1989-774 . . . . . . .uY ' .'.+.an�' w€ . ..�::.!'A"C`:xT'T.�?.v-'^ ar'7! .4:' . ':}'Yrp'F•�.a,- ' ��'�r11F1�i` �F^�.,. VF ._
f -
I CERTIFICATE C3V OCCUPANCY
i
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
4
7 t
I
This is to cerU that work reQuested to be done as shown by Permit No, 89- 774
1
If has been completed.
i This structure may be occupied as a
Location � MaDle Drive
I
Owner Stephen Kelly
ISy Order Town Board
TOWN OF QUEEN38URY
i
Suildin & Zonin Inspector
i
i
BUILDING PERMIT
TOWN OF QUEENSBURY
No, Rg_ �Z4
WARREN COUNTY, NEW YORRK `ID
cry
PERMISSION is hereby granted to gtephi3n Kol l y t '
OWNER of property located at lot 73 Maple Drive Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Si nnl a 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_
�c
rr
1 . OWNER'S Address is r
r-
11 Willow road
Queenslaury , N . Y . 12804 v
eY
[t,
2_ CONTRACTOR or BUILDERS Name
fID
Self
3. CONTRACTOR or BUILDERS Address
Same
4, ARCHITECT'S Name r
C
u
5. ARCHITECT'S Address a
2
m
r_
6. TYPE of Construction — (please indicate by X) r
ff
XKA Wood Frame I I Masonry I I Steel ( I
i. PLANS and Specifications
No- 26 ' x 64 ' Single Family Dwelling as per plot plan , specifications , and
application , including septic , attached two car garage , and drive ay .
ti
8. Proposed Use
c
Single Family Dwelling -
f
$ ,265 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES MAY
(Of 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-) t
Dated at the Town of Queensbury chi Day of Octgber 119 89 1.
r
SIGNED BY for the Town of Queensbury
wilding and fAing Inspector
TOWN OF QUTENSOUR Y
REVIEWED BY TOWN OF C-UECiNg5 UriN;
FEE PAM # r��1t� ►���'�EnJFsv
P'ERMI'T NO. SEP
BUILDING PERMIT APPLICATION
CEL BLDG, & CODE DEPT.
A PERMT MUST BE OBTAMED BEFORE BEGINNDIG CONSTRUCTION. NO INSPECTIONS
WILL BE MADW04'M APPLICANT HAS RECEIVED A VALID BUQ.D[NG PERMIT.
A11 applicants spaces on this application MUST be completed and the signature of the
applicant MUST appear on the reverse side of this application.
The owner of this property is: Ste �w� e -oi , j ,�L,,�}�'r _
P.O. Address W C/9 e Tel. 2 ,02 ",T,361 Z.
Property Location � c 9.3 MAo lme G 14e -E Tax Map No.WMW
r
Has there been any split of this property since October 1 . 1986 ? / K
If yes Planning Board Review is necessary .
yes no
SUBDIVISION NAME, IF APPLICABLE 'IL'lclel LOT NO.
TIME PERSOIJ RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODS IS:
NATURE OF PROPOSED WORK: EsmMATED MARKET VALUE OF
r
V.Construction of a new building „ CONSTRUCTIONTs S„ &/y10 " p
Addition to a building • COMPLETE INFORMATION REQUIRED BELOW.
Size of property // ft x -ft. f'
Alteration to a building " Existing Buildings( 3 ) Size ft. x ft.
- Eno change to exterior dimensions)
Proposed building - distance from property line:
Other work (Describe) Front yard 41e6 ft . Rear yard ft.
Side yards ft* and ft.
GROSS AREA OF PROPOSED STRUCTURE 4 If on corner, setback from side street ft.
ist Floor_' ft. J� + OCCUPANCY INFORMATION
2nd Floor .+'�LJ _ sq. ft. I ; cAPrimary Building ao
Other Fors sq. ft. b'- One Family Dwellir4g
k►
(not collar or ment � . Two Family Dw*Uing
TOTAL FLOOlt AI1.EA oqla4d`sq. * Multiple Dwelling/Number of units
Mse of n w 8tructu".26 ft x . .b..
lowtdation-pi,aelslaif�IcrawU"part f * �
(circle am) " � Other
;, --. �.q..�;�. ryy,�«jc��i �,;, ors . R-� ._ F _ •" i : +� -
11elg t t'1 !s) d w If &"tie% what w im two be! •r.•••r •_
If nWl4Mt1al. reo. of famW
N4:4 of rvoemsGamludUg baths)
' • A
xo* of be4Hooa
No& of batlreeams � ' �� _, � . e; �.,r.� Garage pKE/Two Car
P"MMY
tee•: , a ;, ._ ,_,_wei:;�, o
Ty" of fhal 'gzs ' ��Prlwete starqe build
Ra* of flrep feces to to instawd '�' •
16M a woed stove lie lnsta►lled �t�.'+3� • +Utltiee
Central, Air condtiaaitsrg � '
B� ILEMNG PERMIT APPLIC -\ Tt0 ,N vOvT ti4ED -
BL71LDING �FECIFICATIONS:
Type of construction, wood frame. fire safe. etc. yf. oa
' iII any second-hand or uftraded himherbe used? If so, for what '
Foundation wall material A4 ,eecl C G* fi
C�'►j CxP e � Q Thickness !J
Depth of foundation below grade (to bottom of footing) /,a'p
Will there be a cellar?_Heated or unheated?. &I Floor sq. footage �/�{/�r -sq ft .
Will there be a basement ? Will any portior' be used as living space? D
(If so, what portion ) sq ft . Type of use'
Type of roof - sloped/flat/shed/other s 'Material of roof. /es
Size, wood studs "x c> " spacing Z& " o. c. length T ft.
Joists ( floor beams>m 1st floor �_"x�-" spacing 16 "'o.c. span J ft.
Joist (floor beams) 2nd floor� "x r ram" spacing /6 "o.c. span ,/r ft.
Overlays (telling beams ) "x OFspacing Ft O.C. span ft.
Roof rafters "x IF
spacing o.c. span ft.
Roof trusses (pre-engineered) spacing." o. c. span c;?r ft.
Exterior wall finish of what material? Ar14 Y�- -
Interior wall finish , R ey Oro a
If a garage Its to be attached, describe materials to be used for FIRE SEPARATION:
ica led Sys e e o ,fcc.
Is there to hP an opening between garage and dwelling?' If so will a Fire-rated door, enclosure,
self-closing device be provided? w4as
Will a flue-lined chimney be installed? /t• Height above roof.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well ,/L/ ({ !G ry?.PL
SEPTIC SYSTEM Distance from ANY private well (including adjoining properties ft,
(A separation application is necessary for any repair or new installation of septic system )
NAME OF BUILDER ,57 �(� e �i sr? �/�' 11141 ADDRESS_ fi wr l,�''o4, A5 ao6/ TEL. NO.
NAME OF PLUMBER rr 1 ADDRESS TEL. NO.
NAME OF MASON !{ ADDRESS TEL. NO.
NAME OF ELECTRICIAN ADDRESS TEL. NO.
I- DRCLARAIWKI--
14
To the beet oi; !g seaw►i�edte and belief the sta�te�nenis contasinsd hi ffi1ar 'c=; . thin"w the
puns- d.sp ii'#eat su itt�" �. a true and coenp[*te statement of all �#yreNe � M dew eel
the described prelftises and tMt all pr+o+Wsions of the BUILDING CODE. THE �G pitDq CIL.. No .
all other laws peeta nbW to Me pees" w wk shall be Coln paied #h, wlfirfleelr
such woHt is authorised by the oweeer. INV
3 a. eAd #Flat{
/r�* /�qyy�
SPECIAL Cow
. ._ . . ..._- __ �_ _, __- _ , _ .. _� ._._._,_.,..._. �ri3a s orw� :tir cam z'^t . �aras•rt a<.
TOWN OF QU £ . NSSUR .
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 r. r
2 , Type of heat _e _ ,Z xleP
3 , Is the building mechanically cooled ? /t/Q
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 founds : on walls insulated ? YES NO
1 . If YES . what is the R value ?
3 . Slab on grade YES NO
a . If YES , wh . t 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
mmmmmmm
1 , R value of roof and floors exposed to ambient conditions .
top 3flm
2 , R value of exterior wails N / !x
3 , R value of glazed area lop2Q
4 . R value of doors 4E/3�/ /
5 . R value of floors over unheated spaces GP
2.. -
51 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 )
9 , R value of heated basement / cellar walls ( below grade )
100 Type of insulation _ �'/j 5 G / t 71/t' Ate'
C . Controls ¢
1 . Thersiostat maximum heat setting
D . Duct SXstems
1 . Is duct system installed in unheated spaces ? YE no
a . If YZS , R value of duct installation �//CD
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
P . Service Water Heating
1 . Performance efficiency
2 . Temperature control setting maximum /f� a
G . For Swimming pool Only
1 . Maximum heating
Telephone No . Ja ,;2
( ap icant ' s gna re )
TOWN OF QUEENSBURY
APPLICATION FOR
SEP*nC DISPOSAL PERMIT
DATE
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name:%_ `� / / Telephone: 7 �
Address: e A
Installer's Name: P e71f;6' / T Telephone:_
Number of bedrooms (residential only) ,r
Total daily flow (compute (d 150 gal per bedroom) A C
Topography: Circle one: Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one San Loam Clay Other S Jat/Depth: Feet
Ground Water: At what depth? tr/� Feet
Bedrock or Impervious Material: At what depth? 11�Feet
Percolation test: Circle one: not required required rate min. inch.
Domestic water supply: circle one: Municipal Well Other
If domestic water supply is a wel .
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM. Septic Tank leoe gal. ( minimum size: 1 , 000 gal.)
TILE FIELD : Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of / Size each S feet by ,fd -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 Queensbury Sanitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE: ,/
OVER
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 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 ,
the 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 installa—
tion , alteration or repair of an approved system , a new proposal must
be submitted to the Queensbury Building Department before further
construction ,
Town of Queensbury
BUILDINC and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
TOWN OP QUEENSBURY
BLrXLDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
NEW PORK 1280�
QUEENSBURY,
TELEPHONE ( 518 ) 792- 5832
BUILDING INSPECTOR' S REPORT
,REQUEST FOR INSPECTION RECEIVED.����
NAME
LOCATION ,p�i ni��;pr
DATE PERMIT #___ — -
APPROVED
YES NO
FOOTINGIPIERS FORMS
MONOLITHIC FOURP-PROOFING
FOUNDAT.ION/DAM
BACxFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INStYLATION:
FOUNDATION
FLOORS
WALLS
CEILING
xFINAL INSPECTION:
C,HXMNSy HEIGHT
ROOFING
SIDING
EXTERNAL PORCHESISTEPS
STAIRS-CLEARANCE & RAILS-��
PLUMBING FIXTURES/RELIEF VALVE
INTERIOR TRIMIPRIVACY DOORS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS _
FINAL ELECTRRICAL INSPECTION_
FINAL APPROVAL OF CON,9TRL7CTIdN
OK TCl ISSUE C/O OR C/C
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE'
THESE PREMISES ARE OCCUPIED!
REMARKS: Al"� �a
/60
ARRIVE
DEP INSPECTOR
TOWN OF QUEEI*ISBi3RY
BUILDING AND CODES DEPARTMENT
BAY & HAVSLAND ROADS
1280ao
QUEENSBURY, NEW 792-5832
TELEPHONE
BUILDING INSPECTOR' S REPORT
REQUEST R INS CTr RECEIVED
NAME "
LOCATION
� � PERMIT #
DAT'F' APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR F ROO ------- _~
FOUNDATION/DAMP—PROOFING��_
BACKFILL A-PPROVALROUGH PLUMBING
FRAMING
ELECTRICAL ,ROUGH—IN
rN.SULATXON:
FOUNDATION
\\\ FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHXMNEy HEIGHT__
ROOFING
SIDING
EXTERNAL poRCHESISTEPS �—
ST'AXRS—CLEA2 41VCE & RAMS
PLUKIgING FIXTURESJRELX.F VALVE
INTERIOR TRIMIPRIVACY DOORS
FrNISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSERS)
SMOKE DETECTORS
FINAL ELECTRICAL ,INSPECTION
_ FINAL APPROVAL OF CUNSTRUCTION
ox. To -1SSUE C10 OR c!�
A SIGNED CERTIFICATE OF OCCUEPARgrMPANCY MUST' BE
OBTAINED FROM THE 'BUOILDPIEDfENT BEFORE
THESE PREMISES AR C
REMARxs: <1�1G
ARRIVE
eon
pEPpiR " I NSPEC
MIDDLE D�EpARTM r ' °�-cfa�di ON a�AGENCY, INC.
.►.�aios
aartt February =^ ,
!n accord
. '6-el-6
raved as being .(Ccrtlfie� that W- leCti l mient fisted has been exarnir►e envy rules.
1 C de appf+cable governmental , utility and Agency 4
with the National Elect Q
bwel ling CFall
Vcc'upancy Stephen Kelly ' `TcAi �:
.j.� Y 'G^ ,� sta at+o �rY9
QWf7l°Y' ,. - � c�•� '.pI ;7R'tT meM and �n li n Pecca lees
s+ n gle k','dIllj..i al
i - -a l�J! +"this eer'4 Mcase covers the 4leatncat eGu�p nlroa ucea or altar ations ma0e to
ocGupa Y]t: 1V8 lQ+lx�' 178b 'ry i.' ll additional equxPmeM ouw he licahon far
7 py 0' a aria. nis ceR;llicaw nun and voitl. an4 aPP
} Lot Ma i i , exisn ng n shoo f it t0 this AgCnaY
`QfiatfQ - ,". peCLIOn should ba suambl'IBGI R nsR Y ro rtY insurance carver
a ...�".j.x.tur.e S ; khlZ rorea
p 'Ae.ce.ptacless .5 ageeior[campanY}�aae,ido"FitofcartricatronofelectricaleauiPmeasafaP
Equipment' 115 Qutlets ;gay Appliances ; 3 ' Ven Fans peal I led
C
200 Amp 5erviceq ,
Yy. F
No . 15 -G3c733s
� 'stephen! Kelly
Applicant: 11 Willow Poad
Queensbury , NY 12804
FOrnf nc- JMW
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
pm
BAY & HAVILAND ROADS
QUEENSBURY, NEW YO9 12e Ok
TELEPHONE (518 )
BUILDING INSPECTOR' S REPORT
REQUEST FOR. INSPECTION RECEIVED��_�
NAME
LOCATION
PERMI .--
DATE
PP]'2OVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS NG
FOUNDATION/DAMP
CxFI t,L APPROVAL
OUGH PLUMBING
TAMING
ELECTRICAL ROUGH—IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/ST ILS
STAIRS—CLEARANCE &
PLUMBING FIXTURES/ ELIEF. AEVE --
INTERIOR TRIM/PRI ACy DOO S
FINISHED FLOORS
GARAGE FIREPROO ING
DOOR CLOSER (S)
SMOKE DETECTO
FINAL ELECTRICA INS C ITEP ON
FINAL APPROVAL OF CONSTRUCTION_
A SIGNED CER IFICATE OF OCCUPANCY MUST BE
OBTAINED FR THE BUILDING DSPAR*VNT BEFORE
THESE PREMI ES ARE OCCUPIED!
REMARKS: to yd `
. 4
I�f✓ � 1� "Y ! �j
/ rp f
r
INSPECTOR
1
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12809E
TELEPHONE (518 ) 792-5832
BUILDING INSPECTOR' S REP/PORT
REQUEST FOR INSPECTION RECEIVED / 2
NAME
LOCATION
DATE f, / PERMIT # I`
APPROVED
YES INO
FOOTING/PIERS
MONOLITHIC POUR FORMS_
FOUNDATIONIDAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-I
INSULATION: IL
FOUNDATION
FLOORS
WALLS
CEILING
FINAL .INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEFS
STAIRS-CLEARANCE & j4AILS
PLUMBING FIXTURES/ ELIEF ALVE
INTERIOR TRIMIPRI ACy DOO
dd
FINISHED FLOORS .
GARAGE FIREPROO NG _
DOOR CLOSER (S)
SMOKE DETECTOR
F.-NAL ELECTRICA INSPECTION
FINAL APPROVAL F CONSTRUCTION
A SIGNED CERTI ICATE OF OCCUPANCY MUST BE
OBTAINED FROM E BUILDING DEPARTMNT BEFORE
THESE PREMISES ARE OCCUPIEDI
Nd
`s
REMARKS:
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QuEENSBURY,. NEW YORK I2809&
TELEPHONE (518) 792-5832 _ ry
BUILDING INSPECTOR' S REPORT
r
REQUEST FOR JqSPZCTXON RECEIVED
NAME
LOCATION
DATE fr PERMIT # /
APPROVED
rEs/1 NO
r
FOOTINGfP.IERS
MONOLITHIC POUR kolms
FOUNDATIONfDAMP- OOFING �J
BACKFILL APPROVAL _
ROUjGH PLUMBING
MING
ELECTRICAL ROUGH-IN r
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL .,INSPECTION:
r`
CHIMNEY HEIGHT !
ROOFING
SIDING
EXTERNAL PORCHESfS EPS'
SfiAIR '-CLEARANCE RAILS
PLUMBING FIXTURES RELIEF VA E
INTERIOR TRIMfPR VACY DOORS
FINISHED FLOORS
GARAGE FIREPROO ING
DOOR CWSER (S)
SMOKE DETECTORrNSPECTION
FINAL ELECTRICALFINAL APPROVAL ORUCTION
A SIGNED CERTIFIC TE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
INSPECTOR
7ocvn o/ Queenj " ry ,rye
BUILDING and ZONING DEPARTMENT f/!
Bay and Hawiland Road, R .D. 1 Box 98 o
Queensbury, New York 12801
SEPTIC DISPOSA9.. SYSTEM INSPECTION
NAM
LOCAT I M1
DATE / PERMIT NO.
SOIL TYPE - Sand : Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch -
TYPE of SYSTEM :
Absorption field , tot�l length
Length of each trench `k
Depth of trenches k
Size of t1ravel
SEEPAGE ;?ITS{Number of?
Size- ft. X _ ft.
Gravel size
PIPING : S ' e Type
Bldg . to tank.
Tank to list . box
Dist . boa: to field/p ' t
Openings sealed? S No Partial
LOCA`i IC3N/SEF"ARATI S : s\
Foundation to tan ` t-
Foundation to ab c rption
Absorption to l line f
Separation of p is ft. >
LOCATION OF SY ON PROPERTY (ciriVle one )
Front - Rear - Left side - Right side -
C CMMEN T S
P6�t I I�V A L
SYSTEM USE APPROVED YES ONO
Buil ng Insp ct
01/86 and vl
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT `' 7
BAY & HAVILAND ROADS
QUEENSBURYr NEW YORK I280¢.
TELEPHONE (518) 792--5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME _ _ Ile
LOCATION
DATE PERMIT #
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR , FORMS
4 .P0VNDATI0N1DAMP PROOFING
BACKFILL APPROVAL r
ROUGH PLUMBING
FRAMING i
ELECTRICAL ROUGH-+ TN
INSULATION: '
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION.
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE$`/STE
STAIRS-CLEARANCE A; RA LS
PLUMBING P.TXTUhRS/RELI P VALVE
INTERIOR TRIMIPRIVACY D RS
FINISHED FLOORS
GARAGE FIREhiROOFING
DOOR CLOSR'w(S)
SMOKE DETIVICTORS
FINAL ELECTkXCAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
ti
z
A .SIGNED CERTIFICATE OF OCCUPANCYkMUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS; „
� 0 z .510� r
,
INSPECTO
TOWN OF QUEENSBURY
BUILDrNG AND CODES DEPARTMENT G BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 1280k y
TELEPHONE (518) 792_5832 J
BUILDING INSPECTOR ' S � �� �
ORT�' s
REQUEST FOR rNSPECTrON RECEIVED
NAME
LOCATION
DATE -72
PE
APPROVED
J'
OOTING/PIERS YES NO
MONOL.LTHlC POUR FORMS
FOUNDATSONfDA1NP-P.RCKJFING`�r
BA+C'KFrLL APPROVAL
ROUGH PLUMBING
FRAMrNG
ELECTRrCAL ROUGH-rN
—rNSULATrOra_
FOUNDATTON
+FLOORS
WALLS
CEXZXNG
.FINAL rNSPECTrO
CHIMNEY HErGH
ROOFING
srDrNG
EXTERNAL RCHES/ST S
STAIRS-C ARANCE & RA Ls
PLUMBING r,XTURESIRELr�[rALVE
INTERxO TRIM/PRIVACY D RS
FxNISHE FLOORS
GARAGE FrREPROOF TN--`G:�
DOOR sER (S)
SMOKE DETECTORS' _
FrNAL ECrRTCAL rNSPECTrON FINAL PPROVAL OF CONSTRUCTrON
A SIGN CERTrFrCATE OF CCUPANCY MUST BE
OBTAINED FROM THE BUrLDxN DEPARTMT BEFORE
THESE PREMISES ARE OCCUPrts'b!
REMARKS:
--- rNSPECTO,R �`
National Headquarters .
1300 He'iiddr5 Aver Collin swtaOd N. !. dr�i08
Date: �
'CfitY, Town or Township .s 46 fr A County • 'C•l�//./ "!' + • State
Location/Add ress 'Ci — /Q f9� / i •" •. iG/ .Ps
(If Located in Rural. Area - Please Attach directions) Pole * "
o]wrier ` - . t; Parl4rllt #
Occupied As x, :
r 1�ulldrng New C31d
Occupant
- ~ ; -Y ;r& ea in Buildin (Floor
for: Wirin§ CM Service or: Ready for in hdi
Fee RetrrittecF= $ Cash Cheek = M.C? _ lug iEe able fink . M.D:LA
' Y� � 34, 1 '.}moo LT3a 2a0e 2i.SD 450d 4750 3ea0 �..,r . - - s .
Nurr bet of 13f?ugR W,elnor outlet .. Elect,. Heat
Switches " * r
Lighting �6d Amp. ServlxW Siirfaoe Unit Dishw+ ier - _` Range
Receptacles Water Heater Air Conditioner Dryer " ' Pump ..
x ,.; ry , , - Ovelti =' Wiring and Gorv"Wftar -. Burner
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Mom' ileosiptadl8� k a�t e} t Yute1 H.P. Vent Fans
<J .. -L'r a v Other Equipment:
MOTORS H,P. : � f, �+t �/ s 1/8 1Jfi tJ4 lI3 1/2� 3/4 �1 �1lft 2 �-"� . , S, 7Yz IO 15 20 25 30 40:,- 50 1'S ltila �
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of Each Size -
Applicant's
Signature ITT iF
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Applica s Address: +F
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Correct LocarCfiSn ' Sernie as Above [] oa : t ' '
Red Notice Label Lj �
Rough Wiring Outlets Surface Unit Oven
Switches Ran a :; 3.Ta sap ' L.
ReceMlimies Water Beater. alSilvBslir
fixtures `A,ir'Ganditibner '
Amp. Service Equipment Burner, Wiring & Con#folS for L Am : R " tOnle
Amp. Service Conductors Pump Vent Fans ..
MOTORS
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of Each Size
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