1989-013 i
1 CERTIFICATE OF OCCUPANCY
TOWN OF iQUEENSBURY
WARREN COUNTY, NEW YORK
Date .tune 6 19 $9
This is to certify that work requested to be done as shown by Permit No. 89-13
I
has been completed.
I
This structure may be occupied s. a _ _, One Family Dwelling
Location
l ,t. �, Su ar Pine The Pines of Queensbury
Owner Martin IkRosher
I
By Order Town Board
TOWN OF QUEEr4SBURY
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l !..( _. 5�`�.'�..1
nirector of Bldg. & Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY No 89--13 :C
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Martin Mosher I„4.
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OWNER of property located at Tot 107 White Pine (The fines of Queensbury} Street, Road or Ave.
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in the Town of Queensbury. To Construct or place a One F mily Dwelling °O
at the above location in accordance to application together with plot plans and other information hereto filed and o
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance_ a
9 . OWNER'S Address is
26 Sugar Pine Rd.
Queensbury, N.Y. 12804
2. CONTRACTOR or BUILDER 'S Name
Same
3. CONTRACTOR or BUILDER 'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by X) o
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( X Wood Frame f ) Masonry ( } Steel I } ZE
W.
SY
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T. PLANS and Specifications
W*
No. 261 x 641 as per plot plan, specification s and application including septic to
8. Proposed Use +
One Family Dwelling d p
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m
$25.ao C/O
$ 343- 00 PERMIT FEE PAID — THIS PERMIT EXPIRES A'_.gl!st 1 79 gg Yc
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the tz:j
town of Queensbury before the expiration data.)
[b
Dated at the Town of Oueensbur is D y of ,January
SIGNED BY
for the Town of Queensbury
Building and nirg l nspector
TO BE COMPLETER BY SLOG . DEPT. TOWN OF QUEENSBURY
RECEIVED
✓la�wrt ouc�ere36esr Application No.Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 J�� AN 2 3 1989
Bay and Haviland Road, R.D. 1 Box 98 zoning Designation r
Queensbury, New York 12801 Varian o . Q6r.�l�r. 1 � P.41Y�
site lan ReVie .[+T ._ T._ AA0 — rl
- Ap V43 3 b �
APPLICATION FOR W Ca 6- � S
PU I !._D I NG AND ZONING PERMIT1L --LS ' ` `
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING .
The undersigned hereby applies for a Building Permit to do the following . work which will
be done in accordance with the description , plans and specifications submitted , and such
special conditions as may be indicated on the Permit .
The owner of this property is : �Y�,r
P . O. Address � C,. rfii� C - +C- - cat ra .. f� � 7 fill . 7 9' a=
Property Location : �tx No,/ D ,, 1 . frx a L�':n r .i do grA& b,;6, , Tax Map No . ;/ /
Street number or building lot number
Subdivision name (if applicable) 7'o7%w.,.
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS ;
Naive P . O . Address Tel . No .
Name of builderd,$,2,. Address Tel .
Name of plumber ER .w. c , Address 'Tel .
Name of mason Address Tel .
NATURE OF PROPOSED 6ORIC : ZONING INFQRNWTION :
/.Construction of a new building " A PLOT PLAN MUST BE PREPARED AND SUUMI'TTED ,
_Addition to a building * drawn reasonably to scale and attached hereto ,
____Alter<ktion to a building " showing clearly .and distinctly all buildings ,
(no cha:,ge to exterior dimensions) * whether existing or proposed and indicate all
Other work (describe) set-back dimensions train property lines . Give
street and number or lot number and indicates
* whether interior or corner lot . Show location
FOR DEMOLITION PERMIT. STATE SIZE AND
LOCATION OF ScTRUCTURES AFI'ECTEb . of water supply and location grid configuration
* of septic' disposal area .
*
* COMPLETE INFORMATION REQUIRED BELOW .
* size of property /.. e) ft X. ft .
* Existing building ( 3 ) Size ft X ft .
* . . . . . .
PROPOSED BUILDING AND USE : * Existing building ( 5 ) Use
Size of new structure �^ft ]f691 ft
Foundation-pier/slab/crawl/partial u11 * Proposed building, distance from property lino
(circla one )
* Front yard " Lwl ft Rear yard 'Gt f t
No . of stories (habitable space) * Side yards - : ,�;,5" ft and (m Zp Lt
Height ( grade to ridge ) � 3� tt - If on corner setback from side street logo ft
If rasldential , now of families j * '
No . of rooms 0excludinq baths ) e5l * OCCUPANCY INFORMATION
Now of bedrooms 'f
PRIfAItY BUILDING
No , of bathroorns �R � pne family dwelling
-primary heating system •sr * Two family dwelling
Type of fuel � amaA.-/ A=g:.! * Multiple dwelling / Number of units
No . of fireplaces to be installed Permanent occu nnc
Will a wood stove be installed? * Transient occupancy a
Central Air conditioning?At&42 - " n` y
I3usine5s
5UILDING STYLE, PRIMARY STRUCTURE * Industrial
Ranch Contemporary Log cabin * Other '
Raised ranch Mansion Duplex * If addition , what will use be? _
oplit ltvol Old style Bungalow * -
Cape Cod Cottage Other * ACCESSORY BUILDING-
olonia Row Town ISouso * ' Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * /==" Attached garage/one Car/ two car/ �Z cuz
sk w fe 1r k ar tt tit it yr tc ,� yr a► ar ak at * Private storage building .
ESTIMATED MARKET VALUE OF " Other
CONSTRUCTION
INFORMATION ON BUTLDTNG SPECIFXCATIONS , ON REVERSE SIDE OF THIS SHFET , TO BE COMPLETED I
Form BPA 4/06 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood frame , ,Fire safe , etc .
Will any second-hand or ungraded lumber be used? If so , for what ?
Foundation wall material 'Ole
J Thickness
❑epth of four�datipn below grade
g ( to bottom of footing ) ,, p "
Will there be a cs llar? ' heated or untreated? +.ems.! gloor sq, footag+=t- s Ct
Will there be a baserstern� Will n "- , g y portion be u used as living apace ?
( If so , what portion? sq . ft . - - Type of use:?
Type of root slope flat/shed/other Mateclal. -of roof },
Sipe , wood Stu s "
- %; I spacing I a . c . length _ �ft .
.7oa. st4stfloor beam:;. ) lst . floor ,r2 "x _" spacing.Zf&"o . c . span.'LK..ft .
Joints ( floor beams ) 2nd . floor x s acin "o . c . s an /eft .
OverlayN ( ceiling b4asiisi]J3 '"x ��
rt spacing O.Q . span Z_ft.
F2oaC ratters " �{ ��
' apaci.ng,�o . c , span .� '7 ft ,
1v]ot trusses (pre-engineered) spacing "o . c . span Et .
Exterior wall finish %z "VL Of what material?
Interior wall finish Z • "�� -- — ,__—
If a�rgaraye is to be attached , describe materials to >be used for FIRE SEPARATION :
t � there to be an opening between garage and dwelling? If so will a Fire.-r. at4_!d
door , enclosure , and s¢lf-closing device be provided?
will a flue-lined chimney be installed? G err "eight above rVr oof � fit _
Depth of chimney foundation below grade " ft .
Depth or fireplace hearth ft . in .
Warer supply - Municipal or private well �yyy ag 0r�
SEPTIC SYSTEM _ Distance from ANY private weli ( i.ncluding adjoining properties ft ,
(A separate application is necwn:sary for
nnany repair
' or new inStallation of septic system)
Town of fu Warren
A F F I D A Y I € STATE Ulu NEW Yor,2K
County of warren
I swear that 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 th" t all
Provisions of the BUDDING CODE•' , 'PHE ZONING ORDINANCE , and all other laws Pertaining to
cfie jrOpo ed work shall be complied with , whether specified or not , and that auch work is
t.uthori,4ed by the owpaer ,
SWORN TO I3E:FC1F2E riwC iP3fTS Signature
Owner , owner . s agent , arcanxtecto contractor
clay of l9
Y
Notary Public , Wa r e n County, N . Y .
SPECIAL ONDITIONS Or' THE PERMIT :
By------ ----
WARREN :GUNTY , NEW FORK
Application fore bulLDINC► PERMIT IN CUMPLZANCE NITN T11E NEW YORK
STATE ENEACY CONSrERVATION CODE
A parnit trust be obtained before beginning work .
ANSWER ALL of the f ollowl" 9 i �{
1 . Grow floor area
2 , Type of heat �aC-l " GL✓ J }" Q --� _
1 . Is the building mechanically coaled ? ■ �+r
4 , Percentage of are ^ of uindowe and doors _." t�r_,1. k ") n
A . over 1 6 % OOnnly
Uo value of gross area of walla , roof /ceiling and floors
osed to ambient conditions
2 . ]Floor G Jo-T heated apac * ^
a . Ara foir" Ation wall .- insulated ? YP" S NO
1 . if YEw . , what the R value ?
3 , Slab on elrada 5 !rp
A If YES , at is th R value of insulation around
perime r of floor ?
40 Is ba ment heated ? YES N�}-.
a . value of insulation
5 Type o _" insulat. ion
s . Under Ir, Cnly
1 . R valut• of coo land floorsexpusnd to ambient Conclitions �
2 , R value of exturior walla1G�—f��
3 . R valxxu of glazed area
4 . R value of doors
50 R value of floors over heated spaces L �
6 . R value of slab wine insulation - unheated slab
? . R value of slab insulation - i� eated ulab
a . R value of heated basement/ cellar walls ( above grade ) , _ .
yt , R va ; ur Of yseatcsl lawmen [ /cellar walla (below grade )
100 Typo of insulation_ IG
co Controls
.1 Thermostat maximum heat lotting C'4g,
p , Duct Systems
1 . Is dint systivm installed ire unheated apacea7 yr5 : ems
4 . If YE50 R value of duct inara. 11ation
be R value of duct in other areas
Ea Pining Insulation
1. Size of hot water or cooling carrying agent ,pips
2 . R value of pines insulation
F . Service Water Reefing 1 . Performance efficienty. .�
2 . Temperature control setting maximum Iu cl '
G . For Swimminy Pool OnI
r `J
i . --Maximum heating„r
_ Te; l e,phong No . OmZ ._ 1 �..+, Q�,�. • ' '_- �,1 ,(ca '1 L..- /rL.,' S- 'lrtas.
r 4azrpIicantIs signature )
.J'eafft
APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE�`� .e 0? 19
LOCATION OF PROPERTY FOR INSTALLATION cam. &;r
Owner's Namers4`'/32d�/"i 7_r ', i � � .r Telephone: /04 fi'',e
Address:
Installer's Name: Telephone:
Number of bedrooms (residential only) _
Total daily flow (compute @ 150 gal per bedroom) 4
Topography: circle one: Flat Rolling Steep Slope of slope
Soil Nature: circle one: Sand Loam Clay Other / Depth: feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? feet
Percolation test: circle one: not required required / rate min. inch.
Domestic water supply: circle one Municipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic 'Tank 1 , _ gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench .5~ 0 feet / Total system length �o feet
SEEPAGE PIT(S) : Number of / Size each feet by feet
Size of stone to be used it c: j Depth or Thickness feet
I M P O R T A N T
...Please...IAST NEW EQUIPMENT TO BE INSTALLED
(over)
Section II 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.
Co 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.
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: _ V,2 C,
Bate: --:Z3 9
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY A GOOD. PLACE TO LIVE
TOWN Op QUEENSBIJR'y
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
TELEPHONE ( 528) 792-5832C1+}
QUEENSBURYy NEW Y
BUILDING INSPECTOR' S REPORT
REQUEST FOR ,INSPECTION RECEIVED
NAME
LOCATION —/�
e FERMI #
PATE n J APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC FOUR FORMS
FOUNDATION/' VAL {]OFING
BACX,FILL AP
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
pOINAL INSPECTION "V,
CHIMNEY HEIGHT
ROOFING
SIDING PS
EXTERNAL PORCHES/ ILS -
STAIRS-CLXARANCE & — �—
PLUMBING FIXTUR IVACY IRE EOOR VALVE
--�
INTERIOR TRIMI
FINISHED FLOOR
GARAGE FIREPR
DOOR CLOSER (S _----�- �— Y` --
SMOKE` DETECT S
FINAL ELECTRIC L INSPECTION
FINAL APPROVAL OF CONSTRUCTS
ICATE OF OCCUPA
Y MUST BE
A SIGNED CERT F
OBTAINED FRO THE BUILDING I3EFAR ENT BEFORE
THESE PREMISES ARE OCCUPIED:'
REMARKS: f4`�� • 1 f C/r
`r Afire
f(f{( /ter+/
A i L G
r
r/
INSPECTOR
_.J'aw+n a� �tseerry� e� r�
BUILDING and ZONING DF-PA I Box 9 rA
Bay and Havifand Road, R•D . Box
Queensbury, New York 12801
SEPTIC DISPOSAL SY�ST�EM+; INSPECTION
+-ram G� l ..
LOCATIcxa r§
DATE - y /�• PERMIT
and TYPE - wand . Loam - Clay ----�-
E ired? YES - 140
Percolation T-08 14 n,/Inch
P ercolat ion te
TYPE of sXSTEM total length • -
p.Y�Rarption fie a r
Length of each ench r ---~-
Depth of trench s
size of gravel
SEEPAGE PITS41q er 00
ft. X ft.
Size- -�r-�
Gravel size Size T -
P IP II3G s -----�'
.Blc1g . to tank `
Tank to list. bc "�
Disto boX to fi,p� Sd/PSS NO Partial
openings seale5(?
LocpTION/SEp T70N5 : l0 ft.
O tank - f t .
Foundation o absorption
Foundation i
p�sorptio tca lot line ft
of nits
pTION SYSTEM O[3 PROPERTY (ciri a one
Front
ar - Left side - Right side
NO
SYSTEM USE APP'RC7'�TED
g i in nspeGtor
01/86 and v1
TOWN OF QUEENSBUR.Y
BUILDING AND CODES DEPARTMENT
BAY & HAviLAND NEW OADS
PORK 1280�
TELEPHONE
(E , 518 ) 792- 5832
l3DNE
BUILDING INS'PECTORT S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION ERMIT
DATE AppROVED
YES NO
FQOTINGIPIERS
MONOLITHIC PtOUuR FORMS
FOUNDATIOND4MpIIIIII.pRoOFXNG
BILL APPR6VAL
ROUGH PLUMBING
FRAMYNG <
EL TRY CAL ROUGH-XN �/� •-' �{� .
SULATIDN-
FOUND ATION
FLOORS r
WALLS ,s
CEILING f
FINAL INSPECTION : t
CHIMNEY HEIGHT
ROOFING
SIDING PORCHE /STEPS ,
EXTERNAL RAILS
STAXRS-CLEARANC
INTERXOR TRIM RIVACY DOOR LVE
FINISHED FLU SFING ,.
GARAGE FIRED
DOOR CLOSER ( IRS
SMOKE DETEC L INSPECTION
FINAL PPROVA
FINAL APPROExxicuT I OF CONSTRUCTION
CUPANCY MUST BE
A SIGNED CERTIFICATE HE BUI FOC DEPARTMENT BEFORE
OSTAYriFED FROM
THESE PREMISES ARE OCCUPIED!
REMARKS
INSPECTOR
TOWN OF QUEENSBURY
.BUILDING AND CODES DEPARTMENT
,aAy & HAVILAND ROADS
QUEENSBURY, 5 W� YO�128 01
TELEPHONE
2-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPEC ON R CEI'VED____
NAME --
LocATrON
DATE I PERMIT #
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMING
FRAMING
ELECTRICAL ROUGH-IN
IIV FOUNDATION
FLOORS
WALLS +
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/ST S
STAIRS-CLEARANCE RAXXgS _^----
PLUMBING FIXTURE RELIE�Ii VALVE
INTERIOR TRIM/P VACY DI
FINISHED FLOOR
GARAGE FIRED PING_
DOOR CLOSER )
SMOKE DETE ORS
FINAL ELECT CAL INSPECTION
FINAL APPR AL OF CONSTRUCTION
A SIGNED RTIFICAfiE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED'
REMARKS:
0)
INSPECTOR
UEENSBUR'Y `
TOWN OF Q _ --
BUILDING AND CODES DEPARTMENT ✓
BAY & HAVILAND N,EW ROADS
22809-
QUEENSBURY,
YORK
TELEPHONE ( 518 ) 792- 5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME l
.LOCATION
PERMIT
DATE APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS NG
FOUNDATIONJDAMP- --
BACKFr4L APPROVAL
,ROUGH P MBING k
FRAMING
ELE+CTRICA ROUGH-IN
•�,yrNSULATION: T
FOUNDATION
FLOORS �^
WALL
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING PORCHES/ TEPS
EXTERNAL
STAIRS-CLEARANCE & RAI EF LVE
PLUMBING FIXTURE
VACYIDOOR
INTERIOR TRXnlp
FINISHED FLOORS
GARAGE FIREPROO ING
DOOR ,CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL NSPECTION
FINAL APPROVAL OF CONSTRUCTION
OCCUPANCY SST BE
A SIGNED CERTIFICATE OF
DEPARTMENT BEFORE
OBTAINED FROM THE BUILDING
THESE PREMISES ARE OCCUPIED"
REMARKS :
INSp TOR
TOWN DF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS p 2223L?
CUEEN'SBLIRY. 5Z8y 792_5832
TELEPHONE t
BUT.LDING INSPECTOR' S REPORT
REi7L1EST ,FOR INSPECTION RECEIVED
NAME
LOCATION `` PERMIT
# �
DATE � , � /} 9 APPROVED
YES NO
FOOTINGIPXERS
MONOLITHIC POUR ''FORMS
FOUNDATIONI DAMP-
BACKpILL APPROVA
,ROUGH PLUMBING
, ,FRAMING
I/ ELECTRICAL ROUGH~I
INS ULAT ION
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION=
CHIMNEY HEIGHT
pooFTNG
SIDING
EXTERNAL PORCHESISTEPR —^
STAIRS- CLEARANCE & RA
LS
PLUMBING FI}GTURESIRE IEF VAL -
INTERIOR TRIMIPRIVA DOORS
FIHIISHED FLOORS
GARAGE FIREPROOFI
,POOR CLOSER (S)
SMOKE DETECTORS NSPECTION��_
FINAL ELECTRICAL CONSTRUCTION ���- ---
FINAL APPROVAL O
A SIGNED CERT ICATE OF OCCUPANCY MUST OBTAINED FRO THE BUILDING DEPARTMENT' aEFOR
THESE PREMI ES ARE OCCUPIED!
REm"KS=
I PECTOR
TOWN OF QUEENSBURY y
BUILDING AND CORES DEPARTMENT
BAY & HAVILAND ROADS L2804-
QUEENSBURY. NEW YORK
TELEPHONE ( 518 ) 792-5832
SC3ILI)ING INSPECTOR' S REPORT
REQUEST FOR
INSPECTION RECEIVED
NAMEIAOC
ATION
DATE ---' APPROVED
YES NO
FOOTINGIPIERS, FORMS
MONOLITHIC ,POUR
FOUNDATIONIDA4P_PROOFING��-- --�—
tAACKFILL APPROVAL
ROUGH PLUMBING
,FRAMING N
ELECTRICAL ROUGH—
INSULATION :
FOUNDATION ti
FLOORS
WALLS
CEILING a
FINAL INSPECTION : !/ —
CHIMNEY HEIGHT' =-- }
ROOFING
SIDING STEPSEXTERNAL PORCHE. I
STAIRS—CLEARAN & RA IEF V VE___,
PLUMBING FIXT ESiR
INTERIOR TRIMYPRIVACY DOORS
FINISHED F WORS
GARAGE FIREFJROOFING
DOOR CLOSER S)
SMOKE DETE TORS INSPECTION
FINAL ELECT
CALFINAL APPR AL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED PREMISES THE BUILD,
ARE OCING CUPIED!
BEFORE
THE
REMARKS :
r
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT / YT?
BAY & HAVILAND ROADS YORK 12805-
QUEENSBURY. NEW
TELEPHONE ( 518 ) 792- 5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED �� ---
NAME
LOCATION •}�
_ PERMIT�� -
DATE ���.'�;T:�_._ � APPROVED
YES O
1 , .FOO'TINGfF.IE S
L` MONOLITHIC U FORMFSNG
FOUNDATIONID
BACKVILL APPR VAL
ROUGH PLUMBING.
FRAMING
ELECTRICAL ROUG IN
INSULATION:
FOUNDATION
f
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHESISTEPS
STAIRS-CLEARANCE & RAIPLUMBXNG LS_��_
FIXTURESIRELIEffis
VALVE
INTERIOR TRIM/PRIVACYD06RS
FINISHED FLOORS
GARAGE FXR, PROOFING
DOOR CLOS" (S)
SMOKE DE ECTORS
FINAL El
TRICAL INSPECTION
FINAL AP ROYAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARr7E, O
C
CUPIED !
REMARxS: i' I ' i to /�1L✓
Ail va
I NSPEG'fI'OR
TOWN OF
BUILDING ANDND CODES
DEPARTMENT
BAY & HAVILAND ROADSPORK I28094
NEWlJ 1 J r
QUEENSBURY. W ? 32-5832
TELEPHONE f
BUILDING INSPECTOR' S REPORT
INSPECTION
RECEIVED _ ------
RES?UEST FOR
NAME
LOCATION
0 PERMIT #
RATS APPROVED
YES INO
l
OTINGIF'IERS FORMS
MONOL:rTHIC POUR.
FOUNDATIONI PR�PROOFING
13ACKFILL A
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH- TN
INSULATION :
FOUNDATION
FLOORS
WALLS
CEILING t
FINAL INSPECTION : r:
CHIMNEY HETGHT�
ROOFING
SIDING BPS
EXTERNAL PORCHESI p RAILS^__f- -
STAIRS-CLEARANCE
PLUMBING FIXTURE VR LIEDC70RSLV_---�`-
INTERIOR TRIMIPR
FINISHED FLOORS
GARAGE FIREPROO ING
DOOR CLOSER (S)
SMOKE DETECTOR INSPEC�,ION_1�� -
FINAL ELECTRICA --
F CONSTRUCTION
FINAL APPROVAL
OCCUPANCY MUST BE
A SIGNED CERTIFICATETHE BCTISF N+G DEPARTMENT BEFORE
OBTAINED
FROM
OES ARE OCCUPIEDI
THESE
REMARKS
+ + C
\A,
. !, -
.__----------
TNSPECTOR
gUILQINCt DEPT. COPY FILDE THIS COPY WITH BUILDING-" DE¢. WHE REWIRED�RE NQERWRI7ERS,
TEMP, ft
COUNTY
CITY OR :.--
VILLAGE
STREET AND N10. OR " i-�
ROAD ANO POLE NO. :.� ^{'-�r BL K LOT
BETWEEN WHAT 7WO -r..v ,�, ,r„ irx.^�'�-�.�i IN t •.'-v E T10N
CROSS STREET'$,fE � f�.•+?�!.' BUILMKG
PREMIS �CUpANCY
NAME
OMfNERS NAME � ✓�-�+�'`�..c. 'v f OFFICE
AND ADDRESS ,f•L.- C-•t" ✓
�pp L1ED ! :_--=--' r ' �`. ' R£MOVEO ❑
BUILDING NEW
OLO C� IS
Is ALL EO�I3IPMEAIT YYf-1ICH YOU INSTALLE[7
LIST $E LCSW BRANCH OFFICE use
. oofF��« MOTORS HATERS CIRCUITS ONLY
NUMBER OF OUTLETS R A.W.G. INSPECTION
LOC�tionn Skda Ateadi'f Switch peodans Braokat Ne. TYW wwom Each No' Eee1t No. fiMiga
Calling Walk RODWI*
apurew
Wa
sub.
beta
Saar
ntattt
1st Fl.
2nd Fl.
Srd Fl.
DO NOT USE THIS SPACE.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE:
tad but if at titna of irNpection there it found additional agv.iWnent not attoye listed,
listed apuipnant to ba a addi ent, as Wow ided by the applicant.
This appNeation is +mended to Corot the '�""ad� �fN to awl additional aqu+Wtt TOTAL
YOU me MAJUniaed to make the. i+tsPt'ctt� ELECTRIC SIGN WATTS
LAMIPS
SIYE OF FEEDERS
MAINS EXPOSED GAS
M TUBE SIGN VA
CONCEALED TRANSFORMERS OF ICAPACITYI
CHARACTER INUTABER1
OF WORK SIZE OF SIGN
WORK TO BE COMPLETED
STARTED UNDERGROUND MAKER
SERVICE
OVERIiEAD OF SIGN
S �}
ENTERS OLD 5.�1
I OI NEW
INSP£CTI ON REQUESTED r
W6SSIsLE NEAR AS - GATE OF
APPLICATION
MUST BE FILLED NI pR APPLICATION MAY BE R£TURNEp ION. ALL SPACE �/ SIGNATURE
PRINT NAME AND ADDRESS _ I ..���,...t L 1 '_ —i— OF APPLICANT
M y .-y
NAE OF �r.•{{Lrai r r✓
ONE
APPLICANT __,.�-* -� TELEPH #
r LICENSE NII
STREET ADDRESS M - ti Czip IF 41
ODE WHEN APPLICABLE
CITY OR
POST OFFICE
re �.+- [Its. rleel q �'�pAR14TE APPLICATIONI MUST BE FILED FOR EACFI SEPARATE 'BUILDIIU
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