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1991-204 t CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date IOU l 19 q 1 l/ This is to certify that work requested to be done as shown by Permit No. Q 1-2fl4 has been completed. This structure may be occupied as a _ si nal a family modular home Location Upper Sherman Avenue Owner Robert & Wendy Schill By Order Town Board TOWN OF QUEENSBURY f Director of Bldg. & Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No. 91-204 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to ROBERT & WENDY SCHILL w OWNER of property located at Upper Sherman Av Street,Road or Ave. i' in the Town of Queensbury,To Construct or place a Single family Modular Home o> 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 to RD#4 Northwinds Trailer Park Queensbury NY 12804 I- 2. CONTRACTOR or BUILDER'S Name O0 0- Lamplighter Homes 3. CONTRACTOR or BUILDER'S Address CD RD#2 Saratoga Rd Fort Edward NY 12828 4. ARCHITECT'S Name 5. ARCHITECT'S Address a0 -5 (-D 6. TYPE of Construction—(Please indicate by X) N CD -5 ( )Wood Frame ( ) Masonry ( )Steel ( ) 7. PLANS and Specifications n No. 26'x52' Modular Home as per plot plan, specifications and application including septic system. 8. Proposed Use Single family modular home eL $ 168.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 19 19 92 (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.) 0 rD Dated at the Town of Queensbury this 19th Day of April 19 91 SIGNED BY i for the Town of Queensbury Building and Zoning({spector TOWN OF QUEENSBURY A , - T- REVIEWED BY ' . - " / , :.. �1 F OUEENE$ I - - FEE PAID $ l RECEIVED URY PERMIT NO. '/— 61/ APR 16199 BUILDING PERMIT APPLICATION 1 BLDG. CODE DEpT A PERMIT MUST BE OBTAINED BEFORE 'BEGINNING CONSTRUCTION. NO INSPECTIONS WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT. All applicants spaces on this application.MUST be completed and the signature of the applicant MUST appear on the reverse side. of this application. . • • • • • S. • • •' • • • • • • • •- '• • '• • • • • • • • • • • • • •• • •- • • • * • • The owner of this property is: El,J . �5 . //((�� -fit, � P.O. Address �T �`��%�-t�-N� . ,//Z�z e/0, Tel.(VI- W. y/y Property Location 14 I G4 7449.1 ,41-7 Ai Tax Map No. '2� // c. .6/ Has there been anysplit of thisproperty'since October 1 198 � / If yes Planning Board Review is necessary. - yes no SUBDIVISION NAME, IF APPLICABLE LOT NO. THE PERSON RESPONSIBLE FOR SUPERVISI F WORK AS REGARDS TO BUILDING CODES ISi • NATUR ;OF PROPOSED WOR • ESrIMATED MARKET VALUE OF Construction of a new building • CONSTRUCTION: S �/ ljv . Addition to a buildin_• • COMPLETE INFORMATION REQUIRED BELOW: • Size of property - P _P Y_ -��`Il --- -- ff x ft. Alteration to a buil ing __ - ---_, - * _Existing Buildings(3) Size ft. x ft. - (no-change to exterior dimensions) • •,-- - Proposed building distance from pro po - property line: . Other work (Descri ) * Front yard lc" ft. Rear yard /-9 9 ft. • Side yards`,,Lg0 ft. and Z ft. • GROSS AREA OF PROPOSED STRUCTURE • If on corner, setback from side street ft. 1st Floor /3,coe sq. ft. ' • / OCCUPANCY INFORMATION 2nd Floor .. '. sq. ft. . •. Primar Building • Other Floors • One Family Dwelling sq. ft. (not cellar or basement • Two Family Dwelling TOTAL FLOOR AREA � 5d sq. ft. • Multiple Dwelling/Number of units Size of new structure 4, ft x_,_ft. • Business Foundation-pier/slab/crawl/partial * Industrial (circle one) • Other No. of stories (habitable space) ' / • • Height (grade to ridge) /y` ft.- • If addition, what will use be? If residential, no. of families / : . - • No. of rooms(excluding baths) 6 • Accessory Building No. of bedrooms _Detached Garage ONE/TWO Car 'No. of bathrooms. off. ;� • =.� Primary heating system � , i- :.4 • , Attached Garage ONE/TWO Car Type of fuel • Private storage building No. of fireplaces to be installed 11 fi • • ___Other Will a wood stove be installed . 4)0 Central Air conditioning ti n : • ' OV• ER' I BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS: Tape of construction,cood frame, ire safe, etc. j^p-j. Will any second-hand or upgraded lumber be used? [f so, for what?ci Al 0 • Foundation wall material (?-rt, .,c ,.cam Thickness g Depth of foundation below grade (to bottom of footing) (p Will there be a cellar?= _ _ Heated or unheated? _"} :_ Floor sq. footage sq ft. Will there be a basement? Will any portion be used as living space? (If so, what portion? sq ft. Type of use? Type of roof - ope /flat/shed/other Material of roof ,___,4,14,/..A0 Size, wood studs 62 "x " spacing/6 " o.c. length g ft. Joists (floor beams) 1st floor 2 "x / " spacing / , "o.c. span/3 ft. Joist (floor beams) 2nd floor "x " spacing "o.c. span ft. Overlays (ceiling beams) A "x (o_" spacing JG, " o.c. span /3 ft. Roof rafters "x spacing o.c. span ft. Roof trusses (pre-engineered) spacing /to " o.c. span /3 ft. Exterior wall finish 4;e---ii -mot of what material? �q,,�.,Q Interior wall finish -- 4..' (/ 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? If so will a Fire-rated door, enclosure, -self-closing-device_be_provided? Will a flue-lined chimney be installed? )tp Height above eoof -_----- - - _- -- _ __ft._ _ ___ Depth of chimney foundation below grade ft. Depth of fireplace hearth ft. in, Water supply Ounicipalpor private well SEPTIC SYSTEM Distance from ANY private well (including adjoining properties itiA . ft. (A separate application is necessary for any repair or new installation of septic system) NAME OF BUILDER A ' ADDRESS �J' 119- ,.EL. NO. S/F- 3- 3 NAME OF PLUMBER f` �` ADDRESS �� ry �` TEL. NO. . NAME OF MASON /r f` " �� << _ADDRESS TEL. NO. (� re rc it C t. .c. NAME OF ELECTRICIAN ADDRESS TEL. NO.. �� 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 ORDINANCE, and all other laws pertaining to the proposed work shall be complied with, whether specified or not, and that such work is authorized by the owner. Signature - ' /4-71' Owner, o er's agent archit t,.contractor SPECIAL CONDITIONS OF THE PERMIT: . BY . TOWN OF QUEENSBURY y)��, d (ZiWARREN . COUNTY , NEW YORKh/t�� Application for : BUILDING PERMIT IN COMPLIANCE W TH THE NEW YORKQ% STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work. ANSWER ALL of the following: C�p/�f 1rL/ j?�fa /�1. Gross floor area J6-o` v/ TowN OF QUEENSBURN'' �— RECEIVED 2 . Type of heat 69.4.2 , 3 . Is the building mechanically cooled? ' APR 1 61991 4 . Percentage of area of windows and doors BLDG. & CODE DE T 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 xalue f roof and floors exposed to ambient conditions 2 . Rvalue of exterior walls / r /9 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 8. R value of heated basement/cellar walls (above grade) 9. R value of heated basement/cellar walls (below grade) 10 . Type of insulation C. Controls 1. Thermostat maximum heat setting . l v D. Duct Systems 1 . Is duct system installed in unheated spaces? YES NO a. If YES , R value of duct installation b. R value of duct in other areas E . Piping Insulation' h._ 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. /j�' � ---`� 'e —/ A (apr• , ica)11 t '.s./Jsignatur�. V �i m. o otcemidevi TOWN OF QUEENSBUKY APPLICATION FOR SEPTIC DISPOSAL PERMIT RECEIVED APR 161991 DATE / BLDG. CODEDEPT. LOCATION OF PROPERTY FOR INSTALLATION G,% 14Wf. k G ' 1Q r/ Owner's Name: etriviz-A,� Telephone: Sit-7c / -V/V7 Address: ./7 Installer's Name: Telephone: „/f t '7. 9,), Number of bedrooms (residential only) c Total daily flow (compute @ 150 gal per bedroom) 7(1� Topography: circle one Flat Rolling Steep Slope % of slope Soil Nature: circle one: Said Loam Clay Other / Depth: _ feet Ground Water: At what depth? /U/ feet Bedrock or Impervious Material: At what depth? _AO feet Percolation test: circle one not required required / rate min. inch. Domestic water supply: circle oneunicipal Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption feet PROPOSED SYSTEM: Septic Tank /Q-rd gal. (minimum size: 1,000 gal.) TILE FIELD: Each Trench 4e,) feet / Total system length 2 0(') _ feet SEEPAGE PIT(S): Number of / Size each feet by feet Size of stone to be used # / Depth or Thickness feet * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * IMPORTANT ...Please...LIST NEW EQUIPMENT TO BE INSTALLED * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * (over) Section II Septic System Inspections: 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 plot plan showing: 1.) 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, tile fields and/or drywells B. No system shall be covered before inspection and approval by the building Inspector. Failure to comply with this requirement may result in the uncovering of the system by the installer and a fine of up to $250.00. C. 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 installation, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. I have read the regulations above and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Signature of responsible person: g4,---/ Date: 9 / /7/ Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD,PLACE TO LIVE YOU ARE HEREBY REQUESTED TO INSPECT AND ISSUE CERTIFICATES FOR THE FOLLOWING ELECTRICAL EQUIPMENT TO BE INSTALLED BY THE UNDERSIGNED / , :/ TEMP.it DATE ��/ j (-./i ,); ) /-. `!//f/(. / J / / /' CITY OR VILLAGE a TOWNSHIP COUNTY STREET AND NO:OR ROAD JJ POLE NUMBER V (�.?J-�' �/;) 1:%:�Z.i ter_.-yt� t�.2�c_F,1,,-r..`_ _e BETVy!EEFI W/IAT TWO CROSS-STREETS IS PREMISES LOCATED? SECTION BLOCK LOT r./II?i. - -a.-,name_✓ OCcL'I,PAryt'S NAME y , X BUILDING OCCUPANCY �+ AL?' I ' r( ` t 7 G:-a..--.1y- �.1 d.' ....;J fi 4--H,i(iC� /�?G---AL- -/ A�tj.!!t-L,I'.t"�'_ * /J A i� t-�/� -_ �J HOME TELEPHONE NUMD — IiWNER'S NAME AND ADDRESS ,j J ' - ir. /� V / r.. jf/f/ `//,;. ,P`ii {T AA: i' 2/72,4_,,,' C --1/--✓ , C/y / //Y / CUR\RENT SUPPLIED BY c• } 5 FROM THEIR ��; .�OFFICE WORK TELEPHONE NUMBER - !r .. I J /fin , '1 j �.-.7 .. /.'/ -- 1/ (,�' 2Z/ /Y`. f i,i ,Fri mil./ F'I i -- .eA/i f/� .-- -V"—' l.�1 U�^� J BUILDING IS EE��J r'I u - - -- NEC OLD❑ WORK IS NEW Q--'lam ' ADDITIONAL❑ DEFECTS REMOVED❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED Loca- NUMBER OF OUTLETS Lamp Reo.of lceptacles xtures& MOTORS HEATERS CIRCUITSBRANCH OFFICE ONLY USE tion Side Attach't H.P. Watts AW.G. Ceiling Wall Recep'Is Switch Pendant Bracket No. Type Each No. Each No. Gauge INSPECTION OUT- SIDE SUB- BASE / BASE- fj :h f•'--' MENT , . 1st ! ?�!_��" FL. i I i I I : e 2nd \f d i..,' i'. i . IY I `i,' - FL. g I { ` 'I . 1 3rd ? ' I FL. ' i REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE. THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED,BUT IF AT TIME OF INSPECTION,THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER THE ADDITIONAL EQUIPMENT,AS PROVIDED BY THE APPLICANT. SIZE OF MAINS FEEDERS ELECTRIC SIGNS/LAMPS TOTAL WATTS CHARACTER OF WORK ❑ EXPOSED GAS TUBE SIGN/TRANSFORMERS OF VA ❑ CONCEALED DATE WORK TO BE STARTED DATE COMPLETED SIZE OF SIGN(NUMBER) CAPACITY SERVICE ENTERS BUILDING MANUFACTURER OF SIGN ❑ OVERHEAD ❑ UNDERGROUND DATE INSPECTION REQUESTED ON(OR AS NEAR AS POSSIBLE) MUST DENT F CAT ENTER NUMBERS I I I i AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. PRINT NAME AND ADDRESS / f NAME OF APPLICANT / % I DATE OF PPLICATION SIGNATURE OF AP,LICANT ;� -f'!'1`--;1__;.---.: h.— .// �f+. ,/,�-t.L�-''y,/f ✓7 r.t t.^'i�;,._ `i / (2/s / X -L A/ ', t LA`-,f - STF�SET ADDRESS./i / / p 1 ,/^ / TEIrEPHONE Nb• �c� CITY OR POST,OFFICE" ZIP CODE „ LICENSE NO.WHEN APPLICABLE 0 85 John Street 0 41 Stat Street El570 Delaware Avenue o 217 Lake Avenue 0 202 Arterial Road NEW YORK,NY 10038 ALBANY,NY 12207 BUFFALO,NY 14202 ROCHESTER,NY 14608 SYRACUSE,NY 13206 (212)227-3700 (518)463-2122 (716)884-1155 . (716)254-0141, (315)463-8552 TI—IF NJPVJ V()RK R(IARfl (,F FIRF I INDER/VRITERS • F a-S-e.4 9,kJ.f-In"!•!-I-n l..a,!.S.i:)_"1-- .a9-1. --19,,19,),•!•a7( n-In•In !.-l.i.a.9!.a-91,-1-9t("ia-.tia i.a-.4,A94 .9!- i--1-94-ai.An" M.4-" ,r_-'9,;M-";""-"•,k.' ., J-st;a:v It THE NEW YORK BOARD. OF FIRE UNDERWRITERS SAGE 3. r ': a.l.°'E. BUREAU OF ELECTRICITY" n 41 STATE STREET,ALBANY,NEW YORK 12207 ' o4, if Date UNE 114 1.091 Application No. 7-1091 91 A 053972 CI( 7� 77 THIS CERTIFIES THAT PERMIT NC. . . _ } o 14 only the electrical equipment as described below and introduced by applicant named on the above application number in the premises of p iO3r2i & tit DY 5 CtCLL . !J Tn R SHERMAN AVENUE, Q1PLt .?tCRV, N. �. No in the following location; ❑ Basement ❑ 1st Fl. ❑ 2nd Fl. Section- Block Lot N Fwas examined onJUNE and found to be in compliance with the requirements of this Board. FIXTURE ECEPTACLESI SWITCHES FIXTURES RANGES COOKING DECKS" OVENS DISH WASHERS EXHAUST FANS e OUTLETS INCANDESCENT-FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT: K.W. AMT. H.P. 1 . DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS . SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. " AMT. AMP- MAT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS E SERVICE DISCONNECT NO.OF - . S " " E' R 'V I C E . AMT. AMP. - TYPE METER 1 .02W 1 0 3W 3 0 3W�3 J 4W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A•W G• NO.OF NEUTRALS A.W.G. EQUIP• PER B OF CC.COND.. OF HIdEG OF NEUTRAL :T L 3 � OTHER APPARATUS: ELEC. WATER r.EATER . .1 -4 .r, K-. i, 11 ',13 . . N i • DOR�I`1'jl`i' MURRAY • � - _ UuTeo 1, 1F; BRANCH MANAGER FORT EDUARD i•,4' 12828 " . 239 • Per _ This certificate must not be altered in any manner;,return to the office of the Board if incorrect. Inspectors may be identified by their credentials. N ® ® ® ® 0 D O O M ® ® ® 0 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. : ---.\-- ; -0)k) m_i_,,, TOWN OF QUEE4SBURY d 531 ` , j 'QUEENSBURY,BAY NEWRYAD YORK 12804 .- TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT FINAL INSPECTION C ' REQUEST FOR_ �INSPECTION RECEIVED NAME S C�' ,�'\ ` ► 1 1 1 ? b - LOCATION I AY DATE Coil 7,0/ . PERMIT/ 9 / 0 Li TYPE OF STRUCTURE Na , RECHECK FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE) 2FOOTING FOUNDATION VIACKFILL FRAMING _ROUGH PLUMBING FINAL ELECTRICAL ASEPTIC INSULATION WOONSTOVE/FIREPLACE SITE PLAN/VARIANCE REQUUIREMENTS , YES NO — REMARKS G Aet_.-c, N/APPYESALNO CHIMNEY HEIGHT/LOCATION Ii B VENT/LOCATION it PLUMBING VENT I ✓/ ROOFING f�as ►� SIDING / if DECK/PORCH/STEPS/RAILINGS / ii RELIEF VALVES 7 // FURNACE/HOT WATER OPERAT -NG i BASEMENT INSULATION/DUCTWORK f INTERIOR TRIM/PRIVACY DOORS 1 . / FINISH FLOORS: BATH/KITCHEN WATERTIGHT I :• OTHER FLOORS SWEEPABLE } OTHER FLOORS CARPETED i 1/ STAIR CLEARANCE/RAILINGS_ HANDICAPPED ACCESS t SMOKE DETECTORS/ u�% BATHROOM FANS/WHOLEHOUSE FANS ✓ALL PLUMBING.F,IXTURES OPERATING GARAGE FIRE PROOFING i DOOR CLOSERS i OTHER FIRE SEPARATION FIRE/DEMISE WALLS DUMPSTER ; • ./ FINAL ELECTRICAL Y OK TO ISSUE C/O OR C/C Li COMMENTS: -72,,,r,y,,,,f6r.,.., ,6, .-7,5- . ARRIVE - �U DEPART S �/= / i NSPECTOR • _Jouin o/ Queenibury BUILDING and ZONING DEPARTMENT •, 1��/ Bay and Haviland Road, R.D. 1 Box 98 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME P=; %-�!'-;, /r%P,/.'Cf/�:2(1 ;Ar'ZA LOCATION 4 DATE J/A// / 1/ PERMIT NO. �� - SOIL TYPE -fS d;- Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch _ TYPE of SYSTEM: Absorption field, total length Length of each trench <-,) Depth of trenches • 1 - Size of gravel .f` SEEPAGE PITS{Nuinber of) Size- ft. X ft. Gravel size PIPING: Size Type„ Bldg. to tank -11.1wC''' Tank to dist. box Dist. box to field/wit, Openings sealed? /YE$ NO Partial LOCATION/SEPARATIONS: Foundation to tank /p ft. Foundation to absorption j-7 ft. • Absorption to lot line ft. Separation of pits ft. LOCATION OF SYSTEM ON.:PROPERTY(circle one) (Front- Rear - Left side - Right side - TOWN OF QUELINED�IFIY COMMENTS: RECEIVED ,• fi MAY 28 , ✓�e �t/ / Y i991 BLDG. & CODE DEPT, SYSTEM USE APPROVED ; Y,ES1 ,NO oji41) Bu ^1)ding Inspector 01/86 and vl v. 1 'd7:7 J C x. ,$7•/.1 6 f1a\..r. X • o Sccc ut%vv2S JT�„j iI l' ->, o. .< >. c..., • • F.... II <.z.zt. ' ' cz r.,, .....".. - . sF . ,J 111111 bit I am b Ie jrh e2 onzea Sp.cializing in Modular Hom.t and Manufuctur.d Housing Route 9 RD2 Fort Edward , NY 12828 (518)793-7392 May 23, 1991 Town of Queensbury Building and Zoning Department Bay and Haviland Road RD1 Box 98 Queensbury, NY 12801 Re: Schill - Upper Sherman Avenue, Queensbury, NY Septic Disposal. System Inspection of 5/21/91 Dear Inspector: Enclosed, per your request, please find the new plot plan regarding above matter. If you have any questions, please do not hesitate to contact me. Sincerely, •,��� U Wt-,v Dorothy Murr y TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY, NEW 0 TELEPHONE (518) 792-5834 2 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED S7 li NAME OC� / LOCATION k ).c) DATE 5 g ( PERMIT # / O L/ TYPE OF STR CTURE RECHECK APPROVED N/A YES NO FOOTINGS/PIERS • MONOLITHIC POUR FORM REINFORCEMENT IN PLACE ' THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTECTIONFROM FREEZING FOR 48 HOURS FOLLOWING . ' THE PLACEMENT OF THE CONCRETE. MATERIALS FOR THIS PURPOSE, ON SITE FOUNDATION/WALL POUR • REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING ' BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/VENTS IN PLACE PLUMBING UNDER SLAB FRAMING: JACK STUDS/HEADERS BRACING/BRIDGING JOIST HANGERS JACK POSTS/MAIN BEAM HEATING ROUGH-IN r' INSULATION: FOUNDATION WALLS -INTERIOR R- FOUNDATION WALLS' EXTERIOR R • - FLOORS R- WALLS R- CEILING R- DUCT WORK OR. PIPING IN UNHEATED SPACES REMARKS: ARRIVE DEPART A ` 1447 INSPEC R 9:_5 —&,=,—.:-2 c,1.,(fi / c—e-Of/t4e- TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 792-5832 BUILDING INSPECTOR°S REPORT REQUEST FOR INSPECTION RECEIVED / NAME /}C�t -a V 2'i P�f (L V d' /2.',(7J LOCATION`I44oG�. �h7P�S/1i9a DATE a PERMIT ! 9/- el TYPE OF STRUC URE n /i/,--f / RECHECK APPROVED N/A YES . NO X FOOTINGS/PIERS 1 MONOLITHIC POUR FORM REINFORCEMENT IN PLACE w THE CONTRACTOR IS RESPONSIBLE s" FOR PROVIDING PROTECTION FROM +' FREEZING FOR 48 HOURS FOLLOWING ,^' THE PLACEMENT OF THE CONCRETE MATERIALS FOR THIS PURPOSE ON;SITE ., FOUNDATION/WALL POUR 1 REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING BACKFILL APPROVAL ROUGH PLUMBING f PLUMBING VENT/VENTS IN PLACE PLUMBING UNDER SLAB 4 FRAMING: r j JACK STUDS/HEADERS i, BRACING/BRIDGING . JOIST HANGERS j, JACK POSTS/MAIN BEAM i , FIRESTOPPING j' WALLS CEILING .7 a FIREWALLS HEATING ROUGH-IN ,, INSULATION: 4 FOUNDATION WALLS INTERIOR R-I FOUNDATION WALLS EXTERIOR R- FLOORS R- I WALLS R- ', CEILING R- DUCT WORK OR PIPING IN UNHEATED SPACES REMARKS: j' P . li , ARRIVE DEPART 1 1-iii INSPECT