1989-333 CERTIFICATE OF C�CCLTP AN CY
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YORK
Date 19
ri
A , kc . \r/ Jk� /^ _
This is to certify that work requested to be done as shown by Permit No. 89- 33
has been completed.
This structure may be occupied as a Addition to Dwel l i na
L.cOcatio � Su. e� de_ 3iori t'
Owner Matthias Greene
By Order Town Board
" owr4 OF QUBEIVSDURY
E+irector of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY Na 89-333
WARREN COUNTY, NEW YORK o
t
PERMISSION is hereby granted to Matthias Greene - ---
ro
OWNER of property located at Snnnyside North Street, Road or Ave.
A
in the Town of Queensbury, To Construct or place a A di ti nn to Dwal l i ng 1
at the above location in accordance to application together with plot plans and other information hereto filed and CM
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1 , OWNER'S Address is
RR 1 Box 310 Sunnyside North
2. CONTRACTOR or BUI LDE R'S Name
zr
SELF
rr
rr
3. CONTRACTOR or BUILDER 'S Address rrrr
SAM �
t-1
of
d. ARCHITECT'S Name IN
A
1/f
5. ARCHITECT'S Address
S. TYPE of Construction — (Please indicate by X) V
G
a
( ) Wood Frame ( 1 Masonry f 1 Steel I 1 aaC
N
J
7. PLANS and Specifications M
No. 500 sq . ft . addition to dwelling as per plot plan , specifications „&XX
and application .
S. Proposed Use
Addition to Dwelling (Bedroom, bath , & laundry room)
c/o Incl .
$ 40— nn PERMIT FEE PAID — THIS PERMIT EXPIRES npe-pn*w-r 1 19_$s_ -+
(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_I
1'1
Dated at the Town of Queensbury this 22nd ---Day of __JMay
a
SIGNED BY for the Town of Queensbury _
Building and Zoni rig 4 nspector -'
a
ue:I
TC��►�`N OF QUEENSBURY APPLICATTON FORRUTLPING AND ZONING PERMIT
Pate- OWN- root , i]F
R ec i eU ed 'ReCEi eeN f3LRY
�11 MAY I a 1989
Fee Feud t� BLp�. 'CO
WILDING AND CODES L11111ARODIa,'T Date I.6bued 'rll D+� 1DEp7..
BAY rend 114AVXr.,A4ND ROADS RD I Box 98
(')UEEMSBURY, WR1%F Y0RK 12804 PehniZt No .
Tea . (518 ) 792-58.32 East 204 -
A PE.M.11T MUST 13.4 OBTAIrlF. D BE17ORE BEGINNING CONSTRUCTION * NO INSPEC i6NS
VILL BE MADE UNTIL APPLICANT HAS RLCE IVEO A VALID BLILDINC PERMIT .
All applicable spaces on this application must be completed and the
Qblvuature of the applicant Plust a.p car on the reverse side of this sl� ect .
X 4h A % * A * * * A % * A % % h is at
� i ,�i
1111% e owner of this property is : 1la-r,--`.yam- S C" ro,� ne
P . O . Address _8 R ! is n *k ? r c+ ,�nTi.r�� ♦t/r+, t -� � T E L . "'� c/ . � � � f y2 i �?� -�c��
Property location S A01 ArsrAk\ -TAX MAP
, , as there been any .split of this property since October 1 . 1988 ?
yes no
7f yes . Planning Board Review is necessary .
SUBDIVISION NAME , IF APPLICABLE LOT NO .
The person "responsible for supervision of Work as regards Building Codes
Aiu
NAbtLb P . O . ADDRESS Tel . Nov
Name of builder Address Tel
tsuu>t of Plumber T.ddress Tel
Name of Mason Address Tel
14ATURk OF PROPOSED 4%GRK: . ZONING INFORHA.TION ( 0 .fTlca use onI '1J
Con :: tructiori of a now buildingi ar ZONING DESIGNATION OF PROPERTY
%g'-Addition to a building # PERMITTED PRINCIPAL PERMITTED ACCESSORY
_, - Altt.:r"tion to :► building
( leo cle eltg4 to cxr � r.ior clilncrision:, 3 a REVIEW REQUIRED -- PLANNING BOARD ZONING BOARD
O[l+i: r work (aan crl-bo) ' SITE PLAN REVIEW (( APPROVED DATE
r
CROSS AREA OP PROPOSED. STRUCTURE VARIANCE # APPROVED DATE
let Floor ,jt"' fJ sq ft . „
Remarks :
2nd Floor sq f t . w COMPLL:TE SFI1 L]l Nu►•1•] LiN laLflUlleLD isi 1.Lri1 .
'� .�.z 1•l.a: of pxoLla:Yty Il.i'C.:} tt x f��. fC +
Other Floors sq f t . a Existing L x of 7 rc .
( not cellar or basement ) W
TOTAL FLOOR AREA f t7 sq ft a L'xi::Gina buil�:tinq ( :: 3 U::a:
40iw42 (if nC:w :structure: —x� f t X ; LfC
►•Uaaedation-p.icr/slab/Crawl/L3artial f40) " VXOpoUL:a 1adLlainq , di::tancu Yalu I�ra?jaasL ty liriu
(circle one ) W front yard 2 Fs ft Rear yard _ .sy� ft
Neto of ncorierb (3eabi. t:eblO :_:IazeCe ) 1 w side yard:;; 7c•> rt :And ft
lluight ( grade to ridelu ) _ 46 ! ta " ' ft • I C on corner, i;o tb4ck TtOM side at ru[ t [ L
If ro:3idunGial , no . of families I
too , of rooln.n ( excludinq b"thsj _ t OCCUPANLY INFOR.h1ATICN
Noo of bodroolns "
„ PRY?9:h.ItY TsUILIlINC ASO
No , of "Lllroola:: 1 ,.r pno faukily dwelling
l•villury lll.::etlllq :�y �Le:lll� s4c. 4 A }'' •L'1,1C1 f:.SI►1ly dwe:llinq
•rypQ Uf fuel_ c�1 1 , -- Multiple dwelling / Number of units
NO . of fireplace:, to tau .in::talle:d a 1'a:rluane lrt oce:up;uacy
Will is W004A sLQVQ L+: itx:stallud? .. v " •Cxiln-:iuteL accuparec y
�4"ritCill ALL• Coo& itio"J0119 .}� ,A/ 0 rjW
I3aa«.lrie:as
RUILDING STYL.C, PRIMARY STRUCTURE „ Inclustxial
AW Other
.ae►c Conte+uj ir.+Yy Le,n cabin it f7rwil{ Il u :e t,
I ..:?
ld.:.e3. :.:L.d r.7llClt M:eri:.i .iG� l Du1�1 [,:% r�� '� 12 l ~ -r-
uplit luvdl Old seyl.: %Auee•3.. Iow ---T--
C: 'Pu Cod CoCt"go OCtaur t ACCESSORY UUIL.DING—
(:oIaseia1. tcLow •J.'[]urs S�IOUS@ La,::C.1Che:d [j:.lYi�gL,�/4nD ._.S_�xr,,/ two CiA
{ CIRCL,I: ONl PLb;ASE ) _yAttache a etara�jawe;a Car two car/ cue
a a a a a a ♦ * a Ita a x x a w K 1'riVieC.2 s.tearsege latjl s.ng
L: .STIMATED MARKET VALUE OF W rOG.he: r
CGN ::'1, kUC'l' IC1M
INFORMATION ON DUIL.DINC gPRCIPTCATIONSt ON RCVERSE SIDE OF "T"TS SlILL `1' � 'rO BE COMPLG•reol
Farm DPA 10/88 vI
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe , etc .
Will any second--hand or ungraded lumber be used? If so , for what ?
Foundation wall material j.a i s3, cc ics Thickness i do +
Depth of foundation below grade ( to bottom of footing ) el
Will there be a cellar eate or unheated? Floor sq. footage JO " sq ft_
Will there be a basement Will any portion be used as living space ?
( If so , what portion? sq . ft . - - Type of use?
Type of roof =loped flat/shed/other Material of roof
er X rs €A t f r � i �, ; - 7� y
Size , wood studs _' X spacing__.,1_G_" o . c . length `21' ft . � --�
Jaists ( floor beams ) 1st . floor - " X�K -" spacing_ r-
Joists ( floor beams ) 2nd . floor mix " s cing "o . c . span ft .
Overlays ( ceiling beams ) _ _"X�" spacing " o . c . span ;Iy ft .
Roof rafters "X $ " s� pa�cing�___L_6Lo . c� . s. phan�[ ft .
E $ p 31neered _ " . san-� t .xteriarwa13 finish maim ? weat material ? AC Interior wall finish
if agarage is to be attached , describe materials to be used for FIRE SEPARATION :
rUr k
Is there to be an opening between garage and dwelling? X.._> _ if so will a Fire-. ate}-d - ---
door , enclosure , and salf-closing device be provided? � �
Will a flue-lined chimney be installed? 'Height a ve- roof ft .
Depth of chimney foundation below grade ft .
Depth of fireplace hearth ft . in .
Water supply - Municipal or private well Pr ; v � -1 e_ 0
SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties (:r- ft .
(A separate application is necessary for any repair or new installation of septic system)
DEC L, ARAT10N
To the best of my knowledge and belief the statements contained in this
application , together with the plans and specifications submitted , are a true and
complete statement of all proposed work to be done on the described premises and
that all provisions of the BUILDING CODE, THE ZONING ORDINANCE, and all
other laws pertaining to the proposed work shall be complied with , whether specified
or not, and that such work is authorized by the owner ,
Signature , f �_ ��
Owner, owner's agent, architect, contractor
SPECIAL CONDITIONS OF THE PERMIT :
B
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 P-f
2 . Type of heat en ; j /-As - f i r
3 . Is the building mechanically cooled ? pj0
4 . Percentage of area of windows and doorsr'rr
A . Over 16 % Only
Y . 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 roof and floors exposed to ambient conditions .
2 . R value of exterior walls - ! Gr ��tt
3 . R value of glazed area 74 .3 G
4 . R value of doors ! i`, IL
5 . R value of floors aver unheated spaces_ 1Cj
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 ) )
91 R value of heated basement / cellar walls ( below grade ) __ �_"�
10 . Type of insulation,ejjk.ef )� V 5 G of A:�(
Co Controls
1 . Thermostat maximum heat setting v "
D . Duct Systems
1 . Is duct system installer) in unheated spaces ? YES N4
a . If YES , R value of duct installation
b . R value of duct in other areas.-
E . Piping Insulation
10 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 No * l L /✓ '7 '' '`'�' z_ti- x _ '_
( applicant ' s signature )
TOWN OF OUEENSSURY
13
1
lI14D314G & CODE ENFORCEMENT
74-2 SAY ROAD
QUEENSgURY NY 12604
r �� INSP :
f DEPART : ____----
ARRIVE : ._-- -- _ RESIDEMTjAL
! f'YIIAL INSPECTION REPORT
DATE IN^.� C ON
S T C g I V E'L1 : S
N AME
fl LOCATION PERMIT
T Y S E
TYPE O...PE OF STRUCTURE FRAMING
ancKFxL TaoN
FQOTINGS___„_ FflUNOP'T N INSU
S PTIC IREPLACE,�-
ROUG11 PLUMBING WOOASTOVE OR
FINAL ELECTRICAL
a VENT
CH 1411 y HEIG_�fT,�T--v--
PLUMBING VENT
ROOF
EXTER OR FINISR
DECK!Pi7 R
Ei! STEPSLRAr t rNG
RE J IEF ELVES
FUR A Hflil
p PE
iNT RIO TRIi1 RIVACY DO R
kt �
FINtjFLOORS :
�!HATH l tiE WTT� S-1.T
0 11FsR FLOC EPA LE
OTHER FLOORS CARPS ED
STh It?--Cx' ARANCE RA INGS
ca:OKE D_91—E Tfl S
A FAN
U NG x T S
FOUN�'x IN _ +'TION
�------.._�—
AR.A E R, OOF NG
DOO C SER
44
HAL EL CT
� sxT P A
V RIANC F' `
S
FINAL Su V
O S O O
rr+ � _ 4 f ItCI�I�Cr�e
i
I
1 a
TOWN OF QUEENSBURY
BUILDINC+ & CODE ENFORCEMENT
742 SAY
awl QUEENSBURY NY 12804
C (518) 761-8256
_�2 �W DEPART :
ARRIVE :
F•INAI, INSPECTION REPORT - RESIDENTIAL
phT6 I.NSPECTIaN
gT RECEIVED :
7 'rY
NAME fd y
L ✓
OCATION �/f ,/'„"I!i'" '?. j
f ! f PERMIT
VATS � ✓
TYPE OF STRUCTURE
SE BACKFILL FRAMING
__...
FOOTINGS FO[1NpATIEP INSULATION
ROUGH PLUMBING WOOD
FINAL ELECTRICAL WOOD OR FIREPLACE
N R YES NO
E V I{ G
I I S
VA VE
W aP I
R VACY ORS
5 '
S SWE A E
a ft S C R T p
asp CTEA - NCE ^ ^ * L 14G
D T S
FOU
5
G E
� ND N U T N �r
A F E a N
S
C
T P AN V R NCE
SU V P PL JAkk N
TO IS UE C / OR C C
TOWN OF QUEENSBURY
531 BAY ROAD
NEWTELEPHONEY ( 518)0745- 4447
BUILDING INSPECTOR' S REPORT
FI44AL INSPECTIOII
REQUEST FOR INSPECTION RECEIVED
f
NM 1'w , , E t . S ' L .
4 nL , 11
LOCATION
PERMIT# S 7 �`� ��
DATE
TYPE OF STRUCTURE
RECHECK -
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE )
�iFOOTING AFOUNDATION XBACKFILL 74FRAMING
ROUGH PLUSMBING FINAL ELECTRICAL��SEPTIC
)(INSULATION WOODSTOVE/FIREPLACE
k � .
REMARKS I. iv;a:
APPROVAL
N/A IYES NO
CHIMNEY HEIGHT/LOCATION
8 VENT/LOCATION
PLUMBING VE14T
ROOFING
SIDING
DECK/PORCH/S EPS/RAILINGS
RELIEF VALVES
FURNACE/HOT W ER OP ER T N
BASEMENT
INTERIOR TRIM/ PRIVACYUDOORSK
FINISH FLOORS :
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS
SMOKE DETECTORS
BATHROOM FANS/WHOLEH0 SE FAN
. L PLUMBING FIXTURES OPERATI G
?AGE FIRE PROOFING
;R CLOSERS
4 .4ER FIRE SEPARATION
'IE/DEMISE WALLS
G 4PSTER
S CE PLAN/V R ANCE REQU IRE M N S
FINAL ELECTRICAL��
OK To ISSUE C/o OR C/C�
COMMENTS -* vyt r f ( G
ARRIVE���
DEPART... ti iNSF
CT A/A�)
-cf I (a 1
LA utr
CTra i NCO ( A)6-
tv PAJ
TOM OF QUEEmSBURY
BUILDING AND CODES1 BAY DEPARTMENT
QUEENSBURY, NEW
WORK 128P4
TELEPHONE t
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION
DATE I �7 'PERMIT
TYPE OF STRUCTURE u
APPROVED
RECHECK N/Al YES NO
FOOTINGS/ PIERS
MONOLITHIC POUR FORM_�---
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOWING
THE PLgCE]HENT OF THE COlIGRETE .
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/ DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/ VEN S N P CE
PLUMBING UNDER SLAB
FRAMING :
KGIS DS /FADERS
BRACING/ BRIDGING
JOIST HANGERS
JACK POSTS /MAIN BEAM
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING ROUGH— IN
INSULATION : 'u
FOUNDATION WALLS INTER R R—
FOUNDATION WALLS EXTER OR Ripp
—
FLOORS R—
WALLS
CEILING
DUCT WORK OR P IP ING IN NHFATEI
SPACES
RE RKS : ,�J.eR, 1lcCL.•Z.�° q� f r t- ` �,+ ciK
ARRIVE
DEPART,. I NS PEC TOR
TOWN OF QUEENSBURY
531 BAY ROAD
QUEENSBURY , NEW OR45IZ 04
TELEPHONE
47
SUILDIN6 IKSPECTOR ' S REPORT
FINAL
I NSPECTI ON %T0"'f ,+�,�
REQUEEST FOR IPESPECTION RECEIVED-� �-'�.,,"`--
KANE
LOCATIMl Jc 'v v r
PATE - -I fRHITT# /�/
TYPE OF STRUCTURE /for'/rTTd�
RECHECK
FIRE MARSHAL APPROVAL ICOOMERCiAL STRRAMUNG)
{7TING *" JNDATIGN coSACK'FII.L SEPTIC
vKoUGH PLUMBING
FINAL ELECTRiCAL�—
✓_ [ NSULATiON WGODSTOVE/ FIREPLACE
REMARKS.
��------- --- �` APPROVAL
N/Al YES_ i NO
CHIMNEY HEIGHT/ LOCATION _ 1
B VENT / LOCATION ____._
PLUMBING VENT ,__.__,��__—
ROOF I
SIDING_ _ _____ �.__
DECK/ PURCH/ STEPS /RAILING
RELIEF VALVF.S-
FURNACE/ HOT 'WlT QPERATIN
BASEMENT imSULATION/DU%TWOR
INTERIOR TRIM/ PRIVACY DOORS
FINISH FLOORS -.
BATH/ KITCHEN 'a4ATERTIGHT
OTHER FLOORS SWEEPABLF_.
OTHER FLOORS CARPETED _ .
STAIR CLEARANCE/ RAILINGS,
HANDICAPPED ACCE`_',S�
SMOKE DETECTORS
BATHROOM FANS/WHOLEHO Sl1 E F NS
ALL PLUMBING FIXTURES OPER TING
GARAGE FIRE PROOFING
DOUR CLOSERS_ -_
OTHER FIRE SEPARATION
FIRE/ DEMISE WALLS_
DUMPS TER_ __---..------•---
SITE PLAN/ VARiA�I% E REQUIR MENTS
FINAL ELECTRICAL _ .___.�_
OK TO ISSUE C /O OR C /C
-OMrE
J
dr
ARRIVE
DEPART_-�3' T �,- IN5P
TOWN OF QUEENSBURY
BUILDING AND CODES D'EPARTMENT
BAY & HAVILAN— PORK 12801&
QUEENSBURYr ' g2_ rjg32
TELEPHONE (518 )
BUILDING INSPECTOR' S REPORT
RgQUEST gOR INSPECTION RECEI
NAME
LOCATION
s �PI T #
DATE / � .APPROVED
YES NO
FOOT NGIPIERS
,MQjOLITHIC POUR FORMS --"
OUNDA TIO NI piAMP—PROOFING
$ACKFILL APP�iL1'ti7AL r
ROUGH PLUMBI x
FRAMING
ELECTRICAL lgOUc3{i—IN
INSULATION:
p oEINDAT.ION
.FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING --
E TERNAL PO RC ESISTEPS
STAIRS—CLEA
NCE & RAILSV —�
PLUMBING FX RES/RELIEF VALVE
I
INTERIOR TR MIRFRIVACY DOORS
FINISHED F
GARAGE FIR PROOFING
DOOR CLOSE (S)
SMOKE DET CTORS
FINAL ELECT ICAL INSPECTION
FINAL APPIRO AL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
B SEN D VROESTHE BUX
OCUPIEDEEPARTMENT BEFORE
OTAIEREMARKS :
INSPECTOR
i
r
A
TOW
BUIL OF QD CODES DE .
BU.I,t,DING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
IQUEENSBURY, NEW YORK 1280k
TELEPHONE (518) 792~5832
BUILDING INSPECTOR' S REPORT
REQUEST' FOR INSPE TION RECEI ED
NAME
LACATION
DATE Lo_' b! PER1H3 T
APPROVED
YES I NO
C04OOTING/P RS
MONOLITHIC UR FORMS
FOUNDATION/D P-PROOF NG
BACKFILL APP L
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-I
INSULATION:
FOUNDATION
FLOORS
WALKS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCH S/STEPS _
STAIRS-CLEARAN E & RAILS
PLUMBING FIXTU ES/RELIEF LVE
INTERIOR TRIMIPRIVACY DOO
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:
41
JNSPECTOR
TOWNS OF QUEEN3SBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12SOLL
TELEPHONE (518 ) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INS
PECTION RECEIVEDJ�-----
F:
NAME
LOCATION
DATE PERMS
APPROVED
YES NO
FOOTING/PI RS
MONOLITHIC POUR FORMS
FOUNDATION DAMP-PROOFING
�/I BAc FIL rL A PROVAL
,,r'ti, ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION .
FLOORS
WALLS
CEILING
FINAL INSPECTION *
CHIMNEY HEIGHT %
ROOFING
SIDING
EXTERNAL PORCHE .STEPS
STAIRS-CLEARANCE £& RAILS
PLUMBING FIXTURE3/RELIEF. VALVE
INTERIOR TRIM/PRIVACY DOORS _
FINISHED FLOORS -
GARAGE FIREPROOFS G
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL IN ECTION
FINAL APPROVAL OF CO STRUCTION --
A SIGNED CERTIFICATE F OCCUPANCY MUST BE
OBTAINED FROM THE BU DING DEPARTMENT BEFORE
HESE PREMISES ARE O UPIED ?
REMARKS:
too
1
4NSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY� NEW YORK 280g.
TELEPHONE (518) 79a-5 32
BUILDING IN ECPOR' S REPORT ,
REQUEST FOR INSPECTXO RECR VED l }
NAME (/
f �
LOCATIO
DATE `! U PERMI
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR OIPJ
FOUNDATION/DAM`P-PROOI NG
BACKFILL APPROVAL
ROUGH PLUMBING
I FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
cHxmrfEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/ST _-
STA2RS-CLEARANCE & LS
PLUMBING FIXTURES/ L F VALVE
INTERIOR TRIM/PRIV CY RS
FINISHED FLOORS
GARAGE FIREPROOF G
DOOR CLOSERS)
SMOKE DETECTORS
FINAL ELECTRICAL NSPE•CTI TV _
_FINAL APPROVAL O CONSTRU TZ'ON _
ox TO ISSUE C/o R C/C
A SIGNED CERTI ICATE OF UPANCY MUST BE
OBTAINED FROM HE BUI`LIlIN DEPARTMENT BEFORE
THESE PREMIS ARE OCCUPIE I
REMARKS:
s
} ARRIVE
IDE PAR X _ -�l�
INSPECTO
SELECT BUSINESS FORMS (609) 848.5203
APPLICATION FOR ELECTRICAL INSPECTION
PLEASE BEAR DOWN YOU ARE MAKING (4) COPIES
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
National Headquarters
"—' - 900 Haddon Ave., Collingswood, N.J. 08108
• r •
Date : ,� -�
City, Town or Township >sa ,� n S 6 ,r"lp County�,�; c . r � Q n State 7�
Location/Address i -
( if Located in Rural Area - Please Attach Directions) Pole #
Owner 004r 'HAS C, ` "Q rt Permit #
Occupied As .S� N !K F p31�/ 3e Building: New ® OId O
Occupant sue , C_ Au�I �#'c'.'►
Work Area in Building Floor #, etc. ) : /
A _ for. Wiring [j Service or: Ready for Inspection :
Fee Remitted - $ Cash F_1 Check M.0_ [= Make Payable To : M. D. I.A.
Number gh Wiring Outlets Elect. Heat
SOD 750 1000 1250 1500 17 200012250 2500 2750 3000
Switchesof Rg�l�P
�, '� � `"' Amp. Service Surface Unit DishwasherRange
Lighting 10
Receptacles '"Water Heater Air Conditioner ✓Dryer �'�ump
Number of Fixtures 'ven Garbage Disposal Wiring and Controls for Bumer
Amp. Receptacles Fractional H.P. Vent Fans
Other Equipment :
MOTORS H.P. 112 1112 1/10 1/8 1/6p 1/4 1/3 1/2 3/4 1 lisp 2 3 5 7�i2 10 15 20 25 30 40 50 75 300
Mark Number
0f Each Size
Applicant's
Signature ' �p +� License # Permit #
T/A Utility
Applicant's Address : --" I, Pig1s� a 5_ .� r. ..t r-.Jt. A; - tNAM � IC LOCATION)
(City) QC l4t en (State) f'Iv/ y`- (Zip) I � � ` / Service Request #
Phone # 7 �3 — rl 6.'L / Electrician -
MDIA USE ONLY a DATE RECEIVED: DATE INSPECTED:
Correct Location : Same as Above 0 or :
Red Notice Label ED
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 1112 1A0 1/e 1/6 1 /4 1/3 1/2 3/4 1 1r,2 2 3 5 71/z 10 LS 20 25 30 40 50 15 100
Mark Number
of Each Size
500 750 1000 1250 1500 1750 2000 2250 25D0 2+�50 3000
" Fatriek J Dashnar L. Heal
FO Sax 3
Audsen a S 12Sa�
t , ELECTRICAL INSPECTOR
i:! J
CERTIFICATIONIS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECT FEE PAID
FEE
0 RW Progress : Inc_ 0 L K D 0 Contractor
CFT Violation : Work Comp. 0 Inc. Q CASH Q
[� L/A Owner Fee
CHiC
L/A #
Due MO #
�] IPA, Municipal
INV #
Other Side Utility ApplicantOwner
Card Q Temp 4 Date
aw
TOWN OF +QUEENSBURY
Bay at Haviiand Road Queensbury, NY 1 2804-9 725-5 1 8-79 2-583 2
Date : r
Z/ l 5
} j
/iI't i /rf
L r !
RE : Tax Map #
Building Permi t # -%
Dear % ' ,
The building permit ( s ) indicated above and issued to you on -,
has now expired .
All inspections required by the Department have not been done and no
Certificate of Occupancy or Certificate of Compliance has been issued . In
order for this permit to remain active , and for you to continue with your project
it will be necessary for you to renew your permit as soon as possible for a
renewal fee of $ 25 . 00 . This will extend your permit for a period of one year
with two six month extensions available should you need them ,
Please contact this Department upon receipt of this letter . We anticipate
your cooperation in this matter .
Very truly /yours ,
DAVID HATIN , IRECTOR
BUILDING & CODE ENFORCEMENT
DH : lm
ttJ40ME OF NATURAL 8FAtJTY . A GOOD PLACE TO LIVE"
SETTLED 1763