2000-203 TOWN OF QUEENSBURY
742 Bay Road,Queensky,NY 12804-5902 (S 18)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: 2000203 Date Issued: Monday, September 18, 2000
This is to certify that work requested to be done as shown by Permit Number 2000203
has been completed.
Tax Map Number: 523400-082-000-0002-016-002-0000
Location: 32 CROWNWOOD Ln
Owner: G.MICHAEL&PAMELA DIXON
This structure may be occupied as a:
Single Family Dwelling
By Order of Town Board
TOWN OF QUEENSBURY
Directo o ' b de en
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 146000 Building Permit No. 2000203
TAX .MAP NO. 82 . -2-16 . 2
Permission is hereby granted to DIXON, G. M I CHAEL &
Owner of property located at CROWNWOOD LANE
in the Town of Queensbury,to constructor 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 NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
Owner's Address:
PAMELA 8 SHALLOW CREEK RD.
QUEENSBURY, NY 12804
Contractor or Builder's Name:
PREMIER BUILDERS
Contractor or Builder's Address:
BOX 2315 ROUTE 9N ,
LAKE GEORGE, NY 12845
Electrical Inspection Agency:
COMMONWEALTH ELECTRICAL AGENCY
PO BOX 706
HAGUE, NY 12836
Type of Construction:
SINGLE FAMILY DWELLING
Plans and Specifications:
2012 SQ FT SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE
AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
SINGLE FAMILY DWELLING
247 PERMIT FEE PAID—THIS PERMIT EXPIRES May 1 2 00 2
(If a longer period is required,an application for an extension must be made to the Code Enforcement
Officer of the Town of Queensbury before the expiration date.)
Dated at the Town of f Queensbury this 1 Day of May 2000
\ 1
SIGNED BY \ � --- for the Town of Queensbury
Code Enforcement Officer
i Birtilding .;er,, rtr1` Alv1a►licol`io�t.
l OI'Jll of Queen.4b111 y - apt. r f Cu/1,111luriq' Del'.lop�nc-/It, 712 B(t y Iturrr!
rxo
r� ) Qrrc'c'nsbu ' !Vl' 12t4U'! /7G1-t42.51/
+LLI'y DUIGDING CODE EN/%UItCLA'1ENT
L Rettuiremcnls prior to issuance -"")
/FrA
rutil mural bo oblulncd Iw/iaro ctI_Iliis pct'ntil_ _ /'/:'1tA//'/'/%/L/t NU. `cJc �� 26
-
ning cunrrlI%letloss. No Inrgwollolm G
Willw+undo until uppllcuut hnn rua elvul I_I 1.�ri/Ng IAtXxrtl AC//uct I'!:%tAf/'/'/•'lili/'il/!)$ 6i
LIDIIUIL1aINC7 I'GRM1'1•. All Aacn /Uno
nAlIs' spaces on this npplic+tllon IC CR!•.1%%ON rErz ' f
MUSE'bo completed "d•(Ito signuluro (� Pln/uclr/g lJvn/d Acllon of kilo upplicnnt nttwt nplw+ar aot qao I2LiV/G{{'/s-/) Il1'
tllcalton form, tn.a,,:� SI'IL / Subtlivlslon /a)tlter r.unh hn,,rrror
•• Iteerculion I'eo I'nynxcul _
Appli zill:
Address: AtItIress:
1'6ono # (t-'y"/�) its`
Property i.,ocllt' I: �
Slltsdivisi Nil x Mil) Null sir es—/� z
n �
-- _� - Section Illo k Irat
N�1i • �1'ItOE'OSGll WORIC: � L-?.Y2.--d7
New I1u. I MIATI313 MARKET, VA V of ].'IIC
' CONSTItUCTION: $ V � J--
oaidanca`� commorcitxl
Addil on o tx ld3.ng:
roc�l.dattca / cottunorcl.nl OCCUPANCY INFORMA1TION:
]tlt arut ion to I1u.L1.LI3.lxcj: 1?r.I_mar.y tlui.lcl3.nc7
rcani.donco / conuuox:c.i.a]. V33-ng].a Faiii.Lly Dwol]..I.s
Ran-Ldonco / Commorcicx]• '1'wu lt'a+n.t.ly I)wol.l.i't1. I
no cltttngo l o oxl ox.3:cax: n.i.r.0 1�'rtttt.I..ly 1)wolll.elil '' "�� �
of f1co
Other Work (describe below) Mercantile APR 1 `'/ 2000
i Other Q" t�,da�Y
GROSS AREA OF PIiOPOSri1 STIIUe ];jItZE 1 `�1 -6UfLDIJ,,,a Ft ••iI7.Ot�C�
l �d 7��
18t Floor. . . . . . . , •1� sq. 11UUT'1'IOtJ, what will use2nd .Floor.•. . . . . . act. CL . Of new addi.Lloil be? :
OLtlor Floors . . . . . .; 1L,
•
(not• ulll:i.il.lahed collar or basentonL)
•• AcccssoRx uUZLI]zNGs:
r� UeLtiched Garag-e 1, 2 ar.
TOTAL FLOOR ARUM: -�. SQ. FT. _� Attlichhd Garage 1, �ar
SxZC O PrivaL•e Storage Utlilding
IL NGW STRUC'l'URIs: Commercial Storage Building
lt'PL:'1' X —37 1%1IB'1' Ol hor
Foundation Type . '1'6t0 "T, p7il.i all, 00cond-Ixnild or ungradod
Nlxlnbar of Stor3.oe : —� lenulaor Imo uacd? IC o, for what_?
e3
( Ilab.I.t:ctl�].o rllxtc:a on1.y)
IIo.Ldltt: (c�t'nclla l:o t:.i.c.IcJcy) — foot: l:—oi IlEATIM.
Ntlntl)el: of 1it:oh.LCtc:uo 111010E wocac.ful�ovo ( cll:clo' tt1.J wlticl{ t �l.inn)
to be installed: Electric / Oil as od
Forced Hot Air aseboard / Miler
Per.soll re"u'ponsible for supervis_i. I of work as regards to building '
cosies is : _ y� ol % rrl�l7f 1
NFuue �,PI l no 1'ho1 e -
Builder: Ad
/
Plumber:
Mason: y
Electrician:
DL'C"RATIOIV 1'len.re slgll brloly rtflei yvu l�nve crArafidly rcrul!1/e sYnlcr/nenl,
'I'o the best of my icnowledne the sl:ttemmils conlaincd in Illin siltplicalion, logether with lily p1mis
and spi.cilicalia>ns sultnlitted, arc ;1 Irtle and complete shiletnenl of sill proposed work. to he alone on
the clescrilrcd premises and llt:tl all provisions of Ile liuildinl; Caxle. the ollinl, C.)tdin:utce ;uul all
other laws per(atininl; to the propt).ned wc+rlc shall Ile complied wills, whelhor speeilied or noted, and
iltnt such %vorlc in authorized by the owner. Irualher, it is onderslotxl Ilmt 1/wu shall sulrnait prior lu .1
Certilic:ale of Uccupauloy'or C'ellilicalo of coat :utce heinl; issued, ;sit AS 111.A LA' 1'1..G'I' 111.AN by
a liecused survoyor alr:nvt scale :huwinK tc +.11 lcx:atiun of' project on premises.
. J
Signattirc:
(owner, owner's gent, archi t contractor)
Application foI• vel•Iliit--Septic: [disposal System
7'u11,11 Uf Q11e'entsb111jt 7•J211nylivtrit�Iuccn.ctrrrr►; NY 12804 (.518) 761-82.56
I. OWNER 1NFOR.MA17ION:
......................................................................................................................................
Location of iustallatiou: l_ rf�Z/uA,n,m ,ls-- Office Use
Tax Mail No. �z / � /�/�� Irilo 1101 alit No.
Owitor's Namo: , 'l�'EfjXJ I'ov Paid
�-- f
..................................................................
Address: �_� /`C.�x a / /n. �..�_>�r-• '
2. INSTALLER'S NAME : t"Y>fp ��.r�t_ �p PHONE NO.
3. RESIDENCE INFORMATION: (circle real•of(lwellil►Z;, ittcticCrtc� it be Iruunr(t)a11d 11►11101)ly 7i (?f
beclr(tvnts with applicable g(Illonslter bech-room to e(Itlal total(1Crilyfl0ty)
Xoar of I lotlsn No of Bedrool is __X___ olll�lltlttoll - 1 utal Ua f [ow_
1980 or oldor x 1 SU gal/bclrul =
1980— 1991 x 130 ga!/bclrltt =
1991 —present x 1 IU gal/bdrnl = j�
Garbage Grinder Installed yes ! no K
Spa or Whirlpool Installed yes
4. PARCEL INFORMATION: (circle applicable hirorrnatioit &,irtclicato eitoasur0»teals)
1b 1 •ra 1_t�_ Soi Nature CGuttd_W(>tcr _ ilcd�oc k_or )trt rcrvious Iviatcrial _
— 1- — — -------- ---.. to Suglry
vt a%rrrf do/r11t crt ttfhnt depth
tv/htrl; araM I nuaricl rcr
r�A --
sivelt slope cicry lJ'ivell; tucrter.nyrlr/y
sbpe alder from Crory septic-s)cstent
depth: from
is f7.
1'nrcotatioll'Post: ('1%'.be ctonrllleled by l7cetrsedlu•t fisssivlurl elrl;i»eer ur crrclritec/) tlNrerr^_�� _ •
Rule: �� l f .� 111imae per illch
5. PROPOSED SYSTEM: For New Coilslruction: All individual sewage disposal systems must be clesiglled by a licensed
professional cligincer or architect(unlcs§inslallctl it 1► Phunling 130,11d:lpptoved subdivision). Add 250 t;ailom it)IIIe size
of file septic tank and leach field I'or each Galbagc Grinder, Spa or Whiillx>ol'111b.
Septic Tank: f gollon(ittlm size 1,00UgCrl.)
'file Yield: ecrclt tretw/i fl. 'Total Systerrr Lcrrgth;
Seepage Pit(s): ituotiber Of size tY•ecrch: fl. by
Size of Stotte to be used:
Ded System Size: x
Altemative System: le»b111 a/rtl/ur.she
G. HOLDING TANK SYSTEM: (if required)
Ntinlbor of tanks: / Sizo of each: gallolls /TOTAL Capacity: gallons
Nitta. Alarm System and associated electrical work Must be inspected by a'Town apl:roved
olectrical illspectioll agency,
7, SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON (please read)
For your protection, 1710a50 Itoto that pursuant to Section 136-29 of tlt0 Code of t110'Town
of Qtteensbury, any perruit or at:proval i;t"atite(I wrliich is based upon or is i;ranled in
rotistnoe upon stay ntatoristl ntisrclrrescntstti0tl of Iaitttt'o to ntalce n luatcrial fact or
ciretttlislance krrowil by or oil beltalroran applicant, shall be void.
I have road(110 rogttirttions with lospecl.to this npplicalion and at;too to rtbido by ihoso stud all
rcqui rat ties its or0le' 'otvn of Qucensbuty Sanit. Sowage Disposal ordinance.
Signature of res nsible person at
ENERGY CODE COMPLIANCE APPLICATION
TOWN. OF. QUEENSIBURY, WARREN COUNTY
9000 F_--ATING DEGREE DAYS-
Comnliance Methods : PART 5 Acceptable Practice Method
1&2 Family Dwellings (only)
PART 6 Thermal Rating ncr - *Component Trade Offs
1&2 Fdmily Dwellings; -Multi-Family
Dwellings ( 3 stories or less) .
PART 4 Design by Co=' on' ent Performance
------ Commercial Buildings-Hi Rise Residential
*Requires submission of worksh6ets
c, LZ6,=,
APPLICANT' S NAME : PROPERTY LOCATION:
Aj uce
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE TICE:
1 Gross Floor Area Z ,91-2, scruare feet
2 . T-Y--oe of Heat Elect-ric oil 4-- G�as Other
3 . IS building mechanidaliv cooled? Yes
4 . Percentage of area of windows and doors Over 17% Under 17%
5 . -_-'1-V.3LLUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS
SHOWN ON PLANS SUBMITTED:
a . Roof R
b . Exterior walls R
C . Glazed areas R
d. Exterior doors R , 2-
e . Floors over unheated spaces R
Edge of slab -on grade (heated building) R
g. Basement/cellar walls (above grade) R
h . 8asement/cellar walls (below grade) R
Heating/cooling-ducts-piping in unheated space R
6 . Se-z-vice (domestic) hot water heating device
7
Conforms to minimum efficiencyy-per code t,�<e s No
TEMPERATURE CONTROL MAXIMUM SETTING 1400 WILL NOT, BE EXCEEDED
_;t SiD to P'2one Number
TNSP IS
REMARKS :
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DEED REFERENCE:
LUCIEN L. POTVIN
TO
G. MICHAEL & PAMELA A. DIXON
DATED AUGUST 2,1999
LANDS N\F OF
LUCIEN POTVIN
LEGEND:
I.P.F. = IRON PIPE FOUND
I.R.F. = IRON ROD FOUND
I.R.S. = IRON ROD SET
I.R.S.
SECTION THREE
CROWNWOOD HILLS SUBDIVISION
42
41
I.R.S. S82'5z00"E
I.R.F. 53.30 I.P.F.
S82.5 00"E
156.49
I
►N Z .
N 45,480 sq.ft. Q J I
1.04 acres Z oz I
p � ie.7• O I
I.R.F. I.R.F,
.� J
I
I
io I.i
0
I.R.F.
213.90
N82•4300"W I.R.F.
LANDS N\F OF
JEAN PAUL POTVIN
4,; 06, a D U S
//�'J�/�� C
LJ�► t e v e A�.�
Land Surveyors,
LC
'UNMAHMM ALTETTATION OR ADDRM TO A SURVEY
YAP BE 0 A LICENSED LAND SURVEYORS iAL IS A
NOLATION OF sFMM 720% SUS -MUM 7. OF 7HE
NEW YORK STATE MX=MM LAW
*ONLY COP" FTIOM THE OF 7HEL OF iSU SURVEY
YARIffD MAIN AN OAMOINAL OF 7HE LAID SURVEYORS
SEAL SMALL BE CONSWERED TO AE VAUD TRUE COPIES.•
•CERMCATIONS DOICATED fERIM SIWIFY THAT
THs SURVEY WAS PREPARED N =0RDANCE W M THE
E>SM yW" PRACME TAN#.� ADDP,m
BY THE NEw YOW( STATE ASSOQATON OF PMtOFESSIONAL
LAND SURVEYORL SAD CERWICATIONS *Wl RUN OaY
To THE PERSON FOR MMOY THE SURVEY 6 PREPARED. AND
ON HIS REHMF TO THE TITLE COViW WVEMA04TAL
169 Haviland Road Queensbury, New York 12804 T'0 TIE ; � OF'"& ��IHD USIED�°"' AHD
518) 792-8474 New York Lie. o. 50135
Map of a Survey made for
I.R.F.
I.R.F,
I.R.
GILBERT M. & PAMELA A. DIXON
Town of Queensbury, Warren County, New York
z
I HEREBY CERTIFY THAT THIS MAP WAS PREPARED
FROM AN ACTUAL FIELD SURVEY.
THIS CERTIFICATION SHALL RUN ONLY TO THE PERSONS
FOR WHOM THE SURVEY WAS PREPARED, AND ON THEIR
BEHALF TO THE TITLE COMPANY. GOVERNMENTAL AGENCY
AND LENDING INSTITUTION LISTED HEREON.
CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL
INSTITUTIONS OR SUBSEQUENT OWNERS.
CERTIFIED TO: GILBERT M. & PAMELA A. DIXON
TRUSTCO BANK NATIONAL ASSOCIATION.
ITS SUCCESSORS AND\OR ASSIGNS
OLD REPUBLIC NATIONAL.TITLE INSURANCE COMPANY
C.
• •��pF IV E i�/ �� .
CERTIFIED B
MATTHEW C. 5Q135
i •
DATED: MAY 17. 2000�
AND
0
le 1'=30`
S-1
SHWTIOF: 1
1 5-17-00 FOUNDATION LOCATION DIXON
NO. I DATE DESCRIPTION DWG. NO. 99186
C-165
T
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RESIDENTIAL FINAL INSPECTION REPORT
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement , x d
Dept.of Community Development Arrive rpectorl:
p
Town of Queensbury Initi
742 Bay Road
Queensbury,New York 12804
NAME PERMIT# —
LOCATION. DATE
TYPE OF STRUCTURE -. ,
N/A YES NO COMMENTS
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake
Plumb Vent through roof
Roof Complete
Exterior Finish Complete
Interior/Exterior Railings 30"to 36"
Exterior Handrails,balconies,Ianding 18 in.or more
Interior Handrails stairs both sides 3 or more,risers
Grade 2%away from foundation
0 8"clearance to sill plate
V Gas Valve shut-off exposed/regWator 18"above grade
Gas Furnace shut-off within 30 feet or within line of site
Oil Furnace shut-off at entrance to furnace area
%Aurnace/Hot Water Heater operating
Relief Valve(s)installed
Headroom,6 ft.6 in.on stairs 1141
Basement stairs,6 ft.4 in.
Iandrail exterior stairs both sides more than.3"risers 1
Interior privacy/trim/doors/main entrance 36" Nh
Floor Finish
Bathroom/Kitchen watertight
Interior Handrails Balconies/Landing 18 in.or more
Railing across window in stairwells
Smoke Detectors: ,
every level
every bedroom '
outside every bedroom
inter connected
Bathroom fans "a
/Plumbing fixtures
!!Foundation insulation
3/4 hour fire door/door closer
Garage fireproofing
Garage penetrations sealed
Furnace in separate room protected(in garage)
Light ventilation per room
Safety glazing 18"or less from floor
Final Electrical
rte Plan/Variance required
inal Survey Plot Plan
As Bunt Septic System layout required
Okay to issue P/C(Certif.of Compliance)
Okay to issue temp.C/O(Certif.of Occupancy)
Okay to issue permanent C/O(Certif.of Occupancy)
RESIDENTIAL FINAL INSPECTION REPORT
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement
Dept.of Community Development Arrive am/pm Depart
Town of Queensbury Inspector's Initi
742 Bay Road
Queensbury,New York,12804
NAME PE T# �C --
LOCATION DATE Y `�
TYPE OF STRUCTURE
N/A YES NO COMMENTS
Chimney Height/B"Vent/Direct Vent Location
Fresh Air Intake
Plumb Vent through roof
Roof Complete
Exterior Finish Complete
Interior/Exterior Railings 30"to 36"
Exterior Handrails,balconies,landing 18 in.ormore
Interior Handrails stairs both side r 3 or more risers
Grade 2%away from foundation
8"clearance to sill plate l
Gas Valve shut-off exposed/reguldtor 18"above gradV
Gas Furnace shut-off within 30 fee&r within line of site
Oil Furnace shut-off at entrance to ce area
Furnace/Hot Water Heater operatin
Relief Valve(s)installed
Headroom,6 ft.6 in.on stairs
Basement stairs,6 ft.4 in.
Handrail exterior stairs both sides more �3risers
_�.....
Interior privacy/trim/doors/main entrance 36"
Floor Finish 1
Bathroom/Kitchen watertight /
Interior Handrails Balconies/Landing 18 in.or mor
Railing across window in stairwells
Smoke Detectors:
every level
every bedroom /
outside every bedroom
inter connected
Bathroom fans y.
Plumbing fixtures 1
Foundation insulation \
sl4 hour fire door/door closer
Garage fireproofing
Garage penetrations sealed
Furnace in separate room protected(in garage)
Light ventilation per room
Safety glazing 18"or less from floor
Final Electrical
Site Plan/Variance required
Final Survey Plot Plan
As Built Septic System layout required ]
Okay to issue C/C(Certif.of Compliance)
Okay to issue temp.C/O(Certif.of Occupancy)
Okay to issue permanent C/O(Certif.of Occupancy)
F=11:Zr-= M^F:ZSH^l
-rC>WN C>F
C:fUeeNSE3Ul:;Z-Y, N-V' 12804
(S18) .7E51-820S .
FIRE MARSHAL INSPECTION REPORT
REQUEST RECEIVED
NAME
LOCATION �:3Z - PERMIT #
SCHEDULE INSPECTION ON
A PM
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
FIRE ALARM SYSTEM
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION SYSTEMV
HOOD INSTALLATION
INTERIOR FINISHES
STORA(:;E:
V,
CLEARANCE TO SPRINKIL ex"_ S',4 UNITS
CLEARANCE TO HEATII 0 UNITS
REQUIRED SIGNAOE
�'CHIMNEY
WOOD STOVE
FIREPLACE FJ MASONRY ACTORY BLT-
FINAL
REMA
INSPSLIP.PUB
Fm
RESIDENTIAL FINAL INSPECTION REPO T
V
Office No.(518)761-8256 Date inspection request received:
Building&Code Enforcement k
Dept.of Community Development ;r' Arrive �and 'M# ,-)
Town of Queensbury t Inspector's I
742 Bay Road i Queensbury,New York 12804NAME
LOCATION _ DATE
TYPE OF STRUCTURE
} N/A YES NO `. CONDAENTS
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake ,i k'
Plumb Vent through roof a
Roof Complete ", '
Exterior Finish Complete
Interior/Exterior Railings 30"to 36"
Exterior Handrails,balconies,Ianding 18 in.or more 71
Interior Handrails stairs both sides 3 or more risers `� f
Grade 2%away from foundation l f
8"clearance to sill plate I
Gas Valve shut-off exposed/regulator 18"above grade% 7
Gas Furnace shut-off within 30 feet or within line of site)
Oil Furnace shut-off at entrance to furnace area o
Furnace/Hot Water Heater operating '1Z t , 1j %-\Opv, 0V
Relief Valve(s)installed
Headroom,6 ft.6 in.on stairs s A 14
Basement stairs,6 ft.4 in. �4
Handrail exterior stairs both sides more than 3 'sexs I�Q T-�{�1t��7 'fl il_. C't C+� &IC
Interior privacy/trim/doors/main entrance 36" ,
Floor Finish
BathroomMtchen watertight
Interior Handrails Balconies/Landing 18 A or more
Railing across window in stairwells
Smoke Detectors:
every level
every bedroom
outside every bedroom
inter connected '
Bathroom fans
Plumbing fixtures
Foundation insulation f tiX- t tilbt�t_fC~jL`tJfi't��,3E�
3/4 hour fire door/door,closer
Garage fireproofing ?
Garage penetrations sealed
Furnace in separate room protected(in garage)
Light ventilati�n per room
Safety glazing 18"or less from floor J
Final Electrical
Site Plan/Variance required jt
Final Survey Plot Plan
As Built Septic System layout required
Okay to issue C/C(Certif.of Compliance)
Okay to issue temp.C/O(Certif.of Occupancy) -�• �, ��� � �
Okay to issue permanent C/O(Certif.of Occupancy)
�3ti�aE�t�
UUM1RUN WEALI'ti LLK I KILAL 11yULL HU11 XKV IUD LIU
Main Office 176 Doe Run Road - Manheim, PA 17545 ;000*-zo3
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Panel Board Cut-in Card Not
itfi{.iii#}i#YY#iY4,{4144!#44ii#�1Y1
NOW 69401
Owner,,,c #4,�!}iffil,fftHfl44111#f�!#if.ti##i4.f#1#14.4fIMIYI�ify{i##1/i.#igill41f,l1iiiiNH44,i!!#!�!}iii#fiNIIi11•ly,li/i!H#f14y,1},f Ylff.ffl.f1.14l.f rYi 111111
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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 he promptly made for inspection!
Inspectors of this Company shall have the privilege of maki inspections at any time, and if its
p I�
rules are violated, the Company shall have the right t oke t ' ce ific #
1'�71'Q 1,
J 4�YY I.f## 4441i#...ffYl INSPECTOR �11141Y#111##N14411f1#Ii#.1##.#....I4Y41Y.I.III.N�Irf�fl41!#ifl#Ilyyl#ff#.YIl.Nl11}YI/I.IIYI
Member VIA, LA Us
GENERAL INSPECTION REPORT
( 518) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY,:12804. Arrive 9�am/pm Depart am/pm
Inspector's Initials iG- _
NAME: E'���ar l�l'tyC'? PERMIT# y,
LOCATION: Lc.<. DATE: 2 -
TYPE OF STRUCTURE:
RECHE",\
fir .,•r�s ti!•'' %t.__PP —
N/A YES NO COMA ITS
Footings/Piers , I
Monolithic Pour Fo m _
Reinforcement in Plac
The contractor is res �nsible for
providing protection ffreezing
for 48 hours following \11acemeintof the concrete.
Materials for this purpose on ,.
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofing ,
Backfill Approval
Plumbing Under Slab
Plumbing Vent(Vents in Place/
Rough Plumbing
Heating Rough-In
Insulation
Foundation Wall nterior R
Foundation W s Exterior R-
Floors R-
Walls R-
Ceiling " R-
Duct work or piping in
unheated spaces R-
Proper Vent,Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
Fire Wall 2, 3,4 hour
Firestopping
GENERAL INSPECTION REPORT
(518) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804. rive=,&D Ar pm Depart am/pm
� " P Initials
-1 -�e I it Impecto Initials MT#
NAME:
PERMIT#
LOCATION: DATE: 7 Azm
TYPE OF STRUCTURE:
RECHECK
NIA YES NO COMMENTS
FootingsMers N
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible fd-r
providing protection from fteezing
for 48 hours following the placemAt,
of the concrete.
Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place 2�1
Foundation/Dampproofing_
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents in Place
Rough Plumbing !f`
Heating RoughIn
ulation
Foundation Walls Interior ]R'
Foundation Walls Exterior:
Floors R-
Walls A� &V e Ax
Ceiling R-
Duct work or piping in
unheated spaces R-
Proper Vent,Attic Vent
Framing_
Jack Studsffleaders
Bracing(Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2, 3,hour .
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping_
GENERAL dNSPECTIONREPORT
( 518) 761-8256
Town of Queensbary
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road ,
Queensbury,NY 12804. Arrive am/pm Depart
Inspector's Initials
NAME: PERMIT it
LOCATION: DATE
TYPE OF STRUCTURE:
RECHECK.
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsi a for
providing protection fro freezing
for 48 hours following t placement
of the concrete.
Materials for this purpos on site
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproo g
Backfill Approval
Plumbing der Slab
P um Lvallent ace
gli Plumbing'
Keating Rough In
Insulation
-4
Foundation Walls nterior R-
Foundation Walls xterior R
Floors R
Walls R
Ceiling R-
Duct work or pi ng in
unheated spa es R-
w oiler ent,Attic ent
URI
F Jack Studnl ders
Bracing(Bridgmg
Joist Hangers
'
kck.Posts.' eam j
AAj M iltratimn Barrier " �s�rs�"�J
Fire Separation 1,2, 3,hour
P etration Sealed
ire Wall.23 4 hour
ti M _.
F Ti-ping �.r 4A pia (0 1��c�l,4r C� �
1
I mi
irS+t�X
GENERAL INSPECTION.REPORT
(518) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804. Arrive am/pm Depart 3
Inspector's Initials��'
NAME: U 13 PERMIT# F6 �5
LOCATION: DATE: Z V71691
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers 3
Monolithic Pour Form
Reinforcement in Place f
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/Wallpour
Reinforcement in Place
Foundation/Dampproofing
Backfill Approval ( i'
Plumbing Under Slab ,D-
Plumbing Vent/Vents in Place)
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior -
Foundation Walls Exterior R-
Floors R
Walls R
Ceiling
Duct work or piping in
unheated spaces roer Vent, Attic Vent
.".
d"O"S�7/Headers
BracingBridging
Joist Hanggers
ack Posts/Main Beam
r Infiltzataon Barrier
Fire eparationl2,3,hour
Penetration Sealed.
F,,i. e Wall 2,3.4 hour
rl hest
PA
GENERAL INSPECTION REPORT
(518)761-8256
Town of Queensbary
Dept.of Community Development Date inspection request received:
Building c&Code Enforcement
742 Bay Road
Queensbury,NY 12804. Arrive am/pm Depav Ipm
Inspector's Initials
NAME: PERMIT# —
LOCATION: DATE :
TYPE OF STR CTURE:
RECHECK.
N/A YES NO COMMENTS
Footings/Piers
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placem nt
of the concrete.
Materials for this purpose on site
Foundation/Wallpour
Reinforcement in Place
Foundation/Dampproofing
Backfill Approval
Plumbing Under Slab
Plumbing Vent/Vents i Place �i r
Rough Plumbing
,Heat Rou -In
lation
Foundation:Wanor R
Foundationior R
FloorsR-
01
AR-
CeilingR
Duct work unheatedR-
Proper Vent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
JackPosts/Main Beam.
Air Infiltration Barrier
Fire Separation 1,2, 3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestoppin
,r
1
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Al
GENERAL INSPECTION REPORT
( 518 ) 761-8256 „
Town of Queensbury
Dcpt.of Community Development Date inspection request received:
Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804 Arrive--!�Vr Depa t a
Inspector's Init'
NAME: ( lD - PERMIT#
LOCATION: t _ �,Q ATE
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers i 1
Monolithic Pour Form
Reinforcement in Place
The contractor is responsible for
providing protection fro freezin
for 48 hours fallowing t e placem6nt
of the concrete. i
a Is for this Iu se n site
Reinforcement in act,
Fouiiciafibn_/Dampprootin fi' - �
Backbit Approval _
Plumbing Under Slab_
Plumbing Vent/Vents in lace
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls I tenor R-
Foundation Walls aterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or pi/iing in
unheated spa R-
Proper Vent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier _
Fire Separation 1, 2, 3, hour
Penetration Scaled
Fire Wall 2.3,4 hour
Fi restoppi ng
GENERAL INSPECTION REPORT
(518) 761-8256
Town of Queensbury
Dept.of Community Development Date inspection request received:
Building&Code Enforcement
742 Bay Road
Queensbury,NY 12804, Arrive-JDI--y twlom Depart
Inspector's Initials
NAME: T PERMI # -2.6t!--, 7!i-S7
LOCATION: DATE:
TYPE OF STRUCTURE:
RECHECK
YES O COMMENTS
Footing 'er
Monolithic Pour Form
Reinforcement in Place "2-0r1q A The contractor is respons e far
providing protection fro ezing
for 48 hours following a placement
of the concrete.
Materials for ' urpo on
Foundation/Wallpour
Reinforcement in PI
Foundation/Da fing
Z
Backfill Approval
Plumbing Underab
Plumbing'n ents in Place
Rough Plumbinin
Heating Ron -In
�
Insulation
Foundation Walls Interior R-
Foun Zon Walls Exterior R-
Floor R-
Wal7 R-
Cei ng R-
Duct work or piping in
/ unheated spaces R-
Proper Vent,Attic Vent
Framing_
Jack Studs/Headers
Bracing(Bridging
Joist HangersL_
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1,2,3,hour
Penetration Sealed
Fire Wall 2,3,4 hour
Firestopping
�g6g a m n o�,9xs
"I have seen or observed,or b�lie�e 1 s
all objecis such as houses,Uaells,frees f W eV1deoce of,
o ShOWp 0p INS docu enceS,ets�,
Y peisaualiy me cured th t I also rpreseot that 1 have
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