1989-178 FI p TP
x T�-
i
CERrrimcA.TE C3F CUPAN '0� 7
i
TOWN OF QUEENSBURY �
WARREN COUNTY, NEW YORK j
Date SPptemb ---
6- - I9
0^'y $.�
A.
This is to certify that work requested to be done as shown by Permit NO. 89 - 178 I
has been aompletcd.
I This structure may be occupied as a S itsf l Farm 1 y Dwelling
4 1
95 Luzerne Road
Owner _ LeRoy Sc Pamela LaCross
By Order Town Board
I
TOWN OF QUEENSBURY
! N
i Director of Bldg. & Code Enforcement
I
BUILDING PERMIT
TOWN OF QUEENSBURY
No. $9 -178
WARREN COUNTY, NEW YORK C
1V
PERMISSION is hereby granted to
1
wa
Street, Road or Ave. l I
OWNER of property1-
located at _ yai�sput Road
To Construct or lace a Single Family' Dwelling, 'p
in the Town of Queensbury, p
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 Queenshury Building and Zoning Ordinance.
1 . OWNER'S Address is
RD 3 Bog 268A Luzerne Rand
queensbury . N . Y . 12804 0
cn
2. CONTRACTOR or BUILDER 'S Name
Y
Self
P4. ARCHITECTS
TRACTOR or BUILDER S Address r�iQ
Same '
Name
S. ARCHITECTS Address
G
S. TYPE of Construction — (Please indicate by XI N
XX } Wood Frame [ } Masonry ! } Steal ! }
I:sJ
7. PLANS and Specifications 7d
er
as lot Plan , CD
No. 2693 slqw fC . single family dwelling p F FrV
specifications , and application , Xncludingseptic , and atta hied
B. Proposed Use
y
Single Family Dwelling
25 . 00 c/a November 1 vs $
$ 359 . 00 PERMIT FEE PAID — PHIS PERMIT EXPIRES
!if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the t,
town of Queensbury before the expiration date.) Ce
Dated at the Town of Queensbury this 14ttt Day of Apr i 1 t9
89 �
r—
r,,,r
SIGNED BY for the Town of Queensbury H
Building a Zoning In or C
!t
r
1-
r
'!'C I F UEENS]3URY APPLICATION FOR BUILDING AND ZONINC, Pr• RnkIT
.
Vata-
l7ec,%e� ett 'TOWN OF QUEENSBURY
4el
Rev.i. d � RECEIVED
Free Paid SSE 44 5 APR 14 1gqq
BUILDING AND CODES DJ AM4r* f Date I.o.aued BLDG. 8r CODE DEPT.
DAY and NAVXLAND 4ROALS RD 1 DO-K 98
PUEENSBURY , NEW YORK 12804 Pe n'soi t Na .
Tel . (' 518) 792-5812 Ext -204
r * r t * ve W s i rt ae * x •r * w w x s • a a ■ • ■ s x + * a : w . !
A PLRMT MUST Gq OIITAINEU ]BEFORE Lk. GiNNING CONSTRUCTION . NO INSPECTIONS
VI LL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID DUI LDINC PERMIT .
All applicable spaces on this application Iftust be completed and the
Da tore of the applicant must appear on the reverse side of this sheet .
!� x
Pkce owner of this property is :
' Rd QQu--- 1 i/ 1�[r !� T E L . I C[ 7
i' . O . Address r�
[+ roperty location L .0 � la 'Q ! ' �.&� LAX MAP
t (as there been any split of this property since October 1 . 1988 ? yes/ Ito
, _�
if yes , Planning Board Review is necessary . LOT NO .
SUBDIVISION NAME , IF APPLICABLE
The person responsible for suporvision of work as regards Building Codes is :
E
P . O . ADDRESS TEL . NQ , _
NAMI i / 1 .� 'SBi l3rrLS C�'f
taume of builder ddressTel tip
Name of Plumber / Tel A > r
Name of Mason Address
94ATURE OF PROPOSLD WORK : * zONIPiC: IN !' C1 (tl1lt'1' IO1�! ( ptrica usa on111
✓ Con trucLiar� of a crew building " ZONING DESIGNATION OF PROPERTY
.Addition to a lzuilrlin M
r
q s PERMITTED PRINCIPAL PERMITTED ACCESSORY
.Addition
to a l,uilding REVIEW REQUIRED - PLT.NNING BOARD ZONING BOARD
{
( na Ck4 rri4�V to oxc " rior oiinens• ianal � ry
Uciler wort: (descrxuo ) SITE: PLAIN RZViEW #i .API ;• :V�« W ='
VARIANCE APPROVED DATE
(; itOSS ARL:!1 OL" 1-ftOPOSCD. t; `TftUC '!' UFi.!~
' _'�+�v9� Remarks
1st Floor ; sq ft •
2 nd Floor �p Sq f t . „ COL•t1'Lr::T I �11`Oj 1tA'1'1CIi1 Sc1 riU11cLA U1 LU41 .
ira of prc'opwtrty� ,�C1C? rt %
Other Floors 1 f sq ft . Lati ;tinr} bL4ilaii1.] ( ::) SiFM1` fk: x re .
( not cellar or basement )
TOTAL FLOOR AREA �sq f t . " 1:xi� Ging b4ilai.nrI-Afl (... ) U:.a
taf new -:Lru0Uur*2 ft ?+ ft R �� '
L`Cyr7r.d rcion-riierl la1u/cr:awl/f�artialltull ' l'r4j�ca�ea b"ilraing * di::caneu frout l.zul4Lrty lire
(circle orrc 1 Front yard f e Rear yar. d f t
Na . of stories ()►alSicabla sl�acc ) - * Side yardss� _r t and �C? _r
k(�ighe ( rlrade to ridgy ) ft * ,� if on corner, :iLtl-3aCk train side: strcc:c re
l f rQ!31duntial , no . Of fa(nilies .� C1CCuPANCY 1NFOP4riAT1ON
No. of raQm a ( axcludinq bath:+ ) '
Ito. of �`
PTt Y CrS3ILnINC OWN
No . of L"chrooura �' _ 111� / Onc .family dwelling
I`riut:. ry ktuativi., sy: c,:m�.., 9 .- F 3aftmommmomp Two family dwLillinq
Types of fuel U4 :Q Kulti.141" dwelling / Number of units
Nom of fireplaC LO 1. iIl:�callad # -i'crutancrxt occup urcy
Will :r wood stov.: L� irrt: t»+ llurl?..�l `Pr:ansi4rrt ni eu(uarrcy
tunL'r"I' Air conrlitiunin9:' ; Businuss
Bu n.o l i+kG STYk_E. AR i MA.RY SI-RUCTURE Inau:.•tr ial
W Ochar
:_.uc Cont.:+ul c+r'.ax y Lon c:.k3 in if .addition, what will usa b%37
ranch Mansiu+c puljliax
uplic 1+:Vel Old � cy+ le Uuttcj.alow '
ILDINGION
C:.l.iu Cod Cottaq%2 Oclrur M ACCDsacaRY d 9"ri4go/
'1'owlr House ' li4tachad c2 ►re.c3c/ano cur/ two car! czar
Ccr l an l.a 1 !WMI d 'f:� C a c'
( CIRCLe C"e PLEASE ) " Actochkita gararyulortia cart two [ a
w a ■ / w ,. # f . . ■ Is r . ttStr.iva CLI scocaga bullceing
VSopI MA`1 ED MARKrT V Al. 0 (�. OP
* ��Othc3 r
r
�: aevr ::•r 1c u C•�• T U N -
7Nf'ORmATION ON DUTLOTNC SPrCTVTCATIONS , ON RCVCRSE SIDE OF `PHIS .".kkL:ki , TO Be COMP LC'i`S:D !
Form UPA 10/88 v1
41X IL
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood .frame , fire safe , etc . r KAME
Will any second-hand or ungraded lumber be used? If so , for what ? it) - _
Foundation wall material (� •
Thickness ttyf
Depth of foundation below -grade ( to bottom of footing )
Will there be a cellar . eate or unheated .
,_Floor sq . footage s ft
Will there be a basement? %i MWill any portion be used as living space? Idm
( If so , what portion? sq . ft . - - Type of use ? I -
Type of roof - sloped/flat/shed/other Material of oof Ip_,g
Size , wood studs aci.n" X s
p g� ""o . c . length -ft .
Joists ( floor beams ) 1st . floor �'•X_AC�.1 spacingg_ _1'� l.o . c . span 1� to t .
Joists ( floor beams ) �` JW£loor " X /�6 spacing
s"o . c . span I ft .
Overlays ( ceiling beams ) "X- � r spacing ,� �r� "ca . c . span ] A;1 ft .
Roof rafters _ •' X -" spacing� o . c . span /" ft _
Roof trusses (pre- engineered) spacing "o . c . span ft .
Exterior wall finish 1121 V" F� Of what material ?
Interior wall finish f 5;;�4 Ifs spjD
If a garage is to be attached , Tnescribe materials to be used for FIRE SEPARATION :
ape Ii
Is there t6 be an opening between garage and dwelling? If so will a Fire- rated
door , enclosure , and self- dosing device be provided?
Will a flue- lined chimney be installed? Height abov roof ft .
Depth of chimney foundation below grade ft ,
Depth of fireplace hearthA _ft . in .
Water supply un1i ` ' ��r Qr private well
SEPTIC SYSTEM _ istance from ANY private well ( including adjoining properties ft .
(A separate application is necessary for any repair or new installation of septic system)
DEC LA RATION
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 SUII,DING CODE, TI3E ZONING ORDIN NCF, and '41,
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
SPECIAL CONDITIONS OF THE PERMIT :
By
t 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 4 '� ]
2 . Type of heat I&ftL- Po
3 . Is the building mechanically cooled ? i� --
4 , rcentage of area of windows and doors /' )`)0 --
A , Over 16 % Only
1 . U value of gross area of walls , roof / ceiling and floor
0 osed to ambient conditions
2 . Floor ov heated spaces YE NO (����"�
a . Are fours tion walls 3. nsulat NO
1 . if YES , at is the alue ? l
3 . Slab on grade YES
a . If YES , what the R v e of insulation around
perimeter floor ?
4 . Is basem heated ? YE NO
a , slue of insulation
5 . ype of insulation
B . Under 16 % Only
1 . R value of roof and floors exposed to ambient conditions.
2 . R value of exterior Y: alls �f
3 . R value of glazed area '
4 . R value of doors 14- i f - q
5 . R value of floors over unheated spaces
6 . R value of slab edge insulation - unheated slab
7 . R value of slab insulation - heated slab
e . R value of heated basement / cellar walls ( above grade ) _
9 . R value of heated basement / cellar walls ( below grade )
10 . Type of insulation
C . Controls
1 . Thermostat maximum heat. setting S. s"'�•�R"�
D . Duct Systems
1 . Is duct system installed in unheated spaces NO
a . If YES . R value of duct installation
b . 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 4V
1 . Performance efficiency
2 . Temperature control setting maximum
G . For Swimming Pool Only
1 . Maximum heating _
Telephone No . ` `~ �
( icafnt ' s signature )
TOWN OF QUEENSEURY
APPLICATION FOR.
-t ,rti
SEPTIC DISPOSAL PERMIT
DATE t
LOCATION OF PROPERTY FOR INSTALLATION
moss
Owner's Name: Telephone:
Address: /zl `
Installer's Name: Telephone:
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom) La
Topography: Circle one: Flat Rolling Steep Slope % of Slope
Soil Nature* Circle one: jLand_ Loam
� /Clay Other /Depth: Feet
Ground Water: At what depth? 1z Feet
Bedrock or Impervious Material: At what depth ? Feet
Percolation test: Circle one: not req�u.i—r-e--d required rate min. inch.
Domestic water supply* circle one: Qulunictpal~Yell Other
If domestic water supply is a welli
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic, gnk 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 # 6?, /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 Sa y S age Di Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE:
OVER
Septic System Inspections :
A . All applications for septic systeut installation , alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage Ordinance , shall
be submitted to the building Department at least 24 hours before start
of construction and shall include a plot plan showing :
l . ) the proposed location of the system
? . ) 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 ,
tile fields and /or drywells
H . No system shall be covered before inspection and approval by the
Building Inspector . Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
of up to $250 . D0 .
G . Ai approved copy of the plot plan shall be available on the construction
site . Failure to produce said plot plan at time of inspection may
result in an immediate work stoppage .
n . Should unforeseen problems during construction prevent proper inscalla—
tion , alteration or repair of an approved system , a new proposal must
b, submitted to the Quuunsbury Building Department before further
construction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queonsbury , New York 12804
kuuiarks
Member N.r..P.A. & l.A.E.1.
ATLANTIC - INLAND, INC. - NEW YORK ECectracaC Certificate
Efeciricaf and Fire Inspection-Enforcing & Consuiting Service
997 McLean Road, Cortland. NY 13045 DATE: �`� '=•} �� CERTIFICATE NO-: 'ry
OWNER : L_sF�,,
AS APPROVED FOR:
ADDRESS:
cl
h• i I "t ::ai `.} } s',v�.� S` z^I l_�y1[;: . . # f"4...t: ryf Mt` C :1��: / �:11 . 1. t:+r"'h' ? � .^;=-i- .
ELECTRICIAN:
ADDRESS: -
The c,undihorl5 following governed the issuance of this codificate. aria any certificate previously issued
is cancelled:
This certificate only covers the electrical equipment listed and installation conditions as of dale. Upon
the inlroduction of additional equipment or alterations, application shall be promptly made for inspeclion.
violated-
of this Company shall have the Privilege of making catO, CliOns of any time, and if its rUleS
FRF
are uiCNa[ed_ the Company shall have the right 7o revoke this certificate.
ire ,�t —
� We
At - 27
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY. NEW YORK 2280&
TELEPHONE (518) 792-5832
BUILDING INSPEC"I OR " S REPORT
REQUEST FOR W
TION RECEIVED
/.
NAME
LCICATION
DATE PERMIT
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC PO FORMS _
FOUNFATTON/DAM -PROOFING
BACKFILL APPROV L
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-
INSULATION*
FOUNDATION '
F I..00RS
WALLS
CEILING
FINAL INSPECTION*
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCH ,/STEPS
STAIRS CLEAR E & RAILS
PLUMBING FIX RES/RELIEF- ALVE
INFERIOR TRI /PRIVACY
DOO - -
FINISHED F RS
GARAGE FIRE ROOFING
DOOR CLOSE (S)
SMOKE BETE TORS
FINAL ELECTR CAL INSPECTION
FINAL APPROV?lL OF CONSTRUCTION
p
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED?
REMARKS* }r ale/4/ n 4,
-e�
INSPECTOR
TOWN OF QUEENSBURY ��
BUILDING AND CODES DEPARTMENT p �
BAY & HAVXLAND ROADS +�
QUEENSBURY, NEW YORK I280* -
TELEPHONE (518) 792-58.32
BUILDING INSPECTOR ' S REPORT
REQUEST FOR XNSPECTION ECEIVED
NAME
LOCATXON p6
DATE - �' / PERMIT #
APPROVED
k
YES NO
FOOPTNGY,�,PXERS
M0NOLXTH ZC POUR FORMS
FOUNDATIO)V1DAMP-PRO0FXNG
BAC'KFXLL A)�PROVAL
ROUGH PLUMBNG
FRAMING
ELECTRICAL R GH IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING t
(,,�'FXNAL INSPECTION: '
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES STEPS
STAXRS-CLEARANC & RAILS
PLUMBING FIXTU ES/RELIEF LVE
INTERIOR TRIM RXVACY DOOR
FINISHED FLO S -`
GARAGE' FIR. OOFXNG
DOOR CLOSER S)
SMOKE DETEC RS
FINAL ELECTR CAL INSPECTION
FINAL APPRO AL OF CONSTRUCTION
i
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS: /
V
r'r
INSPECTOR
TOWN OF QUEENSBURY � �^y
BUILDING AND CODES DEPARTMENT ( ter, VGeF�aR� cy^y
BAY & IIAVILAND ROADS �-
QUEENSBURY, NEW YORK 2280+& "^
TELEPHONE (5I8) 792-58.32
BUILDING INSPF)=R " S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION yy c 4
DATE I 1 1°ERMST' �j S� CyS
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-lPROOFING
BACKFILL APPROVALL,
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—TN
INSULATION.
FOUNDATION
FLOORS
WALLS i
CEILING E
FINAL INSPECTION
CHIMNEY HEIGHT'
ROOFING t
SIDING 5
EXTERNAL PORCHES/STE
STAIRS—CLEARLNCE & RA LS
PLUMBING FIXTURES/REZ,�F VALVE
INTERIOR TFr3M/PRIVACY DRS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSERS)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY -]MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
001,
INSPECTOR
.?Own v/ Qeteeriji"ry
BUILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R.D. 1 Box g8
Queensbury. New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION!
NAME r-to C7� 0r` �
LOCATION c;;tI6 ` Gc^
DATE 24 / PERMIT NO. � 1�
SOIL TYPE - and Loam - Clay
Percolation es Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field , total length
Length of Beach trench
Depth of tronches
Size of grav'e1
SEEPAGE ITS## of)
S.3.ze- ft.
Gravel size
PIPING : Size Type
Bldg . to tank
Tank to list_ bow,. �� —
Dist. box to field'
Openings sealed? ES NO Partial
LOCATION/SEPARATI St
Foundation to eta k if
ft.
Foundation to sorptionft .
Absorption to .4t linet.
Separation of kits t.
LOCATION OF STEM ON PRO
c e e)
/Pv/ryo/�n�yt�fTry- Rear - Left side - ht sideCC ifi, EN1S :
1
1
SYSTEM USE APPROVE*YN Bp ce of r
O1/86 and vl
TOWN OF QUEENSBURY
BUZLDSNG AND CODE'S DEPARTMENT '-�1-
BAY & HAVXLAND ROADS
12"E6'S5URY, NEW YORK 2 280&
TELEPHONE (518) 7921111158.32
BUILDING INSPECTOR ' S REPORT
+TWUE"ST FOR INSFECT.ION RECEIVED
NAME !j4
LOCATION
DATE' 9 ,-
APPROVED
FOOTING/PIERS YES NO
MONOL.r r xc FOUR FORMS
FOLINDATIONIDAMP-PROOFING
BAC1{FILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRIC.. ROUGH'•2N
IIVSULATxo)V:
FOUNDATIf 1
FLOORS j
WALLS
�ESLSNG
L..3 "1 NAL XAVSPV�C �r
CHXMMEY NEIGH i
ROOFING
.SIDING
EXTERNAL PORCHES EPS
STAIRS-CLEARANCE RAID ^.
PLUMBING F27f2UR / LIEF VALVE
INTERIOR TRIM/P VAC DOORS
F-rNISHED FLOOR
GARAGE FIREPR FING
DOOR CLOSER (
,SMOKE DETEC RS
FINAL ELECTRI AL INSPECTION
PINAL AFPROV OF CONSTRUCTION
A SIGNED CERT_TFSCATE OF OCCUPANCY g* }3E
OBTAINED FROM THE BUILDING DEPARTMENT1BEFORH
THESE PREMISES ,ARE OCCUF'IEDE
REMARKS:
0
XNSP R
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS �.
QUEENSBURY, NEW YORK 12809.
TELEPHONE (5I8) 792-58.32
BUILDING INSPECTOR ' S REPORT
REQUEST F I SPECTION RECEIVED
NAME -
LOCATXON [7 DATE PERM?T
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATIQ AVDAMP-PROOF2NG
BACKFSLL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
L.r-'INSVLATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT r 1
ROOFING
SIDING
EXTERNAL POR HES/STEPS
STAIRS-CLEA NCR & RAILS
PLUMBING F XTURES/RELIEF VALVE
INTERIOR RIM/PRIVACY DOORS ..
FINISHED LOORS
GARAGE F REPROOFING
DOOR C SER (S)
SMOKE ETECTORS
FINAL ELECTRICAL INSPECTION
FINAL AP,�ROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUpIED1
REMARKS:
r�
r'
XO
I SPECTOR
Member N.F.P.A. & I.A.F3.
jr
NY ATLANTIC - INLAND, INC. ` fectnocat Certifxcc to
Flec�hr'aal and Fire IrrSpecl7i7r7-Errfiarcirlg & Corrsullirug Service �' i ! 8
997 McLean Road, Cortland, NY 13045 � �
DATE: CERTIFICATE NO.-
OWNER. Rd .
a_r _ r7;._ I_:a_��`• i-:rl AS ,APPROVED FOR:
ADDRESS:
ELECTRICIAN:
ADDRESS:
the corwitnons "Ichwing governed the issuance of this certi}icate. and any eartilicate Previously issues?
COis rasmiled�
V This cen""rate only covers the electrical equipment Plated and installation condiNon3 as o} date. Upon
the introduction of additional equipmem or alterations,
Inspectors or this Company shall have the ZIPOIcation shall CT prs All a �made for d if its rule
are violated, the Company shall have the
right torryevoke this cMakeertift atng ee�Ions at any time, and if i5 rules
py
TOWN OF QUEENSBURY
BUZLDTNG AND CODE'S DEPARTMENT
BAY & HAVILAND ROADS C! i
QUEENSBURY, NEW YORK 128D.4
TELEPHONE (5-18) 792-5832
BUILDING INSPECTOR ' S REPORT
RE¢UESfi 4 XIVSPECTXONON R
ECEIVED
NAME
LCCA rXON
DATE / K L f 1°ERM22' # ✓ -� PSi l �J!
APPROVED
FOCJ2ING/PZERS YES NO
MONOLITH-rCr POUR FORMS
F OUNDATTON/DAMP-PROOFING,
BACKFILL APPROVAL
ROUGE PWMBIIVG
xR4MXNc t.
E'LEC'TRZCAL ROUGH-IN
INSULATION:
POUIHDATZON
FLOORS
WALLS
cEZLING
FINAL TNSPECTZON:
CHZMNEY HEZGHfi lie
ROOFING
STDZNG
EXTERNAL PORCHES/Sp PS
STAIRS-CLEARANCE & TLS
PLUMBING FIXTURES/ ELIEF VALVE
ZNTEFtIOR TRZNIPRI ACY DOQRS
FINISHED FLOORS _f
GARAGE FIREPRCY7F NG
DOOR CLOSER (S)
SMOICE DETECTORS
FINAL ELECTRICAL 1XNSPECTION
FINA,; AppROVAL Op CONSTRUCTION
i -�
1
A SIGNED CERTZF�ICAT� OF
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!,
RENARxs:
40
INSPECTOR
TOWN OF
QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVXZAND ROADS
6? Y
UEENSBUR , NEW YORK 1280*
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
ZOCATION
DATE ] PERMIT #
APPROVED
YES NO
FOOI'I1VGf PIERS
MONOLITHIC POUR FO S
FOuxDATION/DAMP-PR FIND
�lO'IJ.L APPROVAL
OUGH PLUMBING
FRAMING
EZECTRICAL ROUGH-I
lUZRTION;
FOUNDATION
FLOORS
WALLS
CEILING
FINAL XJVSPECTION:
CHIMNEY HEIGHT
ROOFING
,SIDING
EXTERNAL PORCHE /STE
.STAIRS-CLEARAN & RA LS
PLUMBING FIX ESfRE F VAL-H
INTERIOR TRIM PRIVACY RS
FINISHED F S
GARAGE FIRE OOFING
DOOR CLOSER S)
.SMOKE DETE F{S
FINAL ELE'CTR CAL INSPECTION
FINAL APPRO L OF CONSTRUCTI
A SIGNED C F2TIFICATE OF OCCUPAN
OBTAINED F MUST BE
M THE BUILDING DEPAR ENT BEFORE
THESE PRE SES ARE OCCUPIEDI
REMARKS.
INSPECTOR �
TOWN OF QUEE.NS$URY
BUILDXNG AND CODES DEPARTMENT
BAY & HAVXLAND ROADS
QUEENSBURY, NEW YORK 12804 `
TELEPHONE (5,18) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FpR INSPECTION RECEIVED
NAME
LOCATXON
DATE --;` __ f' PERMIT #
.APPROVED
YES FOOTING/PIER NO
S
MONOLITHIC POUR FORMS
FOUNDATION1 P—PROOFING
BACKFX;z APP VAL
vvouGH PLUMBIN
BLECTRXCAL Rory —rN
XNSULATXON:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTXON:
CHIMNEY HEIGHT
ROOFING
SrDING
EXTERNAL PORCHE / STEPS
STA_2"RS—CLEARAN & RAT
PLUMBrNG F IXTU IsESIRELIEF VALVE
XNTERZ'OR TRIM RXVACY S
FINISHED FLOO S —
GARAGE FIRE
DOOR CLOSER (
.SMOKE DETECTO S
FINAL ELECTRXCAI , INSPECTXON
FINAL APPROVAL or CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE ,BU rr,D rNG DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!'
REMARKS:
INSPECTOR
TOWN OF QUEENSBURY
BUXLDXNG AND CODES DEPARTMENT �.
BAY & HAVXLAND ROADS
QUEENSBURY, NEW YORK 1280&
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FO X SPECTXON RECEIVED
NAMEp('/
LOCATXON )
DATE
APPROVED
ES
1�"FOOTXNG/PXERS Y NO
MONOLXTHZC POUR FORM
FOUNDATXON/DAMP_PROOFXNG
BACKFZLL APPROVAL ROUGH PLUMbXNG
FRAMXNG
ELECTRXCAL ROU -XN
INSULATXON:
FOUNDATXON
FLOORS
WALLS
CEXLXNG
FXNAL XNSPECTXONr
CHXMNEY HEXGHT
ROOFXNG
SXDXNG
EXTERNAL PORCHESfSTE"PS
STAXRS-CLEARANCE , RAXrr
PLUMBING FIXTURFSsVRELIE'F V VE
2NTERXOR TRXM/PR,rVACY DOORS
FXNXSHED FLOORS -
GARAGE FXREPROOFING
DOOR CLOSER (S)'
.SMOKE DETECTM- S
FINAL ELECfiRXCCAL INSPECTION
FXNAL APPROVAL OF CONSTRUCTXON
A SIGNED CERTXFXCATE OF OCCUPANCY MUST BE
OBTAXNED FROM THE BUXLDING DEPARTMENT BEFORE THESE PREMXSES ARE OCCUPIED!
REMARKS:
AXNSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 1280-4
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FO ;K SPECTTOM RECEIVED
NAME'
LOCATION
DATE 2 PERMIT # 2 Y
APPRO.JjD
YES , NO
FOOTIIVGIpIERS '
MONOLITHTC pOUR FORMS
4 FOUNDAT-TON/DAMP-PI;OOFTNG
L BACkpxLL APPROVAL
ROUGH PLUMBING rr
FRAMTNG
ELECTRICAL , ROUGH-IN
INSULATION:
FOUNDATION
r`
FLOORS
WALLS
CEILING
FINAL INSPECTION r
CHIMNEY HEIGHT • °{
ROOFING
SIDING
EXTERNAL PORCH ll�T,EpS
.STAIRS-CLE'ARA C E &'; RAILS
PLUMBING FIX RES1AELIEF VALVE
INTERIOR TR M/FRXVAgY DOORS
FINISHED F RS
GARAGE" FI EPROOFI NG
DOOR CLO ER (S)
SMOKE D TECTORS
FINAL EL TRICAL INSPECTION
FINAL AP ROYAL OF CONSTRUC72ON
A SIGN fJ CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUpxEDJ
REM MKS
t
NSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
.BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 1280&
TELEPHONE (518) 792-58.32
BUILDING INSPECTOR ' S REPORT
REQUEST FOR XNs5PECTXON RECEIVED
NAME
LOCATION - ,
DATE PERMIT # - �✓'rf/
APPROVED
YES NO
mzf TING/PIERS
MONOLITHIC POUR FORMS
FOUNDATIONIDAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH- ,TN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHESISTEPt
STAIRS-CLEARANCE & RAILS
PLUMBING FIXTURES LIEF VALVE
INTERIOR TRIM/PRI9Y Doollq -
FINISHED FLOORS
GARAGE FIREPROOF NG -
DOOR CLOSER (S)
SMOKE DETECTOR
FINAL ELSCTRICALZINSPECTION
FINAL APPROVALO CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY. MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
INSPECTOR
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