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98-509 CERTIFICATECIF + +�U"P A►.N�Y TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK December 7 98 Date 19 This is to certify that work requested to be done as shown by Permit No. i has been completed. SINGLE FAMILY DWELLING This structure may be occupied as a LOT 76 # 45 SARA-- 3EN DR . w L.acaarion MICHAELS GROUP (Jrvner TAX MAP Nt7 . 7 4 . -- 2 - 7 6 By Order Towns Board T,C+lW�ff OF QUEEN 17�...} I Director of Bldg. do Code Enforcement BUILDING PERMIT VALUE $ 14290TOWN OF QUEENSBURY No. TAX MAP NO . 74 . - 2 - 76 WARREN COOUNTY. NEW YORK PERMISSION is hereby granted to Street. Road or Ave. OWNER of property located at LOT 7 6 - i the Tawas of Queensbury. To Construct or Plate a n the above location in accordance to application together with plot plans and other inform-I hereto filed and at approved and in compliance with the Town of Queensbury Building and Zoning Ordinance, t. OWNER'S Address is 1810 ROUTE 9 LAKE GEORGE , NY 12845 .2. CONTRACTOR or SUl LOE R'S Name MICHAELS GROUPr INC . F4A'FRt"C"MCT0S TR ACTOR or $UI LDE R'S Address JIM CHAt�iDLER , PROJECT MGR 1810 ROUTE 9 LAKE GEORGI NY 12845 Name NEW YORK HOARD S. ANEW BOARD OF FIRE UNDERWRITERS 6. TYPE of Construction — (Please indicate by Xi SINGLE FAMILY DWELLING ) Wood Frame ( 1 Masonry ( I steel ( 1 7. PLANS and Speclficatians 180fjcSQ FT SINGLE FAMILY DWELLING WITH 2 -CAR ATTACHED GARAGE AS PER PLOT PLAN SPECIFICATIONS S. Proposed Use SINGLE FAMILY DWELLING 251 August 21 19 2000 S PERMIT FEE PAID — THIS PERMIT EXPIRES 411 a longer period is required an application lw an extenslon +just be +jade to tAa Building and Zoning ir►tpectOr of the town of Ouaentbury before tote expiration dots.! $ 21 Day of August 19 Dated at the Town of Oueenamry this for the Town of Queensbury SIGNED By f3uildirsg and Zoning irn0411 Build i� r 1jc�rnit� APP iccxtiv t 'Ultall of QlIC'L'115IJIII Jr - Urt>+ . r C rrlrlrrl1111,1y 1lrtrfrr]arrlclrf, 742 1Jrl)r lifxrrl, �hlerllalruly, NY 12804 1761 $25Gj BUiLVINf3 tF C (� G> F lsNrClIiCEAlEN7" _ i � 1- �� �LC[illlt'CIitCItlS pIIUr to ISSUaI1Cl3 YiRMIrHLC NO. i 1{LL.,,��III/rF.f caf this ]tcrrtlix ; �` 5T A lmrrrtil luttsl be elt,ininc(I l el6le 1a�117' FEEPAID $ trcgirruing cunrllxrclion. Ntr intlacctittrrs Zcrlllllg ,N�,,71r1 Aclilm twill I,e ntrrdc until nlal,licrenl hltR reccive(l l�,c•n 1 Irac �Cit77UN l 1' ,lI —� n VAI_11) HU11_I)IIN 1'littlttl l'. All / 1q,lrlicn#tea' tilt, tltiv nlq+iirnli, in ---- �'" MUST W col,#plcted nlur- llte slgr,nlnrc Illatlldrig IICrtllYl Acllvl! IiliY1CWLU 131: vullrlir#g Irssivc+ar of the n1,1t1icallt ttttrat lrl,l,enr lr#t the Sj,IZ / :41,lttlivisms, f Other #171ahI:m lltalf ft,r ell. Th.•�k ae.n�W� �, Keel ent#t„t Fcc l'nymeld .-. . /�l,l,lic �eta: Same 7 fr.e- bft.cflrter'b (,Ittvupr Inc . tlwnur: • �tl tl lt%RS: .� f fs f 0 f$eru f e 9 , C ufte fi(�trlrye , Afy 1 29.41lthess: �6649 - _ 3376 �- 1'Itcrrta # ( _-__.. ) l'rolterty llocnticrrt: r'ax Mill) Nuttltrar lop L r a) Cuu1t� Sectitrtt Block tnt t11reltvi:citrn N :+ lne:: � 'J r y s E rY f Nl1'i'UIII�' OF pl;Oi'OSEU WOIttC : ESTIMATED MARKET V71ilkJX New i]uii- cii. tty : cctnsr, Ru TIO,, : $ rev iL fence I C C1111111R' rC 1 Ft � Adclitl_ot1 t.cr l) ttild s1istner. r' ictl vccuEFl►xscx jzaFonitnTIvrr : re: sildallce / €' ritxlary Dullding -- Al, t er. trk. I. tarr Cl " L1tllitl1. lrt7 : x Single Ftstn9. ly Uwell1ng resicieltc rr / ccrlrrrttcrrCiai Two Family Dwelling It" si_rleltce / [ nitruter. cilxi Family Dwelling cimilgo to exterior fli7e ULtict3 M Ai4G � p ercantile it OL-- her Work ( describe below ) manufacturing _ Other GROSS AREA OF CROPOSED STRUCTURC : if AUDITION , what will use 1sL Cl_vor . . . . . . . it of newt nddltloll be7 : ?. ttd .> loon . . . . . . . ..___—�_ St; . t /° 41 fd A uqw Other Cloors - . . ( rtot ulrtiltished col'l. ar or baseletell ACCESSOnY f3tlILI] xriG1S t 2 car e�7]/ c � Detached Garage 1 ► ca SQ . �vVT . _x_- Attached Garage O 4 'f't]'l'AL E"L,(7C}It 17IlGh : Pr Iva storage f3ui Conttnercial storage Building SIZE or NEW STRUCTUREFEET X : ether FEE'1' » . f'attlrCtl[ Will atz,yy second- hand or ungraded ft wl eL• ? 170UI1(1,1t ort 't'y' f lumber be used ? I sv , Nttulber at ( habitable space only ) � r.r feet T7CI'IM or . HEATING SYSTEx $ es ) sleight ( grade Lo ridge )a ) : circle all w" c Ga6 I Number of ii. rel> lac +~ s artci / or—"vioci�stove Electric / Oil Gas Wood to be istslrr ,llecl : - Forced lint Air / aboard / pLiter Person respostslble for supervision .-of work. as regards to building or Eric Rice P •--- codes is : lclll CFCFtctlzt ,p1r , f'hryor � I�Ic�ai Adtlt: esve €'t'lc� ttl 2S *� J 5 f S - 6G9 - 337G Nnette rJ fSu il.dex 7 f,.e fit i cft:ae[.5 Gnr�txg_, 3 Il� 1810 ,f_� ._R,t `�• f.af�e__Ge errcc;e a ll�A f'at� fa f ad, t� Certh a - i48 - A3 9 F CCb NY 12801 518 l' lutntrer : �f aua f unl3�Il�i fh�lsvn : wI�1��is1-ft_e-ft �[ .._._(3crlc _21z8 ylr - 37f 9922 rrlr ra3r7S 51S t, lectriciall JSIIL.vi. .. �flr ; t= f ?s19r Ict� �frQry�, t Scfr YJ. t1i1 .-1 I)ECTAI[,�173UN.• 111case slgll lleluty etJlei• yolr leave Carefully feud 11:e stalerlrclr�. t her with llte guns I'tr fete Crest or illy krlctwl£dge tilt stalcrttenis cotttaiucd in this appiicativrt, oget ante slrecifications 9ilt]firISLC(iy rtr'e " true attti contlrtete statement nC alltlt of i g ordiltance proposed work to be and alit the tlesctitrctt ttre[niscs atrtc) that rail lrrvvisivns of the 13ttiitlit#g Clx)e, or tauter I:ttvs Ile r k ist ttrtlrvria,cllttayltrised Ite caw terk t'r-ill be urtl crcrrttl[sf urtcicrsiitxrci Ili tt1/we sh ler l submit [rcior iv a tlr:tt sttcit wo Ccrtifiica►tc of 0ceitim tcy or rty sc ttic,ate wi g tactuai 1 beitig s fired,alto Premises. BUtL S s PLOT PLAN by at i;ccttsctl sur-vc r; ctr S i grlatttrc: downer, owlices a 1.scot, architect, contractor) H-cation far a l l �".R. V SAE Pam•• lll'F''l .[ Jl sTAMP RECEIVED I VLsZ] Location of properly for issstallatione. +-F : i , PEW RMITNUN Bcolt Owner' s Nantes The M.cchaea Gnt3ub . LLC - Address: 78 [{1 12nrrtd 9 , Labe Gen ge. NV 12945 U t� Installer' s Nartse: Fnie&nan Excavating ^ _ i'l.k. PAIL? PLone #: ( } 518- 639 - 4035 Number of hcdrooms (if residential ): Th—Aee Total daily flow (resideiitiat - compute 4V 150 gal. per bedraons) : 450 'Ialwography: ® Flat © Rolling F� Steels 5101)0 % of Slope U M8 Serif Nature: Sand l troant Q C'lay Outer {I3ckstit: C Ground Water: at what deptlt7 30 feel Bedrock or Impervious Material ; at what depth? feet Percolation 'Test: Nest Required RequircdlRate r min. per inch Dosnc' tic Water Supply. L—� Municipal © Woll Othcr If dotneslic %vatcr supply Is a WI ;I .I .: water suplsly front any septic alsstttlttiesn is feet �PROPOSTil) SYS'I'1..M: I C� Septic tank: .14-50 gal. (tninitnunt size: 1,000 gal.) 'I7ie Field: each trench w feet. { total system Icngtlt feet. Seepage Pil(s): numiscr of NIA / size each: ft, x ft. Size of stone to lie used: # 2 Atone { depth or thickness feet. li(J1..171NCF *FANK SYSIEM : (if required) Number of tanks: N/A 'Size Uf each: gal. LILT+ Alarm system esrsd associated electrical work to be inspected by a cerarifred agency. For your protection, please mote that prersuarrt to Section 136-29 of the Corte of the Town of Queensbury, any permit or approval granted ►splrich is based upon or is granted ire reliance to poor arry material Pit isrepreseneatiors or frrihrre to make a material fact or circumstance known by or orr behalf of art applicant, shall he void. ( have read the regrrlation.s with respect to this it pplicaliort and agree to alside by these and rill regrrs`rerrtents of the Town of(_Jrrrensbtery Similar Disposal Ordinance � y .Sienattrre o frestlonsihle person _ Dole: / s��� � C -2 un. t TH TOWN OF QUEENSBURY 742 Bay Rd., Queensbury , IVY 12804 APPLICATION FOR SOLID FUEL BURNING APPLIANCES AND CHIMNEYS Date LIL Q I I, , 19 Permit Now APPLICATION IS HEREBY MADE to the Building Dept, 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 to perform required inspections. Please fill out additional form if more than one appliance and/or chimney. Applicant APPLIANCE (check appropriate boxes) Ad d ress k E3 STOVE: ❑ Wood Cl Coal ❑ Pellet '[3 G as Q FIREPLACE INSERT t fp 'i zip tI FIREPLACE, FACTORY-B UL ❑ Wood as Phone - ` _ 0 FIREPLACE, MASONR ❑ Wood ❑ Gas Owner ❑ FURNACE: ❑ Wood a Gas o Oil x Address IF NON-MASONRY APPLIANCE: Manufacturer: 4 , od ei : Zip Phone CHIMNEY (check appropriate boxes) * EXACT ADDRESS of proposed construction ( O MASONRY : © Buck © Brick © Stone ' its .. t FLUE: ❑ Tile r3 Steel _� � � inches nches CONSTRUCTION / INSTALLATION MUST � 'FACTORY-BUILT: Model . CONFORM TO NYS FIRE PREVENTION & ,/ Manufacturer: Number: BUILDING CODE. CONSULT AVAILABLE Listed By : TOWN lOF QUEENSBURY HANDOUTS ❑ Double Wall c3 Triple Wail REGARDING REQUIRED INSPECTIONS. ❑ 1nsula ey Liner Direct Venting Cashier's Department Town of Queensbury, New York Amount C 11edGted Amount Refunded Dept: Fire Marshal .�_. Code Number Title y A 173 3389 ( 190) Public Safety A 233 2655 (2-3~o�) minor Sales Ir Fie Collected Fro Refunded to: Address: , Dated : Town Clerk or Deput White. Applicant Green: Fire Marshal Yellow: Bldg. ept. Pink & Goldenrod: Cashier's Dept. TpwN Op QUEE NSOU pUxLDItrG & CODE NPORY 742 ErrfiORCEMENT QUEENSBURV 'NY Y R'aA r] fSI6 ) 795 Iti' Bf74 I L"F_ ; ARR 4447 i"INAL INSP 8C'fIpN 1Z Dh Tg INS Epp,RT. r- XON R IiESIL1SNTIAc NAME - EST R,E E veb. LOCATIpN L7h T8 > TYPE OF STRU -� PRRF'IT / ti CTURR ROUGH GS PLUMB F'OUNphTxON `_•�.•• •-~_"�,- FINAL ELECTING sEPTIC 8ACK+FILL �~~-•' -' -�_ WOSTpV INSU'LAT pI PRAMINGCHj E OR t+i RSIPLAC6_ PLU MN Y HE GHT VENT Ro©FINc "- xTERI R IN S ---__ 6C O cH S R—�xEfi UES IN S -A FURNA O W O MTERx0 T M P NI LooRS : S It Ax Cry Iv wAT R 4-THRR PLOP S .SWE ...� OTHER FL04R E ---". �`---� .S CA T 4 STAR�LBARJINC R I S S_.Ml_ eMlo c DE`_"'TEC7'rz135 �-1�THR0 1-' QI`? FANS LUMBING FIJCTUR S FC7U'�—NgA O'4 xNSULATIONy` GARAGE FIRE F'ItrAI, ELl ,JRXCAL SIT _'-----_ INis-"— LL-_�URVFY p �-- OI( LOT PLAN TO I-SSU C R pR CC/c n MAP REFERENCE: LEHLAND ESTATES SUBDIVISION PHASE TWO DATED: MARCH 27, 1998 REVISED: MAY 1998 BY: VANDUSEN & STEVES LAND SURVEYORS L an D u s e & Steve s Land Surveyors, LLC 37 Chester Street Glens Falls, New York 12801 (518) 792-8474 New York Lic. No. 50135 PHASE 1 61, PHASE 3 I HEREBY CERTIFY THAT THIS MAP WAS PREPARED FROM AN ACTUAL FIELD SURVEY. THIS CERTIFICATION SHALL RUN ONLY TO THE PERSONS FOR WHOM THE SURVEY WAS PREPARED, AND ON THEIR BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON. CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. CERTIFIED TO: Joseph J. & Theresa P. La Guardia Chicago Title 1np'q, Company N: s� s_ CERTIFIED BY: DATED: December 4, 1998 `L*LWM ZW ALMAIM OR AO IM MA SURVEY Scale 1 "=30' MAP REAMM A UCOISED LAND SURVEYMS SEAL RS A Map of a Survey made for VIOLATION OF SEMAN 7M SUB -WAN Y, OF 71E NEW YOBf STATE EDUCATION LAW.' 'OILY COPES FROM Y E DMONAL OF THIS SURREY MANED L E D 500 ai THE HAND TRUE ORs Sx BESP�>oACOMMR� JOSEPH J. & THERESA P. LA GUARDIA C NTIFlCAIWNS MCAM NEMM SWNFY 1NAr THIS SURVEY WAS PIRP/JiPD N ACCORDNICE r7N Pn EIESIND COOS Q' PRACTLE fOR LAID SIR�EYDRS ADW7ED BY 7H£ NEW TIOIB( STATE ASSOMATM OF PROEE890NAL LAIN SLA MORB. SAW ISRWWAMNS SHALL ISM ONLY M 7EE PMM FOR 940M THE smEY IS PREPARED, AND ON MS BEHALF M 7K VIE COPANY. 00NENU FNTAL SHEET 1 OF 1 AQD= AM �D ff=WnW LH O F0=K AM Town of Queensbury, Warren County, New York M n E ASS04US OF THE LE EM WRUROK' LA GUARDIA NO. DATE DESCRIPTION DWG. NO.89423-76 A_ — N H FIRE MARSHAL TOWN OF QUEENSBURY QUEENSBURY, NY 12804 (518) 761-8205 FIRE MARSHAL INSPECTION REPORT REQUEST NAME ---.-ECEIVED / _ L ER MIT # LOCATION SCHEDLILE INSPECTION ON AM PM ANYTIME APPROVED NIA + YES ' NO EXITS - AISLE WIDTH - - EXIT SIGNS EMERGENCY%LCIGING -- -- FIRE EXTINGUISHE FIRE ALARM SYVEM __- -- - -- - _-- - _ FIRE SPRINKLER SYSTEM FIRE SUPPRESSION SYSTEM HOOD INSTALLATION INTERIOR FINISHES STORAGE: - - CLEARANCE TO SPRINKLERS CLEARANCE TO HEATING UNITS REQUIRED SIGNAGE f CHIMNEY WOOD STOVE FIREPLACE - MASONRY --- FIREPLACE - FACTORY BUILT REMARKS: I OK TO THIS DATE INspsuP.P11B INSPECTOR RESIDENTIAL FINAL INSPECTION REPORT CH ice No. (518) 761-8256 Date inspection request received, V Building & Code Enforcement Dept. of Community Development Arrive arnlpm Depart Town of Queensbury Inspector's Initials 742 Say Road Queensbury, New Xnrk 12804 NAlu"JE PERNUT # 9._ WCATION BATE o( — TYPE OF STRUC NIA YES NO COMMENTS Chimney HeightP'B" Vent/Direct Vent Location Fresh Air Intake Plumb Vent through roof Roof Complete Exterior Finish Complete Interior/Exterior Railings 30" 36" Exterior Handrails, balconies, 19 g 1 S or more Interior H de Handrails stairs both sis 3 e n Grade 2% away from foundation 8" clearance to sill plate Gras Valve shut-off exposed/regulat F above grade_ Gas Furtu ce shut-off within. 30 feet or within line of site Oil Furnace shut-off at entrance to furnace area FurnacelHot 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 3 risers Interior privacy/trim/doors/main entrance 36" Floor Finish Bathroom/Kitchen watertight Interior Handrails Balconiesift ending 18 in, or more . Zit Railing across window in 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 ltps kornAloo, Ci Final Electrical ! r� k Site Plan/Variance required Final Survey Plot Plan As Built Septic System layout required Okav to issue CIC (Certif. of Compliance) Okav to issue temp. CIC) (Ccruf of Occupancy) Okay to issue permanent CIO (Certif. of Occupancy) THE NEW YORK BOARD OF FIRE UNDERWRITERS -! AI . . BUREAU dF RICITY 1TT WASHfNGTe?N AVE., ITE T04, BANY, NY 12210 D CRIJITIE'R (!4 1 'tr1 T yr�r 4 . 35l1 3 .48 A i 3t�44 3 THIS CERTIFIES THATant rt7 only the electrical equipment as described below and introduced by the licant na ed on the above application number is in the premises of PH-U 11" G-HAE.ltS "- OR UPo 4 '_� .SAPA JE N DR .L.0T /r: . PUE.'E'NSBVPf `, 1JY in the following location; Basement M 1st Fl- ❑ 2nd Fl, t"a h Section Block Lot was examined on V C" OYAJ 'R 01 ' 7 J98 and found to be in compliance with the National Electrical Code- FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. N.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. N.P. 1114 36 _ it 1'_i E" DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECTT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.A. GAS H.P. AMT. NO. A. W. G. AMT. AMP. AMT, AMPS, TRANS, AMT. H.P. NO, OF FEET AMT, WATTS SERVICE DISCONNECT NC`- of S E R V I C E METER NO. OF GG GOND. A. W. G. A. W. G. A. W. G. AMT, AMP. TYPE EQUIP.P. 1 0 2W 1 @ $W 3 SW 3 Y 4W pER IH OF Cc. COND. NO. OF HbLEG OF HI-LEG Nf7. OF NEUTRALS OF A. . G.NEUTRAL OTHER APPARATUS: b POST .LIGHT-2 G . F'. C- T. -4 Ik F.3Af D, 1fCPARTLON _7446 .";APE'REY ST. GENERAL MANAGER per This certificate must not be altered in any manner; return to the office ON the Board it Incorrect. Inspectors may be Identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 3 ` ------------ GENERAL Inv PECTi N REPORT Town of Queensbury Dept. of Community Development Date inspection request received: Building & Code Enforcement 742 Bay Road •- Queensbury, NY 12804 Arrive am/pm Depart?✓ Inspector's LnitiaiL�NAME: x , PERMIT # LOCATION; DATE : 4 TYPE OF STRUCTURE: RECHECK NIA YES NO COMMENTS Footingwriers I I Monolithic Pour Form Reinforcement in Place The contractor is responsible f r Providing protection fro for 48 hours followin pi ent of the concrete. Materials for this on site Foundation/Wall Reinforcement ' lace Foundatio pproofin _ Backtill Plu ' g Under Slab Plumbing Vent/Vents in Place Rough Plumbing. Hea ' ugh-In ation Foundation Walls Interior R- Foundation Walls Exterior R.- Floors R- Walls R- Ceilin,g R_ Duct work or piping in unheated spaces R_ per Vent, Attic Vent Framin Jack StudslHeaders cing/Bridging Dist Hangers Jack PosLs/Main Beam Air Infiltration Barrier Fire Separatian 1, 2, 3, hour Penetration Sealed Fire Wall 2, 31 4 hour Firestoppin GENE1?,9L WSPEG`l'ID.�'4� �,'PrD.��'' Town of Queensbury Dept. of Community Development Date inspection Building & Code Enforcement request receive[!: 742 Bay Road Queensbury, NY 128fW Arrive am/pm Depart'- �` CDm �-/ Inspector's In" NAME: PERMIT #LC7CA7TQN: C5 �. TYPE OF STRUC BATE"T RECHECK, Footings/Piers NIA YES NO S Monolithic Pour Form Reinforcement in Place The contractor is responsible for Providing Protection frorn freezing for 48 hours following the placement of the concrete. Materials for this purpose on site Foundation/Wallpour Reinforcement in Place Foundation/Dampproofn Back fill Approval Plumbing Under Slab Plumbing Vent/Vents in Place LZugh Plumbing Heating R,ouglt_In Insulation Foundation Walls Interior R- Foundation Walls Exterior R. Floors R_ Walls R- Ceiling R_ Duct work or piping in unheated spaces R_ Pmp Lr eni, Attic Vent n Jack Studs/Headers 1 T ! ,�f1A AJ a� Bracing/Bridgin / A ' Q` F� Joist Hangers Jack Posts/Main .Beam !q �- �,� r� ,�� �+ ,•sue 4f� Air Infiltration Barrier Q ram►2t re Fire Separation 1, 2, 3. }tour Penetration Sealed {Fire Wall 2, 3, 4 hour Firestopping � a + FIRE MARSHAL TOWN OF QUEENSBURY QUEENSBURY, NY 128G4 (518) 761-8205 FIRE MARSHAL INSPECTION REPORT REQUEST RECEIVED 0 PERMIT # NAME -� LOCATION _y SCHEDULE INSPECOOO ON69 A PM ANYTIME APPROVED EXITS N/A f YES NO AISLE WIDTHS - EXIT SIGNS _'-_- -- -- - - - EMERGENCY LIGHTING FIRE EXTINGUISHERS _ FIRE ALARM SYSTEM ---- - -- - - - FIRE SPRINKLER SYSTEM --- FIRE SUPPRESSION SYSTEM - - - - - - -- HOOD INSTALLATION INTERIOR FINISHES STORAGE: }. - - - CLEARANCE TO PR1NKLERS - - CLEARANCE T HEATING UNI - REQUIRED SIGNAGE f -- CHIMNEY _. .kR WOOD STOVE _ - - - - - FIREPLACE - MASO RY - --- -~ --� - - - -- FIREPLACE - FACT RY BUILT - -- -�- REMARKS: .._ .- -- -- --. -.__�_ ~-OK TO TH DATE INSPSUP-PUB INSPECTOR i TOW OF BUILDING CODE ENFORCEMENT ENFORCEMENT U 742 Bay Road Weensbury My I2804 ' (518) 761-8256 SEPTIC DISPOSAL SYSTEM INLSPECTIOW i Name Location — �7 fn Date - �, -�'�� Permit # SOIL 5a �m-CI ay- Results of Percolation Test. ( if applicable ) Rate- Minot ch TYPE OF SYSTEM: ABSORPTION FIELD: Total ength Length of each trench Depth of trenches t Size of stop SEEPAGE PITS : er- Size - - ft x ft. Stone s1ze PIPING: Size T13lype Tang , to Tank Ly{•• V3 to Tank to Dist . BOX Yi 4t OpeDisn . Box to Fi �eid/Pit s tr.51 i�-rE?tat` Openings Sealed . rho � artia LOC.ATIONI/SEPARATIONfS : Foundation to Tank _ feet Foundation to Absorption � t- feet Separation of Pits feet Conforms as per Piot Plan Ye No LOCATION of SYSTEM ONI PRO PEER� ( circle one ) Front - Rear - Left Side - Right Side Middle Frontea� COMMENTS: SYSTEM USE APPROVED: YES NoArrived : Depar-�t� ed;�- Bui ding I for N uS3 4 N O p Iz O N �^ i ti - - - - - - - - ^ -866t -� tltl N23'14 44 .„E s oa w ` 1r 3.65 1 — cb 07 it Cn aQ 1 Cb " N co- � i► r ~ �' tom' ttA 4 N