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1989-498 .n.t-. v,+ar^*r+rYr7g5,"1�•.: . 2 'n. . . �'ws ,; .. 4# e6 -oYsrsaac.xrrr..� ,-. .4 .v. - -, ..., ,A'•. ,"�q+, . T- ►..�r.�•-- -r „ .. . -n ...,,, � J CERTIFICATE +�` � C CUPAN(a�w'Y' TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date July 27 19 goo ` r ( 2tr !ZA This is to certify that work requested to be done as shown by Permit No. 89- 498 has been completed. This structure may be occupied as a __ ____ Add i t j on to single family Location 3 3 H e i nrr i c k c i rc l e Owner _ _. Roher-f Whiz aboad By Order Town Board 'rOWN OF QUEENSBURY Director of Bldg. & Code Enf ement sy r BUILDING PERMIT x TOWN OF QUEENSBURY No. f39- A9�1 WARREN COUNTY, NEW YORK n� PERMISSION is hereby granted to Robert Whitehead OWNER of property located at 33 Hei nri ck Circle street, Road or Ave. in the Town of Queenshury, 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. a H 1. OWNER'S Address is —¢ rr M Same 2, CONTRACTOR or 13UILDER'S Name C? CD Robert Bolen 3. CONTRACTOR or BUI LDER'S Address PwO , 46 Lake George , N . Y . 12845 r4. ARE1H1lTECT2S Name [b 5. ARCHITECT'S Address C7 5: C r f] 6. TYPE of Construction — (Please indicate by X) l ) Wood Frame ( } Masonry 1 1 Steel I } 7. PLANS and Specifications No. 1716" x 11 " 7 " addition to single family dwelling as per plot plan , specifications , and applicatione c c S. Proposed Use r Addition to Single Family Dwelling < a. 00 PERMIT FEE PAID — THIS PERMIT 'EXPIRES February 1 19gQ u (if a longer period is required an application for an extension must be made to the Buikfing and Zoning inspector of the i town of Queensbury before the expiration date.) Dated at the Town of Queensbury this 5t h pay of July 1989 SIGNED By far the Town of QueQueensbury , ;Building a nirg Inspector ., LV 1 CAI- � UEE SBL'RY ' nl . ti .t. ^ ' �JUIITr IT ". ern 7ONTN � T NOWNWEENOM TOWN OF QUEENSBURY RECEIVED Cv.teW d� } F A) s JUN 2 G 1989 Fee roved { . --� Ari1�r BLDG, & CODE DEPT. WILDING AND CODES Sri J '�%MTVT Date labue.d I�SY .end FfAVIi.r1lVD ROADS RD 1 49ox 73 nUEE'NSBURY , N.EIJ YORF: 1 2d o-4 PCn►ni t NU . � _ Tel . ( 516 ) 797- 5832 Exc 204 w w a w • w w ■ • w • ■ ■ w w w w * ♦ ■ a r r r s a • w w w w a w r w A PERHIT MUST 11I2 OBTAIta £-. D L) EI70RE LECINHINC CONSTRUCTION . NO INSPECTIONS WILL I3L: HADE UNTIL APPLICANT HAS r,,,zc : IVI: D A VALID BUILDINC PERMIT . the All applieablL spaces on this application must be Completed and imature of the applicant must appear on the reverse sick of this sheet * at n a x k * * * w x A A !e 7t 7t fe 'l' 3ie owner of thhis property , is t�"` D J�Ct- C, �^ t `l tTKC li � �►� rf, Add r e s s _J ' �`oC. 1 �- C• t. �C. I TELWIN- o ! rRK MAP NOw lroperty^ locationL.3 '��tl�jj� 1 / / leas there been any split of this property since October 1 . 1S $ $ ' / yes no If yes , Planning Board Review is necessary . suBDIVISION NAME , IF APPLTCABLE LOT NO . 'i' he person respo n sible for suparvision of work as regards Building Codes is ' ? �•� �`� t2rt3 � +r�► fJ tc� '�--�►'VQ �,`ceaR�'SL i1 --4 S � NAME 1 . G . ADDRESS TEL . NO . Tel 14ame of builder acs Address Caarrls of plumber 7.dd.ress Tel Tel Name or Mason AJdr4ss ; iATuRE O PROf'Or.L:D HJRK : FNIN1 ClltrtATION ( office use only ) C'nn :Lruccicf, of a i1 :w building wSICNATION OF PROPERTY �Adlicion to a boil .ling PRINCIPAL, PERMITTED ACCESSORYA1t ,: r,aLian to a LulldLng( no clt.a, u] 4: to .:xc � rior clilnr.3nSiCin:i ) QUIRED - PLANNING 6OARD ZONING 130ARC7�w (jtl ,+ur work { ,la:crLLxt ) + SITE PLAN REVIEW p APPROVED HATE VARIANCE APPROVED DATE is � S5 AkI=A Ol' ti' ROn05L' O. . 'CIcUc: '1' 1Jklx p F� s q f t , ■ Remarks : i- _ st Floor +► n d Floor s q f t ww C cunt V r L'z'� 1 11'Oi,rua'1'SQr1 ScL;}u I1sDLl uL L�+tif . �^� ' Sis:a of prol,4rty tit x \ o0 f t . Other Floors ■� ? sq fc . � Lxi::til1;} L' uil�li, 1•] L :: ) Siaa�1° 1: x_ _'ad ( not collar or bas .: ment ) ■ TOTAL FLOOR AREA L" Sri ft • + ' 1:xa.AMC A ,Iig 0;+ + 11in�Jl:. ) (if nL•w ::tructul t �k fc X fC L'oLw4daci.on-pier a13L r:awl/Ly,arclal/ Cull ` proYaased 1c+ailsinge ciimtancu tr4u1 L, ral�urt f tlnu uirc:l.: one ) # Front yard � 1" t Rear yardawwon fC: N,] , of stories (t►a)ait:abl.: !-L�a.Ce ) �fc and aft „ 8idw yard.:. il,:ighc ( Urada to rifJq%A ) _ It ft . * IF an carnar , sc: G}3.ack frola side ztruc:t �_r' c It: r.::.� iduntiai , now of famili+es �,„�� NO , of rocmustcxcludinq b"Chs ) 1 " C}CCCJPAJyLY tIVFOf�MATIt1N Claw of bradroclax )"L � — F�Y LUILDiNC.: r Now of b:stlrroQutL; - ona family dwelling I'riw:axy 11ia,atirtij Lr 4uu1e 6dja;"ATWO t"mily dwulliny TY1,14A oaf fu,: l Vd-IN7 - ruultlpl" UwQlling / Number of units. No . of firuplacc:: tea U" in:;t:all::d Par►It..ncett caaup"14cy twlill :. wcawA �co++rt k,u inutwliuci? awdEENEEPW .I•r:an::i►:r4t ra,:cu;tartc:y L'untr.al Air wwwwwwwwwwUusinuss ■ BUILDING STYLE, PRInNRY STRUCTURE ■ invuscrial Othar 1`aetCh, Con t%jui .Gr"ry LC.+? cal3in * it .addition , wl,.at 1ri11 u:.0 b)Q? la... isucl ranch run,sic.+c D+uI,lwx 1014e IQV%:l Gild attylu Isu+syalow " �+c Caataq� Oc1w.r ; ACCESSORY IAUILDINGr '�.,LG11Gillia li01I '1'Dwi, House ■ 1ae: tr7C)la:Gl tjariygQ/GnEt Czar/ twocat/ Car CIRCLE: ONL PL ►SE ) awnewpowma' ACtwc11� V t}:ar ag�/'otlr' czar/ two • w ■ a ■ • ■ • a • a * ■ tr lbrivatr• StOC:►43 building L' 41• IMw'L• i: fl etl► 1t1cr•1' VRI. UE OF ' ��OCI'l..: r� LoNsY• kuCTTUN }�rl. �L�irLrr � � rrirrr INFORMATTON ON DUrLDINC spr.CjFrcATiOHSa ON REVERSE SIflr_ OF TNTs sHOE"r, TO BE COMPLGTLDI Force BPA I0/88 v1 rCP �+ BtJITOING PERMIT APPLICATT.. C:7 : �t;uE=, - BUILDING SPECIFICATIONS : Tyte of construction , wood £rare , ire sore , etc . Will any second- hand or ungraded limber be used ? If so , for what ? Foundation wall material Lff.)CI� __Thickness 5 Depth of foundation below grads ( to bottom of foot ' g ) Will there be a cellar ' Heated or unheated ? Floor sq . footage 5q ft Will there be a basemen ? Will any portion be used as living space ? _Y� [ if so , what portion ? sq . ft . - - Type of use ? 1•41 r, Type of roof - sloped/flat/spec/other � •+� material of roof vise , wood studs " x ^" $pacing 'o. c . length &5 -ft . Joists ( floor beams ) 1st . floor " � spacing " o . c . span ft . Joists ( floor beams ) 2nd . floor " X " spacing "o . c . span ft . Gverlays ( ceiling beams ) QFX spacing " o . c . span ft , Roof rafters �" X td spacing o . c . span 1ft , Roof trusses {pre-engineered} spacing " o . c . skan £ t . Exterior wall finish ti f what material ? p ,a Vf Q y's-ripkxl{ Interior wall finish If if a garage is to be attacitidd , escribe materials to be us4ld 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 " e provided? Will a flue- lined chimney be installed? o Height above root ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth "AC-ft . in . Water supply - Municipal or private well 'C4� 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 L A R a. T10N 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 � zk� Owner, owner's agent, architect , contractor or SPECIAL CONDITIONS OF THE PERMIT : By- ....� . ...... -- 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 4 2 . Type of heat 3 . Is the building mechanically cooled ?�'1} y� 4 . Percentage of area of windows and doors ic='?o !o A . over 16 % Only 1 . U 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 ? S 3 , Slab on grade YES NO a . If YES , what is the R value of insulation f arounrd perimeter of floor ? ♦ .9,5 e t 4 . Is basement heated ? YES a . R value of insulation 5 . Type of insulatia C^r1 B , Under 16 % Only C] ,r 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 8 , 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 . 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 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation Fe Service Water Heating 1 . Performance efficiency 2 . Temperature control setting maximum G . For swimming Pool Onl 1 . Maximum heating Telephone No . appl t an ' s signature SYRACU 02 ALBANY 12241 BINGHAMTON 13901 BUFFALO 14203 HEMPSTEAD 11550 NEW YORK 10047 ROCHESTER 14614 S ate Off SEBu 20 ng 100 Broadw av Slate Office Bu,ld MC) Slate plfice Buildonq M enanefs Hawle}+ Street 125 Main Streel 175 Fulton 0.uc nue Two World Trade Center 155 Main Street W. East Washington t- STATE OF NEW YORK �,� g WORKERS' COMPENSATION BOARD THIS AGENCY EMPLOYS AND SERVES THE HANDICAPPED r WITHOUT DISCRIMINATION- OFFICE, AT ROBERT STEINGUT STATEMENT THAT APPLICANT DOES NOT REQUIRE CHAIRMAN WORKERS ' COMPENSATION OR DISABILITY BENEFITS COVERAGE (Ref : Sec . 57 , WC Law; Sec . 220 , Subd . 8 , DB Law) Applicant ' s Name �� . R . Now Address 4 C' ` 1. ('" Office At Business or Trade Name , if Different From Above The above named applicant for permit subject to restriction under Section 57 of the Workers ' Compensation Law , and Section 220 , Subd . 8 , of the Disability Benefits Law , makes the following statement for the purpose of establishing that he / she does not require coverage under these laws . ) ' 1 , Location of work ih' �� ►2rC�C �' 4CFcc �E- Qug `ASfov '-�-7 2 . Exact work to be performed 06mit-[ r4 �` "� J /2 ?6/) ?0Ct -it: 3 . Number of workers Q 4 . Date work is to be (a) commenced Q 'j ^yoa /! S (b ) completed6a /p� jxt S P �12mr ?" } s / ogSov- < IAA fr ' I have workers ' compensation insurance ( certificate attached) . I do not need workers ' compensation insurance because status Is Individual owner or partner with no employees and not a corporation . I do not need workers ' compensation insurance because : ❑ I have disability benefits insurance (certificate attached) . I do not need disability benefits insurance because status is Individual owner or partner with no employees and not a corporation . ❑ I do not need disability benefits insurance because : I hereby affirm, under the penalties of perjury , that I am the above named applicant for permit subject to restriction under Section 57 of the Workers ' Compensation Law and Section 220 , Subd . 81 of the Disability Benefits Law and that the foregoing statements are true . Date Signed (o '�a -? , 19�?L �_�AN: Signature of Applicant Telephone No . _ (O(C:� Title TO STATE OR MUNICIPAL DEPARTMENT , BOARD , COMMISSION OR OFFICE REQUIRING CERTIFICATE OF WORKERS ' COMPENSATION INSURANCE UNDER SECTION 57 OF THE WORKERS ' COMPENSATION LAW AND UNDER SECTION 220 , SUBD , 8 , OF THE DISABILITY BENEFITS LAW Based on the foregoing statements made by the above applicant : The Board has no objections , at this time , to the issuance of the permit requested . 0 The applicant will be required to have a Disability Benefits insurance policy effective not later than four (4 ) weeks after the employment of one or more employees on each of at least 30 days in any calendar year . It is to be understood , however , that the Board reserves the right to request revoca- tion of the permit if , after investigation , it is found that the applicant is required to have workers ' compensation and/or disability benefits coverage for the work referred to in the above application . WORKERS ' tN T O RD (may By Date : 4&17 d" (District Administrator or Supervisor of W . G . Enforcement) G- 105 . 21 ( 7-83 ) TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT L1 BAY & HAVILAND ROADS 11 QUEENSBURYt NEW YORK 12804- TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED "Sleq NAME LOCATION ? / `/ �__lC��i_.•L L_.dCR l�`t C_- {._F' DATE //]� � PERMIT # APPROVFsD YES NO FOOTING/PIERS MONOLITHIC 1\0UR FORMS FOUNDATION/DAMP-PROOFING BACKFXLL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-XN INSULATION: FOUNDATION FLOORS WALLS CEILING ✓FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHESISTEPS STAIRS-CLEARANCE & RAILS PLUMBING FXXTURES/RELIEF VALVE INTERIOR TRXM/PRIVACY DOORS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL XNSPECTZON FINAL APPROVAL OF CONSTRUCTXON A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISEIS ARE OCCUPIED! REMA R KS.: 1 I d r NSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT ^y� BAY 6 HAVILAND ROADS QUEENSBURY, NEW YORK 1 280g- TELEPHONE (5I8) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTIO,Nr RECEIVED NAME LOCATION . , DATE { - ca)� 7 PERMIT #_ APPROVED YES NO t FOOTING IERS MONOLITH POUR FORMS FOUNDATIO DAMP-PROOFING BACKFILL A ROVAL ROUGH PLUMB G FRAMING �EL�CTRICAL RO H-IN SULA0I FOUNDATION FLOORS EXEILsjLING _ FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCR.YVISTEPS STAIRS-CLEARA E & RAILS_ PLUMBING FIX RESIRELIEF VAL E _ INTERIOR TRI /PRIVACY DOORS FINTS'yFD F ORS GARAGE FIR ROOFING DOOR CLOSE (S) SMOKE DET TORS FINAL ELECT TCAL INSPECTION FINAL APPR AL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINER FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES/ ARE OCCUPIED! REMARKS: � F INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURYr NEW YORK 3280k yp�vl TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED (�r' - a --�^ NAMEy� z rQ LOCATION 3 ,3 DATE 5C- q 3 PERMIT /# APPROVED YES NO FOOTING/PIERS MONOLITHIC PIRUR FORMS FOUNDATION/DAMP-PROOFING BACKFXLL APPRII AL ROUGH PLUMBING FRAMING ELECTRICAL. ROUG IN t,. 'SNSULATION: FOUNDATION iL FLOORS f WALLS CEILING FINAL INSPECTION: f CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/S S STAIRS-CLEARANCE & SLS_ PLUMBING FIXTURES RE EF VALVE INTERIOR TRIM/PR VACY DOORS FINISHED FLOORS GARAGE FIREPROO XNG DOOR CLOSERS) SMOKE DETECTO FINAL ELECTRICA INSPECTION ------ FINAL APPROVAL10F CONSTRUCTIO r A .SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROPf THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! V LECTOR MI DOLE MEPARTMENT;IN$PECT#Q.III"ENCYr INGx National Headquarters goo Haddon Ave., Collingswood, N.J. 08108 y Date: - City, Town or Township OQ GrL ! �ACA' v:` � t ; N ,Z i County ,' # _state LocationlAddress 1f + tom .. '4 _.w. C. ( If Located in Rural Area - Please Attach Directions) Pole # _ l'"J N - Permit n New Old Occupied As '� jr3s �r7 P4i .G+ ram� _1E n�r� Permit # Occupant g'. er Work Area in Building (Floor*, etc.): for: Wirii or: Ready for Inspection: Fee Remitted - $ Cash Check M.0. O Make Payable To: M.D.I.A. . saa . o i xse �%500 1760 xaaa aa 22sa xsoo x7ao aa Number of'Ro�jgh Wiring OY�tlets Elect. Heat 7so zoa Switches Lighting Amp. Service Surface Unit Dishwasher Range Receptacles `-' Water Heater Air Conditioner Dryer. Pump- Number of Eixtures Oven- W--r----,-G*rbag& Disposal Wiring and Controls for -Burner AFhp: Receptaclesy : Fractional H.P. Vent Fans Other Equipment: F f!" Mt7TORS tb P, 1/2 1J3 1/10 1/8 1JB ;(4 1J3 1/2 3(4 1 ;ils. 2 3 5 7+1s YO 15 20 25 30 40 50 75 1PO Mark Number of Each Size " Applicent's Signature License # ` Permit # j TIA Utility Applic t`s -Address: /(NAME FFICE to 1014) {City) (State) /f t` (21#i _ Service Request # PhrRed # Electrician: DATE RECEIVED: i t `. ,i:'`, DATE INSPECTEUm. .e. Location : Same as Alcove © or: <-. <tice Label Rough Wiring Outlets Surface unit Oven,. Switches Range Garbage-l}igposal . Receptacles Water Beater Dishwasher, Fixtures Air Conditioner ' i : , b ' IP Amp. Service Equipment Burner, Wirflhg & Controls for ` Amin:-Redeptaele r= Amp. Service Conductors Pump Vent Fans MOTORS H.P. 1120 11/3.2 1110 1J8 1JS 114 3(3 1/2 3(4 1 lr/z 2 $ 7r/x 16 15 20 25 40' 75r :ltld; ' "{ Mark Number .. of Each Size _ . 306 750 loco 125a lsa4 175a xaee xxsa 2 OfD *7 3gaa Elect. Heat €::y 0 RW Progress : Inc. ttid LKo'Q Contractor � Q CFT Violation : Work Comp, Q Inc_ Q r+" L/A Owner ;CASH 0 L/A Fee, - CHIc,# Due .... . MO # IPA Municipal JNV 0 Date: Applicant* , ; Other Side 0 Utility Owr Cut in Card Temp # DateLPA _TNOPIECdci + Q Final # Date TORS SIGNATURE APPLICATION FORM No. 250 EL 11/86 - TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT y BAY & HAVSLAND ROADS ff QUEENSBURY, NEW YORK 12BOI� TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR I SPECTXON� RECEIVED NAME GL /i, y.,[ LOCATION ,DATE fq_PERMIT # ' APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBINGMING v ELECTRICAL. ROUGH- XN ." INSULATION. � . FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT !� ROOFING SIDING EXTERNAL PORCHES STEPS STAIRS-CLEARANC & RAILS PLUMBING FIXTU ES/RELIEF VALVE INTERIOR TRIM PRIVACY DOORS FINISHED F S GARAGE FIRE OOFING DOOR CLOSE S) SMOKE DETE TORS FINAL ELECT ICAL INSPECTION FINAL APPR AL OF CONSTRUCTION A SIGNED 4ERTXFXCATR OF OCCUPANCY MUST BE OBTAINED PROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED!' REMARKS:ku� v L.C)w { 'ice t_I o INSP TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT HAY & HAVfLAND ROADS QUEENSBURY, NEW YORK 12806-- TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT p REQUEST FOR INSPECTION /RECzul�p � NAME1 �JL� `� � cl / _Gam LOCATION __ I. tx ���C..• G/�. DATE �72— f�{ `�PERM22' #� APPROVED - - YES NO FOOTING/PIERS MONOLITHIC POUR" FORMS F UNDATXOJV1DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN & '*fNSULATION: SoOPOUNDATTON FLOORS WALLS CEILING FINAL INSPECTION: li CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORC /STEPS STAIRS-CLEA C9 .. & RAILS PLUMBING FI RES,I' ZELIEF VALVE _ INTERIOR TR M/PRIVACY DOORS FINISHED F RS GARAGE FI PROOFING DOOR CLOS R (S) SMOKE DE CTORS FINAL ELEC�RTCAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A .SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 3280& TELEPHONE (528) 792-5032 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION /REfCE-TVVEED NAME LOCATION r j TG /•' +tea .s r . 11� DATE t APPROVED 1 YES NO FOOTI NGI PIERS MONOLITHIC POUR FORMS BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN )(INSULATION: >(FOUNDATION Id. FLOORS ` WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHESIST STAIRS—CLEARANCE & 4TLS PLUMBING FIXTURES/ L3F VALVE INTERIOR TRIM/PRIV CY LhQRS FINISHED FLOORS GARAGE FIREPROOF NG ` DOOR CLOSER (S) SMOKE DETECTORS 1pi FINAL ELECTRICAL INSPECTION FINAL APPROVAL CONSTRUCTION A SIGNED CERTI ICATE OF OCCUPANCY MUST BE OBTAINED FROM HE ,;BUILDING DEPARTMENT BEFORE THESE PREMISE ARE OCCUPIED! REMARKS: * Y L E' cb M, r`C"►2L-C�i C3 YL INSPEC R TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS OUEENSBURY, NEW YORK J2801 TELEPHONE (5I8) 792-5832 BUILDING INSPECTOR' S REPO /RT� REQUEST FOR IN'5P C ION R CEIVED-��7�` - - - NAME lic LOCATION J p4p / DATE PERMIT # APPROVED YES NO TING/PIERS MONOLITHIC POUR FORMS FOUNDATION/VAMP-PROOFING BAC.KFILL APPROVAL ROUGH PLUMBING f : FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT__ ROOFING SIDING EXTERNAL PORCHE STEPS STAIRS-CLEARAN & RAILS_ PLUMBING FIX ES/RELIEF VALVE INTERIOR TRI PRIVACY DOORS FINISHED FLO RIS GARAGE FIRE ROOFING DOOR CLOSE CS3 SMOKE DE T TORS FINAL ELECT ICAL INSPECTION FINAL APPR AL OF CONSTRUCTION A SIGNED C RTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED ' REMARKS: INSPECTOR SELECT BUSINESS FORMS (609) e48-5203 APPLICATION FOR ELECTRICAL INSPECTION W _ PLEASE BEAR DOWN YOU ARE MAKING W {COPIES MIDDLE DEPARTMENT INSPECTION AGENCY, INC. National Headquarters 900 Haddon Ave. , Collingswood, N.J. 08108 . . Date City, Town or Township__ County (A )6ZEJOIJ State Location/Address ( if Located in Rural Area - Please Attach Directions) Pole # Owner C7F F WtfrTF #> P�3 —� �— Permit # Occupied As LnrL.� �'rxsll �L+s , 1ry� lC� — ---c— w Building: NewO C71d Occupant i24t*7@9k4V;r tAft4smmic4 ] Work Area in BuildingFloor **, etc. ) : A . for: Wirin � Service � or: Read for Ins action _ 'Fee Remitted - $ Cash Q Check � M.O. 0 Make Payable To : M. D. I.A. 500 750 1000 1250 1500 17W 2000 2250 2500 2750 3000 Number of RoYugh Wiring Outlets Elect. Heat Switches 5 Lighting 'J Amp. Service Surface Unit Dishwasher Range Receptacles CS 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 : 4r MOTORS H.P. 112 1112 1110 1/e 1 1/16 1/4 1/3 1 112 3/4 1 1 1112 1 2 3 5 1 7+h 10 15 1 20 25 30 40 1 50 1 75 1 100 Mark Number of Each Size Applicant's Signature License # Permit * T/A Utility : Applicant's Address: (NAME) (OFFICE L CATION (City) (State) (zip) Service Request # Phone # Electrician : ft.9 A BATE 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. 1/20 1/12 1/10 1/B 1/6 1/4 1/3 1/2 3/4 1 11h 2 3 5 7Vz YO 15 20 25 30 40 50 75 100 Mark Number of Each Size Elect. Heat soo 75a laao 1z5a 1500 17so z000 zzsa zaaa z75a zoos q VEI: IrOlf FNITIAL VISiT+DNi•Y GORiIECT R i -• • :- NOTIFIED DATE VMS FIXl1Fe RW Progress: Inc. Q LKD Contractor CFT Violation : Work Comp. Inc. Ej {� L/A Owner CASH © L/A Fee CH K # Due Mp # (� IPA Municipal INV # Date : Other Side O Utility Applicant Owner Cut in Card Q Temp # Date TOWN OF QUEENSBURY zoning Adminis rator Date c 4 � — t R