91-710 •
' CERTIFICATE OF ' OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date /.,Z l9't.-
i
This is to certify that work requested to be done as shown by Permit No. •9Il®8b®
has been completed.
This structure may be occupied as a Single Family Dua'l U 1 ng MU. 2-Car Garage
Location Lake P rkrs iy ssear 1 Poi
Owner Let-ri s 8 Doan Stone
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-710 1 x
WARREN COUNTY, NEW YORK
ca
PERMISSION is hereby granted to Lewis & Joan STone
co
OWNER of property located at Lake Parkway - Assembly Point Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Single Family Dwelling
N
at the above location in accordance to application together with plot plans and other information hereto filed and o
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is r
19 Powderhorn Way - Berkeley Heights NJ 07922
sw
2. CONTRACTOR or BUILDER'S Name
Orville Fuller
3. CONTRACTOR or BUILDER'S Address
r'
IL
4. ARCHITECT'S Name
Al
ti
a
5. ARCHITECT'S Address
N
ca
6. TYPE of Construction—(Please indicate by X) fp
-n
( X Wood Frame ( ) Masonry ( ) Steel ( )
•
r. --I
7. PLANS and Specifications
No. 3079 sq ft Single Family Dwelling as per plot plan specifications tiC,
and application
8. Proposed Use tGa
Single Family Dwelling w/2-Car att. Garage & 2 solid fuel burning appliances
$ 429.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 7, 1992
(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 thi 7th Day o October 19 91
SIGNED BY �G ` for the Town of Queensbury
Building and orng Inspector
Afee a 6/a
S i99/
TOWN OF QUEENSBURY
TOWN OF QUEENSBURY...011111%1A .
REVIEWED BY: RECEIVED
FEE PAID: 31 0� /7
ff OCT 41991
PERMIT NO. : qi, i7m
BLDG. & CODE DEPT.
BUILDING PERMIT APPLICATION
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO INSPECTIONS WILL BE MADE UNTIL
APPLICANT HAS RECEIVED A VALID BUILDING PERMIT.
All applicants spaces on this application MUST be completed and the signature of the
applicant .MUST appear on the reverse side of this application.
Owner of Property: Lv E7 J1 5 T- i'J-a/ S-rOA)E-
P.O. Address: g goDe-ILG`fdRd u/Ry"S6-etEteyI / ?_s A(e7 2zPHONEfiad%- 4C //
Property Location:Z4kE"77is•R/4.6iqy-ASSE-ma Rviv-r- Tax..Map No. g' / / / 9'
Has there been any split of this :p:roperty since October., 1, 1988? Yes No X
If yes, Planning Board Review is necessary.
Subdivision Name, if applicable: Lot No.
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
NATURE OF PROPOSED WORK: * •' ESTIMATED MARKET VALUE OF THE
Construction of new building * CONSTRUCTION: $ 2,5o, Ova
Addition to building
Alteration to building * COMPLETE INFORMATION REQUIRED BELOW:
(no change to exterior dimensions) * Size of Property: /Op ft. x /op ft.
Other work (describe) * . Existing Building Size:
ft. x ft.
* Proposed building - distance from
GROSS AREA OF PROPOSED STRUCTURE: * property line:
1st Floor _ / c17. Sq. Ft. Front Yard ,SD ft. Rear yard 3c ft.
:j�,!a .:Side.Yards zv ft. and 30 ft.
2nd Floor /LOe'�� .:= __ .
l 3 8� Sq. Ft: 3 1. If on corner, setback from side street-
35 -- ft.
Other Floors Sq. •Ft - -*
(not cellar or basement), *. �J OCCUPANCY INFORMATION:
TOTAL FLOOR AREA: 3O'Z l Sq. Ft. * ?1 Primary Building -
X One Family Dwelling
Size of New Structure: iiej.Li" ft. x -76 ft. * Two Family Dwelling
Foundation: * Multiple Dwelling/No. of Units _
Pier/Slab/Crawl/tiaa/Full (Circle One) . * Business
* Industrial
No. -of stories (Habitable space) , Z *. Other
Height (grade to ridge) 34 (o ft. *
If residential , no. of families: / * If addition, what will use be?
No. of rooms. (excluding:baths) :.'. 7
No. of bedrooms: 3. -
No. of bathrooms:
_2 di_t.-1- 2-7z 4- --s " Accessory Building:
Primary heating system: oT- wig• ip . * Detached Garage - One/Tww Car
Tyne of fuel ! .<9. . - - * - le Attachan (;arana - flnantan Par
BUILDING PERMIT APPLICATION CONTINUED:
BUILDING SPECIFICATIONS':''
Type of construction: ;ood frame, fire safe, etc.
Will any seco `d-hand or ungraded lumber be used? If so, for what?
Foundation Wall Material': ( w If
C2L�dt� Thickness: �
Depth of Foundation below grade (to bottom of footing) : 48 "
Will there be a cellar? Heated or Unheated? Floor Sq. Footage:
Will there be a basement? rE5 Will any portion be used as living space?.
If so, what portion? 60 Sq. Ft. Type of Use? /(_,, , -,- ,9,i/4 J7Li4 4;c3/4.7
Type of Roof: - opeel/Flat/Shed/Other Material of Roof p/?E a..4,55 A9sai Lr
4-4
Size, wood studs . " x 6 " ; spacing /6, " o.c. ; length 7 ft. t5W/'" An7
Joists (floor beams) : 1st Floor. 2- x /o ` "; spacing: /.4g, . " o.c. ; span 19 ft.
Joists- (floor .be:ams) : .2nd. Floor. 2_ " x /Q " ; spacing /4. !', o.c. ; span /( ft.
Overlays (ceiling beams) : Z " x 6 " ; spacing /; " o.c. ; span: /6 ft.
Roof rafters: " x /D " ; spacing /6 'o.c. ; span /6 ft.
Roof trusses (pre'-engineered) :� spacing aW " o.c. ; span a ft.
Exterior Wall Finish: /0 ' C� ,f/-L /a,5,-, e of what material ? /4i727--RweE--
Interior Wall Finish: h2 2.)/2yu44LL
If a /a rage is to be attacched, describe materials to be used for FIRE SEPARATION:
--YetW /c,Q coi ORSiiu/-crL
Is there to be an opening between garage and dwelling? If so, will a Fire-Rated door,
enclosure, self-closing device be provided? 1(c s
Will a flue-lined chimney be installed? Yea Height above roof al. ft.
Depth of chimney foundation below grade: . f/ ft.
Depth of fireplace hearth: / ft. 8 in.
Water supply - Municipal or private well : 44I<' Qjz�o,e&T- -
SEPTIC SYSTEM: Distance from any private well (including adjoining properties: /CO ft. M'&t•
(A separate application is necessary for any repair or new installation of septic system. )
NAME OF BUILDER & ADDRESS: e..z.& dus-7-7 , 65)cic��iseu y ,C/Y PHONE 79Z -a03o
NAME OF PLUMBER & ADDRESS: A 4 LI u PHONE k
NAME OF MASON & ADDRESS: �,g-1.6- / ,bu;,( K/f7 j 7-19LIu << PHONE
NAME OF ELECTRICIAN & ADDRESS: AB /1/v2rkm 4)cia�-Wsaehey 11 ' PHONE 793—j9c 3
DECLARATION
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 i uthorize by the owner.
Signature jp-4q ((�///��CCC///��✓J��tttJJJ
. OwwKner owner c ti
a nt a-r-ch4tec-.+
' co actor -,:t
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE DAYS
TOWN OF QUEENSBURY
RECEIVED
Compliance Methods:
PART 5 - Acceptable Practice Method - 1 & 2 Family Dwellings (ONLY)OCT 4 1991
PART 6 - Thermal Rating - Component Trade Offs - 1 & 2 Family DelidgingriCODE DEPT.
Multi-Family Dwellings
(3 Stories or Less)
PART 4 - Design By Component Performance - Commercial Buildings - Hi-Rise Residential
PART 4 & 6 - Compliance Methods Require Submission of Worksheets
&un 5 1- -0,9-it) S-73/1i LA-KG /.9 gu.tifit-}o— A-5-5 04 84,y ,.0 v-
APPLICANT'S NAME PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - 5.1) 9 Sq. Ft.
2. Type of Heat - Elec. Base Board Other 1)/4.. t% eE=D /44;7- Zdti-T-&Yy
3. Is Building Mechanically Cooled? X YES NO
4. Percentage of Area of Windows and Doors Over 17% X Under 17%
THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND TO REQUIRED
THE R-VALUES SHOWN ON PLANS SUBMITTED!
Baseboard
5. Insulation Values: Actual Shown Elec. Heat Other
A. Roof & Floors exposed to ambient temperatures R 3 g
B. Exterior Walls R_ l
C. Glazed Area
D. Exterior Doors R " Co 4-
E. Floors over unheated spaces R ( q
F. Edge of Slab on Grade (Heated Building) R l
G. Basement/Cellar Walls (Above Grade) R l er
H. Basement/Cellar Walls (Below Grade) R q
I . Heating/Cooling - Ducts - Piping in Unheated Space R 4.6 _
6. Service (Domestic) Hot Water Heating Device
A. Conforms to minimum efficiency per code X YES NO
_ -I EMPERA URE-COiv�"7L t AXINUM S TTING`;l4i,®-- _- -W;<LL NOT BE--EXCEEDED- -
J
TOWN Y V d tl OF QUEENSBURY
Bay at Haviland Roads,Queensbury,N.Y.12801-9725
APPLICATION FOR SOLID-FUEL BURNING APPLIANCES AND FIREPLACES
Date � _ 7- ` / — 19 9/ Permit No. Q,/ -7/1)
APPLICATION IS HEREBY MADE to the Building Department 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 for the re,-- fired inspections.. , ,/ "//OOt11v4 Ye_
v mac.. `��s �l�°cT/ �� /- DPra� .
Applicant's Name - I„ APPLIANCE TYPE
Stove X Coal Wood '
Address 9 ✓vfik) 6 -)P::,o tl ieb Furnace X Hot Air Boiler ,X
Zero Clearance X Circulating Unit k
ae-E---ms6 tJR.y . /1)/zip /Z 67
Phone 7c/i_ z d 3 v If Non-Masonry:
Owner's Name 4,,/ s Tp ,9__A,/ •5T A/ / /
Manufacturer /-4----'-,L ro,4 , _
Address /cJ ,�ou )D4-`"Dei-/-ni a UUr4 1~ Model hiP (., ic Outlet Size 6 i ,
- ---/e)e-ce-y 17E/ /17-. A.z.pT z3-7 gZ-Z Listed by C -- Number
Phone 90 ."" 4IC1-S'ey/ .
CHIMNEY TYPC_.
Masonry: Block t/ Brick Stone
Property location of proposed construction Flue: Tile Steel X
G L4/� PA-1 itu/9-V ASS.: 13& Y -c'i �c4- Size: "; i4
Factory Built:
<,,', - i , . , r_. ,,. Manufacturer5iryns0N Model Size 9-- '
COPY OF MANUFACTURER SPECIFICATIONS IS - - Height-2I 4-Z5i 'Listed By UL.-, Number
REQUIRED FOR FACTORY-BUILT:.APPLI-ANCESK•,.e•t �T-ype: Double-Wall -. X, Tr,i'plc,W�all_
AND CHIMNEYS. MUST BE INSTALLED '1 ' ' ` r ' '` '
Insulated X
ACCORDING TO SPECIFICATIONS,.COPY/OF 4.=dpvae-EStitiiaitetl Cost $":_%* .6o` „ Y /=` "K
CONSTRUCTION DETAIL REQUIRED FOR MA- Fee$ ;` _A:9. ...J• /• �i4.-
SONRY FIREPLACES AND CHIMNEYS.
CASHIER'S DEPARTMENT
TOWN OF QUEENSBURY, NEW YORK
- Department; Fire Marshal Amount Collected Amount Refunded
Code Number Title�—� -
A 173 3389 ' (190)Public Safety
A233 2655 (230) Minor Sales
Fee Collected from or Refunded to: �i./Jbr' ( ylil//f � �i_ ( ;
Address: ..
Dated: Town Clerk or Deputy Keu,,,_,., . (1_ _s2, _p_A'K-t(I)
V Ic
• 04'hile:Anniiran! Yellaw and Pink:Cashier's IJenartmeni Goldenrod!Firs Marshal
2 __
#� a TOWN OF QUEENSBURY
? j TOWN OF QUEENSBURY RECEIVED
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee PaiOCT 41991
Date: /D- /- 9/ Review*99• & CODE�DEPT.
LOCATION OF PROPERTY FOR INSTALLATION: .,®/s' /`�9-RIcit 9-�! — SS�ffj?L y ?IIJT'
Owner' s Name: ._./of}-,(/ 5 . 5-7-o/U4
Owner' s Mailing Address: / ,rv,()& //e)m/ 2/9-y-,34'�KELEy- �`/grins , At
� /�
o79Zz,
Installer' s Name: 7 ' aysy7vc7/o,c! a Phone #:
Number of bedrooms (if residential ): 3
Total daily flow (residential-compute @ 150 gal . per bedroom) : `iFSO
Topography-Circle One: Flat Rolling Steep Slope ° of Slope
Soil Nature-Circle One: an Y oam Clay Other /
/Depth: 6
Ground Water-At What Depth? /14,67.77 .,v/ 6 Feet
Bedrock or Impervious Material-At What Depth? ',fI rey29,,r 6 Feet
Percolation Test-Circle One: (Not Requiree Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other 4 e C-6-eve G-&
If domestic water supply is a well -
Separation: Water supply from any septic absorption /3D/, feet
/ZSp
PROPOSED SYSTEM: Septic Tank 00ft, gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 3.S'iE y3 feet//Total System Length /g9 / 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 T wn of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: c DATE: /O —/ 9/
'7
•
;. _ 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:
•
(.7 3' ,a‘ '
-Awn Jown- o/ Queenatur, fR '
BUILDING and ZONING DEPARTMENT -
Bay and Haviland Road, R.D. 1 Box 98 ,
r
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME � }C%�11.\ ( )L
. � 9c-rtiv
LOCATION P SSQA)\l))�-
!.' .
DATE 4/ i ,�-"I PERMIT NO.
SOIL TYPE Sand Loam - Clay - i
Percolation Test Required? YES - NO
Percolation rate Min/Inch
TYPE of SYSTEM: -
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS{Number of)
Size- ft. X ft.
Gravel 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 ft.
Foundation to absorption ft.
Absorption to lot line - ft.
Separation of pits ft. I'
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right s 'de -
COMMENTS: F/391
---resrf
��";��.s?�� St ,r.'ems. 4. , e c]
•
SYSTEM USE APPROVED YES NO, V
• ' v v S r
Building Inspector •
01/86 md vl •
TOWN OF QUEENSBURY 7 7
O
gi
, 531 BAY ROAD
• li0
QUEENSBURY, NEW YORK 12804
... TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED
KAJ E 4',,(./A-e,,%7 ✓ 7j _
LOCATIONS Wale, 1 .e.,
DATE ,77/a/C/R PERMIT, 9/' 7/d
TYPE OF STRUCTURE
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING _FINAL ELECTRICAL _SEPTIC
INSULATION WOODSTOVE/FIREPLACE
REMARKS
APPROVAL
N/AI YES NO
CHIMNEY HEIGHT/LOCATION I
B VENT/LOCATION /
PLUMBING VENT / ✓'
ROOFING
SIDING /•
t/
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES
FURNACE/HOT WATER OPERATING
BASEMENT INSULATION/DUCfWORK,.
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS: /
BATH/KITCHEN WATERTIGHT !t!
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED ✓
STAIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS
SMOKE DETECTORS
BATHROOM FANS/WH@tE 1ODSE TAB" l
ALL PLUMBING FIXTURES OPERATING
GARAGE FIRE PROOFING_
DOOR CLOSERS
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
DUMPS TER
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS: �j
4U /'',� 0g/ JC
(
ARRIVE /
DEPART
NSP T
TOWN OF QUEENSBURY //))FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4424
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED,,-170 L
NAME �S� IA.t.; f
LOCATION ,e_ 9 C✓s, .
DATE ,k//f /9ti PERMIT# C/l 7/6
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS ,
AUTO. EXTINGUISHING SYSTEM
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM
ALARM SYSTEM
%y
INTERIOR FINISHES 'Y
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE `'
ff
CHIMNEY '
' WOODSTOVE .
I FIREPLACE—MASONRY •
"FIREPLACE—FACTORY BUILT
REMARKS: U OK :,TO THIS DATE
24
2/015 INSPECTOR
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPPEECC,TIIIOOWN REECEIVED �8
NAME - 13'
LOCATION-�/ �a,Lb/07 4L cQ ,i-
DATE , j4) Qg PERMIT#' 5X-7/6
/
APPROVED
/ (/ N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS r
EMERGENCY LIGHTING
.
FIRE EXTINGUISHERS ;k
AUTO. EXTINGUISHING SYSTEM
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM
ALARM SYSTEM
INTERIOR FINISHES
STORAGE:
P CLEARANCE;TO SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
$)=CHIMNEY
WOODSTOVE
FIREPLACE-MASONRY
FIREPLACE-FACTORY BUILT
REMARKS: L( OK TO THIS DATE
lU
44(74-A:C.
ARRIVE
DEPART 2 (4/.m*_
IR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447 '
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED J �- C1`
NAME E Lfax �cam cY�
LOCATION 1�5� � 1u..,, --l.t" ) fQ
DATE 1 " %) PERMIT 0 U 9 i f
TYPE OF STRUCTURE _ _
RECHECK APPROVED
. N/A YES NO
FOOTINGS/PIERS •
MONOLITHIC POUR FORM .
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTEdTION FROM
FREEZING FOR 48 HOURS FOLLOWING
THE PLACEMENT OF THE;,CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR. ,< •
REINFORCEMENT IN PLACE/ .
FOUNDATION/DAMPROOFIr
BACKFILL APPROVAL r�
X-ROUGH PLUMBING
PLUMBING VENT/VENTS IN; PLACE
PLUMBING UNDER S,L'AB
FRAMING:
JACK STUDS/HEADERS k
BRACING/BRIDGING R
JOIST HANGERS I
JACK POSTS/MAIN BEAM
HEATING ROUGH-IN
*NSULATION:
FOUNDATION WALLS INTERIOR R- 11
FOUNDATION WALLS EXTERIOR R- •
FLOORS R-3o f
WALLS R-/9 / _
CEILING R- 30 ✓
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS: /�,, /Q�
�. Ai,/ , L��L�S I o 2eovn �fN Qrlc�`
. a. a xy'S (s-rods) d- �cic7--
3. z�� l s
2 p42.0 u >
ARRIVE
\DEPART
INSPE TOR
awn of Queen bur Pj'1�1�
• BUILDING and ZONING DEPARTMENT '
Bay and Haviland Road, R.D. 1 Box 98
•Queensbury, New York 12801 •
(9160.
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME PJ,U`Li 4l'f [J )4
n � �
LOCATION CLIP Poo ld/f�'d�x/ILL
/ Y
DATE'VgPigNi PERMIT NO. qj - I lb
SOIL TYPE - Sand Loam:- Clay -
Percolation Test equired? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: %,, ,,gg�
Absorption field, total lengt�YY .A-pc
Length of each trench/ti i ce_Pu Ar .
Depth of trenches '
Size of gravel 'Z,
SEEPAGE PITS{Number of) '
Size- ft. X
Gravel size
PIPING: Size Type
Bldg. to tank i( /Ut:_
Tank to dist. box 4- ft/
Dist. box to field/ ftl L—
Openings sealed? YES NO Partial
1.
LOCATION/SEPARATION r
Foundation to tank / ft. IJ P&P—
Foundation
Foundation to absorption —ft. '9 ,1.-F/PIM
Absorption to lot line ftF
Separation of pits \ / ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
r n - Rear - Left sideight s13e
COMMENTS:
•
SYSTEM USE APPROV D Y S NO
Bui- ding Insp ctor
01/86 and vl
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S (I`REPORT
REQUEST FOR INSPECTION RECEIVED �I I w�_14
NAME � SlfN-'\ L Q_ -`L9 4 . a oQuv\--
LOCATI ONo t QGxi,(Q CNS QA0 % C)41
DATE PERMIT # l -7/ C)
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
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/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING GNU ✓tBACU ILL'APPROVAL
41
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
FIRESTOPPING
WALLS
CEILING
FIREWALLS
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
REMARKS:
ARRIVE
DEPART
INSPECTOR
TOWN OF QUEENSBURY ��
BUILDING AND CODES DEPARTMENT
531 BAY ROAD PM(2)
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR°S REPORT
REQUEST FOR. INSPECTION RECEIVED /6/7f
1/4
NAME
LOCATION jj,? � ; //�� _ i1
DATE 1 o1J q)9/ PERMIT #
TYPE OF STRUCTURE ,4O
RECHECK / APPROVED
N/A YES NO
g FOOTINGS/PIERS
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/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL,
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS '
BRACING/BRIDGING ,
JOIST HANGERS ',:,J
JACK POSTS/MAIN BEAM
FIRESTOPPING
WALLS s ^.
CEILING �.
FIREWALLS
HEATING ROUGH-I-N
INSULATION: ,'
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR,,R-
FLOORS WALLS R`,
CEILING R
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
r41feW
ARRIVE /;$o
DEPART 02=°f
I CTOR