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1989-390 ';wj' k w + ERTI I+ A� '. OF XC4.UPAl" CY TOWN OF QUEENSSURY WARREN COUNTY, NEW YORK i Dare July 9 1g90 iI This is to certify that work requested to be done as shown by Permit No. 89390 has been completed. This structure may be occupied as a Si nQ,1 g Farm 1 Y Dke.13 i RSl Location ' ft6f '' HelMecfand E ana fchwne. Collette Construction fBy Order Town Board i TOWN OF QUBENSBURY Ple ` Director of Bldg. do Code Enforcement w BUILDING PERMIT " ro TOWN OF QUEENSBURY No. 89_390 WARREN COUNTY, NEW YORK l.+ u� PERMISS1QN is hereby granted to cp!__I_ETTE_C_ONSTRUCTUM in OWNER of property located at -{ftf- —HFRFSF0R0 1 ANIE Street, Road or Ave. M in the Town of Queensbury, To Construct or place a _ _ SINGLE FAMILY D4iELLING 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 C9 RD#1 Box 455 r Hudson Falls , H _ Y _ 12839 2. CONTRACTOR or BUILDER 'S Name m Ken Collette a sn —�I 3. CONTRACTOR or BUILDER 'S Address RD#1 Box 455 Hudson Falls , N . Y . 12839 4, ARCHITECT'S Name S. ARCHITECT'S Address P" 6. TYPE of Construction — (Please indicate by X) 1 i r+i (XlWood Frame { 1 Masonry { } Steel { I to Y1 C. x 7. PLANS and Specifications No. 26 ' x 4W Single family dwelling as per plot plan , specifications , and application , including septic , attached one car garage , and driveway rM 8, Proposed Use r Single Family Dwelling N $ 179 _ nn PERMIT FEE PAID — THIS PERMIT EXPIRES January 1 1990 rM Ilf 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,] � r— Dated at the Town of Queensbury this h Day of June 1989 c wa M SIGNED BY for the Town of Queensbury r Building and Zoning nspectar ""' TOWN OF QUEENSBURY APPI_ rCA TON FOR RUILDI C, AND ZONTNC rr• RNITT t' t - � eeLevect � or TOWN' COF QUEENSBURY '` - - Rev i awed RECEIVED Fee Feud •. J UN � _ 1989 BUILDING AND CODES Uj NPARTPTEi,,T Date. Iaa ued BLDG. � CODE QEP�`, SAY and JJRVSLAJVD ROADS- RD 1 Box 9a OUEEMSBURY , NEW YORK 22804 PeAnl•t NO . Tel , ( 518 ) 792 -5832 Ext 204 w f w w s tw • [ w w w • w w ! w w w w w x t f t R w w +. w w w r w t # A PERHIT MUST DI3 OBTAINED BE- FORE LECINNING CONSTRUCTION * No INSPur. TIONS 14' ILL 13 £ MADE UNTIL APPLICANT HAS RECEIVED A VALID BL; ILDINC PERMIT . All applicable spaces on this application must be completed and the q -ipuature of the :alrplie ant must appear on the xeversc side of this sheet * x is x * alr * xt p x c t * * * x n t * * Mr a x d * :t this * e * F The owner of this property is : � () l' . O . Address 2 /I/daq ) ` T E T. ..�/,�7`..'/^r�/./'-r- Property location z)f- tt ASOES-10en 4u 0.jPi rtLS tA }C MAP NO . IN_! � ► / Has there been any split of this property since October 1 , 1988 ? /• If yes , Planning Board Review is necessary . Yes no ; UBDIVISION NAME , Ir APPLTCABLE LOT NOV The person responsible for supervision of work as regards Building Codes is : .,.,.R:i ' `ASS" ,�J�'ck o��! fWes oc I /2 4!�I8 NAME �/ f]��/ F , O . ADDRESS TEL . NO . Name of builder/yijff (z&eMF— Address Lq- r a� W> A1�cstJ� Tel r4ame of Plumber5i9MC JGxJUSe 1.ddress ( aANst�c � t7 r4r _ Tel 7 Name of Mason Tel SNOW 14ATuRE OF PP%OP0St'D 60PC >•: : ZONING INFORHATI0111 ( or .Fice use on1y1 { nn ; LrucCiGri of a elt_w buildir,.7 ZONING DESICNATION OF PROPERTY Addition to .:a Iauilaing � PERMITTED PRINCIPAL PERMITTED ACCESSORY �AILWCation to " Luilding ' ( 160 CIL.Ajk u to exc � rior raimenLiona ) } REVIEW REQUIRED - PLANNING BOARD ZONING BOARD Ucl,i r work ( JasCrilao] ' SIT£ PLAN REVIEW # APPROVED DATE w CROSS AREA OV VROPosao, :uTrtucoruRE VARIANCE # APPROVED DATE 1st Floor J'f7W sq ft . Remarks : 2nd Floor I ,r sq f t . COmPLLT14 ka.:QU1IfED uLSWW . Other Floors A111 sq ft . SizQ of prop%jrty, l.2k2 _ ft x Ar)l ft . " Lxi ;tirsc] ]:uildi,�.] ( : ) Si su ---- f X r c . ( not collar or basam4n [ ] w TOTAL FLOOR AREAV sq f t , ■ i:xiaciayg ouil+,.l.iria] ( :: } LJs.: _ iee of new :atructuru , .( ft ft r"uw�daLion-pier/ :;lal../crswi/Iaareial tul Nrpl�+3srd builtxlnq , di:: c �xnCa troe« I, rtal.+urty .lino ( circlw anal Front yard _ � '- ft Rsar yur. d Sf r 'r ft No . o€ stories (tk"bi "bla space ) j 11.:ighc ( cjradu to ridcae ) fro . Sida y"rdu ZS ft and ft If residential , no . of families . It art cc'rnar , :uLbaa:k Iro--5h4i3r�u ^ r 4fuuC y31 ft Now of rooini ( cxcludinU b"ths ) '" OCCUPANL:Y INFORMATIQN 11o . of bcdrooma y� -- -- - _- PRIMARY GUILDINC Vo NO . Of b:atl%rooiau T ~ • Ona Fan"y dwelling 11rignary Naa.+ tieu] sy::t} _� /+ f' CJ� + two f:.ueily dwulliny 'I'yla.r tie foal Multl1410 Uwelling / Number of units NOV Of firulalaCWZ� tea UW in::ca.11cd --0 will :+t MWW.1 kiLovu Lv Q +� l,1$rla:anQuAt oc4`1iDzuIcy+ L .:ntr.cl Air cot�c3iciunicwg? w 'irun::ir:L1C ot:Cul "$kcy business BUILDING STYLE, PRIMARY STRUCTURE , Incsustrial OcY►ar 1u+Icll COnto►iol:c.r..ry Lon c:tlairt It "ddiLian , wl,"c will uua bv`l i:.. L sucl rand► Ml;ans ic+�c Dul.+l.:x '' uplic lQv441 Old UCyla U"46LJ.4low ` Capu Cod CoLt;.gu Ocrw:r '" ACCL8'"ORY LUILDINC- CCjIonJ..al NOW 4rowl& douse " cachad _ rriiae/Ono cur/ two C:+ r/ Car ( CIRCLE ONE PLEASS ) ' Act4-ACh4jd q"r"tj"/Oj%4i car two car/ C.ac' • • s ■ w v s • • • w w v . * w '*' l�riv:at.o .tor:,ga 2i�sincj L .'" TIMA'I` EO MARK [:T VALUE OF Other CON 1NF'ORkLRTION ON BUILDING SPECIFICATIONS , ON REVERSE sIDC OF Tl1IS StILET, TO BE COMPLETUDI Form SPA 20188 v1 BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . 1 Will any second-hand or ungraded lumber be used? If so , for what ? Foundation wall material jMrCCr) T (JWC,,'E-t�- Thickness Depth of foundation belo grade ( to bottom of footing ) Will there be a cellar? E- Heated o ,unheatee Floor sq . footage sq ft Will there be a basemen will any portion be used as living space ? ( If so , what par ion? sq . ft . - - Type of use ? Type of roof - slope ` flat/shed/other Material of roof size , wood studs_" X , " spacing J o . c . length .3oists ( floor beams ) 1st . floor `" X " spacing f "o . c . span.�Z-:3 ft . Joists ( floor beams ) 2nd �loor " X spacing -- "o . cl span ft . overlays ( cellin eams ) At "X - " spacing " o . c . span ft . Roof rafters "" X spacing o . c , span ft , Roof trusses (pre-engineered) spacing" o _ c . spanft . ] Exterior wall finish of what material ? b't3�f AfdL?!E9 ©" S- L/_lwlL .siojnc Interior wall finish ;fV `tr) �Ac�,h F.Tl=UQJ< if a garage is to be attached , describe materials to be used for FIRE SEPARATION : Is there to be an opening between garage and dwelling? If so will a Fire-rated door , enclosure , and self-closing device be provided? 65S Will a flue -lined chimney be installed? Height above roar ft • Depth of chimney foundation below grade — ft , Depth of fireplace hearth ft . in . Water supply - Municipal or�private well lywfv.01 SEPTIC SYSTEM _ Distance from ANY private well ( includ ng adjoining properties (A separate application is necessary for any repair or new installation of septic system) DEC LA RATION To the best of my knowledge and belief the statements contained in this application, together with the plans and specifications submitted, are a true and 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 wort: shall be complied with, whether specified or not, and that such work is authorized by the owner, Signature Cam' Owner, owner's ag , ardihitect, cghtractor SPECIAL CONDITIONS OF THE PERMIT : BY........______.............�__--------- TOWN OF QUEENSBURY WARREN COUNTY , NEW YO RK Application for : BUILDING PERMIT IN COMPLIANCE, WITH THE NEW YORK STATE 'ENERGY CONSERVATION CODE A permit must be obtained before beginning work. . ANSWER ALL of the following : � 1 . Gross floor area, ?.2 LE 2 . Type of heat1 � � s T7 3 . Is the building mechanically cooled ? A16 c/ 4 _ Percentage of area of windows and doors I3 /" A . Over 16 % Only 1 . Uo value of gross area of walls , roof / ceiling and floors exposed to ambient conditions 2 _ Floor over heated spaces YES NO a _ Are foundation walls insulated ? YES NO 1 . If YES , what is the R value ? 3 . Slab on grade YES NO a . If YES , what is the R value of insulation around perimeter of floor ? 4 . Is basement heated ? YES NO a . R value of insulation 5 . Type of insulation B . Under 16 % Only 1 . R value f roof and floors exposed to ambient conditions _ I 2 . R value of exterior walls 1. 93 //� 3 . R value of glazed area r�5 • gn 4 . R value of doors � . f 5 . R value of floors over unheated spaces 6 . R value of slab edge insulation - unheated slab � {� 7 . R value of slab insulation - heated slab NM 8 . R value of heated basement/ cellar walls ( above grade ) - 9 . R value of heated basemen-t/ c/ellar walls ( below grade ) 10 . Type of insulation Jt� }zF . Co Controls l 1 . Thermostat maximum heat setting Do 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 d � 1 . Size of hot water or cooling carrying agent pipe 3 dC L 2 . R value of pipe insulation F . Service Water Heating 1 . Performance efficiency a 2 . Temperature control setting maximum U& AjStj= ir+ E' C�C1F-U G . For Swimming Pool Only, 1 . Maximum heating 6Z iq Telephone No . ( applic t ' SU sign ure ) r OWN OF QUEENSS URY APPLICATION FOR �>� SEPTIC DISPOSAL PERMIT DATE LOCATION OF PROPERTY FOR INSTALLATION Owner's Name: aT~~ fit 'LL LI( 1;96 & Te Kok one: Address: IY)-Z=s'i'G?UJ k� x�X l c y C_lz�71ds 14Z(, s ,c&-aJ fir' K r oc? r Installer's Name: °cL+'ii :f7�!` CiCiy�rs _/Vc, Telephone : a% ' Number of 'bedrooms (residential only) Total daily flow (compute (d 150 gal per bedroom ) 6z C'rCTLs. Topography: Circle one: F1at�olling Steep Slope 6 of Slope fioii Nature: Circle one Sand . Loam Clay Other /Depth : Feet Ground Water : At what depth ? ,/yb gAajVf] e e t ` 4,1 `�Ls o /N L Bedrock or Impervious Material. At what depth ? , -kojv (} Feet Percolation test : Circle one: not require require ate min. inch. jr Domestic water supply. circle one:�unictpal Well Other If domestic water supply is a well. Separation: Water supply from septic absorption NZ4 feet PROPOSED SYSTEM : Septic Tank _41 '?) gal. ( minimum size: i . 00n gal, ) TILE FIELD : Each Trench feet/Total system length -- feet SEEPAGE PIT(S): Number of P. / Size each feet by r" _feet Size of stone to be used #..L/Depth or Thickness j 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 Sanitary Sewage Di posal Ordinance, SIGNATURE OF RESPONSIBLE PERSON: DATE : O `I' OVER Septic systeal Inspections : ,� . All applications for septic system installation , alteration or repair , as required by the Town of Queensbury Sanitary Sewage Ordinance , shall be submit-evd to the Building Department at least 24 hours before start Of construction and shall include a plot plan showing : 1 . ) the proposed location of Chu system ^_ . ) location and distance to lot lines 3 . ) location and distance to structures 4 . ) location and distance to :any water supply 5 . ) size and dimensions of all tanks , distribution boxes , the fields rind / or drywells B . tie system shall be covered before inspection and approval by the lsuilaing Inspuctor . Failure to comply with this requirement may result in the uncovering; of the system by the installer and a fine of up to $ 250 . 00 . C . ;%n approved copy of the plot plan shall be available on the construction site . Failure to produce said plot plan at time of inspection may result in an immediate work stoppage . D . Should unforeseen problems during construction prevent proper installa— tion , alteration or repair of an approved system , a new proposial must k}u submitted to the Queensbury Building Department before further L� aLiatruction . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 kie n�a rk.5 ISSUE DATE (MM;DDfYY) 06/ 01 / 89 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. 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 LEr YEHNY A► EXCHANGE MUTUAL INSURANCE COMPANY CODE SUB-CODE INSURED LETTERNY B GENERAL ACCIDENT INSURANCE COMPANY Collette Construction , Inc . COMPANY Collette Lane Road LETTER �' RD #1 , Box 455 COMPANY Hudson Falls , New York 12839 LETTER D COMPANY E LETTER THIS 1S 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS LTR DATE {MMIDDIYY) DATE (M'MIDDIYY) GENERAL LIABILITY GENERAL AGGREGATE $ 1 , 000 A X COMMERCIAL GENERAL LIABILITY p /y�+,/^y �j ryp +�/� / p �j �j,ry ply PRODUCTS-COMPIOPS AGGREGATE S 1 9m4 CLAIMS MADE X OCCUR. 1 1 9-8-99037 08/ 30/88 08/ 30/ 89 PERSONAL &. ADVERTISING INJURY $ OWNER'S & CONTRACTOR'S PROT, EACH OCCURRENCE $ 1 , 000 FIRE DAMAGE (Any one lire) S MEDICAL EXPENSE (Any one person) $ AUTOMOBILE LIABILITY COMBINED B ANY AUTO O /��try �je1 q t1 p (gyp / �p / p fy SINGLE $ 300 ALL OWNED AUTOS BA002395401 l 0/ (]$/ $$ l 0/ 00/ c77 BODILY $ x SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY DAMAGE S X Specified Auto EACH AGGREGATE EXCESS LIABILITY OCCURRENCE $ $ OTHER THAN UMBRELLA FORM STATUTORY WORKER'S COMPENSATION $ 100 (EACH ACCIDENT) B AND WC006505102 11 /01 /88 11 /01 /89 $ 500 (DISEASE-POLICY LIMIT) EMPLOYERS" LIABILITY $ 100 (DISEASE—EACH EMPLOYEE OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESlfi"TRICTIONSISPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Twon of Queensbury EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO Bay & Havi 1 and Roads MAIL '10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Queensbury , NY 12804 LEFT, BUT (LURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZ EPRFSENTA VE ACORD 23-5 [3188) 'CIA RPo RATION i9se TOWN OF QUEENSBURY BUILDING AND COZIES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I2804- TELEPHONE (518) 792-5832 BUILDING INSPECTORS REPORT REQUESTrrfFOR XNSPECTXON RECEIVED 4/ �P40 NAME LOCATION 40 f RATS PERMIT # APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FO S FOUNDATIONf DAMP--PR FING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-I INSULATION: FOUNDATION FLOORS WALLS .$.ICING FINAL INSPECTION: r CHIMNEY HEIGHT ROOFING SIDING r f EXTERNAL PORCHE STE S _fir STA.IRS-CLEARANC & ILS_ 1 PLUMBING FI.XTUR f LIEF" VALVE INTERIOR TRIM/P ACY DOORS -� FINISHED FLOORS . GARAGE FIREPROO ,ING DOOR CLOSER (S) SMOKE DETECTD s FINAL ELECTRIC NSPECTION . FINAL APPROVA OF CONSTRUCTION OK TO ISSUE f0 014 CfC A SIGNED CE TIFICAE OF OCCUPANCY MUST BE OBTAINED F M THE U-T -r)VG DEPARTMENT BEFORE THESE PR SES ARE OCCUPIED! REMARKS: Art ARRIVE � oe � U� DEFART� / INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES .DEPARTMENT BAY & HAVILAND ROADS QUEENSBURYs NEW YORK I280e'd TELEPHONE (5I8) 792-5832 BUILDING INSPECTK)R' S REPORT!,,/f/� .REQUEST FOR INSPECTION RECEIVED—��hiZ& NAME l rs/I G jr r OCATXON X,g t _ / — P tio DATE 1141111 PERMIT # APPROVED YES NO FOOTING./PIERS MONOLITHIC POUR ORMS FOUNDATION/DAMP ROOFINCr BACKFILL APPROVA ROUGH PLUMBING FRAMING ELECTRICAL ROUGH N INSULATION: FOUNDATION FLOORS WALLS CEILING / INAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING ,'EXTERNAL PORCHES/S EP STAIRS—CLEARANCE & LS PLUMBING FIXTURES/ EP VALVE INTERIOR TRIM/PRIVA DOORS FINISHED FLOORS GARAGE FIREPROOFIN DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL I SPECT ON _ FINAL APPROVAL OF ONSTR TION OK TO ISSUE C/o C/C A SIGNED CERTIFATE OF OC PANCY MUST BE OBTAINED FROM T E BUILDING PARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS'': vie No ! J�ARRIVE / c,'� DEPARr i / / L 'F INSPECTOR MIDDLE DEPARTM N AGENCY. INC. CORRECTION �,(t / Date April 8 , 1990 �eCt[f l co that Je' ti $qulpment listed has been 8 aAVI?P. a approved as being in accord with the National Electr' L�r applicable governmental, utility and a. I' p % 1 Owner: J e f f ery Ke l ly , occupant: Same ,fi"1 Location: Lot 1 Heres f d 11a, , et. ur C rtitieeee � uipment and instany tion InspeCted this date. It addition*$ ui nt ire introduced ar alterations maAa to existing system Chi be null and void, and application tpr 15 Outlets ; ep4<acles , y� ; s X € inspection should auromrtt p ht to thin his pr . EQ[f!F)fTient: s +L r`•�nrFY• +I4.^r3R7E oid6! of this Ge fiCeli nt as me to his property insurance Carder 20 0 Amp Service , `4 p p 1 i anc e s agent or compenyl as evid*iMC nifiCPtlari of electrical equipment apprbMd •� es 6PeCified: : E Ken Collette _ 11!ucUC" i1A*A Apphcant: Vaughn. Road _..__.._._._ __ _.__. 01 15 -025497 L. Hudson Falls , NY 128 .✓awn o� �ueens6ur� ,�",,r'�r-j BUILDING and ZONING DEPARTMENT / ✓ r �' Bay and Haviland Road, R. D_ 1 Box g8 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAMEd/� LOCAT II r7,roT �..� ,t e -G�L'G� DATE ��/� PERMIT NO. 'El'! - SOIL TYPE - Sand - Loam - Clay ' - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , total length Length of each trench Depth of trenches ' Size of gravel SEEPAGE P TS-ENtuab ., I, of) Size- ft. x Gravel size PIPING : -- i e Type to tank Tank -- ,� Tank to dirt . boxDist "— Open ]box fiela Openings Seaea led? NOPartial LOCATION/SEPA RAT I ON Si Foundation to tank ft. Foundation to abso tion t . Absorption to lot ,4'Line Separation of pit ft, LOCATION OF TM ON PROP RTY (circle one) Front - ear r7t side - Right side - COMMENT ; fs f r f r 1_ SYSTEM USE APPROVED JES O Buil ing In pector 01/86 and vl R. - IrleF MIDDLE DEPARTMENT ..TION AGENCY, INC. goo H&ddoa AV*0U41, Ca111npw! Ns.1 49706 e: > Date July 16 , 1939 Id L 7 rt� F �ertifi that th olectrital equipment listed has been exalihInsd aridj0 approved as being in ac 7 with the National Electri«~ei�CQde, applicable governmental, utility and 'Ag9naY 11��es. r ;s /! y of 7 Owner. .� �' � .L e r j� Kell\7 ! U.� L`gt,9fF.^ akne St ' 1 I Manx . occupant: ,2 t ment and tnstallalton ins pec T :t} e 1 tlere5 f ori3 €.$ ilk , Q�feexiatturyx -G1�ir�re W'i" 7 erylicaCBdorers YhBaleclnca4acYW P 7 L.ocation: ate ll addilionN a[luipment should be in7I do Or at m existing system thtb Car0froare al1aR be null ant! cold. end appeCa tf-�� TLC inspection should be subtntttgd A pi ly to Jilts Ape ncy. Equipment: 1. Rece p tac 1 r 2 00 t,ml? Sexv I-Gep i !)4t }" l Molder Dl this ceffificale should ,�BnJ same of his le cal S Y to me ncB(agent of complany] asBviWnCiII aru hcatton Of aleClrtcaiBquipmenl a as specified t D l v_• :iam l�o'rlFctl.lse a • t :, : l � . 7O No . 15 -025497 pPP7rcant. 1. 1 PnCtex Road p Cansevoort , TAX TOWN OF QUEENSB'URY BUILDING AND CODES DEPARTMENT BAY & HAVSLAND ROADS QUEENSBURY, NEW YORK 12804, TELEPHONE (5I8) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED" 5 NAME LOCATION DATE �% SG 4PERMIT #- ?S APPROVED YES NO v FOOTING/PIERS MONOLITHIC P R FORMS ly FOUNDATION/D PROOFING BACKFILL APPRO L ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-TA, INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH/STEPS STAIRS-CLEARAN E & RAILS PLUMBING FIX RES/RELIEF VA VE INTERIOR TRI /PRIVACY DOORS FINISHED F RS - GARAGE FIRE OOFING DOOR CLOSER S) SMOKE DETEC RS FINAL ELECTR AL INSPECTION FINAL APPROV L OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED: REMARKS: -� INSPECTOR - ._ lawn 01 Queeny11Arty BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING IINSPf�I= CTO/R/f S REPORT NAME,.,— �':' F ! �/ LOCATION Date /! Permit Noe ✓ = APPROVED - YES NO Footing/Pier Forms 1,+ oundation a terproo f ing Backfill Framing Roof ing Siding Masonry Veneer _ Rough Plumbing Relief valves , Ext . Porches Jr Finished Floors Interior Trim Stairs & Railings/ Cellar Drain Til Concrete Floors / P1b4g . Fixtures Gar . Fireproof ng Door Closers Smoke Detect o s Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- / 10 r17 Building Inspector 6/86 and-vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY 6 HAVILAN ROADS QUEENSBURY„ NEW W YaRK 3280* TELEPHONE (518) 792-5832 + BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION REC VED -J NAME LOCATION DATE PERMI # APPROVED YES I NO (, FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP--PROOFING BACKFILL .APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ TEPS��� STAIRS-CLEARANCE 6 RAILS_ PLUMBING FIXTUR S/RELIEF VALVE INTERIOR TRIM/ RIVACY DOORS FINISHED FLfAL GARAGE FIREFING - DOOR CLOSER SMOKE DETEC FINAL ELECTRIINSPECTION FINAL APPROVAZ OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: Ll r � J, 11 Y IN PECTOR Ord. wei 4se4o • + I6 J (+a+wD4m) PRODUCER THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS C O -Atir Ins. Agenclas Inc. NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, P O Box 1369 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Sow Gl� Falls ' NY 12803 {COMPANIES AFFORDING COVERAGE. COMPANY A . Prefexre F$7 i73Z I]3 . CO. LETTER INSURED ETTERryY B lord G`t3uua3lty Ins. Co. Swu W. & JeAmn Ev Chadic n se .�. POttpY Ind LETTERNY C The Continwital Gansevtxxrtlr NY 12831 ' COMPANY D LETTER COMPANY iET? E ER • 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 RE4UIREMEHT, 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 CONO1- TIONS OF SUCH POLICIES_ LTR TYPE OF INSURANCE .T� POLICY NL,MBER __. '%Lr} -"='-' j6 r '�'� '.: . rP�R,a r;,C,N LIABIL'T` LIMPS IN THOUSANDS AGGREGATE GENERAL LIABILITY ', COMPREHENSis;E =ARM _ 02 L�(J 4 I R0uRY 1/88 /1/89 300 300 PREMIUNDERGROUND P,a'IpNS PROPERTY U PLOSIOGUNU ` DAMAGE $ 100 $ 100 EXPLOSION & C3L'_A{>SE HAZARD X PRODUCTS;'CCMPLET.EO CPERATIONS CUNTRACTUAL i BI $ Po f INDERENDENT �6M1TRACTCRS C4MBiNrD $ $ BROAD FORM PROPERTY DA+AAGE I PERSONAL ':JJURY PERSONAL FNJURY $ i AUTOMOBILE LIABILITY + A 4UTU i SOY $ x w0 IN ]4':"IED A��r,US Pq; , �.,:c d ALL lj6VNED AIU7)S DER TriA4 PRIV PADS 1 f xa a,CLvEy-, 1 $ HIRED auTc` Gl UDC DS72.53 /1/88 12/1/13y PROPEaT :'vON OWNED AUTOS DAMAGE $ GARAGE LIABIL!'Y gI & PO Ai if-emma C-OMOINED f $ so ------------ EXCESS LIABILITY - -------------- -` I UMBRELLA TORM I sI s Pr OTHER THAN uh+epELLa =ORu WORKERS' COMPENSATION STATUTORY AND 11W 812 2989 89A il/l/89 il/l/90 EACH ACC;DENT. EMPLOYERS' LIABILITY DYSEASE-POLICY L:MIT', OTHER " -- '•-+ ---- -_ $ .DISEASE EACH DESCRIPTION OF flf EFlAT10N8/LQCATi(3NSNEHiCLES,+SPEC'AL :TENS -" wiring & PlurlbLng . . • EX- Town �£ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE"burY PWATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO Building & Code Enforc nts 'MAIL? S DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER HAIRED TO THE ���& FiaViland Road LEFT, FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION:TION OR LIABILITY nd to d OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. L7ry ,r AUTHORIZED REPRESENTATIVE • GIECIRGE KURSJSAKA JFZ. . BUILDING SYSTEMS CONSULTANT U ARBUTUS DRIVE QUEENSOURY, N.Y. 12M0{ ( 518 ) 793- 7190 I RESIDENce : 13 ARBUTUS DRIvF QUiEENSBURY, N.Y, 12904 "HoN ¢ spa -zs12 -+ 522 BUILDING INSPECTOR TOWN OF QUEENSBURY re : Factory Manufactured Home TOWN HALL - BAY ROAD Mnstallation Certification.. QUEENQ8URY0 NY 1 .29O4 Attention:. DAVID HATIN Dear s Ir This is to certify that I have observed and inspected the installation of a "Factory Manufactured Home" ; as defined by the New York State Uniform Fire Prevention and Building Code, Chapter D . MANUFACTURED HOUSMgG , Article 2 mw FACTORY MANUFACTURED HCMES , as applicable to your local building regulations ; there appeared to be no apparent structural damage to the units , due to or attributable to the transportation or loading/unloading of the units , herein- ^ after described as follows*. *Svwc_ Date " of Tnstallation : �" A000 0001i Site Locatlon: W 496aa • W*MTMk1&xq& L4* . Community: TOWN OF QU£ENSBURY County : WARREN M anuf acturer/Supplier : Address : ,�'3'/'• /'�'"�'.i� AM�!►'IIBAr. AgoT Tnsignia Serial No. 3 8 Plan A ppraval No. Manufacturar ' s . Model/Component. Nop.�: Z 4rJ'e W .r�s .dP Date of Manufacture : " '� " 6� 0000 '-��� Installer/Supplier : code I have also examined the approved Plans & Specifications for the abovementioned "Factory Manufactured Home"' , and to the best of my knowledge and belief , this $'Home" has been installed in accordance with these approved Plans & Specifications , and all other applicable laws .odes , ordinances , staxidards &/or regulations . (p F NAB! RESPECTFULLY SUBMITTED, Z o� r fir. i ti..`':r W - ""'+'� ..,..x1:.,. __ �+ •.`''"77 cc 4r¢ 05869 4,ka°r (.U.EO£ G,£C3RG£ KUROSAKA JR . • R04j, 14 \ ; f 1756 00 Rom w , . . . TOWN OF QUEENSBURY �2 - Zoning ministomtor DmtR . * L fCE'GJff�i� Z . It 00 /40 VIP # any +j {i ,�• ti f �- '•�.,`_ ,.,,may - �. � ' x • R �Y$ p� >� .�G? � tS.�'LJ11.1.�V/ It E {y 1 `� r y. 1 -7 . 010 4ps 477. ems. /VE�/,'�/r2A4 IV as ,�