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1989-948 CERTIFICATE OF OCCUPANCY TOWN OF +QUEENSBURY WARREN COUNTY, NEW YORK IDate _ 19` L' fr j This is to '� that work requested to be done os shown! by Permit No, t394_948 I has been aotnpleted. This structure may be o=u pted as a _ �Sire gl.e Family I)weliing Location 15 - Bidden mms Drives pier Rich Pe Schermerhorn I i By Order Town Board I TOWN N OF QUICENsBuRY 3 i j 411 Director of Bidg, Lot Code E arcernent I i BUILDING PERMIT TOWN OF QUEENSBURY No, � �r-948 ro WARREN COUNTY, MEW YORK z PERMISSION is hereby granted to RICH P. SCHERMERHORN w OWNER of property located at Lot # 15 — Hidden Hills Drive Street, Road or Ave. in the Town of Queensburyr To Construct or place a Single 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 Oueensbury Building and Zoning Ordinance, 1. OWN'E R'S Address is M 33 Harrison Avenue �} Glens Falls, New York b 2. CONTRACTOR or BUI LDE R'S Name ] Same 3. CONTRACTOR or BUILDER'S Address M a od 4_ ARCHITECT'S Name z S. ARCHITECT'S Address e M ■tF I✓< B. TYPE of Construction — (Please indicate by x) Cl7 XYAVood Frame { ) Masonry ; } Steel ; I CL 7 7. PLANS and Specifications No. 50' x 34' single family dwelling with attached 2 car garage, driveway, nd septic system as per application, plot plan and specifications. G w. S. Proposed Use � �C Single Family Dwelling ce $ 235A0 PERMIT FEE PAID - THIS PERMIT EXPIRES August B, 19 90 1 ;If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of OueensburV before the expiration date.) AP Dated at the Town of Queensbury this fith flay of February 19 90 4F SIGNED BY for the Town of Queensbury Suii ing and zoning 6si5ector NW11160F UEENSI3URY APPLICATION F01Z BUILDING AND ZONING PERMIT rrutL - F.cc.i.euedd� X TOWN OF QUEENSBURY ev i ewe' WAzftRECEIVED Z, Fy ree Paid ,. � DEC � 1989 BUILDING AND CODES DI :PAR ifarr Date 7-saued.Ahtn _ SLIM 8t CODE DEM HAY se1Und BAVILAND ROADS RD 1 Box 98 9 (� rEENSDURY, NEW YO,RF: 13804 PeJIJ►u t No . �q �1 'i�- f Tail . ( 510) 792-5832 Ext 204 x ! tiI ! ■ R * x �' i k ar ar ! I A ■ M • • R R R F ■ x yY � a w w • Y R w A M a A PEIMIT MUST 11" OBTAINED BE- FOIZE BEGINNING CONSTRUCTION . NO INSPECTIONS VILL BE MADE UNTIL APPLICANT 11AS RECEIVED A VALID BUILDINC PERMIT . All applicable spaces on this application must be completed and the qipuature of the applicant must apdear on the reverse side of this sheet . * * * h * * * *' * k * * * * * * * 3t * !t * * * * * * * * * * I% * W * * is * It' IIa owner of this ,property is EQ;c,}ti 2 C crvy� i? [` 1^ r- Ar P . O . Address �! �•,2 1)h atiS"' C y 5 clrnJ A se P C F s._.�✓ Y T c L . _7 9' '$' -' O 1"Js 7 V 1 ' ropertyy location Lod' 15 Hicicle..•-,6 t v LLS TAX MAP Ilas there been any split of this property since October 1 , 1966 ? /. )4 yes no 7f yes , Planning Board Review is necessary . :: UBDIVISION t4AME , TP APPLICAfiLJ3 LA _ LOT NO , 'i' iie person responsible for supervision of work as regards Building Codes is : .R r 5 t.Sti r w+ c c' �.a �. +�✓ _. "33 _ NA14Lm r, . o , ADDRESS TEL . NO * tizimo of builder P.. �t. JLle11°r [ldres5 rVa. ' f I"iSo ,& + &Zt_ Tel -fir 42 `Zf laume of Pluber�Jrrt, y. 1l N T.ddress Tel '7 �(� - SL.9 S m Name of Mason ..Lac pdoe Lin lclraahN Address Tel 11AWRE OF C'(:OPOSCO WJ%'K : ZONING 1NF01LPl/t-'1' --ION f0fficay use on -IV ) ,Co01 :ir C•UCCiorr Of a rtew building ; ZONING DESIGNATION OF PROPERTY AdJicion to a builairtg � PERMITTED PRINCIPAL PERMITTED ACCESSORY Altur"tion to a building { rlra cll:utc]� tea �xta rior climensiortal ' REVIEW REQUIRCO - PLANNING BOARD 2014ING BOARO� Ucht: r work (Ja~:criuo ) " SITE 13L.AN REVIEW # APPROVED DATC [ l< OSS AREA OPL' f201' OSLD, i: '1' SeU ! '1' UftL•' `' VARIANCE # APPROVED DATE lst Floor 101.40 _sq ft go Remarks : 'g {J sq `y`� L:C01411LT -" ]IfAj144ATL0N leLrsUiicY U uL`l rwl . 211d Floor f t , V . ails' of Prolna: rty / 1 /f ft X 1g�. Ct Cattier Plaorss `,�' sc1 Pt . ! t X rt . ( not cellar or ba :.; einentl Lxi�tincl Iialilalitta] { :r) 5i =�' TOTAL P LOOR AREA�Lg' p o-�sq Er • Lxil4c isig bui Lai n0j (:i I Uµu of new structure f t k � ft t'cauridation-pier/ :laL/cr�xwi/Parti:al cull ' Vrapot;ed building , di:: eanc.s rrOW l.ropurty line ( circlu orte ) Front yard �{ ft Roar yard ft Now of S] Cories (llaluit:.hle �'pdea ) 2, Sid.: a.rd:; - £t 11� ighc ( grada� to ricklo } .Z ft . ' l' .. �l1;ut et and U acr 11 ra::;ldatnClal , 1'l(3 . UI � :t111111Cs J • If: Oil CGrria: r , ::Ltb:aClC 1`KOwQ aids tiCl"L'C.0 Cl: No , of rooln:a ( excludintl bath:.: ) g ' OCCUPANCY 1I�IFCIi'.MATIGN tJo . of budrooln : q r PRIMARY LsUILDINC monow tao . of batliroolm; * �pno family dwelling J• ritrt;ary Jta:Jtallr) :: y4.' L .:tki_ 60 % 6ds+ Ail' l'wo family dwullins Typ*iA of fuelS a.4 Multililca dwelling / Number of units 110 . of f iru al acL:4 to U4 j intro al l a:Ct p will a wuoJl : +a:tovu k in : tulla d"' . 1?erin:ancJlt occup:aslcy -------- `1`ransia:rtc occulaartc:y C oncr:al Air coru.litiuni.rrcl? .aJb + Businuus w (iUILDING STYLE, PRIMARY STRUCTURE . Industrial 1;...attCll Cant.:uLaca-.ary LmQQ ca Liin ► Oehcr t� izud ranch Man:3ic..it DL%jAa:x . I1 u4ditiaarl , w1cuL will use bu? _ plit laowa:l Old stylo Uuttal.. Iow to a Cod Cott"Qo OCILQr ACCESSORY JWILDINC- utcirtia Jc[aW Town Maus@ "` Iia CaChad 9 sr2tcfL+/ono car/ two CiaCf Car { CIRCLE: 0144 PLJ•:ASG I • 2L.Accachutd tlarac, u/onax cUC CWo car c:a ,.• w w • ■ r w * a w a r . x X a ar 11rivataa sco.C"ge building l '; 'l' IMA7` Lif] _M11Fi ?CVIO VALUE Ok ' �rOtharr CONS."J' RUC orION � Ih1r'[aR? 1ATION ON BUILDING P, PrCIl' TCATION$ c ON REVERSE SIDE OF T11TS ci{Ecer, To BE COMPLmval Form DPA 10/88 V1 BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : �+ Type of construction , wood frame , fire safe , oa a� 1a.w1 Will any second-hand or ungraded lumber U�o for what? M40 Foundation wall material Ur, Gr &er Joc _Thickness 10 "� Depth of foundation below grade ( to bottom of footing ) .71 Will there be a cellar ?-yC;mS_Heated or ( nheated � Floor sq . footage 79,6 sq ft Will there be a basement? ye.�will any portion be used as living space? ( If so , what portion? AJ / 4 sq . £t _ - - Type of use? to pV Type o€ roof - slope E�la`t�/shed/other, y( Material of roo �f -7� 1►+ uJc� �e� �v+t�w4 � �i Size , wood studs "' X _ " spacing "'o . c . length .S�ft . sJ Joists ( floor beams ) 1st . floor ^ "X�p " spacing 1 (,2 "o . c . spanj.�fto Joists ( floor beams) 2nd . floor "X kILIC" spacing. _A.(4,_'"a , c . span_j3_fto Overlays (cei 1 ing beams ) �L _"X C.P ,' spacing �7 "0 . c _ span? ,(�_f t . Roof rafters jV,`"X - �_ " spacing-._„ tiL o . c . span..y ft . Roof trusses (pre-engineered) spacing_, , " o . c , span_ ft . Exterior wall finish (` 10 0 �10 ,w CA of what material? � Interior wall finish t If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 151 W& Iq { Is there to be an opening between garage and dwelling"' '&,s If so will a Fire-rated door , enclosure , and self-closing device be provided? _ r'C..S Will a flue-lined chimney be installed? AZZ) Height above roof _ d.Z / A ft . Depth of chimney foundation below grade Af /A ft . Depth of fireplace hearth ft _ . kno water supply - Municipal or privat well _ •n,'�1I7q„� SEPTIC SYSTEM _ Distance from ANY private well ( includ� adjoining properties_,_____.ft , (A separate application is necessary for any repair or new installation of sept=c system) D E C L A R A T 1 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, THE ZONING ORDINANCE, and all other Taws pertaining to the proposed work snail be complied with , whether speckified or not, and that such work is authorized by the owner. Signature Po oLj Owner, owner's agent , architect , contractor Al SPECIAL CONDITIONS OF THE PERMIT : Sy---- --------- ------------------------- TOWN of QUEENSDURY WARREN COUHTYo NEW YORK Application for : BUILDING PERMIT IN C014PLIANCV 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 JIS60 2 . Type of heat �"'�� „6 S )0%-DT A i C -- --- 3 . Is the building mechanically Cooled ?_ /V© 4 . Percentage of area of windows and doors 6/r4 - A . over 16 'L Only 1 , U va-l " a of gross area of walls , roof / ceiling and floors exposed to ambient conditions it 2 . Floor over heated spaces YES > NO a . Are foundation walls insu aced ? YES NO 1 . 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 floors ? 4 , Is basement heated ? YES o , R value: of insulatiYYon _ JA 5 , Typa: of insulation 06S.S B . Under 16 _ Only 1 . !t value of r f ors exposed to ient conditions Cc aL *i + � r .� . R value of exterior wall Z' �` -3 . R value of glazed area 14 4 , R value of doors l so R value of floors over unheated space 6 . R value of slab edge insulation - unheated slab A/ / fit w 7 . R value of slab insulation - heated slab��Al 13 , R value of heated basement/ cellar walls ( above gra e ) 9 . �+ value of heated basement/cellar walls ( below gra e ) 10 . Type of insulation Co Controls d • 1 . TUarmostat maximum heat setting S%Co D . Duct Systems l . . Is duct system installed in unheated spaces ? 0 NO AJ a . If YES . R value of duct installation R.- 1 `'► b . R value of duct in other areas.- E . Pining-Insulation y 1 . Size of hot water "or cooling Carr ing agent pipe WIN value of pipe insulation '4V / A F . Service Walter Heating 1 . Ferxoru►ancas err" icienay '4`�`p 2 . 'L' 4urp .Arature Control setting maxi mum i►4 G . For Swimming Pool -Only 10 maximum. heating ie % x A Telephone No . �"r/ `1 49 4 Now Id - ( applicant ' s signature ) �Wr -1 TOWN OF UE ENS B UR, Y • .fir—.,,�-__ APPLICATION FOR SEPTIC DISPOSAL PE MIT DATE I I Z a LOCATION OF PROPERTY FOR INSTALLATION L o ,, h'` Ir C) J i L LS Owner's Name: yi ].-� Ssbe. !'✓4ne,<`6,rAfrelephone: Address: A./ A ►r+ e Installers Name: V%^ & f. y� r^ ry Telephone: � 7 Number of bedrooms (residential only) Y M Total daily flow (compute CL 150 gal per bedroom) & a 4 / Topography: Circle one: lat Rolling Steep Slope % of Slope y1% Soil Nature: Circle one: and Loam Clay Other {Depth: Feet Ground Water: At what depth? A/ fA Feet Bedrock or Impervious Material: At what depth? _ 4/A Feet Percolation test: Circle one: of reauir required rate min. inch. Domestic water supply: circle one: I Municipa Well Other If domestic water supply is a wel : Separation: Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank A"a gal. ( minimum size: 1 .000 gal.) 1J j TILE FIELD: Each Trench feet/Total system length feet f l SEEPAGE PIT (G" 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 Dis�posa/lJ Ordinance, SIGNATURE OF RESPONSIBLE PERSON: 49= DATE: // 1Zo Z / 478' ,q 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 S . ) size and dimensions of all tanks , distribution boxes , tile fields anti / or drywalls B . No system shall be covered before inspection and approval by the Building InspLoctor . Failure to comply with this requirement may riasult in the uncovering of the system by the installer and a fine of up to $ 2500004 Vapproved copy of the plot plan shall be available on the construction ps,Lte . Failure to produce said plot plan at time of inspection may fifes lt • in an immediate work stoppage . � Sh drueforeseen problems during construction prevent proper insralla— tion , alteration or rup;air of an approved system , a new proposal must i r"s bmittod to the Qut,�4nsbury building Department before further . ii'►�Eruct ion , f Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 „A TOWN OF QUEENSBL1RY ' APPLICATION FOR SEPTIC DISPOSAL PERMIT Uj C) 9 k01 JUG '(_ 1 a' �c� ti+ �u �.� G DATE A-P IQL IC Ft cri LOCATION OF PROPERTY FOR INSTALLATION Lo �T- 4 5 610 p c ,( Lc, Owner's Name: Z.,cEA"cam lZ ,c t { r A1� Telephone: "]Q ; — Q 6I Address: a :�, iti1 Installer"s Name* M Telephone: Number of bedrooms (residential only) Total daily flow (compute (a 150 gal per bedroom) Topography: Circle one: lat ) Rolling Steep Slope % of Slope Soil Nature: Circle on : San Loam Clay Other /Depths Feet Ground Water: At what depth ? .Feet Bedrock or Impervious Material: At what depth ? ,�Feet Percolation test: Circle on not required equired rate min. inch. Domestic water supply: circle one I�tu cn ii pal Well Other If domestic water supply is a w Separation: Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank, _ 00 (D gal. ( minimum size: 1 . 000 gal.) TILE FIELD* Each Trench ICJ feet/Total system length � d feet SEEPAG rn er o / Size each e Sine of stone to be used ik.,L/Depth or Thickness Z__ 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 TOWN OF QUEENSBURY RUILDING AND CODES DEPARTMENT EA ,& HAVILAND ROADS (2UEENSHURY, NEW YOR?[ 228016 TELEPHONE ( 5.P8) 792-58.32 BUILDING INSPECTOR' S ORT REQUEST FOR rN PEcTroN RECEIVE NAME �C Gz : �•� C LOCATION DATE S` PERMI APPROVED YES NO FOOTSNG/PIERS MONOLITHIC POUR FO S FOUNDATION/DAMP- PING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN IiNSULATION: f r FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ,ROOFING SIDING ",{'.EXTERNAL PORCHES/S EPS STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES/ ELIEF LVE INTERIOR TRIM/PRI ACY DOO FINISHED FLOORS GARAGE FIREPROOF G DOOR CLOSERS) SMOKE DETECTORS XFINAL ELECTRICAL NSPECTION� AFINAL APPROVAL OF CONSTRUCTION OK TO ISSUE C/O cc V6: A SIGNED CERTSF ATE OF OCCUPAN MUST BE OBTAINED FROM T E BUILDING DEPAR MENT BEFORE THESE FREMTSES RE OCCUPIED! REMARKS: l ..x J ACto o t s-i pEpAR � SPECTOR TOWN (7F QUgRNSBURYj BUILDING AND CODES DEPARTMENT ,RAY & HAV=LANDOADS YaRK I280!6 ¢UEENSBtiRY. NR�528 ) 792-5832 TE�;pHaNE t' gUI.WING INSPEC 'OR` S REPORT REQUEST INSPECTI RIVED F' NAME T Jr ._ LOCATION PERMIT # DATE APPROVED YES NO FpOTING/PxERs MONOLITHIC POUR F RMS �---� ,pOUN,DATxONIDAMP-P FING BACKFIDZ APPROVAL �r- ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS C> v V "l f WALLS CEILING �INAL rN5PECTION CHIMNEY HEIGHT ROOFING SIDING ,EXTERNRL PORCHES/ STAIRS-CLEARANCE & x VALVE PLUMBING FIXTxrRESI INTERIOR TRIMIPRIVA Y FINISHED FF,pORS GARAGE FIREPROOFING DOOR CLOSRR (S) _ SMOKE DETECTORS FINAL .ELEC ICAL INSPS VCTI FINAL APPRCaVAL OF CONS OK TO ISSUE C/o OR C/C A SIGNED CERTIFICATE CUP NCY MUST BE IFICATE OF OBTAINED FROM THE BUIILDoccu� THESE PREMISES A GDDE AT2TMENT BEFORE Rk' REMARKS : pRRIVE�~ L5 pRPAR IN PECTOR BOILDING and ZONING DEPARTMENT Bay au nsbu y. New Haviiand dYorD126001x 98 � SEPTIC DISPOSAL SYSTEM INSPECTION NPME LOCATION / �( f 0 fJ p - DATE �v ` PERMIT NO . - Loam - ay SOIL TYPE - Required? YES- Percolation Percolation rate - Min/In TYPE of SYSTEMS total eng th "Z CJ C7 Absorption £ ield'y Length of each ench Depth of trenches'% Size of gravel SEEPAGE PITS of){"------ �— Size— to X vel size Size Type PIPING : �- Bldg _ to tank Tank to list. box ., Disk . box tea field/ w Partial Openings sealed? NO LOCATIONI/SEPARAT-1 = , f Foundation to tank f . Foundation to absOjkptiO d_ Absorption to lot ;line t. Separation of pit ON PROERTY (circle one) LOCATION CV SYSTE Front - ea - L4ft side knight side - CCbu4ENTS : x �3 1 f`l f SYSTEM 135E APP D �`S NO Bui din In pector 01/8j6 and v1 UEENS'BURY � QZ� O� Q ODES DEPARTMENT aJILDING AND D ROADS �y 6 HAVILAN� PORK 2280& QUEENSSURYr 5,38) 792-5832 TELEPHONE f ,T E ILDING INSPFCTOR' 'S Rom' REi?u FOR NSPECT ON RECE14ED , NAME LS LOCATION. PERM DATE A�/PyP�+ROV�}E�'D k YES NO pOOTING/PIE UR ORMS MONOLITHIC OOFIN ~~- FOUNDATION/DAMP RACKFILL APPROVA ROUGH I'NG RAMING " kE 'ECTRIC L ROUGH- N INSULATION= FOUNDATION FLOORS WALLS - r R: CLrIL ING FINAL INSPECTIO a CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES S PS LS STAIRS.CLEARANC & I VALVE F PLUMBING ��M/P X R SIRE tlAC E IRS D� ._ .INTERIOR FINISHED FLOOR FING GARAGE FIREPR DOOR CLOSERS} SMOKE DETECT O IN ECTI N�� --- FINAL ELECTRICA F : CONSTRU !('ION�� FINAL APPROVAL OK TO -ISSUE C/ I. OR C/C 5T BE CERTI ICATE OF OCG" PANCY MU A SIGNED HE BUILD DEPARTMENT BEFORE OB TAI NED FROM OCCUPIED'Iy THESE PREMISES ARE i REMARKS : =i �S ARRIVE xN PECTOR Lam' �pa tweI � 1 TOWN OF QUEENS S D.E RY .BUILDING AND CODES DEPARTMENT SAX & HAVXLAN� ADS YORK 2280k SUEENSBURY. 5I8 ? 792-5$32 TELEPHONE VjIL}ING INSPECTORS REPORT INSPECTXON RECEIVED REQUEST NAME -AF- In LOCATION PERMrT �~ DATE ppROVED xEs rro___ FOOTING/PI74 R FORMS MONOLITHIC _PROOFING ~ FOUNDA3'xON/ VAL BACKFILL APP XROUGH PLUMBYN "')rFRAMrNG -XN ELECTRICAL ROU --- XNSULATI ON FOUNDA FLOORS WALLS CEILXNG TIt7N : FINAL INSPEC CHIMNEY HEIGHT ROOFING .SIDING EXTERNAL PORCHES/STE STAIRS—CLEARANCE & RA ALVE� _--- INOG T FXXTUpESInEL F .rNTE RS INTERSRRIM/PRIVACY FINISHED FLOORS GARAGE.' FIREPROOF DOOR CLOSERS) SMOKE DETECTORS INSPEC ION FINAL BLECTR OF DONS RVCTXO FINAL pppROV��O OR C/ OK To ISSUE MUST BE F OCCUPANC N,1, BEFORE A ,SIGNED FRpMz THE BU LDING DEPART OBTAXNED +OCCUPXEDI 'THESE PREMISES ARE �---- Dove � es F CG--GCJI -fix R.3 virp Y"v ARRZ"VE� .r DEPAIs ! 'r ! NSPECTOR TOWN OF QUEENSEURY ADS � ILI BUILDING AND CODES DEPARTMENT ,BAY & HAVILA E LYORK 1280k QUEENSBURY , 7y2-5832 TELEPHONE ( 51$ ) BUILd]INC INSPECTOR S,'' REPORT ��- REQUEST FOR I SPECTION RECEZV*D NAME LOCATION PERMIT #i,�DATE APPROVED APPROVED YES NO FOOTINGIPIE S FORMS MONOLITHIC 14OOFING FOUI,,yDATIO APPROVAL BACKFILL OUGH PLUMBING FRAMING ELECTRICAL ROUGH- IN -INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION = CHIMNEY HEIGHT ROOFING SIDING TEPS EXTERNAL PORCHESI RAILS STAIRS-CLEARANCE PLUMBYNG FIXTURE /RELIEF VALVE --v INTERIOR TRIMIPR VACY DOORS----' FINISHED FLOORS GARAGE FIREPROO LNG DOOR CLOSER (S1 SMOKE DETECTOR- _CTION FINAL ELECTRICAL L FINAL APPROVAL OF; CONSTRUCT-TO BE A SIGNED CERTIFIATBEILIJI OF NGCDEP1t7MENTT BEFORE OBTAINED FROM TIR THESE PREMISES ) jR OCCUPIEDf `; REMARKS : i :f x e 3 � � NSPECTOR I 1 TOWS OF QUEERSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAN ROADS YORK 128096 1 QVEENSBURYr NEW 7 $2-5832 TELEPHONE BUILIIING INSPECTOR` S FORT REQUEST FOR INSPECTION RECEIVED Z=Z���` NAME LOCATION pERMIT # DATE APPROVED" YES NO f EOOTING/PIERS ep mON'OLITHTC POUR Fa S ING FOUrpDATIaPROVAL BACKFI ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN IN$UrATXON: FOUNDATION FLOORS d . WALLS CEILING FINAL INSPECTION CHIMNEY HEIGHT ROOFING SIDING STEPS ,EXTERNAL PORCH N E & RAILS STAIRS-CLEA ES/RELIEF DOORS PLUMBING FIXTU � --- INTERIOR TRIM/ RIVACY DOOM FINISHED FLOORIPBING GARAGE FIREPR DOOR CLOSERS) SMOKE I7ETECTO S INSPECTION FINAL ELECTRICA F CONSTRUCTION FINAL APPROVAL A SIGNED CERTI ' HE BUILD C DEPARTMcUPANCY ENIt BEEF OBTAINED FROM OCCUPIED THESE PREMISE ;; ARE REMARKS : f providing he Contractor is responsible for protection from freezing for 48 hours following the Placement of the concrete - 14ateri al s for this Purpose on site ES NO D4 IF —0�� NSpECTOR YOU ARE HEREBY REQUESTED TO INSPECT AND ISSUE CERTIFICATES FOR THE FOLLOWING ELECTRICAL EQUIPMENT TO BE INSTALLED BY THE UNDERSIGNED TEMP. M pq CITY OR VILLAGE 3, TOWNSHIP CO4 N Y S} A\ �0l L POLE NUMBER _ k t J �i..1 BETWEEN WHAT 7M CROSS STR"TS S PREMISES LOCG Em SECTION BLOCK 1V) 1 X C_" I t kj . Ts NAME _ 55 BUILDING OCCUPANCY OWNER'S NAME AND A[1PRESS ] HCVJ TELEPHONE NUMB R 7•y i� t4 v', jrC` t '� 4 /"�l " k1 (may �... 1 j �- 0. t ? 55 CURRENT /SUPPLIED 9Y ) FROM THEIR OFFICE I WORw TELEPHONE NUMBER ) I^-. fi '• / %, 7 f 1 - ! ':•/` BUILDING IS ,�L NEW 1_'l OLD ❑ WORK IS NEW ❑ ADDI'TIOhAL ❑ DEFECTS REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED -NUMBER OF OUTLETS No. of Fixtures & MOTORS HEATERS BRANCH OFFICE USE [FWL. Lamp Receptacles CIRCUITS ONLY Side Attachl Switch Pendant Bractrgt Na Type M.Pry Na Each No. G� INSPECTION Csilin9 Wall rl a pls SUB- BASE REMARKS= LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE. THIS APPLICATION IS INTENDED TO COVER THE A84OVE-LISTED EQUIPMENT TO BE INSPECTED, BUT IF AT TIME OF INSPECTION, THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED, YOU ARE AUTHORIZED TO FdA.KE THE INSPECTION AND ADJUST THE FEE TO COVER THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT. ESUMOFAINS FEEDERS FLEUMC SIGNSfLAMPS TOTAL VOKFT`'ER OF WORK ❑ "PSED GA£.TVBE SIGNITRANSFORMERS OF Mk CONCEALED K TO BE STARTED DAFE COMPLETED SIZE OF SIGN (NUMBER) CAPACITY ENTERS BUILDING MANUFACTURER OF SIGN ovinnHEAD ❑ UNDERGROUND PECTION REOUESWD ON(OR AS NEAR AS POSSIBLE}O'A7 DELAYS OY GWINCI FU AM ACCURATE INFO TION, ALL SPACES MUST Be FILLED IN OR APPLIOATI MAY RETURNED. PRINT NAME AND ADDRESS NAM OF APPLICAhA� _ �., DATE OF APPLI ION �c I�—' ., ? � X 1 iE; , �' TELEF�M NO;�. —T STR, --ET % DR A,/ A / / -y / 0 f ;}F E '1` i ' ' ,y, �,., ZIP z DE� LICENSE N I WHEN APPLICA43LE -'[ I ❑ Al State Street ❑ 570 Delaware Avenue ❑ 217 Lake Avenue El202 Arterial Road ALBANY, NY 12207 BUFFALO, NY 14202 ROCHESTER, NY 14608 SYRACUSE, NY 13206 _ ' % 1/' 1_1k ^ . If=IRE .UNDERWRITERS � .