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1989-459 MEM CER r-nFICATE C�� OCCUPANCY f � TOWN OF QUEENSSURY WARREN COUNTY. NEW 'YORK i Date September 7 l9 90 s � 1 89111111459 This is to certify that work requested to be done as shown by Permit No. has been completed. i This structure may be occupied as a single family dwelling #ri¢n - � Hidden Hills Drive Loc Qwner FOREST WOOD HOMES By Order 'Town Beard TovyrN or QUEENSBUIty Director of Bldg. do Code E cement BUILDING PERMIT TOWN OF QUEENSBURY No_ pg 45g WARREN COUNTY, NEW YOR K , t PERMISSION is hereby granted to FnREST WOO© HOMES u� OWNER of property located at P 1 .OT #S HIDDEN H I L LS DRIVE Street. Road or Ave. in the Town of 4ueensbury, To Construct or place a SINGLE FAMILY 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 Oueensbury Building and Zoning Ordinance. 1 . OWNER'S Address is HC- 2 sox 286P ; WARRENSBURY , N . Y . 12885 M t.', 2. CONTRACTOR or BUILDER 'S Name --1 SELF 3. CONTRACTOR or BUILDER'S Address M SAME 4. ARCHITECT'S Name r— S. ARCHITECT'S Address z G m 6_ TYPE of Construction — (please indicate by XI r XXi Wood Frame I i Masonry I l Steel [ 1 r Le) C 7. PLANS and Specifications No. 1043 sqw ft . first floor , 756 second floor sq . fto as per plot plan , n specifications , and application , including septic , attached two car garage , old driveway , ti . 8. Proposed Use FAMILY SINGLE K ICIKK DWELLING IW m $ 23S_00 PERMIT FEE PAID — THIS PERMIT EXPIRES January 1 19 90 b _ Ilf a longer period is required an application for an extension moat be made to the Building and Zoning inspector of the = town of Queensbury before the expiration date J r � � C=7 Dated at the Town of Queensbury this 0th Da of ,.tune 19 89 rn r r SIGNED BY for the Town of aueensbury Building and Zon I nspector ri 7 TOWN OF .") UEENSBURY APPI. ICATICIN FOR BUILDING AND ZONING PERMIT F e c.i c.v e,f TQYV{V kE [ ulrEsavRY Reviewed FIEiCEIVEQ Y + � x Fee paw. ".1UN � � 1989 BUILDING AND CODES DI :PARTI Date Ie.aued� RAY I NAVXLAND ROADS- RD 1 Flax �a dLD©. �. QlCt]E dEPT. nUEENSBURY, NEIi" YORE 12804 pin L t NO . , " '�• _ Tel . (518 ) 792-5832 Ext 204 • Yr ■ ■ • In •i ■ 1 * IN * t i ■ ! * * w #1 f w ■ • f ■ ■ ■ ■ ■ w ■ w ■ ■ i s A PERMIT MUST BD OBTAINED BEFORE BEGINNING CONSTRUCTION , N© INSPEC'TIONS WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BI; TLDINC PERMIT . All applicable Spaces on this application must be completed and the rwOature of the applicant must al) on the reverse sick of this sheet . „: 7k Yc do 'k * 7C ik 7t 7k 7k ik ak YY fK ih 'k Tile owner of this {property is TEL . Address ;tip r _ - TAX MAP NO . Z [° roperty location lit of this property' since October 1 , Ilas there been any split yes no if yes , Planning Board Review is In LOT NO . SUBDIVISION NAME , IF APPLICABLE The person responsible for supervision of work as regards Building Codes is : P . G . ADDRESS TEL NO . - NAME Tel Name of builder Address � 7.ddress Tel ka:a mt3 of Plumber Tel Name of Masson 14ATuRE OF PP4OPOSCD WORK : ,� 2(3NIPJC IN1I-01I( iLti '1' ION ( [3trice use only ) Jr ron ; truct iorr Of a new builain:7 x ZONING DESIGNATION OF PROPERTY Addition to a Uuil4ing + PERMITTED PRINCIPAL PERMITTED ACCESSORY 1 r �A1t. r .Uion to :+ Luilding „ REVIEW REQUIRED - PLANNING BOARD ZONING BOARD to axt .: rior rlimcnsiona ) Ut#Ir: r work (0 =f:cr -tiII SITE PLAN REVIEW # APPROVED STATE rr VARIANCE t# APPROVED DATE GROSS ARL:A OV PRopoSL' D: !; TI< UCTURE 6 " Remarks : 1st floor � r4 --sq ft . and Floor sq f t r C01•tPI.L 'i'l S{Jl'C3f:rv4'iION 1<L [�UllckiD 1sL L� rLI . 3 Size of prof>.: rt y > : ft }C „ fc . Other Floors sq ft . � 0 ''r r "i.:I inrl`r- [` � X ft ' y uil�lill�] ! = ] 51 -� ( not cellar or bas .: ment ) o� r TOTAL FLOOR AR > n + sq f t . r L:x1z r, 1„9 17ui1 Tina { : ) eau i xa O r' new ::tructuru f t x ft ' 1`c��slldatian-pier/ rlaU/crawl/Varti.al/ full ' Y.ralsascd bui.l0jng , rli : canca cram L,ru1�urcy line (c:irclu on6 ) Front yard 3L � ' it Rear yard ft Now of scori.eu (habi.t:ablO =:13i�CC ) oz r S1d� 'ya= d:l _ [ t :al-I r� LC lluighc ( grade to ric][]+s ) ftw r It on Qornar , ULACb"Ck from side :� Cru(:t ft 1 r ra�; iduntial , na . rar famiiie5yl OCCUPANLY I NFORMATION tlo , of rooms ( excludlnU baths ) ' [!a . of be droo,ns prLTMARY LUILOING - No . of b"Chroaulu Ono family dwelling [=riw,;ary #,u:ating s;y :fuel u� * iro tasnily dwulliny wyp : ref fuel dt � multiple jwulling / Humber of units tio . of firupladu;; to 1u. in::calleu ' pertin:�ncrxt oacupatkoy Will a wI ::cave: kru irrstalluli? ; 1'r:►r�sient occup;arlcy Cun Lr.al Air corlciiLiran ing'' LiuSinr:ss BUILDING STYLE, PRIMNIRY STRUCTURE ; Industrial � Ochar s;.arlCll GanQQ461l:,or.ary Lol? c,:.lain * It .addi. ciun , vllc►t will u::a [ui ;mod ranch Mans1LJ1% Dwill +.:x Jtll1t l4.#Vr.•1 Old scyle llu:l�l.alow r isya Cod Cott"Qo Otkwr " ACCUSSORY UUIL.DIHG- CcI l Qn t..i liC1►Ir 1'owll liO1SSl: r #Jwt.1C]3c'GL r�:srQL&g0/one Czar/ two C:1C/ car ( CIRCi.i:; ONL PLEASE ) 'w ��httacltiav cjar�agls/G+lu*, crsr/ �+w74 • ■ ■ ■ ■ IN s ■ a w • ■ Y Hpx R r �!1'Y'1V:,aGv staY::�g� building USTIMATED MAR. Kt'T VAI. 0 ii OF r �th4= r r JNPOPI14AT'TON ON BUTLOINCrSPECIFTCATIONS , ON TLCVERSE SIDFi OF ` HITS SHVET, TO BE COMPLE'1'L:Dt Farm BPA 10188 v1 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 'Thickness Depth of foundation below grade (to bottom of footing ) Will there be a cellar ? Heated or unheated? Floor sq . footage �sq ft Will there be a basement? w 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 Size , wood studs u " X spacing "'o . c . length ft . ' Joists ( floor beams ) lst , floor " X " spacing " o . c . span ft . Joists ( fl4or beams ) 2nd . floor " X spacing "o . c . span ft . Overlays ( ceiling beams ) "X spacing "o . c . span ft . Roof rafters " X 11spacing o . c . span ft . Roof trusses (pre-engineered) spacing " o . c . span it , Exterior wall finish Of what material ? Interior wall finish cr 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? Will a flue- lined chimney be installed? Height above roof ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth ft . in . Water supply - Municipal or private well SEPTIC SYSTEM Distance from ANY private well { including adjoining properties ft . (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 puns 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 owner, owner agent , architect, contractor � * * * aF * * * e, * * * * * * • * * * * at Nr rt * at Yr * * sr * it * : * 1r .t y, Y, rtr sk +r * * * * s. SPECIAL CONDITIONS OF THE PERMIT : .. ............. 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 . Type of heat + 3 . is the building mechanically cooled ? 4 . Percentage of area of windows and doors A . Over 16 % 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. 2 . R value of exterior walls 3 . R value of glazed area 4 . R value of doors 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 $ . R value -of heated basement/ cellar walls { above grade 9 . R value of heated basement / cellar walls ( below grade ) _ 10 . Type of insulation C . Controls 1 . Thermostat maximum heat setting D . Duet Systems 1 . Is duct system installed in unheated spaces ? YES NO a . If YES , R value of duct installation b . R value 4f duct in other areas E . P12ing Insulation 1 . 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 . r ( applicant ' s signature ) TOWN OF QU.EENSBURY APPLICA"ON FOR ✓1 SEPTIC DISPOSAL PERMIT DATE L=L I ! ) cfu LOCATION OF PROPERTY FOR INSTALLATION J - -' Owner's Name: [c , • , ��': , F: Telephone : (r j �. Address: w Installer's Name: tf ; F rt ;* s _ _ Telephone: Number of bedrooms (residential only) Total daily flow (compute Cd 150 gal per bedroom) Topography: Circle one: (F at '° Rolling Steep Slope % of Slope Soil Nature: Circle one: Viand ' Loam Clay Other /Death : Feet Ground Water: At what depth? Feet Bedrock or Impervious 'Material: At what depth? Feet Percolation test : Circle one: not require4q required rate min. inch. Domestic water supply : circle one: Nj_unicipai} Well Other If domestic water supply is a well: Separation: Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank % ';j gal, ( minimum size : 1 , 000 gal.) TILE FIELD : Each Trench feet/'Total system length feet SEEPAGE PIT(S): Number of / Size each feet by feet Size of stone to be used # /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 Sanitary Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: DATE: OVER Septic System Inspections : A , All applications for septic system installation , alteration or repair , as required by the Town of Queensbury Sanitary Sewage Ordinance , shall be submit-ted 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 an(i distance to structures 4 . ) location attd distance to any water supply 5 . ) size and dimensjons of all tanks , distribution boxes , rile fields anti /or drywells U . No system shall be covered before inspection and approval by the Building lnspt_ ctor . Failure to comply with this requirement may r4Lult in tku uncovering, of the system by the installer and a fine ut up to $2150 . 00 . 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 immudiate work stoppage . D . Should unforeseen problems during construction prevent proper installa— tion , alteration or repair of an approved system , a new Isroposal must h, submitLod to the Qu� unsbury Building Department before further coitstrueLion . Town of Queensbury BUILDING and CODES DEPARTMENT }lay and Haviland Roads Queensbury , New York. 12804 K� Marks TOWN OF CQuEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12SO& TELEPHONE ( 518 ) 792- 5832 BU I I NG INSPE.0 R' S REPORT REQUEST FOR .SPECTION REC IVED _ NAME LOCATION DATE PE IT #� *kl APPROVED YE'S NCJ FOOTING/PIERS MONOLITHIC PO FORMS FOUNDATION/D -PROOFT G BACKFILL APPRO AL ROUGH PLUMBING /}yyy FRAMING I ELECTR1' AL ROUG -IN INSULATION: FOUNDATION FLOORS WALLS CEILING }� FINAL INSPECTION . l` CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH E STEPS STAIRS-CLEARAN E RAILS _ PLUMBING FIX^'LP E5 RELIEF VALVE INTERIOR TRIM/ RI Cy DOORS FINISHED FLOG GAAG FIREPR R E WING DOOR CLOSER (S _- SMOKE DETECTO S FINAL ELECTRICA INSPE XON - FINAL APPROVAL F CONST UCTION OK TO ISSUE C/ OR C/C A SIGNED CERTI XCATE OF CUPANCY MUST BE OBTAINED FROM HE BUILDIN DEPARTMENT BEFORE THESE PREMISES ARE OCCUPI ! REMARKS : I -,- � ARRIVE !�.-. DEPART INSPECTO TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12$046 TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S RT REQUEST' R SNS RQTXON RECEIVED � �� NAMEG�`i'Jr�y�F/J r � LOCATION DATE PERMIT # APPROVED YES NO FOOTING/PIERS MONOLITHIC PO FORMS FOUNDATION/DAM PROOFING BACKFILL APPROV ROUGH PLUMBING FRAMING ELECTRICAL ROUGH- .INSULATION: FOUNDATION FLOORS WALLS CEILING XFINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH /STEPS STAIRS-CLEARAN E & PAX PLUMBING FIX TU ESIRELI'E VALVE INTERIOR TRIM RAVACY D RS FINISHED FLOG S GARAGE FIRED PING DOOR CLOSER ( ) SMOKE DETEC RS _........_ FINAL ELECTRT AL INSPECTION FINAL APPROVA OF CONSTRUCTION OK TO ISSUE 0 OR C/C A SIGNED CER IFICATE OF OCCUPANCY ST BE OBTAINED FR THE BUILDING DEPART NT BEFORE THESE PREMI ES ARE OCCUPIED! REMARKS: d ARRIDEPAR VE / SNIP R TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280&- TELEPHONE (518) 792 -583 BU ING INSP REPORT REQUEST I PECTION NAME r LOCATIO DATE RMIT # ' APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR ORMS FOUNDATION/DAMP— ROO NG BACKFILL APPROVA ROUGH PLUMBING FRAMING ELECTRICAL ROUGH— INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL IN, CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH E /STE STAIRS—CLEARAN & RA LS PLUMBING FIX TU ES/REL F VALVE _ INTERIOR TRIM/ RIVACY OORS FINISHED FLOO GARAGE FIREPR PING DOOR CLOSER {S SMOKE DETEC S FINAL ELECTRIC INSPECTIO - FINAL APPROVAL F CONSTRUC ON OK TO ISSUE C/ OR C/C A SrGNED CERT ICATE OF OCC ANCY MUST BE OBTAINED FROM THE BUILDING D ARTMENT BEFORE THESE PREMISE ARE OCCUPIEDI REMARKS: lei ARRINM DEPART /`/` rNs EcTOR WN OF QUEENSBURY „[J.IZI3ING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, 5$) yoRx 1280ik TELEPHONE ( 5832 BUILDING INSPECTOR' S REPORT REQUEST F INSPECTION RECEIVED �v NAME LgG CATION DATE PERMIT # APPROVED YES NO FOOTINGIPIERS MONOLITHIC PO U FORMS FOUNDATIONIDAM PROOFING BACKFILL APPROV ROUGH PLTJMBING FRAMING ELECTRICAL ROUGH- N INSULATION- FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION : CHIMNEY HEIGHT ROOFING SIDING NxTERNAL PORCHESISTE _ STAIRS-CLEARANCE & RA .S PLUMBING FIXTURESIREL F VALVE- INTERIOR TRIM/PRIVACY RS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL INS CTION FINAL APPROVAL APPROVAL OF CO STRUCTI N --- UK TO =iaSUE C/O OR f C� - _._.�•......� A SIGNED CERTIFICA OF OOCCUPA Cy MUST BE OBTAINED FROM THE UILDING DEPA TMENT BEFORE THESE PREMISES AR OCCUP-FEDj REMARKS : ARRIVE_ DEFAR ;! INSPECTOR olo XXNI OF QUEENSBU Y ro 4.ILDING AND CODES EPARTMENT SAY 6 HAVILAND ROAD QUEENSBURY, NEW YO 1280&- TELEPHONE (518) 79 -5832 BUILDING NSPECTOR ' REPO T REQUEST R INSPECT ON ECEI D _ NAME LOCATION DATE PERM APPkOVED YES I NO FOOTING/PIERS MONOLITHIC POUR FO S FOUNDATION/DAMP--PR FIND SACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH- INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/S EPS STAIRS-CLEARANCE RAILS PLUMBING FIXTURES LIEF VALVE INTERIOR TRIM/P Y DOORS FINISHED FLOORS GARAGE FIREPROO NG DOOR CLOSER (S) _........... SMOKE DETECTORS FINAL ELECTRICAL INSPE ION FINAL APPROVAL 0 CONS UCTION OK 'T'O ISSUE C/O OR CJC, A SIGNED CERTI CATE OF CCUPANCY MUST BE OBTAINED PROM HE BUILDI G DEPARTMENT BEFORE THESE PREMISE ARE OCCUP ED! REMARKS: ,ARRIVE 7 �) DEPART INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I280&- TELEPHONE 518 ) 792-5832 ILDING INSPECTOR' S ORT REQUEST FOR NSPECTION RECEIVED r NAME LOCATION DATE PERMIT # 7 APPROVED YES NO FOOTING/PIERS MONOLITHIC PO FORMS FOUNDATION/DAM -PROOFING -- BACKFILL APPRO L ROUGH PLUMBING FRAMING ELECTRICAL ROUG IN X INSULATXON: / FOUNDATION FLOORS r WALLS _ CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES1 TEPS -- STAIRS-CLEARANCE RA PLUMBING FIXTURES/ L EF VALVE INTERIOR TRIM/PRIVA Y DOORS FINISHED FLOORS - GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL INSP ON FINAL APPROVAL OF CON T CTION OK To ISSUE C/O OR C A SIGNED CERTIFICATE OF UPANCY MUST BE OBTAINED FROM THE BU LDIN DEPARTMENT BEFORE THESE PREMISES ARE CUPIE ? REMARKS :' ARRIVE DEP ,+ ✓ .INSPECTOR awn 0/ B DING and ZONING DEPAR MENT Bay d Haviland Road, R.D. Box 98 .a eensbury, New York 1 8+01 SEPTIC ISPOSAL SYSTEM NSPECTION NAME LOCATION DATE �/ PERMIT NO. SOIL TYPE - a - Loam - lay - Percolation Te Required? YES - T Percolation rat - Min/In _ TYPE of SYSTEM: Absorption field total 1 Length of each t Depth of es Siz gravel_ SEEPAGE ��PwI^yT�� S{Numbe of) Size- 1 J t. X " ft. Gravel s adz e PIPING : ze Type Bldg . to tank --- Tank to dist. boat P cI' _ Dist. box to field/p ip V � openings sealed? NO Partial LOCATION/SEPARATIONS Foundation to tank Foundation to absor i. n f Absorption to lot. 1 ne f Separation of pits f LOCATION OF SYSTEM P oPERTY ircle one) Front - ear - Lef sid - Right side - COPIMENTS : 1-FO L&S O V ocAr ra c7 SYSTEM L� APP EL1 YES O n e a 4 1 �! TOWN OF QUEENSBURY BUXLDXNG AND CODES DEPARTMENT DAY 6 HAVXLAND ROADS { QUEENSBURY, NEW YORK .12801& TELEPHONE (518) 792-5832 BUILD NG INSPECTO ' S REPO T REQUEST FO INS ECTXON REC IVED ��, NAME 73 LOCATION �,. /7 DATE L P RMIT # APPROVED YES I NO FOOTINGJPIERS MONOLITHIC POUR RM FOUNDATIONfDAMP-P 00 ING ACKFILL APPROVAL UGH PLUMBING RAMING LECTRICAL ROUGH- NSULATION: FOUNDATXON PZOORS WALLS CEILING fteFXNAL INSPECTION: CHIMNEY HEIGHT ROOFXNG ,SIDING EXTERNAL PORCHEFIST PS STAIRS-CLEARAN & ILS �^ PLUMBING FIXTU Sf IEF VALVE INTERIOR TRIMf VAC DOORS FXNISHED FLOOR GARAGE F2REPR ING DOOR CLOSERI'S) SMOKE DETECTOR FINAL ELECTRICAL INSFEC ON FINAL APPROVAL O CONSTR CTION _ OK TO ISSUE C/O It C/C ^ " _ A SIGNED CERTIFX ATE OF UPANCY MUST BE OBTAINED FROM TH BUILDIN DEPARTMENT BEFORE THESE PREMISES A Ef6i OOCCUPI I REMARKS:J3 +��-M{' G+ az rsi rf -a ow zymfs-r� ARRIVE DEPART INSPEC R National Headquarters 1337 I t te3r,'PA 19380 Date ; City, Town or Township County el ✓ r rc, State l Location/Address _Pt Cif Located in ural Area - Please Attach Directions) .Pole Owner s #r - _4 / k 44 �. r f k Plfr rtFt '40 I seE occupied As - s ✓ f ��a114 Buildin 9 $wOld �j Occupant ' Work Area in Building Floor #, etc. ) : for: Wiring rvice mar: Ready for Ins 6c[icirl : Fee Remitted - $ Cash � Check - � im O. Make Payable `1'0': M,D.I.A. I .Number of..Fiqu� 5 Wising Outlets Elect, Heat r -$17 .7_W ;000 lzsa 1500 1750 z00o 225o 2500 275a 3000 Switches ' : : *� Amp. Services .Surface Unit DishwitHer -�- Range Lighting Receptacles Y -- —water Heater Air Conditioner Dryer , �u dump Num t i+" ixtures Oven YZllllfrbage Disposal Wiring and Controls for Burner Amp. Receptacles.:: - Fractional H.P. Vent Fens Other Equipment: MOTORS H.P. - 1/ 1/1 t/10 1/e 1/re1,14 1/3 112 3/4 1 :1 2 3 . 5 7Vz 10 15 20 25 30 4Q, .10 a75 , 100 Mark Number of Each Size Applicant's _ Signature L`icehse # Fientlflk �# T/A , Utility- {N r Appi icanif Address: (Ci#Y) rr Qi7 c 8 f5tatey . :[ Rl f .¢. �r Service Request # dF Phone # "y Elec triciaip » 4014TE RECEIVED: DATE INSPECTED."_"—'„ ~"i• e- Correct Location - Same as Above [] or: ' Red Notice Label Rough Wiring Outlets Surface Unit _ Oven Switches Flan ' far fl 3piosal ' Receptacles Water Hearer "' '`l3isfiwa3Kef ' - Fixtures it Conditioner - Eiryer k ; Y •1 Amp. Service Equipment Burner, Wlring"$c bomrolt for Ampr. tacle Amp. Service Conductors Pump Vent, Fans MOTORS H.P. 1J20 1/12 1/10 1/6 1/6 1/4 1/3 112 3/4 ' 1 IM! , 7Jlz 10 15 20 25 3 40 ' e 7 1{kf Mark Numller - of Each Size - 500 rye 1606 1250 1500 1750 2000 22so a5a0 z75a s00o Elect. Heat - ! �; ` ' k i . C .- .e. • 7 ' is _ 1 - 0 RW Progress: Inc. 0.,..�--- LKQ � .,r�ontractor 0 CFT Violation : Work Comp. O Inc. .� - '' El F1 L/A ;; ' Owner CASH Z e CHK # O. L1A _ Due MO # 0 IPA Municipak,, I V # Date; Other Side Q. Utility F ,Appl pan} li.� F -f` S "�"--- Yam: ly/Y1[ i is 4 Cut in Card Temp # Date # Date I 5 I i4Fu FW APPLIGATI ON FOnM N0. 250 EL 't 1/84 TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT HAY & HAVILAND ROADS ¢UEENSBURY, NEW YORK 128Ok TELEPHONE (528) 792-5832 ,! / BUILDING INSPECTOR ' S RF.P{]RT REQUEST FOR INSPECTION RECEIVED NAME LOCATION DATE PERMIT ## __x C APPROVED YES NO POOTING/PIERS A0N0LITH.IC POUR ORMS /yX_,FOUNDATIONInAMP- ROOFSNG /' BACKF-rLL APPRpYA ROUGH PLUMBING FRAMING ELECTRICAL ROUGlY N INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES EPS STA.1rRS-CLEARANCE RAILS PLUMBING F-TXTURES RELIEF VALVE INTERIOR TRIM/PRI CY DOORS FINISHED FLOORS GARAGE FIREPROOF N - DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICAL NSP CTION FINAL APPROVAL O CON RUCTION OK TO ISSUE C/O R C/ A SIGNED CEIR? CATE O OCCUPANCY MUST BE OBTAINED FROM E BUILD G DEPARTMENT BEFORE THESE PREMISES ARE OCCU ED! REMARKSr ARRzvE Z DEPAR�� INSPECTOR 1 To" F QUEENSBURY BUILD NG AND CODES DEPARTMENT y BAY & HAVrLAND ROADS NEW ^ _ ? QUEEN BURY, W YORK 1280j- TELEP ONE (518) 792-5832 f BUILDING INSP.E ' S REP RT 11'EQUES FOR INSPECTION REC rVED NAME r.00ATIO �"` p DATE PE rT #_ _^-- APPROVED YES NO F'OOS'ING/PI MONOLITHIC FORM FOUNDATION/ AMP-PROOFI BACKFILL AP VA ROUGH PLUMSr FRAMING •ELECTRICAL R H-rN INSULATION; FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGJVT ROOFING SIDING EXTERNAL PORCHES/ TEPS STAIRS-CLEARANCE RAILS �- PLUMBING FIXTURES LIEF VALVE IN1'ERIpR TRIM/PR A y FRS FINISHED FLOORS GARAGE FIREPROOF C, DOOR CLOSER (S) -� SMOKE DETECTORS FINAL ELECTRICAL I SPEC ON FINAL APPROVAL OF ONSTR TION OK TO ISSUE C/O a c/c A SIGNED CERTIPrC TE OP OC UPANCY MUST BE OBTAINED FROM THE BurLUYNG EPARTMEN2' BEFORE THESE PRE'MXSFxSS A OCCUPIED REMARKS= AFUUV.E DEPAR +3 rNSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I280I / TELEPHONE (528) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION REcESVED NAME � f LOCATION c//i��J,,arr,��. ',�r�a DATE 11� _ PERMIT # APPROVED YES NO IX FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—PROOFING T� BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN .INSULATION: s FOUNDATION FLOORS WAL IS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHE.S/STEFS .STAIRS—CLEARANCE & RAILS PLUMBING FIXTURES/RE EF ;L*ALVE INTERIOR TRSMIPRIVACI DO0?lS � FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICAL IN PECTION " FINAL APPROVAL OF CJNSTRUCTIOal1T OK TIO ISSUE C/o O C/C A SIGNER CERTIFI TE OF OCCUPANCY MUST BE OBTAINED FROM TH BUILDING DEPARTMENT BEFORE THESE PREMISES RE CJCCUPIED! REMARKS: ,fib 42,E AJ � ARRIVE DEPARZ . � •L - I SPECTOR SELECT BUSINESS Fc)Rm5 (609) 648-5203 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 a • Date: V l+ � City, Town or Township �County �+4+' YC,*16 State r "/ Location/Address / a+ "r ' e e. r ( If Located in Rural Area - Please Attach Directions) Pole # ' 3 Owner kj!�` r.gr► Permit # Occupied As Building: New= Old = Occupant Work Area in Building Floor #, etc.) : App. for: Wirin = service [] or: Ready for Inspection : Fee Remitted - $ Cash es Check C] M.O. F-1 Make Payable To : M. D_ LA_ Number of Rough Wiring Outlets Elect. Heat SOD 150 1000 1250 1500 1750 2004 2250 2500 2750 30D0 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.F. Vent Fans Other Equipment: 4 MOTORS H.P. 1/2 1/1 1/14 1/8 1/6 1/4 1/3 1/2 3/4 1 1V2 2 3 5 742 l0 15 24 25 34 410 54 75 100 Mark Number �I"' of Each Size Applicant's Signature License # Permit # T/A Utility : Applicant's Address : 13 as ,me (NAME) (OFFICE LOCATION) (City) M-"r (State) /J `•'4 (Zip) i Is €"1 Service Request # Phone # Electrician : DATE RECEIVED: LATE INSPECTED: NRI Correct Location : Same as Above [] or: Red Notice Label = Rough Wiring Outlets Surface Unit Oven Switches Ran 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. 1/24 1/12 1/10 1/8 1 1/6 1/4 1 1/3 1/2 3/4 1 1 1kh 2 1 3 1 5 1 7112 1 14 1 15 1 24 1 25 1 34 1 40 1 50 1 75 1 100 Mark Number of Each Size :1ect. Heat 500 1 750 100D 1250 1500 1750 2000 22511 25011 2750 3000 ' Patrick J DasM+ar ,- PO x 321 Hudson Fans, NY 12839 j 518/'?98-3473 . .. : ` '. ELECTRICAL INSPECTOR ' Calmoc-COTIOW j USE FOIE INITIAL VISIT IONILY NOTIFIED OATS COF"� FEE PAID © RW Progress : Inc. LKD Contractor 0 CFT Violation : Work Comp. 0 Inc. ["I 0 L/A Owner CASH LIA Fee CH K # Due MO # IPA Municipal INV # Date: Other Side [] Utility AppleOw• Cut in Card 0 Temp # Date ti o . . ......�...�.-...-... ........ Cim /14#AIla r� scd o' w a l Hi TOWN OF QUEENSBURY 01 Zoning Admini ralor Da tam k LJ r d AUG 71990 nING rJc COO .0p Z> r o r : 4j f . 1�