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1989-673 w s.'• u ,"J F "=. ....,-�,-,a. . CERTIFICATE OF 0 C+CTJPANCxjL7 TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date November 9 19 89 This is to certify that work requested to be done as shown by Permit No, 89- 673 has been completed. a , is structure may be occupied as a —_ _ g _. ami l g DwP j 1 i ncj LzAd +�3 1 , Location l � Eot #21 Corn Pe4.9 „ Ann Rd . & Ladd Sl ,i p r dr pant John & Mary Ellett De5autis Sy Order Town Board 1rOWN OF QUEEN38URY Director of Bldg* & Code Enforcement s� BUILDING PERMIT TOWN OF +QUEENSBURY No. 89_673 # WARREN COUNTY, NEW YORK o V PERMISSION is hereby granted to John ?x Mary Ellen DeSanti s OWNER of property located at Lot#21 Cor . Peggy Ann & Lady Slipper Street, Road or Ave. in the Town of Queensbury, 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 Queensbury Building and Zoning Ordinance. m 1. OWNER'S Address is -4 5 John Street Glens Falls , N . Y . 12801 Cr 2. CONTRACTOR or BUILDERS Name O Paul Sokol 3. CONTRACTOR or SUILDER^S Address .� m m 4. ARCHITECT'S Name S. ARCHITECT'S Address r 0 ry r 6. TYPE of Construction — (Please indicate by X) ,s 4 rs XX Wood Frame I ) Masonry f 1 Steel [ ) -v tp 7. PLANS and Specifiemlons rem v� No. 1686 sq . ft . Single FamilyDwelling as per plot plan , specifications , and application , including septic , attached two car garage and dri mew y . S. Proposed Use Single FamilyDwelling Q tic $ 23 [)[I PERMIT FEE PAID — THIS PERMIT EXPIRES March 1 1S 90 p (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.) Cy Dated at the Town of Queensbury this D y,of August 19 89 r° -rs SIGNED BY for the Town of Queensbury Building and Zo rrino Inspector 'C Q rA zz tQ TOWN OF QUEENSEURY ` REVIEWED I3Y WN OF QUEENSBURY FEE PAID $ `CL rya. 3 RECEIVED PERMIT NO. :Fi,i - AUG 1989 CEL BUILDING PERMIT APPLICATION �C� BLDG. & CODE DEPT, A PERM]rr MUST BE OBTAINED BEFORE BEG174N KG CONSTRUCTION. NO ENSPECTIONS WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT. All applicants spaces on this application MUST be completed and the signature of the applicant MUST appear on the reverse side of this application. a * a * * + a a R a a * a a * * * * * a a a a ♦ a * a * a * * a a a a a a a a a a The owner of this property is: John E . and Mary Ellen ❑eSantis P.O. Address 5 John Street Glens Falls NY Tel. 793- 9289 Q 1 Property Location Corner- oF P,eggyAnn Road + L_adySIipper- Drivc'ax Map No, Has there been any split of this property since October 1 . 1988 ° / If yes Planning Board Review is necessary . yes no SUBDIVISION NAME, IF APPLICABLE LOT NO, THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS: Paul G . Sokol - Buzldinp Contractor^ +r NATURE OF PROPOSED WORK : ESI`MATED MARKET VALUE OF Construction of a new building ,. CONSTRUCTION: S Addition to s building COMPLETE INFORMATION REQUIRED BELOW: Size of property 4 n j� ;! ft x --eft. Alteration to a building • Existing Buildings( 3 ) Size NOAI ft. xt - ft. (no change to exterior dimensions) * Proposed building - distance from property line: Other work (Describe) ' Front yard n Cp ft. Rear yardft- w Side yards �, ft. and C ft. GROSS AREA OF PROPOSED STRUCTURE * If on corner, setback from side street�ft. 1st Floor ' �„ �, sq. ft. , 1 C), * OCCUPANCY INFORMATION 2nd Floors sq. ft. , Primary Building - Other Floors . - --_ _---- sq. fte * 0One Family Dwelling (not cellar or besom*nt • Two Family Dwelling TOTAL FLOOR AREA 1 :) sq. fte " Multiple Dwelling/Number of units Size of new structure Co ft x �fx. + Business ee Faundatlo * Industrial n-pi*r/slab/craw I/partial/full (circle one) • Other No. of stories (habitable space) �— • Hight (grade to ridg*) c �ft• » if addition, what will use be? It residential, no. of families No* of rooms(*xcluding baths) r Accessory E+Juildir Noe of bedrooms • — Detached Gar WQ Car No. of bathrooms �- • '� ONErr Primary heating system k ,f r._ • Attached Garege- ONItITWO,.Car Type of f'uoi.� Private storage building No, of fireplaces to be lnstalled� Other Will a wood stove be iastaUed C� Central Air conditionirc INI f OV* ER BUILDING PERMIT APPLIC .-\ TION CONTINUED - BUILDING 3PFC'IFIC3TIONS: T} pe of construction, wood frame, fire safe. etc . Will any second-hand or upgraded Issmherbe used ? If so, for what ? FULp Foundation wail material ?/ or. IC Thickness 4 C-} Depth of foundation below grade (to bottom of footing) O V Will there be a cellar? 1Heated or unheated? N hey" f.tZ. -F Floor sq. footage.. ...... sq ft . Will there be a basement . �W ill any portion be used as living space ? 1" i (If so, what portion? - - --- sq ft . Type of use'. - - Type of roof sloped/ Yat /shed/other Material of roof ! � I, Z L.::- Size, wood studs -.2 "x�=2�.Pf spacing_ '1 o. ca length t)' ft. Joists ( floor beams) ist floor `") "x " spacing "'o. c. span .�ft. Joist (floor beams) 2nd floor 5�1 x J c ", spacing 1 ::�o.c. span�l ft. Overlays (ceiling-- beams) � "x-_.L. spacing—If." O. C. span I ? Roof rafters "x " spacing 1�- O. C. span f 2^ft. Roof trusses (prime-engineered) spacing a " o. c. span ft. Exterior wall finish Z R ;:_, ,:7Tn! C^x of what material? c�ci Interior wall finish F � -{ � ,� If a garage Fs to be attached, describe materials to be used for FIRE SEPARATION: " (n Ve-c4f ac. V, Is there to be an opening between garage and dwelling? If so will a Fire-rated door, enclosure, self-closing device be provided? , a -'r �> Will a flue-lined chimney be installed . ��Height above roof �� ft. Depth of chimney foundation below grade_e�. # t. Depth of fireplace hearth ft. in, Water supply - Municipal or private well ' C\..`• t , SEPTIC SYSTEM Distance from ANY private well (including adjoining properties / c7 0 ft. (A separation application is necessary for any repair or new installation of septic system) 16 Park Road NAME OF BUILDER Paul G Sokol ADDRESS Airport Ind Park TEL. NO, 7i61 - •4647 NAME OF PLUMBER Fava Plumbinn ADDRESS 16A Park Road TEL. NO. 798 - 4399 NAME OF MASON Paul G sokol ADDRESS TEL. NO. NAME OF ELECTRICIANKen sawyer ADDRESS RR5 BoxlSS GF TEL. No* 793 - 1605 DEC LA 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 dome an 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 Owner, owner's agent, architect, COntractor SPECIAL CONDMONS OF THE PERMIT: 13Y TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK Application fort 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 . Uo value of gross area of walls , roof / ceiling and floors exposed to ambient conditions 20 Floor over heated spaces YES NO a . Are foundation walls insulated ? YES NO 10 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 C roof and floors exposed to ambient conditions 2 . R value of exterior walls 3 . R value of glazed area c7 4 . R value of doors _ T � 5 , R value Of floors over unheated spaces !-�- 6 . R value of slab edge insulation - unheated slab� / -//Z-l _ 7 . R value of slab insulation - heated slab elL 8 . R value of heated basement/ cellar walls ( above grade ) f 9 . R value of heated basement/ cellar walls ( below grade, "" , 10 , Type of insulation � -t- i f c C . Controls 1 . Thermostat maximum heat setting r � D , Duct Systems 1 , Is duct 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 T. Size of trot water or cooling carrying agent pipe 2 , R value of pipe insulation It mm F . Service Water Heating Y:7j 1 . Performance efficiency t /c 0ISvC14 T14 {4/6 Cil� c �L _- 2 . Temperature control setting maxiinum.� G . For Swimming Pool only - 1 . Maximum heating -� Telephone No . ( applicant ' s signature ) TOWN OF Q ULENSB UR Y APPLICATION FOR SEPTIC DISPOSAL PERMIT r DATE ILA c.5 :s , LOCATION OF PROPERTY FOR INSTALLATION �� t" S['" � 2 � �� sr t w /'_ c {� Owner's Name: 6 '"N \ tA 1 \G_ v � lcL "lft 'phone: 1 — � f Address: ' 'Y 1 c w k r Installer's Name: `T'elephone: Number of bedrooms (residential only) Total daily flow (compute ( 150 gal per bedroom) . c> 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 Material: At what depth `.' Feet Percolation test: Circle one: =, - Separation* ired rate i?ich. Domestic water supply: circleWell Other If domestic water supply is Water supply from septic absorption_ z, / //4 feet PROPOSED SYSTEN1 : Septic Tank (-)n L) gal. ( minimum size : 1 . 000 gal.) TILE FIELD : Each Trench s 7feet/Total system length 4n feet SEEPAGE PIT(S): Number of each feet Size of stone to be used #,=2./Depth or Thickness J 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: OVER Septic System inspections : All applications for septic system installation , alteration or repair , as required by the Town of Queensbury Sanitary Sewage Ordinance , shall bt: 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 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 , the fields and /or drywells B * No System shall be covered before inspection and approval by the isuilcling; lirspector . Failure to comply with this requirement may result in the uncoverinb 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 sites . Failure to produce said plot plan at time of inspection may rusulr in an immudiate work. stoppage . 0 . Should unforeseen problems during construction prevent proper installa— tion , alteration or repair of an approved system , a new proposal must be submitted to the Queensbury Building; Department before further c: oirstruccion . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 h4nsark5 TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVX AND ROADS QUEENSBURY, NEW YORK 32804- TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION ry 5 ' DATE [ a� - PERMI APPROVED YES I NO FOOTING/PIERS MONOLITHIC POUR FO S FOUNDATION}DAMP-PR FING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN t,A$1SULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES STEPS_ STAIRS-CLEARANC & RAILS PLUMBING FIXTU SIRELIEF V LVE INTERIOR TRIM/ RSVACY DOORS - FINISHED PIOO S - GARAGE FIRE P FING DOOR CLOSER ( ) SMOKE DETEC RS FINAL ELECTR AL INSPECTION FINAL APPROV L OF CONSTRUCTION A SIGNED C TIFICATE OF OCCUPANCY ST BE OBTAINED F OM THE BUILDING DEPARTMENT BEFORE THESE PRE SES ARE OCCUPIED! REMARKS: I � INSPECTOR 7 .-!Mv TOWN OF QUEENSBURY .BUILDING AND CODES DEPARTMENT F� BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I280k TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED /Q i NAME LOCATION k DATE APPROVED YES NO FOOTINGfPXBRS MONOLITHIC POUR FORMS pOUNDATTON/DAMP—PROOFING BACKFILL APPROVAL ROUGH PLEAUBXNG FRAMING "' • ELECTRZCA.E" q —X INSULATrONc' ' FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION CHIMNEY HEIGH ROOFING SIDING EXTERNAL CHESfSTE$S STAIRS—C RANCE & RA:�.tlS PLUMBING I.XTURESfRELI VALVE INTERIOR .I'M/PRIVACY DlPORS FINISHE FLOORS GARAGE IREPROOFING DOOR C SER (S) SMOKE ETECTORS FINAL ELt CTRICAL INSPECTION FINAL AP ROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR ,_./eawn 0/ Queensgeery Z BUILDING and ZONING DEPARTMENT Bay ,and Haviland Road, R.D . 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL S TEM NSPECTION NAME u J LOCATION ' e r,� DATE T t � PERMIT NO. SOIL 'TYPE - Sand - Loam - Clay / Percolation Test Required? YES NO Percolation rate - m1n/Inch - TYPE of SYSTEM: Absorption fiel4f total lee th_ Length of each trench Depth of trenches. Size of gravel --- SEEPAGE PITS4N mbey� of) Size- ft. X Gravel size PIPING : Size Bldgm to tank _lxpt' Tank to dist. box t Djst. box to field ., ~ Openings sealed? } 'YES 3 ' .NO 'Partial Y LOCATION/SEPARAT ONS : - y Foundation to t k ft. Foundation to sorption �ft . Absorption to of line ft. Separation of Pits — ft• LOCATION YSTEM ON PROPERTY (circle one) Front earl Left . side - Right side - CCr4MES3TS f SYSTEMS USE APPROVED L Y . 7 O Buildi g inspector 01/86 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT SAY 8 HAVILAND ROADS - 1 QUF+ENSBURY, NEW YORK 128011- TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED Q - ) - S'I NAME LOCATION DATE � __� ERMIT } q- APPROVED YES i NO FOOTINGJPXERS MONOLITHIC POUR FORMS 4 � FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUG ;IN INSULATION: FOUNDATION FLOORS WALLS CEILING FSNAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STE STAIRS-CLEARANCE & LS PLUMBING FIXTURES] L F VALVE_ INTERIOR TRIM/PRIV CY RS FINISHED FLOORS GARAGE FIREPROOF NG DOOR CLOSER (S) SMOKE DETECTOR _ FINAL ELECTRICA INSPECTION FINAL APPROVAL F CONSTRUCTION,. A SIGNED CERT FICATE OF OCCUPANCY MIDST BE OBTAINED FRO THE BUILDING DEPARTMENT BEFORE THESE PREMIS S ARE OCCUPIED] REMARKS: Ilk �1f� INSPECTOR TOWN OF QUEENiSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 3280k TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST INSP TION NAME r�, LOCATION DATE PERMIT #_ APPROVED YES NO FOOTINGIPIERS > < e MONOLITHIC POUR FORMS FOUNDATIONIDAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTTON: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHE TEPS STAIRS-CLEARAN "'k AILS - PLUMBING FIX ESIR)tZXEF VALVE 1p INTERIOR TRI PRIVAC*t DOORS FINISHED F RS - GARAGE FIRE OOFING _ DOOR CLOSE (S) .SMOKE PETE TORS FINAL ELEC 2CAL INSPECTOO FINAL APPR AL OF CONSTRUCT N A SIGNED ERTIFICATE OF OCCUPA Y MUST BE OBTAINED ON THE BUILDING DEPARTMENT BEFORE THESE PREM.TSES ARE OCCUPIED! REMARKS: v' INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY 6 HAVILAND ROADS QUEENSBURYo NEW YORK 32809- TELEPHONE (5I8) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIV D NAME .LOCATION 1 -x t DATE 5zd:�- "t PERMIT # +� APPROVED YES NO FOOT.T NGI PI E.RS M0NC7LITfirC PC3L7R FORMS rNDATXON/DAMP—PROOFING BACcKFILI APPROVAL II ROUGH PLUMBING FRAMING 4 ELECTRICAL ROUGH IN INSULATION: FOUNDATION FLOURS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHE STEPS STAIF2S—CLEARANC .r RAILS PLUMBING FrXTU S/RELIEF JVVA INTERIOR TRIM/ RIVACY DOORS FINISHED FLOG S GARAGE FIRE P FING -- DOOR CLOSER ( ) SMOKE DETEC RS FINAL ELECTRIC L INSPECTION FINAL APPROVA OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: r ( 7 f/J r INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT ' BAY & HAVILAND ROADS :J QUEENSBURY, NEW YORK 2280',k TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME _ LOCATION 5 DATE , PERMIT # APPROVED YES NO �OOTING/PIERS MONOLITHIC FOUR F RMS . FOUNDATION/DAMP—POOFING - BACKFILL APPROVAL " ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN k INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH /STEPS STAIRS—CLEARA E & RAIL PLUMBING FIXTES/RELIEF . VALVE _ INTERIOR TR.II /PRIVACY DO S FINISHED FIC7RS — GARAGE FIREPROOFING DOOR CLOSEI (S) SMOKE DETE TORS FINAL ELECT CAL INSPECTION FINAL APPROVAL OF CONSTRUCTION s A SIGNED C,kRTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! �r REMARKS: f INSPECTOR YOU ARE HEREBY REQUESTED TO INSPECT AND ISSUE CERTIFICATES FOR THE FOLLOWING ELECTRICAL EQUIPMENT TO BE INSTALLED BY THE UNDERSIGNED TEMP u DATE ! `r CITY OR VILLAGE TOWNSFIIP GCA/HTY QLmanmbur`yr _ 1Vimr1'%ftm STREET AND NO.OR ROAD POLE NUMBER -" PmggyArsn Romd BE WHAT Trio CROSS STREETS IS PREMISES LOCATED? BEC'1TON ._- BLOCK ._.._� Ccmr r►mr of` f2aggyAnn arc! Lac1ySk1ppmr Chive #fit OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER John and Mnny C m8imi atta 793-S289 CURRENT SUPPLIED BY FROM THEIR OFFICE NARK TELEPHONE NUMBER Ni m arm MoFsswtc G 1 ants Fa 11 as BUILDING LS �--{� NEW IX OLD ❑ AVGRK IS NEW IN ADOITKmm ❑ DEFECTS REMOVED ❑ UST BELOW ALL EQUIPMENT WHICH YOU INSTALLED Loca_ NUMBER OF OUTLETS No, of Fixtures & MOTORS HEATERS BRANCH OFFICE USE tion Lamp Receptacles CIRCUITS ONLY Ceiling Side Att p"hh't SWitch PeneBM Bracket No. T H F INSPECTION WaH RecopYs YPe Each No E h No- Gauge OUT. 870E EuEI- BASE ESE Ni ME IS1 FL- 2nd FL. 3rd FL, REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE. THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED, BUT IF AT TIME OF INSPECTION, THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED, YOU ARE AUTHORIZED TO MARE THE INSPECTION AND ADJUST THE FEE TO COVER THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT. S12E bF MAIN$ FEEDERS ELECTRIC SIIGNSA P. S TOTAL WM'1'S CHARACTER OF WORK ❑ EXPOSED GAS TUBE SIGNfTRAN3FORMERS OF 53A CONCEALED DATE WORK$BE STARTED nArrCOMPLETFD SIZE OF SIGN(NUMBER) CAPACITY SERVICE ENTERS BUILDING MANUFACTURER OF SIGN ❑ OVERHEAD El uNDEnGnGUND DATE INSPECTION REQUESTED ON(GR AS NEAR AS POSSIBLE) MUST ENTER APPLICANTS I. _ IDIENTIFICIMN ►- YS 'BYraAND ACCURATE TiON. ALL SPACES WST ftFILLLO IN OR APPLArATION Mff M RNMMWW ' PRINT NAME AND ADDRESS NAME OF APPLICANT DAIS OF APPLICATION SIGNATURE OF APPLICANT Ke Ix STREET AODRESS TELEPHCfJE NU RAS BoX 155 3- 160S CITY OR POST OFFICE ZIP COOE LICENSE NO WHEN APPLICABLE G Fallem Now Yarwk ! ❑ 85 John Street ❑ 41 State Street O 570 Delaware Avenue ❑ 217 Lake Avenue ❑ 202 Arterial Road NEW YORK, NY 10038 ALBANY, NY 12207 � BUFFALO, NY 14202 I ROCHESTER, NY 14608 SYRACUSE, NY 13206 THE NEW YORK BOARD OF FIRE UNDERWRITERS A MIDUI ISSUE DATE IM YY) 8- 21 - 89 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Community Ins . Agencies Inc . PO Box 1369 , Saratoga Avenue COMPANIES AFFORDING COVERAGE So . Glens Falls , NY 12803 COMPANY LETTER A CODE sub-coDE Aetna Casualty aSurety 4280 COMPANY INSURED LETTER B COMPANY c Paul Sokol LETTER dba Soko 1 ' s Carpentry COMPANY 26 Laurel Lane LETTER D Glens Falls , NY 1280 COMPANY E LETTER . . . . THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 'PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED] OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IM THOUSANDS .I.R TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDTY'Y) DATE (MM1DDfYY) GENERAL LIABILITY / GENERAL AGGREGATE $ 600 A X COMMERCIAL GENERAL LIABILITY 010 ACM 5350831 4 / 2 6 / 8 9 4 / 2 6 / 9 0 PRODUCTS-COMPIOPS AGGREGATE $ 600 CLAIMS MADE X OCCUR. PERSONAL & ADVERTISING INJURY $ 300 OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ 300 FIRE DAMAGE (Any one Fire) $ 100 MEDICAL EXPENSE (Anyone Person) $ 5 AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO : LIMIT ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS {Per person) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per acCident) GARAGE LIABILITY PROPERTY $ DAMAGE EXCESS LIABILITY - EACH AGGREGATE EACH $ $ OTHER THAN UMBRELLA FORM STATUTORY WORKER'S COMPENSATION $ 100 (EACH ACCIDENT) AND A 010 .J C 027328890 4 / 2 6 / 8 9 4 / 2 6 / 9 0 $ 500 (DISEASE—POLICY LIMIT} EMPLOYERS* LIABILITY $ 100 (DISEASE—EACH EMPLOYEE) OTHER DESCRIPTION OF OPERATIOMWL4CAT1ONSfVEHICLESIRESTRICTKIMWSPECIAL ITEMS CEWTIFiCATE HOLDER T SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Queensbury EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Bay & Havi land Road MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Queensbury , NY 12804 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIN UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRIESEWrA /► ACORa 25-S (Sl98) TOWN OF QUEENSBURY "'o BUILDING AND CODES DEPARTMENT BAY 8& HAVILAND ROADS QUEENSBURY, NEW YORK 12804- TELEPHONE (528 ) 792-58.32 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVEDy�- NAME DATE % TC17 4 J 1 9CI- f j %PPROVED YES NQf FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL R GH-IN INSULATION: FOUNDATION FLOORS WALLS ILING NAL 2NSPECTIO CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PdR ES TEPS STAIRS-CLEA NCE RAILS PLUMBING FI TURES/ LIEF VALVE INTERIOR T. IM/PRIVA DOORS FINISHED LOORS GARAGE F EPROOFING DOOR C ER (S) SMOKE D TECTORS FINAL EL TRICAL INSPECTOO FINAL AP ROVAL OF CONSTRUCT N A SXGNEA CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR TOWN OF QUEENSBURY ` BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURYo NEW YORK I2804 TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT -..� - 13/ 6 REQUEST FO INSPECTION RECEIVED NAME LOCATION �1Fe /f G �7G aC� DATEP� APPROVED YES NO POOTYNGJPIE�S MONOLITHIC Pf9UR FORMS FOUNDATION/DAMP—PROOFING C B�BA.! KFSLL APPROVAL Z.. OUGH PLUMBING FRAMING ELECTRICAL ROUGH—SILT INSULATION. FOUNDATION FLOORS ' WALLS ;' {a"AILING G INAL INSPECTION: CHIMNEY HEIGHT r ROOFING SIDING EXTERNAL PORCHES/ TEPS STAIRS—CLEARANC & PAILS --- PLUMBING FIXTUI? S/RELIEF V INTERIOR TRIM/ RIVACY DOORS FINISHED FLOO S GARAGE FTREP FIND DOOR CLOSER ( SMOKE DETEC21ORS FINAL ELECTRI AL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: ca I P TOR i 1 C H ?l : r a4 f ` Ce TOWN OF QUEE`NSBURY `_ Zoning Adminisrr$ r . �.,..�... 1 (o5' 8 L9 0 z Z N Up O TOWN OF QUEENSgURY Zoning Administr for Da - A SCALE' {"- �1 ...►1 REVISIONS OY DATE DATE � � ��/F�•'/S y DR'N CKD AP'VD TITLE NO. L c) r I i, C +-uy H I L.L iAOP-