2000-131 Cy
Uertaiiu^ate' of OCCU all
Town of Queensbury
Warren County,New York
Date July 17 , 2000
This is to certify that work requested to be done as shown by Permit No, 2 0 0 01-13 1
has been completed,
This struc acre may be occupied as a -single family dwelling
Location Lot 43, Fawn Lane
Owner Richard Schermerhorn
VI
By Order Town Board
TOWN OR ..B
Tax Map No.
121-15-43
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518)761-8256
VALUE $ 115000 Building Permit No. 2000131
TAX MAP NO. 121 . -15-43
Permission is hereby granted to SCHERMERHORN CONSTRUCTION
Owner of property located at LOT 43 FAWN LANE
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 NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
Owner's Address:
CORP. 43 H HUNTER BROOK LANE
QUEENSBURY, NY 12804
Contractor or Builder's Name:
SCHERMERHORN CONSTRUCTION
Contractor or Builder's Address:'
43H HUNTERBROOK LANE
QUEENSBURY, NEW YORK 12804
Electrical Inspection Agency:
COMMONWEALTH ELECTRICAL AGENCY
PO BOX 706
HAGUE, NY 12836
Type of Construction:
SINGLE FAMILY DWELLING
Plans and Specifications:
1216 SQ FT SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE AS
PER PLOT PLAN SPECIFICATIONS
.Proposed Use:
SINGLE FAMILY DWELLING
$ 1 PERMIT FEE PAID-TMS PERART EXPIRES March 30 2002
(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 Town of Queensbury this 3 0 Day of March 2000
SIGNED BY.. for the Town of Queensbury
Code Entorceinent Officer
A vi rrut .eappittcanon
Town of Qlt'.eensjltll;y •- Dept. cfCommunity Dei=clop»rest, 742 Baj,Roru t, Qnecns r
T.T• BUILDING & - CODE ENr, ORCEATE '
i Requirements prior to issuance11_1�9 _ /
A Hermit inum-tio-obtained before of this perillit: YLRMI7'IIGE NO. J
Ix�gin:iilig co+iatrl+clion. tJo inat�cctiona
will !w iiuutu utitit applicant has received {� T,orttrig Door-d Actioll lF•KAIIT F E PAID JS
n VAIrID BUILDING PERMIT. All Area /Use
applicants'' spaces onhis t application RECREATION. EE AI
MUST be completed laid•the signature F-1 Plarining Board Action
of the applicant-must nppcilr wi rho REVIEWED Dl'r
s poccation form. i&k y SI-R / Subdivision /olticr rlydr eg Ltc(xr7or
Recreation Fee Payment
Applicant: cl►ec^ +nP-rkof A J C.A5� (�,�p. Owner: f_�• • o� t ., ,s 7� �a��
Address: 3 E� �s,1`� I` �t'oo LN• k L^j
' Address: ____ i�t3 � �.�+ ��r �?�_�
Plionc #I ( )
Property Location: 1--+ 3 « � Lei ----- _--_ /-- Y-^f j , ,./3
Subdivisiou Name:' `J P• Tax Map Number Z
Section Block F rat
NATURE OF PROPOSED WORKt ESTIMATED MARKET VALUE OF THE
x New Building: CONSTRUCTION: - Coe,
residence / commercial ,r—
Addition to Building:
residence / commercial OCCUPANCY INFORMATION:
Alteration to Building: Primary Building -
residence / cotmtiercial _x Single Family w l '�
Residence / Commercial Two Family Diver-�l.a.rCn4,: ! r-.
no change, t:.o exterior size Family Dwelling
Office MAR 2 8 2000
Other Work (describe below) Mercantile
ManufacturinV:''v`%CJI` OULENSBURY
J � Other BUILDING AID D CODE
GROSS AREA OF PROPOSED STRUCTURE: `` Jlf
If ADDITION, what will - use
1st: Floor. . . . . . . _ is ltn sq. fL- of new addition be7 :
2nd .Floor. . . . . : sq. tt 172 a AJ1/r"
Other Floors . . . . /
(not unfinished Cellar or basement) ACCESSORY BUILDINGS:
Detached Garage 1, 2 car
TOTAL FLOOR AREA: 1aIto SQ. FT. se Attached Garage 1, 2 car
Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building.
11 (o FEET X 1-(o FEET Other
Foundation Type: r✓`o AC f-e-;+e. Will any second-hand or ungraded
Number of Stories: / lumber be used? If so, .for what?
(habit-able space only) _ '410
Height (grade to ridge) , A feet TYPE OF HEATING SYSTEM:
Number of fireplaces and/or woo stove (circle' all which a plies)
to be installed: -o-- Electric Oil / a / Wood
Flnf lt, / Baseboard / Other
Person responsible for supervision of work as regards to building
codes is : St�],et�71�t�!t,a�,�> moans�• Go l`r� -7?17-- 04- 791
Naive Addres s s Phone
Builder: . -7g 'F-0tb-7
Plumber: S
Mason: u_r 7
Elect riciat2: o
DECLARATION• Please sigh below after you have carefully read the statement.
To the best of my knowledge the statements contained in this application, together witli the plans
and specifications submitted, are a true and complete statement of all proposed work to be (toile on
the described premises and titat all provisions of the Building. Code, [lie Zoning Ordinance and all
other laws pertaining to the proposed work shall be coi»plied with, whetlier specified or noted, and
that such work is tittiorized by the owner. Further, it is-understood that Mwe shall submit prior to a
Certificate of Occupancy'or Certificate of Coiriplinuce being issued, an AS I3t:IILT PLOT PI-AN by
a licensed surveyor; draw i ato sca, s1lowin ac 'ial location of project oil premises.
Signature: _
(owner, owner's agent, arcliitect, contractor)
,`F"W S Y '.
Application`for Permit-/Septic Oi§postal,System __ ______
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
_....._......................................._......................._........................._.......................-...
Office Use
Location of installation: LAJ
File permit No.
Tax Map No. / /
i s Fee Paid
Owner's Name:
:............ ._.._...................................._.............._............-..................._..................._...
Address:
2. INSTALLER'S NAME : �`7 ;:> > �-5 PHONE NO. ,7 7(�— I0t '�'7 _
3. RESIDENCE INFORMATIC?N:. (circle year of dwelling,indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation Total Daily Flow
1980 or older x 150 gal/bdim
1980—1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdnn =
Garbage Grinder Installed yes / no
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or`Impervious Material Domestic Water Supply
Flat sand at what depth at what depth municipal
Rolling loam feet feet well
Steep slope clay if well; water supply
_%slope other from any septic-system
depth. absorption is ft
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or arclutect(unless installed in a,Plamung Board approved subdivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank: lt7c7-,--�, gallon(m'in. size.1,000 gal.)
Tile Field: each trench ft. Total System Length:
Seepage Pit(s): number of size of each: f} by
Size of Stone to be used: It / depth or thickness feet'
Bed System Size: x
Alternative System: length andlor size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: -I Size of each: gallons /TOTAL Capacity: gallons
-- -Note:- Alarm System aid a`ss`ociated electrical work must be irispected by a Town approved
electrical inspection agency.
7: SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
For your protection,please note that pursuant to Section 136-29 ofthe 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 regulations with respect to this application and agree to abide by these and all
requirements of the wn of ueensbury Sanitary Sewage Disposal Ordinance.
C7
Si ature of responsible person Date
01/03/1996 21:22 5187454437 DtPf"OF C" DEVEL PAGE 01
ENERGY' CODE COMPLIANCE APPLICATION
TOWN OF QUIS SSkTRYt WARREN COUNTY
9000 EATING DEG_,R.EE bAXS
Compliance Xgthads: PART, 5 Acceptable Practice Method -
1&2. Famzly Dwellings (only)
PART 6*' - Thermal.• Rating - Component Trade Offs
1&2 F,�m31y ?Dwellings; Multi-Family
Dwellings (3 stories or less)
PART 4* • Deeign by Corapon6nt Performance
Conunercia.l Buildings-Hi Rise Residential
*Requires. submission'•of worksheets
APPLICANT' S NAME: PROPERTY LOCATION:
c e✓'.�e r-��t- ( , STa:'^P. jb f y3 �. LNG
Tjr.4 -
_'_ART 5 METHOD OF COM1?LSI3NCE •13Y ACCEPTABLE PRACTICE:
I. Cross Floor Area ecru are feet
2. n'y_ne o_ Beat - Electric Oil V Gas Other
3. Is building mechanidally cooled? Yes st No
4, Percentage of area of vindows • and doors st Over 17$ # tinder 17$
S. R-17A-LUES FOR INSULATION Q1VEN BELOW MUST CORRESPOND TO R-VALUES AS
S 0 WIN ON PLANS SUBIJITTED :
a. Roof Rc>
n . Exterior wails
C . Glazed areas R �-
d. Extarlor doors R ^-�
e . Floors over unheated 'spae.es R ! g
Edge of slab on grace. (heated. building) R
q. Basement/cellar walls (above grade)
Y=. Basement/cellar. wA is (below grade) R i1
. heating/cooling--ducts-piping in• unheated space R
s. Sar-rice (domestic) hot water heat In.g device
C0nfo--n.,a to minLmum efficiency per code Yes No
TEMPERAT E CO TROL MA$1MVH. SETTTING i400 - WILL Not HE EXCEEDED
App'_ i.g ur • Date 4!zdne Nc:�iaer
INS?Z G;C ' S REMARKS:
RESIDENTIAL FINAL INSPECTION REPORT
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement
Dept of Community Development Arrive am/pm Depart,` t pm
Town of Queensbury Inspector's Initials
742 Bay Road
Queensbury,New York 12804
NAME PERMIT# ~
LOCATIO G�VJ DATE
TYPE OF STRUCTURE v
N/A YES NO COMMENTS
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake
Plumb Vent through roof
Roof Complete
Exterior Finish Complete
Interior/Exterior Railings 30"to 36"
Exterior Handrails,balconies,landing 18 in.or m e
Interior Handrails stairs both sides 3 or more ris s
Grade 2%away from foundation
8"clearance to sill plate
Gras Valve shut-off exposed/regulator 18"ab ve grade_
Gas Furnace shut-off within 30 feet or wi . line of site
rn
Oil Furnace shut-off at entrance to furnace ea
Furnace/Hot Water Heater operating
Relief Valve(s)installed
Headroom,6 ft.6 in.on stairs
Basement stairs,6 ft.4 in.
Handrail exterior stairs both sides more thar 3 risers
Interior privacy/trim/doors/main entrance 36'
Floor Finish
Bathroom/Kitchen watertight
Interior Handrails Balconies/Landing 18 in. r more
Railing across window in stairwells
Smoke Detectors:
every level /
every bedroom I
outside every bedroom l
inter connected i
Bathroom fans
Plumbing fixtures
Foundation insulation l
3/4 hour fire door/door closer
Garage fireproofing
Garage penetrations sealed
Furnace in separate room protected(in garage)
Light ventilation per ro
Safety glazing 18" le
from oor
Final Electrical 7 V ( l
Site Plan/Varian r uired
Final Survey Plot Plan
As Built Septic System layout required 1'
Okay to issue C/C(Certif.of Compliance)
Okay to issue temp.C/O(Certif.of Occupancy)_
Okay to issue permanent C/O(Certif.of Occupancy)
1 I
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MAP REFERENCE:
SHERMAN PINES SUBDIVISION
SITE PLAN PHASE III
BY MORSE ENGINEERING P.C.
LAST REVISED APRIL 5, 1995
all D u s
Stever
Land Surveyors, LLC
169 Haviland Road Queensbury, New York 12801
(518) 792-8474 New York Lie. No. 60135
N(
C"i i
42
S
6.
8 So'F
a
'os
.00,
'UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY
NAP BEARNG A LICENSED LAND SURVEYORS SEAL IS A
VIOLATION OF SECTION 72DO, SUB -DIVISION Z OF THE
NEV TOW STATE EDUCATION LAW.'
'ONLY COPIES FROM THE ORIGINAL (IF THIS SURVEY
MARKED WTH AN OPoGINAL OF THE LAND SURVEYORS
SEAL SHALL BE CONSDERED TO BE VAUD TRUE COPIES'
'CERTIFICATIONS INDICATED HEREON SIGNIFY THAT
THIS SURVEY WAS PREPARED IN ACCORDANCE NTH THE
EXISTING CODE OF PRACTICE FOR LAND SURVEYORS ADOPTED
BY THE NEW YORK STATE ASSDCIAnON OF PROFESSIONAL
LAND SURVEYORS. SAID CERRWICAIIONS SHALL RUN ONLY
To THE PERSON FOR WHOM THE SURVEY IS PREPARES AND
ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL
AGENCY AND LENDING NNSATUHSON LISTED HEREON. AND
TO THE ASSURES OF THE LENDING INS'MTKN.'
43
10,6000 sq ft
0.24 acres
o'er
Map of a Survey made for
ROBERT F. & KAREN T. HARTMAN
Town of Queensbury, Warren County, New York
MIA
JUL 1 ^ 2000
0.
e
,—
"=20'
S --1
SHM71 OF 1
HARTMAN
NO. I DATE DESCRIPTION DWG. 94246-43
COMMONWEALTH,ELECTRICAL INSPECTION SERVICE, INC.
Maln`Office 176 Igoe Run Road - Manheim, PA 17545 0 6
MUNICIPAL CERTIFICATE a ELECTRICAL APPROVAL
PanelBoard N 6771#Hlif4tlff#ii11#Ifi/4of#fIf Cut-in Card Nei f•i•YYi4iti Y•f Y4N144fY444iiYfyiyli4
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4
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 he promptly made for ins ectidn#
Inspectors of this Company shall have the privilege of maki an inspections at time and if its
p y
rules are violated, the Comp6ny shall have the right t revok s`c i ate,
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Unmhm+N VD A t AV Y
GENERAL INSPECTIQNREPORT
(518) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement i
742 Bay Road 1� <
Queensbury,NY 12804. Arrive am/pm Depart
Inspector's Initials
NAME: �J�� C PERNII.T#
LOCATIO D
TYPE OF STRUCTURE: �`(f
RECHECK.
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsi le for
providing protection from zing
for 48 hours following the Iacement
of the concrete.
Materials for this purpose an 'te
Foundation/Wallpour , 1
Reinforcement in Place
Foundation/Dampproofing i
Backfiil Approval
Plumbing Under 'lab l
Plumbing Vent/Vents irr-Plaecri
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior;R-
Foundation Walls Exterior R-
Floors Rt
Walls I�
Ceiling R-
Duct work or piping in
unheated spaces JR-
Proper Vent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging L
Joist HangersAil
Ja osts/M 1 B
lfiltratian Barrier c + '
Fire Separation 1,2, 3,hou`r�
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
GENERAL REPORT
(518) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road r
Queenshury,NY 12804. Arrive am/pm DepartP r
Inspector's Initials
NAME: �e' W.�1� PERMIT#�D6FZ�—/'J t
LOCATION• DATE: -Z
TYPE OF STRUCTURE:
.RECHECK
f7
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Fo
Reinforcement i lace
The co(tection
r is responsible for
provid from freezing
for 48ollowing the placement
of thee.
Materials� s purpose on site
Foundation/Wallpour
Reinforcement in Place
Foundation/Damp)r fing
Backfiil Approval
Plumbing Under Slab
Plumbing VentlVents in Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceiling
Duct work or piping in
unheated spaces R
Proper Vent,Attic V t
Framing
Jack Studs ers
Bracing/Bri g
Joist Hang
Jack Pos /Main Beam
Air Infilt 'on Barrier
Fire Separation 1,2, 3,hour
Penetration Sealed
F' e Wall 2,3,4 hour
estopping r
GENERAL INSPECT'IONREPORT as\
( 518) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement /�'�
742 Bay Road
Queensbury,N'l' 12804. Arrive r m Depart q t,ai 6ii:�
In Depart
Initials-
NAME. - . .0
OA PERMIT# t�
LOCATIO=N . DATE: — -
TYPE OF
RECHECK.
NIA YES NO COMMENTS
Footings/Piers --�
Monolithic Pour Form
Reinforcement in Place
The contractor is respfnsible or
providing protection m free ing
for 48 hours followin the pla ment
of the concrete.
Materials for this pu eon s' e
Foundation/Wallpour
Reinforcemen m Place
Foundation/D o ng
BackH11 Approval
Plumbing Under Slab
Plumbing Vent/Vents i Place
Rough Plumbing
Heat'Heatio Rough-In
b3sdation
Foundation Walls In 6rior R-
Foundation Walls E erior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping n
unheated spaces R-
Proper Vent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed /
Fire Wall 2, 3,4 hour
Firestoppin
Y �
GENERAL INSPECTI4NREPORT6 1_ _OF
(518) 761-8256
Town of Queensbury M
Dept,of Community Development --Date inspection request received:
Building&Code Enforcement
742 Bay Road Ct i /
Queensbury,NY 12804. Arrive am/pm Depart 6 ` wpm
Ins
ERM
pector's In' ' Is %,
I / -
NAME: IT /
LOCATION: DATE:
TYPE OF STRUCTURE: c"
RECHECK
N/A YES NO OMIVIENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place_
The contractor is responsi le for
providing protection from ing
for 48 hours following the pla ment
of the concrete. \
Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place_
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab l,,✓ / V 1 (/C:•
Plumb' g VentNents in Place
gl Pliinib
H
Insulation
Foundation Walls Interior -
Foundation Walls Exteri R-
Floors -
Walls R
Ceiling R-
Duct work or pipin in
unheated space R-
oper Vent, Attic ent
Frr�nin .
MtudsMWders
BracingBriclging /
Joist Hangers �4111AJ�aff__ l?t�/0 - ��o G1Cl Co- 11.�N C�
/ Jack Pot Beam I-4ui7 l vv
�JAi ItIltxati .rier �
ire�tion 1,2,3,hours
Penetration Sealed C' f Cf7 . 41t. bl
Fire.
our
Ong
tA
a-HIMEAVA-E -WNP-UC7'TO-ZV JZH7PQ-R-T
( 518 ) 761 -8256
Town of Quee-nsbury
Dept. of Community ]Development ]Date inspection request received:
1Ruil4Mng q& Code]Enforcement
742 ]Bay Road
Queensbury, NY 12804- Arrive Z)Eum�� Dep
Inspector's Initi
f A AA-1 PERMIT ;ff
`APE OF Sa-Tt.UCT1jRIz:
RECHECK
YES a CONIlvIENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in place Q�
The contractor is for responsible ib] or
f
providing protection from freezing
for 48 hours following the placement (a:,%1�Cz> t--k
of the concrete-
�))�-->
I-,..site Materials for this purpose 1, -
Fouudation.(Wallpour UA
Reinforcement in Place
Foundation/I:>aiupproofina
Backflll Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
Heating Pon <2--C>ls��x
Insulation
]Foundation Walls Interior P--
-Foundation Walls:Eacterior P--
Floors P--
Walls P--
Ceiling P--
E)uct work or piping in
unheated spaces P--
Attic Vent
\X-fa-mi
Jack StudsMeaders
Bracing/Bridging
Joist Mangers
Jack Posts/Main]Beam,
Air In:Mtration]Barrier
Fire Separation 1, 2, 3, hour
Penetration Scaled I
Fire Wall 2, 3, 4 hour
Firestoppi
v ro 4-) -P -Pp
4- 4- 4- to
u
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AG W \ - p V) a S. 0
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Mhol
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ON
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....... S71
GENERAL INSPECTION REPORT
Town of Queensbury
Dept. of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road j�. C',/
Queensburyg NY 12804 Arrive am/pm Depart am/
Inspector's Initials `4
NAME: GcVkG t PERMIT# ( I
LOCATION: I.�� -3 DATE : Cy
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
FootingsMers
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/Wallpour
Re' orcement in Place
undation/Dampproofing
'VBackfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing
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-
Proper`Tent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging :
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1, 2, 3, hour_
Penetration Sealed
Fire Wall 2, 3, 4 hour
Firestopping
GENERAL INSPECTION REPORT
( 518 ) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request'received:
Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive izo at It
Depart
'Dectol
Initia
NAME: PERMIT
LOCATION: .(; ( ', DATE : l�
TYPE OF STRUCTURE:
RECHECK.
N/A YE*/NO COMMENTS
otings/Piers Y 1 I
Monolithic PojFo
Reinforcemen -- 4
The contrac nsible forproviding p ram frcczin
for 48 hourn the placetInl
of the concrMaterials for tos on siFoundation/W
Reinforcement In Place
Foundation/Dam pproo in r -
Backfill Approval _
Plumbing Under Slab
Plumbing Vent/Vents in PI cc
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interi- r R-
Foundation Walls Extc or R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent, Attic Vent_
Framing_
Jack Studs/Headers_
Bracing/Bridging-
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3, hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
-rOWN OF QUEENSBURY
BUIUDING - & CODE ENFORCEMENT
ca_V Rccact
Qut--t--nshu1r-_V NY XZB04
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Loca-tion
Pe Date -1 -t #
SOIL TYPE- Sin cl ay- C>
Resul -ts 0 per-cola-tion es-t-
( i -F applicable ) Ra -t4a-- Mi u-to/ I ch
TYPE OF SYSXENr
ABSORPTION VIEILD : Total Lc3 ng7t
Length of each '-ty-onch
Depth oT 1--i-onch g
Size, a-F stone \1
SEEPAGE PITS : Nul
Size -t -F-t
stone Sze
PIPING : S -f Z e T-yp e
Blcfg . to Tank
Tank to Dis-t - Box
Dist - Box to FIA--ld/Pit- 2 -7,
Open-nings Se-alod? Yes No P-a V-t---I al-
I-OCA-VI ON/'wz EPARAIrl OHS :
Founda-t! on to Tank -F -t-
-tion fto 'Absar-p -ti n t
- i r- N o,
Fc>unda n
Separation o'fr - Pi is -Feet
Con-For-ms as pear, Plc),-t,,/Plan Yes s
I-OCATXOff OF - SYSTEM ON PROPERTY :
( cir-cle- one- )
Front - Rear - Le-6 Side- - Righ-t Side
Middle Front - Mi,,ddl Rear
COMMENTS
SYSTEM USE APPROVED Y
Inspc! ir