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CERTIFICATE OF- OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date February 14 , 19 95
This is to certify that work requested to be done as shown by Permit No. 93=046
has been completed.
recreation room
This structure may be occupied as a
31 Amethyst Drive,
Location
Robett Hefner
Owner
By Order Town Board
TOWN OF QUEENSBURY
4vitcti;\
Director of,Bldg. & Code Enforcement
—{
_ n
' ' • '<
- BUILDING PERMIT
TOWN OF QUEENSBURY 93-046
No.
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
ROBERT HAFNER
OWNER of property located at 31 Amethyst Drive Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Interior Alterations
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.
1. OWNER'S Address is �
same
0
2. CONTRACTOR or BUILDER'S Name
same
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
Ca
•
a
CD
5. ARCHITECT'S Address
c'h
t7
6. TYPE of Construction—(Please indicate by X) C'
fD
( I Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. 16'x13' Interior Alterations as per layout, specifications and
application.
8. Proposed Use
Recreation room
0
-s
$ 8.00 PERMIT FEE PAID —THIS PERMIT EXPIRES March 9 19 94
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the CD
town of Queensbury before the expiration date.) —5
cF
Dated at the Town of Queensbury this9th Day of Mar 9?9 0
to
SIGNED BY for the Town of Queensbury
Building and Zoning Inspect6
TOWN OF QUEENSBURY
% 1CO2.
40 REVIEWED BY: Ij1 ;FM OF QUEENSEIL,_
li FEE PAID: Of RECEIVED
PERMIT NO. : %Jl U4 MAR 51993
00• & 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: 'o cry 1/A F,-eri
P.O. Address: 3/ Al/92 � 1--hys7z -.. PHONE7pg a30
Property Location: Cj c,_e.ens hip?, Tax Map No. /",/ / / 2 1
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: /-Imkt, 6 A et^ Lot No. 2 7
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
ied e/7 //y Fn.e;^
NATURE OF PROPOSED WORK: * ESTIMATED MARKET VALUE OF THE -
Construction of new building * CONSTRUCTION: $ 3000
. Addition to building
Alteration to building * COMPLETE INFORMATION REQUIRED BELOW:
(no change to exterior dimensions) * Size of Property: ft. x ft.
Other work (describe) * Existing Building Size:
•
* ft. x ft.
* Proposed building - distance from
GROSS AREA OF PROPOSED STRUCTURE: * property line:
*
1st Floor Sq. Ft. * Front Yard ft. Rear yard ft.
* Side Yards ft. and 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: (J,p Sq. Ft. * Primary Building -
// One Family Dwelling
Size of New Structure: /c ft. x /3 ft. * Two Family Dwelling
Foundation: * Multiple Dwelling/No. of Units
Pier/Slab/Crawl/Partial/Full (Circle One) * Business
* Industrial
No. of stories (Habitable space) 2 * Other
Height (grade to ridge) ft. *
If residential , no. of families: / * If addition, what will use be?
No. of rooms (excluding baths) : * O'er hOM1
No. of bedrooms: 3 • *
No. of bathrooms: * Accessory Building:
Primary heating system: of/ J-6,4 ,4 * Detached Garage - One/Two Car
Type of fuel : oil * Attached Garage - One/Two Car
No. of fireplaces to be installed: * Private Storage Building
Will a woodstove be installed?: * Other
Central Air Conditioning: Yes No v' *
(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:
Depth of Foundation below grade (to bottom of footing) :
Will there be a cellar? Heated or Unheated? Floor Sq. Footage:
Will there be a basement? 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 " ; spacing " o.c. ; length ft.
Joists (floor beams) : 1st Floor " x " ; spacing " o.c. ; span ft.
Joists (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 " o.c. ; span ft.
Exterior Wall Finish: 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?
Will a flue-lined chimney be installed? Height above 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 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: PHONE
NAME OF PLUMBER & ADDRESS: PHONE
NAME OF MASON & ADDRESS: PHONE
NAME OF ELECTRICIAN & ADDRESS: PHONE
DECLARATION
To the best of my knowledge 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 authorized by the owner. Further it is understood
that I/we shall submit prior to a Certificate of Occupancy or Certificate of
Compliance being issued, an AS BUILT PLOT PLAN drawn to scale, showing actual
location of project on premises.
Signature
vine , owner's agent, architect
contractor
SPECIAL CONDITIONS OF THE PERMIT:
•
By:
Code Enforcement Officer
if(�'�;; ) MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
National Headquarters
1337 West Chester Pike,West Chester, PA 19380
APPLICANT COMPLETES THIS SECTION Date: j S ?
City; Town or Township Ott,- I ,• ' -• / County 1- i State A-'
Location/Address 5I /1 H,C ;j/ . '/ 19f
y� (If Located in Rural Area - Please Attach Directions) Pole #
Owner /s` :1/ 7' P4 1, ' Permit # >> /-'7?
Occupied As // '- g:
Buildin New❑ Old❑
Occupant A9.-1,-'. / fi",/
Work Area in Building (Floor #,etc.):
App. for: Wiring n Service❑ or: Ready for Inspection: •
Fee Remitted -$ Cash❑ Check I-` 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 : 7
Lighting / /f•. /f ' 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 11/2 2 3 5 7,/2 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size
Applicant's /� 1 f . .
Signature -` .,-'1"- -''<=F." I ,�Zfi2- .,'i License # Permit #
T/A Utility:
Applicant's Address: (NAME) (OFFICE LOCATION)
(City) (State) (Zip) Service Request #
Phone # Electrician:
MDIA USE ONLY DATE RECEIVED: DATE INSPECTED:
Correct Location: Same as Aboven 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 11/2 2 3 5 71/2 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size
500 750 1000 1250 1500 1750 2000 2250 2500 2750 30001
Elect. Heat
CERTIFICATIONS USE.FOR INITIAL VISIT ONLY NOTIFIED DATE CO RECT FEE PAID
❑ RW Progress: Inc.❑ LKD El Contractor
❑ CFT Violation: Work Comp.❑ Inc. El
1-1L/A Owner CASH CI
Fee CHK #
❑ L/A Due
ri IPA Municipal MO #
_ INV #
Date: Other Sided I Utility Applicant ❑Owner
Cut in Card n Temp # Date
n Final # Date INSPECTORS SIGNATURE
Aooi IPATInAI cnonn min OAn CI 11/AQ
,\t/,I,.).„In)•/t11(t•/t•!-It/;t•/-1•!1.1 1 411!t•/1•l. 0i lt/ •1 19! \tl,),•!;. •!�•,\•/ •!,\t/,tt/\t/\•/,t•! 1t%„\t/,\ti,\•/,)•�)•!t•l t•/,\tl_)•1 1.1,1•I 91 M,111._OP,.t•i,\•1•\•1 MI\•1• • t9 1tl,f011 •
li:1.
4.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
i'; 8034885 BUREAU OF ELECTRICITY
I- 41 STATE STREET,ALBANY,NEW YORK 12207
i Date OCTOBER 21, [994 Application No.on file 11.100293/93 H 430480 1
THIS CERTIFIES THAT PERMIT NO• 93-046
'-.' only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
:.
IP
ROB"ERT & KAY H2'FNER, 31 AMETHYST DR., QUEFoDSB1JiRY, N.Y,
: in the following location; r' Basement ❑ 1st Fl. ❑ 2nd Fl. Section Block Lot
was examined on OCTOBER 18 4 1994 and found to be in compliance with the National Electrical Code.
FIXTURE ECEPTACLES SWITCHES RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
i'
g
? 6 2 2
1:
' DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS
1.
SERVICE DISCONNECT NO.OF S E R V I C E
t AMT. AMP. TYPE EQ B'UIP. 1, 2w 1.Jr 3W 3 A'3W 3 U 4W NO. R COND. OF CC.fGOND. NO.Of HI-LEG TRAL
OF HI-LEG NO.OF NEUTRALS OF W.G.
CI
J CI
-4
tc n
4. OTHER APPARATUS: o
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- _
,,:
ROBERT & K£Y HAFNER (..,- (21,1/477e n''
\ 31 AMETHYST DR
fUI ENti BURY.. NY, 12804
BRANCH MANAGER
;9
Per
\,rtificate must not be altered in any manner;return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
•i 7A 'i•Y'r•t r•,74C'!•t!•i 741-re Yeer1Y`i•r 7•CiA '•t do I•{-, .re.l•er1 .!•`./A`..f5, I•C-i•i,•, r•ti.,1 i•i Ai r•,'%p re'41"/A(!•t 4 (4 410-41-ter r !• • a i•S'4 y' l•� • •
• COPY FOR BUILDING DEPARTMENT. THIS COPY CIF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
Pkr TOWN OF QUEENSBURY
1:/.
iliN BUILDING & CODE ENFORCEMENT
531 BAY ROAD % (
QUEENSBURY NY 12804
(518)745-4447 +. //l
ARRIVE: DEPART: 774---- INSP: '
FINAL INSPECTION REPORT - RESIDENTIAL
DATE INSPECTI. REQUESTn RECEIVED: ��II
NAME
LOCATION c ) l /�"w1 e -- hy,- - � Or-
DATE ____4 0 q1' PERMIT B (3-C�7�Q
TYPE OF STRUCTURE l N t._ PCr,
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING SEPTIC . INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE _
N/A YES NO
CHIMNEY HEIGH /B VENT/HEIGHT
PLUMBING VENT •
i .
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/RAILINGS
RELIEF VALVES \ -- I
FURNACE/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY DOOR\ X
' FINISH FLOORS: I \ /c
BATH/KITCHEN WATERTIGHT
OTHER FLOORS 'SWEEPABLE
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS \
BATHROOM FANS \
PLUMBING FIXTURES I
FOUNDATION INSULATION I \ .
GARAGE FIRE PROOFING
DOOR CLOSERS
i X
FINAL ELECTRICALaA r CW S( 1-4
SITE PLAN/VARIANCE RE.
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O O4110
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 .45[1 i b
NAME
LOCATION al
DATE 1
%1:11-t
PERMIT # 93--04u
TYPE OF STRUCTURE 1 O}Mi4tP,. A AIST1rEY
RECHECK AP'ROVED
N : YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBL
FOR PROVIDING PROTECTION FRI
FREEZING FOR 48 HOURS FOL iWING
THE PLACEMENT OF THE CON''ETE.
MATERIALS FOR THIS PURPISE ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PL''E
FOUNDATION/DAMPROOF NG
BACKFILL APPROVAL ? A
ROUGH PLUMBING /
PLUMBING VENT/V'NTS IN PLACE \
PLUMBING UNDE' SLAB 1./
FRAMING: 7
JACK STUD /HEADERS /1
BRACING/i IDGING A
JOIST H' GERS ,l 1
JACK PI TS/MAIN BEAM )
HEATING 'OUGH-IN �` \
INSULATION: 7' k
FOUNDATION WALLS INTERIOR R- \
FOU DATION WALLS EXTERIOR R- n,
FLOIRS ' R- \
WA LS R-
CE LING R-
D CT WORK OR PIPING IN UNHEATED
SPACES
REMARKS: 1/4-�0Pg__ _b3
►•J OCpJ .
ARRIVE vy. 3O •
DEPART 1O
INSP C
TOWN OF QUEENSBURY /3 /
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR°S REPORT
REQUEST FOR INSPECTION RECEIVED 1p,/�j?4,13
NAME ifeVet., X/I./n
LOCATION t ,/ /i2/44°, 4g ;at_
DATE kbljigg PERMIT # g,5-641t
TYPE OF STRUCTURE
,
RECHECK / APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM II
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�fON SITE
FOUNDATION/WALL PO R
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING I'
BACKFILL APPROVAL } ;
ROUGH PLUMBING r b'
PLUMBING VENT/VENTS 'SIN PLACE-
PLUMBING UNDER SLAB '� I
FRAMING:
JACK STUDS/HEADERS '11
BRACING/BRIDGING A
JOIST HANGERS IA
JACK POSTS/MAIN BEAM ,
HEATING ROUGH-IN
)(INSULATION:
FOUNDATION WALLS INTERIQR R-
FOUNDATION WALLS E(TERIOR, R-
FLOORS -.R-
WALLS '.R- //
CEILING I R-
DUCT WORK OR PIPING IN UNHEATED
SPACES J�
REMARKS:
kijftV COM,PI L Z3
ARRIVE 3 :o
DEPART -S,dis
IN PELT R
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 ��/il9,3
NAME
LOCATION / t..e haL)
DATE Ol 14 /q3 PERMIT # DV 9c_7 Q`'`
TYPE OF STRUCTURE1f a 6- (Lure* ; /,
417151724
�r9 �.emu- /7L/--,
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 i /
ROUGH PLUMBING r /
PLUMBING VENT/VENTS I:N PLACE
PLUMBING UNDER SLAB / I
FRAMING: rl'
JACK STUDS/HEADERS;/
BRACING/BRIDGING A
JOIST HANGERS j
JACK POSTS/MAIN JBEAM
HEATING ROUGH-IN/
INSULATION: I 1
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS ETERIOR R-
FLOORS ,� R-
WALLS R-
CEILING / R-
DUCT WORK OR PIPING INN UNHEATED
SPACES 1
I
REMARKS:
s lynx '
mil/ �4
�1
ARRIVE
DEPART I
IN PECTOR
i &• 21/2(.
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 ,�/r/91
NAME �!/�.e!/l
LOCATION AkiA4:4/-4
DATE ,g//0/9j PERMIT #90.?Q4/6
TYPE OF STRUCTURE 'l C'aj, (Ley' g vLo
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 Ct NCRETEL
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR'
REINFORCEMENT IN PLACE /
FOUNDATION/DAMPROOFING f
BACKFILL APPROVAL I I
ROUGH PLUMBING
PLUMBING VENT/VENTS 'GIN/PLACE
PLUMBING. UNDER SLAB ,(
FRAMING:
JACK STUDS/HEADERS \
BRACING/BRIDGING
JOIST HANGERS/
JACK POSTS/MAIN BEAM\
HEATING ROUGH/IN
INSULATION: /
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTER}'IOR R •
-
FLOORS/ R-
WALLS . R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
7-4/.1,0-eL fr-4->
env ()��,A,,22,
ARRIVE 3',
DEPART 31,41(0
' INS CT
. .
_ . .-111
. , Titti, tb
Low - -7 R o 6e IT hi H me .s1 OF OLEENS1 t-.
3/ A en e--th y.s1- Or RECEIVED
Qul.e,n S.Lry IVY.
719' 3 yo :+AR 51993
%Tt - .
" rG. & CODE DEFT..
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i‘Vicio C61 _____
R 13 6.va l/S �Y
R 32 //oor
Orop ceiling js s,G..t- R04 .
D.)(11 Drop ce_1..1 -
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HIS PLAN TO BE fie_ _ RUoJPROJECT SITE AT 1-,.
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