1991-683 •
CERTIFICATE OF • OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date January 7, 19 92
This is to certify that work requested to be done as shown byPermit No. 91-683
has been completed.
•
This structure may be occupied as a 6-a�S�e➢' Bed Bath, Laundryl ®e
Location 17 Buena Ii sta Avenue •
Owner Dr. firs. John Bvllova •
By Order Town Board
TOWN OF QUEENSBURY
)
•
r�J
Director of Bldg. do Code Enforcement
cu
BUILDING PERMIT
TOWN OF QUEENSBURY a
a
No. 91-683 v
WARREN COUNTY, NEW YORK
ry
Co
PERMISSION is hereby granted to Mr. & Mrs John Bulova
OWNER of property located at 17 Buena Vista Avenue Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Addition to Dwelling di th Fireplace
at the above location in accordance to application together with plot plans and other information hereto filed and O
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. Q+
1. OWNER'S Address is 0,
Same
2. CONTRACTOR or BUILDER'S Name
Matt Cifone
3. CONTRACTOR or BUILDER'S Address
�.
Vi
4. ARCHITECT'S Name a
fD
fD
5. ARCHITECT'S Address
a
6. TYPE of Construction—(Please indicate by X)
(X)Wood Frame ( ) Masonry ( I Steel ( ) 0'
7. PLANS and Specifications O
No. 800 sq ft Addition to Dwelling with Fireplace as per plot plan specifications g
and application
-•
8. Proposed Use
Master Bed & Bath Laundry Room -.
r+
s
$ 89.00 PERMIT FEE PAID—THIS PERMIT EXPIRES September 27, 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.)
fD
Dated at the Town of Queensbury thi 27th Day of,, . Se tember 19 91
SIGNED BY G� % for the Town of Queensbury
Building and Zoning spector
,
TOWN OF QUEENSBURY
REVIEWED BY: . `.)tiliN OF QU
,Noi, FEE PAID: 41-1- %',25"�g J
S€P2,5i99
PERMIT NO. : 9/- 1p
u. t. -42PT
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: "Ink My-5 —5o\,,,r, ti3VOov
P.O. Address: 1-7 ive;v'A VISTA AV PHONE 195-15
Property Location: 1, 1:3u-cy)A \fi51rA AVI Tax Map No.AO /c=•Z /
Has there been any split of this property since October 1, 1988? Yes No X
If yes, Planning Board Review is necessary.
Subdivision Name, if applicable: Lot No.
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
MAlt C.; Pone-
NATURE OF PROPOSED WORK: * ESTIMATED MARKET VALUE OF THE
Construction of new building * CONSTRUCTION: $ (05, OO b
� Addition to building *
Alteration to building * COMPLETE INFORMATION REQUIRED BELOW:
(no change to exterior dimensions) * Size of Property: ft. x _ ft.
Other work (describe) * Existing Building Size:
• * ft. x ft.
* Proposed building - distaiice from
GROSS AREA OF PROPOSED STRUCTURE: * property line:
/' *
1st Floor ��� Sq. Ft.Z d� i * Front Yard ft. Rear yard ft.
2 C * Side Yards ft. and ft.
2nd Floor - Sq. Ft. G � * If on corner, setback from side street-
* ft.
Other Floors Sq. Ft. *
(not cellar or basement) * OCCUPANCY INFORMATION:
*
TOTAL FLOOR AREA: OO Sq. Ft. * Primary Building -
* X One Family Dwelling
Size of New Structure: -.4 k ft. x 152, ft. * Two Family Dwelling
Foundation• * Multiple Dwelling/No. of Units _
Pier/Slab Craw /Partial/Full (Circle One) * Business
* Industrial
No. of stories (Habitable space) 1 * Other
Height (grade to ridge) 2.C) ft. *
If residential , no. of families: I * If addition, what will use be?
No. of rooms (excluding baths) : I * /1.rL# . W Q,-J}- i!'
No. of bedrooms: I
No.. of bathrooms: 1 * Accesso y ilding�
Primary heating system: HOT AWN * Detached Garage - One/Two Car
Type of fuel : GA05 * Attached Garage - One/Two Car
No. of fireplaces to be installed: 1 * Private Storage Building
Will a woodstove be installed?: t4O * Other
Central Air Conditioning: Yes X. No *
(OVER)
BUILDING PERMIT APPLICATION CONTINUED:
BUILDING SPECIFICATIONS:
Type of construction: wood frame, fire safe, etc. \,./o,,4J cYAI,=,g___
Will any second-hand or ungraded lumber be used? If so, for what? (y
Foundation Wall Material : Thickness: '' `p' FOP , vL
Depth of Foundation below grade (to bottom of footing)': ell
Will there be a cellar? t// Heated or Unheated? Floor Sq. Footage:
Will there be a basement? tfA Will any portion be used as living space?
If so, what portion? WI\ Sq. Ft. Type of Use?
Type of Roof: Sloped/Flat/Shed/Other eSk,,. j, Material of Roof 1S1,'tv, A...
Size, wood studs x " ; spacing Q‘, o.c. ; length Vj ft.
Joists (floor beams) : 1st Floor t " x ' I 44 " ; spacing . " o.c. ; span 10 ft.
Joists (floor beams) : 2nd Floor " x "; spacing " o.c. ; span ft.
Overlays (ceiling beams) : . " x j " ; spacing tie, " o.c. ; span ►-7-6 ft.
Roof rafters: I " x \ 174 " ; spacing tto o.c. ; span n" ' ft.
Roof trusses (pre-engineered) : spacing " o.c. ; span ft.
Exterior Wall Finish: }4AWI 56LAt `.ufsig of what material ?
Interior Wall Finish: V®-3, S1 r '
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? NIT) If so, will a Fire-Rated door,
enclosure, self-closing device be provided?
Will a flue-lined chimney be installed? siec Height above roof :41 ft.
Depth of chimney foundation below grade: Isur t e.4.a ft.
Depth of fireplace hearth: '1 ft. A in.
Water supply - Municipal or private well : lL44(c_r f0,
SEPTIC SYSTEM: Distance from any private well (including adjoining properties: t/A ft.
(A separate application is necessary for any repair or new installation of septic system. )
NAME OF BUILDER & ADDRESS: (1ecov,•e_ ere0" PHONE 4191 4)141
NAME OF PLUMBER & ADDRESS: *4 °° PHONE "
NAME OF MASON & ADDRESS: '® 48 PHONE
NAME OF ELECTRICIAN & ADDRESS: " °° PHONE e'
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 '
• Owner, owner' agent, architect
contractor
SPECIAL CONDITIONS OF THE PERMIT:
By:
Code Enforcement Officer
ENERGY CODE COMPLIANCE APPLICATION ' `"u4°N OF s`. iJEEN::��,
REC 'cr
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE DAYS
SEP .25 991
Compliance Methods: ' DG. & CODE DEPT
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
►� bve,raigi � Av
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 CAS -csi �wrc
3. Is Building Mechanically Cooled? X YES 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
B. Exterior Walls R
C. Glazed Area R 4.1)
D. Exterior Doors R
E. Floors over unheated spaces R I4 I
F. Edge of Slab on Grade (Heated Building) RA
G. Basement/Cellar Walls (Above Grade) Rom_
H. Basement/Cellar Walls (Below Grade) R t1
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
L ck1 t g q 1 gar " Z.
APPLICANT'S SIGNATURE DATE TELEPHONE NUMBER
INSPECTOR'S REMARKS:
REVIEWED BY
TOWN V 1 V OF Q LIEENSB URY
. Bay at Haviland Roads,Queensbury,N.Y.12801-9725
APPLICATION FOR SOLID-FUEL BURNING APPLIANCES AND FIREPLACES
Date q 4 VI 19 C16 Permit NO. qi -IM
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 conditions that are part of these requirements and also will allow all
inspector to enter premises for the required inspections.
Applicant's Name Mir a. M„ s —5,c,1,„, C)v1.3vA APPLIANCE TYPE
Stove , Coal Wood
Address 11 IF.SuP_nA \J; ijia QV Furnace Hot Air Boiler
p ��/ Zero Clearance X Circulating Unit
aIPI?v-a (1isk4 a�,Y . Zip \20o3
Phone ! 5W> - 1 q - 13565 If Non-Masonry:
Owner's Name C7AvY,e,
Manufacturer Svoerlerr-
Address Model PR--i?)oo Outlet Size
Zip
( Listed by Number
Phone
CHIMNEY TYPE
Masonry: Block Brick Stone
Property Ideation of proposed construction Flue: Tile Steel
I-1 Rki.e nA \l'chi. Mil Size:
Factory Built: X
Manufacturer - Model Size
COPY OF MANUFACTURER SPECIFICATIONS IS Height Listed By Number
REQUIRED FOR FACTORY-BUILT`APPLIANCES Type: Double Wall ( Triple Wall
-AND CHIMNEYS. MUST BE INSTALUED1 Insulated •
ACCORDING TO SPECIFICATIONS. COPY OF Estimated Cost $
CONSTRUCTION DETAIL REQUIRED FOR MA- Fee$
SONRY FIREPLACES AND CHIMNEYS. '\
CASHIERS DEPARTMENT ,
TOWN OF QUEENSBURY, NEW YORK •
Department: Fire Marshal Amount Collected Amount Refunded
Code Number Title `
A173 3389 (190)Public Safety /
-
r
A233 2655 (230) Minor Sales
Fee Collected from or Refunded to: -
•
Address:
•
Dated: 9/7,/y/ Town Clerk or Deputy /4 -
/ /
White:Applicant Yellow and Pink:Cashier's Department Goldenrod:Fire Marshal
s,I
, j TOWN OF QUEENSBURY 41,-N (.,.);- )y__y_S,-
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # . ;,9,, -.. .
Fee Paid -""'' -
SEP 199]
Date: OI 5 1q\ Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: ` aPEAIN \
Owner' s Name: rYRN 4-¶V $ ' u N .
. Owner' s Mailing Address: `` 7 64.,PeArIA I4Is*INV
Installer' s Name: Phone #:
Number of bedrooms (if residential ) : 1
Total daily flow (residential-compute @ 150 gal . per bedroom) : \50
. Topography-Circle One: Flat Rolling . Steep Slope % of Slope
Soil Nature-Circle One:(-Sand Loam Clay Other /Depth:
Ground Water-At What Depth? * • Feet .
Bedrock or Impervious Material- at Depth? WA Feet
Percolation Test-Circle One N t Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: ,municipal ell Other _
If domestic water supply is a wir-�--�
Separation: Water supply from any septic absorption feet
PROPOSED .SYSTEM: Septic Tank IOW gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
. Seepage Pit(s) : Number of 1 / 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: - 5jar oN.._.__ 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: .•
•
- •
• YOU ARE HEREBY REQUESTED TO
• INSPECT AND ISSUE CERTIFICATES
. FOR THE FOLLOWING ELECTRICAL
• • EQUIPMENT TO BE INSTALLED BY
.THE UNDERSIGNED ' ' •
' TEMP.N DATE • 1-4
- I, 3
CITY OR VILLAGE TOWNSHIP COUNTY
STREET AND NO.OR ROAD • / POLE NUMBER
‘—T B�'L_to r., n. \t. SlCP• Nv
BETWEEN/Miff TWO CROSS STREETS IS PREMISES LOCATED? SECT{ION tL BLOCK LOT
/\\i kpt kr-Th# Po—j`G'�. 17 f'\ es1 t-1n•-�+l • I '
OCCUPANTS NAME t BUILDING OCCUPANCY -
f! .l- v t �z.t�,-, �.1,-Vp
OWNER'S NAME AND ADDRESS l tt f\' _ HOME TELEPHONE NUMBER
MV es` \k. < J)\ r P\ ,\n, \ .
CUR}{RENT SUPPLIED BY FROM THEIR OFFICE i WORK TELEPHONE NUMBER
BUILDI 'S • •
NEW OLD❑ WORK IS _ NEW❑ ADDmONAL J 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 A.W.G.
Ceiling Wall Recep'Is Switch Pendant Bracket No. Type Each No. Each No. Gauge . INSPECTION
OUT- -
SIDE
SUB-
BASE
BASE- -
MENT
1st
FL.
2nd
FL
3rd .
FL
REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE.
•
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
YZ,{>
CHARACTER OF WO - ❑ EXPOSED GAS TUBE SIGN/TRANSFORMERS OF _ VA
❑ CONCEALED -
DATE WORK TO BE STARTED DATE COMPLETED SIZE OF SIGN(NUMBER) CAPACITY
SERVICE ENTERS BUILDING MANUFACTURER OF SIGN
❑ OVERHEAD ❑ UNDERGROUND
DATE INSPECTION REQUESTED ON(OR AS NEAR AS POSSIBLE) , US IDENTIFICATION NUMBERS
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 A,P^PLICANT . , (^ t DATE OF APPLICATION SIGNATURE OF APPLICANT
STREET ADDRESS * TELEP Nu.
Q,, 1:,x. t. 'i4 ""?q Q7-4
CITY OR POST OFFICE ZIP CODE . LICEN S NO.WHEN APPLICABLE
��1-pv, 5 ---(1\\i 1? ,:>1
❑ 85 John Street ❑ 41 State Street ❑570 Delaware Avenue ❑ 217 Lake Avenue ❑ 202 Arterial Road .
NEW YORK,NY 10038 ALBANY,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
THE NEW YORK BOARD OF FIRE—UNDERWRITERS
!{„,,IP a9,&e,!1,t:1Pi,"1t!,,..!1,11,r..M,M)„,QQ,14,P0,9).J,"1;01()9l.01/„M.,„M jeei.A0,tti t1PAI".LPi.a11r.ati.:,,t,e.",a,0,11)anAlti.LIPi."..L•r,),L,"."."y\• „%•;.:l.i,"t9,,t9/,,<ti LiP L•r.ter. llr,.y9r;
THE NEW YORK BOARD. OF FIRE UNDERWRITERS PAGI .1
1035 771 BUREAU OF ELECTRICITY
41 STATE STREET,ALBANY,NEW YORK 12207 • E.
Date JANUARY O8,199� ApplicationN on-file 0igG91%91 A OG_3934 41N
: THIS CERTIFIES THAT PERMIT NI;. 91-G83 •of
- -c only the electrical equipment as described below and introduced by t scant named on the above application number in the premises of
to 7,1
!t No g.
_ �',F.. & :1Z�,.� . Ji)Hi•1 P.,I;L•_U,'a. 17 BUENA VISTA a AVE. , OC�LL.;..BUDS-, N.V.
Pc?
in the following location; � Basement ❑ 1st Fl. .❑ 2nd Fl. Section Block Lot
was examined on U AN U A R1 O 3,1 9 9 2 and found to be in compliance with the requirements of this Board. •
FIXTURE I FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS ;'ii
•; ECEPTACLES SWITCHES
OUTLETS INCANDESCENT-FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. ;
.' G4
:: 9 13 1r 8 1 '.�
A. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PTr. le , TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS ! ''
SYSTEMS
' AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.O FEET AMT. WATTS •;S
►-' _ SERVICE_DISCONNECT__ NO.OF-._ -
r AMT. AMP. TYPE EQUIP. 1,B'2W 1,0 3W 3,Er 3W 3,B'4W �•OAR�COND. .OF C COND.. NO.OF HI-LEG OF.HI•LEG •. NO.OF NEUTRALS ORAL • j
y 1
i ''00 CB N 1/0 i.. 2/0
t, OTHER APPARATUS: •
J PADDLE FAN-1
P I
MOTORS:1-F H.P. .
E PAANELBOARDS:1-8 CIR, GO
'-' iii
G.F`.C.I. -1
TRACE LI;OHTIN(:T:-8
0
w. 1
CIFONE CONSTRUCTION �.. LI.
AIR% PORT INDUSTRIAL DR.
�• PO BOX C} i BRANCH MANAGER
GLENS FALLS, NY, 12801 3t)
Per
lf: 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. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
TOWN OF QUEENSBURY
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED 3 92'
NAME �' 61,(4 01
LOCATION 17 ✓ -601 I
DATE A 9 PERMITS V- 46
TYPE OF STRUCTURED# Z ba47
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING ,kfOUNDATION )CBACKFILL }"FRAMING
xROUGH PLUMBING FINAL ELECTRICAL /SEPTIC
k NSULATION WOODSTOVE/FIREPLACE
REMARKS
APPROVAL
N/A YE,S NO
CHIMNEY HEIGHT/LOCATION ✓
B VENT/LOCATION ✓
PLUMBING VENT
ROOFING v
SIDING
DECK/PORCH/STEPS °AILINGS
RELIEF VALVES /✓
FURNACE/HOT W! ER OPERATIP 1/
BASEMENT IN , LATION/DUCTW K `�f
INTERIOR T' M/PRIVACY DOO ✓
FINISH F . ORS: /
BATH/ :_"TCftEN 4ATERTIGHT ' l,
OTHE <' FLOORS SWEEPABLE 1�/
OTH' FLOORS CARPETED ✓�
STAI" CLEARANCE/RAILINGS 9
HANDICAPPED ACCESS f
SMOKE DETECTORS 1BATHROOM FANS/WitecS J/
ALL PLUMBING FIXTURES OPERATING
GARAGE FIRE PROOFING_
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: 664,
; ri7,1 113/?2
is
ARRIVE
n
DEPART .` -'
CTOR
nie
TOWN OF QUEENSBURY S-7 \0.-X)
FIRE MARSHAL c,r °iiC2/
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED 1 ,3i i
NAME B )16V CG \Y fYS AA
t LOCATION Bo PAN_A lif l‘S-1-ei Ali'e--'
DATE // 1 PERMIT# 9 I - 0 R, 3
JJJJ APPROVED
N/A YES . NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
AUTO. EXTINGUISHING YST
HOOD INSTALLATION
AUTO. SPRINKLER SYS EM
ALARM SYSTEM
/
/
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SP INKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
CHIMNEY
WOODSTOVE i
• F„I.REPLACE-MASONRY /
,,/FIREPLACE-FACTORY BUILT :./
REMARKS: i OK TO THIS DATE
C(5,/
ARRIVE /5
DEPART �- �_ %d
INSPECTOR
down of Queenur �' �
-- BUILDINN ..and" ONING DEPARTMENT .
Bay and Haviland Road, R.D. 1 Box 98 .
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME k ,F. /y I"%(11 1 //7,� &e.,_ -77a__/ .
LOCATION /7 Zit, -a_ z 4Ja.J
DATE/1 Z / 9/ PERMIT NO. �/ 6
SOIL TYPE - - 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{Numb of) -I
Size- ft. X j ft. ;/
Gravel size PS73i ;�`
PIPING: 4 /� � y
Bldg. to tank ' U7C
Tank to dist. box '1' /
Dist. box to field/pit , " PUL
Openings sealed? YES/ NO Partial '
LOCATION/SEPARATION5J
Foundation to tank j / Oft.
Foundation to absorption A_(, ft.
Absorption to to line ).eft.
Separation of pits ft.
LOCATION OF SY/ u ON PROPERTY(circle one)
Front -< ) - -ft
ft side•,- Right side -
COMMENTS:
•
SYSTEM USE APPROVED NO
401- 2
Bu' ing Ins ector
01/86 and vl
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FORINSPECTION RECEIVED
NAME \cQ)UJ—(�\�G \ , JJ
LOCATION � N6DO CA\.c V(SA-cN 1HQ
DATE C I i J ! 1 PERMIT # ( —lU R_
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 ,"4
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING A'
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE \ ,
PLUMBING UNDER SLAB ti
FRAMING: !k"
JACK STUDS/HEADERS
BRACING/BRIDGING ,I!
JOIST HANGERS i $
JACK POSTS/MAIN BEAM / ,
FIRESTOPPING a
WALLS a
CEILING
FIREWALLS a`
HEATING ROUGH-IN .<' h,
INSULATION: / Y
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS ,,// R- ¢ -
WALLS / R 9
CEILING / R--
DUCT WORK OR PIPING IN UNHEA ED
SPACES / s,
REMARKS: L
ARRIVE
DEPART
INSPECTOR
V JvY \
Y"Orc
TOWN OF QUEENSBURY
FIRE MARSHAL l "'r n
QUEENSBURY, NEW YORK 12804 v nn i` r)�
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT -
REQUEST FOR INSPECTION RECEIVED OjI I, --1(I I
NAME Q - �,
LOCATION 7 Rue J
v IDS 'v-e,
DATE I PERMIT# f -"10c��
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 ;SS,
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
r. ,4
CHIMNEY
WOODSTOVE r� w
FIREPLACE-MASONRY
/FIREPLACE-,ACTORY BUILT ;,
1/ /.
REMARKS: t ,k /( OK TO THIS DATE
•
G
ARRIVE
A ��L/
DEPART (�"L i L`� /
INSPECTOR
TOW 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
LOCATION I rI 1q / / U , 137/
DATE 1�l// ./f 1 PERMIT # 9l .�13
TYPE OF STRUCTURE gdat 6 di-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
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB / •
X 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 Al S
DEPART // 3a
I NS PECTO%
TOWN OF QUEENSBURY
BUIiLLDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT G1 (�
REQUEST FOR INSPECTION RECEIVED J O1 - L I
NAME `.� ID401-r)VG\, Jehr�
LOCATION 1 i C'Q U'e \_0\
DATE , I PERMIT # 4 0
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 j
FOUNDATION/DAMPROOFING
„ 3ACKFILL APPROVAL
ROUGH PLUMBING t
PLUMBING VENT/VENTS IN PLACE1 r
PLUMBING UNDER SLAB . 1
FRAMING:
JACK STUDS/HEADERS ti, /
BRACING/BRIDGING
HANGERS
JACK POSTS/MAIN BEAM / �.
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS 3 R- . 1
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
3 ?
ARRIVE
DEPART r /6 �' '-
OF 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
NAME 4t,t LOY-4 i
LOCATION I'/ •(1.LI b1/1 a. Vicd,-&c) )I�
DATE 0(5 I J PERMIT # —hpg.3
TYPE OF STRUCTURE Oa t (CLlJeilti1'),
RECHECK APPROV
N/A YE I NO
XFOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM r,•
FREEZING -FOR 48 HOURS FOLLOWING
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SI;TE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN' PLACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS ,k
BRACING/BRIDGING
JOIST HANGERS a \
JACK POSTS/MAIN BEAM,' \
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R- AFLOORS / R-
WALLS R- ti!
CEILING R-
DUCT WORK OR PIPING IN UNHEATED \
. SPACES
REMARKS:
•
ARRIVE /D
DEPART lL #(,f/l/j/
INSPECTOR
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