1991-310 CERTIFICATE OF OCCUPANCY
s TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date &G 77t Z /19 /
This is to certify that work requested, to be done as shown by Permit No. 191-310
has been completed.
This structure may be occupied as a Single Fa119 N l y4Bive1 l 7(E9
Location Lot 16 Herald Drive
Owner Guido Passarelli
By Order Town Board
TOWN OF QUEENSBURY
y Y
Director of Bldg. do Code Enforcement
•
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-310
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Guido Passarel l i
OWNER of property located at Lot f6 Herald Drive Street, Road or Ave. 'o
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
45 Herald Drive
Queensbury, NY
x
2. CONTRACTOR or BUILDER'S Name
O.
(f)
3. CONTRACTOR or BUILDER'S Address
rD
4. ARCHITECT'S NameLea
a+
rD
r-�
5. ARCHITECT'S Address
Cu
N
� y
6. TYPE of Construction— (Please indicate by X)
�a —r
(X)Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. 1,232 sq ft Single Family Dwelling as per plot plan specifications
and application
8. Proposed Use
2
Single Family Dwelling
$ 179.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 15, 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.) —'•
CO
Dated at the Town of Queensbury this 15th Day of M.y 19 91
—h
SIGNED BY COJ.Iw for the Town of Queensbury
Building and Zoning Inspecto6C
r�
(o
TOWN OF QUEENSBURY
REVIEWED Y - TOWN OF QUEENSBUR1f
.. 1�� FEE PAID ,7�1 fECEIVED
PERMIT NO. Q/- /�6
� MAY 15 1991
BUILDING PERMIT APPLICATION
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.
# # a # * a * # * * # # * a * * # # ## a a a */'
#, * * a a a a a a a * * # # # * #
The owner of this property is: l!l 1" '"5 ,,e, i
P.O. Address Yr %0d/L._ ° Tel. 7,,r-,T`/-/
Property Location t 6 4.f' 2:k ` Tax Map No. ____
Has there been any split of this property since October 1, 1988? /
If yes Planning Board Review is necessary. yes no
SUBDIVISION NAME, IF APPLICABLE ,0 /1 1r/ LOT NO.
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
•
NATURE OF PROPOSED WORK: • ESI'IMATED MARKET VALUE OF
/ Construction of a new building , • CONSTRUCTION: $ 9r,' )
Addition to a building * COMPLETE INFORMATION REQUIRED BEM OW:
* Size of property f%/ ft x ���ft.
Alteration to a building * Existing Buildings(3) Size ft. x ft.
(no change to exterior dimensions) •
Proposed building - distance from property line:
Other work (Describe) * Front yard 1 ft. Rear yard /tz) ft.
•
•
Side yards 7 C. ft. and �C) ft.
GROSS AREA OF/fPROPOSED STRUCTURE * If on corner, setback from side street ft.
� 3 7sq. ft. L/4 •
1st FloorOCCUPANCY INFORMATION
2nd Floor sq. ft. _-'-) 7 '`f r_.• ' Prirpary Building -
Other Floors sq. ft. * One Family Dwelling
(net cellar or base: t.. Two Family Dwelling
TOTAL FLOOR AREA/2 7�q. ft. * Multiple Dwelling/Number of units
• Business
Size of new structure ft x W ft.
Foundation-pier/slab/craw1/partinl/full • Industrial
(circle one) • • Other
•
No. of stories (habitable space) •
Height (grade to ridge) 7 2 -- ft. • If addition, what will use be?
If residential, no. of families / •
No. of rooms(excluding baths) 6 • Accessory Building
No. of bedrooms 3 • _Detached Garage ONE/TWO Car
No. of bathrooms ./ •
Primary heating system �/ gA-79 • / Attached Garage ONE TWO Ca�
Type of fuel • __Private storage building
No. of fireplaces to be installed •
• Other
Willa wood stove be installed yt`',r--
Central Air conditioning •
OV•-ER
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe, etc. ad1-----
Will any second-hand or upgraded lumber be used? If so, for what?
Foundation wall material df, a,Cc?Gj- Thickness `f
Depth of foundation below grade (to bottom of footing)
Will there be a cellar? Heated or unheated? Floor sq.e� footage sq ft.
Will there be a basement? ite,( Will any portion be used as living space? r//2
(If so, what portion? // sq ft. Type of use?
Type of roof slped o flat///shed/other Material of roof`J /p/i.,�A( �j}Lrs
Size, wood studs .7/"x C, " spacing /G " o.c. length O ft.
Joists (floor beams) 1st floor 2.- "x /0 " spacing /6 "o.c. span /y ft.
Joist (floor beams) 2nd floor "x " spacing "o.c. span ft.
Overlays (ceiling beams) "x _ " spacing " o.c. span ft.
Roof rafters "x " spacing o.c. span ft.
Roof trusses (pre-engineered) spacing 2/ " o.c. span 30 ft.
Exterior wall finish //%eir/ ` '�j of what material? `
Interior wall finish 5ke7,2z2C/r-/
If a garage is to be ttached, describe materials to be used for FIRE SEPARATION:
Is there to be an opening between garage and dwelling? K If so will a Fire-rated door, enclosure,
self-closing device be provided? L.PJ'
Will a flue-lined chimney be installed? 4f './ Height above roof Z / ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well /%/,77.a
' SEPTIC SYSTEM Distance from ANY private well (including adjoining properties ft.
(A separate application is necessary for any repair or new installation of septic system)
NAME OF BUILDER�14 1/Zedyy<ADDRESS f.r .e a , TEL. NO. 7cf ,r,2-
c-
NAME OF PLUMBER G• Cy�„Gti�---t. _ TEL. NO.
-� ��j,L��i ADDRESS 06-, .797
NAME OF MASONd'� 774 ..,e4 ADDRESS C3' ,d42//,,A TEL. NO. f`Z`" 7J4
NAME OF ELECTRICIA ,�' j?A---ADDRESS 77 _C TEL. NO. 79'7Jf/9/
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, whet er specified or not, and that
such work is authorized by the owner.
Signature
wner, owner's agent, architect, contractor
SPECIAL CONDITIONS OF THE PERMIT:
BY
•
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE DAYS
Compliance Methods:
OWN! OF QUEEN4.BUR).
�EJVED
PART 5 - Acceptable Practice Method - 1 & 2 Family Dwellings (ONLY)
PART 6 - Thermal Rating - Component Trade Offs - 1 & 2 Family Dwellings; MAY 5 1991
Multi-Family Dwellings
(3 Stories or Less) �iLDG. CODE DEPT.
PART 4 - Design By Component Performance - Commercial Buildings - Hi-Rise Residential
PART 4 & 6 - Compliance Methods Require Submission of Worksheets
4/
APPLICANTS NAME PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - 1 Sq. Ft.
2. Type of Heat - Elec. Base Board Other Afil �Zy2
3. Is Building Mechanically Cooled? t/ YES NO
4. Percentage of Area of Windows and Doors Over 17% ✓ Under 17%
THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND TO REQUIRED
THE R-VALUES SHOWN ON PLANS SUBMITTED!
Baseboard
5. Insulation Values: Actual Shown Elec. Heat Other
A. Roof & Floors exposed to ambient temperatures R ?J 0
B. Exterior Walls R
C. Glazed Area R !j,2!''
D. Exterior Doors R /1
E. Floors over unheated spaces R 90
F. Edge of Slab on Grade (Heated Building) R
G. Basement/Cellar Walls (Above Grade) R_12_
H. Basement/Cellar Walls (Below Grade) R
I . Heating/Cooling - Ducts - Piping in Unheated Space R
6. Service (Domestic) Hot Water Heating Device A. Conforms to minimum efficiency per code / YES NO
TEMPERATURE CONTROL MAXIMUM SETTING 140* - WILL NOT BE EXCEEDED
.( ;/Z -f-/f-4/
• APPLICANT'S SIGNATURE DATE TELEPHONE MJMaER
INSPECTOR'S REMARKS :
AV WE Y
�(p�. -"�°�'" MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
(
National Headquarters
�•a 1337 West Chester Pike,West Chester, PA 19380
• ./ ,.
APPLICANT COMPLETES THIS SECTION - Date: ..S,7/(1/P
City, Town or Township G_
GJ'>' � > County//� ?! '`i State / /
Location/Address U/ i !� if'/.!'7_ it. .- ` •
// f Located in/ ural Area - Ple se Attach Directions) Pole #
Owner ! 6/f�� .,/,,/ ,7sTj- 2/&G// % Permit # L// .._%7(0
Occupied As �?3-J� � .-`-2/ ii� Building: New! I Old
Occupant
. • Work Area in Building (Floor #,etc.):
App. for: Wiring n Service n or: Ready for Inspection:
- Fee Remitted-$ Cash n Check n M.O. n Make Payable To: M.D.I.A.
500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Number of Rough Wiring Outlets Elect. Heat
Switches •
Lighting Amp. Service Surface Unit Dishwasher Range
Water Heater Air Conditioner Dryer Pump
Receptacles
Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner
Amp. Receptacles Fractional H.P. Vent Fans
• Other Equipment:
MOTORS H.P. 1/201/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1,/2 2 3 5 7'h 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size' -- -
Applicant's G
Signature (.7" ( ��y— - License # Permit #
T/A Utility:
(NAME) (OFFICE LOCATION)
Applicant's Address:
(City) (State) (Zip) Service Request #
Phone # Electrician:
MDIA USE ONLY DATE RECEIVED: DATE INSPECTED:
Correct Location: Same as Above n or:
Red Notice Label n
Rough Wiring Outlets Surface Unit Oven
Switches Range Garbage Disposal
Receptacles Water Heater Dishwasher
Fixtures Air Conditioner Dryer
Amp. Service Equipment Burner, Wiring &Controls for Amp. Receptacle
Amp. Service Conductors Pump Vent Fans -
MOTORS H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 11/2 2 3 5 7,/2 10 15 20 25 30 40',50 75 100
Mark Number
of Each Size
500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Elect. Heat
•
CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECT FEE PAID
FE
❑ RW Progress: Inc.❑ LKD I . Contractor
❑ CFT Violation: Work Comp.❑ Inc. ❑ CASH
n L/A Owner
Fee CHK #
❑ L/A Due MO #
n IPA Municipal
INV #
Date: Other Side❑ Utility _ Applicant ❑❑Owner
Cut in Card n Temp # Date .
n Final # Date INSPECTORS SIGNATURE
APPLICATION FORM NO.250 EL 11/89
1� � TOWN OF QUEENSBU 't
s � RECEIVED
TOWN OF QUEENSBURY rrrr� y#
APPLICATION FOR SEPTIC DISPOSAL PERMIT Fee 'F� id1 5 1991
BLDG. & CODE DEPT.
Date: 4A7 if, 9l / Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: K 7z 6
Owner' s Name: gZ,'/;4
Owner' s Mailing Address: Xr , ;0 /A�n % aezp,04. 24.tf
Installer' s Name: �� � ,�,��jr� Phone #:
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom) : X.ro
Topography-Circle One: 430 Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank /470 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 45-77 feet//Total System Length 747) 1 feet
Seepage Pit(s): Number of / Size each: ft. x ft.
Size of Stone to be used: # / Depth or Thickness feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
****************
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the To n of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: DATE: 7%01
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.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
TOWN OF QUEENSBURY ��
531 BAY ROAD /
QUEENSBURY, NEW YORK 12804
• .`` TELEPHONE (518) 745-4447
BUILDING INSPECTORS REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED
NAME )4/eitz.-(i_KK.
LOCATION ,j - (t '//P:e iZAZ 41 -
DATE j7h f0 PERMIT/ g/(8/e
TYPE OF STRUCTURE b(l yfinf.(I/!�
RECHECK / /
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
F,.�OOTING FOUNDATION —BACKFILL - AMING
i/KUUGH PLUMBING FINAL ELECTRICAL SEPTIC
UYIGSULATION WOODSTOVE/FIREPLACE
REMARKS__,( rpG f7c� /I .�4' G�?/J�l/(ny,
- / C9z d,2 -,
APPROVAL
N/A YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VENT ' ✓
ROOFING
SIDING \ J-
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES d/
FURNACE/HOT'�,WATER OPERATING /✓
BASEMENT INSULATION/DUCTWORK i/
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS: `••w.
BATH/KITCHEN; WATERTIGHT
OTHER FLOORS\SWEtPABLE
OTHER FLOORS'CARPETED
STAIR CLEARANCE/RAILINGS !/
HANDICAPPED ACCESS
SMOKE DETECTORS
BATHROOM FANS/WHOLEHOUSE FANS /
ALL PLUMBING FIXTURES OPERATING i/
GARAGE FIRE PROOFING_ /
DOOR CLOSERS
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
DUMPSTER
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL r
OK TO ISSUE C/O OR C/C //
COMMENTS:
4a7 //34/
ARRIVE // ��
DEPART / (7///4"
INS CTOR
ELECTRICAL INSPECTICNS
DUPLICATE/ MUNICIPAC1 ECORD
Permit No. 9j.jd D
Owner at/ Oer AL u',}/zeze
-,Occtipant / ��
Location -[J
",:�•---
/°A ike No.rCits" � � Street
/�'C)i• Town or City~l State
Installation as itemized on reverse side has been visually inspected pursuant to applicable
codes.
Installed by .8 job'4/0
- Date ,C/ L l �y�� t,}� ector
MIDDLE DEPARTMENT INSPECTION AGENCY,INC.
FORM No.18 EL _ 1337 West Chester Plke,West Chester,PA 19380
7 F ROUGH WIRING OUTLETS I H.P.AIR CONDITIONER
S_ QUATeWFS 77 j. WIRING &CONTROLS FOR 84"67/4r).
3 9 RECEPTACLES H.P.PUMP
T‘ FIXTURES K.W.OVEN
, AMP.SERVICE EQUIPMENT H.P.►� GARBAGE DISPOSAL UNIT
4 AMP.SERVICE CONDUCTORS K.W. DISHWASHER
('/ K.W.SURFACE UNIT �!" K W DRYER
,0 RANGE AMP. RECEPTACLE-
I K.W.WATER HEATER aq FRAC. H.P.VENT FANS
MOTORS H.P. 1/20 1/12 1/10 'h % '/a Ih 1 % 1 13/4 2 3 5 71/4 10 15 20 25 30 40 50 75 100
MARK NUMBER
OF EACH SIZE
APPARATUS
p1)---e)
/e �4-/e
BURY
//�� FIRE MARSHAL 14 a9
(� �A/LQOEENSBURY, NEW PORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED
NAME WO/Wed
LOCATION j f &/(Y /i'c/
DATE 7/ 4i/ PERMIT# 97-374
i APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING :
FIRE EXTINGUISHERS " , '
AUTO. EXTINGUISHING SYSTEM 4 j
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM
ALARM SYSTEM - (
INTERIOR FINISHES
STORAGE: /
CLEARANCE TO SPRINKLERS .
CLEARANCE TO HEATING' UNITMS
REQUIRED SIGNAGE
CHIMNEY
WOODSTOVE
FIREPLACE-MASANRY r,
FIREPLACE-FACTORY BUILT
REMARKS: VOX TO THIS DATE
ARRIVE
DEPART l4/•,d4/1(/(i'tx:
INSPECTOR
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 (p/17
A-1
NAME 1�%��2e-gye�Are...A.G 6
LOCATION dN G
DATE b/461 PERMIT f
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YES NO
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/WALL POUR / r
REINFORCEMENT I,N PLACE /
FOUNDATION/DAMPROOFINGf
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE /
PLUMBING UNDER SLAB\ '
FRAMING: `
JACK STUDS/HEADERS• E ; 1
BRACING/BRIDGING t11
JOIST HANGERS `, ,J
JACK POSTS/MAIN BEAM \A
FIRESTOPPING /
WALLS /
CEILING / 1
FIREWALLS
HEATING ROUGH-IN /
INSULATION:
FOUNDATION WALli5 INTERIOR-NR-
FOUNDATION WALLS EXTERIOR Rc d
FLOORS / R'„ /
WALLS / R24 J
CEILING R- 3 ti
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE 1 3-4
DEPART /1
INSPECT
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 (0//7�7/
NAME /-Jelc„,J cv- ,l�.2 Q�,
LOCATION U
DATE 61 f 7/9 / PERMIT # C) / 3/O
TYPE OF STRUCTURE (gN. �. .--"->t\iP-il4
RECHECK APPROVED
1 N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESP SIBS E
FOR PROVIDING PROTECTIO' F'•OM
FREEZING -FOR 48 HOURS FiL ING
THE PLACEMENT OF THE CO 'EYE.
MATERIALS FOR THIS PURPOSE ON/SITE
FOUNDATION/WALL POUR 1
REINFORCEMENT IN PLACE j/
FOUNDATION/DAMPROOFIN A
BACKFILL APPROVAL
k/ROUGH_RLUMBING / /
PLUMBING VENT/VENTS IN P A:O
PLUMBING UNDER SLA:
4RAMI-NG:
JACK STUDS/HEAD'RS
BRACING/BRIDGI G
JOIST HANGERS
JACK POSTS/MA BEAM
FIRESTOPPING
WALLS
CEILING i
FIREWALLS
HEATING RO G -IN
INSULATIO, :
FOUNDATION WALLS INTERIOR R-j
FOUNDATION WALLS EXTERIOR R-'
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
•
ARRIVE 11/
DEPART IQ .. ' 6 '
NS PECTOR
_locun of Queensbury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME \ C:, l SC ()C1r—Q
LOCATION 0L 0 • 1 (
DATE CP /�:' PERMIT NO. r i 'i 10
SOIL TYPE - Sand - Loam - Clay -
Percolation Te t Required? YES - NO
Percolation ra e - Min/Inc
TYPE of SYSTEM:
Absorption field, t.ta er).gth 4 7)
Length of each t en h �0
Depth of trenche , ' /
Size of gravel it , _
SEEPAGE PITS-ENumb-x of)
Size- ft. X / ft.
Gravel size f rj
PIPING: / ,' 1 Size Ty Re
Bldg. to tank/ /" f2// `'
Tank to dist. b:x , .' P// (
Dist. box/to f. eld/.i'• Q" t///;
Openings/seal-d? i NO Partial
/
LOCATION/SEP' ,TIONS
Foundation to tank /5 ft.
Foundation ro absorp ion .E-; ft.
Absorption o lot 11 e 1'-> ft.
Separation of _,/JCS ( ft.
LOCATION 0' SYSTEM ON PRO'„ RTY(circle one)
Front R:ar - Left side -\ Right side -
COMMENT :
SYSTEM USE APPROVED YES NO
: t g-OL(1/1"
Du' ding Inspector
01/86 and vl
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 71-/ 5-ret't-e.,_
LOCATION `d p 1/0404 Dr
DATE f431q.I PERMIT # 9J- 3�0
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR F RM
REINFORCEMENT IN P ACE
THE CONTRACTOR IS ESPONS :LE
FOR PROVIDING PROT TION , RUM
FREEZING FOR 48 HOU Ft LOWING
THE PLACEMENT OF TH CiiCRETE.
MATERIALS FOR THIS P .' 'OSE ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLA E\
-FOUNDATION/DAMPROOF , G� ✓J
X BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENT. IN ,LACE
PLUMBING UNDER SL'B
FRAMING:
JACK STUDS/HEALERS
BRACING/BRIDGI G
JOIST HANGERS ,
JACK POSTS/MA. N BEAM
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUG,'-IN
INSULATION:
FOUNDATIO,' WALLS INTERIO R-
FOUNDATII WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART .�o �%'
if INSPECTO'
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 �� � %///q
LOCATION
DATE ,5-X.74/ PERMIT I 9/ 7 //i
TYPE OF STRUCTURE eet it�-1-?/
RECHECK APPROVED
N/A YEAS NO
FOOTINGS/PIERS
/ '
f'
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/WALL POUR
REINFORCEMENT IN PLACE 7
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING .7
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
FIRES TOPPING f
WALLS
CEILING
F I R EWA LLS ,
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 /
REMARKS:
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