1989-026 54zA .
I
1 �
+CERTIFICAT'E" OF CJ► +CT..JT'AN+CY
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YQRK
A3 r r7 19 C I
Date 19 17 19 89
5f This is to certify that work requested to be done as shown by Permit No. 2; , -- ? is
I
has been cotntrleted.
This structure may be occupied ams
.I
Location i' r�:34rou�" ]
k
kOwner � Y'��. C:lie"3 e� 1. '�F:...h ::3i � LuLi
k By Order Town Board
70W N OF QQUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 89 - 26
WARREN COUNTY, NEW YORK �
PERMISSION is hereby granted to Mj c.hae1 Vasi 1 1 o, C
OWNER of property located at T.04- 3 Q !Pyn, rgugc:)C :,d Street, Road or Ave. F
F
in the Town of Queensbury, To Construct or place a Si �_l R a rF l 1—�w+�l l i n� ci
at the above location in accordance to application together with plot plans and other information hereto filed and ti
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1 . OWNER'S Address is
32 Willow Road
Queensbury , N . Y . 12804
2, CONTRACTOR or BUILDER'S Name �
U
F
Same 1--
C
c
3. CONTRACTOR or BUILDER'S Address ti
Same
i-
{
4. ARCHITECT'S Name
S. ARCHITECT'S Address
t
C
6. TYPE of Construction — (Please indicate 6y X) r
c..
e5
fix) Wood Frame { ) Masonry f 1 Steel i 1
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7. PLANS and Specifications
L?
U
No. 2450 sq . ft . Single family dwelling as per plot plan , c`
Specifications , and application . Including septic , t:wo car c
B. Proposed Use garage , anct cirmveway
Single Family Dwelling
U.
25 . 00 c/o C
$ 325 On PERMIT FEE PAID -- THIS HERMIT EXPIRES September 1 yg 89
(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 � _,6 +—h Day,�i of 79 t G�y' �l1'. ly--�'e�a�'laalr'�: -
SIGNED BY � �! for the Town of Queensbury 2C
Building and Zoning Inspector
I-1
FOWN OF QUEENSBURY APPLICATTON FOR Ruri..nTHG AND ZONTNC PERMITWuhENSB
RECEIVED RY
1``GC.teuecl 2 � '� `�
yi1' ^�t �'L'V.L Z M?
e,�,va - FE B 2 1989
Fee Fa.id $
RUILDINC AND CURES DI VART11t.ENT D"e. 14bued � & OMDF�r , .
aAY and IIAYJ.LANL) ROADS RU 1 Box 93
PUEENSOURY. NEW YORK 12804 Pe.+tmzt Nov 'r Z�
Tat . (518) 792-S832 Ext -204 .�
4
!F ar • # • 7t * w' I r Yr # • # r w f Y1 # # # # r r w r # # w # w w r
A PERMIT MUST Lq OBTAINED UEFORE LEGINMINC CONSTRUCTION . NO INSPIi
WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDINC PERMIT .
All applicable spaces on this applicationMust be completed and the
sipuatune of the applicant must appear * on the reverse sick of this sheet .
* W * * .A * * A * A x * * :k k X * % * * �*/' A * x * * k * * * * * 3% * * * !Ik
The owner of this pr•o I Qperty is : 1IC.Lj�/rGL• V'/� Sf4_4? OLJ t 11 . 0 . Address ! 90 -,r� d-1 / c L- yam/ 42'Siw�',._ `PET. . 22a �r�Z3 r
Property location V?E/.lw.9 T+r/dl✓�SLcJtPax3 "PAX MAP NO . / �/
teas there been any split of this property since October 1 , 19887 /. X .-
If yes , Planning Board neview is necessary , yes 60
SUBDIVISION NAMEr IF APPLTCAnLE LOT NO .
'rho person respons ' ble for supervision of work as regards Building Codes is :
/4Lia0
NAMLi Pao , ADDRESS TEL . NOo
l4tanla of builder 6w Atcldr is
W ► c.. L..Cx� Tel %7P%. - �7 !? f1 ?
Hama of Pi%unber 1cdares5 Wit. Tel ,74Z
Name of Mason AddrCss Tel 2 Z�
fiATURL OF PROPOSGD 601'VK : ZONING I NFORIY LkTION ( UFf i ca use onI y )
C4nstruccian of a new building ; ZONING DESIGNATION OF PROPERTY
Additaan to a building " PERMITTED PRINCIPAL PERMITTED ACCESSORY
—hlta:r:aGaOn to :.► building •
� ( '%o chk inqu: to oxcur-ioc clitnenuions) or REVIEW REQUIRED - PLANNING BOARD ZONING BOARD
Uthur wcxrt; ( TS Acl^1(]a! 1 ' SITE PLAN REVIEW # APPROVED BATE
LktOSS ARVA OF lrROPOSCD � '1'ScUC 'L'UttE 'r VARIANCE # APPROVED DATE
Iiernarks
3st Floor ,/y .$^� sq ft . * '
? nd Floor ` sq f C . * COuiPJ.ii'1'L _ xpll601QIA 'SON kk:slUlicL•:p lsLi.U�+ .
Other Floors sq ft . ' SiVoQ of prai,a: rty tit xA fe .
"
( not cellar 1:]f�i�tirkrl LU 1lakij1c) ( � ] si::ay l: L' x x c .
or bcazement '1 ;
TOTAL FLOOR AREA f t . r
Lxi::tir�g nA.i1 tan.T (:: 1 U::a
" i �a! of new ::Gruccura ft 7L f jr
down
!'+a.�,dation Pier/ :laY,/cr:awl/p. rciia ru11 " I'ropo"a buildinr) , di:asanca iraw property line
(circles anc 1
.
.
Of .,torie.n Front yard s ft Rear yard fLQ ft
, (Ik:Abit�tila. ., sacel • - �-'----
kt.,ighL ( UradQ to ridqu) a2 " "ft, r Side yardu et and � :5z -2-P. __-f c
If rQuiduntial , no. of famii las z
„ If an cornara UtW O.)"ok trom uidu atrLo c ..- ro
tio0 of raOkn:a ( ►:xaludino] =s ] ' OCCUPANCY 'INFORMATION
Flow of budroous
� Y LsUILD1NG2
No . of b;stfkroo�il:: _ —...i ones ILI
i'ausily dwelling
k'riru:ary 1kUat44u1 ::y•' %A(6 # TWO rawil dwullin
'rypQ of Eual * Multi ales: aylwcllint g
Now of fireplac44 to !aa inst:allcu �► i J / Humber of units
., lyeruwncut aecup:u►cy
Wail w weaea.J +G4Va: Yac irl::taiia:d . r •rr"nuluckt: c>ccuY�arrcy
cuntr:al Air carLaticionirig: uusinuss
BUILDING STYLE, PRIjeARY :TRUCT k2E d Industrial
U;AALc1k Cont.s+uil orury L.Gn caizin Ocher
a;;aix;ud ra"C11 M:an:3 Duia1 . x w It "ddicion. What will uuA? bu?
:Jlalic 14v*21 Old UCY1 : ULAAILlalow
`. ' Catt;aya Oc#wr " ACCESSORY UUILOING-
ani:al 14aw - - Arowo tiouSB # "tachad y:arirgo/ona car/ two
I: .'.
our/ car
CIRCLe ON PLLAE y Atcuchud V"raqu/ooa: Ctar/ LWO C"Cl C4 k'
w w r r r # • * .• w # • # # = r �, I�raViata: 5t[]tia[3a: building
L- .STIMATk•: D MA RKE_'1' V AI_u v OF " �Ocha r
INF'DTtMATT4N ON nUTLDYNC SPRCIFTCA` TONS. ON TLEVERSE SIOR OF Tt:rs nlleE• P, 9O BE COMALE'IC03
Farm DPA 10/88 v1
wonedow
AVM.
BUILDING PERMIT APPL.ICATIO14 CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction wood frame �. ire safe, etc .
Will any second-hand��umber be used? If so, for what? l r .
II r
Foundation wall material_ � S' ryj x ,� 4/ __ Thickness
ey
Depth of foundat ' low grade ( to bot .om of footing )
Will there be cellar* Heated or unheated'? /-/T� Floor sq. footage ' _.�_sq ft
Will there be basemen Will any portion be used as living space?
( If so , what po -- sq. ft . - - Type o£ use?
Type of roof - slope lat/shed/other Material of roof /tiC,e&a& 4 r $a C
Size , wood studs "]i l = to spacing "o . c . length �—ft .
Joists ( floor beams) 1st . floor _„ __'• n spacing _""o . c . span ft .
Joists ( floor beams) 2nd . floor _"x_ /d _-" spacing./.L. o . c • span ft .
Overlays (ceiling beams ) "x spacing "o . c . span ft .
Roof rafters "X spacing o . co span f t.
Roof trusses (pre-engineered) spacing ^"o . c . span �ft .
Exterior wall finish what material?
Interior wall finish
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? illy If so will a Fire-rated
door , enclosure , and self-closing device be provided? ft .
Will a flue- lined chimney be installed? Height above roof i- -._
Depth of chimney foundation below graderE7ft .
Depth of fireplace hearth ft .ALin .
Wager supply - unici- a or private well
SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties �r�`ft •
(A separate application is necessary for any repair or new installation of septic system)
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, THE ZONING ORDINANCEt 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.
r.
Signature /ee:�V/ Ida oss
Own , wner's agent, chit ct, con ractor
jr
IF * w w w w * w w * w w w a, * * w w tt r ,t w w
SPECIAL CONDITIONS OF THE PERMIT :
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work .
ANSWER ALL of the following :
1 . Gross floor area
�F r
2 . Type of heat -,v� - -
J
3 . Is the building mechanically cooled ? cal
4 . Percentage of area of windows and doors
A . Over 16 $ Only
1 . Uo value of gross area of walls , roof/ ceiling and floors
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a . Are foundation walls insulated ? YES NO
1 . If YES , what is the R value ?
3 . Slab on grade YES NO
a . If YES , what is the R value of insulation around
perimeter of floor ?
4 . Is basement heated ? YES NO
a . R value of insulation
5 . Type of insulation
B . Under 16 % Only
1 . R value of roof and floors exposed to ambient conditions
P` j!- 7
2 . R value of exterior walls
3 . R value of glazed area
4 . R value of doors
5 . R value of floors over unheated spaces
6 . R value of slab edge insulation - unheated slab
7 . R value of slab insulation - heated slab ,ram
8 . R value of heated basement/ cellar walls ( above grade )
9 . R value of heated basement/ cellar walls ( below grade ) �Yl
10 . Type of insulation
Co Controls
1 . Thermostat maximum heat setting 4
D . Duct Systems
1 . Is duct system installed in unheated spaces ? YES
a . If YES , R value of duct installation
b . R value of duct in other areas
E . Piping Insulation
1 . Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulation
F . Service Water Heating
1 . Performance efficiency
2 . Temperature control setting maximum
G . For Swimming Pool Only
1 . Maximum heating
Telephone No .
applicant ' signs ure )
TOWN OF Q UEENS B UR Y
APPLICAInON FOR FILE COPY
SEPTIC DISPOSAL PLrRI4+IlT
DATE
LOCATION OF PROPERTY FOR INSST�ALLATION zzic� � s w�
Owner's Name* STelephone:_ '�`�► fir, — % J�
Address: 3
Installer's Name: Telephone: M79 27 a 24
400
Number of bedrooms (residential only)
7
Total daily flow (compute (d 1- 50 gal per bedroom)
Topography: Circle one• 5 >olling Steep Slope % of Slope
Soil Nature: Circle o Sand Loam Clay Other /Depth: Feet
Ground Water: At what depth ? 4�<(::> Feet
Bedrock or Impervious Material: At what depth? � {�7 Feet
Percolation test: Circle on nrequire c quired rate min. inch.
Domestic water supply:4Ccircle on Municipal Well Other
I€ domestic water supp well:
Separation: Water supply from septic absorption feet
PROPOSER SYSTEM: Septic Tank 16>00 gal. (minimum size: 1 , 000 gal.)
TILE FIELD : Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of / Size each Meet by _feet
Size of stone to be used # /Depth or Thickness feet
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 D `sposfl Ordinance,
SIGNATURE OF RESPONSIBLE PERSON: s
DATE :
OVER
YqV 3111
septic System lnsL�ections :
A . All applications for septic system installation , alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage Ordinance , shall
be submitted to the Building Department at least: 24 hours before start
of construction and shall include a plat plan showing :
le ) the proposed location of the system
2 . ) location and distance to lot lines
3 . ) location and distance to structures
4 . ) location and distance to any water supply
5 . ) size and dimensions of all tanks , distribution boxes ,
the fields and. / or drywells
BO Nu system shall be covered before inspection and approval by the
liuildi.ng Inspector . Failure to comply with this requirement may
ritault in the uncovering; of the system by the installer and a fine
of up to $ 250 . 00 .
co An approved copy of the plot plan shall be available on the construction
site . Failure to produce said plot plan at time of inspection may
result in an immediate work stoppage . '
D . Should unforeseen problems during construction prevent proper lnstalla-
tian , alteration or repair of an approved system , a new proposal must
be submitted to the Queensbury Building Department before further
con!:: tructioa .
Town of Queensbury
BU 1 LDI NG and CODE'S DEPARTMENT
bay and Haviland Roads
Queensbury , New York 12804
Re�riarks : ..,
t ,
CERTIFICATE OF INSURANCEISSUE DATE (MMIDOJYY)
PRODUCER 8- 23-88
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
Wise Insurance Brokers , Inc . NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
517 Glen St. , P. O. Box 2329 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Glens Falls , N. Y . 12801 COMPANIES AFFORDING COVERAGE
COMPANY
CODE SUS-CODE LETTER Insurance Companyof North America
COMPANY
INSURED LETTER B General Accident Insurance Co.
Fava Plumbing SI Heating , Inc. COMPANY TTER C
R. D.#.l , 8 Butternut Hill Drive
Glens Falls , N. Y . 12801 COMPANY
LETTER D
_._ .... LETTER COMPANY E
. " -_. --. III
GOVERACaES _. - . ...._.- I
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 'INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I CO TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION
:LTR POLICY NUMBER DATE (MMJDDJYYI DATE (MMJODJYY) ALL LIMITS IN THOUSANDS
GENERAL LIABILITY
GENERAL AGGREGATE $ 1 , 000r
', X COMMERCIAL GENERAL LIABILITY MFC D17170661 5� I L-88 5- 11-89 PRODUCTS-COMPJOPS AGGREGATE $ 1 * 000 r
CLAIMS MADE X OCCUR. PERSONAL & ADVERTISING INJURY $ 1 * 000*
OWNER'S & CONTRACTOR'S PROT, EACH OCCURRENCE $ 10000
FIRE DAMAGE (Any one fire) $. 50: 1
MEDICAL EXPENSE {Any one person) $ 5.
AUTOMOBILE LIABILITY COMBINED f
ANY AUTO SINGLE $ I
LIMIT
' ALL OWNED AUTOS BODILY I
SCHEDULED AUTOS INJURY $
(Pot personl
HIRED AUTOS BODILY
NON-OWNED AUTOS INJURY $
(Per accident)
GARAGE LIABILITY
PROPERTY $
DAMAGE
EXCESS LIABILITY EACH AGGREGATE
OCCURRENCE
OTHER THAN UMBRELLA FORM
f WORKER`S COMPENSATION STATUTORY
B AND WC 0065829-01 1- 19-88 1- 19-89 $ 100 , O'OOr TEACH ACCtOEN7)
EMPLOYERS' LIABILITY $ 500 , 'OO'O . (DISEASE—POLICY LIMIT)
$ 1001p 000 . (DISEASE—EACH EMPLOYEE
OTHER
f
DESCRIPTION OF OPERATIONS!LOCATIONSJVEHICLESJRESTRICTIONSJSPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
Mike Vasiliau SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
32 Willow Road EXPIRAT�JONi DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
] DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Glens Falls , N. Y. 1,2801 MAIL
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTFIORI EP E TAT E
ACORD 25-S {3189] QACORD CORPORATION T gas {
I
THE STATE INSURANCE FUND
199 CHURCH STREET NEVV YORK, N.Y, 10007
( 2123 312 - 7249
CERTIFICATE OF WORKERS* COMPENSATION INSURANCE
UNITED STAFFING INC
720A 6TH AVENUE POLICY NUMBER
TROY NY 12182 837 561 - 0
DATE
1 /20/89
CERTIFICATE NUMBER
577-666
PERFQ0: CQVERED: :BY:..TH1S CEFiT#fiICA7 �
psi rs:, €ra T : srJaeas
7TROY
ER
CERTIFICATE HOLDER
STAFFING INC TOWN OF QUEENSSURY
TH AVENUE ATTN DAVE HATTEN
NY 12182 BAY AT HAVILAND
QUEENS NY 12804
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE
INSURANCE FUND UNDER POLICY NO , 837 56I --0 UNTIL 8/ I8/89 , COVERING THE ENTIRE
OBLIGATION OF THIS POLICYHOLDER, FOR WORKERS ' COMPENSATION UNDER THE NEW YORK WORK-
ERS ' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK ,
EXCEPT AS INDICATED BELOW ,
IF SAID POLICY IS CANCELLED , OR CHANGED PRIOR TO 8/ 18/89 IN SUCH MANNER AS
TO AFFECT THIS CERTIFICATE , 5 DAYS WRITTEN NOTICE OF SUCH CANCELLATION
WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE , NOTICE BY REGULAR BAIL SO
ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION .
THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION ,
THE STATE INSURANCE FUND
;4 . pd2�0404
423 [?IRECTOR, INSURANCE FUND UNDERWRITING
TOWN
QUEENS BURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILA ROADS
I2817&
gUEENSBURY, NEW 792-5832
TELEPHONE
BUILDING INSPECTOR' S REPORT
REQUEST FO INS/P, CTION ECEIVED _�.___-------
NAME f
LOCATION _ !✓ /_
PE12Od"fI'T 0_�.�s�—
DATE APPROVED
YES NO
FOOTINGIPIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP—PROOFINGBACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN
XWSULATXON,
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL pORCHVgSTEPS
STAIRS.CLEARANCI? & RAILS -----""
PLUMBING FXXTU10ESIRELIEP' VALVE
INTERIOR TRIM�R.IVACY DOORS
FINISHED FLOCS
GARAGE FIREPJ000FING !/
DOOR CLOSERS) G
SMOKE DETECkORS__"_��----�— y
FINAL ELECTR-YCAL INSPECTION�_���— L
FINAL APPROVAL OF CONSTRUCTION_�_�--
A SIGNED CERTIFICATE OF OCCUPANCY MUST DE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS : r �/
f ,
INSPECTOR
RY
TOWN OF QU' 'FANSIS DE
AND COE DEPARTMENT
B�JI D�TNG DADS
SAS' & ROADS ADS 128011- .......
5
QUEENSBURY. EW YORK
8 ? g2- 5832
TELEPHONE f gFpORT
EUTWING ISSPECi'OR' S
REQUEST FOR 11,
XNSPECTION
NAME
LOCA'CIC?N PERMIT
DATE r � APPROVED
YES N
FOOTING/PIERS
FORMS
MONOLITHIC POUR PROOFING —'
FOUNDATION/DAMP
SAC
KFILL .APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION :
FOUNDATION
FLOORS
WALLS
,',�^CCEILING TXON=
XNAL ILNSPEC
CHIMNEY HEXGHT�
ROOFING
SIDING pORGHE /STEPS '
EXTERNAL & RAILS --
STAIRS-CLEARAN ESIRELIEF' .;VALVE
PLUMBING FIX PRIVACY DOORS
INTERIOR TRI IRSFINISHED F I a ROOFING
GARAGE FIRE
DOOR CLOSER S)
SMOKE DETE 'CAL'' INSPECTION
FINAL ELECTR
} L or CONSTRUCTION
FINAL APPRaV
OF OCCUPANCY SST BE
A SIGNED
CERTIFICATE TNG DEPARTMENT BEFORE
OBTAINED FROM THE BOCCPIED!
THESE PREMISES ARE
REMARKS : ��'
INSPECTOR
TOWN OF C�LIEENSBiTRY
BUrrLDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QjUEENSBURY. NEW YORK I28ok
TELEPHONE ( 518 ) 792- 5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION
NAME
LOCATION
_--PERMIT # ~`
DATE `T_y�_,�-- APPROVED
YES I NO
FOOTINGfPIERS
ORMS
MONOLITHIC POUR.
FdUNDATId PRdOFING -�-
APPROVI�.L
BACKFILL i
ROUGH PLUMBING
FRAMING
EL TRICAL ROUGH"'rN
x
NSULATIdN:
FOUNDATION
FLOORS Y
WALLS
CEILING TION:
FINAL INSPEC `-
CHIMNEY HEIGHT
ROOFING
SIDING T IS
EXTERNAL PORCHES / �1LS�----
STAIRS-CLEARANCE F & VALVE
PLUMBING FIXTUR S/RED` TLrs
INTERIOR TRIMIP IVACY \DOpRS��__— -
FINISHED FLOOR FIND
GARAGE FIREPR -
DOOR CLOSER (5 SMOKE DETECT S INSPECTIC?�uT
FINAL ELECTRICOF COTVSTRUC ION
FINAL APPROVAL
A SIGNED CER IFICATE OF OCCUPANCY MUST BE
O THE BUILDING DEPARTMENT BEFORE
OBTAINED FR
THESE PREMX 5 ARE 0CCUPIED :
REMARKS =
3
is
T
i
INSPECTOR
n o �� eer� 36cere� ���G'
,-,-�
HU1l.OINhIG and ZC}T11Pf(3 O1:PARTBox 9$
Bay and Havifand Road. R.O
CQueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
uOCAT I ON
DATE / " PERMIT
SOIL 'TYPE - Sand. - Ljoa n - Clay - 140
Percolation Test Required? YES
Percolation rate - 141n/Inch
TYPE of SYSTEM: total length
Absorption f ieldr
Length of each tre ch
Depth of trenches
Size of yxaveI
Sir t',
Size- ft' X p
Gravel. ze si TYT)e
P I'P ING : y 7 �-�-
Bldg . to bank `
Tank to disc . box .0I
Dist . box to field/ ` No artial
Openings
sealed? ES
T,�ATION/SEPARATIONS = , ,{� ft.
to tank
Foundation ion Y ft '
Foundation to absorP �t.
AbsOrPtian to lot li e is
Separation of pits PROPERTY ircle one]
LION C)F SYSTEM _ Right side -
Rear - Left side
CCt4MENTS :iIt d
: r
NO
SYSTEM USE APPROVED YES
Bui1'aing Inspector
fll/$ 6 ma vl
TO'y,11,,j OF QUEENSBURY
BUILDING AND CODES DEPARTMENT yy�
SAY & NAVILAND ROADS �• ' 1
QVEENSBURYr NEW YORK 12809—
TELEPHONE {53.8 ) 792-5S.32 O RT
WILDING INSPECTOR' S
REQUEST FOR INSP CTION RECEIVED'
NAME
LOCATION
DATE IIIII %� — 7� —PERM T #
APPROVED
YES NO
FOOTXNGJPXERS FORMS
MONOLITHIC POUR FrNG
FOUNDATIO ROO
BACKFILL APPROVA
ROUGH PLUMBING .
FRAMING
ELECTRICAL N
C,,,e?NSVLATrON:
FOUNDATION
,FLOORS
WALLS
CEILING
FINAL INSPECT-TON :
CHIMNEY HEIGHT
ROOFXNG
SIDING
EXTEFLNAL pORCHESJSR' S
I
STAIRS CLEARANCE LXE VALVE�� --"
PLUMBING FIXTURES/ RS
XNTZRIOR TRIMJPRI ACy
FINISHED FLOORS
GARAGE FXREPROO ING
DOOR CLOSER {,
)
,'SMOKE DETECTONsPECTXON
FINAL ELECTRrCA CONSTRUCTIONS
FrNAL APPROVAL
A SIGNED CERTlr ICATE OF OCCUPANCY MUST BE
OBTAINED FROM HE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED !'
REMARKS -0
C(,V( 4�ri /
IN EC TOR
TOWN OF QUEENSBUR`�
BUILDING AND CODES DEFA1gTMENT fV+.
BAY & HAVILAND ROADS ,1280& i
QUEENSBURYr NEW YORK
TELEPHONE (5I8 ) 792-5832
BL3IL13IMG INSPEmp It S REPORT
REQUEST FOR INSPECTION RECEIVED_�t--�-�
NAME
LOCATION IT
DATE ` "� -� -P APPROVED
YES NO
FOOTING/PIERS FORMS /
Non OLITHIC POUR ,
� L'ROOFIIVG
FOUNDATION/D P
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FLOORS `
WALLS
CEILING TION :
FINAL I'NSPEC
CHIMNEY
ROOFING
SIDING STEP -�
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ARANCE & .R4
STAIRS-CLE bktIEF VALVE
-
PLUMBING T RESIR DOORS `>--
INTERIOR RIM
FINISHED F-=(?.)ORS G
GARAGE FIREPROOF I
DOOR CLOSER (S)
SMOKE DETECTL7RS
FINAL ELECTRICAL NSPECTION"
FIL O CONSTRUCTI
NAL APPROVA ON
A SIGNED C,ERTI ICATE PARTMENT BEFORE
OF OCCUPANCI' DUST BE
FROM THE BUILDING DE
OBTAINED ARE OCCUPIED •
THESE PREMIS
REMARKS
INSPECTOR
TOWN OF QUEE'NSBURY
BUILDING AND CODES DEPARTMENT
BAY & FIAVILAND ROADS 2& []SE-
QUEENSBU'RY. NEW
ORK 792-5 I 28
TELEPHONE � 5I8 )
832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION �j
DATE ,-yTs—^—PERMS !' 4 '
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS r
t/FOUNDATION/DAMP—pROOFING
40. BACKFII L, APP.jtOVAL ^—
ROUGH PLUMBI
FRAMING
ELECTRICAL ROUGH"IN
INSULATION :
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION: `
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCUSSf ST $_STAIRS—CLEARANCE Is& RAILS
PLUMBING FIXTURE RELIEF VALVE
INTERIOR TRIM/P VACY IK -rv�
FINISHED FLOOR
GARAGE FIREPR96FING
DOOR CLOSER (
SMOKE DETEC IRS
ELECTR AL INSPECTION
FINAL APPRt7V1E1L OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS :
•4
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j r
# INSPECTOR