Loading...
1989-167 f + CERnFICA':T E QF O CCU. PANC IL j TOWN OF +QUEENSBURY WARREN COUNTY, NEW YORK Date_ _ may 25 l4 B r �C:Q This is to certify that work requested to be done as shown by Permit No. 89- 167 I has been completed. I This structure may be ocvupied as a -S i ngl4pb FAmi i y Dwen-7 i i ng Location L`SE" = ©ak Tree Circle jOwner R.iebard 5chermencorn By Order Town Berard TOWN OF QUEENSBURY Director of Bidge do Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No. $9 - 167 WARREN COUNTY, NEW YORK C V PERMISSION is hereby granted to RICHARD SCRERMERHORN V 1 OWNER of property located at LOT # 117 Oak Tree Circle Street, Road or Ave. u in the Town of Queensbury, To Construct or place a Single Family Dwelling at the above location in accordance to application together with plot plans and other information hereto filed and approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 1. OWNER'S Address is 33 Harrison Avenue Glens Falls , N . Y . 12801 u 2. CONTRACTOR or BUI LDEWS Name h SELF 3. CONTRACTOR or BUILDER'S Address SAME P r a, ARCHITECT'S Name � S. ARCHITECT'S Address C C 6. TYPE of Construction — (Please indicate by X) IM +01 gX'} Wood Frame ( ) Masonry { Steel { I F 7_ PLANS and Specifications C No. 26 ' x 28t Single family dwelling as per plot plan , T$ specifications , and application , including septic and attache two car suridise W 8. Proposed Use ��s r SINGLE FAMILY DWELLING CM 25 . 00 r c ,$ 189000 PERMIT FEE PAID — THIS PERMIT EXPIRES November 1 19 89 i!f a longer period is required an application for an extension must be made to the Building and Zoning inspector of the G town of Queensbury before the expiration date.) F s Dated at the Town of Queensbury this 14th Day of April 19 89 ra SIGNED BY for the Town of Queensbury Bull i and Zoning Inspector !- N H Yt: r r- c T+C 4VN OF QUEENSBUPY APPLICATTON FOR r3UILI) THC AND ZONINC, PERMIT l�tz T' TOWN OF OUEENSOURY 4 ; r�'ti"—�' Rev.ieioed i � RECEIVED }� -- Fee PcLid APR 11 1989 L �3L5 BUILDING MID CODES U1 :11ARTMNfT Date T.saued �5 -- BLDG. & CODE DEPT, 13AY and NAVSLAND ROADS RD 1 BOX 9d PUVRNs,r, VRYoNE1V YORE 13804 PenmiiC No . _ I ,rol , ( 528 ) 792-5832 Ext 204 * ]� * w 'f * * I It Ye * * * W w * X w * R * ■ w * +► w * w ■ w w * ■ w w w A PT: miT musfr 11P OBTAINED BEFORE BEGINNING CONSTRUCTION . NO INSPECTi6NS WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID n'IIILDINC PEFIMIT . All applicable spaces on this application must be completed and the � iruatune of the applicant must appear on the reverse sick of this sheet . ae k A Yc x � Yc is is Y: 7c A h * k :t A �5 7k 7k ,yc Yc it 'k 9e �k 7e 7k � * k * yc 7k k 'ir 7F •r1ie owner or this roperty is : QlrllarA V ,`eAF rairr- s j r . r] cx 14 . 0 . Addre s t �L r* /' ` TEL . Property location [ 10 � � CQ h �rf e° 1LC ti.� 11C E/l !s PAX MAP No . 11as there been any split of this property since October 1 , 1988 ? yes no If yes , Planning Doard Review is necessary . SUBDIVISION 14AMUO II' APPL. TCA13LP LOT No . The. person responsible for sut� ervis ' on of wo € as regard :. Building Co es rryl S 6q NAME P . O . ADDRESS TEL . NO . Nanw of buildar t p Address C � N Tel 14�411u: of Plumber l.ddress (fir( 1 a Tel ti- Nalne of Mason Address Tel tiATURC OF PROPOS"CL) hi RK : ZONING INFORMATION ( Office use onl1 ) 'V'.r"11=; truction of a rlaw tbuilclin7 ; ZONING DESIGNATION OF PROPERTY AdU i t io n to :s bU i l d i ncl ` PERMITTED PRINCIPAL PERMITTED ACCESSORY AILvC .Lion to :.a 1juilding ' t ( lto Cht Lnr)v to axe " rfor 4r1imansions ) REVIEW R£i2UIRED - PLANNINC BOARD ZONING HOARD ULhL: r work W :ncriULr ) ' SITE PLAN REVIEW 1I APPROVED DATE L 1t4 AREA 01-1 PROVOSEL), E II• IcUCTURE ' VARIANCE # APPROVED DATE 1 ., t Floor 7 A I set ft . w Rem-arks . ■ 2 nd Floor 7 a I s q r t - ,� C{]1.1PI�L'€'1 1;#1 Oig4AT1QN 1ct:1)U I Icb:Lt UL:WW . Other Floors sq ft . = i<.: of l�rota.trtyr1 x , r' t x_ Ia5. 77 ft . t }f ( not cellar or basauranG ) Lx] atinri 17uil.Iilr ) ( :: ) Si �•:� ' ^! � t' G . +r PO 'PAL FLOOR AREA ) set f t , L xi::ciaYj buila i.f1k3 0; ) Uz. of new : tructuro Ar ft ]:_ 25 ft l'caulydation-pier/ s1aL/crawl/l�arcial/ ell 4 Yrovoc:+�d builuing , dl:;ca"Ct; troth property line (circle oft[: ) . Front yard ft !"tear yard ft NJ . of stories (1LLLU .Lt:4bla: space ) side yards ft and Yt x it. i he ( t rada to ride 4.: ) O fC . `� j j � r Ifon cornar . st: cl�:ack .fratn side: scruct ct If rasictuntial , noq cxf families lto * of roomLo- ( Qxcl ding b"ths) oCCU['fiPaCY INFORMATION Noa of bedroom : ` Now of 1?atltrtaeuus 1 - „ PRIMARY LUTLDItJC � -�. One fwn ly dwelling PA'itts:ary hu.atin1j t;ysLt irt (I(]_ LtrFalr Two family dwaallinkj Ty€ " of { Uitl i Noft of fire al Cat:: to ba irtst ;alluct . Multi€al.: awLelli.nrj / Nu1n13Cr of units Will a WOOO1 ::4uvu b a= i.ne; talled ' €'a=rin.►nclst ocCuplar,cy '1'r:an:;ia:ttt caacuLWA:ancy Cfijntral Air cotr4.€itioninf'j? A Ila 13u:;inUus s BU1L.DiNG STYLVO PRIKNRY SI' RUCTURC ; Inaluszrial r;.:,llch Cont..:,nl:ur.ary Irc"n calain ► Dtha:r I;.. € aud ranch M:an.Si.G[t pul,lex If •a44diC193,t , wlr,xt will u:.a L.:? _lialit IVVa1 Old scyl� Uultaj"low C.a Cord Ccrtt:arj ,: Or hte.r ACC4SSORY 13UILDINC- olonial I:au t'4wn Slausa: ` 1:t cacha=d g :ar•:tge/ono cur/ two car Car CIRCLU ONE PLIA!:E ) �' Attuchetl rjaragL,:/Qna cur/ wo car c�tl w ■ w w w ■ a * R x ♦ w ■ x w x * t IirlYaGu storuga bailaing L �L*& TIMA` ED MAR9WFd11�''}} VA1,f/.�Ui. �O}(F " Other F•ORr SS 1ATTQN ON BUILDING OPECIPTCATTON . ON VX-VEFLSE STDC OF T1iIS SItEeTo ToCIF. C411•WL> PA 10 /68 V1 BUILDING PERMIT AT'PLICATTC7N CONTINLJED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . %J (�� r (,£_ M e ^ Will any second-hand or ungraded lumber be used.? If so , for what ? - Foundation wall material �( n e re Ile 'Thickness Depth of foundation below grade (to bottom of footing ) Will there be a cellar? g�Heated or unheate Floor sq. footage 7J� sq ft Will there be a basement? Will any portion be used as living space ? _ry 0 ( If so , what portion? sq . ft , - - Type of use? Type of roof - <e oiled flat/shed/other Material of roof )12 0 Size , wood studs fix spacing "01c . length ft , Joists ( floor beams ) lst . floor "' spacing i_fD '"o . c . span ft . Joists ( floor beams ) 2nd . floor �"X- 1 " spacing_ "o . c , span�ft . Overlays ( ceiling beams ) "X It spacing "o . c , span ft , Roof rafters "X Is spacing C . C . span ft . Roof trusses (pre- engineered) spacing D41040 . c . span ft . Exterior wall finish Of what material? ,fLy1 � Interior wall finish � c If a garage is to be attached , describe materials to be used for FIRE SEPARATION : S '+ Is there to be an opening between garage and dwelling? ,ye& If so will a Fire-rated door , enclosure , and self-closing device be provided? Will a flue- lined chimney be installed? Height above roof �, ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth ft . .3.n , Water supply - un1c!pal or } pr ivate well NA 1lb.112, i nil SEPTIC SYSTEM _ Distance from ANY private well ( ino uding adjoining properti.esIM ft , (A separate application is necessary for any repair or new installation of septic system) D E C L A R A T I Q N To the best of my knowledge and belief the statements contained in this application, together with the glans 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 0 Owner, owner's agent , architect, con r r SPECIAL CONDITIONS OF THE PERMIT : By_........_ .................. .. TOWN OF QUEENSDURY WARREN COUNTYr NEW YORK Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGYCONSERVATION CODE A permit must be obtained before beginning work . ANSWER ALL of the following : 1 . Gross floor area 5 2 . Type of heat a=r r 3 . Is the building mechanically cooled ? y�(k 4 . Percentage of area of windows and doors D A . Over 16 % Only and floors le U value of gross area of walls , o roof / ceiling 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 �YE NO a . If YES , what ms the R value of insulation around perimeter of flOor ? 4 , is basement heated ? YES NO a . R value of insulation_Nio 5 . Type of insulation Be Under 16 % Only 1 . R v u f roo and floors exposed to ambient conditions _ 1 2 . R value of exterior wallsy ly " v 3 . R value of glazed area 9 \J 4 . R value of doors 1 � 5 , R value of floors over unheated spaces_ ` LL` -� 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab_ , r Y g . R value of heated basement / cellar walls ( above grade ) 9 . R value of heated basement / cellar walls ( below grade ) _ 10 . Type Of insulation 5 C . Controls 1 . Thermostat maximum heat setting_ D . Duct Systems 1 . is duct system installed in unheated space � `` YES NO a , if YES , R value of duct installation - k b . R value of duct in other areas E . Pipin insulation_ 1 . Size of hot water or cooling Carr ing agent pipe 2 . R value of pipe insulation-u A F . Service Water Heating 1 . Performance efficiency. 2 . 'Temperature control setting maximum G . For Swimming Pool Only_ 1 . Maximum heating � _ S ' ( . l icant ' s signature )No _ pp TOWN OF Q UEENS B U R Y APPLICATION FOR SEPTIC DISPOSAL PERMIT DATEu LOCATION OF PROPERTY FOR INSTALLATION U� # (] � ti Owner ' s Name : R1 Lam, h Gl rLd [`� �^ m f"l-k[} ,[ Telephone : !I' q � , 0 � Address : 33 L r r } I [ f C �� � My I ZED ! Installer ' s Name : s_ 11101 Irij eu J eV Telephone : U 12. - q 2 5 r7 Dan care r c I I o s Number of bedrooms (residential only ) Total daily flow ( compute @ 150 gal per bedroom) Topography : circle one Flat Rolling Steep slope % of slope Soil Nature : circle one :(.!!nd Loam Clay Other / Depth : feet Ground Water : At what depth ? �/ /�, feet 7 Bedrocks. or Impervious Material : At what depth ? feet Percolation test ; circle one : of require required /rate min . inch . --- — Domestte water supply : circle one : Municipal Well Other If domestic water supply is a Well : Separation ; Watersupply from Septic absorption ><:-: feet PROPOSED SYSTEM : Septic Tank / al . (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 aF*yF�r is�k nk ie Yk*aY yr ik it Sk nr*�***ic k nt is at is*at�k it at it**ek Yh#ir ok ak ak ie ak�k ak yk ak ik�#ir a4 it 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 . ,r Signature of responsible person ; ` 'T f Date : Ll lg K j (OVER) Septic System Inspections : A . All applications for septic system 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 : 1 . ) the proposed location of the system 2 . ) location and distance to lot lines 3 . ) location and distance to structures 4 . ) locution and distance to any water supply 5 . ) size and dimensions of all tanks ; distribution boxes , tile fields and /or drywells B . 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 . 00 . Co An 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 . 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 Queensbury Building Department before further construction . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 Remarks : ISSUE DATE 1M1AMIDDlYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERT#FICATE DOES NOT AMEND, I EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, COOL INSURING AGENCY INC PO BOX 2074 COMPANIES AFFORDING COVERAGE GLENS P7ALLS NY 12801 COMPANY A AETNA L R. C _GE 4 LETTER COMPANY INSURED ' LETTER B R ICHARD SCHERMERHORN I COS—u �- 11L'A C €� ANDALL STREET I LETTER C qt_F S FALLS , IVY 12801 COMPANY D _...__ LETTER CCMPANY LETTER IE 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. �__._ r_�..�_ ... ... .__... �:AS,L,r a _.^.+.T IN THOUSANDS Ul AI r`!?E OF INSURANCE POLICY NV"ASER GENERAL LIABILITY RgEI'AISES:c'PraArc'r:S aI~OPEF;"v j Uh tgGRClUNC1 0AMAOF c.(GLw$!CN 3 ..Yn'__.APSE I A ;%Pr, ' PR0OUC'5=Kl P'_iTEG �a a a aD W - ^~ RRCAu =-ARM DFGP�*+"* JA.ti1AGE !N.,UR'! PEr'J4'NA� 1r . v•P -- AUTOMOBILE LIABILITY , a'r . A.. . .._ x. �. T ,r?F:,Fq / ........ _. .. +tl.'Y{ EXCESS LIABILITYpyl µ.~...- -^!Ar. .y M1."9F=_ -.;:RN4 A WORKERS' COMPENSATION C 1 0 J'C C7844,.3 f 2290 0 6 / 0 1 / SR! 06 J 0 1 J"S T? AND is Ina � - ----- EMPLOYERS` LIABILITY `J �.i5EA5'C-FC'I.IC': OTHER i iOESCRiPT,ON OF OPERATION SiLOCATIONS:"VEH IC LE SiSPECiAL ITEMS w � � Q,LJE C.IhI,S L3€.JIB Y BUILDING rHOR OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- ATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO DEPT , DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE A ' : NANC ,t, ROBERTS � ER �S ILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY UPON THE COMPANY TS AGENTS OR REPRESENTATIVES. SAY ftOAL7 PRESENT GLENS EAL-.LS , NY 12901 Aoor f K=76776% A • ISSUE C1ATE (MMID DFYY) PRODUCER 08 03 88 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO Edward C . Hughes Agency , Inc . EXTEIND OR ALTGHTS ER THE THE ECOVERAOE AFFRTIFICATE DORDED THISyGTHE POLICES BE LOW. AMEND, 152 Main Street Hudson Falls ,, New York 12839 COMPANIES AFFORDING COVERAGE COMPANY A EXCHANGE MUTUAL INSURANCE COMPANY LETTER INSURED ETTENY B PENNSYLVANIA GENERAL INSURANCE COMPANY Steven Allen COMPANY RD #2 , Box 2021 LETTER C Fort Edward , New York 12828 COMPANY LETTER 0 COMPANY IC` LETTER T"M IS TO CERTIFY THAT POLICIES OFINSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIC OINDFCATED. BNOTWTTHSTANDWQ ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY I UIED QR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDO_ TK1NS OF SUCH POLICES. 001 TR TYPE OP INSURANCE P4XICY EFFECTNE LIABILITY LIMITS IN THOUSANDS LT POLICY NUMBER RATE (MWOOr Y} DATE YIE AA)CCrfff EAC" wGGREC#ATE GENERAL LIABILITY OCCURRENCE 119-2-67003 11 / 19/87 1 1 / 19/88 BODILY A X COMPREHENSIVE FORM INJURY $ $ PREMISESFOPERATIONS PROPERT EXPLOSION C Y COLLAPSE HAZARD DAMAGE $ $ X PRDDUCTSnCOMPLETED OPERATIONS CONTRACTUAL 81 9 P ED $ 300 �+' 300 INDEPENDENT CONTRACTORS BROAD FORM PROPERTY DAMAGE PERSONA. INJURY PERSONAL INJURY $ AUTOMOBILE LIABILITY BaOn r $ ANY AUTO BA 0023843 02 06/ 18/88 06/ 18/89Rn $ ALL OWNED AUTOS {PRIV. PASS y "mLy/ ALL OWNED AUTOS 1 PItIVERPTA5�5 ) kpiPPEA y RrtlrT $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE GARAGE UAI)ILITY �.t BI & PO 'j d AUto COMBINED $1 000 EXCESS UASIUTV UMBRELLA FORM A FOR COMB) $ $ OTHER THAN UMBRELLA A wommnsp COMPENSATION 119- 3-67024 04/ 28/§8 04/28/89 STATUTORY AND $ (EACH ACCIDENT) EMPLOYERS, LIABILITY $ {OkSEAS&PDLICY LIMO) OTHER '$ JOISEASE-EACH EMPLOYEE) DESCRIPTION OF OPERATK7NS/LOCATIONSOVEHICLESISPECIAL ITEMS Rich SchL'rmerhorn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANL ELLED BEFORE THE EX,PIRATION &THEREOF, THE ISSUING COMPANY WILL ENDEAYOq TO 112-1 / 2 Crandal 1 Street MAIL. "�['tWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAME'O TO THE LEFT, FTO MAIL SUCH SHALL IMPOSE NO OBLIiATION OR LIABILITY Glens Falls , New York 12801 OF ANY KINTHE COMPANY GENTS OR REPRESENTATIVES. A IZED RESENTA VE 1 '001"�s CERTIFicATE OF INSU ,q,�r,I , - ISSUE DATE {MMIIDIYY) PRODUCER �+ 3//22/8.9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE NDF RN INSUPUNG AMIC9�'F TNC . EXTEND OR ALTER THE COVERAGE EAFFFORDED BY THE POLLDER- THIS ICIES BELOW NOT AMEND, PO BOX 90 W IImEI-rzILLe NY 12887 COMPANIES AFFORDING COVERAGE COMPANY J CODE sue-crone LETTER AULuiITED S"PA= FSDELITY & GUARANTy j INSURED T T t+ � p y LETTER COMPANY 13 FI '� ' S FUND MW��Wa1�TI1��r�r��1E�} �r1 .S/-��.Av.Ft..t CW i�RS E INC. COMPANY B0X 33 COMPANY D D41DDI.E GRANV:EIJZ , NY 12839 LETTER __ .- COMPAN LETTER Y E COVERAGES "..." �"'" THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIR£MENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS j CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSION'S AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, i i CO TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXP9RATIOM ALL LIMITS !N THOUSANDS I TR POLICY NUMBER DATE (MMfDDfyY) DATE (MM1UDrYY] . GENERAL LIABILITY GENERAL AGGREGATE $ 600 F A X COMMERCIAL GENERAL LIABILITY I x m 77 82 �� �� $f 8188 ��I$/189 PRODUCTS-COMPIOPS AGGREGATE S ��© F CLAIMS MADE X OCCUR. .+L 7C PERSONAL & ADVERTISING INJURY S y F I OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ 3MO F V FIRE DAMAGE (Any one fire) S 50 F MEDICAL EXPENSE (Any one person) $ 5 F AUTOMOBILE LIABILITY COMBINED ANY AUTO SINGLE $LIMIT ALL OWNED AUTOS BODILY $ SCHEDULED AUTOS INJURY (Per person) HIRED AUTOS BODILY NON-OWNED AUTOS INJURY S(Per accident) GARAGE LIABILITY PROPERTY $ DAMAGE ± EXCESS LIABILITY EACH AGGREGATE OCCURRENCE OTHER THAN UMBRELLA FORM 1 WORKER'S COMPENSATION STATUTORY 1 AND 2 38 WP 80354461 8/8/88 8/8/89 $ 1©4 , (EACH ACCIDENT) $ (DISEASE—POLICY LIMIT) EMPLOYERS' LIABILITY SOCI F 'S loop (DISEASE—EACH EMPLOYEE OTHER d t' i DESCRIPTION OF OPERATIONSILOCATIONSIVENICI.ES/RESTRICTIONSISPECIAL ITEMS i CERTIFICATE HOLDER CANCELLATION Tow OF QuE'EN$BuRY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BUILDINGS rju3T. EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO BAY ANiD HANT11AND FUM MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE QUEMISBURYo NY 12804 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPOWOWRQWA*r4 , icPff ENTATIVES. _ AUTHORIZED REPRESENTATIVE - r �N1 _ ACORD 25-S (3188) OACORD CO ORATION 1908 TOWN 4F QUEENSBURY BUILDING AND CODES DEPARTMENT /] WOBAY & HAVILAND ROADS 14 QUEENSBURY, NEW YORE-58320� TELEPHONE (5I8 ) BUILDING INSPECTOR' S REPORT REQUEST FDR INSPECTIO RE "EIVED NAME LOCATION -y DATE s t w - �?S PERMIT APPROVED YES NO FOOTING/P RS MONOLITHIC OUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPJL ROUGH PLUMBING- FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT h ROOFING e SIDING r'" EXTERNAL POR HES/STEPS STAIRS.CLEA NCE & RAILS f. PLUMBING FT TURES/RELIEF VALVE c INTERIOR IM/PRIVACY DOORS FINISHED F RS GARAGE FI EPROOFING DOOR CLOS R (S1 SMOKE DE ECTORS FINAL ELEC ICAL INSPECTION FINAL APPR SJAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! Jill REMARKS: / ,f? C P ClY,/ INSPECTOR MIDDLE DEPARTMENT INSPECTION AGENCY, INC. n / ''�I 900 Haddon Avenue, CollFnq�woad; N .I: "109 ;�-/,r [� �j C]'ate May 24 , 19 89 WOO V14rtlf[f; that the electrical equipment listed has been examined and is approved as being in]COMOF with the National Electrical Code, applicable governmental, utility and Agency rules. Owner: Rich Schermerhorn. Occuperrcy.' Dwell iirtg Occupant: Same Location: Lot 117 Oak Tree Circles Queensbury (Warren ' 'prdr3)ericate C"1% She eleciricaf equipment and installation in date_ ft additional equipment should be introduced or alleralio existing system this eertilipate shaft he null and void, and ap Equipment: 1/2�2 Outleets ; e60 Receptacles ; 30 Fixtuares ; inspect,)n should be sdbmil l ed p rom pl l y to th is Agency. 2 V© L1IS1 Service ;" Appliances S Holder of this Celtilicete should present Same to his properly In3urP r FP (agent or company) as ev,denceof Certification of electrical equipme ---I as specified. r�Happitts Builders I Appfmant: 36 Boulevard No . 15 - 022467 Glens Falls , NY 12801 n.x.s.r,•�.r�.c.r,..�r..;��..r.r:�w.rs�Mww�?��A�r'e,T�M�.+�..�y.+r.�Ye�.!IMr..'SA.iM.rho.�.!4t/,.�e,�+Lw'�"h,.,�!e..." ".A�!la✓.iA!!"�.^n`.e�4'nrs.`. hS�n'.`��'.ti5t!'.EI�Ss'.`�:�`�� SIN TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12801 TELEPHONE (518) 792-58.32 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION % DATE PERMIT # APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATSON/DAMP-PROOi'XNG BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATI FOUNDRY N FLOORS WALLS CEILING FINAL INSPECTI f CHIMNEY HEIGH ROOFING SIDING EXTERNAL PORCHES T S STAIRS-CLEARANCE RAILS PLUMBING FIXTURE / LIEF VALVE INTERIOR TRIM/P VA Y DOORS T FINISHED FLOOR GARAGE FIREPR FING DOOR CLOSER ( ) ............... SMOKE DETEC RS FINAL ELECTR AL INSPECTI FINAL APPROV L OF CONSTRUC ON A SIGNED CERTIFICATE OF OCCUPA Y MUST BE OBTAINED FROM THE BUILDING DEPA MENT .BEFORE THESE PREMISES ARE OCCUPIED1 REMARKS: kSp, TOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT ; BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I28Q¢ TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR jNSPE TIOlV,"E ED NAME LOCATION / • / DATE 1'-- ` PERMIT #__ S 6P APPROVED YES NO FOOTIN PIERS MONOLIT C POUR FORMS FOUNDATI0 /DAMP-PROOFING BACKFILL A PROVAL TROUGH PLUMB NO FRAMING ELECTRICAL RO GH-IN INSULATION; FOUNDATION ' FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ TEP STAIRS-CLEARANCE & RAI _ PLUMBING FIXTUR SIRELIE VALVE INTERIOR TRIM/ RIVACY DOO FINISHED FLOG S ........................... GARAGE FIREP FING DOOR CLOSER { ) W_.........� SMOKE DETEC RS FINAL ELECTR AL INSPECTION _ FINAL. APPROV L OF CONSTRUCTION A SIGNED C RTIFICATE OF OCCUPANCY Mbj5T BE OBTAINED FROM THE BUILDING DEPARTMEN BEFORE THESE PREMISES ARE OCCUPIEDr REMARKS; dddd I ' r INSPEC TOWN OF UEENSBURY BUILDING AND CODES DEPARTMENT / f BAY & HAVILAND ROADS / QUEENSBURYr NEW YORK 72844- TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTI N RECEI orED NAME LOCATION DATE PERMIT #1 APPROVED YES E NO TINGjPIERS MONOLITHIC POUR FORMS FOUNDA TIONjDAMP—PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGf2—IN INSULATTONr FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL POR HES/STEPS .STAIRS—CLEA NCE & RAID PLUMBING FI TURESjRELIEF �VALV'E^ INTERIOR T IM/PRIVACY DOORS FINISHED rR RS GARAGE FIOOFING DOOR CLOS ) SMOKE DETRS FINAL ELECTRICAL INSPECTION FINAL APPRO AL OF CONSTRUCTION i A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED!' RRrsARxS: r?- ' , f � r /w', r / fr INSPECTOR Jnwn ©� �,ueen3hur� �'� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCAT I '�-[ G^/� DATE _ f PERMIT NO.- � IO SOIL TYPE s r,am -- Clay - Percolat`ton Test Required? YES - NO Percolati rate - Min/Inch - TYPE of SY.S Absorption f eld , total length C t � Length of eac trench + Depth of tree es -' ` Size of gravel SEEPAGE PITs4iq er of) Size- ft_ 'X - ft4o Gravel size PIPING : SizP� Type Bldg . to tank pU'� Tank to dish.. box Dist. bOX to fie /pit . ` Openings sealed? ES NO Partial LOCATIONfSEPA IONS : Foundation to ank 70 f't- Foundation t absorption _ft . Absorption t lot line �o ...ft. Separation pits - LOCATION OF SYSTEM ON PROPERTY (circle one) Front e - Left side - Right side - CCMMENTS : SYSTEM USE APPROVE YE O Bu ding Inspector 01/86 and vl TOWN OF QUEENSBURY BU2LDXNG AND CODES pE'PARTMENT .BAY & HAVTLAND ROADS QUEENSBURY, NEW PORK 12801 TELEPHONE (5I8) 792-58,32 BUILDING INSPECTOR ' S REPORT REQUES 1?, FOR .£NSP,�T2CyN RECEIVED NAME LOCATION DATE ✓' PERMIT # yj APPROVED YES OOTSNG/PIERS YES NO r MONOLITHIC POUR F FOUNDATSON/DAMP—PR PXNG BACKFILL APPROVAL ROUGH PLUMBXXG FRAMING ELECTRICAL ROUGH—IN a INSULATION: F 0UjVZ)ATION FLOORS WALLS CEIL.rNG F XNA,L INSPECTION: CHIMNEY HEIGHfi ROOFING SIDING EXTERNAL PORCHES STEPS STAIRS—CLEARANC & RAILS 4 PLUMBING FI,XTU'F ESIRELIEF VAL E INTERIOR TRIM/ RZVACY DOORS FINISHED FLOG _ GARAGE FIREPR FING DOOR CLOSER ( ) SMOKE DETEC RS FINAL ELECTRS AL INSPECTION — FINAL APPROV, L OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY OBT'.AINED FROM THE BUILpIGDEPARTMNfi F3EFORE THESE PREMISES ARE OCCUPIED! REMARxs: 1� JA �1� INSPECTOR �� BUILDING DEFT. COPY OF APPLICATION FORM 45-EL, NEW PORK BOARD OF FIRE UNDERWRITERS. Flt_E THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. TEMP. s CITY OR •'t DATE VILLAGE } � STREET AND tam OR TOWNSHIP COUNTY ROAD AND POLE ND, 1 �!{ , f !1 BETWEEN EET$ TIMO _ 4 �- k . CROSS STREET$ IIs PRE M TED? �1 }r� V IL Lit NAME ANTS „/ TION BLOCK LOT NAME t { i Ar BUILDING OWNER'S NAME OIxLIPANCY AND ADONESS 1 3 U TEL. BBYSUPPLIED BUILDING FROM THEIR IS NEW OLD © VMRK OFFICE IS NEW Q ADdlTIDNAL Q pEF VTS LIST BELOW ALL EQUIPMENT WHICH YOU IN C] STALLED N UMMEN OF OUTLETS Mo. of Fliaturee 6 bon y Lwnp Ratapp.tlsa MOTORS HEATERS OqW OFFICE USE Oyu Side Atraan•t Well Rapp•le Swig* Pendant Bracket No. TYPe M.P. yVM.R ONLY Eatl. No. Ne AON.6_ INSPECTION OslDW Okla Sul bow Baer mn t let Ff. 2hd Ff 3rd Fl. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. This AP{1IK&Wipn is intended IO corer the ahnva-iisfad .. ... - .-.•"_ �'- W Vofr are "thcrized to wake tfia in again to rt ea M inspac tad but I of time pf i ePectinn and adjuaf lfie fins to coaar tha addiRional ui frtp�eedon the iK ,Dural additkmW equipment not ahora listed. SIZE or nq pmawt, a Woridad 6Y the applicant.. . MAINS FEEDERS EL ECTR IC Si ON CHARACTER LAMPS TOTAL OF WORK EXPOSED GAS TUBE SIGN WATTS WORK TO BE CONCEALED TRANLSFORMERS OF VA STARTED W UMBER I (CAPACITY) SERVICE 'OVERHEAD COMPLETED SIZE OF SIGN EN RING UNDERGROUND MAKER !"SPEC TION RE OU ESTED OF SfGN ON Oft AS NEAR AS POSSIBLE AVOID DELAY BY Gi VINO FULL AND ACLU PATE iNFOq NATI NEW OLD Ej MUST BE FILLED IN OR APPLICATION MAY BE RE ON. ALL SPACES TURNED PRINT NAM JfKND ADDR . MATE OF NAME OF # 1 APPLJCAT ON " APPLICANT SIGNATURE - OF APPLICANT STREET ADDRESS r .. CITY OR { TELEPHONE # POST OFFICE NII ,f] ( } I�� Zip LICENSE No. COPE IL& VMEN AJWL ICABLE 46 Eil, (REV, 7/06) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING u S E COF 0t -vovv , 1 AW A 0 T A9 Q F- CIIIA . E, 40 F-LI / <�L-717--,) U E� Ff: r�14' "KVISIONf my 0ATi �l LOT�I1