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1992-083 e }{E2raA$a,,J2. h K ur- 'af S-84' I5'q.o•� -.,. \ Way-rrx Ems` D.2.Tdy Iv- s?�jvlSOob. 3 SMITH h Vl u) w T; u M.r.W5 0 4 V I flcation Q .�92v� 4A2quf y' LAPR 9145 m N 1' a APR 1995 tv TFiecQ eyed , sbury e" Of Deg n ark �N..d.E.•19'�E�-.v �N�E A_�, E Paoo.�c- "rra�rNeaucENs31l ", Zoo.t-3 C,� SAIA L- MAP OF; A SURVEY MADE FOR Ci m-' 'y Deco 9EFe2eNc.E o FcT. TOWN OF a ll rc zo Ssov-Y W q(LV" of COUNTY, N.Y. J A,J SCALE 5' =So" DATES . [-I,<'9-, -7 (`795' L2aY wAY#) Gwre VanDusen & Steves LAND SURVEYORS,GLENS FALLS,NEV YORK LK.F_: l2..+ L.➢ uof N.Y. STATE LTC. NO. 35617 pIK-3 CERTIFICATE Q►F +(..�+CLJPA.NCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date April 9 19 97 ~ '25 This is to certify that work requested to be done as shown by Permit No. ` 29 has been completed. SINGLE FAHILY DWELLING This structure may be occupied as s 113 DAWN RD . I.ocmtion w Owner CLU'tE , LARRY W . TAX HAF NO . 7 20 . - 1 5 ] . 2 t By Order Town Board TOW7fV_OFQU E ENS B V RY FQ Director of Bildg. & Code Enforcement BUILDING PERMIT -� TOWN OF QUEENSBURY � No. 92-083 z WARREN COUNTY, NEW YORK 'C' r PERMISSION is hereby granted to � Larry W. Cl ute r F OWNER of property located at 140 Dawn Road! Street, Road or Ave. � fv a—■ in the Town of Queensbury, To Construct or place a Single_ Family Duelling 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. i. owNE WS Address is !'7 RR6 Boil 140A ^' Queensbury, MY 12804 r 2. CONTRACTOR or BUI LDE R'S Name r Same 3. CONTRACTOR or BUILDER'S Address 4. AARCHITECT`S Name r a 5. ARCHITECT'S Address Off. S. TYPE of Construction — (Please indicate by X) ( Xi Wood Frame ( I Masonry ( ) Steel ( ) 7. PLANS and Specifications C+7 No. 2400 sq ft Single Family Dwelling as per plot plan specifications and application B. Proposedngle Family Dwelling S. tc cn $ 313. 00 PERMIT FEE PAID — THIS PERMIT EXPIRES March 19 , 1g _ (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the ip town of Oueensbury before the expiration date.) Dated at the Town of Queensix,iry_yfsic.119,th of Marsh 3992 r SIGNED BY for the Town of Oueensbury Building a nd7onIng Trispector Department of Comfrtunity Development Reviewed By: uilding & {Code Enforcement �-. lding 1nsp - - Town of Queensbury Permit No . a-` 74.2 Bay Road &X Queen.sbury, New York 12804 lee 1'nid (518) 745-4447 Building Permit Application a /3gogo A PERMIT MUST BE OBTAINED BEFORE BEGINNING 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 oil the application fora, . Applicant: owner: RN 74> Address- Address; Sol Ln 1'honc # { --___� _ c7 _77a"►-7�, 1'itsanc # { ----) ---- -- � L Property Loc.ttion ; � �+ ���C.�7r ., ��r] t +�Tax Mai' Ntlm arr IISubdivision N .tme: NATURE OF PROPOSED WORKS ESTIMATED MARKET 'VALUE OF THE New Building : CONSTRUCTION : $ residence / commercial Addition to Building : residence / commercial OCCUPANCY INFORMATION : Alteration to Building : Pr ary Building - residence / commercial Single Family Dwelling Residence / Commercial Two Family Dwelling no change to exterior size Family Dwelling Office Other Work ( describe below ) Mercantile Manufacturing Other GROSS AREA OF PROPOSED STRUCTURE : 1st Floor . . . . . . 10 sq . ft . /o' ZO if ADDITION , what will use of new addition be ? : 2nd -Floor . . . . 1 . 1 sq . ft . Other Floors . . . . sq . ft . - ( not unfinished cellar or basement ) ACCESSORY SUILI3INGS : Detached Garage lr 2 car TOTAL FLOOR AREA * _�� SQ . FT • Attached Garage 1 . 2 car Private Storage Building SIZE OF NEW STRUCTURE : Commercial Storage Building FEET X t7;�F FEET Other Foundation Type : C:;t 4f.. Will any second- hand or ungraded Number of Stories : _ lumber be used ? If sor for what ? ( habitable space only ) Height ( grade to ridge ) : feet TYPE OF HEATING SYSTEM : Number of fireplaces and / or woodst- ove ( circle all which applies ) to be installed : �_ Electric / oil / Gas / Wood Forced Hot Air f Baseboard / Other Person responsible for supervision of work as regards to building codes L s : _C�.i~r+- -, t -F --..fir x �?? Name Address Phone Builder : Plumber : Mason : Electrician * DECLARATION To the best of my knowledge the statements contained In this appli - cation , together with the plans and spUcifjcations submittedr are a true and complete statement of all proposed work to be done on the described premises and that all provisions of the Building Coder the zoning Ordinance and all other laws pertaining to the proposed work shall be complied with , whether specified or noted , an ats, sucki work is authorized by the owner . Further it is understood tha /we s �iall subm ' t prior to a Certificate of Occupancy or Certificate of ompli. anoe be ! i sued , an AS BUILT' PLOT PLAN drawn to scaler showing ac ual loc n o - pr " ect on premises . Signature : ( ner , owner agent , architect , contractor ) TOWN OF QCIEENSOURY „�--„ REVIEWED BY : a ? > FEE PAID : PERMIT NO . : O'F v�ENS8U� Fi r �'� � f" � _ , BUILDING PERMIT APPLICATION NAft BLDO, a A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . NO INSPECTIONS WILL L%E UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT . A71 applicants spaces on this application MUST be completed and the signature of the applicant MUST appear on the reverse side of this application . * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Owner of Property : Lgx.rr (,ram . CLA Ae P . O . Address : SZ[�? io ► k4op1 . 6 1 J4 roc-)t-r PHONE "753 .- 74D-77 Property Location : C]a , . ,,.% _Tax Map No . fa Has there been any split of this property since October 1 , 1988 ? Yes No ?^� If yes , Planning Board Review is necessary . Subdivision Name , if applicable : Lot No . THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS : NATURE OF PROPOSED WORK : * ESTIMATED MARKET VALUE OF THE Construction of new building * CONSTRUCTION : $ '�C7� cp4c�o . 4D4^ Addition to building Alteration to building * COMPLETE INFORMATION REQUIRED BELOW : ( no change to exterior dimensions ) * Size of Property : ;"c;kD ft . x � ft . Other work ( describe ) * Existing Building Size : * ft . x ft . * Proposed building - distance from GROSS AREA OF PROPOSED STRUCTURE . * property line : tio * 1st Floor Sq . Ft * Front Yard (47 ft . Rear yard ft , * Side Yards _�5,9 ft , and t5z ft . 2nd Floor Sq , Ft . * If on corner , setback from side street- * ft . Other Floors _ Sq . Ft . (not cellar or basement ) * OCCUPANCY INFORMATION : * TOTAL FLOOR AREA : 9 00 Sq . Ft . * Primary Building - * >< One Family Dwelling Size of New Structure : ft , x 'S (G ft , * Two Family Dwelling Foundation : * Multiple Dwelling/No . of Units Pier/Slab/Crawl /Partial Fu11 Circle One ) * Business * Industrial No , of stories ( Habitable space ) * Other Height ( grade to ridge ) �� ft , If residential , no , of families : t * If addition , what will use be? No . of rooms ( excluding baths ) : No , of bedrooms : 14 No . of bathrooms : ezk * Accessory Building : Primary heating system : S X—CJZ , l %Q, C: �- * _ Detached Garage - One/ Ca Type of fuel : n Attached Garage - One/Two ar No . of fireplaces v be installed : y * :2c Private Storage Building Will a woodstove be installed? : ,mot , * Other Central Air Conditioning : Yes ^ No �— ( OVER ) BUILDING PERMIT APPLICATION CONTINUED : BUILDING SPECIFICATIONS : Type of construction : wood Pram fire safe , etc . Will any second- hand or ungraded lumber be used ? If so , for what ? �Jo Foundation Wall Material : -A Thickness : ` Depth of Foundation below p grade ( to bottom of footing ) " Will there be a cellar? Heated <Unheat ? Floor Sq . Footage : "+ o Will there be a basement ? Will any po r "on be used as living space ? i,.Jo If so , what portion ? Sq , Ft . Type of Use ? Type of Roof : 7 0 /F1 at/ShedJOther s Material of Roof ; t4�1— {� Size , wood studs Q. Is x " ; spacing IN o . c . ; length ft , Joists ( floor beams ) : 1st Floor x 10 It ; spacing ('Lo � Is o . c . ; span 0 _ ft . Joists ( floor beams ) : 2nd Floor x It ; spacing o . c . ; span ft , Overlays ( ceiling beams ) : " x spacing is o . c . ; span ft , Roof rafters : IN x spacing o . c . ; span ft , Roof trusses ( pre-engineered ) : spacing + "' o . c . ; span —G ft , Exterior Wall Finish : Katie Y yr .A &f of what material ? Interior Wall Finish : �, �,lE, ( r.{>ek 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 ? �b If so , will a Fire- Rated door , enclosure , self-closing device be provided ? Will a flue- lined chimney be installed ? Height above roof QL ft , Depth of chimney foundation below grade : ft , Depth of fireplace hearth : - ft . in . Water supply unicipa or private well : SEPTIC SYSTEM is ance 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 & ADDRESS : (`�' t r • f�+ � ,,, 3 prime, ri PHONE "7rr - 7'J7 NAME OF PLUMBER & ADDRESS : PHONE NAME OF MASON & ADDRESS : PHONE NAME OF ELECTRICIAN & ADDRESS : PHONE 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 done on the described premises and that all visions of the BUILDING CODE , THE ZONING ORDINANCE , and all other laws pertain i to a proposed work shall be complied with , whether specified or not , and that such work ' s aut rized by a owner . Signature Own ow r s agen , architect contractor ______..__. ____________ ......... SPECIAL CON IlIONS^OF THE�PERMIT : By : Code Enforcement Officer ENERGY CODE COMPLIANCE APPLICATION TOWN OF QUEENSBURY , WARREN COUNTY - 9000 HEATING DEGREE DAYS Comliance MMethods. PART 5 - Acceptable Practice Method - 1 b 2 Family Dwellings ( ONLY ) PART 6 - Thermal Rating - Component Trade Offs - 1 & 2 Family Dwellings ; Multi - Family Dwellings ( 3 Stories or Less ) PART 4 - Design By Component Performance - Commercial Buildings - Hi - Rise Residential PART 4 8 6 - Compliance Methods Require Submission of Worksheets ------------------------------ APPL S MW PROPEM LOCATION PART 5 METHOD OF COMNPLIANCE BY ACCEPTABLE PRACTICE : 1 . Gross Floor Area - c,�c� Sq . Ft . 2 . Type of Heat on Elec . Base Board Other 3 . Is Building Mechanically Cooled ? YES NO 4 . Percentage of Area of Windows and Doors Over 17 % Under 17% THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND To R _E Q u I R E D THE R-VALUES SHOWN OR PLANS SUBMIITTM! Baseboard S . Insulation Values : Actual Shown Elec . Heat Other A . Roof A Floors exposed to ambient temperatures R B . Exterior Walls R DJ. SS Co Glazed Area R . l D . Exterior Doors R 1 , E . Floors over unheated spaces R. F . Edge of Slab on Grade ( Heated Building ) R "/A G . Basement/Cellar Walls (Above Grade ) R AJ A H. Basement/Cellar Walls ( Below Grade ) R O/A i . Heating/Cooling no Ducts on Piping in unheated Space R 6 . Service ( Domestic ) Hot Water Heating Device A . Conforms to minimmn efficiency per code YES NO TEMPERATURE CONTROL AGI+ men SE?TI_NB /I4o" - WILL NOT SE MEEDED //WLICANTF k TURE DAFE TELEPHONE MU14SER INSPECTOR ' S REMARKS T,OVvWPJUF QUEENSBURY ry say at Havitand Rands, Quoensbury, MY. 121101-9725 � APPLICATION FOR SOLIDJFUEL BURNING APPLIANCES AND FIREPLACES Ll Perwift No. APPLICNI110N IS HEREBY MADE to the Building Department for the issuance of a Building anti Use Permit JMrsuant to the New York State Fire Prevention and Building Code. The applicant or owner agrees to comply with all applicable laws, ordinances, regulations and all conditions that are part of these requirements and also will allow all inspectors to eater premises for the required inspections. Applicant 's Name Ga r � �T APPLIANCE TYPE Stove Coal Wood Address +� , i � t� y "^ i...,..c � Zdl� Furnace Hot Air Boiler Zero Clearance Circulating Unik� zip d Phone -7 .3 If Non-Masonry: Owner's Name t Address Manufacturer Model "'-t Outlet Size Zip Listed by Number Phone - =t CHIMNEY TYPE Masonry: Block Brick Stork Property location of proposed construction Flue: Tile Steel re .M. Size: f wwu�.iw '�" � ..14t� .. Factory Built: Manufacturer �T. c'< ct. Model Sire COPY OF MANUFACTURER SPECIFICATIONS IS Heigh "`y ' Listed By Number REQUIRED FOR FACTORY-BUILT APPLIANCES Type: Double Wall Triple Wall AND CHIMNEYS. MUST BE INSTALLED Insulated ACCORDING TO SPECIFICATIONS. COPY OF Estimated Cost $ CONSTRUCTION DETAIL REQUIRED FOR MA= Fee $ ' SONRY FIREPLACES AND CHIMNEYS. CASHIER'rs DEPARTMENT TowN OF QUEEN5BuRYr NEw YORK 1 elaarlmenti Fire Marshal Amount Collected Amount Refunded C%Ldr Number Mile A 173 3389 ( 190) Public Safety A233 2655 (230) Minor Sales %e Collected from or refunded to: .L t ►j t,.� fF . Dated: t' Towrn Cirrk or Dep y f -• Wh&r: ApppNewwi TvH~and Piwk: CoaMn Daparawrei Go$&nrod: Farr Alarrhai ENERGY CODE COMPLIANCE APPLICATION TOWN OF QUEENSSURY , WARREN COUNTY 9000 HEATING DEGREE DAYS Compliance Methods : PART 5 - Acceptable Practice Method - 1 & 2 Family Dwellings ( Only ) PART G * -- T11ermal Rating - Component 'Trade Offs 1 & 2 Family Dwellings ; Multi - Family Dwellings ( 3 stories or less ) PART 4 * - Design by Component performance Cominercial Buildings - 111 Rise Residential * Requi. res submission of worksheets APPLICANT ' S NAME : PROPERTY LOCATION : PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PR.piCTICE : 1 . Gross Floor .Area - � � .L�C]�Lt square feet 2 . Type of Heat - Electric Oil Gas Other 3 . Is building mechanically cooled ? Yes _ No 4 . Percentage of area of windows and doors Over 17 % � Under 17 % 5 . R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R -VALUES AS SHOWN ON PLANS SUBMITTED : R � a . Roof b . Exterior walls R n C . Glazed areas R �1. do Exterior doors R e . Floors over unheated spaces R f . Edge of slab on grade ( heated building ) R g . Basement / cellar walls ( above grade ) R 19 11 . Basement / cellar walls ( below grade ) R -AA --.._- i . Heating / cooling- ducts - piping in unheated space R 6 . Service ( domestic ) hot water heating devic Conforms to minimum efficiency per code Yes No P"ATURE ONTROL MAXIMUM SETTING 140'O - WILL NOT BE: EXCEEDED o a �s g ;Date Phone Number INSPECTO ' S REMARKS : ev co cc �1{ fS� .rnl QL TOWN OF QUEENSBURY APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # / Fee Paid Date : Reviewed By LOCATION OF PROPERTY FOR INSTALLATION : Owner ' s Name : LCk .rr- LA-,', - Owner ' s Mailing Address : Installer ' s Name : �Cc � F-z ,, ( , Phone # : t r `'i � ? 7 Number of bedrooms ( if residential ) : Total daily flow ( residential - compute @ 150 gal . per bedroom ) : Topography- Circle One : Flat Rolling Steep Slope of Slope Soil Nature-Circle One : San Loam Clay Other /Depth : Ground Water-At What 'Depth ? Feet Bedrock or Impervious Material -At What Depth ? Feet Percolation Test- Circle One : of Require Required/ Rate Min , Per Inch Domestic Water Supply- Circle One : unici al Well Other If domestic water supply is a we Separation : Water supply from an septic absorption feet PROPOSED SYSTEM: Septic Tank -mac gal . ( Minimum size : 1 , 000 gal . ) Tile Field : Each Trench C3 feet//Total System Length �, cxD feet Seepage Pit ( s ) : Number of / Size each : fto x ft . Size of Stone to be used : # / Depth or Thickness feet HOLDING TANK SYSTEM IF REQUIRED No . of Tanks Sizelof Each Gal . Alann systew and associated electrical work to be inspected�y a" certified agency. 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 : 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 , tile 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 . Town of Queensbury Building & Code Enforcement Department 531 Bay Road Queensbury NY 12804 Remarks : - Application fo1. Tr�+ T� ,/ T+ T Location of proper-iy for installation f �+ PFIZMI'1' NC.] 1w11S1;1L Owner' s Narne: � -f-c.: C.�J , i°�• ••. _ Addresse Installer' s Name : (+ c � je V .;—(2W �-� .�. �? ` � I'VE PAID Pho lle # : { ) 7n � Number of bedrooms ( ir residential ): Total daily flow (residential - compute [{r I -so gal . per bedro(,,m ) : Talh,sgraphy: 093 Nat [T _.� !tolling Q Stcep Shape of Slope Sail Nature : Sand I ,oacn [_ C'lay F"I fmler /i)eptlt: Ground Water : at what cfcplli ? feel Bedrock or Impervious Material : at what depth ? feet Percolation TCSt: r Ems ' Not Required C ] Recluered/Rate ntin. per incl, Domestic Water Supply: r9n Municipal 0 WeII © Other If domestic water supply is a WF?Ll .: water supply front any septic absurptitae is feet PI OPOSI; F) SYS'Ill"M Septic tank : �� gzl . (minimum sine : 1 .000 gal . ) A314151 T ^^�� ,,� � CS file Field: each trench �—_ n rect. / total system legth ci) (p _feet. 01 • p Seepage I'it 4 number of to VO& �) / size each: ft. x ft. rf qv'.`+ire of stone to be used: # _ ! depth or thickness 1I01 .1) 1NO TANK SYSr'1:M : ( if required) ! ci Ntimbeerr of tanks: S17.e Or each: gal. lti i Alarm vy.wern aped associated electrical "Pork to be inspected by a certified agency. For your protection, please mote that prrrsrrrrrrt to Section 136-29 oflite Code of the Town of QueereAlccry, air y pe rise it or a p pro vaI grarrled ttyleich is based it pops or is granted ipr relirrrtce it port any material misrepresentation or frpilure to inalce a neaterirrl fact or circrrmstapuce krranvt by or opt be11aIfofart applicrrrrt, shaIt he void. I Jea1Pe read the regulations wills res rt 1cp thin a plplicrr t and agree to abide by these erred rill regrr ire ntePpttsaftJre 7ia wrr of [Joe reshrrry ,Sap nary s xrp �K DisposalOrdine+ pece. siertature o rrestrortsrble Pe f PLOT PL.AM SEPTIC SYSTEM Notice : The following statement must be " stamped " on your plot plan . This sheet of paper may be used for purposes of drawing your plot plan . After drawing such plot plan , please read the statement and sign it . If you choose to use other paper for your plot plan , the office will stamp those plans for your signature . "I have seen or observed, or believe I saw evidence of, all objects such as houses, wells, trees, fences, etc.. Shown on this document. I also represent that I have t�ersonally measured the distances set forth on the diagram."' l SIGNATURE DATE 44 TOWN BUILDING OF QUERNSBURY & CODE SNF'17`RCSMLNr QUERNS 2 BAY ROAD BURY NY x .28D4 ( ' (5113)ARRIVE : 761-8256 "-�'---- DEPART : xHSPRC DATE INSPECT£QN fIL" O IOH .REPORT REstoex2'IAL NAME ¢ CST fLECEI V$D : LOCATION ��''..�''�"_'r' 1 DATE TYPL+ O ,Ruer ---c-�-.__ PERMIT FOOTINGS ROUGII PLUiyB FOONDA T I QN 1''INAL -1r'f'G nACXFTI,,L �-ELEC'f*RICAf S'SFT£C - WOODS'I'PV(r INSULATION OR FIRBPLAC-E C M EY IfSIC;lfrYEs ._�__ PLUMBIC, EN S VEN ' ff 1VA I S'OC)FING filNiSfl Pi CK PQRCIi S Ep '�----- I CE t i ro, WATER OPE r .�_I '�---�ML RIVACY F' ILJI�._._Sii F-1,00 jSi` �BAr1! !tI tj{EM WATER H -- QTHE--LOORS SWE p -------_ Qrf1E FLOORS -----�_ R FLUQ C EA"�CE-LRAII,xNGs "-- ---.—.z. S ORE DETECTORS f QO7� FANS kkQm-l-jqc,puX URES OUNDATIQ NSULATra_ojj _ GARA_ GE PRO NA ELECTRIC ��-----y. S E PL N VARIA- I I, SURVS ssus C p 0 C R I f i it TOWN OF QUEENSBURY FIRE MARSHAL QUEENSBURY, NY 12804 (518) 761 -8205 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED 1� �')' G 7 NAME �'7�' LOCATION DATE ERMrT # APPR pt EXITS NJ YES NO AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTING FIRE EXTINGUISHERS AUTO. EXTINGUISHING YSTEM HOOD INSTALLATIO ~~ AUTO. SPRINKLER ALARM SYSTEM STEM — INITERIOR FINISHES STORAGE: CLEARANCE TO SPRINKLERS CLEARANCE TO HEATING UNITS REQUIRED SIGNAGE CHIMNEY WOODSTOVE FIREPLACE " MASONRY FIREPLACE _ FACTORY BUILT REMARKS: c C7 OK TO THIS DATE )NSPSLIP.PuB 4NSPECTOR BUILD TOWN OF QUEENSOURY INK"' 6 CODE ENFORCEMENT 742 13AY ROAI3 QUEZUSBURY NY 12804 (518) 761-8256 ` ARRIVE : I 1 0 FINAL -"� INSP DATE . IUSPECTION hEpORT - RBSIDen NAME FINAL REQUEST RECEIVED: � 4 LOCATION DATE TYPE 1 �--- PERMIT / �,11,[]' . OF STRUCTURE FOOTINGS FOUNDATION ROUGH PLUMBING RnCt4FILL FINAL ELECTRXCAL, SEPTIC INSULATIDNFRAMING 'I 4 WOObS 'OVE QR FIREPLACE -'__ CHIMNEY HEIGHT B VEN ff N A Yv ._.N_ O_,. PLUMBING VENT ROOFING EXTERIOR FIN H ~" DECK/P Cc)R H. STEpc G R LIEF VA VES FURNA��C�l!� HO _ Yd TER O D V RA --_� �..T. RIOR TR * rpR ._w"S'LS ACY DOORS , FIN FLO gAI— TCHEN WATE TI HT OTHER F p R SWEEP L --- "`—�RS OTHER F CARPETED STAIR CLEARANCE ZINGS SMOK I7ETECTO S RAXARQ,o-m� F S Lu BIN F }r R S FOUNDATION INNSU ON GARAGE FIRE `---- +P FIND DOOR CLO R S F NAL EL CFT AL SITE PLAN VA IAN R R r FINAL S VEY PLp PLA KTQIssu COORcC TOWN OF QUEENSBURY FIRE MARSHAL QUEENSBURY, NY 12804 (518) 761 -8205 FIRE 'MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED � 2 -97 -- NAME [� , LOCATION DATE PERMIT # n Q APPROVED EXITS N/A YES NO AISLE WIDTHS EXIT SIGNS EMERGENCY LIOH F FIRE EXTINGUISHERS AUTO. EXTINGUISHING SYSTEM HOOD INSTALLATION AUTO. SPRINKLER SYSTEM ALARM. SYSTEM INTERIOR FINISHES STORAGE: CLEARANCE TO SPRINKLERS CLEARANCE TO HEATING UNITS REQUIRED SIGNAGE CHIMNEY ti 4$ LACE MI< F EPLACEDST( - MASONRY FIREPLACE _ FACTORY BUILT REMARKS-. 0 OK TO THIS DATE lIV5PSLIP.PEJB --� ECTOR TOWN OF a �� 6UILDING & C7UEENSEURY �' CODE ENFORCEMENT 742 13AY ROAD QUEENSBURY NY 22SO4 (518) 761-8256 ARRIVE : Z a& F IHAL r'HSF$CTION �-�'t_.LI_ INSP ; dd V DATE INSPE REPORT - RE8IDLH ]'AIr . CTION REQU NAME EST RECEIVED . LOChTION DATE -- 1 ---s yF `-----f�_ / TYPE OF S7'R UCT RE PERMrT FOOTINGS FOUNDATION ROUGH PLUM73ING --. BACKFII,L FINAL ELECTRICAL SEPTIC INSUL FRAMING WOODS�'" '�-- TOVE O FIREFLAC ' CHIMNEY�fIE�. IGH,• g V N 1'$8 ._no . E TiESG �,I-` PLUMBING V Nr OOFING KTER.IOR FINISH DECK FO if E ILING `"--- R8 xEF A VES FURNACE HO W T O ERAT NG INTE IOR TR M PRIVACY D RS FINISH FLOOR BATH KITC EN ATER r cm OTHER FLOORS SWEEPA rE OTIIR F OLO $ -- R QARPETED STAx R— CLEA ,RANGE .L�EA_..I LING S SMOK E EC ORS 1i M FA S LUMR NG _FIX,TURU E��--� FOU RATION xNSU ON RAGE FIRE PROOFING DOOR CLOSERS F N L ELECT TCAL Rllk� PLAN VARI NCE RE F AL SU VEY pL0 ` FLAN OK To s ue O p C C 1L i TOW ti } Sf)IL NG &FCQUEENS$URY �\ UE742 SAY Et'IFORCEMENT 1 QUEENS URY myO 12 Y" $Qq ( ' (518) 761-8256 ARRIVE : 2� ,�..�►` DEPART: FxivnL XNSi ECTJOW REPORT - altar max DATE INSP CT REQ EST RGCE : r NAME V6D LOCATION DATE TYPE OF =� -_ - PER T # STRUCTURE FOOTINGS ROUGfi PLUMf;2 NG FINAL UNDIITION ---- SEPTIC ghCKFILFINAL ELEC7'ftlChi` INSULhTIONFftING WQdUS�'O VVE dR FIREPLhCE` `_z CHr--MriEY ExEIGHT,ra N YE#i "--H-T/ VE-._._d_r '1ffEIG1iT . P O BING VENT• - bECKJPO STEPS ILI S � E VALVES��� A AC ffOT WATER OPEN, IN � 31V.2- E ..>:QR Y'RSY M---f�I VACY F tN--�—I�F'LOOR r �1TF3 K2 'lCF EN WE — ---_ TI HT L7TIix'K__�FI..CC)it PAS E _`_y`_' . Orr �F kk ARPETE STAIR --- ' NCE RAIL - S 'z'-------__ Ee S OOM PL BING x URES -� FOU A ION I SU ON GARA E FIRE O MG + 00 CLOSER j SITE AN VARIANC AL SURVEY P O P OK TO ISSUE C O C C �'7 ' BIfILDING OF QUEENS,gURX 53I BAY RD. & CODE ENFORCEMENT ter. , 'RUEENSBURX NY 22904 INSPECTOR ' S REpdRT : ��`.YIC' T_�_ RE4UEST FOR .,+ DEPAR �-IN INSPECTG'OhN,�ARR--=-�n RRCEIVED ;NAME e LUCATIdN 1 A --_-, DATE TYPE OF pERrrlm rR v s vcrRE RECHECK pp OVED C!T_.tNGsrptERS S IN LAC THE CONTRACTOR IS - _ PROVIDT"a PROTS RESPONSIBLE PO FOR 4$ HOURS POI,TION FROM FRBBtINO 'RENT.' OF TILE CONCI.ONIN(i TIIE PLACE_ ft BETE, MATERIALS FdR �``-- HIS PURPOSE OL7N DA T I ON SITE TE WALLpO REINFORCEMENT IN P - . FO_�,UNDATION/DAMPPRt?oF JIL4 APPROVAL PLUMBIIV(y�_ tfEN,T NTS�IN RDU PLUM CE S I NG ()NO R SLAB --�.-, KRAhII_.-- NG _._ JACK s UT ns` JACK P ST {I N '----�" -----�. ASR INFIL7^rtArr `-�- " "'---- N AR _ ER HNATING FOUNDATION WAL FbDNDATIO WN AL't--S- INTERI.R R_ +FLf7OR5""�'�- I—�'EX_TERI CEILING�""_-----__—.U -- DUCT WO OR NHEATED SPA RK PIPING IN CES i i r BUILDIRWN OF QUEENSBURY 531 say no. G CODE ENFORCEMENT :kr. QUEEN,SBURY NY 12604 INSPECTOR ' S RBPORT; ARR ..�- REOUEST FOR INSPLCTION - 1JEPART_ _ `I NAME ON E C E x VEC7 : DArrm TYPE OF STRUCTURE : PERMIT RRCIIECK 1 oorsN Al� P_ R— '°--OVRE) S PxERS N A Y :S M NOI rm ""- = POU ,FORM - ----__ REINFORCEMENT pLA 11$ C4Nx"RACTOR _ PROVroxim<; E'ROT S RES ONSI$;,,$ FO "'---- POR 48 R?JOURS FOLLOOH ROM j0'R$Lg MEiI'1T OF THE CONC W I 0 THIS PLAC _ O RETE . MATERI LS FOR, THIS - -. --�._ PU1 OSE ON SI E OUND TION/war POUR REINFORCE La,NT IN PLACE ------__ _____--- FO_'--. UNDATIONID Roo IN BACKFILLPP OVAL �. MDIN C, 'VENT � c+JTS I PL CE __�'--- �U G"P .----' uMe x Nc PLP UMSZNG UNDER SL FRAMING SACK _~ rzAcr BRI~ HANc_E}1�7$__I __�_�__-__z___ -----__+ ---_� IR R P STS MAIN A NFILT'RATION NBATING ROUGH �*-JHS Ux,A r I ON WALLS - - F,�QNbATION WALLS R UNHEATORK OR PIPxNG IN R- - --.� eI4 p{[ f TOWN R� QUEENSSURY QUEENSSURY �RSHAL TELEPHONE � �r 5I8 YORlC 745- 4424 I2804 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED NAME L OCA TI ON DATE " — � PERMIT,# EXITS APPROVED AISLE WIDTHS N/A YES NO EXIT SIGNS EMERGENCY L GHTIN 'IRE EXTINGUISHERS AUTO , ExrrNGUISff s HOOD INSTALLATION AUTO , SPRINKLER SYS M ALARM SYSTEM INTERIOR FINISHES i STORAGE , CLEARANCE TO SPR KL CLEARANCE S REQUIRED SIGN TO HE ING ITS z CHIMNEY WOODS ToVE FIREPLACE—MASONR FIREPLACE—FACTORY BUIL REM,gRkS o OK To THIS DATE 2iol5 _ s EcroR WN BUILD-INCa OF L7UEENSf3URy _ 53I 13AY RD & CC7f7g; $NFORC$'Iy�ENT `-QVEENSBURY NY I280+3 ' INSPECTOR ' S REPt7ftT : ARR�� REQUEST' FO INS EPART ` NAME I:CT"ION E'CEIVEl7 : IN c LOCATION TYPE or _ �Ipcnmllb # 5lftU y y O TING51r� r APPRgVEfJ `--�----li5 - � YES zNo " dNCILITFf I C"`_ POUR F gRPf ------- R CTOR xS P jrtovz paorg Zr MENT 48 T RS pLLpW N HQN zaLeFRLE2I G E CgNO TH$ PLACE_ MATERIALS R rp punpos ForLjl rIflN "-' --qN SITE -"�- LLP R FtEIM___. p!?IR.CE_. MEt+iT IN F'aUN PLACE - R�OFINCr �ACfCFSL„L. ApPftp pL[IMBING VENT �-�--- --- - -• _- _ Y IN PLh+CE --- PLUMBING UNU AD L M�__..___rtG�.- STUDS _ ' 19 _LFfEA '- -. ` "---.�--vltA NG 8R I tJG I RS _ ANGRRS �+?ACK POSTS -- ----�.. - - ----�- R MAIN •,E,Afy -- -.-_ _ - -- _ -.AI�.-_.INFILTRA ION _- ---.-- 1-��. BARF2IER H$ATSNG kOGH-IN - - ---- --.�_ INSZJLA zaaus T p~f' i"aZj I=xxc R l o R — ----- _, IOR -----NH`. NR.r 12-w'EF fts PS IPING I N R - -- - ACE -- ---- - �. TOWN OF QUCENSBU QUEEIVSSURY E MARSHAL RY TELEPHONE 0 ��� YORK 12804 FIR ) 745- 4424 MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION NAME RECEIVED /d LOCATION EXITS �!/APPROVED WI N AISLE YES NO EXIT SIGNS EMERGENCY IGN NG FIRE EXTINGUISHER AUTO. EXTINGCJISFIIN IS IsEM HOOD INSTALLAT ION AUTO . SPRINKLER SY ALARM SYSTEM INTERIOR FINISHES STORAGE : CLEARANCE CLEARANCE To TO PRINKLER REQUIRED SIG G, EATING U TS CHIMNEY WOODS 70 V E FIRCPLACE- SONR *-FIREPLACE- FACTORY $U- rL OK TO TFFIS DA TE rr VOI5 SP OR BUILb Na or QUvWNSBURy 53; SAY RD. & ConQUEEN ENEORC$MENx SBURY INSPECTQRpS UT 22804 R$PDRT: '^/ '. FLLQUL31^ R ARR"�-+--__ UEPART3 ,w ,r, +s�.�.. {�•a INSPECTIDN RECEIV INTyI NAME L� L L.► i ECI: -- LOCATZDN DATo TYPE' QP' _�_._ n ^.rx.[T , j STRUCTURE : +�"��', , cw J 1 RECHECK i N +�1PPR�_OV D MONO li C --_--- ,r -�. 4_�_ Q FQ RE N p E THo C4NTRACR'O no roRPROV48IlVCi FROtrnsOT$ ITZON DHSIBLNa`Fq MEHT OF T,g"$ copl'LoarIH Ro1*f FR$$X'TwG CRg $ . 'TES 'p�AC$_ ERIALS O 2„ FOUNnAT 10 I u L pOUR S DN EZNFORC_�` N T '------ A ON pROOF 1V � cx2• LL G -----__ AppW L I' SING .`� VE NT V S ROUGII PLU -_-y-�-' -----'—_ --�hlH NG Y ; p'Z-'L UNS I NG UNDE ' SLAB C TUD HA ----NG 19RI RS IR IN! It7o S M —� E -- v+< t 44 IN IN INSU�dICIN:` --_ - —FL7[�N-ILAT �`-"�-- A - EXTE WALLS RIOR I7_ =CEIL ING _ DUCT Wp KR -_� R_ z_ Q S ACES PING IN 'R` _ Vf BUILD DW OF QUEENSBURY 51 C0Y rMF eCEME11fT VUwe 538-j 45_44 84 SEPTrc DISPpSgE S YSTE14 INSPECTrUW Name Location Date C_22 Pe t SOIL Typ —�} San am. Results of �, lay_ Res ercoiatio applicable) Rate. rest_ TYPE OF SYSTEM! a Tnute ABSQRP?7p, F /Inch Length of JWD: TO 7 Depth of each trenc Length 5izeti trenches `�'-�- stone SEEPA Px Size _ Numbe Stone siz �- -____ fit ' PxPrKs: f� • rank` to Tan Size YP Dist . Box �ta 'F Ox } e Openings Seale ? 7d/,pit t Undaxtion Ex`ARATI 5: s a rti a Foundation �o Tank SeparCanfoation of pb s rp on - -- feet rnrs as — feet .cOCATI[�y pF S YS.PerT o f P l n s feet c7e one) PR ERTY: No F Rear Middle f4f ~Front on t S TS: 7ddle Rear zght Side S YSTE1y USE 14PpRUYED_ A rr•i y _ YESDepa h(f of ding BUILp QNG & cove 531 BAY RD . , ENPORcEME �-Y QUEENSRUFty NY I28pq INSPECTOR • g REPORT : REQUEST p'OR ARIP NAME IN PECTION. ,RncwzVEO : LocATIaN i �► 1,.��In11 GATE �!__,�!__�__ TYPE aF sTRvcT IRMIT RECHECK -_'----- 5----�_�. Or N $ P E APPROVEID A y S MONO I HIC P R � O _ -�-' R..._E1 -F'0RC 1NENT Ai -_-_ --�'� ------_-- E AC PRovrazNa GTaR IS Resp KB zolf R'lLNIron T ok.HOt #'OLLF]KI F !! FL E INp T73E CONC x8 , H8 LACE_ TER IA LS p'C1 ---- --._ F[?UNL1A T ION {y ON SITE --�'�-- LPOUR 'EINFORCF.MENT zryr_ PLA FO--UND 7 N BAC�It,F Li, APPROVA IV?Z.C)(icifp UM6 NT ACE FRYING . UN R SLAH AcK STUL)Sit ADER---S JO I . E -gj,140 SA4I+p�G S---. .i HANG .7Acc: POSTS r - ---- . AIR IN � AN IO IN B.�.z_'._."�IL Ray1`--- 19 RIER `---� _ILEA T I NG ------ ru ItvSU Fo A'TION WALLSINTE ON All RTOR It ]CTERIOR OR UNHRA Eb S ACPgPING IN. �_ R- $ 9 PAY p l TOWN FCOI)EEgN oRCFME[^t'P QUEENSBURY NY I2804 --TNSPRCTOR ' - >- s RRP[7Rr : REQUR'ST FO ARft�-�__�. R INSPENAMECTIO 1N'T' DATC TYPE OF TR CTURE : .a't RECIlEcK APPROVED ly PIERS - -�_ YES NO MONO IT t C O R Ff1RM � �"_ RE____IIVF'af`—CEMENT N �-- -----.z PLACE '7'NE CQ.HTRAC �� aRV4 DIHa 'PR'OYRk S RESpOmSj".G �.�_• �`_ - MENT OF 2$ES FO LOW NdRTp �REE£z COI4C T'E. t'LAC$ MA TERxALS Fo TIT PURPOS - - F—!�U?V'C1_ATION WALL R ON PO -- REIN� p___ _�C7RC+4MEN" IN p R CE FOUNDATION DAHPPRO ING - - -- _- -L $AC FI A P—LU HIND VE L NT ----- ROLrG7I VENTS IN PL FRAM Il`~�T ---__ XW PRIH ._-.t]ERy-'----�. HA ING _ ��xACIC PC$R AIR ItE;}+iT,IN'G . R RoUajq .-.z- IN'•— St7LRx'Ic]�l�'`�---fir-� ION - ---_� IU;NIAT2 WALL x - -- -- (?I2S ON WALLS E T'ERIOR R- -- ----- WALL"`�- RRI -UIN H nxK fl Q rrc r "-- PACES I'!V"""�"" ' ' H1 l -� BUII,p NG 6 QUaRNSSURY RD. _ 531 BRY CODE ENFORCE , QUEENSSURY NY EI2804 INSFEC T`OR ' S REPORT: r REQUEST FO ARR-----__ OZPAR4 R INSPECTION RRCEIVED, INT NAME LOCATION DATE t 1tiT- TYP$ OF PERM M ' STRUCTURE : Mr .. • RECHEC `--- G A PR V D r ON T N P R IN O CEM ~ N TR,S CONTRAC ----- PROV.IDZ,NG RrLt rs An ZOHSFOH Z R -� -"�'-- \ FOR d B PR itPU P TH F"RO 8LE FO -----_.. EHT or N$ C CRRTINSi $pezCHZNB +E. TERIAL F FOUR DA ION wA ,yp PU S$ ON SIT' REINFO,RC MEN "-_---- N D PRO I . RC F A FMB L VENT VEN S F2C7UGHz_ PLO B,..x.No CP__ �---�_ ------- P UMBING UNLD$R F ING : JACK STU JACK PH�TSE -•-.----_. --- ----_- MAIN AIR"� -I- F3 ARRNLTRI I tHEATIN RC1UGFf�:iN ---FOWOVAT LaH wLtms Fp ftyL EJLTERI0 R_ z_�__�. ,�._."'_• -----_ - WgLL,� $ SOR R_ - -mod I DUCT wou UN_H$ATEDK O FIR P I _=-_-_ .�.-�� `�-- S Inc;AC$S ---_ � f BU-ILDINsWArOa COPES � - -- 53r BCO ES DEPARTMENT QU+EENSBURY ROAD TELEPHONE ' { EW3 YORK 12804 745- 4447 BUItDIx6 INSPECTORS REPORT REQUEST FOR INSPECTION xAFfE RECEIVED Da rE TYPE PERMIT ._ OF srRUcrURE RECHECK FOQTrNGS/PIERS APPROVED MONOLITHIC POUR FORM N/A YES NO RE7IVFORCEMEMT IN PLACE FOR p ONTRACTOR IS RESP UID ONS I8� -"L FOR Ez£xs -----. RO R PROTECTION F" FRE 48 HOURS FOLLOWING MATERIALS THE PL,Q F 7 OF THE CONCRETE. _ QR THIS PURPOSE FOUNDATION/WAq,L POUR REINFORCEMENT ON SITE FOUNDATION/DAMP N PLACE BACKFILL DOPING ROUGH PLUMBING YA PLUMBING VENT/YE PLUMBING N IN LACE FRAMING : UNDER SLA .LACK STUDS/HEADERS BRACING/BRIDGING JOIST HANGERS HEATING ROOJACK POST IN EA NSULA T ION UGH- I N FOUNDATION WA S Ill OR R- FOUNDATION Hf FLOORS LS EXTER R R. FALLS R- CEILING R_ DUCT WORK R PIPING IN R- SPACES SPACES EA TED REMARKS : ARRIVE DEPART IN EC .OR '_'_---- -- --_ TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QTELEPHONE � (51I8 ) 745- 4447 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED] NAME LOCATION /_..�_ C DATE Il] 9?--PERIiIT # TYPE OF STRUCTUREY R APPROVED RECHECK N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM -� REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTECTION FR FREEZING FOR 48 HOURS FOLLO ING THE PLACEMENT OF THE CONCR E. MATERIALS FOI. THIS PURPOS ON SITE FOUNDATION/W LL POUR REINFORCEMEN IN PLACE FOUNDATION/DA PROOFING BACKFILL APPR VAL ROUGH PLUMBIN PLUMBING VENT/ ENTS N PLACE PLUMBING UNDER LA FRAMING : ,SACK STUDS/HEA RS BRACING/BRIDG JOIST HANGER JACK POSTS/ IN B HEATING ROU - IN INSULATION ' FOUNDATION WALLS IN I R R~ FOUNDATION WALLS E%TEWIOR RR- FLOORS WALLS R- CEILING R- DUCT WORK OR PIPING IN UNHE ED SPACES R RKS��.�'' ARRIVE DEPART INSP R National Headquarters : I 1337'-*f st .C06tei Pike, W. %Nster,r�P;k-'f1838 Date: rL tY, Town or Township 1E �'� t L la+ � ; - County L- r I- f �, State ocati on/Address f oca in Rural Ara - Please Attach Directions] Pole O te #owner Permit � Occupied As Vile sty_ h e� A $t}ililing: New DIdO Occupant - Work Area in Building Floor #, etc.) : A . for: Wirin El Service or: Ready for Ins ion : Fee Remitted 3ash F-1 Check . ` iN.a M Make P' able To: M.D. I.A. 500 1 751) 1000 125U 1500 1750 2000 2250 2500 275U 8000 , Number of Rough Wiring Outlets elect. Heat Switches Mes Lighting # ::? Y— Amp. Service Surface Unit '� Dishwasber ��Range __�__�_,__. Receptacles Water Heater - X. - Air Conditioner Dryer Oven ^T''W.Garbage Disposal Wiring and Controls for Burner Number- of 4&tures •Amp. Receptacles Fractional H.P. Vent Fans Other Equipment: MOTORS H.P_ 1/2 i!1 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 IYz 2 3 5 7Y2 10 15 20 25 3a 4O 50 75 100 Mark Nurnber - of Each Size -� Applicant's --, Signature e dc a,( - LICeRse # Permit # T/A Utility : . Applicant's A dress: 17 � �y,� 3�C"yc- . . , ". : P7 NAM OFFICE L . - T (City) (State) - k ■ (Zip) t f Service Request # Phone # Electrician: �AuTE RECEIVED: DATE INSPECTI: Correct Location : Same as Above Q or: Red Notice Label Rough Wiring Outlets Surface Unit Oven Switches Range ' Gar Dispel ' ' Receptacles Water Heater C}ishwasher I Fixtures it onditioner dryer Amp- Service Equipment Burner, Wiring & Controls for Amp.4tob4ptacle Amp. Service Conductors Pump Vent Fans MOTORS H-P. JI/Ml/3-2 1 1/10 1 1/e 1 1./6 1 1./4 1 1,1.3 1'/2 3/4 1 21Ft 3 5 • 7=/2 10 15 20 25 %6 40 so, + 5 3 Mark Number i• ' j of Each Si; I 500 750 loon 1250 1500 175¢ 20¢8 250 2500 dT2 5000 Elect. Heat � . I i S [ I s 0 RW Progress: Inc. 0 LICE Contractor 0 CFT Violation : Work Comp. 0 inc. 0 Q L/A Qwner CASH 0 Fee CH K # L/A - Due IPA Municipal _ IN IN # V #k ` Applicant Hate : Other Side (7wr Ld Cut in Card Temp # 'Date IN ORS-S IGNAFTCO 9E ' 0 Final # Date APPLICATION FORM NO- 250 EL f1/69 ;�.�-r'c...^.'�'•..�.m-;.r'.a&:r�2w.r•.r. :+F.z...a.�. . n�,,.;'T?�.-�',�..?"E„^"r.,-"'?4"are5c':.2.;�.^V i _ .:' .F ... r . . .. '. r'�r+..n�..'r'�+q?.'¢'w!f!'e.i�u"gs'-�s,•��^,.'r r.-'. isL�. .. Date 19 COMMONWEALTH ELECTRICAL INSPECTION SERVICE INC . (Consulting.and Fire Inspection Services) (lnaarporated In the States of MAIN OFFICE: 357 Elwyn Terrace, Manheim, PA 17545 * (717) 084-2347 Now York, Maryland, Pennsylvania. Delaware) BM732-0043 LOCATION I f4eese Ohre full and accurst+! directions in order eo avoid delay (Use back of sheer if needed! Desiring Certification of Approval, application is made for inspection of electrical installation in the premises described below. On demand, applicant agrees to pay For inspection service in accord with schedule of charges. (See Reverse Side). PLEASEPRINT DATE .......................................................... Owner ...................4.. ....`^ .. .. .......................................... Type Bldg. ❑ DWG ❑ Qlher ................._,..,.. Occupant................................................................�................................................................................... Bldg. Permit Ns,. ............................ Job Location ............. City...... ". �:. " ::?4>.a..� �{..................... Stale...... . . ..... ..I County ................... ................................... Twp. .............................,................. Swimming! Fool — New ❑ Old ❑ Owner's Address ...............[.� ....... .... Pool Pentit Nu. ............................. Directions to Job Site ._.......... SC.r E .-�,.. 4 C..._.rt. . y .._ ` `?!�....... .,..'- ..: %s ^._.r... [ .K_:. r.,........... Application For Rough Wiring ❑ Fixtures ❑ Service 15 or ..............:.........--.._._.—..................................................._.._.........._.... Work — Newt$ Additional ❑ Bldg. -- New 0. Old 0 Ready for Inspection ..................... ............. Fee Remitted ................................................ Check ❑ Cash 0 Make Payable To C E.I.S., Inc. LIST ALL EQUIPMENT AND WIRING NUMBER OF ROUGH NUMBER OF ELEC HEAT AIR CON DITIONERS•BURNE RS•ORYE RS,HEATE RS-RANGES ETC. WIRING OUTLETS FIXTURES NUAABERF TYPE OF DEVICE N P OR K W. [F%IUk1BERl TYPE OF DEVICE N.P. OR K.W. SW#TCHE MERCURY LIGHTING SODIUM RECEPT . FLUORESCENT ELEC. HEAT QUARTZ MOTORS= H.P. , 1/20 /12 1/30 1/8 116 1!4 1/3 1/2 314 L 1.1/ 2 3 5 -1/ 14 15 24 25 34 40 50 75 100 MARK NUMBER OF EACH SIZE ' OTHER EQUIPMENT AP NTS LICENSE Ir PERMIT ■ SIE PLEASE ..c PRONE N PRItE APPUCANT'S NAME of ADC/F1E'� UTILITY OFFICE TO CITY STATE 21P CODE BE NOTIFIED ROUGH WIRING SPACE BELOW FOR USE OF INSPECTORS ONLY OUTLETS AMP SERVICE PUMP EQUIPMENT EAT SWITCHES PUMP OVEN SURFACE GARBAGE RECEPTACLES UNIT DISPOSAL UNIT MEDIUM BASE RANGE FIXTURES MOGUL BASE WATER PRYER FIXTURES HEATER FLUORESCENT AIR FIXTURES CONDITIONER AMP, RECEPTACLES MERCURY VAPOR OR FRAC. H .P. WIRING & CONTROLS FOR BURNERQUARTZ FIXTURES VENT FANS MOTORS: H.P. tl201/'12 1/30 1/M 1!6 1!4 1!3 1!2 3/4 1 -1! 2 1 3 1 5 7-1/ 10 15 20 25 1 30 1 40 1 50 75 10O MARK MUMMER OF EACH SIZE APPARATUS 14A15C. INFO. GATE iNSPEC. NOTIFIED PRR_ 4 IliC FEE PAID CON— TOTAL $ TRACTOR CERTIFICATE ISSUED OWNER CHECK NO. C] R ,W. ❑ OUP OCCUPANT CHARGE 0 FINAL ❑ SERV. PROGRESS 0 AGENT CASH DEFECTIVE ❑ ELEC H O LT Co TEMP CARD ,a DATE INSPECTOR FINAL CARD rF 177 1 S'19627 ReV. c/s'' APPLICATION EXPIRES ONE YEAR FROM DATE. WHITE/Office CANARY/Customr PiNK/lrispoI GOLD/Offlaw r f I r, I gores, a --gum • � f _y 1 ° 1 F q7 ' 12c9 _ Zoning4ArnnIratol /j TOWN OF QU 'EN6"6Uf -'.;� Zoning A `mistr _. tor Date_. . _ -,�--- TEM CO 's Best Fireplaces : TBF Series r. .Tr 1 ;i a _.i 4 MODEL TBF36 MODEL TBF42 with CV42 GLASS DOOR MODEL TBF47 is i5 DIMENSIONS Ins. Best Appearance. Best Performance. w Fi_ n e c D E F u H 4 7 TBF36 36 24 54 46 33 7O 34 :3N_ms The TBF series' excellent finishin and fit TBF42 42 24 57'h 81 tiN 5e 39 i2 409�: T6F47 47 28 61 h Btt'♦s 52 39 52 4t7 �3 performance characteristics derive from its G 'Hearth Area (sq. ins.) unique triple wall construction and then- ACCESSORIES mosiplion cooling system. In this proven , Clearview Glass Doors to enhance safety, ttncc�mprt,mised design , all necessary appearance and performance are available for cot>ling air is taken in at the top of the all mbu tionmod iE _.. .:.; Combustion .Air Kit conserves heated room chimney and contained within the fire- Face, TBF36 air by providing outride air for combustion. place, leaving the face and opening en- CHIMNEY COMPONENTS tr�+5 p tirely free of vents. This allows finishing TBF Series fireplaces use triple wall chimney tip to the opening for a flawless appear- components with l S" o.d. , and 2'" clearance ance , more attrac - to combusrihles. tive than that of • Terminations: A choice of round , round slil+ a type, car architectural terminations are higher cost site- available for all models. built fireplaces. In e INSTALLATION FLEXIBILITY sit?addition , it helps 6' Starter section, packed with fireplace, conserve energy by a required for models TBF42 &. TBF47 keeping the fire- s Up to 4 elbows ( 2 pairs of elbows) may he used per system. place enclosure , Minimum system height, without elbcnvs: and the house , 12 ' , T13F36; 15'6", TBF42 &. TBF47. warbler and more Niinimmi-h system height with l pair caf comfortable. Face, TBF42 & 47 elbows: } 7"' •. 14— r Minimum system height with 2 pairs cif f 1 � Finally, the high elbows: 21 " I 7.1t F/' 1 - Maximum system height: 9C]'" donned transition {v{�F1={f}J/}/r ill assures a reliable 24i4 draw without arz 177 I 1 , unsightly sheet Top . Framing 6 � � f metal smoke deflec- Repe7rt Research Research Report tor. The resulting #MH Report Report # 87 - 31 high openings are 10105 # 3195 #8809 essential for good "' Meets 11LIP Minimum Property Stimdards, ` — Section 610- 1 _ 1 and 610. 2 design with higher R or vattlred ceilings. N ----- c{ —�, " toIS, ,q� Hearth r 01041 r s:'"x ooi .ks c. 4737 . ., a «rt,.vnk.ry M re"116I ,rvr. s1 I S W 71467355 4:89 Printed USA