1989-461 '^ .. . :"y-.' ^ss^ Tw:r:.c .... �. ... .�a�.:c''4►,a=�sAGi^S'{•T"4- '""�`i#' +€w<., . .
i
CERTIFICAl ` +CIFOCCUPANCY j
TOWN Of +QUEENSBURY
1
WARREN COUNTY, NEW YORK
i
Daft janna" 13 . 19 92
i
This is to certitV that wow Lested to be clone as shown by Permit No. 89- 461
5 has been completed.
This structure may be occupied as a ADDITION TO SINGLE FAMILY
i
Lcrcatior� w PICKLE HILL ACRES
Owner R7f HARL] & NA1V Y L1 1SW�}LT - --
i
By Order Town Board
I
TOWN OF QUE NiSBURY
I
sDirector of Bldg. r5C Code Enforcement
SEEN
s
_ x
, - BUILDING PERMIT
TOWN OF QUEENSBURY Na 89- 461 �
WARREN COUNTY, NEW YOiRK
PERMISSION is hereby granted to RICHARD 8 NANCY DUSWALT r.7
OWNER of property located at PICKLE HILL ACRES (1st HOUSE ON LEFT ) Street, Road or Ave.
in the Town of Oueensbury, To Construct or place a ADDITION TO SINGLE FAMILY
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. r�
C._
C!7
t, OWNER'S Address is
r
SUNSET TRAIL
QUEENSBURY , N . Y . 12004
Coal
2_ CONTRACTOR or BUI LIDER'S Name
CONNELLY CONSTRUCTION t=
3. CONTRACTOR or BUILDER 'S Address "
RD#3 BOX 3431 -C
LAKE GEORGE , N . Y . 12845
4. ARCHITECT'S Name
5_ ARCHITECT'S Address
r7
r
m
z
6_ TYPE of Construction — (Pleas* indicate by X) '-
r
I } Wood game I ) Masonry i 1 Steel 4 }
.T.
m
7. PLANS and Specifications
No. 14 ' x 16 ' addition to single family dwelling as per plot plan ,
specifications , and application .
B. Proposed Use
addition to single family
$ 16400 PERMIT FEE PAID — THIS PERMIT EXPIRES January 1 tg 90 c+
(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.) +C•
Dated at the Town of Queensbury this Day of Dt a 19 89 �
m
SIGNED BY for the Town of Queensbury
Building and Zoning inspe r'
TOWN OF �;; UEENSBURY Arrl . rc .t. Tr ry � r � �sc�� I ! r �: c tarn = CNZN � Pr � • arT
t ` ` - TOWN OF
,,,poll � cv i ewedi REC 1V Ep SBURY
J UN 1 tl^o q
Fee Pa.i:d
BUILDING tV%D CODES U1 .PAR1%t fF.1`!T Data I.6.s ued BLDG. & C01:)e DEFT•
.JAY ar7d IIAVILANU ROADS AD I Box 9a
nUEENSBURY . NEW YORK 12dO4 -
Te1 , ( 528 ) 742- sa32 Exr 204
A I"EMIT MUST III) OBTAINIED UEk" ORE CECINNINC CONSTRUCTION . NO INSPuC'fIONS
VILL BE MADE UNTIL APPLICANT HAS r%t- CLIVLD A VALiD BUILDING PERMIT .
All applicable spaces on this application must be completed and the
ii* Aature of the arplic. unt must appear on the reversc side of this sheet
1■ * A * A ye * * 7k ?: 'R A k * A Jr % * * * * 'At 7t iR * Yt * * * * * * R 7k * * 7t
The owner of this property is : r-�
11 . 0 , Address TEL . ��/ -►4 Z .S�ra
roperty location l Ax MAP NO . v / _�/ C2
Has there been any split of this property since October 1 , 19SS ' z
yes no
1f yes , Planning Board Review is necessary .
SUBDIVISION NAMC , IF APPLICABLE LOT NO ,
The person responsible for supervision of wort: as regards Building Codes is :
'NA�ML JJ' )�) P . G . ADDRESS . `/ TEL • NC1,�+
Uume of builder r � /o e .rs d` _ cldress ,r ' ajw p�Tel
r4"me of Plumber I/ 1.ddress0? Tel
Name of M4$Qn AUdreas Tel
Il; ATURE Or PRQP{]c�LO InURK- : W ZONING IN1 ORdNl+.'I' 10M ( Oft -ice use orr3y )
('ctnzllcrucciQri of a ra4w building . ZONING 01:SICNATION OF PROPERTY
S( Ad" ition to a Uuilaiglg ` PERMITTED PRINCIPAL PERMITTED ACCESSORY
Altur..tion to a l.uildtng `
( 110 Cl ,.,, Ls) " to exc � ri.ar clircicns� ionS } ■ REVIEW REQUIRED — PLANNING BOARD ZONING BOARD
Ut144.: r work [ J0lsCrLUa. ) ` SITE PLAN REVIEW # APPROVED DATE
,.; ROSS .ARL: A OL' 1' RoPOSLo, S 'rituc ,L' LiRa VARIANCE It APPROVED PATE
Ist Floor 9442 L/ _ sq ft . } Remarks :
n d Floor s q f t . t COMP LLTk' INI"G[,t•ulTION LCL QU L LcLD UE LU►1 .
` 3i.4.: of prol.� rty ft x rc .
other !^ 1 o a r s --^""'"� s q f t • ■
( not collar or basement ) Laci: Lii�g L' uil .Iii «� ; :: ) Sa -u re x�rc .
TOTAL FLOOR AREA g ' 4 sq f t ■ L`xa aCL+lc] LawL141tns� 1 • ) Uow
or nc w uCLLLra lam' lIf f c x f�f t '
l'u�st�dazi -pi s11L/crawl/1�arcL.►1/ full ' itropomca IpuLla �ng , dxurancu hour 14ZQLtorty iinat
Icirclu onca ) # ` !' t Roar
�wce } // Front yard .� yar. d .
N.,l . of Marierp ( habizablo ••1 G— Sida yards fz and s Cc
lte,l ( grade to ri-dgf ) ft . If on cc.rner . Protn sirlu itr4uc r• c
If rc :: iduaCial , no . rat fermi iC5+� '
No , of rooln;a texcluding )"thin .. SaF OCCUPANLY 1NFORmAT ION
tlow of budrooin* -e ^� "
.tSLS # PRI.M*%RY EaUILDING
No * or b:achroou►m C One f"A ily dwelling
vriwi"ry tlw.acirltf zyt;tu«t Two f"mily dwulliny
•ry11.4 "f f "Q1
liulcxltiu Uwulling / Nutnbar of units.
No . of firulylacus cU Lu inz:t;.11 ..d G? i,enu„z occu :u�cy
Will ;a wood xl:owu Y.w ieuutalllh:cd? J . 1•run;:iucit: ear:Cu s.asu y
L'42nCr:a1 Air Co+ulitiunirlg ? L�us I
nmm� lnuSs
UUILDING STYLE, PftIK462Y STRUCTURE � Inciuszrial
cuC11 contuukl:.ov"ry Len Cabin Ocher
r<.. . ci rartolti M:ansic.�r Duaivx I .addiciun , w(,.az will u:..0
UPIA,Q luv..l Old acylu tautuy.alow • - - -
ti:,+Lau Coca CattagLL OL f u r ' ACCLSS0AY UU I LDINC-
Coioni..i 1+D+nr row� � Clause I:uucachda yrr:i9clone cur/ two czar/ Car
( CIRCLW CNL: PLEASE ) ' Atz" hw" yarzigw/ot1.: C:ar/ two G :ar/ Era c'
• • ■ IN a • 4 ■ • ■ r ■ . •" Pr.iv" cu zLora94 bui,lcting
1: ST1HAT1m% Q MARKET VA1. UV OF � Ocri� r
CONUTkUCTION
2NP nNATTON ON nUILDINC SPrCIFICATTONS , ON TtcvrR.SE Slor OF "TNIs CHCET, •1O 9E COMPLETLDS
Form BPA 10188 u2
BtUILnItaG PERMIT APPLICATTCN CtNTTNUTED
BUILDING SPE(ZIFIC.710i^4S :
:ypa of construction ood r.. . .�,� Lre safe etc .
any second-hand rcS ungragadlux: iz) er be used ? if so , for what ?
Foundation wall material rThicknesso"
Depth of foundation below grade ( to bottom of footing ) (A
Will there be a cellar ? MV Heated or unheated ? - Flook sq , footage sq [ t
Will there be a basement ' - O will any portion be used as living space ?
( If so , what portion? sq . ft . - - Type of use ?
size of roof - ope flat shesppacing c . lenggt of roof
size , wood stu s "` x spacing o . c . len th ds'I ft .
Joists ( floor beams ) lst . floor '+ " x. ./ or " spacinvyrr.�" o , c . span / �{ ft .
Joists ( floor beams ) 2nd . floor ,.- ^ " X " spacing '" o . c . span ft .
Gverlays ( ceiling beams ) c^�" "X spacing "' o . c . span ft .
Roof rafters " x " spacing o . c , span ft . �
Roof trusses (pre-engineered) spacing C o . c . s :an -ft . ,�
Exterior wall finish 1 � C *
/: of what material ? 411XV Jq,,Z "
Interior wall finish CZax &.+ae�
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? A,/ t:] If so will a Fire- rated
door , enclosure , and self-closing device be provided ?
will a flue -lined chimney be installed? ,colt-17' Height above root ft .
Depth of chimney foundation below grade .ram" ft ,
Depth of fireplace hearth -+ ft , .-" in ,
Water supply - Municipal or private well
SEPTIC SYSTEM _ Distance from ANY private w 1 { including adjoining properties
(A separate application is necessary for any repair or new installation of septi system )
DEC 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, T171E 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.
eeSignature
Owner, own s gent, chi c , contra
.�+
♦ * * * * R * aF * * ♦ * * * * * * 'II * * * M * * A * * 1k * w 't � 's' * * * * * • * * • * i
SPECIAL CONDITIONS OF THE PERMIT :
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.
T
2 . Type of heat Aolnp
3 . Is the building mechanically cooled ? /tilt' -
4 . Percentage of area of windows and doors
A . Over 16 ,E Only
1 . U value of gross area of walls , roof / ceiling and floors
o
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 .
c �3 S G cr /w S
2 . R value of exterior walls �� — .�
3 . R value of glazed area 4� -
4 . R value of doors
5 . R value of floors over heated spaces
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 )
9 . R value of heated basement / cellar walls ( beloww' grade )
10 . Type of Insulationf1GG5
C . Controls
1 . Thermostat maximum heat setting �, rc
D . Duct Systems
1 . Is duct system installed in unheated spaces ? YES NO
CIO If YES , R value of duct installation
b . R value of duct in other areas
E . Piping Insulation
1 . Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulation ,t_ ,/ �r .a' .aka
F . Service Water Heating
1 . Performance efficiency
2 . Temperature control setting maximum
G . For Swimming Pool Only
1 . Maximum heating
Telephone Nov
( applicant ' s signature )
CERTIFICATE OF INSURANCE
This is to Certify that ] STATE FARM? FIRE AND CASUALTY COMPANY, Bloomington, Illinois
❑ STA+� d/b/a
ERAL. INSURANCE COMPANY, Bloomington, Illinois
has in force for Marc L . Con Connell ` s Custom Construction
RD#3 Box 3 Address of Policyholder
L �.r1284
location of operations
the following coverages for the periods and limits in: ated below.
POLICY NUMBER TYPE OF INSURA E POLICY PERIOD _ LIMITS OF LIABILITY
(ef I.!ex P.)
92- 37-4037—OF .L.I Comprehensive / 1 ,t8, to 8/ 1 /89 ❑ Dual Limits for BODILY INJURY
Fkh� General L4abil Liability ! / /
Each Occurrence
❑ Manufacturers' an Aggregate $ _
Contractors' Liabil
Owners", Landlerd d PROPERTY DAMAGE
Tenants' Liability
Each Occurrence $
The above insurance includes
(applicable if indicaled by ] ® PRODUCTS-COMPLETE OPERATIONS V Ag9regate" $ ..-
OWNERS OR CON T RS' PROTECTIVE LIABILITY I-q}
Combine
CONTRACTUAL LI Y 1^i d Single Limit roc BODILY INJURY AND
x PROPERTY DAMAGE
BROAD FORM PROPERTY DAMAGE fir. ' S00 } � � .
BROAD FORM COMPREHENSIVE GENERAL LIABILI err Each Occurrence 5
POLICY NUMBER TYPE OF INSURANCE POLICY PERIO A Aggregate $ s
(eft lexp ) CONTRACTUAL LIABILITY LIMITS
(If different than abovey BODILY INJURY
Watercraft
Liability Each Occurrence $
PROPERTY DAMAGE
92-59- 1016-9F ® Di s Ben Lia 0/ 1 /88 to 10/ 1 /89 Each Occurrence $
❑ Aggregate $
❑ Combined Single Limit for: BODILY INJURY AND
EXCESS LIABILITY PROPERTY DAMAGE
❑ UMBRELLA
Each Occurrence $
El OTHER
Aggregate $
Workmen's/Workers' Com- Coverage A STATUTORY
pensa92-37- '1247'-2F Employer's
Coverage A /7/88 to 917 f8�
Employer's Liability Coverage B $lo0 ,Q00
-Coverage B
-Aggregate not applicable if Owners', Landlords' and Tenants' Liability Insurance excludes structural alterations, new construction or demolition.
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS,
EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
NAME AND ADDRESS OF PARTY TO WHOM CERTIFICATE IS ISSUED
Richard DUswalt
e
Sunset Trail
lignalure of Ant rized Representative
'QQuueensbury , NY 12804 Title n*
(558) FB-994.8 Printed in U.S.A. Rev. 11184
or
531 SAY ROAD
QUEENSSURE + ► + ELT
1'ELEP4i0NE �
BUILDING
FINAL INSPECTION f
INSPETIONIrm LgCATION �
PATE
TYPE OF STRt1C"iURE
RE STTURE)
FIRE MARSHAL APPROVALF {C AC RUC
KFII FRAMING
FIN ELECT AL SEPTIC
FOOTING FOUNDATION
-~ROUGH PLUfBINGWO.mSTO E/FIRE CE
YES .1- 140
"+INSULATION
SITE PLAN/VARI FiCE REQU REfAENT
REMARKS
N/A YES No
CHIMNEY HEIGHT/LOCATIO
B VENT/LOCATION
PLUMBING VENT
ROOFING
SIDING
DECK/P /
RELIEF VALVES y
FURNACE/HOT W `fit 'C1dOR��r
BASEMENT IN' /P AC DOORS
INTERIOR TRI�+{ R
FINISH FLOORS : TER IGHT
BAOTHIKiTCHEN LE_��
OTHER FLOORS CAERP ED
OTHER FLOO CEI�ILING
STAIR CLEARA
HANDICAPPED ACCESS
SMOKE DETECTORS
L
BATHROi1M
ALL PLUMBING FIXTURES OPERAT
GARAGE FIRE PROOFING���
DOOR CLOSERS
OTHER FIRE S�A� �
FIRE/'DEMISE WALLS
DUMPSTER
FINAL EL
OK TD ISSUE C/O R �--�—
i
1�
1
ARRIVE
DEPART
`?i `r'z-'�2. 5r0 S
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
,BAY 4 HAVILAND ROADS
QUESNS]BURY. SE�iYORS2-5 2804-
TELEPHONE
32
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
h C
LOCATIONK`,r�./�r.,'/ �`FcGLfF7��
t IIPERMIT ,# e
DATE APPROVED
YES NO
FOOTXNG/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP—PROOFING��--
BACKFILL .APPROVAL x
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—X
INSULATION:
FOUNDATION }(
FLOORS x
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY NEIGH
ROOFING
SIDING
]� EXTERNAL ORCHES/STEP
STAIRS— ARANCE & RA S
PLUMB G FXXTURESIRELI F VALVE
INTE OR TRIM/PRIVACY OORS
FIN SHED FLOORS
GARAGE FIREPROOFING
DOLOR C LOSER (S)
SMOKE DETECTOR
FINAL ELECTRICAL INSPECTION _
_FINAL APPROVAL OF CONSTRUCTION
OK TO ISSUE C/O OR C/C
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!'
REMARKS : I� 7 w_ ` ( �— IPS T"�..�►'q L f `i l
P,RRX V'E
DEPRit" INSP TOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAy & HAVILAND ROADS
QUEENSBURyr NEW FORK 12806-
TELEPHONE (518 ) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR �rNSPECTION RECEIVED
NAME /
,LOCATION
hit" rr �
DATE C PERMIT #
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR ORMS
FOUNDATION/DAMP ROOFING.
BACKFILL APPROVA
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH N
NSULATIONr
FOUNDATION
FLOORS O
WALLS '
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/S PS
STAIRS-CLEARANCE & ILS
PLUMBING FIXTURES/ IEF VALVE
INTERIOR TRIM/PRIV C pCNJRS
FINISHED PL90RS
GARAGE FIREPROOFI G
DOOR CLOSER (S)
.SMOKE DETECTORS
FINAL ELECTRICAL I SPECT N --
FINAL APPROVAL OF ONSTRU TION
A SIGNED CERTIFIC TE OF OC PANCY MUST BE
OBTAINED FROM THE BUILDING EPARTMENT BEFORE
THESE PREMISES AR OCCUPIED!
3
REMARKS:
Icf va
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURYI NEW YORK 12805E „-•' -jp
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INS
PE
C
T
ION RECEIVED J_
LOCATION
DATE PERMIT ## /
APPROVED
i// YES NO
FOOTING/PIERS
MONOLITHIC POUR `i 'ORMS
FOUNDATION/DAMP- 4OOFTNG
BACKFILL .APPROVAL"*
i4�UGH PLUMBING
4,=EcTRX
ELECRICAL ROUGH-IN
INSULATION: i
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/SIPEPS
STAIRS-CLEARANCE & RAILS
PLUMBING FIXTURES/RELIEF VALVE
INTERIOR TRIMIPRIVACY 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 OCCUPTEDI
REMARKS:
INSPECT ' R
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT -
BAY 6 fIA VTLAND ROADS
QUEENSBURY� NEW YORK 3280k
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S REPORT cy
REQUEST FOR INSPECTION RECEIVED
NAME L
LOCATION 0en
DATE 4a ` c 'J - 3 1 PERMIT #
APPROVED
YES NO
$,40OTING1PIERS
MONOLITHIC POUR FORMS
FOUNDATIONInAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH~Xl
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE /STEPS
STAIRS-CLEAR IN & RAILS
PLUMBING FIX r ES/RELIEF VALVE
INTERIOR TRI /PRIVACY DOORS
FINISHED F RS
GARAGE FIRE ROOFING
DOOR CLOSE (S)
SMOKE DET TORS
FINAL ELEC ICAL INSPECTION
FINAL APPR VAL OF CONSTRUCTION
A SIGNED 4ERTXFXCATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
Id
INSP R
SELECT BUSINESS FORMS (609) 84$-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
SECTIONAPPLICANT COMPLETES THIS
Date: r. r I
City, Town or Township County State
Location/Add ress 11 1 r S�
( If Located in Rural A a - P Attach Directions) Pole #
Owner
Permit #
Occupied As . a� Building: New[ Old 0
Occupant
A for Wiring Work Area in BuildingFloor #, etc. } :
Service Q or: Read for Inspection :
Fee Remitted - $ Cash Q Check Q M.O. I Make Payable To : M_D. 1.A.
Number of Rough Wiring Outlets Elect. }-feat s00 1 750 )ono 1250 1500 115a 2aaa 22so 2s0a arso sand
Switches
Lighting Amp. Service Surface Unit Dishwasher Range
Receptacles Water Heater Air Conditioner Dryer Pump
Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner
Amp, Receptacles Fractional H-P, 'Vent Fans
Other Equipment-
MOTORS . 1/2 1/P12 1/10 1/$ ;/6 1/4 1{3 1/2 3/4 1 14r 2 3 5 7 : 10 151261 25 30140 56 75 1W Mark Number
of Each Size
Applicant's
Signature License #
T/A Permit #
Utility:
Applicant's Address: , z/�/ (NAME OF ICE LOCATIO
(City) (StateI (Zip) Service Request #
Phone # Elec clan
+ • DATE RECEIVED:
DATE INSPECTED-
Correct Location : Same as Above 0 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 1112 1/10 2/8 1/6 1/4 1/3 112 3/4 1 llf: 2 3 5 71I� 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size
Elect, Heat 500 750 1000 1Z30 1500 1750 2000 2230 2500 2750 3000
:47, CORRFR,`1
:ejyi #f i¢Q INITFAL M1*IIT ; NOTLSIED DATE FIRE :` pE lAif 'r;
RW Progress: Inc. [D LKD Contractor
0 CFT Violation : Work Comp, 0 Inc. �
0 L/A Owner CASH
[] L/A Fee CH K #
IPA Municipal
Date .• Other Side 0
Cut in Card Temp #
Da*