1989-637 .. ,.g...." .'�.�'7„a.1}_4C7!!6_"s'�'F�",. :.,,,r,�F7x'�"�v3.. . �^^�"�`s'r'�",r'p'T^T'!''.°. 'Si�:'�*„'.. .- . .�,�,r'r�a,+��•••...���,�y ;.-y ,. _�.. •"Ti',�•.-.... a -.- ..- w: .z:.;'^'
q
+ ERTIFI+ T°E' OF CUT''ATY
TOWN OF +QUEENSBURY
WARREN COUNTY, NEW YORK
( Date November 13 19 89
This is to certify that work requested to be done as shown by Permit No. 89-637
has been completed.
This structure may be occupied as a Two F14 m ily
Location 52 Queen Mary Drive
Caner Queen ldisttoria's Grant
By Order Town Board
TOWN OF QUEENSSURY Director of Bldg. do Code Enforcement
BUILDING PERMIT m
TOWN OF +QUEENSBURY
No. 89-837
WARREN COUNTY NEW YORK — o
PERMISSION is hereby granted to Qjlfr pn Vici L rE ia 's Crant
i
OWNER of property located at 52.., Q,ueen. Mary Drive Street, Road or Ave. w
ca
in the Town of Queensbury, To Construct or place a rpWl] Fam ily
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
1 hemphill Place Suite 201
ffammimKTAPW
Ballston Spa, N.Y. 12020 ,p
2. CONTRACTOR or BUILDER S Name �
Self
C
3. CONTRACTOR or BUILDER'S Address
0
Same a
rn'
4. ARCHITECT'S Name
y
5. ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by X)
cn
is
) Wood Frame ( ) Masonry ( ) Steel
7_ PLANS and Specifications CD
No. 31' x 42' Two Family as per plot plan, Specifications, and application,
including septic, attached one car garage, and driveway. �
S. Proposed Use
C
Two Family ro
$ 1_ S1 _oll PERMIT FEE PAID — THIS PERMIT EXPIRES _ Nlarctl 19��
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 9th Day of Au sl
SIGNED BY for the Town of Queensbury
Building and Zoning nwector
y a ! Y
�r�N OF � UEENSL URY APPLICATTON FOR HUIi. .4 • . . . . . . :[40 ZONINC. Pr•. R)ktIT
fi ec.e. <4X
up g
CIL
pal
� ['Fee rai /
BUILDING AND CUDES U1 ;3WITM2h."i• Date I-I BLDG. & CODE DEPT.
RAY and nATIILAMl] ROARS RD I Dow 98
{u►.trruSBtIRY, MEW YORK 12804 Peel. No .Tel . 1518) 792-5832 SVC •204
.. .r r ■ w ■ * ■ * R * * * r r r ■ r r w • * ■ r • * w w • . * ■ ■ ■ w w w r
A I'I± RI• 1T MUST Ell OBTAINED BEFORE: BHGINI'IING CONSTRUCTION . NO INSPL'• CTIONS
- WILL liL'• MADE UNTIL APPLICANT IIAS RECEIVEW A VALID UUILDINC TsI1"11T .
All applicable spaces on this U Plication must be coutpleted and the
%'pint rc * f xthc * u �1 1 :1Nt *tli* 5L* *I�* car * O* * I1 *c +VeRssx side Of this * S1* D * *
'rho owner of this property is : Guyer Bu lderss Inc.
p . o . Address 1 Hemphill Place Suite 201 , Ballston Spa, NY 12020 T C. L . ( 518) 899-9161 ;93,a
t' raperty location S C�cJC � r'III` � •r'• rca� TAX tthP r1D . 121 / 1 99�
11as there been any split of this property since October 1 , 19887 / no
yes CLD
if you , Planning board Review is necessary .
SUBDIVISION NAME , IF APPLICAnLU Qtm VICTORIA' IS GRANT LOT NO * .��.
The person responsible for aupurvision of work as regards Building Codes is $
Richard He Guver III 1 Hempbhjll Place Suite 201 Ballston Spa. NY ( 518) 899-9161
NI► 141i P . O . ADURCSS TEL . NOa
t4waws of buildrarGuyer Builders . IncAddress 1 Hs tlUhi11 Places Ballston S22Tol(5187 $ 9161
ti:at�w ,nf Plutub.3r -same- 1.dclress� -same- Tel -aame-
Nra1RB of Mason -same- htlt3rctss3 _salve'-. Tr.:l -same-
14ATuRk Or PaOPOSLp WORK: Model S ,. Z(lNl r1C 1 N1 OItrIA"I' iC1N l uit i ca ' uaa3 0AI b )
X cons:cructior4 of a tsuw buildincj # ZONING DESIGNATION OF PROPERTY
Adalieion to a buildis►g t PERMITTED PRINCIPAL PEFel4ITTED ACCESSORY
Alcwr:atian to " l:uilding I `
Iuo atras►g" to axc �: rior REVIEW REQUIRED PLANNING BOARD ZONING AOARoIIIIIIIIIIIIIIIIIIIIIIIIP
Ot164r work (ainceib.:) ; SITE PLAN REVIEW # APPROVED DATE
C: itoss ARE l
A O ' P14OLAOSC06 t; TrtUCTuhE ; VARIANCE N APPROVED DATE
1st k' ioor 900 sq f t . ` Remarks . _
and Floor sq f t . „ COl�tt'LL't`t» i{V,1'+Dl !•t1►'P14N IC Uplot uL_L4A1 .
" Sixs of prolawrty 100. plan ec x 120 rt .
Other Floors Lxis:tjerrj l�+sit.li �x+] ir:3 .tii �u ri 8�ft x rc .
snot collar or b4aQ=unc3
TOTAL FLOOR AREA - 900 Sq f t . • wxi.;�cing 0ui. lj-L164j (:: ) U::•s n a
si,xa ue ,now utructuro 31 it a 42 ft
vawad:. ti.ai/ full ` PsajwA;ua buiicsingo di::c:tnn.: iroui L,r+alwxty lino
(c:irclu on& 3 at
„ Front yiard� 30+ Cc Raar y:►rd 30+ f t
N.a6 of ccoriea ikt:aLsi"bla :upace ) 1 '� , +
„ r Sida yards 5+ ez :anti t t
11wignt, iclrada to ridq.: 3 1916 ft . # IP on c+crrn.sr . ::ucb«.:k trout t:idu acrQuc is
It rauLd"At lal, no. of f;"AiIII 1 - 2
tie9 Of roowx i saxcludin+j 1GsII I OCCUPANCY I NFOWIAT I ON
1,100 of bodrocau 2• . p tZk"Y DUILDINIC Im
two* of bweltroasw:: 1 One fatuity dwelling
11cisa.ry tsw:aciikrj UY ard Electric x *Lo,,p f:uai ly dw.sllicsy
sw asf foal Eletric t
7d3 „ Its►1til�l,s .lwuliing / Number of units
tio. of firaplacua to b:: iet;:t.allid n a Porto.tn041t occupwicy
Will ;+ wuw,1 ULGV%k k w no ` 't•ranz;i4wt caticuLs;arsc y
C:waztt.al Air, cosa�iiticanihcj.a no r
„ uuslauu s
WILDING STYiLC, PRIMARY STRUCTtI r Inc.1u»Ur-I
„ +UcTtur
lt.:usc�t Contwn�l:�rus-y Lon cabin * lT .adriiciaan , wluat will u;41;s but
sc.aisiwd ravel► l4anuic+,s Dut,lvx
UJAL .t l"vatl old scyla Lsu4w-j.atow r
C4I Cod Cott:►ga Octu»r " ACC"SORY UUILDINC�
GoLoni:.1 i:ow "rowel }louse 94rucje/ono cur/ two crar/�.�:ar
( CIRCLs: ON" PLEASE 1 • x Actactwa gtarugu wear car/ two car/ clot•
w r * ■ a ■ ■ r w + ■ ■ w r ■ ■ r *` l�riv:at.s sscor:age bug
I:S �• Itiw4' 1? D MARKEY• VA14un or • Othur
LsiY'OfWJITYON ON QUISLDINC sprerprcATTONS , ON RERSK SIDE OF THIS CfiE D bE COMALCi'
L•'1I # 'LS 901
corm RPA ICl/BB v1
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood .frame , fire safe , etco wood frame
Will any second-hand or ungraded lumber be used? If so , for what ? no
Foundation wall material concrete block Thickness 8go
Depth of foundation below grade (to bottom of footing )
Will there be a cellar? no Heated or unheated? Floor sq. footage sq ft
Will there be a basement? no 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 fiberglass shinglesw
Size , wood studs 2 "x b No spacing-2-4"o . c . length 8 ft .
Joists ( floor beams ) 1st _ floor nra "X " spacing •'o . c , span ft .
.joists ( floor beams ) 2nd . floor n a "X spacing "o . co span ft .
Overlays (ceiling beams ) g�f$"X as spacing "o . c . span fc .
Roof rafters n/a "X " spacing C . C . span ft .
Roof trusses (pre-engineered) spacing 24 "o . c . span ft .
Exterior wall finish stained Of what material? 5 /8"x 4 ' x 8 ' texture 1- 11
interior wall finish painted 1 2"' sheetrock
If a garage is to be attached , describe materials to be used for FIRE SEPARATION :
1/2" type "x" sheetrock
Is there to be an opening between garage and dwelling? ye�s 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 n a ft .
Depth of fireplace h`arth nIa ft . in .
Water supply - Municipal or private well Municipal
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)
D E C L A R A T 1 4 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 wner.
a
Signature AWV
Owner, owner's agent , argmirect,, contra for
ri • > • t R • at 9k 7t s • It • 1R * .t !r !r k ♦ t : : * w t /e R A M x ie ! r * It 1 • M * yk It •
SPECIAL CONDITIONS OF THE PERMIT :
By--------------�--_-
APPLICATION FOR SEPTIC DISPOSAL PERMIT
Ref : S. P. E. D. S .
IIATZ , ?/ permit ,#
New York - 0202525 '
MODEL J* !S of
LOCATION OF PROPERTY FOR INSTALLATION 52 queen Mary Drive
Owner's Name. Guyer Builders , Inc , `.. Telephone: ( 518) 899�9161
Address: _ 119 Dunning Street , Ballston Spa , New York 12020
Installer's Name: Guyer Bu lders , Inc Telephone: ( 518) 899-9161
2 A, Co E, I , .J , Ks L, M
Number of bedrooms (residential only) 2 3 F , G, H
Total daily flow (compute @ 150 gal per bedroom) 300
Thy: circle one: Flat Rolling Steep Slope % of slope
Loam Clay Other . / Depth: . 8 ' feet +
Soil Nature: circle onei (i;;
Growad Water: At what depth? mown 8 feet +
Bedrock or Impervious Material: At what depth? unknown feet
Percolation test: circle one: not require required / rate min. inch.
Domestic rater =apply: circle one: Municipal W ell Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption N/A feet
* PROPOSED SYSTEM: Septic Tank gal. (minimum size: 10000 gal.)
TILE FIELD: Each Trench N/A feet / Total systems length N/A feet
* SEEPAGE PIT(S): Number of / Size each feet by feet'
* Size of stone to be used #k / Depth or Thickness feet
IMPORTANT * See S . P. E. D. S .
...Please...UST NEW EQUIPMENT TO BE INSTALLED permit & attached
* * vss * * ss * ssssssssssss * ssssssssssssss * * ss map .
(over)
4
Section H Septic System Ins actions:
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 Z4 hours before start
of construction and shall include a plot plan showing.
1.) the propoaed ,location of the aiystem
Z.) location and distance to lot lines
3.) location and distance to struptures
4.) location and distance to any *ester supply
5.) size and dimensions of all tanks. distribution
boxes, tile fields and/or drywells
B. 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 $Z50.00.
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 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 an regitis�enae�sts
of the Town of Queensbury Sanitary Sewage Disposal Ckltinance.
Signature
11 of.reaponsible person:
Date: /'-'k 4
k�
Town of Queensbury
Building and Code Department
.Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
u
� TLFf� 1709 . . . N " eE OF NATURAL BEAUTY . . . A " " '1 PLACE TG
7' d
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT gzp
BAY & HAVSLAND ROADS
QUSENSBURYr NEW YORK 1280
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR 2WSPECTXON RECEIVED
NAME
LOCATION
DATE /�/ - 1r PERMIT 1/
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFTLL APPROVAL
ROUGH P.LUMRTjRG
i
FRAMING +
ELECTRICAL ROU -IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING {
1 /FINAL INSPECTION:
V CHIMNEY HEIGHT
ROOFING `
.SIDING
EXTERNAL PORC ES/STEPS !.
STAIRS-CLEA NCE & RAI
1�7—
PLUMBING FT TURES/RELIE2} VALVE
INTERIOR IMfPRIVACY DOORS
FINISHED LOCIRS -
GARAGE F EPROOFING Y
DOOR Cl
ER (S)
SMOKE D TECTORS
FINAL EL TRICAL INSPECTION
FINAL AP OVAL OF CONSTRUCTION,
A SIGNED Ck'WTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIEDI
REMARKS:
NSPECTOR
MIDDLE DEPARTME N AGENCY INC.
oaatu November 9 , 1989
VI CCtif iC5 that la tCi equipment listed has been eixe�e an approved as being in accord
with the National Elect Cr ; applicable governmental, utility and ,Atg���c+�{ s-
OwnerGuyer Build �Q1 ;` p D e' 1i
Occupant: Single Fami f ��
�y
Location: 52 Queen Leh ye @n 0 cIf a kite t lee h be intro andinstallationdor ions matl its
date. 11 additional ui nt sh fate introduced uced or 9llere5iona made to
exialing eyelera 7t ica be null and void. and application for
Equipment.: 77 Outlets ; (leceptacies ; B LXt q � napectaon ahoutl aubmin D nyto thin Agencr-
= ek Y Molder of this co; ificate ah Id rtt same to his property insurance Carrier
150 Amp Sery 8 ApMlances fegenl or corn Ay as OW ertiti Gal tan of electrical eq ui pment approved
ea specified-.
FGuyer Builders dr
Ion
Applicant: 119 Dunning Stree - --.. _. _ - - 0 . 15-029121
L.Ballston Spa , NY 120
Farm No. acn EL 1 as
MIDDLE DEPARTM U " ' ""' 1ON�AGENCY, INC.
goo 2 {1 J !
w 14 1 1 U SPEf7e Date tia.remb c5 } 989
., A .
CertlflCg that leq real equipment listed has been exare ed a approved as being in accord
with the National Electr.' pde, applicable governmental, utility and A16'encX les.
Owner: Mary Ann Suen „y pa we 1 11
occupant: 'Same t,��
Location RoctLtxursC , �e slxury rlvarl�elr �' ° 7TiF'scerljhcate t eiarYc uipmem and installation inspecleo this
y i data 11 additional ak,ui ment j eh be introduced Or 8Hlerab One media 10
Osishng System Mill Cgr11tiCAte he null and Void. and application Our
in specl kon should tie so brt lit p tly to this Agency.
Equipment: 3 .S. w7. tc-hes y'y ft.ecep I:ac le s3 �. r', _M _.r 1 F,fiolder 01 Ihis certificate shQ W ne some to his property insurance carrier
(egerd or company) as evid/nc ertill cal ion of electrical on ui pment approved
yy as specified.
Joe Roulier
A iicant: B0;�c 301 i `N'' . } W 6. , f..
Pp c o . 15-022602
fj L Cleverdale , NY 12820" -;e
UEEl3S�BURY j -1
T 01,14 aF 1 D CODES DEPARTMENT
}3UILDTNG
BAY & HAVILA NEW ORK 2804-
QUEENSSURY, ( 518 ) 792�5832
TELEPHONE R' S REPORT
Bij
IyINC; IN5pEC1�
rNSPECTxON
REQUEST FOR r
11
NAME _ -?
LOCATION � pERMIT # ROVED
APpftOV
DATE 'YES NO
F,QOTINGIP:EERS FORMS ----
MONOLITHIC POU p-PROOFING
FOUN'D.ATIO� PRC7VAI'_----�'�-�-_�-�--�:-
ROUGH PLUMBING
ROUGH '
FRAMIN ICAL R(7UGH-IN
ELEC xoN :
V/zNsv TION
p'OUN .'.
FLOOR
WALLS
CEILxNG TxON :
FINAL xNSP GHT
C�{IMNEY H
ROOFING !
SIRING Pf7RC SIETEP#�--- �'---�
EXTERNAL & LS
IF
CLEARPlN R�IEF VALVE
STAIRS- k'IXTLIRE
PLUMBTNG TRxM/PRI ly DOORS
INTERIOR
FINISHED FrpORS
GARAGE FIREPROOFIN
DOOR CLOSER ( S 1
SMOKE DETECTORSr SPECTION
FINAL ELECTRICAL Otd'STRUCTIO
FINAL APPROVAL OF
OCCUPANCY MUST' BE
TE OF BEFORE
A SIGNED CFRTIFrBUILDING DEPARTMENT
OBTAINED FROM TH OCCUPIED :
THESE PREMxSES A E
REMARKS
i
aF QUBBNSBU" �~
AI
'"� Q��N AND CODES I?SPARTIylENT
BUILDING 12809
�, & tiAS7ILAN NF
YORK
QUEENSBURY, 518 ) 792-5g32
TELEPHONE +� pR'T
J11DI ,G INSPECloR' S
INSPECTION RECEIVED
REQUEST FOR t �
NAME - r
LOCATION _ ERMIT #
APPROVED
DATE YES NO
Fal7TS1JG/pIERa' FaF145� --� � '�~
TCp�}FING���-�
MONOLITH POUR
F O rUNDATIONI DAMpr r--
SACKFxLL APPROVAL
ROUGH PLUMBING
FRAMING Ot7GH-IN
ELECTRICAL
INSULATION :
FOUNDATION.��
FLOORS
WALLS '.
CETL INSPECTI 1-----�'
FINAL
CHIMNEY HEIG
ROOFING
SIDINGA HE ,STEPS --- --_
EXTERN A RTla5��� �—
S'T'P1IRS.CLEARANCE L REF VALVE
PLUMBING FxXTURBS IVA DaORS�
INTERIOR TRX14RS �- -
FINISHED FLOORS F
GARAGE FTREPROO
,DOOR CLOSER (s)
SMOKE DCT CTORSIN$PECTTONl --
FINAL ELE doNSTRUCTION.�r,
FINAL APPROVAL OF
pCCUPANCY MUST SE
TE OF pEPARTMENT BEFORE
p, SIGNED CERTIFIC '+ BUxLOOCCUPIEDF
ING
OBTAINED FROM THE
THESE PREMISES ARE
REMARKS :
0
INSPECTOR
TOWN OF QUEENSBURY
TMENT
$UXLDING AND CODES DEPAR
BAY & HAVlr,?LND ROADS .1.280#1
QUEEN,SBURY , NEW YORK
TELEPHONE ( 518 ) 792_5832
BU-1133ING INSPECTOR' S REPORT
RES7UEST FOR INSPECTION RECEIVED
NAME
LOCATION —
PERMIT #�-
DATE APPROVED
YES NO
FOOTXNG/PIE *s FORMS
Z40NOLITHIC PROOFING
FOUTVi]Ah'SO APPROVAL
�,' CICF ILEt MBING
�,/rc UGH PT.YT
RAMING
ELEC`t'RICA ROUGH—IN
INSULATxO
FOUNDATT 4
FLOORS "
WALLS
CEILJtTG ,_ ON :
FINAL INSFEC T
CHIMNEY HEx
ROOFxNG
SIDING SISTVPS,�-------'
EXTERNAZ pORC & RAILS
STAIRS—CLEARAN /RELIEF VALVEI_,
P'LUMBXNG FIXTU t Cy DOORS
INTERIOR TRIM
FINISHED FLOO.K
S
GAGE FIRE3�" OOFIN
DOOR CLOSER )
5MOKE DETEC ORS N
FINAL VLECTRyCAL INSPECT
FINAL APPROVAL OF CONSTRUC ON —�---
CERTIFICATE OF OCCTTFA Y MUST SE
A SIGNET] T3iUILDIIVG DEPAR MENT BEFORE
OBTAINED FROM THE OCCUPIED !
THOSE PREMISES ARE
,REMARKS:
SPEC TOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
OADS
BAY & HAVILAN YORK 1280¢ � }
QUEENSBURY.
NEW
TELEPHONE ( 51.8 ) 792-5832
BUILDING INSpE,C'TOR' S REPORT
REoUF'ST FOR INSPECTION RECEIVED
NAME
LOCATION
�..- c_ _ +a � PERMITikE f�
DATE `�--s--- APPROVED
YES NO
FOOTINGIPIE
MONOLITHIC UR FORMS �-
FOUNDATIONID P-PROOFING
BACKFILL AP P VAL
jr,.-ROUGH PLUMB
FRAMING
ELECTRICAL ROUG -xN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL pORC ESISTEF
STAIRSIIIIIICLEARA CE & RAILS PRIVAC DOORS
E �-
PLUMBING FIX LXE
INTERIOR TRI RS
FINISHED F
GARAGE FIRE FtOOFXNG
DOOR CLOSE (S)
SMOKE DETE TORS
FINAL ELECTR LA OF CONSTRUCL INSPECTION
TION '
FINAL APPRO
A S13
IGNES? C RTIFICATE OF OCCUPANCY MUST BE
OTHB'ZLINED ROM
PROMREMISES AREOCBUILCDUPIED +ING EPAR'IMENT BEFORE
SE
REMARKS :
C1A 4c)
tC,
INSP TOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVTLAND ROADS
QUEE'NSBURY, NEW YORK 1280kt-
TELEPHONE (518) 792 -5832
BUILDING INSPECTOR ' S REPORT
RES;UEv
FOR INSPECTION RECESVED __
NAME f
LOCATION
DATE PERMIT #
PAVED
YES t NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING -
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION {!
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHESISTEPS
STAIRS-CLEARANCE & RAILS
PLUMBING FIXTURES/RELIEF VALVE
INTERIOR TRIM/PRIVACY DOORS _
FINISHED FLOORS
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:
INS CTOR `-
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 22804-
TELEPHONE (5I8) 792-5832
BUILDING INSPECYOR' S REPORT
REQUEST FOR IN PECTION RECEIVED
NAME
LOCATION
DATE J9 PERMIT #
APPROVED
YES NO
i
L ��OOTINGIPIERS
MONOLITHIC POUR FORMS
FOUNDATION'll?A+"1`P-PROOFING
BACKFILL APP' OVAL
ROUGH PLUMBI
FRAMING
ELECTRICAL ROU -IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION-&
CHIMNEY HEIGHT `
ROOFING
SIDING
EXTERNAL PORCHES/STE S _
STAIRS-CLEARANCE & MAILS
PLUMBING FIXTURES/ ELIEF VALVE _
INTERIOR TRIM/PRI ACY DOORS
FINISHED FLOORS -
GARAGE FIREPR009FXNG
DOOR CLOSERS)
SMOKE nETECTO -
FINAL ELECTRICA INSPECTION u
FINAL APPROVAL OF CONSTRUCTION,
f
A SIGNED CER?iIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES .ARE OCCUPIED!
REMARKS:
YJ_
INSPECTOR
.� MI00LE DEPARTMENT INSPECTION AGENCY, INC. �
National Headquarters
�u- 900 Haddon Ave,, Collingswood, N.J. 0610a
Date : _ 7P.
Town orjLXMMM Gamenshury County State
Location/Address 52 Dive
(If Located in Rural Area - Please Attach Directions) Pole #
Owner GUM BILUMg IW� _ Permit *
Occupied As :IT +' u- ii�- � y .� - i; Building: New OWED
Occupant
Work Area in Buildin Floor #, etc.):
App. for: WiriiriI Service or: Ready for inspection :
Fee Remitted , $ Cash E3 Check M.O. Make Payable To. M.D. I.A.
Number of Rough Wiring Outlets Elect. Heat 7
1
750 11000112501250012750 x000 xx5o xsoo x75o 35
3
6
Switches
Lighting - Amp. Service Surface Unit Dishwasher Range
Receptacles Water Heater Air Conditioner Dryer I. IPump
Number of Fixtures Oven +Garbage Disposal Wiring and Controls for Burner
Amp. Receptacles Fractional H.P. Vent Faris
Other Equipment:
MOTORS H.P. 1 1/201/12 1/10 2/8 1 1/6 1 1/4 1/3 1/2 1 3/4 11 1 1 11f2 1 2 1 3 1 5 1 7% 14 15 1 20 1 25 311 1 4D 5e 1 75 100
Mark Number
of Each Sixe
Applicant's -
Signature License # Permit #
T/A - GMEM IILITtVM- TWe Utility:
Applicant's Address: 2 [NAME nioICLOCATION]
(City) 111lidgTIAltzm fba (State) ur (Zip) '12= Service Request #
Phone Electrician:
MENe IIIIIIDATE RECEIVED: r DATE INSPECTED: - y
Correct Location : Some as Above [] or:
Red Notice Label =
Rough Wiring Outlets Surface Unit Oven
Switches Range Garbage Disposal
c. Receptacles Water Heater / Dishwasher
Fixtures Air Condition r, • . Dryer
Amp. Service Equipment Burner, Wiring & Controls for Amp, Receptacle
Amp. Service Conductors Pump Vept Fans
MOTORS N.P. 11/40=/161 -1,141 1/3 1/2 3/4 1 i�lx 2 3 5 17W 1t7 15 2i1 25 O 40- 5O 75 [100
Mark Number II _
of Each Size
Elect, Heat boo 1 760 116111111112511116111111117501 2000 2250 xbpo 2750 aaoo
RIO
x�
0 RW Progress: Inc, LKD 0 Contractor '' rj
0 CFT Violation : Work Comp. El Inc, C] r
0 L/A Owner CASH 0
�] L/A Fee due C14K #IPA Municipal MO # _
_ INV,#
Date: Other Side 0 Uttill Applicantity Owner
Cut in Card 0 Temp # Date ; t
inak # Date INSPECTORS -Sl43NATkjRE
F� /
AP[sLI CA T I"rIIIi
QUEEN VICTORIA'S GRANT
QUMf Y. NY
TOWN OF QUEENSBU
�UlL®!NG � RY
CODES DEPT.
REVIEWED y
DATE
QUEEN
-,oRvs
REFERENCE DRAWINGS:
5 SITE UTILITIES
SEPTIC & WATER
VonDUSEN & STEVES
SURVEY PLAN