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1989-359 4 I F + ER'TIFIC CAI h OF OCCUPA��T�Y j TOWN Of iQUEENSSURY WARREN COUNTY, NEW YORK Date September 27 19 &9 This is to certify that work requested to be dons as shown by Permit No, has been completed- This his structure may be occupied ss a ' a single l=ami 1 Y ps Quipen Nary Drive Location Builders-Queen Victoria ` s Grant Owner Guyer By Order Town Board j TOWN OF QUEENS$URY ,I Director of Bldg. Code Enforcement I I Atm BUILDING PERMIT x F TOWN OF QUEENSBURY No. Rfi_3S WARREN COUNTY, NEW YORK ,_.. ro 1 rr PERMISSION is hereby granted to �JYFRBIJTI not 12S nllFH yrrTnrrrHT W as OWNER of property located at 25b QJ IFF Y J}R i YF Street, Road or Ave. r+a in the Town of Queensbury, To Construct or place a h A SINCI F FAN] J Y 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 1 Hemphill Place Suite 201 Ballston Spa , H _ Y . 12020 ^� rn z 2. CONTRACTOR or SUI LDER"S Name Me= Self CD XI 3_ CONTRACTOR or SUI LDER'S Address �- N Same 4. ARCHITECT'S blame 5. ARCHITECT'S Address f\T t!'t .G C P'1 S. TYPE of Construction -- (Please indicate by X) xxxl Wood Frame ( I Masonry ( 1 Steel I C�7 7. PLANS and Specifications 7G+ No_ 31 ' x 42 ' J� a single family dwelling as per plot plan , specifications and application , includingseptic ,attached one car garages and 8. Proposed Use -116 a SingleFamily Dwelling IMP w 4xAxB1i Vz*xlE*x1zjtX�111K# M r $ n PERMIT FEE PAID — THIS PERMIT 'EXPIRES January 1 19 90 - m (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the y. town of Queensbury before the expiration date_) 3C r-+ r 44 Dated at the Town of Queensbury this 2nd Day of tuna. SIGNED BY for the Town of Queensbury Building and Z'oding Inspector 7'C`��irN OF � C.TEENSF3UPY APPi. TCATTON Fort ;Ux ,_ . . . . , . . _ � n ZONING PERMIT Va , y+ Rev-iewed r TC1Wry OF QUEEfIfBURY - 1?1 RECEIVED Fee Pa,i / _- MAY 2 1989 WILDING AND CODE U1 :rA11Tr1E9r vase Ia64ued tawY And ttwVs[.tiAltt Rowlas 4RD I avx Penmi t Ni a . �'9 - � - BLDG' & CODE DEPT fW EJIfSBl1t2Y, ML�'1�l Y4Rt. 1..804 ! Tot . (518) 792-5832 tixc -204 ■ • w ■ ■ w ■ w 6 ■ w ■ w ■ ■ r ■ ■ w ■ w r w • ■ ■ w w . w • ■ w r ■ w ■ A i'ERFIIT MUST UP OBTAINEU uC11ouLft BEGINr1ING CONSTRUCTION . Na INSp13C'rioms U.' I LL UC• 161ADG UNTIL APPLICANT 11AS RECEIVED A VALID UL: I LDINC PERMIT . All applicable spaces on this application must he completed and the sopuat re sof the aapp * i * akt *PwStt U1�* ear * on the *e arse * licr4x *hws * � �* 4 * � The owner of this ProParty is ; Guyer Builders , Inc. !* . 4 . Add r u s s 1 Yemp all Place Suite 201 , Ballston Spa, NY 12020 T E L . C 518} 892-9161 Ibraperty location '' 15 CCpueS4 'MARY �tye 'FAX MAP NO . 1?�_! �1 -�9" property since October 1 . 1988 ? /, no HAS there been any .plit as this prof y y, aa no if yes , Planning Board Review is necessary . SUODIVISION RAMC . IF APPLICAnLC QUEEN -ICTORIA* S GRANT LOT NO . 36 The Pcarsan responsiblo for aupurvision of wort: as regards Building Codes is $ RicYLard H_C over IIY1Hemphill Place Suite 201 Ballston SRa NY 518 $ -9161 NAMk P . O . ADURC : S TEL NO tJ:ame ei builders;+-iyer Builders . IncRddress 1_ Hemphill Place , Ballston Sipa a ei(51$} 899-9161 idt•�■l of P1ucnbor —same— J.ddroSs -same- TO1 -same- Naa►e of Mk.son —s — n+idroas -same- 'rul -same- lrI.1TuRk' or f'ROl'O�.irD twoI:K : Model S w ?0N1 riG 1 N1� URMA'1' 1ON f Urri ca uaQ onl y X Conz« truCcion of a now building ; ;CONING DESICNATION OF PROPERTY Addician to a buiWiaaca * PERMITTED PRINCIPAL PERMITTED ACCESSORY Alcvr"cion to " lauilding into ciw+►c�+s to *Jxc.: ricc clianan:: ian;;1 REVIEW REQUIRED - PLANNING BOARD ZONING BOARD Ocibar work (JoAncribc:) SITE PLAN REVIEW "PROVED DATE t VARIANCE I APPROVED DATE 4; k4SS AREA OL' 1"biLOLAOSZ04 ::'r[+UC'TU14E � y 1st floor 900 sq ft . Iteu�arxs - 2nd Floor --- sq f G . COatitl.it't•i tjil'OL;h1A'L'tON Ict:+ tUl lC lsa=1.GYJ . • Sixa of pcopurty 1ooiset ' plan ct x 120 re . Ocher Floors --- sq tt . + LY7sstin<} iluilJi.F+] irl si:C*.s n a r` c Xm �� c . Inac cedar or b;,xaamuncl + TOTAL FLOOR AREA 900 sq ft . ' i:xi::tiatc� bu � lalLau� 1s: 1 U:.+a n a Me 4ue now ucructurs 31 it x 42 ft 1'w+a+,d:. cian-Piar,Iz:laLfcr:awl/1,�arc%,�1Jtul1 ' Yaal�►::uct l�uilr�ins� , rii:rc:►ncw iroau l,rotua� ty lines Wirc:ly 0041 Front card 30+ fr. Roar y"ed 30+ fc mess of titorieali (It:Fluie:abl+s UpAcal �l • Side .Frdu 15+�f t and —�1r+�1:c liwight tclradu to Vida%: ) 1916'1 ,ace If Onycearnwr , "U01" ak '`roan side acr"Qc _fC 1i rouldcantial, no* of ezaaaili+e� 1 - 2 lice of rooFas ; oxcludinag b"chul 4CCUPAN4:Y INFORMATICN line at Lwdroawa 2A pltlll"Y UUILDINL; ON Now of b:acktrooana 1 Ona family duelling priaprry iFas:aticFcj a:ystuw Baseboard Electric R x %two i4wi.ly dwallin"1 'tYlcs a of fiAQA Eletriclt Multipl.a alwulltng / Nuwber of units + No. of firuplacaas: tcs 1s:: iccr:c:+llud+ rija � 30 i't3mAntant occup:++acy Will ;+ wooj Stovu to: iFFat:.11.:ci? no IV Tr:+n::iaicc u::cu1a:ucey CvAL :al Air cacaa#iCic�ni+ac]-' no " 13usinusca r i8l.lileDiNG STYLC, PRIMARY STRUCTLAZE Indus:trial Octtcr La:aMaalt COi4t►w�t;GYi.{`y Lrg c"- WLa IC rdditiun , wiaaaL will u;Q L,u7 ir.Fl�ud ranch vu4naiiuu Owy,lux upli.c l.awsl Old ocyio Lau+cy.clow C:60" Coo CoLt4114 Ock"4Ar "' ACCESSORY UUXUDINGAN Colonial L:oMf 'town Clouse WOOMMMM1+.,:rachact y;ariay[rJane car/ two c:+ r carGina' i CIRCi.L ONL: riLfA:>* 1 * x Accuchc:u c3ar:aq, +s,laaa cur/ two • ♦ • ■ a ■ ■ • • • • ■ ■ w ■ r r ; ZFriv:at4j zLor"90 builaing , i:.`• Y' IliA9`i: l] MARKET VAI. UL: OF ' �17ctuar TN['4til1J1TI4N ON WJTLOTriC sprXIFTCATTONSo ON CVRRSE: £Ion or TitTS rtI09T, •!YJ Al: COeIPLL"!`l:D ! Form DPA 10/88 v1 BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe, etc . wood fra[ne Will any second-hand or ungraded lumber be used? If so, for what ? no Foundation wall material concrete block Thickness 8" Depth of foundation below grade ( to bottom of footing ) Will there be a cellar ? no Heated or unheated? Floor sq. footage sq ft Will there be a basement? no Will any portion be used as living space ? ( If so , what portion? sq . ft . - - Type of use? Type of roof - sloped/flat/shed/other Material of roof fiberglass shim es Size , wood studs " X 6 '• spacing "o . c . length 8 ft. Joists ( floor beams ) lsto floor n/a "x " spacing "o . cu span ft . Joists ( floor beams ) 2nd . floor n/a "X " spacing "o . c . span ft . Overlays (ceiling beams ) n/a "x " spacing "o . c . span fr. . Roof rafters n/a "X spacing o . c . span ft . Roof trusses (pre-engineered) spacing 24 "o . c . span ft . Exterior wall finish stained Of what material? 5 /801x 4 ' x 8 ' texture 1- 11 Interior wall finish painted 1 2" sheetrock If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 1 /2" type "x" sheetro_ck _ is there to be an opening between garage and dwelling? yes If so will a Fire-rated ._ door, enclosure , and self-closing device be provided? yes Will a flue-lined chimney be installed? no Height above roof ft . Depth of chimney foundation below grade n a ft . Depth of fireplace hearth n/a ft . in . Water supply - Municipal or private well Municipal SEPTIC SYSTLM Distance from ANY private well ( including adjoining properties ft . (A separate application is necessary for any repair or new installation of septic system) it E C L A R A T 1 0 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 shalt be complied with, whether specified or not , and that such work is authorized by the caner. d Signature Owner, owner's agent, arAMiirecto contra tar • * r * * . . ,s . a s. � . ■ ,s • r * . . . ■ r ■ r ,e . . r ■ ■ w « • r w * . : w * w * * r SPECIAL CONDITIONS OF THE PERMIT : TOWN OF QUERNSSURY 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 . &NONZA ALL of the followings l e Grose floor +Brea Seg Plan . 20 Type of heat Baseboard electric 3 . Is the building mechanically cooled ? No 4e percentage of area of windows and doors See Part 6 A . Over 16 % Only 1 . Uo value of gross area of walls , roof/ ceiling and floors exposed to ambient conditions See. Part 6 2 . Floor over heated spaces YES ,.�;�-� a . Are foundation walls insulated ? (`Y-�' 1 . If YES , what is the R value ? See Part 6 3 . Slab on grade YES NO a . if YES , ' what is the R value of insu on around perimeter of floor ? See Plan 4 . Is basement heated ? YES NO a . R value of insulation n 5 . Type of insulation PolystyKene Be Under 1 +6 % only, 10- R value of roof and floors expose to ambient conditions_ R-38 2e R value of exterior walls R=2 3 . R value of glazed area 3e23 4 . R value of doors R- 14a9 L 5 . R Value of floors over unheated spaces R=� 9 6 . R value of slab edge insulation - unheated slab N/A 7e R value of slab insulation - heated slab 12 . 5 8 . R value of heated basement/ cellar walls ( above grade ) N A 90 R value of heated basement/cellar walls ( below grade ) N/A 100 Type of insulation Fiberglass C . Controls le Thermostat maximum heat setting N/A D . Duct Systems N/A le 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 NIA 1 . Size of hot water or Cooling carrying agent pipe 2 . R value of pipe insulation Fe Service Water Heating 1 . Performance efficiency_ NIA 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating N/A Telephone No . ( 518) $99--9161 ( applican ' signature ) APPLICATION FOR SEPTIC DLSPOSAL PERMIT Ref : S . P,E1kDaS . persalt # I]ATS , New York - 0202525 MODEL uI 5 of 5 LOCATION OF PROPERTY FOR INSTALLATION 25 Queen Mary Drive Guyer Builders , Inc . ..• Telephone: ( 518) 899-9161 Owner s Name. y Address: 119 -Dunning Street , Ballston Spa , New York 12020 Installer's Name. Guyer Builders , Inc Telephone: ( 518) 899-9161 2 A, C , E, I , is K, L, M Number of bedrooms (residential only) 2 W 3 F , G, H • Total daily flow (compute @ 160 gal per bedroom) 300 Tapograpbye circle one: lat Rolling Steep Slope 96 of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: . 8 " feet + Ground. Water: At what depth? mown 8 feet + Bedrock or impervious Material: At what depth? unknown feet percolation test: circle one: scot require required / rate min. inch. Domestic water supply: circle one: Municip�Well Other IF domestic water supply is a Well: N/A feet Separation: Watersupply from Septic absorption * PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1,000 gal.) TILE FIELD: Each Trench N/A feet / Total system length N/A feet * SEEPAGE PIT(S). Number of / Size each feet by feet' * Size of stone to be used # / Depth or Thickness feet IMPORTANT See S . F.E.D. S . ...please...LIST NEW EQUIPMENT TO BE INSTALLED permit & attached map , do (over) Section n Septic System Inspections: A, All applications for septic system installation, alteration or repair, as required by the Town, of Queensbury Sanitary Sewage Ordinance. Shan be submitted to the Building Department at least 24 hours befog of constructiop and shall include a plot plan showing. l.} the proposed .locaton of the slystem 2.) location asd distance to lest lines 3.) location and distance to structures 4e) location and distance to any *%kter supply 5.) size and dimensions of all tasiks. distribution boxes, tile fields and/or drywells Be No system shall be covered before inspection and approval by the building Inspector. Failure to comply with this requirement tray result in the uncovering of the system by the installer and a fine of up to $2500009 C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system, a new proposal must:be submitted to the Queensbury Building Department before further construction. I have read the regulations above mad agree to abide by theme and all to of the Toms of Queensbury Saeniltary Sewage Udsposal Qlyd;inance, Signature of.responsible person: I �. . .,+ Date: Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD. PLACE TCr �1►�.�1���/� CERTIFICATE OF INSUIRANCE ISSUE DATE (MMIDDIYY) 30/3/88 PRODUCER Hequ ('}urg AgElnc7f Inc . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 121 � S$+ NO RIGHT'S UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOE'S NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW P o Box 953 Scteuectady's NY' 12301- W5;3 COMPANIES AFFORDING COVERAGE 372-56 1 r�17 T . � Co . �r� LETTER COMPANY A Lie Automobile Insurance C of Fir3rtford„ C.T CODE ���,� SUB-COPE INSURED 1 ,� T..� LETT N ii�l. ERY B i Aetna Casualty & +Sure Co * COMPA Guyer BuI.Idere 0 Inc a LETTERNY C B$ laiLi n. Spa( NY 12020 LETTERNY.I. D COMPANY E LETTER COVERAGES THIS I$ 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 O,q 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 THOUSANOS LTR DATE (MMIDOJYY) DATE (MMIDDlYY) OENERAL LIABILITY Renewal of GENERAL AGGREGATE S 2,90000 d Y COMMERCIAL GENERAL LIABILITY C0136924 1()IIA8 10/1/89 PRODUCTS-COMPIOPG AGGREGATE S 2.0 0WV CLAIMS MADE X OCCUR. PERSONAL & ADVERTISING INJURY $ 1i sow! OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ 1190 , FIRE DAMAGE (Any coo fire) S 1WjP MEDICAL EXPENSE (Any one person) $ 54 AUTOMOBILE LIABILITY Renewal of pp COMBINED •+ .YI. Z ANY AUTO FJ39o995 1,0 l2 /88 10 /J /89 SINGLE S 17 1 ALL OWNED AUTOS ! '�/ J i.F yJ BODILY INJURY S SCHEDULED AUTOS (Per parson) HIRED AUTOS BODILY INJURY i NON-OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY $ DAMAGE EXCESS LIABILITY Renewal Oy.p EACH AGGREGATE B I UNB ELI& X5475556 zo/z/88 za/ /s9 s 5.vo s S 5, coo, OTHER THAN UMBRELLA FORM WORKEA'S COMPENSATION Renewal Of STATUTORY 'A` AND =66379 1011A8 10/1/89 $ 100,1 ('EACH ACCIDENT) EMPLOYERS' LIABILITY S 500s (DI SEAS E.POLICY LIMIT) S 1 0s (DISEASE—EACH EMPLOYEE OTHER DESCRIPTION OF OPERATKMSILOCAT1ONSIVEHICLES/RESTRICTIONSISPECIAL ITEMS CERTIFICATE MOLDER CANCELLATION Building & Zoning Depter SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE T<]Im of Queenzb=7 EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Bay & HavwJ. nd Road MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE RD # 1S $p= 98 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Queenebux7s IY 12801 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORILEO REPRESENTATIVE ACORD 2" ($/6i) YVON I*" TOWN OF QUEENSBURI BUILDING AND CODES DEPARTMENT 13AY & HAVXLAND ROADS E QUEENSBURYi NEW YORK 128046 k TELEPHONE ( 51.8 ) 792-5832 BUILDING INSPECTOR' S REPORT REQLIEST FOR INSPECTION RECEIVED NAME �. LOCATION J^ / PERMIT DATE # ` APPROVED YES NO FOOTINGI,PIERS MONOLITHIC POUR FORMS FOUNDATIONIDAMP-PROOFING BACKFILL APPROVAL 7 ' ROUGH PLUMBING FRAMING ELECTRICAL ROUGH�IN INSULATION-" FOUNDATION FLOORS WALLS C LING NAL INSPECTION : CHIMNEY HEIGHT ROOFING ,SIDING EXTERNAL PORCH (STEPS ,STAIRS-CLEARAN E & RAIL.S� PLUMBING FIXT RESIRELIEF ^1T7ALVE� INFERIOR TRIM/PRIVACY DOORS ✓ .. FINISHED PL06RS \k � GARAGE FIRE14ROOF'ING - DOOR CLOSER ---- - SMOKE DETE ORS FINAL ELECTR ;CAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE TFIESE PREMISES ARE OCCUPIED! REMARKS : INSPECTOR k 4 s TOWN OF QUEENSBURY t BUILDING AND CODES DEPARTMENT SAY & ,HAVILAND ROADS QUEENSBURY, NEW YORK 3280+I TELEPHONE (5I8 ) 792-5832 BuILC}ING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION DATE _ � /�d _PERMIT # APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN Coo ULATION: " FOUNDATION FLOORS WALLS CEILING ~ FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL ES/STEPS STAIRS-CLEARANCE & RAILS PLUMBING FXXTURES/RELIEF VALVE INTERIOR TRIM/PRIVACY 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 : I r INSPECTOR i TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280� TELEPRONE (5z81 792- 5832 BUILDING INSPECTOR' S REPORT REQUEST FOR I ECTION RECEIVED NAMEalp LOCATION ��` � ' DATE I I - PERMIT # ! �� ,APPROVED YES Nd FOOT.rNGI PI ERS MONOLITHIC POUR FORM FOUNDATION/DAMP-PROOF G BAC L.L APPROVAL H PLUMBING MUING ELECTRICAL ROUGH-IN INSULATION: ✓ FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL CHES/STEPS STAIRS-CLE RANCE & RAILS PLUMBING F HTURES/RELIEF, VALVE INTERIOR TR M/PRIVACY DOORS FINISHED F S - GARAGE FIREPR PING DOOR CLOSERS) 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 flown of QuE,Q � s� eere� BUILDING and ZONING DEPARTMENT Bay and Havifand Road. R•D, 1 Box 98 Queensbury. New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME_ LOCAT ION DATE PERMIT NO , SOIL TYPE .- i Sand - Loam - Clay Percolation \;;st Required? YES '" -NO percolation Vate -- ,oin/Inch TYPE of SYSTE 40 Absorption f le , total jength Length of each ench Depth of trenche " Size of gravel SEEPAGE PIT 4Numbe - Size- t. X to � ^ Gravel size Bldg . to ' I Tank to dist. bo Dist. box to fie d/pit Openings sealed YES NO Partial LOCATION/SEPA TIONS : f t. Foundation to ank t . Foundation to absorption f t. Absorption to lot line Separation o pits to Y ircle one) LOCATION YSTEM ON PROPERT Front Rear - Left side - Right side - CCMMEN � /+ SYSTEM USE APPROVED YES NO Building Inspector 01/86 and vl 1 f TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT DS BAY & HAVILAND RYQRK I2$04- QUEENSDURY, NEW TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR rivSpECTION RECEIVED NAME TI 11 �� sr �� L/ LI LOCA ON -`J_f✓� . �Q PERMIT # e�I " '.�DATE / APPROVED YES I NO FOQTXNG1PXERS LAdNOLIT"HIC POUR FORMS FOUNDAT XONI DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING r FRAMING ELECTRICAL ROU H-IN E INSULATION: f FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES1s £x'PS STAIRS-CLEARANCE & .kAILS PLUMBING FIXTURES/FIEF VALVE INTERIOR TRIM/PRITiACY. DOORS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTOR__, FINAL ELECTRICAL INSPECTION FINAL APPROVAL O CONSTRUCTION A SIGNED CERTIF LATE OF OCCUPANCY MUST BE OBTAINED FROM T E BUILDING DEPARTMENT BEFORE THESE PREMISES R OCCUPIED? RE/MARKS . kl INS ECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT ` DAY & HAVILAND ROADS QUEENSBURYr NEW YORK 1. 28011 TELEPHONE (518 ) 792--5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED.,2_-ll-::- � NAME LOCATION DATE �r_.__ ..! PERMIT # APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATIONIDAMP-PROOFING r BACKFILL APPROVAL BOUGH PLUMBING FRAMING ELECTRICAL ROUGH— N INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ TEPS STAIRS—CLEARANC & RAI PLUMBING PIXTU S/RELIE VALVE INTERIOR TRIM/ RIVACY D025 — FINISHED FLOC? S GARAGE FIRED FING DOOR CLOSER [ SMOKE DETEC RS FINAL ELECTR AL INSPECTION FINAL APPROV L OF CONSTRUCTION A SIGNED CER IFICATE OF OCCUPANCY MUST BE OBTAINED FRO THE BUILDING -DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS : i f i 's INSPECTOR TojwN ©F QUEENSBDVE BUILDING AN D CODES PARTMENT ND ROADS Z28C � SAY & HAVILA QUEENSBURY , NEW YORK TELEPHONE ( 518 ) 792-5832 BUILDING INSPEC roR" S , ,PoRrf REQUEST FOR INSPECTION RECEIVED NAME LOCATION PERMIT � k DATE / —` r APPROVED YES NO t FOOTING/PIERS MONOLXTJIIC POUR FORMS FOUNDATION/17AMP— BACKFILL APPROVAL ROUGH PLUMBING FRAMXNG ROUGH—IIV EFECTRICAL NS LA TxON : b�I FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION : CHIMNEY HEIGHT ROOFING ,SIDING RCHES/STEP EXTERNAL PO & LS STAIRS AN �CLEARCE TRY VALV PLUMBING FIXTUpRIVAEY DOORS�� INTERXOR M FIN ISHED FLOORS GARAGE FIREPROOFXN DOOR CLpSER (5) SMOKE DETECTORSXN PECTIO14 FINAL ELECTRICAL NSTRUCTION FINAL APPROVAL OF CERTIICA E OF OCCUPANCY MUST BE F A SIGNED THE UILDING DEPARTMEN BEFORE OBTAINED FROM CCUPIED ! THESE PREMISES ARE REMARKS : 4T(PSCTOJR TOWN OF QUEENSB'URY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 2 320* TELEPHONE BUIi17ING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION DATE _ !� PERMIT # APPROVED YES NO i (�.1TI NGf PI ERS MONOLITHIC POUR FORMS FOUNDATIONfDAMP-PROOFING BACKFILL A ROYAL ROUGH PLUMB G FRAMING { ELECTRICAL ROU --IN INSULATION: ; FOUNDATION FLOORS L'* 4 WALLS CEILING FINAL INSPECTION: t CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHESfST PS STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES RELIEF VA E INTERIOR TRIMfP ACY DOORS FINISHED FLOORS - GARAGE FIREPROO ING DOOR CLOSER (S) SMOKE' DETECTOR FINAL ELECTRTCA INSPECTION FINAL APPROVAL F CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIEDI REMARKS : INSPECTOR SELECT BUSINESS FORMS 1609) 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. 0810e APPLICANT • MPLETES THIS SECTION ENV Date : 1 IM Town or IQQQUOPL. QueensN try County Warren State DIY Location/Address 25 Queen Mary Drive ( If Located in Rural Area - Please Attach Directions) Pole ax Owner (;jnMR 1 (TTT T) Rq . TNC Permit * Occupied As Building : New® Old Occupant Work Area in Building Floor #, etc. ) : App. for. Wiring 0 service L:3 or: Ready for Inspection : Fee Remitted - $ Cash © Check © M.O. [] Make Payable To : M.D. I .A. 500 750 t666 12 Sa 15aO 1756 2000 2250 250 0 275a 300" 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 H.P. Vent Fans Other Equipment: MOTORS H.P. 1/2 1/12 1/1D 1/$ 1/6 1/4 1/3 1/2 3/4 1 l �lz 2 3 5 7� z LO 15 26 25 3Q 40 5Q 75 160 Mark Number of Each Size Applicant's Signature License # Permit # T/A GUYER 13XJI DER5 INC Utility : Applicant's Address : 119 Dtyruzng Street (NAME (OFF: ICE L[7CATI0 (City) Ballston Spa (State) NY (zip) 12020 Service Request # Phone #_ 899-9161 Electrician : GUYER. BUILDERS INC . • 1161 111, • DATE RECEIVED: PATE INSPECTED : Correct Location : Same as Above Q or-. Red Notice Label [] Rough Wiring Outlets Surface Unit Liven 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 Fi.P. 1/20 1,112 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1I1z 2 3 5 7�rt 10 15 24 25 30 4I1 90 75 1100 Mark Number of Each Size Elect, Heat Sao 750 10001125011500 175Q z000 225Q 25aQ 2]5Q BQoo CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE ODFEECT FEE PAI RW Progress : Inc, E] LKD Contractor I� CFT Violation : Work Comp. Inc. CASH L/A Owner Fee CH K # 0 L/A Due MO IPA Municipal INV # Date : Other Side Utility ApplicantOwner Cut in Card 0 Temp # Hate i. MIDDLE DEPARTMENT INSPECTION AGENCY; INC. National Headquarters 900 Haddon Ave., Collingswood, N.J. 08108 + Date: 7!o!cation/Address Town or ' -s; County Sta 2 D[IVa: ( If Located in Rural Area - Please Attach Directions) Pole # Owner permit # Occupier) As V, 54 Ore - --- ..:.sue-._terms = Ml Suildins: Newm, old Occupant Work Area in Build) Floor #, etc.): for: Wiring rvice or: Ready for to on: Fee Remitted - $ Cash Check M M.O. 0 Make Payable To: M.D.I.A. 5a6 750 E 123a is 175a 2aee 225a 26e0 27sa Aeee Number of Rough Wiring Outlets Elect. Heat Switches Amp. Service Surface Unit Dishwasher Range Lighting Water Heater Air Conditioner Dryer Pump Receptacles - 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 1f10 1/9 1f5 1/4 1/3 lf2 314 1 1J4 2 3 5 716 10 1S 20 25 30 40 50 75 100 Mark Number of Each Size Applicants Signature License # Permit # TIA GU3= mL — nco Utility: � a* Applicant's Address: 119 flt tl�I :,.Yr,It rJFFIC CA i UNJ (City) 1* 1±+u & (State) Wit (zip) 1 q # Service Reuest Phone # 8 1tkl Electrician DATE RECEIVED: DATE INSPECTED: r Correct Location : Same as AboveED or: Red Notice Label Rough Wiring Outlets Surface Unit IrOven ter, Switches ange sposal' Receptacles Water'sHeater DikhWasher Fixtures Air Co itioner' D r Amp. Service Equipment Burner, Wiring & Controls for Arnp. Receptacle Amp. Service Conductors Pump Vent Fans MOTORS H.P. 11/2011/1211/201 lfe jMj3j I Vh 1,2 3 S 7ih l0 15 20 1 25 1 -301 40 f00 1<¢ Mark Number of Each Size 7s Elect. Heat 500 a lean I 1250 xs0a a750 2000 2z5a 2,s0a also a0oa .: _ E 1:3 Rw Progress: Inc. LKD 0 Comtractnr CFT Violation : Work Comp. O lnc.. � . © LIA Owner ;CASH Fee' CHIC # LIA Due .. - . [] IPA Municipal MO # Date: Other Side] Utility � ' { 1pt:licant owner_ _ t Cut in Card 0 Temp # Date ,ram .-.. nal # L .z r'�� �'1-,_Z Date �` r � � - CTORS Sff#N�iTIJRE APPLICATION FORM NO- 250 EL 11186 - MIDDLE D€PAFITMIENT INSPECTION AGENCY, INC. NATIONAL HEADQUiARTER$: 900 Haddon Ave., Collingswood, N .J. 08108 (609) 858-440I;j.. Y � , DELAWARE NEW JERSEY 1815 Newport Gap Pike 1030 Kings Highway North 1525 Cedar Cliff Dr. Marshallton, Del. 19008 Suite 310 Camp Hill, Pa. 17011 (302) 999-0243 Cherry Hill, N .J . 08034 (717) 761 -5340 (609) 667-9200 203 N . E . Front Street 1542 Bristol Pike P.O. Box 306 350 Grove Street U.S. Route 13 Suite 105 Rear Entrance Grove XXI I Corner Bensalem, Pa.. 19020 Milford, Del , 19963 Bridgewater, N.J. 08807 (215) 244-1919 (302) 422-5729 (201 ) 526-0880 (302) 856-2218 Route 19, North 26 S. State Street P.O. Box 136 Hackensack, N.J. 07602 Wexford, Pa. 15090 MARYLAND (201 ) 487-5373 (412) 931 -3028 (412) 935-1558 Milford Professional Bldg, Route 9 3610 Milford Mill. Road Marmara, N.J. 08223 Baltimore, Md, 21207 (609) 390-1940 V I RGI N IA (301 ) 922-1122 3076 Shawnee Drive Burch Oil Co. Bldg. NEW YORK Winchester, Va. 22601 EIS Route 5 - (703) 667-8484 Charlotte Hall, Md. 20622 803 Utica Street (301 ) 645-2219 P.O. Box 145 (301 ) 884-4547 Oriskany, N.Y. 13424 (315) 337-3480 Wash i ngton Co. Office Bldg, 460 State Street 33 W. Washington Ave. Suite 308 Hagerstown, Md. 21740 Rochester, N .Y. 014608 (301 ) 7.91-319() (716) 454-5191 Hitch Bldg. Roam 203 243 Margaret Street - 636 S. Salisbury Blvd. Plattsburgh, N .Y. 12901 Salisbury, Md. 21801 (518) 663-2835 1301 ) 749-0641 Room 301 Maim Street PENNSYLVANIA Court House 121 W.- Tenth Street Elkton, Md. 21921 Erie, Pa. 16501 (301 ) 39"200 (814) 452-4604 Routes 404 & 662 18 N. Wyoming Ave. Wye Mills, Md. 21679 Room 204 (301) 822-8300 : Kingston, Pa. 18704 (301 ) 758-0958 (717) 288-4906 NOTICE TO APPLICANTS: Final inspection and approval may be required by law before electrical current may be energized for use of occupants, The Agency undertakes to provide inspections until final certification is granted if such requests are made within 120 days from date of the last inspection. Upon expiration .of 120 days from the date of the most recent inspection, all duties and obligations owed by the Agency shall be deemed completed, and all fees paid by applicant shall be deemed consideration for services performed. No further inspections shall be undertaken by the Agency without filing of a new application, and the payment of relevant inspection fees. No final certification shall be implied or inferred without issuance of a duly executed certificate. The Agency in accepting application for inspection cannot assume responsibility for unavoidable delays in inspection. "100 YEARS" PROTECTING THE CONTRACTOR AND THE CONSUMER. QUIT VICTORIA'S GRANT QUEEN MARY DRIVE REFERENCE DRAWINGS: 5 SITE UTILITIES SEPTIC & WATER VQnDUSEN & STEVES SURVEY PLAN Q—MODEL ROOF PLAN WILL VARY ACCORDING TO SALE, DRAWING SHOWS ONE STYLE ONLY 2000 gal MODEL : 25,27,29,31,33,35 QUEEN MARY DRIVE PLOT PLAN do SEPTIC SYSTEM GVYER BUII=, Inc. drawn: KW 5/24/89 1 Scale: 1" = 20'-0