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97-627 • • • CERTIFICATE' .OF, OCCUPANCY TOWN.OF QUEENSBURY - • • • - • • WARREN COUNTY, NEW YORK, , July 12 99 Date lq , - This is to certify that work requested to be done as shown by Permit No. 97627 • has been completed. 1120 SQ FT RESIDENTIAL ADDITION • This structurres�may �. occupied as a . `• •• 1 / 7 ,STATE ROUTE 149 •, . Location J HACK; RHONDA Owner TAX MAP NO:. 27 . -3--5 By Order Town Board : TOWN OF QUEENSBURY• • Director of Bldg: & Code Enforcement • BUILDING PERMIT TOWN OF QUEENSBURY VALUE $ 0 No 97627;:,� TAX HAP NO. 27.-3-5 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to HACK. RHONDA OWNER of property located at 1327 .,ST-ATE ROUTE 149 Street,Road or Ave. in the Town of Queensbury,TO Construct or place a ii 1Z0. p MT at the above location in accordance to application together withS plotF�an n otn 'ift tat �rt � d and approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 1. OWNER'S Address is :. 11327 STATE.-.ROUTE. 149 t' FORT, ANN` .. NY . .12827 2. CONTRACTOR or BUILDERS Name ,'MAGK'' -.a=RHONDA 3. CONTRACTOR or BUILDERS Address • 4. ARCHITECTS Name 5. ARCHITECTS Address 6. TYPE of Construction—(Please indicate by X) ( )Wood Frame ( ) Masonry `(='')'ste s(I�3.EN'TIAL. ADDITION;.;.:.. 7. PLANS and Specifications 'f. • RESIDglITIAL ADDTION..AS." PER. PLOTP;P.LAN;.EP:E .I 'ICATIONB 8. Proposed Use . . FTe:RESIDENTIAL ADDITION , $ n ='+-88` ` 'A PERMlT FEE-+PAID —THIS<PERMIT; EXPIRES �x_r >.,a��-NQV@1•be s ie a�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 Oueensbury before the expiration date.) Dated at the Town of Queensbury thusti • SIGNED BY �_ _ k)`Q :r1) for the Town of Queensbury Building and Zoning Inspector, . Building Permit Application Town of Queensbury - Dept. of Community Development, 742 Bay Road, Queensbury, NY 12804 1761-82561 �OBUILDING & . CODE ENFORCEMENT NOTICERequirements prior to issuance • A permit must be obtained before of this permit: PERMIT FILE NO. 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 ' ?:9_____.applicants' spaces on this application MUST be completed attd•the signature n Planning Board Action REVIEWED BY: i . i of the applicant must appear on the SPR / Subdivision /Other :inkling Inspector application form. 7hm,k you. Recreation Fee Payment II,Iy����, � � � „� Applicant: t �[ �� Owner: i t n 1r t-6C - ' A 1 • Address: 2►, 1 >X 1 L ? Address: I_Vt / &XJ_cd c.. 4-t? Phone # ci - ( )� to� q �A�nn � Phone # (SI t�)1�-�y � �� �'7": ��r�' Property Location: VL ILVi c64ANN Subdivision Name: Tax Map Number � / Section Block I of NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE New Building: CONSTRUCTION: $ • residence / commercial Addi ' o Belding: residence commercial OCCUPANCY INFORMATION: Altera ' uilding: Primary Building - residence / commercial X Single Family ing Residence / Commercial Two Family Dw no change to exterior size • Family Dwe • iig • Office Other Work (describe below) Mercantile OCT 22 7997 Manufacturi, . Other iuvvN 01 8Bi../QUEel RY GROSS AREA OF PROPOSED STRUCTURE: • BAG AND CODE _�__-_ _ 1st F _oor__. . If ADDITION, what will use 1� . J__ it)_ sq,. f_t.- -al . •t ew adiit� Lion• ire •e r — 2nd .Floor. . . . . . . . 560 sq. ft. vv, Other Floors sq. ft. U...i I s��` (not unfinished cellar or basement) ACCESSORY BUILDINGS: Detached Garage 1, 2 car TOTAL FLOOR AREA: 016 SQ. FT. Attached Garage 1, 2 car r • Private Storage Building SIZE OF NEW STRUCTURE: Commercial Storage Building Other le(3 FEET X mr FEET • Foundation Type: PCt.IILL-) (1CMCd_61Zr Will any second-hand or ungraded Number of Stories : 2- lumber be used? If so, for what? (habitable space only) /JO Height (grade to ridge) : feet TYPE OF HEATING SYSTEM: Number of fireplaces d/or woodstove (circle all which . . .lies) to be installed: E ctx is �Oil / / Wood Forc —Hot Air / Baseboard / Other Person responsibkp for rssu R �supervision of work as regards to building codes is : j•� Name Addresss Phone Builder: 5Aarbt VVloat/4 r $41 sr 6'F , w, /z-�0l . )bi Plumber: • Mason: Electrician: 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 I/we shall submit prior to a Certificate of Occupancy'or Certificate of Compliance being issued, an AS BUILT PLOT PLAN by a licensed surveyor; drawn to scale,l showing actual location of project on premises. Signature: ' ?ih& fj9 . hkiQ) (owner, owner's agent, architect, contractor) i f ER .R ENERGY CODE COMPLIANCE APPLICATION TOWN OF QUEENSBURY, WARREN COUNTY OCT 2 3 1997 9000 HEATING DEGREE DAYS � �B�i311VG 6�tJ�7 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: gkoINIck Hoo- T2- (-19 Gyi- - n n PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE: 1 . Gross Floor Area - 1 (O square feet 2 . Type of Heat - Electric Oil X Gas Other 3 . Is building mechanically cooled? Yes )( No 4 . Percentage of area of windows and doors Over 17% i/ Under 17% 5 . R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS SHOWN ON PLANS SUBMITTED: a. Roof R b. Exterior walls R /? c . Glazed areas R d. Exterior doors R e. Floors over unheated spaces R 26 f. Edge of slab on grade (heated building) R g. Basement/cellar walls (above grade) R /) h. Basement/cellar walls (below grade) R I / i. Heating/cooling-ducts-piping in unheated space R 46- 6 . Service (domestic) hot water heating device / Conforms to minimum efficiency per code V Yes No TEMPERATURE CONTROL MAXIMUM SETTING 140° - WILL NOT BE EXCEEDED Appl%��c4r's Si nature Da/t�� Phone Number INSPECTOR' S REMARKS : �I Application for SEPTIC DISPOSAL PERMIT Town of Queensbury a") Permit No. Dept. of Community Development Building &Codes Office 742 Bay Road . Fee Paid $ Qie nsbury, NY 12804 . J Location of property for installation: V-.01.3\---cL cl cnik- te1 Property Owner's Name: 'S 2 1ccCJ`--/ -- 4''-'"')C- Property Owner's Mailing Address: .D4/ 7c.\3? og3' Installer's Name: ; &i\S Phone # 713 _oZ-7 3 Number of bedrooms (if residential):. 3 Total daily flow: (residential -compute @ 150 gal./bdrm.) Topography: ' flat; • rolling, steep slope. % of slope Soil Nature: •X sand, loam, clay, other /depth: • Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet Percolation test: not required, required .[rate min. per inch] Domestic water supply: municipal, X,‘, well, other If domestic water supply is a WELL, water supply from any septic absorption is feet. PROPOSED SYSTEM Septic tank: , I gallon (minimum size: 1,000 gal.) Tile field: each trench ;50 feet / Total system length: 9` O feet Seepage pit(s): number of / size each: ft. by� ft. • Size of stone to be used: # / depth or thickness feet HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each: gallons Alarm system and associated electrical work to be inspected by a certified agency. For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbary, 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 S'nitary Sewage Disposal Ordinance. //� Signature of responsible person: VP-0Ni°- . lb—C _. - Date: iole/ ' "1 have sees or observed.or believe 1 se,evid nce of, R‘A ; '� f��1� ail object such as houses,,i fewest tress,fe , 3 Z2- shown on this dot I also represent that I hove �• E C C 1 E__ 1\--\C\ personally measured disteeces set forth on the rm." � `A 1 -HgzT TURE DATE PLOT PLAN SEPTIC SYSTEM Notice: The following statement must be "stamped" on your plot plan. This sheet of paper may be used for purposes of drawing your plot plan. After drawing such plot plan, please read the statement and sign it. If you choose to use other paper for your plot plan, the office will stamp those plans for your signature. 165/ 'LOD L LEARCIk Ft 4 E tiA tze-+— ac cfi c2)06_ct__ 11_0 BLDG. PERMIT NO. 9 7-6 2 7 APPLICATION FOR A TEMPORARY CERTIFICATE OF OCCUPANCY A TEMPORARY CERTIFICATE OF OCCUPANCY is hereby requested for the property located at; 1327 Rte 149 for the following uses: Residential Addition (Rhonda Hack) March 12, 1999 v('_iiArk kIYX DATE SIGNATURE OF APPLICANT TEMPORARY CERTIFICATE OF OCCUPANCY The TEMPORARY CERTIFICATE OF OCCUPANCY is hereby (4)1(PPROVED ___ _ _ _- ( )DISAPPROVED with the following conditions:eCertificate of Occupancy to be issued upon completion of: 1) Install Siding. 2) Complete Bedrooms & Doors. 3 ) Install Foundation Insulation. TEMPORARY CERTIFICATE OF OCCUPANCY F 10.00 DEP SJT• ( )$100.00 received on March 12, 1999 Yf Date of Issuance Director of Bldg. & Code Enforcement THIS TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES 90 DAYS FROM THE DATE OF ISSUANCE. NOTE: This Certificate is NOT VALID unless signed by the Director of Bldg. & Code Enforcement or his designee. • RESIDENTIAL FINAL INSPECTION REPORT Office No.(518)761-8256 Date inspection request received: Building& Code Enforcement Dept. of Community Development Arrive D pm Depa "ji3OTown of Queensbury Inspector's Initial 742 Bay Road Queensbury,New York 12804 / NAME ck\c\glnC1� PERMIT# 91-[� 7 LOCATION \ a..� 1� ,t _� DATE _1 . - TYPE OF STRUCTURE • N/A YES NO COMMENTS Chimney Height/"B"Vent/Direct Vent Location I Fresh Air Intake V/ Plumb Vent through roof ' /I • Roof Complete V Exterior Finish Complete �J` Interior/Exterior Railings 30"to 36" V Exterior Handrails,balconies,1. ding 18 in. or more :(l Interior Handrails stairs both .ide- 3 or more risers ‘/, Grade 2%away from foun•. 'on ,// 8"clearance to sill plate N Gas Valve shut-off • •-•sec- regulator 18"above grade �/� Gas Furnace shut-off , ' .t 30 feet .r within line of site / Oil Furnace shut-off at -nu': ce to t. ace area Furnace/Hot Water Heat• ••. . ; t J Relief Valve(s)installed . J Headroom,6 ft. 6 in. on s .• s Basement stairs,6 ft. 4 i . Handrail exterior stairs ..th sides more than 3 risers ylInterior privacy/trim/doo s/main entrance 36" Floor Finish J Bathroom/Kitchen wat-, .ght i Interior Handrails Balco ies/Landing 18 in. or more i I Railing across window in'stairwells Smoke Detectors: every level ` every bedroom outside every bedroom inter connected Bathroom fans Plumbing fixtures Ji Foundation insulation rt e, _ ` 3/4 hour fire door/door closer Ny Garage fireproofmg V Garage penetrations sealed Furnace in separate room protected(in garage) Light ventilation per room V/ Safety glazing 18"or less from floor •�// Final Electrical / Site Plan/Variance required �/,/ Final Survey Plot Plan J •/ As Built Septic System layout required Okay to issue C/C(Certif. of Compliance) Okay to issue temp. C/O(Certif. of Occupancy) Okay to issue permanent C/O(Certif. of Occupancy) vith1/4 . li3 .u) N.6,, RESIDENTIAL FINAL INSPECTION REPORT —rNl) O Office No. (518)761-8256 Date inspection request received: Building& Code Enforcement ���,,�� Dept. of Community Development Arrive,gym Depart Town of Queensbury Inspector's Initial 742 Bay Road Queensbury,New York 12804 NAME R HN3DA I-t A PERMIT# 9T' 7rS7 LOCATION 1. 7 f F 4 DATE '3 - I o--I`I TYPE OF STRUCTURE VS S,, A 00 N/A. YES NO COMMENTS Chimney Height/"B"Vent/Direct Vent Location I// Fresh Air Intake V/ Plumb Vent through roof V. Roof te Complete/ f ,,,,EtQ C� Exterior Finish Complete � V Interior/Exterior Railings 30"to 36" Exterior Handrails,balconies,landing 18 in. or more Interior Handrails stairs both sides 3 or mo risers 1 Grade 2%away from foundation ,p \ / 8"clearance to sill plate C� V/ Gas Valve shut-off exposed/regulator 18"above ade V Gas Furnace shut-off within 30 feet or wit_`rin line f site Oil Furnace shut-off at en* ce to furnace area Furnace/Hot Water Heater o s• ating I J Relief Valve(s)installed ;I Headroom,6 ft. 6 in. on stair• ', V/ Basement stairs,6 ft.4 in. J/ Handrail exterior stairs both side • ore till.• risers Interior privacy/trini/doors/main entrance 36" V/ �Et•AV 'co B V —6 007 Floor Finish / Y CaP���� Bathroom/Kitchen watertight I V Interior Handrails Balconies/Landing/l 8 in. or more Railing across window in stairwells if •./ Smoke Detectors: every level / every bedroom V f outside every bedroom V/ inter connected N/` Bathroom fans V/ Plumbing fixtures N./ Foundation insulation .1 TI✓MP C-3 3/4 hour fire door/door closer V/i Garage fireproofing V/ Garage penetrations sealed V/ L (� Furnace in separate room protected(in garage) �( / Gc1JD�TI�1�� OF T ` CO Light ventilation per room �/ Safety glazing 18"or less from floor V Final Electrical / 0 `�i���_ 6 i Dl�/ �/ Site Plan/Variance required �/ O ���PLCT� BED door-i6�c, Final Survey Plot Plan ✓ / �� �, As Built Septic System layout required \/ Okay to issue C/C(Certif. of Compliance) /mac® 1 Tp,t___L_ F.)„10 B-,-` ()I Okay to issue temp. C/O(Certif. of Occupancy) CIO nab, (w/ ) ���� Okay to issue permanent C/O(Certif. of Occupancy) •r" GENERAL INSPECTION REPORT ` C).-- , = 2 Town of Queensbury ' G, •,.....i(i) Dept. of Community Development Date inspection request received: Building& Code Enforcement i 742 Bay Road / Queensbury,NY 12804 Arrive ". a Depart WO.- Inspector's Initials NAME:\, \\PI ��I r )� ? 1 PERMIT# III rLOCATION: p ) c` A. , Imo!--C)_ DATE : - -` -C- TYPE OF STRUCTURE: 4 = c-- . A)..) t RECHECK ts,2:,-.4 c.ravr:,'-x -7.4,,Wm- -vititoit,It N/A YES NO COMMENTS -X Footings/Piers I Monolithic Pour Form Reinforcement in Place The contractor is responsible for providing protection Tr. freez. g for 48 hours following the -men of the concrete. Materials for this purpose . site Foundation/Wallpour Reinforcement in Place Foundation/Dampproofing Backfill Approval Plumbing Under Slab Plumbing Vent/Vents in Place Rough Plumbing \eH ting Rough-In ` lation N - Foundation Walls Interior R- Foundation Walls Exterior R- Floors R- Walls R- E ci V Ceiling R- <50 1/ 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 4-7 OSJ"), 130 GENERAL INSPECTION RE Town of Queensburyvirgtio_ Dept.of Community Development Date inspection request received: Building& Code Enforcement 742 Bay Road Quee,i sbury,NY 12804 Arrive \ Oarr p� Depart Z` - , fpm Inspector's Initials NAME:R C PERMIT# 49 LOCATION: �j7 <5 C- DATE : ( 1� TYPE OF STRUCTURE: -(-,e.S 1 Q� Jcs 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 placemer t of the concrete. - Materials for this purpose on site Foundation/Wallpour I Reinforcement in Place Foundation/Dampproofing 1 ` Bacic ill Approval i 1 r _ Plumbing Under Slab ,/ -Plumbing Vent/Vents in Place / �(1 Rough Plumbing_ �� J Heating Rough-Ir: ulation / V Foundation Walls Interior R- Foundation Walls Exterior R- Floors _ LL�� R- \�, ✓f \ 'iT� v.0 5 i \�� � � � smk%; Walls R- c‘_ " '—c\C,F\1--V3.) ‘3e <t 6i�L 10%� Gib Ceiling R r e, C c v et ti Duct work or piping in l r unheated spaces R- Proper Vent, Attic Vent Framing _ Jack Studs/Headers k.k to � �! '�' la O ' Bracing/Bridging Joist Hangers_ Jack Posts/Main Beam Y r c Cp l l p> Air Infiltration Barrier Fire Separation 1, 2, 3, hour Penetration Sealed Fire Wall 2, 3, 4 hour Firestopping T GENERAL INSPECTION REPORT -1 Town of Queensbury Dept. of Community Development Date inspection request received: Building& Code Enforcement 742 Bay Road Queensbury,NY 12804 Arrive_10.1ciapm Depart ±, Inspector's Initials NAME: RIADOD v! PERMIT# — LOCATION: 9 DATE : TYPE OF STRUCTURE: P\QD a 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 lacement of the concrete. Materials for this purpose o site Foundation/Wallpour Reinforcement in Place Foundation/Dampproofing Back ill Approval Plumbing Under J lumbing Vent/Vents in Place Vaough Plumbing — 1J AZ Heating Rough-Ir:+ "C‘Q` O - ' Lxt� .__ V Insulation Foundation Walls Interior R- 'FOP Foundation Walls Exterior R- Floors R- Walls R- Ceiling R- Duct work or piping in unheated spaces R- Jroper Vent, Attic Vent V/' Framing Jack Studs/Headers \// �F_.a) TO CAD b c n C37F\ Bracing/Bridging V 4 ® �6 9?3,E Joist Hangers_ Jack Jack Posts/Ma in Beam Fri pal Air Infiltration Barrier AOC tic Fire Separation 1, 2, 3, hour ��S`5 Penetration Sealed t-) 1 5 Fire Wall2, 3, 4 hour 1 Firestopping GENERAL INSPECTION REPORT Town of Queensbury Dept. of Community Development Date inspection request received: Building& Code Enforcement 742 Bay Road Queensbury,NY 12804 Arrivc��� •:itt • Depart�' >���• ,� Inspector's Initials ''i -�+' NAME: RE-100DA N RC'^F"1 PERMIT# `Cad LOCATION: DATE : ` — — 1 TYPE OF STRUCTURE: Fib. V D° RECHECK N/A YES NO COMMENTS Footings/Piers Monolithic Pour Form Reinforcement in Place The contractor is responsible for • providing protection from freezin for 48 hours following the placem t of the concrete. Materials for this purpose on site Foundation/Wallpour Reinforcement in Place Foundation/Dampproofing Back ill Approval Plumbing Under Slab f Plumbing Vent/Vents in Place Rough Plumbing_ f Heating Rough-Ire / Insulation / Foundation Walls Interior R- Foundation Walls Exterior R-/ . Floors R- Walls R, Ceiling /R- Duct work or piping ri unheated spaces R- Proper Vent, Attic ent • - �� O t-\OS� L C)t - B 6 'Framing 1>�RLL- V Jack Studs/Headers ,6?T 0 3, ALL Bracing/Eridging Joist gangers_ Jack Posts/Ma in Beam Air Infiltration Barrier Fire Separation 1, 2, 3, hour Penetration Sealed Fire Wall 2, 3, 4 hour Firestopping -)1i1 -`. RESIDENTIAL.FINAL.INSPECTION REPORT y0\A Office No. (518)761-8256 Date inspection request received: Building& Code Enforcement Dept. of Community Development Arrive °Cop aik 1 part c ~ ovco, C Town of Queensbury Inspector's Initial V 742 Bay Road 1 Queensbury, New York 12804 NAME Q°'\-\te-IX\t)(7:A., \4'U,,'___X„..._ PERMIT# DI / — U9)\--1LOCATION (.;, ,'] k- ; - \W' DATE t— TYPE OF STRUCTUR'E Cps-_ 1 _C, 0 N/A YE NO COMMENTS Chimney HeightP'B"Vent/Direct Vent Location Fresh Air Intake Plumb Vent through roof t /--,V F 6 C 1 T'6 Roof Complete 7-0 �� Exterior Finis / T Fh.)©A Interior xttailings 30"to 36 V , Pt1`i\PIG Exterior Handrails,balconies,landing 18 in. or more Interior Handrails stairs both sides 3 or more risers .1 ( 1t�C)1 ! Grade 2%away from foundation / �, 8"clearance to sill plate /5.7' Gas Valve shut-off exposed/regulator 18"above grade / Gas Furnace shut-off .thin 30 feet or .rft' line of site V Oil Furnace shut-off a entrance to . ace . ea Furnace/Hot Water Hea opera ' Relief Valve(s)installed / Headroom,6 ft. 6 in. on stair Basement stairs,6 ft.4 in. • Handrail exterior stairs bo‘ sides more than 3 risers Interior privacy/trim/doo-s/main entrance 36" Floor Finish Bathroom/Kitchen wa .ght Interior Handrails Bal onies/Landing 18 in. or more i/ Railing across windo in stairwells f Smoke Detectors: , 1 t0C 1-Cr-- "t- } �p 5F every level 1 tb-V-Ptii every bedroom outside every be oom inter connected Bathroom fans Plumbing fixtures / / Foundation insulation /// 3/4 hour fire door/door closer Garage fireproofing Garage penetrations sealed Furnace in separate room protected(in garage) it? \/ Light ventilation per room Safety glazing 18"or less from floor / / — t-'r OVV\ � � Final Electrical // f Site Plan/Variance required �� , Final Survey Plot Plan � f As Built Septic System layout required Y Okay to issue C/C(Certif. of Compliance) .� 1 ‘O\--‘ 6\--\eie, Okay to issue temp. C/O(Certif. of Occupancy) C6"0 C--t Okay to issue permanent C/O(Certif. of Occupancy) 1--- " 0 4� TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Y4V\044( Location _ 111-e ) 49 Date ) _JO -f) Permit # 9 7 (o):7 SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total e gth Length of each: trench Depth of trenches Size of stone \ SEEPAGE PITS: Number- \ Size - ft. xN'.„ ft. Stone size - PIPING: Size Type Bldg. to Tank I Tank to Dist.. Box . ! Dist. Box to Field/Pit *Openings Sealed? es No Partial LOCATION/SEPARATI Foundation to Tank feet Foundation to Absorption feet Separation of Pits _ feet G?nforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: WKLI- ._6-c _-Q Et.3 ccuo-v-:VA-00 i3t —QkAL_ L A?V C ` G ?L : SYSTEM USE APPROVED: YES (::;Z:2) Arrived: \O`.:4,4; Depar "I 4° 41 .A111 B Thing Id i or TOWN OF QUEENSBURY 9 30 BUILDING & CODE ENFORCEMENT 742 Bay Road `? Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name a b 0,_ 1-11 ( _ Locati on`� L . (� 1 Date 1 ;)- -VI-7 Permit # 911-69q SOIL TYP • San oam-Clay- Results of Percolation Test- (if applicable) Rate- 'nute/Inch TYPE OF SYSTEM: ABSORPTION FIEL : T. al , ength _�►(7 Length of each t en h Depth of trenches �7 Size of stoneL, SEEPAGE PITS: N b' - Size - _ f , x ft Stone size PIPING: Size Type Bldg. to Ta• L 4% '-) Tank to ' 'st. Box A Dist. Box to Field/Pit y't Openings Sealed? Yes No (PairT is j LOCATION/SEPARATIONS: Foundation to Tank 2.77 feet Foundation to Absorption feet Separation of Pits _ feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Sa. Right Side Middle Front fiddle Rear COMMENTS: 6Q) �� ‘20._ SYSTEM USE APPROVED: YE�N� Arrived• b !: Depar • I : 9 h 6 k.1 , Arab i , Mg pec' l' or ��;5-20 01 (518) 761-8256 TOWN OF QUEENSBURY-.4 ��-- BUILDING & CODE ENFORCEMENT 742 BAY RD., QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARRCV3 DEPART , ) REQUEST FOR INS ECTION RECEIVED: ` _ l NAME l`'� Ski, � /� `p--44 -Ldra2 L CATION [ -57' f. Ski, j'r """L 1 -6/ 1,/ 92.4 —q 7 PERMIT e j r TYPE OF STRUCTURE: ��'a, '.41iL O-i, RECHECK APPROVED N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FO:. REINFORCEMENT IN ' THE CONTRACTOR- L' . .. SIBLE FOR PROVIDING PROTE 'ION FROM FREEZING FOR 48 HOURS FOL •WING THE PLACE- MENT OF THE CONCR TE. 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 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- • 30(518) 761-8256 L/ � r T N OF QUEENSBURY BUIL NG & CODE ENFORCEMENT 742 BAY RD., QUEENSBURY NY 12804 %fr� INSPECTOR'S REPORT: A DEPAR F'7r)r ` ,/ RR REQUEST FOR INSPE ION REC IVED•: ( (!` ' !c - /4- NAME LOCATIONf-fL J �� Xn LTT->' fT DATE 11 - i b A ) PERMIT '1 C1 1-' z-T �I TYPE OF STRUCTURE: 1, ' "` fr,-:--` RECHECK APPROVED N/A YES NO TINGS/PIERS MONOLITHIC POUR FORM ' /' _ REINFORCEMENT IN P7 ' TIIE CONT • CTOR IS ESPO SIBLE FOR PROVIDING OTE TI N FRO FREEZING FOR 48 HOURS OLLO NG T PLACE- MENT OF THE CON MATERIALS FOR THIS P POSE ON SITE FOUNDATION/WALLPOUR -- • REINFORCEMENT IN PLACE 1 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 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 ! i 1 . 1 , , Ifl , , ' 1 , I ' 4 1 IY el -5 e , . . / „ ,, , , , „ , : . , , , . 1 , , , , , , , , . , , , , ,, ,_____r, , , , .: : ,. , , , , , „ , , i , . , . , , C9 ,A--- ....._ , IIi_, _i_ '-..}____ I I ' _ ____I .______' . ill.if\-L)** , 0_( ___hA/.___04__N ih have seen all objects kith � �� 1 ' shown on this dr M t alsoi1MtMNt!hoe, • , personally menu , the d Ili MI the diagram." , did ., 9 ,cam L _ SIGN'TURE TE 1 1 I , ! 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