1991-517 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
,WARREN COUNTY,. NEW YORK
Date December 12, 19 91
This is to certify that work requested to be done as shown by Permit No. 91-517
has been completed.
This structure may be occupied as a . of FotBrplex °Dixon II
Location 76 Old lei 11 Lane
Owner C & I Realty/ Masul l o Brothers Builders
By Order Town Board '
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
'lI .- 0-1
BUILDING PERMIT
TOWN OF QUEENSBURY 0
No. 91-517
WARREN COUNTY, NEW YORK Cr\
PERMISSION is hereby granted to ilasullo Brothers Builders
OWNER of property located at 76 Old Mill Lane Street, Road or Ave.
in the Town of Queensbury,To Construct or place a . of Fourpl ex "Dixon I I n
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.
0
1. OWNER'S Address is CA
C & L Realty 0
3049 Broadway
fp
Schnectady, NY . -s
0
2. CONTRACTOR or BUILDER'S Name
Masullo Brothers Builders
' a"
3. CONTRACTOR or BUILDER'S Address C?
0
4. ARCHITECT'S Name
Cu
rD
5. ARCHITECT'S Address
0
I1
0
6. TYPE of Construction—(Please indicate by X)
ffl
( X Wood Frame ( ) Masonry ( )Steel ( ) X
7. PLANS and Specifications
X
No.1,319 sq ft 4 of Fourplex as per plot plan specifications and
application
8. Proposed Use
•
4 of Fourplex
$ 207.00 PERMIT FEE PAID —THIS PERMIT EXPIRES July 17, 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 17 h___) Day of_, ,g > J my 19 91
(
SIGNED BY //G/S?v�" '� / for the Town of Queensbury
Building and Zoning Inspelctor
, TOWN OP qUEENSBURY : , : ,
" • COWN OF QUEENSBUH
REVIEWED BY 7.-7)," RECEIVED
Ol111111Sil FEE PAW $ .0 JUL 1 6 1991
t:LS pERMTI' No.• .
. . .. .
BLDG. & CODE DEPT.
notiia kiiiiii APPLICATION . I .• , . , .. ,,
. . .
. i . . .
. ,
, •
. ,
. . . . .
A PERMIT MUST BE OBTAINER BEFORE maa CONSTRUCTION. NO INSPECTIONS
WILL BE MADE UNTIL APPLICANT liAg'BECEITED A VALID BUILDINCI PERMIT, 1
.',..
All applicants seaces on this application MUST be completed and the signature of the
applicant MUST appear on the reverse side of thit application.
. • e, •,..,; • *, r • ,*, ‘0•,•a,$ 41. 4!., .!!,1„..:i • • • lii .. . ok • • • • • • • * • * • to • • • • •
The ownerof this property Is! CiLleile. 3 ,-: . 1
P.O. Address
:
Property Location 96 61. .`tfia. LAAd • '''' ' . ' . • ' Tax Map No.
:
Hat there been any split of this property since Trq88
October i, I ? ___• / k '
: ,. .k Xpr
If yes Planning Boardl Review is necessary. . Os no
-Di o
n
SUBDIVISION NAME, IF APPLIdABLE,AN /WOO ;,: -;.• ', LOT NO. . . • ;
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS Kt dAitbs Tro4VILDING CODES IS:
. eAT/4/4/6 Z.. PM5l/LiD t, : . , : , . •,
- NATURE OF PROPOSED WORK, : ., 1 :.•,' :II , ,,; ESCIMATED MARKET VALUE OF •
)<, Construction of a new building * CONSTRUCTION: I M000
. , .
Addition to a building • COMPLETE INFORMATION REQUIRED BELOW:
• Size of Ok•Oper.ty!/0/./3. SA:64 ilf Milt x -ft. •
--- er Altation to a building .
1' Existi ,
(no change to eitterior dimensions) :' • • rnti;•,••••-•-
Buildlitzt(3) Size ft. x ft.
. • Propciteir building -,distance from property line:
Other work (Describe) - "' ‘i - ; jo; "
- Front yard w Me ft. Rear yard 3,1 ft.
Side yar 0 ft. and 0 ft.
I . .
ci GROSS AREA OF PROPOSED S1UCTUR4 f : . It on corner, setback from side street ft.
.,1 .?.11 , „.,.,.., ,, ; 1 .. ,.. . ': ,.. ,,,,.., • .,, „ ,0 1
". .z /1 • ! ;;t.'7,1•• >31.):M
! 1St Flocie . ‘.4Po'l= sq. ft. 6'1 ! '(/ ,,i.:.. ,,, .„ . : .. OCCUPANCY-INFORMATION •
.';':14•'.;nA ii. - ' 1', ''•' 1 ! ;.„.• , . .. ,
2nd Floot_. 5,7 . sq. it. P,`l' P. ,, .gr ',.Frimary Building -
''..?,:4•:)1;:k.::"3‘•'':;ICO a r ii -iiii. ..iiin
Other Floors' ' -:/ya ' sq. ft. . , 7 . .67,14.,,,,...,..-- n am y • g ..
(not collator 6ssement) ::•• : ; . '' ,--<•111.:•.,:'!: Two Family Dwelling ' •.'• '
!TOTAL FLOOR AREA 13/q _ sq..ii.:: 5..;`:' , 4: c,/, Ili Multiple Dwelling/Number of units__
businut
18121 of neiv structure 'it tt x 224/ ft. . •
'Foundation-pier/slab/crawl/partial 0. .,. : Industriel
. . . .
1 1 ,•'I,f (circle one) ' ••c ..";. .., •1 ,‘,:, ' '•'other
1 1 ii , • , i , • - I: 1.. t io ! ±,777 ;, ,,I ,-,
. ,.
NO. of stories (habitable spice) ..Z. • ' ! / :'.' . ' .' M. '' ' ,
IHeight (grade to ridge) ' 20 -:-7. • - it., ,- : . • ' li addition, what will use be? • i
If residential, no. of femilles J : • , .
Nei. of roomidexcludIng baths/ , . . . ::. 1,:t,: '.?•:'•'1'!; Accessory Building
;
NO. of Icedrsietne ' ' t Z.' : ' e • '
No. of bathrooms 7 . i: Detached Garage ONR/1110 Car
1 6 ,
Primary heating system 6115 iin-O •ft • ; X Attached Garai 0 E WO Car
Type of fuel 6A.S . :.. ., . Private storage building
• ONINE •mm.M•=0
. 0.
NO. of fireplaces to be Installed -a- . '
• Other
i Win a wood stove be installed NO . ' • ..
•
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
'Noe of construction, wood frame, fire safe, etc., . VOW /KAme w/2"7 X / f WAG' n /YEmt OlitZ5
Will any second-hand or upgraded lumber be used? if so, for what? f)o
Foundation wall material ‘J1VD/� /GIBED Ct� Thickness
Q�
Depth of foundation below grade (to bottom of footing) 1 /ii,ij
Will there be a cellar? E Heated or nheated Floor sq. footage 66Z sq ft.
Will there be a basement? No Will any por ton be used as living space? N0
(If so, what portion? • sq ft. Type of use?
Type of roof - slope flat/shed/other Material of roof ./ / tT ' �iGQSS isms J
Size, wood studs " "x 6 " spacing/6' " o.c. length &vft:.
Joists (floor beams)'lst floor "x /0 " spacing•s 16" ;'o.•c.:spttiti: .•.j3 ft•.;AR.ZFfU. •
Joist (floor beams) 2nd floor Z "x Jd " spacing 16 "o.c. span:a,;I f:.t: p,(<6S5 ;t
Overlays (ceiling beams) Z. "x 6 " spacing 16' " o.c. span )2 ft. .
Roof rafters 2. "x )D " spacing 16 " o.c. span /Z' ft.
Roof trusses (pre-engineered) spacing 24 " o.c. span ft.. keT7063 CCg77fk 0 5
Exterior wall finish I-10q/'i'd,IITAL. B0960 ''of•what material? U lL
Interior wall finish yz'" pan OE OM . •
If a garage is to be attached, describe materials to be used for FIRE SEPARATION; • ' •
X Di x �yp \I '/i . REPeoR 1 eter,t • ..
Is there to be an opening betweengage and dwelling? YES If so will a Fire-rated door, enclosure,
self-closing device be provided? f�ES .
Will a flue-lined chimney be installed? No Height above roof ft.
Depth of chimney,•fotindatio,n bellow•grade ft.
Depth of fireplace hearth• ft. ' in...
, Water supply - Municipal or private well flh,NICI
SEPTIC SY$TEM Distance from ANY. private well (including adjoining properties /5olwuv ft.
(A sepRrAte nppllc.tt.,n Is necessary.for any repair or new installation of septic system)
yy��
NAME OF BUILDER �''IASolto gro7�1i;As ,+co�s U DRESS3V��8IA�IIity. ENE EL. NO. 1011)
NAME OF PLUMBERI IrD aupim ADDRESSZNEYjhW APE. kin TEL. NO. - 1V - /811
NAME OF MASON /'1131 POW NA41O4 ADDRESS ADVAy.40/XEC1 'TEL. NO. 720-1� -0
NAME OF ELECThiCiANO no, act, ADDRESS 179 P�xiOOO 35-51/P0
'� Avg TEL. NO.
•
.�GVS11�cmLr
DECLARATION
To the belt of my knowledge and belief the statements contained in this application, together with the
plans and specifications submitted, are a tits end 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 lawn pertaining to the proposed Work shall be complied With, whither specified or not, and that
such work is authorized by the owner. .
Signature . -
Owner, owner's agent, archltat t, contractor
SPECIAL CONDmONS OP THE PERMITS
BY
i
1
TOWN . OF! QUEENSBURY••.
j
i ..
•
WARREN COUNTY ; NEWYORK ,
Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE i Ot-vm OF OV"�ENSBU1-Ck
A permit must be obtained before beginninqEwor .
ANSWER ALL of the following i JUL 1 6 1991
Onl .' Gross: floor area DG DL • ° COOE DES
.
' 2 .: Type of heat GAS HOT AIR
mechanically cooled?, ; NO
3 ;' Is the building
' I j 4 . Percentage of area of ,windows and doors MIN 8%
A. over . 1 6% Only . i
'1. Uo value of gross area of walls , roof/ceiling and floors
i exposed to ambient conditions
i 2 . Floor over heated spaces YES NO
I 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
1 ! ;i perimeter. of floor?
I
4 . Is basement heated? YES NO
a. R value of insulation •
1
5; Type of insulation .
B. Under 16% Only ` ' •,
- 1. R value of roof and' floor,s exposed to ambient conditions
i R- 30
2 . R value of exterior: walls R_19
3 . R value of glazed area . 2 .25
4 . R value Of doors 2 . 50
5 . R value of floors over unheated spaces -
6. ' R value of slab edge insulation - unheated slab na
7 . R value of slab insulation heated slab
g. R value of heated basement/cellar walls (above grade) na
9. R value of heated basement/Cellar walls (below grade) na
i
1o. Type of insulation FTRFRGIASS RATT
C. Controls • ' !h 90°
1 . Thermostat maximum ;ieat • settling
D. Duct Systems • ; . Zia]
Is duct system installed ih unheated spaces? YES
1 .
' • a. If YES , R value of ductiinstallation
b. R value of duct in other; areas
E. Piping Insulation
1 . Size of hot water or cooling carrying agent pipe 1 /2 & 3/4
: :2 . R value of pipe insulatio
i
I I
. I F. Service Water Heating ; ,
•
!. - `l. Performance efficiency H
2. Temperature' control setting `maximum
• G. For • swimming Pool Only ;
1. Maximum heating ,
! No - 110141411 Telephone . - 1 (applicant ' s signature)
1 ' 1
/�`
TOWN OF QUEENSBURY
s"siz APPLICATIOM FOR SEPTIC DISPOSAL PERMIT
DATE: 7A-9/ OWN OF QUEENSBUvi
RECEIVED
LOCATION OF PROPERTY FOR INSTALLATION 16 OLD Mat LANE'
JUL 16 1991
Owner' s Name: Ct� i'MLry
Address: 3D99 ,6iNDWAy &"ior iDy j4l&w rAx BLDG. & CODE DEPT.
' PAN �7ALUs0 .f .ems Telephone: ;T-00
Installer's Name:
Number of bedrooms (residential only) 2
Total daily flow (compute @ 150 gal per bedroom) 3OO
Topography: Circle one: grl Rolling Steep Slope % of Slope
Soil Nature: Circle one: and Loam Clay Other /Depth:
Ground Water: At what depth? 7 Zaf Feet
Bedrock or Impervious Material : At what depth? 700r Feet
Percolation test: Circle one: Cot required required
Rate - Min. Per Inch
Domestic water supply: Circle one: Municipal Well Other
If domestic water supply is a wel .
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank zoo gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPA E PIT(S): Number of 4 /Size each 6-8 feet
by 136 feet
Size of stone to be used #. 2 /Depth or Thickness /2" 3✓,O6 t E 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: I, DATE: l-l6`9/
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 it least 24 hours before start
of construction and shall include a plot plan shoving:
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 drywalls
B. Nu system shall be covered before inspection and approval by the
Building Inspuctor. 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 installa—
tion, alteration or repair of an approved system, a new proposal must
bu submitted to the Quuunsbury Building Department before further
construction.
Town of Queenabury .
BUILDING and CODES DEPARTMENT
Bay and Naviland Roads
Queensbury, New York 12804
k.zmarks:
•
•
•
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.(..1.1...&A.&A./A.,&A&A.& .&A.,&A J A.&A i.A&A&A&.A tA,.l o&A,&,.,ta&A,&A/.A!..\1:.&J•&A!.a.i..\{.A/,!.&A 4A&Ao&A.CAt1_?.4,A,&Ah.J.b_.1.&-, ,-M-Ate. ,-)°,.?.'-,i..,.&-,i.,,-,i ` I.: ,-� .
1,
.,. •
THE NEW YORK BOARD. OF FIRE UNDERWRITERS FA E '. `
J001'D57
-,.. BUREAU OF ELECTRICITY . :c F
1; 41 STATE STREET,ALBAN-Y;NEVV\YORK- 12207 •
1
Date DECE?I13ER 17,1991 Applicatio N o.on fa7437791/91. A 062965
�: THIS CERTIFIES THAT PERMIT \. . 91 5:i7
. only the electrical equipment as described below and introduced by above application number in the premises of
tILL REALTY, 76 OLD MILL: LANE OI.�t.ENi '(3C�Ri N.'i.
1: in the following location;' El Basement L"J 1st Fl. •LJ 2nd Fl. (J�R Section Block Lot - -
�, was examined onDECABER and found to be in compliance with the requirements of this Board.
_' FIXTURE I FIXTURES RANGES COOKINGDECKS OVENS DISH WASHERS EXHAUST FANS
- DE
ECEPTACLES SWITCHES
OUTLETS INCANDESCENT-FLUORESCENT OTHER AMT. K.W. AMT. . K.W. AMT.. K.W. AMT. K.W. AMT. H.P.
s' DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS �J
1: AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT,. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS )
�, a. 3 1 F. I
_ �_ _-SERVICE_DISCONNECT___ NO.o __ ::_: ._ _,_ -_-- =-S - ._-E- -R--------
V—"- -1 - C� -. - _ -
.
METER
�. AMT. AMP. TYPE EQUIP 1,B•2W 1.fir 3W 3,B'3W 3,t1 4W NO.OFZ ZCOND. OF CC.COND.. Na OF HI-LEG OF•HI-'LEG NO.OF NEUTRALS AJALL
1•
1 150 CB 1 X 1 !D 1 IID .-
OTHER APPARATUS: .- ... .
C7.F'. ... I . 3
•
SMOKE DETECTOR: -1 .:
1 — ..
ANTHONY •
GL Z. RDl -
179 DO :��OOD DRIVE - crt �
k
SCHENECTADY,, �iY , 12303 BRANCH MANAGER
• 239 ,> s
- . . 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. • ^
COPY FOR BUILDING DEPARTMENT. •1HIS COPY OF CERTIFICATE MUST NUI BE ALI EREU IN ANY MANNER.
\ \\).(5, P-D
TOWN OF QUEENSBURY
:jA'` 531 BAY ROAD
QUEENSBURY, NEW YORK 12804
W „` TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION R CEIVED
�
NAME Qk` OC O IL1
LOCATION 9 (0 oI> 1 1 ) l �f'..t'-'� a/
DATE PERMIT# 9 / -,5/
TYPE OF STRUC RE -ii, 4 �1,1 �.,I�%X
RECHECK Db
FIRE MARSHAL APPROVAL C MMERCIAL STRUCTURE)
(FOOTING (FOUNDATION BACKFILL ( FRAMING
ROUGH PLUMBING N4 FINAL ELECTRICAL 'SEPTIC
INSULATION WOUDSTOVE/FIREPLACE
REMARKS
APPROVAL
N/A YES NO
CHIMNEY HEIGH OCATION /,
B VENT/LOCATI `/V/
PLUMBING VENT /
ROOFING ,//
SIDING ./
DECK/PORCH/STEPS RA ' INGS 14
RELIEF VALVES i ✓j
FURNACE/HOT WATER OPERATING
BASEMENT INSULATIg `.DUCTWORK Li/
INTERIOR TRIM/PR AC'1( DOORS
FINISH FLOORS:
BATH/KITCHEN fATERTIGHT
OTHER FLOORS .WEEPABOE
OTHER FLOORS 'CARPETED\ ✓/
STAIR CLEARAN �/RAILINGS%
HANDICAPPED ACCESS /
SMOKE DETECT 'S i,
BATHROOM FAN /WHOLEHOUSE NS /
ALL PLUMBIN FIXTURES OPER TING 11,2
4
GARAGE FIR PROOFING \\
DOOR CLOSE ✓
OTHER FIR SEPARATION
FIRE/DEMI E WALLS
DUMPSTER
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL t/j
OK TO ISSUE C/O OR C/C ►/
COMMENTS:
///,,,,, y),„4/3-/-----
z5
ARRIV E
DEPART `'
INSP TOR
TOWN OF QUEENSBURY (, /
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY,
NEW 0
TELEPHONE (518) 7792-5834 2
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED /9 (1/i
NAME ('I\C(5 (> O )r
LOCATION 7 (p ()I a tn.' kvile
DATE/194 /42/ PERMIT # 9 �)
TYPE OF STRUCTURE 45j
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 I
REINFORCEMENT\IN PLACE
FOUNDATION/DAMPROOFIN'G
BACKFILL APPROVAL Al
ROUGH PLUMBING `�.,
PLUMBING VENT/VENTS. IN PLACE
PLUMBING UNDER SLA?B`,
FRAMING: I `'1
JACK STUDS/HEADERS
BRACING/BRIDGIING '.,
JOIST HANGERS'
JACK POSTS/MAIN BEAM ,
FIRESTOPPING
WALLS
CEILING '
FIREWALLS I
HEATING ROUGH-IN
INSULATION:
FOUND1'rION WALLS INTERIOR R-',
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R- 3
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE J- ��
DEPART /1AGV,
I NS PEC TO
TOWN OF QUEENSBURY g/13
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED / ,/9/
NAME Ad.,1-6a14 .tx-Xi
LOCATION "b/ ? J/
DATE 7/`P3/ / PERMIT # J/ 7
TYPE OF STRUCTURE .%4 o�f 7/ j.((4�J,��j
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/VENTS IN PLACE
PLUMBING UNDER SLAB
y/RAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM , r'
FIRESTOPPING
WALLS ,
CEILING
FIREWALLS x
HEATING ROUGH-IN f'
INSULATION: d
FOUNDATION WALLS INTERIOR R-\
. FOUNDATION WALLS EXTERIOR R- "\
FLOORS / R-
WALLS R- \
CEILING j R-
DUCT WORK OR PIPING IN UNHEATED \
. SPACES i
REMARKS: ),
`\
ma's-c\
ARRIVE /a -�
DEPART //
PECTOR
. _Jown of Queeniur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEMGO
INSPECTION
SU NAME ' i 6 C,
LOCATION Old W/ 014/!ti�
DATE / /d PERMIT NO. 9 / -5? 7
SOIL TYPE - Sand - Loam - Clay -.
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
• TYPE of SYSTEM:
Absorption field, total length
Length of eachjtrench '
Depth of trenches ' '
Size of gravel \
SEEPAGE PITS-ENuMb of) -
Size- Wit. x \ 6 ft. .
Gravel size _ '-e /
PIPING: .\ / Size 'T pe
Bldg. to tank %C 6-1/A
Tank to dist. box , ii
Dist. box to field/pit 'Ill V
Openings sealed? YES NO Partial
N
LOCATION/SEPARATIONS: ,\
Foundation to Eank \,; ft.
Foundation to ,absorption \ re f t.
Absorption to/lot line `\v ft.
Separation 'ofj pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear Left side - Right side -
COMMENTS: •
Cv �L�'l�7CJ
SYSTEM USE APPROVED eff NO
411/1 /laf)441_2
Buing Insp ctor
01/86 and vl •
it'M OF QUEG SBURV / 26)
BUILDING AND CODES DEPARTMENT /eM
531 BAY ROAD /'/
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME Ll?f11,k2J c 9 A 20-v / ,a,
LOCATION 16. R
DATE (0 f3/9J PERMIT # Sf 7
TYPE OF STRUCTURE 7lf ei)-I)-L
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 K
BACKFILL APPROVAL X
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
FIRES TOPPING
WALLS
CEILING
FIREWALLS o-
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R
FOUNDATION WALLS EXTERIOR R-
FLOORS WALLS R-
CEILING R=
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
As p f, Lem;(,)L;.-1;6/6,
ARRIVE
DEPART Z;4() /7:7),„
IR
TOWN OF Q ENSBURY 101)1
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME \cso \ U k ' L)V` f
LOCATION 7(1 '0)O I11l1(-
DATE PERMIT # l 5/ 7
TYPE OF STRUCTURE
RECHECK APPROVE
N/A YES NO
OOTINGS/PIERS
MONOLITHIC POUR FORM r'
REINFORCEMENT IN PLACE /
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOWING/
THE 'PLACEMENT OF THE CONCRETE.,'
MATERIALS FOR THI PURPOSE ON !,SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL\
ROUGH PLUMBING
PLUMBING VENT/VENT\S IN PLACE
PLUMBING UNDER SLIB I
FRAMING: l
JACK STUDS/HEADERS
BRACING/BRIDGING \
JOIST HANGERS \
JACK POSTS/MAIN Br
FIRESTOPPING
WALLS vg
CEILING s ;
FIREWALLS ! \
HEATING ROUGH—IN /
INSULATION: , I
FOUNDATION WALES INTERIOR R—
FOUNDATION WALLS EXTERIOR R—
FLOORS R—
WALLS " \ R—
CEILING J '1 R—
DUCT WORK OR'PIPING IN"UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART (127 k
"INSPECTOR
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