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1989-662 BUILDING PERMIT TOWN OF +QUEENSBURY No. B9- 662 WARREN COUNTY, NEW YORK n cs PERMISSION is hereby granted to Raymona & Marian Sherlock &2021 OWNER of property located at Mud Pond Road Street, Road or Ave. 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. Le t . OWNER'S Address is = rr 29 Lafayette Street Hudson Falls , N . y . 12839 2. CONTRACTOR or BUILDER 'S Name v sU Self `a 3. CONTRACTOR or BUILDER 'S Address. Same _ 0 4. ARCHITECT'S Name 5. ARCHITECT'S Address r C B. TYPE of Construction — (Please indicate by X) C K I wood Frame ( I Masonry I ? Steel I I - C c 7. PLAINS and Specifications � N„_ 1525 sq , ft . single family dwelling as per plot plan , specifications , and application , including septic , attached two car c c B. Proposed Use { Single Family Dwelling $ 2 5 00 PERMIT FEE PAID — THIS PERMIT EXPIRES March 1 �o ga (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of QueensburV before the expiration data.} r August Dated at the Town of Queensbury this 22nd Day of � Au g _19 89 _ c SIGNED BY for the Town of Queensbury i Building and Zonin I spector _ « 1 l r w CERTIFICATE OF OCCUPA NCB' TOWN OF QUEEN56URY WARREN COUNTY P NEW YORK Date February 9 19 90 4 This is to certify that worm requested to be done as shown by Permit No. 89-662 has been completed. This structure may be occupied as a �I k Locanon Lot #F Mud Pond Road CNVner Raywnnd Sj Marian Shprl oc i By Order Town Board TOWN OF QUEENSBURY � Director of Bldg. 1Sc Code Enforcement i t s 1 TOWN OF QUEENSBURY =4 ' ' REVIEWED BY FEE PAID # r5 TC3VVlV OF QUEENSBU PERMIT NO. � - /� /, ;.�- 464W act ivp RY BUILDING PERMIT APPLICATION AUG SLDGO & CODE nEpT, A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO INSPECTIONS WILL BE MADE UN"I M APPLICANT HAS RECEIVED A VALID BUILDING PERMIT. All applicants spaces on this application MUST be completed and the signature of the applicant MUST appear on the reverse side of this application. The owner of this property ise - " yg�g A" yr , jam+ r�rr n��i e ✓/rc7 c /c P.O. Address�Ae r" r� `7 Tel. .�''`� ;,, � -�' % - ti Property Location/ v7` hi �H er I s ,� cr r i�� Cy7 .z e,.al .j�e Y �, Tax Map No. Has there been any split of this property since October 1 , 1888 ? If yes Planning Board Review is necessary. yes no SUBDIVISION NAME, IF APPLICABLE LOT NO. THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS: * NATURE OF PROPOSED WORK : * ESTIMATED MARKET VALUE OF "� Construction of a new building * CONSTRUCTION: $ .4 o 1) Addition to a building ' COMPLETE INFORMATION REQUIRED BELOW: * Size of property a a y r Dv- ft xl�ft. Alteration to a building * Existing Buildings( 3) Size ft. x (no change to exterior dimensions) * /7c .� ft. Proposed building - distance from property line: Other work (Describe) * Front yard 6 L4 ft. Rear yard i ft. * Side yards 45 � ft. and /r, cam. ft. * GROSS AREA OF PROPOSED STRUCTURE+ f� * If on corner, setback from side street ft. 5- � S„ � / r rZ .7 C .lire r.} �{J "' I s t Floor '`" sq. f t. r f (f * OCCUPANCY INFORMATION 2nd Floor sq* ft 01 � - Primary Building - Other Floors sq. ft, I * 4o- 'One Family Dwelling (not cellar or basement . Two Family Dwelling +r TOTAL FLOOR AREA sq. ft. Multiple Dwelling/Number of units Size of new structure ft x ft. +► Business * Industrial Foundation-pierlslab/crawl/partial f (circle one) * Other w No. of stories (habitable space) r Height (grade to ridge)/ ft, * If addition, what will use be? If residential, no. of families / : No. of rooms(excluding baths) " Accessory Building No. of bedrooms " Detached Garage ONE/TWO Car No. of bathrooms Primary treating system Attached Garage ONEIT WO Car Type of fuel E) I rI �' Private storage building No* of fireplaces to be installed " Other Willa wood stove be installed Central Air conditioning 4 n Oiv* ER r BUILDING PERMIT APPLICATION CONTINUED - BUILDING gPECIFICATIONS: Type of construction, woad frame, fire safe, etc. Will any second-hand or upgraded lumber be used ? If so, for what ? 1/7 Foundation wall material � L / ,/ Thickness + Depth of foundation below grade (to bottom of footing) Will there be a cellar ? Heated a - Floor sq. footage sq ft. Will there be a basement ? --Will any portion be used as living space? ,y] (If so, what portion ? sq ft . Type of use ? - Type of roof - s1 Ped/flat/shed/other Material of roof , ,� - , . Size, wood studs `� '"x G '" spacing ` Ar " O.C. length s` ft. �•r / '`' "� '� f S Joists (floor beams) Ist floor'?x�"" spacing "o.c. spare/ - / e ft. Joist (floor beams) 2nd floor."'x "" spacing "o. c. span ft. Overlays (ceiling beams) "x " spacing " o. c. span ft. Roof rafters '"x " spacing o.c. span ft. Roof trusses (pre-engineered) spacing-2� —" owe. span.3 >-- ft, Exterior wail finish ,•a iv of what material? Interior wall finish If a garage is to be attached, describe materials to be used for /FIRE SEPARATION: Is there to he an opening between garage and dwelling? (ale S If so will a Fire-rated door, enclosure, self-closing device be provided? Will a flue-lined chimney be installed? , L4 // "eight above roof ] - ft. Depth of chimney foundation below grade ft. Depth of fireplace hearth ft. in. Water supply - Municipal or private well SEPTIC SYSTEM Distance from ANY private well (including adjoining properties p L ftw (A separation application is necessary for any repair or new installation of septic system ) } ,p g7 ,'— NAME OF BUILDERr&!Z.,a,�1, ,. /, C / ADDRESSf? �yalo.y /may /�S l7� TEL. NO. � � ? - � ?� ) '7 NAME OF P'LUMBEre jR29@Mf _ ADDRESS �iT'4`+� s �r(�/S TEL. NO:^ �•� NAME OF MASON r7 C >ef ADDRESS TEL. NO. 7i"-3 - fist 3 3 sy , y a• NAME OF ELECTRICIAN ADDRESS TEL. NO. ! 4/ i DEC LA RATION To the best of my knowledge and belief the statements contained in this application, together with the plans and specifications submitted, are a true and car*rplete 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. SignaturL �e't�� OvIn I, owner s agent, architect, contractor Now iPECIAL CONDITIONS OF THE PERMIT: BY f TOWN OF QUEENSBURY � COY P C_- WARREN COUNTY , NEW YORK Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . ANSWER ALL of the following : 1 . Gross floor area 2 , Type of heat �`- 3 . Is the building mechanically cooled ? O 4 . Percentage of area of windows and doors lam. A . Over 16 % Only 1 . Uo 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 R 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 1 . R value of roo� and oors exposed to ambient conditions_ 2 . R value of exterior walls 3 . R value of glazed area 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 ) 9 . R value of heated basement / cellar walls ( below grade ) - 1bb "V% lO . Type of insulation C . Controls o 1 . Thermostat maximum heat setting D , Duct Systems 1 . Is duct system installed in unheated spaces ? r7YES / t1 © a . If YES , R value of duct installation 4Y+A % y3 i b . R value of duct in other areas E . Piping Insulation 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating 1 , Performance efficiency 2 . Temperature control setting maximum G . For Swimming Pool Only_ 1 . Maximum heating Telephone Now 7_'__ _ ap licant s signature ) TOWN OF Q UEENSB UR Y APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE 7 `T LOCATION OF PROPERTY FOR INSTALLATION / Owner's / Telephone: Name:� -1 v - ' - vl Y L" t , Address: y° - 1 ' ' 39 Installer's Name: f 4 id � � / i� Y � Telephone :-T ,;� - Z> 2L:r Number of bedrooms (residential only) Total daily flow (compute ( 150 gal per bedroom) Topography: Circle one: Flat Rollin teep 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 rage ' '-/ min. inch. Domestic water supply: circle one: Municipal 4V 1 Other If domestic water supply is a well: Separation: Water supply from septic absorption r"In / ?J feet PROPOSED SYSTEM : Septic Tank gal. (minimum size : 1 , 000 gal.) f TILE FIELD : Each Trench 5 feet/Total system length _!Z w ,p _feet SEEPAGE PIT(S): Number of / Size each feet by feet Size of stone to be used # / /Depth or Thickness ?- feet I have read the regulation on the reverse side of this sheet and agree to abide by these and all requirements of the Town of Queensbury `ia ' tary Sewagg Di o al �Ordinance SIGNATURE OF RESPONSIBLE PERSON : Z4V DATE: OVER Septic System Inspections : A . All applications for septic system installation , alteration or repair , as required by rho Town of Queensbury Sanitary Sewage Ordinance , shall by submitted to the iuilding 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 . ) location and distance to any water supply 5 . ) size and dimensions of all tanks , distribution boxes , tile fields :end /or drywells B . Nu System shall be covered before inspection and approval by the iuilding 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 . Aa 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 Quvunsbury Building Department before further con!z: rruction . Town of Queensbury BUILDTNC and CODES DEPARTMENT .Bay and Haviland ]goads Queensbury , New York 12804 hum:irks .T� OF QUE'ENS$L]RY p BUrLDING AND CODES DEPARTMENT I3AY & HAVSLAND ROADS I28+04- NEW PORK !!! + QUEENSBURY + iSZS ) 792-5832 !! TELEPxC)NE BUILDING INSPECTOR` S REPORT RE4UEST R INSPECTION RECEIV NAME tOCATIO,.N� J[ - PERMIT # DATE = "" `--J` APPROVED YES NO -- FOOTINGIPTERS MONOLITHIC POUR FORMS FOUNDATION/DAMP PA00 FING BACKFI rL,L APPROVAL ROUGH PLUMBING i FRAMING ELECTRICAL ROUGH 'x l-- t INSULATION : �-- FOUNDATION FLOORS WALLS CEILING D FINAL rNS+PECTION = CHS.MNEY HEIGHT ROOFING SIDING PORCHES/ T S EXTERNAL � *AILS STAIRS" CIEARANCE LIEF VALVE PLUMBING FIXTURES/ DOORS INTERIOR TRIMIpRIV Cy FINISHED FLOOR'S GARAGE FIREPROOF ' 0!5� L�D,�OOR CLOSERtS ) , SMOKE DETECTORS TION FINAL ELECTRICAL S : SPRLICT20-N FINAL APPROVAL OF ICON MUST BE RTIFICATE LJ ,J OCCUPANCY FROM THE BUI�'SNG DEP'ARTMFNT BEFORE A SIGNED CE OBTAINED OCCUPIED! THESE PREMISES ,ARE REMARKS . INSPECTOR GaJ ems, V� P .�f -s , ..� . TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT at � BAY & HAVILAND ROADS r "vo y dr QUEENSBURY, NEW YORK 1 2801E TELEPHONE (518 ) 792-5832 TiuILDING INSPECTOR' S REPORT REQUEST FOR NSPECTION RECEI D _ NAME LOCATION DATE PE IT #J '^ APPROVED YES NO FOOTINGIPIERS MONOLITHIC POUR RMS FOUNDATION/DAMP- OOF NG BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH- INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTIO CHIMNEY HEIGH ROOTING SIDING EXTERNAL POR RES/ EPS STAIRS-CLEA NCE &+ RAILS PLUMBING FI URES/ LIEF VALVE INTERIOR TR /PRIVA Y DOORS "r FINISHED F RS �— GARAGE FIR ROOFING DOOR CLOSE (S) SMOKE DETE TORS FINAL ELECTR CAL INSPEC ION FINAL APPRO L OF CONST CTION A SIGNED CEArIFICATE OF O CUPANCY MUST BE OBTAINED FR THE BUILDER DEPARTMENT BEFORE THESE PREMI.4ES ARE OCCUPI I' REMARKS : iA OoWr-e INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVTLAND ROADS QUEENSBURY, NEW YOR.K 3 28 Qi- TELEPHONE (538) 792-5832 } � BUILDING INSPECTOR ' S REPORT REQUEST FOR TNSPECTION RECEIVED T NAME LOCATION DATE �117 /��! _ -P" PERMIT #f APPROVED YES NO FOOTTNGIPIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACK.FILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN NSULATION: FOUNDATION FLOORS WALLS CETLSNG FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS"�. ' STAIRS-CLEARANCE & RAI PLUMBING FIXTURES/RE EF VALVE INTERIOR TRIM/PRIVAC DOORS FINISHED FLOORS GARAGE FIREPROOFIN DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL I SPECTTON FINAL APPROVAL OF ONSTRUCTTON A SIGNED CERTXFXdATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUTLDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS.J, INSPECTOR .Jou.rn a� �ueen36^ure� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. i Box'1 98 � Queensbury, New York 2801 SEPTIC DISPOSAL SYSTEM INSPECTION N,4ME LOCAT I O�N ,,�.� DATE ,/rs� `i"`'� PERMIT NO . SOIL TYPE nd - caa - Clay - Percolation Test Required? YES - — Percolation rate - Min/Inch _ TYPE of SYSTEMS Absorption field , total lengtjY Ca C7 Length of each trench Depth of trenches Size of gravel 3e i SEEPAGE PITS{Number of) _ Size- rE X G size PIPING : Size Type Bldg . to tank �5co( tics Q V 4., Tank to disc. bo �J-f I?u Dist. box to f i / it W L- Openings seal YES NO Partial LOCATION/SE#* TION Foundation tank £t- Foundat ion a absorp ' on 2g Lc�- f t _7 p-+ i Absorptio to lot linK-Et- Separati of pits �r LOCATI OE' SYSTEM ON ftoPERTY (Circle one) Front Rear - Left side - C SS SYSTEM t3SE APPROVED ES NO Bu IdIng Inspec r 01/86 and vl TOWN OF QUEEMSBURY BUILDING AND CODES DEPARTMENT BAY die HAVILAND ROADS QUEENSBURY0 NEW YORK I2804- TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED , NAME LOCATION 7` DATE //2 ` � -PERMIT #� APPROVED YES NO FOOTING/PIE MONOLITHIC FO R FORMS FOUNDATION/D -PROOFING BACKFILL APPRO L ROL;GH PLUMBING MIND ELECTRICAL ROUGH- INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL .INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES/RELIEF LVE_ INTERIOR TRIM/PRIVACY DOOR FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY ST BE OBTAINED FROM THE BUILDING DEPARTM T BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: f)f) Q ( 51 i A� ALL- CA / F i INSP TOR . .�:,,,, ' fllational Weadquarters ,� 9DQ�Fj� or<r'Ai►� C�dtlin`�swood 'I+f::f. bS1'D8 OL City, .Town .or Township County - State Location/Address mkk (if Loca d i Area - Please ttach Directions) Pula # r Nor. pFee er i JP� hni# upied As Bulldind a Old 0 upant ' Work Puea in BuildingFloor #, eto.1. for: Wirin SerVme or: Read . for in edilbin : Rernitted� Cash Check M:O. Make l* ablia td: M.D.I:A. A99 75a soeo IPAa iAltie 17 A0 20aa p2eo YADG 5tzA0 a000Nmber of Rough YYirirrg OutFets Elect. Heat . . Switches - Amp. Sergice Surface Unit Dishwaslier� E mange igfiting Water Heater Air Conditioner Dryer W�p Receptacles QVenGe bage Disposal Wiring and. Contsgls fial @urrl@r :` ecxlptadles �Fractionai H.P. Vent Fans . r; 4 4 Other Equipment: UOTOR /4S-H,P, 1 1/1 1/ 1/8 1/6 1/4 1/3 1/2 3 1 15fa 2 3 5,... 7s/s 10 . 15 20 25 3o a0 r5�0 5. . 1Q6i Mark Number 3 _ of . ! Size . . Signature License # ,. T/A Utility : iNA a Applicant's Ad- iCity} "� 4State} i2ipl Service Request # Ph a Electrician pi TE•FtEC IYED. DATE INSPECMD; ., :''• ' ' Correct Location : Same as Above or: Red Notice Label ` ' Rough Wiring Outlets Surface Unit Oven Switches Range L7lesaF Receptacles Water Heater DishwaihOr Fixtures Air Conditioner l�rysr Y' Amp. Service Equipment Burner, Wiring & Ct;ntrdls for Amp -fieceptacie Amp. Service Conductors Pump Vent Fans MOTORS H.P. 1/20 1/12 1/l0 1/e 1/6 1/ 1/3 1/2 /4 1 i+h =2 3 7jh 10 15 20 2S 30 i Mark Number -�' ; go of Each Size - Elect. Heat aO° zso i000 isso ieoo also z000 szw TeA a000dd p ! C RW Progress: Inc. ©..++ LKD 0 Contractor . Q CFT Violation. Work Comp. Inc. [� CASH El L/A £lwner Fee CeHK abt L/A P PDue. a 0 IPA Municipal Data: Other Side. Utility. 4r Cut in Card © Temp L Date NSPECTORS SIGNATURE Final # Date APPL4CATIl7 Hi FORM NO: 250 JEIL 4%" - . . - TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENTy' BAY & HAVILAND ROADS } �_ QUEENSBURY, NEW YORK I280$ TELEPHONE (518) 792-5632 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME ja LOCATION DATES PERMIT # � APPROVED YES I NO Cw. OOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: r . FOUNDATION FLOORS WALLS CEILING FINAL .INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHESISTEPS STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES/RELIEF VALVE INTERIOR TRIM/PRIVACY DOORS FINISHED F 40ORS GARAGE FXREPROOFING DOOR CLOSPR (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 OCCUPIEDI REMARKS* r,neAS kJ/ ;L roAo*mTo TZ6� e*n�� F`{ u u C- t1 `Co C X LS T^i AlG �o U"A"47JF N INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS f QUEENSBURY, NEW YORK I280& TELEPHONE (SIB) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FO INSPECTION RECEIVED NAME LOCATION 4a DATE PERMIT # . APPROVED YES I NO FOOTING/PIERS MONOLITHIC POUR FORMS F.0f7NDATX0N/ P-PROOFING, 1_ 24111 _. L/BACKFILL APP VAL.--- ROUGH PLUM.BIN FRAMING EL TRICAL ROUG IN SULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/S BPS STAIRS-CLEARANCE RAMS PLUMBING FIXTURE /RELIEF VALVE INTERIOR TRIM/P VACY POORS� FINISHED FLOORS GARAGE FIREPR FIND DOOR CLOSER (S _ SMOKE DETEC S FINAL ELECTRI L INSPECTION FINAL APPROVA OF CONSTRUCTION A SIGNED CE IFICATE OF OCCUPANC MUST BE OBTAINED FRdM THE BUILDING DEPAR ENT BEFORE THESE PREMISES ARE OCCUPIED[ REMARKS: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS �I- QUEENSBURY, NEW YORK 12804- TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION E EIVED NAME LOCATION \N\, G DATE 3 f PERMIT ## APPROVED IL YES NO MONOLI IC U_R FORMS ATION/ P- FING CKFILL APP VAL ROUGH PLUMBIN FRAMING ELECTRICAL ROUG N INSULATION: FOUNDATION FLOORS WALLS z CEILING FINAL INSPECTION CHIMNEY HEIGH ROOFING SIDING EXTERNAL Pq&CHESISTEPS STAIRS--C RANCE & RAILS PLUMBING IXTURES/RELIEF 1 ' LVE INTERIOR TRIM/PRIVACY DOO FTNTSHEY FLOORS GARAGE IREPROOFING DOOR C SER (S) SMOKE ETECTORS FINAL E ECTRICAL INSPECTION FINAL PPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT .BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: Wfl INSPECTOR SELECT BUSINESS FORMS (609) 848-5203 APPLICATION FOR ELECTRICAL INSPECTION PLEASE BEAR DOWN YOU ARE MAKING (4) COPIES MIDDLE DEPARTMENT INSPECTION AGENCY, INC. r � National Headquarters 900 Haddon Ave., Collingswood, N.J. 08108 SECTIONAPPLICANT COMPLETES THIS Date : City, Town or Township County_Z�<JC& Icy .�State Location/Address 01 Located in Rural Area - Please Attach Directions) Pole # _ Owner. �;��1 " () Icn, CA —C4 C In t C Permit # Occupied As Building : New ~ Olct = Occupant Work Area in Building Floor #, etc.) : f. App, for: Wirin Service or: Ready for Inspection : Fee Remitted - $ Cash 0 Check [] M.O. Make Payable To : M.D. I.A- 50017507 1250 1500 1x50 2000 2250 2500 2TSo So00 Number of Rough Wiring O rtlets Elect. Heat Switches 7�rr1'� Amp. Service �^^ Surface Unit Dishwasher �E/ �---Range Lighting — Receptacles f . Water Heater "'--' Air Conditioner �+'� Dryer Pump Number of Fixtures Oven -- Garbage Disposal Wiring and Controls for Burner / -% Amp. Receptacles �'� Fractional H.P. Vent Fans Other Equipment : MOTORS H.P. 1/2 1/12 1/10 1/8 1/45 1/4 1/3 1/2 3/4 1 1112 1 2 1 3 1 5 1 7'12 10 1 15 20 1 25 1 30 40 1 S4 75 190 Mark Number of Each Size #ppl ice r�Ys Signature • License T/A Utility : (NAME E Loc ION Applicant's Address. az2 AM LrA X p {City} (State)___✓ (Zip) Service Request # Phone # Electrician : • ` • DATE RECEIVED: DATE INSPECTED: Correct Location ; Same as Above 0 or: Red Notice Label 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. 11/2011/1211/101 1/8 1/6 1/4 1/3 1/2 3/4 1 1 IVZ 2 3 5 7LFz 10 15 24 25 30 44 50 75 140 Mark Number of EaCh Size 500 ?!So1004 1250 L544 1750 z000 22so 2500 2750 300D Elect. Heat IiiSE FOR INITIAL VISIT 0111 LY NOTIFIED DATE COr E�GT FEE PAID [] RW Progress: Inc- LKDE] Contractor © CPT Violation : Work Comp. Inc. El CASH 0 L/A Owner Fee CHK # [] L/A Due MO # 0 IPA Municipal INV # Date Other Side = utility Applicant R Owner Cut in Card Temp # Date I LC T *-7 :4- t F 41 1w cz S65- OC. UC E 200-00 ICGC GAL. EPT IC ---50 3 5' Tr' Y SINC. FRAME Hr 'LiSE CAR rf) ry) GARAGE �Q 1 WEL LOT 6a� .: X\c DR VE 04 S-70* 2'09E A MUD POND ROAD _ �_ ... � ��� V, 79w to, ES01 VL 101