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1989-916 ■ C ► OF c)CCUPAN%,.. TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date April 25 �1990 I Ihis is 89-916 to certify that work requested to be done as shown by Permit No. has been carnpictc& This structure may be occupied as a of single Family Dwelling LA)'MdOn 7 ) Queen Mary Drive Owner Guyer Builders , Inc . By Order Town Board TOWN OF QUEENSBURY ....... Director of Bldg. & Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No. _ 89-91 1 WARREN COUNTY, NEW YORK L Q ER BULDERSs INC PERMISSION is hereby granted to Street, Road or Ave. OWNER of property located at tv 1 in the Town of Queensbury. To Construct or place a at the above location in accordance to application together with plot plans and other information hereto filed and IND approved and in compliance with the Town of Queensbury Building and Zoning Ordinance_ t. OWNER'S Address is 1 Hemphill Place o,, 9 2. CONTRACTOR or Bill LOER"S Name ITi 50 Same r 0 3_ C]ONTRACTOR or BUILDER'S Address rr7 w 4_ ARCHITECT'S Name ' 5. ARCHITECT'S Address V O � B. TYPE of Construction — {please indicate 6y X} irlm (x)t wood Frame { l Masonry I D Steel ( 1 7. PLANS and Specifications tv No. 31 ` x 42 ' �-2 of single family dwelling with septic system and driveway as er application , specifications , and plot plan -- --MODFLS m B. proposed Use of Single Fami 1 Dwelling - i @NKKXXXX MWEL 5 November 28 , 19 0 $ 151 _00 PERMIT FEE PAID — THIS PERMIT EXPIRES 90 "a' Moyem -n (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the RJ9 town of ousensbury before the expiration date.) 2$th Day of November i9 H9 rrr Dated at the Town of Queensbury this T for the Town of Queensbury SIGNED BY or r Building and Zoning Inspe —C TC►E N Cyr �► UEENSI3URY APPLICATTON roux t�UI ._ . . . . . 01 ZONING PERMIT ,r F.�rieWiit I // , Fee I'a.Ld / / WIL(IING AND CU13E5 l.al :t ARTl+I1*. l' D"e 14.4&Aed BAY and JjjkVXZAM0 ADAW RD I .aox 9.3 �I C� - & GOD pE�. {•UrEAfSSIlRY 2., ssjjr Y012K 2804 3S('Jurii.0 NU . Tfrl . ( 5181 792-5832 8xc 204 ` r ♦ * r ♦ w r r * * r r ■ R r r r r r w R r r r ■ R r . w r R a r + �; A P>~)trllT I`iC1S'(" EIS OlI1*AINfiD BEFORE B"" INNING CONSTRUCT10146 NO INSPI:C'1` IONS WILL UL'- MADE uwrIL APPLICANT IIAS IMCCIVDD A VALTD UUILDINC PL'` MIT . All al+ PliCaQle: spaces on dais application laust be coutpleted and the %; i p ya ture of the a pl icant must allpear tt on the reverse sick of this sheets The owner of this PrOPerty is : 000n" Guyer Builders , Inc . 1* . O . Address 1 Hemphill Place Suite gal , Ballston Spa, NY 12020 TEL E [. . (51$} $99-916i Property location '}9' [►Jn�G .►J �t 'PAX MAP NO . 1�21 _/ '�� 999 llas there beeny any split of this property since October 1 . 19 $ B ' .�1,_ no es t►o 1f yes . Planning Board Review is necessary . LOT N4 . SUBDIVISION NAMe . Ii• APPLICAnLL QUEEN VICTORIA' S GRANT - Tho person rosponsiOla for :;aul" Orviston Of wort: as regards Building Codes is : Richard H. Guyer III 1 Hemphill. Place Suite 201 Ballston S NY 51$ 899-9161 Nartl: Y . O . ADUREss TEL . N Oo wAme of bu i lderGuyer Builders . IncAdd re as 1 Hemphill a Ballston Spa TelTel 1$) g - t+:au of plumber -saute- T.dclre ss 'rul -same- Name of M.aSOn —same- —same - IrATURE OF f'(;WOSCD 601%'K4 Model S . r 'L[3N1tJL� 1NI UlttiA"i` illl"i ( Uiticx usO On ") X conx3crucciot, of a i►uw Guildirlc] • BONING DEsICNA'rION OF PROPERTY mop000lomoAdaicion to a builait►q r PERMITTED PRINCIPAL PERMITTED ACCESSORY Alc►sr:ation tar is IAUilding • "Rl:VI84J RE¢UIRED .. PI.ANNINC BOARD ZONING BOARD_ ,_ [tie cla.ar►qu to axt � riat uitaansion::) Ocher work 1/3al:e:rila.:t • SITE PLAN REVIEW 41 APPROVER DATE r VARIANCE I APPROVED DATE . 1: tiO$ S .!►k1:A Oi• 1", 140110SCO. t; TUUCArUkL-' r Remarks 1st Floor 900 � sq Et , � 1c p 2 nd Floor --_ sq cc . „ CD<Nt'Lk•1'r: . Ir11'01:1iA'1•l4N seNplot uc lrrlcr . • ai..:+a of prol,Wrty 100± plan Et x 12a rc . Other Flooru --- sy tt: . + "i"Clskej 1sui1Ji1►.7tss ) Si _u n a j` e Inert cellar Qr b4sQmwnc ) r TOTAL F LOOt1 AREA 900 sq Et . na • Lxi::ci►►g Duii.sirrlJ [:: ) U:.a :: ix.s trt new ::Lructur.s 31 [ L x 42 ft 1Onat,d:scion-�ricr/::izLfcr:awl/1�3rc1.►1/ toll • 1�rpi}a::e� fauilaincx , di:: L:an►:.: rro,n I,,roturLy ►� i w is ire-lu onc: 1 r Front yurd� 30+ f t RQar yaV4 30+ f t Na . of sseorica (t&:aU.Lc:+b1►a ap4ce ) _ l Side yard" �_ Woo "Ad ��w�tc isvighc ( gradaa to ridges ) 19 ' 6"' fe . R It on corn.:r, ssuW:a4k frata uidu :; cra:"G + tc It rossiatasnLial, no. eat f:aruilil 5 1 - 2 or pCCUPANcY INFORIMATICN No. of roocas [a:xCladirs►1 b:achsl now of "droot►e;: 21 • PDA M RY LUILDING Now of b:a0trootitz; 1 Ono iatuily dwelling t/rilaary hu"Ciliq LyuL; vim Ba. �et► rd Electric x vwa tawny dwelling *ry1j" of [u►.:l E1etr�c t Multilalo aw"ling / Number of units Now of firQj11acU4 to lam �n/aa ,! Poru►&araunc occup:u,Cy Will a w0QJ sLQVU t,.: iFLUL:all"d '��nO 'Prana:i►:t►c oucutx:ancy r caxntr al Air col►,Aicieania►ay? no # ausinuus [tuILDING STYLE, PRIMARY :TRuCTuRE lnelu�cxial QLhcr 1c;aaeCh ConLw,/l elr..ry tx#", c:.Uin r I f .►d.l i c iu,i , wl+•a t will u7pj baa7 tiwaLu"d ranch M:anssa.e.l► Qul.la:x :ttaliL luv41 Old scyla uwu{.. Low r C,a.vu Cob Cottaq%: Oct►wr AGC[:S ORY a Cj"D"_ CJQ1 lowr► }3ouse ' p,,tach+3e1 y:ar:.clefonet czar/ two (.olani;al t:eaw C" ( CITLCLL: ONE: PLk:ASE ) • x wowoom,00Aezach41:1 clar.ages/Data car/ two c.;ar a » a w w r y w r a a r ■ x r r r 't -�o1�Y'iV:aL�.t scar:ai! li�lail4l].f1� L: .: Y' IMATED 141► RKi "1' VJ1l. U1 OF Oth.sr aftanowoo00H :;'1' kUCTT4UH 1 HFQRK^rTON ON UU ILDI NC S pnCIp rCATIaNs , ON RCV'ERSe sloe OP 'Fill$ SHEET# Silo lie COMPLETED 1 Form DPA 10/88 v1 %pow mooffoo BUILDING PERMIT APPLICATION CONTINUED - - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe, etc . wood frame Will any second-hand or ungraded lumber be used? If so, for what ? no Foundation wall material concrete block Thickness $ " Depth of foundation below grade ( to bottom of footing ) 48 TV i5mila:iii Will there be a cellar? no Heated or unheated? Floor sq . footage sq ft Will there be a basement? no Will any ,portion be used as living space ? ( If so, what portion? sq . f t . - - Type of use? Type of roof - sloped/flat/shed/other Material of roof fiberglass shi�s Size , woad studs 2 "x 6 " spacing "o . c , length 8 ft . Joi$ts ( floor beams ) 1st . floor _i1a fox " spacing "o . cw span ft . Joists ( floor beams ) 2nd . floor n S " x " spacing "o . c . span ft . Overlays ( ceiling beams ) n/a "X 41spacing "o . c . span ft . Roof rafters n/a "X spacing o . c _ span ft . Roof trusses (pre-engineered) spacing 24 "o . c . span ft . Exterior wall finish stained Of what material ? S /S"x 4 ' x $ ' texture 1-11 Interior wall finish painted 1 2" sheetrock If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 1 /2" nat "x" sheetrock Is there to be an opening between garage and dwelling? yes If so will a Fire-rated door, enclosure , and self-closing device be provided? yes Will a flue-lined chimney be installed? no Height above roof ft , Depth of chimney foundation below grade n a ft . Depth of fireplace hearth nla ft . in . Water supply - Municipal or private well Municipal SEPTIC SYSTLM _ Distance from ANY private well ( including adjoining 13ropertias ft , (A separate application is necessary for any repair or new installation of septic system) D 13 C L A R A T I O 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, TILE 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 caner. a Signature Owner, owner's agent , a r_J1rjrect, contractor * w w w If * t . x Or w rr If : • to * r w r . If If . r If • : * . w Of for * If r At ■ • If ■ w w t SPECIAL CONDITIONS OF THE: PERMIT : APPLICATION FOR SEPTIC DISPOSAL PERMIT Ref : S . P . E.D. S . permit # BATE 11 L New York - 0202525' MaDEL ,r B 'S of �, 's�"S 70 Queen Mary Drive LOCATION OF PROPERTY FOR. INSTALLATION ( 518) 899-9161 Owner`s Name: Guyer Builders , Inc . r.. Telephones Address: 119 punning Street , Ballston Spa , New Yark 12a20 Installer's Name: Guyer Builders , Inc Telephone: ,I , 899-9161 ns 2 A, G , E , I , ,I , K, L, M �, ,Number of bedrooms (residential only) ____ 3 Fs. G , H , Total daily flow (compute Cg? lso gal per bedroom) 30n Topoor.►pbF* circle ones Flat Rolling Steep Slope % of slope , Sail Nature: circle one: Sand Loam Clay Other 1 Depth: . 8 feet + Ground Water: At what depth? jujk1°o7a 8 feet + Bedrock or Impervious ldaterial: At what depth? uriknown feet Percolation test: circle one: not regwirelu required 1 rate min. inch. Domestic Water supplys, circle one: Municip Well Other IF domestic water supply is a Wenoo N/A feet ,Separation: Watersupply from Septic absorption * PROPOSED SYSTEM: Septic Tank _ gal. (minimum size: 1 ,000 gal.) NIA N/A feet TILE FIELD: Each Trench feet' f Total system length * SEEPAGE PIT(S): Number of / Size each feet by fed't, Depth or Thickness feet * Size of stone to be used � 1� De P s * as * e * as * e * +s * asrs ,:cs * sassss * �t �r * +as: ee * s �► ass * * s *,MPORTAN T .S See S . P .E.U . I & ...Please...L.IST NEW E+QuIPMENT TO BE INSTALLED permit attache So s * * * * * * * * * * * * * aesses * * es * * s * * * * * se * e * sssss map . (over) Section 11 Septic System InsTiections: A. All applications for septic system installationt alteration or repair, as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building Department at least Z4 hours before start of constructions and shall include a plot plan showing: l.) the propo#ed .location of the 14ystem Z.) location and distance to lot l$nes 3J location and distance to structures 4.) location and distance to any **ter 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 installation, alteration or repair of an approved system, a new proposal must:be submitted to the Queensbury Building Department before further construction. I have read the regulations above mud agree to ,abide by these and an lequiriemwstx of the Town of Queenabury Sanitary Sewage Disposal 4dinance. Signature af.responsibde person: Date* 99 . ._ N Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 79Z-5832 Sr TLED 1763 . . . HOME 0F NATURAL. rAUTY . . . A GOOD, P+ "-. CE TC , awn ©� `caCueen .s � ur� BLyll DING and ZONING D��RTgox 98 Say and liaviland Now York 12801 C)ueensbury. G jP15PECTOR ' S REPORT BUILDI LOCATION -7 f perrRi t No . Date * * * No APPROVED - YES gootin9� 'ier Fox' Foundation WaterPr�€inq Back€ill Framing Roof inq Siding j Masonry Veneer Rough Pluu1bing� Relief Valves �-- Ex.r Porches FinishedFloors Trim Interior ---� ^~' Stairs & Railings� Cellar Drain Tile -- C,r,crete Floors - �- Plbg . Fixtures Gar * Fireproof inc3 ,Door Closers Smal . )eteators Chimney :ENSUILATION n Foundation Floors Walls / Ceiling L IN ECTIOL3 FINA ELECTRICAL DRIVEWAY Appg()VAL final Building 5urve ady ) edule insp e tiion ((calwTt'eY" re Next se Remarks- Buil irk nspe"ctOr r' i 6/8 and-vl yr, Cr O AGENCY, INC. WADDLE DEPARTMIEL`II ettt , Irk" 879a� Awwt,u:.". . sr Apxil 23 , 1990 eno ' + w4i j ? r equipment listed has been exarrsined and`is approved as being in accord electrical equip and Agency rules. (�exttf[Q that thL3 ltcable gOvernMentai, ut;l'lty With the National Electri+dat Cade SPP DWelling _fix 11 pccuAancy builders Irto „ ° , ed <h1 G Guye it she electrical �putP nt and +nsta l4xtion tns Q yY/1gf: V� r ,i'tO "L. �v �.f .. w,..\ Yhis Certlf�GRlB Ewen' be 11�YroduGBd Or a7Y0r9Lt6n5 ITt9�s to f uzl r J ...T s .. (]7,]�E'�l soul J se r.'��it� ryRws'a J date If addtUandl MutpT'tent sfliMlkl he nukl and void, and aPP�+Oa��Pn .`or QCcclparft: in M� `yXt-:Dirt ` — ea+sting system MIS Car7ilicat0 f7 5o this A9en p 'y Qucon � �, insoeclton should tae aabmdted p WOO Y Insurance carrier LC1 CialiOn: nt same to hta property - yl 1� iZt1JL ��` Holder of this COI`Ot Case srtauld p'(�'rtjiiCef ion of eieCrnGat e4t+�tament appr Oved hD putlets ; 3Oceptacles ; {� t ,p�,PplianCes y �eut' rF '�'�$ as Speflr ed, Rar1Y1 aieYidMree Q�ItJmBnt: as sPedtfied. '!C 150 Asp gerviCl; �{1 0 . 15_p33177 M1Y Guyer Bui.ldcx�r'���r 119 Street ,,,,i � Aptpucant: �Sa,llstoa SPA , Penn no. Im FL 1-M T01IN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILA14D ROADS +)UEENSBURY. NEW YORK 128f34- TELEPHONE { 5� 8 � 792-5832 BUILDING INSPECTOR' S REPO R T REQUEST FOR INSPECTION RECEIVEDgGx— f —"'� Fe, NAME LOCATION PERMIT DATE APPROVED YES N`O FOOTINGIFIEIV R FORMS ,MoN0LITHIC PROOFXNG�--- FOUNDATIONID . BACKFILL APP VAL x} jUGH FLUMBI / t FRAMYNG___ ELECTRICAL RO . INSULATION : FOUNDATION FLOORS WALLS CEILING INAL INSPECTIO sF CHIMNEY HEIGHT ROOFING SIDING ST PS EXTERNAL XLS STAIRS—CLEARANCE LIEF VALVE pLUMBING FIXTURES . y DOORS INTERIOR TRIMIPRI FINISHED FLOORS NG GARAGE FIREPROO , DOOR CLOSER (S ) _�---- SMOKE DETECTOR INSPEC' ON FINAL ELECTRICA F COIVSTR TION__���-- FINAL APPROVAL r FANCY SS' BE IGNED CERT, FICATE OF OC PAR A S TMENMUT BEFORE OBTAINED F110 THE BUILDING THESE FREMISJS .ARE OCCUPIED REMARKS : f ,,, � y�- �"'"` ("",✓� ! �r c , ! G�' ff//11 OR INSP 01 i oro�jN OF QUEENSBURY ARTmENT BUILDING AND CODES DS may. ,& HAVILAN� YORK 12SOIE QUEENSBURY : 792. 5832 TELEPHONE ( 518 ) �PpRT BU-11 II3SpEC�Rt 5 Gr �- 9 0 INS ECTI{7N RECvxv,BD� --- f /' pXQU,EST FOR 117tn-+r s ' Jf ' Coxr/ �r NAME d LiJCAT.rON PERMIT ' #-^�� _�/� - TJ..�- APPROVED DATE YES NO FOOTING/PIERS POUR S� ��---- IC POUR G �--- MONOLITH Dpp-PR ZN FOUNDATIONI ,�---� BACKFILL APPROVALS ROUGH PLUMBING ELEMING C7'FtICAL F2C]UGx-I LATION : f FOUNL7ATION FLOORS WALLS CEILING E�cTTON : FINAL INSPU CSImNEY HEIGHT ROOFING SIDING pORCHESISTE EXTERNAL STAIRS�CLEAFAN'ICE Fr VALVE � PLUMBING FIXTURES I Rg��-� INTERIOR TRIMIPRIVA ,FINISHED FLOORS GARAGE' FIREPROOFIN DOOR CLOSERS? SMOKE DETECTORS IN ECTIdN OLEG.rgICAL CO ggUC7ION FINIAL � - FINAL ppR�AL O OR C r-�- CIO T BE OK TO 7 S^a[TE_�-- ��`� � ANCY mCTS ICATE F OCC D PARTMENT BEFORE A 5I�GNEn CERfiSF Bu ING OBTAINED FROM THE E O UPIEDY THESE PREMISES AR REMARKS : '1 1 �# 1 t 4 4 ARRIVE I spECTOR T01,14 OF QUEENSB�pV RT!gENT ING AND CODES pEPR'yA BUILD lz8o BAY a HAVILAr!EW YORK OUEENSBURY , ( 518 ) 792-5832 TELEPHONE S PEpORT IT3SPEC'COR NSPECTxdN R E v n REQUEST NAME ATIdN PERMIT APPROVED DATE YSS No F�TIN ! FoRS___--- � MONOLITHIC " �,VROOFING FoUNDATIOrN41 PRO L BACKFILL t/Rd!JGH PLUMBING RAMTNG dUG IN LECTRICAL R INSULATION , FOUNDATION It FLOOR$" WrALLS CEILSNSPNG ECTION : FINAL HEIGHT CHIMNEY gDOF'xNG SIDING RICHES/5 EPS EXTERNAL CLEARANCF3 LIE VALVE STAIRSLS ~ FIXTt1RES DOORS FLTJMB.TNG INTERIOR gRTMIPRx � - - x�ISHE F D FLOORS F NG� GARAGE FIREPROOF g pCLOSER (S) _ ETECTORS ON --� SMOKE CTRITCAL NSFEC TTON__ � --~� FINAL EPROVAL d CONSTR FINAL AP C CIC 1 BE _ OK TO xis C/ pC PANCY MUST BEFORE CERTTFT ATE OF EpARTMENT A SIGNED FROMBUxI-ED ! OBTAINED E OCCUF H TE5E PREMISES ,I RE14At2K5 = s 'ti ^GOWN OF QUF1 EN5BURY TMENT BUILDING AND CODES D$PAR BAY & I3AVILAND ROADS I28a¢ QUEENSBURY, New yORK TELEPHONR ( 518 ) 792 5832 W-jjT)ING i 4spEOTOR' S REPORT REQUE5 -ONfir FOR INSPECTION RECETVED�`�-----'J` ~~ .. "�,vp � S NAME • � ,y ► Y" r r j A q' � ' PERMIT - ! APPROVED DATE ._-- -- YES NQ FoOgTINGIPIERS gQRMS_1 �NOLITHIC POUR FING FOUNDATSONIDAM�'_PROO ---tom~ BACKFILL APPROVAL ROUGH PLUMBING FRAMING 1RojGH�IN -� ELECTRICAL INSULATION- rovNDATION FLOORS WALLS CEIL�NSP NG `TION : -- F I NA L --�" '----- CHIMNEY HEIGIIT - ROOFING ---__' SIDINGESI E EXTERNAL CLEARAN LS CE R��EF VAL STAIRS- FIXTURES PLUMBING TftIMI PR ACY k DOORSINTERIOR --� -- FINISFIED FLOORS F NG GARAGE FIREPRdO DOOR CLOSER(s ) SMOKE DETECTORS SPEC FINAL E F C ON LEC Z R ICAL ONS T9vCTTObl FINAI. APPRL3VAL O e a C RTIYENT BUPAN'CY MUST B gORE IFIC TE OF QC A SIGNED FROM BUILDI . G DEPA ()STAINED FROM THE Occup ED !. THESE PREMISES A REMARKS -� NSPECI'dR I TOUM OV quEENSBURY BUILDING AND CODES DEPARTMENT SAY & HAVILAND ROADS 1280%- QUEENSBURY , NEW YOFtK TELEPHONE ( 5].8 ) 792- 5$ 32 L�3ILDING INSPECT'aR' S REPORT aR CE INSPECTION REIVED REL2UEST NAME LOCATION J ! PERMIT ; APpRO ED DATE YES NO FOOTING/PIERS ORMS ~-- MONOLITHIC Pol RpOp'ING_��� -�--- FOUNDATIa� ,pROVA BAC KF ILL+ 1GH PLUMBING FRAMING UGH IN iD ELECTRICAL R -y-`- 5 I INSULA7`I0N : [ -- FaU1NDATION FLOORS WALLS ,CEILING INSPECTIO FINAL C H IMN E 1' HEIGH nooFING SIDING HES/ EPS ,EXTERNAL POD RAILS STAIRS,CLEA iEL,IEF VALVE___ 7URESI I7Caa _--� -� PLUMBING TIIMIPRIV Y Rs_ INTERIOR RS FINISHED 'F PROOFING GARAGE FIR (S ) DOOR C I,aIS SMOKE DET CTD L INSPE ION,_ _---� ICA FINAL SLEC OF CO, ST UCTION �i FINAL APPRO Ar _ MUST CUPANCI' BEFORE A SIGNED C RTIFICA, OF DEPARTMENT THE BUILDI OBTAINED F S ARE OCCUPY Dr. VIESE PRE 1 REMARKS : a Qa '4 NSPECTOR TOWN OF QuBEN'SBOR''f ND AND CODES DEPARTMENT BUI LAND ROADS BAY HAVI QUEENSBURY" NEW YORK � 28Q4- TELEPHONE ( 528 ) 792-5832 �3ILDI13G INSPECI�JR' S REPORT 0 REQUEST F .LNSPE'GTION RE rVBD��� NAME zpCATIO gPERMIT # l DATE APPROVED E YES NO 3 i FOOTING/PIERS FO S jON©LITHIC U -PR �/_ ACXF'ILL AppROVAL ROUGH PLUMBING -�- FRAMING ELECTRICAL ROUGH-I , IN ULATION: C)UNDATION FLOORS WALLS CEILING TION FINAL IN'SPEC CHIMNEY HEIGHT ROOFING SIDING EPS EXTERNAL pORCHESI RAILS�� STAIRS-CLEA NCE ELIEF VALVE PLUMBING AIM/P S Cy DwRS INTERIOR FINISHED pYOORS GARAGE F -r EPROO IN DOOR CLOSER (S) SMOKE DETECTdR TION ^--- FINAL ELECTRICAL IC UCTION;_�-- CONS FINAL APPROVAL �- CERTI ICATE OF CCUPANCY MUST BE A ,SIGNED HE BUILDI DEPARTMENT BEFORE OBTAINED FROM bCCUPI D! THESE PREMISES ARE REMARKS -0 Tc] C L V I IPECTOR Y Y TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I280& TELEPHONE (5I8) 792-5832 BuILI7ING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED 1 NAME LOCATION DATE PERMIT # - 11 �� APPROVED / YES NO YFOOTING/P2ERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH— INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHESISTE S STAIRS—CLEARANCE & ILS PLUMBING FIXTURES/ LIEF UA VE INTERIOR TRIM/PRIV CY DOORS FINISHED FLOORS — GARAGE FIREPROOFS G DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICAL I PECTION FINAL APPROVAL OF ONSTRUCTION_ A SIGNED CERTIFICATE OF OCCUPANCY MUST S OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED ! 001 REMARKS: S., AyOS /'r,I oA INSPECTOR i �. MIDDLE DEPARTMENT INS I�CTION �A►GENCY, INC. NaF'ti©ltal He4d arters goo Haddon Ave-, Collingswood, N.J, 00108 Date; Toven or � � County State Location/Address _ (If Located in Rural Area - Please Attach Directions} Pole #_ �� Permit Owner Building: NewO OIdO Occupied As Occupant Work Area in Building 'Floor #, etc.) : ..- Ready for Inspection : Fee Remitted $ Cash Check M.O. Make Payable To: M.D.I.A. ypp 'Ty0 1000 12s0 1500 1T SO 2000 22y0 250o 2750 3000 Number of Rough Wiring Outlets Elect. Neat Switches — Amp. Service Surface Unit Dishwasher Range Lighting Water Heater Air Conditioner } Dryer Pump Receptacles _ Oven Garbage Disposal Wiring and Controls for Burner Number of Fix uee Amp. Receptacles Fractional H.P. Vent Fans Other Equipment: MOTORS H.P. 112 1/1 1/10 ve 1/fi 1/4 1/3 1/2 3/4 1 1Y2 2 1 3 1 5 1 7W 10 1 15 1 20 26 30 40 - 50 75 100 PIFT Mar of E k Number ach Size Applicant's - License # Permit. # Signature T/A AM Utility : N (OFFICE L TI N Applicant's Address: (City} (State} (Zip} 12021 Service Request # " # Electrician: GUM RM Phone DATE RECEIVED: DATE INSPECTED: Correct Location : Same as Above or: Red Notice Label Oven Rough Wiring Outlets Surface Unit Switches Range Garbage Disposal Receptacles Water Heater Dishwasher Air Con 'tioner Dryer Fixtures Amp. Service Equipment Burner, Wiring.& Controls for Amp. Receptacle Vent Fans Am . Service Conductors Pump , MOTORS H.P. V= 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 142 2 3 5 7Nr 10 15 20 25 30 40 50 75 100 Mark Number of Each Size 5o0 1,50 1000 1250 15 00 ITyO 2000 2250 250Q 2750 3000 Elect. Heat 0 RW Progress: Inc. LKD Contractor CFT Violation : Work Comp. � Inc. O Owner CASH [] L/A Fee CHK # Q L/A Due MO # © Municipal - 40 IPA INV r--1 Applicant Date: Other Side (� utility Owner Cut in Card 0 Temp # Date INSPECTORS SIGNATURE [] Final # Date APPLICATION FORM NO- 250 EL 11/86 - -