Loading...
1992-087 CERTIFICATE CDF C.: C✓UPA.N+�Y TOWN OF +QUEENSBURY WARREN COUNTY, NEW YORK Tate ��, ,1 r1 14 !Z3 5yl This is to certify that work requested to be done as shown by Permit No. 92 087 has been cornp3etcd. This structure may be occupied as a Single Farm 1 y Dwelling owl C" Il.occsition Owner Michael J . Yasiliou INc . - 3 By {order Town Board f TOWN OF QUEENSBURY Director of Bldg. & Code Enforcement l BUILDING PERMIT TOWN OF QUEENSBURY � No. 92-087 WARREN COUNTY, NEW YORK c F PERMISSION is hereby granted to Michael J. Vasiliou Inc w 1 W OWNER of property located at Lot #S Sunny Side Estates Street, Road or Ave. in the Town of Queensbury, To Construct or place a Si ngl e_ Fami I [)we] t i ng 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. vi �. mow 1. OWNER'S Address is r+• 0 14 Stone Pine Lane Queensbury. NY 12804 r^t 2. 'CONTRACTOR or BUILDER'S Name � SME C.i 3_ CONTRACTOR or BUILDER 'S Address r 4. ARCHM CT'S Name Q et Mlo W NY 1: 5. ARCHITECT'S Address � N d. fb 6 TYPE of Construction — (Please indicate by X) rn IA (X ) wood Frame ( I Masonry ( I Steel ( y ly 4r+ M 7. PLANS and Specifications /n r No. 1650 s ft Single Family Alin as #g 9 y g per plot plan specifications t and application t S. Proposed Use w Single Family Dwelling M CIO $ 223. 00 PERMIT FEE PAID — THIS PERMIT EXPIRES March 24 ig_ 'g3 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the �•. town of Clueensbury before the expiration dame_) CAM Dated at the Town of Queensbury this 24th Day of KXMh 19__ _ 4 SIGNED BY for the Town of Queensbury Building and Zoning nspecto MMMMMMMMMM TOWN OF QUEEN'SBVRY TUwn, ur w.tv�,i. �w . REVIEWED BY : D 9M FEE PAID : ' . .f92 PERMIT NO . : �Rr BUILDING 8& CODE DEPT, BUILDING PERMIT APPLICATION 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 on the reverse side of this application . Owner of Property : Q P . O . Address * Z"51' G.�r �! t` � -� r,�. - ' PHONE Property Location : Tax Map No . Has there been any split oaf this property since October 1 , 1988? Yes No If yes , Planning Board Review is necessary . Subdivision dame , if applicable . �r_ �rr,► ,,,�, �/RK Lot No . OF ? THE PERSON RESPONSIBLE FOR SUPERVISION�F WORK AS REGARDS TO BUILDING CODES IS : _ter NATURE OF PROPOSED WORK : y * ESTIMATED MARKET VALUE OF THE Construction of new building * CONSTRUCTION . $ Addition to building Alteration to building * COMPLETE INFORMATION REQUIRED BELOW : ( no change to exterior dimensions ) * Size of Property : fte x .� ft . Other work ( describe ) * Existing Building ize : * •— f t . x ---- f t . GROSS AREA OF PROPOSED STRUCTURE : Proposed building - distance from property line : 1st Floor e ',�' Sq . Ft . S ple * . Front Yard � ft . Rear yard J+�-�' ft . Side Yards .0 '7 f t . and .Z3 t .f 2nd Floor , � _, Sq . Ft , : %754 * If on torner , setback from side street- Other Floors Sq . Ft ."/ 8 P <X0 * ^"� ` ft . a ` (% not cellar or basement 3 * OCCUPANCY INFORMATION : 40 TOTAL FLOOR AREA : 0 Sq . Ft . C' ` * Primary Building - r 4, 'a * _ One Family Dwelling Size of New Structure : :Zcl _ ft , x ft . * Two Family Dwelling � x - Foundation : * Multiple Dwelling/No . of Unitst- S Pier/Slab/Crawl /Partial /Full ( Circle One ) * Business * Industrial No . of stories ( Habitable space ) * Other Height ( grade to ridge ) a Z ft . If residential , no . of families : * If addition , what will use be? No . - .of _rooms ( excluding baths ) : -► _ No , of bedrooms : No * of bathrooms Accessory Building : Primary heating system : (iT%-G * Detached Garage - One/ Type of fuel : f ��' * Attached Garage - On Two Car No . of fireplaces to be instal-led : * r Private Storage Build ng Will a woodstove be installed ? : * Other Central Air Conditioning : Yes _ No ( OVER ) i BUILDING PERMIT APPLICATION CONTINUED : BUILDING SPECIFICATIONS : Type of construction : od frame fire safe , etc . Will any second- hand or ungraded lumber be used ? If so , for what? : F f Foundation Wall Material : G*u.G Thickness : Depth of Foundation below grade ( to bottom of footing ) : �^ ��' ; Will there be a cellar? X Bated or Unheated ? Floor Sq . Footage : Will there be a basement ? Will any portion be used as living space ? If so , what portion ? A%j� Sq . Ft . Type of Use ? 5 �o ,� Type of Roof : S1ape at/Shed/Other Material of Roof Aa e&at3c Size , wood studs P - x " ; spacing o . c . ; length _ ft . Joists ( floor beams ) : 1st Floor 2� _ " x f CJ spacing o . c . ; span ft . Joists ( floor beams ) : 2nd Floor --2L- " x ' ? " ; spacing _ ,ram o . c . ; span ft . Overlays ( ceiling beams ) : ? " x " ; spacing �,, A o . c . ; span 7 ft . Roof rafters : " x is ; spacing o . c . ; span ft . Roof trusses ( pre-engineered ) : spacing 2.)� o . c . ; span eZ40 ft . Exterior Wall Finish : VVAJ &g. ps.y n of what material ? Interior Wall Finish : , If a garage is to be attached , describe materials to be used for FIRE SEPARATION : Is there to be an opening between garage and dwelling? If so , will a Fire- Rated door , enclosure , self-closing device be provided? �A Will a flue- lined chimney be installed ? Height ab ve roof ft . Depth of chimney foundation below grade : ft . Depth of fireplace hearth : ft . in . Water supply - Municipal or private well ; SEPTIC SYSTEM : Distance from a_�r private well . ( including adjoining properties : ZL ft • ( A separate application is necessary for any repair or new installation of septic system . ) NAME OF BUILDER & ADDRESS : PHONE NAME OF PLUMBER & ADDRESS : PHONE y__7 NAME OF MASON & ADDRESS . ,^c.� PHONE Z Q 22. 2 NAME OF ELECTRICIAN & ADDRESS :47!70 PHONE y 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 provisions of the BUILDING CODE , THE ZONING ORDINANCE , and all other laws pertaining to the proposed work shall be complied with , whether specified or not , and that such work is author zed by t owner . Signature -G•L w , owner s ag nt , arChiteTCE contractor SPECIAL CONDITIONS i`THE PERMIT : eye ode Enforcement Officer ENERGY COQE COMPLIANCE APPLICATION TOWN OF QUEENSBURY , WARREN COUNTY - 9000 HEATING DEGREE DAYS Comlfiance Methods: PART 5 - Acceptable Practice !Method - 1 & 2 Family Dwellings ( ONLY ) PART 6 - Thermal Rating - Component Trade Offs on 1 & 2 Family Dwellings ; + Multi - Family Dwellings ( 3 Stories or Less ) PART 4 - Design By Component Performance - Commercial Buildings - Hi - Rise Residential PART 4 A 6 - Compliance Methods Require Submission of Worksheets APPLICAKTIO 5 KAKE PROPER LOCAT N PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE : 1 . Gross Floor Arer�at - ---oil Sq . Ft . 2 . Type of Heat Elec . Base Board Other C 'r le. 3 . Is Building Mechanically Cooled ? YES 4dq No 4 . Percentage of Area of windows and Doors Over 17 % Under 17% THE R-VALUES GIVEN ON THIS SHEET MIST CORRESPOND TO R E U I R E O THE R-VALUES SHOM ON PLANS SUBMITTE6! So Insulation Values : Baseboard Actual Shown E] ec , Heat Other A . Roof A Floors exposed to ambient temperatures R B . Exterior Walls Co Glazed Area D " Exterior Doors R_ E " Floors over unheated spaces R ----- F " Edge of Slab on Grade ( Heated Building ) R Go Basement/Cellar Walls (Above Grade ) R �j1 H" Basement/Cellar Walls ( Below Grade ) R Jt r i " Heating/Cooling - Ducts - Piping in Unheated Space R 6 . Service (Domestic ) Hot water Heating Device A " Conforms to minimum efficiency per code YES NO TEMPERATURE CONTROL MAXIMUM SETTING 140• on WILL NOT BE E=EEDED ' df ow / r Memo INSPECTOR ' S REMARKSto 07 r r i } At TOWN OF QUEENSSURY APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # Fee Paid Reviewed By Date : LOCATION OF VROP`ERTY FOR INSTALLATIOi : R owner ' s Name : ` --- Owner ' s Mailing Address : Installer ' s Name : Phone # : Number of bedrooms ( if residential ) . _ Total daily flaw { reside -compute @ 150 gal . per bedroom ) . Topography-Circle One : Flat ZRollin Steep Slope % of Slope Soil Nature-Circle One : Sand Clay Other /Depth : Ground Water-At What Depth? Feet } Bedrock or Impervious Material -At What Depth ? ^- ( Feet Percolation Test-Circle One : QNot Requir equired/Rate Min . Per Inch Domestic Water Supply-Circle One : Municipal Well Other If domestic water supply is a well Separation : Water supply from anal septic absorption feet PROPOSED SYSTEM: Septic Tank l� gal . ( Minimum size : 1 .000 gal . ) Tile Field : Each Trench _1 feet//Total System Length �� feet Seepage Pit ( s ) : Number of / Size each : ft . x ft . Size of Stone to be used : # / Depth or Thickness feet HOLDING TANK SYSTEM IF REQUIRED No . of Tanks Sizelof Each Gal . Alarm system an associated electrical, work to be inspecte bcertified 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 . ZSI6MATilRE OF RESPONSIBLE PERSON : DATE = f 2- . � r 1 .•T.f,rj; i= oto 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; drywel l s 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 { rr Remarks : - ' ; _. , fr ro by . , % - : k k r, • < YY ? FlkY . Y. . ." Y %a TjSlfa ,`kt Ii { , ,." rSry '� `.34► i Aw•� 5 � k TOWN OF QUEENSBURY 531 BAY ROAD QUEENSBURY , NEW YORK 12804 TELEPHONE ( 518) 745-4447 BUILDING INSPECTOR' S REPORT FINAL INSPECTION REQUEST FOR INSPECTION RECEIVED QlQo aac/' -,- LOCATION DATE � � _ PERMIT/ �f„W-ooz o e TYPE OF STRUCTURE �� RECHECK FIRE MARSHAL APPROVAL ( COMMERCIAL STRUCTURE ) -I� QTING ,��FpUNDATION j.�ACKFILL + FRAMING UGH PLUURBING P FINAL ELECTRICAL--,...SEPTIC ,INSULATION TWODDSTOVE/FIREPLACE REMARKS -A agp APPROVAL N/A IYES NO CHIMNEY HEIGHT/LOCA ON B VENT/LOCATION . r PLUMBING VENT ROOFING SIDING DECK/PORCH/ TEPS/R ILI RELIEF VALVES FURNACE/HOT W ER Op A NG BASEMENT INSULATION! INTERIOR TRIM/PRIIf Y DO S FINISH FLOORS : BATH/KITCHEN W ERTIGHT OTHER FLOORS £EPRBLE OTHER FLOORS ARPETED STAIR CLEARAN /RAILINGS HANDICAPPED CESS SMOKE DETECT RS — BATHROOM FANS/WH ' ALL PLUMBING FIXTURES OPERATI GARAGE FIRE PROOFING DOOR CLOSERS OTHER FIRE SEPARATION FIRE/DEMISE WALLS -- DUMPSTER SITE PLAN/VARI NCE REQUIREMENTS- FINAL ELECTRICAL OK TO ISSUE C/O OR C/C COMMENTS : c 3 S 3 ARRIVE DEPART 1 = '� yR� N5 �Gi E.E111 C?� �ff P P If .� !'� 4'l I"f� f /'J/r♦','I/+ BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. O. 1 Box 98 Queensbury, New York 12601 1_2.; SEPTIC DISPOSAL. SYSTEM INSPECTION f LOCATION DATE PE RM I T NO SOIL 'TYPE - Sand - Loam - Clay -_ Percolation Test Required? YES - NO Percolation rate - Min/Inch ` TYPE of SYSTEM : - r Absorption field , total length Length of each trench Depth of trenches ' Size of gravel_ SEEPAGE P ITS4Nvinber of ) Size- ft. X ft. w Gravel size _ PIPING : Size Type Bldg . to tan Tank to diet. box Dist . box to field/pit Openings seale ? YES NO Partial LOCATION/SEPARAT S : Foundation to tan ft . Foundation to abso ion. ft . Absorption to lot a ft , Separation of pits ft . LOCATION OF SYST ON ROPERTY (circle one) Front - Rear - L t si - Right side - CCMMENTS : ?'. '+I�S'M� h•�t.-t 02r 5� 5�/� -..,.r /�!- [ yz r [ _ 'yi' �i7 yy S.44 f,�.+,�/i�L� +S+ai ✓�' 4.�r � '�c .vi P$+.11�E'. :r'-/+`i.Ec.rp`,�Y�'��v Y�v C r%erjr 'a5i d ur2` ra � /. "¢rf . of ovncx clod SYSTEM USE APPROVE�YE NO P ^ ..�� Buildin _ Inspector 01j86 and vl r r _ lvwn a/ �eeeer� sheerrd BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Sox 98 Queensbury. New York 12801 SEPTIC DISPOSAL SYSTEM INSP'ECTIfNJ NAME LOCATICI DATE ZeI fit_ PERMIT NO . SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch _ TYPE of SYSTEM: total engtll Absorption field , Length of each trench Depth of trenches ' size of gravel SEEPAGE PITs4Nurnber of) Size- ft. X _ ft. Gravel size - Si + Type PIPING : Bldg to tank Tank to dirt. box Dist . box to field/pit partial openings sealed? YES NO LOCATION/SEPARATICN S . ft. Foundation to tank ft. Foundation to absor ion ft. Absorption to lot ne ft. Separation of pit ITION OF SYS ON PR Q RTY (circle one) ACA Front - Rear - ft side Right side COMMENTS : .— Slow SYSTEM USE APPROVED YESIN guildi.ng Inspector 01/S6 and v1 URY BUILDING D .CODES D PARTMENT+� 531 BAY ROAD QUEEKSBURY , NEW YORK 12804 TELEPHONE ( 518) 745-4447 WILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED_ KAME0011 LOCATION DATE �PERMIT # � — TYPE OF STRUCTURE APPROVED RECHECK N/A YES NO 0 NGS/PIER MONOLITHIC POUR F REINFORCEMENT IN PLACE THE CONTRACTOR IS RESP LE FOR PROVIDING PROTECTION , ROM FREEZING FOR 48 HOURS F LoWING THE PLACEMENT OF THE CO , RETE - MATERIALS FOR THIS PURPAbS£ ON SITE FOUNDATION/WALL POUR _ REINFORCEMENT IN PLACE` FOUNDATION/DAMPROOFIN BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/V S LAC�F PLUMBING UNDER SLAB F, FRAMING : JACK S /HEAD BRACING/BRIDGING _ JOIST HANGERS - JACK POSTS/MAIN 8 �^---- HEATING ROUGH- IN INSULATION : FOUNDATION ALL N . E I R- FOUNDATION WALE EXTERIOR�R- FLOORS R- WALLS CEILING DUCT WOR PI NG III UNHEA E SPACES IF M A ��3\ 740 iJ" ,lL ARRIVE DEPART NSPECTOR TOWN OF QU£EN4SBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD Q * NEW 0 TELEPHONE (518 ) 745 4447 BUILDING INSPECTOR' S REPORT REQUEST FOR INS ECTIOIN REC`EI]VED �N MA14E A-':5 f { C C? V LOCATION DATE DATE / 10 �PERNIT f TYPE OF STRUCTURE RECHECK APPROVED N A YES-NO FWTINGS/PIERS _ x MONOLITHIC POUR F REINFORCEMENT IN PLACE THE CONTRACTOR IS RES BLE FOR PROVIDING PROTECTION ON FREEZING FOR 48 HOURS FOL O6fI THE PLACEMff OF THE CONC MATERIALS FOR THIS PURPOS O SITE FOUNDATION/WALL POUR REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/V N S IN AC PLUMBING UNDER SLAB FRAMING : JACK S EAD M BRACING/BRIDGING JOIST HANGERS n JACK POSTS/MA N HEATING ROUGH IN. INSULATION : FOUNDATION WALLS NTERIUR - FOUNDATION WALLS EXTERIOR R- FLOORS R- "A WALLS R' VcCEILING R" DUCT WORK R I G N UNH E SPACES f 0 12� F:� c7m� Qr� ARRIVE _� DEPART "� �II INSPECTU awl" o/ 'Queeili "ray BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 SEP�T.IrC, DISPOSAL. SYSTEM INSPECTION LOCATIONf+.! DATEZzl PERMIT hNJ. � SOIL TYPE I6a=-- Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , total length Length of each trench 474 0 Depth of trenches f { Size of gravel jf2ts2 SEEPAGE PITS#Number of) Size- ft. X fto Gravel size PIPING ; Size Type Bldgo to tank C. 4�Z) Tank to listo boxy vr' _ Distv box to fief / Openings sealed? NO Partial LOCATION/SEPARAT ONS : Foundation to t k // ft. Foundation to ab orpti eft. Absorption to to 1 in �„f t . Separation of pi � ft. LOCATION OF SYS PROPERTY ( circle one) Front - a - Le side - Right side - CCfm4MEN &Pic k SYSTEM YU � � Du ldin Inspector —� 9 Pry 01/86 and vl ry � n �uperey es "E NT / BUILDING and ZONING DEPARTBC]x 9$ Bay and Haviland Road, R.D. ()ueensbt)ry. New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION LOCAT ION: ON ` G 9 PERMIT Nb . DATE SOIL TYPE - Sand Low clay _ NO Percolation Test Required? YES Percolation rate - Min/Inch TYPE of SYSTEM: field . total leng Absorption th t Length of each trench �^ Depth of trenches Size of gravel er tof ) SEEPAGE P= �-E1N f . -�- size- --�- Gravel Size 52. TYPe P xP I14G Bldg - to tank Tank to dist . box Dist. 'box to field/Pit O Parti l Opening$ Sealed? YES LOCATION/SEPARAT10"S f t. to tank Foundation It f t . Foundation to absOr t. AbSor�Ftion to lot ine separation of P4t1i rcle one) LOCATICR3 OF SYST�M PROPERTY S ide - Front - Rear - Peft side - Right CCMMENTS U4 Yoe 161 SYSTEM USE APPROVED YES Huildi I pectOr 01/86 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 SAY ROAD QUEENSBURY , NEW YORK 12804 TELEPHONE (518 ) 745-4447 BUILDING INSPECTOR' S REPORT REQUEST OR INSPECTION RECEIVED '�'`I 10 } NAME LOCATION DATE �IIE> pl , PERMIT ! *1 6 L TYPE OFF SIUCTURE RECHECK ' APPROVE N/A I YE54 NO FOOTINGS/PIERS ' MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTECTION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACEMENT OF THE CONCRETE. MATERIALS FOR THIS PURP ' SE ON SITE FOUNDATION/WALL POUR REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/VENTS IN AC PLUMBING UNDER SLAB FRAMING : .JACK ST DS/HEADERS _ BRACING/BRIDGING JOIST HANGERS JACK P05TS/MAIN BE HEATING ROUGH- IN INSULATION : FOUNDATION ALL NT R R R- FOUNDATIO N WAL EXT IOR R- FLOORS R- WALLS R- CEILING R- DUCT WORK aA PIPING IW UNHEATED SPACES 17 REMARKS : M1 ARRIVE DEPART "-ECVQR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QTELEPHONE ! ( 518 ) 745-4447 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME . l ams 'tn s i LOCATION DATE*�2 I ' PERMIT TYPE OF STRUCTURE RECHECK APPROVE N/A IYE NO 0 I GS/P E S MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE Cis RESP FOR PROVIDING PROTECTIONFBROM FREEZING FOR 48 HOURS FOLLOWING THE PLACEMENT OF THE CONCRETE. MATERIALS FOR THIS PURPOSE ON SITE FOUNDATION/WALL POUR REINFORCEMENT IN PLAC FOUNDATION/DAMPROOFING BACKFILL APPROVAL. - ROUGH PLUMBING PLUMBING VENT/V N S . IN P A PLUMBING UNDER SLAB FRAMING : JACK S D / EAD -� BRACING/BRIDGING JOIST HANGERS JACK POSTS/MAI B HEATING ROUGH- IN INSULATION : FOUNDATION L I R 0 FOUNDATION WA S EXT IOR RR_ FLOORS WALLS R- CEILING DUCT WOR R PI I G IN HEA E SPACES REMARK � -4 ARRIVE DEPART INSPECT I National Headquarters 1337 Inset CNjatd `49380 . . . Date: �r f City. Town or Township County&.-d.4+,,U State c J 3X Location/Address OPM PC "OF OMEN* If Loc2 in Rur a - Pleag AttIMDireetions) Pt)le # Owner . .:Pdi it :• Occupied07 . As 3� Bu5ldin .'N�rv+r O1d0 Occupantgo _ Work Area in Buildin Floor #, etc. ) : App. for: Wiring Service or: Ready for Inspection : Fee Remitter,#' - Cash Check `M.C1: Make Payable To: M.D.i.A. :eoo• 75 0 xaaaaz2o � x7s+o zaoo zzso 25oa 2750 3000 Number of Rough Wiring Out,I. Elect. Heat Switches ---- Amp. Service F Surface Unit Dishwasher' Range Lighting Water Heater Air Conditioner Dryer Pump Receptaclesu Oven Garbage Disposal Wiring and Controls fdr Burner Number of Fixtures Amp. Receptacles Fractional H.P. Vent Fans Other Equipment: MOTORS H.P_ /2 1l12 .3./'1 1/8 1/fi 1/4 1/3 1/2 3/4 1 lilx 2 3 5. 7�/s 10 15 20 25 30 40 50 75 100 Mark NumlperNo of Each Size Applicant's License Signature _ T/A util4$Yg NAME Applicants dress: (City) (State) (Zip) Service Request # Phone # Electric( - OA TE:RECEIVED: DATE INSPEfx"frEd. � L 7RLN ation : Same as AboveO or: Label Rough Wiring Outlets Surface Unit Oven Svsritches _ Ran Y Garbb a DIOI06si6 Rijpeptacles Water Heater "` L�isf++^uash ` oo F ures AirConditi ,or Oyer •: - : Amp. Service Equipment Burner, Wiring & C66trdl3 for Amp. Receptacle Amp_ Service Conductors Pum Vent Fans MOTORS H_P, 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 -14'z 2 7+fs 10 15 20 25 0 40 5M J`ot5 1, Mark Number of Each Size fi ' Elect. Heat soo tso x25a 15oa x7so 2 5p ana 225 o z75a 3000 r y Y F000l RW Progress : Inc. ® LKD contractor CFT 'Violation : Work Comp. .Inc. 0 , CASH 0 L/A Owner Fee CHK # 0 L/A Due MID # [] IPA MupicipaL. IIV1/ Other Utility Applicant Date: Owner Cut in Card C] Temp d hate INSPECTORS Fir�l` # Date APPLICATION FORM NO. 2E.0 El. TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY , NEW YORK 12804 TELEPHONE (518 ) 745- 4447 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED, / Z NAME f 't LOCATION_ d DATE PERMIT TYPE OF STRUCTURE .2r.22 RECHECK APPROVED N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE -THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTECTION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACEMENT OF THE CONCRETE . MATERIALS FOR THIS PURPOSE ON SITE FOUNDATION/WALL POUR REINFORCEMENT IN PLACE z' FOUNDATION/DAMPROOFING BACKFILL APPROVAL yoROUGH PLUMBING �'-- PLUMBING VENT/VENTS IN PLACE PLUMBING UNDER SLAB z }4 RAMING : JACK STUDS/HEADERS_� � _ BRACING/BRIDGING JOIST HANGERS JACK POSTS/MAIN BEAM HEATING ROUGH- IN INSULATION : FOUNDATION 'WALLS ERI R R� FOUNDATION WALLS TERIOR R- FLOORS R- WALLS R- CEILING R- DUCT WORK OR P, PING IN UNHEATED SPACES R EMARKS : k4-6 R �j� Pam -�-C> I _ ARRIVE ^ DEPART I SPE OR ♦ / ! R y� +4 � A ,44 „ M �� " PAC F v ,h 9. .ro-" s r s J. h. ,✓ ;� I ,.q r+ ,?f, r,'r`,. r, Sx'' ✓ � ups r.....§ fi „ a, s,s ,,,,., �f„.,r , v :.,,, � „ ✓r r r�,r „`"�; , f s,fie: �, r +t,,,r.., rs-: ,r,.,.,.w �< „r, . ,,,,:, ,,,...,. , , ✓, Sr E ,,... 9 ,. ^, ,,.w .,,, ,_, afda ,,,..,.r t„ �Y ✓r .r Pi +��a.� t, ,t`,,,,�,,-::,��r .�:, ,., ,�: <�;mr^,:. ., ,,., ,.r :>�, , ,y,n:`„ ��� ,}'; ru ,t x; f,K � a rrG, rs �': :rs �k )•'fir%fi -wr. wa r� ^ r M, ; of `0 C/ � to go ti ✓ r �p wpp p �r �r f m � ro� vtD.� f r p✓r< 1 v, ° � y r er „