1987-231 I
1 t
CERTIFICATE OF OCCUPANC'"Y
s TOWN Of QUEENSBURY
WARREN COUNTYe NEW YORK
k
l]atc
Febru.ery 2. 19 89
i f
P7- 231
This is to certify that work requested to be done as shown by Permit NZo.
has been completed,
Clzr.e-Family I]welllng
This structure may be occupied as a
Location Lot 62 Willow Road ( St No . 24)
heartland Construction - Staven Removes
Owner
Sy Order Town Board
Pro%rN OF QUEENSSURY
Building 6 Zoning Inspector
BUILDING PERMIT
TOWN OF QUEENSBURY No. U-231
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Heartland Construction — Steven L . Reeves
rt
OWNER of property located at Lot 62 Willow Road ( St . No . 24) Street, Road or Ave.
in the Town of Queensbury, To Construct or place a One—Family Dwelling o
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- +*
ri
G
n
1 . OWNER'SAddressis RD # 3 Box 192 Upper Sherman ave . r*
Queensbury , New York 12801 y
to
rs
2. CONTRACTOR or BUILDERS Name (D
C
same
t"*
3. CONTRACTOR or BUILDER'S Address
ro
same e
ro
m
4. ARCHITECT'S Name
r
rt
5. ARCHITECT'S Address
N>
r.
I�
6. TYPE of Construction — (Please indicate by X) O
f) Wood Frame { } Masonry I ) Steel
r
ty
7. PLANS and Specifications
No, 58j ' x73 ' per plot plan , specifications and application including
sewage system and two-car attached garage .
B. Proposed Use
One--Family Dwelling
I
$ 5 . 00 C/O ;'
$ 136900 PERMIT FEE PAID - THIS PERMIT EXPIRES December 1 19 87 Nc
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the T
town of Queansbury before the expiration date.) f6
1�
Dated at the Town of Oueensbury this llth D,a�y^ of May 19 , 87
SIGNED BY wez �G' + '�=+ for the Town of Queensbury
Building and Zonir; Inspector CE�
TO BE COMPLETED BY BLDG . DEPT . LU
�] / Application No .
_ fourst o ftee►t3641Pt� Permit Issued 19 € MAY 4 W7
BUILDING and ZONING DEPARTMENT Permit Expires 19
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation ' BUILDING & CODE DEPT.
Oueensbury, New York 12801 variance No .
Site P1 view No .
Appr
APPLICATION FOR
BUILDING AND ZONING PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING .
The undersigned hereby applies for a Building Permit to do the following work which will
be done in accordance with the description , plans and specifications submitted, and such
special conditions as may be indicated on the ,rPermit . []
The owner of this property -is -, 4r�A1C ! LA*uh CbN tE L- A)
Tel . �Az- 43s
P . o. Address kll �i RDX f� Z t 5 �1p141&Sc f�J�LPtl � �,L� �V. J_ . 1j �
Property Location : /'ter#ter L l L�GA_ t` 7/��t1 S 7,02,Z E Tax Map No . / /
street Aumber or building lot number
Subdivision name (if applicable) -'[k��I /i (3t Q��&.)Qw
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS :
Name P . O . AU&ress I Tel . No .
Name of builder Address p , yker Tel . p7i q33 s.S
Name of plumber _Address Tel -
Name of mason _ Address Tel .
NATURE OF PROPOSED WORK : ZONING INFORMATION :
ZL
Construction of a new building A PLOT PLAN MUST BE PREPARED AND SUBMITTED ,
_Addition to a building drawn reasonably to scale and attached heretor
Alteration to a building * showing clearly and distinctly all buildings ,
(no change to exterior dimensions) whether existing or proposed and indicate all
_Other work. (describe) � set-back dimensions from property lines . Give
" street and number or lot number and indicate
* whether interior or corner lot . Show location
FOR DEMOLITION PERMIT , STATE SIZE AND * of water supply and location and configuration
LOCATION OF STRUCTURES AFFECTED *
iA a�3l ��i�l area .
Cb j�rM�ATI ON REQU I RED BELOW .
limp erf py 130 ft X / 70_ft .
+ Existing bu±1ding ( s ) Size ft X ft .
PROPOSED BUILDING AND USE : /16# .--
Existing building ( s ) LTse
Size of new structure SI, l ft X-�)3 £t
Foundation--pier/slab/crawl/partial fu11 Proposed building , distance from property line
( circle one)
Front yard ft Rear yard_f` f 2. ft
No , of stories (habitable space )t Side yards ? [ ft and 3 1 ft
Height ( grade to ridge) 2C} �C7 ft •If residential , no . of families * If on corner , setback from side streetft
/
No . of rooms ( excluding baths) '7 OCCUPANCY INFORMATION
No . of bedrooms PRIMARY BUILDING -
No . of bathrooms v
system � 2! * _C�-'One family dwelling
Primary heating
Two family dwelling
Type of fuel �.
No . of fireplaces to be installed j * Multiple dwelling / Number of units
Will a wood stove be installed? �1� {} * TransPermaient occupancy
�, Transient occupancy
Central Air conditioning? Al Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Ranch Contemporary Log cabin Other
iced ranch Mansion Duplex If addition , what will use be?
split level Old style Bungalow
Cabe Cod Cottage Other ACCESSORY B`UILDING-
Colonial Row Town House * Detached garage/one car/ tWia car/ car
{ CIRCLE ONE PLEASE } * Attached garage/one car/ two car car
* * * * * * * * * * * * * * * * _Private storage building
ESTIMATED MARKET VALUE OF � _Other
CONSTRUCTION $ �
INFORMATION ON BUILDING SPECIFICATIONSr ON REVERSE SIDE OF THIS SHEETF TO BE COMPLETED !
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe , etc .
Will any second-hand or ungraded lumber be used? If so , for what ? /per
Foundation wall material / C g7-o _ Thickness- -
Depth of foundation below grade (to 'Otto footing) ++
Will there be a cellar Heated or heated? Floor sq. footage sq ft
v Will there be a basemen'f? Will any on be used as living space?
( If so , what portion? sq . fto Type of use?
Type of roof -- sloped/flat/shed/other Material of rooms f"rgpfCtjg dxjE4Q axaftl�:: 14C45d
Size , wood studs 2." '' X "� spacing /4"o . c . length'f j( t . x +�
Joists ( floor beams) 1st . floor tam spacing_ ,4A"O . c . spar45'4 ft -1"4-X
Overlays ( ceiling beams ) T fix " spacing Z6 plo w c . sparx/I'-�+A
Roof rafters c_"X - " spacing f• o . c . span�"ft . A44x
"Wir Rig is ft*=6"W48jKAE
Exterior wall finish /_.aP, Xl . i� Of what material?
Interiorii wall fnsh Y fIl it OA4 lt'444IL040 jeb
If a garage ot is to be attached , d scribe materials to be used for FIRE SEPARATION :
Is there to be an opening between gar Age and dwelling? ( � If SO will a Fire-rated
door , enclosure , and self--closing device be provided?
Will a - ma chimney be installed? 5r-Eg�V. Height a ve roof 2 , ft . t +[
Depth of chimney foundation below grade ft .
Depth of fireplace hearthftW +` in .
Water supply - Municipal or pr3.vate well
SEPTIC SYSTEM Distance from ANY private well ( Including( inc uding adjoining properties QQ to x �
(A separate application is necessary for any repair or new installation of septic system)
Town of A F F I D A V I T 'STATE OF NEW YORK
ry
Warren
County Off Warren
I swear that to the best of my knowledge and belief 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
provisions of the BUILDING CODE , THE ZONING ORDINANCE , and all other laws pertaining to
the proposed work shall be complied with, whether s ecIfied or not , and that such work is
authorized by the owner .
SWORN TO BEFORE ME THIS Signature _________________
Wdta y of �L[ lgOwne , owner ' s agent , arcn3.mect , contractor
MBERN
!
ulic , Warren Ct3n?Pty, N . Y .
* # for * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * +
SPECIAL CONDITIONS OF THE PERMITe
By___..._--------------- -------------------
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work .
ANSWER ALL of the following :
1 . Gross floor area 0 Y
2 . Type of heat tLC:'rr�'1G T3f3S13C]r9�P� '� '/.a tE l
3 . Is the building mechanically cooled ?
4 . Percentage of area of windows and doors
A . Over 16 % Only
1 . UO value of gross area of walls , roof /ceiling and floors
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a . Are foundation walls insulated ? YES NO
1n, If YES , what is the R value ?
3 . Slab on grade YES NO
a . If YES , what is the R value of insulation around
perimeter of floor ?
4 . Is basement heated ? YES NO
a . R value of insulation
5 . Type of insulation
B . Under 16 % Only
1. R value of roof and floors exposed to ambient conditions.
3S
R value of exterior walls
jf )3 . R value of glazed area T1tr2va � ?Aif
4 . R value of doors
5 . R value of floors over unheated spaces
5 . R value of slab edge insulation - unheated slab
7 . R value of slab insulation - heated slab
8 . R value of heated basement/ cellar walls ( above grade )
9 . R value of heated basement/ cellar walls ( below grade )
CE: rUjAJGS - Fr ¢VEWGt_ASS !3strss
10 . Type of insulation WA (-�- L - r[ 6E�R6�AS4
C . Controls70
,p_tg �; Rccf�s
1 . Thermostat maximum heat setting
D . Duct Systems
1 . Is duct system .installed in unheated spaces ? YES No
a . If YES , R value of duct installation
b . R value of duct in other areas
E . Piping Insulation
1 . Size of hot water or cooling carrying agent pipe `
2 . R value of pipe insulation
F . Service Water Heating
1 . Performance efficiency
2 . Temperature control setting maximum
G . For Swimming Pool Only Y
1 . Maximum heating
Telephone No .
applicant ' s signature )
�� ofa 6wy
APPLICATION FOR SEPTIC DISPOSAL PERMrr
DATE
X07r #62- GuruC oCv >2�r aUffe4js eo)
LOCATION OF PROPERTY FOR INSTALLATION
�7Ff� ��(J�f 0
Owner's Name: ,f .�. E/S► /((/c ///�� ~ '�� �i''t I�Eonet.
1L�1-�, e``l,�-e----phone:
Address: 3 SOX ZiZ _&IC7 ?��i / 7jo
Installer's Name: Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Typography: circle one• Flat Rolling Steep Slope % of slope
Soil Natures circle one Sandj Loam Clay Other / Depth: // feet 4411 ?r
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? � feet
Percolation tests circle one: not required required / rate min. inch. S� '� rrA<o'cr4;
J�R/lt� i ;
Domestic water supply: circle on Municipa Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption. _ feet
PROPOSED SYSTEM: Septic Tank �5"0 _ gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench -elo feet / Total system length ;:)ao feet
SEEPAGE PIT(S) : Number of / Size each feet by feet
Size of stone to be used # / Depth or Thickness feet
IMPORTANT
..Xlease...LLST NEW EQUIPMENT TO BE INSTALLED f
(over)
Section II Septic System Inspections:
A. All applications for septic system installation, alteration or repair, as
required by the 'Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to the Building Department at least 24 hours before start
of construction and shall include a plot plan showing:
1 .) the proposed location of the system
2.) location and distance to lot lines
3.) location and distance to structures
4.) location and distance to any water supply
5.) size and dimensions of all tanks, distribution
boxes, tile fields and/or drywells
B. No system shall be covered before inspection and approval by the building
Inspector. Failure to comply with this requirement may result in the
uncovering of the system by the installer and a fine of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
I have read the regulations above a.nd agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage :Disposal Ordinance.
Signature of responsible person:
Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLE13 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD. PLACE TO LIVE
TOWS j OF QUEENSBUR'Y
BUILDING AND CODES DEPARTMENT
ROADS
/
BAY & HAVILAND /
�ryirEENSBURYr NEW YORK 1' 2809"
TELEPHONE ( 528 ) 792- 5932
BUILDING INSPECTORTS REPORT
REQUEST FOR INSPECTION RECEIVED '
NAME ,�
LOCATION
r-k-� PERMIT #i
_ = a
DATE r ,AFPROx+'ED
YES NO
FOOTING/PIERS FORMS
MONOLITHIC POUR
FoUNDATIONROOFING _
BACKFILL APPROVAL
ROUGH PLU ING
FRAMING
ELECTRICAL OUGH-IN��
INSULATION :
FOUNDATION
FLOORS
WALLS f
CEILING
S'NAL INSPECTIL7N : �
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL CHESrSTE
RANCE RA S
STAIRS-CL VALVE
PLUMBING IXTURES/RELI RS
INTERIO TRI I
MIPRVACY D
FINISHE FLOORS
GARAGE FIREPROOFING
C {
DOOR
SMOKE DETECTORS
FINAL E gROVAL OFICONSTRUCTION
FINAL 1r
A SIGNED CERTIFICATE OF )CCUPANCY MUST BE
OBTAINED FROM THE BUICLDXN D DEPARTMENT BEFORE
THESE PREMISES ARE O
CUPXF
REMARKS : * ,
v INSP TOR
_ lr, wn o� �severey � ur�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. i Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
Date / _ Permit
NO
APPROVED
Footing/1'1er Fe"rms
Foundation
waterproofing
Backfill
yvF ramincg
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext . Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain 'rile
Concrete Floors
Plpg , Fixtures
Gar . Fireproofing
Door Closers
Smoke Detectnrs
Chimney'
IN STJT,ATION
Foundation
Floors
Walls
Ceiling
FINAL ELEC RI CAL INSPECTION
DRIVEWAY PROVAL �-
Final Building Survey
ready )
Next scheduled inspection (call wtsert
Remarks-
fr.
Buil g Insp ctor
C�/E35 and-VI
RY
TOWN NG AND
CODS DE , {
BUILDING AND CODES DEPARTMENT
BAY & FIAVILAND N ROADS
2280 -
QUEESBURY , NEW
792-5832
TELEPHONE
BUILDING INSPECTOR' S MPO7RT
r_
REQUEST FOR INSPECTION RECEIVED /
NAME who
LOCATIc7N d v L e�;? PERMIT # C: - c ✓'�f
DATE ' Alt?
APPROVED
YES NO
FOOTINGIPIERS
MONOLITHIC POUR FORMS
FOUNDATIONIDAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTR ICAL RDi1GH-IN
INSULATXON:
FOUNDATION
FLOORS
WALLS
CEILING
'FJ.NAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
><EXTERNAL PORCHES/S1�EPS���_
STAIR5-CLEARANCE r& RAMS
PLUMBING FIXTUR S/RELIEF VALVE
INTERIOR TRIM/ RIVACY DOORS
FINISHED FLOG?RS
GARAGE FIRE.I*OOFING
DOOR CLOS-EW(S)
SMOKE DET$CTORS
FINAL ELECT5�ICAL INSPECTION
PINAL APPROVAL OF CONSTRUCTION
ICATE OF OCCUPANCY MUST BE
A SIGNED CERTIF
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED±
REMARKS-
OR OR
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
�, ► • - "a Haddon Atrenue. Co"tng+wood. N.d. otl0"
}
January 16 , 1988
44'n; _ roved as being in accord
fril l£$ that the electrical;equipment listed has been examined and is approved
with the National ElectriC81 Code, applicable +governmentalt utility and Agency ru`1es.
n: `- Dwell In
Owner; Heartland Canstr ( Steven Reeves ) 1 .OcauparrC]� _ 1 f
s c
`,� i meM an4 InatanaUoa inspected this
C7CCClF7Elnt: Same :ntrodooed or alterations made to
date If additidnai equipment ahaillyd null and Void, and appt+cshdn for
be
! ncataon: Lf3 t# 62 willow R4ac ; Queens bury LIl�a'rren "CO NY rhia' certlficola Covers the etacblcat � P _
`_ 4 existing system this Cer1j%cato atoll
�' N' Mspection should be su4mit[e6 ProrM!PiIY to tins AgarSCY-
Q.0] Sw l tc h e s ; 5 8^ Re c e p to c l e s ; Holder or IhIS certif rcate should Pijae!nt same to his pr*P*tW msuranca carrier
Equip 136 outlets ; 200— amp . Service
Ge (agent or corn parry) as evidence pf prtifMai 60 n 0 eleclrlcst eq w P M0111 prayed
38� Fixtures ; 16-Appliances ; ,tt aaaPa�rred_ ,
2 - Protective Signaling DiTy l ces ".
Steven Reeves
No .
applicant. R . D . # 3 Box #} 192 15- 017122
Glens Ga17s , New York '! 28' 1
fi
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVXLAND ROADS
QUEENSBURY, NEW YORK I2801
TELEPHONE (518 ) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FORINSPECTION RECEIVED
NAME
LOCATION '�iTT
DATE Agar PERMIT #�_
APPROVED
YES I NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP ROOFING
BACKFILL APPROVA
ROUGH PLUMBING
FR.AMTNG
ELECTRICAL ROUGH-
INSULATION:
FOUNDATION
r
FLOORS
WALLS
ILING
NAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/S EPS
STAIRS-CLEARANCE & RAI
PLUMBING FIXTURES RELIEF VALVE
INTERIOR 'T'RIM/PRI ACY DOO S
FINISHED FLOORS
GARAGE FIREPROOF NG
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL NSPECTION
FINAL APPROVAL OF, CONSTRUCTION_
A SIGNED CERTIFICATE OF OCCUPANCY ST BE
OBTAINED FROM THE BUILDING DEPARTME T BEFORE
THESE PREMISES RE OCCUPIED1
RE K ,�,
r
f
INSPECTOR
� M W - k�
t Fkptional attars
t 900 Had `AiiVi;' C�riiAnt3i#��1,J
.. . _ . . .. W 7
h
. y0. or'To++ hi / i.7R County
for
ftj,
rrt' i' * jbdQp
. ► J PI41tfNt #
:f;
lau" -',�NR _ : , t Old E
Ocalpsnt U Anna in Buildi Floor 0. ate,) :
. forfor: M Serrce a yr
# ua ► Check
M.D. l.A..
rao saa sqe ivee soeo zrsa asea 270MMO 3MM
r i IElom Heat 1 .- i jrr
SnMitcres �, Arfl F.... lnit 17lishwasher Range
Wator Heater Air Conditioner-Dryer . '� Pump
_OVer1 _ :" f3Arbsge Disposal Wiring and Contrdk'for " ;-:', . : Burner
r of rimc. Fractional H.P. Vent Fans
MOTORS H.P. _ . J 11113VI rA 1 1/6 1 1/4 1/3 1/2 3/4 I 1 1% ` $ S 71 . l0 15 20 25 30. ,40- Soli . 171
ftwk Number '
of Each Size r4"
icarit's
nstL
Esrd
Ity) sr i.: (ltatel � � rvlCe fks y i� F .{lri i? , . J A
Phone.- # .,. . r EI O i�
DATE RECEIVED. r � DATE INSPECTEM
Correct Location: a as Abcws
Red Notice Label to
Rowgft W%�' Outlets :Surface Unit T r=1r ram'
Switches Ran 'Ga�ba Di$PtAal
R2Mtwles Water Heater Dishwasher
Fixtures "' Air Conditioner" D er
Amp. Service E ui 'merit Burner; Un r1jilf' �trtais for
,Amp. Service Conductors Pump Vent-Pahs
MOTORS H.P. 1/20 1/12 1/10 1/8 1/6 1J4 1/3 1/2 sJa 1 1% 2 3 5 7Ws 10 15 20 25 3 ' SBjr75 1
Mark umber :•., o: , ` .
LL
of Each Size -
; ,., .E4'ett, sao z'so TO" iseo 11"0 ■r -xyap zsno savo aa4q aaoa
bleat
RW Prpgres5: IrIc. O LKQ. M Contractor . .
0 CFT Violation iNiiek.�vYlnpp:� i .;:1Rc. Owner CASH
L//x al k� Fee CHK #
_ D -
- ".�. _ - -
- -
LL ; �lk t ,.. i Tf. + i{ 3y'i"•' 3 s . -yt1"ice •• .k3 L ka 'ri $b 'I , 4, P'
'. -g >aFA.f zit +'�E.# S-''116-i • .'a,Y!' J'4'�Ji] ': -.�' if:: -
LL
atar,. . .`-..v
Cut in Card 0 Temp # Rabe, .: : : . - . .
I J=.t �• I: s+a, r,.cya ; 91NSPtc-ronS STt3m^7)j14E
Finely Date
APPLICATION FORM NO. 2 i3 ... °• • r i -
p / / BUILDING and ZONING DEPARTMENT
Q / Bay and Haviland Road, R. D. I Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LacATrroJ'n_ry, 4 -1GG _ ,ec�_
Permit No .
ootingyPier Forms .APPROVED r � ]rE NO
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext . Porches
Finished Floors
Interlor Trim
Stairs 6 Railings
Cellar Drain Tile
Concrete Floors
Plbg . Fixtures
Gar . Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROV
Final Building Survey
Niext scheduled inspection (call when ready
Remarks-
41
6/86 and-vl Building Inspector
Oor
� �� ,IOW+► P� �� eer73l7t.�[r�
BUILDING and ZONING DEPARTMENT
f �'J Bay and Hayiland Road, R. D7 a Sax 98
id C3ueensbury, New York 12801
SEPTIC DISPOSAL SYST/E%M' INSPECTICNV
NAME ;Z
LOCATION
DATE PERMIT No *
SOIL TYPE - Sand - :Loam _ Clay
Percolation Test Required ? YES
Min/Inch
Percolation rate - NO��
- _
TYPE of SYSTEM :
Absorption field , total -length �57.Z920
.Length of each tr ch `Zl �eE�
Depth of trenches
Size of gravel_
SEEPAGE PITS-( er )
Size- ft. x f
Gravel size �...�.
PIPING : S e
Bldg . to tank Type
Tank to list . box 10
Dist . box to field/ -7 �z
Openings sealer'!? ES O Paztial
LOCATION/SEPARATI
Foundation to tank
Foundation to abs ft.
ar Lion ft .
Absorption to lot ne
Separation of pit t.
LOCATIONS ON PROPERTY` ( . rcle one)
Front
- ear L t side
COMMENT : - Right ide
SYSTEM USE APPROVE Y
a
Puil g Inspector
01/86 and vl
' t/ ��� , own o� Qaeensl�iur�
17 � � ,y UiLDING and ZONING OEPARTNtENT
fi �+ Bay and Hawiland Road, R. D. I Sox 98
10 Queenshury. New York 12801
BUILDING INSPECTORR '' S REPORT �
NAME
LOCATION .7 J
Date / /4 Permit No , 7-
gw
✓ =Footing/pier Farm APPROVEDs T YES NO
4,4.wwo'un d a t i an
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Venee
Rough plumbing
Relief valves
Ext . parches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg - Fixtures
Car . Fireproofing
Doerr Closers
Smoke Detectors
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL ELECTRIC L INSPECTION
DRIVEWAY APPRU AL
Final Building Survey
Next scheduled Inspection (call when ready )
Remarks- �/C tea` j6yl
6/86 and-vl Buildin Inspector
.._.Dawn a/ Queenshurry
BUILDING and ZONING DEPARTMENT
Bay and Haailand Road, I . D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME � c ark` j a x► d C[Fr. � �'"•
LOCATION
3 1_fg I permit No . 7j 3 j
✓ - APPROVED - YES NO
FOotirig/Pier Forms
Foundation
waterproofing
Backfi.11
Framing
Roofing
Siding
Masonry veneer
Rough Plumbing
Relief valves
Ext . Porches
Finished Floors NJ
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg _ Fixtures
Gar . Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY "PROVA
Final Building Survey
Next scheduled inspection ( call when ready )
Remarks-
t4
Buildi g Inspector
6/86 and-vl
BUILDING DEPT. COPYIOF�LIC WI„IFORM
46- LO NEW DE T ORKWHE BRE(]D OF IRE UNDERWRITERS.
TSUP It ,_,II A��s DATE
CITY OR TOWNSHIP afis COUNTY A aS RL
VILLAGE
STREET AND NO. OR t` ei � � �r. �-�pi
POLE NiD-
ROAD AND POLE NO. W / +�!a�[r �•yly�r
BETWEEN WHAT 3ri0 /� �E +,�'il;y ECTION O # BLOCK 1�6. L07
CROSS STREETS IS �/ ft
PREMISES LOCATED �r
OCCUPANT'S OCCU BUILDING
"'� aftFaq I
«—� OCCU �
NAME
OWNER'S NAME ',/� L .
AND ADDRESS "T E � p. (y.,. g 77fC'+�J
FROM THEIR OFFICE
SUPPLIED f
By 1�1 OLD 0WORK DEFECTS
BUILDING NEW.T3 is NEW ADDITIONAL ❑ REMOVED
IS
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
No. of Fixture A BRANCH OFFICE USE
NUMBER OF OUTLETS Lamp Roeoptacles MOTORS HEATERS CIRCUITS ONLY
LOC'' H.P. W■tts A.W.G. INSPECTION
yen coiling Wede It ll Reoep'It Switch Pendoot Bracket No., TV" Each No. Esesl No. Gauge
Out-
tide
Sub-
bqe
8 SII 3 1
Bass-
let FI. §, X '9 1 '"'jib I j 1 saw
zed FL
3rd FI.
REMARKS: LIST OTHER ELECTRICAL 6EVIGES NOT SET FORTH ABOVE:
0O NOT USE THIS SPACE.
Trios application is intended to cower the abomalisted equipment to be inspected but if at time of irwgmmtion there is found additional oquipntwtt not obowa listed,
u.yo are authorised to make the inspection and adjust the "a to cower' the additional equipment, as provides( by the appi iCant, TOTAL
ELECTRIC SIGN WATTS
SIZE OF ^� w��p@ FEEDERS LAMPS
MAINS dRsw
C.ONCSED OAS TUBE: SIGN VA
CHARACTER
CONCEALED TRANSFORMERS OF
OF WORK - (NUMBER} (CAPACITY)
WORM[ TO BE COMPLETED SIZE OF SIGN
STARTED /'�A+y 497
SERVICE OVERHEAD U ERGROUNO MAKER
ENTERS OF SIGN
1LD NG
INSPECTION RE4UESTEO OLD
ON OR AS HEAR AS NEW
POSSIBLE
AV41D DELAY 6Y GIVING FVLL AN6 ACCVRATE INFORMATION.. ALL SPADES MUST BE FILLED IN OR APPLIGAYIQN MAV BEppRETURN EL7.
PRINT NAME AND ADi]iRESS a/ �] r DATE OF 1�0 .� 3rQ 4qa
NAME OF �'Or� �� � C. � `r'��1 APPLIC ATIOPI�
APPLICANT_ oa { TELEPHONE # g
4 — 9 ' '
s�
ST R E E T ADDR ESS
�_ --_-_—
�. s � y O� LICENSE NO.
CITY OR �l( CODE WHEN APPLICABLE
POST OFFICE
A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILOING
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