86-177 u
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date :July 8th 19 87
This is to certify that work requested to be done as shown by Permit No. 86-177
has been completed.
This structure may be occupied as a One-Family Dvelling
Location hot 73 Nel.son Road (St. No. 2) Court House Estates, Section I!
Owner John E. McCormack
By Order Town Board
TOWN OF QUEENSBURY
Building & Zoning Inspector
BUILDING PERMIT
TOWN OF QUEENSBURY No 86-177
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to John E. McCormack
OWNER of property located at Lot 73 Nelson Road, Section II Court Street, Road or Ave. o
St. No. 2 House Estates �:Y
rj
in the Town of Queensbury,To Construct or place a One—Family Dwelling
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
c�
O
1. OWNER'S Address is 1859 McCormack Drive
Lake George, NY
x
2. CONTRACTOR or BUILDER'S Name
McCormack Industries
3. CONTRACTOR or BUILDER'S Address n rt
° rt 0
rt
7 Sarella St. z
Glens Falls, N. Y.
x •
° Z
4. ARCHITECT'S Name � N N
(c In
O
rt Pd
w o
5. ARCHITECT'S Address (D Cal
rt Ca
V
0
rt
6. TYPE of Construction— (Please indicate by X) H.
°
Ix)Wood Frame ( ) Masonry 1 )Steel ( ) H
H
O
7. PLANS and Specifications
I
No. 52'x52' per plot plan, specifications and application submitted
including two—car attached garage and sewage system.
N•
8. Proposed Use
CJ
One—Family Dwelling
H
N•
5.0 C/O Paid
er
185.00 November 1 86
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 29tth Day of April 1986
SIGNED BY "�' �� for the Town of Queensbury
Building and Zoning Inspector
TOWN OF QUEENSBURY
(Space inside block to Ix- filled in by
WARREN COUNTY, NEW YORK Building Imlx•cior)
Application for A1 piWaticm No.
Permit Issued
BUILDING AND ZONING PERMIT Explre.. M.
%unin� Uistricl
VA11c "I Work
THREE (3) Copies of a PLOT PLAN, Drawn to scale Al)IW',,c•d IIv
showing the actual dimensions of the lot to be built Itc•nlarw
upon, The exact size, and location on the lot of the
building to be erected or altered MUST BE SUB-
MITTEED WITH THIS APPLICATION,7
DATE AR
V �_'..�A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK
ANSWER ALL OF THE FOLLOWING. AFT? 2 a `fir- `e e ry
The undersigned hereby applies for a permit to do the following work xaa j f'�I•
which will be done in accordance with the description, plans and specifi-
cations, and such special conditions as may be indicated on the permit.
The owner of this roperty is:
�?I . .C��. MG.0 M Y. . . . . . . . . . . . . . . . . .f `t . .MCCntiZMi Yam. . .
. . . . . . . . . . . . .
• (NA�aE) lP 0.ADDRESS) . . . . . . .
The person responsible for supervision of the work insofar as the Building Code and the Zoning Ordinance apply is:
Y,. . . . . . . . . . . . ,,. . . . . . . . . . . . .
(NAME) n (P O ADD A,S�S1
Name of Builder. . . .'�OeO . . °.!!�.,�'. . G� . . . .Address . . .(
Name of Plumber.-. . .� �YG. . . . . . . . . . . . . . . . . . . . . . . . . . .Address . . .
�r me of Mason. . . . . . . Tl
• �'��� Address
Na . . . . u"
2- Lot Number. . . .�3. . . . . Unit .;. . . . . . . . . . Estimated value of proposed work.3
Name of Village . . . . . .�t J. .(b.j
Name of Street . . . . .IrYZ,.J.o . . . . . . . . . . . . . . Side of street: north ❑, east ❑, south ❑, west 0'Nearest Cross Street . . . .NQ.�_1y� . . .0.6. . . . . . . . . . . Distance from this ^rosy street . . . . . . . . . . . .j.O. . . . . Ft.
Property is north ❑,south ,east i i, west ❑from Cross Street
If on Corner, which corner, northeast Ll, northwest ❑, southeast 0. southwest
(Designate by marking with an "X" in the correct space.)
2--Construction
�/ NATURE OF PROPOSED WORK OCCUPANCY
Construction of a new building. Main Building
❑ Addition to a building. One-family dwelling
❑ Alteration to a building. Two-family dwelling ❑
❑ Demolition of a building. • • . . . • . .-family apartment house ❑
Store building ❑
.-car attached garage ❑
Other: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Accessory Building
0Describe: ❑Other work. . . . . . . . . One-car detached garage. . . . . . . . . . . . . . . . . . . . . Two-car detached garage ❑
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Private chicken house ❑
Private storage building ❑
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ZONING SPECIFICATIONS. Fill in for new builc9g, or addition to existing building, or a change of occupancy.
Indicate on the plot plan street names, the location and
V size of the property, the location, site and setbacks of pro-
NORTH J posed buildings,and the location of all existing buildings.
Show proposed building(s) in dotted line and existing
NEL6W huilding(s) in solid line.
Size of property . . . . . . . . .l L . . ft. x . . . . . f J1. . . ft..
g Size and use of existing buildings, if any . . . . . . . . . . . . . .
_ . . . . . . . . . . . . . . . . . . . . . . . . . .
y � H
. . . . . . . . . . . .
ow Size of proposed building . . . . .6Z-. . ft.x . . . . ft.
Height(from grade to ridge) . . . . . . . . . .,�. . . Z, ft.
Front yard . . . . . . . . . . . . . . . . . . . . . . . �1 '�. . . . . . . . . ft.
I �l _ Side vards . . .3.� . . . . . ft. and . . . . . . . . GG. . . . ft.
Rear yard . . . . . . . . . . . . . . . . . . . . . . �5. . . . . . . . . ft.
SOUTH If on corner, setback from side street . . . . . . . . . . . . . . . ft..
Note: All distances are net, as measured from street side
line to nearest part of building.
(OVER)
7-73-M
(cont'd.)
BUILDING SPECIFICATIONS.,
Kind of construction: Wood frame, fire safe, etc.?. . . . . . m� ). • • • • • • • • • • • • • • • • • • . . . . . . . . . • . . . . . . . . . . . . . . . . . .
Will any second-hand lumber be used? . . . . . . . . .1JU. . . If so, for what?. . . . . . . . . . . . . . . . . . . . . . . . . . . �A* . . . . . . . . . . .
Material of foundation walls . . . . . . . . .bw(;�6. . . • • • • • • • • . • • • • • • • • • • • Thickness . . . . . . . . . . . . . . . . . . . .
Depth of foundation walls below grade . . . . . . ... . . • • • • • • • • . • • • • • • • • . • • • . Continuous foundation? .
Will there be a cellar? . . . . . . . If so, material of cellar floor . . . .CO!Q .G.ht- . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .
Type of roof: Sloped or flat? . . .. . . . . . . • Material of roof . . . . . . .'4V1 -)Z,-T. . . . . . . . . . . . .
. . . . . .
.. . . . . . . . .
Size, wood studs . . . . . . . . . . . .Z.. . . . . ."x . . . . y. . . . . . .", spacing . . . . . . . l�C. . . ."o.c., length. . . . . . .•. . . . . ft.
Size, floor beams, 1st floor . . . . . .. . . . "x . . . . . . 1 Z.. . . . . .... spacing . . . . . . . . 1("rs. . . ."o.c., span . . . . . .(.fo. . . . . . ft.
Size, floor beams, 2nd floor . . . . . Z,. . . . " x . . . . . . . .l.Z . . . .", spacing . . . . . . . . 1C o. . ."o.c., span . . . . . .[C:. . . . . . ft.
Size, ceiling beams . . . . . . . . � . . " x . . . . . . . . . . . . . . .", spacing . . . . . . . . . . . . . ."o.c., span . . . . . . . . . ... . . . ft.
Size, roof rafters or beams . . . ( `�JS. . "x . . . . . . . . . . . . . . .", spacing . . . . . . . . . . . . . ."o.c., span . . . . . . . . . . . . . . ft.
Exterior finish . . . . . .. .(�OO.I�' .5.< - )► . . . . . . . . . . . . . With what material? . . .700v . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .
Finish of interior walls. . . . . . . l,�.1 �- -. . . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If garage is to be attache of what material is wall between garage and main buij4ing to be constructed?
. . . . . . . . . . . . J1 b". . . . i'.l s?>i_.(S73 0.� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is there to be an opening between g a^ge nd building? . . . .�. . . . . . . . . . . . . . . . . . . . ... . . . . . . . ... . . . . . . . . . . . . . . . .
Kind of heating system . . :1 .� . r�!... . . . . . . . . . . . Oil burner or coal? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Will a flue-lined chimney-be provided? . . YG�. . . . . . • • Depth of chimney foundation below grade . . . . S4.. . . . . . . .
Height of chimney above roof. . . . . . . . . . . . . . . . . . . .
Z`�`'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ._ . . . .
.
Will there be a fireplace? . . . . . 6b . . . . . . . . . . . . . . . Depth of fireplace hearth . . . . . . . . . . . . . . . . . . . . .
Will a toilet be installed?. .. . . . .�.e). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Will a kitchen sink be installed and connected to wa suppply? . . . . C? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Water supply (public water supply or pump) . . . . . ..zm.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Distance of cesspool from any private well . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . feet
Will drainage system be provided with required traps, cleanouts, and vents? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Town of Queensbury AFFIDAVIT
County of Warren
State of New York
I swear that to tt, vc,r of my knowledge and belief the statements contained i -application,together with the plane a d specifications sub-
mitted, are a true and co a. lete statement of all proposed work to be do a on the deacrih�ed rem,ses and that all prov ions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertaining the ro sed w rk ahal be mptied with,w the'specified or not,
and that such work is authorized by the owner.
Sworn to before me this Signature ............... . .......... -... �. . . ... .... ..................... ....
OWNER.OWNER' AGENT,ARC T.CONTRACT
............L�.:'..2..J..........day of..................................................19...
�
....... ...... . . ..... .
NOTARY PUBLIC, WARREN COUNTY, N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work.
ANSWER ALL of the following:
1. Gross floor area 2-1530
2 . Type of heat �imr Tom
3 . Is the building mechanically cooled? FZ) J
4 . Percentage of area of windows and doors
A. Over 16% Only
1 . Uo value of gross area of walls , roof/ceiling and floors
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a. Are foundation walls insulated? YES NO
1. If YES , what is the R value?
3 . Slab on grade YES NO
a. If YES , what is the R value of insulation around
perimeter of floor?
4 . Is basement heated? YES NO
a. R value of insulation
5. Type of insulation
B. Under 16% Only
1. R value of roof and floors exposed to ambient conditions_
2 . R value of exterior walls -Z�
3 . R value of glazed area
4 . R value of doors
5. R value of floors over unheated spaces
6 . R value of slab edge insulation - unheated slab � •ij
7 . R value of slab insulation - heated slab
B. R value of heated basement/cellar walls (above grade)
9 . R value of heated basement/cellar walls (below grade)
10 . Type of insulation
C. Controls
1 . Thermostat maximum heat setting
D. Duct Systems
1. Is duct system installed in unheated spaces? YES NO
a. If YES , R value of duct installation
b. R value of duct in other areas
E . Piping Insulation
1. Size of hot water or cooling carrying agent pipe �rZ
2 . R value of pipe insulation
F. Service Water Heating
1 . Performance efficiency
2 . Temperature control setting maximum
G. For Swimming Pool Only
1 . Maximum heating (�
T \'elephone No.
a �licant ' s Sig a ure)
TOWN OF QUEENSBURY
A BUILDING & ZONING DEPARTMENT -
SEU7AGF DISPOSAL PERMIT APPLICATION -
1 . Owner s Name � nl : G �IV11
Address 18-6 SIG (-oY\NA AC,YN
LP,V-N o c a Telephone No. 71D,-A.d7
2. Property location -7-5 AEL60N -�2,�/-
3. Name of persVCCaWY%DbffR1iff sible for installing system
7 Sarella Street Tele hone No.GLENS FALLS, NEW YORK 12801 P
Address '
4. Number of bedrooms (residential buildings only) -3
5. Daily flow' gallons/day
6. Septic tank capacity (MC) gallons
7. Topography: flat olling, steep
% of slope
8. Nature of soil and depth Q�
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? 2• ft.
10. Percolation test: A is required 6 Ga�� Ov .>E
B is not required 6; `�00
C If required what is the rate minutes/inch
11. Water supply: municipal, well, other
. 12. Type of system proposed: drywell, tile field, other
Any contractor-,. corporation, individual, etc. engaged in' the construction
of a sanitary sewage disposal system who covers the same before inspection,
does not have an approved permit, or varies from the approved application
will be subject to a penalty of $250 as pr ided for in Section 6 . 010 of the
Queensbury Sanitary Sewage Ordinance.
Date
signature of appli a t _
On separate sheet . of paper submit a dia of the .proposed septic system
with all dimensions, including distance rom any structure, distance from
property line and domestic water supply, etc. Include all dimensions of
.the system itself.
Form 3-82
1
NELSON RpAp
r I �
73
llM1^^
_J
10 ."
;t
_Jowtz of Queen-iLry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME .�6 C��alu/11 Z4-0 T
LOCATION Z07- z? I T>
Date Permit No. (96 -A
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
t. Porches
finished Floors
Kterior Trim
"tairs & Railings
Cellar Drain Tile
Concrete Floors
e\�Plbg. Fixtures
KGar. Fireproofing
Xvoor Closers
Amoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
nal Building Survey
Next scheduled inspection (call when ready)
Remarks-
.wl �,
o
Buildi g I specto
6/86 and-vl
Jown of QueenjLry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME A
('0 n
LOCATION �/
L��
Date/ S"? Permit No. / 7
✓ = APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing _
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
)(Final Building Survey
Next scheduled inspection (call when ready)
Remarks
G
Building Inspector
6/86 and-vl
C1
Jowti of Queenilury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION 7
Date /4lO / r Permit No. V� "/ 77
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
XFraming
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTAON
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
o P 5rvoS
v %�
Building Inspector
6/86 and-vl
401% IZ;ro.
nL� Jown of QueenJlury
'L BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME �f
LOCATION-7- ejLLcsaAf-lzn
Date /L % �� Permit No.
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building"Survey
Next scheduled inspection (call when ready)
Remarks-
Building Inspector
6/86 and-vl
y4)- / C�� /" Pin
d
Jown o f QueenjLry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME Jd � n
LOCATION L o l 1 3 o n
DATE 71 6 /X(a PERMIT NO. (p -
SOIL TYPE Sa - Loam - Clay -
Percolation est Required? YES NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel_
SEEPAGE PITS{Number of)
Size- -!;—ft. X ft.
Gravel size '
PIPING: Size pe
Bldg. to tank
Tank to dist. box _
Dist. box to field/
Openings sealed? ES NO Parti 1
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption -�ft.+
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYS PERTY(circle one)
Front - Rear eft side - Right side -
COMMENTS:
SYSTEM USE APPROVED , YES NO
Building Inspector
01/86 and vl
" Jown o f Queenilury
BUILDING and ZONING DEPARTMENT
�` Bay and Haviland Road, R.D. 1 Box 98
r Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION
Date / Permit No. — 7
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
✓F�cof ing
b,Sriding
Masonry Veneer
Rough Plumbing
/,Relief Valves
Lltxt. Porches
LePinished Floors
Vnterior Trim \
/Stairs & Railings "„
Cellar Drain Tile
Concrete Floors
1/flbg. Fixtures Ir
� �'r.. Fireproofing i
Vuoor Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
VF L ELECTRICAL INSPECTION
in al uilding Survey
Next scheduled Inspection(call when ready)
Remarks- -
1
Building Inspector
6/86 and-vl
Jown of QueenjLry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
, b 2 .d -eI--
LOCATION �ji ( l � S�j
Date i5/_ _ Permit No. J G - OLf
Foo�,,,•,,qn �S� = APPROVED - YES NO
ting/Pier F s
Foundation
Waterproofing
Backfill
Framing
t/Zof ing ,
Siding
Masonry Veneer
ugh Plumbing
ZLlief Valves mil
t. Porches QX
Winished Floors
L,--h"terior Trim 01
IS�airs & Railings ZAAZj
Cellar Drain Tile
LarC ncrete Floors
bg. Fixtures rjo�
.. Fireproofing
tKo r Closers
LSmoke Detectors
Chimney p•,
INSULATION:
Foundation
Floors
Walls
Cling )�
'FINAL ELECTRICAL INSPECTION 4v1' �'-
Final Building Survey
Next scheduled Inspection(call when ready)
Remarks- -
Building Inspector
6/86 and-vl
_town of QueenjLry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
f
NAME
LOCATION1L 4�nitl
Date. Z /A( Permit No. -
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES NO
Footing/Pier Forms
Foundation
waterproofing
r-�-'Backfi11
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
Final Building Survey
Next scheduled Inspection(call when ready)
Remarks-
Building Inspector
6/86 and-vl
BUILDING DEPT.COPY OF APPLICATION FORM 46-EL,NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED.
TEMP.# DATE
CITY OR
VILLAGE !J �J /(�' f` , TOWNSHIP �}+ 1�, �y� "J �{/y� COUNTYSTREET AND NO.OR
ROAD AND POLE NO. 7 /�fEL
/V 7Q� �(j�J�t �'7..1�3 /�-, 4✓11'r� POLE NO.
BETWEEN WHAT TWO h a�� �
CROSS STREETS IS r�( t v" �r{ —
PREMISES LOCATED? !/�/t SECTION y. BLOCK LOT 7
3
OCCUPANT'S ���/p� �► nr BUILDING
NAME C N A g sC 4 �I Y, OCCUPANCY — I � � �(}� �7 �/
OWNER'S NAME A �� �,� ` �� TEL.# / 1 !l- 40 7
AND ADDRESS (�` '\j I ✓ / v
CURRENT ,,-n `\
SUPPLIED f�/ 1�7y`/� AA v� ��BY FROMTHEIR �1 �,L� OFFICE
/ tt "( 7r •
DEFECTS
SUILDING NEW OLD❑ SORK NEW ADDITIONAL❑ REMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
No. Fixtures& BRANCH
NUMBER OF OUTLETS LampfReceptacles MOTORS HEATERS CIRCUITS OFFICE USE
Loca- ONLY
tion Side Attach't H.P. Watts A.W.G.
Coiling Wall Recep'ls Switch Pendant Bracket No. Type Each No. Each NO- Gauge INSPECTION
Out-
side
Sub-
base
Base-
ment
1st Fl.
2nd FI.
3rd FL
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE.
This application 1s intended to cover the above-listed equipment to be inspected but if at time of inspection there is found additional equipment not above listed,
you are authorized to make the inspection and adjust the fee to cover the additional equipment,as provided by the applicant.
SIZE OF ELECTRIC SIGN TOTAL
MAINS FEEDERS LAMPS WATTS
CHARACTER EXPOSED GAS TUBE SIGN
OFWORK CONCEALED TRANSFORMERS OF VA
WORK TO BE (NUMBER) (CAPACITY)
STARTED COMPLETED SIZE OF SIGN
SERVICE OVERHEAD UNDERGROUND MAKER
ENTERS
BUILDING OF SIGN
INSPECTION REQUESTED
ON OR AS NEAR AS
POSSIBLE I NEW OLD
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NAME
AND
/nADDRESS
APPLE ANT—!t`� `�VNA�/`kVN IND " lt' )0 DATE OF LL_ a(
APPLICATION ( �} �]�/v
STREET ADDRESS 7 ���� �� - TELEPHONE# 7 I?r (`T 07
CITY OR ZIP - LICENSE POST OFFICE / � CODE WHEN APPLICABLE
46 EL (REV.1/85) A SEPARATE APPLICATION MU BE FILED FOR EACH SEPARATE BUILDING
(/1
the ro e wu§dl
TOWN OF QUEENSBURY
Building- Department
Mora Report Date
Name L, 1
i mat e)
Permit No. R 1A - 1 7 7 Weather
Remarks
Excatia ti on
Footing Forms or
Footing & Piers
Foundation
Cement Coat
Water roofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough P1b .
Relief Valves
Wall Board
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
_ Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Floors
Insulation Foundation
Walls
ceiling
Building Inspector
REMARKS
_town of QueeniLry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILD/JI�NG INSPECTOR ' S REPORT
NAME
LOCATION `13 f/11/_L�Q
Date Z :,:3 / p 0 Permit No. 73
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED -'YES NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
}� Framing it
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
R/,-s �&-Ii-r vA) o �—
/i�, l-ony
B ilding Inspect r
6/£36 and-vl
v tom! R o
S - 82a 40 -40 -E-
DZ I
N - 8 2' ► "i �- 4 0 �- 1n!
PLOT PLAN
OF
Lo T Alo 73 /At s£c Tio Al rWo
Cm
0UJe Ij-LOUSE kTTA Th`S
TO /A,/OF WARCE A( Co. N kw (O Z&
Sc,4L a: : / "= 2o4O,e l4. 24 /98e.'
suPt/EY � ,NiAP BY
l.OUL7-,r,C & lVrCoR/yAck
L !C ENSCv LAND 514IRVe ro,e's
<FL ENS JrAL 45 MF-W