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1989-343 . . ..A'1`s. +9: .�...�,�ar.x,. :': ... ;, ,� ;,�, `;: ...�,,..�y.;gyq� �. .. .�,}a+'�.r.�-awM,,.,r+E�vxT "i ;afy..:,..�.. >.��,.���,•... _ Y�.'+'e ^[.air- . yam„ r � 1 CER.TIFfi a ,. - 'TE OF OCCUPANCY TOWN OF +QUEENSBURY WARREN COUNTY, NEW/ YORK Dace October 12 19 89 This is to certify that work requested to be done as shown by Permit No. 89-343 has been cotnpieted. This structure may be occupied as a S i naal am Fa ai l Y_DMI li ny .._. LA)cation ' Hikdel n Hi 7 7 c Drive Owner Stnphwn Kelly By Carder Town Board 4rowrr of QUEENSSU Y Director of Bldg. do Code nforcement e� BUILDING PERMIT TOWN OF +QUEENSBURY No. 89-343 WARREN COUNTY, NEW YORK w „ Vr IWO PERMISSION is hereby granted to Stephen Kelly OWNER of property located at Lot #84 Hidden Hills Drive Street, Road or Ave. in the Town of Queensbury, To Construct or place a Single Fami 1 y 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 . OWNE R'S Address is 11 Willow Road Queensbury, H . Y . 12W4 Mc 2. CONTRACTOR or 8U1 LDE R'S Name C+ Self = 3. CONTRACTOR or BUILDER 'S Address Same 4. ARCHITECT'S Name r- a S. ARCHITECT'S Address Pd• lob S 6. TYPE of Construction — {Please indicate by XI CL I Xkwood Frame t ? Masonry 11 Steel I ? Jr J 7_ PLANS and Specifications --+ No. 26 ' X 281 ( 1456 sq . ft . ) Single family dwelling as per plot plan , specifications , and application , including septic , attached two car garage , and driveway r>a 8. Proposed Use Single Family Dwelling $ 189 00 PERMIT FEE PAID — THIS PERMIT EXPIRES December 1 79 8g con (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 Queensbu 7Sth Day,of May 19 89 f � % RC SIGNED BY for the Town of Queensbury Building and ZdMig I nslpector J, i 'f LV:ti' ©F QUEE 513L'RY rn ' . rc :t r � �: r � :: c � r � r �Ic t. nr� r. R IT P. LC..i V ed '1 k 1 4 V LE'J CCl Fee F'rzCd ` FPUILDINC ANIO CODES ui .PARTTfFNT Vace Iebued' 2 :riY .:ind HAVIt r1ND ROADS RA 2 Box 93 n( EzjvSBURY , NESJ YoRX 22d0 -1 PeAminiot No Tel . ( 528 ) 792 - 5822 £:rc 204 a * * * a * r w ; * a w w * r w r • ■ s s r r r r • a s • r r s a a r r r A PETWtIT MUST DI3 OBTAINED BEI' ORE EEC, INNING CONSTRUCTION NO INSPECTIONS '' ILL BL' MADE UNTIL APPLICANT IiAS P.ECEIVLD A VALID BUILDrNC ,PER ►( IT . All applicable spaces on this application must be conipleted and the mr* macure of the applicant must appear on the reverse side of this sheet . * * x * u k * * * A x h A * * * !. * * * * * * * * * * * * * * * x The owner of this property is : C 2: A r� �Pzz1/ P . 0 . Address ©Aeemo O 4 TEL . 7 ,' - .3ememem i ' ropercy location AVt lylrlelemvi? A1///S o iog g7 TAX MAP NO . / / teas there been any split of this property since October 1 , 1968 ' /I k yes no if yes , Planning Hoard Review is necessary . � UIBDIVISION 14AME , If APPLICAnLE LOT No . The Person responsible for supQrvision of work as regards Building Codes is : 57Le/%9,4 e *7 rL !/,y 790,3 � 3 'a -� 2 _ NArs � P . cs . ADDRESS TEL . NO . 14amc of builder SA hl Address if .'�- ,.//a �/ d9.1 • Tel 7 7 3 r::..me of PLUmber Ao?J & T.dJress Tel Name of Mason /� �i G Andress Tel � a,tiTuRt s7f f'ROF'p�L'D h+JR1 FNNl () l ,411111' 10N ( Ottice use or039 ) '�.•:nn ❑ tructi .:�it of.a iiuw buildiri] + SICNATION OF PROPERTY Ad.iicion co :a l}ui1 �.Iis1g � PRINCIPAL PERMITTED ACCESSORY Alr: wc..Lion to " LuildLnq( iia cl ..,e «2 . to uxe � ri.Dr cliusens- iona ) rQUIRX D - PLANNING BOARD ZONING BOARD_ Uchvr work {..io ::crLL:..� ) SITE PLAN REVIEW # APPROVED DATE , IcOSS ARUA 01'' 11ROPOSIZO, i 'PAUI: 'L' LIEt �r " VARIANCE # APPROVED DATE 1 .•st Floor el sq ft . r Remarks : / ft r '_ nd Floor b sq f c . r COmPL UT"1 " I;1i•gt.MA•1`ION 1(LQU11cLD ui:1e4r60 . Eicher Floors sq ft x . aie.. of prol,wrty !d S ft x / rno ft . ( not cellar or basement ) TOTAL FLOOR ARr.A ] R4 —sq ft . Lxs :.cLafg t�.. il�li { wl 0 =.: i' i :: u u r new :t: ructurw �f t }i ,�� f t ' F'uus �d:acian-pier/ �131r/Cr,awl/ partL..i/ ul r YralaoLwa buil " .Lng , dL:ec.ancu from L.r+al+urry lino ( circ lw one ) r F`ront yard r t Rear y4rd ft N.) . Of . tories ( 'ks.alaic:.iblQ s13aCc1 ' . 3 et and 3o rt 1i,: I ighc { Urada to ri4cjw ) / ft . f o yarad 1 i reuidunciai , na . cxf t.:.miliaa � r on crn c7 ar , :.w ry.ack frara side atrwut f G Noe of raosns 1 alxaludini2 b.ath31 OCCUP mtT Y I NFMWAT ION 11oo of budroasnu FRIMARY LUILDINC as No * or b.►LlsrGasns: ' ' pna fan"ly dwelling Prisa:ary tsu.► ting sry:,:La:in L at _� I-o * Two t:.uLily dvaxlliny 'rYpu of Cuwl G A7 � r+ulciplw dwu.iling / Number of units„_ Noe of firuplaca:a: era Liw insealla:d 4 Peru4aslesat occurs:uicy wLil :a wNN.,S y�ovisi k+u is�sit;. iluaf? � � `L`r:an::iunt tawiCu �.arir= L%tncr.al Air casislxtLran�xig ? r O ' 1 J L3usinw5s UUILDING STYLE, PRIMARY :TRuCTU12E . inctuss:rial 1�w„sicll Lcog cab&n r ^Os:t►�r li.,a L `w�d ranch M.ansiws D"LAI .:x It wddiciont wh.ac will uuu bw? tAPLLL lwvui Grid sscy1Q i1u, i j. 1QW �'..pas c�ad-� Cort"q*2 OLlwr r ACCL'SSony UU11wax"C- a' how '1`owi & Clouse 1.1a: LJGh2U y ar.agc/ono Ciir/ twca c:xr/ c:ar { CIRCLL ONL PLkASE ) X:Attncnua U:ar:aqu/os1.e car/ cwo car/ 1K caa• ■ r a ■ r a a • a r a a a Priv" cu sror"go building I:STIMATI° D iMARKrol" /L+ ALU L: GAF' ' �—Ottxur C0N :;TkUC"rlud $ y _ 1 J ' lsD4 _ _ r 1NF'GRkkATTON ON nUTLOTNC SPF_CIFICA'TION9 , ON CVERSE SIDT OF TIiIS SHEET, `3`o BE COMPLETV01 Form BPA 10/88 v2 8lili^ I*rG ? RMIT AFPLICATT_ 'CN _ _ ..`: INUE^ - o� ILGifvG SPECIFICr".TIOraS ; ,,f type ci construction , wood frame , r' ire safe , etc _ Will any second-hand or ungraded lumber be used ? If So , for what ? caun nation wall material / -ae, 4 ` e7,G,l Thickness E r� Depth of foundation below grade ( to bcttom of footing ) e4v' 6 " — Will there be a cellar ?_ Heated or unheated ? e-e Floor sq . footage ? ,Qea sq ft Will there be a basement ? - Will any portion be used as living space ? /Lem ( If so , what portion? sq . ft . - - Type of use? Type of roof - 4:10 e flat/shed/other. Material of roof Size , wood studs " X� " spacing.-" o . c . length ft . JaYstsifloor beams ) lst . floor m spacinq_ig" o . c . Spaniel e ft . Joists ( floor beams ) 2nd . floor y" x " spacings"' o . c . span-ft1 overlays { ceiling beams ) "x spacing " o . c . span ft . Roof rafters "' x " spacing o . c , span ft . RoofRooftrusses (pre-engineered) spacing" c . c . scan &2p- ft . Exterior wall finish Of what material ? JG / /1 Interior wall finish $'fj 'e e- If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 7/ f /.R e ,v ¢.ram/ T.4 e e yr eJO�Oc e Is there to be an opening between garage and dwelling? if so will a Fire- rated door , enclosure , and self-closing device be provided ? ]f" oe5 Will a flue- lined chimney be installed ? 4,ee9 Height above roof ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth ft . in . Water supply - Municipal or private well e. IIOA!;7 SEPTIC SYSTEM _ Distance from ANY private wellCincluding adjoining properties ft . ( n separate application is necessary for any repair or new installation of septic system) DECLAR ATIOi`d 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. I Signature / a 4 �� Owner, ow er's agent, arc itect n otractor SPECIAL CONDITIONS OF THE PERMIT . By. ... .. ...................- ____......___ TOWN OF QUEENSBU RY WARREN COUNTY # NEW YORK Application for : S[3IY.1]ING PERMIT IN COMPLIANC9 WITH THE NEW YORK STATE ENERGY CONSERVATION CODE. A permit must be obtained before beginning wont . ANSWER ALL of the following : 1 . , Gross floor area 2 . Type of heat 3 . Is the building mechanically cooled ? T 9 . Percentage of area of windows and doors 4tkd � A , over 16 % gal ym 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 perim ,� .uer of floor ? 9 . Is basement heated ? YES NO 40 R value of insulation 5 . Type of insulation 60 Under 16 % Only . 10 li value of roof and floors expgssed to ambient conditions. 2 . R value of exterior walls lC •3 . R value of glazed area 4 . R value of doors 5 . R value of floors over unheated spaces t 6 . R value of slab edge insulation+ ^ unheated slah� 7 . R value of slab insulation - heated slab + 8 . R value of heated basement/ cellar walls ( above grade ) 9 . R value of heated basement/caller walls ( below grade ) 10 . Type Of insulationtj C . Controls y � 1 . Thermostat maximum heat setting 4 D Duct Systems mmmom- 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 ,w size of hot water 'or cooling carrying agent pipe 2 . R value of pipe insulation_ F . Service Water beating 1 . Performance wfficiency MIN �w�" / 2 . Temperature control setting maximum r ` � t G . For Swimming Pool Onl mXm 1 . iKaximum heating Telephone No . / / - � '� - ( a plica t s nature } TOWN OF QUEENSRURY APPLICATION FOR A% ;'✓ �� SEPTIC DISPOSAL PERMIT DATEf ./� LOCATION OF PROPERTY FOR INSTAL/LATIONp owner's Name: .5t ho el, y Telephone: 4J �- Address: lr Ae, 41, Installer's Name: I L1 C..,rv"',� /- " Telephone : 7/ 5f Number of bedrooms (residential only) " Total daily flow (compute (d 150 gal per bedroom ) er Topography: Circle one: Fla Rolling Steep Slope ° of Slope :Soil Nature: Circle one: a 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 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 SYS=M : Septic Tank gal. ( minimum size : 1 . 000 gal.) TILE FIELD: Each Trench feet/Total system length feet SEEPAGE PIT(S): Number of / Size eachlj® feet by feet 1 Size of stone to be used #.a./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 anitary Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: f DATE: j .gyp`' ,/ d7 OVER Su tic System Inspections : A . All applications for septic system installation , alteration or repair , as required by the Town of Queensbury Sanitary Sewage Ordinance , shall be submitted to the Building 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 S . ) size and dimensions of all, tanks , distribution boxes , mile fields and / or drywells B . No system shall be covered before inspection and approval by the Building Inspuctor . Failure to comply with this requirement may result in the uncovering of the system by the installer and a fine (if up to $ 1-150000 . 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 immediac e work stoppage . D . Should unforeseen problems during construction prevent proper installa— t101) , alteration or repair of an approved system , a new proposal must l;e submittod to the Queensbury Building Department before further c oiis t ruc t ion . Town of Queensbury BUILDING and C0DES DEPARTMENT Bay and Haviland roads Queensbury , New York 12804 Qcorcu . . , . - . - . ! . • . . . . . , NAME AND AUORESS OF AGENCY - COMPANIES AFFORDING COVERAGES I IL G . Jack Robinson Assoc o Inc. LETTERNY �. A EVBfZMM Plaza■ Avillif I P.O. Box 4749 Ph. 798480 COMPANY- LETTER NAME AND ADDRESS dF INSURED COMPANY LETTER vv StCOMPANY # ";I�i 4l Lj4; '� 3. 1 , D LETTER s "t_"'�.�� �. �.�-•- .fir Jt. �'C ���.C --�-�—,n�Y�.-��"";, .r';.'- =dFiiliii ,�-,'�k�ys„?1F': COMPANY - -.. is Willow Roar! This Is to ItItlBlt'tl ilR��7b In IIa�Ce dr io n issued to the insured named above and are in force at this time. Notwithstanding any requirement, term or condition of any contract or other document wish 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 poliCiOS." LIMITS 4F LIABILITY IN THOUSANDS (dDO) 1L�ERY TYPE OF INSURANCE POLICY NUMBER Expi POLICY EACH gA710N DATE OCCURRENCE AGGREGATE GIENEFLAL LIABILITY BODILY INJURY # COMPREHENSIVE FORM CCP31 39938 3 / 11 / 89 _f PREMISES—OPERATIONS PROPERTY DAMAGE S' EXPLOSION AND COLLAPSE HAZARD r i, UNDERGROUND HAZARD _ L PRODUCTSICOMPLETED y OPERATIONS HAZARD BODILY INJURY AND �_ 1 CONTRACTUAL INS3UAANCE - PROPERTY DAMAGE 1 * 000 : 0 BROAD FORM PROPERTY, _ COMBINED DAMAGE - ■�. IN DEP. CONTRACTORS - . . " PERSONAL INJURY - I PER SON AL INJURY AUTOMOBILE LIABILITY _ 80OfLY INJURY # .-" _ © COMPREHENsivE FORM ,� .� 3 �r � ' f BODILY INJURY OWNED [EACH ACCIDENT] # A HIRED PROPERTY DAMAGE # BODILY INJURY AND NON-OWNED PROPERTY DAMAGE COM8INEDCx E%GESS LIABILITY - BODILY INJURY AND UMBRELLA FORM PROPERTY DAMAGE M1 OTHER THAN UMBRELLA = # FORM COMBINED WORKERS' COMPENSATION STATUTORY ` and NC3181147 - 00 4l26f89 A EMPLOYERS' LIABILITY - # EACH ACCIDENT) OTHER 4 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES Cancellation. Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail days written notice to the below named certificate holder, but failure to mail such notice Shall Inn' pose no obligation or liability of any kind upon the company- NAME AND ADORESS OF CER7I FI CAT HOLDER DATE ISSUED: October 21 ■ � 9 � �' Town of Queensbury Town oftices say Road �d` .r `JTG/t � A T Queens wE * ISSUE DATE iMMiDDlY'y"• PRODUCER THIS CERTIFICATE PS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS CERTIFICATE DOES NOT AMEND, �� Y ., (�LENS ,; � � EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. GLEN ST wL E l s L :_ , N ,* 1 1 COMPANIES AFFORDING COVERAGE •--rc.� A ,... r3Sx.^,o^* �yx , ._�... s. i�<=a <*a- rr ::- yy--�� INSURED KELLY El GLENS �'-ALLS .l NY 12SOI E • THIS IS TO CERTIFY THAT POLICIES OF kNSURANCE 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. cc LTR TYPE OF ;NSUrC-ANCE a01- Cv Nkj,%"Dc.' ALL LIMITS !N THOUSANDS n r*.-^. -r. .n r n r. rT-3'/=r. F-s GENERAL LIABILITY 'I'^- :.: 3 .._ f°: ' *./ 'v s ; + ;` ki...�^.' .-, .f. : .r - ._=a� w;:;;�E . „�' *r+ CONINASRCIAL GENE..A� '_ ABCIL Tv _ _ .:,YC �Ln,•: �P. ?GuaeSi-: �` _> 'J� `.7.%L'F Ea' Si NG "J.:::Py $' l ! i oo WONEER S 3 -. MR4 P3C. EC`.E ! u fW' _ v.%)AAG" :A•i'r GNE EiPE- „�j ANY ENE aE RSONI $ C; AUTOMOBILE LIABILITY +aL. •J'r'i r.Ei7 AU�CS 3•vG SCH=_0U_E0 AUTOS a'E rSC h. � .Tr V•.7N-0W%dE0 = 17 d GGS yL aGE h'; +. GARAGIc LIAB•L s EXCESS LIABILITY PdkcN AGGRE�A-E :.Cr'4RREYCE s $ GTHE« TrIA"i U'.+BRE__+ KGRM _ - WORKERS' COMPENSATION F ^ AND :';1fv .=iSL AS= EMPLOYERS' LIABILITY I ! C� 0-%f OTHER I DESCRIPTION OF OPERATIONSe LOCATIONSi VEHICLES • RES'RiCTIC)r.S DD�E'C:AL `E%4,5 l:ER'T`IE --rCi TE HOLDER IS €kEr.�.EC= is DDITI = Nt` 4L IN�U IRED iti' R:P: 5PEI 'r5 WORK DONE Fop, THE TOWN OF PQDULENSRUP.Nbi� A 'T' / O QUEE1` II::�B IRY SHOULD A:NY i`1. F--JPE ABOV E DE SCF41 BED POLICIES BE CANCELLED BEFORE THE EX C fir, BUILOING DEPT . P!RATION CATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO TOWN OFFICE SLOG MAIL DAYS WRITTEN 'NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE BAY RO 40 DEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UEENSBUR- , NY 1:.::804 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. ALTHORIZED REPRESENTATIVE r 7 TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT RAy & HAVILAND ROADS QUEENSBURY,. NEW PORK 1280ak TELEPHONE (518) 792-5832 BUILDING INSPECTOR.' S REPORT REQUEST FOR INSPECTION RECEIVED _ NAME LOCATION DATE —�/ � PERMIT # ZF •�11 APPROVED YES NO FOOTING/PI S MONOLITHIC UR FORMS FOUNDATION1D P—PROOFING BACKFILL APP VAL ROUGH pLUMBIN FRAMING ELECTRICAL ROUGU--IN F INSULATION: FOUNDATION FLOORS WALLS OFfLING NAL INSPECTION : z CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STE IS — STAIRS CLEARANCE & 1�f91`LS PLUMBING FIXTURES/RALIEF VALVE .TNTER.=OR TRIM/PRIVACfY DOORS FINISHED FLOORS _ GARAGE FIREPROOFING 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 OCCUPIEDI REMARKS : 4 6�6 09 fa tes LA- �- lS INSPEC R TOWN OF QUEENSBURY � �, BUILDING AND CODES DEPARTMENT HAY & ,HAVILAND ROADS STYNEW Y 0� ELEPHONEJ ( 5 8) 792-5832 BUILClING INspECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED- NAME LOCATION t PERM T DATE K #„�_,L] i ` 3 APPROVED YES t NO FOOTINGI ERS MDPJt7LITHI , POUR FORMS FOUNDATION P-PROOFSNG� BACKFILL Ap ^IVA L ROUGH PLUMBIN FRAMING ELECTRICAL ROUGH N NS UL.ATION FOUNDATION FLOORS r WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE &,` RAILS PLUMBING FIXTURES/RELIEF V LVE INTERIOR TRIM/PRIVACY DOOM FINISHED FLOORS GARAGE FIREPROO ING i DOOR CLOSER (S) �Z--- SMOKE DETECTOR- ~- FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION i A SIGNED CERTIFICATE OF OCCUPAN MUST" BE OBTAINED FROM HE BUILDING DEPAR ENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: -INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I280!1- TELEPHONE (SIS) 792-5832 BlilLL)ING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME I AC CA TIGiN DATE %,y&2 PERMIT #H_ 9 APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—PROOFING BACKFILL APPRO'RAL .- jeol�OUGH PLUMBING C, eP.AMING ELECTRICAL ROUGH—IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPEL TIDN: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES. TEPS STAIRS—CLEARANCE ;& RAILS PLUMBING FXXTURrA5/RELIEF VALVE INTERIOR TRTNIP IIVACY DOORS FINISHED FLDOR�4 GARAGE FIREPFING — DOOR CLOSERS SMOKE DETEC FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OJCCUPfIED ! REMARK fy oe e'z q+ / -71 A, 4olAC11;-f Xlro, !r �,.4{f� �.�; � yr (w 1-�;. �.fir'" �-,''/'• - ' INSPECTOR _._..lo wn 0/ Qu ee n 3 6 u r r�F BUILDING and ZONING DEPARTMENT Say and Wauiland Road. R .D. i Box 98 queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME_ LOCATION nAT'E PERTtiI7 NO.' � " ` SOIL TYPE - and Loam - Clay - Percolation es Required? YES _ NO Percolation rate - Min/Inch - TYPE of SYSTEM: y Absorption field , total length Length of each trench,,_ rd_' Depth of trenches ' 1 size of gravel ^� SEEPAGE PITS-Number of) Size- ft. X Gravel size PIPING : Size Type f .• Bldg . to tank = /V Tank to dist . brk Dist . box to fiPartial Openings sealedO LC)CATION/SEPARA �r f t. Foundation to t Foundation to a + Absorpt ea ion to ft . separation of LOCATION OFSRR ght1rcle side one) Front - ecxHMENTs = , � X Ze SYSTEMS USE: APPROVED S. N Building I ector Ol/B6 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I280k TELEPHONE (5I8) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION DATE - C — �I __PERMIT 3#_ 1 APPROVED NO FOOTINGIPIERS MONOLITHIC .POUR ;FORMS LeYkOUNDATION/DAMP— ROOFING j,0ACKFILL APPROVA ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTIONr CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ST PS ,STAIRS—CLEARANCE & RAILS PLUMBING FIXTURES ELIEF VALVE INTERIOR TRIM/PR ACY DOORS_ FINISHED FLOORS GARAGE FIREPROO ING �- DOOR CLOSER (S) SMOKE DETECTO FINAL ELECTRICA INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: C � 1 ' r A INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAV I LAND ROADS { ' QUEENSBURY, NEW YORK 1280& y TELEPHONE (51 8) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED � I3 �� NAME LOCATION DATE / y PERMIT # C 1 3 APPROVED YES NO i-^'�QOTING/PIERS MONOLITHIC POUR ORMS FOUNDATION/DAMP- ROOFING BACKFILL APPROVA ROUGH PLUMBING FRAMING s ELECTRICAL ROUGH-I INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHE /STEPS _............_ STAIRS-CLEARAN E & RAILS _w PLUMBING FIX ES/RELIEF ALVE� INTERIOR TRI /PRIVACY DOO FINISHED F RS GARAGE FIRE ROOFING DOOR CLOSE (.S) SMOKE DET RS 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: t7 INSPECTOR SELECT BUSINESS FORMS (609J 848-5203 APPLICATION FOR ELECTRICAL INSPECTION PLEASE SEAR DOWN YOU ARE MAKING (4) COPIES MIDDLE DEPARTMENT INSPECTION AGENCY, INC. i r""f11 p�1A� � National Headquarters = -� 900 Haddon Ave„ Coliingswood, N.J_ 08108 7Lo Date :n orTownshipee ,, ' �f �V County EG F' StateAddress pF- �^ ( if Locate in Rural Area - Please Attach Directions) Pole # Owner ep,4 eos7 6!' P/r Permit # Occupied As d "7 Cc, "[ - Building : New[W Old 0 Occupant Work Area in Building Floor #, etc. ) -- App. for: Wirin Service or: Ready for Inspection : Fee Remitted - $ v Cash 0 Check 17D M.O. Make Payable To : M.D. I .A. 500 T50 SPPP 125D 15D0 1150 2D00 225P 25P0 275D 30DD Number of Rough Wiring Outlets Elect. Heat Switches Amp. Service Surface Unit Dishwasher Range Lighting Water Heater Air Conditioner Dryer Pump Receptacles Oven Garbage Disposal Wiring and Controls for Burner Number of Fixtures Amp, Receptacles Fractional H-P. Vent Fans Other Equipment: MOTORS H,P. 1/2 1112 1/10 1/11 1/6 i/4 113 112 3/4 1 111x 2 3 5 7112 10 15 20 25 30 40 50 75 100 Mark Number of Each Size App Sign ature Signture ' i . /✓ License �* Permit # na T/A Utility . INAMEI FICE L CATION Applicant's Address: _ k .41&AG4✓ (City) (State) .r/Ao (zip)/ �2 ,, ` — Service Request # Phone # Electrician : DATE RECEIVED: DATE INSPECTED : Correct Location : Same as Above [] 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. 1/20 1/12 1/10 1/8 1/6 1 /4 1/3 1/2 3/4 1 11/7 2 3 5 74x 10 15 20 25 30 40 50 75 100 Mark Number of Each Size t. Heat 500 150 lo0a 1250 1500 17s0 2000 2250 25D0 2�50 30OD Patrri}c�k¢J Da5hnar lii1d5f3n Y31 i5, ` 41 F 5 ie/ 1`3$-34 i 3 CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECT ,FEE PAID FEE RW Progress : Inc. LiKD Contractor 0 CFT Violation : Work Comp. Inc. CASH [ LIA Owner Fee CHK # LIA Due N10 # 0 IPA Municipal INV # Date : Other Side 0 Utility Applicant Cut in Card 0 Temp # Date _ At �' v yy t i � s c M ys ft s ..y F t- e _ t z .. .�. y,, e 4. "Wk c Dr �. ac Ctr?o� %.DC-, t T , L'-1- , �:- * '... i .may _ .. � ✓ '��^ fII b P-N 0