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1989-531 3Vrw ifYa4w. . - *a7 l4 L y I v � %MffieERTIFIC _ • OF OCCUPANCY TOWN OF QUEENSBURY i WARREN COUNTY, NEW YORK Date September 5 19 _a9 lThis is to certify that work requested to be done as shown by Pet .. it No. 89- 531 f has been completed. 1 This structure may be occu a --Single Family ©we l 7 i n g Location Ao� a k Tree C i rl to i f Owner Forest Wood Homes By Order Town Board TOWN OF QUEENSBURY [ Director of Bldg. & Code Enforcement I � i BUILDING PERMIT z TOWN OF QUEENSBURY t WARREN COUNTY, NEW YORK No, a 7 PERMISSION is hereby granted to FORES WOOD HfWz u u 04 OWNER of property located at LOT 142 OAK TRFF CTRCI! F Street, Road or Ave. r in the Town of Queensbury, To Construct or place a !STNGI F fAPtTI Y DWFLLLN6 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. t. OWNER'S Address is MIC-02 BOX 286P c KRR=Nz=R51XNX11XX8zR XMR XW row 2_ CONTRACTOR or BUI LOE R'S Name C C self C 3. CONTRACTOR or BUIL.DER*S Address V same 4_ ARCHITECT'S Name 1.. +C r 5. ARCHITECT'S Address 4* 7r 6. TYPE of Construction — (Please indicate by XIrr rn X(XX Wood Frame ( ) Masonry ; I Steel ; } r-- 7. PLANS and Specifications No. 26 ' x 67 ' Single Family Dwelling as per plot plan , specifications , and application , including septic , attached two car garage , S. Proposed Use and driveway . Single Family Dwelling cr, x $ 225- 00 PERMIT FEE PAID — THIS PERMIT EXPIRES FEBRUARY (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the A town of Queensbury before the expiration date.) 3M r is Dated at the Town of Queensbury t ay of July r� rn SIGNED BY for the Town of Queensbury uilding a oni Spector 17'7 TOWN OF QUEE:tiSBURY y r err r tii Pr %,iTT TOWN OF QUEENSOURY Recalveo ReVAL JUL 61989 FaC Paid s kUILDINC /Lh'D CODES ui .l 's`RTItE*4T Date Iasucd BLOM & CODE DEPT. ;Ay Wind HAV rr.XND ROADS RD 1 DOX 9 d 0UEZNSBVRY , NE11r YORK 1 4 d04 penmt� hfU . _ Tel t518J 792- 5832 Ext 204 e f ■ r ■ f f f : ■ w w f r ■ ■ ■ x x x x f x ■ • 0f ■ a r •. r • ■ • ■ a i, E- WILT MUST ZO OBTAINED BE- l" ORE LECINNING CONSTRUCTION . NO INSPECTIONS VI LL BE HADE UNTIL APPLICANT 11AS RECEIVED A VALTD BL' Ii. DrNC PERMIT . All applicable spaces on this application must be cornpletcd and the ifTUaturc of the ;applicant riust appear on the reverse sick of this sheet . * * x * A * * * * A x k A * k A * * * * * * k • 7t •s' I, e owner of this property isi Ile _ i' O . Addr4' ss 4in - �� 4- UC x {' � I ti � r.� f / i . ,� �.. r TEL troperty location `j rAX MAP NO . Ilas there been any split of this property since October 1 , 19es ? /. rf yes no 3f yes , Planning Board Review is necessary .; ,..0 ISICJN NAME . IP APPLTCAnLC � ^ v * 1 ` il5 LOT 1N0 . 1 r The person responsible for s " p4arvision of worst as regards Building Codes is : A, 1 F . G . ADDRESS TEL . NO . NAAr1= _ raume of builder l '1 . ' : U ,.rV : Address f r Tel N .me of Plumba:r T.ddress Tel Name of M..ason ; rlLidrns � f P s Tel : 4ATU e or rRcP0c.'CD wjj2NK- : . _ ONI + L: IN ! 0101ATION ( Orfice usa only ) csn� tructior, of a irww building * ZONINi, OL'SIC'NATION OF PROPERTY �Ad. i .:a ta.nn to UUiflairag PERMITTED PRINCIPAL PERMITTED ACCESSORY � aAlL � r,•Lion to .a L" tlding _.. tjLQ Ck ,..,, L4) � to wxt .: rfor clirni:nL- ionai iREVIEW REQUIRED PLANNING BOARD ZONING BOARD. Uckivc ti,•ork iJ.::cr � }i4 } * SITE PLAN REVIEW if APPROVED DATE - 1tc7SS hkL' A Ql' L' FlC] PQSL' D, :: '1' IcUc: Y' UItLS. VARIANCE. N APPROVED DATE 5 t Floor "�` _ s q f t . * Remarks 2nd Floor � Of ' ; sq ft COMPLLs't: illt'ot.rvE'TiOly !<ar_i� 13 aLL3 uiu,ri . �-`3 ' Sis:u of proluarty r' t x f t . Other Floors sq ft . �` * rc . ( not cellar or braswment ) L%lrCiCiCJ l:aail.ii+ �•] { :: ) Si -� 1' � ?( �,.�� TOTAL FLOOR AREA 1 [�) 1 cl _Sq f t * k xy �tyrtaJ pa• rL L � ruJ L :. l L1aw oe new ►tructure ft a ' eft ` tutu,d:At ion-pior/ tlaL/Cr4Awl/11art If i%Lltiull ' !'r�C�o::�a bu � l .s �ny . dAzoc*Ancw crow t.talj•:rty ILtiQ juirclw one } * Front yard r _ i' t near yard y fc N.] a of stories (ta:aU !"bla: :;ta,sCa ) .* * Silo`to rid .ard::� r t 4nd 7 1twighc ( grad rc s: alwi Y ��-.- If" ra: :idwntial , no. of f:.milia: 5 h . If on Carnar , uWtla.aa:k from side: sCr", t rc krla * of roouts ; a:xcluding b"thu ) !. OCCUPANCY iNF4l'JMTICN 110. of budroomu pFtIMJ►IiY LUILOINC: Na . of b"tkxrooma ° _a Ona Li+Aaaly dwoliinal vri2aar #IutAcira• uU. hu Y J Y'' * 't'►ro faul.iiy darulliny wyliu of fugal Multll�l+a JWulling / Number of units,,,��_,� KO . of firkAplacua; luw in::t:alla:d • Pdrsn•ulcsrat accup:u►cy WILL :a waaam� stove Lr�: isat: t:alla:d? a * '1'r:an�iweat ewcu�y:atae:y G:wntrwl Air coe.aLitiun: iaq : 13usinc:sx BUILDING STYLE, PRIKARY STRUCTURE * lndusL' rial lulactl C01yCaauxliCrrrary fc.+? c .fSin . Other - -- * It .adr1 i t la]n r wk.rat w111 u:iv' 14►i ?,i�,� - 1 . • ia;a:d rar►ckk sunwi.a.rr Oaal,lux _ltal3t Luva21 old styiw UaaraaJilow ~ Cw&pu . _ COC''C"UJ Or, tawr * ACCESSORY UUIU01HC- c DLoni.al j !toss 1'Ow1• k}caa►i4 " { 1wtickas2al c}at:aga/one Ciar/ twa c:_r" c:at ( CIlLCLL' ON1» Pr ]VAL.0 i ' ✓ At toC nw 1 y :•ruaJw/OrLai Carr/ w4 4atr cars • • r a • • • • . r r w • • • • + Priv"c*,: stor"ga3 b6111csing USTIMATFO MARKET VALUE OF ' .Other a: On %; rrhUCTIGm • } Nt•'OR►tATION ON allTLOINC SpnCIFrCATIONS , ON rtEVERSE SJOC OF Tt1IS '�HULTf TO SC CO►SP'LGTUDI Form DPA 10/88 v1 8U: rL =' IN" aE RIM Im APpLICA _ _'I vufuDI %G SREC ; FfCATIJr;S : .yce c .` c0rns� ruction , wood frame , _ arc safe , eta 'eiil ^ ; sevcnd-nand or ungradc? L + er be used ? Ir so , fcr wkat F:,u .lotion wall Material Thickness Gepth of foundation below grade ( tc bottom of rooting ) Will there be a cellar ? Heated or unheated ? Floor sq . footage sq ft Will there be a basement ' will any portion be used as living space ? ( If so , what portion ? sq . ft . - - Type of use ? pe o £ roof - ;sloped/ £ la t/ snedJati Er kiatar :.al of roof ;' . Size , wood studs K spacing " o . c . lLngth ft . Joistsirloor beams ) lat . floor " X spaci :.a 1 41 O . C . span ft . .70 .L8tS ( floor beams ) 2nd . floor 11 '" 'X spa cir.g "o . c . span £ t . �.: verlays ( ceiling beams ) X spacing C . C ." span ft . ,Roof rafters '• X " spacing c . c . span ft . Roof trusses ( pre- engineered) spac : rg " o . c . s "an ft . Exterior wall finish . ; ,. -, Of what material ? interior wall finish ✓ if a garage is to be attached , describe materials to be used for FIRE SEPARATICN : � . n r.Is there to be an opening between garage and dwelling? 1 .. If $o will a Fire- .rated door , enclosure , and self- closing device be provided?Will a flue - lined chimney be installed ? Height above roar ft . Depth of chimney foundation below grade ft # Depth of fireplace hearth ft . water supply - Municipal or private well SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties ft . ( :,. separate application is necessary for any repair or new installation of septic system ) D E C L A R A T I 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- s y`4 Ownerjosioliner'sPacrent, architect , contractor s A ! # * * # # # M # # # * # * # # # * # # 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 2 . Type of heat 3 . Is the building mechanically coaled ? 4 . Percentage of area of windows and doors 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 of roof and floors exposed to ambient conditions . e 2 . R value of exterior walls 3 . R value of glazed area 4 . R value of doors 5 . R value of floors over heated spaces Id 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab So R value of heated basement / cellar walls ( above grade ) g . R value of heated basement / cellar walls ( below grade ) 100 Type of insulation C . Controls 1 . Thermostat maximum heat setting D . Duct Systems 1 . Is (: uct 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 F . Service Water Heating 10 performance efficiency CzG 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating Telephone No , app ican "s "signature ) !'OWN OF QUEENSPURY a APPLICATION FOR r .fti c�I� rj SEPTIC DISPOSAL PERMIT DATE t r dj J LOCATION OF PROPERTY FOR INSTALLATION Owner's Name: r r Telephone: Address: r Installer's Name: " Telephone: Number of bedrooms (residential only) t -a Total daily flow (compute (d 150 gal per bedroom ) ) Topography. Circle one: Flat Rolling Steep Slope % of Slope Soil Nature: Circle one% Sand Loam Clay Other /Depth: Feet Ground Water: At what depth? Feet Bedrock or Impervious INIaterial: At what depth ? Feet Percolation test : Circle one:; not required.`, required rate min . inch. Domestic water supply: circle one.%Iunicipal '' Well Other If domestic water supply is a well: -- Separation: Water supply from septic absorption feet PROPOSED SYSTEIki : Septic Tank " +: ) '. ` ( minimum size: loon gal.) TILE FIELD : Each Trench � ' feet/Total system length <: :.. feet SEEPAGE PTT(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 Rueensbury Sanitary Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON : DATE: .. -s f OVER e Septic System Inspections : A , Ail applications for septic system installation , alteration or repair , as required by the Town of Queensbury Sanitary Sewage Ocdfnance , shall be submitted 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 1 . ) location and distance to lot lines 3 . ) location and distance to structures 4 . ) location and distance Co any water supply 5 . ) size and dimensions of all tanks , distribution boxes , the fields and / or drywells B , Nu system shall be covered before inspection and approval by the Building Irispoctor . Failure to comply with this requirement may r salt in the uncovering of the system by the installer and a fine uI up to $ 250 . 00 . C . An approved copy of the plot plan shall be available on the construction sits . Failure to produce said plot plan at time of inspection may result in an immodiate work stoppage . 0 . Should unforeseen problems during construction prevent proper installa— tion , altoration or repair of an approved system , a new proposal must k, e submitted to the Queensbury building Department before further construction , Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York. 12804 TOlVN OF QUEEI3SBUitY . ,., BUILDING AND CODES DEPARTMENT SAY & HAVILAND ROADS 12UEENSBURY. NEW YORK I281J PHONE (5I8 ) 792-5832 TELE BUILDING INSPECTOR' S REPORT EC)[IEST FOR INSPECTION R RECEIVED NAME �( CATION - !I DATE PERmIIT APPROVED yES NO FOOTING/PIERS MONOLITHIC POUR FORMS FQUNDATTONIDAMP�pl11 NG BACKFILL APPROVAL ROUGH PLUMBING FRAMING E TRICAL R(7L1GFI�IN i NSULAfiIC3N: ' FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION= CHIMNEY HEIGHT_�1 � - r�~ ✓ ROOFING SIDING EXTERNAL PORCHES/STEPS v STAIRS-CLEARANCE & RAILS RSLIEF VA 'VE_�� - -"- PLUMBING FIXTURES/ INTERIOR TRIM/PR2'VACY DOORS r FINISHED FLOORS GARAGE FIREPROOk ^- DOOR CLOSERS) SMOKE DETECTORS FINAL VLECTRICAY INSPECTxON�� FINAL APPROVAL t7F CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST SE FROM THE BUILDING DEPARTMENT BEFORE OBTAINED ARE OCCUPIEDI THESE PREMISES RgmARKS : V 1 f r f INSPECTOR 70 ENT BU11- ING and ZONING DEPAF1T�ox 98 Bay and Naviland Ro Yor© ti28Cri (]ueensbury, SEPTIC D i SpoSAL SYSTEM [I^NSPECT I C*4 hLAME _ LOCAT ION %ZJ6MATE f PERMIT NC) . SCIT, TYPE - sand - IX' _ Clay ~ _ No per Test Required? YES percolation .rate - Min/Inch 5ygTEKw th � � f TYPE of total lent! AbsorPtion f field •trench Length of each tr , L3epth of trenche$ Size of gravel SEEPAGE PItENn £ ) size- Gravel size ,� e r � P Ip T,14G Bldg - to ;'• Tank to List . box Dist . box to field/ - -,. NOPartial openings sealed? ,rI S : J Y,CCATxoN/'SEP`ARA Foundation to a' rpCion eft . Foundation to line � -f'k Absorption to to _-- ft. Separation of Pis pROPER {circle one) jCp TI4t3 Sys _ Right side r ft side Front - eax C0414ENT [] h SYSTEM USE APPROVED E5 NO Hui ing Inspector of/86 and v1 TOWN OF QUEENSBURY BUILDING AND CODES I7EPARTMENR' SAY 4 HAVILAND ROADS 1280k QUEENSBURY, NEW PORK TELEPHONE ( 5.Z8 ) 792- 5832 BUILDING IN'SPECTOR` S REPORT REQUEST FOR INSPECTION NAME £,OCATXON cy G� - ' _ - � -L) JPERMIT --- DATE APPROVED YES NU FOOTINGfPIERS MON?L.TTHIG POUR FORMS FOUNDATION/D 'P-PROOFING BACKF_r,LL APPROVAL ROUGH PLUMBING FRAMING ELECTRI ROUGH-IN U,,:INSULATIO ' FOUNDATI FLOORS WALLS CEILING FINAL INSPECTION; CHIMNEY HEIGHT ROOFING SIDING S EXTERNAL PORCHESfST _��—�-- STAIRS-CLEARANCE & S F VAL� �'� PLUMBING FIXTURESf1,�E INTERIOR TRIM/PRIVACY DOOR FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL, I CONSTRUCNSPEC TION FINAL APPROVAL Q p� SIGNED CERTIFTHEATE BU�DI�C D�ARTMENTVpANCy TBF� ORE OBTAINED FROM ARE OCCUPIED * 'THESE PREMISES REMARKS : J SPECTOR TOWN OF QUFFN SBURY BUILDING AND CODES DEPARTMENT !� BAY & HAVSLAND ROADS 2280!t- QUEENSBURYr NEW YORK 792-5832 TELEPHONE i 518)BUILDING INSPECTOR' S REPORT RE411EST FOR INSPEC TON NAME LOCATION / ,,r y� 1 PERMIT � �S '` ' a DATE APPROVED ti YES no FOOTINGIFIE R FORMS MONOLITHIC FOUNDATI0141D ...PROOFING BACKFILL APPRO L P' Y L,,lf COUGH PLUMBING � FRAMT NG ELECTRICAL ROUGH INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSpECTIONZ CHIMNEY HEIGHT ROOFING SIDING STEPS EXTERNAL PORCHE / STAIRS--CLEARANCIP S f R& RAILS I EF VA L E f J PLUMBING FIXTt7 INTERIOR TRIMAPRIVACY DOORS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSE 65) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CGDNSTRVCTION A SIGNED OF OCCUPANCY MUST BE CERTIFICATE THESE P1 ING OBTAINED FROMSTHE dCCUPTEDlEPARTMEPI�' BEFORE MISE REMARKS: _ INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVIL.AND ROADS QUEENSBURY, NEW YORK 2280& TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED 7 NAME a LOCATION DATE `7 - �i 1r� � � � PERMIT #_ APPROVED YES NO ff�OC?TI NGf PI ERS vMONOLITHIC POUR RMS (..FOUNDATION/DAMP— OOFING J, R. cKFSLL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—iN `s- INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL TNSPECTiON: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL POR ESISTEPS STAIRS—CLEA NCR & RAILS PLUMBING FI TURES/RELIEF. VALVE INTERIOR T IM/PRIVACY DOORS FINISHED LOOKS GARAGE FT EPROOFING DOOR CIA ER (S) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION SIGNED CERTIFICATE OF OCCUPANCY MUST BE TAINED FROM THE BUILDING DEPARTMENT BEFORE ESE PREMISES ARE OCCUPIED! RKS: i s INSPECTOR ©F QC]E L3RY BUILDING BUILDING AND CODES DEPARTMENT G+' r BAY & HAVILAND ROADS ) QUEENSBURY, NEW YORK I2809- TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION (RECEIVED NAME LOCATION �- DATE ` J I 'A �� PERMIT #'F` 1 APPROVED YES NO �OOTING/PIERS MONOLITHIC POUR FORMS_ FOUNDATIONIDAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING / FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHE (STEPS .STAIRS-CLEARAN E & RAILS_ PLUMBING FIX RES/RELIEF. VALVE INTERIOR TRI /PRIVACY DOOVS FINISHED FLO RS _ GARAGE FIRE ROOFING DOOR CLOSE (S) SMOKE DETE TORS FINAL ELECT CAL INSPECTION FINAL APPRO AL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS . INSPECTOR SELECT SQSINESS f CORMS (6O'9,1 848-5203 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 • Date : City, Town or Township County ifrja t s► state N+ r I n Location/Address ( If Located in Rural Area - Please Attach Directions) Pole # i � ( Owner te t`�` Permit 0 _ Occupied As Building: NeW� Old Occupant Work Area in Buildin Floor #, etc. ) : A for: Wirin 0 Service 0 or: Ready for Inspection : Fee Remitted - $ Cash] Check 0 M.O. LD Make Payable To: M. D. I-A. 500 fi5O 1000 12 50 1500 1750 2000 225; 2500 2750 3000 Number of Rough Wiring Outlets Elect. Heat Switches Lighting Amp- service Surface Unit Dishwasher Range Water Heater Air Conditioner Dryer Pump Receptacles Oven Garbage Disposal Wiring and Controls for Burner Number of Fixtures Amp, Receptacles Fractional H.P. Vent Fans Other Equipment: MOTORS HI. P. 1/2 1/12 1/16 1/8 1/6 1/0. 1/3 112 3/4 1 lab 2 3 5 7+/z 10 15 20 25 30 40 50 75 100 Mark Number of Each Size Applicant's Signature License # Permit # T/A Utility Applicant's Address : 1�+ 0 `k h o.x a2 � INANE OFFICE LOCATION (City) k 1 a Y .1 s I L c v +[ (State) (Zi p) 1 � Service Request # Phone G .: ON - 2>4 T1 Electrician : A-� MDIA USE ONLY I DATE 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.C. 1 11/20 1/12 1110 I/8 116 1/4 1/3 1/2 3/4 1 1V2 2 3 5 7?+x 1O 15 20 25 3O 44 50 75 1100 Mark Number of Each Size Elect. Heat 50o 750 1000 1250 15001175012660 225O 25aa 2r5o 300o CERTIFiCATI[SNS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECT FEE PAID 0 RW Progress : Inc. LKID Contractor 0 CFT Violation : Work Comp. 0 Inc. 0 CASH LIA Owner Fee CHK # L/A Due iM O # 0 IPA Municipal INVApp # Date: Other Side 0 Utility Owner ant Cut in Card C] Temp # Date wood me w do At JL 00 Oak #r e C top, cle TOWN OF QUEF.NSBUR ' Zoning Admirnstr rar r _