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1989-140
;Cm: +� 5'} aFMP'q,�P::w6 ".['ryas'°!+4:•_ .�`_^�--'—. 1., ' M i CERTIFICATE A.TE +( F +C7 C'L.JPANCY TOWN OF QUEENSSURY WARREN COUNTY, NEW YORK pytte dune 15 14 13g IL '[ ,6.11 -1--- S q -t 'Phis is to certify that work requested to be done as shown by Permit No. ' a — 1 4 U has been completed. triA ' rn11 � dl trlt , This structure may be occppied as a - y' 4. LA)catlotl T , ...11s' .,1. Y l(� C7wner Kcal 1 & J asp ii NOTE LL By Order Town Board TOWN OF QUEENSBURY Director of Bldg. & Code Enforcement T Jam' BUILDING PERMIT X TOWN OF QUEENSBURY � � _ 14 � ' ,VU No. WARREN COUNTY, NEW YORK o on PERMISSION is hereby granted to Ka r 1 & Team rya ga� p� yy r OWNER of property located at Box 341 West Mtn . Road. . Street, Road or Ave. I'V in the Town of Queensbury, To Construct or place a Addition tGi Djnx' 1 � at the above location in accordance to application together with plot plans and other reformation hereto filed and approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. T- OWNER'S Address is Same t� 2- CONTRACTOR or BU1 LDER'S Name p Roan LaPier .'qz Pq 3. CONTRACTOR or BUILDER'S Address f'S Box 625 Call XXXk. XX Street i XXN Lake Luzeyne , N . Y . 12 $ 46CIA �^ 4. ARCHITECT'S Name fA Iy 5. ARCHITECT'S Address t7.1 0 6. TYPE of Construction — (Please indicate by X) w I ) Wood Frame ; ) Masonry ( ) Steel ( ) F i-� 7. PLANS and Specifications rn No. 16 ' x 241 addition to single family dwelling as per plan , specifications , and application . plot m 8. Proposed Use :cJ Single Family Dwelling w/.Addition f 25 . 00 c/o $ 3 _ R0 PERMIT FEE PAID — THIS PERMIT EXPIRES November (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the ¢ town of Queansbury before the expiration date.) Fj- rr r- Dated at the Town of Queensbu y,lbi� l 0 f h Day of �A . r i 1 �19 SIGNED BY ti/ '�(�u for the Town of Queensbury o Building and ning I nwector C] [b i� r• QQ 3V Dr' QUEENS13URY APPLICATTON F'OR BUILDING AND ZONING PERMIT 000 `3OWl QUEENSBURY � r N ECE(VED ,:1�ri^"-� ` 1zavZ wed �- ---~ Py ,'/ APR 1989 Fee. paid t tiUILDINC AN]) CODES DIuPAiRTP�°T DateTbaued BLDG. Li. CODE ©EPT. 13AY and NAV1LAND ROADS RD I DOIC 93 Yv PUEENSBURY, NEfv YC)Jth 728C14 Pe.�trru t No . '3 -/ - -204 x * • " " : ' x * A CONSTRUCTION , � NO INSPECTIONS A PERMIT T6iUST nil OBTAINED lift=ORE BECINPIING INC Tm WILL BE MADE UNTIL APPLICANT HAS ECation lnustLCE be COB%PlctcdP and lthe All applicable sPaccs on this application� carp or[ the reverse sick of this sticet . ; 1tcLtatuYc of the a licant *mks * *I dk Yt 9: 1: .1 11 .�laa17 v is : v l l� ) at1 ! 1e.1k� /// 'i` he owner o f this property n yr C� TEL . r7 r - 05 f POO . Address ax � 3 ` ' { 1 'FA7C MAP NO * [property location Ylas there been any slit Of this Propertyyes since October 1 , 19f3f3 ? � iY� If yes . Planning Board Review is necessary . LOT NO . SUBDIVISION NAME , IF APPLICABLE � 'rho Person responsible for supervision of work as regards Building Codes is : �, MI6 rv"U Lr v Cr- ` d ` `� 'c TEL . NOw NPLK cc1 .i Tc1 � crl+ r_" �. Gc^wsip . O . ADDRESS / ' Tel 5V/ / 9 � Name of brxilder a t v~ Address i( ori s cc.L.L S / 4- A k L d =t• IV +*�' Tel Name of Plumber c c c ► 7 A r* - r J.ddress Tel Address Name of Mason j; - y- r�,�YuizC Or r�r;dra��D 1ror,�. • Z ONING IrIi�OItF(A't• IC1A1 rt7t"rJcc� use an3y1 xDESIGNATION OF PROPERTY ron:;tructior' of a 'raw building ; ED PRINCIPAL PERMITTEO ACCESSORY �Addicion to a building . Alcwr .tion t4 a building „ REVIEWREQUIRED - PLANNING BOARD ZONING BOARD ( na ck':L&143" to exc .= riot ditnatrsionsl AN REVIEW # APPROVED DATE ochur work Wascribts. ) � { E # APPROVEDCROSS AREA OF F' SYOF' OSCD. FS 'Ff� UC "1' UFtE •1stF t56r - ._■ q f t . „ COftPF.i•:Y'F: , INl`OFcMA"PION icL:tlUilcE:U L11:F.Galr 2nd Floor s If It X� . Sita of projlL.I� cc . other Floors 5q f t .' ' l:xiitiirca builailki] t :: ):11111111111111 MINI, 5i • fc 3i � ( not cellar or laasamencl .r lcli �J s4 ft . Exi.:: cinu FOr+ ir& Es ) U�. TOTAL F LOoR ARE � � � / i �' ixe or new stru+ctur.: �ft X. `trft kfrawcdatian-Pierfsla craw L�arti"llfull ' YrolIoscd buiictin<J . rli::tanc.: fro'u L,rolrcrty line ' It near yard ft tairclu one ) Front yurd it N.] . of stor lea (t ub-Ic �blo '�la ' ccl _ r Side y;araf.; r t and 1twighc tuvada to ridilj A ) � tic „ Ir` on corner , ut: rbzLck from side: scr. Leat _ re If reaidantial; noo of farniliss # OCCUPl4NLY INFO!'JhhATION Nov of room a ( excluding b"thal 1 � No. of lxtdroa".s PTt Y LUILOING - _ ikdoct S _ ] * Ona family dwelling dI ,1(I S T/ N G No . of t�:rtltraorns ; C Primary IrwatirrrJ ysc "u � "l�.'o fauri.ly awatllin�J '1'yy�:s of Fuel Mult:iY1l.: UW4:;lling / Number of uxtics_r_____�_ No . of f irul')laces:: to lz+= i.nzc.:all -d ' i'err'►:xricttt occup:urcY Will ;� wou.k s':4va: t.� in:rtallu'3? Tr"n"wnu occuLwAticy C%Sntr:+l Air corra.litioning'.' © ,� Slusiness Irltluzcrial ., M ' SUI LD I NG STYL.F, PFt IM�fZY Sl'R1lCTUi2C r char 4 Concsugx,r.ary 3.crg � Ic .addiciort , 1�kirii w.i.lt u buT_ I - r C7 r� Ficai ::t cl r""ch, M rn:iiu'r DuF+lux Jl�lit iw�+sl Old scylo UUSLLJ:alow a ACCESSORY 13LtILQlwc- 4 ;, Yu Cod Cotl::+cJ � L3ckwr C:.r t 1;,retachaU cJ ars�cjt+fono turf two cac� C o1 oni:+ 1 F:Pw '1'4wrr F3ouwe fi++ r t CIRCLE: ONL PLEASE ) " ACtac!h.:d rJuracJ'.:/aria car/ two cat �,,�^•,,,,,.. _ 7k w .� w w w x s ■ 1� •' .��Ftriv" to wtortbge building R x .r ociw t k: STXMA°1" 1: [] KARKr'r VA1_U1; or r IN['ORkFA`I'74N ON laurLDINC .qpr `II•' ICAT7ONSs ON RCVEItSE S7t]f: OF grillsSH[?l'T, 'FO Be COMAL!~'F1=DF Form DPA I0/88 V2 BUILDING PERMIT APPLICATION CONTINUED - L. BUILDING SPECIFICATIONS : Type Of construction , word .frame , fire safe , etc . t04 n .r, Will any second-'hand or ungraded lumber be used? If sa, for what ? Foundation wall material r.C_ _sickness f Depth of foundation below grade {to bottom of footing } `—' -- Will there be a cellar?J,r'� fo Heated or unheated? n. Floor sq , footage sq £t Will there be a basement? 4 will any portion be used as living space( If so , what portio ? _s4 - ft . _ Type of use . ? /A G7 _ - ? Type of roof - s ape flat/shed/other Material Of roof Q /~ ✓yza, of - Size , wood studs v-'- " 3!_�, spacing- f If length ft . L Joists ( floor beams ) lst . floor "' X- /� '" sp'acin " Joists ( floor beams) 2nd . floor fix "" 9_zk-t-„4 . c . Span—��•-Ft Overlays (ceiling beams ) g spacing o . c . spy €t . Roof rafters spac.in _ - "o . c . span f_ " Ft . Z ��X^. _" spaCinc} o . c . span _ft . Roof trusses (pre-engineered) spacing o . c . Exterior wall finish. - / ,• s pan t` � , le'6 Of what material? Interior wall finish 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? , - If so will a Fire-rated door , enclosure , and self-closing device be provided? Will a flue-lined chimney be installed? rp Height above roof Depth of chimney foundation below grade £t , ft . Depth of fireplace hearth ft . in . Water supply - Municipal or private well SEPTIC SYSTEM _ Distance from ANY private well ( includ ;.ng adjoining properties £t , (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 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 A, A ' 4 Owner, owner's age t, architect, contractor fir Ar At Ar At SPECIAL CONDITIONS OF THE PERMIT : By 0 ter. TOWN OF QUEENSSURY 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 : 11 Gross floor area 2 . Type of heat JE {= C i k Co 3 . Is the building mechanically cooled ? a 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 CIN" D 1 . If YES , what is the R value ? 3 . Slab on grade YES NO a . If YES , what is the value of insulation around perimeter of floor ? 4 . Is basement heated ? YES NO ) a . R value of insulation '0 � 5 . Type of insulation , B . Under 16 % Only Yloo 1 . R value of roof and floors exposed t ambienLt conditi ns_ 2 . R value of exterior walls / 3 . R value of glazed area anec� , , c4- 4 . R value of doors /`+'.�;.-+...�_- -r-..r�L-A- R I/ 5�.�a�.-�' . ' ,I'" r '�L'" C[` I✓t�-�•.i- 5 . R value of floors over unheated spaces R 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab 8 . R value of heated basement / cellar walls ( above grade ) 40 �p 2 tr 9 . R value of heated basement /cellar walls ( below grade ) 10 . Type of insulation e w .-t. i C . Controls 1 . Thermostat maximum heat setting 2 ty D . Duct Systems 1 . Is duct system installed in unheated spaces ? YES ( .__ O a . if YES , R value of duct installation b . R value of duct in other areas E . Piping Insulation T. 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 No , ( _ S a /_)_ ( applicant ' 's gnature ) APPLICATION FOR SEPTIC L7ISPOSAL PERMIT DATE ` 5/0, LOCATION OF PROPERTY FOR. INSTALLATION Owner's Name: 1hiz.-L %4 JG�} nl �lA GA !� © 1cr`� Telephone: (�/ d? 71 7 � Address: -J ct 1A Cs )U .Z N S B L-t t�--,W Installer's Name: Telephone: Number of bedrooms (residential only) 3 Total daily flow (compute (d 150 gal per bedroom ) Cj Topography: Circle one< Flat Rolling Steep Slope % of Slope :Soil Nature: Circle on ! 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: Water supply from septic absorption feet PROPOSED SYSTEM* Septic Tank gal. ( minimum size: 1 , 000 gal.) TILE FIELD: Each Trench feet/Total system length 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 Rueensbury Sanitary Sewage Disposal Ordinance, SIGNATURE OF RESPONSIBLE PERSON: �uL' w„J DATE: OVER 4A001tlr. CERTIFICATE OF INSURANCE ISSUE DATE (MMIDDIYY) 4 / 3 / 89 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATfON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER_ THIS CERTIFICATE DOES NOT AMEND, *VAN DYKE AGENCY , INC . EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 6 E . WASHINGTON STREET GLENS FALLS , N . Y . 12801 COMPANIES AFFORDING COVERAGE COMPAN LETTER Y A NATIONAL GRANGE MUTUAL INSURANCE CO . CODE 3 1 _ 8 9 6 SUB-CODE COMPANY B INSURED LETTER RONNIE L . LA PIER , D / B A COMPANY / LETTER �+' MOUNTAINEER CONSTRUCTION BOX 625 , CALL STREET COMPANY D LETTER LUZERNE , N . Y . 12846 GOMPANY E LETTER COVERAGE'S THIS IS TO CERTIFY THAT THE POLICIES OF INSURANGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS LTR DATE f,MM7DDIYY) DATE (MMFDDIYYI GENERAL LIABILITY GENERAL AGGREGATE S 1000 A X COMMERCIAL GENERAL LIABILITY PRODUCTS•COMPrOPS AGGREGATE S 1000 CLAIMS MADE X DccuR. MP U 2 1 347 1 / 2 3 / 8 9 1 / 2 3 / 9 0 PERSONAL & ADVERTISING INJURY $ 500 OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE s 500 FIRE DAMAGE (Any one tire) s 500 MEDICAL EXPENSE (Any one person) $ 10 AUTOMOBILE LIABILITY COMBINED ANY AUTO LIMIT $ LIMIT ALL OWNED AUTOS BODILY SCHEDULED AUTOS INJURY S (Per person) HIRED AUTOS BODILY INJRY NON-OWNED AUTOS (Peracldenl) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH AGGREGATE OCCURRENCE s S OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY AND WCU 21347 1 / 23 / 89 1 / 23 / 90 s 100 (EACH ACCIDENT) EMPLOYERS' LIABILITY $ 500 (DISEASE--POLICY LIMIT) s 100 %DISEASE—EACH EMPLOYEE OTHER DESCRIPTION OF OPERATNSNSiLOCATIONS(VEHICLEWFIESTRICTIONS/SPECIAL ITEMS THOSE USUAL TO CARPENTRY/ MASONRY CONTRACTOR CERT . REQUIRED BY QUEENSBURY TOWN PLANNING BOARD CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE KARL & JEAN HAGADORN EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO RR# 5 MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATIti HOLDER NAMED TO THE 341 WEST MOUNTAIN ROAD LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR QUEENS BURY , N . Y . 12804 LIABILITY OF ANY KIND UPON COMP Y, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIV i i__33 VAN DYKE AGE eel I CORl�ORATED ACORD 25-5 9188) D CO N 1988 TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVXLAND ROADS OUEENSBURY, NEW YORK 32804- 7 TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR XNSPECTION RECEIVED �-30 -43�9' NAME �r LOCATXON DATES �^ 3/�" rl' I p P/E�RMIT #E APPROVED YES NO FOOTXNG/PXERS MONOLITHXC POUR FORMS FOUNDATXON/DAMP-PROOFING BACKBI LL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-XN XNSULATION: FOUNDATXON FLOORS WALLS CEXLXNG Z 'FINAL rJVSPECTXQN: 1 CHIMNEY HEIGHT ROOFING SXDXNG EXTERNAL PORCHE /ST S STAIRS-CLEARAhjGEl & LS PLUMBING FIX RES/RELAF'F VALVE XNTERXOR M/PRXVACY ,BOORS FXNISHED F RS 1 GARAGE F EPROOFXNG DOOR C ER(S) ] " SMOKE ETECTORS FINAL E CTRXCAL INSPSCfiXON FINAL ROVAL OF CONSTRUCTION� t A SIGNED CHRTXFICATE OF OCCUPANCY MUST BE OBTAXNED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: L� XNSPECTOR OWN ' UXLD OF AND COD SiJRY BUILDING AND CODES DEPARTMENT BAY & HAVXLAND ROADS QUEENSBURY, NEW YORK 1280* TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION ECEXVED NAME LOCATION , /r /t r V 1 DATE `lam PERMIT # d9le� 1" APPROVED YES I NO FOOTXNGJPXERS MONOLITHIC POUR FORMS FOUXDATTON/DAMP-PROOFTNG BACKFXLL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN NSULAT_I ON: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE ' & RAXLS PLUMBING FIXTUpb$1RELIEF VALVE XNTERIOR TRXM/PRXVACY DOORS FINISHED FLOORS GARAGE FIREPJQCXJFINC , DOOR CLOSER IS)_ SMOKE DETE TORS FINAL ELECTg'rcAL INSPECTION FINAL APPROVAL OF CONSTRUCTION i A SIGNED +CERTIFICATE OF OCCUPANCY MUST BE OBTAINED ,'FROM THE BUILDING DEPARTMENT BEFORE THESE PRE*XSES ARE OCCUPIED! REMARKS: INSPECTOR - TOWN OF QUEENSBURY BUrLDING AND CODES DEPARTMENT BAY & HAVILAND ROADSy-y -7 QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 792-5832 BUILDING INSPEC"IOR ' S REPORT REQUEST FOR rNSPECT-roN /RECErVED NAME ZOCAT-TON L/ DATE _. __ .PERMIT # APPROVED FOOTrNG/PIERS YES NO MONOLITHrC Po "-FORMS FOUNDATION/l7AMPP PROOFING BACKPXLL AP1dROV NTPLUMBI NG MrNG ELECTRrCAL ROUGH-' IN FOUNDATION FLOORS WALLS CErLrNG ZW FINAL INSPECTION: / CHrMNEY HEIGHT ROOFrNG SIDING E.YTERNAL PORCHE /STEPS STAIRS-CLEARA E & RAILS PLUMBrNG FIX RESfRELIHP VALVE rNTER.TOR TR /PRIVACY DOORS FINISHED F R g GARAGE Fr PROOFING DOOR CLOS R (S) SMOKE DE CTORS FINAZ BLEC24RICAL rNSPECTrON FINAL APPROVAL OF CONSTpUCTION A SIGNED CERTIPICATE OF OCCUPANCY MUS7T BE OBTAINED PROM THE BUXLDSNG DEPARTMENT THESE PREMrSES ARE OCCUPTEDf BEFORE REMARKS: rNSPECTOR TOWN OF QUEENSBURY gUILD.fNG AND CODES DEPARTMENT BAY & xAVILAND ROAbS L�UERNSBURY, NEW YORK I280*1. TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION NAME .REC.LCIVEb Z00CA. 4 DATE �? PERMIT �F APPROVED F00TING1 IERS .f"IsS NO NONOLITxIC POUR FORMS FOUNDATION/DAMP-PROOFING "";*XL,L APPROVAL ROUGIJ PLUMBIN F.RAM?NG ELECTRICAL RO INSULATION: FOUIVDAPXo y FLOORS WALLS CEILING FINAL INSPECTION: CIIIMNLY HEIGHT ROOFING SIDING EXTERNAL PORCHESIST STAIRS-CLEARA � CE �-- - Pzum-&Zxc FIXT S URE RA �^�-� INTERIOR 2Iz' ZM/P1q RELI HALVE VACY FINISHED FLOORS R' GARAGE FIRtsPR FINC DOOR CLOSER , SJ --- SMOICE DETECTO S FINAZ ELECTRIC FINAL L INSP CTION APPROVAL OF CONSTRUCTION A SIGNED CERTIFXCATE OBTAINED FROV TxE OCCUPAVcy UST BE TXESE P B (7F M UILDING REMISES ARE OG,CUP BEFORE IEbI DEPA]4TIyENT REMARIC,S i INSPECTOR TOWN OF QUEENSBURY �f Jar BUILDING AND CODES DEPARTMENT BAY & HAVTLAND ROADS QUEENSBURY, NEW YORK 12801- 71ELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME rC f GX d.�. s� LOCATION / a¢1�i oIQ6ER+/�.✓ay DATE PERMIT �# .7 _ APPROVED OOTING/PIERS YES NO 90NOL2THZC POUR FORMS FOUNDAT-TON/DAMP-PROOF2NG BACKFILL APPROVAL ROUGH PLUMBING FRANING ELECTRICAL R GH-IN I1hISULATION; FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHTNNEY HEIGHT ROOF?NG SIDING EXTERNAL PORCHES/I STAIRS--CLEARANCE & J(A3'LS. P UMRXN'G FIXTURES/ ELIEF VALVE INTERIOR TRTM/PR ACy DOORS FINISHED FLOORS GARAGE FIREPR FING DOOR CLOSERS SMOKE DETEC RS FINAL ELECTRT AL INSPECTION FINAL APPROV L OF CONSTRUCTION A SIGNED C TIFTCATE OF OBTAINED FROM THE SUXLDTNGCUpA DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! RE)VARKS.' _. INSPECTOR YOU ARE HEREBY REQUESTED TO INSPECT AND ISSUE +CER77FIG4TES FOR THE FOLLOWING ELECTI4AC14L EQUIPMENT TO BE INSTALLS BY THE UNDERSIGNED x TEMP. m DATE r < 'sf Cm OR YILLRCE�-- UNY T I �: w ,c; N.�. I t� iY �;=' ��TONlNSHIP CO I L v" !y F okk- k" jV 91REEr AND NO OR ROAD �y .�/, /� _ '� '7 / A�.'6/` /7. ope- f 1C .✓�-..)_ POLENUMHER BETWEEN WHA' TWO CROSS STREETS IS PREMISES LCx;ATED7 SECTION BLOCK LOT i OCCILFAAIT'S NAME BUILDING OCCUPANCY CMMER'S NAME AND ADDIRIESS FAME TELEPHONE NUMBEP�, .y, y °- h ) _a CURRENT SUPPLIED BYFROM THEIR OFFICE WORK TELEPHONE NUMBER BDIL[HNG 18 NEW [ OLD CI VA( KIS NEW ADDITIONAL � DEFECTS REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED Luca_ NUMBER OF OUTLETS No. or p- CBS & MOTORS HEATERS BRANCH OFFICE USE Lmp Receptacles CIRCUITS ONLY a troO Side Atlach't Coiling wall ReceP'L% Switch Pendant Bracket No. Type Each Noo. Each Na Gauge INSPECTION SIDE -f / /'tO 3 SUB- BASE 7Nu BASE- MENT IT 1St FL. end FL. 8rd FL, REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE THIS APPLICATION,IS INTENDED TO COVER THE ABOVE-UST£D EQUIPMENT TO BE INSPECTED, BUT IF AT TIME OF INSPECTION, THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED, YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER THE ADDTIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT. 512E DF MAINS FEEDERS ELECTRIC SIGNSLAMPS TOTAL ITS CHARACTER OF WORK El pm X� S ED CA TUBE SIGNITRAJSFORMERS OF yq (A CONCEALED DATE WORK TO BE STARTED DATE COMPLETED S42E OF SIGN INUMBER) CAPACITY SERWCE ENTERS BUILDING y ' MANUPAC rURER OF SIGN CJERHEAD _ '71/' „INDERGRDIIND DATE INSPECTION REQUESTED ON IOR AS NEAR AS POSSIBLE) MUST ENTER APPLICANTS IDMNTIAPICATION MIMO1ER N► �. AVOID BY QtVINQ FULL AND ACCURATE IN TION. ALI, SPACES FILLED IM-QR APPLOCATM MAY BE RETURNED. PRINT NAME AND ADDRESS NAME OF APPLICANT DATE OF APPLICATION STFIEET,AD TE PHON(EE I41a y CITY OR POS'['..QFFJCE ZIP CODE LICENSE NO. #M41EN APPLICABLE ❑ 85 John Street I ❑ 41 State Street 584 Delaware Avenue ❑ ?17 Lake Avenue f ❑ NEW YORR, NY 10038 ALBANY, NY 12207 BUFFALO, NY 14202 00CHESTER, NY 146081 20 202 rtere l RoadosC Lk$E„NY 13206 THE NEW YORK BOARD OF FIRE UNDERWRITE ) t,?t Lod..$LrI? VO -d.. i \• ,� } i1`''-....., ..(/ ~ - ', fir' +, fv 9 rrsx> l�b S� JlP Q; (� i J At 'li !@.'4�M�t.l i