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City of .Saratoga Springs
Building Department [518] 587-3550
INSPECTOR REPORT
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Job Site r�`"1�,.,�,-,-��,.� �4.,T1:,-.�.�a'Z3' Permit �6 t t�.Cf �°'� File �� ! 1� �/ ,.�-�
Footings Foundation Insulation �^^`
before before Roughg Rough g before S�ic�, Other Final
Concrete Backfill Framin Plumbin 1 .�
Sheefrock
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Passed Reinspection Failed
Required Stop Work
Inspection date � � ��, `� �� � !V�'
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669 ROCK CITY RD.-BALLST� SPA, NEW YORK 12020- 518 885-7����
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`Seruing Sarntoga County Ouer 30 Years'
Cleaning ■ Installation ■ Renair ■ Drywells ■ Drainfieids ■ Inspections
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. APPLICATION FOR PERMIT FpR
INSTALLATION OF A PRIVATE SEWAGE DIg�L gyST�y ���
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�P• No. City Halllag���rtment, Department of Public Safety �'7�� �
o9a Springs, New YorS� 12866 - (slg) 587-3550
FILE NO.
FOR OFFICE L1SE OIVI,y
APPLICATION DATE y3 Q�
P�IT �BER `7 Zz� Y N SOIL DISTqRBp1VCE ACTIVITy PERMIT
PERMIT DATE � Y ` rJ — FLOpp HA2ARD DEVELOPMENT PERMIT
OONDITIONS Y N D.E.C, pE�IT
Y r1 STATE HEALTH•DEPARTMENT Pq2MIT
Y _.._. N ,.._ OTHER
Application is hereby m� to the Building I�
installation of a private sewage dis ��tor for the issuance of a
property in the City of Sarat �sal system (includi Permit for the
of the City of Sarat °ga Springs, pursuant to Chaptern97�ArticleeITI, ofathe1Code
all a °ga Springs. The owner, applicant, and contractor agree to compl with
pplicable State and Local Regulations and
this application, and will allow �'dinances, and all conditions expressed on
a11 ins Y
inspections. The. following regulations shal�l lso applYnter the premises for the required
A• This application must be filled in completely and submitted to
B. The application must be accom
1. A plot plan, to scale, sh�il� bY' the Building Inspector.
nq: lot configuration and dimensions; all buildin s or
structures on the lot and their distances to one another and to
includinq a detailed' sketch and description of the pro s 9
location of and distance to an the lot lines; ar�d
etc. on this site or on contigu us X 1 e� and p° � SeWage disposal system; .
ProPosed wells� any waterways, ponds,
2• A Permit fee of $30; ma ke c heck
3• Proof of the contractor's liab 1 ltY linsurancey sf �ratoga Spri
less that y'ng limits so,f liability not
a� $1,OOO,ppp, with the Cft as n Pecif i
contractor's protective lia ilit Aailtional Insured"; pR
liability no� less than $500,Opp each o curreceab�th for �• pr�f of an owner's
a�9e� end with the Cit as �� �°li�Y S��ifying limits of
4. Results of Y N�a Insured". i1Y injury and property
percolation tests and deep hole tests.
�• Construction of the
., D. An Proposed system shall not commence
� � y deviation from the approved plan must prior to
subject to the sar,ie . - bc3 authorized ��lt issuance.
E- The Building I� Nr"i�°u��e established for the examinationyog the originalIp an.
pector is authorized to ins g Aector,
and in any event, the Pe�t the work at a
_= Work is rea Permit applicant shall notify the Build Stage of construction,
, backfilled�, � for final inspe�tion and ng Ins
nspection of the s stem sha�ll be -� u�erg�ound P�ctor when the
notification to the Buildfng I�Y � �ade Within forty-efght�ho�sCofepro or
F. In accordance with Section g� � tor of the need for ins per
sewage dis " ll� the owner shall o ��tion.
City, p°�1 facilities in a sanita Perate and maintain the private
ti'Y manner at all .times, at no expense to the
�• In accordance with Section 97 _
this propertY� a direct connection�shalluch time as.a
applicable Cit P�lic sewer becomes available to
filled with su t ble smateri aihlan a � �ae .to the public sewer fn .compliance with
private sewage disposal system shall be abandoned and
J�B SI� � � ccordance with generally accepted
�. rU �, practices.
NUPMBER OF BEDROpIyS- � SYSTE(y Op,ST -�-�I1, �''
' GARBAGE DISPOSpI, _ ygg
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ADDRESS � Q_�1.C S _ PHONE (S/� ) �'X�I��.�3Z
SIGNATURg Su � .
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APPLICANT DATE ��4�
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SIGNATURE �— .
� DATE ��, L Z Y
� �ONTRACTOR e.n �
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ADDRF.Sg PHONE ( S/Y ) ��S' �
SIGNATCJRE � �j . • . — � •2 y '
DATE �a�v
ENGINEER °'
ADDRESS. LICENSE � PHONE ( � -.
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Ten Eyck Septic Tank Service
669 ROCK CITY RD.- BALLSTON SPA, NEW YORK 12020- 518 885-7324
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`Seruing Saratoga Cour:ty Ouer 30 Years'
Cleaning_ ■_,Insta�lation ■ Repair � 4Jdryyv�l�S � prainfields ■ InspeGtions
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5 BY THIS CERTIFICATE OF COMPLIANCE THE 5
S NEW YORK BOARD OF FIRE UNDERWRITERS 5
5 5
5 BUREAU OF ELECTRICITY 5
5 40 FULTON STREET � NEW YORK, NY 10038 �
5 CERTIFIES THAT 5
5 5
5 Upon the application of upon premises owned by 5
5 5
5 ALTONE ELECTRIC/D. DAVENPORT CECILIA MONACO 5
5 400 LANG ST 12 NELSON AVE �
5 �r_,�FtvFT�nv, �,�Y ,���R, ��.�;;Tc;��, r���� ���;� 5
5 5
5 Located at 12 NELSON AVE SARATOGA, NY 12871 �
S 5
5 Application Number: 1021545 Certificate Number: 1021545 S
S 5
5 Section: Block: Lot: Building Permit: BDC: A636 S
5 5
5 Described as a Residential occupan�y,wherein the premises electrical system consisting of 5
5 electrical devices and wiring,described below, located in/on the premises at: �
5 Basement,Outside, 5
5 5
S5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below,was 5
found to be in compliance therewith on the 28th Day of September,2001. 5
5 5 Name � Rate Ratin� Circuit Tvne �
5 Wiring and Devices �
Receptacle 1 0 GFCI S
SReceptacle 1 0 General Purpose 5
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5 5 1 Phase 3W Service Rating 200 Amperes �
Service Disconnect: 1 200 cb �
5 Meters: 1 S
5 5
5 5
5 5
5 5
5 5
5 5
5 Sea, 5
5 5
5 � of � 5
5 5
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. S
5 5
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