1989-834 f A
� c � c +�Un,�.r�c
�ER.TIF'I+�A
TOWN OF {QUE'ENSBURY
WARREN COUNTY, NEW YORK
Date
December 20 iq 89
This s to certify than work requested to be done as shown bV Permit No. 89- $ 34
has been completed.
'! This struewre may be occupied as a Single F a m i 7 v Mo d u l a r
Sanders Road
`
Cowme: Richard Phillips
1
y
' By Corder Town Board
vrO WN OF QUEENSBURY
a 1
.l.' tMI i..,. ct.
Director of Bldg. & Code Enf regiment
1
G
I
BUILDING PERMIT
TOWN OF QUEENSBURY
No. $9-834 _-- -v
WARREN COUNTY, NEW YORK o
«�
PERMISSION is hereby granted to R HA P r�
S}"s
OWNER of property located aft Sanders Road
Street, Road or Ave.
.a
�.t
in the Town of Queensbury, To Construct or place a Single Family Modular
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
SAME
c�>
2_ CONTRACTOR or SUI LDE WS Name p
�o
LAMPLIGHTER HOMES
r
3. CONTRACTOR or BUILDER 'S Address r
to
RD #2 - Fart Edward
4. ARCHITECT'S Name
Vi
5. ARCHITECT'S Address
rL
7�
a
6- TYPE of Construction — (Please indicate by X)
fZ
[ }Q Wood Frame i ) Masonry { I Steel I )
T_ PLANS and Spacifioations THE ATTACHMENT OF THE TWO PARTS MUST BE APPROVED BY A
LICENSED PROFESSIONAL ENGINEER ,
No. 26 ' x 56 ' single family modular withx septic system & driveway as
r nt to
S. Proposed Use
d'7
s�
SINGLE FAMILY MODULAR .
T
r—
$ I800 OO PERMIT FEE PAID — THIS PERMIT EXPIRES May 1 1990-- K
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the O
town of Clueensbury before the expiration date.) tz�
r—
Dated at the Town of Queensbury this 6th Day of — OCtDber 19 89 , �n
SIGNED BY for the Town of Queensbury
Building and Zori inspedor
T "' � -. .' -, ,-, r� Tr r r Nrh " ,^ � - 1.ii i' f" *) V T
TOWN OF !~' UEENSBURY
Ray.iewcd� 'Cp' 1N REC�V��SBu��
t= ac, F 4� 1
1:4J I LD I NG 4Vl D CODES Ut l;ARnfEIK-T va ce Ia.s ued COOS +psi■
AY end NAVI LAND ROADS RD I BOX ] 3 SLOG &
nuE£'NSBURY , NESJ YORK 22dD4
Penms,t No , kq
Tel , f5181 792 - Sd3 : Ext 204
A 111; 10SIT MUS'r E12 OBTAINED BEFORE EEGINNING CONSTRUL:TLON ., NO INSP1: C4fIONS
VILL BL' MADE UNTIL APPLICANT 11AS RECEIVED A VALID BUILD £ NC PERMIT .
All applicable spaces on this application must be complctcd and the
i rTaature of the jppl icant must appear on the reverso sick of this sheet
* * * * ., A A A * x x * x Ui R x x x x x * * * * R ■ sr 7[ ! k • 71
Ttze owner of this Property is : t C- #j4 r'zj 4� Ai /1a P-j y
(' . O . Address S43 .. to S RID •4 A to e' r- I /Z!X __ T E L . ? d�'f— � G � 'i � /
of T ";�
r rOpercy location _ i +zS '??spa . y Ca'J iv e• .^- J -s r -ser 'T TAX KrP NO ./� �✓ 'r /
rlas there been any split of this property since October 1 . 1988 ? yesf no
If yes , Planning Board Review is necessary . LOT NO .
UBOIVISION NAMCo rr APPLICABLE
- he person responsible for supervision of +worst as regards Building Codes is :
1T E'er L. 7.s •. • '�r ;
/` a..2,. to/. G .�-y'�'r�- /� ��'- � a� rF ? �'�" = 7 1 3
NAME F . G . AOL) RESS EL NO
.� Address +� _ #0�- AZAC-7" �✓� Tel
Z4�AMO Of builder&�le..r f7 �. G +�`rrJr�° _
r4..ma Of P 1 LUAbo r ." � f�J . �'.Si �.rt� l,d.Y T e s s i D rr� - 26WA Tc 1 ?
- Tel 7 f 'a' - 7 3_k_z
Name of MliaSQn
iATuRE Of' PROPOMLD � (] NI tJ { : iNl Oltrl�+. 1' rC1rl ! Ut i icr3 use only )
,:nnzotruccior, of ,a rruw builairt7 ZONING 00SICNATION OF PROPERTY
Ad" ;Lcion to :a U%4ilUir+g r PERMITTED PRINCIPAL. PERMITTED ACCESSORY
�ALcur..tion to .a L.uildLng r
T ( , �o ciy..r ,.7� to � xc � rior cliana:nsion� ) r REVIEW REQUIRED - PLANNING BOARD ZONING BOARD!
r SITE PLAN REVIEW # APPROVED DATE
KOSS ARL:A OC PRODOSCD. r= " rX. u +�oruk rr ■ VARIANCE IF APPROVEDDATE
_ St Floor / sq ft . Remurkst
OF ..
2nd Floor sq ft , COmPLLTA INl'at.ttitiLOt! scar+ ?uilctD LILL.f.Mt .
■ ai4o. of props rry fit x S ft .
ocher Floors s4 ft . I' L' x cc .
I not collar ar bssumdnt 1 r Iaci�tirai} t:uii tiii.] I :: ) �i -u
TOTAL FLOOR ARCA / Y 6 A ft- ` Lxs.zoC .6119 Dw46 W .6flkj l:. ) ua.a
o �nrw trLLCLuro eft x go +
i & t
l'4iaSFad:+ cion-nicr/ ::1zL/cr..ri/L#arci..1�L� ' >?roi�oacra bua.ia +.nq . di:. c.►n4u rraur L.r.il�urCy 1Lr1+:
(QLrcIw one. ) ■ Front yard /� ~ I' t Rear Yurd,� / ift
Na . of . caries IkwJuicwhla spnacl 4001F * Sid.: y,:ard:: ilr ft :Anti / crL' ct
Ila: ighc (gradQ to ridcj.t ) / S� fc . + Ze an corns r z.a: cboAzx from sgLdu ::trr:a:c�fc
If roa: id"Atial , noo c+f f:amilic5 /
ttov of rootw* ( Qxcludinq b"chsl —�� OCCUI7A1Vt:7 i NFORh1AT ICN
Itoo, of budroaistx : p 114*%RY LUILDINQ -
Na . at t"t1troow ' - r 'Vona taaulY dwelling
a•riu►ary lua.aciaNj nyrrLa:w r 4L1xo I"Mv6l.y daaraalliny
'lylaa+ oaf Eu+� iJose Z, 77%. • � Multsl•laa Uwulling / NQjabor of unite,_,^
No . of lira:placug to Ltas inzc:a114.; rxoo l�wlts�arnzltt occupa"ay
'tall " up) ) , *uOvaa tow caa:ciAL1k; [ac:y
Canur.al Air cota.litiun..rag? Liusinctatx
BUILDING ;TYLC, PRIMARY STRt.tCTU► E * Tnalustrial
r Ocher Is
r,
ac)a Corscwu�l:c.r..ty L6.a? a�)ain it aadaiciun , aria.at wall u:.rt baa7
I ■ad ranch Ir►.an■aia+as OWL.sx
Bljl .tc luv►tl old scylas u.aaa•1.►1aw r
ti�laµ Cad CaCr:+ry3 �Ittwr 0 ACCESSORY UUILDING�
Cr,iani..Io tzo►r 1ow/� }loess ` L. cschaa yJr=agt:/ono cr.r/ two car/ a:ar
( CIRCLL': ON4 PLx? rE I " ACt�aCnu❑ 'j"Ci►g"1oj%4 cu.r/ two
■ ■ • s • ■ . ■ s • Is s s • ■ L•riVwGaa stor"gQ balluing
MARK .F kiavlft ^veo V . L Ocher
C0H !;`rkuCT1 (jt4
INFOAMATTON ON ODUTLOINC 5prCIFICATTONs . ON pjEVERS £ STDC: OF TItTS 0^!!ILET , To SC COKPLETUOI
Form BPA I0/88 V1
o:� ILDING SPECIFIC: TI0hjs :
:yn e of construction , wood fraxe , _ : re aafa , etc . e.) a
wtil any se•_cnd-hand or ungrada -i. i mter be used ? -or for wksat '
11.J t:1
FoUnA.ation wall material
Depth of foundation below grade c - o bctt -m of sootin(:z ] -- -
will there be a cellar ? 1J11 Frated or unheated ? � �,fFloor sq . footage /yr S , sg �t
Will there be a basemen't-r`=/-• 0 will any port -Lon to used as living space ?
( If scr what portion ? sq . ft . - - Type of use ?
`✓pe Qf roof -/ s oped flatfsited /otner Materlai or roof S A V
vL e , wood stucC! .. x, LZ spaei �g�/ '" o . c . length '*ft . R
Joists C door beams ) lst . Floor " X /go spacing � �. "o , c , span 'so," .3 ft .
.Joists ( floor Creams ) 2nd . floor " ?C spacing "o c . span ft ,
%: verlays ( ceiling beams ) "' ?c spacing C . C . span ft ,
Roof rafters QFX spacing c . c . spar. ft .
Roof trusses ( pre- engineered ) spacing6" o . c . span ff f
Exterior wall finish S , ,, Of what material ?
Interior wall finis?^. „P ;-r-1 b G fG
if a garage is to be attached , descrice materials to be used for FIR£ SEPARATICN :
Is there to be an opening between garage -and dwelling ? If so will a Fire - rated
door , enclosure , and self-closing device be provider.?
Will a flue -lined chimney be installed ? l�.J Height above roof ft .
Depth of chimney foundation below grace ft ,
Depth of fireplace hearth ft . in .
Water supply - Municipal or private well G lfo' F4-
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 I 0 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 ZON [ NG OIZDIN ONCE, 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.
SignatuOr �«�-- &Vtor
owner's a�, en architect , Ontr oC
k * k * IN Al * k * * * * * * * * k * k OF * k a k •' * IN * * * * * * * * * •
SPECIAL CONDITIONS OF THE PERMIT :
TOWN OF QUEENSBURY
" 4 WARREN COUNTY . NEW YORK
cam ` 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 e. 7/L , C. �l`.P .� K cl �{��„�"�`-U 1L ►Y! 1 tJ Jc,!
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 wails , roof / ceiling and floors
exposed to ambient conditions
2 , Floor over heated spaces YES NO
a , Are foundation walls insulated ? YES NO
16 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 ?
44 Is basement heated ? YES NO
a . R value of insulation
5 , Type of insulation
B . Under 16 % Only
1 , R value of roof and floors exposed to ambient conditions .
2 , R value of exterior walls
3 . R value of glazed area
4 , R value of doors
5 . R value of floors over unheated spaces
6 . R value of slab edge insulation - unheated slab
70 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 )
10 , Type of insulation Imo. SS
C , Controls
1 , Thermostat maximum heat setting.
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
1 , size of hot water or cooling carrying agent pipe
2 _ R value of pipe insulation
F . Service Water Heating
10 Performance efficiency
2 . Temperature control setting maximum /
G . For Swimming Pool Only
1 , Maximum heating
Telephone No . `s+ 3
( applicant szgna ure''
FOWN OF QUEENSBURY
APPLICATION FOR
. �`
SEPTIC i?1SF(7SAL PERMIT
DATE 9
LOCATION OF PROPERTY FOR INSTALLATIONS-' ` t
Owner's Name: R c Lt oltr -d FZt 1 / + ;:7 S Telephone:
Address: -2%-
Installer's Name: it.), Telephone: �tyc,,
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom) Aqr $ "-r)
Topography: Circle one: Flat Rolling Steep Slope % of Slope ZE Tr
Soil Nature: Circle one, IIoam Clay Other /Depth: Feet
Ground Water: At what depth? /I-- Feet l
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one: not required required rat min. inch.
Domestic water supply: circle one: u_n 5,0/ Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank ( minimum size: 1 ,000 gal.)
TILE FIELD: Each Trenchj2 feet/Total system length _ c3 feet
SEEPAGE PIT(S): Number of / Size each feet by 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 PERSO► ,>-
DATE: -' S'
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 shrill include a plot plan showing :
I . ) 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 ,
file fields and /or drywells
LO Nu system shall be covered before inspection and approval by the
Building 1jaspector . Failure to comply with this requirement may
1-� sult in the uncovering of the system by the installer and a fine
of up to $ 250 . 00 ,
co 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
k,e submitted to the Queensbury Building Department before further
construction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
kL.uza rks
Tofu" of (pueensE>;uriq XigWng Department
Bay at Hartland Road* Office Phone 51Sw793-7771 Queensbury, New York 12601
PAUL H. NAYLOR RICHARD A. MISSITA
Superintendent Highways Deputy Superintendent Highways
DRIVEWAY PERMIT
DATE :
APPLICANT NAME : 02 rL 1 f /f r'�S
TELEPHONE NO . '� ' rF ( �.' 9 ''00W ,r
ADDRESS TO BE INSPECTED : Can c#e !L `-��� �L! �' " J b" 4er
RETURN ADDRESS :
Applicant show gxaot 3crczt ` a w
s `
to toe cc+ _
Spec
The.. Uperinteradent v n
r(3viese� the applicei -; �P•e de o
q,o r y
nneyc. a divewa to the° TC01W" its C . 2h
ha a,
STEP _. W J
NEED { ) Sht Swan
_ 1 With The Road
Swail
1
Size Pipe to be used V( if necessary )
{ ) 12of { ) 15 " t 71 $ " ) 24 " { ) 36 "
Preliminary inspection by DATE
Approval by Highway Supt . Depty . Supt .
After receiving the Preliminary Approval , submit the permit
to the Town of Queensbury , Highway Department upon completion
for a Final Approval .
STEP 2 : { ) Final Approval
( ) Rejected
DATE :
Paul H . Naylor
Superintendent .oL highways
Town of Queensbury
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 32SOLL
TELEPHONE (528 ) 7992-5832
BUILDING I SPECTOR ' S REPORT
REQUEST F90N CTIO RECEIVED _
NAME r r f!' r Ar
LOCATION '* C`
DATE ERMIT #
PPROVED
YES NO
FOOTING`"PIERS
MONOLITHIC POUR FORMS
FOUNDATIONJDAMP-PROOFIN
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH--IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
F A L INSPECTION:
CHIMNEY HEIGHT G
ROOFING
SIDING
EXTERNAL PORCHES/STEP - -
STAIRS-CLEARANCE & ILS
PLUMBING FIXTURES/R LIEF
INTERIOR TRIM/PR-TV Cy DOORS
FINISHED FLOORS
GARAGE FIREPROOF G
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL. INSPECTION
FINAL APPROVAL CONSTRUCTION
A SIGNED CERT FICATE OF OCCUPANC MUST BE
OBTAINED FR THE BUILDING DEPART ENT BEFORE
THESE PREMI ES ARE OCCUPIED.'
REMARKS: el
.INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HA VILAND ROADS
QUEENSBURY� NEW YORK 12801E
TELEPHONE (518) 792-5832 -;r, � F"
`l- BUILDING INSPECTOR ' S REPORT ` e b O
RE¢U �lIGFFOORy'F�NSPECTION RECEIVED
NAME �✓
LOCATION
DA fiE } PERMIT # 47
A
PPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR F S
FOUNDATIONIDAMP-PR FIND
BACKFSLL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
/ CEILING
+FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/ST PS
....................
STAIRS-CLEARANCE & IL
PLUMBING FIXTURES1 ELSEF VALVE
INTERIOR TRIMIPRI ACY DOO
FINISIIED FLOORS
GARAGE FIREPROOF NG
DOOR CLOSER (SJ yy
SMOKE DETECTORS
FINAL ELECTRICAL NSPECTION
FINAL APPROVAL O CONSTRUCTION
A SIGNED CERTIF LATE OF OCCUPANCY ArST BE
OBTAINED FROM T E BUILDING DEPARTMENT BEFORE
THESE PREMISES RE OCCUPIED!
REMARKS:
Ile
INSPECTOR
MIPOILE. D#PARTMENT"WECTt *Q, I fi�M1C
Nation g# H+eadquartgiq
90p Haddon }dive:; "CoIling¢wood, Iw1:J Ol ifJ8
Date . aX emlit awr
City, Town or Township ' =-4tz
County 41 ��, State
LocationfAddress .
(If Located in Rural Area - lease Attach Directions) „ �ie .#k
Owner f ,
Oacupied_As %4 lmlit # -
Occupant " - . Building:. New " -Old ]
Work Area in BuildingFIcor #, etc. „
for: Wiring Service or: Read far Ins action Fee Remitted--. Cash Check - #idf: 1 y y
844 �s4 is - - Oo. xsa4 .2044 22a4 2s44 s754 8oa4 Maki a IB Ee M.{S.k.A.Number of Rough Wiring.Ciutlets Elect. Heat
Switches _ - ;..
Lighting Amp- Se+'Uj� ' asuriface Unit ❑ishwaeRher "' Prange
Receptacles Water Heater , , Air Conditioner Dryer :.. Pump
Number 'xfur Ovah " I _'C age Disposal . Wiring and Controls for Burner
' I4ePcet`ita+sies . N s _Fractional H.P: Vent Fans
, . Other' Equipment: : . .
_ 'lX
MOTORS H P. /£` { 1, 1Ja IJ6 I!d 1J3 iJ2 3F4 I 1?h 2 Mark Number 3t- 5. 7�li SD .15 2D 25 30 . 4D 9p
of Each Sizes i' no
'r -
.'
Appl iCenYs � r • -
Si ruxtu
s
9 re License
T/A
APPlicanVs Ad+�ress: Utility:
KCity1r . a .Jr: ►uStats? {Zips Service Requeut #► r'� ,�" -
Phone t
� few
# 1IE'15+CElyU: o4TE .iNSP ' 1
Correct Location : Same as AboveQ or: alalkkk
-
a all
Red Notice Label Y
Rough Wiring Outlets Surface Unit, dven .
Switches Ran
Receptacles
---------------
r 'Hea#er slaw r.., ,
Fixtures ir'Condit' el^_' . :
Amp. Service E uipment Burner, Wirir►g Se Corltrvli #or Amy: Receptacle
P. Service Conductors Pum Vent Pans fff
MOTORS 1i,P. I/ZD 1f12 1/10 1/a lJa 1/4 1f3 I/2 3J us. 1D . I5 20 23 Mark Nurrrber iDD
of Each Size
rt
Elect. Heat Soo ai kpqpqpqpqpqpqpqpql I I I
ss xoo4 xsso xsa4 x�eo s4ao sseo sa4a �+sa 9444
r bs .
LC3R
W Progress: Inc. LKD 0Contractor
T Violation: Work Comp: Q lncF , Q C.*Gr
AA . • Owner . CASRA MuC+ici al
pal Fee
CH
t;~ . .
's.:.. .,;,,,., .. .�.a.. -.:.•.fry'P!'w-9f'..' ' Ih�if'"''c71 '�' >.r VMit'�
a-
Cut in Card y; ;' _
Temp 4 . .: Date .,._i ' •. �.
QPPLoCA' -rrr.�r� FC?F2iuiwNt)C. '1C+0 �L ?I¢'O Y.....n.r.....:...: ...e.¢ �.,. rt.a .' .i'.. �.-. ..., a i..-. .,f�+} e'^IW.¢r "w:.
cc�
_7oW4 a a/ Queens ury
BUILDING and ZONING DEPARTMENT �y�
Bay and Haviland Road, R. D. 1 Sox 98 / `
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME / c _
LOCAT I ON
HATE PERMIT NO.
SOIL TYPE - Sand - Loam - Clay
Percolation Test Required? YES - NO
Percolation rate Min/Inch
TYPE of SYSTEM:
Absorption field , t tal lent h , ' L` `
Length of each tren �J
Depth of trenches
Size of Travel
SEEPAGE ?ITS-(Number of-
Size- ft , X ft :"
Gravel szxe -
PIPING :
Bldg . to tank
Tank to dist. box
Dist . boa. to fieldf `
Openings sealed? S NO Partial
LOCATIOW/SEPARAT NS : q -
Foundation to t k t.
Foundation to a sorption �ta
Absorption to t line ft .
-
Separation of its ft.
OF SY TEM ON PROPERTY (circle one)
07Tso
Rear Left side - Right side
-
r
SYSTEM USE APPROVED ES
Building Inspector
01/86 and vl
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBuRY, NEW YORK 2280&-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECE VED
h '
NAME
LOCATION
DATE r/� �+'� PERMIT #
APPROVED
!r/G� YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
F NDATION/DAMP�PROOFING
ACKFILL APPROVAL
TROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH--tW
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION: t
CHIMNEY HEIGHT r
ROOFING
SIDING
EXTERNAL PORCHES STEPS
.......
STAIRS-CLEARANC & RAI
PLUMBING FIXTU ES/RELIEF VALVE
INTERIOR TRIM/ RIVACY DOO S u
FINISHED FLOG S
GARAGE FIR PR
FING
DOOR CLOSER ( ) 1
SMOKE DETEC RS
FINAL ELECTRI AL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISE'S ARE OCCUPIED!
REMARKS:
%td
Q"
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVIZANDE ROADS
Cl QEENSBURYBURY, NEW PORK I2804.
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME +
IAOCATION
DATE ��+ / PERMIT / '7
APPROVED
YES NO
L,..Y TXNG/PIERS
Lw�TQLXTHIC POUR FORMS r
FOUNDATSON/DAMP—PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN
XNSULAT.roN m
FOUNDATTON..
FLOORS
WALLS
CEILING
FINAL INSPECTION. `
CHIMNEY HEIGHT
ROOFING .
SIDING
EXTERNAL PORCHES/ST PS
.STAIRS—CLEARANCE & RAILS
PLUMBING FIXTURES/ ELIEF . V'ALVE
INTERIOR TRIM/PRI ACY DOORS
FINISHED FIOORS
GARAGE F2REPROOF NG
DOOR CLOSERS)
SMOKE DETECTORS
FINAL ELECTRICAL NSPECTION
FINAL APPROVAL OCONSTRUCTION
a
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISE'S ARE OCCUPIEDI
REMARKS. f
INSPECTOR
National Headqpiorte
: Ii1Q 'f# �lddrl - ill.ln woe i f+i:J �08 �
City. Town or Township [i' r d0 ..
County_ �sPJ !' .� .state "
l-ocationfAddre,*,s :+A,- c.�,e' ear rii � ' =;` �� � ' .i
Elf Located in Rural Area • Please Attach Directions)
Owner ilfC C ! ,rt '.rC ' ' . ►�r = . . Pgle #
OccupiediAs 3 -me r +frr v [yetflAl
Occupant + ...G •' _ .tali r'.�'. # 'Si )dln� ; .Ne O-Old ice.
t
' '`'1N6rFl in,rea in Buildin Floor
. for: Wiri [] Service. isr:
Fee Remitted= Cash Rea for In tiffs:.
Ofia
Check Kok +a; E 8 pa "able' ti: MOD, [*A.
Number .o fip1. t WiPltog E3Utlets; Elect. Heat °0s ae t x7sa a000 rase saes xrao saao r, .
Switches
Lighting Amp, .Serulcgii -;
-Surface Unit
Receptacles Water Heater ^ir Condltione r r )33nge
of l `' .` �- -�—�--Chen . r r r Dryer w
7 . '. Ir1 age Disposal Widhil' Controls far ggmp
- +tee . 6�' e: I ...
Fractional H.P. Vends: ' : .:p Y .
Other Equipment; ;. ;
MOTdFS H,P, f� 1! I1$ lfe .i a x
RAark plumber •r / / 1!2 a1A 1 lEh 2 . 3 5 7l1: IO. x5 2P '25 of Each Size 'yG ♦a�y� yy
Signature '� ,�.1!► + .rt4 " sJ + e� € r r. :^ g 'r4
T/A �: Licensek :_ s . T
Appl lcal) s +Ar+idress: "" 14:r ram/ g• t + �.
(City-ll T''a 1 'di'�1` ha!` '' Estaxe l
Phoyte y- IV iWI :.EiPlr *` ' Service Request III L
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Ele ian.:
kTP@ RECE1yEp: , C1A rE 'INSPEt: p _ . .
Correct Location ^ -
Same 8s 'i4bova +or:
Red Notice Label -
Rough' Wiring Outlets Surl"I Unit _
Switches Ran - . - ' Owen
Piece lea >: E'Yaposah
Water Heater ''' skiwashet
Fixtures fair +Sher .
r : - t
Ain : Service Equipment Burner, iri rtircrls ¢or -
Am . Service Conductors Ami' Ret;ia c '
Pum - Von Fan$
MOTORS H.P. 3/2tf 1J12 1/Ip I148 I x x1 12 / '- 7Ys x VOL 20 2b $ • . • ,
of Ea. Number s.' { ' !r. ,of .Each Size
Elect, Heat sso99
Aso ■oeo rxso isuo a�so saga sxso xoo x7ae aopo ! .
rL . . ;s <
N :M
0 RW Progress: Inc. Q Lkb i,f Contractor
� CFT Violation : Work Con'►lf. E3 Inc, ,Q
L/A �Clwner CASH
CJ L/A
0 IPA' - Fee CH K # .
3 f . , r . ' LO :Municipal t3ue MO - �
Date. 7 . I I Or
4' y .Other a�ldaFM IJttlrt ° ly,
CIA'rn Card TempiT.-. i ,rta,be. . tip' - •, `y51 F31 C ... '. - "j;.{1!. i {<
4 .
Q Final # ' . .t;. , anus.
Date »-
►rPPI-lcprlbnr. Forth NO. tea Et. " :: . « . _ ..
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q� k
OE(7RGE KLJk0 iAKA J,z. . P. e. Rev I sea
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/► BUiLDINC SYSTEMS CRNSULTMT
h 13 ARBUTUS DRIVE
CUEENSDURY, H.Y. In%
( 51 g ) 793- 7190
RESIDENCE :
13 ARDLTTLJ,S oRtvF'
OL)E'E►YSOURY, N. Y. 12904
BUILDING INSPECTOR 5113 792 -1S2 =
TOWN OF QUEENSBURY
TOWN HALL - BAY ROAD re' Factory Manufactured Home
QUEENC9URY , IVY 12904 Installation Certif'icati.rsn.
Attention; pqy p liA 71 fV
Dear sir *
This is to certify that I have observed and inspected the installation of a
"Factory Manufactured Home+t ;, as defined by the New York State Uniform F,j e
Prevention and Building Code, Chapter D - MANUpACT'URED HOUSIMop Article 2
FACTORY MAN3FAC'TURED HcmE:S , as applicable there appeared to be no appar to your Local building regulations ;
ent structural damage to the units , due to or
attributable to the transportation or loac3irlglunloading of the units , herein_
after described as Follows : on
Date of 2nstal.lation : /�// ''y0m; may►
Site Location: X`OA a:^ .w+w�+E,� aC ... Crs a . S i sat
Community: TOWN OF QUtENSBURY
County: WARREN
Manufacturer/Supplier:
Address : ,.�? G► . �'oh. .-
Q
,,"'R'Tr. ca'+C...►.0 .�'c,,,r„t-�j, /0...! /~/'d'q�' ry,C
Insignia serial No. 3 614 " 3 .�
Plan Approval No. .*'L pop
ManufaLcturws " s . Model/'Component No. :
Date of Manufacture: I/,�.� / tr-.sa.� o •,•• •�` ,•�i/ S
Installer/Supplier; a..r+.r'.�y �,,Rv '
2 have also examined the approved Plans"Factory Manufactured Home & Specifications or the abovem � oned
'* , and to the bast of my knowledge and belief , this
"Home" has been installed in accordance with these approved Plans & specifications ,
and all other applicable laws
c��'-�c-odes , ordinances , standards &/or regulations .
� Q�+�j+ RESPE-C TEULL Y SU :A !
0
AROPC �SIOK F�
TOWN ()F OUEENSBU'R`f
Zoning AdministragWr
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