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89-157 _ a . 4.. CERTIFICATE OF OCCUPANCY TOWN OF QUEENSSURY WARREN COUNTY, NEW YORK Date June 9 19 S9 i f is is to certify that work requested to be lone as shown by Permit No. $9 - 15a E has been completed. This structure may be occupied as a Molii 1e Homeuc Location N fgw HAMpnh-i re- EEL'S mnsie Owner Edgar Eggleston Jr . By Order Town Board j TOWN OF QUEENSBURY fir--mil / 11 �W Director of Bldg. do Code Enforcement 1 BUILDING PERMIT � TOWN OF QUEENSBURY No. 89- 157 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Edgar Eggleston 3r . Co 1 OWNER of property located at new Hampshire Avenue Street, Road or Ave. a7+ in the Town of Queensbury, To Construct or place a Mobi "l a 7;ow^ 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 RU#4 Box 296A queensbury , N . Y . 12804 r-� r 2. CONTRACTOR or BUILDER"S Name h� Saratoga Housing, z Y 3. CONTRACTOR or BUILDER'S Address d Glens FallsrN . Y . 12801 4. ARCHITECT'S Name 5_ ARCHITECT'S Address G. TYPE of Construction — (Please indicate by X) 1�1 ( Wood Frame ( Y Masonry i t Steel i t 7. PLANS and Specifications +S' No. 14 ' x 56 ' mobile borne as per plot plan , spectficationsr CC+]] and application . B. Proposed Use Mobile Home 48 . lac /o inC�ERMIT FEE PAID — THIS PERMIT EXPIRES November l �9 89 Ind H (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Clueensbury before the expiration date,] . Q. Dated at the Town of Queensbury this __ Day of Apr,4 7 �g — SIGNED BY for the Town of Queensbury Building and Zoning I ctor F � BE COMPLETED BY nl.rac . DEPT. _Juwn rs �sr�er� 3L,srrs Application No._ r 1 J } P4rmit Inaua d Wool9 TOWN OF QUEENSHURY BUILDINGawnas ZONING ALPwri7rrtCNT Permit "Piro" 10 RECEIVED 8"y "nu Hiaviiand Road. R.0m 1 Box 08 Zoning Desasignation +O►+uasnsoury. Now York 12801 Varianco No., Sites Plan Raview No . �� R :� 1989 APPLICATION FOR Apprt3ves a � A 01 ©G. Sa CODE L71=PT, MOBILE HOME PU I LD I N G AND ZONING PERMIT 7r � • 'IF 4 M 'M � #! 4 Y • R # '4 � • ♦ * 7s • +R M w iM va • w f �r is w +r s N M tf it ;: • A PERMIT MUST BE OBTAINED BE- FORE BEGINNING CONSTRUCTION . ANSWCR ALL OF THE FOLLOWING . The undcruignud hereby applies for a Building Permit to do tha following work which will be done in occordancu with than doacription, glans and sp.:cific4c1o,nrj alubaaitted, and , such : IYecial conditions as may be indicated on thu Permit , The owner of this property is : P . U . Ar:ialreaas L � Taal . � � - 7 Ci/�'r' PropertyLocationsi .(' le � �p y, �� 'Tax Maly No ,���� atr4ga: t I.uw-ler r bulldlny lot numkbar � SL46Ld1visi0n names Iif applicable) THE I+1ORSON FESPONSISLG FOR SUPERVISION OF WORK AS R&GA%RDS DUILDING CODES IS : Add rea as +l`c l . NO . '/ Naerie of Installer ]�a ,4c- 'o �C ."�'dreas .Tel . N.aurc: c:.s= l.laan�a:r Adclrwaaa R•ul . N:aaSra of Adclre:us TtaX . MOBILE 'HOME INFORMATION : r ZONING INIFORMATION 14ew Home Placement ' PLOT P`I*Atr$;iUST BE PREPAREp AND SUBMITTED, drawn rnasan: bly to scale and "Utachud hareto, Roplaaing existing Home " ahowing clearly and distinctly all b"Ildinrys , Size of new Howe ,/f ft liwlm ft * whether ux1at!F99 or pxoposud and indicate all Uut-bwck dimunuions from property lines . Give Single w ' -le 9.or Double wide serout and n►uid-wr or lot numbQr and irsclicate No . of rooms ( excluding baths )_ * w+haschor interior or corner lot . Show location of Water supply and location and configuration Noe of bedrooms of "a:ptic dislaosal area . Noe of bathrooms COMPLETE INFORMATION M- QUI31ErDD DEL43W * Fireplace? fN6 wood stove? r1 C5 " Size of property f�, G'f + ? �-r ft x sy� µ lon style: and - size : " Exiating building ( u) 55i a ft x ft . // y * K^ C Piars— tlo . of- Siz,�--�ft x 50ft. "bating bui14ing (a) Use °.ed -e 5 , Depth below grade ft. + . .�._• ,..4 •a�r2.y,_. __ FOUNDATION _ Hooting size •• .. 3+roposud buildint , d lsLanvo .from property ling ,r Front yard 30 ft. Rear yard ��_ _ ' ft wall material w Side yards, l�� xt and ,' ,G�2 r ft Wall thickness Height ft. + le on corner, setJoack from sid.: atra:ut�fs: Total depth below grade ft. # OCCUPANCY INFORMATION Crade to -Home floor level ft . • PRIMARY DUII.TIZNG w : rr ■ Y x w w s or r * w . ra we ■ x w x w C1 I •Two family dwullinq Proposed date of placement_f � r Muitiglu dwa:lling / Number of unita Pe:-ua�anunt occulxancy Aprox . Yalus. of Home $ r(' C,j ) o ,, # •rr;ansient acculkxncy Water supply -- Well Municipal ' businues • Septic Permit required? +tip £� S ' Industrial 7 • Qc her If additions wia:at will use I-a:1 FURTHER INFORMATION REQUESTED � ACCESSORY I3LfIL0IN4'- ON THE REVERSE SIDE OF THIS SHEET . ++ Detached garage/one car/ two car/ car " Attached garage/one car/ two car1.!:,Ar Private storage building ' Other w Form MH P 5 / 66 md --vl 9 � APPLICATION FOR MOBILE HOME PERMIT, CCONTINUED) State of New York Division of Housing and Community Renewal INSIGNIA OF APPIMAL OF THE . STATE . BUILDING CODE ~ I . INSIGNIA SERIAL NUMBER 2 . NAME OF MANUFACTURER 3 . PLAN APPROVAL NUMBER 4 . MODEL OR COMPONENT DESIGNATION . 5 . MANUFACTURER ' S , SERIAL NUMBER ' G . DATE OF MANUFACTURE AZZ the above tinfo,emation is to be found on a ppZate or st%caker which +� haie Zd be affixed to the Mabi Ze Home . COmplete,.above with that infor,,xxttion• A A A A +f A ♦ R A # A +! +! 4 "# +f * { . .* ,� . * +F rt A +1 # +i A fi 4 * A A +F A h A Town of Queensbury County of Warren A F F I D A V . I T STATE OF NEW Yoruc I swear that to the best of my knowledge and belief the statements contained in this application, together with the plans and apecifications uubiaitted , are, a true and com,Plcte stataluOnt Of all proposed work to be done on the deacribed premineu and that all pravisionu of the BUIL01NG CODE ,. TnE ZONING ORDINANCE, and all other laws pertaining to the proposed work slurll be complied with, whether specified or not, and that such work is authorized by the owner , Signature a own S a , ArChlLerCt, coritraCtOr y w s w w w w w w w w w w w w w ♦ w w w _ • w w 4 R w w w w w w ♦ w w w w w w w w • w w ♦ w ' w SPECIAL CONDITIONS OV THE PERMITt • '• .. s Y �' y�.M��TYii Ty��•�•iYi iFi � �Y4r.�.r�r�� Tti Y i"C'� WN OF QUEENSBURY APPf, IC11TTON FOR BUILDING AND ZONING PERMIT Reviewed P y Fee Paid fi BU I L.DI NG AND CODES UEPARTMP•,T pate Ib a ued 13AY and HAVILAND ROADS RD I pox 93 pUEENSDURY, NE1jF YOORK I2BD4 'PeAm'z t No . wo Tel , ( 518 ) 792-5832 Exc -204 A PERMT MUST LIB OBTAINED BEFORE BEGINNING CONSTRUCTION , NO INSPECTIONS VI LL .13E N(ADE UNTIL APPLICANT 11AS RECEIVER A VALID BUI LDINC PERMIT . All applicable spaces on this application must be confpleted and the c"Ivrkatore of the applicant trust appear on the reverse side of this sheet . * N* * * x * * * * A A Ar * * k * * * * * * W * '* * 'le * * * * * * W '* * * * T1ie owner of this property is : Floe 11 . 0 , Address r 2.pq TEL . 7' .� -►I t' roperty location es� -wv "LAX MAP No . /.a Itas there boon any ::split of this property since October 1 , 1958 ? yes / ra�__ 7f yes , Planning Board Review 1. s necessary . UBD -1vJSION NAME , IF APPLICABLE LOT No . ^f' he person responsible for supervision of work as regards Building Codes r a z NA16% E P * o . ADDRESS 'EEL . NO * taame of }guilder Address _ Tel Tel Name or Plumber T.ddress TelName of Mason Address 14ATURE OF PROPO ED WRK: ZONING INFORMATION ( Orrice use only ) l:on:: t rue tjots of a 1►ew buildinrl ZONING DESIGNATION OF PROPERTY �Adaition to a Liuildirlg PERMITTED PRINCIPAL PERMITTED ACCESSORY TAltow:C"Lian to a Luilding ' � (no cll:ingu to OXt � rior alilnensions ) * REVIEW REQUIRED - PLANNING BOARD000wwwwwo 7.ONINC BOARD Utl�er work We crita.e) J2; ( a,W-ME- Jr SITE PLAN REVIEW $ APPRL7VEn DATE GROSS AkLh QE' PROL' QSED, i "PLIUC "i' UFtE " VARIANCE # APPROVCDA DATE C W Remarks : 1st Floor_ sq ft . ' 2nd Floor sq £ t . COf•1L'f.li'L'l . IP) Ofct4ATION ltl;QUIhL1D UE:LUW . Other Floors sq ft . Size Of l�ralr. rty " .- Latisti.iticl 1]ul. 1Ji� �•] :: 1 S1vm4�,_f` c X���, rt . ( not cellar or basoment ) „ v r F TOTAL FLOOR AREA� 7 _sq f t . Exi:;cing l:ruilJinl (:.: 1 Usu srr'y V of new struc reft K S`� ft ' >`cawl,d:ltiOn-laic slaL, crawl/partial/ full ' l'rOpo::Cd builuing , di::cancc from L,rol�urty iirtu ca.rclu One) „ 'Front yurd O rtt Rear yard4/A ft No . of stories (habitahla sl7ace) f !: t il�ighc ( e rack to rid¢ of Side yards rt and / C"1'1 l l ft . If on corner , :;eLb"Ok lroln side: _ec If rcoiduntial , now of familiesI ` Now of rown:; ( excluding )?;ath_31ww- OCCUPANCY 1hlFQRMA71CriJ tfoe of bedrooms �- , P12I1tARY LUILDINC aw No * of batt►raan► ; One family dwelling l•rirtrary Ili :atii►rl : y::cvtu_adds � "1wo family dw"ling •ryp of fuel aeu I multiple Uwe11ing / Number of units Noo Of firuplaccz; to 1au iflstalltct " I,am"nont occup.ar►cy Wall :a Wt]OJ .`.ilowa k.v lll ; t311a:ci?� t9 ' 'j'rian:.1UIlL" Occupancy Clintrul Air CO1kUiti0n1tn4J ?� I,] - - iiusinc ss WILDING STYLE PRIMARY w7'RUCTURf= * Industrial 1�1a1s : 1 Norn Ocher 1ra�lch Conte+uiwr:aYy LGn. c +lain owwwwwwom, it .addicion ' wilt will u::e icy.a? Ufolic level old style: ilua ►y. .LQW W cq;4vu Cad Cott"gl oclwr At ACCL SSOIZY 13UILDIIyC- L"c+loni;.l luaw '1oul� Hausa ' I :e tachad garl4go/one cur/ two car/ car ( CIR+CL4 ONE PLEASE 1 " AttcachLd ejaragu/onw cur/ two car/ cu ■' r . * ■ . • 1r . . w * x . r ■ !'' Llriv�ICa: .storage building I S '1' IMh"1' l: D MARKr'l' VALUL� OF ' Ocher CONSTRUCTION ' 7NPORLHATTON ON nUILDING SPF_CIFICATIONS , ON TtrVERSE: SIDE OF THIS rrICWT, 9'O BE COMPLE'Pvat Farm DPA 10/88 V2 BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . HC3 "10 E Will any second-hand or ungraded lumber be used? If so , for what ? Foundation wall material Thickness Depth of foundation below grade (to bottom of footing ) Will there be a cellar?_gip _Heated or unheated? Floor sq , footage sq ft Will there be a basement? /_Will any portion be used as living space ? ( I£ so , what portion? sq . ft . - - Type of use? Type of roof - sloped/flat/shed/other Material of roof e� L Size , wood studs "'X q '" spacing " o . c . length ft . Joists ( floor beams ) lst . floor NIXspacinq "'o . c , span ft , Joists ( floor beams ) 2nd . .floor '" X IN spacing "o . c . span ft . Overlays ( ceiling beams ) "'x »' spacing "'o . c , span ft . Roof rafters " X It spacing o . c , span ft . Roof trusses (pre-engineered) spacing "'o . c . span ft . Exterior wall finish 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 b provided? will a flue-lined chimney be installed? Q _ Height above rook ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth ft , in . , �J Water supply - Municipal or private well t- 1 %N/4J a ��`,o t [� SEPTIC SYSTEM _ Distance from ANY private well ( includding adjoining properties ft . (A separate application is necessary for any repair or new installation of septic system) D E CIA A RAT I ON 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 er, er r�� O er, weer s# . ent , are ` tect, contractor Ll It It SPECIAL CONDITIONS OF THE PERMIT : By--............. - ------------- ------- - TOWN OF QUEENSBURY APPLICATION FOR f SEPTIC DISPOSAL PERMIT DATE LOCATION OF PROPERTY FO11 INSTALLATION 4azewonfxjaJr4 , N" Owner's Name: F�1�'iA[+ f�-- GCS . �4 Z ram, _Telephone: '7 q 2- ? jot ;�' Address : r _-►� C�� A 1Q �.) a► SBd+G � I�LL +.J "� sAc_ I ] d° PS� Installer's ?Name: �. '/,/`c,� /J.' /J ���` Telephone: Number of bedrooms (residential only) Total daily flow (compute (d 15U gal per bedroom) Topogr€€phy : Circle one slat Rolling Steep Slope of Slope Soil N€xture: 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 , Water supply from septic absorption feet PROPOSED SYSTFNI : Septic Tank it no a gal. (minimum size: 1 , 000 gal.) TI L E F IELD: Each Trench feet/Total system length feet SEEPAGE PIT(S): Number of /� / Size each feet by ZO 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 Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: DATE: ~-/U' " 7 OVER. Scptic System Inspections : A . All applications for suptic systent installation , alteration or repair , as roquir.rd by rho 'i'own of Queensbury Sanitary sewage Ordinance , shall bt, submirt � d to the building Departmenr at least 24 hours before start of construction and :� hnll include a l3lut plan slxowing. : 1 . ) rho proposed location of the system � . ) locaeian and distance to lot lines 3 . ) locution and distance to structures 4 , ) location and distance to any water supply 5 . ) siau and dimensions of all tanks , distribution boxes , tilt: Lic: lds 41rd / or drywells I3 . Nu -� ystolitshal. l be covered before inspection and approval by the 1suiid11lg 13ispoctor , failure to comply with this requiromuIle may re ult iii tllo uncoverinu of Ch.: systcaua by the installer :.nd a fine uL Lill to $ 250 . 00 . C . Ati approved copy of the plot plan shall be available on Clio construction > ito . Failure to produce said plot plan at time of inspection may result in an irnmcdiate work stoppage . D . ' hould unforeseen probloms during construction prevent proper installa— tion , alteration or repair of an approved system , a new proposal must ho - ubmittocl to the Quounsbury F3uildinb Department before further c: uiar: tructinn , Town of Queensbury BUILDING and COOLS DEPARTMENT Bay and Haviland Roads Quocnsbury , New York 12804 Kt lLui r k s : 0� I'SSLJ E/ DAT/E IMMIDOrY'+': T 3{ LFJF Es.� PRODUCER THTIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, Haylor, Freyer & Coon, Inc . E% END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, yr e, Street S s�rracurcuse, New York 13203 I COMPANIES AFFORDING COVERAGE j COMPANY A LETTER State Insurance Fund _ COMPANY .`. INSURED LETTER B Saratoga Housing Outlet, Inc . Route 5Q, RR8, Box 1 COMPANY �+'LETTER .Sara Toga Springs ,, NY 12866 COMPANY —_ __._....._ LETTER COMPANY E LETTER THIS IS TO CERTIFY THAT POLICIES OF INSURANCE 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 CONDI- TIONS OF SUCH POLICIES. - CO ^: L : - a�:.. . <� -A'IGti LIABILITY n'TS IN THOUSANDS TYPE OF INSURANCE POLICY VL'F,A�BEB up'P .nna.!:[' y':` t :J� f _ ,r.,I cc. ,: . 4 �� _�...... L R 1 ,... 3 a.;GaE ,ATE GENERAL LIABILITY i ¢OL71L COMPREHENSIVE FOAM INJURE � r� -r PREMISES'OPERATIONS UNDERGROUND j �)AmAGE $ $ EXPLOSION 6 COLLAPSE HAZARD PRODUCTSrCOMP;ETED ']PEP.AT,ONS CONTRACTUAL � I ! BIa Pu iNDEPENCENT CONTRACTORS s 1 9ROA0 =ORM PROPERTY DAMAGE PERSONA:, AJURV PERSONAL I"jJURY . AUTOMOBILE LIABILITY 3C£I. k j ANY AUTO $ ALL U:tiYED AUTOS .PRI'u 4 T I j ALL O'r'�'NED AUTOS ( PAIV aPASS^ r j 1 RIMED AUTOS i PROPER^v JS I DAMAGE $ ;;ArWGE _ ARIL!TY I al P- j ;OMBINEU gi g P; UMBRELLA =4RM �- _OMBIvEu `JTHEP ?HAN UMORELL.A FORM WORKERS' COMPENSATION j "' - �.i0 IEACH ACCIDENT) A AND 771 660-8 3/10/89 , 3/10/90 i j � fpISEASE POLICY '_+MIT; EMPLOYERS' LIABILITY j -DISEASE-EACH EMRLDYE�s OTHER DESCRIPTION OF OPERATI(DNSJLOCATIONSNEHICLES/SPECIAL ITEMS SHOULD ANY OF THE ABOVE DESCRIBED P ICIES BE CANCELLED BEFORE THE EX- 'IY,7W1-1 4fr2eT1S�31.7.rS7 PIRATiON DAT THEREOF THE ISSUI G COMPANY WILL ENDEAVOR TO Pltttn : Bldg. t)ept. Connie a LEFT B THE TT UT FAIMAIL LUR O MAIL H TaAY WRITTE CO TH C M IPOSE NO OBLIGAFICATE RTNDN OR UA NAMED OBILITY Bay & Ha2zland Road OF ANY KIND HE C M I AG PRESENTATIVES, Queensburyr ZITS' 12804 AUTHORIZED R R TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT q111? BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I280k TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION DATES / PE MIT # y APPROVED f�a� ES NO FOOTING/PIERS MONOLITHIC . POUR FORMS FOUNDATSO NI DAMP—PROOFING BACKFILL APPROVAL ROUGH PLUMBI G FRAMING ELECTRICAL ROU —IN INSULATION: FOUNDATION FLOORS WALLS FILING tPeIN AL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING � EXTERNAL PORCHESI$TEP STAIRS—CLEARANCE S& RAILS PLUMBING FIXTUREbtIRELIEF VA INTERIOR TRIMIPF#VACY DOORS iI FINISHED FLOORS._. - GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTOR FINAL ELECTRICA INSPECTION FINAL APPROVAL OF CONSTRUCTION -- J r A SIGNED CERT-VPXCATE OF OCCUPANCY MUST BE OBTAINED FROM THE .BUILDING DEPARTMENT BEFORE THESE PREMIS S ARE OCCUPIED! REMARKS : INSPECTOR Member AV.F.P.A. A f.A•E.i. NY ATLANTIC - INLAND, INC. Efeet1lcaf Certificate EkisCir ai and Fire 1rr5pectf0n-Enf0rcing & Consu7irrg Servrca 997 McLean Road, Cortland, NY 13045 GATE: CERTIFICATE NO.: -1i r •i OWNER: E;d-r�„" H , F-r:r � fi ': II , _r . f l w r I mr h 7. y.-r AS APPROVED FOR: ADDRESS: Town f 4n4.r'errv-r+_ti _• iJ ,' s,_.I-.3 1 = Ha .nr ELECTRICIAN: 7 •.; i3 1-1 Fagg 1 e-mot_ •t'i . • 3.�_ �{/�� ADDRESS. 1 - rlv' f CThe is cancelled ideas tolbwing oovornecl the issuance of this certificate, anti any certificate previously issue[ This certificate only covers the electrical equipment Balled and installation conditbns as at dare. vpor the introduction of additional equipment or aimratbora applicat400 shall he promptly made for inspection. E 1 L1 Inspectors of this Company shall have the prrvilage of making inspect One at any time, and if its xule5 ■► am violated, the Company shall have the right to revoke this cce,dititiicc]ate, Py AI - 77 TOWN OF QUEENSBURY BUILDING AND CODES ,DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 329L74— TELEPHONE (5I8 ) 79211-5932 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME E4 Qo LOCATION DATE _ _i� PERMIT # A ROVED ES I NO FOOTING/PIERS L ,�NOL.ITHIC POUR FORMS FOUNDATION/DAMP PROOFING BACKFILL APPROVA ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—I INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: 4 CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHE /STEPS STAIRS—CLEARAN E & RAILS PLUMBING FIXT RES/RELIEF VAL — INTERIOR TRIM PRIVACY DOORS FINISHED F RS GARAGE FIRED OOFING DOOR CLOSER (S) SMOKE DETEC ORS FINAL ELEC_^RI AL INSPECTION FINAL APPROVA OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS : INSPECTOR Dwra c►Ieteen3htcre� . BUILDING and ZONING DEPARTMENT Bay and Waviland Road, R. D. 1 Box 98 Queensbury, New 'York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCAT I ON + -- . DATE _0 / PERMIT NO. SOIL TYPE - Sand - Loam - Clay Percolation Test Required? YES - NO Percolation ate - Min/Inch _ TYPE 4f SYSTII Absorption fie d , total length Length of each Tench Depth of trenchev Size of graver_ _ SEEPAGE P {Ld SIx of! { Size- � ft_ X _ ft. Gravel size PIPING : Size Type Bldg . to tank Tank to dirt . box Distw box to field/p ' Openings sealed? ES '`NO Partial LOCATION/SEPARATIONS Foundation to tank ft. Foundation to abso tion ft . Absorption to lot ine ft. Separation of pi ft_ LOCATI YS� ON PROPERTY (circle one) Front Rear eft side - Right side - CCmmEN I SYSTEM. USE APPROVEDWcr O Bui. spector 01/86 and vl '�v. . . MAIN OFFICE ATLANTIC-INLAND, INC. 997 McLean Rd. NEW YORK Cortland, New York 13045 MEMBER OF N.F.P.A. AND I.A.E.1. PFlOn6: (647) 753-7118(647) 753-7849 FIRE UNDERWRITERS ,� . .(607) 753-1396 (Electrical and Fire Inspection-Enforcing and Consulting Service) (Incorporated in the State of New York) Desiring Certificate of Approval, application is made for inspection of electrical installation In the premises described below. On demand applicant agrees to pay for inspection service In accord with schedule of charges. APPLICATION FOR ELECTRICAL INSPECTION — PLEASE PRINT OR TYPE THIS SECTION TO BE COMPLETED BY APPLICANT DATE OF APPLICATION CITY. TOWN, VILLAGE COUNTY STATE STREET ADDRESS 1 BUILDG. NO. RURAL . � ` DIRECTIONS —:!g r /'7'"� 1 r„ POLE NO. OWNER'S NAME , IZ OCCUPIED AS OCCUPANT BuILDwG New Id L3 WORK New ❑ Additional L) OWNER'S P.O. ADDRESSBsa,& A ?i s AP P. FOR — ROUGH WIRING I7 FIXTURES ❑ OR READY FOR INSPECTION 1g FEE REMITTED — S BY CHECK SH O MONEY ORDER ❑ MAKE PAYABLE To ATLANTICANLAND. INC -- NEW YORK NumbeF of Rcuyh Wiring Outlaw Fixtures Adel Installation Swteh U'xng Rocep_ KW Mec. Mogul Fluor. 500 750 1000 1 1750 1 ISM I 17511 2000 1 2250 2500 2750 3000 Heat Base Base Elect. Heat Amp- Semite Water Hir. au frier Air Cond_ Seneca Unit Oven Range GL Disp_ Dish W. Dryer H.P_ Pump Ex. Fan Hood OTHER EQUIPMENT (Specify Type 6 Capacities) TYPE or SIZE of SUB- WIRING OPEN ❑ CONCEALED O ER MAIN MAIN BRANCHES CIRCUITS _ APPLICANT'S SIGNATURE LICENSE Y PERMIT Y APPLICANT'S JOM r 41'�y�L UT LITY F ADDRESS . , OFF ICE TO CITY S S STATE ZIP CODE BE NOTIFIED BELOWF SPACE • OF • ' ONLY ROUGH WIRING AMP SERVICE K.W. SURFACE OUTLETS EQUIPMENT UNIT SWITCHES AMP SERVICE K.W. OVEN CONDUCTORS H-P.GARSAGE RECEPTACLES H.P_ PUMP DISPOSAL UNIT MEDIUM BASE KW. FIXTURES K.W. DRYER DISHWASHER MOGUL BASE K.W. WATER FIXTURES HEATER M.W. RANGE FLUORESCENT H.P_ AIR AMP. RECEPTACLES FIXTURES CONDITIONER MERCURY VAPOR OR WIRING 6 CONTROLS FOR BURNER SMOKE FRAC. H.P. QUARTZ FIXTURES I DETECTORS VENT FANS MOTORS. H.P 1l24 tJl2 1/10 1r8 1!fi tie 1!3 1f2 3!a 1 I '/a 2 3 5 71a 10 15 20 25 70 40 50 75 100 MARLS NUMBER OF EACH SIZE 500 1 750 1000 1250 1500 1 1750 2000 1 2250 1 25o0 275o 3000 APPARATUS Elect, Heat MISC. INFO. Received Inspected FEE PAID PROGRESS fff TOYAL 'j f/7 d DEFECTIVE I= Rough Wiring CarLLcale Check No. 0 Temporary Sarvlca Money Order Mi on.- Fri . 6-7 :30A. M., o 14gi CERTWICATr Cash 518-4-0 2-9295 4 Du p. Cart. Req. rJ" 18-f73r3-f 339 E3 MUNICIPAL Charga MUN. ADDRESS .rru. ATLAi ..7IC-INLAND, INC. - NEW YORK mArs ArriIcw41r1ow uo. P.O. Box 701 , - — % Groton Avenue Plaza, wc�.r+on Cortland, New York 13045 ✓ C� - - Phone (007) 753-71IS C O Mr RACTO R M R R TO rMusm"V Ar ;lrR THE JOLLOWING DEFECTS WERE NOTED: =r_,G.-yN'' �-ram''=-- ` ow COPIES TO APPLICANT ONLY FIELD KM r" wR ■ ' SIGNED NEW It . - i� Syr � , � ; HALL 4 x 14 - 22_SY f (WA PL rff w.ry ,1F• S 7 T 4.y'art rqr tot�fgsP3l.r. si rabf[ iN ✓ g•5 f f 1 A'Y 1 MST A i'lOU 1 1 ( 6 ' �7f�{J itr! --nl,Y f {�4.t0Cvrt *21 nw *-e +I�(--tea(' 1 ?9' 9a Iet.G4rQ X .r,tir A7x5A' o STD , ern k3 4 11 JJ # n w u t!'a : lT t�C.ri .'vT kiu 4 52 _r .rN 69 I . K f T Zn: i..5fa. d'9, ( i,. y; ?, 7O ..7 j4�a� '� ! �if/J~..Yrv'p4 �. 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Zoning Ad 'nistristr Date L--T4- 71- 3