1991-566 CERTIFICATE' OF OCCUPANCY
TOWN/OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 110trember 25, 19 91
This is to certify that work requested to be done as shown by Permit No. 91-566
has been completed.
Single Family 1, ;e9lirig
This structure may be occupied as a
Location Lot 061 Walton Corrr•ty
•
Owner Fprest Wood Hones
By Order Town Board
TOWN OF QUEENSBURY
r // /
,_ /
•
Director of Bldg. & Code Enforcement
BUILDING PERMIT
a
TOWN OF QUEENSBURY
No. 91-566
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Forest Wood Homes OWNER of property located at Lot #61 Walton Court Street, Road or Ave.
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.
O
1. OWNER'S Address is CD
HC-02 Box 286 P r°'
Warrensburg, HSY 12885
O
O.
2. CONTRACTOR or BUILDER'S Name
O
Same
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3. CONTRACTOR or BUILDER'S Address
O
Cri
I-1
4. ARCHITECT'S Name
a
rr
5. ARCHITECT'S Address O
6. TYPE of Construction— (Please indicate by X)
tO
( X Wood Frame ( ) Masonry ( ) Steel ( ) O
'7'I
7. PLANS and Specifications =d'
t �
No. 1,878 Sq Ft Single Family Dwelling as per plot plan specifications
and application
8. Proposed Use
Single Family Dwelling with attached two car Garage
$ 268.00 PERMIT FEE PAID —THIS PERMIT EXPIRES August 12,19 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 12th D y of August 19 91
SIGNED BY _ / /� for the Town of Queensbury
Building and Zoni Inspector
TOWN OF QUEENSBURY
4 REVIEWED BY:
F r FEE PAID: f2// %542owN OF QtiEENSBUhi
RECEIVED
PERMIT NO. : q/—J-D�
AUG 81991
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.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Owner of Property: • _nrpc+
P.O. Address: Jlc_o) L,,,r ,.,? � /„lx�. s�.��� �l Y o /,c-- PHONE
Property Location: /01- GI A/ /I,, r,,,,,,yf Tax Map No./Z// /7/ 45/
Has there been any split of this property since October 1, 1988? Yes No ,/
If yes, Planning Board Review is necessary.
Subdivision Name, if applicable: O IAPP,M5 m f rr;<I Lot No. /1/
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
Fore' INfovd 'IOWA
NATURE OF PROPOSED WORK: * ESTIMATED MARKET VALUE OF THE
/ Construction of new building * CONSTRUCTION: $ 90, 0b0
Addition to building
Alteration to building * COMPLETE INFORMATION REQUIRED BELOW: ;:
(no change to exterior dimensions) * Size of Property: 1 ' ft. x ig,
Other work (describe) * Existing Building Size:
* ft. x ft.
* Proposed building - distance from
GROSS AREA OF PROPOSED STRUCTURE: fn * property line:
1st Floor ri/D Sq. Ft.6/16( 0'0* Front Yard 35 ft. Rear yard ft.
Si
2nd Floor s Sq. Ft. /U�ID U * Ifdone Ycorner, setback ards ft. afrom sidend street
ft.
Other Floors Sq. Ft.
(not cellar or basement) OCCUPANCY INFORMATION:
TOTAL FLOOR AREA: Igk 7 W Sq. Ft. f "(/* Primary Building -
* ,/ One Family Dwelling
Size of New Structure: A ft. x yt ft. * Two Family Dwelling
Foundation: * Multiple Dwelling/No. of Units _
Pier/Slab/Crawl .P aParti_q/Full (Circle One) * Business
* Industrial
No. of stories (Habitable space) a * Other
Height (grade to ridge) as ft. *
If residential , no. of families: I * If addition, what will use be?
No. of rooms (excluding baths) : $ - *
No. of bedrooms: y _
No. of bathrooms: c * Accessory Building:
Primary heating system: La-f ,,;;. * Detached Garage - One/Two Car
Type of fuel : t5r,5 * -,/ Attached Garage - One%Two Car
No. of fireplaces to be installed: I * Private Storage Building ,
Will a woodstove be installed?: ho * Other
Central Air Conditioning: Yes No ,/ *
(OVER)
BUILDING PERMIT APPLICATION CONTINUED:
BUILDING SPECIFICATIONS:
Type of construction: wood frame, fire safe, etc. Ark L;/7 bWei
Will any second-hand or ungraded lumber be used? If so, for what? sin
Foundation Wall Material : cohrwAir Thickness:
Depth of Foundation below grade (to bottom of footing) : 4,11:? ,
Will there be a cellar? no Heated or Unheated? Floor Sq. Footage.:
Will there be a basement? Wj Will any portion be used as living space? iv
If so, what portion? / Sq. Ft. Type of Use?
Type of Roof: loped/Flat/Shed/Other Material of Roof _
Size, wood studs . " x 1,, " ; spacing . IL " o.c. ; length y ft.
Joists (floor beams) : 1st Floor 7 " x in " ; spacing /A " o.c. ; span /? ft.
Joists (floor beams) : 2nd Floor a " x /n " ; spacing J( " o.c. ; span /y ft.
Overlays (ceiling beams) : " x "; spacing " o.c. ; span ft.
Roof rafters: x " ; spacing o.c. ; span ft.
Roof trusses (pre-engineered) : spacing 7y o.c. ; span ( 36:2 ft.
Exterior Wall Finish: v;h) / s;/ �J of what material ?
Interior Wall Finish: ,s(,, -/. I
If a garage is to be attached, describe materials to be used for FIRE SEPARATION: 4i SJ,oG,L
c11-1- �i ��hg S r,uj �;!c 1,16Its
Is there to be an opening between garage and dwelling? Yes If so, will a Fire-Rated door,
enclosure, self-closing device be provided? \f,pS 1
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 - Municipa oor private well :
cLn�a� mar
SEPTIC SYSTEM: Distance from any private well (including adjoining properties: ubo ft.
(A separate application is necessary for any repair or new installation of septic system. )
NAME OF BUILDER & ADDRESS: Frnsi- Infhn ti pf �l( -0) 91i hW44,,7.itH�s fyi/, PHONE (�a )1)
NAME OF PLUMBER & ADDRESS: VI Owl((r,�.�/SI (2,� a, J PHONE 42/- p
NAME OF MASON & ADDRESS: II !%nS P,x(fl i r�.r i/I;^,viIf Sl, Anid5g11 6/lf PHONE -7.17-wx).
NAME OF ELECTRICIAN & ADDRESS: LI r:/jr,h) �..! �,,,n 1<i,�s �� ; ,//y PHONE -)k-0-00/kj
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 pertai ing to the proposed work shall
be complied with, whether specified or not, and that such works authorized by the owner.
Signature I\
• Own:err} owner' s agent, architect
contractor
SPECIAL CONDITIONS OF THE PERMIT:
By:
Code Enforcement Officer
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE a DMS OF QIlEENSBUh,
RECEIVED
Compliance Methods: AUG 8 1991
45
PART 5 - Acceptable Practice Method - 1 & 2 Family Dwellings (ONLY) 4 ;
BLDG. & CODE DEPT.
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
&its+ MO) thr01s 101. (Ai 1il/a,Hon ( ur/
APPLICANT'S NAME PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - Sq. Ft.
2. Type of Heat - Elec. Base Board Other C4zz lint Gl 1r
3. Is Building Mechanically Cooled? YES J✓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 3 0
B. Exterior Walls R 1°(
C. Glazed Area R /(0
D. Exterior Doors R
E. Floors over unheated spaces R /6) rr
F. Edge of Slab on Grade (Heated Building) R 2 ihC/
G. Basement/Cellar Walls (Above Grade) R
H. . Basement/Cellar Walls (Below Grade) R
I. Heating/Cooling - Ducts - Piping in Unheated Space R. 10
6. Service (Domestic) Hot Water Heating Device
A. Conforms to minimum efficiency per code V/ YES NO
TEMPERATURE CONTROL MAXIMUM SETTING 140° WILL NOT BE EXCEEDED
/Lil 61711
APPTT1S SIGNATURE J DATE TELEPHONE NUMBER
INSPECTOR'S REMARKS:
REVIEWED BY
Olabil
sskr.
�.., � TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Pe�r�m,i,.�t F �'°.r-r—A at ill
k
Fee ral ECE-0.t. i
Date: �#,t4 ( / 041 ReviewedAgG 8 1991
LOCATION OF PROPERTY FOR INSTALLATION: 104 b.f Ida I 1p1, 601.144-*Dr,„ & CoDE TIE PT.
Owner' s Name: ��oild LJOoj POIM,5
Owner' s Mailing Address:
J
Installer' s Name: )4nI ,�� ,,,,, -„,✓6 .
r�►P Phone #: 7Ll7-0)A2
J J
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom) : ton V
Topography-Circle One: Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? - Q' Feet
Bedrock or Impervious Material-At What Depth? -a 8 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 we -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank 1000 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 0 feet//Total System Length .240 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 Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: 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 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:
THE NEW YORK BOARD OF FIRE UNDERWRITERS CERTIFICATE NO.
DO NOT WRITE HERE-FOR OFFICE USE ONLY
BUILDING((( PERMIT NO.` I
• TEMP q DATE C) I /5'n' /�
CITY OR VILLAGE j TOWNSHIP/ COUN_TYI �j/lll���///
/ J -
STREET AND NO.OR ROAD / l 1,•' -�1 POLE NUMBER
t
BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION / ' ( BLOCK / tpT
OCCUPANT'S NAME BUILDING OCCUNCY Y/✓"1
( �^
,J HOME TELEP
OWNER'S NAME AND ADDRESS HONE NUMBER
CURRENT SUPPLIED BY - FROM THEIR OFFICE WORK TELEPHONE NUMBER
• ,
BUILDING IS
NEW L=d_, '- OLD❑ WORK IS NEW Lam. ADDITIONAL❑ DEFECTS REMOVED❑
• LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS No.of Fixtures& MOTORS HEATERS BRANCH OFFICE USE
Loca- Lamp Receptacles CIRCUITS ONLY
tiOn Side Attach't ---- H.P. Watts AW.G.
Ceiling Wall Recep'Is Switch Pendant Bracket No.' - pe .Each No. Each NO• Gauge INSPECTION
OUT- f `' f' %.,
SIDE -� 1 f. .I) \0, l .?f� + T I 1�w /.
SSUB-ASE / �1 + t.1 ' i_r 1 ; ,.. .
I ,..,
BASE-
MENT J it f.' 1 /. ' --
1st /FL. \ yy
1 l
2nd `L /- ,1 i! /FL.
3rd \ ,`
FL. ,,,•
REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE. _ ..w
THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED,BUT IF AT TIME OF INSPECTION,THERE IS
FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER
THE ADDITIONAL EQUIPMENT,AS PROVIDED BY THE APPLICANT.
.
SIZE OF MAINS FEEDERS/ ELECTRIC SIGNS/LAMPS TOTAL WATTS
CHARACTER OF WORK ❑ EXPOSED GAS TUBE SIGN/TRANSFORMERS OF VA
❑ CONCEALED
D/UE WORK TO BE STARTED DATE COMPLETED SIZE OF SIGN(NUMBER) CAPACITY
SERVICE ENTERS BUILDING MANUFACTURER OF SIGN
0 OVERHEAD ❑WWDERGROUND
DATE INSPECTION REQUESTED ON(OR AS NEAR AS POSSIBLE) MUST ENTER APPLICANTS
IDENTIFICATION NUMBER
AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NAME AND ADDRESS
NAME OF APPLICANT DATE OF APPLICATION SIGNATURE OF APPLICANT
STREET ADDRESS -• I- TELEPHONE NO.
� - i--.,,- - -4. r7 r"S ''',._ /c7•.7(
CITY OR POST OFFICE J1 - `" ZIP CODE LICENSE NO.WHEN APPLICABLE
❑ 85 John Street - n 41 State Street ❑ 570 Delaware Avenue ❑ 217 Lake Avenue ❑ 202 Arterial Road
NEW YORK,NY 10038 ANY,NY 12207 BUFFALO,NY 14202 ROCHESTER,NY 14608 SYRACUSE,NY 13206
(212)227-3700 (518)463-2122 (716)884-1155 (716)254-0141 (315)463-8552
TI-1G MII=\A/ V(1172VC R(1QRf1 fF FIRP I IN IPRWRITFRg
l,; ,r'i-)} /1.r. w 'i, . a"'J" . ...I i. r ` :y`• , • - r _ • ....d'.•.. r •.1^:•.., • ;J.}i 'Vll . 'V
TOWN OF QLIEENSBLIRY
.
Y
Bay at Havlland Roads,Queensbury,N. .12801-9725
APPLICATION FOR SOLID-FUEL BURNING APPLIANCES AND FIREPLACES
11• c 9����
Date 414,0 �a 19 9l -.:''-Permit No.
,
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building and Use Permit
• pursuant to the New York State Fire Prevention and Building Code. The applicant or owner agrees to comply with all
' applicable laws, ordinances, regulations',and all.:cond�ilions that areipart of these requirements and also will allow all .,
•
inspectors to enter premises for the,,required inspections.,
1 �7/3 0," '01 If-�:.: ' APPLIANCE TYPE
Applicant's Name Pp :1 / wood A�,i;'S
f•- / r; ),) -,1� ` Stove . c. ', :Coal: Wood
Address #fl�/2) k ,Zr / GPI .- ns4,ra .i/;' :Furnace Hot Air Boiler
likte I 1 jf. {Zero1c arancep" Circulating Unit
s Zip r/ J ,J. r r II
,`7Phone f,.2, 3 7 If Non2gooncy.
s
Owner's Name Samq 4 f Ah�te• , Manufacturer
Address
Model . Outlet Size
Zip Listed by Number
Phone
. CHIMNEY TYPE
Masonry: Block Brick Stone
Property location of proposed construction ( / )) Flue: Tile Steel
/ol 11)R// ouv/ Size:
.. Factory Built:
1
ManufacturerJ1��'a°w'6' '. Model ;` - Size
('OPY OF MANUFACTURER SPECIFICATIONS IS - Height Listed By - Number
REQUIRED FOR FACTORY-BUILT APPLIANCES Type: Double Wall L Triple Wall
AND CHIMNEYS. MUST BE INSTALLED Insulated
ACCORDING TO SPECIFICATIONS. COPY.OF Estimated Cost $ fc 00
CONSTRUCTION DETAIL REQUIRED FOR MA-• Fee$
SONRY FIREPLACES AND CHIMNEYS.
t' CASHIER'S DEPARTMENT .
` TOWN OF QUEENSBURYNEW YORK
Department: Fire Marshal Amount Collected Amount Refunded
1 Code Number Title .
A173 3389 (19,,0)Public Safety ��
l A233 2655 (230) Minor Sales
h llected from or We to: —('_d_-h' //(/;71-/ () KUI,42---j
Address:
g/S/�� --
'• Dated: Town Clerk or Deputy
6 White:Applicant Yellow and Pink:Cashier's Department Goldenrod:Fire Marshal
. MOvv. --01)) S-4" N
Ctka
TOWN OF QUEENSBURY �\�
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED ///?I/9
NAME
L OCAT I ON j--r- t L I UpGZl--rf'Y\ O(k
DATE PERMIT# - (p
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING :y
FIRE EXTINGUISHERS\., /
AUTO. EXTINGUISHING, SYSTEM /
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM
ALARM SYSTEM
r;
INTERIOR FINISHES
STORAGE: 1'
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAG,E'. :a
J
/
CHIMNEY /
WOODSTOV, y .
• FIREPLACE-MASONRY
✓FIREPL(CE-FACTORY BUILT
1
REMARKS: OK TO THIS DATE
ARRIVE
//
DEPART/2 G
PNSPECTUR
•
I
tTIWN OF Q EENSBURY
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPIECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED (. / I Lt 1 1
NAME cOYeC"\i,JOo Nrhk-124
LOCATION (p( ( 2 i+DA ee
DATE Cj PERMIT, C -7540
TYPE OF STRUCTU E a --
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL FRAMING
- ROUGH PLUMBING FINAL ELECTRICAL--_SEPTIC
- INSULATION WOODSTOVE/FIREPLACE
REMARKS
APPROVAL
N/A Y5,--NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION ✓j
PLUMBING VENT \ ff
ROOFING \ ✓
SIDING
DECK/PORCH/STEPS/R'AILINGS/.'
RELIEF VALVES �, �- ✓
FURNACE/HOT WATER OPERATING ✓
BASEMENT INSULATION/DUCTWORK
INTERIOR TRIM/PRIVACY LOORS
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE \
OTHER FLOORS CARPETED \ ✓
STAIR CLEARANCE/RAILINGS \
HANDICAPPED ACCESS
SMOKE DETECTORS \ �/
BATHROOM FANS/WHOLEHOUSE FANS \ ✓
ALL PLUMBING FIXTURES OPERATING ✓�
GARAGE FIRE PROOFING! '� ✓�
DOOR CLOSERS { ✓
OTHER FIRE SEPARATION ✓
FIRE/DEMISE WALLS
DUMPSTER
SITE PLAN/VARIANCE REQUIREMENTS ✓
FINAL ELECTRICAL ',
OK TO ISSUE C/O OR C/C ,�-
COMMENTS:
#S ,4 /o//i
ARRIVE
DEPART
INSPECTOR
ir
_a77 // `� �./
wn o� �Q6 enibur 4 . .
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC. DISPOSAL SYSTEM INSPECTION
NAME c"--- g� �1,Lb0Cfl Q )
LOCATION LA01 ,`Qc,_` (,1'1 C t
DATE ll / 'I PERMIT NO. 61 f-S7(tp
SOIL TYPE .► Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: ; -
Absorption field, total 1'ength �
Length of each trench V
Depth of trenches 3- i'
Size of gravel Of.._ I ' _
SEEPAGE PITS*Number ofY
Size- ft. X fti
Gravel size , 1 /y
PIPING: dize /Type
Bldg. to tank (/ '' a' P g
Tank to dist. box '0I) / Pl
Dist. box to field/pit „C�Wit P(
Openings sealed? YES A NO Partial
i
LOCATION/SEPARATIONS: aI
Foundation to tank )' II ft.
ii
Foundation to absorption _.J.6 ft. •
Absorption to lot line/ ", 3'x-ft.
•
Separation of pits $$§§ ft.
LOCATION OF SYSTEM ON'PROPERTY(circle one)
Front - Left/Side 4A Right side -
COMMENTS: i `
•
SYSTEM USE APPROVED AD NO
Bu' ing n ector ,
01/86 and vl
. . . .
' /7: ;5'74+57.. " . - -1 l' .•:-.%!..
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OWN OF QUEF..NE-1:5"-iJil. .
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ELECTRICAL INSPECTIONS
DUPLICATE MUNICIPAL RECORD
Permit No. 9/-,540 6
Re-S 7co 0
Owner
Occupant
,
Location Lo.r/VGu frf----/ 6 Li
a_Li-et-PS Oa/0W Street
Town or City _ State
Installation as itemized on reverse side has been visually inspected pursuant to applicable
codes.
Installed by 126 6 f'4'.Al
6 a
o ' tgo/Lea . tor
Date
MIDDLE DEPARTMENT INSPECTION AGENCY,INC.
FORM NO.18 EL. 1337 West Chester Pike,West Chester,PA 19380
ROUGH WIRINGRI OUTLETS H.P.AIR CONDITIONER
6WTCPTS „l t.A./ WIRING &CONTROLS FOR BURNER
6 RECEPTACLES H.P.PUMP
02� FIXTURES K.W.OVEN
MP.SERVICE EQUIPMENT P.GARBAGE DISPOSAL UNIT
4/ )AMP.SERVICE CONDUCTORS . DISHWAFHER
((LLPP V/.SURFACE UNIT K.W. DRYER
t/K.W. RANGE AMP. RECEPTACLE
K.W.WATER HEATER . FRAC. H.P.VENT FANS
oyee
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TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED Clt /C1
NAME �O`C��S�" cX 1 O
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LOCA ON J
DATE '- PERMIT# I---�`(P(p
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
AUTO. EXTINGUISHING SYSTEM
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM
ALARM SYSTEM
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKLERS ` t;
CLEARANCE TO HEATING UNITS/
REQUIRED SIGNAGE
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CHIMNEY ".
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DEPART
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TORN OF QUEENSBURY "24
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME , ‘Ft 4( 1� •44 (Z.<2.1
LOCATION 4&1'7'p j -44Z hrn (2
DATE 6/k/1/ PERMIT # 9/-oh
TYPE OF STRUCTURE ✓/.f/y) 4r (�,�ry��j. (1.601d4(,,
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
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REMARKS:
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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 REP i
1 3/ ci/
REQUEST FOR INSPECTION RECEIVED
NAME_C esV(/0A X/ gru:2-2
LOCATION , (o ' 'Y�l/G) \C u
DATE 1 (o) Co 1 PERMIT t# - 1 I-1 s6(r%
TYPE OF STRUCTURE C , ��/p'-}�i- ,-2 Cti'
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 SLTE
FOUNDATION/WALL POUR ,off
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROQFING
BACKFILL APPROVAL;; /
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PLUMBING VENT/VENTS IN1PLACE
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FL ORS R-
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CEILING , R-
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DEPART// ,� s% /
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BUILDING AND CODES DEPARTMENT r
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED ,c4--- /(24f
NAME *N.Q/1i' Ya .��-t"!7-4
LOCATION , 4)/ 7fo.i t (
DATE X/ 9" PERMIT ! 9/t-06
TYPE OF STRUCTURE 4 4d, 11//-/7z. -ail A?:dl
RECHECK / / APPROVED
N/A YE/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
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- �-
DEPART
INSP e3R
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
PNA14E
LOCATION ( 1 (le u f
DATE S17-t ql PERMIT # 1 1-�5G�r 4�
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
XFOUNDATION/DAMPROOFING X.
X BACKFILL APPROVAL 6
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE i'
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
FIRESTOPPING /
WALLS /
CEILING /
FIREWALLS ; /
HEATING ROUGH-IN F`
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FOUNDATION WALLS EXTERIOR` R
FLOORS / R-,
WALLS ,t R
CEILING R-
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SPACES
REMARKS: i
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DEPART -7 r j I .,
PNSpECTOR
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BUILDING ES AND COD DEPARTMENT �-�
531 BAY ROADjo
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT/
REQUEST FOR INSPECTION RECEIVED A�jr/�/
NAME Yo d -
LOCATIO Ga/ %y ("2/-
DATE e//7A/ PERMIT #
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YE 'NO
)(FOOTINGS/PIERS tt��
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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 j
FOUNDATION/DAMPROOFING i ?"
BACKFILL APPROVAL
ROUGH PLUMBING 1`
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING: I /4
JACK STUDS/HEADERS ;
BRACING/BRIDGING .l
JOIST HANGERS '
JACK POSTS/MAIN BEAM i•
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 ``� • . 1
` INSPECTO'
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RECEIVED
AUG 8 1991
BLDG. & CODE DEPT.
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