1989-839 S S
CERTIFICATE (31F OCCUPANCY
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YORK
i
Da, , March 30 , 1990 rq�.
'i This is to certify that work requested to be done as shown_ by Permit No. '89-839
I
has been completed.
This structure ma be occupied as a s i n Q 1 e f am i I dwe i I i n q
Location Let A'.T�G-� Maple Drive Hidden Hills
1
l Owner A TO Z DRAWALL DEVELOPMENT , INC
i By Order Town Board
f
TOWI#4 OF rQUEENSDURY
f
Director of Bldg. do C d Enforcement
i
BUILDING PERMIT x
TOWN OF QUEENSBURY
No. 89-839
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to A To Z ERYWALI_ DEVELOPMENT , INC _ w
t
exi
OWNER of property located at Maple Drive - Lot # 55JHi dden Hills Street, Road or Ave.
t.rr
in the Town of Oueensbury, To Construct or place a single family dwel 1 i ng
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 Oueenshury Building and Zoning Ordinance.
t. OWNER'S Address is
RR #2 - Box 520 �
Granville . New York ----,
2. CONTRACTOR or BUILDERS Name Cy
--e
r
r-
3_ CONTRACTOR or BUILDER'S Address 0
m
M
m
r
ca
-c�
4. ARCHITECT'S Name m
--1
5. ARCHITECTS Address ;n
6. TYPE of Construction — (Please indicate by x)
( X) Wood Frame i } Masonry ( 1 Steel ( 1
rra
7. PLANS and Specifications try
No• 28 ` x 72 ' single family dwelling with attached two car garage ,
driveway and septic system as pera lication specifications and plot plan .
8. Proposed Use
0
-s
Single Family Dwelling {
to
a
$ XXX279 _ 00 PERMIT FEE PAILS - THIS PERMIT EXPIRES F.'ay 1 s 79 Q[3 - ,tee
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Ousensbury before the expiration date.) �C
a.
Dated at the Town of O.ueensbury this 26th Day of OC tgber 1989 _ "'
SIGNED BY { /� for the Town of Queensbury A cn
Building and Zorriffg Inspector �.
!r7
TOWN OF QUSENSBURY
REVIEWED BY
4
el
FEE PAM S Tpyv� OpP E R M1T NO. ` s RPOF 1e'p
BUILDING PERMIT APPLICATION ocr4e
S�,OG � COOS,79L9
.9 -
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION_ NO INSPECTIONS
WILL BE MADE UIaIT L APPLICANT HAS RECEIVED A VALID BUILD124G 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 * * * * * s w w * * * w w w w w ��w'rr,,,, * : w a r s * w • # w r +r nr * w a ,� a j +u s ■ s
The owner of this property ism.. 1J t.a ! �} (✓� V ��ti E, - J
~� i[7 �P.O. Address " [ ei
Property Location 1 X L- 0 V l f•� �' Tax Map No, "
Has there been any split of this property since October 1 . 198e ?
If yes Planning Board Review is necessary reyes no
� _
SUBDIVISION NAME, IF APPLICABLE LOT NO. ,`� �
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
•
64ATU/R'E OF PROPOSED WORK ; ES I': ►IATED MARKET VALUE OF
V Construction of a new building „ CONSTRUCTION: S
Addition to a building " COMPLETE INFORMATION REQUIRED BELOW:
' Size of property I O 0 ft x
Alteration to a building , " Existing Buildings( 3) Size ft. x Ct.
(no change to exterior dimensions) �
Proposed building - distance from property line:
Other work (Describe) " Front yard 5747 ft. Rear yard 3--b ft.
Side yards 1 5-f- ft. and
•
GROSS AREA OF PROPOSED STRUCTURE If on corner, setback from sine street ft.
Ist Floor ` fi sq. ft. / `41 �
cc77 OCCUPANCY INFORMATION
2nd Floor 7_, 7 sq. ft. /0 (: • Primary Building
Other Floors sq. ft. 3`� +► One Family Dwelling
(not cellar or " asement) Two Family Dwelling
TOTAL FLOOR AREA_ j2=,k jsq. ft. ' Multiple D'welUng/Number of units
Size of new structure ft x 7.;--- ft. Business
Foundat#an-piper/slab/crawl/partial ' Industrial
(circle one) • Other
•
Noe of stories (habitable space)
I'assist (grade to rim �_ft. If addition, what will use be?
If residential, no* of families _ #
No6 of roomslexcluding baths)
No, of bedroom& __ LL/ Accessory Building
•
No* of bethroonw a2 `"Detached Garage ONE/TWO Car
Primary heating system Attached Oars" ONE w4 Car
Type of fuel 1�1� 1 ' _Private storage building
No* or fireplaces to be installed
Win a wood stove be installed X. + C7threr
Central Air conditioning fir ' '
OV' ER
BUILDING PERNUT -\ PPLIC .XTION CONTINUED
BUILDING SPECIFIC A TIONS.
T} pe of construction, wood frame. fire safe, etc. ►-�'C�`
V%rill any second-hand or upgraded ltim "rbe used ? If so, for what '
Foundation wall material 0 cl� 6 sz 'C Thickness
Depth of foundation below grade (tobottom of footing)
Will there be a cellar ? AM Heated or unheated? /\J p Floor sq. footage ;q ft .
Will there be a basement ?_ es Will any portion be used as living space ? P ) n
(if so, what portion'' sq ft . Type of use ?
Type of roof 42ii at /shed/other :Material of roof___ Pr- s. V) (F ��-
Size, wood studs "x_ ,. " spacing_ " o. c* len t ft .
Joists ( floor beams) 1st floor
.-'"x� '" spaclf3 / �vv "o. c, sparjl s ft.
Joist ( floor beams) 2nd floor"x /��" spacin�'o. c. span
Overlays (ceiling beams ) "x " spacing." O. C. span ft.
Roof rafters "'x " spacing�o. c. span -ft.
Roof trusses (pre -engineered) spacing o. c. span- ya
ra ft.
Exterior wail finish i � Acw 412!!n ov of what material ? rd0.r9
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 garagea �and dwelling?��``' ep If so will a Fire-rated door, enclosure,
self-closing device be provided? _�...
Will a flue-lined chimney be installed?i&L_a Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hrtat th ft. in.
Water supply unicipal rivate well
SEPTIC SYSTEM Distance from ANY private well (including adjoining propertied%/L)- la ft.
(A separate application is necessary for any repair or new installation of septic system)
NAME OF BUILDER ADDRESS +'� ~k' 13ux Tam TEL. NO. Z ( 4s 3
NAME OF PLUMI3ER p4y+DDRESS _ s'rn �! V1x - E TEL. NO. b `� �- (`R Sr
NAME OF MASON C,R �nv rc_c rr► rs " ""A IQ
ADDRESS TEL. NO.
aT `f ~ ; '�`'� + �0
NAME OF ELECTRICIAN 1'>L1i3 Ir liAta" 6' ADDRESS TEL. NO.
DECLARATION
To the best of my knowledge and belief the statements contained in this appl3•= �^ _ _ < <. together with the
plans and specifications submitted, are Ie 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 compiled with, whether specifled or not, and that
such work is authorized by the owner.
3 tore
Owner, awneCs agent, architect, contractor
SPECIAL CONDITION'S OF THE PERMIT:
BYJy
WARREN COUNTY , NEW YvRK
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 Jae
A . Over 16 % Only
1 . Uo value of gross area of walls , roof / ceiling and floors
exposed to ambient conditions
2 . Floor over heat 3 spaces YES No
a . Are foundat 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
1 . R value of roof and floors exposed ambient conditions
2 . R value of exterior wails f
3 . R value of glazed area i
4 . R value of doors 1 L
5 . R value of floors over unheated spaces "
6 . R value of slab edge insulation - unheated slab R ' Jj
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 )
100 Type of insulation � 4 - :n;o -5
C . Controls Cj
1 . Thermostat maximum heat setting
D . Duct Systems
1 . Is duct system installed in unheated spaces ? YES
a . If YES , R value of duct installation ` - --.
b . R value of duct in other areas
E . Piping Insulationr,f
1 . Size of hot *rater or cooling carrying agent piS�¢ {
2 . R value of pipe insulation l 1 M Z )l
F . Service water Heating
1 . Performance efficiency.
2 . Temperature control setting maximum o
G . For Swimming Pool only
1 . Maximum heating
Telephone No . (n Gf` 2�
( applicant ' s signature )
MENNEN
{ aturs of Queenahur i$f�fnxx fe#tttrtstt�tnt
Bay at Haviiand Road* Office Phone 518-793-7771 Ohioan:bury, New York 12801
PAUL H. NAYLOR RfCHARf7 A• f1Al551TA
Superintendent Highways Deputy Superintendent Highways
DRIVEWAY PERMIT
DATE :
APPLICANT NAME : p e L, yj C v c L L7
TELEPHONE NO .
ADDRESS TO BE INSPECTED : S J � ► #9 /G'L is✓ h
RETURN ADDRESS : 1�: S+. S -zG C� '.9 .►aV /1e /` / � �? . r 2 S- 5 �
Applicant lnu t show exact locaticw au4 w�dtjrk. of 4W -V s )
to be con4ect.ed at.o the. highw4wy by. pl&at#lg 44uale� at the
specif:ted locatcEDn
The Superintendent of Highways , Tawn of ,._QUeensbury.. !ic%W_
reviewed the application of the above na. nad resident to
connect, a driveway to the Town road . The fok � cnnti,l^tg aaers
has been taken :
STEP l ; Approval ,
NEED * S2j ght Swai 1
L4�,*Oa1 with The Roar}
( f p Swa i 1
Size Pipe to be used ( if necessary )
( ) 12 " ( ) 15 " ( ) 18 " ( ) 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 of highways
Town of Queensbury
TOWN of QULENSB UR Y
APPLICATION FOR
SEPTIC DISPOSAL PERMIT
DATE
LOCATION OF PROPERTY FOR INSTALLATION (> r
Owner's Name: {7j: Z 0" W A-QL D-e y . �Zh e, a Telephone: 4P `'4 Z- 1 ` 3 5 "
Address: �1� - C77t � + l�q rru L Le ls�j '�i .
Installers Name: 12 Ar Y1 0 1 �� `e + � '� � 0 n A Y t't Telephone:
Number of bedrooms (residential only) 4
Total daily flow (compute Cd 150 gal per bedroom) L� , G�-�-
Topography: Circle one: Flat Rolling Steep Slope %
Soil Nature: Circle on San Loam Clay Other / Depth: ,�"�CT`� Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle on not require required rate min. inch.
Domestic water supply: circle on^ - es 1unz sc pal Well Other
If domestic water supply is a we
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank 16--" gal. ( minimum size: 1 . 000 gal. )
TILE FIELD : Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used #.L/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 Dispa ~ � O�rdinance.
SIGNATURE OF RESPONSIBLE PE
R
SON:
DATE: V 'Z• ~F z L 5' <?
OVER
Septic System Inspections :
A . all applications for septic system Installation , alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage Ordinance , small
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 ,
rile fields and /or drywells
B . No system shall be covered before inspection and approval by the
auilding Inspector . Failure to comply with this requirement may
result in the uncovering; of the system by the installer and a fine
ui 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
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
li�m,, rks .
pil
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAV,rLAND ROADS
QUEENSBURY, NEW YORK 1280&
TELEPHONE (51e) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST R IN PECTION REC IVED �--
NAME
LOCATI
DATE PERMIT
APPROVED
YES NO
,t
FOOTING/PIERS
MONOLITHIC POUR OOFING
FOUNDA'PIONI AMP-
BACKFILL APPROVAL
FO-UIGH PLUMBING
RAMING
ELECTRICAL ROUGH^I
INSULATIONZ
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT ,
ROOFING
SIDING
EXTERNAL PORC ES/ST S
ST.AIRS-CLEA CE & �r'S---�-�'
PLUMBING FIX RES/RE EF VALVE
INTERIOR TR /'PRIVAC DOORS
FINISHED F RS
GARAGE FIR ROOFING
DOOR CLOSE (S)
SMOKE DST TORS
FINAL ELEC ICAL INSPECT ON
FINAL APPR AL OF CONSTR TI
OK TO is C/O OR C! C �...- -- .
A SIGNED ERTIFICATE OF UPANCY MUST BE
OBTAINED ROM THE grjTILDIN DEPARTMENT BEFORE
THESE PR ISES ARE OCCUPI !
REMARKSz
I SPECTOR
9Cir] ' pN. AGENCY, INC.
MIDDLE pEPARY'M U
75�t -V IMSPEcr, aat% Marckf 23 , 1990
`� approved as being in accord
c�eCt {f[ Cg that th 'eie9trjea'', equipment listed has been ex e $ S.
with the National Elects Q Cg ie• appocabie ,governmgrltal , utility and
A & Z Develo a *
pWrfer: , r r t■d rhrs
Single Farni t uaen§ 87� � r t uipn■M ■uad or A1161 ac
Occupant: yicy s ceryhcate be lnrraduC+d or allar■hona made to
i,o t 7 ii i, iCi 6I1 iii 1 ii : date. If adairionar u ■� ah bo null d void. and applical on Tar
�,ocatlQ0: existing system thi rr�tt��I tr tothisNPrWy-
. - -F i xture8 ; inspection snoufd au6tr+af D Y n insurance realer
/; n .R,eC @ 1]t`,. c l e s f � order of this ce llcate ■ td nt x.me of !dx pr'OPa Y
'i'itt ertiticatlon of eleCrric■IaRu;prtttane aPPro�+sd
Equepment: 2 <.i�pli�nces A ' as5pinred,, vlaxari
",,ZJi.} tiiiif> SeYV i! ! ..a as specitlea.�.'
� 13 J~jarIow ,y 3 f tt $ tIb EEL s .. Q .
Riz2 , Bax ? 12i ,. -. 15 -03178[)
Lake: Luzerize , i� 1�
. r
Fnrrn Vae, 7117 F.l 1-13
TOWN OF QUEENSBURY
BAYL&I XA7 AND CODES[7ILAND ROADSEPAR'I'MEN'I' 11
QUEENSSURY, NEW YORK I280k
TELEPHONE (5].S ) 792-59- 32
BUILDING INSPECTOR, S REPOT C
REQUEST R rNSPECTJ RECETVED�
L
NAME
LOCATXON PERMIT #
DATE APPROVED
YES NO
FOOYTXNG/PIER.S
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING��
BACKFILL AP VAL
ROUGH PLLTMSI G
FRAMING -IN
ELECTRICAL ROU
INSULATSON:
FOUNDATION��
FLOORS
WALLS
CEILING
(FINAL INSPBCTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTISRNAL PORCHES/STE STAIRS-CLEARANCE TLSEF VA VE --
PLUMBING FXXTURES/ R
INTERIOR TRIM/PRIVA Y DOORS �- Y
FINISHED FLOORS
GARAGE F'REPROOFTN
DOOR CLOSERS)
SMOKE DETECTORS
FINAL ELECTRICAL rN PIN
k'INAL APPROVAL OF C NSTRU
O dR /'C �� �
OKOF TO ISSUE C/ --�
UPANCY MUST BE;
A SIGNED CERM THE UILDINC DEPARTMENT BEFORE
OBTAINED FROM OCCUPIED!
THESE PREMISES AR
r
REMARKS: 1, 00 --
F l
rNspECTOR
TaWN of {�[jEEt+1SBURY DEPARTMENT
CODES
=LDI G AND ND ROADS
BAY E& VLW YORK I28Q
STELEPxONE (5I8 )SBURY. 792-5832
Tsr.
WILDING INSPECTOR' S REPORT
N ItECEIVED
REQUES
FOR INSPECT
NAME _
LoCATIO PERMIT #
PATE APPROVED
Y,ES NO
FOOTINGIPXERS
MONOLITHIC POURFING -- --
�NDATXONIDAMP
BACK
F'XLL APPROVA
ROUGH PLUUMD-rNG
FRAMING L ROUGH N
ELECTRXCA
XNSULATXON:
FousDATION
FLOORS-
WALLS
f} CszLZNc
rNAL INSPECTION :
" } CHrzmxy H:vxGHT
SIDrNG���� TEPS
EXTERNAL PORCHB RAz1
STAIRS-CLEARANC LXEF VALVE
PLUNKING FIXTU IRE
AC Y DOORS
INTERIOR TRIMI ;3
FINISHED FIE CA) �-
GARAGE
I R;S FIDOOR
SMOKE DETEC S
FINAL ELECTRIC L IA75P TION
FINAL APPROVALOOF CONS UCTION
ow To x SSUE G If Q OR C/C
A SIGNED CERT��rFTCATE UPANCY MUST BE
OF
C
OB'7'SE PRE tjED FRO STARE OCCUPI D DEPARTMENT 81RFORE
THE
t7
RElyAE2KS : /# C1�`+
,4 4 p o I4 l G '
i
,
PaiRzvF ► f
INSPEC N
BUILDING and ZONING DEP49TMENT
Bay and Hai+land Road, R.D. 1 Box 98
aueensbury, New 'York 12801
BUILDING INSPECTCIR ' S REPORT
NAME
LOCATION Q ,�
Date +�'- ��
Permit NO
APPROVED - YES NO
Footing/Pier Fo s
Foundation
Waterproofing
Backfill
Framing
Roof ing
Siding
Masonry Veneer
Rough plumbing
Relief Valves
East . Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg . Fixtures �-
Gar . Fireproofing
Door Closers �----
smoke Detectors
Chimney
V' SULAT1ON
roundation
Floors
Wails
Ceiling
FINAL. ELECTRICA INSPECTIGPN
DRIvEwAY AT}PROV
Final Building , urvey
L3exC schedu] e inspection (call wlhe �I{ydY )
Remarks- �y.�`+ � �� //•��
C) +{ 4
Building spector
6/86 and-vl
-701vn 01
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12aO1
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME.
Lf .dam
EOCAT I ON
DATES PERMIT N4 .
SOIL TYPE S n Loam clay - �---
Percolation Requirtnch
? YES - NO
Percolation ra e - MinI
TYPE of SYSTEM:
Absorption field tot 1 length
Length of each tr nch
Depth of t,Yenches
Size of ,;ravel
SEEPAGE iT ITS-(Nurnbe f)
Size- &.ft* X t .
Gravel size Size TY,�,'e
PIPING : ff✓✓
Bldg * to tank r
Tank t4 (list . box y!
Disto boD. to field/ it Partial
openings sealed? ES NO
LOCATION/SEPIONf ft,
Foundation to tank
Foundati.an to absc tiara ft.
Absorption to lot ine
Separation of pits
ft .
'CATION OF SYSTEM ON PROPERT(circle one)
prt Rear - Lef t� side Rig
C-III[TS
1
1
'SYSTEM USE RPPRC7C1E1] ES
NO
Suit ing Inspec r
i
i
'. 01/86 and vl
TOWN OF +QUEENSBURY f '
,BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROAD'S
QUEENSBURY, NEW 5$ ) YORK 9 128 04-
TELEPHONE
BUILDING INSPECTO R' S REPORT
REQUEST FOR INSPECTION RECEIVED ��_,�
NAME G~--
LOCATION
DATE [} PERMIT #
APPROVED
YES NO
FOOTING/PIER
MONOLITHIC R FORMS
FOUNDATION/D P-PROOFING
BACKFILL, APP VAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUG -IN
INSULATION= [
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/S PS
STAIRS-CLEARANCE &
PLUMBING FIXTURES/RE EF VALVE_
INTERIOR TRIM/PRIVAC DOORS_`___
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL IN PECTIO
FINAL APPROVAL OF C NSTRUCT
ON
A SIGNED CERTIFIC E OF OCCUP CY MUST BE
OBTAINED FROM THE BUILDING TMENT BEFORE
DEP
THESE PREMISES A OCCUPIEDr
REMARKS-
INSPECTOR
i
_70usn vj 'Queensbury
BUILDING and ZONING DEPARTMENT ■-t
Bay and Haviland Road, R. D. 1 Sox 98 I III
Queensbury, New York 12801
S C DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
DATE / 11Z-1 PERMIT NO.
SOIL TYPE - S nd - Loam - Clay -
Percolation T st Required? YES - NO
Percolation r e - Min/Inch _
TYPE of SYSTEM
Abs;orPtian fief total.
Length of each
Depth ench � �-
Si of 'gravel
SEEPAGE )?ITS-(N r of)
Size- ft. X _ ft.
Gravel size
PIPING . Size Type
Bldg . to tank ��
Tank to tlist . box
Di st. boa: to field/P t
Openings sealed? Y S No Partial
L,OCAT I ON/'SEPARAT I ON S
Foundation to tank �-ft=�"
Foundation to abscrp ft .
Absorption to lot 11 a ft .
Separation of pits ft.
LOCATION OF SYSTEM PR PERTY (circle one)
Front - Rear - Le side - Right side
COMMENTS
Coo
SYSTEM USE ,APPROVED YES NO
[�+ / Huxlding ns ctor
I - d '
O1/86 and vi
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
DAY & HAVILAND ROADS !J/`1►
QUEEN.SBURYo NEW YORK 12809E
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
j REQUEST FOR INSPECTION RECEI D__�_
NAME
LOCATION � y
DATE PERMIT # 1 - �
APPROVED
YES NO
FOOTINGIPIERS
MONOLITHIC PO FDRMS_
FOUNDATIONIDAM -PROQFIN - ----
BACKFILL APPRO AL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROU H-IN
: el�SULATION:
FOUNDATION
FLOORS
WALLS
CEILING r
FINAL INSPECTIO
CHIMNEY HEIGH
ROOFING
SIDING
EXTERNAL FO HE (STEPS
STAIRS--CLEA NC � RAILS
PLUMBING F XTURE IRELSEF VALVE
INTERIOR T IMIPR ACY DOORS
FINISHED LOORS
GARAGE F EPROOFIN
DOOR CLO ER (S)
.SMOKE D TECTORS
FINAL EZE TRICAL SNSP TION_
FINAL AP ROVAL OF CONS UCTION
A SIGNS CERTIFICATE OF CUPANCY MUST BE
OBTAIN FROM THE BUILDS DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPS
REMARKS:
3 ,
1 + ,
S SPECTQR
,x r
Or -6ti 4
� � 5-. 75
ylh�eadquatersr '
9U0`Flaiitlori Ave
.. GFollingswood, IV.J. 013138 _
d.
E)ate 000,
00
,•�1 .. -! k't .i i S" j$• -fig �R ._
l .......,s' 7 3. County' Of
.pR
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Water Heater
R.eceptaCFes _ Air Candi-tigner _ . I'3t7+er ' LAD
: p4rt
lWum Owen . . w - _ _ [#asbage Disposal, -Wiring and lContrsyia for Burner
" , Ix Reaeptae .. II _fractional H.P. Vent Fans _
- . : Other Equipment.
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of Eacle Size j'.
Applicant's -
Snaturs
Tiigna License # ' `
UtiI.EY
Applicarrt'a ress _
(City) c
: IState) Lli�f�-r" — Service Request #
� .
yr,• .. T
;f4CiIVED:' DATE INSpgL'`�1'tt) . '
Correct L x e as Above or:
Red Notice _ ,; . - _
Rio. Wiring Outlets Surface Unit_ Qvpn'
SpM Ran ti - b . r ;
Race 6es Water H tar: Via. a ..
Fixtures Cll Condl iiil7t+ - - • .- w. '. ., + <. : .
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A Service IEqui ment Burner, Wi n BrCCt►htfols for qm ti .: '- .
Amp. Service ConduC;org Pum _ qi'
MOTQRS H,P, 1/20 S/I2 1/1P /8 l 1f4 t/S 1 3/ T4s . '1 -'is, ae: P$
hftrk Number
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Date Or r
OIL
Or
APPUcATIt)i�l' ircSltSui '+: ., ..r... .-. . .. a�..x;. .a .t.� ; .r _
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS 161H
QUEENSBURY„ NEW YORK 12809-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST F INSPECTION RFsCEIVED
NAME % \\
DATE ' F IT #E F �7 7
APPROVED
YES NO
FOOTING/PIER
MONOLITHIC R FOy
FOUNDATIONI P—PR ING
BACICFILL APPR AL
ROUGH PLUMBING
FRAMING
ELRCTRICAL ROUG N
NSULA TION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPEC ON:
CHIMNEY- HE GHT
ROOFING
SIDING
EXTERNAL RCHES'fST S
STAIRS—C ARANCE & LS -
PLUMBTN FIXTURES/RE. F VALVE
-ENTERIC] TRIM/PRIVACY RS
FINISH D FLOORS
GARAGE FIREPROOFING
DOOR LOSER (.S)
SMOKE DETECTORS
FINAL ECTRICAL INSPECTION
FINAL PPROVAL OF CONSTRUCTION
A SIG ED CERTIFICATE OF OCCUPANCY ST BE
OBTAI p FROM THE BUILDING DEPARTME BEFORE
TFIESE PRE ISES ARE OCCUPIEDI
REMAR S
G
INSP TOR
TOWN OF QUEENSBURY
BUILDING AND .CODES DEPARTMENT �11
DAY 6 HAVXZAND ROADS
QUEENS.BURY, NEW YORK 1280%,
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED _
NAME � - t �
LOCATION `
42
DATE PERM # ^��
APPROVED
YES NO
FOOTINGIPIERS
MONOLITHXC POUR FORMS
FOUNDATION/D.,MP-PROOFI4VG
B4OCKFFLI, APP*VAL f
IkKOROUGH PLUMBI
FRAMING
ELECTRICAL R GH-IN ;`
INSULATION: �:
FOUNDA TSON
FLOORS
WALLS
CEILING
FINAL IN.SPECTI
CHIMNEY HEIGH
ROOFING
SIDING
EXTERNAL PARCH STEPS
.STAIRS-CLEARAN E & RAILS
PLUMBING FIXTU ES/RELTEF VALVE
INTERIOR TRIMf RIVACY DOORS
FINISHED FLOUR
GARAGE FTREPR FING
DOOR CLOSERS)
SMOKE DETECTO
FINAL ELECTRTCA INSPECTION
FINAL APPROVAL CONSTRUCTION
A SIGNED C'ERTTF ATE OF OCCUPANCY MUST BE
OBTAINED FROM T BUILDrNG DEPARTMENT BEFORE
THESE PREMISE'S A E OCCUPIED!
REMARKS:
�" ,ti �' ►�' lac"'l�1 ''�'
Z f �2_ �"
I A PEC OR
TOWN OF QUEENSBURY � s �
BUILDING AND COPES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 1280!9
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR XNSPECTtQN RECEIVED
NAME _
LOCATION •- r
DATE PERMIT if
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR ORMS
FOUNDATION/DAMP- OOFING
BACKFILL APPROVAL
R UGH PLUMBING
400FRAM.rNG
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHXMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHESISTE
STAIRS-CLEARANCE &
PLUMBING FIXTURES/ ELI F VALVE
INTERIOR TRSMIPR2V CY OORS
FINISHED FLOORS
GARAGE FIRE.PROOFI G
DOOR CLOSERS)
SMOKE DETECTORS
FINAL ELECTRICAL NSPECTrO _
FINAL APPROVAL O CONSTRUC ON
A .SIGNED CERTIF CATE OF OCCU NCY MUST BE
OBTAINED FROM T E BUILDING D ARTMENT BEFORE
THESE PREMISES RE OCCUPIEDf
REMARKS: � } t�r•'j..r �'��`ti'[' -
kTT�OR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & fi"AVILAN ROADS
$
QUEENSURY, NEW YORK 2280$.
TELEPHONE (518) 792-5832
BUILDING INSPECTORTS REPORT
REQUEST FOR XNspECTXONCEIVED -
NAME
LOCATION
DATE � - r ` PERM # -
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC R FORMS
FOUNDATION/DAM -PROOF NG
y.-ACKFILL APPROV
ROUGH PLUMBING T
FRAMrNG
ELECTRICAL ROUGH-I
INSULATION:
FOUNDATION
FLOORS
WALLA
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/ST S
STAIRS-CLEARANCE & ILS'k'
PLUMBING FIXTURES/ ELrEFALVE
INTERIOR TRIMjPRIV CY DOO
FINISHED FLOORS
GARAGE FIREPROOF NG
DOOR CLOSER (S)
.SMOKE DETECTORS
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL O CONSTRUCTION
A SIGNED CERTI CATE OF OCCUPANCY MUST BE
OBTAINED FROM HE BUILDING DEPARTMENT BEFORE
THESE PREMISES RE OCCUPIED.!
REMARKS ,
f/ .r7 �r y i► ., i j n / , ' ] ,y///
�l c�
INS TOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORX 128ok
TELEPHONE (518) 792-5$32
BUILDING INSPECTOR ' S REPORT
REQUEST FOR XNSPECTXONAECEXVED
NAME
LOCATIO'N ,.: A �
DATE' �/� Y� /� �r�PERMI�T #
,APPROVED
YES NO
k`fOOTING/PIERS . _
MONOLITHIC POUR ORMS
FOUNDATION/DAMP-PROOF-rNG
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-_TN
INSULATION_
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/S PS
STAIRS-CLEARANCE RAILS
PLUMBING FIXTURE RELIEF VALUE
INTERIOR TRIM/ VACY DOORS
FINISHED FLOORS
GARAGE FIREPR FING -
DOOR CLOSERS
SMOKE DETECT�S — —
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION S
k
A SIGNED CER'T±FICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIEDI
REMARKS:
d 40
NSPECTOR -
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
SAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 32804- /
TELEPHONE (528) 792-5832
133I LDI NG INSPECTOR ' S S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION
5,5
DATE ,I�/- �/? PERMIT cot
APPROVED
YES NO
DOTING/PEERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUG -XN /
INSULATION: f
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING e
EXTERNAL PORCHES/STEP
STAIRS-CLEARANCE 6 IA
PLUMBING FIXTURES/ L-TEA VALVE
INTERIOR TRIM/PRIV CY Dp RS
FINISHED FLOORS
GARAGE FIREPROOF NG
DOOR CLOSERS)
SMOKE DETECTOR _
FINAL ELECTRICA INSPECTION ---
FINAL APPROVAL F CONSTRUCTIONS
A SIGNED CER FXCATE OF OCCUPANCY IOJST BE
OBTAINED FRO THE BUILDING DEPARTMENT BEFORE
THESE PREMXSE'S. ARE OCCUPIED!
REMARKS:
00 _ ,�,
SNIP CTOR
.. Y
!�! . MMPN
National I.leadquarte rs
t t : Date: !r �7
.s
IV
County4#R tQ State . f .
Cityw Town or Township _ 3 -
L¢c$tion/Address
(If Located in Rural Area Please Attach. Directional �r yPoie #y y R^— T
Owlier sIN I.- .. t �✓ ? . IB'vr - .`OIdO
Occupi
n.�,l 8.e �+. i ► ' '' ' I"I �k ,.�.�: Ititn7l . . ,
I� i4rea in Buiidin Floor iF e2c l
Read . for InS eLlon:
Appofor: Wirin Sarwee or: f lake P 'abl�f 10: IIR D.IA .
Fee Ramltted"". " . Ca . Check ' '
.. Cash j , • . , . Eiao soap t
'Tse E¢e TC1Pa ITSa EilaD ' ,- '
Number of Rough Wiling 4yuteCa Elect. Heat .`•
Switches Tf Dishw86t7@r, Range .-
Unit _
' Amp. SerSi �— r, 4, 1:pump
Lighting , Water. Heater At�ditDb:Fler Dryer . . —
Reoepiacies ( Dislmsa +n�ofor
umber i —� " . r ion l „ Ong
MOTORS H P. J i1 lfa iffi If2 3f4 ii'h 2 3 5 - Tsh` !10 1520 25 30 40_
Mark Number
of Each Size
"� es<w l3 ' a ?.ta
ApOicant's
Signature �'. . _ : i_'»" rY_`.�.w:,..•." it a i."'.w'3:g ,
T/A : NA
Applicant'S Address: Service Fiequegt
,.y. ... Y
(City) •. '"j`- (Stag . r ._ ;-3'S. .� ,� T '^;'r�•
Phtxaa -
a1 • ` 4 lectrician :
ISATE I NSP ELvT :
A'IYICTt R£+CEIVIED.
Correct Loco# on: Same as Above [] or: k.
�;+ f
Red Notice Lakiel
• Rau Wiring Adu7ors
Surface Unit w
SwitchesRan
ReceptaclesWater Heater . -
Fixtures
llir C.onditi nor" r
Amp. Service Burner, Wlri &'Controls for apt'
Burn a Vent Fans H
put+ . Service S , •
20 1/ lf2 /4 -
Mark NRµrr�klar s + k
Y
of Each Size
'Y. SOa 1100
Elect. ,Heat _
s_i. .Ya . �.• . y _ .. -
7/A
Progress: Inc, 0 L1CD 'k. gontractor
Violation : Work Comp. Q i+tc- � Owner CASK. .
, , Fee CHIC
IVIQDue 11MV nt. 4 . -Other Si dB �: � .a
jL
Cut n Card
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- APPLICATION FORM NO. 250 'EL:'4)C $+
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