97-506 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date November 21 19 97
This is to certify that work requested to be done as shown by Permit No. 97506
has been completed.
This structure may be occupied as a SINGLE FAMILY DWELLING
RIDGE RD.
Location
Owner HAYES , MICHAEL & SARAH
TAX MAP NO. 5 5. -2-2 2 . 21 By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & ode Enforcement
BUILDING PERMIT
VALUE $ 75000 TOWN OF QUEENSBURY 97506
TAX MAP NO. 55 . -2-22 . 21 No.
WARREN COUNTY, NEW YORK
HAYES , MICHAEL & SARAH
PERMISSION is hereby granted to
RIDGE RD.
OWNER of property located at Street.Road or Ave.
SINGLE FAMILY DWELLING
in the Town of Oueensbury,To Construct or place a
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and inn compliance with the Town of Oueensbury Building and Zoning Ordinance.
t.5 tiLP;N Utcis
QUEENSBURY, N.Y. 12804
2. CONTRACTOR or BUILDERS Name
SCHERMERHORN CONSTRUCTION
1-P9NAITffitgaftWiWVATH
QUEENSBURY, NY 12804
4. ARCHITECT'S Name
COMMONWEALTH ELECTRICAL AGENCY
5. C935+CT:Wdress
HAGUE , NY 12836
6. TYPE of Construction—(Please indicate by X) SINGLE FAMILY DWELLING
( )Wood Frame ( 1 Masonry ( )Steel ( )
7. PLANS and Specifications
1000 aQ FT SINGLE FAMILY DWELLING WITH 1-CAR ATTACHED GARAGE
AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SINGLE FAMILY DWELLING
145 September 8 99
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(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.)
8 September 97
Dated at the Town o nsbury this Day of t9
/ /�SIGNED BY is — for the Town of Oueensbury
Buil ng nd Z ning Inspector
Lut utrtg rearnit Application
Town of Queensbury - Dept. of Conununity Development, 742 Bay Road, Queensbury, NI' 12804 1761-8256]
NOTIC° BUILDING & CODE ENFORCEMENT
E Requirements prior to issuance
A permit must be obtained before .. of this permit: PERMIT FILE NO. 7 0
beginning construction. No inspections
will be made until applicant has received n Zoning Board Action PERMIT FEE PAID$ / ,.........--
a VALID BUILDING PERMIT. All Area /Use
applicants' spaces on this application RECREATION FEE PAID$
MUST be completed and•the signature n Planning Boatel Action I
of the applicant must appear on the REVIEWED BY: �'
`pplicnlion form. 11.4 rm SPR / Subdivision /Other Building Inspector
J Recreation Fee Payment 1'
Applicant: ScAie.r-. erkarAd Co,AsiDit4.;.,.J Owner: 7. 46 [,S
• Address: T, IMoShe$ Covv4vv‘o,v A lor4-4 Address:
Phone # ( sag ) 718 - 140 Phone # ( ) -
Properly Location: 1,1ta9e. {Q. , JTS �a. .$
thilnllvlalun Nitiiwi 'InK Mnit Nil mho r .-....�J.,.... .�.
Ntwllan Ilhwk I ni
•NATURE OF PROPOSED WORK:
ESTIMATED MARKET VALUE OF THE
y New Building: CONSTRUCTION: $ 75,006
residence / commercial
Additio O Building:
'jesidenc / commercial OCCUPANCY INFORMATION:
Alteration to Building: Primary Building -
residence / commercial $z Single Family Dwelling
Residence / Commercial Two Family Dwelling
A no change to exterior size Family Dw ling
Office
Other Work (describe below) Mercantile ,iP ,
Manufacturin14v.;Z' t
Other �
GROSS AREA OF PROPOSED STRUCTURE: I 9
O. iO
1st Floor o00 X If ADDITION, wh tib"1�1 -,use
/ sq. f t. SUI �.r. :, °,v,.
2nd .Floor of new addition b 11U11VC,g640
K sq. ft. CpD
Other Floors $4 sq. ft.
(not unfinished cellar or basement) ACCESSORY BUILDI GS: o'
Detached Gar 2
TOTAL FLOOR AREA: - 4 )00 0 SQ. FT. K Attached Garage 1 2 car
Private Storage wilding
SIZE OF NEW STRUCTURE: Commercial Storage Building
Sy FEET X 56 FEET Other
Foundation Type: Cor►Ge&I-e. Will any second-hand or ungraded
Number of Stories: / lumber be used? If so, for what?
(habitable space only) /1.,0
Height (grade to ridge) : .ICo feet TYPE OF HEATING SYSTEM:
Number of fireplaces and/or woodstove (circle all which .. . .li s)
to be installed: X .l ertri c: / Oil Ga /Mood
cr.
Forced Hot Ai? / Baseboard / Other
Person responsible for supervision of work as regards to building
codes is : Sci,,Q,e,ntQ(r o Cjv Gems c,,,c,4-;odo Gore
Name Addresss Phone
Builder: ScA.e,cwc. Cl chid •7 9 A -067y
Plumber: si.e.,,e, Aile.N 7Y7-5I093
. Mason: .no,,LP. 5a.1clwI N 79Z- 1371
Electrician: j) ; kp , t...e,n,.;Skj— )1qy-39o5
DECLARATION: Please sign below ajler 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 I/we shall submit prior to a
Certificate of Occupancy'or Certificate of Compliat e being issued, an AS BUILT PLOT PLAN by
a licensed surveyor; dr n scale, Ito ng ctua °cation of project on premises.
Signature:
(owner, owner's agent, architect, contractor)
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Permit No.
_5 J (
Dept. of Community Development
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
Location of property for installation: PL;c13 2 gct.
Property Owner's Name: 1m i k 110.1&S.
Property Owner's Mailing Address: (1
Installer's Name: 5 e,r+4 e,'ho Av Co,v s'11'.0 c/ ' Phone # 7 9 8'-O( 7 y
cope.
Number of bedrooms (if residential): 3 Total daily flow: yso
(residential - compute @ 150 gal./bdrm.)
Topography: Y 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: X not required, required [rate min. per inch] � eeA,I '0.r
cc:414,, `c.
Domestic water supply: Y municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is /°0 feet.
PROPOSED SYSTEM
Septic tank: /000 gallon (minimum size: 1,000 gal.)
Tile field: each trench 5 o feet / Total system length: .026 b feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # 0 / depth or thickness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
(Alarm system sad associated electrical work to be inspected by a certified agency.)
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or
approval granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a
material fact or circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this appli and agree to abide by and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance. q
Signature of responsible person: Date: / — 7
•
3 ram,� ENERGY CODE COMPLIANCE APPLICATION 7 -50 TOWN OF QUEENSBURy, WARREN COUNTY 6
9000 HEATING DEGREE DAYS Pr c.�"Y-4
Comoliance Methods : PART 5 - Acceptable Practice Metho - SEP () 2 1997
1&2 Family Dwellings (onl
PART 6* - Thermal Rating - Componen �sN
1&2 Family Dwellings; Mul i- uDEY
Dwellings (3 stories or less)
PART 4* - Design -by Component Performance -'
Commercial Buildings-Hi Rise Residential
*Requires submission of worksheets
APPLICANT' S NAME: PROPERTY LOCATION:
544c.,•v, hors cijo/JCoep. R col�Q Pa.
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
I . Gross Floor Area - /479 scuare feet
2 . Type of Heat - Electric Oil $e Gas Other
3 . Is building mechanically cooled? Yes k' No
4 . Percentage of area of windows and doors tiC Over 17% Under 17%
5 . R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS
SHOWN ON PLANS SUBMITTED:
a . Roof • •• R So
b . Exterior walls R
c _ Glazed areas R j •g
d- Exterior doors R a•55
e . Floors over unheated spaces • R !9
f . Edge of slab on grade (heated building) R //
g. Basement/cellar walls (above (=rade) , R /9
h _ Basement/cellar walls (below grade) R i/
1 . Heating/cooling-ducts—piping in unheated space R �l•(o
6 . Service (domestic) hot *water heating device
Conforms to minimum efficiency per code X • Yes. No
TEMPERATURE CONTROL MAXIMUM SETTING 1400 - WILL NOT BE EXCEEDED
APP li 's i n t e Date Phone Number
S 9—a —91 -298-047 y
INSPECTOR'S REMARKS:
fin)
GENERAL INSPECTION REPORT
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive am/pm Depart 2' am/
Inspector's Initials g
NAME: **MIT# L S O
LOCATION: l? ATE : 01 -/l'
TYPE OF STRU : \C)
RECHECK
N/ YES NO COMMENTS
Footings/Piers I I
Monolithic Pour Form
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
Fo .dation/Dampproofing,
- .i ll Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
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-
Proper Vent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1, 2, 3, hour
Penetration Sealed
Fire Wall 2, 3, 4 hour
Firestopping
k O Cr 00
GENERAL INSPECTION REPORT
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building& Code Enforcement ` ,�
742 Bay Road
Queensbury,NY 12804 Arrive pm Depart - jm/ j -'
Inspector's Initialsn �1 � /'
NAME:f-y ' -- �.y .1, PERMIT# l ..m`� - 52*
LOCAT4( : `j�- J.E) { 1 DATE : e1` 1 `5
TYPE OF STRUCTURE: ` �'(T
RECHECK
N YES NO C• I 1 NTS
Footings/Piers I
Monolithic Pour Form
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
Fou�daaation/Dampproofing
\---Bgkkfill Approval / 0 /'rf 0
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
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-
Proper Vent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam f
Air Infiltration Barrier
Fire Separation 1, 2, 3, hour \\
Penetration Sealed
Fire Wall 2, 3, 4 hour
Firestopping
GENERAL INSPECTION REPORT \V-30
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive am/pm Depa� • pm
Inspector's Initials
NAME: ` O D, CYY PERMIT# O v
LOCATION: �� y.fi?QnN_ 0-Q.- DATE : -9 '_ C1
TYPE OF STRUC :
RECHECK
N/A YE/NO COMMENTS
F tings/Piers I
Monolithic Pour Form
Reinforcement in Place 4t
The contractor is responsible fo
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofi
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in P1.•
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls In w 'or R-
Foundation Walls E "rior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1, 2, 3, hour
Penetration Sealed
Fire Wall 2, 3, 4 hour
Firestopping
(518)761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: AR -) DEPART INT�
REQUEST FOR INSPECTION RECEIVED:
NAME Rftle
LOCATION 1`Lr E (Z4) •
DATE i 4 7-K1 PERMIT I / ' 5V&
TYPE OF STRUCTURE:
RECHECK APPROVED
, N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPO I FOR
PROVIDING PROT TION F M FR ZING
FOR 48 HOURS FO MING THE PLA E-
MENT OF THE CONC
MATERIALS FOR THIS PUR''OSE ON SITE,_
FOUNDATION/WALLPOUR f
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING _
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING _
PyMBING UNDER SLAB
RAM I NG �T Vic=* iir L/D�C-Itj
ACK STUDS EArJ tF�
BRACING/BR
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 QUEENSBURY011b
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARW 1,4 DEPARO�`VJIj�j
INT ‘ ` --
REQUEST FOR I SPECTION RECEIVED:
NAME
LOCATION /�11OCb€ Rio/f// /T7
DATE 24 PERMIT 1 7) +45.-06
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPON'IBL FOR
PROVIDING PROTE TION FRO FREEZING
FOR 48 HOURS FOLLOWING T E PLACE-
MENT OF THE CONCRET .
MATERIALS FOR THIS PU"O` ON, SITE _
FOUNDATION/WALLPOUR -"
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLAC'
ROUGH PLUMBING _
P MBING UNDER SLAB
FRAMING g J1 6L/O6/ '
ACK 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-
Peter .oil) Do4 DfRC6 4. 5. A. P,
j 4eHeduc6 , 4v5 /04) OF
l A ��.T /O M1& DR. i-ikAt?
RESIDENTIAL FINAL .INSPECTION REPORT
Office No. (518) 761-8256 ,
Building &Code Enforcment Arrive,' Insp:
Dept. of Community Development
Town of Queensbury Date Inspection Request Received:
742 Bay Road
Queensbury, NY 12804 NAME 40Wt.` PERMIT NO. Cti� (Q
LOCATION • ��=� DATE L
TYPE OF STRUCTURE 5F D
QUA YES NO COMMENTS
ChimneyHeight/"B" Vent/Direct Vent Location 11//,
Fresh Air Intake
Plumb Vent Through Roof
Roof Complete
Exterior Finish Complete1,t/
Interior/Exteri s 30" to 36"
Exterior drails, Balco 'es, Landing 18 in. or more
Interior drails Stairs Bo Sides 3 or More Risers j
Gra % Away From Fo tion a/
8" ea ce To Sill Plate
Valve ShutZff Exposed/Regulator 18" Above Grade
s Furnace Shut-Off within 30 Feet or within Line of Site
'1 Furnace Shut-Off at Entrance to Furnace Area
umace/Hot Water Heater Operating Relief Valve(s) Installed J/
Headroom 6 ft. 6 in. On Stairs
Basement Stairs 6 ft. 4 in. /
andrail Exterior Stairs Both Sides More Than 3 Risers
Interior ✓
Privacy/Trim/Doors/Main Entrance 36" ` A0.f115 T
Floor Finish ✓/�
Bathroom/Kitchen Watertight
Interior Handrails Balconies/Landing 18 in. or more 1!
Railing Across Window in Stairwells
Smoke Detectors: J
every level
every bedroom
outside every bedroom
inter connected j
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) t/ /
Light Ventilation Per Room •/
Safety Glazing 18" or Less From Floor
Final Electrical
Site PlanNariance Required
Final Survey Plot Plan
As Built Septic System Layout Req.
Okay to Issue Temp C/O l' �J
c 1<r 7 j��vE /a co/ p . 1}4- 'Suk✓el ,QP�/ , /[C ut5e-z) �uoN4. /144/ 4Ev15 -4J
6.
4_&1/4 ,vti C�iv .tiC-64.5 4° 4 (anic_A TE- / E=4( QQ rS x F4T( &, v(
T �/Z
TOWN OF QUEENSBURY
BUILDING & CODE.0110
742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256
11
ARRIVE: DEPART: INSP: Ammo
FINAL INSPECTION REPORT
COMMERCIAL MULTIPLE DWELLING
(hotel, motel, apt. complex)
DATE INSP TION REQUEST RECEIVED:
NAME L
LOCATION pb'
DATE I//P[ f 7 PERMIT # 9
• TYPE OF STRUCTURE (t
FOOTINGS __BACKFILL FRAMING PLUMBING
INSULATION
N/A YES NO
CHIMNEY/"B" VENT/HEIGHT
PLUMBING VENT/FIXTURES
ROOFING
EXTERIOR F ISH
HEATING/H T WATER 4 _
RELIEF VA VES
FLOO$S
FOUNDATION INSULATION _
INTERIOR S IRS/RAILINGS
STOCKROOM E CLOSURE
FIRE/DEMISE WALLS PENETRATION
FIRE DAMPERS`. L�
CEILING FIRE STOPPING
FIRE DOORS/CLOSERS
EXIT DOOR HARDWARE
EXIT STAIRS/RAILS
PLATFORM/ELEVATOR
HANDICAPPED ACCESS
HANDICAPPED BATHS
HANDICAPPED PARKING
FINAL ELECTRICAL
SITE PLAN/VARIANCE REQ.
FINAL SURVEY PLOT PLAN, IF REQ
OK TO ISSUE C/O OR C/C
"(kti
c_".v
RESIDENTIAL FINAL INSPEC770N REPORT
Office No. (518) 761-8256 0 r�
Building &Code Enfoncment Arrive: lJ , p: V 6
Dept. of Community Development / Cj
Town of Queensbury Date Inspection Request Received: / /-2"// -/ 7
742 Bay Road
Queensbury, NY 12804 NAME f C. PERMIT NO. q /rJ- Co�
LOCATION • DATE /j -c3/-Gj 7 hof
TYPE OF STRUCTURE
N/A YES NO COMMENTS
Chimney Height/"B" Ve t/D ect Vent Location (7/Fresh Air Intake Plumb Vent NI ough • i•f
Roof Complete v
Exterior Finish Compl:"-
Interior/Exterior Railin Is 30" to 36" (/)
Exterior Handrails, B. ones, Landing 18 in. or more Interior Handrails Stair Both Sides 3 or More Risers
Grade 2% Away From oundation
8" Clearance To Sill Pl.to - V
Gas Valve Shut-Off Ex,•sed/Regulator 18" Above Grade
Gas Furnace Shut-Off within 30 Feet or within Line of Site /
Oil Furnace Shut-Off at Entrance to Furnace Area V
Furnace/Hot Water Heater Operating IRelief Valve(s) Installed
Headroom 6 ft. 6 in. On Stairs
Basement Stairs 6 ft. 4 in. V
Handrail Exterior Stairs Both Sides More Than 3 Risers
Interior Privacy/Trim/Doors/Main Entrance 36"
Floor Finish
Bathroom/Kitchen Watertight
Interior Handrails Balconies/Landing 18 in. or more
J 1
Railing Across Window in Stairwells
Smoke Detectors: �/
every level y/
every bedroom V/
outside every bedroom /
inter connected /
Bathroom Fans tJ/
Plumbing Fixtures/
Foundation Insulation /,...-
3/4 Hour Fire Door/Door Closer
Garage Fireproofing
Garage Penetrations Sealed 1 1/
Furnace In Separate Room Protected (In Garage) 7
Light Ventilation Per Room
Safety Glazing 18" c r`L I' �1/+s_Flom Floor
Final Electrical l ` l .. /
Site Plan/Variance Required
Final Survey Plot Plan
As Built Septic System Layout Req.
Okay to Issue emp C/O yam/ 4,-*6eAt-'41Z--
S ii Dew
`/(.4 a(t/ �14 C , oe/Av#0. 8e¢f✓f ,LEAftcv , .
, I). �� t4,
, c�'er& )/mo,e
A' TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 14
Location ,42
Date _ 'L rmi t # (17-5--es
SOIL TYPE: Sand Loa -Clay-
Results of Perco ation Test-
(if applicable) . e-Minute/Inch
TYPE OF S TEM: )
ABSORPTION EL) .ta L th
Length of each rench ' 'j�
Depth of trenche. 3
Size of stone
SEEPAGE PITS: N mbe"-
Size - ft. x ft.
Stone size
PIPING: S �e D
Bldg. to Tank Zk
Tank to Dist. Box V 4
Dist. Box to Field/Pi LA v+
Openings Sealed? ausi No Partial
LOCATION/SEPARATII
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits eet
Conforms as per Plot Plan - No
LOCATION OF SYSTEM ON PROPER
(circle AFT)
Front - e - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: NO
Arrived: /2 °
Departed: p
Building nspector
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 357 Elwyn Terrace — Manheim,PA 17545 Ci; /- C
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Panel Board No. Cert. N° 4 9 9 7 4 Cut-in Card No.
Owner "/(A-) 4/.1'7') 4
Occupant
br-if e'
Location
Installation Consisting of )4'
P/2 . j7/ („;
14 le(
Installed By /1/ (;.('').;I A S 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 inspe ions at any time,and if its
rules are violated,the Company shall have the right to revokejth' certi att.(/'
Date //* ti INSPECTOR
ember N.F.P.A.,I.A.E.I.
(518) 761-8256
TOWN OF QUEENSBURYOjib
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804t ^^��
INSPECTOR'S REPORT: AR . EPARV ' INT 'v
REQUEST FO INSPECTION RECEIVED:
/VEED: �
NAME HL ee N0/2/�/ �f'l e'S)
LOCATION fC1O6E 49.
DATE l07/q1 PERMIIT J 97- 5216
TYPE OF STF�UCTURE: c r J
RECHECK �// APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM _
1:
REINFORCEMENT IN PLACE J
THE CONTRACTOR IS RESP NSIBLE FOR
PROVIDING PROTE TION OM FREEZING
FOR 48 HOURS FOLLOWIN 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
H ATING ROUGH- N 'l
NSULATION• gOt /� VGN f
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
si-Crl-
(518) 761-8256
(O r.`
TOWN OF ODEEENB CalliA
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR .. DEPART IN'1N
REQUEST FOR INSPECTION CEIVED: tO -"l(' -1 7
NAME
G
LOCATION l' a�f {/
�
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(518) 761-8256
TOWN OF QUEENSBURY0
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 128044''�� ``''
INSPECTOR'S REPORT: ARR DEPART'? )INTIP
REQUEST FO INSPECTION RECEIVED:
NAME 714e4Jd
LOCATION /ea
DATE /aPERMIT I 47 7" SO6
TYPE OF STRUCTURE:
RECHECK APPROVED
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(518) 761-8256
TOWN OF QUEENSBURY
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742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR DEPART 3 Y INti
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NAME
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DATE / b 1 14/(q7 PERMIT I ( 2' 5 (e
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TOWN OF QUEENSBURYOlb
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
3INSPECTOR'S REPORT: ARR3t DEPARTC`° IN�IaQ�
REQUEST FOR INSP CTION RECEIVED: L O/4/ ` T1
NAME C,- /
LOCATION LC1(I-`0(-1- `4- 24
DATE t t)1 l 41 1-) PERMIT f e""7-
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INSPECTOR'S REPORT: AR* 6." DEPAR INT
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742 BAY RD., QUEENSBURY NY 12804 �CC !
INSPECTOR'S REPORT: ARR ' DEPART)•
REQUEST FOR oINSPECTION RECEIVED:
NAME44
LOCATION J
DATE CilijR 7 PERMIT 1
TYPE OF S _ `RUCTURE:
RECHECK APPROVED
N/A J YES NO
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