1991-833 • .
g*tl•q)
°
A
CERTIFICATE OF OCCUPANCY -
TOWN OF QUEENSBURY
WARREN' COUNTY, NEW YORK
/ •
•
Date February 26, 19 92
3 hAITV-11
This is to certify that work requested to be done as shown by Permit No. 91—:,
has been completed.
This structu may be occupied as a Single Family Dwelling
LocatioVC\, Lb t CIPraifil firivez
Owner guide) Passarel 11. Herald SIgaarP
By Order Town Board
TOWN OF QUEENSBURY
birector of Bldg. & Code Enforcement
MEL.
L
BUILDING PERMIT cri
1-1
TOWN OF QUEENSBURY
No. 91-833 w
WARREN COUNTY, NEW YORK
x
fD
PERMISSION is hereby granted to Herald Square
OWNER of property located at Lot 43 Herald Drive 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.
r
0
1. OWNER'S Address is rt.
45 Herald Drive
Queensbury, NY 12804
x
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2. CONTRACTOR or BUILDER'S Name
Same o.
3. CONTRACTOR or BUILDER'S Address
fD
4. ARCHITECT'S Name
N
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5. ARCHITECT'S Address T
v
6. TYPE of Construction—(Please indicate by X) fD
( XWood Frame ( ) Masonry ( )Steel ( )
to
7. PLANS and Specifications
No. 1,176 sq ft Single Family Dwelling as per plot plan specifications
and application
8. Proposed Use
Single Family Dwelling
$ 204.00 PERMIT•FEE PAID —THIS PERMIT EXPIRES December 2, 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 2nd Day of December 19 91
SIGNED BY s‘ U._ _r for the Town of Queensbury
Building and Zoning Inspector
I
TOWN OP QUEENSBURY -
el% REVIEWED BY: ArZif, ,11f�:
4 LANN OF QUEENSBL.
�N, FEE PAID: `/'~ FP 20 ._ RECEIVED
PERMIT NO. : g3 DEC 21991
San-le a-5 q 1-(a(/ V F.°,DC. & 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:
P.O. Address: �✓ /n- PHONE 7VJ--4-YZ
Property Location.: mod' 1/3 Wee'ead e Tax Map No. / /
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: /��1 -� Lot No. X.3
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
NATURE PROPOSED WORK: * ESTIMATED MARKET VALUE OF THE
1,7 Construction of new building * CONSTRUCTION: • $
Addition to building
Alteration to building * COMPLETE INFORMATION REQUIRED BELOW:
(no change to exterior dimensions) * . Size of Property: /9/ ft. x /rll ft.
Other work (describe) * Existing Building Size:
* ' ft. x ft.
* Proposed building - distance from
GROSS AREA OF PROPOSED STRUCTURE: * property line:
1st Floor � . .Sq. Ft. i�K
J/7 *' Front Yard o. ft. Rear yard . rf ft.
* ' Side Yards• 90 ft. and ft.
2nd Floor V Sq. Ft. 1 * If on corner, setback from side street-
* v6 ft., •
Other .Floors Sq. Ft. -01 * -
(not cellar or basement) * OCCUPANCY INFORMATION:
TOTAL FLOOR AREA: '�/7' Sq. Ft. * Prima} Building" -
* ✓ One Family Dwelling
Size of New Structure: Z' ft. x 7/7t. * Two Family Dwelling
Foundation: * Multiple Dwelling/No. of Units
Pier/Slab/Crawl/partial/Full (Circle One) * Business
/ * Industrial
No. of stories (Habitable space) / * Other
Height (grade to ridge) �,(' ft. *
If residential , no. of families: / * : If addition, what will use be?
No. of rooms (excluding baths): *
No. of bedrooms: V * —
•
No. of bathrooms: 1 / * Accessory Building:
Type Primary fuel :ing system: %Z/ R * / Detached Garage - One/
✓ Attached Garage - On /Two .0
No. of fireplaces to be installed: / * Private Storage Build
Will a woodstove be installed?: . * Other
Central Air Conditioning: Yes j/ 'No *
(OVER)
BUILDING PERMIT APPLICATION CONTINUED:
BUILDING SPECIFICATIONS:
Type of construction: wood frame, fire safe, etc. ,eleiv ___�
Will any second-hand or ungraded lumber be used? If so, for what? fiX)
Foundation Wall Material :
/�� ' � /lowcx/t/e_Thickness:
Depth of Foundation below grade to bottom of footing) : �'6,
Will there be a cellar? fgdIr Heated or Unheated? Floor Sq. Footage:
F :Will there be a basement? 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 -47AV
Size, wood studs Z.—" x " ; spacing / " o.c. ; length ft.
Joists (floor beams) : 1st Floor 1!----" x /U ";" spacing " o.c. ; span J 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 Z/ " o.c. ; span 241/ft.
Exterior Wall Finish: /i44j / S of what material ?
Interior Wall Finish:
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? If 'so, will a Fire-Rated door,
enclosure, self-closing device be provided? �CJ
Will a flue-lined chimney be installed? Zi.7lf Height above roof Z' ft.
Depth of chimney foundation below grade: ft. '
Depth of fireplace hearth: ft. in.
Water supply - Municipal or 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: Aidez..v///,°A PHONE Af c6/ /
NAME OF PLUMBER & ADDRESS: PHONE / 74'- 3'y'
NAME OF MASON & ADDRESS: e map PHONE -/�
hz
NAME OF ELECTRICIAN & ADDRESS: PHONE
•
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 �.
621
• 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
.uvvi a OF C ,�.ENSEsl..
REC1
Compliance Methods:
DEC 21991
PART 5 - Acceptable Practice Method - 1 & 2 Family Dwellings (ONLY)
PART 6 - Thermal Rating - Component Trade Offs - 1 & 2 Family Dwellings;LIDG" & 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
l
APPLICANTS AME PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - //7 Sq. Ft.
2. Type of Heat - Elec. Base Board Other !° •/ /g, ii0
3. Is Building Mechanically Cooled? / 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 ?U
B. Exterior Walls R
C. Glazed Area R mil• Jv
D. Exterior Doors R
E. Floors over unheated spaces R 30
F. Edge of Slab on Grade (Heated Building)
G. Basement/Cellar Walls (Above Grade) R
H. Basement/Cellar Walls (Below Grade) R / 3
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
i /a ) 7X/
AP ICANT'S SIGNATURE DA l TELEPHONE MJ ER
T'E / M
1
INSPECTOR'S REMARKS:
REVIEWED BY
Oft
1rj TOWN OF QUEENSBURY
' APPLICATION FOR SEPTIC DISPOSAL PERMIT P@rjrn4t-4 OUF r Sh,,
Fee Paid
Date: A/24/ Reviewe�d�LBy ' 1991
LOCATION OF PROPERTY FOR INSTALLATION: L,- f 3 t w O� & CODE DEPT.
Owner' s Name:. -ZZ c . U>// ,
Owner' s Mailing Address: Z2
Installer' s Name: ;, :/ Phone #: 7/�2'3eQ
Number of bedrooms (if residential ) : 3
Total daily flow (residential-compute @ 150 gal . per bedroom):
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: 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 well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank /i z) gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 5-0 feet//Total System Length ZA-7.) 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
i 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: a__ DATE: /2/'z4 J
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 $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
°0'...,4' MIDDLE DEPARTMENT INSPECTION AGENCY,-INC:
National Headquarters
' 1337 West Chester Pike,West Chester, PA 19380
APPLICANT COMPLETES THIS SECTION i_ Date:J��, ��/
City, Town or Township L /7-f 4-+-c/ /1// County aZt .4- ----- State
Location/Address Z/v/- , 3 -az/ f-/ase Di
� '
(If Lorca/fed'in Rural Area Attachrections) Pole #
Owner ./0 / ����----- /1 Permit # I ,4 'l
S
Occupied As -/-t,4" 9lL',91/7 Building: New Old
Occupant
.Work Area in Building (Floor #, etc.):
App. for: Wiring❑ Service❑ or: Ready for Inspection:
Fee Remitted-$ Cash n Check n M.O. n Make Payable To: M.D.I.A.
500 '750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Number of Rough Wiring Outlets Elect. Heat
•
Switches
Lighting •
Amp. Service Surface Unit Dishwasher Range
Receptacles - Water Heater Air Conditioner Dryer Pump
•
Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner
Amp. Receptacles Fractional H.P. Vent Fans
Other Equipment:
MOTORS H.P. 1/201/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 11/2 2 3 5 7'/2 10 15 20 25 30 40 50 75 100
'Mark Number
of Each Size
Applicant's ��
f^f/� &-
Signaturec.-- --- License # Permit#
T/A Utility:
Applicant's ddress:- Vf. �?,�.,.. , •''' (NAME) (OFFICE LOCATION)
(City) 7,71. ,65 4�L--• (State) /6/•�t (Zip) /z•i&' � ervice Request
Phone # 7 — 3l�L / Electrician: / Z 1/ / _
MDIA USE ONLY DATE RECEIVED: DATE INSPECTED: '
Correct Location: Same as Above or:
Red Notice Label n
Rough Wiring Outlets Surface Unit • . Oven
Switches Range Garbage Disposal
Receptacles Water Heater . Dishwasher
Fixtures Air Conditioner Dryer
Amp. Service Equipment Burner,Wiring &Controls for Amp. Receptacle •
Amp. Service Conductors Pump Vent Fans
MOTORS H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1J/2 2 3 5 71h 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size
500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Elect. Heat
' CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECT
FEE PAID
❑ RW Progress: Inc.❑ LKD❑ Contractor
❑ CFT Violation: Work Comp.❑ Inc.. ❑
. n L/A Owner CASH n
n L/A Fee CHK #
•
Due MO-#
n IPA Municipal
INV #
Date: Other Side! I Utility Applicant ❑
l Owner I I
•
Cut in Card ❑ Temp # Date
Final # Date • INSPECTORS SIGNATURE
T�f�f '}'.f 4 �J7' 77'`�V
i V Oi Q EE �SBLT \1
Bay at Haviland Roads,Oueensbury,N.Y.12801-9725'
APPLICATION FOR SOLID-FUEL BURNING APPLIANCES AND FIREPLACES
Date ` Permit No.
1.9
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 premises for the required inspections.
Applicant's Name f P : �{ APPLIANCE TYPE
., Stove Coal Wood
Address " � Furnace Hot Air Boiler
Zero Clearance Circulating Unit
Zip
Phone �'� ; 7' If Non-Masonry:
Owner's Name _.
Address "' Manufacturer , 7,t e
Model ', Outlet Size
f:'
,y Zip - ' Listed by Number
Phone Y''` y,-•
CHIMNEY TYPE
Masonry: Block Brick Stone
Property location of proposed construction Flue: Tile Steel
Size:
;-" Factory Built:
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 INSTALLED Insulated
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
A173 3389 (190)Public Safety
A233 2655 (230)Minor Sales
Fee Collected from or Refunded to: •
Address:
Dated: s Town Clerk or Deputy •
Wh le:,Aanlicant Yellow and 1'ivik:Corhier's nemrlmcnl l:nlllanrnii•F;r.,Afn.rk.1
„ TOWN OF QUEENSBURY
Ailimai& 531 BAY ROAD
", ti QUEENSBURY, NEW YORK 12804
�' z TELEPHONE (518) 745-4447
” -` BUILDING INSPECTOR'S REPORT .
FINAL INSPECTION
REQUEST FOR -INNSSPPECTION RECEIVED
-! 7
NAME ��
LOCATION `-rY4( 5006;4
DATE /ci/ PERMIT# 9) d
TYPE OF STRUCTURE�FL)
RECHECK
_FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL FRAMING
_ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC
INSULATION WOODSTOVE/FIREPLACE
REMARKS
APPROVAL
f N/A YE,r NO
CHIMNEY HEIGHT/LOCATION d�
B VENT/LOCATION k ✓/
PLUMBING VENT I ✓✓
t;ROOFING
SIDING /
DECK/PORCH/STEPS/RAILINGS d
RELIEF VALVES \\ ✓/'
FURNACE/HOT WATER OPER ING ✓✓
BASEMENT INSULATION/DU TWORK /
INTERIOR TRIM/PRIVAhC DOORS
FINISH FLOORS:
BATH/KITCHEN WAT ,TIGHT ✓/
OTHER FLOORS Sl EP,ABLE J
OTHER FLOORS RPE`FED
STAIR CLEARANgE�/RAILINGS
HANDICAPPED 'CCESS a
SMOKE DETE 'ORS 1 v///
BATHROOM NS/Ii1OtEHOUSE FANS ✓!
ALL PLUDBING FIXTURES- OPERATING t/
GARAGFiFIRE PROOFING
DOOR/CLOSERS
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
DUMPS TER
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL J
OK TO ISSUE C/O OR C/C v
COMMENTS: 0)"
ARRIVE /V
45
DEPART /f _//
INSP TOR
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECT ON RECEIVED y/� y 2—
NAME / �Q r
LOCATION G jj i'J/%ete
DATE 34 6;0 ' PERMIT# Oei�0
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
AUTO. EXTINGUISHING SYSTEM
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM
ALARM SYSTEM,
a
INTERIOR FINISHES
STORAGE: /
CLEARANCE/TO SP. INKLERS
CLEARANCE TO HEATING UNITS
REQUIRED Ss/GNAGE
CHIMNEY
WOODSTOVE
FIREPLACE-MASONRY
FIREPLACE-FACTORY BUILT
REMARKS: U OK TO THIS DATE
OK-P*4
ARRIVE
DEPART// 6°4.--
INSPECTOR
ELECTRICAL INSPECTIONS
/"�L%
FDUPLICATE MUNICIPAL RECORD
Permit No. �� �9/-1.�-�
Owner /24W s c2 l///-'L
Occupant
Location LG f `T S f 7 �
No. Street
U,IF-Cr-4/3 . -eC 2 V
Town or City State
Installation as Itemized on reverse side has been visually inspected pursuant to applicable codes.
Installed by ' fa rli..0
Date Inspector
MIDDLE DEPARTMENT INSPECTION AGENCY INC.
FORM NO.18 EL. 900 Haddon Ave.,Collingswood, NJ 08108
/ c./�0 ROUGH WIRING OUTLETS H.P.AIR CONDITIONER
,' W / 64 - WIRING &CONTROLS FOR BURNER
4-0 RECEPTACLES H.P.PUMP
PapFIXTURES K.W.OVEN
/P CAMP.SERVICE EQUIPMENT H.P.GARBAGE DISPOSAL UNIT 7`�4MP.SERVICE CONDUCTORS / K.W.DISHWASHER
K.W.SURFACE UNIT / K.W. DRYER
K.W.RANGE AMP. RECEPTACLE
r
K.W.WATER
,� �f� yR�
HEATER FFRRAC.H.P.VENT FANS
/
IOTORS H.P. I/20 I/12 1/10 11e % % '% I '/ 1 11 2 3 5 7/ 10 15 20 25 30 40 50 75 1
4ARK NUMBER
F EACH SIZE .
IPPARATUS
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
. QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED // 1 Lp CJ,-
NAME HON/a I (-) S rv, [
LOCATION �> ! - 4/3 j-e ii t r—,
DATE 1 /i(pigo_ PERMIT 0 01 j -- '33
TYPE OF STRUCTURE CS ' `'Co
RECHECK APPROVED
4 . N/A YES NO
FOOTINGS/PIERS • 1
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE i. j
THE CONTRACTOR IS RESPONSIBLE 1 /
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOWING
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE 0 ' sITE
FOUNDATION/WALL POUR /
REINFORCEMENT IN PLACE ./ 1
FOUNDATION/DAMPROOFING ,i 1
BACKFILL APPROVAL 1
ROUGH PLUMBING 1
PLUMBING VENT/VENTS .I PLACE i /
PLUMBING NDER SLAB ,/'''(FRAMING:) t-.0 (./ .i,e c,s �/�_rfir
JACK S UDS%HEADERS f
BRACING/BRIDGING I
JOIST HANGERS / P
JACK POSTS/MAIN BEAM a
HEATING ROUGH-IN
_ _NSUL`MTION:
' FOUNDATION WALLS INTERIOR R- /940 (....---
FOUNDATION WALLS EXTERIOR R- •°1 _
FLOORS R- i_--
WALLS R- ,ci
CEILING R- 35' a/
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE /
DEPART % / /
INSPECTOR
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED)4e I 1 &2f
q c
`
NAME c l d S
LOCATION Lt 14-PNc 1p trLQ
DATE ,2 PERMIT# 1 --
APPROVED
a" N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
;1 F
J.
/
FIRE EXTINGUISHERS
AUTO. EXTINGUISHING SYSTEM'
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM' ,
ALARM SYSTEM r,
INTERIOR FINISHES 1
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
CHIMNEY
WOODSTOVE
FIREPLACE-MASONRY /
,rFIREPLACE-FACTORY BUILT - -y1
REMARKS: OK TO THIS DAT
/171/117/thy../4".47,7
ale z �p
ARRIVE
DEPART L C ei4te-victPE TO
A TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
- TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED l/3J cj J NAME )-Ieiyr;At) UG`Y id J 1
LOCATION 02,04 A eai0 1 %
DATE j PERMIT 0 9 4 8 �j
TYPE F S RUCTURE S _ C �_.,
RECHECK APPROVED
. N/A YES NO
FOOTINGS/PIERS •
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROT CTION FR
FREEZING FOR 48 HO RS FOLLt ING
THE PLACEMENT OF T E CONC'ETE.
MATERIALS FOR THIS 3URPO;E ON SITE
FOUNDATION/WALL POU2
REINFORCEMENT IN PLAC
FOUNDATIBACKFILL APPROVAOOFI�
BACKFILL_APPROVAL
XROUGH PLUMBING(
PL-UMBTNG-VENT/V. TS IN PLACE
PLUMBING-UND SLAB
y FRAMING;
JACK S,FUDS/HEADE'`
BRACrING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN EAM
HEATING ROUGH-IN, :
INSULATION: k7
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R- _
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS: . if Afar IZe- u f-W t&egL.z__
ARRIVE
DEPART
SPECTOR
•
•
Jouin of Queeniar, •
-BUILDING and ZONING DEPARTMENT .
-Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME d4CJ/�
LOCATION v`qL /3
DATE /0 0 / 9/ - PERMIT NO. frcji
SOIL TYPE - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - /Inch :
TYPE of SYSTEM:
Absorption field, to al ength
Length ,of each 'trenc ' e
Depth of trenches ' -a '
Size of gravel'_' _4
SEEPAGE PITS{Numb: .f) '
Size- ft. X ft. •
Gravel size _
PIPING: V Size �ypCe
Bldg. to t. 'k 51
Tank to • :st. box . L(
Dist: pax to field/;pit ( a
Openi- gs sealed? fi ►
tt NO Partial
LOCATION/SEPARATIONS :
Foundation to tank It ft.
Foundation to absorption 049 ft.
Absorption to lot line ? ft.
Separation of pits --- ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front towLeft side -Right side -
COMMENTS:
i&OQJ - - .
- r
1 .
•
50M &-,141-• 43CK
S'STEM USE APPROVED AYES
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Buil ng Inspector
01/86 md,vl • '