1989-639 CERTIFICATE C FI� 0CCUPANC,Y 1
TOWN OF +QUEEN56URY
r
WARREN COUNTYr NEW YORK
Apri 1 13 l4 90
Datek
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Th'Ts is to Certify that work requested to be done as shown by Permit No. $ 9- -39
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has been completed.
This strucre may be occupicd as : Two Family
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L.ocution 68 O en Mary give
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1 Owner oueen Victoria's Grant
By Order Town Board
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`rovlN OF QUEENSSURY
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Director of Bldg. do Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSSURY No. 89-639
WARREN COUNTY, NEW YORK :a
PERMISSION is hereby granted to 1 "
1
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OWNER of property located at Street, Road or Ave.
ca
in the Town of Queensbury, To Construct or place a
at the above location in accordance to application together with plot pans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance_
1. OWNER'S Address is
1 hemphili Place Suite 201 AD
Ballston Spa, N.Y . 12020 ci
M
2. CONTRACTOR or BUILDER'S Name
C
Self
0
3. CONTRACTOR or BUILDER'S Address �
w
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Same
4. ARCHITECT'S Name >
7-.
5. ARCHITECT'S Address
cc
00
6. TYPE of Construction — {Please indicate by X}
X X Wood Frame ( I Masonry ? Steel S 1
4D
7. PLANS and Specifications
No- 291 x 561 Two family as per plot plan, specifications, and application, lrl
including septic, attached one ear garage, and driveway. !
C
8_ Proposed Use rD
Two Family
$ 165.00 PERMIT FEE PAID - THIS PERMIT EXPIRES March 1 19 90
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queansbury before the expiration date.] ' 3
O
Dated at the Town of Queensbury this 9th Day of August 19 89
to
SIGNED BY for the Town of Queensbury
Building and Zoning lKsjector
N OF QUEENS13 URY APP I. I CATION FOR HU I L . . _ . . . :0) ZON I NC PERMIT
\ f y S l5c7
bb
XL'a�4L' V4aj ,. RECEIVED "C ~•
Rewoc ed AUG 7
, ' y 1989
Fee PaL _ /' � BLDG. & CODE DEPT.
BUILDINC AND CURES ur.j Nu'tq .r pate 1.64ued 779 - VL
MY and MAVILAMD ROADS RD 1 BOX 93 C
rJUVZMS40 RY,.M8ir1 Y0lt1C 12804 Pehal.i.t No . c]�I
( 518J 792w5832 Ext -204
,. ■ • • ■ ■ • r■ r K w * w w ■ ■ r ■ ■ ■ ■ ■ ■ ■ • ■ ■ ■ w w r • r a ■ w r •
A pCeItttlT b)US`t' UQ OBTAIt1CL) UMmORE BECINHINC CONSTRUCTION . NU INSPECTIONS
V' ILL UE MADE UNTIL. APPLICANT JJAS RECEIVED A VALID I1VILDINC PDRMIT .
All apj) licable spaces on this application Must be completed and the
Silt lature Of the applicant must allpear on the r �eversc sick of this shooto
to a ■ a A; a i A is * a 9 A * * A & k i * * 9s * • * * a 6 * * * * ae N i ti *
The owner . Of this PrOPerty is : Guyer Builders Inc .
V . O . Address 1 Hemphill Place Suite 201 Ballston Spa., NY 12020
Property location _ (®$ &utgLrJ wmtf Dawg TAX MAP HO . 121 / /-
Has there been any split ce this propurty since October 1 , 19BB4 ! no
gas uO
if yes , Planning Hoard Review is necessary .
SUBDIVISION NAMEa IF APPLICABLE LOT NO . �
The person rosponsiblo a: or :: upurvision of work as regards Building Codes isa
Richard „H Guvver III 1 Hemphill Plan. - Ballston Spa , NY 12020 518-899-9161
Nw �+ Ir
P . O . ADDRESS TI:: L . Noa
eeu of builder
Guyer Builders , IncAddressl Hemphill Place .Ballston 52a.NY_T+u151�
NiAM0 of Plumb`r -same- l.ddress -same- 11
N:saa►Q of Kasensame— Address
—same— Tel —cia*■�—
tietTURE or- PROPOSCO 60a : : A 7.0141M; LN )'URMATLON ru-ffic ..e udO 001u )
X Cons:trucciore Of :a ieuw buildinq • z0NING DL.SICNA'TION OF PROPCRTY
1"WLcion to :a builbliaag ; PERMITTED PRINCIPAL. PEF04ITTED ACCESSORY
A1Lwe"cion to :a L.uilding `
taco clw jLcjw to axc.jrioc climQnsionu) REVIEW REQUIRE] — PLANNING HOARD ZONING DOARD
OC1142C r.ork tL1ar0riUa: l P SITE FLAN REVIEW Y APPROVED DATE
r
CKOSS ARIA Ol` VRONOSC0. t:TAUCTUkU
VARIANCE PI APPROVED DATE
lot floor 1000 sq ft . Remarks :
2 nd F 1 oo r n/a sq it e COKPLeLVdL 4 ipll olanAT,&ON lu:riu text L 44l .
"gee bplot
}
a4"� of Prol,ucc + plan f c x 1 (l F t .
Other Floors n/a sq ft . -' y 100� .w
ui
Inot cull :► r or bas .sruuncl ""Liautj L' uil.11a�.� i ::) ::+: n a eu ILr„��w c *
"r �«
TOTAL 'FLOOR AREA^ 1000 __sq f t . ` 1 xi::cLIk be.i U n a
i:is,.I of new utruc r A 29 it X 56 f t --•----
Nauaaed:.tion-ISie3r 1a1. r.+wi.Fl�arti.alf l u11 ' l'taius::a:[l builuing , d""LAL'ti c roue i+rail+a:rcy iirw
tu&rclw Or►41 , Front yard 3C7+ ft Roar yard 30+ ft
NO . of 'Georia" (J"bit:.hla ::LIacc) 1 Side y:.rd:: + rc :and 15+ rt
1lwighc (uradu to ridq" ) 17 f r , If pp cornar . �ft uro "Ok Troia slates ucruu& 3Q+ f't
if xQuid"ALial, no * of famiiiagi I f
Naa, of rooaarata�xcleulire=j b:ath4l 5 ' pCCi,IPFuic:Y ) NFOR1nA7IW
1100 of basdreouLu 2 ■
• ; >Pz;I.>,IAltx buix.nxac
"a. of WAChroombu Opp family dwelling
I,*ri.larry taraaCiaacj uys:cwau Base ar ectric `
wX ki%da fawily dwelLiny permit for 1 side only
•Yyyxa uff Eu+:l Electricity MultiTai.s aawulling / Number of ur►its _
No. of fir.:rilaCu9 to bQ inscalluu n a laersaanulat occup:uacy
Will :a wa>•a].l g6ow" "q Lna:c:allwd? no W
Tr;ana:ieslac a3a:cula:aearr
coazr:al Air colaelitionlrag? na +
Iiva:inasas
UWLGING STYI o PRIMARY STRLICTURL" inuu :trial
Oa:twr
ta,aaack ContwuiX:Qr4Ary L.sa czAUin Ic .addiciaal . wi'uu►t will uiors bu7
uwi�:4d acancia ft a&Auic+aa UTA w
u0xic lwwal Old acyla: u w
02 &' a Cod COLt:u}.a OLIM4r • ACCESSORY IdtJii.Lfl#IG-
Coloaial haw Towle House L+.seacriau y:ar:age�,/ono r/ two car/ czar
( CIAiCta: ON' PLEASE 1 ' w7rAttuchou 'riar"'Ou Ell c:ar two c.ar/ c:aly
• ■ • • ■ ■ w '■ ♦ r • ■ • ■ ■ ■ ■ ■ � Ilriwatu f.Lair"94 b," Lng .
190TIMATED MARXr•a• VALUE or •k CIIhasC
CoM u•r• kuCT ION •
ww w w � w w wwwww w.. wrrr
3HV0R0A?TON ON BUIL.DInC :SPr=IFTCATTONS , ON REVERSC SIDE OF Tills .^.HIM..T, 41*0 BE COMPL+C•TIMS
rerm DPA 30188 V.1
BUILD114G PERMIT APPLICATION CONTINUED -
al"LI)ING SPECIFICATioN5 :
Type of construction, wood frame , fire safe, etc . wood frame
Will any second-hand or ungraded lumber be used? If so , for what? no
Foundation wall material oncr- rD 11pck , _Thickness 8"
Depth of foundation below grade ( to bottom of footing ) 48" m=11TRIr
Will there be a cellar? no Pleated or unheated? Floor sqo footage sq ft
Will there be a basement? _1W Will any portion be used as living space?
( If so , what portion? sq . ft . - - Type of use?
Type of roof a ope�d flat/shed/other Material of roof fit r�lass shingles
Size , wood studs "DC 6 spacing "o . c . length 8 ft .
Joists ( € loor beams ) lat . floor n/a "X " spacing "o . c . span ft .
Joists ( floor beams ) 2nd , floor n a "D{ ' " spacing "o . c . span ft .
Overlays (ceiling beams ) n/a "D( of spacing '•o . co span ft .
Roof rafters 2 "Di 10 " spacing 24 o . c .ng span 14 ft .
Roof trusses (pre-engineered) spaci 24 "o . c . span 42 ft .
Exterior wall finish stained Of what material ? 5 /8" texture 1-11 41x 8 '
Interior wall finish painted 2` sheetrock
If a garage is to be attached , describe materials to be used for FIRE SEVARATION :
1/2" type x sheetrock
Is there to be an opening between garage and dwelling? yes If so will a Fire-rated
door , enclosure , and self-closing device be provided? yes
Will a flue-lined chimney be installed? no Height above roof ft .
Depth of chimney foundation below grade_ /a ft .
Depth of fireplace h.Aarth n/a ft . in .
Water supply - Municipal or private well Municipal
SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties n/a ft .
(A separate application is necessary for any repair or new installation of septic system)
_,.. _see S- 136E-D- S- permit #QZQ2525
D E C L A RATION
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.
r-
Signature. '`
Owner, owner's ages , +architect, contractor
• • 7Y • ! Me t A * iF k at * f 4 1r 1k * 14 IF M lY • R 1� x fY t ft R k !e ■ • .k • • • M ♦ 'M tF !r i tM
SJ+SCIAL CONDITIONS OF THE: PERMIT :
$y_ ���
APPLICATION FOR SEPTIC DISPOSAL PERMIT
Ref : S. P. E. D. S .
DATS �� E �" permit New York - 0202525 '
MaDEL _ Of
LOCA71ON OF PROPERTY FOR INSTALLATION 68 'Veen Mary Drive
�' ( 518) 899-9161
Owner's Name: Gayer Builders , Inc . ..• Telephone:
Address: 119 pgpni.ng Street , Ballston Spa , New York 12020
Installer's Names
Guyer Builders , Inc Telephone: ( 518) 899-9161
2 A, C , E, 1 , is K, L, M
Number of bedrooms (residential only) 2 _ 3 F , G, H
Total daily flow (compute Q 150 gal per bedroom) 300
Topographlre circle one: lat Rolling Steep Slope % of slope
Soil Nature: circle one: Sand Loath Clay Other / Depth: , 8 ' feet +
Cwxm d. Water: At what depth? ,urlk"wn 8 feet +
Bedrock or Impervious b"terial: At what depth? unknown feet
PemoLation testa, circle one: hat require required / rate min. inch.
Domestic water supply'w circle one. Municip Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption N/A feet
* PROPOSED SYSTEM: Septic Tank gal. (minixnuxa size: 1 ,000 gal.)
TILE FIELD: Each Trench N/A feet- / Total system length N/A feet
* SEEPAGE PIT(S) : Number of / Size each feet by fedt`
* Size of stone to be used / Depth or Thickness feet
sssssss �sssssssssssssr * se * * �cs +sssr * * * ass * * +s * +r
IMPORTANT * See S . P.E.D. S.
**.Please.**LIST NEW gQUIPMENT TO BE INSTALLED permit & attached
* * * sss * sssseesss * ssss * sssssssss * * sss * * sss map ,
(over)
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Section 11 Septic System Inspections:
A. All applications for septic system installation, alteration or repair, as
required by the Town of Queensbury Sanitary Sewage Ordinance. shall
be submitted to the Building Department at least 24 hours before start
of construction and shall include a plot plan showing:
1.) the propo$ed ,location of the Rystem
2.) location and distance to lot lines
3.) location and distance to structures
4.) location and distance to any vater supply
5.) size and dimensions of all tasiks. distribution
boxes, the fields and/or dryw ells
Be No system shall be covered before inspection and approval by the building
Inspector. Failure to comply with this requirement may result in the
uncovering of the system by the installer and a fine of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plat plain at time of inspection may result
in an immediate work stoppage. '
D. Should unforeseen problems during construction prevent proper installation.
alteration or repair of an approved system, a new proposal must:be submitted
to the Queensbury Building Department before further construction.
I have read the regulations above and agree to ,abide by these .and all requirQ=A*" ats
of the Town of QLteem ..bury Sanitary Sewagq Disposal Ckilluance.
Signaturet�-o�f.responsible person:
Date:
YI
Town of Queensbury
Building and Code Department
Say at Haviland Road
QQueensbury, New York 12801
(518) 792-583Z
rT1_ En 1763 . . . MOME OF NATURAL RFAUTY . . . A GOOD F TCj
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & . HAVILAIVD ROADS
WEENS.BURY, NEW YORK 3 28 U+I
TELEPHONE (528) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME /
LOCAT. r ow Cs7
DATE PERMIT #�
APPROVED
/ ,/7j YES I NO
FOOTING/PIERS F
MONOLITHIC POUR FO
FOUNDATION/DAMP-PR FING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH~.rN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
;X FINAL INSPECTION:
al CHSMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEP
STAIRS-CLEARANCE & RAI PA
PLUMBING FIXTURES/RELX VALVE
INTERIOR TRIM/PRIVACY R$
FINISHED FLOORS -
GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECT N
_ FINAL APPROVAL OF CONSTOL 7TXON
OK To ISSUE C/O OR C/
A SIGNED CERTIFICAT OF UPANCY MUST BE
OBTAINED FROM THE BUILDIN DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIE
REMARKS:
ARRIVE
mwmz
INSPECTOR
c�I a ' eI
MIDDLE DEPARTM � N AGENCY, INC.
Sao ti� r Co nq�
,c_x 9i�frG'Ja R . ..l April r�' U �.990
Certxfll�� that thp'�Iegtriaa� equipment listed has been examined and is approved as being in accord
with the National Electriti Code, applicable governmental, utility and Agency rules.
�.:�� �# : .;
Owner: C;1.1y x t3ullcte7c r?c � Vypancy l
Occupant. S ixi , l e i'auti 1 ♦ h 1i ,y } "A7���
Location: b II A-le eia U1 r D' �-�✓k ,' ( �1TS �lr]7 " (V � \+�J - }SIS co rt�ticata cal ads the re Illicit ipik equipment end in sl a Ila t pan inS pec led Ih is
date I adaittana{ equipment 'Shol be tntrOduCad Of a leratl Or+e made 10
exlsltng system Chill Cattibcate shelf be nuh and rued, and appucatlori. for
YT' }� inspection should be submitted prptnpilyta this Agancy.
Equipment: ii UtiL1eL E ; kiecepi;acles ; 15 Ff_ t;uret ; .
6 4fT Holder of this ce rtlheate should l7llLent some 10 his property insurance carrier
151J r400 service-! 6 x%pp1i.ar+ce j dErYG ' �115 (agent or company1 as avidanceef Certification of electrical equipment Approved
l� - as Specified
r C kl;yel"
Applicant: 1 l a 01,1111111,18 a Lre7� w. . 4 " No .
Ballston Spa , tlY 1Y620-' 15 - 03 263 8
Farye No. ins EL +-"
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURYr NEW YORK 22804-
TELEPHONE (528 ) 792,5832
BUILDING INSPECTOR ' S PORT
REQUEST I jSpFCTXON1tRpCEIV D L l G 70 r -r
NAME
LOCATION ,n
DATE 2 CrS..,__�_i PERM
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POU0 FORMS
FOUNDATION/DAMPVPROOFI G
BACKFILL APPROV L
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE /ST S
STAIRS-CLEARANC & LS
PLUMBING FIX TU S/REL EF VALVE_
INTERIOR TRIM/ IVACY RS
FINISHED FLOOR
GARAGE FIREPR FIND
DOOR CLOSERS)
SMOKE DETECTOR _
FINAL ELECTRICAL INSPECTIO
FINAL APPROVAL CONSTRUCT N
A SIGNED CERTTF ATE OF OCCUP NCY MUST BE
OBTAINED FROM T E BUILDING DE RTMENT BEFORE
T11ESE PREMISES RE OCCUPIED!
/
REMARKS :
//+ / o
r
SPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12804�
TELEPHONE (518) 792-5832
BUILDING INSPECTO " S REPORT
REQUEST FOR (INSPECTION REC IVED
NAME
LOCATION
DATE - ► 7 D PE IT # "f
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR F S
FOUNDATION/DAMP-PROOF G
BACKFILL APPROVAL
ROUGH P.LU ING
FRAMING
ELECTRICAL ROUGH-IN .
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/ TEP
STATRE-CLEARANCE RA S
PLUMBING FIXTURES RELI F VALVE
INTERIOR TRIM/PRI ACY ORS
FINISHED FLOORS
GARAGE FIREPROOF G
DOOR CLOSER(S)
SMOKE DETECTORS
FINAL ELECTRICAL I SPECTIO
FINAL APPROVAL DF ONSTRUC ION
A SIGNED CERTTFIC E OF OCC PANCY MUST BE
OBTAINED FROM THE UTLDYNG EPARTMENT .BEFORE
THESE PREMISES AR OCCUPIED
REMARKS:
y 44atA,
"" - --'
�- INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
,BAY & HA VILAND ROADS
QUEENSBURY, NEW YORK I2804-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST R INSPECTION RECEIVED
NAME ,�r++
I.00ATSON /'j
DATE [� r PERMIT #
APPROVE
YES NO
FOOTING/PIERS
MONOLITHIC POUR RMS
FOUNDATION/DAMP- OOFING
BACKFILL APPROVAL
ROUGH PLUMBING
Lw,PAAMING
ELECTRICAL ROUGH-
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/ST S
STAIRS-CLEARANCE & j LS
PLUMBING FIXTURES/,REL EF VALVE
INTERIOR TRIM/PR.TVACY ORS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL SPECTIO
FINAL APPROVAL OF 'CONSTRUCT DN
i
A SIGNED C'ERTIFI ATE OF CUP NCY MUST BE
OBTAINED FROM TH BUILDING DE RTMENT BEFORE
THESE PREMISES A E OCCUPIED.+ #
REMARKS:
`z
NSPECTOR
BUILD(NG and ZONING DEPARTMENT
Say and Haviland Road, R .D . 1 Box
Oueensbury, New York 12801 f
SEPTIC "OSAL SYSTEM INSPECTION
NAME
LOCATION k 4� q......
DATE J PERMIT NO . k41
SOIL TYPE Loam - clay
Percolation -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field , total length
Length of each trench
Depth of trenches
Size of grave]:_
SEEPAGE .SITS-(Number of } —
Size- ft . x _ ft .
Gravel size
PIPING : Size`: Type
Bldg . to tank
Tank. to ( Ust . box
Dist , boa: to field/pij
Openings sealed? YtS y NO Partial
LOCATION/SEPPARATI NS :
Foundaticn to t :k �� ft.
Foundaticn to scrptiory ft
Absorption to of lineft
Separation o pits f ft. /
LOCATION OF "SYSTEMS ON kROPERT+ Y (+�ircle one }
Front - Re r - Left Sidi .ght! side
COMMENTS :
SYSTEM USE APPROVED YES O
�rL
Build ng Inspector
01/86 and v1
r
TpIVA1 OF Qi1.1EENSSl3RY
] >
BUILDING AND CODES DEPARTMENT ,✓7
DAY & HAVTLAND ROADS /f fir'
QUEENSBURY, NEW YORK 12804-
TELEPHONE (518 ) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION
�TON RECEIVED
NAME
LOCATION
DATE PERMIT #_
APPROVED
YES NO
FOOTTNGIPIERS
MONOLITHIC POUR FORMS
FOUNDATTONIDAMP—PROOFING t, --
BAC FILL AP VA
LR6UGH PLUMBS
FRAMING
ELECTRICAL
INSULATION: s
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION : 3
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCH /STEPS
STAIRS—CLEARA CE & RAT
PLUMBING FIX RESIRELIEF ALVE�
INTERIOR TR /PRIVACY DOO
FINISHED F RS
GARAGE FT PROOFING
DOOR CLOS R (S)
SMOKE DE ECTORS
FINAL ELEC RICAL INSPECTION
FINAL APP OVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
TFIESE PREMISES ARE OCCUPIED ?
REMARKS:
INSPECTOR
TOWN OF QUEEN SBURY �.
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUSENSB UZzYo NEW YORK I280&
TELEPHONE (51.8 ) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
L0CATXON PERMIT
DATE � �"'� APPROVED
YES NO
VOCTINrGIPIERS
RMS
MONOLITHIC pOURPPOOOFINGf� ,
POUNDATI+ONI DAM
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUG IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL XNSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL pORCHESI TEP
STAIRS—CLEARANCE & RAI
PLUMBING FixTUR VACY r iV4AS VE
INTERIOR TRIMI
FINISHED FLOOR FIND
GARAGE FIREPR
DOOR CLOSER (SRS
SMOKE DETEC
SPECTION
FINAL ELECTRIC OFICONSTRUCTION
FINAL APPROVA
A SIGNED CER FICATE OF OCCUPANCY MUST BE
OBTAINED FRO THE
R pCCUPTEDfDEPARTMENT BEFORE
THESE PREMISE
REMARKS :
INSPECTOR
TOWN OF QUEENSBURY
BUILDING* AND CODES DEPARTMENT -I
BAY 6 HAVILAND ROADS
QU,EENSBURY. NEW YORIC 1280&
TELEPHONE (518) 7"92^S832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED 2 �
NAME
LOCATION
DATE
���{' ._ <� PERMIT #,^
APPROVED
YES 1 .1140
FOOTING/PIE
MONOLITHIC R FORMS
FOUNDATION/ —DROOPING
BACKFILL APPRO L
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH— N '
LIIII�t,,rLATION:
—,PCfUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
a^IDING
EXTERNAL PORCHES/STISPS� �---
STAIRS—CLEARANCE ' RAI
PLUMBING FIXTURES /RE=� LIVE
INTERIOR TRIM/pgIVACY DOO
FINISHED FLUOR$
GARAGE FIRE'aPR FIND
DOOR C LOSER (S) -�
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION '
ASIGNED CL'RTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMA,RICS:
INSPECTOR
�ncuri o� �uee►tshur�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME , w + 0
LOCATION 5c:> ,d44 Q t x ay.r.�
PERMIT
SOIL TYPE - Sand - Loam - Clay -
Percolation , Test Ftecquired? YES - NO
Percolationlrate - 14in/Inch
TYPE Of
Abeorp4E39m fi Ld, totsI r
Length of emc trench
+r
Depth of trenc es
Size of gravel
SEEPAGE PITS#N r of) —
size- ft. X ft.
Gravel size
PIPING : ze Ty)pe
Bldge to tank
Tank to diet . box
Dista box to field/ yr ~-
openings sealed? � r{ 7kE No artial
LOCATION/SEPARA'TI `> �-S--� ft.
Foundation to tak
Foundation to aVsorptione ° ft.
Absorption to t line ft.
Separation of its `k ft.
LOCAT1013 . $ STEM ON PROPERTY (Circle one)
Front - Rea Left side - R1 ht side
CCMMEb7T5 = ,
r
.� 4�2
SYSTEM. USE APPROVED YES NO -
Build g Inspector
01/86 and vl
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK .I280&—
TELEPHONE ( 518 ) 792- 5832
BUILDING INSPECTOR ' S REPORT
REQUE R INSPECTION RECEIVED ,-
NAME U
LOCATION
DATE
PERMIT ,c'
APPROVED
YES NO
OOTSNG/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP—PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL SNSPECTIONr
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCKES/STEPSN
STAIRS—CLEARANCE & RAILS
PLUMBING FIXTURES/RELIEF VALVE_ _
INTERIOR TRIM/PRIVACY DOORS
FINISHED E�LOORS
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 OCCUPIED!
REMARKS :(
J/
INSPECTOR
1� �. _�✓
M1170_ EPAKTM1[!1�'' IN;Sf+EICT#L'1WAASE111CY;4NC.
........ !National Headquarters
lip vuond, N..I: 0810$
Date: .g
Town County State M
Location/Address Q
( If Located in Rural Area - Please Attach Directions) . Pole #
Owner Permit # '�
Occupied AS % i. Building: New OldO
Occupant Work Area in 6uildin Floor #, etc,) : -
App. for: Wiriri Service or: Ready for Inspection :
Fee Remitted - $ Cash 0 Check M.O. M Make Pa able To : M.D. I.A_
Number of Rough Wiring Outlets Elect. Heat I 1
9003 1 750 loan 125a 1a0a 1750 "00 2250 2500 275a 3000 r
Switches Amp. Service Surface Unit r 0Dishwasher Range
Lighting Water Heater Air Conditioner Dryer Pump
Receptacles Oven Garbage Disposal Wiring and Controls for Burrwr
Number of Fixtures
Amp. Receptacles Fractional H.P. Vent Fans
Other Equipment:
MOTORS H.P. 1f201/1 1/10 1/8 1 1/6 1/4 1 1/3 1/2 3/4 11 1 1 1Wh 1 2 1 3- 5 7Y2 10 1 15 20 25 1 ,30140 54 75 100
Mark Number
of Each Size
Applicant's .
Signature License # Permit # .
-I-/p1 s. Utility :
Applicant's Ad r (NAME I � CATk
dd
(City) (State) (zip) " Service Request #
Phone #_ Electrician :
DATE RECEIVED: DATE INSPECTED: -
Correct Location : Same as AboveED 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 Sa Controls for Amp, Receptacle
Amp. Service Conductors Pump Vent Fans
MOTORS H.F',.. 1/20 1/12 1/10 118 1/6 1/4 1/3 112 [3/4j 1 1 llh 2 3 s 7t& 1 10 15 1 20 1 25 1 30 40 50 75 IO0
Mark NIumJ3r K. .
of Each Sidi.
_ - I£Ct. Heat 900 750 1000 19 1500 1750 2000 2250 25g0 2750 3000 ..
2'.
RW Progress : Inc. LKD 0 Contractor
0 CFT Violation: Work Comp, 0 Inc. `.
L/A Owner G �
Fee CH K # -
L!A Due
[] IPA Municipal -
INV # '�
4PPlicant
Date : Other SideEJ Utility. ' - Owner
Cut in Card Temp # Date
NSPEUMORSZIGNATLIRE
Final # 7 � Date s�
APPt_ICATION P0RM No-