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1989-222
CUPAMCIiL CERTIFICATE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK j February 15 19 � 90Date 1 t r1q- S 'Phis is to certify that work requested to be done as shown by Permit Nov $9-222 has been completed, This structure may be occupied ss a ... Shale Family Dwelling I.cwrntiarn l 1 OwnerJams Johnson By Order Town Board TOWW OF QUEENSSURY Director of Bldg. & Cod nforcement MINIMUM i w BUILDING PERMIT TOWN OF QUEENSBURY No. WARREN COUNTY, NEW YORK rs"v a PERMISSION is hereby granted to p, Street, Road or Ave. OWNER of property located at in the Town of Queensbury, To Construct or place a _ Single Family Wellh . 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- F2C=ONTR4C RR#1 Box 16i72 Lake Georges N . Y _ 12845 r TOR or BUI LDE V "5 Name Gr Self N 3. CONTRACTOR Or BUILDER'S Address SANe 4. ARCHITECT'S Name CL un till 5. ARCHITECT'S Address 00 CL r7. TYPE of Construction — (Please indicate by X) XX3 wood Frame 11 INesonry I ) Steel f I PLANS and Specifications No. 28 ' x 44' Single family dwelling as per plot plan , specifications , an application , including 1411B septic and driveway_ c a. Proposed Use Single Family Dwelling ` 1 25_ 00 c/o $ 111 " nO PERMIT FEE PAID — THIS PERMIT EXPIRES , �g — llf a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Queensbury before the expiration date.) Dated at the Town of Queensbury this Day of Iry 19 89 SIGNED BY t r for the Town of Queensbury Building and Zanirg I Gtor TOWN OF QUEENSI�3URY APPI. ICATTON FOR BUILDTMG ANn ZONING PERMIT Pate- of _. l;e�r iewed Ales, � k r Fee Paid $ zjgg97 b�fl �PR jQ BUILDING AND CODES UI :P 'ARTP'Eh!C pate 7esoued G, � rq 13AY and HAVIZAND ROADS RD 1 BOX 9d OUEENSataRY, NMIr YORK 12804 'PeAM-Lt Noe 61F.2 4::� ( 518 ) 792-SSJ2 Exc •204 * * * x * IN '* * , * * * k : * * w * IN * * : t r w s * • x A PERf1IT MUST D4 OBTAINED BEFORE BEGINNING CONSTRUCTION . NO INSPIiC`rIONS WILL BE MADE UNTIL APPLICANT IIAS RECEIVED A VALID BUIILDINC Pr- RMIT0 All applicable maces on this application rtrust be CO",pleted and the �; i nnature of the uVp1 icant must appear on the reverse side of this slicer . v A u r x n x x x �e �e �e re a� �e x x •i" 1ze owner of this ,PrOPOrty is : S ark=ic5 P . O . Address _! - 2 �` f T� � fG � Z L kc r� r "�r� , wI . _TEL . 47 8 a�I 'PAX MAP NO t° roperty location 1� 1 � � o t( oo ? Y t Ec3G " VI; e -cb5 tide there been any split of this property since October 1 , 19BB ? yes / Ito if yes , Planning Board Review is necessary . LOT NO . SUBDIVISION NAME . 117 APPLICABLE "S' lie person responsible for supervision of work as regards Building 'Codes is ! �ArMc�.s f]r+ r �L1'rr't. �M� /�'•5 �d+s _. F IIIIII. O . ADDRESS TEL . NO . II Tel t44me of builder Address Tel Nuzne of Plumber Address Name of Kasen F.ddress Tel catiTURC OF f'i:Ol'QS.lp 60I:K : ZONING INFORMATION ( 0- fica use only ) '�Construcciorr Of a now building * ZONING DESIGNATION OF PROPERTY Rd•xician to a lauildir[g t PERMITTED PRINCIPAL 'PERMITTED ACCESSORY _ � �Altur:ation to a lluilding w REVIEW REQUIRED - PLANNING BOARD ZONING BOARD ( ILO Ct [�L[lg�: CO eXC. eri+?r [litnension. ; Ocher work (a.%a cril. � 1 SITE PLAN REVIEW #30 APPROVED DATE � f1 (�. +r VARIANCIM # APPROVEDDATE , vim CROSS AREA OP 11110POSCD= EETrct. C "1' l3ftE � Remarks 1st Floor 1 � 3l- sq ft . : and Floor s q f t , cai•1L' r.L'1'1 x�JF'Qr rKn '1'ION I(C U I1t1iD BL W61 . Sie:a Of proluerty. Ft . Other Floors sq Ft . "iziulnl bui1a1Ak=] ( :s) Si : u 1` 4 H rc . ( not cellar or basoment ) TOTAL FLOOR AREA / z 3 L sq f t . ' Lxistia,al building (:.: ) Ua.: of nLw ::truetur� .! f It 'f `� f t iIidation-pier/ :z1aL/crawl/p�arciaal ful " Nrol�oaed building , cli:: eancu trou[ l,rol�erty line (circle one ) PrOnt yard :, -4 "O ft Rear yur. d 'ft No . of stories thabit:able sl�accl / Side yardsP __ . ft :and 4 a rt ft.:iclhk: tUrade to rider: ) ft • If on earner , sur."ck rrotn si.du a;trI& uc ft IC residential , no , Of f"Inilies � / „ OCCUPIII INFOP4&IION No , of roam:- ( cxcludinq b:athsl , klo. of bedrOo[nr; p1LI1�LARY raUILDINC - No . of b;achroolus =one faruily dwelling C'riti" ry liu:atintl sYt; : L't 116 , i" T "iwo family dwulliny III of f ual F'7 A t - � MulCirala L.lwullinCj / t1u[nber Of units No . of fireialac ; to Occupancy Will :.a woQJ :;k:{dv[: be ir[utalled? e c � 1'u:an_ ia:nL' occuis;A1kCy r L'+jntr"l Air cOr[alitiQnI;I Business BUILDING STYt_C, PRIMARY STRUCTURE inc►ustrial "" Ocher l a.iLLC=1 on t�N 4j+G r:ar 1Ieo9 calyin it •addition , wl'k ac will u:ai ::c:d ranch tK"naicj[[ 0%417 -Ux :.limit lVvel Old seyle UurL=l.ale�w '" iaNaa Cod COtC:a<ju oc1Li r " ACCESSORY UUILDING^- Lr�cachacl tjaraalc/onQ CUr/ two czar/ carColonial. l:Ou •1•cawr� )louse e;,[ L• [ CIRCLki ONE PLEASE I � Attached cjUragelOr1a: Car/ twO car/ • w * * ■ r +i '>< • • w a ■ * w �' 1'Y1V:a t.: wtOri:L CjC building f �aCher 1. !; •1' IMATUD MARKET V ALU U ar' ] N['ORMIATION 'ON BUTLDING SPECIFICA`PIONS . ON REVERSE SID! OF `rt4T5 Skll:i"P, TOBeCOMPLE'I'ritS1 Form BPA 10/88 vl X* T HUILDINC—i i • E:HMIT APPLICATION CONTINUED — BUILDING SPECIFICATIONS : Type of con�:truction , wood frame , fire safe , etc . i.. f �Z �1 U , Will anv lsecond-hand or ungraded lumber be used? If so , for what ? Fc3undat 1C7Ii Wall Ma teYlal Irr. + . vN w < . S, -,p Thickness O , Depth of foundation .below grade ( to bottom of looting ) _1:' ' Will there be a cellar ? rf Heated or unheated.? Floor sq. footage / Z 5 sq ft Will there be a basement? Will-' any portion be used as .Living space ? :i � ( If so , what portiQn? sq . ft . - - Type of use? Type of roof - :slope flat/shed/other Material of roof Size , wood studs " x it spacing "o . c . length ft . Joists ( f ] t)or beams ) lst _ floor "X " spacing "o . c , span ft . Joist:; ( hoar beams ) 2nd . floor "X IN spacing "o . c . span ft . Overlays ( (_ eiling beams ) " x to spacing "o . c . span ft . Roof rafto - rs " X spacing o , c , span ft . Roof trus= _ , eS (pre- engineered) spacing „i q "O . c . span ft , Exterior wall finish Of what material ? Interior Wall finish If a gartic; c is to he attached , describe materials to be used for FIRE SEPARATION : Is there a_o be an opening between garage and dwelling? If so will a Fire-rated door , c.nc:losure , and self-closing device be provided? Will a fILAe- lined chimney be installed? Height above roof ft , Depth of c.-, h.imney foundation below grade ft . Depth caf fireplace hearth ft * in . Water surdsiy - Municipal or private well SEPTIC SYL;Tf.M _ Distance from ANY private well ( including adjoining properties // d ft , (A separcire application is nocessary for any repair or new installation of septic system) D E C L A R A T 1 0 N eVO 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 011 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 the ner. Signature Owner, ner's ent , architect, contractor * for for A A Yt ]k it * * * * YF for +r * * f SPECIAL CONDITIONS OF THE PERMIT : $ ,�------------------........... —�--w 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 : r 1 . Gross floor area � 1 2�3 45<p 2 . Type of heat 3 . Is the building mechanically cooled ? 6 '• LJ 4 . Percentage of area of windows and doors �r 44r 712 ;1 J5 A , Over 16 % Only. r Uo value of gross area of walls , roof/ ceiling and floors exposed to ambient conditions 2 . Floor over heated spaces YES a .. Are foundation walls i. nsulatecT't ,e 1 . If YES , what is the R value ? 3 . Slab on grade YES IeZO a . If YES , what is the value of insulation around perimeter of floor ? 4 . Is basement heated ? YES NO a . R value of insulation 5 . Type of insulation B . Under 16 % Only _. I * R value of roof and floors exposed to ambient conditions. 2 . R value of exterior walls , '` 3 . R value of glazed area. 4 . R value of doors jor �" ,+ 5 . R value of floors over unheated spaces 6 . R value of slab edge insulr- h'eated::::s: uheated slab 7 . R value of slab insulation , R value of heated basement/ cellar walls ( above } , R value of heated basement/ cellar walls ( below grade ) _ _ 10 . Type of insulation ,/ co Controlsts 1 . Thermostat maximum heat setting D . Duct Systems � 1 . Is duct system installed in unheated spaces ? YES o a . If YES , R value of duct installation b . R va* e of duct in other areas E . ptpfr►g Insulation 1, size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Beat ! 1 . Performance efficiency 2 . Temperature control setting maximum /' G . For Swimming Pool Only 1 _ Maximum heating_ � Telephone No . { app 1ALAnant s signature ) 1 O PYS ENERGY AUDIT FORM NAME: h� S ,� t� bt-.CC�tJ ---- DATE : 2G� +� S� ORDER # Sr'�l cxa2 INSULATION VALUES U Value . C2 Walls l t{I.or.) U Value Ceiling 11 U Value . 422 Ceiling �� , � ( ISP lF�) U Value d Floors PART IV - NEW YORK STATE ENERGY CONSERVATION CONSTRUCTION CODE. Uo = UwAw + U Ag + Ud Ad Ao Degree hays Table 4- 1b N r " Wall Sq . Ft . Doors w /� Sq . Ft . Floor 'Z30 - - - Sq . Ft . Glazing Sq . Ft . Roof '"��a� Sq . Ft . (ruAZ ) Roof +4 Sq . Net Wall jCp*, 3 Sq - Ft • Max Allowable Uo Wall Roof Floor Glass Door C up x + OA6)+( .C7'9 x 12 t d1 )+G04X 1%3 Z )+C 3'R x "IS )+(Sm,v �Z } ; l,► Wall , Roof , Floor Sq . Ft . Uo Actual Residence Uo Wall Roof Floor Glass Door � � S ( �+52x Ic�dB)+( .32Gx1 l�f}+(.o52x 1232 )+ 1 Pi )+05� K 42 } C 3 Lo S '3 } •v9 Wall , Roof , Floor Sq . Ft . Uo * Actual Uo < Max . Allowable Uo MEETS NYS ENERGY CODE PRE "ARED BY : - © WN OF QUEENSPURY APPLICATION FOR. =s✓ } SEPTIC DISPOSAL PERMIT DATE r }, LOCATION OF PROPERTY FOR INSTALLATION or Owner's Namme: t..., Telephone: Address: Installer's Name: ;;: Telephone: tofu. - 2317 ? Number of bedrooms (residential only) 3 Total daily flow (compute (a 150 gal per bedroom) '- .S'O .� !q Topography: Circle one: Flat Rolling _Steep Slope '% of Slope Soil Nature: Circle one: 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 ell Other If domestic water supply is a well: Separation: Water supply from septic absorption /I a feet PROPOSED SYSTEM : Septic Tank f, r, 4 b gal. (minimum size: 1 , 000 gal.) TILE FIELD: Each Trench feet/Total system length • _�� c� . feet SEEPAGE PIT(S): Number of / Size each feet by feet Size of stone to be used # � sue' /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 Queeinsbury Sanitary Sewage D' posal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: x-�, Q � — DATE : OVER Suptic System Inspections : A , .411 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 . ) rite proposed location of rite system 2 . ) location and distance to lot lines 3 . ) location and distance to structures 4 . ) location and distance to any water supply 5 . ) size and dimensions of all tanks , distribution boxes , 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 . C . An approved copy of tyre plot plan shall be available on the construction site . Failure to produce said plot plan at Came of inspection may result in an immediate work stoppage . D , Should unforeseen problems during construction prevent proper insCalla— tion , alteration or repair of an approved system, a new proposal must be submittud to the Qumensbury Building Department before further cotisrruction , Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland loads Queensbury , New York 12804 beta rks TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT* BAY & HAVTLAND ROADS QUEENSBURY, NEW YORK 3280s. TSLEPHONE (518) 792-583.2 BUILDING INSPECTOR ' S REPORT REQUESF R NSPEC!'rON RECErVED NAME LOCAT I rN p DATE ! — �' ! PERMIT # +'] +�- 2 .... APPROVED YES NO FOOTSNGfPIERS NONOLXTHrC POUR FO FOUNDATION/DAMP—PR ING BACKFILL APPROVAL r ROUGH PLUMBING FRANrNG ELECTRICAL ROUGH—rN -rNSVLATION: FOUNDAT TON FLOORS WALLS CEILING FXNAL rNSPECTION: r CHX-MNEY HEIGHT + ROOFXNG SXDXNG EXTERNAL PORCHES/STppS STAIRS—CLEARANCE 3 PLUMBING FIXTURES ELrE VALVE INTERIOR TRXMjpRr ACy S FXNXSHED FLOORS GARAGE' F�i'REPROOF NG DOOR CLOSER (S) SMOKE DETECTORS ° FrNAL ELECTRICAL NSPECTXON FINAL APPROVAL O CONSTRUCTI N s A SIGNED CERTIF-tCATE OF OCCUP NCY MUST BE I OBTANED FROM T E BLTXLDrNG DE RTMENT ,BEFORE THESE PREMISES ARE OCCUPIED! REN,?A�RKS: INSPECTOR TOWN OP QUEENSBURY BUILDING AND CODES DEPARTMENT / BAY & HAVXLAIVD ROADS r (r QUEENSBURY, NEW YORK 12801& TELEPHONE (528) 792-5832 BUILDING INSPECTOR ' S REPORT RLUESR INSP�EfC �ON REC'EXVED NAME \1p LIJCATSOAV 42 DATE t F PERMIT .APPROVED FOOTZNG/PIERS YES I NO MONOLITHIC POUR FORMS FOVXDA!VZON1DA yP-PROOFING BACJtF'XLL APPROVAL f' �*JGH Pz UMBrNG FRAMING ELECIVRXCAL RO GH-IN L-op`�SULATSON: FOUNDATrON FLOORS WALLS CEILXNG FINAL INSPECTION: f CHIMNEY HEIGHT ROOF.rNG ¢. SIDING EXTERNAL PORCHES/S EPSi ' STAIRS-CLEARANCE RA,L s PLUMBSNG FXXTUAERELXEF LVE INTE'RSOR TRIM/PR ACy R FINrSHED FLOORS GARAGE FIREPROO NG -- DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRXCAL NSPECTION FINAL APPROVAL O CON.STRUCTICJ-N A SIGNED CERTIFICATE OF OCCUPANCY MUST `PR OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMXSES ARE OCCUPIEDI REMARKS }� . y !? i z...: S INS TOR TOWN OF QUEENSBURY .BUILDING AND CODES DEPARTMENT SAY & HAVI LAND ROADS QUEENSBURY, NEW YORK 12801 w i TELEPHONE (518) 792-5832 BU I L.DI NG INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCA ON DATE PERMIT APPROVED YES NO FOOTINGIPIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH IN �SULATION: � , FOUNDATION FLOORS WALLS CHILLN X FINAL INSPECTION: irw CHIMNEY HEIGHT `: ROOFING Pi SIDING !. a EXTERNAL PORCHE.�F/STEPS .STAIRS—CLEARANCI} & RAILS PLUMBING FIXTUR4S1RELSEF VA-9VE INTERIOR TRIMfPR;IVACY DOOR FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICAL INSPECTS N FINAL APPROVAL OF CONSTRU TION S { A SIGNED CERTIFICATE OTIME CUPANCY MUST BE OBTAINED FROM THE BUIL DEPARTMENT BEFORE' TFfESE PREMISES ARE OCCDI REMARKS: �j43ti ■}� Lc • INSPECTOR TOWN OF QUEENSBURY BUXLDXNG AND CODES DEPARTMENT BAY & HAVXI,AND ROADS QUEENSDURY. NEW PORK I280& TELEPHONE (518) 792-58.32 BUILDING INSPECTOR ' S REPORT REQU s FOR INS I RECEXVED NAME z4.7CAr , r DATE [ r y PERMIT" APPROVED YES NO FOOTING/PIERS MONOLXTHIC PC7U.R FORMS F0UNDATXON/,L1AMP_PROOF TNG BACICFXLL APPROVAL G--• H PLUMBING FRAMING ELECTRICAL ROUGH-XN XNSULArrON. FOUNDATXON FLOORS WALLS CEXLXNG FINAL XNSPECTXON. CHXMNEY HEXGHT ROOFING SXDXNG EXTERNAL POR HES/STE'p^S STAXR.S-CIAaW XCE & RAXLS PLUMBING �TURES/RELIEF VALVE INTERXOR XM/PRXVACY DOORS FINISHEDIQORS GARAGE F*.EPROOFxNG DOOR CLO$ER (S) SMOKE DZ+ZCTORS FINAL ELHdTRIC,A r, XIITSPECr.ION FINAL APPROVAL OF CONSTRUCTIO . A SIGNED CERTIFICATE OF OCCUPANCk".MUST BE OBTRTNED FROM THE BUXLD2NG DEPARTMENT BEFORE THESE PREMXSE^S ARE OCCUPXED! REMARIC,S s ECToR _Ja�uin o� �ueen .s6urt� ,fir BUILDING and ZONING DEPARTMENT „ //��go, Bay and Haviland Road, R. D. 1 Box 98 [/!1} Clueensbury, New York 12801 SEP DISPOS� SvTE INSPECTION NAME dd k:x� RATE PERMIT NO, i ^� SOIL TYPE - Sz' nd - Loam __ J P ew Percolation Test Required? YES N Percolation rate - Min/Inch TYPE of SYSTEMa / Absorption field , total leroi:h '2V-4✓ Length of each trench Depth of trenches : �. Size of gravel SEEPAGE ;SITS{Nub mer oV1 Size- ft. x Gravel size - PIPING . e Bldg . to tank pe Tank to ciist . bo Dist , bo7: to fi ld/ G Openings seale ? ES kNO Partial LOCATION/SEP TIONS Foundation tank ft. �,.Foundaticn o abscrption ft . Absorption to lot line / t_ Separatio of pits ft. LOCATION YSTEM ON PROPER ; (circle one) Front - ear Left side - Right side - COMMENT . SYSTEM USE APPROVED S NO Sui ing tnSpector 01/86 and v.l .. Joeefr� v� '�uteereyhurt� BUILDING and ZONING DEPARTMENT Bay and Haviiand Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME { �05 LOCATION -�-� Inclo Date e))4/ V L Permit No - Footing/P er Fo OVED YES NO Foundation ` Waterproofs gAr Backfill Framing Roofing Siding ti Masonry X Rough PlumbiRelief ValveExt . Porches Finished Flo - Interior Tri "� `Stairs & Rai. — e re DrainConcrete FloPlbg . FixturGar . Firepro Door Closers Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECT INSPECTION DRIVEWAY APPROVAL "— Final Building Survey Next scheduled inspection ( call when ready ) Remarks- GAS �---.--.-------- - Building Spector 6/86 and-ul TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENS'BURY, NEW YORK 1280k TELEPHONE (518) 792-58.32 BUILDING INSPECTOR ' S REPORT REQUEST FOR TN.SPECTION RECEIVED NAME OCAT ION �3 DATE � T PERMIT APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS G.-�UNDATXON/DAMP-PROOFING BACKFILI, APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-TN INSULATION: FOUNDA TION j FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING STDTNG EXTERNAL PORCHE STEPS STAIRS-CLEARANC & RAILS PLUMBING FXXTU S/RELIEF VALVE INTERIOR TRIM/ RTVACY DOORS FINISHED FLOG S GARAGE FTREP PING - DOOR CLOSER ( ) 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: 40 INSP TOR �- TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVrLAND ROADS C)UEENSBURY, NEW YORK JY 2jgo& qk + `� TELEPHONE (528) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FY7 INSPECTrON RECEIVED NAME' Cl�r tiQ_ � —� -7 LOCATrO DATE ... - �'n- �• .�„^ PERMIT' # t0000FOOT-rNGIP-TRRS YES O MONOLr2'HIC ,POUR FORMS FOUNDATION/DAMP.PROOFING BACKFILL APPROVAL ROUGH PLUMBrNG FRAMrNG ELECTRrCAL ROUGH- SNSULAT,TON: FOUNDATION FLOORS WALLS CErL.ING FrNAL IN.SPECT1rON: CHIMNEY HEIGHT' � ROOFING SIDrNG EXTERNAL PORCHES/ST Ps STArRS-CLEARANCE & GRAILS PLUMB-TUG FIXTURES LTEF'NTEl?XOR TRIM/FR ACy DOORS_ VALVE FINrSHED FLOORS GARAGE FIREPROO ING DOOR CLOSER (S) SMOKE DETECT01?p FINAL ELECTRrCA* -TAFSPECTION FINAL APPROVAL F CONSTRUCTION A SrGNED CERTIFICATE OF S7, BE OBTAINED FROM THE BUILDrNG DEPARTMCUPANCY ENT BEFORE THESE PREMrSES ARE OCCUPIED ! REMARKS: + X 16 r 0-7-r.(/C, s (AJ 2 '%c INSPEC R is M# ODG P,ARTMENT NSPECTI©N AGENCY, INCH National Headquarters . 900 Haddon Ave., Collingswood, N.J. 08108 Date: 2/ City. Town or Township : !. : 7 - �.° ; .t- r' 4 , > County t'.l * 4 tc :•� State Location/Address 1 c er- A Q cot CIl 44. Y .P k �s f Located in Rural Area - Please Attach Directions} pole # Owner awr z S �� o � •n Cstr *�"* Occupied As . c tti, S Permit # 1y ` Occupant G v'' <� + G+ %A � C. VA "ECuilditsg: NeWL' 7. Old Work' Area in Building Floor #, etc.}. for: Mring Lin Service L!:I . or: Read for Ins action : Fee Remitted - $ Cash 0 Chock M.O. Make Payar,le To: M.D. I.A Number of hough Wiring Outlets Elect. Heat 3°° 'So raoq axlio lson also zoos sxs0 xsoa 27s0 soon Switches Lighting Amp, Service Surface Unit Dishwasher Range Receptacles Water Heater Air Conditioner Dryer _Pump; umbar of Fix#ures Oven Garbage Disposal Wiring and Controls for Burner Amp. Receptacles Fractional H.P. Vent Fans Other Equipment: MOTORS H.P. I 1/2 11- 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 l /x 2 3 5 7Yz 1Q lg 20 25 3Q 40 gp 7g 100 Mark Number of Each Size-, Applicant's ' .-� `—� - Signature - - r'/{•'^ License # Par it T/A Utility* 1 • r Applicant s Address: NA O L 1UNJ (City)— -k Ire, H +n (state)- (Zi a . Phone # �� p) 'G7 Service Request # J Electrician: ! { DATE RECEIVED: / DATE INSPECTED; ^ Correct Location : Same as Above ( or: Red Notice Label Rough Wiring Outlets Surface Unit Oven Switches Range Garbs a Disposal Receptacles Water Heater Dishwasher Fixtures Air Conditioner Dryer C3 Amp. Service Equipment Burner, Wiring & Controls for Amp. Receptacle Am . Service Conductors Pump Vent Fans M Mark Nu H.P. 1120 1/12 1/10 1/e 1/6 1/4 i/9 1/2 3/4 1 l�fz 2 3 5 7vz 1Q 15 2Q 25 $Q Re' be 7g 1QO Mark Number of Each Size Elect. Heat so0 75a aawu axso 2600 3750 9000 2xsa 2500 s750 sacs f i .� El RW Progress: Inc. LKD Contractor0INSPECTORSSIGNATPURE . Q CPT Violation : Work Comp. M Inc. Q L/A Owner 0 IPA #Municipal #Date : Other Side El UtilitycantrCut in Card Q Temp # Date Final # Date APPLICATION FORM NO. 250 EL 11/46 TOWN OF QUEENSBUR'Y BUILDING AND CODES DEPARTMENT BAY & HA VILAND ROADS QUEENSBURY, NEW YORK 12809. TELEPHONE (518) 792-5832 BUILDING INSPECTOR " S REPORT REQUEST FOR INSPECTION RECEIVED NAME -' LOCATION l3 DATE //`},lF 'f PERMIT xx APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROV ZKL RO H PLUMBING MMAING ELECTRICAL ROUGH-.ITV INSULATION: FOUNDA PION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH$S1sTEPS STAIRS-CLEARANCE & RAILS PLUMBING F-wURESIREL,IEF VALVE INTERIOR TR M/PRSVACY DOoltg FINISHED F RS GARAGE FI PROOFING DOOR CLO R (S) .SMOKE D ECTORS FINAL ELE TRICAL INSPECTION - FINAL AP OVAL OF CONSTRUCTION A SIGNS CERTIFICATE OF OCCUPANCY ,MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR ` - r " � h � f 3 iv I� wm AWN 11 wv • 7 f . fr. . cli r zol w}, A1✓ � F sr _ter s ep i �1 a4$+urtupb dtAIUOZ j �r60000, � AunSSN33n " JO NMOJ L y c%''' j' eye jDff �.Jfyl T �r1 ZC# f F u u Z t' R 4 NNW 97 { y I 1 V '#ti 17 6/�000N , 6� ClS .00 �1 N1v