1991-806 N.4
- ' -
CERTIFICATE OF OCCUPANCY •
TOWN OF QUEENSBURY
•WARREN COUNTY, NEW YORK
Date dptiji 27 19 22,
This is to certify that work requested to be done as shown by Permit No. 91-806
has been completed.
- This structure may be occupied as a Single Family Dwelling
j,ratioiLt ; HeresiFord Lane
Owner David A. Bowen
By Order Town Board
TOWN OF QUEENSBURY
Vc4.1,:c7
Director of Bldg. & Code Enforcement
BUILDING PERMIT
Iz
TOWN OF QUEENSBURY
No. 91-806
WARREN COUNTY, NEW YORK
0
PERMISSION is hereby granted to David A. Bowen
OWNER of property located at Lot #3 Neresford Lane Street, Road or Ave.
w
in the Town of Queensbury,To Construct or place a Single Family Dwelling'
at the above location in accordance to application together with plot plans and other information hereto filed and p
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
l7
PO Box 4781
Queensbury, NY 12804
2. CONTRACTOR or BUILDER'S Name
Same
3. CONTRACTOR or BUILDER'S Address r
tW
4. ARCHITECT'S Name CD
fD
V1
-h
0
5. ARCHITECT'S Address
r
rD
6. TYPE of Construction-(Please indicate by X) N
( X Wood Frame ( I Masonry ( )Steel ( ) t0�
CD
7. PLANS and Specifications
No. 1,248 sq ft Single Family Dwelling as per plot plan specifications
and application v
V
8. Proposed Use -, fD
Single Family Dwelling with attached 2-Car Garage el'
$ 204.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 15, 19 92
(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 this 1 t Da of f November 19 91
SIGNED BY GIZP for the Town of Queensbury
Building and ZoninWispector
TOWN OF QUEENSBURY
REVIEWED BY: d .
i4ili
� FEE PAID: 0 9604,.451 0.0_ : o 0,0
- TO A'I 9} ' .-.7h "'1'.:.a`;.::4.•:.;.,.
PERMIT NO. : / 1,,.', ;,,,,_-- r
BUILDING PERMIT APPLICATION_n1 13 1
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTIOWYMSfERNAPITI 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: cNVib A ) J \1
(�
P.O. Address: Q"..Q01 ( v€(4\1Se\) IV Z13 f PHONE �J (j1
Property Location: Nk-itiNkA) t_ Tax Map No. /i9/ / 27
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: �..9--)00D Ra;k Lot No.
THE PERSON RESPONSIBLE FOR SUPERVISION OF A s WORK AS REGARDS TO BUILDING CODES- IS:
Z c \i\Q J�.!
NATURE OF PROPOSED WORK: • * ESTIMATED MARKET VALUE OF THE
Construction of new building * CONSTRUCTION: $ 90 d 0
Addition to building *
Alteration to building * COMPLETE INFORMATION REQUIRED BELOW:
(no change to exterior dimensions) * Size of Property: aliS ft. x CHI/ ft.
Other work (describe) * Existing Building Size:
• • * ft. x ft.
* Proposed building - distance from
GROSS AREA OF PROPOSED STRUCTURE: * property line:
*
1st Floor 1 2, a Sq. Ft. * Front Yard So ft. Rear yard 1_1 ft.
* Side Yards at ft. and 'L6 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: (t j Sq. Ft. * Primary Building -.
® * ) One Family Dwelling -
Size of New Structure: 2) ft. x 0 ft. * Two Family Dwelling
Foundation: * Multiple Dwelling/No, of Units
Pier/Slab/Crawl Partial ull (Circle One) * Business
* Industrial
No. of stories (Habitable space) 1 * Other
Height (grade to ridge) 29 ft. *
If residential , no. of families: ( * If addition, what will, use be?
No. of rooms (excluding kaths): �j *
No. of bedrooms:, * —
No. of bathrooms: . * Accessory Building:
Primary heating system: - pe \C W\) * Detached Garage - One/Tw Ca..�
Type of fuel: S * 7c Attached Garage One/ wo Cater
No. of fireplaces to be installed: ' * Private Storage Building.
Will a woodstove be installed?: ^(7 _ * Other
Central Air Conditioning: Yes ' No )C *
(OVER)
BUILDING PERMIT APPLICATION CONTINUED:
BUILDING SPECIFICATIONS:
Type of construction:- wood frame, fire safe, etc. 13-0�D n4K
Will any second-hand or ungraded lumber be used? If so, for what? 'Op
Foundation Wall Material : NLI `�
�1�� ��i�.�(�Thi ckness: e,
Depth of Foundation below, grade (to bottom of footing) : 14'
Will there be a cellar? Heated or Unheated? \ \ „ Floor- Sq. Footage: Ma
Will there be a basement? �—c Will 'any portion be used as living space?
If `so, what portion? — Sq. Ft. Type of Use?
Type of Roof: Sloped/Flat/Shed/Other S'- e n Material of Roof 94j j. .
Size, wood studs 2. " x o "; spacing N " o.c.,; length ; ft.
Joists (floor beams) : 1st Floor " x Ib' spacing tk " o.c. ; span ft.
Jois'ts '(floor'beams) : 2nd Floor `— "' x spacing " o.c. ; span -- ft.
Overlays (ceiling beams) : ' " x -- " ; spacing — " o.c. ; span ft.
Roof rafters: x " ; spacing - o.c. ; span _ ft.
Roof trusses (pre-engineered) : spacing L--`1 " o.c. ; span SliD ft. +�
Exterior Wall Finish: k. I J�
" of what material ? Digeq I Al\)yLI4)11\)(3-
Interior Wall Finish: 1!2-" � WS -g) -14 (tAriS gAik.C .\.0
If a garage is to pe attached, describe materials to be used for FIRE SEPARATION:
d'(%" 1 % NJ\ &Li'?S\)3A qOAQ-IJ
Is there to be an opening between garage and dwelling? If so, will a Fire-Rated door,
enclosure, self-closing device be provided? *:$S2
Will a flue-lined chimney be installed? JcS Height above roof `��-Z. ft.
Depth of chimney foundation below grade: — ft. c�
Depth of fireplace hearth: ft. in. �,�C4 1\x 1.9�� (,
Water supply - Municipal or private well : MU* CJ-Q,OL
SEPTIC SYSTEM: Distance from any private well (including adjoining properties: €J, tl_ft.
(A separate application is necessary for any repair or new installation of septic system. )
NAME OF BUILDER & ADDRESS: %1 ‘% A 190 �� � , PHONE
NAME OF PLUMBER & ADDRESS: C.c ��i- \j, PHONE t
NAME OF MASON & ADDRESS: - 14a) oS iiy. PHONE _- 6 �'
NAME OF ELECTRICIAN & ADDRESS: 1.ta1 Lj Su HONE - (�(�
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
311 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 au ' oriz d b th owner.
Signature \\
• Owner, ow,ierrs a nt, architect
contractor
iPECIAL CONDITIONS OF THE PERMIT:
By:
Code Enforcement Officer
`� j TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid
Date: N'6v\ ` �"�� Reviewed
LOCATION OF PROPERTY FOR INSTALLATION: 0 (3 ‘ ttk-W-A-0 LAWE-
Owner's Name: 4\f\'% I eYlo
Owner's Mailing Address: 9og0)0A1-b1
�Q
Installer' s Name: U \)�- �, ( � - Phone #: ' 00.9,
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom) : -tco
Topography-Circle One: Flat Rollin Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? 9 1 C-lJilZ Feet
Bedrock or Impervious Material-At What Depth? k\YG1 {--6 Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: unicipal Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption 1100 k feet
PROPOSED SYSTEM: Septic Tank )40 0 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench SO feet//Total System Length Zo 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 —" Size of Each Gal .
Alarm system and associated electrical work to be inspected by 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 own of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
V��� DATE: 1 ( Novi [c1cf
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:
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
INA A\ 9P2L%.") uf‘, / , \AE-ac , .te, k u*X-
APPLICANT'S NAME PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - rli-A% Sq. Ft.
2. Type of Heat - Elec. Base Board Other Cc k4o` 'Ala-
3. Is Building Mechanically Cooled? YES NO
4. Percentage of Area of Windows and Doors Over 17% )C Under 17%
THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND TO REQUIRED
THE R-VALUES SHOWN ON PLANS SUBMITTED!
Baseboard
5. Insulation Values: Actual Shown Elec. Heat Other
A. Roof & Floors exposed to ambient temperatures R .fig
B. Exterior Walls R II
C. Glazed Area R ii.
D. Exterior Doors R NI
E. Floors over unheated spaces R 11
F. Edge of Slab on Grade (Heated Building) R
G. Basement/Cellar Walls (Above Grade) R
H. Basement/Cellar Walls (Below Grade) R "-
I. Heating/Cooling - Ducts - Piping in Unheated Space R
•
6. Service (Domestic) Hot Water Heating Device -
A. Conforms to minimum efficiency per code X YES NO
EMPERATURE CONTROL MAXIMUM SETTING 140° - WILL NOT BE EXCEEDED
11 VA\ TN1 61
APPLICANT S SIGNATURE DATE TELEPHONL (UMBER
INSPECTOR'S REMARKS:
REVIEWED BY
TOWN OF Q UEENSBURY
Bay at Haviland Roads,Ouoensbury,N.Y.12801-9725
APPLICATION FOR SOLID-FUEL BURNING APPLIANCES AND FIREPLACES
Due ,`; >` ' 19 ', Permit No.' d`
APPLICATION IS HEREBY MADE to the Building Department 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 for the required inspections.
APPLIANCE TYPE
Applicant's Name ;� - `t,�`„
Stove Coal Wood
Address Furnace Hot Air Boiler
Zero Clearance Circulating Unit
Zip
Phone '? If Non-Masonry:
Owner's Name ': f
Manufacturer
Address Model Outlet Size
Zip Listed by Number
Phone
CHIMNEY TYPE
Masonry: Block Brick Stone
Property location of proposed construction Flue: Tile Steel
Size:
Factory Built:
Manufacturer Model Sim •
COPY OF MANUFACTURER SPECIFICATIONS IS Height 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'S DEPARTMENT
TOWN OF QUEENSBURY, NEW YORK
Department: Fire Marshal Amount Collected Amount Refunded
Code Number Title •
A173 3389 (190)Public Safety
A233 2655 (230)Minor Sales
Fee Collected from or Refunded to:
Address:
Dated: Town Clerk or Deputy
. ''` MIDDLE DEPARTMENT INSPECTION AGENCY, INC. .
�.. ' National Headquarters ••
1337 West Chester Pike,West Chester, PA 19380
APPLICANT COMPLETES THIS SECTION pp Date: �, I i��{i
L _(UJ State t
City, Town or Township ''� ` ( \\nn�� County �� }r•
Nj
Location/Address lC\ `` ,) \, ' l1 � t&c 6V ,
Lo ate in"Rural Area-Please Attach Directions) ''Pole #
Owner Permit # ' • 9_1- 8 0
Occupied As Building: New I Old❑
Occupant
Work Area in Building (Floor #,etc.):
App. for: Wiring❑ Service❑ or: Ready for Inspection:
Fee Remitted-$ Cash n Check n M.O. n Make Payable To: M.D.I.A.
500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Number of Rough Wiring Outlets Elect. Heat
Switches
Lighting Amp. Service Surface Unit Dishwasher - Range
Receptacles Water Heater Air Conditioner Dryer Pump
Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner
Amp. Receptacles Fractional H.P. Vent Fans
Other Equipment:
MOTORS H.P. 1/201/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1'/2 2 3 5 71/2 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size .
Applicant's
,, C-..9
Signature y }�-- License # Permit #
T/A Utility:
Applicant's Address: DSO\ I'''VI C . (NAME) (OFFICE LOCATION)
(City) (1 C�f'SN(' a (Slate) (Zip) I2b0 -' Service Request #
Phone # i % -91 Electrician:
MDIA USE ONLY DATE RECEIVED: DATE INSPECTED:
Correct Location: Same as Above n or: •
Red Notice Label n
Rough Wiring Outlets Surface Unit Oven
Switches Range Garbage Disposal
Receptacles Water Heater Dishwasher
Fixtures Air Conditioner Dryer
Amp. Service Equipment Burner,Wiring &Controls for Amp. Receptacle
Amp. Service Conductors Pump Vent Fans
MOTORS H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1'/2 2 3 5 7'/2 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size .
500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Elect. Heat
CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECT
FEE PAID
❑ RW Progress: Inc.❑ LKD n Contractor
❑ CFT Violation: Work Comp.❑ - Inc. ❑
n L/A _Owner _ CASH ❑
❑ L/A Fee CH K #
Due MO #
IPA Municipal
INV #
Applicant ❑
Date: Other Side❑ • Utility ❑
Owner
Cut in Card n Temp # Date
7 Final # Date INSPECTORS SIGNATURE
1.
r: TOWN OF QUEENSBURYY
�, 531 Bay Road, Queensbury, NY 12804-9725-518-745-4400
1
May 6, 1992
TO WHOM IT MAY CONCERN:
RE: Building Permit # 91-806
issued to David A. Bowen
for Lot # 3, Heresford Lane
Tax Map # 119-6-3
PLEASE BE ADVISED THAT THE SEPTIC SYSTEM INSTALLED AT THE LOCATION STATED ABOVE
AND FOR THE SINGLE FAMILY DWELLING BUILT THEREON, WAS APPROVED BY THIS DEPARTMENT
FOR USE ON JANUARY 8, 1992 AND THAT THE CERTIFICATE OF OCCUPANCY ISSUED BY
THIS DEPARTMENT ON APRIL 27, 1992 WAS ISSUED WITH ALL REQUIRED INSPECTIONS
COMPLETED AND APPROVED.
DAVID HATIN, DIREC OR
DH:lm BUILDING AND CODE ENFORCEMENT
"HOME OF NATURAL BEAUTY. . . A GOOD PLACE TO LIVE"
SETTLED 1763
;erg;
OWN OF QUEENSBURY
��A►'f, 531 BAY ROAD
'`���''�,j `'QUEENSBURY, NEW YORK 12804
� � TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED
NAME D ALJ[b & r
LOCATION Ler 3 I - i' 6 4 Af)
DATE Lf/2'7/?Z_ PERMIT# q f— �d
TYPE OF STRUCTURE
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING FINAL ELECTRICAL SEPTIC
INSULATION WOODSTOVE/FIREPLACE
REMARKS
ff
/
APPROVAL
N/A YES NO
CHIMNEY HEIGHT/LOCATION(
B VENT/LOCATION /
PLUMBING VENT ;`
ROOFING src
SIDING / PC
DECK/PORCH/STEPS/RAILINGS / �C
-`- -RELIEF"VALVES 9 / -
FURNACE/HOT WATER OPERAT;IN'G
BASEMENT INSULATION/DUCTi4ORK
INTERIOR TRIM/PRIVACYYOORS
FINISH FLOORS:BATH/KITCHEN WATER,TIGHTV X
OTHER FLOORS SWEEPABLE \ }c,
OTHER FLOORS CAOETED 1.
STAIR CLEARANCE/FAILINGS \
HANDICAPPED ACCESS V
SMOKE DETECTORS I 1 X
BATHROOM FANS/WHOLEHOUSE FANS\
ALL PLUMBING FIXTURES OPERATING }�
GARAGE FIRE PROOFING k
DOOR CLOSERS
OTHER FIRE SEPARATION
FIRE/DEMISE WALLS
DUMPSTER
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL x'
OK TO ISSUE C/0 OR C/C
COMMENTS:
ARRIVE 2 6 7
DEPART ;()
INS
oo(›C VIN Sri fT
TOWN OF UEENSBURY
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE- _(518) 745-4424
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED t---1-/ a.-l-/cj'.
NAME iKDe.A,N
LOCATION 'I 3 PeireS-c -c1 Levu---(
DATE:/pea_ PERMIT# l / -8O C7
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
AUTO. EXTINGUISHING SYSTEM
HOOD INSTALLATION ';, /
AUTO. SPRINKLER SYSTEM
ALARM SYSTEM ;;
r• .
N
INTERIOR FINISHES �
STORAGE: I
CLEARANCE TO/ SPRINKLERS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE 4
CHIMNEY �t
WOODSTOVE
FIREPLACE-MASONRY \
t/FIREPLACE-FACTORY BUILT ✓r,
REMARKS: U OK TO THIS DATE
MA
2/015 INSPECTOR
of‘14, 84 TowN OF QUEENSBURY
�, 531 BAY ROAD
;;lit''nt QUEENSBURY, NEW YORK 12804
'`N :° TELEPHONE (518) 745-4447
;,
:-7;.', ....�" BUILDING INSPECTOR'S REPORT
FINAL INSPECTION REQUEST FOR INSPECTION RECEIVED LiJ "r�
/ v1-4 C
NAME . i NT1 '- a
LOCATION _ a/1' .(
DATE ).PERMITS (A ( --g CX
TYPE OF TRUCTURE CE) C S) --
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION _YBACKFILL YgRAMING
TIROUGH PLUMBING "FINAL ELECTRICAL SEPTIC
NSULATION _WOODSTOVE/FIREPLACE
REMARKS
APPROVAL
N/A YES NO
CHIMNEY HEIGHT/LOCATION J
B VENT/LOCATION / ;
PLUMBING VENT ( !
ROOFING 1 /'
SIDING \ /
DECK/PORCH/STEPS/RAILINGS / I/
RELIEF VALVES • \
FURNACE/HOT WATER OPERATING / „fi
BASEMENT INSULATION/DUCTWW ✓,
INTERIOR TRIM/PRIVACY DOORS', V
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT/ \ L/7
OTHER FLOORS SWEEPABLE/ \ ,J'
OTHER FLOORS CARPETED/ ‘ /
STAIR CLEARANCE/RAILINGS \ I
HANDICAPPED ACCESS / \ -' I
SMOKE DETECTORS /
BATHROOM FANS/WHOLEHOUSE FANS \
ALL PLUMBING FIXTURES OPERATING \
GARAGE FIRE PROOFING `
DOOR CLOSERS / ,)/
OTHER FIRE SEPARATION tf; \
FIRE/DEMISE WALLS/ Z/,_ \
DUMPSTER / V r
SITE PLAN/VARIANCE REQUIREMENTS ''�
FINAL ELECTRICAL /
OK TO ISSUE C/O OR C/C
COMMENTS:
ARRIVE
DEPART
IN P T
ELECTRICAL INSPECTIONS
/� p DUPLICATE MUNICIPAL RECORD
Permit No. 9—O_:
•
Owner (TV:t�
Occupant
Loca:ion LO 3 K /2L-s Fo�z4�
a l ` /2_) Street
Town or City ( State
Install tion as itemized on reverse side has been visually inspected pursuant to applicable .
codes. •
Installed by ___(s-t L C
GZL�
Date s� — Z� sector
MIDDLE DEPARTMENT INSPECTION AGENCY,INC.
FORM NO.18 EL. 1337 West Chester Pike,West Chester,PA 19380
ROUGH WIRING OUTLETS H.P.AIR CONDITIONER
7r(,��.D}JSJ.�S ,/ ( (,L WIRING &CONTROLS FOR 6 BURNER
33 RECEPTACLES H.P.PPttMP
FIXTURES K.W.OVEN
AMP.SERVICE EQUIPMENT H.P.GARBAGE DISPOSAL UNIT
7/I)AMP.SERVICE CONDUCTORS K.W. DISHWASHER
(((/ K.W.SURFACE UNIT / K.W. DRYER
K.W. RANGE AMP. RECEPTACLE
K.W.WATER HEATER S FRAC. H.P.VENT FANS
Ss---;44a-/CGS
OTORS M.P. I/20 1/12 1/10 Vi % % 1 1' 2 3 5 71% 10 15 20 25 30 40 50 75 10
ARK NUMBER
EACH SIZE
,PPARATUS
PILUAr
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT IF8)
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4.447
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
�
NAME
LOCATION oL-
DATE PERMIT , I-go(p
TYPE 0 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 i
REINFORCEMENT IN PLACE I
FOUNDATION/DAMPROOFING 1
BACKFILL APPROVAL 10
ROUGH-PLUMBING / I/
PLUMBING VENT/VENTS{ INPLACE
PLUMBING UNDER SLAB
FRAMING: k 1
JACK STUDS/HEADERSAI
BRACING/BRIDGING ?k,
JOIST HANGERS ;?
JACK POSTS/MAIN BEAMY.
HEATING ROUGH-IN 4/
NS� UNION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS a. r•.R-
WALLS ;i R- j /
CEILING t' R-
DUCT
DUCT WORK ORJPIPING IN UNHEALED
SPACES
REMARKS:
Jd5
ARRIVE / J
DEPART/
INSPECT
�20 c_.,, eQYG
TOWN OF QUEENSBURY
FIRE MARSHAL
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
FIRE MARSHAL INSPECTION REPORT
REQUEST FOR INSPECTION RECEIVED 1 py yo_
px),..._ ,NAMEt \-----. .;
LOCATION 1 -3 e4r7Y "-e----
DATE ) 1612.__ PERMIT# 91 .g)2
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
AUTO. EXTINGUISHING SYSTEM
HOOD INSTALLATIO
AUTO. SPRINKLER S TEM
ALARM SYSTEM
INTERIOR FINISHES
STORAGE:
CLEARANCE TO S'''I KLERS
CLEARANCE TO " AT NG UNITS
REQUIRED SIGN C
47
CHIMNEY' '
WOODSTOVE
FIREPLACE-MASONRY
\ cIREPLACE-FACTORY BUILT
REMARKS: , L OK TO THIS DATE
/77-"--/-a/r1g4/2 /1//262/5-16/
ARRIVE /L--
DEPART /2- 4
INSPECTOR
•
Jotun of • Queen.ibury 711
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98,
Queensbury, New York 12801
•
SEPTIC DISPOSAL SYSTEM INSPECTION
NAMETDOL.Z..)-ek\ S U I CJ
LOCATIONJ-64- )--kiyesleye)
DATE /I /a PERMIT NO.. 9/--A210(0
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required?' YES - NO
Percolation rat: - Min/Inch
TYPE of SYSTEM:
Absorption field, total le g h V
Length of each trenh ' 5U 1
Depth of trenches -5 1/i
Size of gravel_
SEEPAGE PITS{Number .f) '
Size- ' ft. X y/
Gravel size
PIPING: Size Type
Bldg. 'to tank <1 `in- pd'C,
Tank to dist. box / 01/(,
Dist. box to fie s/pit `' Pie/ ,
Openings sealed?/, YES NO Partial
LOCATION/SEPA:I' 'IONS:
Foundation t. tank / 2-ft.
Foundation ro absorption ft. •
Absorption o /lot line —i ft.
•
Separatio oft pits . • (; ft. .
LOCATION/4F SYSTEM ON PROP RTY(circle one)
Front - /cea' - Left side -. Right side - -
COMMENT :
•
•
•
•
•
•
•
•
SYSTEM USE APPROVED NO
•
Bui ing ,In pector
01/86'md vl •
C\VOAA/41 (
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT -
REQUEST FOR INSPECTION CEIVED I a 9
NAME
LOCATION ff(% e lG� PEWIT -(Al et+ --
Q
DATE Op 1 ( #
CC �
TYPE OF STRUCTURE
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS '^INSIBLE
FOR PROVIDING PROTECT,ON FROM -
FREEZING FOR 48 HOURS OLLOWIN.
THE PLACEMENT OF THE CINCRETE
MATERIALS FOR THIS PUR'OSE 0' SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS ;N "LACE
PLUMBING UNDER SLA:
FRAMING:' ���
JACK STUDS/H ' iERS
BRACING/BRID NG
JOIST HANG •`S
JACK POST:/MAIN BEAM.
FIRESTOPP G
WALLS
CEI NG
FI' ALLS
ISTING ROUGH-IN
NSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS: �I N
4/oc4hy ".��ee/ eck-r,--q
� l
ARRIVE DEPART Atilt(
�
7SP CTOR
TOWN OF QUEEMSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY,
NEW 0 4
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT /
REQUEST FOR INSPECTIOO RECEIVED 1 c/ -)/
NAME 7-2:rk\ C eA, \
LOCATION .2 (�Y 3 I- -r�,c�- trr)
DATE o el / PERMIT I 9 G
TYPE OF STRUCTURE 6 C. N
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM P
REINFORCEMENT IN PLACE I
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING P OTECTIONJFROM
FREEZING FOR 48� OURS FOLLOWING
THE PLACEMENT OF\THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL PO13 I
REINFORCEMENT IN PLACE 1
OUNDATLON/DAMP-ROOFING I k
BACKFILL APPROVAL - \ /4:
ROUGH PLUMBING \
PLUMBING VENT/VENTS I F1ACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING -
JOIST HANGERS
JACK POSTS/MAIN BEAM
FIRESTOPPING \
WALLS
CEILING
FIREWALLS
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
RVO
KS:
.i^ L
Ce LyJ /1;0PDA-rat.) 0-J4-LCc;
A5-prii)c-c-DA 'mp_Pa-6 c;«rc ,
ARRIVE /0,'2()
(kb- C1-)-
DE PART (6 .' 6 f
I NS PEC TOR
TOM OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY,
NEW 0 4
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED / 7�91/fja/
NAME 4)g41(d l/
LOCATION � j .,_3 RS/_ 4 (L 4--
DATE///447/q/ PEWIT I 9/-f1�.,4
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 PLACE
(FOUNDATION/DAMPROOFING
�(BACKFILL APPROVAL 1
ROUGH PLUMBING ;,
PLUMBING VENT/VENTS SIN PLACE.
PLUMBING UNDER SLAB \
FRAMING: l',
JACK STUDS/HEADERS `, ,,
BRACING/BRIDGING \ f
JOIST HANGERS
JACK POSTS/MAIN BEAM y
FIRESTOPPING
WALLS ye\
CEILING /
FIREWALLS / 0
HEATING ROUGH-IN 1 �.
INSULATION:
FOUNDATION WALLS NTERIOR R- \
FOUNDATION WALLS 'EXTERIOR R- \
FLOORS R- ti,
WALLS R-
CEILING R-
DUCT WORK OR RIPING IN UNHEATED '
SPACES I
REMARKS: L1, ,���f�
l'L P
6-r..re_ Oil,
ARRIVE f �� Wit,
DEPART 17-% 0
INS EC R
TOWN OF QUEENSBURY J Ui�t-
BUILDING AND CODES DEPARTMENT ` i`) L1
531 BAY ROAD
QUEENSBURY,
NEW 0 4
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME 10(4,(/Y 11849-L!
4!
LOCATION f-,57 XV-eUdie-bd
DATE /// ,19/ PERMIT # //—a U,6
TYPE OF STRUCTURE s3---;47-z)
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
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN .PLACE
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING 4
JOIST HANGERS b '
JACK POSTS/MAIN BEAM,
FIRESTOPPING
WALLS
CEILING \ /
FIREWALLS
HEATING ROUGH-IN
INSULATION:
FOUNDATION WALLS INTERIO,R R-
FOUNDATION WALLS EXT RIORR-
FLOORS ,R A-
WALLS R-
CEILING d' R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
ARRIVE
DEPART
I PECTOR
•';,1' ;;. •- ;,.• • i' .; i •
•', .------;-------.6; . ,
, 0 1 • : 111101111111111IIim'
• ,.,
- •
. i
. ..a.' ..essiggnoldim••worimormimuailian.
• ,
. ,
. • .
. 1
. .
. ;
. .
. .,
.. ..
. -
. .
. .
. .
. .
. _
- . . •
• .
. • .
. .
. .
• .
.... .
DiAm. cr pe PYtt pipe, Pelir..1)/A1J,A1/1Z JZOPet Xf ./f7
. ?
lelt)e(Phite; 7767IT.A.MirJ, illtAt. .110Per:. Ai
. -
, . .
,0/41A4• pk-eaca,cArkt, Ale frive7z R/Pe",A444 il-OrDE: ya -/,x
. .
" t .• .. .
•
:.,
. .
. . , .
. ,
. .
. . .., .
, .
• • i ., .
- . . .
, •
. . . . ._ .
, .
. . .
. . . . , . .
• ,•
.. . .
. ,
. , .
.. .,
TOWN OF •
.. , TO
. ., • s:
. .1
1 .
.,'
• .
, .
..,_:‘, .4' on' ing&A, 4,.; .7. ,,, ...„,„•:.„,..,..7..,___. ,,..:'' '
nlirr• ,.
.._
' .. .,
,.\ • • . : ......----"e,'
. . ... .
--,,v........- ,
1.. .
. G -•••
k5 4 . ..... .
, ....., .--.-- -1" vpirrivnia ; . ••, • .
4.1,‘ •.!, Ni ! ., . . . • .
''' .• T;t •: k ,. I --Pt.
.....),„ •
.. v, s .. . • .
'o I., . .• ...
r . .
, • fj way - p . .
_
i . . . •,,
, . \
/ / /
1 I \... .
N 1 •
L. 71/barE ' 4:1r
kl
14.1 •
•
k
•• /4 . . .
Ct. • . : '/-.." / fie/
• .
r /I
. i .
14 /1 1
> .
, 1 ior or,
1 ve jaLr•olf •
----- -------
//p.r1 „ v x„z/
Y � NiHW d'D1 N�s
6,4° b m�dd r•Q..a/• 9
V cat!), X� N/(S,X�
96 ab olt'P'
nieit-
.00Z _. ` }�,�• - (^t4� /^'//ILA,\�f
_z_____ZN'quigk 0.0, r
a I Ltiby2,� , oo•SL,
c\/--):)::
( ,
0 \\ . ko,c,
0 1 .
1). .\ \ i
el tv
ot ‘1113N
----- 9/ IJ
"(:::.._)_y- s r;,' .•70
))• \ l/
.. '44 o o ofr,oz lb
l'? • s'io0i-) ) ', iz,
I 5)/, il \
�,
��o ; �� q o° o G� � ; sv -o /e N
i //0.,47..//:z 6
Z�8 '8 IL_______. , : s\iz.1 si
i i \ s/ r Y'! '8S8 ZZ
Zf
I � ^1a
\ �, \ �-
r s. i o
/` •
�' o � �4 .o 0' 1
,,„ \,s,............,L,
i /
0�
/ ° � _��� -
, / 14
N
oci.q. /I u51 '\''z'' 7 .
(b
.go/ st)C1 c?'s ' z . Cs: 4 .
i a os�
/ / 4/ A ' C''Cs 17.1#
., (1'i le (6\ .. .17/ ''.C:;:2‘ 3/6-.7. C ,.. ---------------
/ OV'‘(04 09:0:
\.
/ , : ao >\
by //X•
� ,�',