92-668 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date April 2 19 96
!
This is to certify that work requested to be done as shown by Permit No. 9 2 6 6 8
has been completed.
UNFINISHED ATTIC
This structure may be occupied as a
11 GOLDFINCH RD.
Location
Owner HATTE . MARY B.
TAX MAP NO. 14 8. -2-1.6 By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Dace December 22 19 92
This is to certify that work requested to be done as shown by Permit No g2`668
has been completed.
This structure may be occupied as a single family dwelling (modular)
Location Lot 16 Goldfinch Road, Inspiration Park
Owner Mary B. Matte
Issued for lower level only.
By Order Town Board
TOWN OF QUEENSBURY
f
Director of Bldg. do Code Enforcement
n
x
BUILDING PERMIT
z
TOWN OF QUEENSBURY
No. 92-668
WARREN COUNTY, NEW YORK 4�b
N
1
N
PERMISSION is hereby granted to Mary R Matte
OWNER of property located at I of 16 Goldfinch Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a S i nn
at the above location in accordance to application toget er with plot plans and of er information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is
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2. CONTRACTOR or BUI LDER'S Name
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name O
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5. ARCHITECT'S Address Q
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6. TYPE of Construction—(Please indicate by X)
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( )X Wood Frame ( ) Masonry ( )Steel ( ) O"
7. PLANS and Specifications Model : 1A
36'x25.42' Modular Single family dwleling as per plot plan, speci-
icati0ns'and application including septic system.
8. Proposed Use
Sincle family dwelling C-n
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$ 158.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 27 19 93 0)
E3
(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.) cC
a.
Dated at the Town of Queensbury this 27th Day of October 19 92
J
SIGNED BY U for the Town of Queensbury cn
Bu and Zoning Inspector
REVIEWED BY: UMV or
FEE PAID. ;/'A� F®
I PERMIT NO. : Ott 20199?
CODE
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: Ms:' Mary B. Matte - Lot .#16 - Model IA
P.O. Address: Goldfinch Road PHONE -
Property Location: Queensbury, NY 12804 Tax Map x Map 1,No.&/7. & 7_4
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_4
Lot #16, 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 INFORMATION REQUIRED BELOW:
(no change to exterior dimensions) * Size of Property: 100 ft. X 100 ft.
Other work (describe) * Existing Building Siz- V None
* ft. x - ft.
* 'Fro—posed building - distance from
GROSS AREA OF PROPOSED STRUCTURE! CP property line: -
1st Floor' 915 Sq. Ft. Front Yard 30 ft. Rear yard 44 ft.
* Side Yards —= ft. and �0 ft.
2-.id Floor Sq. Ft. � * If on corner, setback from side street-
' * - ft.
Other Floors - Sqo Ft'.
(not cellar or basement *. OCCUPANCY INFORMATION:
*
TOTAL FLOOR AREA: 915 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 families: - 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 : Elecrrlc * 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:
BUILDI�"G 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: an
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? - No
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. Mom_
Joists (floor beams): 2nd Floor. 2 " x 10 "; spacing 16 " o.c. ; span. ft.where
Overlays (ceiling beams) : - x . - "; spacing - o.c. ; span - ft. Applicable
Roof rafters: - " x - of; spacing - o.c. ; span - ft.
Roof -trusses (pre-engineered): spacing 24 " 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:
N/A
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? No Height above roof N/A ft.
Depth of chimney foundation below grade: N/A ft.
Depth of fireplace hearth: N/A ft. N/A in.
Water supply - Municipal or private well : Municipal
SEPTIC SYSTEM: Distance from any private well (includi-ng adjoining properties: +100 ft.
(A separate application is necessary for any repair or new installation of septic system. )
NAME OF BUILDER & ADDRESS: The Quinn company, Inc. - P.o. Box 615o - Rutland, vT. o57o2 PHONE (802)747-7010
NAME -OF. PLUMBER & ADDRESS: Same as Above PHONE
NAME OF MASON & ADDRESS: saw 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,- 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 9. 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 ( --- �
OvIner, Mer's agent, architect
contrac
--------------------------------------------------------------------------------------------
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)
PARS• 4 - Design By Component .Performance - Commercial Buildings - Hi-Rise Residential
PART 4 & 6 - Compliance Methods Require Submission of Worksheets
Ms. Mary B. Matte Inspiration Park (Lot #16)
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%)
(9000 D.D.)
THE R-VALUES GIVEN ON THIS SHEET-MUST CORRESPOND TO R E Q U I R E D
THE R-VALUES SHOWN ON PLANS SUBMITTED!
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 NIA - -
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
APP ICAN S SIGNATURE DATE TELEPHONE NUMBER
INSPECTOR'S REMARKS :
co �' APPROVED .
111fN OF QUEENSEN. Application
OCT L of26M2 �P
& CODE IDEP
c e
TOM
F QUEENSBURIf - THE STAt� '�,
' GOLDFINCH;BROAD
5.7�5• �. 1G0.0 284 I
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Volt
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elf
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DAIS CUSHING. DYBAS ASSOCIATES,
DRAW � _ ARCHITECTS. P.C.. - � PLOT PLAN _
LOT 16'
_ �,E �: INSPIRATION PARK
SCALE: 1"=20' PAX' 1_s11-79s-a2n
274 54Y ROAD,MSG f41S N2*YOM 129M P"OIE 1-516-M-5113
e L TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid
Date: 10/19/92 Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: rnsp.irati.on Park, Queensbury, NY 12804
.Owner' s Name: Ms. Mary B. Matte - Lot #16 - Model 1A
Owner' s Mailing Address: Goldfinch Road, Queensbury, NY 12804
Installer's Name: The Quinn company, Inc- Phone #: (802) 747-7010
Number of bedrooms (i f residential ): Three
125 375 Gals.
Total daily flow (residential-compute @ gal . per bedroom):
Topography-Circle One: Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other _/Depth: +20'
Ground Water-At What Depth? +6'_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: Munici Well Other
If domestic water supply is a well -
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: 1/z" to 1-1/2" 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: -•.� ��---� DATE: U,
UNAUTHORIZED ALTERATION OR ADDITION TO MA.P. {ZLFES>F 4Y c
THIS DOCUMENT IS A VIOLATION OF SECTION "INSPIILJ.'T10U FA"iC1�- SUODIVLS\orJ
7209 SUBDIVISION 2 OF THE NEW PORK STATE
EDUCATION LAW. CA.Y OL]T PL/►�s" Ps[.�DAREO dY M�J►1J G1J
'F—QG1 U F-F-IL►0om/ G.T.Mi►LE ASSCG. P.0.
LA►J0S N F HOME 0Ww1e.R-S ASSOC.tATk<DQ
N. -750 Os' oo' w.
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TBL.Pao T3LyT '71�QQa'`. ...
O—TY.PG. f S. -75' 05' 00" E. . 100.00
=l certify to the following
that this survey has been
prepared in accordance with
the Coda of Practice for Land C.T. MALE ASSOCIATES, P -
Surveys adopted by the N.Y.D.
Association of Prof
Land essional C SO R.o.ti1.�
Surveyors as last
revised.' NOV 3 01992
MARS( �. MATTE
5Tp.TEW1DE_ F0001t.1G C.C]RP.
ITS SUc.GF-SSOTL.S ANO/O iL .�SSIm1J.S
GHIGnGo TITLE l►1SURANGE CaMPA1JY PRINTED AND 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
G . J F E EN\SCfi1 PLS 490 OATS BE CONSIDERED TO BE A VALID TRUE COPY"
Dote RECORD OF WORK Appr- LOT 1 Co - G O 1-0 T=l IJ G" ROAD
11•?�Fi2 FCUw1C)AT\Ot1 LOGA.TIOaI
INSPI RA`r10N PARK
E
To�1w� OF QuEEw)SBUR`! WARREIJ COUNTY, NEW YORK
01
C.T. MALE ASSOCIATES, P.C. FA
6 50 CENTURY HILL DRIVE, P.O. BOX 727, LATHAM, NY 12110 �-
(518) 786-740D o FAX (518) 786-7299
cA
� Drafter: F, Checker: ENGINEERING + SURVEYING + ARCHITECTURE + LAND PLANNING 4P
LANDSCAPE ARCHITECTURE + COMPUTER SERVICES 0
Appr. by:c. Proj. No. 92 .ITe_s SCALE: 1" = 30' DATE: Nou. kq , 7q2
0
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
.(51B)745-4447
:... ;Vc.: DEPART: _ INSP:
FINAL INSPECTION REPORT - RESIDEN L
DATE INSPECTION REQUEST RECEIVED:
NAME 0 ��A t-
LOCATION
DATE PERMIT #
TYPE OF STRUCTURE
FOOTINGS FOUNDATION _ BACKFILL FRAMING _
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
NIA YES I 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 RE .
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C C
TOWN OF QUEENSBURY
BUILDI�G & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
(518)745-4447
..,:;1 V F,: ° DEPART: 16S .
FINAL INSPECTION REPORT - RESIDE
DATE INSPECTION REQUESTRECEIVED:
NAME
LOCATION ` 1 :LLOE—1 c ," RD
DATE 910 PERMIT
TYPE OF STRUCTURE F 1 /
FOOTINGS FOUNDATION BACKFILL FRAMING _
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
FI A TES No
CHIMNEY HEIGHT B VENT 11EIGHT
PL MBING VENT 1
RO FING
EXT 'RIOR FINISH /
DECK PO STEPS RAILINGS
RELIEF VALVE
FURNACE HOT WATE PERATING
INTERIOR TRIM PRIVAC OOR
JI
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 IISSUE C/O OR C/C
Mp" tA
1>R6 ExpiQ� 1p�pnt5 ���OG
TOW OF QUEENSBURY
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION
DATE r' ,,4 PERMIT$
TYPE OF STRUCTURE
RECHECK
_FIRE MARSHAL APPROVAL (COMMERICIAL STRUCTURE)
_FOOTING _FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC
-ROUGH
WOODSTOVE/FIREPLACE
REMARKS
APPROVAL
N/A YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VENT
ROOFING
SIDING
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES
-FttltME/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY DOORS 1
FINISH FLOORS: y'
BATH/KITCHEN WATERTIGHT,
OTHER FLOORS SWEEPABLE V I
OTHER FLOORS CARPETED J
STAIR CLEARANCE/RAILINGS N,
SMOKE DETECTORS
DOOR CLOSERS
BATHROOM FANS- I
ALL PLUMBING FIXTURES OPERATIN G
GARAGE FIRE PROOFING a
DOOR CLOSERS !
OTHER FIRE SEPARATION 1 r/
FIRE/DEMISE WALLS
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS:
ARRIVE
r
DEPART
INSPECTOR
TOW OF QUEENSBURY
531 BAY ROAD
QUEENSBURY,, NEk�YORK 12804
TELEPHONE (518j 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED %%'4
NAME
LOCATIONZI // ���sr �
DATE ;/ PEFMIT#
TYPE OF STRUCTURE SS`
RECHECK
FIRE MARSHAL APPROVAL (COMMERICIAL STRUCTURE)
_SOOTING _LFOUNDATION /;�ACKFILL FRAMING
ROUGH PLUMBING /'FINAL ELECTRICAL SEPTIC
`INSULATION WOODSTOVE%FIREPLACE
REMARKS
1
APPROVAL
N/A YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VENT 1!
ROOFING 1
SIDING
DECK/PORCH/STEPS/RAILINGS__'
RELIEF VALVES J ��
E/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY -OOkS
FINISH FLOORS:
BATH/KITCHEN WATERT GHTI.
OTHER FLOORS SWEEP BLE
OTHER FLOORS CARP TED h
STAIR CLEARANCE/RAL INGS
SMOKE DETECTORS
DOOR CLOSERS
BATHROOM FANS �.
ALL PLUMBING FIX URES OPERATING_
GARAGE FIRE PROD ING
DOOR CLOSERS
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
FINAL ELECTRICAL /
OK TO ISSUE C/O OR C/C ✓
COMMENTS:
`may 2//���.
1//214
ARRIVE
DEPART t
INSPECTOR
ELECTRICAL INSPECTIONS
DUPLICATE MUNICIPAL RECORD
PermitiNo.
Owner AN
Occupant
Location. ! G J-105"w-le-Al
No. Street
Town or City Stale
Installation as itemized on reverse side has been visually inspected pursuant to applicable codes.
Installed by Lt#1,( CiZi&(
J ` No.
Date /� '�i�9Z, Inspector
MIDDLE DEPARTMENT INSPECTION AGENCY INC.
FORM NO.ie EL 900 Haddon Ave.,Collingswood, NJ 08108
1 ROUGH WIRING OUTLETS H.P.AIR CONDITIONER
cam... ONWIF91V &JJ1 � ' _ WSRYNG+&CONTROLS FOR BURNER
RECEPTACLES H.P.PUMP
'i
FIXTURES K.W.OVEN
Zo()AMP.SERVICE EQUIPMENT H.P.GARBAGE DISPOSAL UNIT
AMP.SERVICE CONDUCTORS K.W. DISHWASHER T
K.W.SURFACE UNIT K.W. DRYER
K.W.RANGE AMP. RECEPTACLE
K.W.WATER HEATER FRAC. H.P.VENT FANS
sit 'G _ /�9Q •(1 ��
OTORS H.P. 1/20 1/12 1/l0 % 1''A 1% 1h V2 1 I 1%1 2 3 1 5 7Vz 10 115 1201251301 40 50 75 100
ARK NUMBER
'EACH SIZE
PPARATUS
Jown of Queenilury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION >JJL�� J
DATE ` / /�v( PERMIT NO.
SOIL TYPE Sander Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench' 07
Depth of trenches ',,7,
Size of gravel_
SEEPAGE PITS{Nuinber of)
Size- ft. X _ ft
Gravel size
PIPING: ' Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/,pit y �i
Openings sealed? ES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line'. ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - RC a�- Left side Right side COMMENTS: -- I l._.__—'';
r' '1
SYSTEM USE APPROVED "Ifs NO
1
Bui d ng Inspector
01/86 and vl
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 ` PERMIT f qZ�
TYPE OF STRUCTURE sla) GCi
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 FOR THIS PURPOSE ON ,SITE
xFOUNDATIO y,
REINFORCEM LACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING .
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING: 4
JACK STUDS/HEADERS f
BRACING/BRIDGING
JOIST HANGERS !�
JACK POSTS/MAIN BEAM
HEATING ROUGH-IN
INSULATION:_
FOUNDATION WALLS INTERIOR R-
FOUNDATION WADS EXTERIOR R-
FLOORS R-
WALLS f' R-
CEILING d R-
DUCT WORK OR PIPING IN UNHEATED >;
SPACES
REMARKS:
ARRIVE ,a
DEPART 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
LOCATIONS
DATE / PERNIT # e,;?
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 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
JACK POSTS/MAIN BEAM 1;"
HEATING ROUGH-IN c
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS ; R-
CEILING ' R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVER`f:' ,
DEPART �e'�� ✓/,
INSPECTOR