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1992-198 +�ERTIFZ+��i.TE 3F C +�I.: PAN�,Y TOWN OF QUEENSSURY WARREN COUNTY, NEW YORK Elite_ 'l ''a 19 Thai-a+'1ta t[� certify c wt work requested to be dare as shovim by Permit No. has bcen completed. I This structure may be occupied as a _ Addition to dwelling [Master Bedroom w/Bat Location 7 Greenwood Lame Mr. & Mrs Ira Neifeld Owner By Order Town TOWN OF QUEENSSURY Director of Bldg. & 'Cade Enforcement w BUILDING PERMIT " TOWN OF QUEENSBURY No 92_ 198 `; o WARREN COUNTY, NEW YORK ro Tw PERMISSION is hereby granted to Mr. A Mrs . Ira Neifeld �N OWNER of property located at 7 Greenwood Lane 'Street, Road or Ave_ in the Town of Oueenslaury, To Construct or place a _ Addition to Dwel l ing at the above location in accordance to application together with plot plans and other information hereto filed and W. approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. J 1 , OWNE WS Address is 7 Greenwood Lane Queensbury, NY 12804 2. CONTRACTOR or BUI LDE R'S Name Valente Builders V S7 3_ CONTRACTOR or SUILDERS Address r 4. ARCHITECT'S Name as CD S. ARCHITECT'S Address A CL C. r. 6. TYPE of Construction — (Please indicate by X) .fir i7 ? Wood Frame ( ) Masonry i l Steel l I 7_ PLANS and Specifications No, 602 sq ft Addition to ©welling as per plot plan specifications moon and application 8_ Proposed Use Master Bedroom with 1 bath $ 48 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES MAY 42 1993 [If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Oueensbury before the expiration date_} Dated at the Town of Queensbury th�ls--� 4t D y of "ay 19 92 SIGNED BY ' for the Town of Queensbury Bu irtg and noi ctor TOWN OF QUEENSBURY f'OVVN OF QUEENSBUk REVIEWED BY : RECEIVED FEE PAID : 1 1992 PERMIT NO . : q-1 ` / ?� BLDG. & 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 : _ +'Y1 C' YY1 IZS' rZ• - ,�` s #ca: G Q P . O . Address : "0 Lis-� wov L> C►1 oczf PHONNEr�+��/� Property Location : LCL .- fC3y _ � ! d' � Tax Map No . d'A 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 : wit- wc7o9 Lot No . / THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS : k6V/.1r'rV 9's NATURE OF PROPOSED WORK : * ESTIMATED MARKET VALUE OF THE 112000000 Construction of new building * CONSTRUCTION : $ �roa y - - i%- Addition to building Alteration to building * COMPLETE INFORMATION REQUIRED SELDW : ( no change to exterior dimensions ) * Size of Property : /y �. z-�ft , x ;Ft . Other work ( describe ) * Exis ing Buildin Size : * Proposed building - distance from GROSS AREA OF PROPOSED STRUCTURE : * property line : Ist Floor Sq , Ft . * Front Yard 5t�4> ft . Rear yard 76 ft . * Side Yards M S r ft , and Y Z .-- ft , 2nd Floor ©Zi Sq , Ft , * If on corner , setback from side street- ft * Other Floors �-` Sq . Ft . ( not cellar or basementT * OCCUPANCY INFORMATION : * TOTAL FLOOR AREA : 40 Z = V� Sq . Ft . * Primary Building - * One Family Dwelling Size of New Structure : '2Z ft , x �Xl ft . * Two Family Dwelling Founda n : * Multiple Dwelling/No . of Units Pier/ la Crawl /Partial /Full ( Circle One ) * Business * Industrial Noo of stories ( Habitable space ) * Other Height ( grade to ridge ) ,�.e( ft . If residential , no . of families : * addition , what wilt be . _ No . of rooms ( excluding baths ) : �s ' No . of bedrooms : I No . of bathrooms : I * Accessory Building : Primary heating system : tN �' --' * Detached Garage - One/Two Car Type of fuel • Cs�r * Attached Garage - One/Two Car No . of fireplaces to be installed : * Private Storage Building Will a woodstove be installed ? : 144 * Other Central Air Conditioning : Yes #.;—Nv--- * �z fr►- `--� � - • vn•t-� ( OVER ) BUILDING PERMIT APPLICATION CONTINUED : BUILDING SPECIFICATIONS : Type of construction : wood frame , fire safe , etc . Will any second- hand or ungraded lumber be used ? If so , for what ? [ — Foundation Wall Material : . Thickness : 40 Depth of Foundation below grade ( to bottom of footing ) : .4 1 { Will there be a cellar ? Heated or Unheated ? Floor Sq . Footage : Will there be a basement ? 0 Will any portion be used as living space ? If so , what portion ? Sq . Ft . Type of Use ? Type of Roof : Sloped/Flat/Shed/Other : _ Material of Roof Size , wood studs x " • '" �Ca spacing— , � r o . c . ; length ' ft . Joists ( floor beams ) : 1st Floor _, "' x " ; spacing o . c . ; span - ,�j4ft . Joists ( floor beams ) : 2nd Floor _ '° x " ; spacing 442 o . c . ; span ft , Overlays ( ceiling beams ) : � x 6 spacing " o . c . ; span 1r ft . Roof rafters : x __ l� spaci ng _L_."_ o . c . ; span a ft . Roof trusses ( pre-engineered ) : spacing o . c . ; span — ft . Exterior Wall Finish : //::w of what material ? —��d� Interior Wall Finish : �' /(,,u. 0 c 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 provider! ? f Will a flue- lined chimney be installed ? /�/�� Height above roof c;L �-� 3 a `� ft . Depth of chimney foundation below grade : ft . `Z co- - t+o Depth of fireplace hearth : �` ft . �-�` r in . Water supply - Municipal or private well : t-r /'�'Z, _ SEPTIC SYSTEM : Distance from any private well ( including adjoining properties : ft . ( A separate application is necessary for aV repair or new installation of septic system . ) NAME OF BUILDER & ADDRESS : Gwf" LA + s PHONE Ipia 0 NAME OF PLUMBER & ADDRESS : rzLA� Q PHQNE `I I 3 3 I NAME OF MASON & ADDRESS : V&kztuj t . L2 ra u PHONE 4750P�J�- NAME OF ELECTRICIAN & ADDRESS : 01D CP -o- Qr�L vy-.� � '� PHONE (zaCF 4'' -2-3SI' 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 perta2r%, ownbr "§ the proposed work shall be complied with , whether specified or not , and that such wororiz by he owner . t Signature Zo agent , architect contractor SPECIAL EONDITIONS OF THEPERMIT : By : Code Enforcement Officer ENERGY CODE COMPLIANCE APPLICATION T0A OF QUEENSBURY , WARREN COUNTY - 9000 HEATING _DEGREEDAIS rOWN OF C?UEENSBUk . RECEIVED CoMl iance Notlwils PART 5 - Acceptable Practice Method - 1 b 2 Family Dwellings ( ONLY ) MAY 1 1992 PART 6 - Thermal Rating - Component Trade Offs - 1 b 2 Family Dwellings®LDG. ,& CODE DEPT 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 APPLICANTFS PROPERTY PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE : 1 . Gross Floor Area Sq . Ft . 2 . Type of Heat - Elec . Base Board Other 1424*4— W xt - ' 3 . Is Building Mechanically Cooled ? L/ YEAS "� ZI�+U�r 02. 4 . Percentage of Area of windows and Doors Over 17 % looOLU[nder 17% THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND TO R E 0 U I R E D THE R-VALUES SHOW ON PLANS SUBMIT'I Baseboard S . Insulation Values : Actual Shown Elec , Heat Other A . Roof A Floors exposed to ambient temperatures R '59' B . Exterior walls R Vj S Co Glazed Area R 72�" D . Exterior Doors R E . Floors over unheated spaces IZ F . Edge of Slab on Grade ( Heated Building ) R G . Basement/Cellar Walls (Above Grade ) R He Basement/Cellar walls ( Below Grade ) R T . Heating/Cooling - Ducts - Piping in Unheated Space R 33J'� 6 . Service [ Domestic ] Hot Water Heating Device A . Conforms to minim■ efficiency per code ✓ 'DES No TENIERAT RE CONTROL MIXIM7N SETTING 1400 - WILL NOT BE EXCEEDW INSPECTOR ' S RE«r►W TOWN"',QPIF ENS URY any #t "ityll"411 a1 1RumnsbUry, My. 128014725 APPLICATION FOR SOLID-FVJJ L ] LVRNING APPLIANCES AND FIREPLACES Date "` "" ' r 19 .. Permit No. - e� A111441CX1 ION IS HEREBY MADE to the Building Department for the issuance of a Jiuildirig an(I kJ se Permit pursuant rsunt to the New York State Fire Preveptic at d -vilding Code. The applicant or owner agrees to comply with all .rtaplicable laws, ordinances, regulations and all cond €ions that are part of these requirements and aiso will allow all inspectors to enter premises for the required .inspections. Applicant 's Name L/ 6c—,n 11 "" � c � c � rx ! AP ,I NCE TYPE S " y�'r Coal Wood Adclress (r, Iaurnaee Hot Air Bailer Zero Clearance Circulating; Unit tie - zip ? a Phone p-� If Non-lasfmry: i Owner's Name wit 4s tbfri . 441 ­4 1 w4ar s IP Manufacturer Address Y ' ea n.► fir, ct Model . Outlet Size gg Zip 4 Z 0 Listed 6W Number Phone c '`,7 �j - / ' Ct `-r/ CHIMNEY �. . TYPE Masonry: Block Brick Stone IIvoperty Iodation of proposed cons Tellion Flue: Tile Steel y Size:Factory Built: - ,.�, _ 6 v LN/7" Manufacturer Mode! Size �A 6: e1 ' �y Numaer. YO D IANCE3 WallTeDoubW Triple AND CIiMNYS MST BE INSTALLEl Insulated, . A(.'CORDING TO SPECIFICATIONS. COPY,,O ' Estimated b st %2. CONSTRUCTI()N DETAIL REQUIRED FOR MA. Fee $ SONRY FIREPLACES AND CHIMNEYS. #V.�$ X)EPARTIkiENT TowN OF QuE>ENsstrtrr, NEw YoRx Del2jrtment • Fire Marshal Amount Collected Amount Refunded C ►de Number • Ti le A ) 73 3389 (190) Public Safety A233 2655 (230) Minm Sales t ears Cwrlltt tt*t#�r� u sic bt+eisfnded to: Address: Date<#:.— Town Clerk-or DeputyLZ j White: ApypXoAuw! respr.W 06*ves"400e dieperbsewl� ' Goldenrod: Fine Afa=hal TOWN OF QUEEN&BURY 531 BAY 'ROAO QU£ENSBURY , NEW YOW J28 44 TELEPHONE ( 518 ) BUILDING INSpECTOR' S REPORT FINAL INSPECTION REQUEST FOR INSPECTION RECEIVED LOCATION. _ .._lS�_-!•�� ( rY Q DATE _ -- TYPE OF STRUCTURE RECHECK FIRE MARSHAL APPR AL ( C ACKFILLL STRUCTURE ) -FOOTING FOUNDATI NNA ELECTRICAL SEPTIC 1MSING ROUGH PLl _ INSULATION _WOODS O £/FIREPLACE REMARKS` APPROV LALA NIA YES NO CHIMNEY HEIGHT/ CATION ^--- B VENT/LOCATIO PLUMBING VENT ROOFING SIDING DECK/ PORCH/ TEPS/ RAILINGS RELIEF VA E5 FURNACE/H T WER OP ATERATING BASEMENT INSULATION/DUCTWORK INTERIO TRIM/ PRIVACY DOORS FINISH LOORS : 8AT KITCHEN WATERTIGHT OTH R FLOORS SWEEPABLE OT ER FLOORS CARPETED�____r - STA CLEARANCE /RAILINGS HAN ICAPPED ACCESS p(SM KE DETECTORS FANS/WHOLEHOUSE FANS ALL PLUMBING FIXTURES OPERATING GARAGE FIRE PROOFING_- DOOR CLOSERS__ FTHERFIRE SC IRE/DEMIS 'E WA LSTION_ UUMPSTER SITE PLAN/ VARIANC REQUIREMENTS_ FINAL ELECTRICAL -.---- OK TO ISSUE C /O OR C /C_._---.--. COMMENTS : F ARRIVE___ OEPART, __------- INSP ,r49 ROUGH WIRING OUTLETS. H,P. AIR CONDITIONER r �I Lm ._-.w"wr f ` L WIRINo R CONTROLS FOR BURNER j -� RECEPTACLES H.P. PUMP f FIXTURES K.W. OVEN AMP, SERVICE EQUIPMENT ".P. GARBAGE DISPOSAL UNIT AMP. SERVICE CONDUCTORS K.W. DISHWASHER K.W. SURFACE UNIT K.W. DRYER j K.W. RANGE AMP. RECEPTACLE " K.W. WATER HEATER FRAC. N.P. vENT FANS i 1MoroRs H.P.. 1/20 1l12 1110 Sfi '/ SS 'h 34 t lIh 2 3 5 7q 10 15 20 25 30 46 50 75 100 IN� ARK NUMBER +OF ETCH SYZE (APPARATUS BURY TOM531 SAY OF ROADNEW YORK����� T EELE4HORE [BURY 's78� +� S IMPORT INSPECTOR' FINAL INSP�CEIYEDl. REQUEST FOR IIISPECT"o. NAME LOCATION DATE I. / � PERMIX# .� TYPE OF STRUCTURE RECHECK ERICIAL ST RAMINGE FIRE MARSNG HAL N 40N (C KFILL � -g SEPTIC XL -nuGKPLr"BiNG STOVE/ IREPL CE SULATTON wOC1�DSY0VEIFIREPLACE REMARKS Ll APPROVALNO H{A YES CHIMNEY HEIGHTILOCATION B VENT/LOCATION PLUMBING VENT ROOFING SIDING IS IL NG DECK{P RCH/ RELIEF VALVES NG_� FURNACE/HOT Nd EY ORS_ INTERIOR TRIM{PRIVAC FINISH FLOORS : WATERT G BATH{ KITCHEN LE OTHER FLOORS Ed OTHER FLOORS CARPS IDy� STAIR CLEARANCEIRAI SMOKE DETECTORS DOOR CLOSERS —�--�- BATHROOM FANS U ' NI . ALL PLUMBING O�� GARAGE FIRE PRUOFI �� DOOR CLOSERS RAtiI� OTHER FIRE SSA N FIRE/DEMISE WALLS FINAL OK TO ISSUE {OL { C EN A _ bf '- ARRIVE�,�.�--� TOWN OF QUEENSBURY FIRE MARSHAL 804 QUEENSBURY , NEW YORK12 TELEPHONE ( 518) 45 l 4424 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED - ` NAME LOCATION HATE PERMIT#`��_1r� --�---'� APPROVED N/A YES NO EXITS AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTING FIRE EXTINGUISHERS AUTO . EXTINGUISHING SYSTEM HOOD INSTALLATION AUTO . SPRINKLER SYS M ALARM SYSTEM INTERIOR FINISHES STORAGE : �- CLEARANCE TO SpRINKL CLEARANCE TO HEATIN U TS RcQUIRED SIGNAGE .ti CHIMNEY WOODSTOVE F I REPLACE-MAS Of1RY ✓FI REPLACE-FACTO RY BUILT OK TO THIS DATE REMARKS : I SPEC OR 2/015 TOWN OF QUEENSBURY �jtu `--s BUILDING AND BCAODERSOADEP'ARTMEMT TELEPHONE ' (518)°745-444z BUILDING INSPECTOR' S REPORT REgWST FOR INSPECTION RECEIVEO..� G . i LOCATION DATE�7 PERMIT # ,="I TYPE OF STRUCTURES-a+ � APPRO 0 RECHECK N/A IYESI NO FQOT N S/PIERS MONOLITHIC POUR FORM EINFORCEMENT�IIS LACE RES SIBLE THE CONTRACT FOR PROVIDING pROTECTION FROM FREEZING FOR 48 OF OURS FOLLOWING THE PLACNT MATERIALS FOUNDATION/WALL THIS P RP4SE ON SITF� REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING BACK,FILL APPROVAL mAQ4PLUMBING PDLUUMMBING VENT/VEN S IN PLA E PLUMBING UNDER SLAB FRAMING JACK S S/HEAD BRACING/BRIDGING JOIST HANGERS JACK POSTS/MA B AM HEATING ROUGH- IN INSULATION : FOUNDATION W L N E r FOUNDATION 'WALLS EXTE : OR RR` FLOORS _ WALLS CEILIN DUCT WORK PIP IN N UNHEATED SPACES REMI ARRIVE DEPART &TN4ST TOWN OF QUEENSSURY FIRE MARSHAL Q �TELEPHONE ( 511 0 8 } 745- 4424RK 4 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED-.4 NAME LOCATION DATES PERMIT#_ -� ' APPROVED G'.,�C¢.�' N/A YES NO EXITS AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTING 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 WOODSTOVE FF.IREPLACE-MASONR ;/FI REPLACE- FACTOR BUIL REMARKS : OK TO THIS DATE r 2/015 SPECT R i TOWN OF QUEENSBURY BUILDING A D N CODES DEPARTMENT BAY ROAD qTELEPHONE � (5I8 ) 7454447 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTI ON RECC/EE^IIV/VED NAME LOCATION4STRUCTUREi 'DATE RMITTYPE OF � Tc. APPROVED RECHECK N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FO M - ^� REINFORCEMENT IN ACE THE CONTRACTOR IS RESPOIOSIBLE FOR PROVIDING PR ECTION FROM FREEZING FOR 48 OURS FOLLOWING THE PLACEMENT OF THE CONCRETE . MATERIALS .FDR T IS PURPOSE ON SITE FOUNDATIO['� WAL POUR FOUNDATION/NA ROOFING BAGKFILL AP VAL •1 ROUGH PLUMBI ✓/ PLUMBING YE EVENTS IN P ACE PLUMBING U Ei2 ..5LAB FRAMING : ,TACK S S/HEA ER5 BRACIN /BRIDGING+ JOIST ANGERS --- JACK OSTS/MAIN B CEATIN ROUG - 1' INSULA ION : r ` FOU ATION WALL NT R R FOU ATION WALLS EXTE OR R-� _.. ....... FLO RS R WAL S R- CEI ING DU WORK OR PIPING IN UNH SPACES REMARKS l ARRIVE DEPART INSPECTOR TOWN OF QUEENSBURY BUILDING 5A3 D BAY CODES DEPARTMENT QTELEPHONE � ( 518)NEW a745- 4447 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION /RECEIVED NAHE �ir'�! LOCATION ` DATE / Z PERMIT TYPE OF STRUCTURE +' rY - APPROVED RECHECK N/A IYES 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 FOUNDATION/DAMPROOFING BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/V N S IN PLACE $ PoMBING UNDER LAB RAMING : JACK ST DS/HE E S BRACING/BRIDGI G JOIST HANGERS JACK POSTS/MA BEAM HEATING ROUGH- IN INSULATION : FOUNDATION WALLS IN ER R- FOUNDATION WALLS XTERI R R- R- FLOORS R- WALLS R- CEILING DUCT WORK OR PIPIN IN UN}{EATED SPACES REMARKS ARRIVE DEPART INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QTELEPHONEy NEW 0( 518 } 7 45- 4447 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED�� NAME E' ► _ 4" AI LOCATION:: DATE PERMIT # . TYPE OF SIT TURF' APPROVED RECHECK N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE COWMCTOR IS RESPONSIBLE FOR PROVIDINFORG PROTECTION FROM fTRHEE ZINGPLACEMENT OFNTHE CONCRS RETENG MATERIALS FOR THIS PURPOSE ON S TE FOUN REINFORCEMENTLINPOUR PLA E t FOUNDATION/DAMPROOFING BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/VENT IN PLAC PLUMBING UNDER SLAB FRAMING : JACK S DS HEADE S BRACING/BRIDGING "- JOIST HANGERS -~ JACK POSTS/MA N BE HEATING ROUGH- IN INSULATION : FOUNDATION W LLS L TE 0 FOUNDATION WALLSEXTE OR R- FLOORS R_ WALLS R_ CEILING DUCT WORK OR' PI ING I 'UNHEATED SPACES REMARKS : ARRIVE DEPART YITOR 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� � NAME LOCATION 71_ � ' / ,j - DATE� PERMIT # :4z ! TYPE OF STRUCTURE RECHECK. APPRO D V N/A Y NO -FOO ING /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 OW SITE FOUNDATION/WALL POUR REINFORCEMENT IN PLACE __ _...... ... FOUNDATION/DAMPROOFING _...... BACKFILL APPROVAL r ROUGH PLUMBING PLUMBING VENT/V NTS IN E PLUMBING UNDER SLAB FRAMING : JACK S DS/HEADER BRACING/BRIDGING _ JOIST HANGERS JACK POSTS/MAINS HEATING ROUGH- IN INSULATION ; FOUNDATION ALL IN ER OR - FOUNDATIQN WALLS EXTERIOR R- FLOORS R» WALLS R' CEILING R"' DUCT WORK OR PIPING IN UNHEA ED SPACES REMARKS : 't ARRIVE_ I' DEPART INSPECTOR TOWN OF QUEENSBURY AS BUILT PLOT PLAIT VERIFICATIOK Certificate of Occupancy I , �LVM&4� UA' &fib have verified that the attached Plot Plan is a (Print Name ) true and accurate drawing as to the location of the1 (7p- z 2 YYI �r Q (Type of Structure ) for which a Certificate of Occupancy is being submitted . I understand if the information is false or not accurate , that a Certificate of Occupancy may be revoked and I will have le for a variant r� to the Zoning Board of A+YWldig I]UEENSb� 7 7 Jii�VRJ.7-C C-_qV E D ( Date Filed ) ( signature ) 6l.DG. & CODE DEFT" 700 SO. CLAREIW T ST_ SAN MATEO. CA. 94402 INEENEENE #for sS.. 1 ` ' CIS i TOWN OF QUEENSBUFt 7 i RECEIVED f MAY 11992 TOWN 4F QUEENSBURY BLDG. � CODE DEPT. Zoning Admini o t i 4