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92-083 CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date April 9 i9 97 This is to certify that work requested to be done as shown by Permit No. 92083 has been completed. This structure may be occupied asa SINGLE, FAMILY DWELLING 13 DAWN RD . location Owner CLUTE , LARRY W. TAX HAP NO . 120 . - 1-61 . 21 By Order Town Board 1/^TOO,WWN OF QUEENSBURY V Director of Bldg. & Code Enforcement BUILDING PERMIT X TOWN OF QUEENSBURY No. 92-083 WARREN COUNTY, NEW YORK c PERMISSION is hereby granted to Larry W. Clute N I OWNER of property located at 140 Dawn Road Street, Road or Ave. IV f+ in the Town of Queensbury,To Construct or place a Single Fami 1 y Owp_].]i ng 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. 1. OWNER'S Address is RR6 Box 140A Queensbury, NY 12804 V 2. CONTRACTOR or BUILDER'S Name Same S 3. CONTRACTOR or BUILDER'S Address 4. ARCHITECT'S Name f+ A O 5. ARCHITECT'S Address y n 6. TYPE of Construction—(Please indicate by X) A Wood Frame ( ) Masonry ( )Steel ( ) 7. PLANS and Specifications H 7 No. 2400 sq ft Single Family Dwelling as per plot plan specifications t� and application ro 8. Proposed Use 'A Single Family Dwelling , 0 $ 313.00 PERMIT FEE PAID —THIS PERMIT EXPIRES March 10_ 19 93 (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, 19th of March 1992 SIGNED BY for the Town of Queensbury Buildings oning nspector TOWN OF QUEENSBURY REVIEWED BY: FEE PAID: 6-0 T�U/N OF QUEENSBURIQ � PERMIT NO. : El og� VEp b4AR 1 � 199,E BUILDING PERMIT APPLICATION $LDG A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO INSPECTIONS W�IL� B £ UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT. All applicants spaces on this application MUST be completed and the signature of the applicant MUST appear on the reverse side of this application. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Owner of Property: L ck n t„ Go P.O. Address: qa(o j�4pA �CJrov �`� r3�r)�I PHONE -ZS3 -7J77 Property Location: lLfr� n„ II)IN Tax Map No. Imo/ 1 Has there been any split of this property since October 1, 1988? Yes No If yes, Planning Board Review is necessary. Subdivision Name, if applicable: Lot No. THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS: C-(wA2 C�.��1e E✓�4 t(�r�S l vac NATURE OF PROPOSED WORK: * ESTIMATED MARKET VALUE OF THE x Construction of new building * CONSTRUCTION: $ 50, o0o, OD Addition to building Alteration to building * COMPLETE INFORMATION REQUIRED BELOW: (no change to exterior dimensions) * Size of Property: I?L�o ft. x DOD ft. Other work (describe) * Existing Building Size: * ft. x ft. * Proposed building - distance from GROSS AREA OF PROPOSED STRUCTURE: *uo property line: orb 1st Floor �y�p Sq. Fi: * Front Yard (4-7 ft. Rear yard ft. * Side Yards ft. and 1,T ft. 2nd Floor Sq. Ft. * If on corner, setback from side street- ft. Other Floors Sq. Ft. (not cellar or basement * OCCUPANCY INFORMATION: * TOTAL FLOOR AREA: !P /W Sq. Ft, * Primary Building - * x One Family Dwelling Size of New Structure: ft. x 5G ft. * Two Family Dwelling Foundation: * Multiple Dwelling/No. of Units Pier/Slab/Crawl/Partial Full Circle One) * Business * Industrial No. of stories (Habitable space) 1 * Other Height (grade to ridge) ��, ft. If residential , no. of families: t * If addition, what will use be? No. of rooms (excluding baths): 9 No. of bedrooms: L/ No. of bathrooms: Q * Accessory Building: Primary heating system: C.er * X Detached Garage - One/ o Ca Type of fuel : �:a 5 Attached Garage - One/ ar No. of fireplaces to be installed: �_ * X Private Storage Building Will a woodstove be installed?: v�o * Other Central Air Conditioning: Yes No _ * (OVER.) BUILDING PERMIT APPLICATION CONTINUED: BUILDING SPECIFICATIONS: Type of construction: wood fram fire safe, etc. Will any second-hand or ungraded lumber be used? If so, for what? Ua Foundation Wall Material : CCn&12 �, , Thickness: Depth of Foundation below grade (to bottom of footin ): Will there be a cellar? Heated Unheate ? Floor Sq. Footage: D1�c� Will there be a basement? t�l� Will any por on be used as living space? Oa If so, what portion? —1" Sq. Ft. Type of Use? Type of Roof: toe /Flat/Shed/Other Material of Roof Size, wood studs 0- " x (I "; spacing o.c. ; length ft. Joists (floor beams) : Ist Floor x 10 spacing (lo o.c. ; span L ft. Joists (floor beams) : 2nd Floor x "; spacing o.c. ; span ft. Overlays (ceiling beams) : " x spacing o.c. ; span ft. Roof rafters: Itx spacing o.c. ; span ft. Roof trusses (pre-engineered) : spacing 2 Lf o.c. ; span � ft. Exterior Wall Finish: ��(e_ Y vzA4 ( of what material ? Interior Wall Finish: S Lejmc If a garage is to be attached, describe materials to be used for FIRE SEPARATION: Is there to be an opening between garage and dwelling? K-�b If so, will a Fire-Rated door, enclosure, self-closing device be provided? Will a flue-lined chimney be installed? Height above roof QL ft. Depth of chimney foundation below grade: ft. Depth of fireplace hearth: - ft. in. Water supply <unicipa or private well : SEPTIC SYSTEMis ante from any private well (including adjoining properties: ft. (A separate application is necessary for any repair or new installation of septic system. ) NAME OF BUILDER & ADDRESS: - Cc c (P N r pri'�r nc _ PHONE ZS3-�7 / NAME OF PLUMBER & ADDRESS: PHONE NAME OF MASON & ADDRESS: PHONE NAME OF ELECTRICIAN & ADDRESS: 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 visions of the BUILDING CODE, THE ZONING ORDINANCE, and all other laws pertaini to t e proposed work shall be complied with, whether specified or not, and that such work •s aut rized by a owner. Signature Own , owqq r s agen , architect contractoP� ------------------------------------------------- ------------------------------- SPECIAL CONDITIONS OF THE PERMIT: By: Code Enforcement Officer 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 3 6 - Compliance Methods Require Submission of Worksheets APPLICANT'S NAME PROPERTY LOCATION PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE: 1. Gross Floor Area - ayoo Sq. Ft. / 2. Type of Heat - Elec. Base Board Otheres 3. Is Building Mechanically Cooled? YES NO 4. Percentage of Area of Windows and Doors Over 17% _Under 17% THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND TO R E Q U I R E D THE R-VALUES SHO1/M ON PLANS SUBMITMI Baseboard 5. Insulation Values: Actual Shown Elec. Heat Other A. Roof A Floors exposed to ambient temperatures R L/5 B. Exterior Walls R Z0,5S C. Glazed Area R 3• I D. Exterior Doors R I E. Floors over unheated spaces R_ F. Edge of Slab on Grade (Heated Building) R O/A G. Basement/Cellar Walls (Above Grade) R iJ A H. Basement/Cellar Walls (Below Grade) R O A 1 . Heating/Cooling - Ducts - Piping in Unheated Space R 6. Service (Domestic) Hot Water Heating Device A. Conforms to minimum efficiency per code _YES NO TEMPERATURE CONTROL MGXIR!1!: SETTING 1400 - WILL NOT BE EXCEEDED AGL -TELEE6F8NE NUMBER INSPECTOR'S REPARKS: l� TOWN-OF QUEENSBURY .Bay at Haviland Roads,Queensbury,N.Y.12801-9725 APPLICATION FOR SOLID-FUEL BURNING APPLIANCES AND FIREPLACES Dale z '' t;' _19 r-} Permit No. (1` APPL.ICA'1'lON IS HEREBY MADE to the Building Department 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 for the required inspections. Applicmtl's Name t t, APPLIANCE TYPE ! Stove Coal Wood Address V. k, i „ l u,7 .1 Furnace Hot Air Boiler Zero Clearance fit` Circulating Unit ' Phone i -t..y--; 7 If Non-Masonry: Owner's Name Manufacturer Address _ Model "t LL L Outlet Sire Zip Listed by Number Phone �•-,., ,,,.• ; CHIMNEY TYPE Masonry: Block _Brick _ Stone Property location of proposed construction Flue: Tile Steel Size- ` Factory Built: Manufacturer �R s Model Size 11-1 COPY OF MANUFACTURER SPECIFICATIONS IS Height i 7` ' Listed By Number REQUIRED FOR FACTORY-BUILT APPLIANCES Type: Double Wall Triple Wall AND CHIMNEYS. MUST BE INSTALLED Insulated ACCORDING TO SPECIFICATIONS. COPY OF Estimated Cost $ CONSTRUCTION DETAIL REQUIRED FOR MA- Fee$ SONRY FIREPLACES AND CHIMNEYS. CASHIER'S DEPARTMENT TOWN OF QUEENSBURY, NEW YORK Department: Fire Marshal Amount Collected Amount Refunded Code Number - A]73 3389 (190)Public Safety A233 2655 (230)Minor Sales Fee Collected from or-Refunded to: Address: / V Dated: ., Town Clerk or Dep iy 1 '. 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 *Requires submission of worksheets APPLICANT' S NAME : PROPERTY LOCATION: Lar E34 I A ICam. 1� [ tip ►2L�,� PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE: 1 . Gross Floor Area - \06 1 square feet 2 . Type of lleat - Electric Oil Gas Other 3 . Is building mechanically cooled? Yes _X_ No 4 . Percentage of area of windows and doors Over 17% Under 17% 5 . R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS SHOWN ON PLANS SUBMITTED: a. Roof R 3� b. Exterior walls R C . Glazed areas R y.5 d. Exterior doors R e . Floors over unheated spaces R f . Edge of slab on grade (heated building) R g. Basement/cellar walls (above grade) R 19 h . Basement/cellar walls (below grade) R i— i . Heating/cooling-ducts-piping in unheated space R 6 . Service (domestic) hot water heating dev' Conforms to minimum efficiency per code :k Yes No P"ATURE ONTROL MAXIMUM SETTING 1400 - WILL NOT BE EXCEEDED a � g ur at Phone Number 3/5(5 S '717 3 -7��7 INSPECTO ' S REMARKS : <PA \ \ M M Y" „ I. TOWN OF QUEENSBURY APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # Fee Paid Date: Reviewed By LOCATION OF PROPERTY FOR INSTALLATION: (L40 baL�V-, Q, ? Chi v hen �r Owner' s Name: L-0-rr Lk-9, C(,�A 2 Owner' s Mailing Address: 99& OQg \46A k)e,-,1xSAs-ivk,.9.U, _-7,6 Installer' s Name: Lca-D4 ( ,(w(2 Phone #: `Yi3-7a77 Number of bedrooms (if residential ): V Total daily flow (residential-compute @ 150 gal . per bedroom): Topography-Circle One: Flat Rolling Steep Slope % of Slope Soil Nature-Circle One: Sand Loam Clay Other /Depth: Ground Water-At What Depth? Feet Bedrock or Impervious Material-At What Depth? Feet Percolation Test-Circle One: of Require Required/Rate Min. Per Inch Domestic Water Supply-Circle One: unici al Well Other If domestic water supply is a we - Separation: Water supply from any septic absorption feet PROPOSED SYSTEM: Septic Tank 1Z:?50 gal . (Minimum size: 1,000 gal . ) Tile Field: Each Trench SO feet//Total System Length 3 p0 feet Seepage Pit(s) : Number of / Size each: ft. x ft. Size of Stone to be used: # / Depth or Thickness 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: DATE: 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. Town of Queensbury Building & Code Enforcement Department 531 Bay Road Queensbury NY 12804 Remarks: Application for SEPTIC DISPOSAL PERMIT SFAMP RE 131 V1iD Location of properly for installation: PIiRMI'1'NUMI)fSR Owner's Name: (ICIrrtw Cam)_ k,r.fe Address: tZ Installer's Name: Jr �a2nss - FEE PAID plione #: ( ) -73? 7 Number of bedrooms (if residential): Z) Total daily flow (residential - compute Ci) 150 gal. per bedroom): 30� Topography: [Flat Q Bolling Q Sleep Slope °'n of Slope Soil Nature: Sand 0 Loam Q Clay Q Other -/Depth: Ground Water: at what depth? feet Bedrock or Impervious Material: at what depth? feet percolation 'rest: MT Not Required Q Required/Bale _min. per inch Domestic Water Supply: CK Municipal Q Well Q Other If domestic water supply is a WELL: water supply from any septic absorption is feel PROPOSIiD SYS'1'FM: Septic lank:yLX) Lgal. (minimum Size: 1.0()0 gal.) 11,L�3141S7g',> 'file Field: each trench SC) feet. / total system length DOG feel, cp Seepage Pil(s): number of / size each: ft. x ft. eciG S � Size of stone to be used: # depth or thickness feel. HOLDING 'TANK SYS'1'IiM: (if required) cs j N�uumbbe'rr of tanks: Size of each: gal U--W Alarm system and associated electrical work to be inspected by a certified agency. For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or approval granted which is based upon oar is granted in reliance upon any material misrepresentation or failure to slake a material fact or circumstance known by or on behalf of an applicant, shall he void. 1 have read else regulations with res cl to this a pplica ' t and agree to abide by these and all requirements of the Town ofQue nsbury Sat itary S wage Disposal Ordinance. Sienatnreal responsible ne .tYh: / Pate: PLOT PLAN SEPTIC SYSTEM Notice: The following statement must be "stamped" on your plot plan. This sheet of paper may be used for purposes of drawing your plot plan. After drawing such plot plan, please read the statement and sign it. If you choose to use other paper for your plot plan, the office will stamp those plans for your signature. "I have seen or observed, or believe I saw evidence of, all objects such as houses, wells, trees, fences, etc., shown on this document. 1 also represent that I have personally measured the distances set forth on the diagram." SIGNATURE DATE TO 10F UEEj,.!UM Bay at H d nA",I& AMI-9725 APPLICATION FOR SOIFUEL BNING APPLIANCES AND FIREPLACES Date' I-- t.��r 17, 19_S3 Permit No. APPLICATION IS HEREBY MADElo the Buiong Department for the issuance of a Building and Use Permit pursuant to the New York State Fire Prevoa ion and Building Code.The applicant or owner agrees to comply with all applicable laws,ordinances,regulations arKiall eondillons that are part of these requirements and also will allow all inspectors to enter premises for the required inspections. Applicant's Name _G r ; ,/ � �� APPLIANCE TYPE * Stove Coal Wood Address V.ZL .. t�tt_ a Furnace Hot Air Boiler Zero Clearance )!< Circulating Unite C 1� u_rt Phone -fir, 7 UNon-Masonry: Owner's Name i :Manufacturer Address 4,r� .t a `� Model —A&r- 7(�, Outlet Size 2* _ Listed by Number Phone CHIMNEY TYPE Masonry: Block Brick _ Stone Property location of proposed construction. Flue. Tiler Steel t lk , i�..-.�.. ► ct + C,r w F t �� , ,, Size: .Factory Built: - � Manuf turer ,C t i C L Model Size /410 VOPY OF MANUFACTURER SPECIFI fiTIONS IS j t ' Listed By Number ,,.,REQUIRED FOR FACTORY-BUILT A*,IANCES Type: Double Wall Triple Wall 's _ AND CHIMNEYS.MUST BE INSTALLI Insulated ACCORDING TO SPECIFICATIONS.COPY OF Estimated Cost$ CONSTRUCTION DETAIL REQUIREO$OR MA- Fee$ SONRY FIREPLACES AND CHIMNEY'; CASHIER!#DEPARTMENT TOWN OF Qf EENsRuxy, NEW YORK Degartmente Fire Marshal AmoustCollected Amount Refunded Cade Number Titleqit A173 3389 (190)Public Safety _. A233 2655 (230)Minor Sales ) �J J ee Collected front ur'OeNaded to: �� Y Y ` Qj„�i Address: Dalyd: r,r --- Tovru Clerk or De 1rL1/t:Awafieul.a- F]tt,wa./-Nrt�Fa Ala,wWoiYls._!�fbAwtl.r�. a/ur .' TEMCO s Best Fireplaces: TBF Series 4_ - - MODEL TBF36 MODEL TBF42 with CV42 GLASS DOOR MODEL TBF47 DIMENSIONS Ins. Best Appearance. Best Performance. tr1pDEL A B C D E f 2 H « TBF36 36 2d 54 — db 33 to 34 23 542 TBF42 42 2d 57 Vi ]PM 5[ 39 12 40 ?9 655 The TBF series excellent finishing and s MF47 47 2e 61V 6119 52 39 12 d0 29 655 1 performance characteristics derive from its 6''' c 'Hearth Area(sq.ins.) unique triple wall construction and over ACCESSORIES nu>siphon cooling system. In this proven,, e • Clearview Glass Doors to enhance safety, uncompromised design, all necessary appearance and performance are available for cooling air is taken in at the top of the all TBF models. Ea • Combustion Air Kit conserves heated room chimney and contained within [h: fire- Face, TBF36 air by providing outside air for combustion. place, leaving the face and opening en- CHIMNEY COMPONENTS tirely free of vents. This allows finishing " • TBF Series fireplaces use triple wall chimney up to the opening for a flawless appear- components with 15" o.d., and 2" clearance ance, more attrac- to combustibles. rive than that Of • Terminations: A choice of round, round slip ti cost site- type, or architectural terminations are higherD available for all models. built fireplaces. In D INSTALLATION FLEXIBILITY addition, it helps 6-t Starter section, packed with fireplace, keeping: energy by required for models & TBF47 keeping the fire- 6 • lip to 4 elbows (2 pairs o of f ellxlws) may he used per system. place enclosure, Minimum system height, without elbows: and the house, L 6V 12', TBF36; 15'6", TBF42 & TBF47. warmer and more ICE = Minimum system height with 1 pair of comfortable. Face, TBF42 a 47 elbows: 17" N-_r • Minimum system height with 2 pairs of Finally, the high 'PIG elbows: 21" domed transition f • Maximum system height: 90" assures a reliable 24ne draw without an I tULunsightly sheet Top. Framing M I* ' 4 f metal smoke deflec- Report Research Research Report tor. The resulting #MH Report Report #87-I1 _ high openings are Meet H [l#3 #880 essential for good " Meets U Minimum Property Standards,'`_ design with higher Section 610-1.1 and 610.2 or vaulted ceilings. Nam „s _�--"'•'` �"^`, Hearth °`r•n-1171.1..0 usan„ i SULu.x,.Y M lem,e.NM.x,...s.Ini 7N67355 41F'.I Printed USA 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 NAMEEQI1lLu LOCATION 140 DATE IL L* y?_PERNIT # 9.?-G1F.2 TYPE OF STRUCTURE k)(4 /C4 RECHECK �� APPROVED N/A IYESI NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTECTION FROM FREEZING FOR 48 HOURS FOLLOJIING THE PLACEMENT OF THE CONCRETE. MATERIALS FOR O THIS PURPOSE' ON SITE FOUNDATION/W THIS POUR REINFORCEMENJ IN PLACE FOUNDATION/DA PROOFING BACKFILL APPR PAL ROUGH PLUMBING t PLUMBING VENT/VENTS ; N PLACE PLUMBING UNDER SLAB FRAMING: JACK STUDS/HEA RS BRACING/BRIDGING JOIST HANGERS '- JACK POSTS/MAIN BEAM HEATING ROUV-IN INSULATION: FOUNDATION WALLS INTERIOR R- FOUNDATION WALLS EXTERIOR R- FLOORS R- WALLS R- _ CEILING R- DUCT WORK OR PIPING IN UNHEATED SPACES REMARKS: ARRIVE DEPART ®R ! INSP 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 RECEIVEDIl l NAME �GJI (/J� ,zz LOCATION /wm 1/pim4 Ice DATE PERMIT P`E�RMIT # 9a �d 3 TYPE OF STRUCTURE RECHECK APPROVED N/A YES 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. 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 EAP HEATING ROUGH-IN INSULATION: FOUNDATION WA S INTE OR R- FOUNDATION WAILS EXTER R R- FLOORS R- WALLS R- CEILING R- DUCT WORK R PIPING IN U EATED SPACES REMARKS: �L lk lye/C C/�B< 6,4, G�� Zc ARRIVE ZV DEPART INS EC OR TOWN OF QUEENSBURY `r BUILDING 6 CODE ENFORCEMENT - 531 BAY RD., QUEENSBURY NY 12804 � INSPECTOR'S REPORT: ARR DEPARJ�-�TI/. t,1 INT REQUEST FOR INSPECTION RECEIVED: NAME LOCATION DATE / t PERM TYPE OF STRUCTURE: RECHECI( I APPROV D N/A YES NO FOOTINGS�PIERS MONOLITHI POUR FORM REINFORCEM T IN PLACE THE CONTRAC R IS RESPON41BLE FOR PROVIDING PA TE TION FROM FREEZING FOR 48 HOURS OLLOWING THE PLACE- MENT OF THE C CRETE. MATERIALS FOR 71IS PURPbSE ON SITE FOUNDATION/WALLPNUR t — REINFORCEMENT IN LACE _ FOUNDATION DAMPPRO IG BACKFILL APPROVAL PLUMBING VENT/VENTS 'I PLACE ROUGH PLUMBING PLUMBING UNDER SL 8 �, FRAMING: \ JACK STUtlS/HEADER BRACING RIDGING JOLT HANGERS JACK POSTS/MAIN BEAT 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 -<r- BUILDING 6 CODE ENFORCEMENT 531 BAY RD. , QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARR DEPART��Lkl� INT REQUEST FOR INSPECTIO ECEIVED: � NAME LOCATION c DATE PERMIT 4 6 TYPE OF TR CTURE: RECHECK APPROVED -N/A YEES^ NO �DOTINGS PIERS /1 MONOLITHIC POUR FORM "� REINFORCEMENT N PLACE THE CONTRACTOR S RESPONSIVL LE FOR ING PROTE TION FROM FREEZI FORHOURS FO LOWING THE PLACE F THE CON RTE. ALS FOR TIi PURPOSE ON S TE TION WALLPORCEMENT IN P ACEION DAMPPROO INGLL APPROVALNG VENT VENTS IN PL CEPLUMBING PLUMBING UNDER SLAB FRAMING: JACK STUDS H _ADERS BRACING BRI ING - -- JOIST HANGE JACK POSTS ! N BEAM AIR INFILTRATION ARR ER HEATING ROUGH-IN/ i INSULATION: FOUNDATION WALLS INTERIOR R- _ FOUNDATION WALLS EXTERIOR R- �FLOORS _ R_ -- - WALLS R- C EILING R_ DUCT WORK OR PIPING IN UNHEATED SPACES R ���C�i�t-S �,►/n ,�(� /`fir ;i CGS AI 1l T( i frrmtii � crY, / L"T l l /�M� TOWN OF QUEENSBURY 1--J �� _ .=. . BUILDING 6 CODE ENFORCEMENT 531 BAY RD. , QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARP J(?• DEPART N�1T✓ REQUEST FOR IN PECTION RECEIVED: J NAME C LOCATION DATE ��—� PERMIT TYPE OF STRUCTURE" s \� RECHECK APPROVED A YES NO FOOTINGS PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLAC THE CONTRACTOR IS RESP NSIBL FOR PROVIDING PROTE TION F M F EEING FOR 48 HOURS FOLLOWING HE LACE- MENT OF THE CONCRETE. MATERIALS FOR THIS PURPO ON SITE FOUNDATION WALLPOUR REINFORCEMENT IN PLA FOUNDATION DAMPPRO ING BACKFILL APPROVAL PLUMBING VENT IV IS IN PL CE ROUGH PLUMBIN i - C PLUMBING UN R SLAB - FRAMING: ACK STUDS/HEADERS BRACING BRIDGING —' J0I3T 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- ' I TOWN OF QUEENSBURY BUILDING 8 CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location _ Date S'22 �iS Pe t a 083 SOIL TYPE( San am- lay- Results of Percolatio Test- (if applicable) Rate- inute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: To 1 Length Length of each trench Depth of trenches Size`,of stone SEEPA PITS: Numbe 2EEE Size - • �.ft ft. Stone siz PIPING: Size We Bldg. to TanjPlotPl t Q 1� Tank to Dist. _ t4tt Dist. Box to t — L Nt Openings Seals No Partia LOCATION/SEPA Foundation to �_ feet Foundation to 'on _?� feet Separation of _ feet Conforms as p1 n Yes No LOCATION OF SPR ERTY:(circle one) Front - Rear - fight Side Middle Front - Middle Rear \ L COMMENTS: \ SYSTEM USE APPROVED: YES NO Arriv : ;, L Dep uilding I ector TOWN OF QUEENSBURY =ram BUILDING S CODE ENFORCEMENT 531 BAY RD., QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARR DEPART31d INTJ•—r— REQUEST/F�O�,R INSPECTION RECEIVED: NAME l LUTe LOCATION DATE s7 0 PERMIT A TYPE OF STRUCTURE: �F RECHECK APPROVED N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM _ REINFORCEMENT IN PLA' E THE CONTRACTOR IS REAPONSIBLEFOR PROVIDING PROTE TION FROM FRXEZING FOR 48 HOURS FOLLOWING THE PLACE- MENT OF THE CONCRETE.; MATERIALS FOR THIS PURE SS ON SITE FOUNDATION/WALLPOUR _ e REINFORCEMENT IN PLACE �. FOUNDATION/DAMPPROOFING _ 1 BACKFILL APPROVAL PLUMBING VENT/VE4TS IN PLA E ROUGH PLUMBING / PLUMBING UNDER SLAB FRAMING: JACK STUDS HEADERS _ BRACING BRIDGING JO=T ST HANGERS J CK POSTS MAIN BEAM AIR INFILTRATION BARRIER HEATING'ROUGH-IN INSULATION: FOUNDATION WALLS INTERIOR R- FOUNDATION WALLS EXTERIOR R- FLOORS g_ WALLS R- CEILING R_ DUCT WORK OR PIPING IN UNHEATED SPACES R- A4X_ TOWN OF QUEENSBURY FIRE MARSHAL QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 745-4424 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED /b NAME_ yrs/C�/I`e LOCATION DATE4 l PERMIT# Y'L Off' APPROVED EXITS N/A YES NO AISLE WIDTHS EXIT SIGNS EMERGENCY LIGH NG FIRE EXTINGUISHER AUTO. EXTINGUISHINGiSYSTEM HOOD INSTALLATION AUTO. SPRINKLER SY M ALARM SYSTEM INTERIOR FINISHES STORAGE: CLEARANCE TO PRINKLER _ CLEARANCEJ\� O EATING U TS REQUIRLO SIGMAG CHIMNEY WOODSTOVE FIREPLACE-MASONRY FIREPLACE-FACTORY BUILT REMARKS: ,1 OK TO T�H-IS DATE 2/015 kSPC CGAu-_6A'TI(N T'-Qj TOWN OF QUEENSBURY -`x-- BUILDING S CODE ENFORCEMENT 531 BAY RD. , QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARR,'�)EPARTI,_M IN REQUEST FO INS ECTION tECEIVED: NAME LOCATIONWO DATE / U - PERMIT A TYPE OF STRUCTURE: -_ED RECHECK APPROVED N/A YES NO FOOTINGS PIERS MONOLITHIC POUR FORM _ REINFOR EMENT IN PLAC THE CON CTOR IS RE PONSIBLE FOR PROVIDIN PROTE TIO FROM FREEZING FOR 48 H RS FOLLOW NO THE PLACE- MENT OF T E CONCM- MATERIALS R THI PURPOSE ON SITE FOUNDATION { LLP R REINFORCEMENT IN PLACE FOUNDATION DAM ROOFING IiACKFILL PPRO PLUMBING VENT EN IN PLACE UGII PLUMBIN PLUMBING UNDE SLAB ,__PfLfM LNG: JACK STUDS/HE UDS/HEA RS --- BRAC NG BRIDGIN --- - JOIS HANGERS -""- ---- JACK POSTS MAIN EAM _ AIR INFILTRA ION BARRIER _ HEATING ROUGH-IN INSULATION• FOUNDATION WALLS INTERIO R- FOUNDATION WALLS EXTERIOR R- FLOORS R_ --- - -- - -- WALLS R_ -- --- CEILING R_ - ---- --- -- DUCT WORK OR PIPING IN UNHEATED SPACES R- TOWN OF QUEENSBURY FIRE MARSHAL QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 745-4424 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED NAME l Ag" 6 r-F LOCATION DATE ta1 i PERMIT# %7 _ - 4j,� APPROVED N/A YES NO EXITS AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTIN FIRE EXTINGUISHERS AUTO. EXTINGUISHING S S EM HOOD INSTALLATION AUTO. SPRINKLER SYSTtMj ALARM SYSTEM ` 1 INTERIOR FINISHES STORAGE: CLEARANCE TO SPR KLEaRS CLEARANCE TO HEA ING l)NITS REQUIRED SIGNAGE t CHIMNEY WOODSTOVE FIREPLACE-MASONRY FIREPLACE-FACTORY BUILT REMARKS: U OK TO THIS DATE 2/015 S?ECTOR TOWN OF QUEENSBURY ;-r- BUILDING & CODE ENFORCEMENT 531 BAY RD., QUEENSBURY NY 12804 i INSPECTOR'S REPORT: ARRb��DEPART��I REQUEST FOR INSPECTION RECEIVED: NAME Lq RF� C um = LOCATION , J P 1 k: _ 8CAD DATE Qj 1nnnn PERMIT 1 ri2 TYPE OF STRUCTURE: RECHECK i APPROVED N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLA E THE CONTRACTOR IS RES ONSIBLE FO PROVIDING PROTE TION ROM FREEZ O FOR 48 HOURS FOLLOWIN THE PLAC - MENT OF THE CONCRETE. MATERIALS FOR THIS PU OSE ON SITE FOUNDATION WALLPOUR REINFORCEMENT IN PLACE FOUNDATION DAMPPROOFIN BACKFILL APPROVAL PLUMBING VENT VENTS I PLACE ROUGH PLUMBING PLUMBING UNDER SL FRAMING: JACK S DS(HEADERS BRACI !BRIDGING JOL.^T HANGERS JACK POSTS/MAIN BEAM AIR INFILTRATION BARRIER HEATING ROUGH-IN ,INSULATION: FOUNDATION WALLS INTERIOR R- FOUNDATION WALLS EXTERIOR R- FLOORS R- �WAAL_LS R CEILING R_ DUCT WORK OR PIPING IN UNHEATED SPACES R- O Y-% To b F1e EC G P�oTt� C3Ep�oC,r{5 `� GR��EOM TOWN OF QUEENSBURY BUILDING 6 CODE ENFORCEMENT 531 BAY RD. , QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARRAD�6DEPARTW;�5 IN e REQUEST FOR INSPECTION RECEIVED: ct�--- NAME _ L R RR Y S )1 E: LOCATION 1 q O DATE IC�RUCTURE: PERMIT # 9 zTYPE OF SJ FD RECHECK APPROVED N/A YES NO FOOTINGS PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTE TION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACE- MENT OF THE CONCRETE. MATERIALS FOR THIS PURPOSE SITE FOUNDATION WALLPO REINFORCEMENT IN PLA E FOUNDATION DAMPPROOFItG BACKFILL APPROVAL PLUMBING VENT/VENTS IN ACE ROUGH PLUMBING PLUMBING UNDER SLAB FRAMING: i JACK STUDS( AD S BRACING BRI GING�� JOIST HANG 5 JACK POST MAINEAM AIR INFILI'RATI N ARRIER HEATING ROUGH- #YNSULATION: FOUNDATION WALLS INTERIOR R- FOUNDATION WALLS EXTERIOR R- 46 R- WA_LLS R- CEILINGG R_. DUCT WORK OR PIPING IN UNHEATED SPACES R- L TOWN OF QUEENSBURY �1 BUILDING 6 CODE ENFORCEMENT 742 BAY ROAD QUEENSBURY NY 12804 7 (518) 761-8256 � ARRIVE: li DEPART: INS FINAL INSPECTION REPORT - RESIDENT DATE INSPgY/ CT REQ EST RECEjVEU: � NAME LOCATION r� 2 DATE -- - 'I PER T A J TYPE OF STRUCTURE ttt---111 FOOTINGS FOUNDATION BACKFILL FRAMING ROUGH PLUMBING SEPTIC INSULATION FINAL ELECTRICAL WOODS'IOVE OR FIREPLACE N A YES NO CHIMNEY HEIGHT/B VENT/HEIGHT _ PLUMBING VENT ROOFING EXTERIOR FINI DECK POR STEPS I L I JS RE VALVES FURNACE/HOT WATER OPERATING _ INTERIOR PRIM PRIVACY FINISH FLOORS: / BATH/KITCHEN ATE TI HT OTHER FLOOR WEEPABLE OTHER F S ARPETE STAIR NCE RAILI S _ S ECT S OOM S PL BING IXTURES UNDATION INSULA' ION GARAGE FIRE PROOFING DOOR CLOSER FINAL ELECTRICAL %� SITE PLAN VARIANC .RhE FINAL SURVEY PLOT PLAN "\ OK TO ISSUE C O OR C C 3.L15kp TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 BAY ROAD QUEENSBURY NY 12804 (518) 761-8256 ARRIVE: , DEPART: 3.,5 1 INSP: FINAL INSPECTION REPORT — RESIDEN IAL DATE INSPECTION REQUEST RECEIVED: / NAME _ARM CaJ1 LOCATION _ P1LJ DATE _ ('PERMIT / l ? TYPE OF STRUCTURE h 1/ FOOTINGS FOUNDATION BACKFILL FRAMING ROUGH PLUMBING SEPTIC INSULA FINAL ELECTRICAL _ WOODSTOVE OI FIREPLACE ` N/A YES NO 4, c, CHIMNEY HEIGHT B VENT/HEIGHT PLUMBING VENT QL ROOFING XTERIOR FINISH DECK PORCH TEP RAILING RELIEF VALVES FURNACE HOT WATER OPERATING INTERIOR TRIM PRIVACY DOORS FINISH FLOORS: BATH/KITCHEN WATERTIGHT OTHER FLOORS SWEEPABLE 10 OTHER FLOORS CARPETED STAIR CLEARANCE/RAILINGS SMOKE DETECTORS BATHROOM FAN LUMBING FIXTURES FOUNDATION INSULATION GARAGE FIRE PROOFING DOOR CLOSERS FINAL ELECTRICAL �IT�E PLAN VARIANCE REQ. /F MAL SURVEY PLOT PLAN OK TO ISSUE C O OR C C © Dcoi WA*30�-F- C I'�A�FrtEr�T V FI�JR � �j�(ZVE� FtQEQLAC� - FALL v0\S� 13�u`�; TOWN OF QUEENSBURY FIRE MARSHAL QUEENSBURY, NY 12804 (518) 761-8205 FIRE MARSHAL INSPECTION REPORT _ REQUEST FOR INSPECTION RECEIVED NAME LOCATION -70(-A■`Y\ K DATE PERMIT # APPROVED N/A YES NO EXITS `� AISLE WIDTHS EXIT SIGNS EMERGENCY LIGH i FIRE EXTINGUISHERS AUTO. EXTINGUISHING SYSTEM HOOD INSTALLATION AUTO. SPRINKLER SYSTEM ALARM SYSTEM INTERIOR FINISHES STORAGE: CLEARANCE TO SPRINKLERS CLEARANCE TO HEATING UNITS REQUIRED SIGNAGE CHIMNEY "E ODSTOVE F EPLACE-MASONRY FIREPLACE - FACTORY BUILT REMARKS: ❑ OK TO THIS DATE -7 INSPSLIP.PUB ECTOR TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 BAY ROAD -� QUEENSBURY NY 12004 (518) 761-sub ARRIVE: _ .j CW DEPART: JA_� INSP FINAL INSPECTION REPORT - RESIDEN DATE INSPECTION REQUEST RECEIVED: NAME t-flRP,� �.^l�C�_k _L1lL N LOCATION O Al)�� gcgp DATE _ 7_ /PERMIT / q TYPE OF STRUCTURE FOOTINGS FOUNDATION BACKFILL FRAMING _ ROUGH PLUMBING SEPTIC INSULATION FINAL ELECTRICAL WOODSTOVE OR FIREPLACE FINAL ELECTRICAT-� N/A YE NO CHIMNEY HEIGHT B VEN H GHT PLUMBING VENT ROOFING EXTERIOR FIN H DECK PORCH STEPS RAILING RELIEF VALVES FURNACE HO ER S WATER FRAYING _Me.ST MUD TERIOR TRIM/PRIVACY DOORS FINISH FLOORS: BATH/KITCHEN WATERTIGHT OTHER FLOORS SWEEPABLE OTHER FLOORS CARPETED STAIR CLEARANCE/RAILINGS SMOKE DETECTORS BATHROOM FANS PLUMBING FIXTURES --- -19 -13 FOUNDATION INSU ATION GARAGE FIRE PROOFING DOOR CLOSERS FINAL ELECTRICAL SITE PLAN/VARIANCE REO. FINAL SURVEY PLOT PLAN OK TO ISSUE C/O OR C C TOWN OF QUEENSBURY FIRE MARSHAL QUEENSBURY, NY 12804 (518) 761-8205 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED ' l NAME � / ' l Lde- LOCATION DATE,PERMIT # 4 rnn*'i APPR ED()� N/A YES NO EXITS AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTING FIRE EXTINGUISHASTEM AUTO. EXTINGUI HOOD INSTALLA AUTO. SPRINKLE ALARM SYSTEM INTERIOR FINISHES STORAGE: CLEARANCE TO SPRINKLERS CLEARANCE TO HEATING UNITS REQUIRED SIGNAGE CHIMNEY WOODSTOVE FIREPLACE-MASONRY FIREPLACE- FACTORY BUILT REMARKS: ❑ OK TO THIS DATE INSPSLIP.PUB INSPECTOR TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 BAY ROAD QUEENSBURY NY 12804 (! (518) 761-8256 ARRIVE: DEPART: INSP: FINAL INSPECTION REPORT - RESIDENTIAL DATE INSPECTION REQUEST �1�RE�CEE{I VVED: z4 � 7 NAME C�G.�(Y�� \ X./A�I Q . \\ LOCATION �?.q��/,tA A Sty Q C-) DATE - �- / ' - PERMIT / 2= ✓�}Q U 3 TYPE OF STRUCTURE FOOTINGS FOUNDATION BACKFILL FRAMING ROUGH PLUMBING SEPTIC INSULATION FINAL ELECTRICAL WOODST07VE OR FIREPLACE N/A YES NO CHIMNEY HEIGHT/B VENrIHEAT PLUMBING VENT ROOFING EXTERIOR FINISH DECK/PORCH STE /RAIIUGS RELIEF VALVE FURNACE/HOT WATER OPERATING INTERIOR PRIM/PRIVACY DOORS FINISH FLOORS: BATH/KITCHEN WATERTIGHT OTHER FLOORS SWEEPABLE OTHER FLOORS CARPETED STAIR CLEARANCELRAILINGS SMOKE DETECTORS BATHROOM FANS PLUMBING FIXTURES FOUNDATION INSULATION --- GARAGE FIRE PROOFING DOOR CLOSERS -- FINAL ELECTRICAL S E PLAN VARIANCE RE . FINAL SURVEY PLOT PLAN -- OK TO ISSUE C/O OR C C INU. Date Iq_ COMMONWEALTH ELECTRICAL INSPECTION SERVICE INC. (Consulting and Fire Inspection Services) (Incorporated In the States of MAIN OFFICE: 357 Elwyn Terrace, Manheim, PA 17545 • (717)654-2347 New York,Maryland,Pennsylvania,Delaware) 800-732,0043 LOCATION Please give full and accurate directions in order to avoid delay (Use back of sheet if needed) Desiring Certification of Approval, application is made for inspection of electrical installation in the premises described below. On demand, applicant agrees to pay for inspection service in accord with schedule of charges. (See Reverse Side). PLEASE PRINT 11 DATE..................... Owner..................... .....�:L!....�:,.._i! :k:f.'............................................. Type Bldg. ❑ DWG ❑Other........................ Occupant.......................................................................................................... .. Bldg. Permit No............................. Job Location .............i <.. . ..i....K.:. :s?::: ......:>; �.t..:.r.`....... CityL County....................4:.... :;::.i..s.......:. ........................................ Twp. ............................................... Swimming Pool —New ❑IOId ❑ Owner's Address...............L.Z..........� :.: .......1 .....:.:.:;................................._....................... Pool Permit No. ............................. Directions to Job Site ........... L_<.r:..... i E r. .........:... ..........................sL....�....::....::..t:�..:...........1...... ........... Application For Rough Wiring❑ Fixtures ❑ Service M1 or .............................................................................................................. Work —New I . Additional ❑ Bldg. -- New ❑ Old ❑ Ready for Inspection.................................................................. Fee Remitted................................................ Check ❑ Cash ❑ Make Payable To C.E.I.S.,Inc. LIST ALL EQUIPMENT AND WIRING NUMBER OF ROUGHWNUMBEROF=HEAT. R CONDITIONERSOURNERS-DRYERSHEATERS-RANGES.ETC. WIRING OUTLETS H P OR K W NUMBER TYPE OF DEVICE H.P.ORKw. SWITCHES LIGHTING RECEPT.ELEC.HEAT MOTORS: M.P. .1/ 2 3 5 7-1/2 10 1 15 20 25 30 40 50 7511001 MARK NUMBER OF EACH S1ZE OTHER EQUIPMENT APPLICANTS SIOWITURE LICENSE N PERMIT N Pl EABE PRINT NAME PHONE N APPURMr8 9DDRESB NAM umm CRY STATE ZIP CODE OFFICE BE NOTIFIED ROUGH WIRING SPACE BELOW FOR USE OF INSPECTORS ONLY OUTLETS AMP SERVICE PUMP EQUIPMENT SWITCHES HEAT PUMP OVEN RECEPTACLES SURFACE GARBAGE MEDIUM BASE UNIT DISPOSAL UNIT FIXTURES RANGE MOGUL BASE WATER FIXTURES HEATER DRYER FLUORESCENT AIR FIXTURES CONDITIONER AMP. RECEPTACLES MERCURY VAPOR OR WIRING & CONTROLS FOR BURNER FRAC. H.P. OUART7. FIXTURES VENT FANS MOTORS: M.P. 1 1/201%121/10 1/8 1 1/6 1/4 1/3 1/2 3/4 1 1 1-1/2 2 3 5 J-1/ 10 15 20 25 1 30 1 40 1 50 1 75 1 100 MARK NUMBER OF EACH 512E APPARATUS MISC. INFO. DATE INSPEC. RE- 0p NOTIFIED Pon. 2 IIIZi FEE PAID T Q Z O a1T F TOTAL $ FACTOR CERTIFICATE ISSUED OWNER CHECK NO. ❑ R.W. ❑ DUP ❑ FINAL ❑ SERV. OCCUPANT CHARGE PROGRESS ❑ AGENT CASH DEFECTIVE ❑ LETCLECO. H.O. TEMP CARD s DATE INSPECTOR FINAL CARD at SPI9627 flBv.1/94 APPLICATION EXPIRES ONE YEAR FROM DATE. WHITE/Office CANARY/Customer PINK/Inspector GOLD/Officer ! \I MIDDLE DEPARTMENT INSPECTION AGENCY, INC. National Headquarters 1337 West Chester Pike,Wesi Chester, PA 19380 • • Date: � City, Town or Township . ..� .�ya• County State Location/Address 1 - f ocated in Rural Araa- Please Attach Directions) Pole # Owner r � f-4 Permit Occupied As A I t i Building: New Old❑ Occupant Work Area in Building Floor #,etc.): App. for: Wiring❑ Service Q, or: Ready for Inspection: Fee Remitted-$ Cash❑ Check❑ M.O. ❑ Make Payable To: M.D.I.A. Number of Rough Wiring Outlets Elect. Heat 500 1 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 Switches Lighting -" Amp. Service Surface Unit k' Dishwasher Range Receptacles Water Heater u Air Conditioner Dryer Pump Number of Fixtures Oven X Garbage Disposal Wiring and Controls for Burner Amp. Receptacles Fractional H.P. Vent Fans - Other Equipment: MOTORS H.P. 1/2 1/12 1/30 1/8 1/6 1/4 1/3 1/2 3/4 1 141 2 1 3 1 5 742 30 15 20 25 1 30 40 50 75 300 Mark Number of Each Size Applicant's ,I Signature � �1 ; _ ice; I - -,� vs-J 1'. �t'� License # Permit #_ T/A Utility: Applicant's Andress: ✓%'14 % yL jf ��✓ >/!a (� fi' .( (NAME OFFICE LOCATION (City) �.�6' �,�:,x f (Statel_____t�� (Zip) I; x;•_,-t Service Request # Phone # Electrician: MDIA USE ONL DATE RECEIVED: DATE INSPECTED: Correct Location: Same as Above❑ or: Red Notice Label ❑ Rough Wiring Outlets Surface Unit Oven Switches Range Garbage Disposal Receptacles Water Heater Dishwasher - Fixtures Air Conditioner Dryer' Amp.Service Equipment Burner, Wiring &Controls for Amp. Receptacle Amp.Service Conductors Pump Vent Fans MOTORS H.P. 1/20 1p2 1p0 1/8 1/6 1/4 1/3 1/2 3/4 3 1 14z 1 2 3 1 5- 742 10 1 15 1 20 25 30 1 40 1 50 1 75 100 Mark Number of Each Size Elect. Heat 500 1 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 CORRECT CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE •FEE ''FEE PAID ❑ RW Progress: Inc.❑ LKD❑ Contractor ❑ CFT Violation: Work Comp.❑ Inc. ❑ ❑ L/A Owner CASH ❑ ❑ L/A Fee CHK # Due MO # ❑ IPA Municipal INV # Date: Other Side❑ UtilityApplicant ❑ 1 Owner ❑ Cut in Card ❑ Temp # Date ❑ Final # Date INSPECTORS SIGNATURE APPLICATION FORM NO.250 EL 11/89 MIDDLE DEPARTMENT INSPECTION AGENCY, INC. NATIONAL HEADQUARTERS:.. 1337 West Chester Pike,West Chester, PA 19380 DELAWARE NEW JERSEY 1815 Newport GapPike 1G30 Kings Highway North 3901 Hartzdale Drive Marshallton, Del 19808 Suite 310 Suite 112 (302) 999-0243 Cherry Hill, N.J. 08034 Camp Hill, Pa. 17011 (609) 667-9200 (717) 761-5340 203 N.E. Front Street Suite 105 Rear Entrance 350 Grove Street 1542 Bristol Pike P.O. Box 306 Grove XXI l Corner U.S. Route 13 Milford, Del. 19963 Bridgewater, N.J. 08807 Bensalem, Pa. 19020 (302) 422-5729 (201) 526.0880 (215) 244-1919 (302)856-2218 26 S. State Street Route 19, North Hackensack, N.J. 07602 P.O. Box 136 MARYLAND (201) 487-5373 Wexford, Pa. 15090 (412) 931-3028 Burch Oil Co. Bldg. Route 9 (412) 935-1558 E/S Route 5 Marmora,-N.J. 08223 Charlotte Hall, Md. 20622 (609) 390-1940 (301) 645-2219 VIRGINIA (301) 884-4547 NEW YORK Washington Co. 706 Erie ie Boulevard West 3076 Shawnee Drive . P.O. Box 1626 P.O. Office Bldg. 285 Winchester, Va. 22601 33 W. Washington Ave. Rome, N.Y. 13440 (703) 667-8484 Hagerstown, Md. 21740 (315) 736-0477" (301) 791-3190 (315) 337-3480 Hitch Bldg. Room 203 460 State Street 636 S. Salisbury Blvd. Suite 308 Salisbury, Md. :21801 Rochester,N.Y; 14608 (301),74970641 - (716) 454-5191 Cumberland City Bldg. 52 Margaret Street Third Floor Plattsburgh, N.Y. 12901 20 Bedford-Street __ (518) 563-2835 Cumberland'',Md. 21502 (301) 759-6519 PENNSYLVANIA 318-A Commerce Drive 121 W. Tenth Street Easton, Md. 21601 Erie, Pa. 16501 (301) 822-8300 (814) 452-4604 18 N. Wyoming Ave. Room 204 Kingston, Pa. 18704 (717) 288-4906 NOTICE TO APPLICANTS: Final inspection and approval may be required by law before electrical current may be energized for use of occupants. The Agency undertakes to provide inspections until final certification is granted if such requests are made within 120 days from date of the last inspection. Upon expiration of 120 days from the date of the most recent inspection, all duties and obligations - owed by the Agency shall be deemed completed,and all fees paid by applicant shall be deemed consideration for services performed. No further inspections shall be undertaken by the Agency without filing of a new application, and the payment of relevant inspection fees. No final certification shall be implied or inferred without issuance of a duly executed certificate. The Agency in accepting application for inspection cannot assume responsibility for unavoidable delays in inspection. "100 YEARS" PROTECTING THE CONTRACTOR AND THE CONSUMER. Department of Community Development Reviewed By: Ltlilding & Code Enforcement •lding InspeaN Town of Queensbury Permit No. 742 Bay Road 5&D Queensbury, New York 12804 CL Fee Paid (518) 745-4447 Building Permit Application 4� /3y.L( A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO INSPECTIONS WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT. All applicants ' spaces on this application MUST be completed and the signature of the applicant MUST appear on the application form. Applicant: Owner. t' � Address: (71 f>k :r, Address: � n �a� f N Phone # ( ' ) -�rfi'v ��7 7 Phune # ( -----) ---�� --- �G S o ----- ---- ------ Y7 i0 • property Location: /��,y�l cY�� Subdivision Name: Tax Map Numb '.Scw�irm�`t7S1`ijck Lot NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE New Building: CONSTRUCTION: $ residence / commercial Addition tO Building: residence / commercial OCCUPANCY INFORMATION: Alteration to Building: Pr ary Building - residence / commercial Single Family Dwelling Residence / Commercial Two Family Dwelling no change to exterior size Family Dwelling _ Office Other Work (describe below) Mercantile _ Manufacturing _ Other GROSS AREA OF PROPOSED STRUCTURE: If ADDITION, what will use 1st Floor. . . . . . . . c_fj5 sq. ft ./901 of new addition be? : 2nd .Floor. . . . . . . sq. ft . Other Floors . . . . . sq. ft. (not unfinished cellar or basement) ACCESSORY BUILDINGS: _ Detached Garage 1 , 2 car TOTAL FLOOR AREA: ipo;g SQ. FT. Attached Garage 1 , 2 car _ Private Storage Building SIZE OF NEW STRUCTURE : Commercial Storage Building Other FEET X t�17 FEET Foundation Type : if - Will any second-hand or ungraded Number of Stories : lumber be used? If so, for what? (habitable space only) Height (grade to ridge) : feet TYPE OF HEATING SYSTEM: Number of fireplaces and/or woodstove (circle all which applies ) to be installed: _L_ Electric / Oil / Gas / Wood Forced Hot Air / Baseboard / Other Person responsibl for supervision of work as regards to building -- codes is : L_ C-M= I' A t C ["k -7r-, -7)77 Name Addresss Phone Builder: - Plumber: Mason : Electrician: DECLARATION To the best of my knowledge the statements contained in this appli- cation, 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 noted, an -ate such work is authorized by the owner. Further it is understood tha /we shall subm' t prior to a Certificate of Occupancy or Certificate of ompl 'Lance bei�sued, an AS BUILT PLOT PLAN drawn to scale, showing ac ual loca '" n o - pr ect on premises . Signature: ( ner, owner agent, architect, contractor) J ` Q b 3 S M rrt{ 4J W G t �¢: 5-0.37' #Af. � o J O NI 0 M S $Z920 , n NApplication v; APR 1995 ME T c tt APR 1 9 1995 Received 15 2' f Q Town of Queensbury �Aa Bldg.Dept o� �� Ju..a�• 19 • �°-,� FtN�E �drLp....� MA.s2tcE PAppec) zon: `n1sus�. I Zoo.Z3 TOWN OF QUEENSBURY MAP OF, A SURVEY HADE FOR (lea►�p E, SAA A L- �a,At7way DEtro R E��►c.t:a� �.A fLR�") � A�T1 t G �...2.1-L � ,� TOWN OF a U GZ0 c 'G%3rL-'( W A(t-'e-cc^t COUNTY, N.Y. ,C 91)(4 E �}. � ..J o A�J �"IaGT. SCALE. DATE . /���-��. -7 ty'i 5' T - ,� VanDuse n & - Stem* L� Y LAND SURVEYORS,GLENS FALLS,NEV YORK N.Y. STATE LIC. NO. 35617 `12- o 1 .3