1989-880 � I
4CE`.R rnFICA.TE OF C]CCUPA MCNON
II
TOWN OF QUEENSBURY i
� I
WARREN COUNTY, NEW YORK i
Au June 19 19 90
I
This is to certify that work requested to be done as shown by Permit No.
has been completed.
� This structure may be occupied as a .II_addition
Loc
„r;,p„ Susan Place
Chvner Gerard A Cynthia Nudi
� 13y Order Town Board
TOWN OF QUEEN8SURY
I
� Director of Bldg, do Code Enforcement
I
I
BUILDING PERMIT
TOWN 4F QUEENSBURY No. 89-880
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to N[InT , 13FRARIA CYNTHIA �
w
OWNER of property located at Al Slfcan Place Street, Road or Ave, C74
in the Town of Queensbury, To Construct or place a n addition _
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
RD #5 - Box 50A
Queensbury, NY
2. CONTRACTOR or BUILDERS Name v
r
M
rr1
3. CONTRACTOR or BUILDER'S Address
me
C7
2
4. ARCHITECT'S Name —I
OC
H
5. ARCHITECTS Address
6. TYPE of Construction — (Please indicate by X) 00
(x ) Wood Frame { ) masonry { I Steel { )
AE
7. PLANS and Specifications
No. 18 ' x 16 ' addition as per plot plan , application and specifications . rrn
B. Proposed Use
Addition
$ 94_ 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 1 19X90
0
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the pow*
town of Quaensbury before the expiration data,) �
Dated at the Town of Queensbury this Day of November 1969
SIGNED BY for the Town of Queensbury
wilding and Zn n iNvI nspector
TOWN OF QUEENS13URY
4et
REVIEWED BY . J TOWN 01,E E UEL7 SBIjRY
FEE PAID #�
PERMIT NO. � J
ClV ' 79RO
BUILDING PERMIT APPLICATION BLDG_ & COD€ 1)
EP7r
A PERMIT MUST BE OBTAINED BEFORE BEGDCNMG CONSTRUCTION. NO INSPECTIONS
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.
The owner of this property is: v'
P.O. Address Tel
Property Location Tax Map No. ! %3/ S'� - 6P
Has there been any split of this property since October I . 1988 ?
If yes Planning Board Review is necessary. yes no
SUBDIVISION NAME, IF APPLICABLE LOT NO. r
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
NATURE OF PROPOSED WORK: * ESrIMATED MARKET VALUE OF
S
Construction of a new building w CONSTRUCTION:
Addition to a building " COMPLETE INFORMATION REQUIRED BELOW:
" Size of property ft X14 ft.
Alteration to a building /
(no change Existing Buildings( 3 ) Size 3a ft. x `�` ft6
nge to exterior dimensions?
Other work (Describe) Proposed building - distance from property line:
Front yard _ f ft . Rear yard f ft.
w
Side yards 3S' ft. and ,� S' ft.
wON
GROSS AREA OF PROPOSED STRUCTURE If on corner, setback from: side street ft.
1st Floor j � sq. ft. # OCCUPANCY INFORMATION
t
2nd Floor sq. ft. * Primary Building -
OthMer Floors sq. ft. . VLOne Family Dwelling
(not cellar or sasemeennt)OO" Two Family Dwelling
TOTAL FLOOR AREA 31�sq. ft. " Multiple Duelling/Number of units
Size of new structure- y ft x eft. " Business
Foundation--pierlsia Industr
blcrawl/parts full
*' ial
(circle one) • Other
No. of stories (habitable space) MOONS
Height (grade to ridge) ft. „ If addition, what will use be.P.
If residential, no, of families! :
No* of rooms(*Xcluding baths) _ • MONO
Accessary 8uildillg
No, of beedreao�ns " � Deetacherd Garage ONE/TWO Car
No. of bathrooms •
Primary heating system__ 'GsGr,-1"+o�frG _Attached Garage ONE/TWO car
Type of fuel " Private storage building
No* of fireplaces to be installed "
# Other
Will a wood stows be installed
Central Air conditioning
OV* ER
BUILDING PERMIT ,-� PPLICATTON C0 4TI ` UED
Bf_' ILDfNC �PFCTFIC _3TIONS=
Tope of construction, wood frame, fire safe. etc. pp 00 � 3
Will any second-hand or upgraded ltimberbe rased? if so, for what ? c3
Foundation wall material p ,,�e'e� _Thickness ' c�
Depth of foundation below grade (to bottom of footing)
Will there be a cellar ? Heated or unheated?
Flour sq. footage sq ft .
Will there be a basement ? Will any portion be used as living space:' c
(If so, what portion ? sq ft . T�e ?f use ?
Type of roof - Io /flat/shed/otherR�fr,` Material of roof
Size, wood studs "x " spacing " o.c* length ft.
Joists ( floor beams ) 1st floor 22 - x / 93R " ;pacing 'o. c, span Iry fi ft.
Joist ( floor beams) 2nd floor."x " spacing "o. c, span ft.
Overlays (ceiling beams ) r'x " spacing " o. co span ft.
Roof rafters "x " spacing o. c. span ft.
Roof trusses (pre-engineered) spacing r✓ a Y-ko,:cspan ft.
Exterior wail finish 1/f of what material?
Interior wall finish ,T G 6w, y� +
4
If a garage is to be attached, describe materials to be used for FIRE SEPARATION.
Is there to be an opening between garage and dwelling? If so will a Fire-rated door, enclosure,
self-closing device be provided?
Will a flue-lined chimney be installed? Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in,
Water supply - Municipal or private well
SEPTIC SYSTEM Distance from ANY private well (including adjoining properties ft.
(A separate application is necessary for any repair or new installation of septic system )
NAME OF BUILDER_, DRESS TEL, NO. ' S 5 •G' �
NAME OF PLUMBER <' _ADDRESS TEL, NO.
NAME OF MASON.--_ Gio� "y�iu -�-� ADDRESS TEL. NO. 6�>,�2 rs'� •�
NAME OF ELECTRICIAN( ADDRESS TEL. NO. 3 S �
DECLARATION'
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 donee on
the described premises and that gill provisions of the BUILDING CODE, THE ZONING ORDINANCE, and
All other laws pertaining to the proposes! work shall be complied with, whether specifled or not, and that
such work is authorized by the owner.
Signature
wrier, owner's agent, architect, contractor
SPECIAL CONDITIONS OF THE PERMIT:
BY
WARREN COUNTY , NEW Y3RK
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 ': i �;% .' 57
2 . Type of heat IEFI/ +fic. S�YSOA
3 . Is the building mechanically cooled ? .zc�)
G
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 Cl C.c.)Ac) /�/' -Rn
2 . Floor over heat - 3 spaces YES ,.�--�
a . Are foundat on walls insulated ? C NO
1 . If YES , what is the R value ?
3 . Slab on grade YES
a . If YES , wh . t is the R value of insulation around
perimeter of floor ?
4 . Is basement heated ? YES (_.N-
a . R value of insulation /
5 . Type of insulation
B . Under 16 % Only
value of roof and floors exposed to ambient conditions .
2 . R value of exterior walls
3 . R value of glazed, area g �
4 . R value of doors
5 . R value of floors over unheated spaces
6 . R value of slab edge insulation -m unheated slab
7 . R value of slab insulation - heated slab
8 . R value of heated basement/ cellar walls ( above grade )
9 . R value of heated basement/ cellar walls ( below grade )
104 Type of - insulation �-
ce Controls
1 . Thermostat maximum heat setting 7.5
D , Duct Systems
i . 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 . Peiping Insulation
VMM
1 . Size of hot water or cooling carrying dyw .. L� pipe
2 . R value of pipe insulation_
F . service water Heating
100 performance efficiency
2 . Temperature control setting maximum /4- y
G . For Swimming Pool 0nIY r
1 . Maximum heating r Iry
Telephone No . 3 9 4 '77G-? v- •�
"" ( plicant ' s signature )
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURYo NEW YORK I2804-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S ORT
REQUEST PC) INSPECTION RECEIV
NAME
LOCATION
DATE A PERMI # �
APPROVED
YES INO
FOOTING/PIE
MONOLITHIC R FORMS
FOUNDATION/D -PROOFING
BACKFILL APP AL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROU -IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
,,FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/ BPS
STAIRS-CLEARANCE & RAI
PLUMBING FIXTURES F VALVE
INTERIOR TRIM/PR Y DOORS
FINISHED F _
GARAGE FI ROOF NG . ............................................_............
DOOR C SER (S)
SM DETECTORS
F L ELECTRICAL NSPEC ION_
INAL APPROVAL O CONS T CTION
OK TO ISSUE C/O C/C
A SIGNED CERTIF ATE OF CUPANCY MUST BE
OBTAINED FROM T E BUILDIN DEPARTMENT BEFORE
THESE PREMISES RE OCCUPI l
REMARKS., \4=,!>I°kcle L..,L.- 4 JlP
0�ko L
cwrl
t�s
ARRIVE
DEPART
ONSPOECTCOR
TOWN O 94?-3
QUEENSBTJRY qe-s u .-ee .4L Corti c/t�
BUILDING AND CODES DE'PARTMENNT
BAY & HAVILAND r4OADS 6gtt .6E , oef
QUEEMSBURY, NEW IYORK I280&t
TELEPHONE (518A 792-5832
BUILDING INSPECTOR ' S REP T
1
REQUEST FOR INS ,ECTION RECEIVED
NAME
LOCATION
DATE PERMIT
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR ORMS
FOUNDAT.£ON/DAMP I200FTNG
BACFGF'ILL APPROV L
ROUGH PLUMBING E
FRAMING
ELECTRICAL ROUG .tN
INSULATION:
FOUNDATION
FLOORS.
WALLS
CEILING
((FINAL INSPECTION
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE STEPS
STAIRS—CLEARANC & RAILS
PLUMBING FI]CTU /RELIEF VALVE
INTERIOR TR.rml ACY DOORS ,ry
FINISHED FLOG
GARAGE FIREPR FIB -
DOOR CLOSER ( .!/I
.SMOKE DETEC RS
FINAL .ELECTRIC L INS TION �
FINAL APPROVA r OF CoN TRUCTION * —
OK TO ISSUE C O OR G/ j'
A SIGNED CER IFICATE O OCCUPANCY MUST BE
OBTAINED FRO THE BUILDNG DEPARTMENT BEFOR
THESE PREMI S ARE OCCU ED?.
'ssur C
REMARKS:
r] v v veFT x) I Al 5v 600—z'() j4J Q is s L— r�5 -
C r,,-G C- i�v l $�/� cc) A 0/� J'J
U � 5 P A-ct I+-F19 P4
ARRIVE
DEPAR
I PEC TOR
THE NEW YORK BOARD OF FIRE UNDERWRITERS
- BUREAU OF ELECTRICITY 1
41 STATE STREET, ALBANY. NEW YORK 12207
Dates . ; . I ! j Applica�(t"ion .Vo..[oo fife
THIS CERTJFIES THAT V A (J ✓only the eisctrical equipment ae described below and Introduced by the a pplicarst Esa++serd on the above appiscaEtoer n lAmber irl the pre+nises
of
+TI�k1+..� N�1Y1L . l4 •S11SlI�, �..' ' Q �'�` N
in the following location; LJJ $nsernent I_1- 1ya�t /w'1. ❑ 2red Fl. Section Block Lot
was examined on MWG lei , ti4
1� and jaa.,Kd to be in compliance with the requirements of this Board.
lqx
OUTLEMTS ECEFTACLES SMrITCHRS FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST TAMS
INCANDESCENr MOORESfiEN? OTHER AMT. K. W, AMf, K. W. AMT,
K-w. AMT.
# A
DRYERS MRNACE MOTORS FUTURE "ftIA►tCII FEEDERS SFECtAL RIIC'FT TEME CLOCKS Epi, UNIT HEATERS MULTI-OUTE:Ei E,�r AMT, K. W. oft H. P. GAS H. P. AMT. NO, A. W. G. AMT. AMP. AM7, SYSTEMS
AMPS. TRANS, AMr. H. P. NO. Oi FEET �T- WATTS
SERVICE DISCONNECT NO. S E R V I C
AMT. AMP. 7vfIE maTERRii{EIP. 1 .E" 2W 10 3W 3 Jr SW 9 / .Iw NO. Of CC. COND, A, W, G. E
PER .E" Of CC. COND. NO- Of HPAEG Op"IN LEG NO- OP NEUTRALS A. W. G.
OF NELITRAI
OTHER AMARATUS:
ftafl.0 Fa-1
m%2— K.W_
W1+* t%m% OIL - L BRANCH MANAGER
PC
This certificate must not be ahersd in any manner, return to The office of the Board if incorrect. Inspectors may be identified by Their credentials.
— COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED 1N ANY MANNER.
TOWN OF QUEENSBUR'Y
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSEURY, NEW YORK 1180mL Ao
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST R NSPECTIO Rl; 3 VED_. 2E- - +-`=-•.'._NAME
LOCATION ; 7
DATE Pj� RMIT #
1 APPROVED
.YES NO
FOOTINGjPIERS �
MONOLrTHIC POUR ORM
FOUNDATION/DAMP- ROD ING
BACKFrLZ APPROVA
ROUGH PLUMBING
FRAMING
(� ,ELE'C2 RrCAL ROUGH-
(( xNSULAT-roN:
1 FOUNDATION
FLOORS
WALLS
CErLING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SrDING
EXTERNAL PORC S/S PS
STAIRS-CLEARA CE & ILS
PLUMBING FIX RES/R LIEF VALVE
INTERIOR TRI PRrVA Y DOORS
F-T NISHED F S
GARAGE FIR OOFING ..
DOOR cLOSER ( -
SMOKE DETECT RS -'�--
FINAL ELECTRIC L INSPEC _ OJV --�-
FINAL APPROVA OF CONST CTION
A SIGNED CERT F.ICATE OF MUS_ T BE
- -
OBTAINED FROM THE BUILDIN DEPARTMENT BEFORE
THESE PREMISE ARE OCCUPI r.
REMARKS:
x
r pL s
. >T
SPECTOR
TOWN OF QUEENSBURY
BUILDXNG AND CODES DEPARTMENT
I3AY & HAVILAND ROADS
QUEENSBURY, NEW YORK _Z280g
TELEPHONE (528) 792-5832
BUILDING INSPECTOR ` S REPORT
REQUEST FOR INSPECTION RRCEIVED
NAMEJ.__ D
LOCATION ! —J V
DATE /r t / t{rl PERMIT #
APPROVED
FOOTING/PIERS YES NO
NONOZXTH2'C POUR FORMS
FOUNDATIONJDAI yP-PROOPTNG
BACKFILL APPROVAL
ROUGH PLUMBING
,^',FRAMING
ELECTRICAL ROUGH-XN
INSULATION.
FOUNDATION
FLOORS
WALLS
C.EXLING
FINAL IJVSPECTXoV.
CHIMNEY HEIGHT `
ROOFING r
SIDING
EXTERNAL PORCHES/S EPS
.STAIRS-CLEARANCE 6X
PLUMBING FIXTURES/LIEF VALVE
INTERITOR TRIM/PRI VA�.'yr DB0FoRS
PXNZ'SHED PLOORS
GARAGE FIREPROOFINGi
DOOR CLOSER (S)
SMOKE DETECTORS -',--
FINAL ELECTRICAL INS a
FINAL APPROVAL OF Col.VS 2UCTXON
A SIGNED CERTXFICATR OF
OBTAINED FROM THE CUPANCY MUST BE
�UILDXN DEPARTMENT BEFORE'
THESE PREMISES ARF, OCCUPIE�Dt
REMARKS.
� 1
f
XN E OR
TOWN OF QUEENSBURY
BU-TLDING AND CODES DEPARTMENT
RAY & HAVILAND ROADS
QUEENSSURY, NEW YORK 1280&
TELEPHONE (528) 792-5832
BUILDINiG INSPECTORiS REPORT
REQUEST FOR r1VSPECTrON .RECEIVED
NAME LOCATION U S N
DATE -- L
��PERnd2T ##
APPROVED
F'oor-XrNG/PIE YES N[7
MONOLITHIC PO FORMS
X F'OUJVDATI0N/DAM -PROC3FI N `
*BACKFILL APPROV L �--�
ROUGH PLUMaXjVG u
FRAMING
ELECTRICAL ROUGH- N
.)(INSULATION:
XFO"UNDATrON
FLOORS
F1ALS.S
C ls'ILrNG
PSNAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EX!VERNAL PORCH1s�S/S�•
S7W xRS-CLEARANCE & IL�--
PLUMBING PrXTURESIR EF VALVE �-
INTERrOR TR.IM/PR2VA
F'rNSSHRD FLOORS Y RS
GARAGE F'rREPI200FI
DOOR CLOSER(s)
.SMOKE DETECTORS _
PrNAL EZ ECTRSCAL I SPECTrON -
FrNAL, APPROVAL OF ONSTRUCTr N
A SIGNED CERTXrX
OBTAINED PROM TH U- OF OCC RIPAR MUST BE
BUrLUPTEDXNG DEPAR MENT BEFORE
2'HL'S'E P14EMSSES A
OCCTJPrED(
REMARKS;
` f■+1yli
V
rNSpEETOR
f
TOWN OF QUEENS .BURY
BUXLDXNG AND CODES DEPARTMENT } L
BAY & HAVXLAND ROADS
QUEENSBURY, NEW YORK 12490g,
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR XN TION RECEIVED
NAME _
LOC'ATXON e
DATE
PRRMTr
APPROVED
YES N
TXNG/PIERS
MONOLXTHIC POUR FCa yr
FOUNDATZONfDAMP—PRO( FXNG
BACKFILL APPROVAL f
ROUGH PLUMBXNG
FRAMXNG
ELECTRICAL ROUGH—XN {
INSULA TXON:
FOUNDATION
FLOORS
WALLS
CEXLING
FXNAL XNSPECTION:
CHIMNEY HEXGHT
ROOFING
SIDING
EXTERNAL S/S PS
STAIRS—CLEARANCE ILS
PLUMBING FXXTURE' fRE IEF VALVE
TNTERIOR TRXM/P VAC DOORS
FINISHED FLOOR
GARAGE FXREPR PING
DOOR CLOSER (
SMOKE DETEC RS
FXNAL ELECTR AL INSPECT ON
FXNAL APPRO L OF CONS7$R TZON
A SXGNED CERTXFXCA TE OF OC PANCY MUST
OBTAINED FROM THE BUIL.DX YAI4TMENT BEF
NG MUST EBE
THESE PREMISESOCCUPXEDr.
ARE ORE
REMARKS. �"�---
1VSFECTOR
'0"'N OF QUEENSBURY 14000)4 �'
BUILDING AND CODES DEPARTMENT Jrc�,
.aAY s HAVXLAND ROADS /O
QUEENSB'URY, NEW VORX 12801,
TELE"YONE (518) 792-5832
BUILDINC INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVETi
NAME _
LOCATXON
BATE
PERMIT ## r3
APPROVED
TrNG/PI YES VO
MONOLXTNIC
FOUNDATION UP FORI�SS
/ P-PROOFING
BACKFrLL AP P OVAL
ROUGH PLUMBIN
+FRAMING
ELEC2RrCAL ROU H-IN
rNSULA TION:
FOUNDATION
FLOORS
WAT,Ls
CErL.ING
FINAL rNSPECTrON:
CHIMNEY HEIGHT
ROOPrNG
SrDrNG
EXTERNAL PDRCHE'S/S PS
STAXRS-CLEARANCE & ILS - --
PLUMBING FIXTURES/ IEF�-~~'
"TE.RSOR TRIM/PRr VALVE
C
FINISHED FLOORS DOORS
GARAGE FIREPROOpX G
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL rN PECTr N
FINAL APPROVAL DF
NSTRU Trppy "'
A STGNED CE'RTTFICA
OBTAINED FROM THE E OP OCC A7CY MUST BE
THESE PREMISES ,ARE U-OC UPTUPr CGEDf I ARTMENT BEFORE
REMARKS.
The Contractor s
,protection fr sAons9 1e to
ame freesP providefollowing the P� ,CeMent of t' 4t3 hours
he concrete_
Materials for th?$ purpose o site
YES �0
ECTOR
�atcrrr of �u'eerrs6
sulLdlNG urea
and ZONING DEPARTMENT
Bay and Haviland Road, R. D. f Box 98
Queensbury, New York 128t11
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCAT I01\r G2 to
us
C_e
DATE ms
.. PERMIT No.
SOIL 'TYPE Sand - Loam - Clay
Percolation Test
Pereolat ic>rt Required ? YES
rate - in/inch
TYPE Of SYSTEM:
Absorption field , tot 1
Length of each length
Depth t.rench
P of trenches
Size of ';ravel
SEEPAGE a7ITSfNiurtber of
Site- ft. X
Grave] size - ft.`
PIPING :
Bldg . to tank Size Type
Tank to mist _ box - - �-- .
lt}1$t*
b03. t0 field/pi
openings sealed? YES
� No ,` Partial
LOCATIGN/'SEPARAT110NSs
Faundatic1n to tank
Foundation to absorption ft'
Absorption to lot line
Separation of ft .
LOCATION Pits ft.
�" SYSTEM OI+T PRO Front - Rear - Left side ERTY (clrcle one)
'C C"ENTS : Right side
2
SYST USE APPROVED YES N
13U d 9 ns
ctor
01/86 and v1
TOWN OF QUFENSBURY
BU2-ZD2NG AND CODES 4DEPARTMENT
J3AY & HAVILAND ROADS
','UEENSBURYr NEW YORK 12804-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S RFpORT
REQUEST FOR INSp$CrXON 4RECEIVED
NAME r
LOCATION
DATE PERMIT # ,r}
APPROVED
{ YES NO
�00?°ING/PIERS
MONOLTTHTC POU FORMS
FOUNDATXON/DAM —PROOFSN�G—�
BACKFILL APPRO L
ROUGH PLUMBING
FRAMING
ELECTRICAL, ROUG IN
TNSULATIONa
FOUNDATTON
FLOORS
WA ZZ�S
CEILING
FINAL TNSPECTTON
CHIMNEY HETGH
ROOFING
SIDING
EXTERNAL RCHES/S PS
.STAIRS—C ARANCE & T r�,S—�
PLUMBIN FIXTURES/RE IEF VALVE
TNTERIO TRIM/PRIVAC-V% DOORS
FINISH D FLOORS
GARAG FIR$PROOFING
DOOR LOSER (S)
SMOK DETECTORS
FINAL ELECTRICAL INSPECTIO'
FINAL APPROVAL OF CONSTRUCT QS IV
ti
A SIGNED CERTIFICATE OF
OBTAINED FROM OCCUPANCY MUST BE
THE OCCUPANCY
DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
The Contractor is responsible to provide
Protection from freezing for 48 hours
following the placement of the concrete .
Materials for this purpose on site
YES Mp
a r;wv
TN TOR
THE NEW YORK BOARD OF FIRE UNDERWRITERS CERTIFICATE NO.
00 NOT WRITE HERE - FOR OFFICE USE ONLY
BUILDING PERMIT NO.
TEMP
CITY OR VILLAGE ll7lYN5HIP
...% COUNTY
_
STREET AND No. OR ROAD
POLE NUMBER
BETWEEN WHAT TWO CROSS STREETS [S.?FFMISEE LOCAfIED? S£CTIom BLOCK LOT
OCQUAANT'S NAME BUILDING OGCUPAN CY '
OWN RA NAME AND ADORLSI.S HOME TELEPHONE NUMBER
G URRE NT SUPPLIED BY PROM THEIR ,1 J _ OFFICE WdRK TELEPHONE NUMBER
BUILDING"IS• ei
NEW '-� OLD I_I VADRK IS NEW ❑ ADDITIONAL F_. DEFECTS REMOVED F I
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
_ NUMBER OFOUTLETS No. OF Fixtures & BRANCH OFFICE USE
LOca Lamp Receptacles MOTORS HEATERS CIRCUITS
lion ONLY
C.9111n Side ATTae�"t H.P. Watts A.W.G.
9 Wall Recep`Is Switch Pendan[ Bracket No. Type Each hlo. Each No. Gauge INSPECTION
OU LT
SIDE
SIrB-
BASE
BASE.
MENT
FL.
2nd "—
FL.
3rd
FL.
REMARKS! LIST OTHER ELEcrRICAL DEVICES NOT SET FORTH ABOVE,
THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED, BUT lF AT TIME OF INSPECTION, THERE IS
FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED, YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER
THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT.
SIZE OF MAINS FEEDERS ELECTRIC SIGNSILAMPS TOTAL YA FTS
CHARACTER OF Y RK 4�❑y E%POSED CaA� TUBE SIGNITAANSFORMFRS OF VA
_ El CONCEALED
DATE %MORK TO BE STARTED DATE COMPLETED SIZE OF SIGN (NUMBER) CAPACItY
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NEW YORK, NY 10038 ALBANY, NY 12207 BUFFALO, t 1a242 � ROCHESTER, IVY 146081 SYRACUSE, NY 13206
THE NEW YORK BOARD OF FIRE UNDERWRITERS
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