1991-632 : -
tt•'''...1%;,;!: V-;'' IC ' '''''rf;'','':; 1 t., -i
V ge
. . CERTIFICATE OF OCCUPANCY
.p. ,.,
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date March 2. 19 92
--- .
‘9015, lo--D__ - i',-1 -
This is to certify that work requested to be done as shown by Permit No. 91-632
has been completed.
Single Family Dwellitkg
This structure_may be occupied as a
3 1 neation - 41.04ireShallow Creek Road
Robert Pratt
Owner •
c• , . By Order Town Board
• • . TOWN OF QUEENSBURY
i.
Director of Bldg. & Code Enforcement
1 ,
-..(i..) _
"
. .
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-632
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Robert S. Pratt
OWNER of property located at Lot B3 Shallow Creek Road Street, Road or Ave. v+
in the Town of Queensbury,To Construct or place a Single Family Dwelling w
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
34 Bluebird Rd
South Glens Falls, NY
2. CONTRACTOR or BUILDER'S Name
Robert Pratt
O
C-
3. CONTRACTOR or BUILDER'S Address rD
I
4. ARCHITECT'S Name
5. ARCHITECT'S Address
O
W
N
6. TYPE of Construction—(Please indicate by X) S
(X)Wood Frame ( ) Masonry ( )Steel ( ) - O0
7. PLANS and Specifications
fD
fD
No. 1,643 sq ft Single FAmily Dwelling as per plot plan specifications
and application a
8. Proposed Use
Single Family Dwelling
CM
tin
September 6, `D
$ 227.00 PERMIT FEE PAID —THIS PERMIT EXPIRES Se p19 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 6th Day of September 19 91 a'
SIGNED BY /! / for the Town of Queensbury
Buildi g and Z- pector
TOWN OF QUEENSBURY
REVIEWED BY: J OWN OF QUEENSBUh,
lt
RECEIVED
%jA411 FEE PAID: '8 �7
� SEP 21991
PERMIT NO. : 7/ ,3,2,
BLDG. & CODE DEPT.
BUILDING PERMIT APPLICATION
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: •
j :
P.O. Address: .3 L1 ,L, , -GAJ _ .CY,J ` 11 t y PHONE 790)-1,06
Property Location: , 5 trio (A a n , ,P Tax Map No. 75/ /
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: Lot No. 43
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
NATURE OF PROPOSED WORK: * ESTIMATED MARKET VALUE OF THE
X Construction of new building * CONSTRUCTION: $ 620 f15b
Addition to building * 1
Alteration to building * COMPLETE INFORMATION REQUIRED BELOW: •
(no change to exterior dimensions) * Size of Property: /020 ft. x /r„ft.
Other work (describe) * Existing Building Size:
• * 76 ft. x 3z/ ft.
* Proposed building - distance from
GROSS AREA OF PROPOSED STRUCTURE: * property line:
1st Floor fi y Sq. Ft. 19` * Front Yard
r� 3 0_ ft. Rear yard 36 ft.
Side Yards 0,. ft. and 5 ft.
2nd Floor Sq. Ft. a 7 * If on corner, setback from side street-
* ft.
Other Floors Sq. Ft.
(not cellar or basement) * OCCUPANCY INFORMATION:
TOTAL FLOOR AREA: J Lo Y3 Sq. Ft. * Primary Building -
* One Family Dwelling
Size of New Structure: 90 ft. x 3 4/ ft. * Two Family Dwelling
Foundation: * Multiple Dwelling/No. of Units
Pier/Slab/Crawl/Partial 4(Circle One) * Business
* Industrial
No. of stories (Habitable space) f * Other
Height (grade to ridge) 9 ft.
If residential , no. of families: j * If addition, what will use be?
" No. of rooms (excluding baths): (�
No. of bedrooms: _7 • *
•
No. of bathrooms: * Accessory Building:
Primary heating system: Gas HT N ;r * Detached Garage - One/Two Car
Type of fuel : r * )( Attached Garage - One/twCa o r
No. of fireplaces to be installed: N pNe * Private Storage Building
Will a woodstove be installed?: ni h * Other
Central Air Conditioning: Yes No )(
(OVER)
BUILDING PERMIT APPLICATION CONTINUED:
BUILDING SPECIFICATIONS:
Type of construction: ( od fram fire safe, etc.
Will any second-hand or ungraded lumber be used? If so, for what? 27&)
Foundation Wall Material : ��1y�� oto Thickness: cs7 /f
Depth of Foundation below grade (to bottom of footing) : X '
Will there be a cellar? ve,n Heated or nheatedV Floor Sq. Footage: l (oy 3
Will there be a basement? Will any portion be used as living space? '(J()
If so, what portion? Sq. Ft. Type of Use?
Type of Roof: loped2flat/Shed/Other (g//a Material of Roof 420.
Size, wood studs 7 " x 1, " ; spacing / to " o.c. ; length j' ft.
Joists (floor beams) : 1st Floor 2 " x "; spacing / (o " o.c. ; span / 3 ft.
Joists (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 )6, " o.c. ; span _3() ft.
Exterior Wall Finish: /J ,r . , of what material ? fJ
44,u/
Interior Wall Finish: ..4JL0 0-7-rar
If a garage is to be attached, describe materials toQ be used for FIRE SEPARATION:
'5/4 ¢4..4_17,c.-QN76 /1 �0 C i D
Is there to be an opening between garage and dwelling? Lje4 If so, will a Fire-Rated door,
enclosure, self-closing device be provided? 1,rCA
Will a flue-lined chimney be installed? "no Height above roof ft.
Depth of chimney foundation below grade: ft.
Depth of fireplace hearth: ft. in.
Water supply -CunicipaDor 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: AO-t-ei ) i-)A.6Lzt. PHONE 7Jo7 '��Jp7
NAME OF PLUMBER & ADDRESS: ] Cw7 7,c4p PHONE 792 S27D
NAME OF MASON & ADDRESS: �,� PHONE 79.E c'707
NAME OF ELECTRICIAN & ADDRESS: i��,� �✓iu� PHONE 79/ 4 ) //
66 _a 4/
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 Xaed-J ��
• Owner, 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 DAYS
TOWN GE Q E;S SBUh
REC;E1VE1
Compliance Methods:
PART 5 - Acceptable Practice Method - 1 & 2 Family Dwellings (ONLY) S EP 2 1991 PART 6 - Thermal Rating - Component Trade. Offs - 1 & 2 Family Dwel F1 n, ,;& CODE DEPT.
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
Pam, 4b3 J,l zks oic 67,P!
APPLICANT'S NAME PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - 11c L/3 Sq. Ft.
2. Type of Heat - Elec. Base Board Other Go ' ,c 'J ,t a_
3. Is Building Mechanically Cooled? YES )( NO
4. Percentage of Area of Windows and Doors Over 17% J.7 9b 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 o2. 1
C. Glazed Area R q
D. Exterior Doors R / y
E. Floors over unheated spaces R
F. Edge of Slab on Grade (Heated Building) R
G. Basement/Cellar Walls (Above Grade) R ►3
H. Basement/Cellar Walls (Below Grade) R/
I. Heating/Cooling - Ducts - Piping in Unheated Space R.
6. Service (Domestic) Hot Water Heating Device
A. Conforms to minimum efficiency per code YES NO
TEMPERATURE CONTROL MAXIMUM SETTING 140° - WILL NOT BE EXCEEDED
treeAl- PiLetzt- 9
APPLI ANT'S SIGNATURE / -'DATE TELEPHONE NUMBER
INSPECTOR'S REMARKS:
- RE E1d�D
v OWN OF QUEENSSu ,,
RECEIVED
csire
lej TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fe/eDPa ird CODE DEPT.
Date: /.1 a te, 199/ Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: ' J_Lal1 .) (-24 ,n,�'� D 7,(,/Lp
Owner' s Name: Ari,ferifjP/Leaf
Owner' s Mailing Address: / {j, �/ � ,,. e/,�n,,,,� 1,14 �'/� I; 13
Installer s Name: mA_Yll � #: 74f f 9q6 /
Number of bedrooms (if residential ) : "
Total daily flow (residential-compute @ 150 .gal . per bedroom).: Lle
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand e Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other
If domestic water supply is a we
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank /&On gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s) : Number of a- / 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. D^
4.4
SIGNATURE OF RESPONSIBLE PERSON: '1 .,/ ?et. DATE: qt?/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 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:
/
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
National Headquarters �
1337 West Chester Pike,West Chester, PA 19380
APPLICANT COMPLETES THIS SECTION ' Date:
'
City, Town orTownship /. � ^-` ' ' ` / ' County / State
Looatnn/Addmss
(� -��` in Rural Area ' Please Attach Directions) Pdo *
Owner
ponnit #
Occupied As / / '' ! � Building: NowF�l 0 ��
d
Occupant 'i '- � // T-�- .
Work Area in Building (Floor #,etc.): ,
App for: Wiring SomicoF� or: Ready for Inspection:
Fee Remitted * Cash F-1 ChookF-1 ` M.O. F] Make Payable To: M.D1A.
Number of R n0Oudms Boot Heat
na 1mw z2� ,�m nm �o '�" so omo ,�o
Switches '�' '/L' ' Amp. Service Surface Unit )( Dishwasher X Range
Lighting Water Heater Air Conditioner �� Dryer
pump
R»«»Pta«|»' ' '^ Oven Garbage Disposal Wiring and Controls for Burner
Number of Fixtures �j /
' . L Amp. Receptacles y / Fractional H.P. Vent Fans ~
Other Equipment:
MOTORS
H.P. z�nz/zcz�o 1/8- z/o z/^ z/m �p 3/4 z zm e a s r* m 15 m z, ao +o no 75 xm
���chrk SizeNumber
Annxn,nt',
Signature �\�1 ����/ J/!'�- ��'(� . Unon,o # Permit #
T/A / Utility:
(NAME) (opF/os.LooAr/om)
�ant�
-'� � �
(City) �^~ `/ ? (State) X) �/ (�p) / � /� � Service #
Phone # '/ � / � {/� '� ' Electrician: -�'' ' ' /! ^ f 7-
K8D|A USE ONLY
DATE RECEIVED: DATE INSPECTED:
Correct Location: Same m` Above F-1 o,:
Red Notice Label F-1
. Rough Wiring Outlets Surface Unit Oven
Switches Range � Garbage Disposal
Receptacles _ Water Heater Dishwasher
Fixtures Air Conditioner unm,
Amp. Service Equipment Burner, Wiring &Controls for Amp. Receptacle
Amp. Service Conductors Pump Vent Fans
MOTORS H.P. 1/20 1/1e 1/10 z/u 1/6 z,` 1/3 z/c 3/* 1 z* u a o 71/2 m zs cv u» ao ^o 50 ,, zvv
Mark Number
of Each
,00 ,,o moo a,° no" 1750 2000'2250 ,,"o 2750 s000
Elect. Heat
. .
-
osnr/p/oAr/mmm _ _USE FOR INITIAL �� ��nReor FEE PAID
� om�� wmT/p/so _ q�re pes
[-7 RVV Progress: Inc. LKD Contractor
�-1 �CFT Violation: Work Comp �� Inc. | � �7�-~ �-- ' CASH
L/A Owner Fee CHK #
L1 L/A Duo MO #
IPA Municipal \NV #
Applicant L�
Date: Other Side 1:1 utility Own*, � |
`
Cut inCard Temp -'1]ma
INSPECTORS SIGNATURE
Final # Date
APPLICATION FORM NO.usosL ,1my
TOWN OF QUEENSBURY
"y' 531 BAY ROAD
` y ; QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED 3 �] c)
NAME ? D A Q\'cl ,
LOCATION . _-..c.,,`- - 3 S1ic /(inc' C(ed<KI
DATE PERMIT#( I / r( ,3
TYPE OF ST UCTURE S c��
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL SJ.RUCTURE)
\_.-P'OOTING •LFOUNDAT N---\/BACKFI-L FRAMING
UGH PLUMBING • AL ELECTRICA), 4EPTIC
1/INSULATION WOODST EPLACE
REMARKS
APPROVAL
) . N/A0 YEr NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VENT a
ROOFING
SIDING ;i':, 14
DECK/PORCH/STEPS/RAILINGSY ?. ✓RELIEF VALVES i`
FURNACE/HOT WATER OPERATTING IT', ✓/
BASEMENT INSULATION/DUCTWORK ,; ✓
INTERIOR TRIM/PRIVACY/DOORS ✓
FINISH FLOORS: /
BATH/KITCHEN WATERTIGHT •
OTHER FLOORS SWEEPABLE �/
OTHER FLOORS CARPETED ,�j
STAIR CLEARANCE/RAILINGS �
HANDICAPPED ACCESS
SMOKE DETECTORS .1 ✓,
BATHROOM FANS/ S V
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 v/
COMMENTS:
i/zA- ` 4/
30
ARRIVE
DEPART / 9
INSPE TOR
ELECTRICAL INSPECTIONS
DUPLICATE MUNICIPAL RECORD •
Permit No. �j� 9/0LI/
/Owner W ,ems -CR-7T
Occupant
Location I-sa! S#-LV w C' z K ,O
No. Street
Ayr
Town or City State
Installation as itemized on reverse side has been visually inspected pursuant to applicable codes.
Installed by / 7M V9 - T 7.
N . Gld
7
Date �� � �+ �""'=' c�-C Inspector
MIDDLE DEPARTMENT INSPECTION AGENCY INC.
FORM NO.18 EL. 900 Haddon Ave.,Collingswood, NJ 08108
/VO ROUGH WIRING OUTLETS H.P.AIR CONDITIONER
443, gt.ISLcrs G�f1) r /e WIRING &CONTROLS FOR BURNER
. S RECEPTACLES H.P.PUMP
3 2- FIXTURES K.W.OVEN
Pr�,,,c2AMP.SERVICE EQUIPMENT H.P.GARBAGE DISPOSAL UNIT
Y 6AMP.SERVICE CONDUCTORS / K.W. DISHWASHER
K.W.SURFACE UNIT / K.W. DRYER
/ K.W.RANGE AMP. RECEPTACLE
K.W.WATER HEATER 6 FRAC. H.P.VENT FANS
, / 67 I
MOTORS H.P. 1/20 1/12 1/10 % % % h %2 '% 1 11/2 2 3 5 71/2 10 15 20 25 30 40 50' 75 100
MARK NUMBER
OF EACH SIZE
APPARATUS
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447 '
BUILDING INSPECTOR'S REPORT
REQUEST FQR, INSPECTION RECEIVED 1 / '/ ;2—
NAME VA')Q) CZ'O
LOCATION , � 1( I l( t) C J2 ( T)
DATE 1 /,3jl CO PERMIT # 9 /
TYPE 0 STRUCTURE S ? n
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE . /
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION ROM /
FREEZING FOR 48 HOURS FOLLQWIN
THE PLACEMENT OF THE CONCRETE;
MATERIALS FOR THIS PURPOSE \ON SITE
FOUNDATION/WALL POUR X •
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING ,
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS ,YN PLACE
PLUMBING UNDER SLABS
FRAMING: 1,
JACK STUDS/HEADERS
BRACING/BRIDGFING
JOIST HANGERS
JACK POSTS:MAIN BEAM
HEATING ROUGH—IN
.)
I NSULAT I ON�b '
FOUNDATION WALLS INTERIOR R=
FOUNDATION WALLS EXTERIOR R • i
FLOORS R=
WALLS R— I/—
CEILING R— 1
rDUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART 3 Ofp4/r.
INSPEC R
TOWN OF QUEENSBURY PriV1
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT (
REQUEST FOR INSPECTION RECEIVED /�„j -t I
NAME C 0\7 0\r\- Yra\' c
LOCATION)j rn1\rns() (h P`<7
DATE \ �j \ 61 PERMIT # 9 I l493
TYPE OF STRUCTURE ST 4
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS "• SPONSIBLE
FOR PROVIDING PROTE TION FROM
FREEZING FOR 48 HOU:' FOLLOW NG
THE PLACEMENT OF TH CONCRETE.
MATERIALS FOR THIS RPOS ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFI
BACKFILL APPROVAL /
`�ROUGH PLUMBING i/
PLUMBING VENT/VENTS N PLACE
PLUMBING UNDER SLA: f
FRAMING: V
JACK STUDS/HEAT RS
BRACING/BRIDG ' G
JOIST HANGER ✓
JACK POSTS/ IN BEAM
FIRESTOPP IN
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:
1•
ARRIVE /d
DEPART /0 I / e—/
INSPE OR
awn of Queenitury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME , N S,
iL
LOCATION: * ?3 SikQ 1 6 0eV 'o rll\c1
DATE w i/S PERMIT NO. qt-6 ,3c77._
SOIL TYPE - an53 - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches '
Size of gravel
SEEPAGE PITS{Numbe of) '
Size- *X ft. X ft.
Gravel site Z
PIPING: \ Size pe
Bldg. to tank.` Ci k' bi
Tank to dist.`.' box CrG �)
Dist. box to „ field/pit .41" }
Openings seal 'd? YES NO artial
LOCATION/SERARA IONS:
Foundation tol tank /0 •ft.
Foundation tolabsorption ft.
Absorption to Olot 'line ft.
Separation of pits '-ft.
LOCATION OF SYSTEM ON,, PROPER Y(circle one)
Front - Rear -Left side - Right side -
COMMENTS: 3
(3--Th „
CW WO q
. ,4 mkt,
/ ' -\
SYSTEM USE APPROVED ® NO
C i n_1_644,
Bu iding In pector
01/86 and vl
TOWN OF QUEENSBURY A.3BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED //6/9 /
NAME IV t / t27
LOCATION �5 f .3 Athid ( �� _ IL--
DATE 9/l6/QG/ PERMIT # 9/—(p 3�
TYPE OF STRUCTURE A44q6 -vL tLtJ'e 1
RECHECK APPROVED.
N/A YES *0
) FOOTV "1Z/
INGS/PIERS
" MONOLITHIC POUR FORM c,//
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 `s,„i
FRAMING:
JACK STUDS/HEADERS '
BRACING/BRIDGING'' \
JOIST HANGERS
JACK POSTS/MAIN BEAM \
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUGH-IN
INSULATIONI:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS' R-
WALLS R-
CEILING R-
DUCT` WORK OR PIPING IN UNHEATED \
SPACES t
REMARKS: �\
ARRIVE
DEPART �• Er 'I •t''l I/2.�
�j; INSPEC/R