95-519 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK -
April 5 96
Date 19
This•is to certify that work requested to be done as shown by Permit No. 95519
has been completed.
SINGLE FAMILY DWELLING
This structure may be occupied as. a
27 HILLMAN RD.
Location
Owner FRAZIER, JOSEPH & DIANE
Or
TAX ,MAP NO. 11. -1-1. 29, By der Town Board
TOWN OF QUEENSBURY
_
• Director of Bldg. & Code Enforcement
BUILDING PERMIT
VALUE $ 75000 TOWN OF QUEENSBURY 95519
TAX MAP NO. 11. -1-1. 29 No.
WARREN COUNTY, NEW YORK
FRAZIER, JOSEPH & DIANE
PERMISSION is hereby granted to
27 HILLMAN RD.
OWNER of property located at 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.
1. OWNER'S Address is
27 HILLMAN ROAD
CLEVERDALE, NY -
2. CONTRACTOR or BUILDER'S Name
STEWART CONSTRUCTION
3. CONTRACTOR or BUILDER'S Address
PO BOX 42
BURNT HILLS, NY 12027
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SINGLE FAMILY DWELLING
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
1330 SQ•FT SINGLE FAMILY DWELLING AS PER PLOT PLAN SPECIFICATIONS
EXISTING RESIDENCE WILL BE DEMOLISHED SEE PERMIT #95520
8. Proposed Use
SINGLE FAMILY DWELLING
179 September 7 97
$ PERMIT FEE PAID—THIS PERMIT EXPIRES - 19
(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.)
=-11- September 95
Dated at the Town of Queensbury this Day; f 19
SIGNED BY for the Town of Queensbury
ing and Zoning Inspector
De
e pment of Community Development IOWReviewed By:
' Building & Code Enforcement „� !AP e,,tiding I e or
Town of Queensbury i, it Permit No. . c
742 Bay Road Y
Queensbury, New York 12804 Fee Paid $ f 59,°V .95
(518) 745-4447 pp
Building Permit Application P 179c,
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 application form.
Applicant: � A��� a. Je,Tlot� Owner: C\C o$1-t") AO:3*w_ A- -1 -
Address: �-�_.13x- 6. ..= K /2o27 'Address: iii, Ki lfr-O r-oA-9, S, tom{
Phone # ( 5r6 ) $g5 -4-7o2, Phone # ( 5-l$ ) 4-36 --7276
Property Location: 21 �LL644-,✓ ,Cly.1e iki, J / ,,Zq
IINb0rrv/D� Tax Map Number / 4
Subdivision Name: Section 'Block Lot
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
- New Building: CONSTRUCTION: $ '75.1000
i ence / commercial
Addition o Building:
residence / commercial OCCUPANCY INFORMATION:
Alteration to Building: Primary Building -
residence / commercial 4 Single Family Dwelling
Residence / Commercial Two Family Dwelling
no change, to exterior size _ Family Dwelling
Office
Other Work (describe below) Mercantile
Manufacturing
Other
GROSS AREA OF PROPOSED STRUCTURE: •
1st Floor ab sq. ft . k<. 0d If ADDITION, what will use.
1st of new addition be? :
2nd Floor
6/a sq. ft. 70 AVA
Other Floors sq. ft �. — --
•
(not unfinished cellar or basemen ACCESSORY BUILDINGS: •
Detached Garage 1 , 2 car
TOTAL FLOOR AREA: 03,0 SQ. FT. Attached Garage 1 , 2 car
Private Storage Building
SIZE OF NEW STRUCTURE : Commercial Storage Building
Other
il'77o FEET X 24' FEET
Foundation Type: paief,onmk-g-rvM Will any second-hand or ungraded
Number of Stories : 0- , lumber be used? If so, for what?
(habitable space only)
Height (grade to ridq ) : 2 feet TYPE OF HEATING SYSTEM:
Number of irep a_ cesl-dnd/or woodstove (circle- all which applies)
to be installed: / (Electric)/ ,Oil / Gas / Wood
Forced Ho it / Baseboard / Other
Person resposible or supervision of work as regards , to building
codes is : on �ftt� 1/i/�? i )*tT �'�oN9 c 7o.J/sv�: 6c�5,�9oZ
741
• Nam Addresss Phone
Builder: 6/q-t2( �N��-vcron/ /Nc. -
Plumber:
Mason: -
•
Electrician:
• - - - - --- -- DECLARATION - —-- -_ . --.
To the best of my knowledge- the statements contained in this appli-
cation, 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 noted, and that such work is authorized by the owner.
Further it is understood that I/we shall submit prior to a Certificate of
Occupancy or Certificate of Compliance being issued, an AS BUILT PLOT PLAN •
drawn to . scale, showing actual loc. ion of project on premises .
Signature: ,-/ ire";r' iio - -
- o ner/owner's agent, architect, contractor)
•
CM
. 1 ENERGY CODE COMPLIANCE APPLICATION
j';` 'TOWN OF QUEENSBURY, WARREN COUNTY
.ie' 9°00 HEATING DEGREE DAYS
Compliance Methods : 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-Ill Rise Residential
*Requires submission of worksheets
APPLICANT' S NAME : PROPERTY LOCATION:
./
0.4010.--1 &� 1�/GT7viI AVG 47 H'7W?Q0 ,eop &Wee-0
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1 . Gross Floor Area - _ /330 square feet
2 . Type of Heat - k Electric Oil Gas A Other 447-Pamp .
3 . Is building mechanically cooled? X Yes No
4 . Percentage of area of windows and doors Over 17% K Under 17%
5 . R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS
SHOWN ON PLANS SUBMITTED:
a . Roof R ra
b. Exterior walls R ft
c . Glazed areas R _
d. Exterior doors R
e . Floors- over unheated spaces R i/,4
f . Edge of slab on grade ( heated building) R 11)/A
g. Basement/cellar walls (above grade) R /0
h . Basement/cellar walls (below grade) R f
I . Heating/cooling-ducts-piping in unheated space R /i1A
6 . Service (domestic) hot water heating device
Conforms to minimum efficiency per code k Yes '_ No
TEMPERATURE CONTROL MAXIMUM SETTING 1400 - WILL NOT BE EXCEEDED
Appli is na ure Phone Number
/7e
5- OB5:5-9
I PECTOR' S REMARKS :
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4424
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED;)-
NAME N`C20:. 6 J�CLSt'i
LOCATION a77 J-;'� (
DATE f - ) -° PERMIT# - S C\
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHER
AUTO. EXTINGUISHIN SYSTEM
HOOD INSTALLATION
AUTO. SPRINKLER YS EM
ALARM SYSTEM
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
CHIMNEY
WOODSTOVE
FIREPLACE-MASONRY ✓
FIREPLACE-FACTORY BUILT ,
REMARKS: 1 I OK TO THIS DATE
2/015 PECT R
p+Akty
��,. TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY ROAD
,1•. ,�y� QUEENSBURY NY 12804
�k''''a fi . .z• (518)745-4447
:a iVE: zQJ DEPART: IIj' WINSP:-..../
FINAL INSPECTION REPORT - RESIDEN I L�l,
DATE INSPECTION REQUEST ECEIVED:� ,%`'('
NAME ��A-7 46/E �, OS.
LOCATION Z7 K1LL- i.4-Q,1 4?,..
DATE '��/ 40 PERMIT fl 9a 5?9
TYPE OF STRUCTURE
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING _ SEPTIC _ INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES HO
CHIMNEY HEIGHT/B VENT/HEIGHT
PLUMBING VENT
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES
FURNACE/HOT WATER OPE TI
INTERIOR TRIM/PRIVACY ORS
FINISH FLOORS:
BATH/KITCHE ATERTI HT
OTHE LOORS SWEEPABL
( HER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
EMOKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES
`�/FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
SITE PLAN/VARIANCE REQ.
FINAL SURVEY PLOT PLAN
OK TO ISSUE OR C/COOP
P6C146(-14 t4 /2 111 •
ot4 .1 /6. 06 c/0 ( L
�k TOWN OF QUEENSBURY
Y•�
±�A�` ,� BUILDING & CODE ENFORCEMENT
742 BAY ROAD
*Jt
QUEENSBURY NY 12804
(518)745-4447
:` IVE: 11111 DEPART: �f '
FINAL INSPECTION REPORT - RESIDENTIAL
DATE INSPECTION REQUEST RECEIVED: � -a 1` CI (ff
NAME Y
r^/
LOCATION 1 \A \\ SWtir
DATE 3 - 1 "9 Co PERMIT n , / I
TYPE OF STRUCTURE S)
FOOTINGS_ FOUNDATION BACKFILL FRAMING _
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A T S NO
CHIMNEY HEIGHT/B VENT/HEIGHT
PLUMBING VENT ✓�
ROOFING
EXTERIOR FINIS
DECK/PORCH/STEPS RAILINGS
RELIEF VALVES
FURNACE/HOT WATER JP "TING ' 1
INTERIOR TRIM/PRI 0 Y DOORS
FINISH FLOORS:
BATH/KITCHEN A ERTIGHT
OTHER FLOW SW EPABLE
OTHER FL"uRS C,RPETED /
STAIR C ARANCE/'•,ILINGS //
SMOK DETECTORS
B• HROOM FANS
PLUMBING FIXTURE•
FOUNDATION INSUL TION
GARAGE FIRE PROOFING
DOOR CLO�.'
FINAL ELE ICAL
SITE PLAN/VARIANCE REQ.
FINAL SURVEY PLOT PLAN
OK TO ISSUANI OR C C
Vir
17RU ) '6 5uk\)0
TOWN OF QUEENSBURY 61)1
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4424
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED -Z-1, C
NAME VC\721101 Ogi/ N )(1n
LOCATION (9-1 \- \) 17101,1'Sj
DATE\ PERMIT# 5-51
APPROVED
A N/A YES NO
EXITS
AISLE WIDTHS ` j
EXIT SIGNS
EMERGENCY LIGHTING /
V
FIRE EXTINGUISHERS
AUTO. EXTINGUISHINGSYSTEM
HOOD INSTALLATIOJ//
AUTO. SPRINKLER/SYSTEM
ALARM SYSTEM
INTERIORFINISHES
STORAGE:
CLEARANCE TO SPRINKLERS
CLEARANCE TO HEATING UNITS
`REQUIRED SIGNAGE
•
CHIMNEY
WOODSTOVE
FIREPLACE-MASONRY
FIREPLACE-FACTORY BUILT
REMARKS: ( ' OK TO THIS DATE
dye`f
4 If,- .ff.
„2 5/2 e-Le D", C��. 417dO/V
2/015 INSPECTOR
•
TOWN OF QUEENSBURY `t: rs'' `
BUILDING & CODE ENFORCEMENT
531 BAY' RD., QUEENSBURY NY 12804 `',,.; :.
INSPECTOR'S REPORT: AR! .CO DEPARC. IN
REQUEST FOR INSPECTION RECEIVED:
AO
NAME �.-,r !
� . -1 �
7 \ V
LOCATION nC , ( VAtL "CIA PoRD
DATE 1.2 1 1 151\yib .. PERMIT # C4- c51C\
TYPE OF STRUCTURE: I)Pn /
RECHECK /APPROVED
/N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE �.
THE CONTRACTOR IS RESPNSIFLE FOR
PROVIDING PROTE TION/tROM FREEZING
FOR 48 HOURS SI FOLLO NG THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR 14S PURPOSE ON SITE _
FOUNDATION/ ALLPOUR • I
REINFORC MENT IN PLACE
FOUNDdKTION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE yy_
ROUGH PLUMBING h.�\l.�-�E J
PLUMBING UNDER SLAB -
FRAMING: _
JACK STUDS[HEADERS
BRACING/BRIDGING
JOIST HANGERS f
JACK POSTS/MAIN BEAM 1-
AIR INFILTRATION BARRIER •
HEATING ROUGH-IN
_
INSULATION:
/
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIORaR-
AFLOORS r3oEQ --> 7 --
WALLS _ —R-
CEILING R-
DUCT WORK OR PIPING IN
' UNHEATED SPACES R-
P
TOWN OF QUEENSBURY *
BUILDING & CODE ENFORCEMENT
531 BAY RD., QUEENSBURY NY 12804 4t°' +i,FU.
i*'
t .r
INSPECTOR'S REPORT:, AR;3 DEPARP . �� ' '
REQUEST FOR INSPECTION RECEIVED: I - /I[�,J O
AME Q/ S U O•W°c
ON a-� k t!A'- .� 1
DATE 1 I 1 Vi eK PERMIT # CIS CPI
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE i
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROVE TION FRO ; FREEZING
FOR 48 HOURS FOLLOWING TIlE PLACE-/
MENT OF THE CONCRETE. /
MATERIALS FOR THIS PURPOSE/ON SITE
FOUNDATION/WALLPOUR7.7
REINFORCEMENT IN/PLACE
FOUNDATION,BAMPPROOFING
BACKF L APPROVAL 1.- _
)'UMBING VENT/VENTS IN $ACE "1/41/
ROUGH PLUMBING I�
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
HEATING ROUGH-IN
eSULATION:
- FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS =R-
CEILING
DUCT WORK OR PIPING IN
UNHEATED SPACES, R- ,
CO, FL
_ory,
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT Y'
531 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR/fr DEPART/AV INT ((D/L--
REQUEST FOR INSPECTION RECEIVED: / c 2. T —s
NAME \CC'- Q-J\ c3-e:3-0-Q
e-Thi‘
LOCATION 41 \ c
DATE l ie7 PERMIT $
TYPE OF STRUCTURE:
RECHECK APPROVED
���,�� (� '1' N/A YES NO
1/OTINGS/PIERS �"F"""" 4vrWEA1)4)
11 MONOLITHIC POUR FORM ��jj
REINFORCEMENT IN PLACE
THE CONTRACTO'• IS RESPONSIBLE FeR
PROVIDING PROT TION FROM FREEZNG
FOR 48 HOURS FO►< OWING THE PLAT -
MENT OF THE CONC'' TE.
MATERIALS FOR THIS 'URPOSE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACL f"
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLA•.E (.7
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING:
JACK STUD /HEADERS
BRACING/=RIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
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 R-
•
41&I/r7 AA./ r
i' yr rfci/Imo( �/• 6
�..�7 lJ
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR,-ZD DEPART\-4b I
REQUEST FOR INSPECTION RECEIVED:
NAME
LOCATION Z t
DATE \ z y 1gG- PERMIT # -61c1
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RE:PONSIBLE rOR
PROVIDING PROVE TION , ROM FRE ING
FOR 48 HOURS FOLLOWINt THE PL.CE-
MENT OF THE CONCRETE. ,
MATERIALS FOR THIS PUPOSE 'N SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE, -
FOUNDATION/DAMPPROOFIN,• _
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING: • 1 __
JACK STUDS/HEADERS _
BRACINGJBItIDGING
JOIST HANGERS _
JACK POSTS/MAIN BE
AIR INFILTRATION BARRIER
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 R- I
6))/1
Nni\vA •
0-\1)\-(z
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT d,,,
531 BAY RD., QUEENSBURY NY 12804 "° . 4'.
INSPECTOR'S REPORT: ARRt-PO DEPART a- Ilk. I ' / f
REQUEST FOR INSPECTION RECEIVED: / AIM C
NAME \c 0,7 0 iNK r
LOCATION ,. (` - II f"1O ro)
DATE / - LI"'95 PERMIT # 9 ,^ 1 oi
TYPE OF STRUCTURE: We
RECHECK O 1 (� J APPROVED^
11..✓� � t (/� /A YES NO
FOOTINGS/PIERS 6
MONOLITHIC POUR FORM
{
REINFORCEMENT IN PLACE
THE CONTRACTOR IS R SP9NSIBLE FOR
PROVIDING PROTE TIO OM FREEZING
FOR 48 HOURS FOLLOWI tTHE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS P 'POSE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN P ACE
FOUNDATION/DAMPPRO$FING
BACKFILL APPROVAL ! - -
PLUMBING VENT/VEN S IN :LACE
ROUGH PLUMBING
PLUMBING UNDER SLAB y� /�
�FgAMING: V C_� Am�,A `s/
JACK STUDS/HEADERS\
BRACING/BRIDGING \
JOIST HANGERS \
JACK POSTS/MAIN BEAM \
AIR INFILTRATION BARRIER \
HEATING ROUGH-IN \1
INSULATION: J
_ FOUNDATION WALLS INTERIOR R- _
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R- •
'- \mo b -1z t3N1 -1,
RNI=c\-\ ti.-"1S6‘ 16. 1 va
VAt, .\__._ �21--,1/4‘ k LA__ et_
bOVO-C,"'
4r/ � Gtaw,. ij/rq�
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447 . •
SEPTIC DISPOSAL SYSTEM INSPECTION
ikaita
Name \pco( t ,Jcii*
Location .a:-1 ; (bnaft
,a4.cam,
L
Date i �� 5 Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Percola .ion Test-
(if applicable) Rats-Minute/Inch -
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x f' .
Stone size
PIPING: iz • Type
Bldg. to Tank y' .. Pc-
Tank to Dist. Box y s2VZ
Dist. Box to Field/Pit
Openings Sealed? Yes o Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorptio, _ feet
Separation of Pits feet
Conforms as per Plot P an Yes No
LOCATION OF SYSTEM ON ROPERT :
(circle one)
Front - Rear .- Left S 'de •- Rig t Side
Middle Front - Middl : Rear
COMMENTS:
— A ern/ram 4i t_
1:4;74
SYSTEM USE APPROVED: 4110 NO
i
Arrived: //?"_
Departed: mA
Building Inspector
A ill '
TOWN OF QUEENSBURY `',=
BUILDING & CODE ENFORCEMENT '-- .
531 BAY RD., QUEENSBURY NY 12804 •: t_ ';;',Y, .,
IP'
INSPECTOR'S REPORT: ARR\\: D DEPART ,,
REQUEST FOR INSPECTION RECEIVED! `i
NAME .Nc--Q, 7.L C..f\(
LOCATION - 0- 1 f 1i b� 'M 1 1 y�
la \
DATE I\_ C N PERMIT $ c15 5-1 6\
TYPE OF STRUCTURE: . 7:5C
RECHECK - - - - - APPROVED -
N/A YES NO
FOOTINGS/PIE S -
MONOLITHIC PO R FORM"
REINFORCEMENT N PLACE .
THE CONTRACTOR S RESPONSIBLE FOR
PROVIDING PROTE ION FROM FREEZING .
FOR 48 HOURS FOL WING THE PLACE
RENT OF THE CONC TE
MATERIALS FOR THIS " URPOSE ON SITE f_
FOUNDATION/WALLPOUR - :
REINFORCEMENT IN PLAC
FOUNDATION DAMPPROOFIN _
BAhAPP _L '
PLUMBING VENT/VENTS IN PACE
ROUGH PLUMBING - .. -
PLUMBING UNDER SLAB .
FRAMING: .
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BE 4 -
AIR INFILTRATION BARRIER .
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 R- -•
11
4
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT '"
531 BAY RD., QUEENSBURY NY 12804 Ky7 /rye�U
INSPECTOR'S REPORT: AR /lry DEPART' V
REQUEST FOR INSPECTION RE E VED:J -7
NAME 1 r1 / li(e
LOCATION G
NYA. l 1 1')r77, PERMIT # q5 —5
TYPE OF STR CTUR! : S: %"
RECHECK APPROVED
POTINGS/PIERS
N/A YE'- NO
MONOLITHIC POUR FORM /
REINFORCEMENT IN PLACE(/2-1— I V
THE CONTRACTOR IS RES.ONSIBLE FOR
PROVIDING PROTE TION ROM FREEZING
FOR 46 HOURS FOLLOWIN' THE PLACE—
MENT OF THE CONCRETE.
MATERIALS FOR THIS PU'R•OSE ON S TE
FOUNDATION WALLPOUR
REINFORCEMENT IN PLACE ._
FOUNDATION/DAMPPROOFIN
DACKFILL APPROVAL •
PLUMBING VENT/VENTS ` PLACE
ROUGH PLUMBING __ _____,___
PLUMBING UNDER AB
FRAMING:
JACK/STUDS/HEADE'S
BRACING/BRIDGING
JOIST HANGERS
LACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER _
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 R—
•
•
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 7 /e; c-S
Location /�G•-
Date /Q / - Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Percola ion Test-
(if applicable) Rat--Minut:/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tatal L-ngth
Length of each tren
Depth of trenches
Size of stone
SEEPAGE PITS: Numbe -
Size - ft. x ft.
Stone size .�
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Fie .•/Pi ;
Openings Sealed? Ye No Partial
LOCATION/SEPA' . IONS:
Foundation to ank feet
Foundation to'Absorpti $n _ feet
Separation o Pits feet
Conforms as per Plot P an Yes No
LOCATION OF SYSTEM ON 'ROPERTY:
(circle on-)
Front - R-ar .- Left S'de - Right Side
Middle F ont - Middle'Rear
COMMENTS. /f
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