2001-839 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: P20010839 Date,Issued: Monday, May 10, 2004
This is to certify that work requested to be done as shown by Permit Number P20010839
has been completed.
-
Tax Map Number: 523400-308-005-0001-051-000-0000
Location: 17 BELLEWS Cir
Owner: MICHAEL A MIDDLETON
Applicant: MICHAEL &PAMELA MIDDLETON
This structure may be occupied as a:
By Order of Town Board
Garage -2 Cars Detached TOWN OF QUEENSBURY
4
Director of Building& de E rcement
4111111 ` TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010839 Application Number: A20010839
Tax Map No: 523400-308-005-0001-051-000-0000
Permission is hereby granted to: MICHAET, &PAMF,T,A MIDDT,ETON
For property located at: 17 BELLEWS Cir
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: MICHAEL A MIDDLETON
16 BELLEWS Cir Garage-2 Cars Detached 12,000.00
Total Value 12,000.00
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2001-839
720 SQ FT 2-CAR DETACHED GARAGE AS PER PLOT PLAN SPECIFICATIONS
$72.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 15,2002
(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 f Queen ury; h sday,November 15,2001
SIGNED BY for the Town of Queensbury.
Director of Building Code nforcement
Building Permit Application
Town of Queensbury—Dept of Community Development, 742 Bay Road, Queensbury,NY
(518)761-8256
A permit must be obtained before beginning construction. Permit File N 3
No inspection will be made until applicant has received a Fee Paid S o
valid building permit. All applicants' spaces on this Rec. Fee Paid S
application must be completed and must appear on the Reviewed By•
application form.
Applicant: m l CLc,d dd( Owner: K,,c_\„_v e t Nit , c0,l.;t c,.1
Address: I t, f.eI/ewS Address: e-w , C
OlfeeAbury NY 1 zsoq .e
Phone# (S/3)79g - 973 b Phone# (S/S - 971(a
Property Location: Lot Number: C / House Number , /
Subdivision Name: Tax Map Number:
New Building: residence /commercial Estimated Market Value of Construction: S AROSSO
o Addition: residence/ commercial If an Addition,what will use of new addition be?
o Alteration: residence/ commercial
❑ No change to exterior size: residence/com'l
❑ Other work(describe )
Check Occupancylnformation IS`Floor 2"d Floor Other floor Total
Below sq.ft. sq.ft. sq.ft. Square Feet
❑ Single family dwelling___. _.. ., ..
❑ Two family dwelling
❑ Townhouse
• ❑ Multifamily dwelling RECEIVE*
.
#of units
❑ Office NOV 0 9 2001
❑ Mercantile
TOWN OF QUtENSBURY
o Manufacturing BUILDING AND CODE
o 1 car detached garage
li. 2 car detached garage 79() 7(20
❑ 3 car detached garage
'❑ 1 car attached garage
❑ 2 car attached garage
❑ 3 car attached garage
❑ Storage building-
commercial
❑ Storage building-
residential
❑ Other
What is the proposed height of the structure 22 feet inches
Will any second-hand or ungraded lumber be used? If so, for what?
Type of Heating System: electric/ oil / 0/wood /forced hot air/ baseboard/other:
Number of Fireplaces to be installed Number of Woodstoves to be installed
List below the person(s)responsible for supervision of work as regards to building codes:
Name Address Phone Number
Builder 1/W,�- e I t gcI l -Ate..- • 7 9 g 5236
Plumber t
Mason t r
Electrician t
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 Uwe shall
submit,prior to a Certificate of Occupancy or Certificate of Compliance being issued,as requested by the Zoning
Administrator or Director of Building and Codes,an As Built Survey by a licensed surveyor;drawn to scale,showing actual
location of all new construction.
Signature:7/7,-_,€2 f�:�"/„G.,0 er,owner's agent,architect,contractor
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Oueensburv, NY 12804 (518) 761-8256
1. OWNER INFORMATION: Office Use
Location of installation:
l le--OS C (- 6
File Permit No.
Tax Map No. 12-( / / / 52' ' Z'Z
1 \ \� Fee Paid
Owner's Name: % C�Z 1 \ `�1�Y ‘e__ W'`
Address: , (5 1 \ �1e..%, (I-
2. INSTALLER'S NAME :
\, ' ` �C PHONE NO. I 1 9 I 1
��f U ��1�-5`�d�
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of -
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow -
1980 or older x 150 gal/bdrm =
1980- 1991 x 130 gal/bdrm =
1991 -present 1 x 110 gallbdrm = 1 t O cr,_it
Garbage Grinder Installed yes / no
Spa or Whirlpool Installed yes__ I no )(
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
To ography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat san at what depth at what depth 4�rv' gal
Ro mg loa I feet 1 2..5 feet 0�
Steep slope clay if well; water supply
slope other from any septic-system
depth: absorption is LY-c-3 ft.
other
Percolation Test: (To be completed by licensed professional engineer or archiI.ct)
Rate: minute per inch
5. 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: 1 0 0 t' gallon (min. size 1,000 gal)
(
Tile Field: each trench ft. Total System Length: ,ft
Seepage Pit(s): number of 1 -- size of each: 2R IC) ft by ft.
depthZ feet 7i�^''`
Size of Stone to be used: # 3 or thickness
Bed System Size: x .
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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.
V , r2r // l /V / n1
Signature of responsible person ' Date
. _ _ = ENERGY CODE COMPLIANCE APPLICATION
1- _-__ TOWN OF QUEENSBURY, WARREN COUNTY
''„�•. r= 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
• *Requires submission of worksheets
•
APPLICANT' S NAME: PROPERTY LOCATION:
fNl :oh���1 1 -{,i' , _ 1Lu-Y . CA---- . Lc1
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1 . Gross Floor Area - � square feet
2 . —_roe of Heat - Electric Oil Gas Other
jci
3 . Is building mechanidally cooled? Yes No
4 . ?er ce ntace of area of windows and doors Over 17% under 17°s
5 . R-V=E S FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-V=L ES AS
SHOWN ON PLANS SUBMITTED:
a . Roof R 30
b . Exterior wails R z ) 9
c . Glazed areas R
d . Exterior doors R
e . Floors over unheated spaces R 19
_ . Edce of slab on Grade (heated building) R
c. Basement/c=1 i walls (above grade) R I
h . Basement/cellar walls (below grade) R
i . Heating/cooling—ducts-piping in unheated space R K,
6 . Service (domestic) hot water heating devi c
Conforms to minimum efficiency per code Yes No
T E M=ERATURE CONTROL MAXIMUM SETTING 140° - WILL NOT BE EXCEEDED
Da App
1 4 J v 1/ / l G( acne�`�( ceNume:`7 ctt ?moo
_N5= R' S RE:,LARKS:
Residential Final Inspection •
. Office No. (518) 761-8256 Date Inspection requ; t r;c= ..
. Queensbury Building&Code Enforcement Arrive: • p ►epart: `"lh am pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initia
NAME: VA aDs-) 1 C)t1 P.. . IT#: Z-c_f>, k3
LOCATION: I to �E E Ci ROE_ 0 •TE: vr'— I 0--0 ,
TYPE OF STRUCTURE: Frpickiev
Comments
Y N N/A
• Chimney Ht./"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumb Vent through roof
Roof Complete
Guard 30 in. or more @ stairs,decks,patios
Guard at stairwell at 34 in. or more
Guard at deck,porches 36 in. or more
Exterior Finish Complete
Interior/Exterior Railings 34 in.to 38 in.
Platform at all exterior doors
Interior Handrails stairs 2 or more risers
Grade away from foundation 6 in. with 10 ft.
Handrail Termination at Newell Post or Wall
8 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18"above grade
Gas Furnace shut-off within 30.ft. or within line of site
Oil Furnace shut-off at entrance to furnace area
Furnace/Hot Water Heater operating
Low water shut-off boiler •
Relief Valve(s)installed •
Interior privacy/trim/doors/main entrance 36 in.
Bathroom/Kitchen watertight
Safety glazing
Window in stairwells safety glazing
Interior Smoke Detectors:
Every level: / Every Bedroom:
Outside every bedroom area:
Inter Connected: / Battery backup:
Bathroom Fans,if no window
Carbon Monoxide detector
Plumbing fixtures
Foundation insulation
Floor truss, draft stopping fmished basement 1,000 sf
Emergency egress below grade
Basement stairs closed rise>4 inches
3/4 hour fire door/door closer
Garage fireproofing
Duct work Sealed properly
Attic access 30 in.x 24 in.x 30 in.(ht.)In accessible area
Crawl Spaces 18"x 24"access, 1 sq.ft.-150 sq. ft.vents
Building No./Address visible from road
Final Electrical
Site Plan /Variance required
Final Survey Plot Plan
As Built Septic System/Sewer Dept.Inspection Sticker
Flood Plain Certification, if required
Okay to issue C/C(Cert.Of Compliance)
Okay to issue Temporary C/0(Cert. Of Occupancy)
Okay to issue Permanent C/0(Cert. Of Occupancy)
L:\SueHemingway\Building.Codes.Inspection.FORMS\Res.Final Insp.form 2.doc edited January 28,2003
0.; _oj-. _ - Ot'--T
/27,-, ;ti-
Residential Final Inspection
Office No. (518) 761-8256 Date Inspection reque ei S & O Hil
. Queensbury Building&Code Enforcement Arrive: '.e1t) a p art: ?. m/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initia /\
NAME: i , i d r°�C>;� P T#: Db I — Si
LOCATION: Up i �o g,A,tb_ E: p Li
TYPE OF STRUCTURE: (� U �n�
Comments t '�`c(
Y N N/A
Chimney Ht./"B"Vent/Direct Vent Location �;�� y, cr►"-
Fresh Air Intake f
3 inch Plumb Vent through roof / C. r
Roof Complete V
Guard 30 in. or more stairs,decks,patios /,, J/
c,,. ,L.
Guard at stairwell at 34 in.or more o b s U� l S f
Guard at deck,porches 36 in.or more �,n ; k� vN�
Exterior Finish Complete r ice'
Interior/Exterior Railings 34 in.to 38 in.
Platform at all exterior doors V
Interior Handrails stairs 2 or more risers
Grade away from foundation 6 in.with 10 ft.
Handrail Termination at Newell Post or Wall
8 inch clearance to sill plate /
Gas Valve shut-off exposed/regulator 18"above grade ✓
Gas Furnace shut-off within 30.ft. or within line of site i
Oil Furnace shut-off at entrance to furnace area
Furnace/Hot Water Heater operating -/ '
Low water shut-off boiler /
Relief Valve(s)installed Interior privacy/trim/doors/main entrance 36 in. V/ •Bathroom/Kitchen watertight
Safety glazing /
Window in stairwells safety glazing .
Interior Smoke Det9etors:
Every level: / Every Bedr,6om:
Outside every bedroom/ea: �/
Inter Connected: ✓✓ / Battery backup:
Bathroom Fans,if no window ✓ ,
Carbon Monoxide detector ,//
Plumbing fixtures ✓
Foundation insulation
Floor truss, draft stopping finished basement 1,000 sf
Emergency egress below grade
Basement stairs clo ris >4 inches
3/4 hour fire door door closer
Garage fireproofing ✓
Duct work Sealed properly
Attic access 30 in.x 24 in.x 30 in.(ht.)In accessible area
Crawl Spaces 18"x 24"access, 1 sq,ft.-150 sq.ft.vents
Building No./Address visible from road
Final Electrical ✓
Site Plan /Variance required
Final Survey Plot Plan
As Built Septic System/Sewer Dept.Inspection Sticker
Flood Plain Certification, if required
Okay to issue C/C(Cert. Of Compliance)
Okay to issue Temporary C/0(Cert. Of Occupancy)
Okay to issue Permanent C/O(Cert. Of Occupancy)
L:\SueHenvngway\Building.Codes.Inspection.FORMS\Res.Final Insp.form 2.doc edited January 28,2003
Residential Final Inspection
Office No. (518) 761-8256 Date Inspection regt st eceive . L /j ` 0 4
Queensbury Building&Code Enforcement Arrive: m/p art: m/ •
742 Bay Rd., 1 �/,�j/
Queensbury,NY 12804 Inspector's Initi s• .
NAME: s /:11 L ' 1Pi P IIT#: &Di R 3 9
LOCATION: !`7 L?/ ;_,3; (,«� ATE:
TYPE OF STRUCTURE: 2� / - ti
Comments , I
Y N_ N/A v
Chimney Ht./"B"Vent/Direct Vent Location
Fresh Air Intake -
3 inch Plumb Vent through roof l://i
Roof Complete .),�—/l^i iGuard 30 in. or more @ stairs,decks,patios L�Guard at stairwell at 34 in. or more '6. \ ��
�v
Guard at deck,porches 36 in. or more
Exterior Finish Complete / ���_
Interior/Exterior Railings 34 in. to 38 in. I/
Platform at all exterior doors li•
Interior Handrails stairs 2 or more risers \LV - ? i— 7 1 1� L 1 )
Grade away from foundation 6 in. with 10 ft. Lb
Handrail Termination at Newell Post or Wall , 75 +'"0\)IC:\>
8 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18"above grade I C.,,
Gas Furnace shut-off within 30.ft. or within line of site /
Oil Furnace shut-off at entrance to furnace area J ,� i"v-Ez-.4.\ Ft_zzL,p....
Furnace/Hot Water Heater operating
Low water shut-off boiler q k%c -x--- �Relief Valve(s)installed 1j\ -2
Interior privacy/trim/doors/main entrance 36 in.
Bathroom/Kitchen watertight `Y" eVa—VL V .--
Safety glazing Q� � l
Window in stairwells s fety glazing / C'N-TZ-
Interior Smoke Dete ors: / vJ
Every level: / ery Bec]y(otn:
Outside every bedroo area: _//
Inter Connected: / Battery backup:
/
Bathroom Fans,if no window
Carbon Monoxide detector
Plumbing fixtures
Foundation insulation
Floor truss,draft stopping finished basement 1,000 sf
Emergency egress below grade
Basement stairs closed rise>4 inches
%hour fire door/ oor closer 6 r j fr1 ��� ‘'!4 .
Garage fireproofing -
Duct work Sealed properly
Attic access 30 in.x 24 in.x 30 in.(ht.)In accessible area
Crawl Spaces 18"x 24"access, 1 sq.ft.-150 sq. ft.vents
Building No./Address visible from road
Final Electrical
Site Plan /Variance required _
Final Survey Plot Plan
As Built Septic System/Sewer Dept.Inspection Sticker
Flood Plain Certification, if required
Okay to issue C/C(Cert. Of Compliance)
Okay to issue Temporary C/0(Cert. Of Occupancy)
Okay to issue Permanent C/0(Cert. Of Occupancy)
L:\SueHeniingway\Building.Codes.Inspection.FORMS\Res.Final Insp.form 2.doc edited January 28,2003
GENERAL
Office Use
GENERAL INSPECTIONREPORT Inspector: TO i't'✓l
Town of Queensbury Ready at time:
Dept. of Community Development Request received: 1' O Z Meet:
Building& Code Enforcement At time:
742 Bay Road
Queensbury, NY 12804 • ARRIVE 7t D am/ E'44R I I ,can" Notes:
(518) 761-8256 Inspector's Initi s
NAME: PHr do(-e Q)r) PERMIT# G uu a— S 3
LOCATION: /r pp 1(01,d S �t'�- INSPECT ON(date): Gl( d o 2
TYPE OF STRUCTURE: l9'�"c�e,. 1 irk V/1 L S Csz_. Q
RECHECK •
J J
N/A YES NO COMMENTS
Footings/Piers •
• Monolithic Pour Form /f,
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/Wallpour
Reinforcement in Place
Found ati o n/D ampp r o o fing
Backfill Approval •
Plumbing Under Slab
Plumbing Vent/Vents in Place
•
Rough Plumbing
Heating Rough-In � ,
�sulation S-Aa6
Foundation s Interior R-
Foundation Walls Exterior R-
Floors R- t \ gJ
Walls It-
Ceiling R-
Duct work or piping in
• unheated spaces R-
Proper Vent,Attic Vent
•
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main B eam
Air Infiltration Barrier •
Fire Separation 1,2,3,hour
Penetration Sealed
Fire Wall.2,3,4 hour •
Firestopping
•
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
(7 ) .,—a_ ,c ' � I 1 Office Use
GENERAL INSPE ION REPORT v� Inspector:
Ready at time:
Town of Qaceensbury ro/ _
Dept. of Community Development Request received: ! . Meet:
Building& Code Enforcement . At time: .
742 Bay Road n
Queensbufy, NY 12804 ARRIVE'' (PZ / n . A �` a pm ii. Notes:
—
(518) 761-8256 Inspector's Initia G r
NAME: /1 I,` Ve Ul,4 j(WOK PERMIT# ;OUT 0 J
LOCATION: /6 C Olio 5 C t irC l e INSPECT ON(date): iU/3/0 2_
TYPE OF STRUCTURE: at
•
RECHECK U
N/A YES NO COMMENTS •
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/Wallpour
Reinforcement in Place
Foundation/D ampproofing
Backfill Approval
-` 1 i bing Under Slab
lu bing Vent/Vents in Place f/
R. ghPlumbing _ ,/ ` �\ � lr \ \���\`���
sting Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
eiling R-
ct work or piping in
cheated spaces R-
'rop: Vent,Attic Vent /
ra '`ng ✓ .
ack Stu../Header.
Bracin: ' .i 0
Joist Hangers �\ '1-�L\--
Jack Posts/Main Beam ��1 v J ` �` 1�� L
Air Infiltration Barrier a V `\r�`�'
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
L:\SueHemingway\Building.Codes.Inspcction.FORMS\GENERAL INSPECTION REPORT.doc
•
Office Use
GENERAL INSPECTION REPORT Inspector:
Town of Queensbury
Ready at time:
Dept. of Community Development Request received. Meet:
Building& Code Enforcement At time:
742 Bay Road
Queensbury, NY 12804 ARRIVE\n=2,5 m: EPA ID! _4 m Notes:
(518) 761-8256 Inspector's Initia
NAME: DpLE1---- PERMIT# 2./DD I —g3
LOCATION: I LO G\Q C1 F INSPECT ON(date): g—Z—pZ
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
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/W allpour
Reinforcement in Place
Foundation/Dampproofmg
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing V\D \° Q` ,\ V�W6
Heating Rough-In W
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent,Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping —_
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL.INSPECTION REPORT.doc
•
Office Use
GENERAL INSPECTION REPORT Inspector:
Town of Queensbury
Ready at time:
Dept. of Community Development Request received: Meet:
Building& Code Enforcement At time:
742 Bay Road
Queensbufy, IVY 12804 ARRIVES Z m • 'A 'T9 35R ism Notes:
(518) 761-8256 Inspector's Initial
•
NAME: PERMIT# 2C.-%G1 _ S3c1
LOCATION: \ �FL! � � C INSPECT ON(date): 7-\
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
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/Wallpour
Reinforcement in Place
Foundation/D amppro o fmg
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
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-
,Proper Vent,Attic Vent e
`i Framing Q��LT MY v:%{���1 - v`� Z �C—> QC� -1 O J
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
�T � q ���\ Office Use
GENERAL INSPECTION ll NV_1 Inspect r:Ready t time:_y--9/Town of Queensbury
Dept. ACA
ofDevelopment Request received: 5 i `�
Community Dlo t
p yMeet:
Building& Code Enforcement At time:
742 Bay Road
Queensbury, NY 12804 ARRIVES'.1 h ama -P- ' 1-,�J a pm Notes:
(518) 761-8256 Inspector's Initi4
NAME: 42('a06 / / PERMIT#D/— > 3
9 ,
LOCATION: /0 L1��S �-t -� INSPECT ON(date): S 2 )--
TYPE OF STRUCTURE: — er-G� G4
RECHECK 1`4'1°
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place •
The contractor is res ible for
providing protection from ezing
for 48 hours followi ig the pla meat
of the concrete.
Materials for this purpo e on site
Foundation/Wallpour ‘r 1 DO\F�CSC VD /3 CQ 6 ��, ��<1
Reinforcement in Place �/ (
Foundation/D ampproofin
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Pla,e
ou 1 1
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Walls Exterior i'-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent,Attic Vent
Framing
Jack Studs/Headers •
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
L:\ ueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
Office Use
GENERAL INSPECTION REPORT Inspector:
Town of Queensbury
Ready at Z-e-:/°
aAl
Dept. of Community Development Request received: �-3 Meet:
Building& Code Enforcement At time:
742 Bay Road
Queensbury, NY 12804 ARRIVE 1 a aEPAR .► 'tea , . Notes:
(518) 761-8256 Inspector's Initials
NAME: 41— (4? PERMIT# O ?J7JJLOCATION: /(7 t 4 INSPECT ON(date): d-J �—
TYPE OF STRUCTURE: _ Cam_ n6 t .1-,Z ;------
RECHECK
N/A YES NO COMMENTS •
Footings/Piers
Monolithic Pour Form
Reinforcement in Place."--N
The contractor is res 'onsible for
providing protection rorrii freezing
for 48 hours following the placement
of the concrete.
Mat- 'als for this purpotse on site
Fo 56 a T y
'orcem-nt in Place! 1 0
FoundationlD ampproofmg: •
(Backfill Appro�1 i I , 7
Plumbing Under Slab I /'
Plumbing Vent/Vent n Place
Rough Plumbing —_
Hearing Rough-In
Insulation I
Foundation Walls I tenor R-
Foundation Walls E terior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping i
unheated spaces R-
Proper Vent,Attic Vent
Framing .
Jack Studs/Headers
Bracing/Bridging
•
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
•
•
INSPECTION 7� Office Use
GENERAL REPORT Inspector:Ready at time: I+)V F/ \y',,
Town of Queensbury
Dept. of Community Development Request received: Meet:
Building& Code Enforcement At time:
742 Bay Road
Queensbury, NY 12804 ARRIVE ; D a E T '. a ; I Notes:
(518) 761-8256 Inspector's Initia y
NAME: I\� �'k m PERMIT# O�
1
LOCATION: / (9O2o C l ( INSPECT ON(date): I
TYPE OF STRUCTURE:
RECHECK
N/A YES�IIVO COMMENTS •
ings/Piers f
Mono,ithic P_our Form
Reinforcement in Place
The ontractor is responsible for
provi:.'ng protection from freezing
for 48 hrurs following the lacement
of the con rete.
Materials for e's purpose on sr e
Foundation/Wa e our
Reinforcement in 'lace
Foundation/Dampp ofing
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents 'I '1 . e
Rough Plumbing
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-
Proper Vent,Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
L:\SueHemingway\Building.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc
,.._- 0_7 3 ell)
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name j\' f�� ` 1�1 C �-P
Location As
Q PIQ \e,i) )r�
Dat } - 0 a Permit # 1—831
SOIL TYPE: Sand-Loam- ay-
Results of Percolati n Test
(if applicable) Rate Minute Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To a1 Len th
Length of each trenc
Depth of trenches
Size of stone _
SEEPAGE PITS: Number _
Size - T2_ ft. x ft.
Stone size * \e
PIPING: Size Type e
Bldg. to Tank C.1h
Tank to Dist. Box ,,_
Dist, Box to Fiel Pi Hzi el CA yp
Openings Sealed? e No . Partial
LOCATION/SEPARATIONS
Foundation to Tank / \� feet
Foundation to Abs.orpti on . _j O .feet . .
Separation of Pits. et
Conforms as per Plot Plan Yes
LOCATIION OF SYSTEM ON PROPER .
(circle
Fron - Rear - L - Right Side
Midd = n. - Middle Rear
COMMENTS:
•
7pN—
SYSTEM.USE APPROVED: ' • YES
Arri •• if ''1 ,--
De, . ffAra„,
�s it. i i/
': ' ding-7p=' or
'h am• • 1E-f••
r.
6.c-e_ ,I, R. c jfis). .
\ , ' E -... .. .. . .4c:: ,ciz
46m-
r 3 �� • 16 V •
. C) 66/---S)(1..3 ?
RECEIVED
33, • • �: .; , ? 0 0�E 110-1 sA�; ,�, TOWN OF QUEENSBU Y
�►,1 �d `e I BUILDING AND CODE
N .•47,153.iio• `S _ '' •
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4 / 5.83./7. tai 2-74./ 19 / .
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"I have seen or observed, or b i saw evidence of,
all objects such as houses,::. ;::trees,fences, etc.,
shown on this document b..:represent that I have .6. _
!Ili::: personally measured distances set forth on the diagram." :1::.:i
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