1991-334 CERTIFICATE OF OCCUPANCY
,TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date September 24 19 91
This is to certify that work requested to be done as shown by Permit No. 91-334
has been completed.
This structure may be occupied as a _ Single Family Dwelling
Location Lot 30 Lady Slipper DRive
Owner Forest Wood Homes
By Order Town Board
TOWN OF QUEENSBURY
,v
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-334 kn
WARREN COUNTY, NEW YORK
O
PERMISSION is hereby granted to FOREST WOOD HOMES
"r1
OWNER of property located at LOT 30 LADY SLIPPER DRIVE Street, Road or Ave. 0
CD
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 C
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 0
a
1. OWNER'S Address is 0
HC-02 Box 286P
Warrensburg, NY
2. CONTRACTOR or BUILDER'S Name
CO
Same
3. CONTRACTOR or BUILDER'S Address �•
CD
4. ARCHITECT'S Name —'
la
r—
C
5. ARCHITECT'S Address r•i'
W
O
Cu
O.
6. TYPE of Construction—(Please indicate by X)
tn
(Xl Wood Frame ( ) Masonry ( )Steel ( ) _ •Lj'
TJ
CD
7. PLANS and Specifications
No. 1,554 sq ft Single Family Dwelling as per plot plan specifications <'
and application
8. Proposed Use
Single FAmily Dwelling
$ 252.00 PERMIT.FEE PAID —THIS PERMIT EXPIRES May 23, 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.)
Dated at the Town of Queensbury this 23rd Day of May 19 91
SIGNED BY �1j— t1 l.Al\n �� for the Town of Queensbury
Building and Zoning Insper
TOWN OF QUEENSBURY / J
11/
REVIEWED BY , .�pY r,;,- •., /� PtLL� ^pa Thy7�t��77
� `.i QU EN8BUR A
.4/ FEE PAID RECEIVED
5,4" " PERMIT NO. 9/- _
* MAY 211991
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.
« * * * * * * « * * « * * * I * * * * * * * * * * * I * * « * * * * * * * * * « *
The owner of this property is: Aro ,1 tne`ni
P.O. Address J/-Q2 Liu MP Warreosipto `vA 1'8(s- Tel. 1 -397q
/ J
Property Location 0 hick Si;.ey y1 ve Tax Map No. / /
/ 1 —
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 feni, Diu Aek LOT NO. SO
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
fare,(( 1Ior Nnw c
•
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF
•
Construction of a new building * CONSTRUCTION: $ r4(o)Or7n
/
Addition to a building * COMPLETE INFORMATION REQUIRED BELOW:
• Size of property jJp ft x Dd 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 (a) ft. Rear yard /0,3 ft.
•
Side yards ft. and .3 ft.
•
GROSS AREA OF PROPOSED STRUCTURE • If on corner, setback from side street ft.
1st Floor l55 sq. ft. r�(� :^`•
� OCCUPANCY INFORMATION
y �*
2nd Floor sq. ft. /-1, , ' Primary Building -
Other Floors sq. ft. `�' '"? One Family Dwelling
h
(not cellar or base:-:ert Two Family Dwelling
TOTAL FLOOR AREA )33'J ,sq. ft. • Multiple Dwelling/Number of units
• Business
Size of new structure_ 37 ft x /0s ft.
Foundation-pier/slab/crawl/partied/a)
• Industrial
(circle one) * Other
•
No. of stories (habitable space) I •
Height (grade to ridge) /7 ft. • If addition, what will use be?
If residential, no. of families ( •
No. of rooms(excluding baths) it, Accessory Building
No. of bedrooms ' _Detached Garage ONE/TWO CarTW
No. of bathrooms a *
V Attached Garage ONE O Ca-la
Primary heating system idol/
Type of fuel nit • _Private_ storage building
No. of fireplaces to be installed I • Other
Will a wood stove be installed no
Central Air conditioning •
OV• ER
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe, etc. STirk baj i1, 14O0e) me_
Will any second-hand or upgraded lumber be used? If so, for what? no
Foundation wall material Gv1eyp Thickness en
Depth of foundation below grade (to bottom of footing) y'g"
Will there be a cellar? 'o Heated or unheated? Floor sq. footage sq ft.
Will there be a basement? eS Will any portion be used as living space? t)Q ,
(If so, what portion? • sq ft. Type of use?
Type of roof sloped flat/shed/other Material of roof ASr1,0 I1'
Size, wood studs "x " spacing " o.c. length ft.
Joists (floor beams) 1st floor . •a "x Jp " spacing ./t "o.c. span /S 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 ay " o.c. span 35 ft. _
Exterior wall finish Willi/ Sidiv,, of what material?
• 1+ pp,, J
Interior wall finish c1rr4yrr�r.k aPel on,i rvaiEa rd
I 1 S
If a garage is to be attached,Ll describe materials to be used for (FIRE SEPARATION: $sl.-e[..I,roc.k e,.,-ham
CCI Iihq A vvi walls AJ tLtc��Zd -1 `ioctse ,c' au4 s,'rr ,,, Il_s
Is there to he an opening between garage and dwelling? S If so will a Fire-rated door, enclosure,
self-closing device be provided? yes
Will a flue-lined chimney be installed? Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply Munpal r private well
• SEPTIC SYSTEM Distance from ANY private well (including adjoining properties O. to-b ft.
(A separate application is necessary for any repair or new installation of septic system)
NAME OF BUILDER F,f,,,ci- Woroj J ,w/ ADDRESS f/P j„A.241(.41,,,,,d ti TEL. NO. ��'-g971
NAME OF PLUMBER g,ap n)„afi, ADDRESS ,,,.,,i 5/1 AL,A, TEL. NO. /4/- Niv
1 YY /+
3JriP
S r� „NAME OF MASON �ADDRESS I�i��t>>�': ,�1: �:°,o�,r,id, TEL. NO. 74,'7 -0�aa-
U J s
NAME OF ELECTRICIAN Al; ribrAi ai., ADDRESS r;,a„ ".;.#yitit t 1p TEL. NO. 7�i-4- 00/y
I /
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 \\r
�wn r,'wner's agent, architect, contractor
SPECIAL CONDITIONS OF THE PERMIT:
BY
ENERGY CODE COMPLIANCE APPLICATION I
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE DAYS
Compliance Methods:
TOWN OF QUEENSRuR°s
PART 5 - Acceptable Practice Method - ' 1 & 2 Family Dwellings (ONLY) RECEIVED
PART 6 - Thermal Rating - Component Trade Offs - 1 & 2 Family Dwelling Ay 2 1 1991
Multi-Family Dwellings
(3 Stories or Less
BLDG. & COIDE DEPT.
PART 4 - Design By Component Performance - Commercial Buildings - Hi-Rise Residential
PART 4 & 6 - Compliance Methods Require Submission of Worksheets
fntPsf 11 P )571 id la iv Shifr6rr at,ke.
APPLICANT'S NAME PROPERTY LOCATION I
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - kcrlf Sq. Ft.
r 2. Type of Heat - Elec. Base Board Other Oif hot ail"-
3. Is Building Mechanically Cooled? YES NO 4. Percentage of Area of Windows and Doors Over 17% R,/"/
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 , ()
B. Exterior Walls R___O___
C. Glazed Area R 1-1
D. Exterior Doors R (0
p 2-/--4.r-s ,�ar�, 1 3o Iy
E. Floors over unheated spaces
F. Edge of Slab on Grade (Heated Building) R
G. Basement/Cellar Walls (Above Grade) R I
H. Basement/Cellar Walls (Below Grade) R 1
I. Heating/Cooling - Ducts - Piping in Unheated Space R 10
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
it Gl ai l T T/ TELEPHONE 7NUMBER
APPLIO ANT S SIGNAT RE / DATE
INSPECTOR'S REMARKS :
, "--)
i iTh
I K;--g,( t
REVIEWED BY' /j
TOWN OF QUEENSBURY 4'
` � APPLICATIOfi FOR SEPTIC DISPOSAL PERMIT
VpdliDATE: I911 TOWN OF QtUEENSBURI•
// I RECEIVED
LOCATION OF PROPERTY FOR INSTALLATION Ibf SIItL[4vr 11iIf1T 21
/ �, iyuiT
Owner's Name: �D, `7 /400J lL, o,c
Address: /,1/-I� 6Qy #9j BLDG. & CODE DEPT.
Installer' s Name: llhi es exra,, -417� Telephone: 7y) -aaa -
✓
Number of bedrooms (residential only) 0
Total daily flow (compute @ 150 gal per bedroom) yD
Topography: Circle one: 4 Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth:
Ground Water: At what depth? ° S? Feet
Bedrock or Impervious Material : At what depth? a Feet
Percolation test: Circle one-otfrequired required
Rate - Min. Per Inch
Domestic water supply: Circle one: *---c-i-p7a?':syell Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank ( O v0 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench ) feet/Total system length Rio feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used it: 9, /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 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: -20, __
•
111
•
•
Septi s stem 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.) locacion and distance co lot lines
3.) location and distance co structures
- 4.) location and distance to any water supply.
. 5.) size and dimensions of all tanks, distribution boxes.
file fields and/or drywalls
B. Nu system shall be covered before inspection and approval by the
uuil4ing Inspuccor. Failure to comply with this requirement may
result in the uncovering of cha system by cha 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 co produce said plot plan at time of inspection say
rusulc in an immeediace work stoppage.
D. Should unforeseen problems during construction prevent proper installa-
tion, alteration or rupair of an approved system, a new proposal must
bu submiccad co the Queensbury Building Department before further
construction. •
•
•
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
• Queensbury, New York 12804
!CJmarks:
•
TOWN OF Q1 EE VSBL RY
Bay at Haviland Roads,Queensbury,N.Y.12801-9725
APPLICATION FOR SOLID-FUEL BURNING APPLIANCES AND FIREPLACES
. Date Mav 21) 19 qi Permit No. gJ -3 4
I
APPLICATION IS I-HEREBY MADE to,the Building Department for the issuance of a Building and Use Permit
pursuant to the New York State Fire Preventiori and Building Code. The applicant or owner agrees to comply with all
applicable laws, ordinances, regulations and all conditions that are part of these requirements and also will allow all
inspectors to enter premises for the required inspections. ,_
Applicant's Name' F , ,- APPLIANCE TYPE
orr c f �, ,,,,� EI„ < Stove . Coal Wood
Address /4 -0,2 J Y a8G P Furnace: Hot:Ai,r ' Boiler
!!\\ AA�� , . . . Zero Clearance ,% Circulating Unit
• Mart^ro.Sho`,yra . N,Y, Zip` id i - . .. . .
Phone V If Non-Masonry:
Owner's Name .ca,,v),? as aI,0vp, • — -
Manufacturer vi 4 i-`�i"(--cc ,,,' /. .�J-.-,—
Address Model r_> , (. outlet Size ii
Zip Listed by Number •
Phone •
CHIMNEY TYPE
Masonry: Block Brick Stone ••r �,
•
Property location of proposed construction Flue: !`'. Tile Steel
Jo -I- .30 /4 rJ'/. l'c I,-I Pk r�..i ;r10. Size:
w
Factory Built:
Manufacturer Model Size
COPY OF MANUFACTURER SPECIFICATIONS IS . Height Listed By Number
REQUIRED FOR FACTORY-BUILT APPLIANCES Type: DoubleWall �'f Triple Wall
AND CHIMNEYS. MUST BE INSTALLED Insulated
ACCORDING TO SPECIFICATIONS. COPY OF Estimated Cost $ C, 9 )
CONSTRUCTION DETAIL REQUIRED FOR MA- Fee$
SONRY FIREPLACES AND CHIMNEYS.
•
CASHIER'S DEPARTMENT
TOWN OF QUEENSBURY, NEW YORK
Depar•(ment; Fire Marshal Amount Collected Amount Refunded
Code Number Title-', . l]4 6
A173 3389 (190)Public Safety "(
A233 2655 (230) Minor Sales ,
I'dd\ tfrniunded to:
Add ,-1J4 779' b
Address: -
, I
_ �� (--JI�\Dated: O/af� Town Clerk or Deputy ,
White:Applicant Yellow and Pink:Cashier's Department Goldenrod:Fire Marshal
�4R MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
National Headquarters
` •�; 1337 West Chester Pike,West Chester, PA 19380 /
APPLICANT COMPLETES THIS SECTION Date: r , 27) i'Iir
City, Town or-Township . ` • -Z- County !'•i _ , State
Location/Address .+ )'I- II, r • /, ./.• ,!• . -
(If Located'in Rural Area -Please Attach Directions) Pole #
Owner , J I-i el
1/': Permit # t!/ .__%=-+.. .f ,,
Occupied As Building: Newel. Old
Occupant /
Work Area in Building (Floor #, etc.):
App. for: Wiring❑ 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'/2 10 15 20 25 30 40 50 75 100
Mark Number
' of Each Size ri '
Applicar`tt's \ i• --
Signature I _;/ License # Permit #
•
' T/A if Utility: -..
Applicant's Address: I-if ;yam I-.t" __`,'i• 1 (NAME) (OFFICE LOCATION)
(City) ,',t•-., I., - (State) /'i (Zip) ' Service Request #
.Phone # - 1 ;%,°;,s —'`Electrician: \
MDIA USE ONLY DATE RECEIVED: DATE INSPECTED: -' --
Correct Location: Same as Above n or:
Red Notice Label n . - r"
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 e' '
Mark Number - ° '
of Each Size .
Il 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 '
Elect. Heat
8
ECT
CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE• 'CORRRE FEE PAID
❑ RW Progress:, Inc.❑ LKD I I Contractor ---
❑ CFT Violation: Work Comp.❑ Inc. ❑ -❑ L/A Owner CASH n
- Fee
CHK #
❑ L/A - - Due MO #-
n IPA Municipal •
INV #-
Date: Other Side Applicant ❑
❑ Utility. �� Owner
Cut in Card n Temp # - Date -
- INSPECTORS SIGNATURE
n Final # - Date ' _
APPLICATION FORM NO.250 EL 11/89
e
TOWN OF QUEENSBURY
/A► 531 BAY ROAD .
arid' WEENSB(SRY, NEW YORK 12804 -/
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED '407
NAME ` 1I/24(- )(ld-7 i v-
LOCATION (l) Cl/ C - h ,
DATE 94:?rn/ PERMITS '9 - 11/
TYPE OF STRUCTURE .A/(r 4u%ui 464.4 02
RECHECK n j iuiJI- )
FIRE MARSHAL APPROVAL (COMMME-RCIAL STRUCTURE)
/FOOTING j OUNDATION ✓BACKFILL 4,-FR'AMING
1,ROUGH PLUMBING L- 1NAL•" ELECTRICAL EPTIC
1,„-INSULATION _ ODSTOVE/FIREPLACE
REMARKS
st,
Est APPROVAL
�q N/A YES NO
CHIMNEY HEIGHT/LOCATION:1 ��/
B VENT/LOCATION '
PLUMBING VENT
ROOFING f ✓
SIDING /
DECK/PORCH/STEPS/RAILINGS/
RELIEF VALVES
FURNACE/HOT WATER OPERATING
BASEMENT INSULATION/DUC`TWORK V/
INTERIOR TRIM/PRIVACY ,;DOORS V
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEERABLE
OTHER FLOORS CARPETED /
STAIR CLEARANCE/RATLINGS ✓
HANDICAPPED ACCESS:
SMOKE DETECTORS
BATHROOM FANS/WHOLEHOUSE FANS i/j
ALL PLUMBING FIXTURES OPERATING t //
GARAGE FIRE PROOFING r //
DOOR CLOSERS :/
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
DUMPS TER
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS:
/ -/. 7 9/44
ARRIVE fu
DEPART /l' US
INSPECTO
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED 19/2-th/
NAME , /7� �1���
LOCATIONS 4,4",/,/0-/e;r1_,
DATE /� PERMIT# `
g� / -Ha'
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING /
FIRE EXTINGUISHERS ,
AUTO. EXTINGUISHING SYSTEM
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM /
ALARM SYSTEM /
' f'
INTERIOR FINISHES /f
STORAGE: if
CLEARANCE TO SBRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE'
�'
CHIMNEY
WOODSTOVE /
FIREPLACE-MASONRY
%FIREPLACE-FACTORY BUILT
REMARKS: ( 1 OK TO THIS DATE
i
ARRIVE /7.
DEPART `/ am-_ (4 -2,,,,e'-
INSPE OR
ELECTRICAL INSPECTIONS
DUPLICATE MUNICIPAL RECORD
Permit No. • /
Owner / 2 5.% 14.1— —6 "54 G�
Occupant Location 4) r 3b Q y 3'(fi"2
al'S
, e t .B street
� Town or City lF/ State
Installation as itemized on reverse side has been visually inspected pursuant to applicable
codes.
Installed by 620ti 7
Date 9-1 v 1/ ae,,p54,24
iirispectiar
MIDDLE DEPARTMENT INSPECTION AGENCY,INC.
FORM NO.18 EL. 1337 West Chester Pike,West Chester,PA 19380
g, ROUGH WIRING OUTLETS H.P.AIR CONDITIONER
3 9 GUTCET6.SOU 1 Tt WIRING &CONTROLS FOR Q/�_ BURNER
3 3 RECEPTACLES - _
H.P.PUMP
FIXTURES K.W.OVEN
ez)`TO-( AMP.SERVICE EQUIPMENT C'/H.P.GARBAGE DISPOSAL UNIT
/.4 AMP.SERVICE CONDUCTORS �/K.W DISHWASHER
'II! K.W.SURFACE UNIT KW DRYER
" KK�W"RANGE AMP. RECEPTACLE
K.W.WATER HEATER FRAC. H.P.VENT FANS
/
t. ( / zC lJ
MOTORS R.P. 1/20 1/12 1/10 % % I h I/: 1/4 1 11/ 2 3 5 71h 10 15 20 25 30 40 50 75 100
MARK NUMBER
OF EACH SIZE
APPARATUS
_/own o/ QUQflJUrcy
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
aueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME i )1/ (1
LOCATION „76.4 a)
DATE 7 <i4( / 9/ PERMIT NO. /��-���
SOIL TYPE 4. , - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: f
Absorption field, total length cep;
Length of each trench 521
Depth of trenches .3_.S/ /,
Size of gravel i 't - I _
SEEPAGE PITS4Nuinber of) •.j ,r`
Size- ft. X ft. '1 /
Gravel size . /
PIPING: Slip! Type
Bldg. to tank 411v Pf
Tank to dist. box
Dist. box to field/pit/''1
Openings sealed? YES/ NO Partial
LOCATION/SEPARATIONS:'
Foundation to tank f 0 ft.
' Foundation to absorption ft.
Absorption to lotfline
Separation 'of pits ( ft.
40_, ATION OF SYSTEM ON PROPERTY(circle one)
Front Rear - Left side - Right side -
''I' NTS:
SYSTEM USE APPROVED dpr> NO
Buil ng Inspect r
01/86 and vl
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTIOON RECEIVED
NAME
LOCATION /4 36 4 czyNie n ti
DATE *4/ PERMIT# 9/-2 1
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTI\G
FIRE EXTINGUISHERS r `
'AUTO. EXTINGUISHING STEM
HOOD INSTALLATION .'• /
AUTO. SPRINKLER SYSTy
ALARM SYSTEM \;'
INTERIOR FINISHES ,/
STORAGE: ` /
CLEARANCE TO'SPRINKLERS }
CLEARANCE Tt HEATING UNIT
REQUIRED SIGN' E
CHIMNEY ,/f
WOODSTOV/E
FIREPLACE-MASONRY
FIREPLACE-FACTORY BUILT 1/
REMARKS: ( K TO THIS DATE
"I
.114
ARRIVE
DEPART gdIAlUef-30
INSPECTOR
TOWN OF QUEENSBURV
L6ni
n
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR°S REPORT �I
REQUEST FOR INSPECTION (RECEIVED j�//
NAME � -e k 1r\./C,'t`X �) / 1 U 1
LOCATION 1c 30 C ,)(._,S I P 291
DATE V.L1I_1) PERMIT # f — 3 3 '1
TYPE OF STRUCTURE SIP trh,113 �,,046
RECHECK w � ✓ 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 IN PLACE
FOUNDATION/DAMPROOFING /
BACKFILL APPROVAL a"
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE; j.
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS :C
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
.
FIRESTOPPING /
WALLS
CEILING /
FIREWALLS / f
HEATING ROUGH-IN /
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FOUNDATION WALLS INTERIOR R4
FOUNDATION WALLS /EXTERIOR R .
FLOORS / R-,
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CEILING / R-3b 1%
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REMARKS:
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DEPART�/
PE TOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY,
NEW 0 4
TELEPHONE (518) 792-5832
BUILDING INSPECTOR°S REPORT
REQUEST FOR INSPECTION RECEIVED/' ��_�
NAME C 77�L��' /U�`�-e-7(9V- 2--)tg "
LOCATION v)f
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DATE 7/ / / PERMIT
TYPE OF STRUCTURE , /,/21, (4w,4
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
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
\( ROUGH PLUMBING / t/
/, PLUMBING VENT/VENTS IN PLACE I'
PLUMBING UNDER SLAB
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BRACING/BRIDGING
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JACK POSTS/MAIN BEAM /
FIRESTOPPING
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CEILING rs
FIREWALLS
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 / �•
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REMARKS:
ARRIVE f� �S
DEPART /I aj 4-
INSPECTOR
TOWN OF QUEENSBURY /Ry'i' Y
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR®S REPORT j /17
//)j REQUEST FOR INSPECTION RECEIVED ( t/ "L
NAME n.re c - LLL2o c5 M1U2
LOCATION )'.30 C(r 5//�p�
DATE G PERMIT if 11 -33 y
TYPE OF STRUCTURE SMf Z ,rnD_WP
RECHECK APPROVE
N/A YE 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
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 .
FIRESTOPPING
WALLS
CEILING
FIREWALLS
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:
ARRIVE /
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DEPART 7V
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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
NAME Q'F es N,occ) 1-
LOCATION t.)0-1-- 30 clG0
DATE PERMIT # —33 Cf Yevy,,TYPE OF RUCTURE 5�AD � n
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RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM e�
FREEZING FOR 48 HOURS FOLLOWING j
THE PLACEMENT OF THE CONCRETE. /
MATERIALS FOR THIS PURPOSE ON SIDE
FOUNDATION/WALL POUR ,
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
3FBACKFILL APPROVAL ; ✓
ROUGH PLUMBING !, j
PLUMBING VENT/VENTS IN PLACE/
PLUMBING UNDER SLAB ;l
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
FIRESTOPPING
WALLS
CEILING
FIREWALLS r;
HEATING ROUGH-IN A'
INSULATION:
FOUNDATION WALLS ;INTERIOR R-
FOUNDATION WALLS, EXTERIOR R-
FLOORS R-
WALLS R- t
CEILING R-
DUCT WORK OR PIPING IN UNHEATED',
SPACES
REMARKS:
L "
ARRIVE 3:0 S
DEPART 7�
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 (Q /O/9/
NAME U0o Pe �
LOCATION �, R ?O d SI-� -
DATE J o/Ct i PERMIT # 1 s 331/
TYPE OF STRUCTURE
RECHECK / APPROVED
N/A YE-NO
OOTTNGS:/P.DER'S 1
MONOLITHIC POUR FORM I
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE I
FOR PROVIDING PROTECTION FROM
FREEZING -FOR 48 HOURS FOLLOWIN
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON ITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE ( >�
FOUNDATION/DAMPROOFING a /
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB I
FRAMING: ,/
JACK STUDS/HEADERS
BRACING/BRIDGING r�
JOIST HANGERS `' /
JACK POSTS/MAIN BEAM t .�
FIRESTOPPING °
WALLS
CEILING /
FIREWALLS 1/
HEATING ROUGH-IN /{
INSULATION: /
FOUNDATION WALLS INTERIOR
FOUNDATION WALLS EXTERIOR- I
FLOORS / R- @
WALLS / R-
CEILING / R- f
DUCT WORK OR PIPING 7,1 UNHEATED
SPACES
1
REMARKS:
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ARRIVE `S--
DEPART
INSPECTOR
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F1ECEIVED
MAY 21 1991
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