2007-219 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20070219 Date Issued: Tuesday, July 17, 2007
This is to certify that work requested to be done as shown by Permit Number P20070219
has been completed.
Location: 22 WESTERN RESERVE Trl
Tax Map Number. 523400-301-009-0001-036-000-0000
Owner. GARY & MERCEDES BARNARD
Applicant: WESTERN RESERVE, LLC
This structure may be occupied as a:
Garage - 1 Car Attached By Omer of Town Board
Single Family Dwelling TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 BayRoad, Queensbury, NY 12804-5902 (518) 761-8201
Community Development -Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number:
P20070219
Application Number. A20070219
Tax Map No:
523400-301-009-0001-036-000-0000
Permission is herebygranted to: WESTERN RESERVE, LLC
For properly located at: 22 WESTERN RESERVE Trl
in the Town of Queensbury, to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: WESTERN RESERVE, LLC
395 BIG BAY Rd Garage - 1 Car Attached
QUEENSBURY, NY 12804-0000 Single Family Dwelling $250,000.00
Total Value $250,000.00
Contractor or Builder's Name /Address
Plans & Specifications
Electrical Inspection Agency
-219
SQ FT SINGLE FAMILY DWELLING WITH 400 SQ FT GARAGE
$290.80 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, May 23, 2008
(If a longer period is required, an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To eensb V~e~dn sday, May 23, 2007
SIGNED BY >,fea for the Town of Queensbury.
Director of Building & de E orcement
~"~~- V ------------------OFFICE USE ONLY ".......................... r-------......-----
I~ ,
-I--~~ , , _ -;
TAX MAP NO. /~j , ~- ~' ~ ,
FEES: PERMIT RECREATION ~,~`~~ ` ' 1
~, ,
' ENGINEERING
i. i,, ~~
............... ...................................(Ifappiicabie) , ,
... ..... ---]"IIbv,u~ .~, a.JY.
PRINCIPAL STIZUCTUR.E: BU-Ll~a :,r f ~"~ ,~/~r- ..
APPLICATION FOR ZONING APPROVAL F~ BUILDING PE
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. aP RMIT
REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION. PLICATION IS SUBJECT TO
APPLICANT/BUILDER: ~
ADDRESS: ,~ ~; j 6 ((~
PHONE NOS._ L ~, o~~(r L~ Z
OWNER:
ADDRESS:
PHONE NOS.
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE•
f PHONE:3~n I a~
LOCATION OF PROPERTY: f~ '~`-
r,
SUBDIVISION NAME:
PLEASE I NDICATE ME ASUREMENT S AS REQUIR ED BELOW:
CHECK ALL THAT Z
APPLY TO YOUR
PROJECT Z
O O
~ ~
0 ~
~ ~
~
C'1 o
w ri
?? 0 W J~ ~~ W ..! ~__
Z Q Q ~ ~ Nfn ~~ O~
1-- rY W?
SINGLE FAMILY a = its
~l ~b ~ ~~~
TWO-FAMI
LY
MULTI-FAMILY
(NO. of UNITS__.__)
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACHED
GARAGE(1,2,3)
~~ ~ ~
l
OTHER
~~
IF COMMERCIAL OR INDUSTRIAL -NAME OF BUSINESS: --.
ESTIMATED CONSTRUCTION COST: j0 c~Op
FUEL TYPE:
HEAT TYPE: `*HOW MANY FIREPLACE(S): ~ AND / OR ODSTOVES(S):_~
ZONING CATEGORY: S ~ ARE THERE WETLANDS ON THiS SITE? ~
IS THIS A HISTORIC SITE?
>~
PROPOSED USE OF BUILDING OR ADDITION: S
*Please complete a separate Application for "Fuel Burning Appliances & Chimneys" available in our office
B 3-LGL 11-OS
Tazun of Queensbury • Community Development Office. ~ 742 Bay Road, Queensbury, NY 12804
OFFICE USE ONLY .. .............. ..... ~ ~.._..,,.... -,
~ ~
~ TAX MAP N0. I
PERMIT N0
'~! ~i ERMIT F / /
~ ~ ~ ~ ~ ~ ® "
~
APPROVALS: ZONING .
EE
TOWN CLERK ;
~
; , ~
, ~
; `•
. .,.. jry
APPLICATION FOR SEPTI C DI SPO SAL SYSTEM PERMIT ~ ILA t,~,~~ ~~~~.'_a ~ ~ .ry- ~,
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: f~ ~jy~ _
ADDRESS: ~ c1 j __~lj ((o /~j ~ ~~
PHONE NOS.... 1 ~ ~ q I
LOCATION OF INSTALLATION:
INSTALLER:
ADDRESS:
PHONE NOS. ~ ~e i - ~ Co ~ ~? l/LL~ ~ o
v
NO.OF 1 ............. t
.........................................................................t...............................................:...............,.,.......,...........,
RESIDENCE INFORMATION:
YEAR BUILT COMPUTATION- I - i '
,,,„,,,,,,,,,,„,,,,,,,,,,,,,,,,,,,,,,,,,,,, BEDROOMS I X - TOTAL DAILY FLOW
..................................................................................................................................:a...,.......~...............,..........................................................
1980 or older , ~ GARBAGE GRINDER
X 150 allon er bedroom i
........................................................................_........... i INSTALLED?
1981 -1991 .. ........... .. . X.. .....130...„all........p................,.._om.....,~..._ ..~.. ,....................................................................i
.,„ ,,,, ,,,,,,,,, g on er bedro
...
~...,1992,»present......~ ......................1.......„....„...„..i..„X..........„1„1....„g...„„..~„per ,bedroom..., ,.#....a. ............... .~.................................` NSTALLED? TUB
0 alto
............1 ................................. `~....„.I...„.~..~...........................~
PARCEL INFORMATION:
/ TOPOGRAPHY: FLAT ROLLING ~ STEEP SLOPE %5LOPE
/ SOIL NATURE: SAND X LOAM ~ CLAY OTHER
/ GROUNDWATER: AT WHAT DEPTH?~ BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
/ DOMESTIC WATER SUPLY: MUNICIPAL WELL
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT,
/ PERCOLATION TEST: RATE IS _ Cn ` ~ PER MIINUTE PER INCH (TEST TO BE
COMPLETED BY A LICENSED PROFESSIONAL ENGINEER OR ARCHITECT) I p,~., ~~--~c._
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by
a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
/ SEPTIC TANK: ~ v~-S~ GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH S~FT.
/ TOTAL SYSTEM LENGTH: v? a O FT, SEEPAGE PIT(S): HOW MANY? ~~--
/ SIZE OF EACH FT. X ~•
/ SIZE OF STONE T B U ED• /DEPTH OR
/ BED SYSTEM SIZE: X
/ ALTERNATIVE SYSTE
/ HOLDING TANK SYS EM: (If required) N0.OF TANKS
/ GALLONS. /TOTAL CAPACITY.• GAL.
AND/OR SIZE
/SIZE OF EACH
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY1A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
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 QUESTIONS ? CALL 761-8266 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codes~aueensburvnet
VISIT OUR WEBSITE FOR MORE INFORMATION
- www.aueenaburv.net
igna ure of Person Responsible ate
~~ Town of Queensbury • Community Development Office • 742 Bay Road, Qtceensbury, NY 12804
~ ~. ~
Foundation Inspection Re rt
Office No. (51$) 761-8256
Queensbury Building & Code Enforcement
742 Bay Rd., Queensbury, NY 12804
1
NAME:
LOCATION:
TYPE OF STRUCTURE:
Date Inspection request received:
Arrive: am/p DepartL~ -~ am/pm
Inspector's Initials:
PERMIT #: ~~~~
INSPECT ON:
Footings
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this on site.
Foundation ! Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampprooftng
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 incites above footing
6 mil 1 for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC /Cast /Copper
Foundation Insulation Interior /Exterior
R-
Rough Grade 6 inch drop within 10 8.
Commenta~
S'-
Z'`A'S ~~ .. ,
L:\Building & Cades forms\Bullding & Codes\Inspec~on Forms\Fourtdaiion Inspection Ite{wrtcbc
L85t printed 12J20/2005 9:24:00 AM
Foundation Inspection Report
Office No. (518) 761-8256 Date Inspection nest received:
Queensbury Building ~ Code Enforcement Arrive: pm „ / Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's itials: ~ V`~'~ (~'
~'
NAME: l S PERMIT #: Ca ~ -'"
LOCATION: C~5 ~ ~ INSPECT ON: _
TYPE OF STRUCTURE:
Comments
N
Footings
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this se on site.
Foundation / Wallpour
Re' ent in Place
ting Dowels or Keyway in place
Foundation Dampproofmg
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
1 ~ ch width
inches above footing
6 mil 1 for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC /Cast /Copper
Foundation Insulation Interior /Exterior
R-
Rough Grade 6 inch drop within 10 8.
Y
~~~,~J
nr~~
IU
L
L:\Building & Codes forms\8uilding 8~ Codes\Inspection Forms\Foundatlon Inspedioti Repo~t.doc
Last printed 12/20/2005 9:24:00 AM
-f
Foundation Inspection Report ~ - C ~ ~~'~-
Office No. (518) 761-8256 Date Ins ~tio~request received: Jb 0
Queensbury Building & Code Enforcement Amve: am/pm~~~ Depart: pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ~fGt! ~q,
~g~ ,~1Q / ~/'
NAME: I~ ~ ~~, " `~ t PERMIT #: ~ 7 ' ~-
LOCATION: 1N~T ON:
TYPE OF STRUCTURE: /Y-C.. C ~;
~c b7
Comment
Y A
Footings
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this se on site.
Foundation / Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofing
Foundation Waterproo g
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil 1 for wet areas under slab
Baclcf~ll Approval
Plumbing Under Slab
PVC /Cast /Copper
Foundation Insulation Interior /Exterior
R-
Rough Grade 6 inch drop within 10 ft.
,q~ D~~~ ~Sc~J
L:\Building & CAdes Forms\Building ~ Codes\IrOn Forms\Foundation Inspection Repoitdoc
last printed 12/20/2005 9:24:00 AM
Foundation Inspection Report
Office No. (518) 761-8256
Queensbury Building ~ Code Enforcement
742 Bay Rd., Queensbury, NY 12804
Date [nspectiQQn request received:
Arrive• RJ am/p Depart:
Inspector's Initials:
am/pm
NAME: ~ ~7 C~ Z' ~`
rERMT i~:
LOCATION: 1, ~T~- INSPECT ON: CQ / ~ /D '7
TYPE OF STRUCTURE: -"T7'
Commenb
A
Footings
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this on site.
Foundation / Wallpour
Reinforcement in Place
F ' g Dowels or Keyway in place
oundation Dampproofing
Foundation Waterproofmg
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil 1 for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC /Cast /Copper
Foundation Insulation Interior /Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building & Codes Forms\Buikling A~ Godes\Inspection Forms\Four~daiion Ir>sp~on Report.doc
Mast ptiMed 12/20/2005 9:24:00 AM
Framing /Firestopping Inspection Report ~ , ~
Office No. (518) 761-8256 Date Inspection request received: CJ
Queensbury Building & Code Enforcement Arrive: am/pm De art." am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: ~ ,CY
NAME: ~`1~~~~~
LOCATIONI ~ ~~-
TYPE OF STRUCTURE:
Y N NIA
Framing
Attic Access 22" x 30" minimum
Jack Studs /Headers
Bracing /Bridging
Joist hangers
Jack Posts /Main Beams
Exterior sheeting nailed properly
12" O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Headroom 6 ft. 8 in.
Notches /Holes /Bearing Walls
Metal Strapping for Notches Top Plate
1 `/z w 16 au e 8 16D nails each side
Draft stopping 1,000 sq. ft. floor trusses _
Anchor Bolts 6 ft. or less on center
I e and water s ~ ld 24 inches from wall
Fire separation 1, 2, 3 hour
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed
16 inch insulation in cavi min.
Garage Fire Separation
House side %z inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceilin wall
Windows Habitable Space /Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above /below grade
5.0 sf ade
~~
PERMIT #:
INSPECT ON:
COMMENTS
~-1D
Rough Plumbing
~v~SL~,A~y 6~Z~~D~
/ Insulatio~i inspection Report
Office No. (518) 761-8256
Queensbury Building & Code Enforcement
742 Bay Road, Queensbury, NY 12804
Date Inspection request r
Arrive: = ep : '~=~,- a m
Inspector's Initials:
NAME: PERMIT #:
LOCATION: INSPECT ON
TYPE OF STRUCTURE: _
.~~~ `.'
~ ~_
Y XN NI.
Rough Plumbing /)Nail Plates
/Vents in Place
1 ~/z inch minimum Drain Size
_Washing Machine Drain 2 inch minimu
Cleanout every 100 feet /change of din
Pressure Test
~~'
,, ..___
.S.I. or 10 ft above highest connection for 15
Pressure Test
Piping
P.S.I for 15 minutes
iat~~,n i Residential Check /Commercial Check
Proper Vent, Attic Vent
Duct /Hot Water Piping Insulation
If required unheated spaces
Air
Duct work sealed
COMMENTS:
r Furnace
v i No duct to
L:~Pam Whiting~Buitding 8c CocleslInspection Forrris\Rough Plumbing Insulation geport.reviaed Nov 17 2003.doc Revised February 15, 2005
a/
c
~~ C.!
1
rarrung Fir
Office No. (518) 761-8256
Queensbury Building & Code Enforcement
742 Bay Road, Queensbury, NY 12804
~ ~6 0
l
~~~ ~
estoppi:ng Inspection Report
Datf~ Inspection re st receiv
-~ ~ -~-
Arriv . a D a
Inspector's Initials:
2~
NAME:
LOCATION:
TYPE OF STRUCTURE:
Y N/A
Framing
Attic ss 22" x 30" minimum
Jack Studs /Headers
Bracing /Bridging
Joist hangers
Jack Posts /Main Beams
Exterior sheeting nailed properly
12" O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Headroom 6 ft. 8 in.
Notches /Holes /Bearing Walls
Metal Strapping for Notches Top Plate
1 %z w 16 au a 8) 16D nails each side
Draft stopping 1,000 sq. ft. floor trusses
i I
Anchor Bolts 6 ft. or less on center
i
Ice and water shield 24 inches from wall
Fire separation 1, 2, 3 hour
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed
16 inch insulation in caul min.
Garage Fire Separation
House side'/Z inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceilin wall
Windows Habitable Space /Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above /below grade
5.0 sf ade
PERMIT #:
INSPECT ON:
COMMENTS
Rough Plumbing /Insulation Inspection Report
Office No. (518) 761-8256
Queensbury Building & Code Enforcement
742 Bay Road, Queensbury, NY 12804
NAME: t~LaPC PERMIT
LOCATION: 7 ~ ~ r ~ Ie INSPECT
TYPE OF STRUCTURE:
#• ~~-21 ~
C"'i' 0N:
Y N N/A
Rou h Plumbin Nail Plates
Plumbin Vent Vents in Piace
1 ~/a inch minimum Drain Size
Washin Machine Drain 2 inch minimum
Cleanout eve 100 feet chan a of direction
Pressure Test
Drain /Vent
Air /Head
5 P.5.I. or 10 ft. above hi hest connection for 15 minutes
Pressure Test
Water Supply Piping
a
5 P.S.I for 5 minutes
Insulation esidential Check Commercial Check
r ent Attic Vent
Duct /Hot Water Piping Insulation
If re uired unheated s aces
Combustion Air Su f for Fur e
Duct work sealed ro erl o duct to
COMMENTS: UCH l~ ~~ "~"""~
~~ < s
Date Inspection request received:
Arrive: am/p Depart: ~ J~~am/pm
Inspector's Initials: ~-~~J
L:~Pam Whiting~Building 8c CodesUnspection FannsVtough Plumbing ]nsulation Report.revised Nov 17 2003.doc Revised February 15, 2005
i ~..,
Rough Plumbing /Insulation Inspection Report
Office No. (518) 761-8256 Date Inspection request received: ~~~
Queensbury Building & Code Enforcement Arrive: am/pm Depart: ~--~=- am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: ~~
NAME: ~Z
LOCATION:
TYPE OF STRUCTURE:
PERMIT #: ~ ~ Z/ ~.
INSPECT ON:
Y N N/A
Rou h Piumbin Nail Plates
Plumbin Vent Vents in Place
1 ~/z inch minimum Drain Size
Washin Machine Drain 2 inch minimum
Cleanout eve 100 feet than a of direction
Pressure Test
Drain /Vent
Air /Head
5 P.S.I, or 10 ft. above hi hest connection for 15 minutes
Pressure Test
Water Supply Piping
ea
50 P. .I for 5 minutes
Insulation esidential Check Commercial Check
ro t Attic Vent
Duct /Hot Water Piping Insulation
If re uired unheated s aces
Combustion Air Su I for Furnace
Duct work sealed ro erl No duct to e
COMMENTS: ~~C(? ~ ~(~l~N~
~' C/` ~
-~-~~~~ -
L:~Pam Whiting~Building & CodeaVnspection FarnuUtough Plumbing Insulation RepoR.revised Nov 17 2003.doc Revised February 15, 2005
Rough Plumbing /Insulation Inspection Report
Office No. (518) 761-8256 Date Inspe n.~equest received: QU~~
Queensbury Building & Code Enforcement Arrive: ~ am/pry Depart: am/pm
742 Bay Road, Queensbury, NY 12804 Ins or's Initials: 4~i
NAME : I~/t'0,~`tCiV'-~
LOCATION
TYPE OF STRUCTURE:
Y N /A
Rou h PI ail Plates
Plumbin Vent Vents in Piace
1 ~/z inch minimum Drain Size
Washin Machine Drain 2 inch minimum
Cleanout eve 100 feet than a of direction
Pressure Test
Drain /Vent
Air /Head
5 P.S.I. or 10 ft. above hi hest connection for 15 minutes
Pressure Test
Water Supply Piping
Air /Head
50 P.S.I for 15 minutes
Insulation Residential Check Commercial Check
Pro er Vent Attic Vent
Duct /Hot Water Piping Insulation
If re uired unheated s aces
Combustion Air Su I for Furnace
Duct work sealed ro erl No duct to e
COMMENTS:
_ ~ ~~
~~
7l~
~~
~~
~~a~
L:~Pam Whiting~Building 8c CodesVnspection ForrnslRough Plumbing Insulation Report.nvised Nov 17 2003.doc Revised February 15, 2005
D-/~~,
Queensbury Building & Code Enforcement - Resit
OfficZ No. (518) 761-8256
Date Inspection request received:
NAME:
LOCATION:
TYPE OF ST
Ye No N/A
Buildin Number /Address visible from road
Chimne Hei ht / "B" Vent/Direct Vent Location
Fresh Air Intake
3 .inch Plumbin Vent throu h roof minimum 6 inches
Roof Com fete /Exterior Finish Com lete
Platform at all exterior doors
Guards at stairs, decks, atios more than 30 inches above ade
Guard at stairwell at 34 inches or more
Guard at deck, orches 36 inches or more
Handrail Termination at Newell Post or Wall
Interior/Exterior Railin s 34 inches to 38 inches
Interior Handrails stairs 2 or more risers
Grade awa from foundation 6 inches with 10 feet
6 inch clearance to sill late
Gas Valve shut-off exposed /regulator 18 inches above grade
Interior rivac /trim /doors /main entrance 36 inches
Bathroom /Kitchen waterti ht
Safe lzin /Win win stairwells safe in
Interior Smoke De ctors:
Every level: Ev Bedr m:
Outside every bedroo ea:
Inter Connected: Batte backu
Carbon Monoxide Detector
Attic access 30 inches x 22 inches x 30 inches hei t in accessible area
Crawl S aces 18 inch x 24 inch access, 1 s . ft.-150 s . ft. vents
Bathroom Fans, if no window
Plumbin fixtures
Foundation insulation
Floor truss, draft sto in finished basement 1,000 s . ft.
Emer enc a ess below ade
Gas Furnace shut-off within 30 feet or within line of site
Oil Furnace shut-off at entrance to fiunace area
Furnace/Hot Water Heater o eratin
Low water shut-off boiler
Relief Valves installed /Heat Tra /Water Tem 110
Enclosed Stairs Sheetrock Underside minimum''/s" Gypsum
Basement stairs closed rise > 4 inches
Gara a Floor Pitched
Gara a fir roofin J'/< hour fire door /door closer
Duct work Sealed ro erl
Gas Lo sin Sealed or Glass Enclosure
Final Electrical
Final Surve Plot Plan
As Built Se tic S ste Sewer De t. Ins ection Sticker
Site Plan ariance re uired `
Flood Plain Certification, if re uired
Oka to issue C / C or C / O Tem or /Permanent
Comments
~~~~~~.
L:~Building & Codes FormslBuilding & Codes~Inspection Forms~Residential Final Inspection Form revised_100405.doc
Septic Inspection Report
Office No. (518) 761-8256 Date Ins 'orbrequest received:
Queensbury Building & Code Enforcement Arrive: ~ am/Q ~~-Depart: am/Pm
742 Bay Rd., Queensbury, NY 12804 Inspe~cto s Initials: v
NAME:
LOCATION:
RECHECK:
PERMIT NO.: ~ ~/ Zl
INSPECT ON:
Sai T :Sand Loam Cla
T of Water: Munia I Weli Water
Waterline se ration distance ft.
Well separation distance
Other wells: ft.
ft.
Abso Field: Total len ft.
Len of each trench ft.
De of trenches ft.
Size of Stone
See a Pits: Number
Size: x
Stone 5ize•
Pi i Size T
Bulldi m tank
Tank to Distribution Box
Distribution Box to Feld Pit
O ni Sealed: Y N Partial
End Ca
In Outlet Pi & Baffles Y N
Location Se rations
Foundation to tank ft.
Foundation to absor ion ft.
5e ration of Pits 'ft.
Conforms as r Pkrt Plan N
E ineer Re rt and As-Built N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Mi Rear
s•
Approved
Partial Approved
Disapproved
Last revised 021006
Comments and/or diagram
~~~ ~~~5 ~~iP
and needs to be re-inspected, please call the Building & Codes Office
Last revised 1/6/OS
0~-z19
169 Haviland Road, Queensbury, NY 12804
Phone - 518-745-4400 Fax - 518-792-8511
. --~~' July 16, 2007
~tQ'due~ Y Job # 47320
New York State Dept. of Health ~~~~~ ~~~,p~~ r,~~~ ~~~
77 Mohican Street
Glens Falls, NY 12801
RE: Western Reserve Subdivision - Queensbury (T)
xx Western Reserve Trail (Lot # 5) Septic System
Dear Sir/Ma'am:
This letter is to inform you that we inspected the completed septic system for the house at
22 Western Reserve Trail (Lot #5) in the Western Reserve Subdivision on July 16, 2007.
The septic system as installed was for a four bedroom house and consisted of a 1,250 gallon
septic tank and 240 lineal feet of absorption trench constructed with stone and perforated pipe.
The system conforms to the requirements of the approved subdivision design drawings.
Please call me if you have any questions or concerns.
Sincerely,
G`o-7'~`"-L-
Thomas Center Jr., P.E.
cc: Dave Hatin, Town of Queensbury
Hayes Construction