97-294 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
December 10 97
Date 19
This is to certify that work requested to be done as shown by Permit No. 97294
has been completed.
SINGLE FAMILY DWELLING
This structure may be occupied as a
640 RIDGE RD.
Location
Owner WEEKS , RANDY, & PAULA
TAX MAP NO. 5 5, - 1-9 . 2 By Order Town Board
TOWN OF QUEENSBURY
s /)&4 '-
Directorbfl--5 -
of Bldg. & Code Enforcement
BUILDING PERMIT
VALUE $ 95000 OWN OF QUEENSBURY
No. 97794
TAX MAP NO. 55. -1-9:)\ WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to WEEKS, R ANflY, & PAULA
OWNER of property located at 676 RIDGE R11 Street,Road or Ave.
in the Town of Oueensbury,To Construct or place a SINGLE FAMILY DWELLINC
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
8 HICKS ROAD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
WEEKS , RANDY
3. CONTRACTOR or BUILDER'S Address
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
( 1 Wood Frame ( I Masonry ( )Steel I )
7. PLANS and Specifications
240' sq ft SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE AS
PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SINGLE FAMILY DWELLING
$ 299 PERMIT FEE PAID -THIS PERMIT EXPIRES June 9 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 9 D of June 19 97
SIGNED BY for the Town of Queensbury
Building and Z Inspector
4., Duetting rer mit Application
Town of Queensbury - Dept. of Community Development,' 742 Bay Road, Queensbury, NY 12804 1761-82561
'O BUILDING & CODE ENFORCEMENT
NOTICE Requirements prior to issuance c
' 1 of this permit: PERMIT FILE NO. 9' -7 - ) L IC
A permit must be obtained before
beginning construction. No inspections
n 9, 1" v
will be made until applicant has received n Zoning Board Action PERMIT FEE PAID$ `�
a VALID BUILDING PERMIT. All Arca /Use
applicants' spaces on this application RECREATION FEE P ID$
MUST be completed and the signature pi Planning Board Action REVIEWED BY: eC
of the applicant must appear on the
SPR / Subdivision /Other Building Inspector
application form._nK.a),,, - J / Recreation Fee Payment
Applicant: "iffin4 '/�4% (!/e-eA:S Owner: �a-pt e
• Address: f /471<-- iec�
s - l eee_12,z7' Address: ` u'•-e
Phone # ( -SW) 7c/3 - 03-s7 Phone # ( ) .
Properly !motion: ��,-(2e ,ei. cremS t7 (-
i
Subdivision Name: . Tax Map Number_ ��
Section Block Int
• NATUE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
New Building: CONSTRUCTION: $ SCbv
residence / commercial /
Addition to Building:
residence / commercial OCCUPANCY INFORMATION:
Alteration to Building: Primary Building -
residence / commercial ✓ Single Family Dwe1g .
Residence / Commercial Two Family Dwellirigt ' .„
no change to exterior size Family Dwelling
Office
Other Work (describe below) Mercantile
Manufacturing ,,s->u '
Other
GROSS AREA OF PROPOSED STRUCTURE: /it/
If ADDITION, what will use
1st Floor r�yb sq. f 3� of new addition e? :
2nd .Floor //Stv sq. ft A1
44
Other Floors sq. ft.
(not unfinished cellar or basement) ACCESSORY BUILDINGS:
Detached Garage 1, 2 car
TOTAL FLOOR AREA: ,1 -7/6 1 SQ. FT. ,/ Attached Garage 1,L2r
Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building
Other
FEET X FEET
Foundation Type: u_r ' 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 which ppli9s)
to be installed: / Electric / Oil / as /./Wood
Forced Hot Air ,C. seboaiE / Other
Person responsible for /supervision of work as regards to building,
codes i s : �u-n ' .11..,1'G 1 �-6 t f- 4-/7, 47r) ? �-
. G 3 r4'`
Name . Addresss Phone
Builder: (,., AO A Afy „/ t-- 4/. (v?. - SZY9
Plumber: 'st-, i,2 t'/ /,',! a-ra 753 - )«
Mason: i� -e -/ ,c i 77c2 —Jd'/'(
Electrician:_.4 ar' i ; l 3 n A/. /))c � l 7e-i 3-G 3J,
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 I/we shall submit prior to a
Certificate of Occupancy Certificate of Compliance being issued, an AS BUILT PLOT PLAN by
a licensed surveyor; drawn too scale, showing actual location of project on premises.
/ .Signature: J /i(�J C
(own owner's agent, architect, contractor)
•
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY
• 9000 HEATING DEGREE DAYS '
Comol i ante Methods : PART 5 — Acceptable Practice Method -
1&2 Family Dwellings (only)
PART 6* - Thermal Rating - Component Trade Offs
l&2 Family Dwellings; Multi-Family
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:
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1 . Gross Floor Area - c `7'o p•- scuare feet
2 . Type of Heat - Electric Oil ✓ Gas Other
3 . Is building mechanically cooled? Yes ✓ No
4 . Percentage of area of windows and doors Over l7% ✓Under 17%
5 . P.-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS
SHOWN ON PLANS SUBMITTED:
a . Roof • _• R
b . Exterior walls R
c . Glazed areas R
d_ Exterior doors R
e . Floors over unheated spaces R
f . Edge of slab on grade (heated building) R
g. Basement/cellar walls ( above grade) R
h. Basement/cellar walls (below grade) R
1. Heating/cooling-ducts-piping in unheated space R
6 . Service (domestic) hot 'water heating device /
Conforms to minimum efficiency per code V. Yes, No
TEMPERATURE CONTROL MAXIMUM SETTING 140° = WILL NOT BE EXCEEDED
Appl„/ant's S;tg atur � D//atq Phone Number
INSPECTt - ' S REMARKS:
•
•
•
•
TOWN OF QUEENSBURY
742 Bay Rd., Queensbury, NY 12804
APPLICATION FOR SOLID FUEL BURNING APPLIANCES AND CHIMNEYS
1
Date "-' -" s ,19 ' Permit No. • ;
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.
4
Applicant >>,�,7,?7;; !' s APPLIANCE (check appropriate boxes)
Address / (_c-,t:, << u ❑ STOVE: ❑Wood o Coal o Pellet ❑ Gas
0 FIREPLACE INSERT
_'17 ;. 44'4 � �,, Zip A,, o FIREPLACE, FACTORY-BUILT:
❑ Wood Erdas
Phone "2 % 0 FIREPLACE, MASONRY:
❑ Wood ❑ Gas
Owner ;1 ;,, ; 0 FURNACE: ❑ Wood ❑ Gas ❑ Oil
Address IF NON-MASONRY APPLIANCE:
Manufacturer: -6,)
Zip Model: r:
Phone
CHIMNEY (check appropriate boxes)
*EXACT ADDRESS of proposed constructir i
❑ MASONRY: 0 Block 0 Brick 0 Stone
FLUE: 0 Tile 0 Steel
Size:. _ . inches
CONSTRUCTION / INSTALLATION MUST E''FACTORY-BUILT:
CONFORM TO NYS FIRE PREVENTION & Manufacturer::;:, :,.e•••j— Model: �'-
BUILDING CODE. CONSULT AVAILABLE Listed By: Number:
TOWN OF QUEENSBURY HANDOUTS 0 Double Wall 0 Triple Wall
REGARDING REQUIRED INSPECTIONS. 0 Insulated 0-Direct Venting
0 Chimney Liner
Cashier's Department Town of Queensbury, New York
Dept: Fire Marshal Amount Collected Amount Refunded
Code Number Title
A 173 3389 (190) Public Safety
A 233 26 (230) Minor Sales
Fee Collected From or Refunded to: -- =:
Address:
Dated: Town Clerk or Deputy:
White: Applicant Green: Fire Marshal Yellow: Bldg. Dept. Pink & Goldenrod: Cashier's Dept.
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No.
Dept. of Community Development
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
J
� ��
Location of property for installation: 6' 4/0 �Zile et"
Property Owner's Name: h),, /
- - P
Property Owner's Mailing Address: 1/4e ��#
Installer's Name: ?ci.4 G1.4 y Phone # 11
Number of bedrooms (if residential): A/ Total daily flow: 600
(residential - compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, " loam, clay, other /depth:
Ground water: at what depth? 02. feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, required [rate /-S,,min. per inch] F 1/eI ores
Domestic water supply: municipal, /well, other
If domestic water supply is a WELL, water supply from any septic absorption is 1O) feet.
PROPOSED SYSTEM
Septic tank 1,200 gallon (minimum size: 1,000 gal.)
Tile field: each wench 5 O feet / Total system length: of 6-6 feet
Seepage pit(s): number of Pk- / size each: ft. by ft.
Size of stone to be used: # 3 / depth or thickness a feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: AY/a- Size of each: gallons
CAlarm system and 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 application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance
Signature of responsible person: L J Date: /` ��''
ti EFSIDEN IAL FINAL E C 'REPORT //i`rIt
Office. No. (518) 761-8256 -�
13tai?duto &Code Enforcment Arrive: 90- Insp:
Dept. of Community Development
Town of Queensbury Date Inspection Request Received:
742 Bay Road C
Queensbury, NY 12804
NAME 7AI% e. PERMIT NO.LOCATION �/v .c £/ DATE
TYPE OF STRUCTURE 9
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, Balconies, Landing 18 in. or more
Interior Handrails Stairs Both Sides 3 or More Risers
Grade 2% Away From Foundation
8" Clearance To Sill Plate
Gas Valve Shut-Off Exposed/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
\\-(1)
Furnace/Hot Water Heater Operating
Relief Valve(s) Installed
Headroom 6 ft. 6 in. On Stairs
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
Interior Handrails Balconies/Landing 18 in. or more
Railing Across Window in Stairwells
Smoke Detectors:
every level
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)
Light Ventilation Per Room•
Safety Glazing 18" or Less From Floor y/ /, r"
Final Electrical ior
_ye •r -ice
Site PlanNariance Required
Final Survey Plot Plan ✓
As Built Septic System Layout Req.
Okay to Issue Temp C/O
Okay to Issue Permanent C/O L'
Okay to Issue C/C
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. (► �
Main Office 357 Elwyn Terrace — Manheim,PA 17545 e•` ,,
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Panel Board No. Cert. 5 2 5 3 1 Cut-in Card No.
Owner r2 '4)# 7 G?J I7Z-,7''S (/
Occupant /2t
p 6 e ,
Location // L" 'G���� C/
Insulation Consisting of 7 Z O I '7 7 26- eP �� / S
(I L4Vt.-19}.. D f G0 Pi -V6 L j ( //git1S�
Installed By /2.� 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 ton at any time, and if its
rules are violated,the Company shall have the right to revok th' cer f' t �
Date..l - 97 INSPECTO AA-6
Member N.F.P.A.,I.A.E.I.
TOWN OF QUEENSBURY
Aft
FIRE MARSHAL
QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR PECTION RECEIVED /,)--/O'47 7
NAME -ti "? )4 s
LOCATION
DATE PERMIT # /,� _/O �� q7- rQ%9
APPROVED
N/A YES NO
EXI
AISLE WIDTHS
EXIT SIGNS
EMERGEN LIGHTIN
FIRE EXTINGUISHERS
AUTO. EXTINGUISHI G SYSTEM
HOOD INSTALLATIO
AUTO. SPRINKLER SY TEM
ALARM SYSTEM
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
CHIMNEY
WOODSTOVE
FIREPLACE- MASONRY V
FIREPLACE- FACTORY BUILT
REMARKS: 0 OK TO THIS DATE
6.4i at-
Li d� ha//ems
INSPSLIP.PUB INSPE T R
TOWN OF QUEENSBURY
,f1 BUILDING & CODE ENFORCEMENT
1r- 742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256
ARRIVE: DEPART: INSP: )
FINAL INSPECTION REPORT - RESIDENTIAL
DATE INSPECTION REQUEST RECEIVED:
7.
NAME .AC"
LOCATION " i %4A. + 4
.
DATE •
' ^-i � 11 PERMIT 1 g.
TYPE OF STRUCTURE J
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING _ SEPTIC INSULATION _
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
A YES NO
CHIMNEY HEIGHT/B VENT/HEIGHT
PLUMBING VENT
ROOFING
EXTERIOR FINISH
DECK/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
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
SITE PLAN/VARIANCE REQ.
FINAL SURVEY PLOT PLAN /
OK TO ISSUE C/O OR C/C
x
,RESJDEIVTIAL FINAL INSPECTION REPORT
Office No. (518) 761-8256 qii"Building &Code EnforcmentArrive: 9i Insp:
Dept. of Community Development
Town of Queensbury Date Inspection Request Received:
742 Bay Road
Queensbury, NY 12804
"j o
-\
NAME `.�e �C,7 , CA:1\f PERMIT NO. ` /
- (`-'\
1 � _ _c7 -7
LOCATION � C}C) Q,cr Q cy-e J DATE ) t /
TYPE OF STRUCTURE it
N/A YES NO COMMENTS
Chimney Height/"B" Vent/Direct Vent Location ,,Y/
Fresh Air Intake Y
Plumb Vent Through Roof �<
Roof te Cr Finish , // I c`' trAtet � ' fr1/-1"Exterior Finish Complete i_ / (/t ����� �4�S-
Interior/Exterior Railings 30" to 36" 1/` �" f,
Exterior Handrails, Balconies, Landing 18 in. or more I,/ `� /
Interior Handrails Stairs Both Sides 3 or More Risers ✓l r n e��` ,P�
Grade 2% Away From Foundation
8" Clearance To Sill Plate
Gas Valve Shut-Off Exposed/Regulator 18" Above Grade V •
Gas Furnace Shut-Off within 30 Feet or within Line of Site �, V
Oil Furnace Shut-Off at Entrance to Furnace Area
Furnace/Hot Water Heater Operating .,
Relief Valve(s) Installed V
Headroom 6 ft. 6 in. On Stairs I/
Basement Stairs 6 ft. 4 in.
Handrail Exterior Stairs Both Sides More Than 3 Risers
Interior Privacy/Trim/Doors/Main Entrance 36" �r
Floor Finish VA,
Bathroom/Kitchen Watertight 1
V.
Interior Handrails Balconies/Landing 18 in. or more
Railing Across Window in Stairwells �,
Smoke Detectors: t�
every level ✓r
every bedroom ,1
outside every bedroom a j
inter connected ✓/
Bathroom Fans
Plumbing Fixtures
+. ' t4 -4,--,
Foundation Insulation l��f
3/4 Hour Fire Door/Door Closer or
Garage Fireproofing •, w.�
Garage Penetrations Sealed
Furnace In Separate Room Protected (In Garage) tV
i .
Light Ventilation Per Room- >f
Safety Glazing 18" or Less From Floor /�1 AC/ 4� ,.,�
Final Electrical e� Jt
Site PlanNariance Required ,�/ `S
Final Survey Plot Plan / /Ve , ✓,,JeEy
As Built Septic System Layout Req. /
Okay to Issue Temp C/O
Okay to Issue Permanent C/O
Okay to Issue C/C
TOWN OF QUEENSBURY
4111aZi FIRE MARSHAL
QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED / .2
NAME `
LOCATION U ` 0 \ l 1 9\6
DATE PERMIT # CA1 f D.9 J 9 7
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
AUTO. EXTINGUISHING
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM
ALARM SYSTEM
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
CHIMNEY
WOODSTOVE
FIREPLACE-MASONRY
/FIREPLACE- FACTORY BUILT r
REMARKS: 0 OK TO THIS DATE
/fCr`
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4, -
INSPSLIP.PUB INS TOR
11
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(518) 761-8256
TOWN OF QUEENSBURY (PIO
BUILDING & CODE ENFORCEMENT
742 BAY RD. , QUEENSBURY NY 12804
4 4
INSPECTOR'S REPORT: ARR V•�"D�PART�'� ) NT a-
t
REQUEST FO INS TION ECEIVEfj:
NAME
LOCATION
DATE PERMIT
TYPE OF STR TURE: .x
RECHECK APPROVED
'y N/A YES NO
FOOTINGS/PIER
MONOLITHIC PO FORM
REINFORCEMENT PLACE I
A
i
THE CONTRACTOR RESP SIBLE FOR
PROVIDING PROTE ION F OM FREEZING
FOR 48 HOURS FOLDWING THE PLACE-
MENT OF THE CONCRTE. j _
A
MATERIALS FOR THIS'PU POSE ON SITE,_ _
F
FOUNDATION/WALLPOUR.
REINFORCEMENT IN PL E ._
FOUNDATION/DAMPPROOkING
BACKFILL APPROVAL Y
PLUMBING VENT/VEN IN PI1ACE
ROUGH PLUMBING
PLUMBING UNDER S AB
FRAMING:
JACK STU S/HEADERS
BRACING/ RIDGING
\\
JOIST H GERS
JACK POS. S/MAIN BEAM
AIR INFILTRATION BARRIER
HEATING ROUGH-IN iI _
SULATION: IA& f FL/Z, _
_FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R- _/
FLOORS R-
WALLS R-fa
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
Al TOWN OF QUEENSBURY
ral FIRE MARSHAL
QUEENSBURY, NY 12804
(518) 761-8205
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED 7
NAME
LOCATION O
DAT ERMIT # 4 /q7 9/1
-�- 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 FACTOR UILT
REMARKS:/ 'OK TO THIS DATE
INSPSLIP.PUB SP T
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD. , QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR DEPARQ' INT WL..
REQUEST FOR INSPECTIOON RECEIVED:
NAME ✓I, LQC5
LOCATIO ( .LA c. & Qc , '
DATE /-1 _ PERMIT A ,
1121
TYPE OF S UCTURE: 'a'
/
RECHECK APPROVED
N/A YES NO
FOOTINGS/PI RS
MONOLITHIC UR FORM
REINFORCEMEN IN PLACE
THE CONTRACTO IS RESPONSIB FOR
PROVIDING PRO TION FROM F EEZING
FOR 46 HOURS F LLOWING THE LACE—
MENT OF THE CO BETE.
a
MATERIALS FOR THIS PURPO ON SITE
FOUNDATION/WALLPO R
REINFORCEMENT IN PLACE
1--
FOUNDATION/DAMPPROOF G
BACKFIL APPROVAL
PLU ING VENT/VENT IN PLACE
RO GH PLUMBING -
UMBING UNDER S AB
FRAMING: - ' /
JACK S DS/HEADERS
BRACIN /BRIDGING
JOIST ANGERS
JACK STS/MAIN BEAM
AIR INFILTRAT/ON BARRIER
HEATING ROUGH—IN
INSULATION: i
FOUNDATION WALLS INTERIOR R—
FOUNDAT ON WALLS EXTERIOR R— —
FLOORS ' R—
WALLS ? R—
CEILING R—
DUCT WORK OR PIPING IN
UNHEATED SPACES R—
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(518) 761-8256
0 „..\..
TOWN OF QUEENSBURY
BUILDING 6 CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARRf DEPART INT)/
•
REQUEST FO�t\INSP CTION REC V(E�D:
NAME 1 � �lv
LOCATION 0
_I - wilik 4 b liIP '
DATE PERM # # 47
TYPE OF STRUCTURE: S tp
RECHECK APPROVED
N/A YES NO
FOOTINGS/PI>RS `
4
MONOLITHIC PUR FORM ,
REINFORCEMENT`:FIN PLACE /
THE CONTRACTOR, IS RESPONSIBLE FOR
PROVIDING PROTH TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE. ,'
MATERIALS FOR THIS PURPOSE ON SITE
X
FOUNDATION/WALLPOUR I
REINFORCEMENT IN PIACE f_
FOUNDATION/DAMPPROOING
BACKFILL APPROVALI _
PLUMBING VENT/VETS IN PLACE _
ROUGH PLUMBING i _
PLUMBING UNDER SLAB
FRAMING:
JACK TUDS/HEADERS
BRAG G/BRIDGING
JOIS HANGERS
JACK, POSTS/MAIN BEAM
AIR INFILTRITION BARRIER
HE TING ROUGH-IN
NSULATION•
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS �7 /
i3F(-WALLS LJN.< t R 1�
CEILING R- l
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
et a _. 773 per
TOWN OF QUEENSBURY
`/f, BUILDING & CODE ENFORCEMENT
WAN 742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256
/ y ,
ARRIVE: Z'2 DEPART: -3 INSP:Jt
FINAL INSPECTION REPORT R IDENTIAL
DATE INS CTION REQUEST RECEIVED: -14 7
NAME 1 L-'C/ / \ Y
LOCATION e,\PJ�-D vQ 1 i-e i
DATE C.1'-------- ' II 9 i �
/- PERMIT !
TYPE OF STRUCTURE A,vv614",-(0 ( 74
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING _ SEPTIC INSULATION _
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE _
- N/A YES NO
CHIMNEY HEIGHT/B ENT/1EIGHT`.
PLUMBING VENT
1
ROOFING
EXTERIOR FINISH
DECK/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
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFFI �(II G [f�
DOOR CLOSERSCF6 �` ' /
'L//)
FINAL ELECTRICAL 7143--OLOCaS
SITE PLAN/VARIANCE REQ.
FINAL SURVEY PLOT
OK TO ISSUE C/O 7)(
(518) 761-8256
s
6()
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT (Nil
742 BAY RD., QUEENSBURY NY 12804
KW
�
INSPECTOR'S REPORT: ARRliO_i5EPAR IT. :rI
REQUEST FO INSPECTION RECEIVED: A
NAME YNA l 1) W P P, c .\
LOCATION 7 1 n� ,• 0
DATE 1 Is - lM PERMIT R,� `7 --"g9L/
TYPE OF STRUCTURE: S
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM -
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RES•. LE FOR
PROVIDING PRO - TION •• REEZING
FOR 48 HOURS FO. OWING : PLACE-
MENT OF THE CONCRE .
MATERIALS FOR THIS PURP• E ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE �__
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING: _
1 JACK STUDS/HEADERS _ _
BRACING/BRIDGING _
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
HE TING ROUGH-IN
INSULATION:
_FOUNDATION WALLS INTERIOR R-
FLOORATION WALLS EXTERIOR R-
WALLRS R-
WALLS
WALLS 'L � ��� R-�
_ CEILING it <' R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPT* DISPOSAL SYSTEMIINSPECTION
NamVAice-e -
Location' _t .,- ,
Date 6/ S,r Pe it #q7-25p-1
,..___
SOIL TYPE: Sand-Loa -C1ay-
Resul is of ff ercol:it on Test-
(if applicable) Re-Minute/Inch
TYPE OF SYS
ABSORPTION ELD: Total Length
Length of eal t ench
Depth of treh
Size of stone
SEEPAGE PITS: umber-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank \
nk to Dist, Box_
i st. Box t ` Field/Pi
Openings S led? '. No Partial
LOCATION/S ARATIOI
Foundatio to Tank '. feet
Foundatio to Absorption feet
Separati of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATI OF SYSTEM ON 'fROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle ront - Middle Red r
COMMEN S:
•
SYSTEM USE APPROVED: ( --. \,)YES NO
Arrived: 3 ili
Departed: ,
Building Inspector
4 ffr-- 7 M
(518) 761-8256
TOWN OF QUEENSBURY
3
BUILDING & CODE ENFORCE ENT
742 BAY RD., QUEENSBURY N 12804
INSPECTOR'S REPORT: ARR/ DEPART INT 241
REQUEST FOR INSP• "' ION RECEIVE':
NAME rr
LOCATION ,� '
DATE •Gr PE714IT A r /
1
TYPE OF STRUCTU�(2E:
RECHECK \1 APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FO"
REINFORCEMENT IN PL CE
THE CONTRACTOR IS REPO SIDLE FOR
PROVIDING PROTE TION F M FREEZING
FOR 48 HOURS FOLLOWINt /THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PU• 'OSE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLAC
FOUNDATION/DAMPPROOF!NG
BACKFILL APPROVAL _ ,V PLUMBING VENT/VENTS IN PLAC /
ROUGH PLUMBING V
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS4HEADERS
BRACING BR DGING
JOIST HANG:RS -
JACK POSTS/MAIN BEAM
AIR INFILTRATION B7r.RRIER
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- ,
n av
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
/ 1,_
Name k--f"'e S
Location — 7 '
Date 1 Permit 9
7(
SOIL TYPE Sand-Loa Clay- /
Results 'f Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
f
ABSORPTION' FIELD: Total Length , J 3t)
Length of each trench
Depth of trenches
Size of stone jy-
SEEPAGE PITS:< Number-
Size - ft. x ' ft.
Stone size
PIPING: Size Type . l
Bldg. to Tank / " 10 YQ
Tank to Dist. Box w —____4-
Dist. Box to Field/Pit 1.4 u
Openings Sealed? Yes NoCP is
LOCATION/SEPARATIONS:
Foundation to Tank I' -- feet
Foundation to Absorption '2S feet
Separation of Pits feet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPER .
(circle ,.-
Front Rea Left Side - Right Side
Middle .nt Middle Rear
COMMENTS:
CO&44_ 4PiAy/any—
€ate / /' " 0 -�'o 0A,bA-17 o Co4t -
pivie
grer.44oQk
SYSTEM USE APPROVED: YES NO
Arrived: !U`J a
Departed: j '
Building Inspector
1C) 1 .ffi18)
761-8256
TOWN OF QUEENSBURY0110
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR47 `(I DEPART "IN I
IEQUEST FOR INSPE I RECE VED: //
VANE (�
AT I ON �' i
�✓ )441
q7 PERM 1 i-OL •
PYPE OF TRUC URE: 7— f
2ECIIECK },PPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
CHE CONTRACTOR IS RESPONSI E FOR
?ROVIDING PROTE TION FROM F EEZING
!OR 48 HOURS FOLLOWING THE CE-
4ENT OF THE CONCRETE.
4ATERIALS FOR THIS PURPOSE ON SITE
?OUNDATION/WALLPOUR
ZEINFORCEMENT IN PLACE _
?OUNDATION/DAMPPROOFING
jACKFILL APPROVAL
?LUMBING VENT/VENTS IN PLACE
LOUGH PLUMBING
'LLUMBING UNDER SLAB _
GAMING:
JACK STUDS/HEADERS -
BRACING/BRIDGING ly
JOIST HANGERS //
JACK POSTS/MAIN BEAM NI
SIR INFILTRATION BARRIER _ _
{EATING 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- _
oRg i Aek oc►2G *kis,vA) 6-TA(2_
t '6" 1..)12NA 1J
i 10 TM A) L (0 1
�� ,`ooZti ._
--0 it-kPL t- (3 L�ciG C0 E. C&-LCKt-i<
--7,y1 Y 1 (518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR(9/t6 DEPART INTT CT.--
REQUEST FOR INSPECTION RECEIVED: 7' /_ l
NAME -\C-'� 1 x) j
LOCATION / Cc 1 (1 _-
DATE i� PERMIT lT-c;.q
TYPE OF STRUCTURE:
RECHECK APPROVEQ
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE _
THE CONTRACTOR IS RESkONSIBtE FOR
PROVIDING PROTE TION ROM FREEZING
FOR 48 HOURS FOLLOWIN THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PUR SE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE _
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL -
PLUMB G VENT/VENTS IN PLACE
UGH PLUMBING _ v�
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-
f/U,v, 1,-j
/7J'
't.r 1 14x-0 a a- Seca-J *AV
` N (518) 761-8256
lj
TOWN OF QUEENSBURY11110
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804 _ r/`�
INSPECTOR'S REPORT: ARd`cf j�
.DEPAW ' I/ "INT`Jr L
REQUEST FO` w_N _ECTION RECEIVED: ` / f q I
VAME
s .
LOCATION 1 (. l \ S �-
J ` . �
DATE l %� 9 I PERMI
PYPE OF STRUCTURE: .,
RECHECK APPROVB
N/A YE NQ
?'OOTINGS/PIERI \�1'
MONOLITHIC POUR FORM
REINFORCEMENT ACE L - /4
CNE CONTRACTO IS R SPONSIHLE FOR
PROVIDING PRO E TION FROM FREEZING
!OR 48 HOURS OLLOW'ING THE PLACE-
MENT OF THE C C E.
1ATERIALSDR S PURPOSE ON $ITE
!OUNDATION WALL OUR
REINFORCEMENT I PLACE
?OUNDATION/D PROOFING
3ACKFILL APPROVAL
?LUMBING VENT/VENTS IN PLACE
LOUGH PLUMBING ,
?LUMBING UNDER SLAB
'RAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
\IR 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-
G cyrf�
j (518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804 0R*'
INSPECTOR'S REPORT: A J DEPAR ! INT V/"'(
1EQUEST FOR INSPECTIN RECEIVED:
DAME (V{1Q()�l �
.00AT ON- 7 \k
11)ATE ����: PERMIT - t �r��
CYPE OqRU• U 111�7
1ECHECK APPROVED
N/A YES NQ
SOTINGSIME r )(0.0-
40 0 THIC POUR FORM •
tEINFORCEMENT IN PLACE
CBE CONTRACTOR IS RE ONSIBLE FOR
?ROVIDING PROTE TION OM FREEZING
NOR 48 HOURS FOLLOWING THE E-
SENT OF THE CONCRETE.
IATERIALS FOR THIS PURPO E ON SITE
rOUNDATION/WALLPOUR
tEINFORCEMENT IN PLAC
rOUNDATION/DAMPPROOFING
3ACKFILL APPROVAL
?LUMBING VENT/VENTS IN PLACE
tOUGH PLUMBING
?LUMBING UNDER SLAB
?RAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
U R 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-
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY��NY 12804
CNSPECTOR'S REPORT: ARF/�• °-DEPART , . IN'NeC".
tEQUEST FORSPECTION RECEIVED:
)AME )A .L. .4
,OCATIONNJ
)ATE / q 7 PERMIT A
'YPE OF STRUCTURE:
tECHECK APPROVE
N/A Y NO
'!OTING'
IPPIP
iONOLITHIC POUR FORM , /!
tEINFORCEMENT IN PLACB5'1 ')4. 1
'HE CONTRACTOR IS RESPONSIBLE FOR
'ROVIDING PROTE TION OM FREEZING
'OR 48 HOURS FOLLOWING HE PLACE-
LENT OF THE CONCRETE.
UITERIALS FOR THIS PURPOS SIDE
'OUNDATION/WALLPOUR
tEINFORCEMENT IN PLACE
'OUNDATION/DAMPPROOFING
IACKFILL APPROVAL
'LUMBING VENT/VENTS IN PLACE
OUGH PLUMBING
'LUMBING UNDER SLAB
'RAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING _
JOIST HANGERS
JACK POSTS/MAIN BEAM -
SIR INFILTRATION BARRIER
EATING 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-
(518) 761-8256
TOWN OF QUEENSBURY ,
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR t/ DEPAR INT
IEQUEST FOR ECTION R CEIVED:
4AME
:,OCATION Q T+ �U
)ATE I n —.- / 7 PERMI l
CYPE OF STRUCTURE: 3 f
IECIIECK I APPROVED
1 N/A YES NO
i00TINGS/PIERS f
4ONOLITHIC POUR F044
tEINFORCEMENT IN PUCE f'
i
CHE CONTRACTOR IS RE': PONS/SLE FOR
?ROVIDINO PROTE TION ' ROH FREEZING
NOR 48 HOURS FOLLOWI TOE PLACE-
;4ENT OF THE CONCRETE.n::
4ATERIALS FOR THIS PUI> SE ON SITE
?OUNDATION/WALLPOUR I
i.
tEINFORCEMENT IN PLAgE
OU , TION/DAMPPROOItING _ /
SACKFILL APPROVAL ' F
,LUMBING VENT/VENTS IN P CE ,.
COUGH PLUMBING
?LUMBING UNDER AB
I
rRAMING: i
JACK S DS/HEADERS
BRACIN /BRIDGING
JOIST ANGERS
JACK STS/MAIN BEAM _
►IR INFILTRAT ON BARRIER
t
(EATING ROUG -IN
INSULATION: I 4
FOUNDATI N WALLS INTERIOR R- ;
-
FOUNDATI N WALLS EXTERIOR ft- \ _
FLOORS R-
WALLS R-
CEILING R- _'°
DUCT WO K OR PIPING IN
UNHEATED SPACES R-
i
C
;LH))
(518) 761-8256
TOWN OF QUEENSBURY ,
BUILDING & CODE ENFORCEMENT alo
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR004) DEPART IN/T�
REQUEST FO NSPECTION RECEIVED: V `
VANE �
`te
: Tc
N � � a 08 ^ (]Y. 0 -� 1 PE• TT A `l
PIPE OF STRUCTURE: ' 173 l E.(:)
'
RECHECK it APPROVED
N/A YES NO
OTINGS •IEI S
4ONOLITHIC POR FORM / -
REINFORCEMENT IN PLACE
PHE CONTRACTOW IS RESPONSIB FOR
?ROVIDINO PROT TION FROM F EEZINO
NOR 48 HOURS F LOWING THEPLACE-
BENT OF THE CON RETE.
MATERIALS FOR T S PURPO ON I E
rOUNDATION/WALLPR
tEINFORCEMENT IN kLACE: _
'OUNDATION/DAMPPRO FI G
3ACKFILL APPROVAL
?LUMPING VENT/VENTS ' N PLACE
11
LOUGH PLUMBING _
,LUMPING UNDER S •B j
,
?RAMING:
JACK ST 'S/HEAD' RS
BRACING BRIDGIN'
JOIST 'NGERS
JACK P'STS/MAIN AM
,IR INFILTRAT •N BARRIER ;
k
IEATING ROUGH IN
INSULATION: /
FOUNDATION WALLS INTERIOR -
FOUNDATI N WA LS EXTE IOR Z -'-
FLOORS R
WALLS R-
CEILIN R-
DUCT W RK OR PIPING IN
UNHEAT D SPACES R-
re&4 \
0
c4h,
3(/ 11)✓ (518) 761-8256
TOWN OF QUEENSBURY (PIO
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: AR4 SPAR ' / INTJ
REQUEST FOR INSPEECTTIOD RECEIV /
NAME
LOCATION �
[ 1 (� 042 CO
DATE ' 1/ / 1
' PERMIT A
ttTT ���
TYPE OF STRUCTURE:
RECHECK APPROVED
/� N/A YES NO
/FOOTINGS/PIERS
O OL C OU F
REINARC M NT It PLACE
THE CONTRACTOR IS RE PON IBLE FOR
PROVIDING PRO E TION FRO FREEZING
FOR 48 HOURS F NI G THH PLACE-
MENT OF THE CONC
MATERIALS FOR THIS PU OSE ON SITE,_
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE ._
FOUNDATION/DAMPPROOFING _
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE _
ROUGH PLUMBING
PLUMBING UNDER SLAB
F ING•
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-
utitiL
� (518) 761 256
TOWN OF QUEENSBURY (010
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR 26"DEPART INT*
REQUEST FOR PECTION RECEIVED: C
NAME 3, qL
LOCATION ��L.� /
DATE '7 RMITT # y
TYPE OF STRUCTURE: C\1 CIL
RECHECK APPRED
N/A YES NO
FOOTINGS/PIERS
MONOLITUIC 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 APPRO AL
PLUMBING VENT VENTS I 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-
&/�,dvJ live,14— 4 j- lam`,'-l''t,
/No/ 14,k are( a 4 *effri-,
ZJZ
TOWN OF QUEENSBRY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name � y hiee
Location ,✓ L 07
'
Date 5/5/7 Permit # /4
SOIL TYPE: Sand-Loam-Clay-
c�
Results of Percolation Test-
(if applicable) Rate- n e/Inch
TYPE OF SYSTEM.
ABSORPTION FIELD: tal Length
Length of each tre 1
Depth of trenches
Size of stone
SEEPAGE PITS: N ber-
Size - f . 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 of 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:
,5;S/4,"
SYSTEM USE APPROVED: YES NO
Arrived: 02',2o
Departed:
Building Inspector