit p Middle Rear
COMMENTS:
C- <-i< TI LeefAlf< 1-4-/o i< 1A)/
SYSTEM USE APPROVED: YES N0 `
Arrived: H
O
Departed: / : /5
Niec
Building Inspector
6
/ Ci4111 (518) 761-8256
TOWN OF QUEENSBURY
�j
BUILDING & CODE ENFORCEMENT ��� I',`
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR )'G-4 DEPART , ..Ale
_` ` ' G
C
REQUEST FOR INSPECTI N RECE ^/ �I
NAME - '„/ j� CV)
LOCATION �1 1 Gyf � Q
DATE '-1 cam` c4-7 PERMIT N 1 7-X7c
TYPE OF STRUCTURE: •:!5ct-2)
RECHECK APPROVED
N/A YES NOS
/ QOTINGS/PIEROW Q.:0)
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE 7-- 2-113
THE CONTRACTOR IS RESPON ISLE FOR
PROVIDING PROTE TION F . REEZING
FOR 48 HOURS FOLLOWING PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PUR'OSE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE _
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE - -
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING: I.
JACK STUDS/HEADERS
BRACING/BRIDGING _h
JOIST HANGERS _
JACK POSTS/MAIN BEAM _ _
AIR INFILTRATION BARRIER _ -
HEATING ROUGH-IN
INSULATION: _
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R- _
FLOORS R-
WALLS _
R-
-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES K-
'L F. Cc* C C OtAt
4R‘S -- N _E'S) _%. C. tt _.__?-1.,„b
We?--c) Pkt_-- C)1 CAPrtJC��.._
t) F �rt- b\Z - s -
A14() (518) 761-8256
TOWN OF QUEENSBURY161
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR •/✓ DEPA ' INT
LA
REQUEST FOR INSPECTIOO
RECEIVED:
NAME O_AN iTY J `
LOCATION ' <?o1
DATE 9 aa7 PERMIT I / '�7(
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMEN IN PLA E
THE CONTRACTOR RE PONSI LE FOR
PROVIDING PROTE TI RO REEZING
FOR 48 HOURS FOLLONI THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PUR OSE ON SITE,�
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOU TION/DAMPPROOFING
ACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING _
PLUMBING UNDER SLAB _
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS _
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
-3
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD. , QUEENSBURY NY 12804
J� � .
INSPECTOR'S REPORT: ARf , ��' DEPART)-/ INTV
REQUEST FOR INSPECTION RECEIVED:
.;.&6-(..4!&/10
LOCATION 1 '/Z.. /' -
DATE ti l /6( PERMIT A c7 Z
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS _
MONOLITHIC POUR FO
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPO SIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.
7TERIALS FOR THIS PURPOSE ON SITE 1(///
/FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE '
FOUNDATION/DAMPPROOFING _
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE _
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS MAIN BEAM
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR97 DEPARII'd' INT q/2-4
REQUEST FO INSPECTION RECEIVED:
NAME , et-CZ& )
LOCATION ! i V `7C ,
DATE /ern') PERMIT A ! 7-2-7
0
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS _
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FRO EZING
FOR 48 HOURS FOLLOWING T b•CE-
MENT OF THE CONCRETE.
TERIALS FOR THIS RPO'E 0 SITE _
FOUNDATION WALLPOUR0,1�
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R- _
FLOORS R- _
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
C' - Re64g. / pc. 8erov
po U 21 A t, w
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR`S REPORT: ARR _, JDEPART/ / INTJ
REQUEST FO.INSPECTION RECEIVED:
NAME %'� , 42/
t a r,�
LOCATION �/ :"c" 4"& ,
DATE 4�'/`,' PERMIT # !
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
!'�QOTINGS/PIERS V
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE /i _
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
UHT OF THE CONCRETE.
4ATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALLkOU _
REINFORCEMENT IN P
FOUNDATION/DAMPPROO ING
9ACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE _
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
kIR INFILTRATION BARRIER
iEATING ROUGH-IN
[NSULATION:
FOUNDATION WALLS INTERIOR R- _
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R- -
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R- �1
Ailif,&*416, e&- -roe-,A/0„ /-4 4 Ai
63/<7 . 0/ di- -rr
(945(-)/Q auk, 45.1<
,v4Z, )4 -L etf4-4164 c )
��OF" NEW*.
c�P'PQ,O KE I TH 40,003)
W
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7:' f firl
40' E
;' i,t 1.1t
11 June 1997 4 I' .--- #
6/0F � te
96� a,
r()PES S1OC\
Mr. Todd Martin
28 Fifth Street
Glens Falls, New York 12801
Re: Single Family Residence
Garlinghouse Design #34825
Sealed 5/22/97
Dear Mr. Martin:
Regarding the above referenced project, the following foundation changes are
acceptable:
1) Eliminate the vertical #5 rebar 4' oc shown on A/6A.
2) Replace the 4 horizontal - #5 rebar shown on A/6A with 3
horizontal #4 rebar.
Please feel free to contact me if you have any questions or comments.
Sincerely
qk OSP
Edward . aPoint, P.E.
22 Brookshire Trace
7 1 — e) Queensbury, New York 12804
518-798-3654
RFC,''':'7-s'l VFD
JUN -16 1997
BUILDING,ANC CODE
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name '
Location r X_
Date Z Permit # 92-d7(>
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Numb
Size - ft. ft.
Stone size _s
PIPING: Size Type
Bldg. to Tank _
Tank to Dist Box
Dist. Box o Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation tc, Absorption — feet
Separation Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
(S- 97erh
c, 7_
New Afiyht,
3 L1 €
/ /f Co '1 I- OBI_
SYSTEM USE APPROVED: 461, NO
Arrived: L3a
Departed:
Builds g Inspector
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
S ,\
Name e
\\
Location Cky __,\ �`'�
r
Date c-1:7 "-61 7 PermititC),
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank _
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption _ feet
Separation o'= Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS: /
04 ? ' °,pki 0/ .2 S
t? L� %�y /e04' £7 J /'.Q L4 J
ler ye C4,.. !0 6/ Z-1/ ex_
SYSTEM USE APPROVED: YES g
Arrived: '/;Ga
Departed:
Building Inspector
, I have seen or observed,or blow I sow evidence of
all objects such as howls,wolls,toss,fascest
shown on this document,I also repent that I have
personally measured the dktenoes set forth oh the dram.
SIGNATURE DATE
PLOT PLAN
SEPTIC SYSTEM
Notice: The following statement must be "stamped" on your plot
plan. This sheet of paper may be used for purposes of drawing your
plot plan. After drawing such plot plan, please read the statement
and sign it. If you choose to use other paper for your plot plan,
the office will stamp those plans for your signature.
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