92-642 ,a CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSSURY
t: WARREN COUNTY, NEW YORK
15
Due Ha-rc:li 24 19 _97
This is?to certify that work requested to be done as shown by,Permit No. 92642
has been completed.
SINGLE FAA DWLG--UPPER LEVEL
This-,structure may be occupied as a
18 GOLDFINCH RD.
Location,
Owner CRAIG, WILLIAk & JANICE,
By Order Town Board
TAB HAP NO, 148. 2-9
OWN OF QU� SBU
Director of Bldg. do Code Enforcement -
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OFOCCUPANCY
Permit Number: 92642 Date Issued: Monday, March 24, 1997
This is to certify that work requested to be done as shown by Permit Number 92642
has been completed.
Tax Map Number: 523400-315-006-0002-024-000-0000
Location: LOT 9 HOUSE#18 GOLDFINCH ROAD
Owner: CRAIG, WILLIAM 9 JANICE
Applicant: CRAIG, WILLIAM & JANICE
This structure may be occupied as a:
By Order of Town Board
TOWN OF QUEENSBURY
SINGLE FAMILY DWELLING-UPPER LEVEL ONLY
F �
Director of Building&Code Enforcement
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CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
:
WARREN COUNTY, NEW YORK
Dace 19
This is,to certify that work requested to be done ai shovm by Permit No. 92-642
-has been completed.
single 'family d4aling
This structure may be occupied as a
Lot 8 Goldfinch Road
Location Ihcniration Park Subdivisinn li
Owner Mr. & Mrs. Raymond Humphregy
Issued for lower level only.
By Order Town Board
TOWN OF QUEENSBURY
Director of.Bldg. & Code Enforcement
a
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 92-642
WARREN COUNTY, NEW YORK
N
PERMISSION is hereby granted to MR. & MRS. RAYMOND HUMPHREYS 1°
OWNER of property located at Lot 9 Goldfinch Road Street, Road or Ave.
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 Town of Queensbury Building and Zoning Ordinance. _
c
1. OWNER'S Address is 3
S
m
:n
2. CONTRACTOR or BUI LDER'S Name 3
3
w
�
3. CONTRACTOR or BUILDER'S Address §
a
4. ARCHITECT'S Name
r-
0
5. ARCHITECT'S Address `t
O
O_
6. TYPE of Construction— (Please indicate by X)
n
(x)Wood Frame ( ) Masonry ( I Steel ( ) �'
0
7. PLANS and Specifications Model 16 a
No. 40'x25.42' Single family Modular Dwelling as per plot plan, specifi-
cations and application.
B. Proposed Use
Single family dwelling
Co
170.00 OCTOBER 19 93
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(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.) 1G
O_
Dated at the Town of Queensbury this 19th Day of October 19 92 m
SIGNED BY for the Town of Queensbury c°
Buildings Inspector
i
REVIEWED BY:
FEE PAID: `OWN OF QUEENSBUT
RECEIVED
PERMIT NO. :
OCT 131992
I3LDG. & CODE OEPT.
BUILDING PERMIT APPLICATION
PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO INSPECTIONS WILL BE MADE UNTIL.
,PPLICANT HAS RECEIVED A VALID BUILDING PERMIT.
J1 applicants spaces on this application MUST be completed and the signature of the
,pplicant MUST appear on the reverse side of this application.
'Wner of Property: My-- 9 Mr_c_ Raymond HumnhrPi)S
.0. Address: 17 Goldfinch Road PHONE -
148_7.1, 7.3 6 7_4
'roperty Location: Queensbury, NY 12804 Tax Map No.
las there been any split of this property since October 1, 1988? Yes x No
f yes, Planning Board Review is necessary.
subdivision Name, if .applicable: Inspiration Park Lot No. 148.7.1,7.3&7.4
'HE PERSON RRUPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
Cushing, Dybas Associates, Architects, P.C.
IATURE OF PROPOSED WORK: * ESTIMATED MARKET VALUE OF THE
X Construction of new building * CONSTRUCTION:
* $ 79,994.00
Addition to building
Alteration to building_ * COMPLETE INFORMATION REQUIRED BELOW:
(no change to exterior dimensions) * Size of Property: 100 ft. �c 100 ft.
Other work (describe) * Existing Building Size: lNone
* ft. x ft.
* Proposed building - distance from
;ROSS AREA OF PROPOSED STRUCTURE: * property line:
Lst Floor 1017 Sq. Ft. * Front Yard 30 ft. Rear yard 44 . ft.
* Side Yards 40 ft. and ao ft.
?!.id Floor - Sq. Ft. * If on corner, setback from side street-
_ * ft.
Aher Floors Sq. Ft.X
(not cellar or basement- * OCCUPANCY INFORMATION:
*
DOTAL FLOOR AREA: 1017 Sq. Ft. * Primary Building -
One Family Dwelling
size of New Structure: an_o ft. x 95_4 ft. * Two Family Dwelling
Foundation: * Multiple Dwelling/No. of Units
Pier/Slab/Crawl/Partial ull)(Circle One) * Business
* Industrial
No. of stories (Habitable space) 1 * Other
Height Wade to ridge) z4 ft.
If residential , no. of families: One * If addition, what will use be?
No. of rooms .(excluding baths): Five
No. of bedrooms: - 3
No. of bathrooms: One * Accessory Building;
Primary heating system: Baseboard * Detached Garage - One/Two Car
Type of fuel : RLe-CEnc * Attached Garage - One/Two Car
No. of fireplaces to be installed: None * Private Storage Building
Will a woodstove .be installed?: No * Other
Central Air Conditioning: Yes No
(OVER)
BUILDING SPECIFICATIONS:
Type of construction: wood frame, fire safe, etc. Wood. Frank--
Will any second-hand or ungraded lumber be used? If so, for what? No
Foundation Wall Material : Poured Concrete Thickness: s"
Depth of Foundation below grade (to bottom of footing): Below V-o
Will there be a cellar? Yes Heated or Unheated? Unheated Floor 'Sq. Footage: 1017GSF
Will there be a basement? No Will any portion be used as living space? NIA
If so, what portion? N/A . Sq. Ft. Type of Use? -
Type of Roof: Sloped/Flat/Shed/Other Sloped Material of Roof Asphalt shingles
Size, wood studs -2 _" x _6_"; spacing76
_" o.c. ; length _ ft.
Joists (floor beams): 1st Floor —Z " x �_ "; spacing 1s o.c.; span -- ft. max,
Joists (floor beams) : 2nd Floor _2 " x �— "; spacing o.c. ; span 12 . ft. Whe
Overlays (ceiling beams) : - " x - "; spacing _ " o.c. ; span _ ft. Appiicabl
Roof rafters: - of x - "; spacing - o.c. ; span _ ft.
Roof trusses (pre=engineered): spacing - 2 " o.c. ; span 13 ft.
Exterior Wall Finish: ciapboard Siding of what material? yzn37
Interior Wall Finish: 112" Gypsum Board
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
N/A
Is there to be an opening between garage and dwelling? N/A If so, will a Fire-Rated door,
enclosure, self-closing device be provided? N/A
Will a flue-lined chimney be installed? Height above roof NIA ft.
Depth of chimney foundation below grade: N/A ft. N/A
Depth of fireplace hearth: N/A ft. N/A in.
Water supply - Municipal or private well : Runicipai
SEPTIC SYSTEM: Distance from any private well (including adjoining properties: +loo ft.
(A separate application is necessary for any repair or new installation of. septic system. )
NAME OF BUILDER & ADDRESS: 7he Quinn company, inc. - P.o. sox f6io - Rtitiana, vT. 051o2 PHONE_t802)747-7010
NAME OF PLUMBER & ADDRESS: same as Above PHONE
NAME OF MASON & ADDRESS: same as Above PHONE
NAME OF ELECTRICIAN & ADDRESS: ' same as Above PHONE
DECLARATION
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 specified or not, and that such work is authorized by the owner.
Signature
Owner, o er s agqnt,-architect
contractor
--------------------
SPECIAL CONDITIONS OF E I :
By:
Code Enforcement Officer
i ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE DAYS
Compliance Methods:
PART 5 - Acceptable Practice Method - 1 & 2 Family Dwellings (ONLY)
PART 6 - Thermal Rating - Component Trade Offs - 1 & 2 Family Dwellings;
Multi-Family Dwellings
(3 Stories or Less)
PART, 4 - Design By Component Performance - Commercial Buildings - Hi-Rise Residential
PART 4 & 6 - Compliance Methods Require Submission of Worksheets
Mr. & Mrs. Raymond Humphreys Inspiration Park (Lot #9)
APPLICANT'S NAME PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - 1017 Sq. Ft.
2. Type of Heat - x Elec. Base Board Other
3. Is Building Mechanically Cooled? YES x NO
4. Percentage of Area of Windows and Doors Over 17% x Under 17% (10.65%)
THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND TO (9000 D.D_).
R E Q U I R E D
THE R-VALUES SHOWN ON PLANS SUBMITTED!
Baseboard
5. Insulation Values: Actual Shown Elec. Heat Other
A. Roof & Floors exposed to ambient temperatures R 38 33 24
B. Exterior Walls R 19 23 18
C. Glazed Area R 3.45 2.6 1.7
D. Exterior Doors . R 14.9 2.5 2.5
E. Floors over unheated spaces R 19 24 19
F. Edge of Slab on Grade (Heated Building) R N/A 10 10
G. Basement/Cellar Walls- (Above Grade) R N/A 10 � 10
H. Basement/Cellar Walls (Below Grade) R N A - -
I. Heating/Cooling - Ducts - Piping in Unheated Space R NIA - -
6. Service (Domestic) Hot Water Heating Device
A. Conforms to minimum efficiency per code x YES NO
TEMPERATURE CONTROL MAXIMUM SETTING 1400 - WILL NOT BE EXCEEDED
(518) 793-5183
APPLICANT SIGNATURE DATE TELEPHONE NUMBER
INSPECTOR'S REMARKS:
_y
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # _
Fee Paid_
Date: October 7, 1992 Reviewed By
LOCATION OF PROPERTY .FOR INSTALLATION: Queensbu y, NY 12804 (Inspiration Park)
Owner' s Name: mr. & Mrs. Raymond Humphreys
Owner' s Mailing Address: 17 Goldfinch Road, Queensbury, NY 12804
Installer' s Name: The Quinn Inc. Phone #: 802-747-7010
- Number of bedrooms (if residential ): Three
Total daily flow (residential-compute @ 150 gal . per bedroom): 450 Gals_
Topography-Circle One: Flat Rolling Steep' Slope % of Slope
Soil Nature-Circle One: San Loam Clay Other _/Depth:
Ground Water-At What Depth? +6'-0" Feet
Bedrock or Impervious Material-At What Depth? +20 Feet
Percolation Test-Circle One: Not Required Required/Rate 2 Min. Per Inch
Domestic Water Supply-Circle One '. Municipal Well Other
If domestic water supply is a we
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank l000 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 27 . feet//Total System Length 162 feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: 1/2" to 1-1/z" Depth or Thickness 1.0 feet
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size\of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency..
****************
I have read the, regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: -,Q --�A�:
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BALOGH CONSTRUCTION
20 JOHN STREET
QUEENSBURY, NY 12804
UNAUTHDRIZED ALTERATION OR ADDITION TO T.nP.T. RLF��IYF
THIS DOCUMENT IS A WOLATION OF SECTION "INSptRwT►ou P�.ctK'Su6DIvlSlolJ /�7209 SUBDIVISION 2 OF THE NEW YORK STATE
EDUCATION LAW. ��.y ouT PV.�3• Ota�?AccEO 6Y MJ►A.IJ GIJ
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I certify to the following
that this survey has been
prepared in accordance with GO
the Code of Practice for Land
surveys adopted by the N.Y.S.
Association of Professional
Land Surveyors no last
revised.
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"ONLY COPIES OF THIS MAP SIGNED IN TIED
j/ 2d Qy INK AND EMBOSSED WITH THE SEAL OF AN
s J c• OFFICER OF C. T. MALE ASSOCIATES, P.C.,
OR A DESIGNATED REPRESENTATIVE SHALL
G• E �{ �1=�4SO1V PLS -erg 4-,q- DATE. BE CONSIDERED TO BE A VALID TRUE COPY'
Dote RECORD OF WORK Appr. LOT
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50 CENTURY HILL DRIVE, P.O. BOX 7 NY 27, LATHAM, 12110 •l ■�sL�,J�U.
(518) 785-7400 • FAX (518) 786-7299
Drafter: �•F• Checker: �� ENGINEERING * SURVEYING • ARCHITECTURE + LAND PLANNING ��t_G
LANDSCAPE ARCHITECTURE • COMPUTER SERVICES
U
Appr. by: Proj. No. 92 .1-74-5 SCALE: I' = 30� DATE: Nov . 1 9 \992
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256
ARRIVE: Cf DEPART: INS
FINAL INSPECTION REPORT - RESIDE IAL"
DATE INSPECTION REQUEST RECEIVED: (�
NAME sx— �_`pst-A C_-) ?-'1, (--)
LOCATION
DATE _ -7 _ PERMIT H
TYPE OF STR CTURE ��5b¢$ � ��
FOOTINGS_ FOUNDATION BACKFILL _ FRAMING _
ROUGH PLUMBING SEPTIC INSULATION
FINAL ETECTRICAL WOODSTOVE OR FIREPLACE
N A YES NO
CHIMNEY f[EIGHT/,,B VENT/HEIGHT
PLUMBING VENT
ROOFING
EXTERIOR FINI
DECK H STEPS RAI NGS
RELIEF VALVES
FURNACE HOT WATER OPERATING
INTERIOR TRIM PRIVACY DOORS
• FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS 'SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
;Lv--
SITE PLAN VARIANCE REQ.
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C C
(518)761-8256
TOWN OF QUEENSBURY —'
BUILDING 6 CODE ENFORCEMENT
742 BAY RD., .QUEENSBURY NY 12804
I
INSPECTOR'S REPORT: ARR a� L J DEPART !-
REQUEST FOR INSPECTION.RECEIVED: A 1 97
NAME /��✓\ V�J 1 t �G
LOCATION
DATE —"7 `q PERM
�I IT
TYPE OF STRUCTURE:
RECHECK APPROVED
N/A YES NO
OOTINGS PIERS
MONOLITHIC POUR FORM
I
REINFORCEMENT IN PLACE,
THE CONTRACTOR IS RESPO LE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLONING THE PLACE—
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
I INFILTRATION BARRIER
ATING 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—
(518) 761-8256
TOWN OF QUEENSBURY
BUILDING 6 CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR DEPART'
/i
REQUES'P R INSPECTION RE�CE`IV\ED:
NAME 1 C' J
LOCATION
DATE 3 9 7 PERMIT A "-
TYPE OF STRUCTURE:
RECHECK APPROVED
t__N A YES NO
FOOTING PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE R
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
EI,LMBING-VENTLVENTS IN PLACE
ROUGH PLUMBING \
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER
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-
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 BAY ROAD
QUEENSBURY NY 12804
CL
(518)745-4447
ARRIVE: DEPART: _ INSP:
FINAL INSPECTION REPORT - RESIDE IA
DATE INSPECTION REQUEST RECEIVED:
NAME MC-�j1 Q�ARJ1(�IJC� ! `k1\�fV��
LOCATION , D E% �G" P�D
DATE Talh, E �-7 PERMIT # _.NL �
TYPE OF STRUCTURE
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
i
i
EXTERIOR FINISH
DECK/PORCH/STEPS/RAILING'S
ti
RELIEF VALVES I
FURNACE HOT WATER OPERA NG
INTERIOR TRIM PRIVACY 00RS
FINISH FLOORS: i
BATH KITCHEN WA RTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOOR CARPETED
STAIR CLEARA CE RAILINGS
SMOKE DETEITORS
BATHROOM /FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
SITE PLAN VARIANCE REQ.
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C C
Tom OF QUEENSBURY
531 BAY ROAD
__ TTELLEPHONEY NEW 518 0 745-64447 /
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED /O
NAME
LOCATION t �'d
DATE PERMIT#
TYPE OF STRUCTURE
RECHECK
_FIRE MARSHAL APPROVAL (COMMERICIAL STRUCTURE)
_FOOTING FOUNDATION BACKFILL FRAMING
_ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC
INSULATION WOODSTOVE/FIREPLACE
REMARKS
APPROVAL
N/A ES NO
CHIMNEY HEIGHT/LOCATION L
B VENT/LOCATION d
PLUMBING VENT
ROOFING
SIDING
DECK/PORCH/STEPS/RAILINGS ;
RELIEF VALVES
FUZNM/HOT WATER OPERATING';-'
INTERIOR TRIM/PRIVACY DOORSN,
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT'
OTHER FLOORS SWEEPABLE' y
OTHER FLOORS CARPETED../
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS
DOOR CLOSERS
BATHROOM FANS ✓
ALL PLUMBING FIXTURES OPERATING\
GARAGE FIRE PROOFING
DOOR CLOSERS i "x
OTHER FIRE SEPARATION a✓.
FIRE/DEMISE WALLS
FINAL ELECTRICAL "
OK TO ISSUE C/O OR C/C '
COMMENTS:
lia 45�ec 47, c2
ARRIVE
DEPART
INSPECTOR
Jown ol Queensburcy 0)�
BUILDING and ZONING DEPARTMENT
Bay and Havitand Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
i
LOCAT I ON
DATE PERMIT N0. 9?- cl,4/2—
SOIL TYPE - Sand, T; - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench ' (SEZ
Depth of trenches �2
Size of gravel_
SEEPAGE PITS{Nuinber of) '
Size- ft. X._ i` ft. a`
Gravel size
PIPING: ` Size Type
Bldg. to tank �, �;/ SP2_35- -
Tank to dist. box ^. -ij,' /2G/+c.
Dist. box to field/pit,,.;F� et
Openings sealed? f S, , NO Partial
ry.
LOCATION/SEPARATIONS•,S
Foundation to tank „ -Jo ft.
Foundation to absorption ;,?,o ft.
Absorption to lot line / ft.
Separation of pits r %ft.
LOCATIONOF SYSTTtON PROPERTY(circle one)
Front Rearj- Let side - Right.. side -
COMMENTS:
3�
;79E
i
SYSTEM USE APPROVED "YES NO
Bui ding Inspector
01/86 and vl ed
I ,
TOWN OF QUEENSBURY 9�
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVE // f
NAME
LOCATION�j�
DATE PERMIT #
TYPE OF STRUCTURE_�5��
RECHECK APPROVED .
FOOTINGS IERS N/A YE NO
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/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
HEATING ROUGH-IN-
INSULATION: '
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTER OR R-
FLOORS J R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING/IN UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART
SPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT l
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE ('518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED,___
NAME
LOCATION
DATE y Z PERMIT IlZ-
TYPE OF STRUCTURE (��/yC �Gt�Crr� J
RECHECK APPROVED
N/A YES N(
FOOTINGS/PIERS
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/WALL POUR
REINFORCEMENT IN PLACE/
FOUNDATION/DAMPROOF IN6i
�BACKFILL APPROVAQ
ROUGH PLUMBING ,
PLUMBING VENT/VEY IN PLACE_
PLUMBING UNDER LA
FRAMING:
JACK STUDS/ EADER
BRACING/BR DGING
JOIST HAN ERS
JACK POS S/MAIN B�AM
HEATING R�UGH-IN
INSULAT N:
FOU ATION WALLS INTERIOR R-
FOU DATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
r
ARRIVE
DEPART
INSPEC T
f
i
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
`ZIUA /
NAME �fj
LOCATIOW�j
_PERMIT f
PE OF STRUCTURE
RECHECK_ APPROVED
_ N/A YESI NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOWING
THE PLACEMENT OF THE CONCRETE.
bATEf� -81�._THIS PURPOSE ON SITE
�EbUNDATION/_WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTSJIN PLACE
PLUMBING UNDER SLABg
FRAMING: }
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS y
JACK POSTS/MAIN B�AM
HEATING ROUGH-IN
INSULATION: y
FOUNDATION W/ LS INTERIOR R-_
FOUNDATION LLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART
INSPECTOR
TOWN OF QUEENSBU,
BUILDING AND CODES DEPARTMENT
531 BAY ROAD ,
QUEENSBURY, NEW YORK 12804 � l
TELEPHONE (518) 745-4447
BUILDING INSPECTOR°S REPORT
REQUEST FOR INSPECTION�RECEIVED 1 C)�-per{ ' 1:2/a-
NAME TS -s J 1
LOCATIONfl�
DATE �/� PERMIT 9
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YES NC
OOTINGS/PIERS
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/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING _
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PL.A �—
PLUMBING UNDER SUM
FRAMING:
JACK STUDS/HEADERS ,
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIpr BEAM
HEATING ROUGH—IS
INSULATION: /
FOUNDATIOWALLS INTERIOR R— _
FOI WALLS Eg ERIOR R—
FLOORS / ` R—
WALLS R—
CEILING R—
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART
sIVSPECTOR
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
?��
Main Office 357 Elwyn Terrace — Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Panel Board No................... Cert. 43205 Cut-in Card No.........................
�
Owner...........I C t✓ OW#1 6
Occupant................................................................................................. ......................
Location... �.L.' � .. ................................. .
Installation Consistin of.. U.....
_ 1 ............. .....f..... ..................
f....:��...Y GLf� ... . .....�.....- ...................................
............................................................ ...............................................................................
Installed By.....15 J/A ! ............................... Lic.#..................
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 maki insp ion. at any time,and if its
rules are violated,the Comp ny shall have the right to revok th' ti cate.'
Date.... ..-. ``.`:..21.......... INSPECTOR .. .. ..... ........................................ ...
Member N.F,P,A.,I.A,E,I.