1989-944 :,y, ,
f CERTIFICATE OF 0CCUPAN C•Y'
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
f�7 + ay •/^� Date. 4''` ,.rz, �1.�s-!�`- ''�-' �' 19 Lt/'
This is to certify that work requested to be done as shown by Permit No. 89- 944
has been completed.
Thin structure may be occupied as a Single Family Dwelling
L,ocairion # Plasters Commons North
C7vMer Jack Pol adi an
By Order Town Board
TOWN OF QUEENSDURY
�i suildi&Q r5r Toning inspector
BUILDING PERMIT
TOWN OF QUEEWSBURY No. 89-944
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to , Jack Pol andi an
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OWNER of property located at Lot #25 Ma5ters Common Forth Street, Road or Ave_ I
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in the Town of Oueensbury. To Construct a place a Single Family Dwelling
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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
728 Northgate Plaza
Glens Falls , New York 12801
2. CONTRACTOR or BUI LDE R'S Name
Daniel Valente Q
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3. CONTRACTOR or BUILDEWS Address
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60 Sweet Road
Queensbury , NY Fir
4. ARCHITECT'S Name
5. ARCHITECT'S Address
R.I#
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6. TYPE of Construction — (Please indicate by XI
KA Wood Frame I ) Masonry I l Steel { } .
7. PLANS and Specifications
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No. 72 ' x 40 ' single family dwelling with driveway and three car garage
as pera lication , specifications and plot plan .
S. Proposed Use
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Single Family Dwelling .
S 471 PERMIT FEE PAID — THIS PERMIT EXPIRES December 6 19 90
(it a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of O.ueensbury before the expiration date.)
'!A
Dated at the Town of Queensbury # 1/ Da of December 1989 y+
SIGNED BY �, _ for the Town of (]ueensbury CCM+
Building and Zoning Inspector 2
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TOWN OF QUEENSBURY TOWN OF OUM94SER.IRY
REVIEWED BY XVV
RECEIVED
-� FEE PAID # ' 1 ' ¢(n � 5 NOV 3 1989
PER14I r NO.
BUILDIING PERMIT APPLICATION
A PERMIT MUST BE OBTAINED BEFORE BEGINNMG CONSTRUCTION. NO INSPECTIONS
WELL BE MADE UNTEL 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.
s # s a s w 0 w s ! s s ■ * U a * a U 0 s s * 0 s s t * * s s r w r 0 r * a w ar *
The owner of this property is: 1m
P. O. Address 'arc[ " 0fl41 5 �i � �y tom' / Tel.
Property Location Z 4 aVgl Tax Map No. I�I
Has there been any split of this property since October 1. . 1988 ? /�
If yes Planning Board Review is necessary. yes no
SUBDIVISION NAME, IF APPLICABLE 4 � b � A4Z : LOT NO. t4= ";?t, S�
THE PERSON, RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
NATURE OF PROPOSED WORK: ESI':'�tATED MARKET VALUE OF
%eleUR Construction of a new building ,. CONSTRUCTION: $ ! �l .tea K5
Memo
COMPLETE INFORMATION REQUIRED BELOW-
Addition to a building
• Size of property / + ft x ft.
Alteration to a building • ,Existing Buildings( 3 ) Size 4VO ft. x '� Z. ft.
(no change to exterior dimensions)
Other work (Describe) Proposed building distance from property line:
* Front yards S ft. Rear yard I I ft.
Side yards 2. Z ft. and -fit -7 ft.
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GROSS AREA OF PROPOSED STRUCTURE * If on corner, setback from side street ft.
1st Floor /267 sqe ft. � r " OCCUPANCY INFORMATION
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2nd Floor / 4r <-e el sq. ft. Primpirfry Building -
Other Floors sq, ft. = M i/ One Family Dwelling
(not cellar orbasement) Two Family Dwelling
TOTAL FLOOR AREA 3Sri 3 sq. {t - ; • Multiple Dwelling/Number of units
-- - -- „ Business
Size of new structure ya ft x 14:�) ft.
Foundation-pier/slab/crawl/parti&Lpt ,' " Industrial.
(circle one) • Other
Noe of stories (habitable space) 72�
Height (grad* to ri+dEe)��7 ft. a If addition, what will use be?
If residential, no. of famiileg / 0
Noe of roohns(exctuding baths) 9 * Accessory BuiUWW
No. of bedrooms_ -- � • Dethed G WO Car
Noe of bathrooms, ac aurase ONS/T
Primacy heatint yst+emy G' (o 4- tOt q • A ttached Garage ONE/TWO Car
Type of fuetl� a Private storage building
Noo of ftreplaces to be installed "
Will a wood stove be installed ? • Oth,rr c + r
Central Air conditioning 4 /,, -C '
OV ER
.
8L: IL0IN PERMIT APPLIC -, TTON COts; TrN U E 0 -
BUTI. DrNG 3PECTFIC' ATIONS;
Type of construction, wood frame, fire safe, etc. C,. G+ o cl 472p-r" C-7- '
Will any second-hand or upgraded lumber be used? If so, for what ?
Foundation wall material _ 6-V-O 6A (xPift-CnAA- Thickness
Depth of foundation below grade (to bottom of footing) ' r
Will there be a cellar ? =- Heated or nheated Floor sq. footage /� E -] sq ft .
Will there be a basement ? Will any portion be used as living space? h ( rJ
(If so, what portion9 sq ft . Type of use?
Woo-
Type of roof - /flat/shedlo#her Material of roofmac-eg-J ..g'
Size: wood studs e��_ "x Cn " spacing" o. c. length ft.
Joists ( floor beams) ist floor Cd9_ "x ,:=.„ spacing 1 60 "o.c. span _14k" ft.
Joist (floor beams) 2nd floor ' D "x I Z " spacing /6 "o.c, span f ft.
Overlays (ceiling beams) "x 9"' spacing..Z" o.c. span / 6.ft.
Roof rafters "x / 0 " spacingd.6o. c. span 2- ft.
Roof trusses (pre-engineered) spacing " o.c. span -- ft.
Exterior wall finish ( 0 4W d , of what material? C-JeC r"� -
Interior wall finish - 'i- � � ��
If a garage is to be attached, de �SY
scribe materials to be used for FIRE SEPARATION:
Is there to be an opening between garage and dwelling?V rr3 - If so will a Fire-rated door, enclosure,
self-closing device be provided?` V LT-1
Will a flue-lined chimney be. installed?Height above roof c� t � 4h ry,. 1 ft* rr
Depth of chimney foundation below grade � ft.
4W
Depth of fireplace hearth � ft. cl in. , �� f�
Water supply - Municipal or private well y" " AU t C 119 '•" 'C L. O
ZZZ
SEPTIC SYSTEM Distance from ANY private well (including adjoining properties ft.
(A separate application is necessary for any repair or new installation of system)
NAME OF BUILDER � ADDRESS 60 � � 'Wc Cx WTBL NO.
NAME OF PLUMBER O1 U+ 4e,au pwtkbn ADDRESS OLA'P� f4t . TEL. NO. �'i �^f - -...- 3; S l
NAME OF MASON ADDRESS ? ( f rC r•.. 1 J` CAA1 :1r EL. NO. 14 �C 7 "0 d�o 7
NAME OF ELECTRICIAN 1V C_A-ei- j ADDRESS_ C ,Fa.^,cL - TEL* NO. 6
DECL.ARAMON
To the best of my knowledge and belief the statements contained in this application, tosether 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 provisiowm"o ,of the BUILDING :. ., :.. ..9 . iiE ZONING 0 RDINANCE. and
&H Other laws pertaining to the proposed work shall be complied whether spec, ed or not, and that
such work is authorized by the owner.
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Signature
Owner, Owner's agent, architect, contractor
SPECIAL CONOMONS OF THE PERMIT:
/ BY
TOWN OF QUE . NSSUac _
WARREN COUNTY , NEW YORK
Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW PORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work ,
ANSWER ALL of the following :
1 , Gross floor area T
2 . Type of heat e44/ t2�
3 . Is the building mechanically cooled ? urs
4 . Percentage of area of windows and doors 640cQ(� "er
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 an walls insulated ? ( NO
1 . if YES , what is the R value ?
i
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
9 , Under 16 . Only
1 . R value of roof and floors exposed to ambient conditions.
2 , R value of exterior walls E - � 07
3 . R value of glazed area e!
4 . R value of doors P I
5 . R value Of floors over unheated spaces
6 . R value of slab edge insulation - unheated slab
7 . R value of slab insulation - heated slab
a . R value of heated basement/ cellar walls ( above grade ) - ��
9 . R value of heated basement / cellar walls ( below grade )
14 . Type of insulation -
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
1 . Performance efficiency
2 . Temperature control setting maximum
G . For Swimming Pool Only
1 . Maximum heating
Telephone No . �/ �T ' S-2 G-0 /0/i2
( applicant ' s signature )
TOWN OF QUEENSaUrY
APPLICATION FOR
ri ti' SEPTIC DISPOSAL PERMIT
DATE ,+�3� r
LOCATION OF PROPERTY FOR INSTALLATION .� 7� c ✓ �I�'7sb`� � S G"� ''`° �
Owner's Name: �400 Telephone: L
Address: UI?
P
Installer's Name: Telephone:
Number of bedrooms (residential only)
Total daily flaw (compute (d 150 gal per bedroom)
Topography: Circle one: Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious !Material: At what depth? Feet
Percolation test: Circle one: not required required rate min. inch.
Domestic water supply: circle one: Municipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank 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 # /Depth or Thickness feet
M 1k k lk+k Me rFe�e ale ale R k*#�* *** F�t*Me#yr
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 Qlueensbury Sanitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON.
DATE:
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
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
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 installa—
tion , alteration or rupair of an approved system , a new proposal must
b4 submitted to the Quuensbury Building Department before further
construction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
h4ns : rka :
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
yopx 12804-
OUEENSBURY, NEW
TELEPHONE (518 ) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION ECEIVVD
NAM d-
,E
LOCATION
PERMIT #
DATE
APPROVED
YES NO
FOOTINGIPIERS
MONOLITHIC POUR ORMS
FOUNDATION/DAMP— OOFXNG3. u�
BACKF"ILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—I ..
INSULATION:
FOUNDATION
FLOORS
WALZ.S .
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES ST
STAIRS—CLEARANCE & I VALVE
PLUMBING FIXTURESIR
INTERIOR TRIM/PRIVA y
FINISHED FLOORS
GARAGE FIRElcyj :>FI
DOOR CLOSERS)
SMOKE DETECTORS
FINAL ELECTRICAL SPEC2'ION
FINAL APPROVAL OF CONSTRUCTI
OK TO ISSUE C/o R C/C
A SIGNED CERTIF CATE OF OCCUPA Cy MUST BE
OBTAINED FROM HE BUILDING DEPA TMENT BEFORE
THESE PREMISES ARE OCCUPIED!'
REMARKS : s /
ARRIVE
,ih1 ECTOR
7rOWN OF QUE'ENSBURY �
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS 1280k
QUEENSBT1RYr NEW YORK
TELEP ONE (518 ) 792-5832
WjILDING INSPECTOR' S RFPORT
REVt7ES FOR INSPECTION RECE.XV.
NAME }'
LOCATIO ---
PERMIT
DA,TE APPROVED
YES NO
FOOTING/F RS
MONOLITHIC UR FORMS,. �—
AMP-P`FE+DOFING_
FOUNDATION/ OVAL
BACKFXLL AP r
ROUGH' PLtTMBI G
FRAMING D7
ELECTRICAL RO GH�IN
'y( INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL, INSFECTION
CHIMNEY 14SXGUT
ROOFING
SIDING
EXTERNAL PARCHES T PSILS
STAIRS�CLEARANCEEF VAL-LVVE~~
PLLIMBINCrgIM/xTviptvs
PRI Y DOORS
INTERIOR FLOORS
,FINISHED -�-
GARAGE FIREPROOFI G
DOOR CLOSER (S) -
SMOKE DETECTORS
FINAL ELECTRICAL I S ONSTR PEC O TIO�N�- �---
FINAL APPROVAL OF C/C
OK TO ISSUE CEO OC O C/C FANCY MUST BE
A SIGNED CERTIFI A BU OL.FF NapARTMENT BEFORE
OBTAIN D F SESROMT HRE OCCUPIED :'
THESE
REMARKS :
ZIEPAR"' / • INSP TOR
TOWN OF QUEENSBURY
SUILDXNG
Np CODES DEPARTMENT
BAY & I " LAND ROADS POR 1280&
QU,EEHSBUR . NEW 2 K K2 5832
TELEPHONE
ITi TANG INSPE R` S REPC]RT
REQUEST FOR INSPECTION
NAME
.LOCATION '
ERMrT #,�.�
/74
DATE APPROVED
YES NO
FOOTINGIPIERS
FORM
MONOLITHIC PO —FROG ING��
FOUNDATIONIDAM L
SOCKET PLUMBING
ROUGH ,k
FRAMING
ELECTRICAL ROUG —I
INSULATION:
FOUNDATION '.
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDINGAL poRCH SI 'TEPS���
EXTERN ARAM E RAILS
ST.a1IRSXCLF ES/4EL'IEF VALVE
PIxTMBING TRXIM PRIVAp1' DOORS
INTERIOR
FINISHED FLOG S
GARAGE" FIRE P PING
DOOR CLCiSI {'
SMOKE DETEC RS �—
FINAL ELECTRIC L INSPE ION��.�._�—�
FINAL FLEC PA OF CONS+T*UCTIONJ�
OK TOI S$UE C O OR C/C
DOPARTM
BE
A SIGNED CERT ICATE OF 6CCUPANCY MUST
THE ,SUILDrN7� ENT BEFORE
OBTAINED FRO ARE OCCUPIliDY
THESE PREMI''S
,t
REMARKS : 'g
,C
Y.
{Y
1
aRRavE
DEP R'�' /.� : I VspsC R
TOWN OF QUEBNSBURY
BUILDING AND aO )ES DEPARTMENT
BAY & HAVILAN� YO ROADS DS I280sk
�IUEENSBURY, NEW
792-5832
TELEPHONE f
518 )BUILDING INSPE OR' S REPORT
x ED �r~
REQUEST FOR INSPECTxO f rim
NAME
LOCATION ERMIT #
DATE APPROVED
YES NO
FOOTINGIPXERS
,MON'OLxTHIC POUR FR FING
FOUNDATION/DAMP- �-
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELsCTRICAL ROUGH- l
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING RC SISTEPS
EXTERNAL
STAIRS.CLEARA CE 6 RAI VE-- T
PLUMBING FIX RESIRE'LIE VALVE
INTERIOR 'PRIM SR.IvACY D RS
FINISHED F
GARAGE FIRED OCYFING
DOOR CLOSER ( 1
SMOKE DETECT RS
FINAL ELECTRIC L INSPECTION
FINAL APPROVAL OF CONSTRUCTIO
ox TO ISSUE C/ OR C/c
A SIGNED CERT ICATE OF OCCUPA Y MUST BE
OBTAINED FROM THE BUILDpNEDEPA TMENT BEFORE
THESE PREMISE ARE --
REMARKS:
ARRIVE
DEPAR'�' -�I f J INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
ORK 2280+2
QUgE SBURY, NEW
TELE HONE (5I8 ) 792-5832
BUILDING INSPEC OR' S REPORT
REQUE FOR IN TION EIVED
NAME
L,OCATIO 1 -
ERM
DATE APPROVED
YES NO
FOOTING/P RS
MONOLITHIC POUR FORMS
~-
FOUNDATION AMP-
PROD NG
BACKFILL AP VAL �-
ROUGH PLUMB, G �~
FRAMING H_IN
ELECTRICAL R
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTXON :
CHIMNSY HEIGHT
ROOFING
SIDING
BPS
EXTERNAL PORCHE / & RAILS
STAIRS-CLEARAN S/ LIEF VALVE
PLUMBING FIXTU RIVA DOORS
INTERIOR TRIM/ -
FINISHED FLOOR
GARAGE FIREPR FIND
DOOR CLOSER BSI
SMOKE DETECTO Sr
FINAL ELECTRICA INSPECT ON
_ FINAL APPROVAL OR
CONSTR TION
OK TO I i3 gSE CI OTt C/C
PANCY MUST BE
A SIGNED CERTI ICATE OF OC ILDING EPARTMENT BEFORE
OBTAINED FROM HE gt7CCUPI
THESE PREMISE ARE OCCUPIED
REMARKS:
DEPAR` -- -----= INSPECTOR
TOWN OF Qu ENSBURY
BUILDING AND ODES DEPAR NT Am
BAY f HAWS ROADS
OUBENSBURYr YORK 7 Ok
TBLEPHONS ( 18) 792-58 2
BCI IDING INS MR' S REPORT
REQUEST FOR SPECTION RECEIVED �-
NAME
LOCATI _t{Zrl1f
DATE 0 PERMIT #
APPROVED
YES NO
,BOOTING/PIERS
MONOLITHIC POU FO S
FOUNDATION/ -PR FING
BACKFILL APPRO L
, ( ROUGH PLUMBING
Y� FRAMING
/ ,ELECTRICAL RCH1G N
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL XNSPECTIO r
CHIMNEY HEIGH
ROOFING
SIDING
BXTERNAL POP HES STEPS
SLS
STAIRS-CLEA NCE �--� -�
PLUMBING FI RBS RELIEF VALVE
INTERIOR TR /PRI Cy DOORS -
FINISHED F RS
GARAGE FIRE ROOFIN
DOOR CLOSER S)
SMOKE DETEC RS
FINAL ELECTRIOAT, INSP TION
FINAL APPROVAL OF CONS UCTXON
OK TO ISSUE wo OR C/C C �--�-
BE
A SIGNED CERTIFICATE or
I DEPARTMENTNCy TBEFORE
OBTAINED FRO
THESE PREMISES ARE OCCUPX
REMARKS:
ARRIVE
DEP' T� � INSPECTOR
1
3
TOWN OF QrUEE SBURY
BUILDING AND C DES DEPARTMENT
BAY & HAVXLAND ROADS
YRK 128[7
QUEENSBURyo N
TELEPHONE (51 J 792-5832
BUI NG INSPECTOR'S PORT
REQUEST FOR INS ECTXON RECEIVED
ID 1
NAME
i
LOCATION p
DATE PERMIT 7 �
APPROVED
YES NO
FOOTXNGfPIERS
MONOLITHIC POUR F PING
FOUNDATION/DAMP—F'
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRrCAL .ROUGH—IN
XNSULATZ.ON'
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEP r
STAIRS—CLEARANCE & RA VALVE
PLUMBING FXXTURES/RE
INTERIOR TRIM/PRIVAC D RS '
FINISHED FLOORS
, GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL INS TION
_ FINAL APPROVAL OF CO STRUCT N
_�...
G?1C T() T SSUE C/D CAR C__,_ _� -----.: ---- -----
A SIGNED CERTIFICAT OF OCCUP Cy MUST BE
UILDING DE RTMENT BEFORE
OBTAINED FROM THE
THESE PREMISES ARE OCCUPIED :'
REMARKS r
- a4
ARRIVE
w
DEPART
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 2280+I
TELEPHONE (518 ) 792-5832
BUIL I G INSPECTOR' S REPORT
REQUEST FOR INSPE TION RECEIVED D,� _�-
NAME
LDCATI
DATE / PERMIT #
APPROVED
YES INO
FOOTXNG/PIERS
MONOLITHIC POUR FORMS
FOUNDATIONJDAMP— FROOFIN.
/ BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN
INSULATION:
1
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEPS
.STAIRS—CLEARANCE ,It
RAILS
PLUMBING FIXTURES/RELIEF VA VE
INTERIOR TRIM/PRIVACY D RS c.
FINISHED FLOORS _ — —
GARAGE FIREPROOFING;
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTI ;
FINAL APPROVAL OF CONSTRUf?TION
k
A SIGNED CERTIFICATE OF OCCUPANCY ST BE
OBTAINED FROM THE BUILDING DEPARTME BEFORE
THESE PREMISES ARE OCCUPIED!
c
REMARKS
i
F i
r�
n 1,
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS 1
gUEENSBURY, NEW YORK 1280&-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S REPORT
REOUE R INSP N RECEIVED
NAME
LOCATIO
PERMIT
DATE #
APPROVED
YES NO
OOTING/PIERS
NOLITxIc PO[1R s _
FOUNDATION/DAMP— FING_
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL XNSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHESISTEPS _
STAIRS.CLEARANCE & RAILS'
PLUMBING FIXTURES/RELIEF ALVE
INTERIOR TRIMJPRIVACY
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPE TXON
FINAL APPROVAL OF CON T,RUCTION
OR TO ISSUE C/O OR C
A SIGNED CERTIFICA OF OCCUPANC MUST BE
OBTAINED FROM THE" UILDING DEPAR ENT BEFORE
THESE PREMISES'" A OCCUPIEDI
REMARKS:
ARRIVE � . �
pEPnrrm��_ ,
INSP TOR
TOW
RY
BUILDING
OF QD CODES DE
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURYe NEW YORK 1280&
TELEPHONE (518) 792- 5832
BUILDING INSPECTOR ' S REPORT
r
REQUEST FOR INSPECTI N RECEIVE ,/
NAME
LOCAT N
DATE PERMIT # � '4�
A PROVED
ES NO
FOOTING/PIERS
MONOLITHIC POUR FO
FOUNDATIONfDAMP-PROO IN _
G
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL. ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTIONr
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEP r
STAIRS-CLEARANCE & RA S
PLUMBING FIXTURES/RE F. VALVE
INTERIOR TRIMIPRIVAC RS
FINISHED FLOORS
GARAGE FIREPROOFING -
DOOR CLOSER (S)
SMOKE .DETECTORS
FINAL ELECTRICAL IN PECTSO
FINAL APPROVAL OF C NSTRUCT ON
A SIGNED CERTIFIC E OF OCCUP NCY MUST BE
OBTAINED FROM THE BUILDING DER MENT BEFORE
THESE PREMISES A OCCUPIED!
REMARKS:
Ole 171p�� t1jo
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVSLAND ROADS
QUEENSBURY� NEW YORK 3*280$-
TELEPHONE (518 ) A92-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION
DATE
1�( PERMIT
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING -
FRAMING
ELECTRICAL ROUGH-IN
.INSULATION:
FOUNDATION 4v coop
F 40ORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEPSz
STAIRS--CLEARANCE & RAILS
PLUMBING FIXTURES/RELIFiF VALV)t
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLOORS
GARAGE FIREPROOFING -
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTI-og
FINAL APPROVAL OF CONSTRLpbTIDN
OK TO ISSUE C/O OR C/+C
A
A SIGNED CERTIFICATE QP OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE Q&CUPIED!
REMARKS:
�.
ARRIVE
DEPART
INSPECTOR
,IFiENTIEST�E�11�A�i�ISIEiC, Iilf£.
National Headquarters
900 Hadeldn Aire., Gollingswood, *N.J. 08108
Date :
city, Town or Township kA 4.�t*�"l %JW County 'S lRr�-1 State
Location/Address "!s .�r
If Located in Dural Area - Please Attach Directions} ,Pole #
owner. ii . t � of [ CA& ,e ^w o Permit W. i 4
Occupied As S7 * � omc*-r"y { Building.. : N1e►nR " Old n
Occupant lr+ . € . zia t�s c..,.ur� ; .
Worts Area in Building Floor #, etc.}:
f ' _: Wiring Q- ...,Servi or: Ready for Ins a iiorl: .
Fee Remitted - $ Cash k NI.O.' t�,+ IGf �r.pa abtk T Nf.D. I.A.
Number of RPugh $Wirin Outlets Elect. Heat soo xao rood as 1�s0 sa0a 2saa szs0 sao0 ,
Switc
ghting 3 a r +° P• Service ' . • Surface Unit Dishwooher, Range
Receptacles s " WaOW4:1eater' Air Conditioner Dryer . r` Pump
Numbe --- - - co �Gerbage Disposal Wiring and Controls for Burner
Amp.-Iiieoeptacles Fractional H.P. Vent Fans
Other Equipment: ` L
MOTOR�l / fl L P4Bitj/,S
3 5 7% 10 15 0 25 30 40- 50 7R 14f0Mark Nu2�r
of Each Size
Applicant's �+ L L .. . .k - -
Signature + - f�f' f License dL
1Perrnit #
T/A .� ti: �Jtility:
Applicant's Address: + } I L
[State)_dts. ...�.�.:r�Iz+Ia} Service. Request #
w
ibm"WoArTs
-. :L lectr'cian: _1
Receiver): .. GATE INsKeCTEm
Correct Location : Same as Above { or:
Red Notice Label Lj
Rough Wiring Outlets Surface Unit . Oven
Switches Ran isposat
Rece acles Water Heater fAffBMWr
Fixtures ithiF' ditfo#ie
Amp. Service Equipment Berner Wlrih & cont4rols for Amp: Receptacle
Amp. Service Conductors Pung Vent Fans
MOTORS H.P. 1/^rA 1/i2 1/l0 1/8 1/6 1/ 1/3 . lf . S/4 "1 2 ' 3 7Vr 10 '1$ 20 25 3 St! 7 00'
Mark Number hk "' • ' '>
of Each Sim
Elect. t soo re0 1000 12s0 1a0o 1750 2000 2250 2 il 2750 a 'L
[� RW Progress: Inc. LKD Contractor
0 CFT Violation: Work Comp. 0 IPc. []
0 L/A Owner CAST 1 EJ
L/A Fee CHK
IPA NIA�nicipA� ... a. 11110
llVCi' # < .
�pp���.,-yam
+•'}a3'..' :f.�. .:r - .ry.,r.:: ..:.".,4 _ + +P:...,. .� �:-¢ tip ; y " °'V f� lt�• .`�"';.�3ri.. : if`"'-3R7" .�
Cut in Card C] Temp # -Date x ~ '•
A�
Final # Date
f = 44
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3
00
40, 00
112!
ILn
CM 200
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