91-349 E
CERTIFICATE OF' QCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date_ "�1�✓��YrIAm, 2 I 19
This is to certify that work requested to be done as shown by Permit No. 91-349
has been completed.
This structure may be occupied as a Commrcial Bldg Office Building)
A
Location Lot 7 Baywood Drive
Owner John Hughes
Tenants ' Dr. David Sherlock
By Order Town Board
TOWN-OF QUEENSBURY
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Director of Bldg. & Code Enforcement
s—�
BUILDING PERMIT
TOWN OF QUEENSBURY
No. ci-349
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to John Hughes F
"
OWNER of property located at Baywood Drive Street, Road or Ave. "
in the Town of Queensbury,To Construct or place a Commercial Bui l chin®
at the above location in accordance to application together with plot plans and other information hereto filed and c
C
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is C
375 Bay Road
Queensbury, MY 12804 �
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2. CONTRACTOR or BUI LDER'S Name
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name e
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( X Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. 2,234 sq ft Commercial Building as per plot plan specifications
and application
8. Proposed Use
Office Bldg.
$ 330.00 PERMIT FEE PAID —THIS PERMIT EXPIRES JUNE 4, 19 92
(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 this 4yh Day of JUNE 19 91
k
SIGNED BY ( / —1J(.��� for the Town of Queensbury
Building and Zoning InSP4Y r
TOWN OF QUEENSBURY
REVIEWED BY ��� 'rOWN OF "'::"N88UAv
FEE PAID $ �j C) B
PERMIT NO. M AY9��
BUILDING PERMIT APPLICATION
KDO. 8� CODE DEP.!..P
A PERK" MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO INSPECTIONS
WILL BE MADE UN71L APPLICANT HAS RECEIVED A VALID BUELDING 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.
The owner of this property is:
P.O. Address ? 7� z?,g Tel.
Property Location- / 47P. Tax Map No. . A/0/ 7/// /
Has there been--any split of this property since October 1, 1988? f,/� / 11 _�S_9Q
es 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:
*
NATURE OF PROPOSED WORK: * ESf;MATED MARKET VALUE OF
V- Construction of a new building * CONSTRUCTION: $ - D
Addition to a building * COMPLETE INFORMATION REQUIRED BELOW:
* Size of property _� d '/ ft x eft.
Alteration to a building * Existing Buildings(3) Size ft. x ft.
(no change to exterior dimensions) *
Proposed building - distance from property line:
Other work (Describe) * Front and
y ft. Rear yard sd ft.
* Side yards ft. and ft.
*
GROSS AREA OF PROPOSED STRUCTURE * If on corner, setback from side street ft.
1st Floor �sq. ft. * OCCUPANCY INFORMATION
*
2nd Floor sq. ft. * Primary Building -
Other Floors sq. ft. * One Family Dwelling
(not c--:!ar or basement) Two Family Dwelling
TOTAL FLOOR AREA_= sq. ft. * Multiple Dwelling/Number of units
Size of new structure__aft x ft. * Business
Foundation-pier/slab/c- --'i�drtiai/full " Industrial
(circle Other
•
.:o. of stories (habitable space) l
Height (grade to ridge) _ 2 ft. , If addition, what will use be?
If residential, no. of families ,
No. of rooms(excluding baths) w
Accessory Building
No. of bedrooms ' __Detached Garage ONE/TWO Cat'
No. of bathrooms •
Primacy heating system o?s gyp. _,_Attached Garage ONE/TWO Cam'
Type of fuel * _Private storage building
No. of fireplaces installed
__
Will a wood stove be installed Other
Central Air conditioning -_ -
OV* ER
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING iPF.CIFICATIONS:
Type of construction, wood frame, fire safe, etc. �mo.l ."";.',-
Will any second-hand or upgraded limber be used? If so, for what? hVo
Foundation wall material ('e ,Q,, b/mei� Thickness /o f(
Depth of foundation below grade (to bottom of footing)
Will there be a cellar? e�/ S Heated or unheated?_(_,, Floor sq. footage sq ft.
Will there be a basement?? Will any portion be used as living space?
(If so, what portion? sq ft. Type of use?
Type of roof - sloped/flat/shed/other,S Material of roof �soti��i7 �Sh.NgJ�s
Size, wood studs
,"x spacing__" o.c. length V ' ft.
Joists (floor beams) 1st floor _A"x )-'I " spacing /L"o.c. span ft.
Joist (floor beams) 2nd floor "x it spacing "o.c. span ft.
Overlays (ceiling beams) "x " spacing " o.c.'span ft.
Roof rafters "x—Z---',- " spacing )6 o.c. span /i
Roof trusses (pre-engineered) spacing j� " o.c. span_ 'ft.
Exterior wall finish eY% s.ol•� n of what material?
Interior wall finish
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? If so will a Fire-rated door, enclosure,
self-closing device be provided?
Will a flue-lined chimney be installed? Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well
SEPTIC SYSTEM Distance 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 q 2 TEL. NO. 7 Qa q 20 (,
NAME OF PLUMBER �,g,y, Cr9Y/�v�.S a ADDRESS ('�tise doo�� TEL. NO. 9a5a 7 0
NAME OF MASON �2 r !��9/eS ADDRESS TEL. NO.
NAME OF ELECTRICIAN Sin, C,,, h,,vre-ADDRESS TEL. NO.
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
?�ner, owns 's agent, architect, contractor
SPECIAL CONDMONS OF THE PERMIT:
BY
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
AP LICANT' AME PROPERHMTION
AA Old S
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - Sq. Ft.
2. Type of Heat - Elec. Base Board Other
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 SHOWN ON PLANS SUBMITTED!
Baseboard
5. Insulation Values: Actual Shown Elec. Heat Other
A. Roof & Floors exposed to ambient temperatures- R
B. Exterior Walls R
C. Glazed Area R
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
H. Basement/Cellar Walls (Below Grade) R
I. 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- MAXIMUM SETTING 1400 - WILL NOT BE EXCEEDED
APPLICANT'S SIGNATURE DATE TELEPHONE NUMBER,
INSPECTOR'S REMARKS : Forvr(p Sa"rrvfi • �s /VOf /4P�t
8WILa 1,04 W 1 tL CbiV$::M A4 rO
Phcfr 4 OWL 34 I
TJe4 f
Raymond Maloney Enterprises LTD.
President �'j�i�� p For Complete
Michael Pucunas P.O. BOX 2136
Sales/Service T1. �C� SCOM, NY 12302 Sales di Service
Geoffrey Searl (518) 399-0281 of Medical and
Dental Equipment
Operations Manager
8/6/90
MEMO
To : '-Mr . John Hughes •
From : Mr . Ray -Maloney
Re : Dental Office waste line considerations .
' 1
To Whom It May Concern :
As regards the use of a Cast Iron Drain Line , the Was.te
Line required on the Automatic Film Processor , Manual Film -
Developing Tank, and the sink in the Dark-Room area should be
of a material impervious to the chemical action of Film Developer
and Film Fixer components . (I.E. - CPVC, PVc , or glass ) . Any
copper , brass , -and or iron fittings must be avoided , as they
are reacted upon by, and decomposed by, Film Development Chemicals .
Yours _.Truly,
Ray Maloney
President , Med-Tech
TOWN OF QUEENSBURY
APPLICATION,,FOR SEPTIC DISPOSAL PERMIT
DATE:
LOCATION OF PROPERTY FOR INSTALLATION—
Owner' s Name: ���,�
Address:_
Installer' s Name: --?',91) ��Q,�es Telephone: pga42o 6
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: Circle one: Flat Rolling Steep Slope_ % of Slope
Soil Nature: Circle one: Sa Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: not required required
Rate - 1 110 /S Min. Per Inch
Domestic water supply: Circle one: unici Well Other
If domestic water supply is a, wel
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank y gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench L D feet/Total system length Z 6 y feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #. /Depth or Thickness /1) feet
*****************************
HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alarm system and associated electrical work to be inspected by an approved
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 Syste■ 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 co any water supply
5.) size and dimensions of all tanks, distribution boxes,
rile fields and/or drywells
B. No system shall be covered before inspection and approval by the
Uuilding Inspuctor. Failure to comply with this requirement may
ruault 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 tine of inspection may -
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper inscalla—
cion, alteration or repair of an approved system, a new proposal must
be submitted to the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDTNC and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
_ k/0"
NAME (WX-., .d' I
LOCATIO
� p
DATE (p PERMIT #
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YE5et 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 `11
REINFORCEMENT IN PLACE 'i,
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL `
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS f
JACK POSTS/MAIN BEAM
FIRESTOPP ING
WALLS
CEILING
FIREWALLS
HEATING ROUGH—IN `
INSULATION:
FOUNDATION WALLS INTERIOR R—
FOUNDATION WALLS EXZ'ERIOR R—
FLOORS k' R—
WALLS I R—
CEILING R—
DUCT WORK OR PIPING IN UNHEATED
S PAC ES
REMARKS:
ARRIVE
DEPART
I NS PEC TOR
TOWN OF QUEENSBURv
BUILDING AND CODES DEPARTMENT X
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RE E/IYED
-
NAME I 464J
LOCATION �L cure L o
DATE Y f/ PERMITT f
TYPE OF STRUCTURE O q,c
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. !
MATERIALS FOR THIS PURPOSE ON SITE r�
FOUNDATION/WALL POUR !
REINFORCEMENT IN PLACE
�ZUNDATION/DAMPROOFING f
BACKFILL APPROVAL /
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING: 4 /
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM
FIRESTOPPING
WALLS
CEILING E
FIREWALLS 4
HEATING ROUGH-IN 1
INSULATION: A
FOUNDATION WALLS INTERI Rr R-
FOUNDATION WALLS EXTER OR��R-
FLOORS WALLS I R-
CEILING R`,,
DUCT WORK OR PIPING N UNHEATED
SPACES
REMARKS:
I
i
\ lv
ARRIVE
DEPART
INS P CTOR
TOWN OF QUEENSBURV
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR°S REPORT
REQUEST FOR INSPECTION RECEIVED
NA14E
LOCATION
DATE 7 a< PERMIT f
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YEtj NO
FOOTINGS/PIERS I
MONOLITHIC POUR FORM l
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 i
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL I
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE r
PLUMBING UNDER SLAB
FRAMING: I t
JACK STUDS/HEADERS a�
BRACING/BRIDGING I,f
JOIST HANGERS
JACK POSTS/MAIN BEAM /
FIRESTOPP ING
WALLS ' a
CEILING I'
FIREWALLS /
HEATING ROUGH—IN
INSULATION: /
FOUNDATION WALLS I TERIOR R—;I
FOUNDATION WALLS TERIOR R—,
FLOORS R
WALLS L R—
CEILING R—
DUCT WORK OR PIPING IN UNHEATED
SPACES
i
REMARKS: !
fY
1�J
ARRIVE T*
DEPART Ab 05
INS PEC TOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION
DATE E;tMIT # --
TYPE 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.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR p'
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOF,ING
BACKFILL APPROVAL I
�-''-ROUGH-PLUMBING..,
PLUMBING VENT/VENTS4IN PLACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS:
BRACING/BRIDGING /
JOIST HANGERS
JACK POSTS/MAIN BEAM
FIRESTOPPING
WALLS /
CEILING
FIREWALLS /
HEATING ROUGH-IN !
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WA LLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVEq
DEPART _?4-M`
SPECTO a
,ir
TOWN OF QUEENSBURT
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR°S REPORT �+
REQUEST FOR INSPECTION RECEIVED lJ
NAME ZP.�
LOCATION
DATE k PERMIT fjo
TYPE 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 PLACEMENTiOF THE CONCRETE.
MATERIALS FOR`'.THIS PURPOSE ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE F
FOUNDATION/DAMP.ROOFING ;!
BACKFILL APPROVAL �
ROUGH,PLUMBING
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING: J
JACK STUDS/HEADE
BRACING/BRIDGING
JOIST HANGERS
JACK POSTS/MAIN BEAM\
FIRES TOPPING
WALLS
CEILING ,
FIREWALLS
HEATING ROUGH-IN
INSULATION::
FOUNDATION WALLS INTERIOR\R-
FOUNDATION WALLS EXTERIOR `R-
FLOORS' R
WALLS' R_,
CEILING R- 3
DUCTWORK OR PIPING IN UNHEATED,
SPACES
REMARKS:
U
ARRIVE u&
v
DEPART
INSPEC OR
TOW,, OF QUEENSBURY
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL IIISPECTIOFd �� J
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION
DATE g / PERMIT#
TYPE OF STRUCTURE_ �e
RECHECK
i
_FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE),
SOOTING tiFOUNDATION Ji�ACKFILL _4,FRAMING,
�ODUGH PLUMBING FrINAL ELECTRICAL _SEPTIC
L,--SULATION _WOODSTOVE/FIREPLACE
REMARKS / `
1 !
° APPROVAL
t N/Af YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION ^s
PLUMBING VENT N '{
ROOFING
SIDING
DECK/PORCH/STEPS/RAILINGS'~,
RELIEF VALVES '
FURNACE/HOT WATER OPERATING/
BASEMENT INSULATION/DUCTWOR•K
INTERIOR TRIM/PRIVACY DO AS\
FINISH FLOORS:
BATH/KITCHEN WATERTI T �,
OTHER FLOORS SWEEPA E
OTHER FLOORS CARPE ED
STAIR CLEARANCE/RAI NGS
HANDICAPPED ACCESS
SMOKE DETECTORS
BATHROOM FANS/ 15 = 5
ALL PLUMBING FI fURES OPERATING
GARAGE FIRE PR OFING
DOOR CLOSERS
OTHER FIRE S PARATION
FIRE/DEMISE ALLS
DUMPS TER
SITE PLAN VARIANCE REQUIREMENTS
FINAL EL CTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS:
ARRIVE `
DEPART-
1 N S P T
_locun o� QueenJlLry
BUILDING and ZONING DEPARTMENT '
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
7"—
DATE 0/-ZL PERMIT NO.
SOIL TYPE - Sand - Loam - Clay,. -_
Percolation Test Required? YES - NO
Percolation rate - Min/Inch j'
TYPE of SYSTEM: r
Absorption field, total lengt17X0
Length of each trench '; nS0,'
Depth of trenches ' r
Size of gravel_ Zt;f
SEEPAGE PITS{Number of)'{, J'
Size- ft. X
Grave ,'
PIPING: Size Type
Bldg. to tank ,� J L/ P(,/i—
Tank to dist. box C—
ti
Dist. box to field/pit
Openings sealed? 1jYES NO Partial
LOCATION/SEPARATIONS:
Foundation to tan;k ft.
Foundation to absorption 'eft.
Absorption to lot line eft.
Separation of ]tits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear Left side - Right`: side -
( �.
COMMENTS: ( '
/V 0 To r—lf 6-c�iL`1�� t�C7"K
SYSTEM USE APPROVED fW
Buildi g InsI c t o r `
01/86 and vl
11�TOWN OF QUEENSBURY -e7
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION
DATE / / ( PERMITS
TYPE OF STRUCTURE
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING LFOUNDATION vB-CCKFILL /FRAMING
Z�ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC
.4_I.NSULATION _WOODSTOVE/FIREPLACE
REMARKS
`APPROVAL
N,/ r YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION
PLUMBING VENT i
ROOFING 7/
SIDING L/
DECK/PORCH/STEPS/RAI NGS
RELIEF VALVES `, r
FURNACE/HOT WATER OPERATING ✓
BASEMENT INSULATION/DUC,TWORK
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED %
STAIR CLEARANCE/R'AILINGS�.
HANDICAPPED ACC�SS �.
SMOKE DETECTORS
BATHROOM FANS/WHOLEHOUSE FANS
ALL PLUMBING FIXTURES OPERATING
GARAGE FIRE PROOFING
DOOR CLOSER
OTHER FIRE' SEPARATION
FIRE/DEMISE WALLS
DUMPSTER
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS:
ARRIVE
DEPART
IN3PECTOR
TOWN OF QUEENSBURY
FIRE MARSHAL s
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION
RECEIVED /
NAME ()I&
v a
LOCATION ` ja
DATE PERMIT#
APPROVED
EXITS
N/A YES NO
j
AISLE WIDTHS / 1�
EXIT SIGNS
EMERGENCY LIGHTING
t
FIRE EXTINGUISHERS
AUTO. EXTINGUISHING SYSTEM J ,�
HOOD INSTALLATION
AUTO. SPRINKLER SYSTEM /11
ALARM SYSTEM /
INTERIOR FINISHES
STORAGE: /
CLEARANCE TO SPRINKLERS ✓
CLEARANCE TO HEATING UNITS ✓
REQUIRED SIGNAGE w
t
CHIMNEY /
WOODSTOVE /
FIREPLACE-MASONRYf
FIREPLACE-FACTO Y BUILT
REMARKS: WOK TO THIS DATE
J
nb ln.�
ARRIVE /Q
DEPART 12
INSPECTOR
ELECTRICAL.INSPECTIONS
DUPLICATE MUNICIPAL RECORD
Permit No.
Owner ``� m-Aj 1,+. v c
Occupant 11
Location
No. Sheet
t iU "�; j-:3 01 Z'
Town or City State
Installation as itemized on reverse side has been visually inspected pursuant to applicable Codes.
Installed by Sc�JLt. Ce 2%Aaa:5—
n o
Date //" L / l r r %('%� Inspector
MIDDLE DEPARTMENT INSPECTION AGENCY INC.
FORM NO.18 EL. 900 Haddon Ave., Collingswood, NJ 08108
6 ROUGH WIRING OUTLETS H.P.AIR CONDITIONER
S, OUTLETS WIRING &CONTROLS FOR 6 5 BURNER
�U U RECEPTACLES H.P.PUMP
FIXTURES K.W.OVEN
Q AMP.SERVICE EQUIPMENT H.P.GARBAGE DISPOSAL UNIT
t
AMP.SERVICE CONDUCTORS K.W.DISHWASHER
K.W.SURFACE UNIT K.W. DRYER
K.W.RANGE AMP. RECEPTACLE
K.W.WATER HEATER FRAC.H.P.VENT FANS
//2C- F 567-Ctk r 7` S
--m 2 /,/iNs 7'&-S
OTORS H.P. 1/20 1/12 1/10 � i/s V Y! % Y. 1� 2 3 5 7h 10 115 120125.130140 150175 1101
IARK NUMBER
F EACH SIZE
APPARATUS