1991-758 --e ,t• •Th, „ _ •, - „
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I
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date iiiqz./4!))1 if 19 9_1--
-
This is to certify that work requested to be done as shown by Permit No. 91-758
has been completed.
This structure may be occupied as a Addition to Dwelling
(Famlly Roam„ k Bath and Screeded Porch)
TT Location 17 Whippoorwill Rd
Owner Nary Ann Tfifilic
• By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code.Enforcement.
AMILWIMMOM.
. - 1
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-758
WARREN COUNTY, NEW YORK
0
PERMISSION is hereby granted to Mary Ann Tomi s
N
OWNER of property located at 17 Whippoorwill Rd Street, Road or Ave. ti'
in the Town of Queensbury,To Construct or place a Addition to Dwelling
at the above location in accordance to application together with plot plans and other information hereto filed and 0
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
V
1. OWNER'S Address is
Same au
2. CONTRACTOR or BUILDER'S Name
Fuller Construction
1-4
.M
3. CONTRACTOR or BUILDER'S Address i
.O
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4. ARCHITECT'S Name 2
a
5. ARCHITECT'S Address
a
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rf
6. TYPE of Construction—(Please indicate by X) 0
(X)Wood Frame ( I Masonry ( )Steel ( ) _ e
' C
7. PLANS and Specifications
a'D
No. 576 Sq Ft addition to Dwelling as per plot plan specifications
and application
8. Proposed Use
Family Room, 2 Bath and Screeded Porch
$ 73.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 25, 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 Queerisbury before the expiration date.)
Dated at the Town of Queensbury this 25th Day of ,October 19 91
SIGNED BY for the Town of Queensbury
Building and Zoning Inspect
•
TOWN OF QUEENSBURY
REVIEWED B n �
01111111% FEE PAID $ 2 d'�5 ' /�i ap
Iklc.. PERMIT NO. 01l -75-e
___ :-„�-yet.:.; �..,,,__., ,
BUILDING PERMIT APPLICATION ET% V4 , tir' 4;,S 0 , t"' ;�`'i f.
OC2 1991 '
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION , IINSPMITOWSPT•
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.
* « « * * * a * * a * a * * * * a a s, * * * * * * * * * * a a * * * * a a * * a *
The owner.of this property is: /PR Y/4i[/4/ N[5
P.O. Address GJff/Y, OOR w/LL Jb . U) 30,QV Tel.
Property Location .5A-J�9 --- Tax Map No. / /
Has there been any split of this property since.October 1, 1988? / _
If yes Planning Board Review is necessary. yes no
SUBDIVISION NAME,.IF APPLICABLE - .LOT NO. . `
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES [S:
•
NATURE OF PROPOSED WORK: :• ESTIMATED MARKET VALUE OF •
Construction of a new building a CONSTRUCTION: $ �j Q� �Gp
�.yr
l�Addition to a building • COMPLETE INFORMATION REQUIRED BELOW: o
• Size of property `Do. - ft x /6S ft: �.
Alteration to a building , * ,/
Existing Buildings(3) Size „6/ ft. x `T ft.
(no change to exterior dimensions)
* Proposed building - distance from property line:
Other work (Describe) * Front yard 90 ft. Rear yard 3 2.. ft.
•
Side yards l ft. and ft.
• If on corner, setbac ohm suers"tree ft.
GROSS AREA OF PROPOSED STRUCTURE •
1st Floor //Of sq. ft. *. .
OCCUPANCY INFORMATION
gMor !(o •sq. ft. * - Primary Building -
Other Floors sq. ft.
• �ne Family Dwelling
(not cellar or basement • Two Family Dwelling
TOTAL FLOOR AREA -'�i' sq. ft. * Multiple Dwelling/Number of units
_
Size of new structure , :! ft x G8 ft.
* Business
Foundation-pie!slakrawl/partial/full • Industrial
(circle one) • Other
- - - - - -- - ---�-- —__.:_.. ---- :_,._._
•
No. of stories (habitable space) •
Height (grade to ridge) L ft. • If addition, what will use be?,? f/Lci f oitj
If residential,no: of families * `f ,eg-)1 -1-1 ,=1- ,Q6 6-D a
No. of rooms(excluding baths)- ` ' • Accessory Building
No. of bedrooms • _Detached Garage ONE/TWO Car
No. of bathrooms /' - //2 ,Alv-ig . •
Primary heating system ' -gyp/moo • • —___Attached Garage ONE/TWO Car
Type of fuel ' _Private storage building
No. of fireplaces to be installed � * - •* ,
- - • Other
Will a Wood stove be installed
Central Air conditioning e, •
OV• ER
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING "SPECIFICATIONS:
Type of construction wood frame fire safe, etc.
Will any second-hand or upgraded lumber be used? If so, for what? /r%:
e.
Foundation wall material �L O S Thickness
Depth of foundation below grade (to bottom of footing) +F
• Will there be a cellar? /r4; Heated or unheated? Floor sq. footage sq ft.
Will there be a basement? /l/o Will any portion be used as living space?
(If so, what portion? • sq ft. Type of use?
Type of roof sloped flat/shed/other Material of roof 47711-
Size, wood studs o'2 "x . " spacinec4" o.c. length f ft.
Joists (floor beams) 1st floor ".swing . "o.c. spun ` ft. . .
Joist (floor beams) 2nd floor "x "-spacing "o.e. spun €h-
Overlays (ceiling beams) a "x " spacing /d" o.c. span a ft.
Roof rafters "x " spacing// o.c. span / ' ft.
Roof trusses (pre-engineered)er� " spacing - " o.c. span
Exterior wall finish a(-,/72.Q-o/Wvs of what material? /274D,CJ / Ta `
Interior wall finish 0_,64-2),yLd AL[ .,
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
Is there to be an opening between gar`s� and dwelling? �S If so will a Fire-rated door, enclosure,
self-closing device be provided? J` ' _
Will a flue-lined chimney be installed? A eight above roof . , / ft.
Depth of chimney foundation below grade ft Prea'"Fit-tg Fv
Depth of fireplace hearth _ ft. In. •
Water supply - Municipal or private well
SEPTIC SYSTEM Distance from ANY private well (including adjoining properties .4-
(A separate application is necessary for any repair or new installation of septic system)
4AME OF BUILDER LG 'la/5i,e ADDRESS 4)0 v5SU / TEL. NO. Z-- Za 3 0
'TAME OF PLUMBER !r � ADDRESS TEL. NO. k
IAME OF MASON !1 ADDRESS TEL. NO.
'TAME OF ELECTRICIAN 4 c, ADDRESS ti TEL. NO. (P
DECLARATION
To the best of my knowledge and belief the statements contained in this application, together with the
lla .s-and spc'd-fieactive.cl':ubiaittedi-ore-a=-true and t: pleoe-statCmentt=U'f 6a1- r'C�'i 5sel-Yuri"to
a , e� �' �v'-�. . .__,, R a ram--deii2 a:;- ----_ --t-
he described premises and that all provisions of the BUILDING CODE, THE ZONING ORDINANCE, and
ll other laws._pertaining to the proposed work shall be complied with, whether specified or not, and that
uch work is 'authorized by.the owner.
Signatu,
Owner, owner's agent, architect, contractor
PECIAL CONDITIONS OF THE PERMIT:
BY "
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE:DAY$
'3 j�3 1 U \ �° � S '
o s 1„r + sus �
Compliance Methods: 6(�L; � ��
PART 5 - Acceptable Practice Method - 1 & 2 Family Dwellings (ON ) GC
PART 6 - Thermal Rating - Component Trade Offs - 1 & 2 Family De1]30!.irn icn & CODrf-' DEP "
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
4-te( �144 l 5 / 7 td/7‘/ppre e/e& ic.,L /67
APPLICANT'S NAME PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - 274e g Sq. Ft.
2. Type of Heat - K Elec. Base Board Other
3. Is Building Mechanically Cooled? YES x NO
4. Percentage of Area of Windows and Doors Over 17% X 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 .38
B. Exterior Walls R
C. Glazed Area R 3,2
D. Exterior Doors R _6, Z
E. Floors over unheated spaces R
F. Edge of Slab on Grade (Heated Building) R //
G. Basement/Cellar Walls (Above Grade) R
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
CZ
LD/Z3 c// 7i2 -2-0 30
PLIC NT'S SIGNATURE ` DAT TELEPHONE NUMBER
INSPECTOR'S REMARKS :
"it/
IEwE BY
YOU ARE HEREBY REQUESTED TO - to
INSPECT AND ISSUE CERTIFICATES
FOR THE FOLLOWING ELECTRICAL
EQUIPMENT TO BE INSTALLED BY
THE UNDERSIGNED
TEMP.# DATE
/
CITY OR VILLAGE / 'j � / TOWNSHIP COUNTY
� � ) �;` J!1
STREET AND NO.OR ROAD _ POLE NUMBER
/ 7i ( ,/�; / -�,?OI c- .,) /L. r 11JT
BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT
OCCUPANTS NAME BUILDING OCCUPANCY
f i 7/`i:\ I/ i 1/1. I/i.1 ___ ".: /` / j )
OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER
CURRENT SUPPLIED BY FROM THEIR y.O
J OFFICE WORK TELEPHONE NUMBER
/1/ / . 1 6) / L 6,;' � f�'/Z--e
BUILDING IS ..
NEWp. A;:),I) I T /()Ai OLD❑ WORK IS NEW Ksl 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
Lion 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
CHARACTER OF WORK ❑ EXPOSED GAS TUBE SIGN/TRANSFORMERS OF VA
❑ CONCEALED
DATE WORK TO BE STARTED I. DATE COMPLETED SIZE OF SIGN(NUMBER) CAPACITY
SERVICE ENTERS BUILDING 1, MANUFACTURER OF SIGN
❑ OVERHEAD ❑ UNDERGROUND
DATE INSPECTION REQUESTED ON(OR AS NEAR AS POSSIBLE) MUST DENT E ENTER AN NUMBER
AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NAME AND ADDRESS �� �:'
NAM F-APPLICANT DATE OF PPLIC TION / IGNAJURE OFAPPL`EANT,s—// /52, i
/ //L l f"/,�? (�-)/s-'.>//r i�>�77J;V (f) 7G� ��/ ICJ'° ( ::,--,-�---L.._r
STREET ADDRESS, _ .-) TELEEHONE NO._, _
/_./ /1' / '/ - �O J✓)
CITY 9R POST OFFICE ZIP_CODE LICENSE NO.WHEN APPLICABLE
)I`
q.
❑ 85 John Street O 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
. TOWN OF QLIEENSBLIRY
•
Bay at Haviland Roads,Queensbury,N.Y.12801-9725
APPLICATION FOR SOLID-FUEL BURNING APPLIANCES AND FIREPLACES
Date /v /29 19 / Permit No. (r75g
• ,. •
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
inspectors to enter premise for the required inspections. .
i—
Applicant's Name / Go, ,,� �; C APPLIANCE TYPE
1,
� � Coal ' Wood
Address � -To'er C/ - Stove t'AJ�, IQ Furnace Hot Air Boiler
,�
/ / Zero Clearance Circulating Unit
P/?
(Pt, 1 .1-r �i f, A//t Zip /?fd !
Phone ?/-7 — 2 0,.0 If Non-Masonry:
Owner's Name Mit-A X,tih e 7—U , is ,—,
Addressd Manufacturer
A
W ✓✓. ..d4�',,, / /'� :-/ Model. Outlet Size
26t P ei-.24( =-'sal Zip / 2 fig/ Listed by Number
/
Phone
CHIMNEY TYPE
Masonry: Block Brick Stone
Property location of propqsed construe i =n Flue: Tile Steel
/ � vU
��II ''Gr// ,}�
/h, ,rerv/ I iedalf Size:
/7 Factory, Built: ,, •
Manufacturer • Model Size X-
COPY OF MANUFACTURER SPECIFICATIONS IS Height 7 Listed By Number
REQUIRED FOR FACTORY-BUILT APPLIANCES Type: Double Wall • Triple Wall
AND CHIMNEYS. MUST BE INSTALLED Insulated X'
ACCORDING TO SPECIFICATIONS. COPY OF Estimated Cost
CONSTRUCTION DETAIL REQUIRED FOR MA- Fee$ •
SONRY FIREPLACES AND CHIMNEYS.
' CASHIER'S DEPARTMENT
TOWN OF QUEENSBURY, NEW YORK
Department: Fire Marshal Amount Collected Amount Refunded
Code Number Title e4 6°
A173 3389 (190)Public Safety
A233 2655 (230) Mindr Sales
Fee Collected from or Refunded to: �11\ learAlf-06-41(2V1
Address: •.%"Th1 )r
Dated: /�)�v � Tciwn Clerk or Deputy �� �, a,,I)7
While:Applicant Yellow and Pink:Cashier's Department I Goldenrod:Fire Marshal
a
- _ m/*yin/s anPla WA AKARMK/Elm7RIMCmMgMa MAMA 7MC7MCmm7J♦Cmlilm7>t(I✓LFUSIV ILClilm7MCMARC7iCmmmmm7Ms.m7!♦Cmmm
THE NEW YORK BOARD. OF FIRE UNDERWRITERS PAGE 1 ._
4156065 BUREAU O• F ELECTRICITY
k T.41 STATE STREE .ALBANY,NEW,YORK 12207
Date DECEMBER 04,1991 Application on e)8183991/10 : 1 062042 1-
THIS CERTIFIES THAT PERMIT NO 91-758
only the electrical equipment as described below and introduced by t plicant named on the above application number in the premises of ® -.
0MAR\' ANN TOMIS, 17 WHIPPOORWILL RD. , QUEENSBURI, N,I'.
I •
in the following location; ❑ Basement 1st Fl. ❑ 2nd Fl. Section Block Lot
z
0 was examined on NOVEMBER �'S r 19 91 and found to be in compliance with the requirements of this Board. g
ii
FIXTURE ECEPTACLESI SWITCHES FIXTURES RANGES COOKING DECKS - OVENS DISH WASHERS EXHAUST FANS
0 OUTLETS INCANDESCENT-FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. ^""-
Ek
7 7 5 "7 f,
Is . DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
k' 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 ®�.
•
11
SERVICE DISCONNECT NOF S E R V I • C. E
AMT. AMP. TYPE E
.OQUIP. 1 if 2W 1,e"3W 3,B'3W 30 dW NO.OFpeR.COND. OF CC.COND.. NO.OF HI-LEG. OF.HI-LEG NO.OF NEUTRALS OF NEUGRAL
e a i
1 p
OTHER APPARATUS: ;�W
•
PADDLE FAN-1 .
I ia
ELEC, ROOM HE tTERS,;-.75 I .W.� _ 1-'1.5 K.W. . •
G.F.C.I.- :` a
k
0 '
E
k
k FULLER CONSTRUCTION CO.
0. ORVILLER FULLER . . __ crT� =
9 JOHN CLENDON ROAD . BRANCH MANAGER
a
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. : ..
V 1'1 f7"CY Ti i'iY'i(Y Y'r CY\'1 Y'i Y-)('i?'%?7 i'?i''7'i'I C'i Y'i?Y 7'i Y4 Y'i Y9(Y YY?`i.Y'%f-i Y'r C'r C'i C'i?1 C'7 Y'i C'I, ''i'C.'?CY?'i?Y C-1'-i'C7 YY C'r C'7 .1'r CY C7 i , . 'Y
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
' TOWN OF QUEENSBURY
Mit 531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL .
REQUEST FOR INSPECTION INSP ECEIVED 4 f f( f
_� 0 ff
NAME t CIAVA ` �\ Y r1 `'1,n
iJ )/LOCATION t 7 lt i 9 fOC) 1v e )
DATE " - a PERMIT# 9 / - 7 sY
TYPE OF STR CTURE AO 8 Ni--.6 >-e_QQ
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
_FOOTING FOUNDATION BACKFILL \FRAMING
ROUGH PLUMBING 4 FINAL ELECTRICAL _SEPTIC
INSULATION W DSTOVE/FIREPLACE
REMARKS
APPROVAL
N/A Y, NO
CHIMNEY HEIGHT/LOCATION r
B VENT/LOCATION f /
PLUMBING VENT
ROOFING / ✓/
SIDING / r/
DECK/PORCH/STEPS/RAILINGS /
RELIEF VALVES + /
FURNACE/HOT WATER OPERATING
BASEMENT INSULATION/DUCTWdRK
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATERTI`G; T
OTHER FLOORS SWEEPAB6E ✓
OTHER FLOORS CARPET 'D\ ✓
STAIR CLEARANCE/RAIL , GSA
HANDICAPPED ACCESS \
SMOKE DETECTORS f)
\
BATHROOM FANS/WH FA-Ns ✓/
ALL PLUMBING FIXTU, ES OPERATING ✓
GARAGE FIRE PROOF NG
DOOR CLOSERS
OTHER FIRE SEPARATION 1
FIRE/DEMISE WALLS
DUMPSTER / 1
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL �, f/
OK TO ISSUE C/ OR C/C \ c/
COMMENTS:
ARRIVE //
1� ' /
DEPART J/
PCTO
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 III ft9 0
bm
NAME l > S ( 9 [ x�%P)A1r1 f
LOCATION /2(-)1- will PC),"
DATE II 1 / -j l ) PERMIT # `q/i 1
TYPE OF STRUCTURE N;} A-Q
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 I
')FRAMING: / ,IJ
JACK STUDS/HEADERS A
BRACING/BRIDGING
JOIST HANGERS 4 �
JACK POSTS/MAIN BEAM
FIRESTOPPING Ink
WALLS
CEILING p'
FIREWALLS f
HEATING ROUGH-IN /
4INSULATION:
FOUNDATION WALLS INTERIOR° R-
FOUNDATION WALLS EXTERIOR R-
FLOORS / R-
WALLS / R- 1//
CEILING I R- 3 ', d
DUCT WORK OR PIPING IN/UNHEATED `,
SPACES I
l '
REMARKS:
,`1
•
669
ARRIVE /I 'l
DEPART / ` JS 1C40.\
INSPECTO
CLOLli
vim' \��F QUEENSBURY
, ,CSI)Cf\
BUILDING AND CODES DEPARTMENTC�-- ¢'I
531 BAY ROAD
QUEENSBURY,
NEW 0 4
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED /%P f/9-I
NAME \("j'fY\\ S � '\0`; V1
LOCATION \ )\ tCa)Y W1
DATE l c/2J f 6/ PERMIT # \ 1 '7 ll�
TYPE OF STRUCTURE 06r) 4-6 1P 1l
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 f'
FOUNDATION/DAMPROOFING j
BACKFILL APPROVAL /
ROUGH PLUMBING ;; /'
PLUMBING VENT/VENTS IN PLACE J.
-PLUMBING UNDER SLAB
FRAMING: "
JACK STUDS/HEADERS !
BRACING/BRIDGING ,4
JOIST HANGERS �-
JACK POSTS/MAIN BEAM /
FIRESTOPPING j
WALLS I
CEILING
FIREWALLS
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R- '\
FOUNDATION WALLS EXTERIOR R- .
FLOORS R- k
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART
EC TOR
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