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89-545 s+arrv^-#Ar sS :tom'. „_'.,;•.s'.a. i, . .-,.* 77 . 4 . . _ .. .� t � I I I CERPnIWAlt- E, OF +C�CCZJPA.NCY i TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK ry 17trte 1�.gcz-��,cl° 13.,c..19 . . I This is to certify that work requested to be done as shown by Permit No. 89- 545 � has been completed. 'Phis structure may be c�oeupied as a --SiSin� e_ Fam_ _. y Dwelling Locsrson _ ` ,J2, Oak Tree Circle Owner _ _EP}or Havpnc I By Order Town Board a� 7OW N OF QUEVNSSURY i Director of Bldg. & Code Enforcement i i I c� BUILDING PERMIT TOWN OF QUEENSBURY No. U9- 545 WARREN COUNTY, NEW YOR K �r cam+ cr PERMISSION is hereby granted to Peter Havens 1 F- OWNER of property located at Lot 131 Oak Tree Circle Street, Road or Ave. in the Town of Queensbury, To Construct or place a Single FamilyDwelling 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 SiiliE 14 Seward Street a Queensbury , N . Y . 12604 ry u 2. CONTRACTOR or BUI LDER'S Name .. YV Self m 3. CONTRACTOR or BUILDER'S Address Same 4_ ARCHITECT'S Name r c 5. ARCHITECT'S Address. r L c 6. TYPE of Construction --- (Please indicate by XI —_ { ) Wood Frame { ! Masonry ; ! Steel 7_ PLAINS and Specifications . r No. 28 ` x 44 ` Single Family Dwelling as per plot plan , specifications , and application , including septic and attached one car 8. Proposed Use garage , and driveway Single Family Dwelling u $ 197 . 00 PERMIT FEE PAID -- THIS PERMIT EXPIRES February 1 19 90 r: (it a longer period is required an application for an extension must be made to the Building and Zoning inspector of the _ town of Queenabury before the expiration date.l Dated at the Town of Queensbury this lath Day of July 19 89 '-¢ SIGNED BY for the Town of Queensbury {� Building and Zonirqrinspector TOWN OF QLTEEN$73UI2Y APPLICATTON FOR BUILDING AND ZONING PERMIT I'utc- Fec' eved ' ()WN OF QIJ f LFFiY iS ReU.i 60ed I ? RECF't =ram 7 � JUL. 3 Lnj Fee Fa.%d fi /toy 11)ClILDINC AND CODES DITARTKiNfr Date Ia. ued SLOG" CODE DEPT. BAY and HAVIZ.AND ROADS RD l BOX 93 puEENSBURY, NEw YORK 12804 PeAnti,.t Na . Tel . ( 528) 792-5832 Ext •204 • r w s * is 'w wow s : : x ,. ■ ,. w w a a ■ * s x : x * . * . * * • ► A I' 1 R?iIT MUST I;I OBTAINED BEFORE CONSTRUCTION . NO INSPECTIONS WI LL BE MADE UNTIL AP1' LI CANT IIAS RECEIVED A VALID IiUI LDINC PERMIT * All applicable spaces on this application must be contltleted and the givnaLure of the applicant must aapcar on the reverse side of this sheet . It it $: fi a ih: kk 7k �G , lC c 1k 7k k t 7�i $ yC 'k at 7t it 7k 7k 7k �C lk !C 7k 7r lk iK ik i� .`k yt 'I' !te owner of this property is : f vrTgrz J HA Ent V . O . Address sEw^ev S"r TEL . 79Z -(a 1Co3 i' rop +erty location L. OT- � � � - � IV ©@;n1 fLL s TAX MATS N4 . �93 • / Has there been any split of this ,property since October 1 , 1988 ? /� ' yes no 7f yes , Planning Board Review is necessary . , UBDIVISION NAME , IF APPLICABLE LOT RO ' The person responsible for supervision of work as regaLds Building Codes is : NAME PoOo ADDRESS TkL . NQ * tJume of builder ov-JN Address Tel Name p- Tea 1 C7E of Plumber Ar..+�+4� x.EI-R-_ T.ddress 793 - a..r' 11 ,?'fe{ reel-� Name of Mason ��N �F+ liddres5 14ATURE OF PR[)POSCD 6ORK: ZONING INFORI•lATION ( Office use On111 ). Cnn:: [ructi011 of a new buil" "C) 2ONIHG DESICNATION OF PROPERTY Ad" itian to a bUilaickg r PERMITTED PRINCIPAL PERMITTED ACCESSORY AIL.:rution to :a 14wilding � ( rto cllLktuy� to OXCurior ctitacnki4ns) REVIEW REQUIRED - 'PLANNING SOARD ZONING BOARD C)tlL&�: r cork (.lascrii3.:} SITE PLAN REVIEW # APPROVED DATE C UOSS AREA OV PUOiIOS V. D. STr< UC'i' U K4C VARIANCE # APPROVED DATE Remarks 1st floor � ''to+ s9 f t r `S 2 nd Floor "too sq ff t . �� , Ce]PtP( U'1'L I�tJt'4t:M!►'1"IQN lcl:r?tlllctiU lai LUt.J . C '� * : iz. o f prop4j r ty 13a f c x G+ thcr Floors sq ft ; "istincl L.juiId1j &L] t ::) 5i-4 ! L }C rC . ( not cellar or bas .zmentl TOTAL FLOOR AREA 15C)C> sq f t . " Lxiittg tauilainq (:: ) U::.a ow :.ttructur.= 28 f t X `j ft caeLa atio picrf ::3-ak+/cr:xwi/paLrtial/ full ' VA:opascd building , di:5tanc4 trolu Prolaorcy littu (circle ans: ) Front yard I"f3 rt Rear yard (07' ft ta3 . of stories (14abIt:ablo. sj)ace ) � � Side yard:a 77 _ er. :and is it�ighc ( Uradu to ridcla: ) 2312. ft • If on corncar, UL* CL1a%k frosa side: scr. ee:t A.NK fc If r.: :.:icluntial , no . of fatuilies ) " race . of room,4I ( excludinal b:atha) 7 ' OCCL1l�lWc:Y 1NF(!1'J4AtTIDN t to. of be<droauks Z. ' PRIMARY I'iUILDINL' - tjow of batitroot«: "X One fasuily dwelling t•x'ittk:ary )kuatilkrl sysul ui 14CYr- WAI66(% ei%do family dwollincl `t'yll.: of fu.: l NArUozo E: te+4tS w rtultiY�la �lwulling / Number of units IAO . of fireplacu:: tct LJQ irt::calluct N -- I1L`r1a:anCnt occupwtcy Will :a Wed r:hLOVaa LW irl :t:allc d? Tr "nsiuekU oe:a"p aakcy cfsntrul Air coiulitiUsn.:fkg? No # Iiusine:ss i3UILDING STYLC, PRIMARY STRUCTURE lrtdustrial ,� Orchar l:.k� �clt manl.:.C�r.a]Cy L.Gra cabin If ddition , wtk:.i suu Will u Ilu? t wai4:.tid ranch M:inu:.tidjic,lt pulalux .a alalii luv.al Old > tyl.a Lauakl.alow c`a end Catt:.krlu 4[ Lkur # ACCESSORY bUILDIWC~ r+ lortial UQW TOWS& House L►1:+ 'taehacs g:ariage/one curl two czar/ car ( CIRCL " ONI PLEASE ) '� �+►`tu. hud tjt,ru�je:for3e c:ar! two car! CI w w ■ R r ■ s a w • r ■ x w w s ♦ priv:ata St.Oruge building VS `t• IMATUD MARKET VALUE OF " �^Och` r a L]N :;'a' RUC 'L IUtI p + INPORAIATTON ON nUILDT14C 0, PrCII•' ICATTONS , ON REVERSE SIDr OF TtlIS SHVET, '140 RE COKPLC•I'L•'ol Form DPA 20/88 V2 BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . V,000p Fr2AMF Will any second-hand or ungraded lumber be used? If so , for what ? I�ID P 9"^ +nlO6U VN 14 f. Foundation wall material ,fyp p-T j2F"/v Thickness Depth of foundation below grade (to bottom of footing ) :E. Z ' Will there be a cellar ? No Heated or unheated? Floor sq. footage sq ft Will there be a basement? Y� g -Will any portion be used as living space ? yS` ( If so , what port ' Itpp sq . ft . - - Type of use? W0tL► "%H09 Type of roof - loped flat/shed/other Material of roof ASPHAC,7 ' Size , wood studs Z " X_- 42_,_." spacing 16410 . c . length a ft . Joists ( floor beams ) 1st . floor 2 "X 12 " spacing 16 "o . c . span 1 '4 ft . Joists ( floor teams ) 2nd . floor ..` spaczng i � "o . c . span ft . '' ,e to" s PActV 33'oc. Overlays ( ceiling beams ) NIX (�_" spacing- _1i �"o span ! Z. ft . SPAW 4 V+ Roof rafters "L " X y " spacing _o . c . span Roof trusses (pre-engineered) spacing " o . c . span ft . Exterior wall finish I/L."' X G"" EMW4ow Of what material? Interior wall finish I&" coyf>sw" if a garage is to be attached , describe materials to be used for FIRE SEPARATION -/ GIs there to be an opening between garage and dwelling? y15S If so will a Fire-rated door , enclosure , and self-closing device be provided? Will a flue- lined chimney be installed? N O Height above roof ft . Depth of chimney foundation below grade ft . Depth of fireplace -bjuarth ft , in . water supply - unicipa or private well --� EPTIC SYSTEM _ Distance from ANY private well ( including adjoining .properties ft . ,(A separate application is necessary for any repair or new installation of septic system) D E C 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, 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 lvR I • klayro a,a Owner, owner's age t, architect, contractor SPECIAL CONDITIONS OF THE PERMIT . By _---__ ---._.------------- Tflsai# o � QUEENSDURY WARREN COUNTY * NEW YORK Application for : BUILDING P£ RMIT IN COMPLIANCU WITH THE HEW YORX STATE ENERGY CONSERVATION CODE ,% permit must be obcai. ned bafcre beginning work . ANSWER ALL of the fallowing : 1 . Gross floor :, rca 1600 SV " Typi: Of hi: .at ' 407 ^ WAT1'e2. 3 . Is the building machanically .cc3olad ? r#d q . Percentage of area of windows and doors 13. i A . Over 16 % OnlY ' 10 uo va•iuu of gross area of wzLlls * road/ ceiling and floors c# xpos .. d to aa�foienc conditions Floor over heated spaces YES NO a . Ara fouadaul6n 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 p.: riY wcur of floor ? q , Is basement heated ? YCS h# 0 ;, . It vuluA.s of insulation 5 . Type of insulation I1 . finder lGt Only i . it value or roof and Floors exposed tR 3Q� S EA7?l � Tc conditions.nt Q— 2 Co i' sr+EA1rrrna4, tfic , . . R vulua of .: xterior 4+alls { 03 . R values Of glazed. area q , R value of doors - i 5 . R value of floors over unha."ted spaces value of slab edge insul4ti. anol - unheated slab 7 . R value of slain insulation - heated slab . £3 . R value of heated basement cellar walls ( above grade ) 9 . a value of heated baseu►ent/cellar walls ( below grade ) 10 . Type of insulation^ co Controls 7Z 1 . •sr► .: rruastaC raaxivaum heat setting O . duct Systems 1 . • Ito d„cc system installed in unheated spaces ? YES No a . If YES , R value of duct installation b . Yl value of duct in other areas E . pipinel Insulation_ 1 . Si = w or taint water ' or cooling carrying agent Pipe 2 . a value or pipe insulation �' . Service Wacer " Oatin �r 1 . Pvriorm" oo " " Iteiciency 2 . 'I: raturs control setting uiaxia►uw G , r• or Swimming Pool only • 1 . lot uxiwu.Uk hc: :ating Telephone No . { ;,appl #, cant ' u ss. gnaturu ) APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE 7/1 ► J 809 LOCATION OF PROPERTY FOR. INSTALLATION Lcar )3 ( � H t yice,%j HULA T Owner's Name: glejoefZ 14A'+JEN.$ Telephone: 79Z- (APL1 (a3 Address: T' - CJUrEEN S l3un y f f C9 -- f ?��� c(e� ��.. . Installer's Name: S14"r7' llyf Si kEPYIC,. Telephone: Number of bedrooms (residential only) Total daily flow {compute (d 150 gal per bedroom) ""� �► �. Topography : Circle one: Ia Rolling Steep Slope 1/6 of Slope Soil Nature: Circle one: and Loam Clay Other /Depth: Feet Ground Water: At what depth ? Feet Bedrock or Impervious Material: At what depth ? Feet Percolation test: Circle one : not required required rate min. inch. Domestic water supply : circle one: unicipal Well Other If domestic water supply is a well: Separation: Water supply from septic absorption feet PROPOSED S'YSTEKI : Septic 'rank { 000 gal. ( minimum size: 1 , 000 gal.) TILE FIELD : Each Trench ,Z0 feet /Total system length 2. 0Cl feet SEEPAG1] PITS): e / Sr •r• T fet t by Size o ne to be use /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 Ordin nee. f �� SIGNATURE OF RESPONSIBLE- PERSON: DATE : OVER Septic Sy-st t' iii f11 spe c t i 0 ns - A All applications for suptle system installation , alteration or repair , as roquired by the "Town of Queensbury Sanitary Sewage Ordinance , shall bu SUbInICted to the Building Deparcmu nt at least 24 hours before start of construction and shill include a plot plan showing : 1 . ) the proposed location of the system location and distance to lot lines 3 . ) IOCati011 and distance to structures 4 . ) location and distance to any water supply 5 . ) si :: e and diinerisions of all tanks , distribution boxes , rile fields rifid /or drywells Be No :; ysteui shall be cov:tr,sd before inspection and approval by the Building lilspector . .failure to comply with this requiremerst may rU -. ult in the uncovering of the system by the installer .and a fine uf, up to , 250 . 00 . C . ALI xi-)proved copy of the plot plan shall be available on the construction failure to produce said plot plan at time of inspection may 17 Solt in in immudiaate work stoppage . D . tillouLd. unfores,` un probl.; ms during construction prevent proper installa— tion , alterationl or of an approved system . a new proposal crust bu r: ubmitted to the Qu� � nsbury Building Department befors: further coiiS t ruc t ioll * Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Hav3.land Roads Queensbury , New Yurlc 12804 d`" TDi BOFBAY QMEENNSSBBURY RD QUEENSBURY , NEW YORK 12804 TELEPHONE ( 518) 792-5832 BUILDING Imo' S REPORT FINAL INSPECTION REQUEST FOR INSPECTION RECEIVEDPL NAME LOCATION I p:�L 131 r)QCk AQ0 , �'�� L s( rz..• DATE q } L5j PERMIT# TYPE OF RECHECK FIRE MARSHAL APPROV ( COMMERCIAL STRU TURF) 17FOOTING �X FOUNDATION BACKFILL '�F ING ROUGH PLWBING FIN ELECTRICAL [ PTIC INSULATION WODDSTOV FIREPLACE TE PLAN/VARIANCE REQUIR ENTS YES NO REMARKS APIROVAL A YES NO CHIMNEY HEIGHT/LOCATION B VENT/LOCATION PLUMBING VENT ROOFING SIDING DECK/P / RELIEF VALVES FURNACE/HOT WATER OPERATING BASEMENT INSULATION/DUCTWOR INTERIOR TRIM/PRIVACY DOORS FINISH FLOORS : f BATH/KITCHEN WATERTIGHT : ✓ OTHER FLOORS SWEEPABLE OTHER FLOORS CARPETED STAIR CLEARANCE/RAILING HANDICAPPED ACCESS r SMOKE DETECTORS BATHROOM FANS/WHOLEHOUSE FANS ALL PLUMBING . FIXTURES OPERATIr. GARAGE FIRE PROOFING DOOR CLOSERS OTHER FIRE SEPARATION FIRE/DEMISE WALLS DUMPSTER FINAL ELECTRICAL OK TO ISSUE C/0 OR C/C ARRIYE_�!�_ . DEPART TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT ,BAY & HAVILAND ROADS QUEENSBURY0 NEW YORK 12802- TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR' S REPORT REOUBST�, 1,FOR INSPECTION RECEIVED. NAME \-4 nn ti•- -SZr�;a LOCATION �� Y� I Y 4P 0 , G_ A Cy Q DA TE j 2/aI PERMIT # -- 5 y t i APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PRf�OFING $ACKFILL APPROVAL OUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN ' INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/S^TE STAIRS-CLEARANCE & RA ,a s PLUMBING FIXTURES/REL F VALVE- INfiERIOR TRIM/PRIVACY" RS _ FINISHED FLOORS GARAGE FIREPROOFING - DOOR CLOSER (S) SMOKE DETECTORS_ FINAL ELECTRICAL INSPECTION) T FINAL APPROVAL OF CCINSTRUCTN OK To ISSUE C/O OR Q/C A SIGNED CERTIFICATE OF OCCUP NCY MUST BE OBTAINED FROM THE BUILDING DE TMENT BEFORE THESE PREMISES ARE OCCUPIEDt REMARKS : ARRIVE ,1 DEPAR / IN ECTOR TC71VN OF QU EENSBURY 10 ry) BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I2809ft TELEPHONE (538 ) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR .INSPECTION RECEIVED., NAME LOCATION DA TE � J.I� `!'I PERMIT # � APPROVED e iQk YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN YS U.&AT ION: FOUNDATION FLOORS WALLS 9 ✓ CEILING t FINAL INSPECTION. CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS f STAIRS-CLZnRANCE & RAILSr PLUMBING FIXTURES/RELI$F VtLVE INTERIOR TRIM/PRIVACY FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTIO OK TO ISSUE C/O OR C/C A SIGNED CERTIFICATE OF OCCUPAN MUST BE OBTAINED FROM THE BUILDING DEPAR MENT BEFORE THESE PREMISES ARE OCCUPIEDI' y REMARKS: ARRIVE� r DEPARZ �Ati u �cK.r INSPECTOR Dawn a Qv ee" j miry WILDING andqZQNING DEPARTMENT / Lay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 128 ry ` SEPTIC DISPOSAL SYSTEM INSPECTION NAME u / LOCATION DATE/ J_� PERMIT NO. SOIL TYPE - (San - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM : Absorption field , total length o Length of each trench ICI ' Depth of trench 03_0_ Size of gravel SEEPAGE PITS{N r of) kr Size- ft. X - ft. Gravel size PIPING : Size g Bldg . to tank Tank to list . box Dist . boa. to field/p t �/ Openings sealed? YE NO Partial LOCATION/SEPARATIONS : 5 Foundation to tank + �ft. Foundation to abscrpon f t. Absorption to lot 1 i e Ao-f t . Separation of pits ft. ION OF SYSTEM OM PROP RTY (circle one ) nt - Rear - Lef t side - Might side - C TS : SYSTEM USE APPROVED YES NO C roe 13-U3. 1&rng Inspe car 01/86 and vl HIDDEN HILLS SUBDIVISION � ~' MADE FOR RALPH & MICHAEL WOODBURY {}� BY VanDusen & Steues DATED MARCH 26 1986 1'1 FILED SEPTEMBER 2,2, 1986 LOT 130 pp IN MAP CABINET A SLIDE 44 r C APFMtt)VED S 83 95 '00 " E FOR SEWAGE DISPOSAL VFW YURR STATE DEPARTMENT 0 HEALTH 00 dy SANIIARY ENGINEER P.E. OCT. 3 0 goo �1 GATE 96l LOT 131 �k 22,587.56 sq. ft. 4 l97 0.52 acres L � .�Q1`i HOUSE too 460 4L l ° 99 - �_ 98 N •3 �� Q� MAP OF A SURVEY MADE FOR 4. _P. WTE N 80 4 A20 ' A� y TOWN OF QUEENSSURY COUNTY OF WAI SCALEi 1'.3p' DATE , JUNE 12, . A _ OF S SiJ R i' BUILUXL DING ANDND CODES DEPARTMENT BAY & HAVILAND ROPDS QUEENSBURY� NEW Y#7RK I280& TELEPHONE (518) L792-5832 BUIL]]IPECTOR " S REPORT REQUEST FOR INSP RECEIVEJr NAME LOCATION DATE PERM T APPROVED YES I NO FOOTING/PIERS MONOLITHIC POUR ORMS FOUNDATION/DAMP-- OOFI G BACKFSLL APPROVA13 ROUGH PLUMBING FRAMING ELECTRICAL ROUGHT INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION:) , CHIMNEY HEIGHTS 1 ROOFING r SIDING EXTERNAL PORC ES TEPS STAIRS-CLEA CE RAILS PLUMBING FIX URESJrRELIEF VALVE INTERIOR TR /PRI CY DOORS FINISHED F RS GARAGE FIRE ROOFI .DOOR CLOSE' ' S) SMOKE DETE ORS 1 FINAL ELECTR CAL INSPECTION FINAL AFFROV L OF Cd TRUCTION OK TO ISSUE op/O OR C/ A SIGNED CE TIFICATE OCCUPANCY MUST BE OBTAINED FR M THE BUI ING DEPARTMENT BEFORE THESE PREMI ES ARE dCC PIED; REMARKS: s 3 v ARRIVE DEPART,�" INS TOR T C QUEENSBURY ✓��� BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I280& TELEPHONE (518) 792-58.32 BUILDING INSPECTOR' S REPORT REQUEST FOR IN NON RECEIVED NAME LOCATION J ! ��rril DATE /tJ f(© �/J �7� PERMIT # CJ APPROVED YES NO FOOTING/PIERS NOLITHIC POUR FORMS 4" FOUNDATION/D -pj?OOFING �ACKFILL APPR? AL t ROUGH PLUMBING FRAMING ELECTRICAL ROUGH- N INSULATION.: I or FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING k EXTERNAL PORCHE (STEPS STAIRS-CLEARAN & RAILS _ PLUMBING FIXTU ES/RELIEF V .VE INTERIOR TRIM PRIVACY DOORS' FINISHED FLO S _ GARAGE FIRE OOFING DOOR CLOSER l ) SMOKE DETEC RS FINAL ELECTRI AL INSPECTION FINAL APPROV L OF CONSTRUCTION A SIGNED CER IFICATE OF OCCUPANCY MUST BE OBTAINED FROMkLTHE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS. INSPECTOR TOWN OF QUEENSBUR'Y BUILDING AND CODES DEPARTMENT ,r7 BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FORIN�TIO,J.N// RECEIVED 17 1 - ] NAME s� LOCATION f Q E DATE - - "`� PERMIT # APPROVED r s No t�,FOOTTNGfPIE MONOLITHIC R FORMS FOUNDATXOIVID -PROOFXNG BACKFILL APPRO L - ROUGH PLUMBING a FRAMI NG ELECTRICAL ROUGH- i INSULA TION: FOUNDATTON FLOCJRS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING STDING EXTERNAL PORCHES/ EPS IRS-CLEARANCE RAILS PLUMBING FIXTURE /RELIEF` VA ' VE INTERIOR TRIM/P IVACY BOORS FINISHED FLOOR GARAGE FIREPR FING _ DOOR CLOSERS SMOKE DETEC S FINAL ELECTRIC L INSPECTION FINAL APPROVA OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE TfIESE PREMISES ARE OCCUPIED! REMARKS: , r INSPECTOR SELECT BUSINESS FORMS (609) 848-5203 APPLICATION FOR ELECTRICAL INSPECTION PLEASE BEAR DOWN YOU ARE MAKING (4) COPIES � . MIDDLE DEPARTMENT INSPECTION AGENCY, INC. National Headquarters SM Haddon Ave„ Collingswood, N.J. 08108 ' CO Date' 7 �. 1 - I1 City, Town or Township V��N���Ry 1r County A9ZlIZErJJ State Nay, Location/Address Lerr 13 (4 IDpc^j Wi LA=4 aZu Q D kv19 oN ( If Located in Rural Area - Please Attach Directions) Pole or Owner. 4A1 451%jS Permit # S Occupied As Q I p£'i 'x Building: Ne>� OIdQ Occupant p' we Work Area in BuildingFloor #, eta. ) : A for: Wirin Service or: Ready for Inspection - Fee Remitted - $ Cash F1 Check ED M_O. Q Make Payable To: M.D. I.A. 500 760 1000 1250 lsoo 17sa 2oao 22sa 2soo 2750 3000 Number of Ro_u�h Wiring Outlets Elect. Heat Switches N 2woo Amp. 'Service Surface Unit Dishwasher Range 4 Lighting. 2�� Water Heater Air Conditioner I Dryer Pump Receptacles Oven Garbage Disposal Wiring and Controls for Burner Number of Fixtures Amp, Receptacles Fractional H.P. Vent Fans Other Equipment: MOTORS H.P, 112 1/12 1/10 1/6 1/6 1/4 1/3 1 1/2 1 3/4 1 1 1 1jh 1 2 1 3 5 7Nx 10 15 1 20 25 30 40 50 75 100 Mark NUMber of Each Size Applicant's Signature -� 1 License # Permit # T/A r Utility : fy) r M� CO ' Applicant's Address: iNAME (OFFICE LOCATION) (City) r`1S u1��r {State) (Zip) IZ� ` � _ Service Request # Phone # 792- ta4(o3 7 +�14 - �"i I Z7 Electrician: a 2 7Receptacles DATE RECEIVED: DATEINSPECTED : ion : Same as AboveQ or: abel 0ough Wiring Outlets Surface Unit Oven witches Ran Garbage Disposal 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. 1120 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 11h 2 3 5 74'x 10 15 1 20 25 30 40 50 1 75 1100 Mark Number Of Each Size Elect, Heat soo Tao loo0 12so asoa 17so 2000 22s0 2sao 2750 3oao pp Box 321 $ r vaXTIRCAiL�i NSPECTUB JT�IT I�NTIALYk78aFEph NOTIFIA6 - DATE C17R1l�EC s ' Paz w ., [� f1w Progress. Inc, Q LKD Q Contractor 0 CFT Violation : Work Comp. Inc. CASH El © L/A Owner Fee CH K # LIA Due MID # 0 IPA Municipal INV # Data; Other Side Q Utility Applicant 8 Owner Cut in Card Q Temp 40 Date N sE V 04 LET ! 3b o 1 7 ��FFNiI — R.KY7L F�1d'✓r�� --# 770 I ui Lai L 1 1 a za L4 C,AIZA Cam Iz C1 �y RF_rnrr ImG WAL pbFLcH .. .__. . �f ? R6Ssnf_NcE ��so � F 4 1 fib 3h ` 91NE � y� •`•, � r �ifyr �� Pl�57-,q ND- 12A 1; FEN£E. 1 pi�oPF_y2TY LIxJ ... . i � s u M M i Y i PRDPD.SED RESIDENCE ------ - ..__ PETER LOT qP� 's1 } cJ �3Crw I rNv Lr) F =; W t N Fo`.,15 t3NI r &IZIE sz s5 F8W 712EAL VF- i JRrc{M�l+"JG�C>N (}21 '� y- AWh�1y. 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