2011-015 TOWN OF QUEENSBURY
goo 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20110015 Date Issued: Friday, April 06, 2012
This is to certify that work requested to be done as shown by Permit Number P20110015
has been completed.
Location: 6 CHARLTON Ln
Tax Map Number: 523400-308-006-0002-016-000-0000
Owner: CLUTE ENTERPRISES, INC.
Applicant: LUZERNE VENTURES, LLC
This structure may be occupied as a:
Garage Attached By Order of Town Board
Single Family Dwelling TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property (-- 41.40 4 „a-it
owner of the responsibility for compliance with Site Plan,Variance,or
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement
or Zoning Board of Appeals.
00` TOWN OF QUEENSBURY
01 .
F , 31 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110015 Application Number: Ar110015
Tax Map No: 523400-308-006-0002-016-000-0000 1
Permission is hereby granted to: LUZERNE VENTURES. LLC
For property located at: 6 CHARLTON Ln
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other infi•• atio by reto filed
and approved and in compliance with the NYS Uniform Building Codes and the Quee-n:: Z. ,-
Ordinance. T A.a of Constructio Value
Owner Address: CL . E TERPRISES, INC.
6 'OLDE Ave arae- Attac e:
1 UEENSB Y,NY 12804-0000 •ingl ami , Dwelling 35,000.00
otal : ue $135,000.00
h
' .
Contractor or B is Name / dress \ Electrical Inspec • n Age.
Plans&Specifications
2U11-015
1300 sq ft single family dwelling& 3 sq ft garage
$310.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,February 03,2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the T(strircueen ryrj h , February 03, 2011
SIGNED BY ,Yf for the Town of Queensbury.
Director of Building&Code Enforcement
41°1111hTOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110015 Application Number. A20110015
Tax Map No: 523400-308-006-0002-016-000-0000
Permission is hereby granted to: LUZERNE VENTURES. LLC
For property located at: 6 CHARLTON Ln
in the Town of Queens bury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queens bury Zoning
Ordinance. Type of Construction Value
Owner Address: LUZERNE VENTURES, LLC
22 SULLIVAN Pky Garage Attached
FT. EDWARD, NY 12828-0000 Single Family Dwelling $135,000.00
Total Value $135,000.00
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2011-015
1300 sq ft single family dwelling &320 sq ft garage
$310.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday, February 03, 2012
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Tg rn of` eens iyuyi :hu sd�y, February 03, 2011
l av / V
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
/N r �s ���0010
3 08. OFFICE USE ONLY """'
TAX MAP NO. (J PERMIT NO. /)-' 0 15 r� rl lr
n
FEES: PERMITS. ____.„,.f,
RECREATION 342-' ENGINEERINGjA; �� 2 i1 iL,
t /��, / (If applicable)
'k) .
PRINCIPAL STRUCTURE: APPLICATION FOR ZONING APPROVAL & BUILDING
PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO REVIEW
BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.
APPLICANT/BUILDER: C .) OWNER:
ADDRESS: (P k YO`C\e�Ak...9 e ON ADDRESS:
PHONE NOS. -7 9 S 7 a7 7 PHONE NOS.
CONTACT PERSON FOR BUILDING &CODES COMPLIANCE: c i. PHONE: CP ( i55
LOCATION OF PROPERTY: Cj C �
it-\ --`. ) 30 , (, -- D - I C-
HAS THERE BEEN A SITE PLAN REVIEW;VARIANCE OR SUBDIVISION APPROVAL? glES 0 NO
IF SO, INDICATE APPLICATION NO.AND DATE OF APPROVAL: 0407 4 1$
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT z
0 APPLY TO YOUR Z p o "- u)
PROJECT0 OOH OJT: Oil
w JW WW W Q e- OU
D L.L. o 2 I- O — z
Z < < ,- � i" � OOIL I- UU.. CL
00
SINGLE FAMILY K (49D-9 &2 13 co a7 # (9-64
TWO-FAMILY
MULTI-FAMILY
(NO.of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
6.
ATTACHED
GARAGE() "S' -C) 3D.p 1 g
OTHER
Town of Queensbury * Community Development Office * 742 Bay Road, Queensbury NY 12804
Revised 4/14/2010
IF COMMERCIAL OR INDUSTRIAL—NAME OF BUSINESS:
ESTIMATED CONSTRUCTION COST: L 5`7 00 p FUEL TYPE: 9Q
HEAT TYPE:Lc-c c.i *HOW MANY FIREPLACE(S): cL AND/OR WOODSTOVES(S):
ZONING CATEGORY: ARE THERE WETLANDS ON THIS SITE? V u
IS THIS A HISTORIC SITE?
PROPOSED USE OF BUILDING OR ADDITION: „..Le
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? o
ARE THERE EASEMENTS ON PROPERTY? �b
*Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in our office
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans, and supporting materials are a true and
complete statement/description of the work proposed, that all work will be performed in
accordance with the NY State Building Codes, local building laws and ordinances, and in
conformance with local zoning regulations. I acknowledge that prior to occupying the
facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand
that I/we are required to provide . as-buil' survey by a licensed land surveyor of all newly
constructed facilities prior to ' suance of a c: I e of occupancy.
I have read and agre_ o
Signed
Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction codes
or septic systems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
Town of Queensbury* Community Development Office * 742 Bay Road, Queensbury NY 12804
Revised 4/14/2010
Permission is hereby granted to the above This application / proposed action described
Applicant to erect or alter the building herein is found to be in accordance with the
described herein in accordance with said zoning Laws of the Town of Queensbury.
Application:
BUILDING & CODES APPROVAL ZONING APPROVAL
DATE DATE
QUESTIONS? CALL 761-8256 OR EMAIL
codes(a�queensbury.net
Office Use Only VISIT OUR WEBSITE FOR MORE INFORMATION
www.dueensbury.net
Operating Permit Issued: Yes No
Occupancy Type: Construction Classification:
Assembly Occupancy Limit: Special Conditions:
Town of Queensbury* Community Development Office * 742 Bay Road, Queensbury NY 12804
)fOi5
Revised 4/14/2010
Town of Queensbury
Highway Michael F. Travis
Department Highway Superintendent
742 Bay Road, Queensbury, NY 12804 Home (518) 798-0413
Office Phone: (518) 761-8211 Thomas R. Vanness
Fax: (518) 745-4466 Deputy Superintendent
Home (518)745-0929
www. Queensbury.net
DRIVEWAY PERMIT
Date: 1 f 1ir-I Li
Applicant Name: CA.)k ( P4._ .
Address to be inspected: ,.N.
Return Address: (p %.-6‘&4./N. INt,fe c;1L(�
Applicant must show exact location and width of driveway(s) to be connected to the highway by placing
stakes at the specified location.
The Superintendent of Highways of the Town of Queensbury has reviewed this application. The following
action has been taken:
Step 1: ( ) Preliminary Approval
Need: ( ) Slight swale
( ) Deep swale
( ) Level with the road
( ) Level with the top of the paved wing
Size culvert pipe to be used (if necessary)
( ) 12" ( )15" ( ) 18" ( )24" ( )36"
Preliminary inspections completed by: Date:
Approved by Higway Supt: Deputy Supt.:
Upon completion, please resubmit this approved permit for a final approval.
Step 2: ( ) Final Approval
( ) Rejected
Date:
Michael F.Travis, Highway Superintendent
Thomas R.Van Ness, Deputy Highway Superintendent
Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
I(i :7 t`P .i•.
ri I Revised 4/14/2010 il
OFFICE USE ONLY , J
// O1ERMIT
TAX MAP NO. PERMIT NO. FEE TG. %....., -
F: 11 C„ - i.-. ib:3iJRY
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PERMIT.g .
OWNER: 11 C��v^^ INSTALLER: ��v1
ADDRESS: (L £k0 .- INwe_. GN/7 N ADDRESS:
_7
PHONE NOS. —79 -7.7 7 J PHONE NOS.
LOCATION OF INSTALLATION: CO 0.--..0-r—kN•-0.e-� Ne CZt 1:1-/5
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED? tii o
1981 -1991 X 130 , = SPA OR HOT TUB i ('ti
1992-present X 110 = &- 0 INSTALLED? V--J p
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi]
(Test to be completed by a licensed professional engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer
or architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: MOO GALLON(MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder,spa or whirlpool tub.
SYSTEM TY : r
ABSORPTION FIELD(WITH NO.2 STONE) Total length If" O ft. Each trench 3 X So
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
For your protection,please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval
granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or
circumstance known by or on behalf of an applicant,shall be void.
I have read the -gulations with -spect to this application and agree
to abide by ese and all requi • - il,, . t e Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanita :ewag-.Iispos•./c, d' an'-. codes(a)queensburv.net
/'� ��� L VISIT OUR WEBSITE FOR MORE INFORMATION
)017'at 'hof Person Responsible Date www•aueensburv.net
Town of Queensbury* Community Development Office *742 Bay Road, Queensbury NY 12804
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
............
Permit No......
Cert0 19080 Cut-in Card No.........................
F
r ��.
v .�
.. r � �
Owner............. ..
Location.... ... ' /'.. ���. z...�
.f
Installation Consisting of.. .. � �. q """'"""'
�,gry
....... . .. .... j ..�. .......71(..............................................
..........................'J..........
. ...........................................................................................................................................
InstalledBy...... .P .1.............................................................Lic.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privile of aking peck ns at any time, and if its
rules are violated,the Company shall have the right to ev e is c rtii
/ �................ INSPECTOR.... ....
' L �. ._........................
Date... ..:.. .! ..:. ........... . ....................................
"' Member N.F.P.A.,I.A.E.I.
jr ' d -
Queensbury Building & Code Enforcement - Residt,fitial Final Inspection
Office No. (518) 761-8256 Arrive: am/pm Depart:tO II 3'"am/pm
-
Date Inspection request received: ` 5',oZ Inspector's Initials:
NAME: C ) 9d PERMIT#: // O/,}
LOCATION: (.o e -
H - ' ,-r I\ar7 DATE: _Cr)-/
TYPE OF STRUCTURE:
Comments:
YetVA NIA
4" Building Number Address visible from road �f
Chimney Height/"B"Vent/Direct Vent Location ,VV 7 fkPa S��
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 18 inches
Roof Complete/Exterior Finish Complete t k'L' --
V �G R3 -
Platform at all exterior doors [ ' �� >.t/ `
Handrail 4 or more risers11-644/Fih
Guards at stairs,decks,patios more than 30 inches above grade / 1 -keF°3 `-
Guard at stairwell at 34 inches or more t!
Guard at deck,porches 36 inches or more t/ 17'
Handrail Termination at Newell Post or Wall Vf
Interior/Exterior Railings 34 inches to 38 inches /�
Deck Bracing/Handicapped Ramp Compliant ►/
Grade away from foundation 6 inches with 10 feet /
6 inch clearance to sill plate ✓�
Gas Valve shut-off exposed/regulator 18 inches above grade
Interior privacy/trim/doors/main entrance 36 inches ✓V
Bathroom/Kitchen watertight
Safety glazing/W' ow in stairwells safet $�I;azing
Interior Smoke D Lectors/Carbon noxid¢Detectors
Every level: Eve Bedro m:
Outside every bedroom a:
Inter Connected: Battery backup:
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area /
Crawl Spaces 18 inch x 24 inch access, 1 sq.ft.-150 sq.ft.vents /
Bathroom Fans, if no window y/f
Plumbing fixtures
Foundation insulation to floor/Sticker on Panel
Duct work sealed properly/Blower Door Test Certification
Floor truss,draft stopping finished basement 1,000 sq.ft. ✓
Emergency egress below gradet/
Gas Furnace shut-off within 30 feet or within line of site
Oil Furnace shut-off at entrance to furnace area +/
Furnace/Hot Water Heater operating
Low water shut-off boiler ✓
Relief Valve(s)installed/Heat Trap/Water Temp 110 /
Enclosed Stairs Sheetrock Underside minimum 1/2"Gypsum / t/
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing 1%hour fire door/door closer /
Gas Logs in Sealed or Glass Enclosure // �/
Final Electrical; Energy Saving Light Bulbs 50% V
Final Survey Plot Plan V
Arc Fault Breaker Habitable Spaces/Tamper Proof Receptacles ...//
Flex Gas Pipe Bonding ✓/
As Built Septic System/Sewer Dept. Inspection Sticker V
Site Plan /Variance required -6.-0
f j
Flood Plain Certification, if required t�
Okay to issue C/C or C/0[Temporary/Permanent]
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form_revised_100405.doc; Revised
January 7,2008; Revised 6126/08; Revised 12/22/10, Revised 04/13/11
Final Survey Inspection
Dept. of Community Development
Town of Queensbury
742 Bay Road
Queensbury,NY 12804
Date received: LI .±-1A
NAME: C� 2-
LOCATION: to G7drx.
PERMIT#: 01 5
Final Survey Plot Plan
Approved Denied
The attached final
survey has been
received by the
Dept. of
Community
Development.
Upon review the
survey has been:
Craig Brown,Zoning Administrator
Notes:
L:\SueHemingway\Building.Codes.Inspection.FORMS\Final Survey
Zoning Administrator.doc
MAP REFERENCE
SUBDIVISION PLAN MADE FOR
HAYES AND HAYES
BY. VAN DUSEN & STEVES
DATED: JUNE 15, 2007
LAST REVISED: NOVEMBER 5, 2007
D u sF e
Steve s
Land Surveyors
169 Haviland Road Queensbury, New York 12804
(518) 792-8474 New York Lic. No. 50135
UTILITIES
A�'RAt r oRi�
a
MN
'UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY
MAP BEARING A LICENSED LAND SURVEYORS SEAT. IS A
MOLA71ON OF SECTION 7209. SUB-DMSION 2. OF THE
NEW YORK STATE EDUCATION LAW.'
'ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY
MARKED WITH AN ORIGINAL OF THE LAND SURVEYORS
SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES.'
'CERTIFICATIONS INDICATED HEREON SIGNIFY THAT
THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE
E)aTING CODE OF PRACTICE FOR LAND SURVEYORS ADOPTED
BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL
LAND SURVEYORS. SAID CERTIFICATIONS SHALL RUN ONLY
TO THE PERSON FOR WOM THE SURVEY IS PREPARED. AND
ON HIS BEHALF TO THE TITLE COMPANY. GOVERNMENTAL
AGENCY AND LENDING INSTITUTION LISTED HEREON. AND
TO THE ASSIGNEES OF THE LENDING INSTITUTION.'
0
�Z
A4
A
LOT 16
LOT 14
6101
64
3, r9 �l'
S83--14- E
75y. 79
LOT 15
15,810.20 sq. ft.
0.36 acres
Map of a Survey made for
Clute Enterprises
Town of Queensbury, Warren County, New York
J /3 LANDS N/F OF
GILMAN
1 3/26/12
NO. DATE
UPDATE
DESCRIPTION
liazel May i i,
Scale 1'=20'
S-1
SHEET 1 OF 1
Clute
DWG. NO. 04007-15
q-4/ A---
Rough Plumbing I Insulation Inspection Repo
Office No. 518 761-8256 Date Ins action u hire•.-iv- •: I1� f Z
Queensbury Building &Code Enforcement Arrive: ) ani m i t = .art: v a
Q ry 'i"� • • ;p n�P�►
742 Bay Road, Queensbury, NY 12804 inspect° s In€tials:L— ,,,.‘ —�
/:
C (ciC 1.--0 za-, -� e SIS�
NAME: PERMIT#.
LOCATION: (a C,(� kA\2. +t' L;-lp--- INSPECT ON: /2,
TYPE OF STRUCTURE:
Y N N/A1
Rough Plumbing/Nail Plates
Plumbing Vent/Vents in Place
1 'r4 inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/change of direction — LO\t ., – ).,_5
Pressure Test
Drain I Vent LK, = d
Air/Head
5 P.S.I. or 10 ft. above highest connection for 15 minutes tt.L\--7 _
Pressure Test < . '�))"�...--
Water Supply Piping < '( l� Z1
!
Air/Head 1,'
50 P.S.I for 15 minutes 1V ` /
4risulation/Residential Check/Commercial Check — V----Vc% ,v' Lj
Tyvek or Similar Exterior Sealant
Proper Vent,Attic Vent P-' 3 Lei U 4,
Door/Window Sealed (No Insulation)
Duct I Hot Water Piping Insulation
If required unheated spaces 7 *
Combustion Air Supply for Furnace
Duct work sealed properly I No duct tape W4,1L, Vi.x..---- /
COMMENTS:
Rough Plumbing Insulation Report.revised Nov 17 2003,revised February 15,2005,revised January 7,2008
f/I/o
Framing / Firestopping Ins, = -, Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm, - Depart: A MI am/pm
742 Bay Road, Queensbury, NY 12804 I is Initial . f G
NAME: P (-0 .
ERMIT#:
LOCATION: (liar(ym_ ljriNNIIIININSPECT ON:
TYPE OF STRUCTURE:
Y ti , COMMENTS:
Framing
Attic Access 22°x 30*minimum
Jack Studs/Headers
Bracing/Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12"O.C.
Headroom 6 ft. 8 in.
Stains 36 in. or more
Exterior Deck Bracing
Headroom 6 ft. 8 in.
Notches/Holes/Bearing Walls
Metal Strapping for Notches Top Plate
1 'A(w) 16 gauge(8) 160 nails each aide
Draft stopping 1,000 sq.ft. floor trusses
Anchor Bolts 6 ft.or less on center
ice and water shield 24 inches from wall
Fire separation 1, 2,3 hour
hour
Firestopping
(2. )141
sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side'A inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space!Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above!below grade
5.0 sf grade
L:1Buitdng&Codes Forms-OLOttutiding&Codes\nspecian Forme Fnoning Finstopping inspection Repos.doc Revised Januety 7,2008
Septic Inspection Report
Office No. (518) 761-8256 Date Ins• on -• - re -•
Queensbury Building &Code Enforcement Arrive: s - /i:..rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial
NAME: C LUTE_ E0 Rft 15 E)D -'MIT NO.: ," �'
LOCATION: (n C' 1�a'�L 211)U\iJE SPECT ON: I — [ 17
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water _
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO] t'
Absorption Field: Total length ft.
Length of each trench _ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit _
Opening Sealed: Y N
End Cap Y_ N
Inlet/Outlet Pipes&Baffles Y— NAS B LT
Manholes 12"or less below grade _Y N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank ft.
Foundation to absorption /ft.
Separation of Pits ft.
Conforms as per P • - an 'N —N
Engineer Report . d As-Built Y _._N
ETU Maintena•ce Co t . Y N
provided L`
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
tern se S .to-.
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc
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ILDING&COD
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Septic Inspection Re rt
•
Office No. (518) 761-8256 Date Ins a on -'- reg: ved: I 1 .. ) 13-
Queensbury Building &Code Enforcement Arrive: 9=ZR i►, • D.4.0;rt: 12n am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial •
NAME: P" IT NO.: I I - C) / 5/
LOCATION: (p CArtfv. L-1INSPECT ON: 1 I I cx 1 eil--e) i:-
RECHECK:
Comments and/or diagrarrl
Soil Type: oam / Clay
Type of Water: unici..1 1 Well Water
Waterlin- eparation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench (: ft.
Depth of trenches Z ft.
Size of Stone • Z
Seepage Pits: Number _
Size: x
Stone Size:
Piping Size Type
Building to tank 4" hCG Lit)
Tank to Distribution Box IA" bO R 39-
Distribution Box to Field/ Pit // >-v" s/r7 Rt__ 6 LA"c3U_- c,F
Opening Sealed: VX—N
End Cap ✓ _N
Inlet/Outlet Pipes&Baffles . N
Manholes 12"or less below grade V Y_f'
[provide extension collar if Yes] „ Y ✓N
Location/ Separations {
Foundation to tank 16. ft.
Foundation to absorption �l�O frzft.
Separation of Pits
Conforms as per Plot Plan ___.Y 7N > 0C (\1J_Qv\L�
Engineer Report and As-Built _Y N
•
ETU Maintenance Contract _Y_N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status___vi(
proved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc
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Rough PlumbingI Insulation Ins �cio port
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building & Code Enforcement Arrive: > am/pm\ Depart: am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials:
NAME: v -� PERMIT #: )/
LOCATION: d! // INSPECT ON: NAV
TYPE OF STRUCTURE:
— Y N N/A
Rough Plumbing I Nail Plates
Plumbing Vent/Vents in Place
1 % inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet I change of direction
Pressure Test
Drain /Vent
Air/ Head
5 P.S.I. or 10 ft. above highest connection for 15 minutes
Pressure Test
Water Supply Piping
Air! Head
50 P.S.I for 15 minutes
,I u ationResidential Check/ Commercial Check
7Tyvek or Snilar Exterior Sealant
ro e dnt, Attic Vent _
Door/Window Sealed (No Insulation)
Duct/ Hot Water Piping insulation
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly/ No duct tape
t1/4)i f1c,,0
1-6L-re-
COMMENTS:
-61peCOMMENTS:
Rough Plumbing Insulation Report.revised Nov 17 2003, revised February 15, 2005, revised January 7, 2008
3op-N
Framing Firestopping Inspection Report
Office No. (518)761-8256 Date Inspection request received: I 1 4- I I
Queensbury Building&Code Enforcement Arrive: am/. Depart pm
742 Bay Road, Queensbury, NY 12804 inspector's In�als: 'I\
NAME: _ PERMIT#: a d I 1 —D 1-5-
LOCATION:
SLOCATION: INSPECT ON:
TYPE OF STRUCTURE: SCO
Y N COMMENTS:
Framing
Attic Access 22'x 30"minimum
Jack Studs/Headers
Bracing/Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting naked properly
12"O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Exterior Deck Bracing
Headroom 6 ft. 8 in.
Notches/Holes/Bearing Walls
Metal Strapping for Notches Top Plate
1 '6(w) 16 gauge(8) 160 nails each side
Draft stopping 1,000 sq.ft.floor trusses
Anchor Bolts 6 ft. or less on center
Ice and water shield 24 inches from wall
Fire separation 1, 2,3 hour
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side'A inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
abita e : = -.rooms (-"r1
24 in. (H)
20in. (W) TAPt.
•:. _ . _ • !rade
5.0 sf 'rade
L:1Buttdtng&Codes Fontes-OLDDBulWtng&Codes!nspecticn FoonsiFnuning Firestopping inspection Repoitdoc Revised January 7,2008
C)0) -C-(377
Framing I irestopping Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: _am/pm Departm/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: .r,
NAME: Cf t] PERMIT : CA—
LOCATION: c r f f INSPECT ON:
TYPE OF STRUCTURE: „AIM
N N/A COMMENTS:
Framing
Attic Access 22" x 30" minimum
Jack Studs/Headers
Bracing / Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12" O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Exterior Deck Bracing
Headroom 6 ft. 8 in.
Notches/ Holes/ Bearing Walls
Metal Strapping for Notches Top Plate
1 ' (w) 16 gauge (8) 160 nails each side
Draft stopping 1,000 sq. ft. floor trusses 7Th \
/Anchor Botts 6 ft. or less on center '
Ice and water shield 24 inches from wall
"Fire separation 1,/2, 3 hour
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed I
16 inch insulation in cavity min.
Garage Fire Separation
House side %inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space / Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above/below grade
5.0 sf grade
L:\Suilding&Codes Forms-OLD\Building&Codes\nspection Forms\Framing Firestopping Inspection Report.doc Revised January 7,2008
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Foundation Inspection Report
Pc RP
Office No.(518)761-8256 Date Inspection • •-
Queensbury Building&Code Enforcement Arrive: - , „!• epart: ` 3 n
742 Bay Rd.,Queensbury,NY 12804 Inspector's Init: s:
NAME: PERMIT#: /17— /
LOCATION: vrz r ‹.7-0L— b.._ N ECT ON: ,2 — /0
TYPE OF STRUCTURE:
Comments
Z-- \ i _-3---- --=1-1'
Y N N/A
Footings
Piers
Monolithic Slab
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. _
n Foundation/Wallpour
\) Reinforcement in Place
F•• '._ s.wels or Keyway in place
Foundation Dampproofmg ) . /
oun. : o ' : - • .. , :
Footing Drain Daylight or Sump
/Footing Drain Stone:
i34, 12 inch width
'• '• hes above footing
6 mi .•ly for wet areas under slab
Backfill • iiiroval
P . i mg Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L•\Bulding&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
(floo ) 1 0 /cL
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart:it_k_am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: C,
NAME: C / PERMIT#:
LOCATION: INSPECT ON: i — —l�
TYPE OF STRUCTURE:
Comments
N N/A
Footings I
Monolithic Slab
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/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place ,,�
Foundation Dampproofmg
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
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