2012-146 TOWN OF QUEENSBURY
43' 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
All
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120146 Date Issued: Tuesday, January 15, 2013
This is to certify that work requested to be done as shown by Permit Number P20120146
has been completed.
Location: 13 OWEN Ave
Tax Map Number: 523400-295-019-0003-024-000-0000
Owner: RAYMOND & ELEANOR JACOBS
Applicant: RAYMOND & ELEANOR JACOBS
This structure may be occupied as a:
Residential Addition By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property
owner of the responsibility for compliance with Site Plan, Variance, or
other issues and conditions as a result of approvals by the Planning Board "� •
Director of Building& e e En.: ement
or Zoning Board of Appeals.
ow...,..
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120146 Application Number: A20120146
Tax Map No: 523400-295-019-0003-024-000-0000
Permission is hereby granted to: RAYMOND &ELEANOR JACOBS
For property located at: 13 OWEN Ave
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: RAYMOND & ELEANOR JACOBS Residential Addition $17,000.00
13 OWEN Ave Total Value
QUEENSBURY,N.Y. 12804 $17,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
RIDGEWOOD HOMES
NY 12804-0000
Plans&Specifications
IBP 2012-146
94 sq. ft. residential addition: Master Bathroom
$100.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, April 03, 2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Quccnsbury beforethe c iration date.)
Dated at the Tow of Qu a sbu J e. t;: ' pril 17,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
/ t�•FFICE USE ONLY -E. -g-t-V-E
0
TAX MAP NO �o a / PERMIT NO. C,-, - Neo it..1
FEES: PERMIT PM cP RECREATION ENGINEERING � �'�
aE(If applicable) ,TOWN OF QUESB
U
11 "'BtJit�tidF; t'2D
PRINCIPAL STRUCTURE: +
APPLICATION FOR ZONING APPROVAL & BUILDING PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO REVIEW
BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.
APPLICANT/BUILDER: 2Id3d OWNER: 4//,4A/OE. / 5
ADDRESS: /1/064.I6i //tit" ADDRESS: l: chit--XJ AUg
PHONE NOS. (5)g 2 ?6/-1/67Z2 PHONE NOS. .7 y3.- 65'-/3
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE:A7/40. go,// 7/ PHONE: ( �j6 ) 36/---47t
LOCATION OF PROPERTY: 1,3 4.4/0C) AUi
HAS THERE BEEN A SITE PLAN REVIEW; VARIANCE OR SUBDIVISION APPROVAL? 0 YES 0 NO
IF SO, INDICATE APPLICATION NO. AND DATE OF APPROVAL:
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT z
APPLY TO YOUR z oW Ci cc O oLL co
PROJECT co
p • ft J O w
D W U. u- w Q o_ = V
u- o = I— O _Z
Z < < � C Hu) 0u i— u n=- = a'S
SINGLE FAMILY 'r '9 1 5�;. '�' / 91 /3
TWO-FAMILY !\
MULTI-FAMILY
(NO.of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACHED
GARAGE(1,2,3)
OTHER
IF COMMERCIAL OR INDUSTRIAL—NAME OF BUSINESS:
)/j -4I
ESTIMATED CONSTRUCTION COST: l 7 CC FUEL TYPE: (-).,4_5
n#5�
HEAT TYPE: . 62,--,,,A. !HOW MANY FIREPLACE(S): ( AND/OR WOODSTOVES(S): (
ZONING CATEGORY: ARE THERE WETLANDS ON THIS SITE? A/O
IS THIS A HISTORIC SITE? /(/7 JJ
PROPOSED USE OF BUILDING OR ADDITION: 1/1 Ier-bA-Mroom
'Please complete a separate Application for"Fuel Buming Appliances&Chimneys"available in our office
B 3-LGL 11-05
05,:
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN?
ARE THERE EASEMENTS ON PROPERTY?
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans, and supporting materials are a true and
complete statement/description of the work proposed, that all work will be performed in
accordance with the NY State Building Codes, local building laws and ordinances, and in
conformance with local zoning regulations. I acknowledge that prior to occupying the
facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand
that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read a agree to t e abov/
Signed
xi‘
P
Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction codes
or septic systems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
Permission is hereby granted to the above This application / proposed action described
Applicant to erect or alter the building herein is found to be in accordance with the
described herein in accordance with said zoning Laws of the Town of Queensbury.
Application:
BUILDING & CODES APPROVAL ZONING APPROVAL
DATE DATE
J
QUESTIONS? CALL 761-8256 OR EMAIL
codes(a�queensbury.net
Office Use Only VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
Operating Permit Issued: Yes No
Occupancy Type: Construction Classification:
Assembly Occupancy Limit: Special Conditions:
,Queensbury Building & Code Enforcement - Residential Final Inspection
r
Office No. (518) 761-8256 Arrive: am/pm art: am/pm
Date Inspection request received: Inspector's Initials: /� i1�
NAME: PERMIT#: v — CO
LOCATION:
DATE:
TYPE OF STRUCTURE: vq--111)
Comments:
iev No N/A
4" Building Number Address visible from road
Chimney Height/"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumbing Vent through roof minimum 18 inches
Roof Complete/Exterior Finish Complete
Platform at all exterior doors
Handrail 4 or more risers
Guards at stairs,decks,patios more than 30 inches above grade
Guard at stairwell at 34 inches or more
Guard at deck,porches 36 inches or more
Handrail Termination at Newell Post or Wall
Interior/Exterior Railings 34 inches to 38 inches
Deck Bracing/Handicapped Ramp Compliant
Grade away from foundation 6 inches with 10 feet
6 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18 inches above grade
Interior privacy/trim/doors/main entrance 36 inches
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells safety glazing
Interior Smoke Detectors/Carbon Monoxide Detectors
Everylevel: Bedroom:
Outside every bedroo Eare a: /
Inter Connected: Battery backup: q!
Attic access 30 inches x 22 inches x 30 inches(height)in accessible area ✓
Crawl Spaces 18 inch x 24 inch access, 1 sq.ft.-150 sq.ft.vents
--------------Bathroom Fans,if no window
Plumbing fixtures
Foundation insulation to floor/Sticker on Panel
Duct work sealed properly/Blower Door Test Certification
Floor truss,draft stopping finished basement 1,000 sq.ft.
Emergency egress below grade
Gas Furnace shut-off within 30 feet or within line of site
Oil Furnace shut-off at entrance to furnace area
Furnace/Hot Water Heater operating -�
Low water shut-off boiler
Relief Valve(s)installed/Heat Trap/Water Temp 110
Enclosed Stairs Sheetrock Underside minimum:4"Gypsum
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/%hour fire door/door closer
Gas Logs in Sealed or Glass Enclosure
Final Electrical; °
Final Survey Plot Plan
Arc Fault Breaker Habitable Spaces/Tamper Proof Receptacles
Flex Gas Pipe Bonding
As Built Septic System/Sewer Dept. Inspection Sticker
Site Plan /Variance required
Flood Plain Certification, if required
Okay to issue C/C or C/0[Temporary/Permanent]
L:1Building&Codes Forms\Building&Codesllnspection Forms\Residential Final Inspection Form_revised_100405.doc;Revised
January 7,2008; Revised 6/26/08;Revised 12/22/10, Revised 04/13/11
Dec 12 12 10:52a ROBERT MARLOW ELECTRIC & 5186964957 p.1
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:,::ii, i\1.ii)DI;_.7_ DEPAIRTMNT INSI'FCTION AGENCY, INC A
%?> .%c,f1f., that the electrical wirng to the elact�ical equipment listed below has been examined ands approved as �•
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!4 being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date e
1...'-'! noted below and.s issued sub ect to the following conditions.
Owner. Ellie Jacobs Date: ko
;t,, 07/1112012
Occupant: Same Location. 13 Owen Ave.
le.>; Occupancy: Queensbury, Warren Co. NY
Services
''j Applicants
Marlow Electric •itis
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Robert D. Marlow 'ri5
PO Box 448
Lake Luzern, NY 12846 i
-! Joseph A.Holmes 1'7
`.-`: Ne. . .. 00i848.14.5,589EL__ _ _ _ _ '
_qu pit eilt.
''' 410 Amp Service Conductors Lateral; Replaced Meter Enclosure 3
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:.•';. Tn,s,etiifieate applies to the electrical wiring to the olertncul eauipmem fisted immediately null and void. This cenitkate asp)es only to:he use.occupancy and p
!' above and the instafta'ior ins=acted as ai t.ie adove ruled date based on a visual owrashp as iniicateo herein. Upon a cttangs in the use.occupancy or ownership
„S. inspection. No warranty:s expresser)or tmpEisd as to the -eechanicai safely,eth- of the property indicated above,this certificate shall ba immediately null end void. .
:,fancy x fnnosa Cl the eQuipmeII to-an,cart.cular purpose. This cartilicsta shaft In the event that this certificate oecomea inva6a basso upc,the adove cendittonS, F%Yt�
_e:a•id for 7.period of one year Aran the weave noted fiat. Should the electrical this cert ficate may be revalidated_pon rerfepecl on by WIddle Department �, i
:'a system to which atilt cerlit.cate applies ce altered in any way.Including but rot'tm•t. lns):ect:on Agency.Inc An application br inspection must be submitted to Mlodle rry>
ad to. l-e inhoouctIon o•additrona electrical a v.:Omer!andtor the replacement o' Department Inspection Agency.Inc.to initiate the Inspect on and revalidation t
iarty ci the corrponon;s tesla leo as aI the above nrned cafe.this certilica;te shall be proress A fee will be charged for this service �'
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Dec 12 12 11:22a ROBERT MARLOW ELECTRIC & 5186964957 p.1
I
5W i`ems .
MIDDLE DEPARTMENT E `� iNSPE�'TI()J�31�AGENCY, INC. .•
:r:;1;r; that`h; electricai wiring to the electrical equipment listed below has been examined and is approved as ,
,:(.4 being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date 'tFr
noted below and is issued subject to the following conditions. s.'?
f'`` Owner: Date:
>u Ellie Jacobs
t�
07.111/20 12
• Occupant: Location:
Same 13 Owen Ave
r
Occupancy: Queensbury, Warren Co. NY v.
r 8a`hroom - 1st Floor __ ,`,I,
, Applicant: i l
!p.
ii Marlow Electric
`:) Robert D. Marlow
:' PO Box 448
.. _ Lake Luzerne. NY 12846 J
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p
? lvo. Joseph A.Holmes 't4
tx _._OQt818�446Q4EL__-- - _
c:, Equipment:
f,,,,
?. 4-Switches:4 - Receptacles; 4 Fixtures; 1 Vent Fan
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')t+ '-S CSAaicate applies'o the etect:c8i.wing to the electrical equipment listed immediately null and void. This certlflcate applies only to the USE,occuparcy and
_3 above ane the installation inspeceo as o:thr-above noted date cased on a visual Clvmershic zs indicated herein. Upon a change In the use-occupancy or ownership I '.I
-.a` inspection No warranty is expressed or rrnpbec as to the mechan.cal solely.efl{- of the p-ope1—mdcated above.thus certittcate shall be immediately null and void. • i
:;c cioncy o•I:uhess of the equipment for any pancula7 purpose. This certificate shall In the warn that this certil.cate becomes invalid based upon the above conditions, •
be valid for a period of one year from the above noted date. Stoud Inc eleclncal this terd.oate may be revalidated upon reinspection by Middle Depanment l
•
„t) system to volt!,this certificate applies to altered n any way.incIud ng bul not Jinn- Inspeclon Agency Inc An application for inspection must be submitted to!Riddle K
[4 ed to. tna int-motion of additional electrical equ.pmeni andlor the replacement of Department Inspection Agency. Inc. to initiate the ins:ection end revalidation
any of the components Instated as of:he above rioted nate,this certifcare shall be process. A fee WO be charged for this service.
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Rough Plumbing I Insulation Inspection Report
Office No. (518) 761-8256 Date Inspection request received: (i' Z
Queensbury Building & Code Enforcement Arrive: am/pmDepa .; pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: yiti+
NAME: n Co i' 5 PERMIT #: / _l (1&
LOCATION: 1i-& „)-(2- INSPECT ON: VO2
TYPE OF STRUCTURE: -k
Y N N/A
Rough Plumbing / Nail Plates
Plumbing Vent/Vents in Place
1 % inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/chan•e of direction
Pressure Test
Drain /Vent
Air/Head
5 P.S.I. or 10 ft. above hi hest connection for 15 minutes
Pressure Test
Water Supply Piping
Air/Head
50 P.S.I for 15 minutes
Isulation / Residential Check/Commercial Check
Tyvek or Similar Exterior Sealant
Proper Vent, Attic Vent
Door/Window Sealed (No Insulation)
Duct/ Hot Water Piping Insulation
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly/ No duct tape
COMMENTS:
- 30-k -0,-c,74,3)2
Rough Plumbing Insulation Report.revised Nov 17 2003, revised February 15,2005, revised January 7,2008
Rough Plumbing I Insulation Inspection Report
Office No. (518) 761-8256 Date Inspection request received: 6� I.3 6
Queensbury Building & Code Enforcement Arrive: am/pm Depart: - 1 r=m/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: e+4,9 ' � ►.
NAME: ��c s PERMIT #: /d—Nto
LOCATION: /,3 D t..) Px) _ INSPECT ON: 5 — ! a.
TYPE OF STRUCTURE: (Ra 3 add`4'1 o n bS5Dre
Y N NIA ' o� �
hQ
Rough Plumbing / Nail Plates
Plumbing Vent/Vents in Place11/
1 1/2 inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/change of direction _ sta.-3936
Pressure Test
Drain 1 Vent ena�u n.r"
Air/ Head �
5 P.S.I. or 10 ft. above highest connection for 15 minutes
Pressure Test
Water Supply Piping
Air/ Head �'
50 P.S.I for 15 minutes
Insulation / Residential Check/ Commercial Check — _
-r-
Tyvek or Similar Exterior Sealant _
Proper Vent, Attic Vent
Door/Window Sealed (No Insulation)
Duct/ Hot Water Piping Insulation
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly I No duct tape
COMMENTS:
Rough Plumbing Insulation Report.revised Nov 17 2003, revised February 15, 2005, revised January 7, 2008
Cly c 0 I( -��
Framing / Firestopping inspection Report
Office No. (518) 761-8256 Date Inspection request received: 5 / � �Z
Queensbury Building &Code Enforcement Arrive: am/pm Depart. i ; amlpm
742 Bay Road, Queensbury, NY 12804 Inspector's InitialsR )"
NAME: --) 1/. U,(2 PERMIT#: I r
LOCATION: 1 i,v
`�-� 1\-v-�. � '-� INSPECT ON:
TYPE OF STRUCTURE:
\:),-- Y N NIA COMMENTS:
2eFraming
Attic Access 22" x 30" minimum
Jack Studs/ Headers ✓r'
Bracing/Bridging .r"
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12" O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Exterior Deck Bracing
Headroom 6 ft. 8 in. •
Notches/Holes/ Bearing Walls
Metal Strapping for Notches Top Plate
1 '/2(w) 16 gauge (8) 18D nails each side
Draft stopping 1,000 sq. ft. floor trusses
Anchor Bolts 6 ft. or less on center
Ice and water shield 24 inches from wall
Fire separation 1, 2, 3 hour
Fire wall 2, 3, 4 hour
Firestopping "
Penetration sealed ~
16 inch insulation in cavity min.
Garage Fire Separation
House side %inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space 1 Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above /below grade
5.0 sf grade
L:\Building&Codes Forms-OLD\Building&Codes\nspection Form Framing Firestopping Inspection Report.doc Revised January 7,2008
C(a
Rough Plumbing / Insulation InsC ion Report
Office No. (518) 761-8256 Date Inspection request received: ((p( --
Queensbury
ZQueensbury Building & Code Enforcement Arrive: am/pm Depa . am/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials: eit-A-
NAME: I (/' PERMIT #: Z - I `41C.;
LOCATION: o ,. , INSPECT ON: Ail Z
TYPE OF STRUCTURE:
Y N N/A
Rough Plumbing / Nail Plates
Plumbing Vent/Vents in Place
1 % inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/change of direction
Pressure Test
Drain /Vent
Air/ Head
5 P.S.I. or 10 ft. above highest connection for 15 minutes
Pressure Test
Water Supply Piping
Air/Head
50 P.S.I for 15 minutes
/Insulation / Residential Check I Commercial Check
/Insulation
or Similar Exterior Sealant
Proper Vent, Attic Vent
Door/Window Sealed (No Insulation)
Duct/ Hot Water Piping Insulation
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly/ No duct tape
COMMENTS:
Rough Plumbing Insulation Reportrevised Nov 17 2003, revised February 15, 2005, revised January 7, 2008
Framing / Firestopping Inspection Report
Office No. (518) 761-8256 Date Inspection request received: '-9-(a,
Queensbury Building &Code Enforcement Arrive: am/pm Departam/pm
742 Bay Road, Queensbury, NY 12804 Inspector's Initials:
NAME: PERMIT#:
LOCATION: INSPECT ON: -A-/
TYPE OF STRUCTURE:
Y N r COMMENTS:
Framing
Attic Access 22° x 30" minimum
Jack Studs/ Headers
Bracing/Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12" O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Exterior Deck Bracing
Headroom 6 ft. 8 in. •
Notches/ Holes/Bearing Walls
Metal Strapping for Notches Top Plate
1 'A (w) 16 gauge (8) 16D nails each side
Draft stopping 1,000 sq. ft. floor trusses
a�Bolts 6 ft-or-Less-on-cent
Ice and water shield 24 inches from wall
Intlf.mration 1, 2, 3 hour
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side 'A inch or 5/8 inch Type X
Garage side 518 inch Type X
Ceiling/wall
Windows Habitable Space/ Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above 1 below grade
5.0 sf grade
L:\Buiiding&Codes Forms-OLD\Building&Codes\insped on Forms'Framing Firestopping Inspection Report.doc Revised January 7,2008
"-u es cdak °J-( ) C bis‘�
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection request received: f)--9\--3-- —,(a_
Queensbury Building&Code Enforcement Arrive: am/pm Depth:/______amikom
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: •
NAME: J Gq o\o.S PERMIT#:
LOCATION: /.3 O 13 n INSPECT ON: 5 /— JO.
TYPE OF STRUCTURE: : \-El£l
Comments
Y N N/A
Footings
Piers
Monolithic Slab
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/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place r
Foundation Dampproofing
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval l
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building&Codes Forms\Building&Codes\1nspection Forms\Foundatlon Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
/-(eter
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection request received: ittb-07,)-rJ0
Queensbury Building&Code Enforcement Arrive: am/pm Depart. am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: ,,L4
kevi 31
i4
NAME: 3-/-L(-_-0(3 S 6).1'4.(-- {� PERMIT#: l a ' 1 `7!
LOCATION: w « ��tt/`Cr
l 3 v � INSPECT ON: i-}
TYPE OF STRUCTURE:
Comment,
iers
Monolithic Slab
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/Wallpour
Reinforcement in Place 2 fj � Oc
Footing Dowels or Keyway in place
Foundation Dampproofing
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Buiiding&Codes Forrns\Building&Codes\1nspection Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
RX Date/Time 10/02/2012 12:55 518 273 1202 P.002
,A e 0 r, , 2 2 012 12:5 4 P 1!�. M D I A W a t e r v 1 i e t N Y•,�:;�.•,J�`,�s,,,"��*j,3,, rw,�•�•4,1•/��•fr, o \J. 'J� ,Nt. , `c•
t. MIDDLE DEPARTMENT INSPECTION AGENCY, INC. µ.F
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•
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ft 4 that the electrical wiring to the electrical equipment listed below has been examined and is approved as • •i
(- being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date s
(Cry noted below and is issued subject to the following conditions.
0 Owner: Ellie Jacobs Date: 09/24/2012 1
�'�J Occupant: Same Location: Owen Ave •
,
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Occu anc Queensbury, Warren Co. NY �ti>
p y' Kitchen
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6. Applicant:
�C
Marlow Electric
.. Robert D. Marlow •'" j=•a !`',•` `'`.` `
Cc•r PO Box 448 ;; - :4•: ._ .
la) Lake Luzerne, NY'`92846` -�" '�"
. :::: -..... :. ti
A Joseph A.Holmes ' :. .x , ;i
0018,18'14.1-7,3Z451$:4,45.;:::kct4 No ' • Z..:,�x ,;' , ,•ys r+ ,.r
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>`i Equipment: s: :: : .•. . + ..7;t5:%• ,
ant: t :.:� r` . :.�: .: .r_.
( 6 -Switches; 14 - Receptacles; 12.=`'Fixtures; 1:Lr ang '' ,"G`Dish tidsher 1 Dryer:."1;'�20 Amp. Receptacle Washer "';)
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. This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void, This certificate applies only to the use,occupancy and '
(;).?. above and the installation inspected as of the above noted date based on a visual ownership as indicated herein. Upon a change in the use.occupancy or ownership
0 Inspection No warranty is expressed or implied as to the mechanical safety,eft!. of the property Indicated above,this certificate shall be immediately null end void. r
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� ciency or fitness of the equipment for any particular purpose. This certificate shell In the event that this certificate becomes Invalid based upon the above conditions, i\(r
.>;,: be valid for a period of one year from the above noted dale. Should the electrical this certificate may be revalidated upon relnspection by Middle Department 4•t
A system to which this certificate applies be altered in arty way,including but not limit- Inspection Agency, Inc. An application for inspection must be submitted to Middle r�%'
fi: ad to.the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc. to initiate the inspection and revalidation f,�'
��' any of the components installed as of the above noted date,this certificate shall be rocess. A fee will ?,
4�1 Dbe charged for this service.
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• '7 f Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
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Town of Queensbury * Community Development Office * 742 Bay Road, Queensbury NY 12804