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1989-209 iWY:74VIr- r .F-r� ...y,4w .;wow CERPnFICATE OF UPA 1 V i pp TOWN OF +QUEENSBURY k WARREN COUNTY, NEW YORK Datre_._-Septembpr 21 I9 a9 I 'This is to certify that work requested to be done as shown by Permit No. 89- 209 f has been completed. E This structure may be occupied as a SINGLE FAMILY DWELLING 142'- 1 sari -coT� QAK IREE C I RGLE Owner ROBERTi BALOGH,MICHAEL WOODBURY I By Order Town Board sj TOWN OF QUEEN8BURY Director of Bldg. do Cade Enforcement I I . BU LDING PERMIT TOWN OF QUEEi'dSBURY � No. 89-209 0 WARREN COUNTY, NEW YORK No w PERMISSION is hereby granted to Robert Balogh , Michael Woodbury OWNER of property located at Lot 136 Oak Tree Circle Street. Road or Ave. `a 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 RD#2 John Street Box 286 Queensbury,N . Y . 12804 = 2. CONTRACTOR or BUILDER 'S Name Self a CONTRACTOR or BUILDER 'S Address Same $pp� . C 4. ARCHITECT'S Name r 3C r. 5_ ARCHITECT'S Address J B. TYPE of Construction -- (Please indicate by XI XX) Wood Frame ( ) Masonry i ) Steel I f— t7 s+ J. PLANS and Specifications No. 58 ' x 50 ' single family dwelling as per plot plan , specifications , and rn application , including septicsattached two car garage ,drireway , and e w S. Proposed Use --I t� Single Family Dwelling M. 25 . 00 c/o � $ 215 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES December 1 99 89 0 (If 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 Queensb his 1st Day of Hay 1989 cn r. SIGNED BY for the Town of Queensbury D Building ening Inspector J TO �'vI ©F` VEL�"N I3UPY APPLICATTON roe, BUTLDINCe Alva ZONING PERMIT V F.ec i evert TOWN OF QUEENSBURY Pei,,i.ewed RECEIVED Fee PaLd t In APR .3 rtl ! 13L}ILDINO AND CODES DI :1 'AR' T:N'T pate. 7o,4ued BLDG. & CODE DEPT. BAY and NAVILAND ROADS RD I Box 98 PUEENSBURY, NEfV Y08K 1 w 804 PeAnIzt Na Te.1 . ( 528 ) 792-5832 Exe 204 -x x x x x w w w 1 w to * * r x r r w x w w x w r w * * t x r x r x w x x a A PERIITT h1US'1' uq OBTAINED BEFORE BEGINNING CONSTRUCTION , NO INSSPECTIONS WILL BE 1*1ADE UNTIL APPLY CAMT HAS RECEIVED A VALID BUILDINC PURMIT . All applicable spaces on this application must be completed and the f= >latun of the applicantant must apacar on the reverse side of this sheet . s- i9r k k do e k 7k is yc x x c ,�rlc 'Pile owner of this �proper-yt--y� is t M er- V .G . Address ' -+ L1 /�i� ,ram r _ E L . Y '6 1� 11ropertyy location „ 01 � L3 + ©I�I� I/�- l i-1 _ TAX MAP NO . alas there been any split of this property since October 1 , 198 $ ? /, yes Ito If yes , Planning Board Review is necessary . SUBDIVISION NAME . IF APPLICABLE A1,46.6 LOT NO . /f 3 t lithe person responsible for supervision of work as regards nuildi. ng Codes is : P.O* ADDRESS 4TEL Tel . �2NO o ^7 94 tdame ., ; builder_.�SA N r i.ama of Plumber Tel T.ddrassy pq ��13 LL•r" -' . Name of Mrs son Addressr :n l[J 0Eel l4."1TU/R.E OF PROPOSED WORK : r ZONIitC� IN1;0101A'1' 101 1 ( Offic & use only } 1/ r nritructior, of a rsew building ` ZONING DESIGNATION OF PROPERTY Aci.. ! - son to :s building # PERMITTED PRINCIPAL PERMITTED ACCESSORY A! LM4:"Lion to " l.uilding ' (Ito cla.trrqa: to Qxc � rior clifnonSions} " REVIEW REQUIRED - PLANNING BOARD ZONING JBOARD� OLILC. r work f44 cr.LULO. j ; SITE PLAN REVIEW (1 APPROVED DATE GROSS ARCA OF YROPOSCD, =; TPLUC '1`Ll " VARIANCE � APPROVED DATE # Remarks : 1st Floor ,� �'��f `l� sal f r 2 nd Floor sq f it . „ COIIriI.E 'i`l: . Iril°L]i:t4A"1`I ON 1il/r�Uy lick L1 LIL LUtiT . ' S !zQ of laYQf�aarty ! [/ +Q f c % rt Other Floors SwEC UiiT3ir! builalirr• re . { not cellar or b�aaema. nt } �0 ] ( ;; } aj �e rw % 88S �[OH .TS i+lHQr.. Sa TOTAL FLOOR AR>~h t � • ilcli Pal (:; ) Us:u Of new !;CruCtura: 4E Lft loft r . f'c�.xr,d . cion-picr � :lal�lcrawl/Iyarti+►1 uil r Px0pos awci building , d.i::cancu trout TACO Jerty lift: (circle one: ) n�y ; Front yard ft Roar Yard^ r ft N.'f . of acoriea (habic:x :D blo : ace ! (fN Side: yard:u 7_. I et :and 7 � i c lla:ight ( grade to riclala: ) � fe . a it on corner, Neti7,:+a k from side: ucrwer rc If rcaiduncial , no . of NO . of rooms ( excluding ath:s )_ ' OCGUfaANr:Y INFOFMATlLY� 11o. of 134(jodrooms _ Pits yrutx LUILDINC No * of C rZA.J0 » onefamily dwelling 1•riuury ltuacirua syaL .ru "ri,lo family dwelling "1`ypQ r.If fuel /-Z L- Multiple: alwalling / Number of units No . of firuglacuz Lu Iau in::cialla:C1 .tsc�ic+as ` L,CriG:araC rlt occup:anCy Will :a WOQJ :atQvar k+a: ierstallud? a r 'rr:anai4frt occuLlancy L'uncr:al Air conaii.tiuning? 4o # �, Business BUILDING SETYLC, PRIMARY STRUCTURE . 1'nduscrial 1;:ralcla CanCe rnx,c'rury LoQq cabin r Other r if .Addir. ion . wl&"t will uUu be:? ..0 ranch M;anm7ie.il oL4plvx UPLic larval Old scyla laer, .ai.slow ` L-.:.tau Cod Catt;Aq% Ochwr ; ACCI=SSORY UUXLDING- Coloni:al Lu3v town House 'r G.atacharA 9 "riage/ono cur/ two cur,/ czar { CIRCLE: 0" PLEA:= } kv E./�1ttaCtaa e1 el:ar:agujo�la: Ciar -- CLa' • w w a r r w * x • r r w = * lerivuta: SLQr"eQ building L: STIMATPO MARYCrV VALUE OF ' Othe: r INPORMNTTON ON BUTLDTNIC gPfrC1FICATTONs4 ON REVERSE; slot OF T#Irs stiv " . TO AC COMPL>w" EDI Form DPA I0/89 V2 1 fib . BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , od fr fire safe , etc . Will any second-hand or ed lumber be used? If so , for what ? Foundation wall material 0 �r Depth of foundation below grad to bottom of footing ) _ ' Will there be a cellar? leate or unheated? �}�7K Floor sq . footage J .tl/ !2 sq Will there be a basement? i---- ill any portion be used as living space ? ,, J " ( If so , what portion? sq . ft . - - Type of use? Type of roof - slope flat/shed/other Material of roof_AsAe r� ­ Size , wood studs " X " spacing j(,"o . c . length eft . Joists ( floor beams ) 1st . floor �" " X_ZA�:) _" spacing j ,6 " o . c . span/AV ft , Joists ( floor beams ) 2nd . floor "X spacing "o . c , span ft . Overlays ( ceiling beams ) acing " o . c . span fc . Roof wafters -„ " X spacing o . c . span 27R=ft . Roof trusses ( pre-ena . veered) spacing ' o . C . spank&_ft , Exterior wall finish�� ,Gy'� C/ Of what material ? (fZ.+ / Interior wall finish T If a `garage is to, be attached , describe materials to be used for FIRE ,SEPARATION : Is there to be an opening between garage 9nd dwelling? If so will a Fire-rated door , enclosure , and self-closing device be provided? �_ will a flue -lined chimney be installed? /V<- Height above roof ft . Depth of chimney foundation below grade ft . Depth or fireplac tYL --- £t . -- in . Water supply - unicipal or to well GL� �"?L� �r""u � r�'?�� SEPTIC SYSTEM _ ce from ANY private well ( including adjoining properties - ft . (A separate application is necessary for any repair or new installation of septic system) DEC L A RAT 10 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. Signature Owner, 6 wner s age a h "". SALOG14 0MUFMOMN IL go 412* SPECIAL CONDITIONS OF THE PERMIT : gy---_ ___ -_-- ------------ _ ...__ s a TQ1.'L'N OF QUEENSBURY APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE /71( LOCATION OF PROPERTY FOR INSTALLATION �r-��,r�[-} 7,!��"� Owner's Name: �C� 1 ' I rf--3 �/' telephone: �+^7 3 " � / % 15 Address: IL � r /✓ - �. ?t�s1 [1/�f , Installer's Name: ,r / Lam' C Telephone: 7 e9 Number of bedrooms (residential only) Total daily flow (compute Ca 150 gal per bedroom) ` /56 Topography: Circle one: Flat Rollin Steep Slope % of Slope Soil Nature: Circle on�nd oam Clay Other /Depth: *2,C✓ Feet Ground Water: At what depth ? 47 Feet Bedrock or Impervious Material: At what depth ? '� c) r-� Feet Percolation test: Circle one: t required required rate min. inch. Domestic water supply: circle one Municipal Well Other If domestic water supply is a well: Separation: Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank 461 QC) gal. (minimum size: 1 , 000 gal.) TILE FIELD: Each Trench -- feet/Total system length - feet SEEPAGE PIT(S): Number of 2 Size each S feet by y feet Size of stone to be used # �`y /Depth or Thickness -- feet I have read the regulation on the reverse side of this sheet and agree to abidatwthese and all requirements of the Town of Queensbury Sa ry Sew o a Ordin ce. SIGNATURE OF RESPONSIBLE PERSON: DATE: 40� e IL � 14or ��Cf OVER Septic System Inspections ; A . All appliceitions for septic system installation , alteration or repair , as required by the Town of Queensbury Sanitary Sewage Ordinance , shall he submitted to the [3uilding Department at least 24 hours before start of construction and shall include a pleat plan showing : 1 . ) the proposed location of the system ry . ) 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 drywelis B , Nu system shall be covered before inspection and approval by the Building laspuctor . Failure to comply with this requirement may result in the uncovering; of the system by the installer and a fine ut up to $ 250 . 00 . c . 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 " submitted to the Quuensbury Building Department before further Construction . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury : New York 12804 lt4ttt:irka + `. ill►. CERTIFICATE OF INSURANCE _ ISSUE D/EriM/8lD9DIYY, PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS CERTIFICATE DOES NOT AMEND, Wise Insurance Brokers , Inc . EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW lU Railroad Place COMPANIES AFFORDING COVERAGE Saratoga Springs , NY, 12866 COMPANY A Insurance Cat-) ny of North America LETTER CODE P00180 SUB-CODE COMPANY INSURED LETTER COMPANY C David Horward d/b/a LETTER Howards Excavations R. D . #p6 Peggy Ann Lane COMPANY ER � Glens Falls NY 12801 COMPANY LETTER 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 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS LTR DATE (MMlDDIYY) DATE (MM7DDIYY) GENERAL LIABILITY GENERAL AGGREGATE '$ COMMERCIAL GENERAL LIABILITY PRODUCTS-COM PlO PS AGO REGATE $ CLAIM'S MADE - OCCUR. PERSONAL & ADVERTISING INJURY $ OWNER'S 8 CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MEDICAL EXPENSE (Any one Person) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per 9ccidenli GARAGE LIABILITY PROPERTY $ DAMAGE EXCESS LIABILITY EACH AGGREGATE OCCURRENCE S $ OTHER THAN UMBRELLA FOAM STATUTORY WORKER'S COMPENSATION S 100 OF (EACH ACCIDENT) AND / $ J F (DISEASE—POLICY LIMIT) A EMPLOYERS' LIABILITY C2L3g59110 12/15 / 88 ('�('�12/15/89 $ 100 or (DISEASE—EACH EMPLOYEE OTHER DESCRIPTION OF OPERATJONSILOCATIONSFVEHICLFSlRESTRICTIONSISPECIAL ITEMS Excavations CERTIFICATE HOLDER CANCELLATION � _ Tan of Que,ensbury SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Building Department EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Flay Rd. MAIL -,.30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Queensbury NY 12804 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUT HO RI Z ED.AE1'RE SE N TATI V E .o attn : Nancy uA ACORD 25-S (3198) I �� (DACORD CORPORATION 1988 SSUE DATE iMM?0DiYY) + 12 06 88 PRObUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS CERTIFICATE DOES NOT AMEND, Edward C . Hughes Agency , Inc . k EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 152 Main Street Hudson Falls , New York12839 COMPANIES AFFORDING COVERAGE CL E IET`'E;; Y AEXCHANGE MUTUAL INSURANCE COMPANY INSURED ^� LETTER 13 Kenneth F . Celeste Plumbing & Heating , Rb #7 , Patten Mills Read c -- --- - --- -_ ..� ._.__ - Glens Falls , New York 12801 --- - --- THIS IS "O CERTIFY `u AT ?CL:CIES OF !NSURANCE LIS' ED BELOW r A ie BEEN S -4AMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM OR CONI iTzON OF ANY CONTRA^" ^R eD."EI•y 'C'.JCUMF 'NtTR .'tE5 P8CT TO WfNIC f+ T1i4S CERrtctCA TE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE PO i =!ES - F-.4E N S SvB. EC' "U ALA 'HE TERMS. SKCLUSIONS AND CONDIL TIONS OF SUCH POLICIES. NDS L RI r ;'„E Or .,,,�_,c.;^.�.E � =.�L L. ` '. �'.43E � _ l :rr. � ,�'T — - _ L�A' � GENERAL LJABiLITY y _ A nr.aP4E�= ,$It;= Ftar. 119 -8-99028 04/ 01 / 88 04/01 / 89 i�—"'—'— P4£h1!aE$.i]P'_�ar:,�•,3 !! pp' t: y _!r14EaGaauvJ 7x•.aa3F $ Ex?L'JSn]r; g ': ,,,LAPSE ^..-%•RC X I PR00UCTS.rnj0P:.F—E, PERA7.101.$ j X c r<-; c A- uti' $ 500 S 500 X IhvcPEVCE"J' :.h�RAC".7RS .r 4 ' X ,3RI;AC cI.RM aR,-;P_--• D.F.,A,St ! PE=SCMA� :NJLIR , PGPSONAL I AUTOMOBILE LIABILITY ` A ALy'r ,WNEC A ,,r.7V R �t:7$ ~Y aL;. )Vol .:u -..,:: '"��.,'"'^": } 1 19-4-69013 04/ 01 / 88 04/ 01 /89 4 PRIL' -ASS Specified Auto } y -" ''~_ $ 500 EXCESS LIABILITY :'---T ilM$REi...A FC4h,1 9vti�8 ',E•L . `.} '' A WORKERS" COMPENSATION 1 19- 3-6701904/ 01 /88 04/ 01 /'89 EKC:• =CL:C`=`.-. 1 AND JIS:ASE POL!C • EMPLOYERS' LIABILITY ! 100 ,^-.I$E aSEE WCr EMP'_ 7Y=E' 1OTHER DESCRIPTION OF OPIERATIONSiLOCATI(DNSr'VEHICLES+SPECIAL ITEMS I}ueenstaury Town office Building SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Ex- PIRAJI,QN DATE THEREOF , THE ISSUING COMPANY WILL ENDEAVOR TO RiI� #1 Box 98 MAIL JV PAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 7O THE Glens Fat 1 s , New York 12801 LEFT' SU All ORE TO MAIL SUCH N ICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANYkj1ND UPON JHE COMPA S AGENTS OR REPRESENTATIVES, UTHORIZ REPRESS ATIVE 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 are /a� 2 . Type of heat +�/ / _ cam-, 5 r�,r A0 T + rr'— 3 . Is the building mechanically cooled ? 4 . Percentage of area of windows and doors A . Over 16 % Only 1 . U value of gross area of walls , roof / ceiling and floors 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 lk� value of insulation around perimeter of flexor ? 4 , is basement heated ? YES NO a . R value of insulation 5 . Type of insulation 11 B , Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions _ 2 . R value of exterior walls /Z�- f 3 . R value of glazed area f 4 . R value of doors 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 8 . R value of heated basement/ cellar walls ( above grade )ikA + i 9 . R value of heated basement / cellar walls ( below grade ) 10 . Type of insulation F1r� 0265�-<r- jC Iq ram` C . Controls ¢ T. Thermostat maximum heat setting D . Duct Systems i . is duct system installed in unheated spaces ? YES 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 ^A. C -- ~ F , Service Water Heating 1 . Performance efficiencyrr- 2 . Temperature control setting maximum 17 3 41 G . For Swimming Pool Only 1 . Maximum heating Telephone No . J % 9 applicant ' ur TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT SAY 6 HAVILAND ROADS© I280� QUEENSBURY. NEW5 8 ) 792-5832 TELEPHONE C BUILDING INSPECToRI S REPORT REQUEST FOR INSPECT N rRECEe K NAME C R 1JOCATIO�IN PERMIT # DATE "7 Q--'-- APPROVE,D YES NO FOOTINGIPIERS MONOLITHIC POUR FORMS FOUNDATIONIDAMP ,FROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING OUGH-IN ELECTRICAL ' INSULATION: FOUNDATION ` FLOORS WALLS ILING INAL INSPECTION: `,. CHIMNEY HEIGHT" ROOFING_ ^._ -. SIDING S EXTERNAL PORCHES/S _-.---�- �. STAIRS�CLEARANCE IL VALE.--- .. VE PLUMBING FIXTURE IRE IEF. INTERIOR TRIMIP TrACY DOORS L FINISHED FLOOR GARAGE FIREPR FING DOOR CLOSER (CLOSER ( ) SMOKE DETEC ORS FINAL ELECTR CAL INSPECTION G FINAL APPROT)A�L OF CONSTRUCTION r A SIGNED CERTIFICATE OF OCCUPANCY MUST BE FRO14 THE BUILDING DEPARTMENT BEFORE OBTAINED THESE PREMISES ARE OCCUPIED +. REMARKS: INSPECTOR _.Down o� ��een �he+ re� BUILDING and ZONING DEPARTMENT Bay and Haviland Road. R.D. 1 Box 98 pueensbury. New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION C;ri1 c� }]ATE �Q - / PERMIT NO. _ �✓' SOIL TYPE - Sand - Loam - Clay - .�- percolation Test Required? YESrr= NO Percolation rate - Min/Inch _ r' TYPE of SYSTEMS AbsOrption field , total 1 gth Length or each trench Depth Of trenches size of gravel_ SEEPAGE /P3:TS4N-Ljmb Q } Size- ft_ X Gravel size Si a Type PIPING : Bldgo to tank s" Tank to list , bolt pint. box to f ' ld/YES N0 Par�tial Openings Seale LOCATION/SEPA ATIONSO f t_ Foundation t9 tank tiara €t- Foundation tab absorp ft. Absorption o lot line 3-ft . Separation € pits PROPERTY (circle one) LOCATION STEM ON Front - e r Left side - Right side CCMMENT ryyca+I+EM USE APPROVED Y IN O P ctor Buil 01/86 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT SAY & HAVI 'AND ROADSQUEENSBUR TELEPHONE Yr NEW Y ORK U� (5 8 ) 792�5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION _.------ NAME LOCATION DATE -� _ PERMIT # APPROVED YES" NO pOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH^IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION-- CHIMNEY HEIGHT ROOFING SIDING EXTpRNAL PORCHES/STEPI STAIRS^CLEARANCE & LS LIEF VALVE PLUMBING FIXTURES/ INTERIOR TRIM/PRXvACY DOORS FINISHED FLOORS GARAGE FIREPROOF NG DOOR CLOSER (S) SMOKE DETECTORS'._ -- FINAL ELECTRICAL : INSPECTION FINAL APPROVAL 017 CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED ? REMARKS: 7 � 1 � C�f INSPECTOR TOWN OF QUEEN SBURY BUILDING AND CORES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY. NEW YORK 3280-%% TELEPHONE ( 51.8) 792-5832 BUILDING INSPECTOR" S REPORT REQUEST FOR INSPECTION RECEIVED NAME _ .�� LOCATION DATE ��� PERMIT #_ APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—PROOFSNG .aAC,KFXLL A.PPRO"L ROUGH PLUMBING 4 FRAMING ELECTRICAL ROUGH— N INSULATION: FOUNDATION t FLOORS WALLS CEILING FINAL ,INSPECTION: CHIMNEY HEIGHT ROOFING .SIDING EXTERNAL PORCHES/STEPS. — STAIRS—CLEARANCE & RAILS ' PLUMBING FIXTURES/RET,icTEF ALVE— INTERIOR TRIM/PRIVACY DOO FINISHED FLOORS pp GARAGE FIREPROOFING DOOR CLOSERISI 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 : INSPECTOR B , OF QUEENSBURY UjjDING AND CODES DEPARTMENT + ,-- BAY & HAVILAND ROADS QUEENSBURY. NEW YORK 92-5832C?� TELEPHONE BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED _ NAME LOCATION DATE PERMIT' ! — aG7 F APPROVED ' YESI NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATI IDAMP-PROOFING BACKFILL A ROVAL Lw�ROUGH PLUMB G L-gRAMING ELECTRICAL ROU if N INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: x CHIMNEY HEIGHT s ROOFING SIDING PEPS EXTERNAL PORCHES/ STAIRS-CLEARANCE RAILS PLUMBING FIXTURES/RELIEF VA.. E_ INTERIOR TRIM/PRXVACY DOORS FINISHED FLOORS GARAGE FIREPROolvXNG DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL bF CONSTRUCTION A SIGNED CERTIFICATE OF C?CCUpANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED? REMARKS : NSPECTOR TOWN OF QUEENS'BURY BUILDING AND CODES DEPARTMENT BAY 6 HAVILAND ROADS OUEENSBURY, NEW YORK I2SO¢ TELEPHONE (5I8 ) 792- 5832 BUILDING INSPECTOR' S REPORT REQUEST FOR IN PECTION RECEIVED NAME ` Jf LOCATION ���� �y .y DATE LD ` /r "Fs PERM22' # rf 7 LOP APPROVED YES NO r 6OTXNG/PIERS MONOLITHIC FOUR FORMS ——� FOUNDATION/DAMP—PROt7FING BACKFILL APPROVALk ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN INSULATION : FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION : CHIMNEY HEIGHT f ' ROOFING SIDING EXTERNAL PORCHES/STEP STAIRS--CLEARANCE & LS PLUMBING FIXTURESIR IEF VALVE VE INTERIOR TRIMIPRIV Y DOORS FINISHED FLOORS GARAGE FIREPROOFI G DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICAL NSSPECTION FINAL APPROVAL O CONSTRUCTION A SIGNED CERTI ICATE OF OCCUPANCY MUST BE OBTAINED FROM HE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIEDU REMARKS : INSPECTOR TOWN OF QUEENSBURY /-"o BUILDING AND CODES DEPARTMENT BAy & HAVILAND ROADS QUEENSBURY. NEW YORK 12804- TELEPHONE ( 518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSVECTION RECETAE NAME f h -r " !� d LACATION 3 9 DATE PERMIT #�--..-C�--� APPROVED YES NO FOOTINGIPIERS MONOLITHIC POUR FORMS 1CY,wILL UNDATIONIDAMP-PROOFING APPROVAL ROUGH PLUMBING . FRAMING ELECTRICAL ROUGH- N INSULATION: FOUNDATION \ FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH /'STEPS STAITRS-CLEARAN E & RAILS PLUMBING FIXT RES/RELIEF VA VE INTERIOR TRI /PRIVACY DOORS FINISHED F RS GARAGE FIRE ROOFING - - DOOR CLOSE (S) - SMOKE DETE TORS --- FINAL ELECT ICAL INSPECTION FINAL APPRO AL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS : Ax PE TT OR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS /I QUEENSBURYo NEW YORK 22809- I ' TELEPHONE ( 518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR I PECTION RECEIVED NAME LOCATION DATE PERMIT # � s?� APPROVED YES I NO FOO ING/PIERS NOLITHIC POUR FORMS FOUNDATION/DAM —PROOFING � BACKFILL APPRO L ROUGH PLUMBING FRAMING ELECTRICAL ROUGH'-XN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHESISTEPS STAIRS—CLEARANCE & RAILS PLUMBING FIX'TE*ES/RELIEF` VALVE INTERIOR TRI /PRIVACY DOORS FINISHED F DRS GARAGE FIR ROOFING DOOR CLOSE (S) _..... ....� .SMOKE DET CTORS FINAL ELEC ICAL INSPECTION_ FINAL APP VAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT .BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: NSPECTOR SELECT SUSINESS FORMS (604) 848-5203 APPLICATION FOR ELECTRICAL INSPECTION PLEASE BEAR DOWN YOU ARE MAKING (4) COPIES MIDDLE DEPARTMENT INSPECTION AGENCY, INC, National Headquarters 900 Haddon Ave., Collingswood, N.J. 08108 • • ❑ate : ,,[„�/'�f' / " Z: City, Town or TownsFt//ipr-� ' ,r �' '+� ,ram_ County '{ State Location/Address yr,1' � /� --+''�•- �7�/�1!}� LI ,per ( if Located in Rural Area - Please Attach Directions) Pole ,y# Owner /'Cy Q ��3 "-�^�rCLr Permit # �-- Occupied As 4A2`4e:: lAe—Zle Building: New Old 0 Occupant Work Area in Building Floor #, etc. ) : Ap , for: Wiring Service or: Ready for Inspection : Fee Remitted - $ Cash [] Check M-O- = Make Payable To : M.D. LA, 500 �50 3000 1250 1500 1T5D 20D0 2250 2500 2750 8000 Number of Rough Wiring Outlets Elect, Heat Switches Lighting Amp, Service Surface Unit Dishwasher Range Water Heater Air Conditioner Dryer Pump Receptacles Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner Amp, Receptacles Fractional W.P. Vent Fans Other Equipment: MOTORS H.P. 112 1/12 1110 1/8 1/6 1/4 1/3 1/2 /4 1 3 1L/z 2 3 5 7«z 10 15 20 25 30 40 50 75 100 Mark Number of Each Size Applicant's Signature License # Permit A T/A Utility : Applicant's Address : INAME OF ICE LOCATION (City) (State) /t9 (Zip) Service Request # Phone 40Electrician : '` MDIA USE ONLY DATE RECEIVED: GATE INSPECTED : Correct Location : Same as AboveO or: Red Notice Label [ 1 Rough Wiring Outlets Surface Unit Oven Switches Range Garbage Disposal Receptacles Water Heater Dishwasher Fixtures Air Conditioner Dryer Amp. Service Equipment Burner, Wiring & Controls for Amp. Receptacle Amp. Service Conductors Pump Vent Fans MOTORS H,P, 1/211 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1k/2 2 3 5 7vx 10 15 20 25 30 40 50 75 104 Mark Number of Each Size nib s t. Heat 500 '!S4 100❑ 1250 1544 1 ]50 2000 225D 2SDo 2]So 3o0D �..,. - Patrick ,3 DaShnelr PO Box 321 Hudsan £aI yy i b=3x z 5i3f7 . $�=3473 w ELEURZCIAL INSPECTOR CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECT FEE PAID RW Progress : Inc. © LKD Contractor [] CFT Violation : Work Comp, 0 Inc. 0 CASH LIA Owner Fee CHK # 0 L/A Due MO # IPA Municipal {NV # Date : Other Side Utility Applicant Owner Gut in Card 0 Temp # Date cc z ul w M TS U. lJp 06 It Ci