97-065 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
June 23 97
Date 19 _
97065.
This is to certify that work requested to be done as shown by Permit No.
has been completed.
SINGLE FAMILY DWELLING �"
This structure may be occupied as a
LOT 75. 455 PEACHTREE LANE
Location "
Owner SCHERMERHORN CONSTRUCTION
TAX MAP NO. 121. . -15-7.1 By Order Town Board
WN OF QUEEN BURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
VALUE $ 95000 TOWN OF QUEENSBURY No 97065
TAX MAP NO. 121 . -15-71 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to SCHERMERHORN CONSTRUCTION
OWNER of property located at LOT 71 #5 5 PEACHTREE LANE Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SINGLE FAMILY DWELLING
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
CORP. 9 MASTERS COMMON NORTH
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
SCHERMERHORN CONSTRUCTION
3. CONTRACTOR or BUILDER'S Address
79 MASTERS COMMON NORTH
QUEENSBURY, NY 12804
4. ARCHITECT'S Name
COMMONWEALTH ELECTRICAL AGENCY
5. ARCHITECT'S Address
PO BOX 706
HAGUE , NY 12836
6. TYPE of Construction—(Please indicate by X)
SINGLE FAMILY DWELLING
( )Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
1484 StP.FT SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE
AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SINGLE FAMILY DWELLING
$ 199 PERMIT FEE PAID -THIS PERMIT EXPIRES March 11 19 99
(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 this 11 ►'ay of March 19 97
SIGNED BY - for the Town of Queensbury
B ilding a oning Inspector
Building Permit Application
, ..
Town of Queensbul y - Dept. of Community Development, 742 Bay Road, Queensbury, NY 12804 [761-8256]
BUILDING & .CODE ENFORCEMENT
NOTICE Requirements prior to issuance
_4111 Op
. A permit must be obtained before
of this permit: PERMIT FILE NO. __• C
beginning construction. No inspections PERMIT FEE PAID$
will be made until applicant has received n Zoning Board Action
a VALID BUILDING PERMIT. All • Area /Use RECREATION FEE P D$
applicants' spaces on this application •
MUST be completed and.the signature n Planning Board Action REVIEWED BY:
of the applicant must appear on the SPR / Subdivision /Other — -'" - Building-Inspector
Application form. Thank, J Recreation Fee Payment 7.
•
Applicant: jr Xne.^.ti.e r1-so r� Co,-Ns•4rQcA:o..0 Corp. Owner: LLl.�TIF NI ,- �_ )/
' Address: -79 M0-5Ve-rs ..,-,d.� A-At-F� Address: - --- -- - i_ -
Phone # ( Si 2) ) -9 9 8 - o(,� Y Phone # ( 517 ) 7 9 if - 6(off y
�-- -- ---- -
. Property Location: t l of 7 I 9ea04r ee. )-4-/ - 4S ) i / ) 1 Z
Subdivision Name: She v a ry 0;ry ES Tax Map Numberr
Section Block Lot
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
V New Buildin CONSTRUCTION: $ 95, oao
residence / commercial
Addition to Building:
residence. / commercial OCCUPANCY INFORMATION:
Alteration to Building: Primary Building
residence / commercial x Single Family DW,e<:aTrb . 7-
_Residence / Commercial Two Family Dwelling'.:: 1 L -
' no:..change to exterior size Family Dwelling .
OfficeI MAR 051997
-Other Work (describe below) Mercantile:
Manufacturing. • O;'-
•
p, • Other c<<..;,,_JiN(- .=4t:;C t: _.
GROSS AREA OF PROPOSED STRUCTURE: C
If ADDITION, what will use
1st Floor 7. S sq. ft.,?S of new addition be? :
2nd .Floor • 7SG, sq. ft:- - ___ .
Other Floors sq. ft.
(not unfinished cellar or basement)
. ... ACCESSORY BUILDINGS:
/' Detached Garage 1,t7
TOTAL FLOOR AREA: iW$`/ SQ. FT. sC Attached Garage 1,
Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building
—
•
HG, Other
FEET X („ FEET
Foundation Type: L`�Y.cJre,kt. Will any second-hand or ungraded
' Number of Stories : a., lumber be used? If so, for what?
(habitable space only) //c?
Height (grade to- ridge) : 95 feet TYPE OF- HEATING SYSTEM:
Number of fireplaces and/or woodstove (circle all which a• •1' es)
to be installed: a �1-ectric/ Oil / et, /Wood
_
Forced Hot Air Baseboard / Other
Person responsible for supervision of work as regards to building
codes is': R. 5ca,,,,,,r,n,.e.r\,ori
Name •Addresss Phone
Builder: A. c.Ned`Jkef\- ed•.,J '798-0(7Y •
•
Plumber: 5f8,9-e . �)/P-nJ 717-_5493
. Mason: Act.P T a.ich.a.',V • ? 9 - 13 7/
- -- -- Electrician.: 44 'kp, (:- ;vi-.,rk,../ - - - - --- - y y-5 0.5 -- -
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 Occup. cy•or Certificate of C pliance being issued, an AS BUILT PLOT PLAN by
a licensed survey , awn to s e, it ' actu location of project on premises.
Signature:
owner, owner's agent, architect, contractor)
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h��. I OWN OFQUELNSIJURY
` 41, :. APPLICATION FOR SEPTIC DISPOSAL PERMIT
Aiew
DATE: 3- y7 .�� a . .2e.e.c56uC,
LOCATION OF PROPERTY FOR INSTALLATION L.6 1- 7> 4acl i✓e_e_. ./v •
Owner' s Name: �,Q.,,P 1/10 r �a.-,s,/-.- .� �o� .
Address: 7 g )44 s i'S szA—
Installer' s Name: /. Sc/ie,✓ 6' Telephone: 77y--oc,
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) /S o
Topography: Circle one: Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one: SandILoam Clay Other /Depth:
Ground Water: At what depth? / Feet 97-061c-'
Bedrock or Impervious Material : At what depth? /� ..._
Percolation test: Circle one: not required required
MAR 0 5 1997
Rate - Min. Per Inch y
Domestic water supply: Circle one: Municipal Well Other Bv►�Dt
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank / '° o gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #. /Depth or Thickness feet
*****************************
HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alan system and associated electrical work to be inspected by an approved
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: .3-V-7 '1
� TOWN OF QUEENSBURY
L' • ' BUILDING & CODE ENFORCEMENT
742 BAY ROAD
• QUEENSBURY NY 12804
(518) 761-8256
ARRIVE: DEPART:. INSP:
FINAL, INSPECTION REPORT - RESIIDEENTIA
DATE INSPECTION REQUEST RECEIVED:� `-� �� 7
NAME 3 Cil-P/YI�'1 P/Yh , I1(J'(A- 1S<1ltoCA
.LOCAT ON 7.. ` V �_L� _
DATE
PERMIT I 7-O�
TYPE OF STRUCTURE L
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING SEPTIC _ INSULATION •
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY NEIGH- -/-B_1VENT/HEIGHT -
PLUMBING VENT •
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/• PILIN
RELIEF VALVES
FURNACE/HOT WAT'R OPERATING
INTERIOR TRI /PRIVACY DOORS
F I N I S H'••FLOO`S:
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 REO.
INAL SURVEY PLOT-PLAN
OK TO ISSUE C/O OR C/C
.?. ---``,, /0-5-0
TOWN OF QUEENSBURY
#550:
1 BUILDING & CODE ENFORCEMENT
s �i 742 BAY ROAD
t QUEENSBURY NY 12604
(518) 761-825/6�
ARRIVE: /6 02)• iis DEPART:. j/. INSP: %)
FINAL .INSPECTION REPORT - RESIDENTIAL
DATE INSPECTION REQUEST RECEEIVV D:/ (p 'l3 9 7
NAME �`,;1[i%t/C�(i���/�(�f,Q"�'.
LOCATION 4% /7 / ��✓' /
DATE 6�z3 7 PERMIT 1 ! -1� ?
TYPE OF STRUCTURE E �J\.
FOOTINGS FOUNDATION BACKFILL FRAMING _
ROUGH PLUMBING SEPTIC _ INSULATION
FINAL ELECTRICAL _ WOODSTOVE OR FIREPLACE
- N/A YE / NO
CHIMNEY HEIGHT/B VENT/HEIGHT 1i��//,
PLUMBING VENT '
ROOFING '
EXTERIOR FINISH M '
DECK PORCH STEPS RAILIN'L
RELIEF VALVES °'
FURNACE/HOT WATER OPERAT,NG V
`
INTERIOR TRIM/PRIVACY DObRS 1/
FINISH FLOORS:
BATH KITCHEN WATERTI HT
/
OTHER FLOORS 'SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS V:(
SMOKE DETECTORS ►/
BATHROOM FANS
PLUMBING FIXTURES -/
FOUNDATION INSULATION V
GARAGE FIRE PROOFING V.
DOOR CL SERS /
FINA 'EL/E /CR1(:AL _ C6l4
SITE PLAN/VARIANCE REQ.
Vill
FINAL SURVEY PLOT PLAN
OK TO ISSU C/O OR C/C
1 e' MU ' I lINk` 4ug(i6--y
A 09kouAL
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 357 Elwyn Terrace — Manheim,PA 17545 91-0(�
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Panel Board No.�. Cert. N° �4 9 960 Cut-in Card No.
Owner 5' -e ? T/ ' ei7977
Occupant _ /J�ss
Location r 7/ f& dam'4`7i2 G 4,at14" ` ' �/l,/
Install-tion Consisting ofQ`- < �m1 `� E t!..�r.e t-/7
.'t�. tc �.....3Y� 5f to 6 � s -/geA 'eAtzl �
Installed By.. 21 C ei 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, insp tions at any tim and if its
rules are iolated,the Co pany shall have the right to revoke illt Ftif'•ate:
Date "—174 j INSPECTOR
' Member N.F.P.A.,I.A.E.1.
TOES OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY I2804 •
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name C5Cyt-Ne,;>M --,\--\0 _
Location —_/\ 3
Date L ) f /97Peit # �—
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPION`FIELD: Total Length
Length cf e.'ch trench
Depth of •.r-nches
Si : , - o
SEEPAGE PITS: Number-
Size - - . x ft.
Stone size
PIPING: Size Type
Bldg. to Tank1'/(Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? es No Partial
LOCATION/SEPAL':'+T ,
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan Yes o
LOCATION OF SYSTEM ON PROPERN
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived:
Depart•�r. II�j 2
,,/2---/1(- Adr .Z.
:ui1dirig Iias;a" onr
r
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name S-jAQRJYylpfikR,e5ThriNito ;
Locati one 71 62C(Vii -rre_Q___
Date l9- J3--- I7Permit # 9'7r0(c6
SOIL TY -Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYST' ;
ABSORPTION F aLD: otal Length F
Length of eac'. ench 6
Depth of t '-s 7'..3
Size of stone t ES) J,
SEEPAGE PITS: N ber-
Size - f . x ft.
Stone size
PIPING: Size Type
Bldg. to Tank 1-Vs '-1A 113t_ibm-k L ��
Tank to_Dist. Box Ariyi �
Dist. Box to Field/Pit 41,4
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank ii\ feet
Foundation to Absorption c 4.,feet
Separation of Pits — feet
Conforms as per Plot Plan -' N.o
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front S' Right Side
Middle ont - Middle , ear
COMMENTS:
. a�5�
SYSTEM USE APPROVED: Y NO
Arrive q
Depa
e
u ding spector
`/(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY//�� NY 12804 px
INSPECTOR'S REPORT: ARR//IaS DEPART ` /�INT Ci
REQUEST FOR INSPECTION� ✓ RECEIVED:NAMEeij�R.f'v °/1,0r44.)
LOCATIONt°(J
DATE 616143.7 PERMIT A av
TYPE OF STRUCTURE:
RECHECK _ APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FOY _
REINFORCEMENT IN .' ,,CE
THE CONTRACTOR. IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON ITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING _
PLUMBING UNDER SLAB _
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER 4�
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- •
4411 (518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804 '4;;'^ ' ,
INSPECTOR'S REPORT: AR;7.-X bEPARI I6 V INTv
REQUEST FOR/INN PEC)TIONNRECE VED:
,C �/ r
NAME
LOCATION...47/ . ;c - re C
DATE j PERMIT # 9 �J OLS
TYPE OF STRUCTURE: ,5
RECHECK _ APPROVED
N/A YES NO
1OOTINGS/PIERS
1ONOLITHIC PO- FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE 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
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING _
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
HE ING ROUGH-IN
INSULATION-: V//T
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R- _
FLOORS R- /
WALLS R- jN� /,
CEILING R- b V
DUCT WORK OR PIPING IN
UNHEATED SPACES R- •
.�R0P /- V`G41 ✓ •
// (>6T1- -- (518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT +'
742 BAY RD., QUEENSBURY NY 12804 "''.• rl,*y
INSPECTOR'S REPORT: ARRD DEPAI3, v, I]NT 43`--
REQUEST FO ECTJJION RE��CEIVED: tll t7 I T1
NAME (
LOCATION 1 17/ ifr'Ma---0-{-e -{ ,-
DATE • f/`D/ 4 PERMIT fl /,
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IE1-YLALE
THE CONTRACTOR IS RESP SIBLE FOR
PROVIDING PROTE TION F M FREEZING
FOR 48 HOURS FOLLOWING THE 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 •
_
08UGH PLUMBING _
PLUMBING UNDER SLAB
ING: nt, v.. I 92-421k..R5, - -
J CK S DS/HEADERS �4
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 •
-
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT e'
742 BAY RD., QUEENSBURY NY 12804 %"" r,
INSPECTOR'S REPORT: ARRO:/ ' DEPARg Gl�OINTJ
REQUEST FO INSPECTION'k-RECEIVED:
NAME sf-lle R✓)
LOCATION 4- / C/ Z1( .: L
DATE /Ob. PERMIT
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS 1
MONOLITHIC POUR FORM
REINFORCEMENT IN PL CE
THE CONTRACTOR IS ESPONSIBLE FOR
PROVIDING PROTE TIpN FROM FREEZING
FOR 48 HOURS FOLLOFING THE PLACE-
MENT OF THE CONCRETE..
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOU DATION/DAMPPROOFING
B KFILL APPROVAL
UMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
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-
1 (518) 761-8256
TOWN OF QUEENSBURY
BUILDING G. CODE ENFORCEMENT r: f
742 BAY RD., QUEENSBURY NY 12804
JD
INSPECTOR'S REPORT: ARR DEPART/ //vINTr'/M"G
REQUEST FOR INSPECTION/ RECEIVE : 7_c1 7
NAME 75 4J19
LOCATIO y
DATE 3 -/ 7-017 MIT ff77- a(P�
TYPE OF STRUCTURE:
RECHECK APPROVED/
N/A YES/ NO
FOOTINGS/PIERS COCCtiO\ '
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE )- *61 _
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
k'OUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS_
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
J!EATING 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- •
10( 0,21/LAC:1 -
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR 5C ("DEPART OINT
REQUEST FOR INSPECTION RECEIVED: 3/ 1 / i% 7
NAME (id J6-`/�)fk�) Z -1-
LOCATION 0--074 7/ /+�/Y�a�
DATE f eG,c'G 2� MIT I F ' V6/.s'
TYPE O STRUCTURE:
RECHECK APPROVED
N/A YES , NO
FOOTINGS PIERS
MONOLITHIC POUR FORM -
REINFORCEMENT IN/PLACE
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
ACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING _
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING _
JOIST HANGERS
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FOUNDATION WALLS EXTERIOR R-
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TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
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INSPECTOR'S REPORT: ARR DEPAR'12; / N'Nh -Ej
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REQUEST FO INSPECTION RECE VED:
NAME am LOCATION 111 / voln`
DATE �h PERMIT A 9 . (c
TYPE OF STRUCTURE: S `n
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FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
k'OUNDATION/WALLPOUR
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FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
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PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING -
JOIST HANGERS
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AIR INFILTRATION BARRIER _
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NAP REFERENCE:
SHERMAN PINES SUBDIVISION
BY WORSE ENGINEERING P.C.
FILED IN THE WARREN COUNTY
CLERK'S OFFICE ON JANUARY 29, 1993
IN PLAT CABINET A SLIDE 197
COMMON AREA
I HEREBY CERTIFY THAT THIS MAP WAS PREPARED
FROM AN ACTUAL FIELD SURVEY.
THIS CERTIFICATION SHALL RUN ONLY TO THE PERSONS
FOR WHOM THE SURVEY WAS PREPARED, AND ON THEIR
BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY
AND LENDING INSTITUTION LISTED HEREON.
CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL
INSTITUTIONS OR SUBSEQUENT OWNERS.
CERTIFIED TO: DAVID E. LEWIS
FLEET MORTGAGE CORPORATION,
IT'S SUCCESSORS AND\OR ASSIGNS
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY
CERTIFIED BY:
MATTHEW C. STEWS, LLS NYS 50135
DATED: JUNE 18, 1997
uti
'UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY
MAP BEARING A LICENSED LAND SURVEYORS SEAL IS A
VIOLATION OF SECTION 7200, SUB -DIVISION $ OF THE
NEW YORK STATE EDUCATION LAW.'
'ONLY OOPIES FROM THE ORIGINAL OF INS SURVEY
MARKED VATH AN ORIGINAL OF 7HE LAND SURVEYORS
SEAL SHALL BE CONSIDERED TO BE VAJD TRUE COPIES.'
'CERT* A7WM VdWA7ED HEREON SIGNIFY THAT
THIS SURVEY WAS PREPARED IN ACCORDANCE MATH THE
M71 NO CODE OF PRACTICE FOR LAND SURVEYORS ADOPTED
BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL
LAND SURVEYORS. SAD CERTIFICATIONS SHALL RUN ONLY
TO 7HE PERSON FOR WWM 7HE SURVEY IS PREPARED, AND
ON HIS BEHALF TO THE TITLE COMPANY. GOVERNMENTAL
AGENCY AND LENDING IN"TU171ON LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTITUTION.'