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1989-052 ' f f I CERTIFICA, ; CJF OCCUPANCY oil TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date March 12 J� lq 90 CA This is to certify that work requested to be clone as shown by Permit No. > d I has been completed. S\ Thin structure ja ' -'�1��- ! Location 9 1�riE i1y iZca� c: 1i Owner - i i By Order Town Board TO" OF QUEENSBURY i k Ilirecto'r of Bldg. c3c Code forcernent i i i i { BUILDING PERMIT TOWN OF QU EENSBURY ro No. $ 9 - 5 o WARREN COUNTY, NEW YORK r✓ n� PER MISS10N is hereby granted to CT zt F pf � rnr i mac �' I I� OWNER of property located at rot 43 U Amethyst Road Street. Road or Ave. � in the Town of Queensbury, To Construct or place a 199J n,Tl t;j, l�_O���Q l 1 � at the above location in accordance to application together with plot plans and other information hereto filed and approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 1 OWNER'S Address is c/o 51 Glenwood .Avenue Queensbury , N . Y . 12804 1~ 2. CONTRACTOR or BUI LDE R'S Name Northern Homes �-3 t� 3. CONTRACTOR or BUILDER'S Address 51 Glenwood Avenue r � Queensbury , N . Y . 12804 m m 4. ARCHITECT'S Name 6. ARCHITECT'S Address w CD t� 6. TYPE of Construction — (Please indicate by X) �3 t� XX Wood Frame I ) Masonry I 1 Steel I ) M y i. PLANS and Specifications 'o C7 No. 44 ' x 43 ' Single family dwelling as per plot plan , a specifications , and application , including septic and a. Proposed Usa attacriea two car garage . Single Family Dwelling 25 . 00c/o 7: $ 311 , 00 PERMIT FEE PAID — THIS PERMIT EXPIRES SR * mhtmr l t9 R C (If a longer period is required an application for an extension must be made to the Ruilding and Zoning inspector of the town of Queensbury before the expiration date.) Dated at the Town of Queensbu7:Buil ' D y of F�brLtr-v 19gr C SIGNED BY for the Town of Queensburyding and ning Inspector t17 C ' C t-i r7 T N OF � UEENSI3URY APPLICATTON FOR UUTLF)THC AND ZONINC PERMIT i'u•t c- Fec.r:eved TOWN. pF QUEENSBURY RECEIVED FEB 1 3 1989 Fee ftid 't , 3,56 (,UILDING AND CODESq DEPARTP'[LNrr Date Ib.eue.d CODE DEPT, r and IJAVI.LAND ROADS RD 1 pox 9a purrms luRY, nEw YORK 12804 PeJtm-it 1J0 . , �- ToZ . (518) 792-5832 Kxc -204 •• .r i i w w 7U r4 w I w i w i A } w w * w■ 1F w w R ■ * • w R w w w w ■ w w r A t' Ett?1IT MUST O731'AINZ (] BEFORE BEGINNING CONSTRUCTION . NO INSPI~CTIONS WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID DUILDINC PERMIT . All applicable spaces on tizis application must be completed and the s -; pmaturc of the applicant must *I.-rpear * o * the reverse shale * o this s eht . lie owner of this property is : A. 0A 'er-)i ;j ,, S - . O . Address G Ste/ f / ✓� , e �xS Jr A}, 1 -0Vod' TUX• . _i.`�_c�r - roperty location 4ae *50 ' •rnx MAP NO . / �.► / 999 as there been any split of this property since October 1 , 1900 ? ____ i,, i✓� yes So f yes , Planning Board Review is necessa/ry . UBDIVISION HAMEe I1" �G APPLICABLE •� � or4r,Li - LOT NO . r�' d he person responsible for , ulaerVisian of work as regards Building Codes is : -}-y , �aeKs .7r f NAML Pr. O .r ADDRESS TEL . NOo xme of builder �Jlu(a � Ern fYd+�� S Address 5/dt� ,ra� ad[ !'y��GAIJ � e:% Tel 's 41 k� oo7 ._ 7"�'a Tel � iw a £ Plumber ' ° T.c3 iras5 amc of Mason r . Aildrasy Tel .TURF. OF f'PZWGC�LD WOi.F. ' „ ZONING l Nl :OltmA'1' 10N ( tiffs ce use Onl v ) Xronxcrucciorm of a new balildin+q or 'ZONING DESIGNATION OF PROPERTY Addition to a b6silJiog - ` PERMITTED PRINCIPAL PERMITTED ACCESSORY �A1ca:r:aGion to a 1:uilding ` ' � ( ira clrzsri+l� to axccrior mllncnuions] nEVIEw REQUIRED - PLANNING HOARD ZONING AOARD� QchAGwr wort: (Ja ncr•ibco ) " SITE PLAN REVIEW # APPROVED BATE r LOSS ARLA OV PROPOSED. :;: "1" nUCTURE ; VARIANCE it APPROVED DATE1 ` Remarks ' � t 4ANW: s�7 sq f t , „ � /r 7 s q id F 10o r I f t . COt•1P [_L{"1'1: , Ir[l'Of.rr.P►'1'SC1N lcl:QU I1cLED 1il::LUY! • } s ].'I'.v.`. of propiarty /04C ft X 'Q-7 rt . char Floors set ft . 1xi�tinr l�ui3.lisi. not collar or basemont3 ] TAx. FLOOR AREA Q3& `Y s+q, f t . " 1»xi :zi buiJUirtU ( :; I U::�: � AUe ixv of new srruatur.z ` j6Lft x AINX ft �au�dation-piarJ ;lab/crawl/laaXtial tui '� Nrapa::r:d builuing , di::cancu xrour tara]i+trty line: (viral.: one) ` f t near ui'd //.a't ft 3 , of Dtoria . (1%ab.Lc:.ble ::Lance ) c� fide zAr&u -6S Y' rt �i hz ( r rade to ride u ) 12 , ft . • Side yaYd:; � rt and — r" c r] J Ii on corner , :: wtbuok ,from lido �trecc C rc :; irluntial , no . csf families I o . of room:c ( axcludinU bath:31 OCCUPANCY k1NFOPJ4AT1CN o . of be:droams IV PgRI ZY LUILDIMC o . of I�:atllrGauau ., �C Ono fal"ly dwelling riu"ry I:caciirrl :;y:; c%A0 rj2.V-.Cm.AA +' r Two fzLmlly dwelling Y11" of Cuol oifli _ -- rlultil�l.: dwelling / Humber of units_ a . of firuplacU4 to 1ae insc :.I T ' Pannanent occupwicy ill " wooa.l :4LOV4: 1av i11:41Lallua7 /VO a PL11n3ii:lat accul�ara[ Y vntr" I Air cal,cliCic,nirig :'� V* t 13u3:1nLsy s ,UILDING 1TYLC, PRIMARY STRUCTUIZE . indu : crial , Ozhcr .41tch Cont.:,lpoc"ry L.Gr? c4bin 1E addition , ►rl �uc will ri :;4d ranch Kanuiva � Ruplux � 1 nl ' t lVvel Old acyle uu1 <<a.. iaw r ':. u Cad CoGt:arje Ocl4ur ACCL:S:3S.ORY 13UILDING- 'Gloniul l:aa rcr,+rc 1louse ` lay tachea Lour-igo/ona car/ two czar/ car ( CIRCLL: C3[dl: PLE7►11+ 1 httachud garaqu/000 c4r/= 4wo ar via x• w ■ a a a IN s w . R w a x r * ■ '�' �11r.iV" cu ;tOr"9Q bluilding - L: .''. 'r :JMATJ' E ] MhRKr'l' V Al. ULi Or ' Ocher HF011414ATTON ON nUILOINC SPrCIFICATIONS , ON REVERSE: SIDE OF TI1'IS CtIO2 * TO no COMALG' COJ Farm DPA I0/68 V1 301LI3ING PERMIT APPLICATION CONTINUED - B13ILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . Will any second-hand or ungraded lumber be used? If so , for what? ,lit5 Foundation wall material C.0kircrf, &, gKoiak Thickness Depth of foundation below grade (to bottom of footing ) jam, ` S " Will there be a cellar? E Heated or unheated�� ,Floor sq. footage IRAA r sq ft Will there be a basement? Will any portion be used as living space ? A/4::7 ( If so, what portion? sq , ft . - - Type of use? Type of roof sZo lIX/shed/other�� Material ofb oaf r s f i" Size , wood studs Z " x �} " spacing;. bo length ft . Joists ( floor beams) lst . floor "X " spacings_"o . c . span 149 ft . .joists ( floor beams) 2nd . floor " x /do _" spacing /g;�"o . c . span. ft . overlays ( ceiling beams ) �Z"X '" spacing_ _ 'O . c . span /,G? ft . Roof rafters Z. "X / '" spacing _o . c . span.Zfft . Roof trusses (pre-engineered) s acing +,/ "o . c . span Z Cw ft . Exterior wall finish of what material?_ sCr&a c. 4e interior wall finishr` �7� u 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? E If so will a Fire-rated door , enclosure , and self-closing device be provided? YES Will a flue-lined chimney be installed? VC Height above roof ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth ft . in . ,may Water supply - Municipal or private well ► ► r L4 A'Ori C� If �'- 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) D E C L A R A T I O N 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 CODES 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 ,� Z4tea am Owner, caner s agent) architect, contractor sr Vr � fe * A * * ! nr rt yr * * K' * w * * #t * '* k ik 4 * #r t w ri it * * * : k * it # * * ,rr * • * it SPECIAL CONDITIONS OF THE PERMIT : By_......_________. ......_______ 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 L. 5 & 4 2 . Type of heat �—be.00�#:�M' 'Afarwk AOLCZ� ? 3 . Is the building mechanically cooled. ? L 74e s yy 4 . Percentage of area of windows and doors 14 a z* 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 — j 51 3 . R value of glazed area 4 . R value of doors F I 5 . R value of floors over unheated spaces J o 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab jyIL 8 . R value of heated basement / cellar walls ( above grade ) .=-1-0 9 . R value of heated basement /cellar walls ( below grya—die ) .{] 10 . Type of insu1ation_tJ, 1r�E r �� _ �/'Hr2 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 r.1 b , R value of duct in other areas A E . Piping Insulation r 1 . Size of hot water or cooling carrying age nt// pipe _ � SI_ 2 . R value of pipe insulation I /,A� F . Service Water Heating_ a,/+ i . Performance efficiency, LQ2 /C 2 , Temperature control setting maximum 140 " G . For Swimming Pool Only 1 . Maximum heating W / �, - Telephone No . applican ` s signature ) OF QUEENSBUI2Y c .ry;f. APPLICATION FOR. SEPTIC DISPOSAL PERMIT DATE f`y_ LOCATION OF PROPERTY FOR INSTALLATION 14rOC `tR f C 7' J QR '�'V Pr 'I" ef4 Owner's Name:i_..Z CAA'OCJIr4 ��%'''�' 1%346-s Telephone: 6/8 9c? e 69!>O'�/ Address: d;;/rei aS f';1" Installer's Name: Telephone : Number of bedrooms (residential only) Total daily flow (compute (d 150 gal per bedroom) C� G+G7 Topography: Circle one: Flat J Rolling Steep Slope % of Slope Soil Nature: Circle one Sand) Loam Clay Other /Depth: Feet Ground Water: At what depth? 1'© Feet Bedrock or Impervious Material: At what depth? 'r"�' �a ' 'Feet Percolation test: Circle one: riot require required rate '! _min. inch. Domestic water supply: circle one: Municipa Well Other If domestic water supply is a well: Separation: Water supply from septic absorption feet PROPOSED SYSTEM: Septic Tank ID00 gal. {minimum size: 1 ,000 gal.) TILE FIELD: Each Trench S�C> feet/Total system length o;X 5'�] feet SEEPAGE PIT(S): Number of / Size each Meet by feet Size of stone to be used # /Depth or Thickness / feet I have read the regulation on the reverse side of this sheet and agree to s.bide by these and all requirements of the Town of Queensbury Sanitary Sewage/Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: DATE : OVER Septic System Inspections : A . All applications for septic system installation , alteration or repair , as required by the Town of Queensbury Sanitary Sewage Ordinance , shall bu submitted to the Building Department at least 24 hours before start of construction and shall include a plot plan showing : I . ) the proposed location of the system 4 . ) 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 ranks , distribution boxes , rile fields anal /or drywells B . No system shall be covered before inspection and approval by the lsuilding InSpecror . Failure to comply with this requirement may result in Clio uncovering; of the system by the installer and a fine of up to $ 250 . 00 . C . An approved copy of the plot plan shall be available on the construction site . Failure to produce said plot plan at time of inspection may rt� sult in an iimnediace work stoppage . D . Should unforeseen problems during construction prevent proper installa-- CiOCI , alteration or repair of an approved system , a new proposal must be submitted to the Queensbury Building Department before further con :. truccion . Town of Queensbury BUTLDTNC and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 K�warks : 3§3 3��' TOWN OF Q iIEENSBURY 4!qG�� rsr BUILDING AND CODES DEPARTMENT ,BAy & RAVILAND ROADS ¢UEENSBURY NEW PORK I280k TELEPHONE ( 518) 792-5932 JPM BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED ci �- NAME LOCATIO C � f � fi7 PERMIT # DATE APPROVED YES NO FOOTING/PIE MONOLITHIC FORMS FOUNDATION/D -PROOFING BACXFXLL APP AL ROUGH PLUMBING FRAMING ELECTRICAL ROUG IN INSULATION: FOUNDATION FLOORS WALLS CEILING INAL INSPECTION : CHIMNEY HEIGHT �r ROOFING SIDING EXTERNAL PORCHES S PS STAIRS�CLEARANCE & RAILS PLUMBING FIXTURE ELIEF VALVE INTERIOR TRIM/PRI Cy DOORS FINISHED FLOORS GARAGE FIREPROOFI DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL I Sp TION . FINAL APPROVAL OF ONS RUCTION _ OX TO ISSUE C/o o C/C �_----- -- --`�- A SIGNED CERTIFIC TE OF CUPANCY MUST BE OBTAINED FROM TH BUILDI DEPARTMENT BEFORE THESE PREMISES A E OCCUPI Di' REMARKS : o ARRIVE DEPART 3 a5 ---- INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS , ; BUREAU OF ELECTRICITY ' 41 STATE STREET. ALBANY. NEW YORK 12207 Date ', ."_ ir+ �, E � I: -. Application No. on file ;. ., THIS CERTIFIES THAT Only the electrical equipment as described below and introduced by the appReent nonsod on the above application tatsna.ber its thepnensisee of . F IiI''''� 7 .' ? f : 4,. _ in thefo rT llowin location, ❑ Baaernent I� Fat Fl. 0 Snd Fl. di Scrtion i . , Block j Lot euaa examined on ^; E{ , •i i ; ? and found to be Ira compliance with the requirernenta of Chia Board, FIXTURE AGES SWITCHES FIXTURES RAEKiLS COISICINt; OECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANtIE$[ENT FLLK]EESCENt QTNER AMT. K. W. AMT. K. W. AMT. K.W. AMT. If. W. AMT. M. P. �• ,`: I ! I F DRYERS FURNACE MOTORS F„MM ARNIINCE /EtD�EES SPECLU WTT TIME CLACKS Mau UNIT HEATERS iMMT14XJTLNT HERS AMT. X W. Ala N. ►. GAS M. r. AMT, NO. A. W. G. AMT. MM►, AMr. AMAS. TERNS. AMT. H, r, EYSTEMt AMT. WATTS I'tQ. OF FRET SERVICE DISCONNECT NO.OF S E R V I C E p lMAT. AMP, TYPEAMUR gQtnp. 1 X 41M T SW 30 3W 3 / +IW NO. OF CC. COINn. A. w. 0. Na,. OF MI-LEG A.W CE Nt1. Of NEUTRAIS OF NWE4lIRAa PER .e OF C:C. CON6. F: OTHER AMAEATM F LIT, .:' , , . u' ` I3E ': TFF; 4 ? 1 t TI 'lc :: : r .�._. r.. •: I : } i , . ! ' :' 1 3 BRANCH MANAGER f This certificate must not be oMered in any manner, return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN OF QUEENS BUILDING AND CODESS DEPARTMENT BAY & HAVILAND ROADS QUEENSBURYo NEW YORK 22809- TELEPHONE (528 ) 792- 5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME 1 LOCATION DATE PERMIT # � " ,APPROVED YES , NO FOOTXNG/PIERS ` MONOLITHIC POUR FORMS FOUNDATXON/DAMP-PROOFING BAC,KFILL APPROVAL t 'H PLUMBING FRAMING ELECTRICAL ROUGH-XN L -raULAT -ON: r FOUNDATION FLOORS WALLS f CEILING FINAL INSPECTION: { CHIMNEY HEXGHT ROOFING SIDING EXTERNAL PORCHES/STE S STAIRS-CLEARANCE & OILS PLUMBING FIXTURES11ELIEF LVE INTERIOR TRIM/PRIVACY DOORS FINISHED FLOORS - — GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL INNSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE` BUILDING DEPARTMENT BEFORE THESE PREMISES AAE OCCUPIED ! REMARKS : Y r I � r r � INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280k TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RRfE' CEIVED 9 NAME pr LOCATION HATE - +E+ � PERMIT #, APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APP AL 4,�"ROUGH PLUMBING �..-3°'RAMIIVG ,ELECTRICAL ROUGH�-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/,STEPS STAIRS-CLEARANCE a& RAI'LS'l PLUMBING FIXTURES/RELIEF ALV VE INTERIOR TRIM/PAIVACY DOORS FINISHED FLOORS - GARAGE FIREPR FING DOOR CLOSERS) SMOKE DETECTO S FINAL ELECTRICAF INSPECTION FINAL APPROVAL F CONSTRUCTION IL A SIGNED CERTI ICATE OF OCCUPANCY MUST BE OBTAINED FROM HE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: A%2 PECTOR /o wre o/ "ee"3 9"r y BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 96 &113 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME Si�4,.).�,l��w°• •' o • � n. LOCATION_,a DATE PERMIT NO. S"9--t; SOIL TYPE Sand - Loam - Clay -_ Percolatio Test Required? YES - 140 Percolatio rate - Min/Inch TYPE of SY.ST Absorption fi ld , total Length of each trench Depth of trench s L Size of gravel SEEPAGE PITS{Numb oft _ Size- ft. X ft. Gravel size PIPING : Si Typ Bldg . to tank > fI1 `- Tank to list. box Dist. box to field/ C �_ Openings sealed? ES O PaiFtial LOCATION/SEPARATIONS : Foundation to tank t. Foundation to absorp ion Absorption to lot 16 e Sepcjration of pits -fit • - A OF' SYSTEM N PROPERTY (circ one) r Front ear - Lef side - Right side Cp�ME - SYSTEM USE APPROVED YES NO 1 � r 5 Building Inspector 01/86 and v1. TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY 6 HAVILAND ROADS QUEENSBURY, NEW YORK 128094 TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INS ECTIO RECEIVED NAME r LOCATION 3 DATE PERMIT # Of APPROVED YES NO FOOTINGIPIERS MONOLITHIC UR FORMS FOUNDATION/D P—PROOFING BACKFI,L L APPR VAT, ROUGH PLUMBING FRAMING ELECTRICAL ROUG IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE '& RAILS PLUMBING FIXTURE$/RELIEF V LVE INTERIOR TRIM/PRIVACY DOORS FXNISHED FLOORSs' GARAGE FIREPROOFING DOOR CLOSER (S) :5 SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: a INSPECTOR TOWN OF QUEENSBURY !7 BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUFENSBURY, NEW YORK 12809- TEL,EPHONE ( 518 ) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR ��TNSPE/CT2©N RECEIVED c:? NAME LOCATION DATE c>2�� y PERMIT # APPROVED YES INO FOOTING/PIERS MONOLITHTC POUR FORMS FOUNDATION/DAMP—PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFXNG SIDING EXTERNAL POR ES/STEPS STAIRS'—CLEA NCE & RAILS PLUMBING KrxojOORS TURES/RELIEF VALVE INTERIORM/PRIVACY DOORS FINISHED GARAGE F REPROOFTNG DOOR CLO ER (S) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFTCATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS : s INSPECT YOU ARE HEREBY REQUESTED TO INSPECT AND ISSUE CERTIFICATES FOR THE FOLLOWING ELECTRICAL_ EQUIPMENT TO BE INSTALLED BY THE UNDERSIGNED DATE CITY[UP VILLAGE T],N+�',NSSHIP OOUHTY STREET AND NO OR F u t F/ Jr 1 / F .� F^ 7r- /I3 ! t.G/ ¢ RXE NVMBER BETWEEN WHAT TyyLJ C+x)v`5 SrREE'I'S, Ig RREMISE$ LOI;wOEDY R t } SECTK]N BLC7CK f �V LOTI'Wyr sNAME BUILDING OCCUPAIJCl/ - r— , CiMVNICH'S//NAME �AND ADDRESS / / 1 I'- !V / A+ I r t 1VF :S C' _' j f ''A e. ' e..0-:� AVF-' r/-! ! f !'�"'!r. r�-'ff G '� HC_1ME TELEPHONE NUMBER CURRENT SUPPLIED QY _ FROM THEIR OFFICE I . . 12 +7 L {. WORK TELEPHONE NUMBER BUILDING NEW eS J OLD ❑ y WVRk IS NEW 1100� ADDITIONAL ❑ DEFECTS REMOVED ❑ LOST BELOW ALL EQUIPMENT WHICH Yl7U INSTALLED Lorca- NUMBER OF OUTLETS No. rh Fixtures & MOT HEATERS BRANCH OFFICE U tion Lamp Rooe}alacIRs CIRCUITS Ceiling Wall ,�SideC�tarwi ONLY YYaJI eCe '!s S'RAICFt Pendent BTacltgt No. Type Ea P. ND WARS No, OUT• Each Nor. Gauge INSPECTION SIDE SUB- 13ASE BASE- MENT ISI FL. 2nd FL. 3rd FL_ REMARKY: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: THIS APPLJCATION IS INTENDED TO COVER THE ABOVE-LISTED EOUIPMENT 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 ADDJTIONAL EQUIPMENT, AS PROVIDED By THE APPLICANT. 512E OF MAINS FEEDERS ELECTRIC SIGNS+LAMPS TGRAL WATTS CHARACTER OF WORK ❑yy.E-%POSED 'GAS TUBE SIGN/TRAIN SF06 MERS OF VAL'S CONCEALED DATE WORK TO BE STARTED DATE COMPLETEp S12E OF SIGN fNUMBERI CAPACITY SERVICE ENTERS BUILDING ,�., � I MANVFACTIJRER DF IGN ❑ OVERHEAD I.hJ"LINDERGRgUND DATE INSPECTk7N REIXJESTED ON iLIR AS NEAR AS P(35516LE1 iM1�T E�T�� APiM.It�11MIT8 ` ID DEZAYS GrirING F1ILL ANO RATE INFORMAT ALL SPAC@S MUSS FILLED INOR I ON MAY pT{J ED. � PRINT NAME AND ADDRESS NN�.rA--M/£ OF APPLICANT - DATE OF APPLICATION C STREET ADD/RESS .,3 / ! iI`rAt1.Gr '(_=Y_. .�+� �- ,.+ r E PHONE Np. +Q +' r i ' {if / vc: r . � '4 < /✓r f F /ar ' ` ty ( i ?1�'. CITY OR POST OFFICE ZIP CODE LICENSE NO. WHEN APPLICABLE ❑ 86 John Street ❑ 41 Stake Street C] 564 Delaware Avenue ❑ 217 Lake Avenue NEW YORK, NY 10038 ALBANY, NY 12207 BUFFALO, NY 14202 R0CHESTERO NY 14608 1 ❑ SYRACUSE. NY 13206 THE NEW 'YORK BOARD OF FIRE UNDERWRITERS E�2% 1^• 1989 14 , oe, rgcPHILLIPS INS . 519 ?92 5941 P , 02 * r 15 US DA-1 F {MMrf?fi y THIS cGRTIFICATE IS ISSUED A$ A MATTER OF INFORMATION ONLY AND CONFEpS Wv oaeph ZOO k'L lI. p$ y Z-x1Q • r EXTEIGHTS ND OR ALTER THE COVHE IFICATE ERAGE AFFORDED @Y THE POLICIESI BELONOT W. AMEND. 20 E . Waelhin,gton Street - C3lana Falls , NY 128ol COMPANIES AFFORDING COVERAGE LP A Pireman ' �s rnel . L'4 . of Newark , NT Ara : .. _ .._ J ry , , _V 14 rudJw`'s S,:F rtFpr, f TF+; tNSUR I,U NAI !L :J AF.OVF FUR T FSF P0�jcy PIE RIQD INDICAT♦~p, N - NT Ic :r ,:: " r - ? G1 - 4 „ r -,PFs ,: "J';VMLf•ITxy,r- .. f :� ,C r. ,P'.;'+. 'iLc;('-tfJ iS S:+{3 IFS:T Tr:7 FE JL�THr rF-isfJH f.H `ri'S GE RTIF'iG A TE M AY - - JIS• FY%CLLF$I01`45, AND CONDI- -$ +f I lr i j S S 1. � . y Nifl, S .r Y4•f��,. yTF l- e _ -• *xlZr':91i(3 ti:1%..,"" ' ' ,:. + kj f•iF AA rj 1, SCfjj l :7 P0LI CIF 5 OF GANGELLP0 HE FORE 7HE Eli 'j, . ., f " H EFi LC..r s. &JING C[3FAPANY WILL ENDEAVOR TO r' .^^".I(' r=. �yE CLPTIFIGATE HUL❑ER NAMED TO THE . E' rv + . 0 .' F:',:f_ . r;' . £� t, :Y•, F,I_i;;-i `JJ�TICE Sr+.AIL INIP05F NO OBLIGATION OR :-.I ZL"I. I :;rr.., ANY KIND '_ 7rU ' •z,` PANV. ITS ACiENTS OR REPRESENTATIVES 7777 J s k • .�" TOTAL -- _- - W; 4 1 F' A ['LE 0S