92-667 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW'YORK
Dace January 12 19 98
4 '
This is to certify that work requested.to be done as shown by Permit No. 92667 ,
has been completed.
SINGLE FAM DWLG-LOWER LEVEL ONLY-
This structure may be occupied as a
9 GOLDFINCH RID.
Location
Owner CAPROOD, PATRICIA
TAX MAP -NO. 14 8. -2-15, ' . By Order Town Board
TOWN OF QUEENSBURY,'
Director of-Bldg. &c-Code Enforcement
' _ry1... .. -. , ... .. , .. ^ram r'r: s -. .-. .,'-+-H - • � "'i ,- -
A
CERTIFICATE OF ' OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date /'0/" 19
This is to certify that work requested to be done as shown by Permit No.q9m AA7
has been completed.
This structure may be occupied as a single family dwelling (modular)
Location Lot 15 Goldfinch Road. Incniratinn Park
Owner Dale L. Shaw
ssued for lower level only. By Order Town Board
TOWN OF QUEENSBURY
V
Director of Bldg. & Code Enforcement
a
x
BUILDING PERMIT
z
TOWN OF QUEENSBURY
Na. 92-667
WARREN COUNTY, NEW YORK
I
N
I
PERMISSION is hereby granted to Dale L. Shaw U,
OWNER of property located at Lot 15 Goldfinch Road Street, Road or Ave.
in the Town of Queensbury,To Constructor place a _ Single family dwelling (modular)
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 n
5
2. CONTRACTOR or BUILDER'S Name (D
r
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name r
O
c-h
Cal
t7
5. ARCHITECT'S Address O
rZ
J.
6. TYPE of Construction—(Please indicate by X)
tz
( )0 Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications Model : 1A
No. 36'x25.42' Modular Single family dwelling as per plot plan, specifi-
cations and application including septic system. i
8. Proposed Use C/>
J.
Single family dwelling
CD
:L
3
$ 108.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 27 19 93
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the Q
town of Queensbury before the expiration date.)
fD
Dated at the Town of Queensbury this 27th Day of October 19 92
u]
SIGNED BY for the Town of Queensbury
13)&�kLndZoning Inspector
VOWN QF-QUEENSBURY
REVIEWED BY:
JjCFFEE PAID:
PERMIT NO. :
BLDG. $ COOF 4)EPT.
BUILDING PERMIT APPLICATION
A' RERMIT 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.
* * * * * * * * * -it * * * * * * * * * * * * * * * * * * * * * * * * * * *. * * * * * * *
Owner of Property: Mr. Dale L. Shaw - Lot #15 - Model lA
P.O. Address: 'Goldfinch Road PHONE
148.7.1, &.3 & &.4
Property Location: Queensbury, NY 12804 Tax Map No. ,Z ` /�/f�
Has there been any split of this property since October 1, 1988? Yes X No
If yes, Planning Board Review is necessary.
Subdivision Name, if applicable: Inspiration Park
Lot No. 148.7.1.7.3&7.
Lot #15, Model 1A
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
Cushing, Dybas Associates, Architects, .P.C.
NATURE OF PROPOSED WORK: * ESTIMATED MARKET VALUE OF THE
X Construction of new building * CONSTRUCTION•: $ 76,459
Addition to building
Alteration to building * COMPLETE INFORMATIONoQUIRED BELP�Ia
(no change to exterior dimensions) Size of Property. ft. ft.
Other work (describe) * Existing Building S ze: None
* - ft. x - ft.
* Proposed building - distance from
GROSS AREA OF PROPOSED STRUCTURE: h� * property line:
1st Floor 915 Sq. Ft. * Front Yard 30 ft. Rear yard 44 ft.
* Side Yards 34 ft. and 30 ft.
2•.1d Floor Sq. Ft. �� * If on corner, setback from side street-
, * - ft.
Other Floors Sq. Ft.
(not cellar or basement * OCCUPANCY INFORMATION:
*
TOTAL FLOOR AREA: 9 Sq. Ft. * Primary Building -
* X One. Family Dwelling
Size of New Structure: 36.0 ft. x 25.42 ft. * Two Family Dwelling
Foundation: * Multiple Dwelling/No. of Units _
Pier/Slab/Crawl/Partial ull Circle One) * Business
* Industrial
No. of stories (Habitable space) 1 * Other
Height (grade to ridge) 22 ft.
If residential , no: of fam 1 es: One * If addition, what will use be?
No. of rooms (excluding baths): Four
No. of bedrooms: TWO
No. of bathrooms: one * Accessory Building;
Primary heating system: Baseboard * Detached Garage - One/Two Car
Type of fuel : B ec c. * Attached Garage - One/Two Car
No. of fireplaces to be installed: None * Private Storage Building
Will a woodstove be installed?: No * Other
Central Air Conditioning: Yes No
(OVER)
BUILDING PERMIT APPLICATION CONTINUED:
BUILDING SPECIFICATIONS:
.Type of construction: wood frame, fire safe, etc. Wood Frame
Will,. any second-hand or ungraded lumber be used? If so, for what? No
Foundation Wall Material : Poured Concrete Thickness: 8"
Depth of Foundation below grade (to bottom of footing) : Below V-0
Will there be a cellar? Yes Heated or Unheated? Unheated Floor Sq. Footage: 915
Will there be a basement? No Will any portion be used as living space? N/A
If so, what portion? N/A Sq. Ft. Type of Use? N/A
Type of Roof: Sloped/Flat/Shed/Other sloped Material of Roof Asphalt Shingles
Size; wood studs 2 x 6 " ; spacing 16 o.c. ; length 8 ft.
Joists (floor beams) : 1st Floor 2 x 10 "; spacing 16 o.c. ; span �_ ft. max_
Joists (floor beams) : 2nd Floor 2 " x 10 "; spacing 16 it o.c. ; span 12 ft. Where
Overlays (ceiling beams) : " x _ " ; spacing _ " o.c. ; span _ ft.Applicable
Roof rafters: - x - It; spacing - o.c. ; span - ft.
Roof trusses (pre-engineered): spacing 24 If o.c. ; span 13 ft.
Exterior Wall Finish: clapboard Siding of what material ? vinyl
Interior Wall Finish: 112" Gypsum Board
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
Is there to be an opening between garage and dwelling? N/A If so, will a Fire-Rated door,.
enclosure, .self-closing device be provided? N/A
Will a flue-lined chimney be installed? HQ_ Height above roof N/A ft.
-Depth of chimney foundation below grade: N/A ft.
Depth of fireplace hearth: NIA ft. N/A in.
Water supply - Municipal or private well : municipal
SEPTIC SYSTEM: Distance from any private well (including adjoining properties: +100 ft.
(A .separate application is necessary for any repair or new installation of-'septic system. )
NAME OF BUILDER & ADDRESS: uie Qahm,company, Inc. - P.O. Box 6150 - Rutland, VTos1o2 PHONE Iso2I141-voio
NAME OF PLUMBER & ADDRESS: same as Above PHONE
NAME OF MASON & ADDRESS: same as Above PHONE
NAME OF ELECTRICIAN & ADDRESS: same as Above . PHONE
DECLARATION
To the best of my knowledge and belief the statements contained in this application,
together with the plans and specifications submitted, area true 'and complete statement of
all proposed work to be done on the described premises and that all provisions of the
BUILDING.'CODE, THE ZONING ORDINANCE, and all other laws pertaining to the proposed work shall
be complied with, whether specified or not, and that such work is authorized by the owner.
Signature � ' , ,
Ow ner, ner s agent, architect
contract r
SPECIAL CONDITIONS OF THE PERMIT:
By:
Code Enforcement Officer
ENERGY. CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE DAYS
-Compliance Methods:
PART 5 = Acceptable Practice Method - 1 & 2 Family Dwellings (ONLY)
PART 6 - Thermal Rating - Component Trade Offs - 1 & _2 Family Dwellings;
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
Dale L. Shaw- Inspiration Park (Lot #15)
APPLICANT'S NAME PROPERTY LOCATION
PART. 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - .915 Sq. Ft.
2. Type of Heat - x Elec. Base Board Other
3. Is Building Mechanically Cooled? YES x NO-
4. Percentage of Area of'Windows and Doors Over 17% x Under 17% (10.3%)
THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND TO (9000 D.D.)
THE R-VALUES SHOWN ON PLANS SUBMITTED! R E Q U I R E D
Baseboard
5. Insulation Values: Actual Shown Elec. Heat Other
A'. Roof & Floors exposed to ambient temperatures R 38 33 24
B. Exterior Walls R -19 23 18
C. Glazed Area R 3.45 2.6 1.7
D. Exterior Doors- R 14.9 2.5 2.5
E. Floors over unheated spaces R 19 24 19
F. Edge of Slab on Grade (Heated Building) R N/A 10 .10
G. Basement/Cellar Walls (Above Grade) R N/A 10 10 .
H. Basement/Cellar Walls (Below Grade) R N/A -
I. Heating/Cooling - Ducts - Piping in Unheated Space R N/A- - -
6. Service (Domestic) Hot Water Heating Device
. A. Conforms to minimum efficiency per code x YES NO
TEMPERATURE CONTROL MAXIMUM SETTING 1400 - WILL NOT BE EXCEEDED
518 793-5183
APPDICANT13 SIGNATURE DATE TELEPHONE NUMBER
INSPECTOR'S REMARKS:
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid
Date: ' ,10/19/92 Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: Inspiration Park, Queensbury, MY 12804
:Owner's Name: Mr. Dale L. Shaw - Lot #15 - Model 1A
Owner' s Mailing Address.: Goldfinch Road - gueensbury, NY 12804
Installer' s Name: The Quinn company, Inc. Phone #: (802) 747-7010
Number of bedrooms (if residential ): Three
Total daily flow (residential-compute @ ??S gal . per bedroom): 375
Topography-Circle On C Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One Sand Loam Clay Other /Depth: +20'
Ground Water-At What Depth? 61-0" Feet
Bedrock or Impervious Material-At What Depth? +20 Feet
Percolation Test-Circle One: Not Required Required/Rate 2 Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other
If domestic water supply is a we
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank 1000 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 27. feet//Total System Length 162 feet
Seepage Pit(s): Number of / Size each: ft. x ft.
Size of Stone to be used: i/2R to i-1 2„ Depth or Thickness 1.0 feet
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size\of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: vti,�QQ�..,s. DATE:
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r'ErsavED
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OCT2 � 1992
N V
BLDG. & CODE DEPT. Z Y
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GOLDFINCH - ROAD
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IN.G. DYBAS ASSOCIATES,
zon 1,�}ninist etor ARCHITECTS, P'.C. PLOT . PLAN
yOW OF QUEENSBURY LOT 1.5
C'E `°' _ INSPIRATION PARK
SCALE: �s 20� 274 MY ROAD.01FNt FILL nv YM 12M FFl1M : 1-515-703-u ,
UNAUTHORIZED ALTERATION OR ADDITION TO
THIS DOCUMENT IS A VIOLATION OF SECTION "\NSp1RAT1o�.1 PAiLIL-SuOD1vt51o1J 7209 SUBDIVISION 2 OF THE NEW YORK STATE
EDUCATION LAW. T-.`1CauT PLA-&3" P=r-P^- S0 dYmr—
EuG11JFaETL.\uo�G.S..f.�r_E ASSoc. P.G.
LANDs NIF HOME OWTJER.S ASSOCIATION
N . -75` 05' Ode W. 100.0c
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S certify to the following
that this surrey ban been
prepared in accordance with
the Code of Practice for Land
Surveys adopted by the X.Y.S. RPRINTED
ALE ASSOCIATES, C,
Association of Professional G Q L Q F 1 w,C." R O A 0
Land Surveyors as last •v B ♦ /'ate
revised. �S� R.o.w.�
OALE L. SF\At+l _
STATi=wtOE Fc�tJOItJG ��P . NOV 3 0 I992
ZTS SU�•P_$SOfZS AJ,]O��R A�SSIGr.�S
CH\CAGO `°r\T l..E_ l tJ SU RANGE GOM PAN Y
ANIa ISSUED
ONLY COPIES OF THIS MAP SIGNED IN RED
INK AND EMBOSSED WITH THE SEAL OF AN
_ OFFICER OF C. T. MALE ASSOCIATES, P.C.,
OR A DESIGNATED REPRESENTATIVE SMALL
C • .� E1JtSCt�1 Pl s SAT E BE CONSIDERED TO BE A VAUD TRUE COPY"
Date RECORD OF WORK Appr' LOT S - GO LO iV CH ROAD
I N S P 1 RAT % 0 W PARy"..
E
Toww1 OF wA5z-RE1J COUNTY, NEW YORK
C.T. MALE ASSOCIATES, P.C. FkIPU
50 CENTURY HILL DRIVE, P.O. BOX 727, LATHAM. NY 12110 Li
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(518) 786-7400 • FAX (518) 786-7299
Drafter: L .�O ENGINEERING • SURVEYING • ARCHITECTURE • LAND PLANNING �J�LvaJl
J.F. Checker: �J
LANDSCAPE ARCHITECTURE • COMPUTER SERVICES 0
m` .
Appr. byo•]�- Proj. No. 92. 17e-5 SCALE: I`l= 3o DATE: Wo-4 . \9 , I992
0
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING 6 CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR�EPART `.
REQUEST FOR INSPECTION RECEIVED:
NAME
LOCATION
DATE PERMIT A 9`7 ` �S�Cs1-7
TYPE OF SIURE:
RECHECK APPROVED
N/A YES NO
OOTINGS PIERS y
MONOLITHIC OUR FO 1 I
REINFORCEMENT IN P ACE
THE CONTRACTOR IS RESP NSYBLE FOR
PROVIDING PROTE T ROM FREEZING
FOR 48 HOURS FOL KING THE PLACE-
MENT OF THE CONC ETE.
MATERIALS FOR T IS PURPOSE ON SITE
FOUND ATION WALL OUR
REINFORCEMENT I PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PL3ICIBING VENT VENTS IN PLACE
OUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER _
HE NG ROUGH-IN
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R- _
FLOORS R-
WALLS R-
CEILING
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
(518) 761-8256
TOWN OF QUEENSBURY x--
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR5�30DEPAR
REQUEST FOR INSPECTION RECEIVED:
NAME ve (�C'�»�
LOCATION ) -3 F%
DATE ZI PERMIT
TYPE OF STR CTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS PIERS
L
MONOLITHIC OIFORMREINFORCEMENTTHE CONTRACTOSJCBJ) FOR
PROVIDING PROM FREEZING
FOR 48 HOURS E 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 1
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-
�0
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256
ARRIVE: k ' DEPART: _C7 I N S P L
FINAL INSPECTION REPORT - RESIDEN L
DATE INSPECTION REQUEST RECEIVED: (�
NAME P63Tf�t�'(N ` •l1 L e)on L�
LOCATION 11 p pi Y )cj
DATE _ PERMIT 97--:-- -
TYPE OF STRUCTURE ,
a
FOOTINGS_ FOUNDATION /11ACL FRAMINGROUGH PLUMBING _ SEPTICLATION
FINAL ELECTRICAL WOODSFIREPLACE
N/A YES NO
CHIMNEY HEIGHT B VENT BIGHT
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 of
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL Gar
SITE PLAN/VARIANCE REO.
FINAL SURVEY PLOT PLAN
OK TO ISSUUE C/O OR C C
C>Y\ vbv-
c-o
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 357 Elwyn Terrace — Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Panel Boar o................... Cert. 43212 Cut-in Card No..........................
Owner..... I.......... . .�f�Q d.p..........................................................................
Occupant..
Location ... .........................0 / IlVe-* —1,( ��/''••
Installation Consistin of 10...t!L................ .f...............................
............................................................................................................................................
InstalledBy...... .. .`...,............................................. 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 maki inspe io s at any time,and if its
rules are
(viiolated,thee/Company shall have the right to revoke h' er if• .
Date..../. .....l....�............. INSPECTOR ..... .... ..............................................
Member N.F.P.A.,I.A.E.1.
TOWN OF QUEENSBURY U
BUILDING & CODE ENFORCEMENT
531 BAY ROAD 3
QUEENSBURY NY 12804
(518)745-4447
ARRIVE: DEPART: r _ INSP
FINAL INSPECTION REPORT - RESIDEN L
DATE INSPECTION REQUEST RECEIVED:
NAME
LOCATION
DATE PERMIT #
TYPE OF STRUCTURE
FOOTINGS_ FOUNDATION BACKFILL _ FRAMING _
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT B VENT HEIGHT
PLUMBING VENT
ROOFING
EXTERIOR FINISH
DECK PORCH STEPS RAILINGS
RELIEF VALVES
l �
FURNACE HOT WATER OPERATING
INTERIOR TRIM PRIVACY DOOR
{
FINISH FLOORS:
BATH KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED i
0
STAIR CLEARANCE RAILINGS
SMOKE DETECTORS i1
BATHROOM FANS t
PLUMBING FIXTURES , +'
FOUNDATION INSULA ION
GARAGE FIRE PRO FING
DOOR CLOSERS
FINAL ELECTRICAL
SITE PLAN VARIANCE REQ.
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C C
� L
/ fONr1 OF Q_�EEN 8URr
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATIONf
DATE PERMIT# c/�
TYPE OF STRUCTURE -/I
RECHECK
_FIRE MARSHAL APPROVAL (COMMERICIAL STRUCTURE)
_FOOTING FOUNDATION BACKFILL FRAMING
_ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC
INSULATION WOODSTOVE/FIREPLACE
REMARKS
11
jAPPROVAL
N%A ES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VENT ✓
ROOFING i
SIDING
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES
-F-OR4I ff/HOT WATER OPERATING/
INTERIOR TRIM/PRIVACY DOORS'
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT'
OTHER FLOORS ,SWEEPABLE' ;
OTHER FLOORS CARPETED!
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS
DOOR CLOSERS
BATHROOM FANS
ALL PLUMBING FIXTURES OPERATING
GARAGE FIRE PROOFING
DOOR CLOSERS
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS:
ARRIVE
DEPART
INSPECTOR
Jown o/ QuvenAury �-dJ_)d
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
DATE `1 ' / 9A PERMIT NO. 9�- (��i
SOIL TYPE - <.S Loam - Clay
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench �3(
Depth of trenches i-
Size of gravel_ /
SEEPAGE PITS{Number of
Size- ft. X _ fti.
Gravel size
PIPING: ; 5ize/ Type
Bldg. to tank f �Gg
Tank to dist. box V /f
Dist. box to field/pit/' y Y
Openings sealed? NO Partial
LOCATION/SEPARATIONS/
Foundation to tan4tion
/0 ft.
Foundation to abs ft.
Absorption to loline ,�, ft.
Separation of p s ft.
LOCATION OF SYS EM ON PROPE, TY(circle one)
Front -Rear Left side - ight side -
COMMENTS:
A
SYSTEM USE APPROVED' YES,I q NO/
Building Inspector
01/86 and vl
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT ^
531 BAY ROAD off)
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR°S REPORT
REQUEST FOR INSPECTION RECEIVED/
NAME JAU4� -
LOCATION f�.�ii 1�
�°t �
DATE Illlql PERMIT I
TYPE OF STRUCTURE �/r}2p Qc
RECHECK APPROVED
N/A YES NO
OOTING
ONOLITHIC POUR FORM
' INFORCEMENT 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 X � �
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS I,N PLACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS'
JACK POSTS/MAIN BEAM
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INSULATION: '
FOUNDATION WALLS INTERIOR Rn
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R- "
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
Q,,
ARRIVE
DEPART
INSPEC OR
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 A/`lv/��
NAME
LOCATION A
DATE f` PERMIT # `
TYPE OF STRUCTURE SiG ,�GL
RECHECK ( APPROVED
N/A YES NO
DOTING r
MONOLITHIC POUR FORM !
REINFORCEMENT IN PLACE 1
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION -,.FROM
FREEZING FOR 48 HOURS FOLLOWING �
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON YTE_
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING 1,
BACKFILL APPROVAL
ROUGH PLUMBING
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PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING 4
JOIST HANGERS
JACK POSTS/MAIN BEA 9 I
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS YNTERIOR R4
FOUNDATION WALLS XTERIOR R-4
FLOORS R-
WALLS R- i
CEILING R- 1
DUCT WORK OR P PING IN UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART
INSPECTOR
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 / ,3j 6/
NAME/
LOCATION. f
DATE /t o PERMIT #
TYPE OF STRUCTURE ,_��D ( �f,
RECHECK APPROVED
N/A YESI NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLL04ING
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE �N SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE 1
(FOUNDATION/DAMPROOFING h
56 BACKFILL APPROVAL
ROUGH PLUMBING ]
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PLUMBING UNDER SLAB `
FRAMING:
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JOIST HANGERS
JACK POSTS/MAIN BEAM
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INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS a' R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES t'
i
REMARKS:
ARRIVE
DEPART
IN PECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSP CTION RECEIVED // s 2—.
NAME
LOCATION
DATE / .� �7A PERMIT 0
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YESI 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 URPOSE ON SITE
xFOUNDATIO ALL PO
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING I
BACKFILL APPROVAL t
ROUGH PLUMBING I
PLUMBING VENT/VENTS IN PLACE
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FRAMING: 7
JACK STUDS/HEADERS
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JOIST HANGERS
JACK POSTS/MAIN BEAM P
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR ,R-
FOUNDATION WALLS E ERIUR R-
FLOORS R`=
WALLS R
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES /
REMARKS:
ARRIVE
f ;,NV
DEPART .1''; 1 ,
`" INSPECTOR
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
NAME
LOCATION
DATE �q,�_PERNIT 9 �` r
TYPE OF STRUCTURE
RECHECK APPROVE
N/A YE
/,FOOTINGS/PIERS
/ MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOWING
THE PLACED PIT OF THE CONCRETE.
MATERIALS OR THIS PURPOSE ON SITE
FOUNDATION 14ALL POUR
REINFORCEME T IN PLACE
FOUNDATION/5AMPROOFING
BACKFILL AP ROVAL
ROUGH PLUMBING /
PLUMBING VENrt/VEN S jIN PLACE
PLUMBING UNDE' SLA
FRAMING:
JACK STUDS/HEA RS
BRACING/BRIDG G
JOIST HANGEM
JACK POSTS/JAI'(V BEAM
HEATING ROUGHH-INr
INSULATION:
FOUNDATION WALL INTERIOR R-
FOUNDATI6N WALLS EXTERIOR R- �I
FLOORS 7 R-
WALLS I R-
CEILIN R-
DUCT W,ORK OR PIPING IN UNHEATED
SPACES
r
REMARKS:
ARRIVE
DEPART
INSPECTOR