1989-063 I,
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I i
II �
i` CERnT ICA T`EOCCUPANCY
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TOWN CIFF QUE'ENSSURY �
I 'WARREN COUNTY. NEW YORK
i I
1
Date December 89 �
This is to certify that work requested to be done as shown_ by Permit No,
has been completed. , ( �]� 1
This structure may be occupigo as a .21
Location 7 I3
Owner Jam 1: t �' ui1. iu
c
By Order Town Board
TOWN OF QUEENSSURY
i
Director of Bldg. do Code En or'cement
i
BUILDING PERMIT
TOWN OF QUEENSBURY No. 89 - 63
WARREN COUNTY, NEW YORK
Y 0
PERMISSION is hereby granted to 'fra l pntcz R7t f l c3r� r �
w�
OWNER of property located at ] 7B na7}aridge Street, Road or Ave. N
I
in the Town of Queensbury, To Construct or place a )r jot: R'rixi rpl r�x
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-
t- OWNER'SAddressis 60 Sweet Road
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Queensbury , N . Y . 12804
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2. CONTRACTOR or BUILDER 'S Name [6
td
Same !✓
3. CONTRACTOR or BUILDER 'S Address
SU
Same n
4. ARCHITECT'S Name
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5. ARCHITECTS Address `}
bj
W
A�
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6. TYPE of Construction — JPlease indicate by M ri
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KXWood Frame f } Masonry I } Steel I } QQ
(D
7. PLANS and Specifications
No. 291 x 42 ' 4 0f Fourplex as per plot plan , specifications , i
and application , including attached one car garage .
Ali
B. Proposed Use
A%IL 0
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4 of Fourplex
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25 . 00c/o
$ 219 . 00 PERMIT FEE PAIL? — THIS PERMIT EXPIRES October 1 fy 89
{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.l
Dated at the Town of Queensbury this 8th Day of March 19 89
SIGNED BY C/ foe the Town of Queensbury
Building and Zoning Inspector
'J wT+J� F UEENSI3UI2'Y APPLICATTON FOR BUTLOTUG AND ZONING PnR1%1TT
1'rx•t G-
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y
RL'.L.G d
r Fee Fred t --
MILDING AND CODES 'U1 :11ARTPsENFf Date Taaued
1AY and lIAVrLAJVD ROADS 1RD I Arai 93 �e
pURRNSBURY, NRIJ yopK I2804 pC mitt No . ;F -!j
Tel . ( 518 ) 792-5832 Rxt -204
.w w w ! a w' Ix w I r w a w w w w : w w w w w aw w w w w w w w w w w Y s
A PERMIT MUST D4 OB16AINED BEVORE BEGINNING CONSTRUCTION . NO INSPECTIONS
WILL B1: MADE UNTIL. AP141LICANT IIAS RECEIVE !] A VALID BUILDINC PERMIT .
Ali a ,-, Pl icatalC spaces on this application must be canlnleted and the
c. i jvuature of tile applicant must ap car on rite reverse side of this shoot .
k ar Ak A Q X
The owner of this property is �C:►t1T�`� ��rl,Ld..a '� G •
PoO . Address
rs err l a'� _TAX MAP N o .
sroperty location ova r2s 4
alas there been any spliL oC this property since October is 198E3 ?
Yes no
1f yes . Planning Board Review is necessary . LOT NO .
. UBDIVISIOtt " AMEN IP APPLICABLE
The person responsible for supervision of work as regards Building Codes
NAA1L P . O . ADURCE � S TEL . NO .
Z� Q < Tc 15ac c )
f builder ] Address & Q 5��
14LLMO o
6�. Tel � � 1 - � �s f
tdautic Df Pluuih. r a {ta2ca<.L Ccrarrs� l.ddres5b f' _
Nalne of Mason JY� G Y►^a t-� � '� '
Add ress Z +3uw r �* Le. N �� 'Tel '4A 9ci - z^ rxc�'�'
14.•l7URE or PROPOSED %Nolzr" : ZONING 1NVORPIATION ( Uffica: use On .i1 )
CnrtstrucLinr� of a Iaew building 'r I ZONING pLsicNNr3: 1N OF PROPERTY
_Ad4iciurl to a Uuil3ilaq # pER.MYTTED PRINCIPAL PERMITTED ACCESSORY
(Itoi:.Lian co e lC rjoing „ REVIEW REQUIRED - PLANNING HOARD ZONING BOARDeeewavee
{rro cla.�lrr] � to exc � riar rlilnensions ]
UGt+ur worl: (a4scriU -] SITE PLAN REVIEW fl APPROVED SATE
r
VARIANCE # APPROVER STATE
C14OSS AREA OV PROPOSED, S 'TTrUCTUkE
aw
a
1st Floor _ /�r /� ''`� sq ft .
Remarks :
2nd Floor sq s t . CO, iNi OLUM'1"IOIi R LIU114120 UL=1JA
# aiea of prolifiar
sq 1 C . t Other Floors lacisCil►q l�uil� liaaj { ::] Si=• I•` t X_„____,� _ .rt .
{ not cellar or bas .: rnentl ,r
`DOTAL FLOOR AREA ,(f L� Z+ sq f t ' Lxiitlrl lauilL1in&J l«: 1 U�•:
L• i4a of new x:Lructure
L'I,waa]:acion-XsierlslaL/ sw T�artial/ roll 1'salao::rr3 >,uiluinc] r cli : [ anc:u rrotu pra]lxul ty line
(circle one: ]
r a- � :.• xdcc ] Z Front yard � J i't Rear yar'B � f L
Nae of cmarie., 0L;Luit:.bl� i { Sidw ardu ?� T"��ft :and _
llVight [rJrar]¢ to riclrle ) tF ' fL . It on corner , ;uti�:x.:k frown Sielfd ,[ raaUt rG
1 f re;idL:nti:al , noo of frunt. lias / -- OCCuPA"c:Y INF0P.t4PATICH
Now of roots:; { excluding b"rhal � '7 `
too. of 1judrooiwa .3 r
p1tl)4AkiY LUILDING -
NO . Of fa;.l.Lltrooln:; Ono .Calmly dwelling
PrilwAry lru:xt1wLll9j sy :.• c �u;� �4-zp V- + 41 ''z Two f;AuVely dwull.iny
•Tylaw raf fuel f> r s • l�suitiplo �lwrsllirrrJ I' Number of Units
.. to L>� in!:e:alle d '"
No . of firclllacu :,; ��' • � Pa:ruuancnt occup:s[►cy
will :a woof sGUV.: Lie; 11tsst:. 11ud? rho '1'ran::ia ale occul�:arlc f
L'.:ntr"I Air colluititialsrr] ' .jf r �
� '� * Gsusi.nwss
BUILDING STYL.C, PRIK6*RY SI-RUCTURE lncluscrial
OLYt�r
tulact► cont"a.=:+ +r.ary Loonc .lain ; lE aaddiLioria wia.aG will uru k]e7
d rancli M.ansiu, l Dulalex
1l.*liL level Old u LCYIO 1.tuarLJe& low
C;Apu Cod Cottarle Ott r ACCi25SORY 13UILDIt�Io
Colonial lt+ow fawn House • UaLachau cj arsrrjGJanC car/ tvcr c;ar
car
CIRCLE ONE r• w hCtia.:Y1+=+:1 rj:arurjr+/ AQ MCA two car/ c�+ c'
w w w r w w 7k • w . w w r w IN w IN rULor"90 ]psi rlincl
LfI •l• YMh1' 1: [3 MA. RKr.01' VAI, UK OF 0 OL11a r
Aw
1NVORN&TION ON DUTLDTNC SprCIFYCATTONSa ON TCVERSE SIDS: Op 'rt1?a'' MSILL P 1'o 13P CO PLeo Vol
Form DPA 10188 V1
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BUILDING PERMIT APPLICATION COOTINUED -
BU1LDINC SPECIFICATIONS :
Type of construction , wood .frame , fire safe etc .
Will any second-hand or ungraded lumber be used? If so , for what ?
FoundatiOil wall material _
o0idC-/7� _Thickness
Depth of foundation below grade ( to bottom of footing,lt� .�/ " � � � a �
i r - r
Will tiler(! 1�e a cellar? a Heated or unheated? r� �` ct' FlDor set . footaget
Will there be a basement? --- Will any portion be used as living space ? �� ,�
( If so , wliat portion? sq , ft . - - Type of use >
Type Of roof - s Ope flat/shedfother �Lf L47 , Materaal of roofjj6_i �SCs,�s�r
Size , wood studs " X "' spacing "o , c , length c ` ft . :
Joists ( floor beams ) 1st . floor "X�" spacing,2 6 "o . c . span_ f� ft .
.Joists ( floor beams ) 2nd . floor .._cam"X_jo " spacing.ZE_ "o . c . span /ems' ft .
Overlays coiling beams ) lix spacing "o . c . span /hf ft .
Roof rafters "X9k Spa cing-o . c . span ft ,
Roof trusses (pre-engineered) spacings"o . c . span_ ft .
Exterior wall finish L O eay9 bj G., Of what material? CC�1-p f L
Interior wall finish ?14_c�eLu CA
If a garacle is to be at ached , de r ' be materials to be U!,6aO for I SEPARATION :
Is thorc tO be an opening between arage and dwelling". If so will a fire-rated
door , enclosure , and self-closing device be provided? ir --S
Will a flue-lined chimney be installed? cS Height aboveroof ft «
Depth of chimney foundation below grgVe ft ,
Depth of fireplace hearth_ ft . <1in . �-v-7
Water e;ul >J.,ly - Municipal or private well I L4 ru i
SEPTIC 5Y5'1'F :M _ distance from ANY private well ( inclu ing adjoining properties ft ,
(A separ .ite application is necessary for any repair or new installation of septic system)
D E C L A R A T I O N
'ro 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 ttIl provisions of the BUILDING CODE, THE ZONING ORDINANCE, and all
other laws pertaining to the proposed work shall be complied with, whether specified
or not , and that such work is authorized by the owner.
Signature
Owner, owner's agent , architect, contractor
ar
SPECIAL CON131TIONS OF THE PERMIT :
Ey--__ » .----------- - ------- --
ANN
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 . Type of heat u'r �
3 . is the building mechanically cooled ? t -�s
4 , Percentage of area of windows and doors
A . over 16 % Only
1 . ❑ 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
Be Under 16 % Only
1 . R value of roof and floors exposed to ambient conditions_
3 9'
2 , R value of exterior walls (2AQ
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
? . R value of slab insulation - heated slab
Be R value of heated basement/ cellar walls ( above grade ) f2* J . )
90 R value of 'heated basement /cellar walls ( below grade ) )
s �
lO , Type of insulation f ! -Yi 1 ==
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
be R value of duct in other areas
E . Piping Insulation
1 . size of hot water or cooling carrying agent pipe
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
Telephone Noe
applicant ' s signature )
a THE STATE INSURANCE FUND FILE COPY
199 CHURCH STREET, NEW YORK, N. Y. 10007
(212) 962-8900
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
EMPLOYER CESTi EICATE HOLDER =283-8
Town of Queensbury i
Valente. Builders Inc I
fiD Sweet Rd
Dave 'Haden
Queensbury N Y 12804 Bay Rd
Queensbury , NY 12804
UNIT PERIOD COVERED CERTWICATE NUMBER DATE ISSUED
Alb . 2 /l /88 — 2 /1 / 90 U — 4 . 1: 3/2 /89
THIS IS TO CERTIFY THAT THE EMPLOYER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND
UNDER THE ABOVE NUMBERED POLICY COVERING THE ENTIRE OBLIGATION OF THIS EMPLOYER FOR
WORKERS` COMPENSATION LINDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK.
IF SAID POLICY IS CANCELLED OR CHANGED IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 5 DAYS
WRITTEN NOTICE OF SUCH CANCELLATION OR CHANGE WILL BE GIVEN TO THE CERTIFICATE HOLDER. ABOVE.
NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION, Tcbtt><
16][R.�Ictt�ttniSi rae�cFckl �icSt�t�r&ies35t�111bf:�c5c6f 3f7d:i{i�it.�l�sYad�sTchtSc��ltTxS3.f�rF.t"'�ik1�6114x��c�x�c'x�c i"s��rJc�'ak��c1C�it
THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION .
/ V •.
H. JACOBS
DIRECTOR iNSURANCE
FUND UNDERWRITING
U-25.3 (19771
R 7l I S U R A. I+1 C 1)ATE : 01 3 d ��
r -� � r
-------`----------- --------------- - ------------- -- -------------------- -..........---"`---._._----------------
PRODUCER ; THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
1 ; NO RIGHT UPON THE CERTIFICATE HOLDER . THIS CERTIFICATE DOES NOT AMEHD , ;
Kinner ` s Insurance Agency ; EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW ;
202 &roadwayy - ----- ------- - - ---- - - ------------- ------- ---------------- --- f
F .Q. Box 179 ; COMPANIES AFFORDING COVERAGE
Whitehall , NY 12887 ; ------------ --------------------------------------------------------
(518) 499-0458 ; COMPANY A Hational Grange Mutual Ins. Co a
LETTER "
.............._---- ----_........._------r_----`- ---- ; COMPANY B `
INSURED ; LETTER
--__..-_----_,._______ 1
William Manell & Gary Manell DBk t COMPANY C '
M 3 M Construction ; LETTER
27 Blinn St . ^--`-------------------................--....... ----------------------
Whitehall , N . Y . 12887 ; COMPANY D
LETTER
-------- ----r- ----- '
COMPANY E ;
f LETTER _
COVERAGES __ ---"--------- _-_____---____---_
THIS IS TO CERTIFY-THAT POLICIES OF INSURANCE LISTEDBELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD ;
INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ;
GERTFFICATE MAY BE ISSUED OR MAY PERTAIN 1HE INSURANCE AFFORDED BY. THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, a
EXCLUSIOHS , 41iD CONDITIONS OF SUCH POLICES . "
POLICY ; POLICY ;
; CO ; ; EFFECTIVE ' EXPIRATION 'E
; LTR ; TYPE OF INSURANCE ; POLICY NUMBER ; DATE DATE ALL LIMITS IN THOUSANDS
GENERAL LIABILITY ; ; GENERAL AGGREGATE 5600000
A ; Cx3 COMMERCIAL GENERAL LIABILITY MF N35 580 ; 04/11 /8V ; 04/11/90 1 PRODUCTS-COMP/OPS AGGREGATE $6"0" ;
1 3 i 1 CLAIMS MADE Cx3 OCCURRENCE PERSONAL ADVERTISING INJURY 58800
& 0V
f 3 OWNER ' S F CONTRACTORS PROTECTIVE; ; ; EACH OCCURRENCE $300000
FIRE DAMAGE (ANY ONE FIRE) 5500-00 ;
MEDICAL EXPENSE (ANY ONE PERSON) 55000
1 1 --
AUTOMOBILE LIABILITY '
CSL 5
{ l ANY AUTO -- ---------- : -----`_._----- ;
I I ALL OWNED AUTOS ; ; ; t BODILY INJURY ;
C 3 SCHEDULED AUTOS ; ; (PER PERSON) ; 5 --
I ] HIRED AUTOS ; t ; ------^--------- ; ------`--- -- :
C I NON-OWHED AUTOS ; ; ; BODILY INJURY ;
E 3 GARACE LIABILITY ; ; ; IPER ACCIDENT) `+............
PROPERTY
DAMAGE ; 5
EXCESS LIABILITY EACH OCCURRENCE --_AGGREGATE
C I UMBRELLA FORM ; ; ----- -- ;
C I OTHER THAN UMBRELLA
{ ft ; 3 STATUTORY ;
; A ; WORKERS ' COMPENSATION ; W F39 78n 0t/21/8Y G6/21/90 ' --__- ; 5100000 R- (EACH^ACCIDENT)
-------- ,
AND ;
E S500000 (DIS
EMPLOYERS ' LIABILITYEASE-POLICY LIMIT) i
51G MOO (DISEASE-EACH EMPLOYEE) ;
OTHER
1 1 ;
1 1
1 1
t '
DESCRIPTIOti OF OPERATIONS/LOCATIONS/VENICLESISPECIAL ITEMS "
CERTIFICATE HOLDER _______________________________________` CANCELLATION --
SHOULD ANY OF THE ABOVE-DESCRIBED^POLICIES^BE CANCELLED BEFORE+THE-EX-
Tow of Clueensbury
; PIRATICH DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAKD TO THE
Bay Road ;
Glens Falls} H . Y . 12801 LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE ND OBLIGATION OR
LIABILITY OF ANY KIHD UPON THE COMPANY , -ITS -AGENTS OR REPRESENTATIVES. - i
ATTH: Dave Hatian ; -------------------------__------ - ;
-------AUTHGRI2 -_ REPRESENTATIVE
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1 1 001 WESTERN AVENUE — _ �,� .., t �.itii� .� .:i'r " i�+r:_:: r•i � . � ilJ�t�{AC.i
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LFTTER
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I. .~• —T! 11 t; I;,i i O CEiiljr Y THAT FG L3ii�:: Ur ui::iJ R.+ J::� LI:.TCD L;.:L[7;! rY.�.VV I-.i +'1 3 'U;=JIeJl tfk= lr3.fllrlt_DE ++L r0 L.i CY PI=FIOD INI)ICATEJ.
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CbLLAPSE IIAGnJ rhj*jd i LC LtTEO OPLriti ' G.55 1 - - ---- _ _—
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AND S ;- - --(,,,;r i.::E-F-U(JCY Ll l WIN ll
EMPLOYERS' LIAr31L47Y --_-- -._.-__.�- ---y; ILI:i:i,SE'-EACH I:I.iYL UYEEj
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�I OWN Or QUL-:I_:NSBURY PYHA1' IOId D 7L THCRLOF, Tlit 1`, .li C. CCUi:,:PANY WILL ENDEAVOR TO
AT l N W DA V E. F M I �-N e � n,AiL 3 f!) UAY:� WHIT_rEN Nv7 ,C:. 'I CLI, i rr=L a7c HOLDLk NAi.+ED 'rO THL
BAY LOAD L.=L'T, :J i rr+IL U,4U TO MAIL SLIC:.i r,.: i I.-:- =as: ,LL id.krG:: NU OULIG..7 ION Oic LEALSILITY
k Gr ArJY Kk iO `kOH T_Ht CMAI>A114 1 r.'r` r;a i;ZPitESENTATIVES. 1'
QUh FN�;DURY , NY 12804 ! ; :.cFTrcl ,I.to Z 3L =rJT IV k
t ter- r:1 Y:• - :;Y� `:}=YS' : 1�
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THE NEW 'YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
41 STATE STREET. ALBANY. NEW YORK 1220T
Date , - ApPlicatiart :Yo. onfile . .
THIS CERTIFIES THAT
only the eleat"'cal *q" Pnssrs.t ae desenibed below and introchsced by the �t n�iraiifd an the Above spplicrs.+rn. nu�rabaer in the pro++aasaar of
t' r. . .
in thefollowing Location; 0 Hosement lat Fl. 2nd Ff. Section Black Lot
was examirsed on - - } r ok and found to be in cornpliance with the requirements of this Board.
RXTURE TACLES aWIT+CMES FIXTURES MANORS COOKING DECKSOVENS NSH WASHERS EXNAIM FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMr• K. W. AMT_ K. W, AMT. K.W. AMT. K. W_ AMT. It P.
. ;
DRYERS RJRNACE AAOTORS FUTURE AFFUANCE FEEDERS 5MCIAL REVINT TIME CLOCKS UNIT MEATERS MULTI.OUTLET E1IMMERs
AM7, K. W- OIL H. p. GAS R, r. AMT. NO. A. W. G. AMT. ANTI. AMT. ANTIS. TRANS. AMT. H. I, SYSTEMS AMT WATTS
NO. OF FEET
i r
SERVICE QLSCONNECT NO. OF S E R V I C E
4M7. TYr'E METERR 1 ,V 2W 110 3W 3 A" 3W 31 4W RIO• OFP6R A•COND. GF C COhID. NO. 8f RI.1€G OF � NO. OF 1iEUTRALS i1'Al
V \
.
O A TUS:
I
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. f r C
J. I' ,
Fi
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BRANCH MANAGER
This certificate must not be altered in any manner, return to the office of the Board if incorrect. IkWoors may be identified by t r credentials.
BE 0111101
COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MASTMT BE ALTERED IN ANY MANNER.
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK I2809-
TELEPHONE (528) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEXVED
NAME ia
LOCATXON f �/
DATE PERMIT # ( — 3
APPROVED
YES NO
FOOTING/PXERS
MONOLITHXC POUR FORMS
FOUNDATION/DAMP—PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN
p,,.JFN'SULATXON: f
FOUNDATION
FLOORS
WALLS (,
CEILING V
FINAL XNSPECTXONe
CHXMNEY HEIGHT
ROOFXNG
SIDING
EXTERNAL PORC ES/STEPS
STAXRS—CLEA NCE & RAXLS
PLUMBXNG FX TURES/RELIEF VAIaVE
INTERXOR T IM/PRIVACY DOORS
FXNXSHED RS
GARAGE F EPROOFING
DOOR CLO ER (S)
SMOKE D TECTORS
FINAL E TRSCAL INSPECTXON
FINAL APPROVAL OF CONSTRUCTION
A SXGNED CERTXFXCATE OF OCCUPANCY MUST BE
OBTAXNED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPXEDL
REMARKS:
1
T
XNSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
SAY & HAVILAND ROADS
QUEENS.BURY, NEW YORK I280&
TELEPHONE ('518) 792-5632
BURRING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME ♦z
LOCATION
DATE PERMIT # j - 3
APPROVED
YES NO
OTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
SC�ROUGH PLUMBING
RAMING
ELECTRICAL ROUGH-IN
INSULATIO
FOUNDATI
FLOORS
WALLS {
CEILING
FINAL INSPECT'ZON.:
CHIMNEY HEIGHT"
ROOFING
SIDING
EXTERNAL PORCHE STEPS
STAIRS-CLEARANC & RAILS
PLUMBING FIXTUR S/RELIEF VA VE
INTERIOR TRIM/ IVACY DOORS
FINISHED FLOOR
GARAGE FZREPR FING
DOOR CLOSERfS
SMOKE DETECTO S
FINAL ELECTT'ICA INSPECTION - -
FTNAL APPROVAL F CONSTRUCTION
A SIGNED CERTI ICATE OF OCCUPANCY MUST BE
OBTAINED FROM HE BUILDING DEPARTMENT BEFORE
THESE PREMISES RE OCCUPIED!"
REMARKS:
axNSPECT�OR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HA VILAND ROADS /J
QUEENSBURY, NEW YORK I280Q&
TELEPHONE (518) 792-58.32
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION Z
DATE S - ,/ PERMIT # k47�
APPROVED
YE NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHESI STEF?S
,STAIRS-CLEARANCE & MILS
PLUMBING FIXTURES/ZELIEF VALVE
INTERIOR TRIMIPRI CY DOORS
FINISHED FLOORS
GARAGE FIREPROOF NG
DOOR CLOSERS)
SMOKE DETECTOR
FINAL ELECTRICAq INSPECTION
FINAL APPROVAL PF CONSTRUCTION
f
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE ,PREMISES ARE OCCUPIED!
REMARKS.
4xspEc:TOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVrLAND ROADS
(2USENSBURyf NEW YORK 12801
TELEPHONE (528) 792-58.32
BU'LDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
- - NAME w , -�w•...�.�._�_
DATE PERMIT # L f
APPROVED
YES NO
DOTING/PIERS f
AONOLITHIC POUR FORMS
FOUNDATSON/DAMP-PR00F2NG f
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-rN
INSULATrON:
FOUNDA TION
FLOORS
WALLS
CEILING
FINAL rNSPECTrON:
CHrMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEPS
.STAIRS-CLEARAIVcE & RAILS
PLUMBING FXXTURES/RELIEF VALVE
INTERIOR TRrX1PRIVACY DOORS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSBIR (S)
SMOKE DETECTORS
FINAL ELEC'7RICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
x
A SrGNED .CERTIFICATH OF OCCUPANCY MUST BE
OBTAINED FROM THE BUrLDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS.
7
I
i
TOWN OF QUEENSBURY
BU.ILDXNG AND CODES DEPARTMENT
BAY & HAVILAND ROADS .. ___. . Ff :
PUEEN,SBURY, NEW YORK 12801
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST INSP. CTION RELIVED /
NAME
LOCATION f
DATE � PERMIT �'# r
APPROVED
YES NO
FOOTXNG/PXE S
MONOLITHXc UR FORMS
FOUNDATION/D ~PROOFING
BACKFXLL APP VAL
ROUGH PLUMBIN
FRAMXNG
ELECTRICAL ROUGE!'-IN
XNSULATION: kt.
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION: 1
CHIMNEY HEIGHT
ROOFING
.SIDING
EXTERNAL PORCHESIS S
STAIRS-CLEARANCE & ILS
PLUMBING FIXTURES RE BF VALVE
INTERIOR TRXM/PRX ACY DOORS
Pl NXSHED FLOORS
GARAGE FIREPRO9 NG
DOOR CLOSERS)
SMOKE DETECTOR _
FINAL ELECTRICAL INSPECTIO
FINAL APPROVAL F CONSTRUC ON
A SXGNED CERTI XCATE OF OCCU NCY MUST BE
OBTAINED FROM HE BUILDING DE ARTMENT BEFORE
TIIESE PREMXSES ARE OCCUPIED!
REMARKS:
1
1
INSPE,,. MR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
,BAY & HAV I LAND ROADS
QUEENSBURY, NEW YORK 52809-
TELEPHONE ( 5I8) 792- 5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME �� k"r i r' a S
,7
LOCATION /� c � rf /,y [ ?� h'%}
DATE , "�' i /PERMIT # 'Y _
APPROVED
YES NO
FOOTINGfPIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
X ROUGH PLUMBING
XX464MING
ELECTRICAL ROUGH-£N
INSULATION:
FOUNDATION
Fr.OoRS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING f
EXTERNAL PORCH S/STEPS
STAIRS-CLEAT CE & RAILS
PLUMBING FIX E
S/RELIEF VALVE
INTERIORrRTCAL
/PRIVACY DOORS
FINISHEDRS
GARAGE FOOFING
DOOR GLO
SMOKE DERS
FINAL ELEC INSPECTION
FINAL APPROVAL OF CONSTRUCTION
f
r
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
�f�/7�r �f7•°t-R.f�T4Q �1.J PG 12 �L-Ll NS
INS CTOR
i
TOWS OV QUEENSBUR'Y
BUILDING AND CODES D EPARTMENT
ROA
BAY 5 HAVILANNEW YORK 22804 Ip
-
OUEENSBURY. 528 ) 792-1132 ,
TELEPHONE ItEpf7RT
BUILDING LDISG -INSPECTOR'S
REQUEST FOR INS P CTION RECEIVVV�
NAME
LOCATION ERMIT #
DATE _— V D
YES NO
FOOTIN61PIERS
MONOLITHIC POUR CORMS-- -
FOUNDA TIONI DAMP.t'ROOF=NG_�-�
BACKFILr. APPROVAL
ROUGH PLUMBINd
FRAMING 3'
ELECTRICAL ROUGH-IN__�- -�
INSULATION-*
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT v
ROOFING
SIDING S Ep5
EXTE.RB PORCHEE RAILS
STAIRS--CLEARANCE RELIEF VA
PLUMBING FIX3URE _---
INTERIOR TRIMII'R VACY DOORS
FINISHED
FI LOO EpROoING
GARAGE CLOSER (S)
DOOR
SMOKE DETECTOR INSPECTIONS-�-
FINAL ELECTRICA F CONSTRUCTION_��
FINAL APPROVAL
CERT FICATE OR OCCUPANCY MUST BE
A, SIGNED THE BUILDING DEPARTMENT BEFORE
OBTAINED FRO OCCUPISD !
THESE PREMISES ARE
REMARKS 441M
�f I NS PEC TOI2
i W
YOU ARE HEREBY REQUESTED TO
INSPECT AND ISSUE CERTIFICATES
FOR THE FOLLOWING ELECTRICAL
EQUIPMENT To BE INSTALLED BY
TEMPO
THE UNDERSIGNEDG / C
CITY COUNTY
VILLA`GE w. TD/ NSMIP/'
�./'-..&A"� L4 to V/'.c-"
POLE NUMBER
STRF.IET NO Of# ROAD dIr G 0 `
'42r� LZ aw
BE'fv4E£N WHAT TD CROSS R,STE 95 PAEMt I..IXJB'EU7 --. SEG'f�1N RI..OGK T
W
OCCUPANT'S NAM ^ BUILDING OCCUPANCY
�r HOMET LEPHOIVE NUM RER
OWNER'S NAME AND ADDRESS t r �^ f"15 f . l -4Z &-0
tc,
CURRENT SI.IPPL7ED BY EROM T IN CE W'UFtl{ EI.F,PHONE NUMBER
c /his ,,..."..
BUILDING IS
NEW OLID ❑ WORK IS NEW bee ADPITIDNAL ❑ DEFECT'S REMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU 1N87rAL1 ,ElD
NUMBER OF OUTLETS ND' Uf Fxtures & MC+fORS HEATERS BRANCH f7FFICE USE
Loca- Lamp Receptacles CIRCUITS ONLY
Wam ntgo INSPECTION
tlUn Side Aecep'It Switch Percent Bracket Na Type EHaccin Na. E„IchzIch NQ- �UgB
Ceiling Wall Reoep'Is
OUT.
SIDE
SUB-
BASE
BASE-
MENT
FL.
end
FL-
3rd
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REMARKS: LIST Cn HER ELECTRICAL DEVICES NOT SE}' FCIFSPH ABOVE:
THIS APPLICATION IS 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 AUTHORIZEID TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER
THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT
PCHARACMH
S
FEEDERS ELECTRIC SIGNSILAMPS TDTAL 4WTT3
GF WORK ❑ E%POSEDGAj TUBE SM:Ji'rPAN5FURMERS GF `
CCNJCEALEDTo BE STAFffEUD' 'E IX}MPLETED 52E OF SIGN{NUMBER] G4PAGITY
TERS BUILDING MANVFACTURER OF SIGN
OVERHEAD L-'. UNDERGADUNO �F 3 /y
DATE INSPECTION REQUESTED ON iOR AS NEAR AS POSSBLE} MWDc � it A - !♦/�I _.I I _I . &I � �. } � �.9 1 '�
MCX LAYS BY GIVING FULL AND ACCURATE WO MATION. A SPACE, MU$T BE ED tN C1R APPLI 7TI�IN�Iillr��!! s 7ll ��/!U' RAINED.
PRINT NAME AND ADDRESS
NAME OF APPLICANT DATE OF APPLICATION CW w
LEP ONE N0
STREET ADDRESS
ZIP CODE LICENSE NO. WHEN APPLICABLE
CITY OR P06T OFFICE
❑ 115 John Street El41 State Street El584 Delaware Avenue [� 217 Lake Avenue 1 ❑ 202 Arterial Road
NEW YORK, NY 10038 ALBANY, NY 12207 ` BUFFALO, NY 14202 ROCHESTER, NY 1460& SYRACUSE, NY 13206
THE NEW YORK BOARD OF FIRE UNDERWRITERS