1992-236 OF
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
# C1ate fJC/LLa, IN t
- S.
This is to certify that work requested to be done as shown by Permit No. 92'236
has been completed.
This structure may be occupied as a S i nal a Family Dwel 1 i nts
Locationa Mm mChippewa Circle
Owner John D `Ambrosi o
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY � ='
No_
WARREN COUNTY, NEW YORK + '
r�o
1
PERMISSION is hereby granted to John DtAlmbroSio 4a
OWNER of property located at LotOV4 Chippewa Cl rcle Street, Road or Ave_
in the Town of Queensbury, To Construct or place a Si n� @ Faeli ]y Drrel 1 i ng
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. Cr
3
to
1. OWNER'S Address is G
w
Sarre
O
S
2. CONTRACTOR or BUl LOE WS Name C
Michael J . Vasiliou Inc.
3_ CONTRACTOR or BUILDER 'S Address
#14 STone Pine Lane h
Queensbury, NY 12804
r�
NOD
.1'
4. ARCHITECT'S Blame
5. ARCHITECT'S Address
C'J
J
6. TYPE of Construction — (Please indicate by X)
( XI Wood Frame ( ) Masonry ( ! steel I !
KI7
r--'
i_ PLANS and Specifications
(D
No. 3210 sq ft Single Family Dwelling as per plot plan specifications
and application
_ J
8. Proposed Use # vC
Single Family Dwelling
J
J
$ 427 mOQ PERMIT FEE PAID — THIS PERMIT EXPIRES May 79 � 19_93—
(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.l
Dated at the Town of Queensbury this 19th Day of May 19 92_
SIGNED BY � ' for the Town of Queensbury
Building and Zoning I nspe
TOWN OF QUIRENSHVRY
REVIEWED BY : ,
FEE PAID : j"� Ir
PERMIT NO . : �,►
BUILDING PERMIT APPLICATION
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION , NO INSPECTION Ohl
t � BE M TIL
APPLICANT HAS RECEIVED A VALID BUILDING PERMIT . OrE6Z
All applicants spaces on this application MUST be completed and the signature of the
applicant MUST appear on the reverse side of this application .
Owner of Property :
Y3
_ _ }
P . U . Address : cs J•� /�- 1 f}'_�/t C[ z { /4Cf` `�PHONE t'r 513
Property Location : � y' f fy � Szip Tax Map No,/�
l /
Has there been any split of this property A +since October 1 , 1988? Yes No
If yes , Planning Board Review is necessary ,
Subdivision Name , if applicable : Lot No .
THE PERSON RESPONSIBLE FOR SUPERVI ON OF WORK AS REGARDS TO BUILDING CODES IS :
� C 0 L) < C'
NATURE OF PROPOSED WORK : * ESTIMATED MARKET VALUE OF THE
Construction of new building * CONSTRUCTION : $ Z5 Z700 a�
Addition to building * "—
Alteration to building * COMPLETE INFORMATION REQUIRED BEI.�W :
( no change to exterior dimensions ) * Size of Property : .106 ft , x // o ft .
Other work ( describe ) * Existing Building Size : 1ZR- C=4noc�o4-oqrwz"-
* 'V00 ft . x 'YA ft ,
* Proposed building - distance from
GROSS AREA OF PROPOSED STRUCTURE : * property line :
1st Floor A 3 a Sq . Ft . * Front Yard 3e ft . Rear yard � ft .
* Side Yards and- ft . � ft ,
2nd Floor /Srsp Sq . Ft . / 6 0 * If on corner , setback from side street-
S"o '? - C'c,*-
Other Floors Sq . Ft .
( not cellar or basement * OCCUPANCY INFORMATION :
TOTAL FLOOR AREA : ZIL} Sq . Ft . * Primary Building
* _ One Family Dwelling
Size of New Structure * ft . x 31 ft , Two Family Dwelling
Foundation : * Multiple Dwelling/No . of Units
Pier/Slab/Crawl /Partial /Full ( Circle One ) * Business
* Industrial
No . of stories ( Habitable space ) Other
Height ( grade to ridge ) 2.!j ft .
If residential , no . of families * If addition , what will use be?
No . of rooms ( excluding b ths ) :
No , of bedrooms :
No . of bathrooms : 2 * Accessory Building :
Primary heating system : AlIzz * Detached Garage - Tw
Type of fuel ; C3fA - * _ Attached Garage wo Ca
No . of fireplaces to be installed ; * Private Storage Builds
Will a woodstove be instal le .; rvcs * Other
Central Air Conditioning : ,`r-Ye-S No
( OVER )
BUILDING PERMIT APPLICATION CONTINUED :
BUILDING SPECIFICATIONS :
Type of constr and frame , ire safe , etc .
Will any - hand grace lumber be used ? If so , for what ?
Foundat Wall 46terlal : Thickness :
Depth o ou flIUn beplow de ( to bottom of footing ) :
Will the a a� ellar? �" Heated or Unheated ? Floor Sq . Footage :
Will there baserree Will any portion be used as living space ?
If so , what por Tan ? - Sq . Ft . Type of Use ?
Type of Roof : Sloped 7 at/Shed/Other Material of Roof A-5 egH'}-,c. -
Size , wood studs �- x r spacing 4gp - o . c . ; length _ f ft .
Joists ( floor beams ) : 1st Floor x �Zf spacing / o . c . ; span ft .
Joists ( floor beams ) : 2nd Floor _`�' x la " ; spacing � �" o . c . ; span ft .
Overlays ( ceiling beams ) : " x " ; spacing '" o . c . ; span t .
Roof rafters : '" x spacing o . c . ; span ft .
Roof trusses ( pre -engineered ) : spacing " o . c . ; span -ft .
Exterior Wall Finish : -010-` of what material ?
Interior Wall Finish : ,,4ap
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 ? E� If so , will a Fire- Rated door ,
enclosure , self- closing device be provided ? _w
Will a flue- lined chimney be installed ? �' Height above roof _ ft .
Depth of chimney foundation below grade : 4:0 ft .
Depth of fireplace hearth : / ft . in .
Water supply - Municipal r private well :
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 & ADDRESS : `Js r [ _ .�tl PHONE -,7j �r�
NAME OF PLUMBER & ADDRESS : rr /! PHONE ;; -C r
NAME OF MASON & ADDRESS : PHONE
NAME OF ELECTRICIAN & ADDRESS : = sty ,. / PHONE
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 i authorized by he owner ,
Signature
01
er , own , arc 4ec
ntractor 60or
SPECIAL CONDITIONS HE PERMIT :
By :
ode Enforcement Officer
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY , WARREN COUNTY - 9000 HEATING DEGREE DAYS
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
PART 4 & 6 - Compliance Methods Require Submission of Worksheets
A, r z P /0
PL CANT PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE :
1 . Gross Floor Area - /�+C Sq . Ft .
2 . Type of Heat - Other (_/•,L
3 . Is Building Mechanically Cooled ? Y_YES NO
4 . Percentage of Area of Windows and Doors Over 17 % r Under 17 %
THE R-VALUES GIVEN ON THIS SHEET MST CORRESPOND TO R E Q U I R E D
THE R-VALUES SHOWN ON PLANS SUBMITT6i
Baseboard
5 . Insulation Values : Actual Shown Elec . Heat Other
A . Roof & Floors exposed to ambient temperatures R�
B . Exterior Walls R ,
Co Glazed Area R�
D . Exterior Doors R ,.
E . Floors over unheated spaces R
F . Edge of Slab on Grade ( Heated Building ) R `
G . Basement/Cellar Walls (Above Grade ) R�ZI
H . Basement/Cellar Walls ( Below Grade ) R__ _ L�
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 C NTROL 14AXIM1M SETTING 1400 - HILL NOT BE EXCEEDED
INSPECTOR ' S REMARKS :
TOWN WN OF Q UEENSB URY
Bay at Haviland Roads, Cauoonsburyr, N.Y. 12801m9725
APPLICATION FOR SOLD FUE4-BURNING APPLIANCES AN FIRE .ACES
-4,.4m J,
rate OE 4W;+r! lg Permit No. :� Lr
A !'PLIC NI110N+I IS HEREBY MADE tothe Building Department for the issuance of a Building anti Use Permit
pursuant to the New York State Fire Prevention and Building Code. The applicant or owner agrees to comply with till
ttpplicttble 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 A.4 e* G" APPLI[ANCi TYPE
�r Stove Coal Wood
!Address Furnace Hot Air Boiler
Zero Clearance Circulating Unit
Zip +� j '/� '„�i LI�,rV
Pbone .. If Nan-Masonr
()►vner's Name ,
A" tress Manufacturer
Model Outlet Size
Zip Listed by Number
i l'h«etc
CHIMNEY TYPE
Masonry: Block Brick Strout
Property location o pr sed construction. Flue: Tile Steel
-^,p" 'AI" "'�" �. A= I,.z2or On7 Size:
Factory Built:
Manufacturer Model Size
f '() Py [ l+ MANUFACTURER SPECIFICATIONS IS Height Listed By Number
iEQUIRED FOR FACTORY-BUILT APPLIANCES Type: Double Wall Triple Wall
AND CHIMNEYS. MUST BE INSTALLED Insulated
ACCORDING TO SPECIFICATIONS. COPY OF Estimated Cost $ +ZV4 t
CONSTRUCTION DETAIL REQUIRED FOR MA- ��----
SONRY FIREPLACES AND CHIMNEYS,
CAsmER's DEPARTMENT
TowN OF QuEENsauRY, NEw YORK
4
lIgnartrnet1l:_Fire &t=hal Amount Collected Amount Refunded
S..cldcJS=b E Title
A ] 73 3389 (190) Public safety
A233 2655 (230) Minor Sales
...tee Collected from r Refunded to:
Address: {\
f3atitil: [ t' "li r,'. fY y ti l
Town Clerk or Depot
Whike. AppNa¢wif Yspnw and Pimiu Cx~i Dwraremens `Gatdearad: FjPw.4rnrahat 1
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid '—
Date r Reviewed By
LOCATION OF P5ROPS TY FOR INSTALLATI N :
6pc c- D
.o .= 'Name : C d
Owner ' s Mailing Address :
Installer ' s Name : ,I, J �+ f' -g .z/ Phone # :
Number of bedrooms ( if residential ) :
Total daily flow ( residential - compute @ 150 gal . per bedroom ) :
Topography-Circle One • aFla� Rolling Steep Slope % of Slope
Soil Nature- Circle One Loam Clay Other /Depth :
Ground Water-At What Depth ? 20 Feet
Bedrock or Impervious Material -At What Depth ? Feet
Percolation Test- Circle One< Not Requir Required/Rate Min . Per Inch
Domestic Water Supply- Circle One : Municipal Well Other T
If domestic water supply is a well -
Separation : Water supply fro c absorption feet
PROPOSED SYSTEM: Septic Ta gal . ( Minimum size :
Tile Field : Each Trench eet/!Total System Len eet
Seepage Pit ( s ) : Number of / Size each : fto 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 a jTown of Queensb ry Sanitary Sewage Disposal
Ordinance .
SIGNATURE OF RESPONSIBLE PERSON : � r9 L DATE :
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 a7 tanks , distribution boxes , the 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
x 531 Baoad
Queens ury NY 12804
Remarks :
TOM OF gUEEKSBURY
531 SAY ROAD
WL i
QUEENSBURY , NEW YORK 12804
TELEPHONE t518) 745-4447
BUILDING INSPECTOR ' S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED /r z/�Q
N ��yy���� � 4
LOCATIONN
DATE 2� PEMIT#
TYPE OF STRUCTURE
RECHECK
FIRE MARSHAL APPROVAL ( COMMERICIAL STRUCTURE )
f�FOOTING FOUNDATION *�BACKFILL FRAMING
TROUGH PLUMBING 4w INAL ELECTRICAL oe�EPTIC
INSULATION �WOODSTQVE/FIREPLACE
REMARKS/Xp.G d ,¢ .W � ,l!!!; ++
k
APPROVAL
N/A YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VENT k
ROOFING X
SIDING On.
DECK/PORCH/STEPS/RAILINGS) �.
RELIEF VALVES
FURNACE/HOT WATER—OPERATINGli A _
INTERIOR TRIM/PRIVACY D RS r*
FINISH FLOORS :
BATH/KITCHEN WATERTI T
OTHER FLOORS SWEEPAB E
OTHER FLOORS CARPET dl,
STAIR CLEARANCE/RAILI G " .
SMOKE DETECTORS
DOOR CLOSERS
BATHROOM FANS
ALL PLUMBING FIXTURFS OPERATING _
GARAGE FIRE PROOFI
T.
DOOR CLOSERS
OTHER FIRE SEPARA N
FIRE/DEMISE WALLS
FINAL ELECTRICAL oxt
OK TO ISSUE C/O OR C
c ENTS :
ARRIVE zxzDEPART � r=oj� ' '�---�
IN
s
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY , NEW YORK 12804
TELEPHONE ( 518 ) 745- 4424
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED
NAME'��r � c
LOCATION .{- /��
DATE / D 1 ¢L-- PERMIT#
APPROVED
EXITS N/A YES NO
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS t
AUTO . EXTINGUISHING SYS EM
HOOD INSTALLATION
AUTO . SPRINKLER SYSTEM
ALARM SYSTEM
INTERIOR FINISHES
STORAGE :
CLEARANCE TO SPRIN LERS
CLEARANCE TO HEATING UNIT
REQUIRED STGNAGE t'
CHIMNEY
WOODSTOVE
FIREPLACE-MASONR
FIREPLACE- FACTORY BUILT
REMARKS : Lj OK TO THIS DATE
2/015
N PECTOR
i ELECTRICAL INSPECTIONS
i pl,Ipt ATE MUI+IICIPAL RECORD
permit No. _ -•--..... '--`-- -
-------`--- ---
Owner
s
---:--"l --
—'- 4
......L�ationjam 7— I _
// �'•ry� _ -
-----------------
LL
70Wn 4f C,:itY
i applicable ,
Installation as itemized On reverse sine has been visually Ynspected pursuant rn app
Codes. ! i
�- Installed lny --- - -
aAM -
fy� , { spect r
----- INC-
Date .._-."- --`--
1 MIDDLE DEPARTMENT iNSPECTIflN AGENCY 9W Iiaddon Ave., C0111n9ewood. NJ 08108
FORM V40- iB E.L.
' Caer:. �w it_. r Y� y ; N.P- A1R COMOI TION ER WIRING h
RECEPTACLLESES CCNTRpI'S FOR
13VRNER
15 y FIXTURES H-P, PUMP
2- oMP. SERVICE EOUI PM EN7 K�W- OVEN
�
H.P.. GARBAGE OISP<3 AL UNIT 1MP, SERVICE CQNgUCTpR3
K.W. SURFACE NiT K.W• DISHWASNER
V
K.W. RANGE K•W. ORYER
K.W. WATER HEATER Rl=CEPTACILL
FRAC. H.P. WEN: FA Ny'i '
MOTORS H,P. 1/20 1/12 1/10 x,£
.MARK NVMBF % 1 114 2 3 5 714 �Q �S z¢
!OF EAGR 312E 255 ,3Q 4Q So 75
:APPARATUS
BUILDING and ZC)NING DEPARTMENT
Bay and Haviland RoadI, R. D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYST NS hf IO
LOCATION /
DATE
PERMIT NCI .
SOIL TYPE - Sand - Loam - Clay
Test Required? YES - No
Percolation - Min/Inch
Percolation rate -
TYPE of SYSTEM:
Absorption field , total lengtth
Length of each trench
Depth of trenches
Size of gravel'
SEEPAGE PITS*Nuynber oft) —
size-- ft. X -
Gravel size Size Type
PIPING :
gldq , to tank
Tank to di.st_ box ----
DIsto box to field/pit
XES NO Partial
openings sealed?
LOCATION/SEgARATIONS : t.
Foundation to tank tion ft .
Foundation to absorp ft.
Absorption to lot line ft .
Separation of pits p C)PE
Left TX (circle one)
LA]C.,AT10K OF SYSTEM ON fight side -
Front - Rear - sid-k-
CC7MMEN`SS : T
-n
V
SYSTEM USE APPROVED YES
NO
LtWIIIIIII-
Bu31ding Insp for
r-
ql�� vl
_,./own v/ Queensburry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801
tSEPTIC DISPOSAL SYSTEM INSPECTION
NAME ► 1 ��c��, f !" 7 ,�
LOCATiot -6 AC
,HATE 2( /_?�Z PEPN'MIT NO. C ?L - C7
SOIL TYPE - San Loam - Clay -
Percolation Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field , total length
Length of each trench f
Depth of trenches
Size of grav,$
SEEPAGE PITS4Number of)
Size- .!Zft. X �ft.
Gravel sizeZ�
PIPING : Size pe
Bldg . to tank A4 ( LCQ t,I t-
Tank to lost. box fi
Dist . box to field/pit
Openings sealed? YES O Partial
LOCATION/SEPARATIONS :
Foundation to tank IK ft.
Foundation to absorption pk� ft .
Absorption to lot line f—Lo
Separation of pats & Kft. YYY
LOCATION OF SYSTEM ON ERTY (circle one)
Front - Rear - Left s a Right side -
^COMMENTS .
pip i S '467)'N- L4W
SYSTEM USE APPROVED YES NO
J5(�'L7> tA
t ro �
Building ns ector
Purr
01/86 and vl
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY , NEW YORK 12804
TELEPHONE (518) 745= 4447
BUILDING INSPECTOR' S REPORT
REQUEST FOR
�I~N-SSPPECTION RECEIVED ,31
NAME ''y � { �c~[ C�`�i J a�y) 1
LOCATION/ d '7 rYM i 0 d2
I % ..
DATE PERMIT # � s
TYPE OF STRUCTURE ± 3,b
RECHECK `) hrr +C �S Cnr YS APPROVED
N/A YESI 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 C CRETE.
MATERIALS FOR THIS PURT?SE ON SIDE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN P[*CE
PLUMBING UNDER SLAB
XFRAMING :
JACK STUDS/HEARERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
HEATING ROUGH- IN
.INSULATION : IL
TT� FOUNDATION WALLS INTERIM R
FOUNDATION WALLS EXTERI R R-
FLOORS R-
WALLS R=
CEILING R-
DUCT WORK OR PIPING Ind UNHEATED,,
SPACES
REMARKS : p
f'vcK 4*v t.,
ARRIVE . .
DEPART
INSPECT)DR
TOWN OF QUEEN BURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY , NEW YORK 12804
TELEPHONE (518 ) 745-4447
BUILDING INSPECTOR 'S REPORT
REQUEST FOR INSPECTION RECEIVED
1
N,AME_.�__,��'��j
LOCATION
DATE PERMIT # -
TYPE OF S RUCTURE
RECHECK APPROVED
FOOTINGS/PIERS N/A IYES1 NO
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOW114G
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE C)N SITE :
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
->f ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLAC
PLUMBING UNDER SLAB
FRAMING : i
JACK STUDS/HEADERS
BRACING/BRIDGING
MOIST HANGERS
JACK POSTS/MAIN BEA
HEATING ROUGH- rN
INSULATION :
FOUNDATION WALLS ERI R R-
FOUNDATION WALLS XTERIOR R-
FLOORS R.
WALLS R-
CEILING R_
DUCT WORK OR PIS ING IN UNHEATED
SPACES
REMARKS :
ARRIVE
DEPART
PECTOR
TOWN OF {QUEENSBURY /
BUILDING AND CODES DEPARTMENT /
531 BAY ROAD
QUEENSBURY , NEW YORK 12804
TELEPHONE (518 ) 745- 4447
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED , 7'
NAME
LOCATION
DATE v/�IJ� 'I�/l� PERMIT
TYPE OF STRUCTURE_����?
RECHECK APPROVED
FOOTINGS/PIERS N/A YES NO
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 TE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLAICE
FOUNDATION/DAMPROOFIING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS P CE
PLUMBING UNDER SLAB
X FRAMING -
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN E
HEATING ROUGH- IN } �
INSULATION :
FOUNDATION WA LS IN ERI R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R»
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
R EMARKS :
{. c""
ARRIVE
DEPART
;jIfSECR
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY , NEW YORK 12804
TELEPHONE ( 518 ) 745- 4424
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVE
NAME V4,,
LOCATION Z Q ,
w
GATE PERMIT# 5 Z
7
A,` VED
EXITS I
N/A YES NO
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
AUTO . EXTINGUISHING SYSTEM.
HOOD INSTALLAT ON
AUTO . SPRINKL SYST M
ALARM SYSTEM
INTERIOR FINISH
STORAGE :
CLEARANCE RINKLER5
CLEARANCE 0 H TING UNIT
REQUIRED SI AGE
CHIMNEY
W¢ODSTO/E-MASONRY
IREPLA
FIREPLAFACTORY BUILT
REMARKS : OK TO THIS"DATE
4&T 2/015 ECTOR
T6WN OF QUEENSBURY
3 P�-
BUILDING AND CODES OEPARTMENTO( +�' '
531 SAY ROAD ptT - +-
QUEENSBURY , NEW YORK 12804
TELEPHONE (518 ) 745- 4447
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVES . ^ 4
NAME 44
LOCATION
DATE PERNIT #
TYPE OF STRUCTURE
RECHECK APPROVED
JIB' FOOTINGS/PIERS N/A YES NO
/ MONOLITHIC POUR O
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPOASISLE
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 I PLACE
PLUMBING UNDER SLAB
FRAMING :
JACK STUDSMEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM r
HEATING ROUGH- IN
INSULATION :
FOUNDATION ALLS INTEWOR R-
FOUNDATION WALLS EXT OR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIP
SPACES JMG I N U EATE
REMA KS :
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ARRIVE
DEPART�?'. C3 _
INS EC R
r
TOWN OF QUEENSBURY i'lra
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY , NEW YORK 12804
TELEPHONE (518) 745- 4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIYEI!
NAME
LOCATION pF`
DATE.. .A PERMIT
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
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VEIITS IN PLACE
PLUMBING UNDER SLAB
FRAMING :
JACKS UDS/HEAD RS
BRACING/BRIDGING
MOIST HANGERS
JACK POSTS/MAI BEA
HEATING ROUGH- IN
INSULATION :
FOUNDATION LL IN E iO -
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK O PIPING N IINNEATE
SPACES
REMARKS :
ARRIVE
DEPART
INSPECTOR
T06111 OF QUEENSSURY
BUILDING 53 D BCODES AY ROAD DEPARTMENT
QUEENSBURY , NEW YORK 12804
TELEPHONE ( 518 ) 792- 5832
BU I Li1ING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION CC A \ ���
DATE 9 Z- PERMIT !
TYPE OF STRUCTURE
APPROVED
RECHECK N/A YES IILNO
x OOT N S/PIERS
MONOLITHIC POUR FORM ---
REINFORCEMENT IN PLA' E
THE CONTRACT IS RESPONSE^
FOR PROVIDING PROTECTION FROM
FREEZING N S
PLACEMENT OF FOLLOWING
THE 'F CONCRETE&
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE -
FOUNDATION/DAMPROOFING��_
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VEN S IN PLACE
PLUMBING UNDER SLAB
FRAMING :
JACK STUDS /HEADERS
BRACING/ BRIDGING -
JOIST HANGERS
JACK POSTS / I AM
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUGH- IN L
INSULATION:
FOUNDATION WA S I ERIO
FOUNDATION W LLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING
DUCT WOR OR PIPING IN UNHEA ED
S PACES
£MARKS :
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ARRIVE
DEPART NS E R
I Id
MIDDLE DEPARTMENT INSPECTION -7A Yr ..C
NWonal He amens
1337 1 Ghp . P1 r�;WQst Chera;pw. P'A419 '
Date :
City, Town or Township County lf�4aft -,—.Slate
ocationfAddress
ilf Lac d ' u al Area Please Attach Directions} Pole #�
Owner /E•. s9r Permit
r Building*. New[71 Old E3
Occupied =
Occupant WQjrk Areajo Buildin Floor 0, etc.1 :
for: Whin Service or: _ Read for Inspection ;
Fee Remitted - $ Cash m Check 0 Mi Maps Pa ble'. Fo .IiA:i3.l.A
sac 75a loan ;2w 1sAo 7
.zoos s25o R5D0 4750 aOOP
Number of'RouO Wiring Outlets Elect. Heat
Switches Amp. Service r$Urfage .Unit Dishwasher -R
Lighting Water Heater Air Conditioner Dryer .!
Receptacles ;
Oven ,__; , _�Gark►age-Disposal Wiring and Controls for- E wne.r
Number of Fixtures . Amp. Receptacles _ Fractional H.P. Vent Fans
Other Equipment: .
MOTORS PUS. 1/ Y/ Y/10 1¢e Y/6 1/4 l f3 1/2 3/4 1 4¢ 2 - 3. 5' 7 l0 15 24 25 34. 40 50 7e foRf
Mark Number -
of Each Sixe - ' '
Applicant's License.# Permit #.
Signature I _ utility: ' '
T/A AM
Applicant
(City) LL tate) (Zip) Service Request #
ician: ,
4TE#Ff(* IVE£i: . DATE INSPECTED:
Correct Location : Same as•Alpt0m : ox:
Red Notica Label
litiugh WPrin IDUtlet& Surface iJnit Oven .
Switches Ran . . : GarbAW Di oral .
Receptacles Water Heater Dishwasher
Fixtures '' -; �' ` '. Air Conditioner D ryer
Amp, Service Equi ment Burner. Wiririg.&&Corrtrols for - Amp[: Retieptacle
Am .:Sasvine r Gondu&lof '
PumP ;� VenC Faris° -
MOTORS H P.
1/4 1/a 1/2 3/ '1 -' �'. ' 2+ - 3 ,r
Mark Number
of Each Si xe
500 75C lees 125GF 1500 17ee 241C4 2SSO xee0 p7ao
Elect. Heat] ..
[� RW Progress: Inc. LKD 0 Contractor
Q CFT Violation : Work Comp. 0 inc. CASH
L/A Owner Fee CHK #
L/A Duen fill[] # .
0, IPA .. Mu ;ci pal tw IV
E. ' �r .. S p;pplicant
Q Other Side Q Lmllty x9A 5 �14i/fTer
fi + n
Cut in Card �] Temp # Date - - ., .
Yhi S163NPcT
Final # Date
:.. .. n..'n. a ,C n. . . •b r,. .n.. '- ' T. .z.a...A: = 7
,e P i tioi+l`FoAM i O- 2eo Ci`i
' , _ HIDUL.E DLPARTMFP'+T INSF'I C1 10N AGENCY , IPIC . " •
IT IS YOUR RESPONSIBILITY TO CALL FOR ELECTRICAL INSPECTIONS BEFORE WIRING
IS COVERED .
FEES FOR ELECTRICAL INSPECTIONS ARE SEPARATE FROM THE TOWN OF OUEENSRURY BUILDING
PERMIT FEE .AGENCY AND PAYMENT IS
TO DOCWITN�IT1iE � OW�IE POLICY OF OF i7UEENSI3URY �iE INDIVIDUAL INSPECTION
ELECTRICAL INSPECTOR FOR THIS AGENCY IS '
DONALD LOVELAND I - snO- 479- 4504 call between 7 : 00 a . m . and 9 : 00 a . m .
Monday through Friday
Middle Department. Inspection Agency . Inc .
National # leadgoarters
goo f#arldnn Avenue
Col 1 ingswon(i Nil OSIOS
2324
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TOWN OF QUEENSSURY
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