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1989-276 .._.. _'�.,'.T.'�i.`1 "y''ly �".,«-i / �wr.yy. u ':s �'-•', ' .r�t�-: ..r.p_.= V.�:. s...FM ..Ii's•K''l 'I•wCRi'F_ .'_M.' f ,,.. .}�._ :> �'..+�- MEN IP I1`I CERTIFICATE �►�: OCCUPANCY ; TOWN OF QUEENISBURY WARREN COUNTY, NEW YORK i Dace October 25 19 89 This is to certify that work guested to be done as shown by permit No.--- has been completed This structure may be occupied as a Single Family Dwelling Location Lot 17 Hidden Hills Drive Rich Schermerhorn Owner BY Order Town Board. i TOWN OF QUERNSBURY F Director of Bldg. do Code nforcement I - 1 BUILDING PERMIT TOWN OF QUEENSBURY No. 89-276 WARREN COUNTY, NEW YORK ca crt PERMISSION is hereby granted to ~ Rich--SsherrnPrhorn .... OWNER of property located at Lat 17 Hidden Hills Drive 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. 1 _ OWNER'S Address is CIO 33 Harrison Avenue Glens Falls , N . Y . 12801 2. CONTRACTOR or BUI LDER"S Name = a Self 3. CONTRACTOR or BUILDER 'S Address � r7 SA914 Same 4. ARCHITECT'S Name r 0 5. ARCHITECT''S Address e+ !� 6_ TYPE of Construction — {}Tease indicate by X) m XXI wood Frame I I Masonry I ? Steel I I Y J. J 7_ PLANS and Specifications No, 24 ' X 32 ' single family dwelling as per plot plan , specifications , s and applications including septic , attached one car garage , and driveway . m S. Proposed Use Single Family Dwelling c/o incl . c.� $ g vnv_.,_______.,_._ PERMIT FEE PAID — THIS PERMIT EXPIRES Dernmhpr 1 19 (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.) ..,Z Vu Dated at the Town of Queensbury th' 2th Day of May 1989 rr SIGNED BY for the Town of Queensbury ,p Building and ZoninbTrrspector —' uZ TOWN OF QUEEANSBURY APPLICATION FOR BUILDING AND ZONING PERMIT Ck Rec veo saunvYMAY 5 1989 Fee Pa.t_d �✓' �LIWILDTt fFT,`f Date Ie.aued 4 Cpp� Dept DA ]' and fI.AVrLAND .ROADS JRD 1 Box 93 PUEENSBURY, NEW YOR1: 22804 PC'./UiJZt No . Try// .c Tel . (5I8) 792-5832 E•xt 204 r 71r t # x ak r * i w iR r > ! � r r x s r a ■ ■ w r yl >< >• .l r # Ili ■ ■ Yt, } ■ A PERMIT MUST III) OBTAINED BEFORE BEGINNING CONSTRUCTION . NO INSPL::C'PI ©NS ttILL. BE HADE UNTIL APPLICANT HAS RECEIVED A VALID DUILDINC PERMIT . All applicable spaces on this application must be completed and the s4ipuature of the applicant must appear on the reverse side of this sheet . * a* -A; * A * * * * A. * A * * tit A * * * * * * * * * 7k * * * it * * = * * A * The owner of this properc is : idlaydY 'ryI J t f� a //+� [' . O . Address TEL . q -rn -..,,Cj., r1 Lj i l' roperty location TAX MAP NO . 7 � / f /��� teas there been any split of this property since October 1 , 1980 ? If yes , Planning Board Review is necessary . yes no SUBDIVISION NAME , IP APPLICABLE _ LOT NO . 't' lte person responsible for •� upe vision of work as regards Building Codes is : l q - NAI4L P . O . h AD RESS TEL 0 C7 . 1Jame of buildQr Address @. ' Tel [3a1n� of 1"ltxriil�erw1un P,c3drE ss Tel N"Ine of MasoA revs Tel - U Granvry raATuRC or PRO 0eCD 4UINIK: ZONING 1NIq10IRIP.`1` I0J'k1 ( Utxice use only ) �Cnn : tructiar4 of a now 1buildin:J ' ;CONING DESIGNATION OF PROPERTY Ad.litian to a bUildinq # PERMITTED PRINCIPAL PERMITTED ACCESSORY �AlturaLion to a Luilding ~ � (rta ci <<tncJ.: to .sxC � riOr cliinens' ions3 OF REVIEW REQUIRED - PLANNING BOARD ZONING BOARD istltur work SITE PLAN REVIEW N APPROVED DATE » CROSS ARUA OV PROPOSED. !: TItUc: TIJftE ' VARIANCE # APPROVED RATE 1st ]' loor � j _ sq ft . * R' inar]`s : 2 nd f•1 oo r � sq f C W COl•tPI.E:'s`l. 1{tl'0kMATI ON ItCQUIULR B'ELUW . Other Floors sq f t . ' of propL:rcy ! /S f t X !SU 3' C . ( not CeIlar or b � s , m. nt } " LatistSrrg builili� ( :: ) tt x rcar TOTAL FLOOR AREA-1 stl ft . ' iCittg « of new tructur j ft X.J EX c: ft ' Rlrll8 140 » building , d!Z!CUnCQ iron L+roi-surLY lints ar (circle onc, ) * Front yard, _ 04 .5 f c Iwar Y44*-d /'LO 7 ft No of :tnrsc (ki;alaicable space ) �w IL. ight ( 'Jra.drs to rldcju ) ft . kwSidts yards i7. tt and gY rt 1l raOidunLiµl , no . of fk-tmilic: s r It on cQrni:r, i;uiC7:xck from si.du ; CrV+L' C r C llo , of room:&- ( exclu ` n+J baths; ) '■ OCCUPA CY ZNFORPIATICN I Io, of bedrooms _ _ ._ ; tu�tAdtY ra[]ILCIIMC No . of b:atirroouw : » J� one family dwelling 0riNA" ry )l�.ntiluJ «y«L +..:ui "1"wo falail dwullinL 1 ac of fu:: l C; .. » S J No . Of firulzl :tcu:: LU bu i.n :t :,llud r multiple �1wrs11ineJ / Number of units Will :. Wood :;-. LQ �u Lu inULal�l} k;d?� i rQn:► iU1&t accuri:arrcy Cuntral Air co[ulitioniricj? U11 # 1'r:+n : Ot:rtt oLcul�;at�c y Uasinuss BUILDING STYLE, PRIMARY STRUCTURE „ IaduLtrial I:.ukckv ConC.:rnl:.c.r"ry LGn cal in Other 1wis�el rancie M xnuic.tr our,l x + it addition , wlu.tt will u::e LA.? UIJ011t lev.sl G+ld .-; Cyl� ULAA4&J...1ow " Cm C: Cod CoLtucla Otli&.: r " ACCESSORY IIUILDIWC- aloni.. l:ow 1'Ow1A� ]leauSd lsc tach.:d cJ�tr:t[J L".� � two { CHICLE' ON1: PLEA: } ' Attoc he+ l rlarug a two car/ cif t' # w ■ ■ : ■ ■ ri ■ # # m r W x ■ ■r '► 1'ri Va te= ZLor:.g ` Uildino E: `.; T I M A T 1: D _M h K K E"!' VALUE OF '" �...�.O t h+s r ] NPOPIMATYON ON UUrLDINC 9PrCIFICATIONS , ON REVERSE SIOf_ OF 'rillS SIIEL"r, TO BE COMPL!~TUDI Farm DPA 10/88 v1 BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . o Will any second-hand or ungraded lumber be used? If so , for what-? �t/r Foundation wall material C ► xrt . _ Thickness Depth of foundation below grade (to bottom of footing ) -7, fe,, Will there be a cellar ?. �Heated or unheated? Floor sq. footage sq ft Will there be a basement? Will any portion be used as living space? ( If so , what port ' sq . ft . - - Type of use? Type of roof - slope flat/shed/other Material of roof size , wood studs - . " X__..._.� " spacing—_"o . c . length eft . Joists ( floor beams ) lst . floor �a "X 1 a ^ spacing_, yr ."o . c . span.. /Z,.__.ft . Joists ( floor beams ) 2nd , floor Q six � " spacing ,16"o _ c . span___�_ft . Overlays ( ceiling beams )_"X_ _" spacing it span ft . Roof rafters "X It spacing o . c . span ft . — r� Roof trusses (pre-engineered) spacing " o _ c . span a!i„ ft . Exterior wall finish {LAIN y l t a Of what material? Interior wall finish � T If a garage is to be att�ched , descri a materials to be used for FIRE SEPARATION : � I Is there to be an opening between garage and dwelling? . If so will a Fire-rated door , enclosure , and self-closing device be provided? e I a Will a flue-lined chimney be installed? A 140 Height above roof �r�do. ft . - Depth of chimney foundation below grade4+.ft . Depth of fireplace hearth _ft . in . water supply - Municipal or private well ' ' :dc:3 f ' ZX- SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties ft . (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 speolfied or not, and that such work is authorized by the owner. Signature je� jot Owner, owner's agent, arc itect, Contractor * * * * * * It * * * * k * * * * * * * * * * * * * * * * * * rk �t -X * * * * * * * * '+ * Is * h 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 : 1 . Gross floor area {i 2 . Type Of h e a t C l r c Y S_k1 s e ()Uri 3 . Is the building mechanically cooled ? No 4 . Percentage of area of windows and doors I "1 D A . Over 16 % Only i . Uo value of gross area of walls , roof / ceiling and floors exposed to ambient conditions 2 . Floor over heated spaces YE NO a . Are foundation walls insulated ? YES Rv•' 1 . if YES , what is the R value ? 3 . Slab on grade YE NO a . if YES , wha as the R value of insulation around perimeter of floor ? 4 . Is basement heated ? YES Nl3 a . R value of insulation 5 . Type of insulation_ Sre. r C f B . Under 16 % Only 1 . Rrvoa ue r2 � �n fl o1 ex used o ambient conditions_ 2 . R value of exterior walls Il 11" Ll 3 . R value of glazed area 4 . R value of doors l � 5 . R value of floors over unheated spacesy`y� ' 6 . R value of slab edge insulation - unheated ��+�,slab � 7 . R value of slab insulation - heated slab F 'VYT 8 . R value of heated basement / cellar walls ( above grade ) — 9 . R value of heated basement / cellar walls ( below grade ) �� 10 . Type of insulation V1 (' r (,C � (j ,$ C . Controls 1 . Thermostat maximum heat setting D . Duct Systems 1 . 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 crying agent pipe 2 . R value of pipe insulation_F . Service Water Heatin 0 1 . Performance efficiency 2 . Temperature control setting maximum G . For Swimming Pool only 1 . Maximum heating Telephone No . ( applicant ' s signature ) TOWN OF QUEENSBURY APPLICATION FOR. SEPTIC DISPOSAL PERMIT DATE 1 ]] LOCATION OF PROPERTY FOR INSTALLATION U 1r 4S I iIs Owner ' s Name : ptr • ' Telephone : 0 Address : T Installers Name : Telephone : ats Number of bedrooms (residential only ) �� }} Total daily flow ( compute @ 150 gal per bedroom) `-1 S Topography : circle one : ( DatRolling Steep slope % of slope Soil Nature : circle' ane : 6D Loam Clay Other J Depth : feet Ground Water : At what depth7 lLel& feet Bedrock. or Impervious Material : At what depth? ,zLIA- feet Percolation test : circle one : not require requiredJratemin , inch . Domestic water supply : circle one Municipal Well Other If domestic water supply is a Well : Separation : Watersupply from Septic absorption � /r/ Ac- feet PROPOSED SYSTEM : Septic Tank (minimum size : 1 , 000 gal . ) TILE FIELD : Each Trench feet / Total system length p- feet SEEPAGE FIT ( S ) : Number of J Size each 4!r feet by C7 feet Size of stone to be used tf /Depth or Thickness ,,� feet * * *ik fc+t*Yk ak Ylr�s y4**# Ik ak*ic�k do k it*ic*sF*,1rlc it at kat*,k*ak ik nt*is lk is k�F dt is k it**ak* I have read the regulation on the reverse side of this sheet and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance . Signature of responsible person : - Date : s (OVER) Septic System Inspections : A. All applications for septic system installation , alteration or repairs ear required by the Town of Queensbury Sanitary Sewage Ordinance , shall be submitted to the Building Department at least 24 hours before start of construction and shall include a plot plan showing : 1 . ) the proposed location of the system 20 - location and distance to lot lines 3 , ) location and distance to structures 4 . ) - location and distance to any water supply S . ) size ,and dimensions of all tanks ; distribution. boxes , -- tileifields and/or drywells a . No system shall abe covered before inspection and approval by the Building$ Inspector . Failure to comply with this requirement may result fn the 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 the construction site . Failure to produce said plot plan at time of inspection may result iti an immediate work stoppage . D . Should unforeseen problems during construction prevent proper installa- tionj alteration or repair of an approved system , a new proposal must be submitted to the ' Queensbury Building Department before further construction . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 Remarks : ISSUE DATE (MMIDD"YY% ,ter PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY SHE POLICIES 8ZLOW, COOL. INSURING AGENCY IPN%� PIS 13 [7x. 2074COMPANIES AFFORDING COVERAGE GLENS3 FALLS NY 12801 ':vMPANy A AETNA L C GF �ETTEP COMPANY INSUREDL=rEP B R." CHAIRD .S. '1. HERMERHORN i 12A C' RANDALL STREET _ TFa C ._- 9LEPd'S FALLS , IVY 12301 CON+Par: D LE ER LETTER • THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS. AND CONDI- TIONS OF SUCH POLICIES- —__ . LlAB� '^'' -. �N THOUSANDSLTR — CO TYPE OF INSURANCE POi'C:''- ^IJMBER __ _. -'` � . eo_�:p �E NERAL LIABILITY COMPPEHENSIVE FORM j 7 $ PREMISES14PEpATIONS aG.^Pcr=T•+ ' UNDERGROUND I UA6A'& j $ I $ EXPLOSION & COL_APSE HAZARD i --- PRDDUCTS,CCMP�ETEu OPERATIONS ' { BROAD =.Dq%l PROPER'Y DAMAGE _� .--- -------- �--d PERSONAL iNjUA`r I .^. AUTOMOBILE LIABILITY ` Q�nCfl THAN C I j HCREI) Adri;t, j !Q1Pr '_'.V�YEC AUT:.'Ef 115ARAGE LABI ! N ---i ' E%CFAs LIABILITY _�- --_ �- - - -- - �T j OTHED THAN U"18RE11�A =ORM A i WORKERS' COMPENSATION I AND EMPLOYERS' LIABILITY OTHER m DESCRIPTION OF OPERA TIONSILOC AT!ONS�VE HSCi.cl S:SPE'^. a_ ;TFt,IS � r • :AUTH0PAqoo9EPRESENT ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FX- GUEE 'lr«a• SUR Y BU I L.D I NG TION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO DEPT , arj DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO "HE , BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY ATTN -_ NANCY ROBERTS NY UPON THE COMPANY TS AGENTS OR REPRESENTATIVES, DAY ROAD It GLENS FALLS . IVY 12901 oo DA Issue TE (MWDD(YY) PfidbUCEA 0$ 03 88 NO R (UPON THE CERTIFICATE C RATE "OLDE CATE IS ISSUED AS A MA . INFORMATION DO S THIS CERTIFICATE E NOT AINEND M RIGHTS D, Edward C . Hughes Agency , Inc . EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, 152 Main Street Hudson Falls , New York 12839 COMPANIES AFFORDING COVERAGE LOmPPR Y A EXCHANGE MUTUAL INSURANCE COMPANY INSURED LETTTER Y B PENNSYLVANIA GENERAL INSURANCE COMPANY Steven Allen RD #2 , Box 2021 LE C Fart Edward , New York 12828 COMPANY D LETTER COMPANY E LETTER THIS M TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN "MUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERWO RMICATED. NOrTMRTNSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE m OF ISSUED SUCH POLIGES-on MAY PERTAIN, THE. MSUFLAFICE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLIISfONg, AND CONOh Tf0 W TYPE OF INSURANCE POUCY EFFECTFVE LIABILITY LIMITS IN THOUSANDS L POLICY NUMEIEA DATE (MMlL1WM DATE E?ASWM OCCURRE N NCE AGGREGATE GENERAL LIASR.ITY LY A X cnMPRFHENsivE FDw 119-2-67003 11 /19/87 11 / 19/88 + "AY $ $ UPREMESESIOPERATIMS E7IPL Iq & COLLAPSE HAZARD p�43ETM $ $ X', P90OUCTS0DbIPLETEO OPERATIONS 3OO]A/1 CONTRACTUAL GOMB NEp $ 300 $ B'NI.]EPEEpENT CONTRACTORS BROAD FORM PROPERTY DAMAGE PERSONAL OKIURY PERSONAL INJURY $ AUTOMOBILE LIAIII& TY BI701LY ANY AUTO 8A 0023843 02 06/ 18/88 06/ 18/89 MMPE „ $ . ALL OWNED AUTOS (PpR7IFV. PASS,) Baoav ALL OWNED AUTOS ( pP7} N) RAW MFt +Li]O[NII $ HIRED AUTOSPPOPIEFITY . . NON-OWNED AU DAk"G TOS E AlNAE GARAGE LIABILITY �t <t: 7 d ut0 c�pw,el+7Ep $1 000 EXCESS LIABILITY UMBRELLA FORM BPS PD $ $ OTHER THAN UMBRELLA FORM A WOMWR6b COMPENSATION 1 19-3-67024 04/228/08 04/28/89 STAnitORY AND ;, $, (EACH ACCIDENT) ' EMPLOYERS' LIABILITY $ (DISEASE-POLICY LIMIT) $OTHER (DISEASE-EACH EMPLOYEE) OESCRIF'FM7 A OF OPERATEONSA.00ATIONSIVEHICLEWSPECIAL ITEMS • r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX. Rich Schermerhorn PIRATION DAAE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 112-1 /2 Crandall Street MAIL ���}r�KI rs WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Glens Falls , New York 12801 OF ANY RE rORMA1L Y gHALLSIMPOSE OR Esc)bLE6A 'OR LIABILITY A )ZED RESENTA E CERTIFICATE OF INSURANCE ISSUE DATE IMM1ODfYY) 1 PRODUCER ��� �� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER_ THIS CERTIFICATE DOES NOT AMEND, NOIM-MRN INSURING ACENCYe INC * EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW PO BOX 90 WHIT :r;ALLr NY 12887 COMPANIES AFFORDING COVERAGE 1 i COMPANY CODE sue-COOS LETTER A UNITED STATES FIrju Ty & GLZpANrry COMPANY INSURED LETTER s FIREMAN I .Oj, FUND GPANVIT,T F PMSONRY CCNTRACMRS r INC . COMPANY & R TH Tff(XT 1S LETTER C ' . i BQX 33 COMPANY TTER D MIDDLE GRANWT T , NY 12839 COMPANY LETTER ' COVERAGES i 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 TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIOrN DATE (MMiODIYY) DATE (4AMIDDrYY) ALL LIMITS IN THOUSANDS GENERAL LIABILITY GENERAL AGGREGATE $ 600 r A X COMMERCIAL GENERAL LIABILITY ZlIP077482306 01 8!/8/ 88 8/8/89 PRODUCTS COMPIOPS AGGREGATE S 600 r CLAIMS MADE X OCCUR. PERSONAL & ADVERTISING INJURY $ 300 OWNER'S & CONTRACTOR'S PROT, EACH OCCURRENCE $ 3Q0 f FIRE DAMAGE (Any one firel S SO r MEDICAL EXPENSE (Any one person) $ rJ I AUTOMOBILE LIABILITY COMBINED ANY AUTO SINGLE S i 1{ LIMIT ALL OWNED AUTOS BODILY SCHEDULED AUTOS INJURY $ {I (Per person) HIRED AUTOS BODILY $ NON-OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY $ DAMAGE I EXCESS LIABILITY EACH AGGREGATE OCCURRENCE $ $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION 'STATUTORY B AND 2 38 WP 80354461 8/ 8/88 8 f 8/89 $ 10O F (EACH ACCIDENT) S (DISEASE—POLICY LIMIT) EMPLOYERS' LIABILITY 5C) r $ 10000 (DISEASE—EACH EMPLOYEE)i OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIRESTRICTIONSi8PEC1AL ITEMS I CERTIFICATE HOLDER CANCELLATION TOM OF QUEENSBUPY SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BUILDINGS L1EPT . EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO BAY AM HAVII-IAND ROAD MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE S QUEE24SB[,JRYr NY 12804 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPOIll90WpQWAF} T ,� icP SENTATIVE5. AUTHORIZEO REPRESENTATIVE 1 BYj + .C)Cit2tC� � +p�ftw. ACORD 25-S (3188) ®^CORD CORPORATION 1988 TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURYr NEW YORK 22804- TELEPHONE (518) 792--5832 BUILDING INSPECTOR9S REPORT REQUEST FOR INSPEC TON RECE VEIJ__ II �� NAME LOCATIO Ao DATE PER41VIT APPROVED YES NO FOOTING/Pj*RS MONOLITlfXC '.POUR FORMS FOUNDATION/DAMP—PROOFLG� BACKFILL. APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN INSULATION: FOUNDATION FLOORS WALLS z # CEILING ✓FINAL INSPECTION: CHIMNEY HEIGHT ROOFING ,SIDING EXTERNAL PORCHES TEPS STAIRS—CLEARANCE P & RAILS PLUMBING FIXTURE / LIEF VALVE _ 40r— INTERIOR TRIM/P VA Y DOORS 410 r' FINISHED FLOORS J AJ GARAGE FIREPROO ING DOOR CLOSERS) SMOKE DETECTOR FINAL ELECTRICAL INSPECTI FINAL APPROVAL O CONSTRUC ION A SIGNED CERTTF ATE OF OCCUPANCY MUST BE OBTAINED FROM T E BUILDING DEPARTMENT BEFORE THESE PREMISES RE OCCUPIEDI REMARKS: po INSPEC R M# GIs - --�-- Naeloiriiil HeadcEuarters _ . I 1Ulddni Aiti=:; CoflingsLn 64r W..J. oisibe Id 4 . mum / Data: City, Town or Township 4 or je c ,4 County #.. f 2C f# State. L:ocatian/Address 0ei 74 ! dA" A• IjS A r f [If Locate 'n Rural Area - Pease ttach Directions) Pole Owner4 920Pell- rrElit "4 " Oaxcuplied.As Building.:. LNew ' Old 0 ( [ C � . fit .. • ' Occupant Vlfdrl2 a in'Buildin Floor #; ate. }: , for: Whin Service or: Read for In " uAl. ' Fee .Rernittedx h Check M.Q. - !V#ake �a abJrWj'd-: M.D.1.A.: lab LabO I21W labs 17 as 2aaa 22sa 25a0 27sa a0aa ' Num bar. of Romgh 41�`}ting Vats Elect. Fleet Switches ` , . := , Ligh#iris _� Amp. Seiwlf ee -'• , s Su#ace .Unit DishINa47ier Range . Rel7eptacleg Water Heater Air Conditioner Dryer `. ` -i, Pu- p 1 . iictu 41 --- --- Qven.L. 4 jai Gachage Ciisp�al Wiring and Controls for $lr€r r LL c �R� ,r : Fractional H.P. Vent Fans Other Equipment: r . NICITCEFRS H.P_ /5,�.., 11 - 1,/ 1/$ 1/6 1/4 1/$ 1/2 3/4 1 lYr 2 3 , S 74f 10 15 20 zs so 40. . so 75 14D _ !Nark Number of Each Size r a Apok:@ t.'s .h .: , .-.`3i, i -y,- . Signature . Lloense + . . .. "Pit J'ii # . •. Applicant's. Ad r 4Cit7r) (State) h; Ziix1 " Service Request # £4 . � `. Ele+ctrici iiAiV4 RECEIVED: L DATE INSP CTEtD: Correct L oration: Same as Alive © or: ;_ ±tVT Red !Notice Label Rough Wiring Outlets Surface Unit Oven Lr Switches Ranger °f '': 3a.. l tsl c&jA Receptacles Water Heater ' [Jishwas Fixtures -Alt-Conditioner' Of"r Amp. Service Equipment Burner, WiYGrrg &' Controls for Amp. fieceptacte Amp, Service Conductors Pump Vent Fans MOTORS 1i,P, 1/20 1/12 IAA 1/e 1/6 1/4 1/3 112 3/4 1 1+h 2 3 5 7% 10 15 24 25 40 50 75 Mark Number _ of EachrSize _ (. i Elect. Heat aao 1 Tea laao 1 1250 1a0a 2750120001225012 ieeo aaoo RW Progress: Inc. LKD d Contractor CFT Violation : Work Comp. E3 Inc. E 0 L/A Owner Fee CASH VA CHK (� IPA Clue MO # Monlci pal. lfdV Applicant Date• Other Side �' Utility + •? F Owrier Cut in Card EJ Temp # Date ;: , . , Date S10 E?tiT' APPI.LICATI0N FoftM No: i awn o/ Qe4eenJI944py BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTIOhl NAME f LOCAT I ON i }] V�►��} n L lJ — DATE: �I- -1- PERMIT --- SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM : F l Absorption field , total length Length of each trench (jcDepth of trenches Size of grave]:_ SEEPAGE P'ITS4Nu�er of) e Size- .~ X .L -�"'"� Gr SiZe _ PIPING : .ZSilze Type Bldg . to tank r" y �Jcr{ '-(p PAL - C:. Tank to dist . box &4 Dist. box to field CI 6t' c.._- Openings sealed? ES ) O Partial RA LOCATION/SEPAT ONS : Foundation to t nk INLt . Foundation to sorption �Absorption to of line � Separation of pits ft: LOCATION OF STEM ON PROPERTY (cirr,le one ) Front - - Left side - Right siAje - CCMMENTS • D n s`L ��l�.l'a! 6 Na la PP ir [" cam V t 1j&I ( +. AA #J , 4-A /� iv a ��-crc5 l? to pcd � PL �'S 1r'` • I.,la-+ LI Y � .. SYSTEM USE APPROVED YES NCl�,,..% Building Insp for 01/86 and vl _ .4" o/ Queenshury BUILDING and Zt]NfIVG DEPARTMENT r Bay and Haviland Road, R. D. 1 Box 98 Queensbury. New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME ^�3i� LOCATION DATE / PERMIT NO . d��J SOTL "TYPE - Sand - Loam - Clay Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYST : { Absorption fi ld , total len4th Length of each trench Depth of trench s Size of gravel _ .. - SEEPAGE ;�) ITS{Nuimb Z Size- Grave ze P Ge Size Type Bldg . to tank _ Tank to dist . box Dist , boi: to fieldlplt � ' openings sealed? / YES NO Partial LOCATIONS"SEPARA ONS : Foundation to ank ft. Foundation to scrption ft . Absorption t lot line ft. Separation o pits ft. LOCAfiION OF 'SYSTEM ON PROPERTY (circle one } Front - Re - Left side - Rigrht side - COMMENTS : SYSTEM USE APPROVED YES NO Bui cling Inspe for 01/86 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAN ROADS Q ,S UEENBURY, NEW W Y(7RK 128Qk TELEPHONE (5I8) 792-5632 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED ,r NAME LOCATION ' DATE 7 J�--=-I PERMIT # APPROVED YES I NO FOOTING/PIERS MONOLITHIC , POUR FORMS FOUNDATION/,DAMP-PROOFING BACKFXLL A ROVAL ROUGH PLUMB G FRAMING ELECTRICAL ROU IN I LATrON: FOUNDATION FLOORS WALLS ' ` lk CEILING FINAL INSPECT O CHIMNEY HEIG T ROOFING SIDING EXTERNAL RCHES/STEPS STAIRS-C ARANCE & RAILS _ _..... PLUMBIN FIXTURES/RELIEF. LVE INTERI TRIM/PRIVACY DOOR FINISH D FLOORS - GARAG FIREPROOFING MOOR LOSER (S) SMOK DETECTORS FINAL LECTRICAL INSPECTION FINAL PPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MU BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: IN TOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY 6 HAVSLAND ROADS QUEENSBURY, NEW YORK I2804 TELEPHONE (5I8) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR rNSPECTra RECEIVED NAME I LOCATION�y � /_,�i� r* / DATE "I r !7 PERMFT # - • �i APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING .� ILL APPROVAL cw PLUMBING I FRAMING +11� ELECTRICAL ROUGH N INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING '` SIDING EXTERNAL Pf]RCHES/ EPS _ , STAIRS-CLEARANCE RAI _ PLUMBING FIXTURE /RELIEF ° ALVE INTERIOR TRIM/P VACY DOORS FINISHED FLOOR GARAGE FIREPROPFrNG DOOR +CLOSER (S SMOKE DETEC S FINAL ELECTRICAL INSPECTION FINAL APPROVAJ OF CONSTRUCTION A SIGNED CER rFICATE OF OCCUPANCY MUST BE OBTAINED FRO THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED[ ,OWRK5: G t" C,�f f ►�'rt� r a ,►+� j cow pt �r I SP TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT .BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 2280k TELEPHONE (51B ) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR NS�PECfiION ECEI ED NAME LOCATION DATE PERMIT #� t3 Imo' APPROVED YES NO FOOTING/PXERS MONOLITHIC POUR FORMS t,, LOUNDATION/DAMP-PROOFING t.eeACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN .INSULATION-* FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ --- STAIRS-CLEARANCE hl RAILS PLUMBING FIXTURESIRELIEF VALVE INTERIOR TRIM/Pp+OrVACY DOORS FINISHED FLOORS GARAGE FIREPR PING DOOR CLOSER (S) + - SMOKE DETECTOFjS - FINAL ELECTRICAE INSPECTION FINAL APPROVAL OF CONSTRUCTION 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 & HAVILAND ROADS (2UEENSBURYr NEW YORK 1280k TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR IN PECTION RECEIVED _ NAME LOCATION tt� DATE PERMIT # APPROVED f- .y•.t ram...,. .. YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUJVDATIONIDAMP-PR6 FING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: L CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STCPS STAIRS--CLEARANCE . RAILS PLUMBING FIXTU IREEIEF VALV INTERIOR fiRSM RIVACY DOORS FINISHED F RS GARAGE FIR ROOFING DOOR CEO R (S) SMOKE D ECTORS .......................... FINAL EL CTRICAL INSPECTION FINAL A PROVAL OF CONSTRUCTION A SI NED CERTIFICATE OF OCCUPANCY MUST BE OBT INED FROM THE BUILDING DEPARTMENT BEFORE TH SE PREMISES ARE OCCUPIED: REMARKS: p / lot f' INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES ,DEPARTMENT BAY & HAVILAND ROADS !!! QUEENSBURY, NEW 5 S ) YORK� _58320& TELEPHONE BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED,..] NAME LOCATI�O^^N �F3'-r�.- � � � c� ^7 DATE �S PERMIT #_ �r�^ ��' APPROVED YES NO FOOTING/' PIERS MONOLITHIC, POUR FORMS FOUNDATION AMP—PROOFING BACKFILL AP VAL ROUGH PLUMBI G FRAMING ELECTRICAL RO H—IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION,- CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ , EPS STAIRS—CLEARANCE: RAFT PLUMBING FIXTUR�/RELIEF ACNE INTERIOR TRIM/VkIVACY DOO' FINISHED FLOORS GARAGE FIREPROOFING_ DOOR CLOSERS} SMOKE DETECTORS FINAL ELECTRICAL INSPECTION ---" FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE NED FROM THE BUILDING DEPARTMENT BEFORE' OBTAI THESE PREMISES ARE OCC�U.P"IED! REMARKS : ` �z� j Awl � - - � INSPECTOR YOU ARE HEREBY REQUESTED TO INSPECT AND ISSUE CERTIFICATES FOR THE FOLLOWING ELECTRICAL EQUIPMENT TO BE INSTALLED BY THE UNDERSIGNED / TEMP # DATE �I /- 1r, CITY OR VILLAGE 1 TOWNSHIP COUINTV }l I l l a RDW S STREET AND NO, OR ROAD y (- NUMBER � S BETWEEN INHAS TWO CROSS STREETS IS PREMISED LOCMEW SEC"IION BLOCK Lar QGGUNT PA '$ NAME LD ING OCCUPANCY OWNER'S NAME AND ADDRESS { I "on O T HUM B I CURRENT SUPPLIED E V IR OFFICE WOAX TL6PPRONIFNIUMBEIR BUILDING IS NEW � DLO C LH7RK IS NEW ❑ ADDITIONAL DEFEi;:7F,, REMOVER ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS No. ofFixtures & MOTORS HEATERS BRANCH OFFICE USE Luca- Lamp Receptacles +CIRCUITS ONLY tips Side Attach't H.P. VYlatls A W.G. Cailin9 Wall R tt alh't Switch Pendant BRIX:k91 No. Type �h No. =h No. C,ge INSPECTION OUT- SIDE SEIB- BASE EASE_ MENT Tel FL. 2nd FL. 3rd FL. REMARKS: LIST OTHER ELECTRIC'JAL DEVICES NOT SET FORTH ADOVE: THIS APPLICATION IS INTENDED 70 COVER THE ABOVE-LISTED EQUIPMENT 10 BE INSPECTED, BUT IF AT TIME OF INSPECTION, THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED, YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT. SIZE OF MAINS FEEDERS ELECTRIC SIGNS&AMPS TOTAL VA9TS CHARACTER OF WORK ❑ EXPOSED GAS TUBE SIGNITRAN SF("AERS OF ❑ CONCEALED DATE VJORK TO BE STARTED VALE COMPLETED SIZE OF SIGN(NUMBER) CAPACMy SERVICE ENTERS BURRING MANUFACTURER OF SIGN ❑ OVERHEAD ❑ UNDERGROUND 6RE INSPECTION REQUESTED ON IOR AS NEAR AS POSSIBLE! lr1U$T Eti'fER APP'1.MCRt'1TS '�. I_ : I '_:I _. 117E�TIFICAT1f3N NUMEER j % MKMD DE EY QIYINCi F LL AMU RATE INFOFWAATION. ALL SLAKES M BE FI IN OR APPUCJMON MAY ISE RET PRINT NAME AN ADDRESS NAME OF API'+_I T DATE APJ LICVTI a i ry r r v? t STREET ADDRESS E CITY OR POST OFFICE �I LI ENSE NQ WHEN AP CAnLE 85 Jahn Street ❑ 41 State Street I ❑ 584 DelaWare Avenue f_1 217 Lake Avenue ❑ 202 Arterial Road NEW YORK, NY 10038 ALBANY, NY 12207 1 BUFFALO, NY 14202 ROCHESTER, NY 14&)S SYRACUSE, NY i3206 THE NEW YORK BOARD OF FIRE UNDERWRITERS i DNS cd 0 w OF Q� C� APPROVED fol SMACE DISPOSAL LOT 15 PE's7 YORK STATE GEPARTM "!T H iLTH 40 OIL �v SANITARY ENGIREER� _ OCT ? f 1989 r LOT , 18, 163 so. ft. B t)rirE l 0. 4-1 acres .7 1p , -7t% 4 16' 99 �. v ry�� a ^ • U .rIcqt 14 mmu crhr 7T •ii ♦• sp: t9 A t'© . �1 MAP Y A SURVEY MADE FCR RICH S u'H rMERHORA rQfi ►> ! UN IF 'QUEENSSUR dUNTY IF NARRE"� v �/ XALEF 1w= 74' r DA i E 0C'CB€R " . ' 989 'CRK n jV �.= ���r �,, t� ..�: