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1989-086 wR* , .� h l +CERTIFICATE ` CIF ,OCCUFAT CY r s TOWN OF QUEENSSURY WARREN COUNTY, NEW YORK � I 1 Daft I I July 17 xq $ 9 i This is to certify that work requested to be done as shown by Permit No. has been completed. This structure may be iu=wied sa a rig t' riwra 1 l_ J taQ i l„OCatiOtl Owner FtsJCe s t L Tooc3 Iic��st� i By Order Town Board i TOWN OF QUEENSSURY Director of Bldg. do Code Enforcement :I f i = BUILDING PERMIT I TOWN OFQ.UEENSBURY 89 - 86 11-0 No. � WARREN COUNTY, NEW YORK G PERMISSION is hereby granted to w T o 1 09 C7alc Tree Cf rr- 1 a Street. Road or Ave. I �+ OWNER of property located at wo n 1P `� i]vac� in the Town of Queensbury, To Construct or place a '.i<�"��x�-�C� j I I S i n g 4wo 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. [2. OWNER'SAddressis HC- 02 Box 286P Warrensburg . N . Y . 12885 C) trt CONTRACTOR or BUILDER'S Name `a L0 rt Self ME 0 0 3_ CONTRACTOR or BUILDER'S Address z �+ Same f] i N 4. ARCHITECT'S Name F6. RCHITECT'S Address p rt Ci YPE of Construction — (Please indicate by X) 131 �. Wood Frame { ) Masonry I ) Steel H 1"f 7. PLAINS and Specifications f4 No 26 ' x 28 ' Single family dwelling as per plat plan , m specifications , and applicationincluding septic and attached n B. Proposed Use 10- r M Single Family Dwelling X ri 25 . 00 C/O 18 89 � S _ 199 . 00 PERMIT FEE PAID - 711IS PERMIT EXPIRES October 1 11f a longer period is required an application for an extension must be made to the Building and toning inspector of the town of Queensbury before the expiration date.) h 17th Day of March 19 89 Dated at the Town of Queensbury this F f for the Town of Queensbury SIGNED BY Building and zoning Inspector A n r i4 TOWN OF QUEE1VS13U7 Y APP1. TCATTON FOR TiUILi7Ir1C AND ZONING PPRh1IT Pecieved /�G' ©WN F QUEEN EDSBURY RECEReviewed ` ��5" MAR 1989 Fee MINI fi Date. 1.abued BLDG, & CODE DEPT. WILDING AND CODES U1 �] ARTN�..A.T — - BAY and 11AVILAND ROAMS RD 1 BOX 93 (�UEEWSBURY, tmr YojRx sasoa Fehrni t Na . _ _ Tel . ( 518 ) 792-5832 Ext 2L1l • iY x' x x M LW x 1 x x ak YY x } x ][ x x R x } x x x x fa x • Ia x x x ■ x x x A I'ERHIT MUST Do OBTAINED 13EFOIIE BEGINrIING CONSTRUCTION . Na INSPECTIONS U' L' HADE UNTIL API"LICAMT HAS RECEIVER A VALID BUILDINC PERNITT . A11 sl� IzlicabT � spaces on this application bust be completed and the � ji vnatuTe of the � aripiiAant *must appear * o * the *ever ' side of �h � srtsl*ekt � 'rile owner of this property is : � 1111 [ 1 TET. . _f , PIN Address - + kk r l (i roperty location 11'�� Q �+ Niv r i vrl� ►o[� `TAX MAP NO . tlas there been any spl. ic of this property since October 1 . 19BfI ' yesu no' If yes . Planning Hoard Review is necessary ' { LOT NC► . SUBDIVISION NAME , IF APPLICAnLE . --{hi_ Crudes is ; person responsible for supervision of work as regards Building Uc NAME P . O . ADDRESS i` 9 � �+'' ;x,�w' , , �";• sir= i��Tel 3 � Name of tauilder r 1 Q� - dT�, +.'� Address 12.E iar', I Tel wame: of Plumber-��, a �� L T.ddress Tel Name of Mason � 7. Y�y( is ��!) l{�� Addro5s G f � NATURE OF fROPO,IED 6011r% : ZON NG IN1-'WU1A'I' ION ( orf.ice use onill " ' f'on PCs uCcion o£ a [tuw building + ,CONING DESIGNATION OF PROPERTY ' PERMITTED PRINCIPAL PERMITTED ACCESSORY Addition to :a building { ,A1Ca.:a:.acion to a Luilding . REVIEW REQUIRED - PLANNING 130ARD ZONING BOARD (ara ch'Lknal.: to a:xtvrior Uimcnsiran ;l APPROVED DATE OLI [c: r work isle_cril-i SITE PI-I REVIEW # + ,r VARIANCE # APPROVED CROSS AREA OF vitoposcD. sTiitUC't' URE f +r lst Floor J� � sq ft . Remarks : Ar ��ii 2 nd Floor %t �} to _ sq f t ,. COitPi.L`1't» I;li'Ol:itr►'L'2ON 1t "U114LUD JAL L.JW M I �^yQ rt x ! rt . � �(, Sixa of prol,urty�,,--1 ' other Floors sq ft ' "it;uJi j bUi1l1.1LJ1 :: 1 S3x+= fC x rC . ( not collar or basement ) ,. TOTAL FLOOR AREA sq f t . ' uxi.r: cing ga. i. la.J .' iG. of nrw structur. ft Y. ft " �"�-- t'oa=rad;arson-pier/ ::laL7ctnwlli�arGia.1 1] 1• rpgoand iauilt3ing , c1i :canCa: from proporty sirwu (exrclU oni ) Front yurd3` f' t !tear yurd ? ' ft Na of stories (habi.t:.Yala: •pace ) o 3 t^ t :and ,�- �; rc t'' ,� Sida: yards r` c Ila.igtsC ( tirade to ri,dqu ) � N) ft . If on corna3r4 siclu :tr. : r c If rasiduAtialm no* Of f OCCUpAN,1tl INFORMATION Noo of rootn1l3 ( excluding b:-athal Lo Ho. of b(_droa[a:t # P114HA1tY LUILDINC: NO * of b:.C)wroo[[ fancily dwelling prill"ry Iti4jaciik4i :;y L . u[ ' Two family dwuiling lYlau uC fuol uns Multilala 4wclling / Number of units,._ No . Of firu11laca:;; tG> Ian alY::tallcd i�w'ritw:inLllG accup:urcy Will :w woud stave: ba ilwt; l :. 11a:d ' Tr"n:;"mnt OCCUJI:araay C:cnGr"l Air coaulitianinUN? _ iiu..int+ss BUILDING STYLE, PRIMARY STRUCTURE ,� Ynclwtscrial Ozhur IunClt Contaau,ix,r.Lry LorIN W a Cabin if addition . wl «ati will u :u ha t l;.ai :mod ranch MN:an:sic,n Dupl IN:x w Iillit luva:l Old acylaa 1tujatj"1Qw ACCESSORY BUILDING as Co d Cott:.at� .: Qr h :r Car L'a7wr, liause Uc:cacbad gariwcle/fone czar/ two c ' `01oni"l ROW cuv lYY� CILLCLL� CJt1J: PLEASE ) ' v'-Attuchu�:i q:+ragu/o11a: talc", who car F . _ • s * • . w x ■ • x • * i'r i.V.:a Ce 4'.tO r:a C]L' k}wlilGlina] a� 'L' IMA7' 1. R MARKr-AV V AI. 0 * ^Toth+= r L r INT'ORFtATION ON i3tiTL.pTNC �SriFCIFICATIONS , ON REVERsce f.IDE OF TliIS SHCETir R'o BE CompLeTco : Form BPA 10/88 v1 BUILDINGG ijE'RMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe etc . Will ar'y second-hand or ungraded lumber be used? I£ so , for what '? Foundation wall material { t. r..,'. Thickness Depth of foundation below rade g { to bottom of footing } :5- Will thero be a cellar ? Heated or unheated? Floor sq . footage sq ft Will them be a basement? Will any portion be used as living space ? rI ( If so , what portion': sq . ft , - - Type of use? Type of roof - tslope.d/iflat/shed/other Material of roof ' ` ! �2 t tom , lr, . � ' !3 _ Size , wood studs _ � '�}C ( spacing ! "o , c . length c ft , ei Jam^ Joists ( floor beams ) 15t . floor C;";1_1 Fox E 1.3 " spacing �'oo . c . span fd ft . Joists ( floor beams ) 2nd . floor 0 "X l (J " spacing "o . c . spun� t . Overlays ( c: e .i. ling beams ) "K " spacing "o . c1 span ft . Roof raft.Ears "x " spacing O . C . span ft , Roof trusE; es (pre- engineered) spakcing_ ,� y " o . c . span�"L_ft . Exterior wall finish S . .� Of what material ? Interior wall finish� r . � If a garacEe is to be attached , describe ateraals to be used for FIRE SEPARATION : p kl od Is there to be an opening betwedr'x ga age and dwelling? r= If so will a Fire-rated door , enclosure , and self- closing device he provided? �j r -S Will a flue- lined chimney be installed? y Height above roof �- ft , Depth of chimney foundation below grade ft . Depth of fireplace hearth ft , in . Water supply - Municipal or private well - . - t. ° ' SEPTIC SYsq,EM _ 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 1 0 N To the best of my knowledge and belief the statements contained in this applic0tion, together with the plants and specifications submitted, are a true and complete statement of all proposed work to be done on the described premises and that tall 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, Y Signature ` r'. , ,r* ram_ Owner caner'$. agent , architect, contractor 4 SPECIAL CONDITIONS OF THE PERMIT : By f 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 ho P I PGTr I - 3 , is the building mechanically cooled ?� ( } � y 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 3 . R value of glazed area 4 , R value of doors C 5 . R value of floors over unheated spaces f � 1 6 . R value of slab edge insulation - unheated slab _ 7 . R value of slab insulation - heated slab s . R value of heated basement/ cellar walls ( above grade ). g , R value of heated basement/ cellar walls (below grade ) ` \� — ti low Type of insulation C , Controls 1 . Thermostat maximum heat setting � 1 -- D . Duct Systems 1 . Is duct system installed in unheated spaces ? lES NO a , if YES , R value of duct installation b , R value of duct in other areas E . Piping Insulation 10 Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating gip✓ 1 . Performance efficiency }( *� 2 . Temperature control setting maximum ol O G . For Swimming Ponly 10 Maximum heating Telephone Now t fJ1 ■ -- ( a lican s signatu +e ) '!'OWN.,OF QUEENSBUR'Y APPLICATION FOR. SEPTIC DISPOSAL PERMIT DATE_ � p1 LOCATION OF PROPERTY FOR INSTALLATION J 0J k ±Yee- � Yr"!P Owner's Name& L y S dh 26J _}p7'7?rr� Telephone: { Address: nr l7 k r r G IVr T Installer's Name: balvid1 l G6�'�' r Telephone: Number of bedrooms (residential only) Total daily flow (compute ( 150 gal per bedroom) V,12 — _ Topography: Circle one: la Rolling Steep Slope % of Slope Soil Nature: Circle one: O'and') Loam Clay Other /Depth: Feet Ground Water: At what depth? J Feet Bedrock or Impervious Material: At what depth? Feet Percolation test: Circle one(. not required required rate min. inch. Domestic water supply: circle on c Munictlp Well Other If domestic water supply is a wf Separation: Water supply from septic absorption feet PROPOSED SYSTEM: Septic Tank c X-- 2 gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench feet/Total system length L feet SEEPAGE PIT(S); Number of / Size each feet 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 abide by these and all requirements of the Town of Queensbury Sanitary S .,age Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: ' DATE: A i �r OVER R S(= PCic S stem Ins�aectians : A . All aPPIequi edCions for septic system installation , alteration or repair , by Ch as required o Town of Queenshury 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 . 1 . } Clio 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 , rile fields and /or drywells BW No :system sha.11 be cOvr: red before inspection and approval by the Building Inspector . Failure to comply with this requirement may result in Che uncovering of the syst 01 up to $ 250 . 00 , e::I by the installer and a fine C . An approved copy of the plot plan shall be available on the construction Site . Failure to produce said lot P plan at time of inspecti result in an immediate work stoppage , on may D . Should unforeseen problems during construction prevent proper installa— tion , alteration or repair of an approved system , a new proposal must be submitted to the Quoonsbury Building Department before further Construction . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 R� jiiarks : tw 11 /21HOT/88 PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS ENO RIGHTS XTEND URUPON ALTERHE CERTIFICATE HOLDER. THIS T4`iE COVERAGE AFFORDED 6Y THE IFPOLICIES 9ICATE E LOW.S 140T AµENfl, Avid Insurance AGency , Inc . 425 New Karn+er Rd . COMPANIES AFFORDING COVERAGE Albany , NY 12205 LETTER COMPANY AGeneral Accident Ins . Co . COMPANY LETTER B The State Ins . Fund LETTER INSURED G & C Plumbing & Heating Co . , Inc . COMPANY LETTER 130 Quail St . ;Y Albany , NY 1 2206 CC)MiANY JD LETTER COMPANY ka LETTERfd THIS i5 TO CERTIFY THAT POLICIES OFINSURANCE LISTED BELOW HAVE BEEN ISSUEE)TO THE INSURCO NAMED s UW,;E. FOR THE POLICY PERIGO INDICATL:13. THIS IS O CERTIFYSTANDING ANY REQUIREMENT, TE.RMI Ofi CONDITION OF ANY CONTRACT Ok OITRcrS DOCUh4CNT 1n111i i11:SPFCT TO WHICH THIS CErKLflFiC,^,TL �.'..AY BE SSSUCD OR MAY PERTAIN, THE 4NSURANCE Ari=UtIUL 7 BY THE POLICIES DLSSCRi"D itc'iiEIN IS SsJWEC r �f O ALL T Ixi l�EII..�S. F.XCLk It7I:::, .1.I,IU Gt7NDI• �. iX TIONS OF SUCH POLICIES. k ` . kA aILITY Lk 111 ri•4UU -1,ri U:i �� I' PI.L IC4 Lfi Lf r4 PtA I + t IL•I .VI. _. CO TYPE OF INSURANCE POLICY NUMBER LTR GENERAL LIABILITY noun r IiJJ it l'1T ,[U $ CUMP#3LN ErJ SIVE TORmt !� A PRLhIISC.510PERATICNS IrFiCji l;F3TY l��i UI.UCROROUNO E7{PLO3I014 & COLLAPSE HAZAROi. r POOUGISJCO:tPLETEL) EIPLRAT40N5 la s .•u , core riucruAL srtP 701251-C11 3f29/88 3f29f89 L�Jr.,II:NI-� � SbO , k5c7(7 , ; IriaEPLNUENT CONTRACTORS - ---- —fk k_ BIiUAO FORPA FRUPfRT'r C7FuVIAGE n PEIiSUNAI. INJUTAY PEH50I`dAL INJURY AU16FIvLO 1LE LIABILITY f $ANY AUTO lrfli r[.+9NrI A ALL OWNED AUTOS (PRIV. PASS I ALL O OTHER THAN}OWNED AUTOS PRIV PA:,;.. - r_ H1RE,O AUTOS PFi(:' '1:1ITY S, . ir"ON-OWNED AUTOS BA 0019391 01 3/ 29/88 3/ 29/ 89 ..� '. GARAGE LIABILITY 61 s PU con,ISIh�D 750 , EXCESS LIABILITY [`1I S 1'Ll UMBkELLA FOWA ` ..., OTHER TRAN UI.16F;LLLA FORt.3 53 A I U!L�r•+.Y YVORICERS' COMPENSATION IIAUH ALLII:3LNT) r� B AND To Follow from The Stat Ins . Fund 823336-3 $ {L)IScnsE-POLIi:r I LI.IIII a EMPLOYERS4 LIABILITY IUISLr:;;E-E,AUREMPLUVEL) Ilk OTHER a • DESCRIPTION OF OPiERATION&LCnCAliQt.lSNEHICLES,'SI'ECIAL ITEMS -- ' Plumbing & Heating Contractor . Subject to conditions & exclusions of the policy . `.k" .;, 9 S t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX kd Forest Wood Homes PIRATILIAI DATE THEREO:'r ZHE ISSUING COMPANY WILL ENDEAVOR 7O 13 'Thunder Run MAIL EE ll1l DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICEA E SHLL IMPOSE NO OBLIGATION OR LIABILITY Ir �;l^ GansevODrt , NY 12831 OF ANY KIND UPON E CUM?ANY I - AQENTS OR nEPRESFNTATWES. AUTHORIZED HEPR N ATIVE ., . !• c f r ♦ Y r A w e +�sisl 41,i' F i+ i.# . � r4#f '.' . , r y i` • • P 0-1 1 14 R . ia�' rr8il.i '' S 3sa1 '�' •�I LPL, itr V,sy t �' �.:I>mr ..wS, i ISSUE DATE (MMI4OIYY) Ila :u�: s►. CERTIFICATE OF INSURANCE 3 /10/8`9 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON" AND CONFERS EXTEND OR A RIGHTS LTTER THE COVERAGE AON THE CERTIFICATE FFORDED BY THEI THIS RTIFICATE DOES POLICIES BELOW NOT AMEND, Wise Insurance Brokers, Inc . 10 Railroad Place COMPANIES AFFORDING! COVERAGE Saratoga Springs, NY, 12866 COMPANY A Insurance c'.-w„Ts-�any North erica LETTER CODE P00180 SUB-CODE . i COMPANY . ... - LETTER INSURED - - . COMPANY David i1co Jard d/b/a LETTER C iicnaardJIs ]Excavations COMPANY D R. Dv #6 Peggy Ann Lane LETTER Glens Falls NY 1_2801 . COMPANY E LETTER COVERAGES THIS 15 TO CERTIFY THAT THE POLICIES OF lTlSURANCE LISTED BELOW HAVE BEEN. ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD GERT CERTIFICATE MAY BE OR MAY PERTAIN,REQUIREMENT INSURANCE ADITION FFORDED BY THE POLICES rp ESCRIBEDOF ANY CONTRACT OR OTHER OHERE�N IS NT IUBJECT TO ALTH RESPECT OL THE 7ERM5, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS � THOUSAND$ TYPE OF INSURANCE DATE (MMIADiYY) DATE (MMIDWYY) TR GENERAL AGGREGATE $ GENERAL LIABILITY p RODUCTS-C4MP74PS AGGREGATE COMMERCIAL GENERAL DABi L}TY PERSONAL & ADVERTISING INJURY $ CLAIMS MADE ' OCCUR. EACH OCCURRENCE _ OWNER'S & CONTRACTOR'S PROT. FIRE DAMAGE (Any one fire) $ MEDICAL EXPENSE (Any one parson) $ COMBINED AUTOMOBILE LIABILITY SINGLE S LIMIT ANY AUTO BODILY ALL OWNED AUTOS INJURY S (Par Person) SCHEDULED AUTOS ROOiLY HIRED AUTOS INJURY S (For accident) NON-OWNED AUTOS GARAGE LIABILITY DAMAGE TY S DAMAGE EACH AGGREGATE OCCURRENCE EXCESS LIABILITY S y OTHER THAN UMBRELLA FORM STATUTORY WORKER'S COMPENSATION S 1000 (EACH ACCIDENTy AND y 500 $ (DISEASE—POLICY LIMIT) EMPLOYERS' LIABILITY C29959110 12/15 /88 12//1 5/89 S 1000 (DISEASE—EACH EMPLOYEE A OTHER DESCRIPTION OF OPERATIONSILOCATIONS!VEHICLES/RESTRICTIOHSISPECIAL ITEMS Excavations CER7IFICATI= HOLDER CANCELLATION ZIP] C7.. ( OLDER sbury SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Tc&gndof Deensbury EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL _ it) - 'DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Bay Rd. QuL�ensbury NY �-2�� ,'� LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE No OBLIGATION On LIABILITY OF ANY KIND UPON THE. COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHO RI Z EO.,R£PRES6NTATIYE attn Nancy s QACORD CORPORATION 1988 ACORD 25-S (3188) lip v.d "0fNY t't'+ ISSUEDATcjc,/�I'�'�} I I �... .�► r 3`hrl` ` '- l I / 2tiJ1 j PRODUCER THIS GENTIFIGATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS rr Charles W . Merriam SOn Inc . NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT Alhi SiD, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 701 Union Street , Bois 1038 k:_ Schenectady , NY 12301 COMPANIES AFFORDING COVERAGE `S LCOMPA Y A Commercial Union Insurance CooETTER COMPANY ,y',! INS LETTER UMED COMPANY Forest Flood Homes , Inc . LETr �R C 4 ETTE c /o Joseph Ammirati E Thunder' 13 Thunder Run L NY ILA LETTER '.. . Gansevoort , NY 12831 pppii COMPANY LETTER d IV THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED AC30VE Ff]Fi THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT ON OTHER DOCUMENT V I3�H H=r;PEG'14 TO WHICH THIS CER'i'IF ICATE MAY k BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUS.iECT TO r:Ll i-Lui TEF.+I EXCLUSIONS, ANL) COLtiDI- ;r '`` TIONS OF SUCH POLICIES. VI:LI�Y iilc ClitiE PGu4"r Pti i,v.l,iire LIABILITY LIMITS IN THOUSANDS CO TYPE OF INSURANCE POLICY NUMBER CAN 1MriiUU.'YVI ur,rE p,tl,yls,xY{i EACH .�[aGIVAC n're LTR _ (SEC VijV+t NC,F: ,r GENERAL LIABILITY BODILY INJURY Y ' Y . . . . PREWSESlOPERATIONCOMPREHENSIVE FORM 'S }'htCJ F'cri rY 9 UNDERGROUND DAMAGE $ $ -' F EXPLOSION & COLLAPSE HAZARD PRODUCTS.CGMPLETED OPERATIONS r� ' i jr y' F:l1MIsD $ . CONrAACTUAL ' WOEPENDENT CONTRACTORS BROAD FORM PROPERTY DAMAGE PERSDLJAL INJURY PERSONAL INJURY ' AUTOMOBILE LIABILITY ' nl :nr L ANY AUTO $ D .y ALL UVI AUTOS [PRIV. PASS.) ALL OWNED AUTOS (OTHER THAN) "�`� ac,.w`r11] PRIV PASS 11 '{ HIRED AFVV IS NON-OWNED AUTOS ---' GARAGF LIABILITY bl a PO i,'Cilrtbr N'EP $ �y ^'e EACESS LIABILITY r Eli a FO ; , $ $ UMBRELLA FORM cU+.icslNr=o >''` - DEFIER THAN UMBRELLA FORM UTORY " "j {EACH :xCr:IUEF TTy WORKERS' COMPENSATION ° r4 A AMU CJ89HO999649 4 / 9 / 8$ / 9189 $ tDIsFASE-FoucY Li7vil ry EMPLOYERS' LIABILITY — (UCSFiSF FnCll f h1PLDYEEI k�., DESCRIPTION OF OPf~ IATIONSILOCATIC)NSIVE:H[CLESI FECIAL ITEMS TIV x rk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED Di:FORE THE EX- Town Of Crlueen Sl:furY c " PIF IQ DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Building ]Dept . � MAIL +� DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE IFNI LEFT, BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY Queensbury ,, NY OF ANY KIND UPQN THE COMPANY , VIS_AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 4,eL'� /,/ � Brian H . Merriam M1f i! 7, 1 f ' " < a > fi ♦ }f_ / I + ' fl Ss.' 1 �j, I ,'!Le. r{ '.. L .i i TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT SAY & HAVILAND ROADS /�•#; ? QUEEIVSBURY, NEW YORK 12801- TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME// LOCATION DATE /� -_ PERMIT # ,APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATIONfDAMP ` ROOFING BACKFTE APPROVA ROUGH PLUMBING FRAMING ELECTRICAL ROUGH- N INSULATION: FOUNDATION FLOORS WALLS ` CEILING j,,frINAL INSPECTION: E CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ TE STAIRS-CLEARANCE & RA LS PLUMBING FIXTUR /REL F VALVE_ INTERIOR TRIM/P IVACY FINISHED FLOOR - GARAGE FIREPR FIND DOOR CLOSERS SMOKE DETECT RS - FINAL ELECTRI L INSPECTION.%- El ^' FINAL APP.ROVA� OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPTEDf REMARKS: i s trz.,1l [ o"5T"cnot o .0 ►v ' ram �►v Pr ,c sr 1 INSPECTO jp� ■■ �ourn n/ Queenshury BUILDING and ZONING DEPARTMENT + Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION LOCAT i Ohl C�K)q la . 1.[� Q Q DATE j /ft PERMIT NO . ` q - k SOIL 'TYPE - Sand - Loam - Clay -_ Percolation Test Required? YES -- NO Percolation rate - Min/Inch TYPE of SYSTEM : Absorption field , total length Length of each trench Depth of trenches �. i Size of g vel_ SEEPAGE PI {Nuinlaer of) - Size-Size- ft. X ft. Gravel size PIPING : Siz Type Bldg . to tank ( Tank to dirt . box Dist . box to field/ tr Openings sealed? NO artial LOCATION/SEPARATIONS : Foundation to tankft. Foundation to absoxp ion "ft . Absorption to lot A ne Et . Separation. of pits t. 10 TI YSTEM ON PROPERTY (Vircle one) Front - ' ear - Le side - Right side - COMMENT SYSTEM USE APPROVED ES O Bull In Inspector 01/86 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY S HAVILAND ROADS QUEEN.SBURY, NEW YORK 12804. TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FUR INSPECTION RECEIVED 6 , / NAME LOCATION Q c DATE _ I `� - !,. .. PERMIT # S ! APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATXON/DAMP-PROOF2NG BACKFILL APPROVAL + ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING .SIDING EXTERNAL PORCH/STEPS STAIRS-CLEARAN E & RAILS PLUMBING FSXT ES/RELIEF VALVE INTERIOR TRIM PRIVACY DOORS FINISHED F S GARAGE FIRED OOFING DOOR CLOSER ( ) .SMOKE DETEC RS FINAL ELECTRI L INSPECTION FINAL APPROVA 11 OF CONSTRUCTION A SIGNED CERTI'2I.CATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: `�t, '"o INSPECTOR r * Wd TOWN TOF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 2280k TELEPHONE (526) 792- 5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED "- NAME t ^�"LJ'O-ek H12=: .•(-fir+ ^ LOCATION /G l -c' DATE &W- " y 1 3 '<1 PERMIT # APPROVED ES NO 4�FOOTINGIPIERS Ix 4NOLXTHIC POUR; FORMS 0UNDAT2'ON/DAMP--'ROOF XNG CKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES/RELIS`F VALVE INTERIOR TRIM/PRIVACYf DOORS FINISHED FLOORS GARAGE FIREPROOFING' DOOR CLOSER (S) SMOKE DETECTORS ! FINAL ELECTRICAL NSPECTXON FINAL APPROVAL C�P CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS o� QUEENSBURY, NEW YORK 32805F TELEPHONE (528) 792-5832 BUILIING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION zi r , DATE _ If "�> �I PERMIT # y�'— APPROVED YES NO VFOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP^—PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGIY—IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: ' CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHE�F/STEPS ' STAIRS—CLEARANrE & RAILS PLUMBING FIXTORES/RELIEF VALVE" INTERIOR T�/PRIVACY DOORS FINISHED F RS GARAGE FZFEPROOFING DOOR CLOSER (S) SMOKE DBtrECTORS FINAL ELF TRICAL INSPECTION —' FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: j INSPECTOR SG LtI. i tlV5l1V CSb Y'M1J}[IYI.', {DV.'�} GLO'^Ill3 APPLICATION FOR ELECTRICAL INSPECTION PLEASE BEAR DOWN YOU ARE MAKING (4) COPIES MIDDLE DEPARTMENT INSPECTION AGENCY, INC. —j National Headquarters 900 Haddon Ave., Collingswood, N.J. 08108 COMPLETESAPPLICANT ' Date : 3 ! s City, Town or Township _ � < < County Wca r rr' " State f`( -V , Location/Address ` 1 � e k I ci r i ! II ( If Located in Rural Area - Please Attach Directions) Pole # Owner Fnr s s 7 Wntj _ 0 " f-j. C. Permit # Occupied As Building : Newts Old 0 Occupant Work Area in Building Floor #, etc. ) : for: Wirin 0 Service = or: Ready for Inspection : Fee Remitted - $ Cash © Check Make Payable To: M. D. I.A. 500 7b0 1000 125q 150C 1250 2000 2250 2500 275D 3000 Number of Rough Wiring Outlets Elect. Heat Switches Lighting Amp, Service Surface Unit Dishwasher Range Receptacles Water Heater Air Conditioner Dryer Pump Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner Amp. Receptacles Fractional H.P. Vent Fans Other Equipment. MOTORS H.P, 1/2 1/12 1/10 1/6 1 1/5 1 114 1/3 1 1/2 3/4 11 1 1 1412 1 2 L.J. 5 7L/2 10 1 15 1 20 1 25 36 1 40 1 50 1 75 1 100 Mark Number of Each Size Applicant's I Signature License # Permit T/A + Utility : Applicant's A dress: HC ' ( A �" GX � 15' (NAME (OFFICE LOCATION (City) ytiiG4 %A-P is F- iO Ad- (State) >* ' t Y'. � (zip) I ) R. � Service Request # Phone # 192 S ` �297�1 Electrician : * DATE RECEIVED: DATE INSPECTED: Correct Location : Same as Above Q or : Red Notice Label Cf Rough Wiring Outlets Surface Unit Oven Switches Range Garbage Disposal Receptacles Water Heater Dishwasher Fixtures Air Conditioner Dryer Amp. Service Equipment Burner, Wiring & Controls for Amp. Receptacle Amp_ Service Conductors Pump Vent Fans MOTORS H.P. 11/2011/1211/101 1/6 1 1/6 1 1/4 1/3 1/2 3/4 1 1 14'2 1 2 1 3 1 5 1 74x 1 le 1 15 1 20 1 25 30 40 50 1 75 1100 Mark Number of Each Size Ij _1 L � Elect. Heat 5O° 75q lggo 125° 15oq s7sa 2000 225a 2500 275q 3q 1q L'_ : Patricgk� x 32 LOaw Hudson 1 1!Y f 839 51. f 134 3 ELECTRICAL INSPECTOR CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE COR ECT FEE PAIL} RW Progress- Inc. O LKD Contractor CFT Violation : Work Comp. © Inc. CASH Q [� LIA Owner L/A Fee CHK 40 [� IPA Municipal Due MO * INV # Date: Other Side C] Utility Applicant H Owner i Cut in Card Q Temp # Date I'1 Final V Date INSPECTORS SIGNATURE Isjulwpv r AO NMOJ 71 401 401