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99-701 -% ane U .51tineate tc)%f 0 c c u p Town of Queensbury Warren County, New York Bate March 3 s 2 0'0 U: ' 99701 This is to cortify t(ia.t work requested to be done as shown by Permit No. has been completed. This structure niay ba occupied as a — SINGLE FA-MIL Y DWELLING - Location LT 91 r#t 16 3 VIC CORMACtt DR. ------- — Owner TAX 14AP NO. 3 6 , -4-91 By Order Town Board F NVN- F QUEENS Director of Building& Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No VALUE $ 110000 WARREN COUNTY, NEW YORK TAX MAP NO. 36 . -4-91 PERMISSION is hereby granted to HIGL)UN, . HILDA OWNER of property located at Street.Road or Ave. in the Town of Queensbury,To Construct or place a at the above location in accordance to application togetP4W&$Iof4MI9d RMWQtion hereto filed and approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. t. OWNER'S Address is LOT 91 MCCORMACK DRIVE QUEENSBURY, NY. 12804 2. CONTRACTOR or dU1LDERS Nome CLUTE, LARRY 3. CONTRACTOR.or BUILDER'S Address 13 DAWN RD. QUEENSBURY., NY . 12804 4. ARCHITECT'S Name COMMONWEALTH ELECTRICAL AGENCY 6. ARCHITECTS Address PO BOX. 706.. . HAGUE, NY 12836 6. TYPE of Construction—(Please indicate by X) ( 1 Wood Frame ( )Masonry l -)Steel SI(NPLE- FAMILY DWELLING 7. PLANS and Specifications 1541N`SQ FT SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE B. Proposed Use SINGLE FAMILY DWELLING $ 215 PERMIT FEEPAID —THIS PERMIT EXPIRES November 16 19 2001 (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 16. Day.of November 19 1999 SIGNED BY for the Town of Queensbury 8uildirg and Zoning Inspector " ' Building Permit Application Town of Queensbul y - Dept. of Community Development, 742 Bay Road, Queensbur y, NY 12804 1761-82561 BUILDING .& . CODE ENFORCEMENT NOTIl.tr� Requirements prior to issuance A permit must be obtained before of this permit: PERMIT FILE NO. r beginning construction. No inspections PERMIT FEls 1'A1D ) will be made until applicant has received Zonhig Board Action a VAWD BUILDING PERMIT. All Area /Use applicants' RECREATION FEE P D pp spaces on this application MUST be completed attd•the signature 0 Planning Board Action REVIEWED By- of of the applicant-must appear an the SPR / Subdivision /Other ulWin rs crar plicution form. n Recreation Fee Payment Applicant: Owner: Z. Address: �� �u �Z'� V Address: Phone #. ( ) � - �7D-7-7 Phone # ( ) ----- ----- ----- ------- Property Location: - L L'c- Subdivision Name:' -�u.w� Tax Map Number_ / `e Section Rl1ock Lot NAT RE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE New Building: '� residence / commercial CONSTRUCTION: $ Addition to Building: residence / commercial OCCUPANCY INFORMATION: , Alteration to Building: Primary Building - residence / commercial Single Family Dwelling Residence / Commercial Two Family Dwelling no change to exterior size Fami , LBwerltl-j� ,g,-r Office Other Work (describe below) Mercantile ManufacturATV 0 9 199y Other GROSS AREA OF PROPOSED STRUCTURE: /PQ 3� ice!t; 1st Floor. . . . . . . . 15 `( f sq. ft\ If ADDITION, what - wE l ilse 2nd .Floor.•. . . . . . sq. fJs of new addition be? : . Other Floors . . . sq. ft. (not unfinished cellar or basement) ACCESSORY BUILDINGS: Detached Garage 1, 2 car TOTAL FLOOR AREA: 15 SQ. FT. Attached Garage 1 2 car Private Storage Building SIZE OF NEW STRUCTURE: Commercial Storage Building 3 FEET X S 0 FEET Other Foundation Type: Will any second-hand or ungraded Number of Stories : 1 lumber be used? If so, for what? (habitable space only) Height (grade to ridge) : � l feet TYPE OF HEATING SYSTEM: Number of fireplaces and/or woo stove (circle all which applies) to be installed: _. Elect / Wood or �"_ff—as-eboard Otherd A Person responsible for supervision of work as regard building codes is : to7, -7 _ Name Addresss Phone Builder: Plumber: Mason: Electrician: DECLARATION• Please sign below after you have carefully read the statetnent. To the best of my knowledge 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 isions of the Building Code, the Zoning Ordinance and all other laws pertaining to the sed w rk shall be complied with, whether specified or noted, and that such work is autho ' ed by the o ner. Further, it is undeA W that Uwe shall submit prior to a Certificate of Occ ncy'or Certi cate of Compliance be' is led, an AS BUILT PLOT PLAN by a licensed sure or; drawn . ale, showi ctual loc on f project on premises. Signatur . (owner, owner's(Went, architect, contractor) Application for SEPTIC DISPOSAL PERMIT Town of Queensbury Dept. of Community Development Permit No. Building &Codes Office 742 Div Road Fee Paid $ Qu�.^s'aury, NTY 12804 Location of property for Lastallation: �c ��,c-�- ;c_L ()r= .-,— Property Owner's Name: C c 21 P �- Property Owner's Mailing Address: Installer's Name: r4ePhone ' 71 -1?7 7 Number of bedrooms (if residential): Total daily flow: (residential - compu'te @ 150 gal.fbdrm.) Topogi�phy: K t, rolling, stems slope 90 of slore Soil Navure: loam, ciav, other /depth: Ground water: at wi_t depth? feet / Bedrock or L-i ervious Material: at wl;at depth? feet Percolation test: not require-Lire raqui_-ed [_ate min. pe:inch] Domestic water sutmly: �! muraclDal, well, other If domestic water supply is a WELL, water sT-=Iv Lora a v septic absorptca is feet. PROPOSED SYSTEM Septic tares lQ00-alon (minimum size: I,C)CO g_l.) Tile field: each wench 56 feet / Toil system length: feet Seepage pit(s): zumber of / sze each: f-by f" Size of stone to be used: -u / d�th or tHclmess feet HOLDING TANK SYSTLM: (if required) NL,,,,ber of tam.-: Size or"e`c o nons darn system associated electrical worm to be by a certified ageocy. For vc:-protecsen, please note that pursusut to Section. 136-29 of ths-, Code of the Town of Qceersar^f, any pew or ate-val wed v.-ich is based=a or is granted in relic -ca rpc� a-y serial misrepreae'.�ce or failure to.Jake a sate:=aj fa=t or cr.^,stance know by or on of , avplir. s:sil be void. I bav-e :.a.d the regtlahous with this atplic on sad to a by and all:ari =eas of the Town of Qtee,--s f SaaiLvry Sewage Disoz Ordiia.^ce. of responsi e per: f Date: RESIDENTIAL FINAL,INSPECTION REPORT , C Office No. (518)761-8256 Date inspection request received: MM OP, Building& Code Enforcement 60 Dept. of Community Development Arrive am/pm Depart il�am/ Town of Queensbury Inspector's Initials v 742 Bay Road Queensbury,New York 12804 NAME i b D op) PERMIT# 1 — 761 LOCATION_ _ V�;,c-L;, i C,�1C� DATE TYPE OF STRUCTURE N/A. YES NO COMMENTS Chimney Heightf'B"Vent/Direct Vent Location -- Fresh Air Intake ' Plumb Vent through roof Roof Complete Exterior Finish Complete Interior/Exterior Railings 30"to 36" PZAC-_ 1 Exterior Handrails,balconies,landing 18 in. or more /�� I Interior Handrails stairs both sides 3 or more risers ` Grade 2%away from foundation 8"clearance to sill plate Gas Valve shut-off exposed/regulator 18"above grade Gas Furnace shut-off within 30 feet or within Iine of site L:: Oil Furnace shut-off at entrance to furnace area 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 than risers Interior privacy/trim/doors/main entranc " Floor Finish Bathroom/Kitchen watertight Interior Handrails Balco ding 18 in. or more Railing across windo m stairwells Smoke Detectors: every level every bedroom outside every bedroom inter connected Bathroom fans Plumbing fixtures Foundation insulation 3/4 hour fire door/door closer Garage fireproofing Garage penetrations sealed Furnace in separate room protected(in garage) Light ventilation per room Safety glazing 18"or less from floor Final Electrical Site PlanNariance required Final Survey Plot Plan As Built Septic System layout required 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) V V�, A-P 1P/f 8 k, 1 TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 BAY ROAD QUEENSBURY NY 12804 t (518) 761-8256 ARRIVE: DEPART: INSP: C1 _ FINAL INSPECTION REPORT - REST71 AL DATE INSPECTION REQUEST RECEIVED: NAME C �w c ----- - LOCATION {V3 c-(20 -U, CA p1/ i v< -11 DATE PERMIT H qq�qoj. TYPE OF STR C RE FOOTINGS_ FOUNDATION BACKFILL FRAMING ROUGH PLUMBING SEPTIC INSULATION FINAL ELECTRICAL WOODSTOVE OR FIREPLACE N A YES NO CHIMNEY HEIGHT/B VENT HEIGHT PLUMBING VENT ROOFING EXTERIOR FINISH DECK PORCH STEPS RAI INGS RELIEF VALVES /� FURNACE HOT WATER 0 ERATING INTERIOR TRIM PRIV CY DOORS FINISH FLOORS: BATH KITCHEN WrkERTIGHT OTHER FLOORS S EEPABLE OTHER FLOORS ARPETED STAIR CLEARANCE RAILINGS SMOKE DETECTOR BATHROOM FANS PLUMBING FIXTURES FOUNDATION INSULATION GARAGE FIRE PROOFING DOOR CLOSERS FINAL ELECTRICAL SITE PLAN VARIANCE RE . L, INAL SURVEY PLOT PLAN Ck OK TO ISSUE C/O OR C C s RESIDENTIAL FINAL INSPECTION REPORT Office No. (518)761-8256 Date inspection request received: Building& Code Enforcement ; Dept. of Community Development Arrive am/pm Depad am/ Town of Queensbury Inspector's Initial 742 Bay Road Queensbury, New York 12804 NAME PERMIT# LOCATION DATE TYPE OF STRUCTURE 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. e -yALc— 2 A-Gl A.7 61 Interior Handrails stairs both sides 3 or in risers . Grade 2%away from foundation G N 8"clearance to sill plate Gas Valve shut-off exposed/regula "above ad e 1 X)3 j—) -LL fZ d�E�T Gas Furnace shut-off within 30 feethin 1' e of site <: Oil Furnace shut-off at entrance toe Furnace/Hot Water Heater operating Relief Valve(s)ivalled Headroom,6 ft. 6 in on__ rs Basement stairs,6 ft.4 in. Handrail exterior stairs both si s more than 3 risers Interior privacy/trim/doors/mai entrance 36" Floor Finish Bathroom/Kitchen watertigh Interior Handrails Balconies anding 18 in. or more Railing across window in s 'resellsV. Smoke Detectors: every level every bedroom outside every bedroom inter connected Bathroom fans Plumbing fixtures Foundation insulation 3/4 hour fire door/door closer Garage fireproofing Garage penetrations sealed Furnace in separate room protected(in garage) 6 Light ventilation per room Safety glazing 18"o less f om floor Final Electrical ;- Z 3 op Site Plan/Variance re'quired Final Survey Plot Plan As Built Septic System layout required 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) COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. C I -?o Main Office 176 Doe Run Road-Manheirn,PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL Panel Board No..............................Cert. N2 64359 ' Cut-in Card No—d".... Owner................. .............. ...................................................................... Location....1-0.7.......R.../.............H.. ....C"k....aa..........Qix.en. S.A..K44 Installation Consisting of..... �$�. z-�A......4=.; ...... n..,j ...12 SS..w.,�Uhcl? ................ jC5261.. IS.A..................................................... Installed By.......Q udA .. /- ...12.. ..........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 privilege of making inspections at any time, and if its rules are violated,the Company shall have the right to revoke this certificate. D a t .............. INSPECTOR. ............. 9 ` GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Queensbury Dept.of Community Development Date inspection request received: Building fir. Code Enforcement \ 742 Bay Road Z =3U Queensbury, NY 12804 Arrive am/pm Depart am/pm � Inspector's Initials o—c--- NAME: 9�1-1;ale)bfl PERMIT It 9q- 01 LOCATION: r/ ;1 DATE Z-0 TYPE OF STRUCTURE: RECHECK N/A YES NO COMMENTSG Footings/Piers Monolithic Pour Form Reinforcement in Place -�j,� e�d The contractor is responsible for providing protection from freezing %�j for 48 hours following the placcm t of the concrete. - Materials for this p se on site Foundalion/Wallpour Reinforcement in Place _ Foundation/Dampproofi ng Backfill Approval Plumbing Under Slab Plumbing Vent/Vcnts in Place Rough Plumbing eating Rough-In %r�- lJ nsulat,i 1 ��C �`rP /3©. /C (fe- L1NC� oundalion Walls Inlerio R- Foundation Walls Extc or R- Floors R- Walls R- Ceiling R- Duct work or piping in unheated spaces R- ,�Sy'Di;�r✓ � �,�^� �G-� ( G? ope r_Vent, Attic Vent ack suds/Headers Bracing/Bridging Joist Hangers_ OA.) Jack Posts/Main Beam ��'"�T Page C� Air Infiltration Barrier_ Fire Separation I, 2, 3, hour ,Penetration Scaled Fire Wall 2, 3,4 hour ==.-Firestoppiu 1 -Fte4 �AIM (30 GENERAL IN.VPECTION 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 am/pm Depart am/ ill Inspector's Initials J NAME: �Cx � PERMIT# 9q. LOCATION: , DATE : C7 TYPE OF STRUCTU RECHECK N/A YES NO COMMENTS Footings/Piers —� Monolithic Pour Form Reinforcement in Place The contractor is res nsible for providing protection rom fre zing for 48 hours followin the ph ement of the concrete. Materials for this purpo on s' c Foundatioh/,Wallpour_ Reinforcemet i imP}-ac _ Foundation/Dampproofi n Backfill Approval Plumbing Under Slab_ Plumbing Vent/Vents in Ph e Rough Plumbing ! coati g 1ou •-114 _ lation Foundation Walls Interior R- Foundation Walls Exterior R- Floors R- Walls R- Ceiling R- Duct work or piping in unheated spaces R- % roper Vent, Attic Vent Framing hick Studs/Headers_ Bracing/Bridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier___ Fire Separation I, 2, 3, hour Penetration Scaled Fire Wall 2, 3,4 hour Firestopping (518 ) 761-8256 GENERAL INSPECTION REPORT Town of Qucensbury Dept.of Community Development Date inspection request received: Building& Code Enforcement 742 Bay Road Queensbury, NY 12804 Arrive am/pm Depart "a Inspector's Initials NAME: , I ��\GL PERMIT# q9 -7 0 1 LOCATION: J, DATE TYPE OF STRUCTURE: RECHECK N/A YES NO COMMENTS Footings/Piers —j Monolithic Pour Form Reinforcement in Place The contractor is responsible for providing protection from freeing for 48 hours following the placement of(lie concrete. Materials for this purpose on si Foundation/Walipour1 Reinforcement in Place tt Foundation/Dampproofi g Backfill Approval Plumbing U der Slab__ m Plu 'ng Ve Vents n Ph Insulation Foundation Wa s Interior R- Foundation W lls Exterior R- Floors R- Walls R- Ceiling R- Duct work or iping in unheated paces R- PrPr tic Vent �Yg L f Jack Studs/Headers_ 1/tJ'S j&tC. LA-<, 4H,;RT- Bracing/Bridging Cj r�v✓ Joist Hangers ia Posts/Main Beam US/, tom- D lnfiltratio»�Bricr_:_. _ [ , iva Fire Separation 1, 2, 3 ho ' , 5;LVs "W Penetration Sealed Fire all 2. 3 4 hour I V r TOWN OF QUEENSBURY BUILDING_ & CODE ENFORCEMENT 1 2 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name 1 r7k 0 Location 1 7J Date - �Pe 't # Q - SOIL TYPE: Sand oam- ay- Results of Percolation Test- (if applicable) Rate-Minute/I ch TYPE OF SYSTEM: ABSORPTION FIELD: Total Le th _ Length of each 'trench E. . Depth of trenche 2 Size of stone2� SEEPAGE PITS: Number- Size - ft. x ft. Stone size,,.. PIPING: Si- e Type' Bldg. to Tank 11 ��D v Tank to Dist. Box Dist. Box to Fie P�No Openings Sealed? . Partial LOCATION/�SEPARAT OW . Foundation to Tank Meet Foundation to Absorption feet. . Separation or Pits feet Lcl rms as per Plot Plan Yes No ION OF :SYSTEM ON PROPER e Rear - Left Side - Right Side e Fron - Middle Rear NTS: SYSTEW USE APPROVED: YE NO Arrived: Departed: Building Inspector I have seen'or observed, or'believe I saw evidence of, s'objects L{cll iJs Douses, wells, trees, fences, etc., Ii howrJ on tli ..., .�._.._._,.... , . . �{n�r,nt.:I also represent that I have person nJea.a ed i... ..,.._._.1.._ .i ._.....I . for on the m file list et th diagra l A NATURE (� .__1...._.. , I �._.. ' '• DATE I _..-_--._.1.....-. _.._.L......, •.....1.... I I I I i I 5 1999 i I I , I I I^ - 1O �C17 .. {viJ LJt-utj - r 45 J I -I-.......I_ .. .i._._..1.... I...._.J._.....i.. I-___ +j - .i..... .. i • ! � J I t , 1 I I I I I J I j I I I I I 1 I , i I--.....' I..... - I I ' , J-- 11. 1 1 i I I - • � i I I I1 I I , I 1 I GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Queensbury Dept. of Community Development Date inspection request received: Building& Code Enforcement 742 Bay Road , 6 Quecnsbury,NY128f94 Arrive am/pm Dcpartm/pm Inspector's Initials NAME: D O^o PERMIT# LOCATION: DATE : 2- l TYPE OF STRUCTURE: RECHECK N/A YE NO COMMENTS Footin E' iur + I MonolitForm Reinforcement in Place The contractor is responsible for providing protection from freezing for 48 hours following the placem t of the concrete`„ Materials for this purpose on site Foundation/WalI pour _ Reinforcement in Place _ Foundation/Dampproofing Backfill 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- Cei I ing 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 Scaled Fire Wall 2, 3,4 hour Firestopping GENERAL INVPECTION REPORT ( 518 ) 761-8256 Town of Queensbury Dept.of Community Development Date inspection request received: Building& Code Enforcement 742 Bay Road Queensbury,IVY 12804 Arrive a►n/pm Depart! Inspector's Initials �7� 01 NAME: \ � C ERMIT# � 1- l — LOCATIDN: �tIDATE : I TYPE OF STRU TURF: RECHECK N/A YE /NO COMMENTS /ootings/Piers(, .rC Monolithic Pour Form Reinforcement in Place The contractor is responsible or providing protection from fir \ for 48 hours following the acement of the concrete. Materials for this purpose on s to Foundation/Wal 1pour_ Reinforcement in Place _ Foundation/Dampproofifig Backlill 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 Vent, Attic Vent Framing_ Jack Studs/Headers Bracing/Bridging Joist Hangers___—,--- angers____ _ Jack Posts/Main Beam Air Infiltration Barrier _ Fire Separation 1, 2, 3, hour Penetration Sealed Fire Wall 2, 3,4 hour Firestopping �y GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Qucensbury Deist.of Community Development Date inspection request received: >P J Building& Code Enforcement 742 Bay Road Queensbury,NY 12804 /1 Arri e _am/pm Departl0, r �Pm Inspector's initials NAME: 7711 �` PERMIT# LOCATION: ATE TYPE OF STRUCTURE: X RECHECK UUU N/A YES NO COMMENTS Footings/Piers Monolithic Pour Form Reinforcement in Pla Tl contractor is r sponsib for provi g protccti n fro freezing for 48 ho g the placement of the concrete. Materials for this urpose on site Foundation/Wall ur_ Reinforcement ii Place _ F nda a pproofing ackfill A r Plumbing Un r Slab_ Plumbing Ve t/Vents in Place Rough Plum ing Heating Ro di-In Insulation Foundaiion Walls Interior R- Foundation Walls Exterior R- Floors R- Walls R- Ceiling R- Duct work or piping in unheated spaces R- Proper Vent, Attic Vent Framing__ Jack Studs/Headers B raci ng/B ridgi ng Joist Hangers_ Jack Posts/Main Beam Air Infiltration Barrier___ Fire Separation I, 2, 3, hour Penetration Scaled Fire Wall 2, 3,4 hour Firestopping GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Qucensbury Dept.of Community Development Date inspection request received: w� d Building!c& Code Enforcement 742 Bay Road Quccnsbury,NY 12804 n Arrive am�p_nr V0' a // Inspector's INAME: i/ k 0 � Up�4 PERMIT# LOCATION, T�/ 7 DATE : !" TYPE OF STRUCTURE: RECHECK N/A YE / NO COM(IENTS ,ioti ngs/)'iers VI Monolithic Pour Form Reinforcement in Place— — ' The contractor is responsible for providing protection from rcezing for 48 hours following a PI cmcnt of the concrete. Materials for this purpo a on sit Foundation%Wallpour Reinforcemekiin Pla e _ Foundation/Danl r ofing _ Backlill Approval _ Plumbing Under ab Plumbing VenU I nls in Place Rough Plumbing Heating Rough-li Insulation Found;t-i—onV ails Interior R- Foundation ills Exterior 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 I, 2, 3, hour Penetration Scaled Fire Wall 2, 3, 4 hour Firestopping I ' "I hove'seen or - ---•-..___-- ---.. .. .__ .,----__-_-- j -observed,-or'believe I saw evidence of -' --! - a!I ohjects_s�ch.as houses, wells,Arees fences efc:� I I shown on this ument,:I_also represent that thave person rhea - - __ } ! , ued a — the list forth on th ' �---�--- --r- - -�---� -- --_ _- e drag am:- - - - _-------- -�--- --�----.�. — , ' - -- -,___L..----�-----. TURF. DATE t ' I f i i I 1 I ! • I , { i �. ilia AND.C � , LIJ : I : , C , I • I I i. � I i f,. 1 I I I I I i i � I • II , { I ; : , : i . I, I , _�