1989-633 ,,. -a. .. 4 � i.{ ^w :.. ' �-i,p',.. ;y"?C;^"� ._r�,...:' -' �•�•S_Tr.."iF&.:�s"!T'+"�iRl�li!""`""".�s�-'vrr T5�1Y"'"'r''_.'.��.�'r•n�.; .- . . .-.. ,r .-R.�£' _ „ r � ..
CERTIFICATE 'OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
I
( D*w December 15 1989
a
This is to certify that work requested to be done as shown by Permit No. 89-633
I
has been completed.
i
This structure may be occupied as a ;Sing1P Family Dwelling
i
Location ' � ' l crnquin Drive
i
Owner Thomas & Llizabeth Glancy
i
By Order Town Board
OrOWN OF QU$LNSSURY
l
Director of 1314dg. do Code Enforo, meet
i
BUILDING PERMIT
TOWN OF QUEENSBURY
No-
WARREN COUNTY, NEW YORK
I
PERMISSION is hereby granted to Thomas do F'lizabeth Clancy °O
rn
OWNER of property located at Tot 165 Algonquin DRive Street, Road or Ave.
in the Town of Oueensbury, To Construct or place a Single Family Dwelling
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 Oueensbury Building and Zoning Ordinance.
0
1 . OWNER'S Address is
a
z
2. {CONTRACTOR or BUILDER'S Name
t7
Raven Industries
3. CONTRACTOR or BUILDER'S Address rr,
58 McCormack Road
Queensbury, N.Y. 12804 V
M
a- ARCHITECT'S Name
S. ARCHITECT'S Address
Cr.
rsi
S. TYPE of Construction — (Please indicate by X)
�3
NXXIVood Frame I I Masonry fi I Steel I } �
.sue
?. PLANS and Specifications
i;.
No. 53' x 32' Single Family Dwelling as per plot plan, specifications, and applciatiom
INCLUDING septic, attached two car garage, and drivewe cro
S- Proposed Use
Single Family Dwelling
i
Uq
$ % rcl f1D PERMIT FEE PAID — THIS PERMIT EXPIRES March 7 19 Q
r
0It a to nger period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueans'bury before the expiration date-I
Dated at the Town of 4ueensbury this Day of 19 139...-_ d
E
SIGNED BY for the Town of Clueensbury
euil ring and Zoning ctor °�
'I� +C7k N OF QLJET- i � � ,..� LJRY 1t1' r1_ ICAI' InN roe. 13Ui . , . zoNiNc� PERMIT v
rate-
�"ec.tetaeci�- 7 -
evtewed
e. T WN OF OUSENSGURY
Fe Pa.,%d $ lS'7'c? . �� AUG dt 198q
BUILDING AND CODES D I DA1tTPiG!f Pate Ie a ue.tl
BAY and HAVILAND ROADS RD 1I3ox 9c3 / BLDC3. 3 CODE DEFT.
OUEENSBURY, NEIV YOoRK 12804 Peluttit NU . a~s3
Tel . ( 518 ) 792-5832 Exc �209
.. .w x w r +k x 'w w i w • w yk * : w w x w r w x w r w r x w � * r r r w w a a.
A 1IMMIT MUST Do OBTAINED BEFORE BEGINNING CONSTRUCTION & NO INSPECTIONS
WILL BE HADE UNTIL APPLICANT 11AS RECEIVED A VALID BU- TLDTNC PERMIT .
All applicable spaces on this application must be conipleted and the
40guatore of the applicant must appear on the reverse side of this sheet .
The owner of this property is : �'�•+ ��
P . O . Address ///f L- L ( t / 1/ a .a T E L . ---
(' r o p e r t y location Lm 2`- ,.ac TAX .MAP NO
kias there been any split of this property since October 1 , 19aB ? 1, - -"
yes iko s Ito
if yes , Planning Board Review is necessary .
SUSoIVISION NA14C0 1P APPLICARLE LOT NO . Ze�c --
The person responsible for supervision of work as regards Building Codes i" -s :
,�i',6ls'rs"�' �-, < �.'-�%r,j' ..�.- C l�j-- .,,• �' Gr�Y sue"— ,1'_ .`t�••'
NAM1 P . ❑ . ADDRSSS TEL . NO .
blame of builder -�i� r f' Address G' r / 404z►" Tel
i4"- ma of Plumber l,ddress Tel
Name of Mason Address Tel
l,iATURE OF PROPOSCO 6ORK. : ZONING INI'011HATION [ office use o.n1u )
Conscruccion of a glow t�uildinrj ' ZONING DESIGNATION OF PROPERTY
Addition co a buildinq " PERMITTED PRINCIPAL PERMITTED ACCESSORY
.Alcur , ciocr to a l,uilding `
(rro ZONING BOARD
clrl.ri.qu to .:xcu: rior dimensional '' REVIEW REQUIRE[) - PLANNING BOARD
` [:ii rllLAN ri fa i ♦o.vl1 sr .+�.[++ J+.T
�.. 1
CROSS ARLEA a ' PROPOSED, 5; TRUCTURE � � VARIANCE � APPROVED OATS
L
1st Floor , GG' sq ft .,/e Rararks -
Ind Floor _sq f t .Y W cottr' r_Li'ri: SNf C7suul'rlaLl Lei {?UiYcLA LSI LL+41 .
Ocher Floors 5q € t . 22 ; aixa of prOPtjrty . / Z,� Yc X_�fC .
[ not cellar or basement ) Lacistirycl buil�.lirr+] ( ;: ) 7ilouc X rc .
TOTAL FLOOR AREA .j'190� sq Ft . +' L;xircing builJirry (4.0 Us.:
'. ixe of nc-w utructura Ste' ft.
L�oru&d;acion-•pier/math/crawl/parci ful Yrai�o::s:d tauilcYincj , di : tancu frarrr +ra(jurcy lirru
( circler erne ) Franc yard ft Rear yard 40,F- ft
N.S . of scories {)r"bic"- bIa �pace) _ Side yard:; cs i s ;and 4 +..^ ft
Erich} ( grade to ridqu ) ;2tw fto
If ra:ssitiuntiai , nO . of f:atnil .ias +i` w It on carn.:r , Lr�:x�:k from side �: crac:t rc
moo of room: ( excluding b"cha) r7CCUl'AI�II:Y INFpI'+MATICt4
Igoe of IuUdrooius _ '� 000
+ I_'sT.L�I-,McA-YtY BUILDINGMW
No . of b:sckrroour: -TT ' _,-na family dwelling
I"riur:ary ha:acituj UytaUkw;ru sjiG .- .Y*wo f"LlIily dwelling
'lylais u € fual^ a0ewil, Multip14 dwelling Number of units
No . Of firoplacv:: to bQ irt::tµll4dr c.^.�r ' l�cx�n:►r►cne occup:urcy
Will s wood scoVu k+u iffINL all"do?
'!•x�an::iunt nc:cul,x;arrcy
C"ntr"l ,Air co11+l1ticani9k9 ? .. ..e:Tr i?' � uusinoss
BUILDING STYLE, MimARY STRUCTURE Ir►du:.trial
i:.:+trctt t:Or►t.:+uy:c+z:.ry Log? cabin { Gchar
If .addicican , w1+ut will u::a ba?
I::ai::ud ranch M:.►naiurr L]uylux
uplic IQVQI Old acylo tlustclalow -
C;,yas Cod Cott"gl Ock+ter ACCESSORY BUILDING-
crionsa l:otd •Town }louse ` " cached gariAgOlOnO curl t :+ car
{ CIRCLE ONE PLEASL f ' =Accc.chuul 9;araqu.:/041a Cur& wo cart c:, r'
w a a r w a x r a r a r w x * x •Priv;ata: sLor"ge building
L: .°' TIMATIM MARKrolo V AY_ U 1� OF athor
OON :;'16kuc'l' rusr
Moo Moo
7NCOrUlIXTTOM ON nUTLOTNC SPrCIFTCAT'IONS , ON REVERSE SIDE OF 'PlirS CkILML ', TO BE COMPLCTC01
Form FPA 10188 V3
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , Wood fr erpa Mire safe , etc .
Will any second-hand or ungraded lumber be used? If so , for what ?
rr
Foundation wall material ,�/',!/ �� Thickness
Depth of foundation below grade ( to bottom of footing )
Will there be a cellar? Heated or L a�Fed&? Floor sq. footage reT sq ft
Will there be a basement? Will any portion be used as living space ? - -�
( If so , what portion? sq . ft . - - Type of use?
Type of roof -flat/shed/other Material of roof
Size , wood studs �*' X_ �" spacing_�i " o . c . length ft .
joists ( floor beams ) 1st , floor "� „ ?C^ spacing- �' r-_� 'o .O . C . span /fir ft .
Joists ( floor beams ) 2nd . floor -�-" X spacing /.e" ` '"o . c . span�ft .
Overlays ( ceiling beams ) "X spacing " o . c , span ft .
Roof rafters "X "' spacing o . c . span ft .
Roof trusses ( edJ spacing " o . c . span 2' ' ft .
Exterior wall finish A1.01V c- ,._ of what material ? C_" cog�
Interior wall finish
If a garage is to be attached , describe materials to be used 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 he provided? r - zo
Will a flue-lined chimney be installed? L. t o Heigh above roof. ft .
Depth of chimney foundation below grade ft ,
Depth of fireplace hearth ^Z_ £t "O�/Sn .
Water supply - Municipal or private well
SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties �ft .
(A separate application is necessary for any repair or new installatio septic syste )
✓ .02
DECLARA. TI0N
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 t described premises and
that all provisions of the BUILDING CODE, THE Z (]1+71 . 1 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 �
C]wn , caner s agent , architect , can tractor
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 /~- �'
2 , Type of heat
3 . Is the building mechanically cooled ?
4 . Percentage of area of windows and doors
A , over 16 % Only
1 . U value of gross area of walls , roof / ceiling and floors
o
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 £ laor ?
4 . Is basement heated ? YES NO
a . R value of insulation
S , Type of insulation
S3 Under 16 % Only
1 « R value nf roof and floors exposed to ambient conditions .
2 . R value of exterior walls
3 , R value of glazed area
4 . R. value of
S . 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 ) --e�` �
10 . Type of insulation
c . Controls G
1 . Thermostat maximum heat setting %
D . Duct Systems
10 Is duct system installed in unheated spaces ? Na
a . If YES , R value of duct installati. on�����"!
b « R value of duct in other areas
or
E . Piping Insulation
1 . size of hot water or cooling carrying agent pipe
2 . R value of pipe Insulation
F , Service Water Heating
1 . Performance efficiency
2 . Temperature control setting maximum
G , For Swimming Pool Only
1 . Maximum heating_ �" ' ""�- '`
■
Telephone No «
applicant ' s signature )
APPLICATION FOR SEPTIC DISPOSAL PERMIT
3 .
DATEG��*-
I .y
4 «
LOCATION OF PROPERTY FOR INSTALLrrATION
�f Owner's Name : d � .r' + +7 .,r�. Telephone:
i
Address:
Installer's Name: G$ �G'' �" �� - _ Telephone:
Number of bedrooms (residential only)
t Total daily flow (compute @ 150 gal per bedroom)
I
Tcypagraphps circle one: la olling Steep Slope 3& of slope //////
Soil Nature: circle one: an Loam Clay Other / Depth: feet
Ground Water: At what depth? / va. feet 4vt.
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: Watersupply from Septic absorption _ feet
A PROPOSED SYSTEM: Septic Tank r/®!s gal. (minimum size: 1 ,000 gal.)
TILE FIRLD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of Size each ee feet
Size of stone to be used # — Depth. _ar Thickness feet
IMPORTANT
...Pleas+e...LIST NEW EQUIPMENT TO BE INSTALLED
r
(over)
x� N
,..,, .V '
Section II Septic System In_syections: 1
A. All applications for septic system installation, alteration or repair, as )14
required by the Town of Queensbury Sanitary Sewage Ordinance, shall 0
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
2.) location and distance to lot lines
3.) location and distance to structures '
4.) location and distance to any water 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 $250.00.
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.
1 have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal C}rdinan,ce..
Signature of responsible person: �
Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New fork 12801
(518) 792-5832
ms
Z.' di
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . A GOOD PLACE TO LIME �F �'
TOWN OF QUEEldSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
¢UEENSBURYr NEW
792-5I28 [3 -
YORK 128
TELEPHONE C
832
BUILDING INSPECTOR' S REPORT
! ! 37f9s2_
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION
DATE
-y� PERMIT
APPROVED
YES NO
FOOTING/PIER
MONOLITHIC POUR FORMS
FOUNDATXONI DAMP-PROOFING --�-
BACKFILL APPROVAL��_
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
-'FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING CHES/STEPS .
EXTERNAL POR
STAIRS-CLEARANCE & RAIL VALVE
PLUMBING FIXTURESIRELI -- -�
INTERIOR TRIM/PRIVACY RS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSERS)
SMOKE DETECTORS
FINAL ELECTRICAL INS ECT N N
FINAL APPROVAL OF C NSTRF TION,f�
OR /C� �
A SIGNED CERTIFIC TE OF CC7PANCY MUST BE
ILDIN Dj5pARTMENT BEFORE
OBTAINED FROM TH gU
THESE PREMISES E OCCUPY ! .
REMARKS ,*
MI
❑SPAR Z'. AOINZECTOR
TOWN OF QUEENSBURY five,
BUILDING AND CODES DEPARTMENT '
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 32809-
TELEPHONE (5I8) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR I-NSPECT-Toev RECEIVED
zle
NAME
LOCATION
DATE / PE IT
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFIN
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
L,of:"INAL INSPECTION .
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCH ES/ST PS
,STAIRS—CLEARANCE & RAILS_
PLUMBING FIXTURES RELIEF VA ' VE
INTERIOR TRIM/PR.ilACY DOORS
FINISHED FLOORS +
GARAGE FIREPROO ING
DOOR CLOSERS)
SMOKE DETECTOR
FINAL. ELECTRICA INSPECTION
FINAL APPROVAL CONSTRUCTION
A SIGNED CERT FICATE OF OCCUPANC MUST BE
OBTAINED FRO THE BUILDING .DEPART ENT BEFORE
THESE PREMIS S ARE OCCUPIED!
REMARKS.
INSPECTOR
1����� Jcrran cr� �ueens6crre�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOS L SYSTEM INSPECTION
NAME �
LOCATION Z �.
DATE rr _ _/ a) PERMIT NO. Fje -- z,
SOIL TYPE - Sa d - Loam - Clay -
Percolation Te t Required? YES - NO
Percolation rat - Min/Inch
r
TYPE of SYSTEM : /
Absorption field , total length_f
Length of each tre ch /
Depth of trenches 7
Size of c1ravel
SEEPAGE ;aITS-(Number }
Size- ft. X _ f ,
Gravel size
PIPING : S ' a Type
Bldg _ to tank
Tank to d1 st , brti
Dist. boa: to fi
Openings sealedO Partial
LOCATION/SEPPARAFoundation► to tft,Foundation to a tAbsorption to lt_
Separation of p ,fLOCATION OF SYSERTY (c ' rcle one }
Front - Rear - Right ide -
CC�IMENTS :
r7
SYSTEM USE APPROVED ES
Building 14spkctoz
01/86 and vl
_lnwrt 01 QueernJiury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, RID- 1 Box 98
oueensbury , New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME d
LOCATION
DATE F( Or PERMIT NO ,
SOIL TYPE - Sand - Loam - CIaY -
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 gravel --
SEEPAGE -? ITS4Nvunber of)
size- ft. X
Gravel size
PIPING : Si TVA
Bldg . to tank
Tank to d1st , box
Dist. bo1: to field/p � Ppr �EE
Openings sealed? S O
LOCATION/'SEPARATI S
Foundation to t ft,
Foundation to a crption ft .
Absorption to t line ft .
Separation of its
IACATIbN STEM ON PROPERTY (circle cane)
Front - ear Left side - 'Right side -
CCx+IMENT : d I �i
SYSTEM USE APPROVED YES O
r --
Bui ing Inspector
01/86 and v1
TOWN OF QUEENSBURY
B'UTLDTNG AND CODES DEPARTMENT
BAY & HAVTLAND ROADSC)UE
TELEPHONE , NEW YORK792 32t9L74
TELEPHONE (518) 792-5l9.32
BUILDING INSPECTORiS R.EF'ORT
REQUEST FOR INSPECTION RECESVED
NAME
LOCATTON
DATE1 �^
,f
A,OPFROVED
&YES NO
FOOTTNGf PT ERS ,r
MONOLTTNTC POUR FORMS
FOUNDATIONfDAMP-PROOFING
B TLL APPR VAL --
OUGH PLVMBZN
FRAMING
ELECTRICAL ROUGH XN
ULATTON:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHTNNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE (STEP
STAIRS-CLEARAN & RAI S
PLUMBING FTXTU ES/REL-r4 VALVE
TNTERTOR TRIM PRIVACY D6PRS
FTNTSHED F ,S
GARAGE FTREP OOFTNG
DOOR CLOSER
SMOKE DE TEC RS
FINAL ELECTRT AL TNSPECTTON
FINAL APPROV L OF CONSTRUCTIOX
A SIGNED CER TFICATE OF OCCUPANCY MUST BE
OBTAINED FROM- THE BUILDING DEPARTMENT BEFORE
THESE PREMISES 'ARE OCCUPIED!
REMARKS.
INSPECTOR
f
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSSURYr NEW YORK 1 2802¢
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RE IVED
NAME
LOCATION f p r
DATE PE T #17
APPROVED
YES NO
FOOTING/P RS
MONOLITHIC UR FORMS
FOUNDATION/ P—PROOFING
BACKFILL APF TEAL
j ROUGH P- UMBIN
FRAMING
ELECTRICAL ROUG —IN
INSULATION:
FOUNDATION
FLOORS or
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL P(7RC ES/STIsP
STAIRS^—CLEA NCE & RAXAS
PLUMBING, FRES/RELIEP, VALVE
INTERIOR TRIVACY DOERS
FINISHED Fro
GARA IGE F EPROOFING
DOOR CLO ER (S)
SMOKE D ECTORS
FINAL ELE TRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT .BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS
y <
J
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAV'ILAND ROADS
QUEENSBURY, NEW YORK 128061 -
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST R INSPECTION RECEIVED
NAME '�
LOCATIONi
DATE .,I PERMIT # S<le -"�573
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POU� FORMS
Lam' OUNDATXON/DAM -PROOFING
C,85CCKFILL APP"L
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-INN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING s
FINAL INSPECTION-
CHIMNEY HEIGHT
ROOFING {
SIDING
EXTERNAL PORCH STEPS
STAIRS-CLEARA E & RAILS_
PLUMBING FIk7 RES/RELIEF VALVE
INTERIOR TRX PRIVACY DOORS
FINISHED F RS
GARAGE FIRE ROOFING
DOOR CLOSER S)
SMOKE DETE TORS
FINAL ELECTR CAL INSPECTION
FINAL APPROV L OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES'' aARE OCCUPIEDI
REMARKS:
INSPECTOR
�+r .
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY 6 HAVILAND ROADS
QUEENSBURYf NEW YORK I280&
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEXVED J
NAME _
LOCATION
I DATE PERMIT # ,
APPROVED
r > YES NO
r
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATXON/DAMP-PROOFING
BACKPILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS /
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE /STEPS
STAIRS-CLEARANC 6 RAILS
PLUMBING FXXTUAVESIREZXEF VALVE
INTERIOR fiRIM/A'RIVACY DOORS
FINISHED FI.0 o#s GARAGE F,TREPf*0FING N
DOOR CLOSER ($)
SMOKE DETEC RS
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:
-+- r014rt,
INSPECTOR _ _
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVI LAND ROADS
QUEENSBURYr NEW YORK 1280k /y
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME _
LOCATION
DATE �/ ] p 14,7RM T ## -j?_ _
APPROVED
YES I NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATXON/DAMP--PROOFING
BACKFILL APPRCV'AL
5PUGH PLUMBING'•
d'FRAMING
ELECTRICAL ROU H-IN
INSULATION: rY
FOUNDATION '
FLOORS
WALLS
CEILING
FINAL INSPECTION: 3
CHIMNEY HEIGHT
ROOFING ;
SIDING
EXTERNAL PORCHE /STEPS'
STAIRS-CLEARAN r & RAILS
PLUMBING FIX ES/RELIEF VALVE
INTERIOR TRXIfIPRXVACY DOORS
FINISHED F RS
GARAGE FItAL
OOFING
DOOR CLOS )
SMOKE DETRSFINAL ELECTL INSPECTIONFINAL APPROOF CONSTRUCTION
EE
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
INSPECTOR
YOU ARE HEREBY REQUESTED Tip
INSPECT ARID ISSUE CERTIFICATES
FOR THE FOLLOWING ELECTRICAL
EQUIPMENT TO BE INSTALLED BY
THE UNDERSIGNED
TEMP, ;
CITY OR VILLAGE DATE
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EN WH {� +IIl� r T^r
SETWE Ar T WO Ross STREETS f3 PREMISES LGi/A'ED7 �w'7' �'^3 user �i%�r : PDI-E NUMBER
GEC:rbN BLOCK OCOLIPANT'S NAME /* _ / IAT
! '� IIIII +rf 'C. BUI
'^'•7�v'f.v Ytrh' ,/^�,i� LOdNG OCCUPANCr'
OWNER'S NAME AND ADO �ry T^�Y'�"„y-j ,�.,Ir
OURgEI SUPPLIED BY HCMIE TE LEPMONE NUM
`Myyr FROM THEIR OFFICE
BUILDING IS �1'�'.1'•�/�.�/"�+�� '_-"'"+'`/ yygRK
N OLD
1NORK IS
LEST BELOW ALL EQUIPMEIVTYNFflC1 f YOU INSTALLED ADDITIONAL ❑
tfon NUMBER OF OUTLETS NO. Of FixtUreS & DEFEl'rS REMpyED ❑
tiCsn
ceiling side AtIsch•i MID R+�%+Bp!'stcleS MOTORS HEATERS BRANCH OFFICE USE
OUT- wau Rscep'ts Switch Rarydanl Bracket NO. ypeHIP CIRCUITS ONLY
S'°rz Each No Warts NO
SUB a INSPECTION
BASE
BASE-
MENT
1st
FL-
2r W
FL.
3rd
FL.
REMARKS: LIST OTHER E E LCTRICAL DEVICES NpT SET FORTH ABOVE-
THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LIST D EQUIPMENT
THOU ND ADDITIONAL
EpU PML�NT EQUIPMENT NOT ABOVE LISTED, EYOU-LI T D AUTHORIZED
BE INSPECTED. BUT IF AT TIME F INSPECTION.AS PROVIDED L THE APPLICANT. THORIZED TO MAKE THE INSPECTION AND ADJU TTHEEE THERE IS
SIZE CIF'MAINS ADJUST THE FEE TO COVER
FEEDERS ELECTRIC SKiNSII,AMPS
Cl'WRACI'ER OF NOgk TO'fRl I'uAM
❑ ExPDSED GAS TUBE SIGNITRANSFORMERS OF DME WORK TO BE STARTED ❑ CONCEALED
DATE COMPLETED SIZE OF SIGN fN UMBERy
SERVICE ENTEg3 BUiLDNJ3 CA/'AGl7Y
❑ pF Sllryy
OAI'E INSPECTION RE4UE3TED OVERHEAD ON fOR AS NEAR AS ❑ UN ROUND MANUFACTUMUST ENTER
RER
POSS1BLEy
MME&MMIFfit
ev Fu A rE wFN*IF+ ItiTotM ► 1 f t l
PRINT NAME AND ADDRESS S IN
NAM MAY BE POET
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CITY TV OR OFE � �'�""�" � � TEL Hp�Nr-.-w•t . :. .
r Z 4'�! Ater.. .. LICENSE NO. WHEN,RAP{IC,Ag .,
❑ 85 John Street ❑ 47 State Street
NEW YORK, NY i0p3g ALBANY, NY 122D7 ❑ 570 Delaware Avenue ❑ 217 Lake AvenUe
BUFFALO], NY t42D2 ROCHESTER, NY Y4"0 ! ❑ SYArterial
CUSE, NY7 3206
THE NEW YORK 130ARD OF FIRE UNbERWRITERS
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