94-706 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date !9 _
This is to certify that work requested to be done as shown by Permit No. 1)$"106
has been completed.
;Ingle FAmily Dwelling
This structure may be occupied as a
location ,5? Rhode �,lana Ave.
Owner Jessica Ponce & Rivhard SITC.
1 —5 By Order Town Board
TOWN OF QUEENSBURY
I
Ye-
Director of Bldg. & Code Enforcement
1-3
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 94-706
WARREN COUNTY, NEW YORK
CO
Jessica Pond & Richard Smith
PERMISSION is hereby granted to
OWNER of property located at 351 Rhode Island Ave Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Modular
at the above location in accordance to application together with plot plans and other information hereto filed and 'b
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
SAme c'
to
m
N•
2. CONTRACTOR or BUILDER'S Name n
521
Primrose Lane Homes
rn
3. CONTRACTOR or BUILDER'S Address H•
rt
256 Reynolds Rd
Ft Edward, Ny 12828
4. ARCHITECT'S Name
ri
5. ARCHITECT'S Address
to
6. TYPE of Construction—(Please indicate by X) 0
N
( ►Wood Frame ( ) Masonry ( I Steel ( )
In
7. PLANS and Specifications
No. 1008 sq ft Modular as per plot plan specifications
8. Proposed Use
Modular ( Single Family Dwelling)
n
$ 120 . 00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 12 , 1995
(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 12 th Day of ecember 19 9 4
SIGNED BY c_ 1 for the Town of Queensbury
Building and Zoning n ctor
/
11
{tx„,.
TOWN OF QUEENSB URY e f4,01* , 1,;' i o �`iab s�
. \, 41,,ifee/4 of 0' !.:')
i IREVIEWED BY: \ vie\ 0A� /`
FEE PAID: $ 00 -
PERMIT NO. ` Li - '70 ,
APPLICATION FOR _PERMIT�J
MOBILE HOME OW-MODULAR
A BUILDING PERMIT MUST BE OBTAINED BEFORE PLACEMENT OF MOBILE HOME.
NO INSPECTIONS WILL BE MADE UNTIL A VALID BUILDING PERMIT HAS BEEN ISSUED.
The owner of this property is: Z-c55ida�. A,,ic,-D -,,e/A N-, tf~e/..
P.O. Address: 351 ,4 2 / Q / L cc,,,,;stc r Phone Number
Property Location Tax Map Nod ))/ / / ->
NAME OF APPLICANT:
Address of Applicant:
All applicants spaces on this application MUST be completed and the
signature of the applicant MUST appear on the reverse side of this application.
PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES:
MOBILE HOME INFORMATION APPROXIMATE VALUE OF HOME: $ /-5, cut.%
New Home (Yes'', No ZONING INFORMATION:
Replacement Home Yes No Size of Property: 9c-% ft x / 6 U ft
Size of mobile home _ftx ft Existing Buildings: dt1€1 P e
Singlewide Doublewide
-- Proposed building-distance from property line:
No. of rooms (exclude baths) ) Front Yard 37 ft Rear Yard Y6 ft.
No. bedrooms 3 Side Yards is` ft and . ; ft.
Occupancy Informati
No. of bathrooms Primary dwelling: Ye No
Fireplace f:r Woodstove Gv)//1/ Accessory Building(s): ,u/
Detached garage (one car /two car car)
Foundation style and size: c2'/ ? V —_Attached garage (one car_/two car car)
•
Piers-No. of Size ft x 'ft —Storage building
Other
Depth below grade ft * * * * * * * * * * * * * * * * *
Foundation-Footing size& " x ,7 "
Pro os d date of. placement:
Wall material ,(^e_4-c-6 l''Z/ 3/f
Wall thicknessf " Height .'� "
Water Supply: Well Municipal 4----
Total depth below grade I/ ft. Septic permit required?
Grade to home floor level ft. yet
FURTHER INFORMATION REQUESTED ON THE REVERSE SIDE OF THIS SHEET
Mpg p-
A
NAME OF INSTALLER/MOBILE HOME DEALER: j_Kijoto /Y� o
ADDRESS/PHONE NUMBER cj (1c �e 01 a S €c j
co k'T 6a lt.,C:\c-3 AJ / � c�-25
STATE OF NEW YORK DIVISION OF HOUSING AND COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
1. Insignia serial number
2. Name of Manufacturer 4- 7611 ,\e`c
3. Plan Approval Number /O 5 (r
4. Model or Component Designation
5. Date of Manufacture
All the above information is to be found on a plate or sticker which
should be affixed to the Mobile Home. Complete above with that information.
76t'a...72_ 3 a
Town of Queensbury State of New York
County of Warren
AFFIDAVIT
I swear that to the best of my knowledge and belief 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 not, and that such work is authorized by the owner.
Signature
Owner, owner' s agent, architect,
contractor
SPECIAL CONDITIONS OF PERMIT:
By
Code Enforcement Officer
dhOWIL
TOWN OF QUEENSBURY (�
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # = l (
Fee Paid
Date: /)) 5— 1.� Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: 35/ 160de if' e-/ trcaykke7, LI
Owner' s Narne: Te,ss'cA.e,. " /4i Vom.ed
Owner's Mailing Address j c b J: pp
Installer' s Name: ,wt s���P,/d.� Phone #:
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom) : yid
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth: 4/, 0
Ground Water-At What Depth? Ait44)C Feet Tom ®
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: Not Required Required/Rate /3 Min. Per Inch
Domestic Water Supply-Circle One Municipa`h3 Well Other
If domestic water supply is a we =___�
Separation: Water supply from any septic absorption _ feet
PROPOSED SYSTEM: Septic Tank /co e gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench ,, , feet//Total System Length fro feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # / Depth or Thickness feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size\of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
****************
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: DATE:
Septic System Inspections:
A. All applications for septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to the Building Department at least 24 hours before start
of construction and shall include a plot plan showing:
1) the proposed location of the system
2) location and distance to lot lines
3) location and distance to structures
4) location and distance to any water supply
5) size and dimensions of all tanks, distribution boxes, tile fields
and/or drywells
B. No system shall be covered before inspection and approval by the Building
Inspector. Failure to comply with this requirement may result in the
uncovering of the system by the installer and a fine of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
PRIMROSE LANE HOMES, INC.
256 REYNOLDS ROAD 70(10
FORT Edward, New York 12828
Phone: 518-792-7230
PROPOSED PLOT PLAN FOR: JESSICA POND & RICHARD SMITH
351 RHODE ISLAND AVENUE
QUEENSBURY, NEW YORK
House is 3 Bedroom; 1 Bath
1-eh c H F,gL "b /�
T le i s s o ' Ca i; Ai.� &it/cd �./S/S,f'.
1
- • -_•_ -- ---f
Co® 6400
en rs "r4 ret- �- 4Q' o
33
d
Sib ta`W+5fg k a
te
3 / R b rELANb AUK.) Gen/ bt .Prj
SC4 Lk ' / '' --
"I have seen or observes,or DeReve 1 saw erwnnu c w,
PRIMROSE LANE HOMES, INC, all objects such as houses,wells,trees, fences, etc.,
256 REYNOLDS ROAD shown on this document I also represent that I have
FORT Edward, New York 12828 personally measured the distances set forth on the diagram."
Phone: 518-792-7230
4, ":0-Al
c!rhAT' nF DATE
PROPOSED PLOT PLAN FOR: tJESSICA_.POND &RICHARD' SMITH
=� 351 RHODE ISLAND AVENUE
QUEENSBURY, NEW YORK
el?f14060 '
House is 3 Bedroom; 1 Bath ,r
1-t i4 c hi ' "4 b
Y R u,n S 30 ' 40,7 w TT�. & .�'Nwr
4.--i lm n o n ,_, .
/oS ' t�c�;upTio,�
/fti' ' x
\ i/
sA.
7)isre i ro^, _ _ -
- -- --- �q ��C194
ok e
ei
tee/),54 j'
17--
s - UEC i 2 +99Ir
to Ilk
/coo �iia , d r�
en 7 S "n:6 7�,te'�4. c iI ' o
/ 0
�4'
t ' .--- --- A, r;*1.7
', 'd
}
— /S —)
/1( ,e 1 )t Ecrv4 r�.h
/oyf
3 51 R 1-1 f b Z"sL,4Nb // vA'"� �,ueeivs, ..r ,1 A4
CA+ I 0 rl/rV\
v - Re.--TOWN OF QNSBURY�
liaMBUILDING & CODE ENFORCEMENT
742iBAY ROAD
� QUEENSBURY NY 12804
(518)745-4447
r
ARRIVE: DEPART: !(} N INSP:
FINAL INSPECTION REPORT - RESIDENTS
ESIDENT Aj,� • 5
DATE INS, 0TION R Q ST ECEIVES: LA 11I1
NAME `S 11
�� n
LOCATION /J �QY i0t/}�
DATE L\`1� CIS PERMIT N )1=' - /V��
TYPE OF STRUCTUR � / (`)C) -a.
FOOTINGS FOUNDATION BACKFILL FRAMING _
ROUGH PLUMBING _ SEPTIC _ INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT/B VENT/HEIGHT
PLUMBING VENT
ROOFING d
EXTERIOR FINISH !�
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES //
FURNACE/HOT WATER OPERATING /
INTERIOR TRIM/PRIVACY DOOM ,
FINISH FLOORS: ,
r
/
BATH/KITCHEN WATERTIIT , ,
OTHER FLOORS 'SWEEPOBLE
OTHER FLOORS CARTED
STAIR CLEARANCE/: ,ILINGS ,
SMOKE DETECTO''.
BATHROOM FA.. f
t
PLUMBING v' XTURES
XFOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
SITE PLAN/VARIANCE REO.
FINAL SURVEY PLOT PLAN
OK TO ISSUE SU�?, �
C/O OR /C�/.0 .
5 46..&I lK - 1 ,vici L.i 6-rJ 0 u
gpl;NI —Q IC —cam, (5SCI C(6
jf- 0o or OLA-.t.J 15SuE it i CO
TOWN OF QUEENSBURY
BU1 ING & CODE ENFORCEMENT //�
531 BAY ROAD lLJ /
QUEENSBURY NY 12804 l
(518)745-4447 �
ARRIVE: DEPART: J' .(�J INSP:
FINAL INSPECTION REPORTr - RESIDENTIAL
DATE IN CTION I\EQU ST RECELVED• y
NAME )
LOCATION ` 'Y ^)C( , ,
/I l��A
DATE / 15 PERMIT # /O 9"( p
TYPE OF STRUCTURE
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT/B VENT/HEIGHT
PLUMBING VENT ,^(
ROOFING \
EXTERIOR FINISH .
DECK/PORCH/STEPS/RAILINGS ��k
RELIEF VALVES '\
FURNACE/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE pp
OTHER FLOORS CARPETED /\
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS
BATHROOM FANS �\
PLUMBING FIXTURES
FOUNDATION INSULATION 75i4lO€s---
lid_ A
•�rsxri,t r Ixn rxvvr ING
-POOP CLOSERS
FINAL ELECTRICAL ( A/ c7 1- - )\
SITE PLAN/VARIANCE REQ.
( FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C/C
I v'' 14J5U2 e -Tio.j M v5 7 6.6-C OUEz. 1)
D R G 4C.("61,
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name r/24/1
Location ?4,1, ,..4-;6'4..e,
Date a2/ e rm i t # L�,,��// i(.X,,
SOIL tYPE: Sand-Loam-C1 y-
Results of Percolation Te t-
(if applicable) Rate-Minut /Inch
TYPE OF, SYSTEM:
ABSORPT1JN FIELD: Total Le gth 6244)
Length o, each trench SZ
Depth of renches
Size of s ne /3
SEEPAGE PI : Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank 4' Pc.
Tank to Dist. B 4" wco
Dist. Box to Fie /Pit 1/1' /nli'�
'I0
Openings Sealed? Yes No Partial
LOCATION/SEPARATI
Foundation to Tank ,\. /v feet
Foundation to Absorpty on , o feet
Separation of`Pits H , „feet
Conforms as per Plot Plan 0 No
LOCATION OF SYSTEM ON PRtPER
(circle
Front Rear Left Side -\Right Side
Middle - Middle Rear
COMMENTS:
kiii-e"Ma,-k. S4-t.,, /11?"i
Z,4,-- L,4-6
154,0„= 10,pQs. 40 .
SYSTEM USE APPROVED: (i.;) NO
Arrived: AO--
Departed:
C,V
Building Inspector
kOUi6eNt1)vV\11�1L>
tiles.") TOWN OF QUEENSBU Cl)tq 30
BUILDING & CODE ENFORC T
531 Bay Road
Queensbury NY 12804- `;;t= 6A/l ;
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name P \ J
P(.7CNN <S '(V1
Location 7)c j CI c)e S1•e:
Date P-13-9 rj Permit # c7P-1 - 7oG
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Te:t-
(if applicable) 'ate-Mi 'ute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD To 'al Length
Length of each t en,
Depth of trenche-
Size of stone
SEEPAGE PITS: Nu'ber-
Size - f� x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to ield Pit
Openings Se. ed? Yes No Partial
LOCATION/S.'ARATII S:
Foundatio to Tank feet
Foundatio to Abso •tion _ feet
Separation of Pits feet
Conform. as per Plo Plan Yes No
LOCATD OF SYSTEM 1 PROPERTY:
(circ e one)
Fron - - Rear - Left Side - Right Side
Mid. e Front - Middle Rear
CO ENTS:
L/i=t. lei// 6c 5/' "42.,-/-
Afkil,./
SYSTEM USE APPROVED: YES NO�,
Arrived: ) -
Departed: /,/o
Building In ector
"I have seen or observed,or believe I saw evident( of,
all objects such as houses,wells,trees,fences, etc.,
PRIMROSE LANE HOMES , INC. shown on this document. I also represent that I have
FORT Eddwawa.rdd,, New York 12828 P
F RE NewD ersonally measured the distances set forth on the diagram."
Phone : 518-792-7230 / -�s/�
1/ SIGNATURE DATE
PROPOSED PLOT PLAN FOR: �JES.STCA PONn R RICHARD' SMITH --
•L351 RHODE ISLAND AVENUE
QUEENSBURY, NEW YORK
House is 3 Bedroom; 1 Bath 1•7061
Lt/9c H irjF4 b
y R ttAs S'1 ' .to,,7 w.T� ea, ed0 •eAlS,s.
'os ' /As- ,
\ /
fitpre
1.---- __ ....._ c.
2,,,„„r„,,,„7.7,_, __ __ ....... -----_----:- . ,.............., -iv:24 , ,
f?,„,, ,10,01
r4s _ :-; .11,k_„,_ _—� k c Q Iniyn[f (1.0
ir
np/.
fr
10
i . ,ninq st:r O
Ceiri enTS /.?iC 7�v� ,�r � o
f '
/<E-- /5. 33 ) v,�,;,o
Tr41
/O p, /
---•
'�� � �� Y
;-o� I C
v 60.
i ,
/r(
71
C 0.c=tiff 77.4
iog-
4-levMT/..4 '
35 1, 8fls ' b Z s L ANb AU x�j c�uee.v.shu��� /'`�• 7
S C / L � ; I ,. _ 20 '
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY RD., QUEENSBURY NY 12804 t.
O.,
INSPECTOR'S REPORT: ARI, kDEPAR � 1. "L�
REQUEST F INSPE TIO -)R EIVEp: -L 3'-9-s-
NAME -jC7'1\C) /
LOCATION 3 5 1 ► a) L-_Sixt4 ! IVY
DATE - S PERMIT # £9 LI -7
-O 67
TYPE OF STRUCTURE: S 1 -\O6 `�/`
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 , L
FOUNDATION/WALLPOU' _
REINFORCEMENT IN PLA E
_
FOUNDATION/DAMPPROOFI G
EBACKFILL APPROVAL 1
PLUMBING VENT/VENTS IN •L CE
ROUGH PLUMBING _
PLUMBING UNDER SLAB _
FRAMING:
JACK STUDS HEADER I
BRACING/B: DGING _
JOIST HA ERS
JACK PO S/MAIN BE,
AIR INFILTRAT IN BARRIER
HEATING ROU '-IN
INSULATIO .
FOUND_TION WALLS INTEI •R R-
FOU. PATION WALLS EXTE•IOR R-
FLOCRS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R- _
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR // D DEPART/ /,0 1NT,
REQU FOR NS TION RECEIVED: 1 151S
NAME _
LOCATIONe
DATE PERMIT A -
TYPE OF STRU TURE: -
RECHECK APPROVED _
l_N/A YES NO`
OTINGS/PIERS
MONOLITHIC POUR FORM - -
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPON-IBLE FOR
PROVIDING PROTE TION FRO FREEZING
FOR 48 HOURS FOLLOWING T E PLACE-
MENT OF THE CONCRETE. - --
MATERIALS FOR THIS PURPOS, ON SI '
FOUNDATION WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL -_ - _
PLUMBING VENT VENTS I PLAC _
ROUGH PLUMBING
PLUMBING UNDER SL'B
FRAMING:
JACK UDS/HEADERS
BRAC 'G/BRIDGING _-__-• -------
JOI HANGERS
JA POSTS/MAIN BEAM _ __
AIR INFI RATION BARRIER
HEATIN ROUGH-IN
INSU ,TION:
OUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R 1-
FLOORS R-
WALLS R-
_ CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R- -
3 l- (c�
QI
4
I TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY RD., QUEENSBURY NY 12804 �/ . '.
INSPECTOR'S REPORT: ARR /j/DEPART/'?O INT C7i/
REQUEST F INSPECTIO RECEIVED:
NAME
LOCATION
DATE ' ' 24, '9 S PERMIT H -....-
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 FRE- ING
FOR 48 HOURS FOLLOWING THE PLA E-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON S E
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFIN!
1ACKFILL APPROVAL
PLUMBING VENT/VE S IN PLACE
ROUGH PLUMBIN!
PLUMBING 'DER SLAB
FRAMIN .
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-
of - /-"WiL41‘.4*, eh /vo-
<Se 44-1(5
"1 have seen or observed,or believe I saw evidence of,
•• all objects such as houses,wells,trees,fences, etc.,
"PRIMROSE LANE HOMES, INC.256 shown r.,n this document. I also represent that i have
FORT REYNOLDS ROAD personally measured the distances set forth on the diagram."
Edward, New York 12828 p y
Phone: 518-792-7230
SIGNATURE DATE
PROPOSED PLOT PLAN FOR: t� JES/ . _nnNn R f'RICHAB SMITH —
351 RHODE ISLAND AVENUE
QUEENSBURY, NEW YORK
House is 3 Bedroom; 1 Bath .0
10(40
L-t si c N F',gL b •
Y R L S so ' xa,s, ed,r� &.. c.e 4r/va,s.
4,LL,' Mr,e17 Ch1.70 47"icv.
ios AS BUILT 2"�
9
' A
�-/S./-- __. ommol
- - — — ..._ ,.._
WOO.
•
2>)5 rir i is,..4 1,...,0.,..., -.... •••••10 .•••.• 1:...41.: 7a.............•.•N.., Wmo....1.4.......awl
K74p' 9 J
a .. tom"+�+ "� • c}, 07 Rf
. '>‹, 6 4‘.11 7f(fG0fr1:15--
000 6bet fic ,r ,. 1
GT's rrd. ram" c.r° --.- ,„ ‘
j- --- /0 '
is.
o �-�' '� I
k �-
d
^off
Z.
V .M in r�F x l� W 1
a�
� �S. S.
< t-- is''-> _
if 90 1 ELL:v 4 r',.h
/o y.
kL<JvyT/.N
/oy ' ,
3 51, R I-I b b x s i A N b A UA , elm c ease,./-y, A4 Y
Sc � �. �_ : 1 ,, _
- TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name �' (;+ Ci 5rn -a\
Location �jS L J �' )J/ i' -
Date I- -C)5 Permit # 1-I ' 7O(p
SOIL TYPE: Sand-Loam-Cla -
1
Results of Percolatiop/Test-
(if applicable) Rat."Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD-;Total Length 200
Length of each ranch 56
Depth of tren es ` 2--
Size of ston-
SEEPAGE PIT:: Number-
Size - ft. 'x ft.
Stone si e
PIPING: ; Size Type
Bldg. o Tank t/A �t
Tank o Dist. Box
Dis '. Box to Field/"i ` C
Op-nings Sealed? 40. No Partial
L� ATION/SEPARATION` .
oundation to Tank /O feet
Foundation to Abso i ti on ,30 feet
Separation of Pits eet
Conforms as per Plo Plan 404, No
LOCATION OF SYSTEM $ PROPERTY:
(circle one)
Front - Rear - Lef , Side - Right Side
Middle Front - Midqle Rear
COMMENTS:
1111111
SYSTEM USE APPROVED: YESeo.
Arrived:
Departed: /,-
Build nspector
\M
1 D 130 c).
TOWN OF QUEENSBURY
BUILDING F. CODE ENFORCEMENT y
531 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR ,ZDDEPART\ I .. �/
REQUEST F R INSPECTION RECEIVED: ) / r G L5
cl:NAME _ O I % . MI - -
LOCATION 35 I: QN\r\IJ L'.. ysYQ�"f\{. )f�
DATE / " /7 9 5 PERMIT # ,�/��t ( — l V 4
TYPE OF STRUCTURE: J `C c �11�J6 U LPAJ
RECHECK / APPROVED___
j N/A Y ,NO
OOTINGS PIERS �f ..
MONOLITHIC POUR FORM
i REINFORCEMENT IN PLACE 3 ' Yf - /
7
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM.FREEZING
FOR 48 HOURS FOLLOWING TEtE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PUF'POSE •N SITE _
FOUNDATION/WALLPOUR
REINFORCEMENT IN LACE {
3
i
FOUNDATION DAMP ROOFING _
.BACKFILL APPR VAL -
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING _ ._. __. ______
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS HEADERS _ _
BRACING/BRIDGING
JOIST HANGERS w
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R- __
FOUNDATION WALLS EXTERIOR R- f
FLOORS R- _
WALLS R- _
CEILING R- _
DUCT WORK OR PIPING IN
UNHEATED SPACES R-