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1992-295 CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date This is to certify that work requested to be done as shown by Permit No. has been completed. This structure may be occupied as a — - Si nal a Family dwelling Location Lot #104 Mobbwk J rnb .w \ JiJ Owner Michael J . Vasi l iou By Order Town Board TOWN OF QUSENSBURY Director of Bldg. Coda Enforcement a x BUILDING PERMIT T TOWN OF QUEENSBURY No 92_295 WARREN COUNTY, NEW YORK ^' r.+ r PERMISSION is hereby granted to MiChael J . Vasi l iOU A OWNER of property located at Lot# 104 Mohawk Street, Road or Ave. in the Town of Queensbury, To Construct or place a Si ngl a Fami 1 y Dwel 1 i ng ICU a 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. J,, v 1. OWNER'S Address is 14 Stone Pine Lane Queensbury, MY 12804 =- ta J 2. CONTRACTOR or SUI LDE WS Name Sam r 3_ CONTRACTOR or BUILDER'S Address �rre F.+ O 4. ARCHtTECT'S Name pu w 7R' 5. ARCHITECT'S Address COO) 6. TYPE of Construction — (Please indicate by X) NC { 1 Wood Frame I I Masonry ( I Steel 11 AIM 7. PLANS and Specifications t,+C No. 20340 sq ft Single Family Dwelling as per plot plan specifications L 1. �+ and application 8. Proposed Use ro Single Family Dwelling s 314* 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 3 , 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 Queensbury before the expiration date.) Dated at the Town of Queensbury thiis"�� rd Day of June 1992 ( C --- SIGNED BY for the Town of Queensbury Building and Zonino cto TOWN OF QUEENSBURY FIREVIEWED BY : e fa FEE PAID : PERMIT NO . : BUILDING PERMIT APPLICATION of a., A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . NO INSPECTI ILL B MA[ s„ TIL 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 : G : +G • ` P . O . Address : 4r PHONE23 �. Property Location : d � � � Tax Map No . 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 : 6 4wAo 6A0P !!;§0 40 Lot No . ,fi e THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS : NATURE OF PROPOSED WORK : * ESTIMATED MARKET VALUE OF THE OP _ Construction of new building * CONSTRUCTION : $ �I Addition to building Alteration to building * COMPLETE INFORMATION REQUIRED BELOW : ( no change to exterior dimensions ) * Size of Property : /2,Cb- ft . x ZOO ft . Other work ( describe ) * Existing Building Size : * �-- ft . x ft . * Proposed building - distance from GROSS AREA OF PROPOSER STRUCRE : * property 'tine : 1st Floor II �� q . Ft . ley * Front Yard ft . Rear yard 120c ft . �„ r ( O * Side Yards ft . and M, 7 ft . 2nd Floor S Ft . * If on corner , setback from side street- _ * ft . Other Floors � °� � ' Sq . Ft . � ( not cellar or basemebt ) OCCUPANCY INFORMATION : * TOTAL FLOOR AREA : Sq . Ft . * Pri�rrary Building - *-� * / One Family Dwelling Size of New Structure * ft . x [ ft . * Two Family Dwelling Foundation - * Multiple Dwelling/No . of Units _ Pier/Slab/Crawl /Partial /Full ( Circle One ) Business * Industrial No . of stories ( Habitable space ) 002 * Other Height ( grade to ridge ) Z?Lw�w ft . If residential , no * of families : ^ r * If addition , what will use be? No . of rooms ( excluding aths ) : _^ No . of bedrooms : No . of bathrooms : * Accessory Building : Primary heating system : PFAM& Q�' +I * Detached Garage - On Type of fuel : * attached Garage - One 2M No . of fireplaces to be installed: Jr.�^ * Private Storage Building Will a woodstove be installed ? : 7 .� * Other Central Air Conditioning : Yes No ( OVER ) BUILDING PERMIT APPLICATION CONTINUED : BUILDING SPECIFICATIONS : Type of construction wood frame fire safe , etc . Will ,any so and or ed lumber be used ? If so , for what ? 04 Not ndation 'Wa Ma ial : Thickness : pth of 4" on low grade ( to bottom of footing ) : 1 th ce r? Heated or Unheated? Floor Sq , Footage ; W W �the be a ment ? Will any portion be used as living space ? _40 If s o Sq . Ft . Type of Use ? Type of Roof : Slope l at/Shed/Other Material of Roof A% owAormfoovow Size , wood studs 'Lw It x 16 spacing if & " o . c . ; length " ft . Joists ( floor beams ) : Ist Floor x T I " ; spacing *T of o . c . ; span ft . .foists ( floor beams ) : 2nd Floor '' x /Q "' , spacing `� "" o . c . ; span to ft * Overlays ( ceiling 'beams ) : it x "' ; spacing " o . c , ; span ft . Roof rafters : "' x to ; spacing o . c . ; span ft , Roof trusses ( pre-engineered ) : spacing 2 o . c . ; span ft . Exterior Wall Finish : C&nq * JZ St 1 9 of what material ? Interior Wall Finish : CWco,.,/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 provided ? W S Will a flue- Tined chimney be installed ? iy/ 'S Height above roof , ,. ft . Depth of chimney foundation below gr de : �. ft . I� Depth of fireplac rth : _Z "'ter-- - ft . in . Water supply unici 1 or private well : SEPTIC SYSTEM : Distance 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 : K, � / ` � P HONE 7FY 73xj NAME OF PLUMBER & ADDRESS : PHONE y NAME OF MASON & ADDRESS : pHONEjj;0jU 4022Z. NAME OF ELECTRICIAN & ADDRESS : 7 *�s sk ,/AVOCII "f PHONQftj( �'' 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 th BUILDING CODE , THE ZONING ORDINANCE , and all other laws pertainin to the prop d w rk sha 1 be complied with , whether specified or not , and that such uthor d t owner jorIs Signature w er s AdEjontohitect ntractor .......... V SPECIAL CONDITIONS OF THE PERM IT : Y By : Code Enforcement Officer ENERGY CODE COMPLIANCE APPLICATION TOWN OF QUEENSBURY , WARREN COUNTY - 9000 HEATING DEGREE DAYS Compliance Methods * PART 5 - Acceptable Practice Method - 1 & 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 & 6 - Compliance Methods Require Submission of Worksheets APPLICANT'VS lE SJ' /Asi L / w /KX, PRO )CA 6 PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE : I . Gross Floor Area - Sq . Ft , 2 . Type of Heat - �, 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 ON 'PLANS SUBMITTED! Baseboard 5 . Insulation Values : Actual Shown Elec , Heat Other A . Roof A Floors exposed to ambient temperatures R B . Exterior walls R� Co Glazed Area D . Exterior Doors R_ 3�• E . Floors over unheated spaces R — F . Edge of Slab on Grade ( Heated Building ) R G . Basement/Cellar Walls (Above Grade ) R_k/ H . Basement/Cellar Walls ( Below Grade ) R T . Heating/Cooling on Ducts - Piping in Unheated Space R 6 . Service (Domestic ) _ Hot water Heating Device A . Conforms to minimum efficiency per code YES NO TEMPERATURE CONTROL MRXIMUM SETTING 140" - WILL NOT B"E �EXCEEDED � r ` i ! �:Oo� J E TELEPHONE NUMBEW� INSPECTOR ' S REMARKS: TOWN OF Q UEENS B�pU,� R Y 531 Say Rd.. Ckieermbury, NY 12804 APPLICATION FOR SOLID FUEL BURNING APPLIANCES AND CHIMNEYS Date � �? , 19 Permit No. �. .� APPLICATION IS HEREBY MADE to the Building Dept. for the issuance of a Building and Use Permit pursuant 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 enter premises to perform required inspections. Please fill out additional formif more than one a,p ,pllence and/car chimney. APPlican# ���_� e1 J,. rAPPLIANCE (check appropriate boxes) Addrew A o STOVE: ❑ Wood ❑ Coal © Pellet CI Fl EPLACE 1 NSERT 1 Zip �L�r ❑ FIREPLACE, FACTORY-BUILT: Phase 3 1 3 Fi REPLACE, MASONRY:od r3 Gas Woad ❑ Gas Owner . 5A")" E ❑ FURNACE: ❑ Wood ❑ Gas ❑ Oil Address IF NON-MASONRY: Manufacturer: Zip Model: Outlet: inches Phone Listed By: Number: Eteac# address of ropcsed construction CHIMNEY (check appropriate boxes) >Q MASONRY: A Black ABrick ❑ Stone C7 7 FLUE: PK Tile ❑ Steel Size: Inches CONSTRUCTION/INSTALLATION MUST ❑ FACTORY=BUILT: CONFORM TO NYS FIRE PREVENTION & Manufacturer: Model: BUILDING CODE. CONSULT TOWN OF Listed By: Number: QUEENSBURY HANDOUTS PROVIDED tO Double Wall ❑ Triple Wall REGARDING REQUIRED INSPECTIONS. ❑ Insulated Cashier's Department Town of Queensbtuy, New York. Dept: Fire Marshal Amount Collected Amount Received Code Number Title p A 173 3389 (190) Public Safety •- ��, A 233 2655 (230) Minor Sales Fee Collected Frei n or Refunded to: # r (-- A r .� V Q `7 � ,; � +� ,. --• Darted: n ITown Clerk or Deputy: , White. Ap,pficatst Greets: Fire Marshal YrUaw: Bldg. DepL Ptnk & Goldenrod: Cashier"s .De xL TOWN OF QUEENSBURY FIRE MARSHAL QUEENSBURY , NEW YORK 12804 TELEPHONE ( 518 ) 745- 4424 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED r - NAME LOCATION /G%' 1' G' '�''' DATE 711 PERMIT# APPROVED N/A YES NO EXITS AISLE WIDTHS EXIT SIGNS t EMERGENCY LIGHTING t" FIRE EXTINGUISHERS AUTO . EXTINGUISHING YS EM HOOD INSTALLATION AUTO , SPRINKLER SYST ALARM SYSTEM INTERIOR FINISHES STORAGE ; CLEARANCE TO SP NK ERS _ CLEARANCE TO HE TIN UNITS REQUIRED SIGNAGE f CHIMNEY W$ODSTOVE rIREPLACE-MASONRY FIREPLACE- FACTORY BUILT REMARKS : 0 THIS DATE joz 2/015 NSPE TOR TOMS OF QUEENSBURY j 531 BAY ROAD EENSBURY , (SIB)SIB) 745-44447 TELEPHONE BUILDING INSPECTOR' S REPORT FINAL INSPECTION " REQUEST FOR INSPECTION RECEIVED WANE LOCATION ! Gt DATE: � t� PERMIT# TYPE OF ST,4CT6# 7 - - RECHECK FIRE MARSHAL APPROVAL ( COMMERICIAL STRUCTURE ) FOOTING "�,�OUNDATION '`�,J'BACKFitL FRAMING OUGH PLUUMMBING FINA ELECTRIC SEPTIC NSULATION _WOW� STOVE/FIREPLAC '' ` REMARKS A ROV N/A YES CHIMNEY HEIGHT/LOCATI N B VENT/LOCATION PLUMBING VENT ROOFING SIDING DECK/P RCH/S E IRAI IN RELIEF VALVES ✓ FURNACE/HOT WASPTING INTERIOR TRIM/PRIVAC DOORS �-- FINISH FLOORS : BATH/KITCHEN WATE IGHT OTHER FLOORS SWE SLE OTHER FLOORS CA E END STAIR CLEARANCE/ IL G SMOKE DETECTORS DOOR CLOSERS BATHROOM FAN ALL PLUMBING URES ERA' IN GARAGE FIRE PR FING DOOR CLOSERS OTHER FIRE SE ION FIRE/DEMISE LLS FINAL ELECTRI AL OK TO ISSUE O U��L7C COMMENTS : // ARRIVE qWE DEPART . AVIC TO R �DLVIL- D� �c[een36tlrf�f BUILpiNG and ZONING DEPARTMEN4/ Say and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SE-P-�TII,C DISPOSAL SYSTEM INSPECTION NAIM l_OCAT I DATE PERMIT NO., SOIL TYPE Loam - Clay Percolation Test Required? YES - NO Percolation rate - Min/Inch _ TYPE of SYSTEM : Absorption field , total length Length of each trench /'r[a i Depth of trenches ' Size of gravel I 5;L- SEEPAGE PITS{N'uMnb0) ' Of ) Size- ft. X Gravel size PIPING : ize Type Bldgw to tank Tank to list. box 4f _ Disto box to field/ it Openings sealed.? E NO Partial LOCATxON/SEPARATI Sea Foundation to t ;Z f"te Foundation to a Orptionft . Absorption to 1 t line Separation of p is �ft. LOCATION OF Sy EM ON PROPER .circle one) Front r- Rear - Left side - Rlght side - C~CRM'ENTS a Apr 13 d 1 SYSTEM USE APPROVE4illng NO B Inspector 01/86 and vl TOWN OF QUEENSBURV 31 30 BUILDING AND CODES DEPARTMENT 531 BAY ROAD 15M QTELEPHONEs NEW a ( 5118 ) 745- 4447 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION CEIVED�� G3 ! AME ` lee CA r S LOCATION �; IL r DATE�ILLPI.PERMIT TYPE OF STRUCTURE ` - RECHECK APPROVED N/A I YES NO FOOTINGS/PT RS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTWt IS RESPONSIB FOR PROVIDING PROTECTION F FREEZING FOR +48 HOURS FOLL INS THE PLACEPIENT OF THE CONC E . MATERIALS FOR THIS PURPOS ON Si E FOUNDATION/WALL POUR REINFORCEMENT IN PLAC FOUNDATION/DAMPROOFING BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/V N S IN PLA PLUMBING UNDER SLAB FRAMING : S EADE 111 JACK � BRACING/BRIDGING 1 JOIST HANGERS JACK POSTS/MAT B M HEATING ROUGH- IN INSULATION : FOUNDATION W L N ER R - FOUNDATION WA S EXTERIOR R- FLOORS R- WALLS R- CEILIN R- DUCT WORK R PI IN IN UNHEATE SPACES ARRIVE. __— DEPART 7NSPFCTCIR TOWN OF +QUEENSBURY FIRE MARSHAL Q � NEW 0 TELEPHONE ( 518) 792- 5832 FIRE MARSHAL IRSPECTION REPORT REQUEST FOR INSPECTION RECEIVED ' NAME /'+/�, S„+/tl LOCATION DATE 9 ' PERMIT# ' __,✓� APPROVED N/A YES NO EXITS AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTING---- FIRE EXTINGUISHERS AUTO . EXTINGUISHING SYSTEM. _ HOOD INSTALLATION f AUTO . SPRINKLER YSTEM� ALARM SYSTEM INTERIOR FINISHEXHEANLG _ STORAGE : CLEARANCE TO S CLEARANCE TO kITS REQUIRED SIGNAGE CHIMNEY ODSTOVE IREPLACE-MA NRY FIREPLACE- FAN OR UIL REMARKS : � Ole 1 ARRIV r DEPART INSP'ECTOR TOWN OF QUEEKSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY , NEW YORK 12804 TELEPHONE ( 518) 745- 4447 BUILDING INSPECTOR ' S REPORT p REQUEST FOR INSPECTION RECEIVED - [ NAME i61 LOCATION DATEPERMIT # frf "t TYPE OF STRUC RE - CHECK� - APPROVED N/A - l .-YESj NO FOOTINGS/BIERS 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 PURPO E ON SITE - '• FOUNDATION/WALL POUR REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING BACKFILL APPROV �xROUGH PLUMBING PLUMBING VENT/VENTS IN PLA PLUMBING DER SLAB .)( FRAMING : JACK ST DS/HERDERS BRACING/BRIDGING JOIST HANGERS JACK POSTS/MAIN B AM HEATING ROUGH- IN tfLATION : FOUNDATION WAL IN OR - FOUNDATION WA S EXTERIOR R- FLOORS R- WALLS R- CEILING R- DUCT WORK OR PIPING IN UNHEATED SPACES REMARKS : Poo c ARRIVE DEPART %:1 - . lG ' I SP CT R TOWN OF QUEEKSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY , NEW YORK 12804 TELEPHONE (518 ) 745- 4447 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAM �v LOCATION A_l, DATE PERMIT it TYPE OF STRUCTURE — 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 LACE FOUNDATION/DAMPR FIND BACKFILL APPROVAL FiDUGH PLUMBING PLUMBING VENTfVE S IN LACE PLUMBING U ER SL B >(FRAMING : A '% # JACK STUDS/HEAD BRACING/BRIDGIN JOIST HANGERS JACK POSTS/MAI EAM HEATING ROUGH— I INSULATION : FOUNDATION LLS IN ERI R R— FOUNDATIO WALLS EXTERIOR R— FLOORS R— WALLS R— CEILING R— DUCT WORK OR PIPING IN UNHEATED SPACES REMARKS % us-r �Sr*.,V�. iL�'1-fix 5 t"�T� [" 94 t!CP'J'C} !� L�'�� � �r�{� '�I-�,r �� - {,x hi2.I5►-+Gr is � E] C.! l�- '� A iL 1`hr r � f t vJk 13 i L rGr CrJ A.;r2a' f—rQ L W l ARRIVEE��, DEPART I SPE OR , TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 SAY ROAD QUEENSBURY , NEW YORK 12804 TELEPHONE (518) 745-4447 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED 0- ) NAME ) - i LOCATION IC,ON cl n -y h DATE L ! PERMITt^# TYPE O STR TUBE �c RECHECK APPROVED N/A YESJ NO *FOOTI NGS/,RP.IEro MONOLITHIC-POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTECTION FROM FREEZING, FOR 48 HOURS FOLLOWINYSE THE PLACEMENT OF THE CONCRETE . MATERIALS FOR THIS PURPOSE ON FOUNDATION/WALL POUR REINFORCEMENT IN PLACE, FOUNDATION/DAMPROOFING BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/VENTS IN , �CACE PLUMBING UNDER SLAB /' FRAMING : JACK STUDS/HEADERS BRACING/BRIDGING JOIST HANGERS _ JACK POSTS/MAIN S AM HEATING ROUGH- IN INSULATION : FOUNDATION WALLS INTERIOR R- FOUNDATION MALLS EXTERIOR R- FLOORS R- WALLS R- CEILING R- DUCT WORK OR PIPING IN UNHEATED SPACES REMARKS ; C3 1'i 1 C3 F?4 t f al`.'� `{ (i-' {3R�#r7�ER`si:4� ARRIVE DEPART -�^ I 5PE TOR r� TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAM QUEENSBURY , NEW YORK 12804 TELEPHONE ( 518 ) 745- 4447 BUILDING INSPECTOR' S REPORT REQUEST FOR IN S P ECTIONRECEIVED NAME LOCATION Z/ r f f w . DATE � PERMIT # TYPE OF STRUCTURE g J RECHECK APPROVED N/A YES NO OTINGS PIERS MONOITTRIC 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/VENTS IN P CE PLUMBING UNDER SLAB FRAMING : JACK S UD /HEAD S BRACING/BRIDGING_ JOIST HANGERS JACK POSTS/MAIN RE HEATING ROUGH— IN INSULATION : FOUNDATION WALLS NTERIOR R— FOUNDATION WALLS EXTERIOR R— FLOORS R— WALLS R— CEILING R— DUCT WORK OR PIPING IN UNHEATED SPACES REMARKS : ti 1 c ' c t7 ] TL,) S11A.J6 I� eFti'x 43 '+ t c / i ARRIVE / DEPART - I tiC ENS ECTO TOWN OF QUEEN56URY � f BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY , NEW YORK I2804 TELEPHONE ( 518 ) 745- 4447 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECU V EO NAME / LOCATION DATE PERMIT 0 qcA TYPE OF STRUCTURE RECHECK APPROVED N/A IYES NO OOTINGS/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 r ROUGH PLUMBING PLUMBING VENT/VENTS IflptACE PLUMBING UNDER SLAB FRAMING : JACK STUDS/HEADER BRACING/BRIDGING JOIST HANGERS JACK POSTS/MWI BE M HEATING ROUGH- I INSULATION FOUNDATION LLS i ERIOR R- FOUNDATION ALLS EX ERIOR R- FLOORS R- WALLS R- CEILING R- DUCT WO OR PI iNG IN UNHEATED SPACES REMARKSS* ARRIVE '. ! DEPARTT� I SP TAR . .. ...... .... TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY , NEW YORK 12804 TELEPHONE ( 5I8 ) 745- 4447 BUILDING INSPECTOR'S REPORT REQUEST FO INSPECTION RECEIVED NAME f rll�) LOCATION pqpqpq r[ % ✓Y// 7 13 ' i LL_ �d DATE C �- PERMIT # - i ! TYPE OF STRUCTURE ' , RECHECK APPROVED IFOOTINGS/PIERS, -- N/A Y S N0 MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPON IBLE FOR PROVIDING P�OTECTI FROM FREEZING FOR 48 0 OLLOWING THE PLACEMENT 0 TH CONCRETE_ MATERIALS FOR TH S URPOSE ON SITE FOUNDATION/WALL UR REINFORCEMENT IN LACE FOUNDATION/DAMP NG BACKFILL APPR AL ROUGH PLUMB PLUMBING V T/V NTS I PLACE PLUMBING NDER SLAB FRAMING JACK [IDS/HEADER BRA NG/BRIDGING JOIST HANGERS JACK POSTS/MAIN BE HEATING ROUGH— IN INSULATION : FOUNDATION WAL S IN ERIOR R— FOUNDATION WALLS EXTERIOR R— FLOORS R_ WALLS R- CEILING R— DUCT WORK OR PIPING IN UNHEATED SPACES REMARKS : ARRIVE i — DEPART' 3 _ ,2 � INS EC R !' MIDDLE DEPARTMENT INSPECTION AGENCY, IIILC. r National Headquarters 1337 West Chester P 9, West Ch sayer, PA ,1 paw-a422, . ♦ Ir. bate: " iity, Town or Township ,r� �/0!:$ Coto il�i� �r,"t State Location/Addr+ess +�-� f'a1 llf Lo ated i rat Area - Please h Directions)Owner Pole # Occupied As .A. s Permit # Occupant Building: NewQ OWE] for: Wirin Service Work 're in Buildin Floor # etc.) : or:Fee Remitted - Rea Check for Inspection: $ Cash �] M:i�, Number of Rough Wiring Outiets Elect. Heat aoa Tao a0oo azao 16¢e 17$q gOao Y260 Eaoo s�so uao Make Payable To: .l1ll.D, I.A. Switches Lighting Amp. Service —� —_Surface Unit Dishwasher Receptacles Water t leater Range Air Conditioner Dryer Puq►p Number of Fixtures- ' Oven Garbage- Disposal Wiring and Controls for Amp. Receptacles .. Burner P Fractional H.P. Went Fans Other Equipment: MQTOFiSH:P. . 1j2 t/1 2/10 216- ,1/a 1/4 1/3 Mark Number 20 1S 20 25 30 40 50 75 100 of Each Size r.. . APpiicant.s k - Signature. T/A License # Permit # ApplieaAt s°' lhility:"' NAM (City) S F EL _ Ph e' # , p1 - Service Request # ... Eiectriciart' 0ATe;FSECrIVED: ' x Correct Location : Same as' A13ebw"' DATE INSPECTED: or: Red Notice Label Rough Wiring outlets Surface Unit Switches r Ran 'fin_ Rece acies Gar#lage Disposal Fixtures Water Heater Dishwasher Air Conditioner Amp, Service Equipment Burner, Wiri Dryer Am : Servitae Conduetors : ' i:Ca>IMMIX,1tbt " AmPL; :Reoeptacie- ' Pump °N3snt'Faris , Mark Nu H,F, 1/20 ,1{i2. 2A0' 1/8 1/6 1/4 1/3 2/2 3/4 25 30 40 50 75 290 ' Mark NumtiEr Of Each Size EI t. lie soo :ao a000 asso asoo a7go soon Yzao zao0 z�so a000 0 RW Progress: Inc. El LKD 0 Contractor CFT Violation : Work Camp. Q Inc, C] L/A 0.. L/A Owner CAST-{Fee : :. . M =, Due CHK # Municipal I ��--�yy - IV r;}tller.Bidai s-# iJdY[iai+ ApPNcant '. Owner Cut in Card [� 7emp �k T,. '; 1 f [] Final Date Ilga^PECTf3R8 �1[3IYE�7 UfiB A�Pf3LII;A°rlCial' r-C►Fili�'rbi5. �5o EL i#i$'4 ' `' r .i ^:" -. ' . .. ., - _ - .- ._.-. o Ooo.7 9 a � � f (� ovj ' 10 /v" i p - s