1989-220 � S
or
CER711FI+ A� " OF 0CCT.JPA NCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date October 22 lq 90
k$ ��- z a
This is to certify that work requested to be done as shown by Permit No,
has been completed.
This structure maYylbe occupied as a Single Family Dire l i i na
Location ■ _ a. 1 .■.>r■ 4 45�`y '^`� Tr'ac�
Owner Timothy & Nancy Grace
By Order Town Board
TOWN OF QUEENBBURY
Director of Bldg. do Code Enforcement
a
BUILDING PERMIT "
TOWN OF QUEENSBURY No 89- 220 0
WARREN COUNTY, NEW YORK N
er+
t
ts�
PERMISSION is hereby granted to TIM(]THY MANGY RAC r +
r�
00
OWNER of property located at LRT 178 ._ggnnKSHTRIF TOME Street, Road or Ave.
in the Town of Queensbury, To Construct or place a
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 . OWNE R'S Address is
7305 REGENCY PARK
QIJEENSBIJRY , N . Y . 12804 rti
m
2. CONTRACTOR or BUILDER'S Name �
GARY GOLDEN
x
-e
3. CONTRACTOR or BUILDER'S Address as
4. ARCHITECT'S Name
5. ARCHITECT'S Address
r
C
r-
N
B. TYPE of Construction — (Please indicate by X1 a
v
a
I Wood Frame ; 1 Masonry ; } Steel ; 1
7
C
r
?. PLANS artd Specifications
No. '63080 x 40 ' single family dwelling as per plot plan , specifications , r
and application , including two car garageseptic and driveway. 9
c
kP
osed Use r
Single Family Dwelling
25_ 00 c/o November 1 19 89
$ 367 .00 PERMIT FEE PAID — THIS PERMIT EXPIRES
(II a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.}
89 1
Dated at the Town of Queenshury this 27th Day of April 1g I
i
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
ll
BLDG. PERMIT NO. g9-220
APPLICATION FOR A TEMPORARY CERTIFICATE OF OCCUPANCY
A TEMPORARY CERTIFICATE OF OCCUPANCY is hereby requested for the property
located at; Lot 128 Brookshire Trace (Bedford Close)
for the following uses: One Family Dwelling
10/19/89 �44
DATE SIGNATURE OF APPLICANT
TEMPORARY CERTIFICATE OF OCCUPANCY
The TEMPORARY CERTIFICATE OF OCCUPANCY is hereby APPROVED
( )DISAPPROVED
with the following conditions; Interior trim and flooring to be completed before
Certificate of Occupancy will be issued
TEMPORARY CERTIFICATE OF OCCUPANCY FEE: )$10.00 DEPOSIT: ( )$100.00
ell
received on 10/19/89 w S tr ,� , C Z!!
Date of Issuance Director of Bldg. & Code Enforcement
THIS TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES 90 DAYS
FROM THE DATE OF ISSUANCE.
NOTE: This Certificate is NOT VALID unless signed by the Director of Bldg. & Code
Enforcement or his designee.
ON OF UEENE13URY AT' P ICATTION FOR nuILOTtIC AND ZONINC. PERMITF'ecieved � -c TOWN OF QUEPNSBURY
Reviewed RECEIVED
APR 2 1'q0}
Fee Paid fi s
MILDIEIC AND CODES UI1TARTtT-, f gate Iaoued 1ru� BLDG. & CODE DEPT.
DAY and IIAVIL1Ni3 ROADS R!3 L 13ox 93 5 �-� 3 1 pUEENSBURY , NEiti► Y04RK 12804 PPlef►4Lt 1�10 . L t�
Te.1 . ( 51eJ 792-5832 E'xc •204
.s w * a x * * x I x a * w * * a ■
A PERMIT htusT uq OBTAIP4E1) BEFORE BEGINNING CLINSTRUCTIO14 o NO INSPECTIONS
WILL BE MADE UNTIL APPLICANT IIAS RECEIVED A VALID BUILDINC PEM IT .
All applicable spaces on this application must he conxplcted and the
x t r� � ature of the ;applicant Pxust appear on the reverse side of this sheet .
'K A k 7r Jt 7k d: #� i1r X .yc Yc fIC is * sti
'i` iie owner of this property is :
201
T >rL .
0 . 00 Address
raroperty location €Sy- / k'Sh'f • �' 'G� � !'Ctr TA:ac . HAP too ./�S
leas there been any split of this property since actol[ner. yes ram.
if yes , Planning Board Review is necessary .
LOT NO .
SU13DIVISION NAME . IF APPLICABLE
The person responsible for supervision of wor}: as regards Building Codes is :
NA !`11 P 10 . ADDRESS TEE . NO .
Address Tel
Name eat builder Tel
tJII of Plumber /�- -�-,_�h� �+.-. _ JWdrass
_ •T
Nddres5 el
Name of Mason _ .
[ u1TuRL OF PROPOSED WORK : 20NI11G INI ORDIATION ( o cfjce usa only )
x ron :: cruccior& of a now building ;CONING DESIGNATION OF PROPERTY
Ac1.lition to :a 1aui1 .3ing r PERMITTED PRINCIPAL PERMITTED ACCESSORY
� .: :..Lion to " luilding
�A1cr( rro C}kurrgu to axt � riar elirnr:n:.- i4n5 ] REVIEW REQUIRED — PLANNING S3OARD ZONING BOARD
AtlLier work (..a�scribk!) SITE PLAN REVIEW (I APPROVED DATE
VARIANCE APPROVED DATE
GKOSS AREA OV PRO L130SCD, _`: 'TrWC `TURE
#
E/ 'f a sq f t . Rema r]cs : --
lst Floor ,r �
2 n d Floor I < +P sq f t . „ Cobh f L'a'a iFJi'L7� tM`L`lON lel r�u I laL r3 lrk [.U�r .
sip.: of laro13urty ! ar`.r
Ift x�—f c .
Other Floors sq ft ' kxiutirtig Sauii.liarg ( ::5 Si -4 rc x rc .
( not Cc11 :ir or 'bwsemant )
TOTAL FLOOR ARCAx a SJ' sq ft . ' t:xi :ciaag builrainLj (u3 U:.0
=.' iLo ut new wtruccura Gr3� -S tt x 1/0 ft "
►`i3e2aad . tion-Iaicr/ slat/cr:awl/IaaY [i al ` Nroposwu building & distAncu from (;arolaasrtY linu
(eirclu ones ) Front yard 1' t hear yard ft
NOI of storiea (j"b.itablQ Sj)a4Ccl o� # Sid.a yards fc : OLI r't
Iluight ( Uradu to ridc�u � 3 _ fto if on corn.: r , zoucbaCk xrorn side scra:e c = [
If r4Incial , no . of Cwmili.ea ALLOP
OCCunp"LY INFDP.h1ATION
No , of room: ( Cxcludin+l
tao. of bedrooms
�l � PTtSMRTZY raUILDINL' -
Noo of ro"Likroour: ` One family dwelling
1•riu)Zry Iruaciiuj :;ys;cvru }fie Two ta=Lly dwelling
III of f "al Multipja jwulling / Number of units.
No . of firu!placu:: tt> 1aa ira::[:alled rjanaanoltc occ:upzurcy
will :.► wea�e5aa sLov.: 1:,v irti:: tall.:d'' Z+ •a'r:ansiurrt oe:culy:ar,cy
IIIIIIIIIII�
L'.antr:al Air corrclitiunirsg.' /t/f2l- + DuSinuss
BUILDING fTYLffo PRIMARY STRUCTURE lndu::trial
O[hur
y;:.ar►cb Lontuu�l.c.rury Log cabin Z,f ..dditlon , wlLut will u I; Q bu?
rc:ai. t�.ud ranch M"nuiurr OuaFlux '
J 141 L iuv,:l old > cyla tlusL l..alow
t.:. a Cod Cact:aga Or. 1L6zr ` ACCESSORY a3U'l6GIWC car
Colonial boar
aowrr House ' "tachad y :ariagC/onra C"CO two c:+ rf
( CIRCLE•' ONE•: PLEASE l qP
ACz4ahi.I U4riLqu/04ta ctarf two Cur - C" r
* „ * a . x r r r w • * 0 prly ac&I storage butldi. ng
E : `s• xM14Tt: D HhRFLi:`3• VALUE OF * —"ocnur
CON Sk •a• kuc*rToN
] Nparr MATTON ON LiL rLDINC—Sf+!?uTFyCATTONS , ON REVERSE SIDE OF THIS SCHR.ET, TO BE COMPLC:'1'riA !
Form DPA 10/98 VI
BUILDING PERMIT APPLICATION CONTINUED - ►�
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe , etc . ZAD is 'Z �yf �G
Will any second-hand or ungraded lumber be used? if so , for what ?
Foundation wall material 4bn r ela & !1 L 2C Z- Thickness
Depth of foundation below grade (to bottom of footing ) ;;
Will there be a cellar? Heated or unheated? N"p Floor sq. £aatage r&&sue sq ft
Will there be a basement? Ye, will any portion be used as living space ? �/
( If so , what po,.r�.t�i-o�-n�--�? sgq . ft . - - Type of use ?
Type of roof - C /flat/shed/other Material of roof
Size , wood studs '"X
_� _�- spacing �/(�"o . c , length g ft .
JQiSts ( floor beams ) 1st . floor 99- " X /G NO spacing " o . c * span� ft .
.joists { floor beams ) 2nd . floor aca "'X �/��"' spacing "o . c , span /y ft .
Overlays ( ceiling beams ) ON spacing - c . spa�c ,
Roof rafters ONspacing o . c . span.ft ,
Roof truas (pre-engineered) spacing �j/ "' o> c _ span Tn ft .
Exteriorfor wall
wall finish �a w] .�, • +.a do Of what material ?
Interior wall finish " - � r{ Z
If a garage is to be at lcnedis descr pbe materials to be used for FIRE SEPARATION :
JC�j
r Lon oGS Fi �F�' s� 6Gr
Is there to be an opening between garage and dwelling? � if so will a Fire-rated
door , enclosure , and self-closing device be provided? �
Will a flue- lined chimney be installed? e S Height above roof a " ft .
Depth of chimney foundation below grade�_ft ,
Depth or fireplace hearthLE in _
Water supply - Municipal or private well INLj.7,pOr/I .s .
SEPTIC SYSTEM _ Distance from ANY .private well ( in luding adjoining properties
(A separate application is necessary for any repair or new installation of septic system)
D E C L A R A T I O N
To the best of my knowledge and belief the statements contained in this
application, together with the plans and specifications submitted, are a true and
complete statement of all proposed work to be done on the described premises and
that all provisions of the BUILDING CODE, THE ZONING ORDINANCE, and all
other laws pertaining to the proposed work shall be complied with, whether specified
or not , and that such work is authorized by the owner.
SignatureOwner, owner's owner's agent , architect , contractor
W NOW
SPECIAL, CONDITIONS OF THE PERMIT :
By
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 : ^y
1 . Gross floor area p (J
2 , Type of heat / + f r 'f � G't. t7 � x `c
3 , is the building mechanically cooled ? /iZQ
4 , Percentage of area of windows and doors
,—L7r „] 5tn
A . Over 16 % Only
1 . U value of gross area of walls , roof / ceiling and floors
o
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 YES NO
a . If YES , what is the R value of insulation around
perimeter of floor ?
4 , Is basement heated ? YES NO
a . R value of insulation
5 , Type of insulation
Be Under 16 % Only
1 . R value of roof and floors expose 3 two ambient conditions
2 . R value of exterior walls j
3 . R value of glazed area
4 , R value of doors _ C " / i ! /�
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
S . 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 Cs
1 . Thermostat maximum heat settingQ
D . Duct Systems
1 . Is duct system installed in unheated spaces ? Y NO
a . If YES , R value of duct installation - 2-
be R value of duct in other areas
E . Piping Insulation 3r N
1 . Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulation
F , Service Water Heating
1 , Performance efficiency
2 . Temperature control setting maximum
G . For swimming Pool Only
1 . Maximum
/ heating
�7
Telephone No ,
applicant s signature )
.�►,/601101la {CERTIFICATE OF INSURANCE rSSDE DATE (rrwuDOrvY)
4--18-89
PRODUCER 518/793_9683 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHT$ UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
Wm P .L..eonaurd Agency Inc EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
RR #5 Lake George Road COMPANIES AFFORDING COVERAGE
Glens Falls NY 12804
COMPANY A
CODE SUB-CODE LETTER GA Insuirance CcxTpa y of New York
COMPANY B
INSURED LETTER
GARRY B GMDEN -DBA- GOLDEN COMPANY_ C
�NICAL
PO Box 4094 COMPANY
Glens Falls NY 12801 LETTER D
COMPANY E
LETTER
NY
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PLRt0L7.
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR O'FHER DOCUMENT WITH RESPECT TO ICYWHI P THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN k5 SUBJECT RESPECT
ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
T TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS
R DATE (MWDDIYV) DATE (MMIDDIYY)
GENERAL LIABILITY GENERAL AGGREGATE $ 1 r 500 '
A x COMMERCIAL GENERAL LIABILITY MZ:p 0892203-00 3-- 16-89 3- 16-90 PRODUCTS-COMPIOPS AGGREGATE $ 1 000
CLAIMS MADE x OCCUR. PERSONAL & ADVERTISING INJURY $ 300 I{
OW NEFI'S & CONTRACTOR'S PROT. EACH OCCURRENCE S 300
FIRE DAMAGE (Any one Ike) $ ra0
MEDICAL EXPENSE (Any one person) $ 5
AUTOMOBILE LIABILITY COMBINED
ANY AUTO SINGLE S
LIMIT
ALL OWNED AUTOS BODILY
SCHEDULED AUTOS INJURY $(Per person)
HIRED AUTOS BODILY
NON-OWNED AUTOS INJURY $(Per accident)
GARAGE LIABILITY
PROPERTY $
DAMAGE
EXCESS LIABILITY EACH AGGREGATE
OCCURRENCE
$ $
OTHER THAN UMBRELLA FORM
WORKEWS COMPENSATION STATUTORY
A AND WC 0162049-00 1-24-89 1-24-90 a 100 (EACH ACCIDENT)
EMPLOYERS' LIABILITY $ 500 (DISEASE—POLICY LIMIT)
OTHER $ 100 (DISEASE—EACH EMPLOYEE)
DESCRIPTION OF OPERATIONSILOCATRONSJVE"ACC-EWRESTRICTIONWSPECIAL ITEMS
CERTIFICATE HOLpER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Tim Grace EXPIRATION DATE- THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 1_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Regency Park APts — Apt 7305 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
Queensbury NY 12804 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORI Z'E R 'PRES ATIVE
ACORD 25-S (318a) COACORQ CORPORATION 1968
TOWN WN OF Q UE- ENS13 LTP y
_iy rS"" �-C- APPLICATION FOR
SEPTIC DISPOSAL PERMIT
DATE
LOCATION OF PROPERTY FOR INSTALLATION Z-&r 122A
Owner's Name:"� K' kaey L+'
JCL Telephone: , G5 '
Address: G- � L�L�i ,��c�3✓, y�sc�
Installer's Name: Telephone:
Number of bedrooms (residential only)
Total daily flow (compute Ca 150 ,gal per bedroom) 4 �
Topography: Circle one: lat olling Steep Slope %, of Slope
Soil Nature: Circle one Sand oam {Clay Other /Depth: Peet
Ground Water: At what depth? / 3 Feet 7`
Bedrock or Impervious Material: At what depth? &0 01 Feet
Percolation test: Circle one.-(
ne: not required equired rate min. inch.
Domestic water supply: circle one; < unicipal Well Other
If domestic water supply is a well .
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM: Septic Tank _gal. (minimum size: 1 , 000 gal.)
TILE FIELD : Each Trench 6µO feet/Total system length �? ,S'b feet
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used #Yy(�' /%Depth or Thickness
/ ^Cv feet
I have read the regulation on the reverse side of this sheet and agree to abide by these
and all requirements of the Town of Rueensbury Sanitary ewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE: f 7
1 1&! _�
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 1wi .lding 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 aria 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 ,
the fields and / or drywells
B . Nu system shall be covered before inspection and approval by the
Building Inspector . Failure to comply with this requirement may
result in tiie uncovering of the system by the installer and a fine
of up to $ 250 . 00 .
C . An approved copy of the plot plan shall be available on tho 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
he submitted to the Queensbury Building Department before further
construction .
Town of Queensbury
BUILDTNC and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
l;.emark6
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & AVAVILAND ROADS
'QUEENSB'URY. NEW YORK 1280&
TELEPHONE (.518) 792-5832
BUILDING INSPECTORS REPORT
REY?C7EST FOR INsPECTrON RECE-rVED
NAME
� _�
r
LOCATroN ----�
DATE /1 PERMXT
,/
R
.APPROVED
FOOTING YES NO
t IERS
MONOLITHIC POUR RMS
FOUNDATION/DAMP. OOFING
BACtCPXZZ APPROV,A t
ROUGH PLVMBrNG
F'RAMXIVG
ELECTRICAL ROVGHrIN
INSULATrON: f.
FOUNDATION
FLOORS
WALLS
CE.I'LrNG ;
F INSPECTIO
CHX hT CFfIMNEY f!E'IGH
ROOFING
SIDING
EXTERNAL PORCHES/STEPS
STAXl?S-CLEARANCE & RAILS
PLUMBING FI7C27URES/RELIEF VALVE
�1INTERrOR TRIM/PRIVACY DOORS
FINrSHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER (S) -
SMOKE DETECT CJRS
FINAL ELZCTRrCAL xfvs.RECTrON
FINAL APPROVAL OF .CO T1quCyrnzON
- OK TO 'ISSUE C/o QR C/
A SrG1VED CERTrp2-C.AT E O
OBTAINED FROM Tf)$ BrjZ OCCUPANCY MUST BE
NG
THESE PRENTSES ARE OCCU EDDEPARTMENT BEFORE
DEPARTIIf: fG+
INS TOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUIaENSBURYw NEW YORK 3280k
TELEPHONE (5I8) 792-5832
WILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED A/�
MANE
LOCATION
DATEFERMIT #_
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP--PROOFING
BACKFILL APPROVAL
ROUGH pZUMBING
FRAMING
ELECTRICAL ROoUGH—IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
�C FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEPS
STAIRS—CLEARANCE ,& RAILS
1°LUMB1rNG FXXTUR /RELIEF VALVE
.INTERIOR TRxm/P E VACY DGk
FINISWED FLOORS
GARAGE F'IREPR ING —
DOOR CLOSER (S)
SMOKE DE;TECTO
FINAL ELECTRICA IINSFECTIQN
?o FINAL"' APPROVAL OF CONSTRt?CTION
/ OK TO ISSUE O OR C/C
A SIGNED CE TIFICATE OF OCCUPANCY MUST BE
OBTAINED F M THE BUILTIING DEPARTMENT BEFORE'
THESE PRE SES ARE OCCUPIED!
REMARKS
is
e
r"
r
f
1< t
A"1vz
DEPART
INSPECTOR
TOWN OF QUEENSBURY
BUrLDSNG AND CODES DEPARTMENT 4 �
BAY & HAV2-rSAND ROADS t
QUEENSBURY, NEW FORK 1280
TELEPHONE (518) 792-5832
i
BUILDING INSPECTOR ' S REPORT
REQUEST FOR rNSPE'CTrON RECEIVED
NAME _-
LOcATrON
DATE
PERMrT #— ..
APPROVED
FOOTING1 IERS YEs NO
MONOLrTHIC POUR rolzms
FOUNDATIONfDAMP-.PROOFING
BACKFrLL APPROVAL
ROUGH PLVMBrNG
4PRAMING
ELECfiRICAL ROUGfI-IN
rIVSULATrON:
FOUNDAT.I01V
FLOORS
WALLS
CE ILSNG
FINAL rNSPECTION:
CH-I HEIGHT
ROOFING
SrDING
EJCTERNAL PORC Es STEPS
STArRs-cz,E,y N
PLUM.BrNG Fr E RAILS
vRs
INTERIO rREL tEF CDIR T rMjPRIVACY DOORS
FINrSHED ,_,r
GARAGE Fr EPROOFIN -���---- -~
DOOR eL0 ER(S) _----------__ -
SMOKE D TECTORS
FINAL E TRrCAL IN,SPECTIdN
FINAL AP ROVAL OF CONSTi4UCTION
A SIGNED CE.RTIF-I OF
OCCUPANCY mUST BE
OBTAINED -ITR,E BU-rLD-TJVG DEPARTMEN7 BEFORE
THESE PR-FMrSES ARE OCCUPIEDI
REMARKS
.1 ..r- .0
INSPECTOR " -
_70"In 0/ �ueens6ur�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ,
LOCATION .,�1��. G
DATE � 1 PERM i T .�"
SOIL TYPE - Sand - Loam - Clay =
Perool tion Test Require . YES - NO
Fercola ' on rate - MinfI ah
TYPE of SY
Absorption eld , total Zen th
Length of ea h trench1
Depth of tre hes y
Size of grave
SEEPAGE PITS{ er oJ }
Size- ft. f L
Gravel size
PIPING : Size Type
Bldg. to tank
Tank to list . box
Dist. box to field i �-
Openings sealed? % NO Partial
r
LOCATION/SEPARAT ONS :
Foundation to t k y ( ) t.
Foundation to a sorptio �"'�,c. ft.
Absorption to of line '•` -+ ft .
S on of its , ft.
CATION OF S STEM ON PROPE TY (circle one )
F ont - ear - Left side - R ht side -
r�1+7'1?S
SYSTEM USE APPROVED NO
Bu Iding In ector
01/8 6 and vl
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & BURYT ANE ROODSQUE
TELEPHONEY, NEW YORK 1.280+P
TELEPHONE (5I8) 792-56.32
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME _ 1
LOCATION
DATE ] PERMIT #
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
f
CHIMNEY HEIGHT
ROOFING,
SIDING
EXTERNAL PORCHES/S I
STAIRS-CLEARANCE RAILS
PLUMBING FIXTURE /RELIEF VALVE
INTERIOR TRIM/P XVACY DOORS
FINISHED FLOOR
GARAGE FIREPR FING
DOOR CLOSERS
SMOKE DETECT RS
FINAL ELECTRI L INSPECTION
FINAL APPROVA OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT .BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
INSPECTOR
sr
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK .I28ok-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR I PECTION RECEIVED _
NAME I A t i&
LOCATIONI L SfY►�Q �ICt �T -
DATE 71— _. PERMIT
APPROVED
YES NO
FOOTINGfPIERS
MONOLITHIC POUR FORMS
FO N IONfDAMP PROOFING
ILL APPROVAL
OU PLUMBING
VRAM G
ELECTRICAL ROUGH-IN
LZ
INSULATION:
FOUNDATION +
FLOORS
WALLS
CEILING
FINAL INSPECT N:
CHIMNEY HE HT
ROOFING
SIDING
EXTERNA PORCHE STEPS
.......�
STAIRS LEARANCE 'F RAILS
PLUMB G FIXTURES;*ELIEF VALVE
INTER OR TRIM/PRIVA'�Y DOORS
FINI RED FLOORS
G E FIREPROOFING
DOO CLOSER (S)
M KE DETECTORS
FINA ELECTRICAL IN
FINA APPROVAL OF C+ONSTRUCTIO,NN
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
INSPECTOR - �-
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVX LAND ROADS
QUEENSBURY, NEW YORK 3280$-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION CEIVED _
NAME
LOCATIONDATE PERMIT PERMIT # Jf J L c7
APPROVED
YES NO
FOOTING/PIERS
MONO ITHIC POUR FORMS
NDATXON/DAMP-PROOFI NG
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH--m
INSULATION: s
FOUNDATION f
FLOORS
WALLS ti
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STE
STAIRS-CLEARANCE & RA
PLUMBING FIXTURES/RE VALVE
SNT'ERIOR TRIM/PRIVA D RS
FINISHED FLOORS
GARAGE FIREPROOFIN -
DOOR CLOSERS) --
SMOKE DETECTORS
FINAL ELECTRICAL SPECTION
FINAL APPROVAL OF CONSTRUCTION
` Y
A SIGNED CERTIFICATE OF OCCUPANCY MIT BE
OBTAINED FROM THE BUILDING DEPARTMENT, BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
INSPECTOR
TOWN OF QUEENSBURY /�—
BUILDING AND CODES DEPARTMENT J
BAY & HAVILAN ROADS /
QUEENSBL7RY,. NEW
W PORK .I28(}$
TELEPHONE (5.18) 792-5832
BUILI]ING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION G/+ 7��,� ����
DATE _c.. l` PERMIT # �
APPROVED
YES NO
TINGIP RS '
MONOLITHIC POUR FORMS
FOUNDATION/DAMP--PROOFING
BACKFILL APPROVAL
ROUGH PLUNBfNG
FRAMING
ELECTRICAL R GH—IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL XNSPECTTONAx el-
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES S PS
STAIRS—CLEARANC & ILS
PLUMBING FIX TU SIR IEF VALVE
INTERIOR TRIM/ RIVAC DOORS
FINISHED FLOP S
GARAGE FIREP FING
DOOR CLOSER ( )
I k _..�
SMOKE DETEC RS
FINAL ELECTRI AL XNSPECTXOIV
FINAL APPROV L OF CONSTRUC ON
A SIGNED CE TIFICATE OF OCCUPANCY MAST BE
OBTAINED F M THE BUILDING DEPARTMENT BEFORE
THESE PREM SES ARE OCCUPIED!
REMARKS:
/ 7
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY 6 HAVILAN ROADS
QUEENSBURY, NEW
W YORIC 12804-.
TELEPHONE (5I8) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED _
NAME
LOCATION ',� " '� n s� /r✓ C �4-
DATE - Z f4z fy
` PERMIT' # "r
/ A
N
Ul0
OOTINGfPIERS
MONOLITHIC POUR FORMS
FOUNDATIONIDAMP—PROOFING
BACKFILL APPROVAL'
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH--IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STZPS
.STAIRS--CLEARANCE &/2ZAILS1.
PLUMBING FIXTURESIPRELIEF VANE
INTERIOR TRIMIPR.TVACY DOORS
.FINISHED FLOORS/
GARAGE FIREPROOFING
DOOR CLOSER (S)
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: IJ
1 1 I r
INSPECTOR
rea rxr ..m
MAIN OFFICE ATLANTIC-INLAND, INC.
997 McLean Rd, NEW Y+ORK
Cortland, New York 13045
MEMBER OF N.F P A AND I A E I
PfiQne� (607) 753-771 $(607) 753-7809 FIRE UNDERWRITERS
L^
{607} 753- f396 (Electrical and Fire inspection-Enforcing and Consulting Service) C 5 73z) [.1
(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 — PLEASV PR! T OR TYPE
THIS SECTION TO BE COMPLETED BY APPLICANT DATE OF APPLICATION
CITY. TOWN. VILLAGE eiew Liz, COUNTY STATE I r
STREET �ft � / �}� �,,,." / 77�G.
ADDRESS I.�F•I' JG-�" C7K._ ✓'�' ff' .• � RUILOG+. NO
RURAL --�-y �p1� .�. ��/y +� '/ / �,�y� ,} ¢
DIRECTIONS � �r AC405 ViG�C�. � /�jVi�`I 'f,/I Al (e rlr; POLE NO,
OWNER I�' r,NAME ' I /� OCCUPIED AS
OCCUPANT BUILDING — Newy Old 71. WORK — New C Addrocnal ❑ /
ADDOWNER'S
ESS P.O. ¢S `:T J I.f�PV'S CT+ a / ■ /2 40
APP. FOR — ROUGH WI RIN
G FIXTURES O OR READY FOR INSPECTION 19
FEE REMITTED — 3 BY CHECK ❑ CASH ❑ MONEY ORDER ❑ MAKE PAYABLE To ATLANTIC-INLAND, INC — NEW YORK
Nu m I1er of Rough Wiring Outlets Fixtures Add Installation
Swtoh Li'Ing Recep KW Mad. Mogul Fluor 5IX1 750 1 1000 1 1250 1500 1750 2000 22511 250i0 27511 3000
Heal Base Rase
Elect. Heat
Amp. S.a"'Ce Water H1r. eurrier Air Cond.
Surface Unit Oven Range Gr DisP. Dish W
Dryer H.P. Pump En. Fan Hood
OTHER EQUIPMENT ISpocrty Type & Capi crtiesl
TYPE OF SIZE OF SUB- BRANCHES NO. OF
'.HIRING OPEN M CONCEALED ❑ OTHER MAIN MAIN CIRCUITS
„ APPLICANT'S
SIGNATURE LICENSE M PERMIT X
APPLICANT'S NAME OF
ADDRESS UTILITY
OFFICE TO
CITY STATE ZIP CODE BE NOTIFIED
BELOWSPACE • - USE OF r • ONLY
ROUGH WIRING AMP SERVICE K.W. SURFACE
OUTLETS EQUIPMENT UNIT
SWITCHES AMP SERVICE _ KW. OVEN
CONDUCTORS
H.P GARBAGE
RECEPTACLES HP PUMP DISPOSAL UNIT
MEDIUM BASE K W
FIXTURES K,W DRYER DISHWASHER
MOGUL BASE K.W. WATER
FIXTURES HEATER K.W. RANGE
FLUORESCENT H.P AIR AMP RECEPTACLES
FIXTURES CONDITIONER
MERCURY VAPOR OR WIRING & CONTROLS FOR BURNER SMOKE FRAC. H P
QUARTZ FIXTURES DETECTORS VENT FANS
MOTORS, H.P 1120 1r12 1 /10 118 1 /6 1 /4 1 r3 172 314 1 1+ip 2 3 1 5 1 7+h 1 10 1 15 1 20 1 25 1 30 1 40 50 75 100
MARK NUMBER
OF EAC31 $RE
Soo 750 I 1000 1 1250 1 1500 1750 2000 2250 2500 2750 3000
APPARATUS Elect Hear
MISC. INFO. Received FEE PAID
Inapeelod
❑ PROGRESS TOTALS
U DEFECTIVE
./>. �� ❑ Rough Wiring Certificate Check NO_
L' - ' -• r + - x/4 /-24?6?/0t ❑ Temporary Service Money Order
M004- Fri , G`7:30A•MA ❑ FINAL CERTIFICATE Cash
O Dup. Con- Reo-
�� �. .� C MUNICIPAL Charge
MUN. ADDRESS
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSHUR'Yr NEW YORK I280&
TELEPHONE (5I8) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION R CEIVED
NAMEGh � —
LOCATION
DATE / � —/ PERMIT # `y
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC ,SOUR FORMS
FOUNDATION/DAMP—PROOFING
BACKFILL APPJROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROVGgar.FN
INSULATION:
FOUNDATION
F.I..00RS
WALLS
CEILING
AL INSPECTION: /
CHIMNEY HEIGHT +VI
ROOFING
SIDING
EXTERNAL PORCHES/ TEPS
STAIRS—CLEARANC & RAILS '
PLUMBING FIXTU S/RELIEF V LV
INTERIOR TRIM/ RIVACY DOORS .Lpel.e k
FINISHED FLOO S ►.
GARAGE FIR EP OOFING
DOOR CLOSER )
SMOKE DETEC RS
FINAL ELECTR CAL INSPECTION
FINAL APPRO L OF CONSTRUCTION
A SIGNED CE TIFICATE OF OCCUPANCY MUST BE
OBTAINED FR M THE BUILDING DEPARTMENT BEFORE
THESE PREMI S ARE OCCUPIED!
RB'MARKS
1'
�- /�.-,mac o`�- e�,•a�+�'�'�..� ��,1�
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVIZAND ROADS /3
f?UEEN.SBL7RY, NEW YORK 128 pg-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REP(?RT
REQUEST FOR INSPECTION RECEIVED
NAME ".
LOCATXON6 '
DATE PERMXT #
APPROVED
YES NO
DOTING XERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFXLL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRXCAL . ROUGH-XN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILXNG
FINAL INSPECTIONz
CHIMNEY HEIGHik
ROOFXNG
SIDXNG
EXTERNAL PORCHE TEPS
,STAIRS-CLEARANCE & �7AILS
PLUMBING FXXTUAHSIRE,.�pXEF VALVE
XNTERXOR TRXM PRIVACYi, DOORS
FXNXSHED FLOORS
GARAGE FIREPPOOFXNG \
DOOR CLOSERS}
SMOKE DETE TORS
FINAL ELECTRCAL INSPECTION
FXNAL APPROVAL OF CONSTRUCTS
i
r
A SIGNED CERTIFICATE OF OCCUPANC , MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
r 4
INSPECTOR
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