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96-085 CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date November 25 19 96 This is to certify that work requested to be done as shown by Permit No. 96086_ has been completed. This structure may be occupied as a SINGLE FAMILY DWELLING W-2-CAR ATT. GMAGE BAY RD. Location Owner DOBROSKI , ANDREW & LINDA By Order Town Board TAX ttAP NO. 28. --3.-3.5 TOWN OF QUEENSBURY \'----2/11. - Director of Bldg. & Code Enforcement BLDG. PERMIT NO. 9 6-U 8 5 APPLICATION FOR A TEMPORARY CERTIFICATE OF OCCUPANCY A TEMPORARY CERTIFICATE OF OCCUPANCY is hereby requested for the property located at; Bay Road for the following uses: Single Family Dwelling w/2-car Garage DATE 1 SIGNATURE OF APPLICANT TEMPORARY CERTIFICATE OF OCCUPANCY The TEMPORARY CERTIFICATE OF OCCUPANCY is hereby ( )APPROVED ( )DISAPPROVED with the following conditions: Certificate of Occupancy to be issued upon completion of : 1 ) Complete exterior finish 2 ) Complete foundation insulation incluting r-19 insulation in box by 1O/18/9t:: TEMPORARY CERTIFIC,9iTE F OCCUPANCY FE�1 10.0OO DEP . SIT: (A$100.00 received on 9,2d 6 c /)'% Date of Issue Director of Bldg. & Code Enforcement • THIS TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES 9 DAYS FROM THE DATE OF ISSUANCE. NOTE: This Certificate is NOT VALID unless signed by the Director of Bldg. & Code Enforcement or his designee. r BLDG. PERMIT NO. ci APPLICATION FOR A TEMPORARY CERTIFICATE OF OCCUPANCY A TEMPORARY CERTIFICATE OF OCCUPANCY is hereby requested for the property located at; �B\ Rr'F C for the following uses: 1 1 t(-,LE (-1\L" )u =t p,:\,(] i 7 C'.F►R DATE SIGNATURE OF APPLICANT TEMPORARY CERTIFICATE OF OCCUPANCY The TEMPORARY CERTIFICATE OF OCCUPANCY is hereby (%PPROVED ( )DISAPPROVED with th f owin conditions: c�v \C)10 \ t '-)U LA-TV-AO t (1 O I1.1C 01 ho Lim no irAlqA(D TEMPORARY CERTIFICATE OF OCCUPANCY FEE: (h$10.00 DEPOSIT: ( $100.00 received on Date of Issuance Director of Bldg. & Code Enforcement THIS TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES C() DAYS FROM THE DATE OF ISSUANCE. NOTE: This Certificate is NOT VALID unless signed by the Director of Bldg. & Code Enforcement or his designee. BUILDING PERMIT VALUE $ 119000 TOWN OF. QUEENSBURY No 96085 TAX MAP NO. 28. -1-15 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to DOBROSKI, ANDREW & LINDA BAY RD. OWNER of property located at Street,Road or Ave. in the Town of Queensbury,To Construct or place a SINGLE FAMILY DWELLING W-2—CAR ATT. GAR 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 R.D. #1 BOX 1333A FT. ANN, NY 12827 2. CONTRACTOR or BUILDER'S Name DOBROSKI, ANDREW 3. CONTRACTOR or BUILDER'S Address 4. ARCHITECT'S Name COMMONWEALTH 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) SINGLE FAMILY DWELLING ( 1 Wood Frame ( ) Masonry ( )Steel ( ) 7. PLANS and Specifications 2570 SQ FT SINGLE FAMILY DWELLING WITH 2—CAR ATT. GARAGE AS PER PLOT PLAN SPECIFICATIONS1111 8. Proposed Use SINGLE FAMILY DWELLING W-2—CAR ATT. GARAGE $ 397 PERMIT FEE PAID —THIS PERMIT EXPIRES April 3 19 96 (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 Quee sbury this 3 Day of April 19 96 SIGNED BY for the Town of Queensbury uilding and Zoni Inspector Department of Community Development •Reviewed By: �f� Buildi;ik & Code Enforcement rig* 11i(ding_in ector Town of Queensbury '0 Permit No. (C 742 Bay Road 7/ r ^ c Queensbury, New York 12804 '� Fee Paid $ J / , `4 � , �� (518) 745-4447 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 application form. Applicant: AVQ 2c w T.' DOl3 f2&Yii' Owner: .S'. M C Address: �1). i 30ft; l.J--?3#-t Address: �41/M = F a 2T 14..,.-0 / "I._y. ( ...1._ ts 1-7 Phone # ( st h- ) -7 2 - /07 0 Phone # ( ) ' - Property Location: 13kAv ZD ,,a-- / / / /S- 1 Tax Map Number . Subdivision Name: • Section Block Loy NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE New Bui . ' 4 • • CONSTRUCTION: $ / / 7, OOG residenc- / commercial Addit = - o Building: residence / commercial OCCUPANCY INFORMATION: Alteration to Building: Primary Building - residence / commercial )( Single Family Dwelling Residence / Commercial Two Family Dwelling no change to exterior size Family Dwelling Office Other Work (describe below) Mercantile Manufacturing - _ Other GROSS AREA OF PROPOSED STRUCTURE: ✓/a If ADDITION, what will use 1st Floor 25-7 sq. ft . ' � of new addition be? : 2nd .Floor sq. ft�_ Other Floors sq. f:t: . --- (not unfinished cellar or basemen 7 \ ____ ACCESSORY BUILDINGS: Detached Garage 1 , 2 car TOTAL FLOOR AREA: as- 7 O S7 Attached Garage 1 ,(Tca r �. Private Storage Bui ding SIZE OF NEW STRUCTURE : Commercial Storage Building f L Other ( i/ FEET X 1111 FEET f 78' - Foundation Type : Coi%)CrzCrC" Will any second-hand or ungraded Number of Stories : / lumber be used? If so, for what? (habitable space only) ivp Height (grade to ridge) : feet TYPE OF HEATING SYSTEM: Number of Cfirepla and/or - oodstove� (circle all ch applies ) % to be installed: ! EAc/f Electric / Oi / G / Wood ( Forced Hot Air / ase oar / Other Person responsible for supervision of work as regards to building codes is : ,' NO, L -7 'Doc rao._3 -' -7 g -iv 7o - 796 --5'oy Name Addresss Phone Builder: ---- Plumber: Mason: Electrician: DECLARATION: Please sign below after you have carefully read the statement. 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 noted, 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 by a licensed surveyor; rawn scale, showing actual location of project on premises. --7;,:::__ )2Z Signature: (owner, owner's agent, architect, contractor) ,--3 Application for SE1.'1'IC DISPOSAL PERMIT' o ISTAMP RECEIVED '� 1 ocntion nt lama:tty for inst:dlntion: Sa _l—_` _.(n?R-A---_VD__4. ° N owner's Manic0n� (• D6�? s.i I'IM II l' 140MI1Fit r.ram=�- C Owner's Mailing Address: __—CD%_— b—Yt_ 7-A (!3'_') Cil ,+l Fuz- Roi.S rrtr Installer's Name: l) C_ - S Et1.o Phone #: ed C, Number of bedrooms (if residential): _ Total daily!low (iesidenti:tl • compute hi) 150 gal. pc' bed.otau): (9C.1 -- -- Topography: ( ( Flat (']Rolling (—) Steel, Slope 4' of Slope Soil Nature: m� /tpd, (_} Loam (--I t'f'ty 1-1 Other /I)epth: ..- (around Water: at wind depth?? _ feet Bedrock or Intlx:tvious Material: at what depth? feet Percolation 'Test: (_ Not Repoli et! ( _1 Itetniit ed/hate• min. pet inch Domestic Water Supply: (_._—( Municipal ( ell (--) Other If domestic water supply is a WI?1.1.: water supply from any septic absorption is _LQD Icct -A.- [I'KOI'OSFI) SYS.'FM: I l Septic l,•tnk:l2- 7�V gal. (minimum sire: I.110(1 gal.) ' � I 'tile Field: each trench .�0 Feet. / total system length [ r,� feet. Seepage I'it(s): number of —_.....-------- / size each: ft. x.------ It. Size of stone to he used: /1 / depth or thickness ______ feet. HOLDING TANK SYSI FM: (if tequircd) l Number of tanks: _ Size of each: gal KirAlarm system and usSociuled electrical work to be inspected by o certified agency. For your protection, please note runt putr.cuarrt to Section 136-29 of the ('ode of the 'lbtt•n of Queen.cbury, any permit or a p prortrl granted which is based upon or is granted in reliance upon any material misrepresentation or firilute to Ara/cc a material fact or cir•crurtctance known by or on behalf of an aindicartt, shall he void. 1 have read the regulations with respect to this a pplication and agree to abide by these and all requirements of the 'Toren o f Queensbu .Sanitary Serra , ' Disposal Ordinance. Signature o f resporrsib'e person: ssi�2i`'"-, _ Date: 3 0, 1 1)1'g__)C LANDS OF SUSAN R. WRIGLEY Application _.. .. APR - 2 1996 i I 8/' '33 — 36" E- I # 4111Er' '�i 86` 9 Zoning Administrator I TOWN OF QUE 641 For 0 I WELL 'r `�'"""�"P7oposed bri ve T PROPOSED fI ' 9O 5.095± Ac. ) \o t o J / 250't Q I Q f 50'1 W 3 i -> 1F PROPOSED /STY FRAME RESIDENCE % f` 'O I Q ) /TH BASEMENT {��,?p��'�` �j ' ►�' o // ^_' POSED L L T1C AREA o '0.20' _ _ Stonewoll.b, 0 m imilb.sisaut.cH------;"-----.. 1 A,/ 8/'-38:4p �Remains�� 0�'� I • • 563.8. Remains Of Slc F_ "I have seen or observed,or believe I saw evil i e of, all objects such as houses, wells,trees, fence' .shown on this document I also represent that !_rt I personally measured the distances set forth on the d ; t i OF u ��.?f� . ‘ ENKINS iA4UIE "�ATE. ?45 ) j 1 LANDS OF GEORGE GORE & TJ-IOMAS MCDONOUGH TOWN OF QUEENSBURY 531 Bay Rd., Queensbury, NY 12804 APPLICATION FOR SOLID FUEL BURNING APPLIANCES AND CHIMNEYS 3 ' - \ q N C Date ,19 \ t C 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 form if more than one appliance and/or chimney. Applicant4,7>yi7(/ r-7- Pi 'i ;jj; ' APPLIANCE (check appropriate boxes) Address i. , ,c) i j ,}'?/ 0 STOVE: 0Wood ❑ Coal ❑ Pellet o Gas 0 FIEPLACE INSERT 1 , ?" , t1jrJ ;..�f Zip ) 2 j 0 FIREPLACE, FACTORY-BUILT: frid Wood ❑ Gas Phone '-;d% --- :, 70 --- -;, %c 4.r 0 FIREPLACE, MASONRY: ❑ Wood ❑ Gas Owner i';tv'i t ❑ FURNACE: ❑ Wood ❑ Gas ❑ Oil Address IF NON-MASONRY APPLIANCE: Manufacturer: Zip Model: Phone CHIMNEY (check appropriate boxes) *EXACT ADDRESS of proposed construction � ❑ MASONRY: CI Block 0 Brick 0 Stone t o y Ti' (a`k/TEi,.k51ju/Ly iV '(. FLUE: 0 Tile ❑ Steel Size: inches CONSTRUCTION / INSTALLATION MUST ig FACTORY-BUILT: - CONFORM TO NYS FIRE PREVENTION & Manufacturer: Model: BUILDING CODE. CONSULT AVAILABLE Listed By: Number: TOWN OF QUEENSBURY HANDOUTS 0 Double Wall yl Triple Wall REGARDING REQUIRED INSPECTIONS. 0 Insulated 0 Direct Venting - Cashier's Department Town of Queensbury, New York Dept: Fire Marshal Amount Collected Amount Received Code Number Title n A 173 3389 (190) Public Safety (---1 D. A 233 2655 (230) Minor Sales Fee Collected From or Refunded to: . 1r� : "a' , 1 diess: Dated: 3 —- 5< el Cr' Town Clerk or Deputy l I.l :et , i1.. .: ..., White: Applicant Green: Fire Marshal Yellow:Bldg. Dept.JPink & Goldenrod: Cashier's Dept. TOWN OF QUEENSBURY 531 Bay Rd., Queensbury, NY 12804 APPLICATION FOR SOLID FUEL BURNING APPLIANCES AND CHIMNEYS Date e7/2- ,19 ( ( Permit No. S 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 form if more than one appliance and/or chimney. 4 Applicant / i;,D12E ' o3,2 1 , ' APPLIANCE (check appropriate boxes) Address ,r .,' _ 4 STOVE: [Wood o Coal ❑ Pellet o Gas / 0 FIREPLACE INSERT . . , 4,4� J Zip 0 FIREPLACE, FACTORY-BUILT: Phone 'r ❑ Wood ❑ Gas " �} ❑ FIREPLACE, MASONRY: 0 Owner ❑ Wood ❑ Gas 14.,-, c ❑ FURNACE: ❑ Wood ❑ Gas ❑ Oil Address IF NON-MASONRY APPLIANCE: Manufacturer: Zip Model: Phone CHIMNEY (check appropriate boxes) *EXACT ADDRESS of proposed constru ti n ‘ \\ IQ t c Q\€- 14 C! C \ L 0 MASONRY: 0 Block 0 Brick 0 Stone )\*\ — > FLUE: 0 Tile ❑ Steep Size: ches CONSTRUCTION / INSTALLATION MUST 14 FACTORY-BUILT: CONFORM TO NYS FIRE PREVENTION & I Manufacturer: Model: BUILDING CODE. CONSULT AVAILABLE Listed By: Number: TOWN OF QUEENSBURY HANDOUTS o Double Wall r, Triple Wall REGARDING REQUIRED INSPECTIONS. 0 Insulated ❑ Direct Venting ❑ Chimney Liner Cashier's Department Town of Queensbury, New York Dept: Fire Marshal Amount Collected Amount Received Code Number Title 0 C.)A 173 3389 (190) Public Safety c9 5A 233 2655 (230) Minor Sales Fe ollected m-or Refunded to: D �3\' . C3 , 'Address: Dated: - Town Clerk or Depu White: Applicant Green: Fire Marshal Yellow: Bldg. Dept. Pink & Goldenrod: Cashier's Dept. g'62 '-(1g5 ;i7 t ' -4 ENERGY CODE COMPLIANCE APPLICATION TOWN OF QUEENSBURY, WARREN COUNTY ` ,4,,:'.& 9000 HEATING DEGREE DAYS Compliance Methods : PART 5 - Acceptable Practice Method - r 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 *Requires submission of worksheets APPLICANT' S NAME: PROPERTY LOCATION: 4/o,z DOQ/ZoJ1 !�/1-ry '-?.i7 PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE: 1 . Gross Floor Area - �Son, square feet 2 . Type of Heat - Electric l Oil Gas Other 3 . Is building mechanically cooled? .. Yes ( No 4 . Percentage of area of windows and doors /Over 17% )( Under 17% 5 . R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND TO R-VALUES AS SHOWN ON PLANS SUBMITTED: a. Roof R 3 r b. Exterior walls R c . Glazed areas R � i d. Exterior doors R ,3 e. Floors over unheated spaces R µ/A f . Edge of slab on grade (heated building) 'R ) /A g. Basement/cellar walls (above grade) R II h . Basement/cellar walls (below grade) R 4j i. Heating/cooling-ducts-piping in unheated space R 444 6 . Service (domestic) hot water heating devicv/ Conforms to minimum efficiency per code ^' Yes No TEMPERATURE CONTROL MAXIMUM SETTING 1400 - WILL NOT BE EXCEEDED Apan ' s Si re D to Phone Number l/i INSPECTOR' S REMARKS : 410106. TOWN OF QUEENSBURY #� iN BUILDING & CODE ENFORCEMENT iriTsj 742 BAY ROAD QUEENSBURY NY 12804 ( (518) 761-8256 1)1( ARRIVE: DEPART: INSP: FINAL INSPECTION REPORT - RESIDE TI DATE INSPE ION REQUEST RECEIVED: NAME ,,QQ/e�/pG'��J/ LOCATION ��J �0 . Q/� DATE 41110 PERMIT I 96 409 TYPE OF STRUCTURE FOOTINGS FOUNDATION BACKFILL FRAMING ROUGH PLUMBING SEPTIC INSULATION _ FINAL ELECTRICAL WOODSTOVE OR FIREPLACE N/A YES NO CHIMNEY HEIGHT/B V T/HEI► IT PLUMBING VENT ROOFING EXTERIOR FINIS r DECK/PORC STEPS/RAILI GS RELIEF VALVES FURNACE/HOT WATER OPERATING INTERIOR TRIM/PRIVACY DOORS FINISH FLOORS: BATH/KITCHEN WATERTIGHT OTHER FLOORS SWEEPABLE _ _ OTHER FLOORS CARPETED STAIR CLEARANCE/RAILINGS SMOKE DETECTORS BATHROOM FANS PLUMBING FIXTURES • FOUNDATION INSULATION GARAGE FIRE PROOFING DOOR CLOSERS FINAL ELECTRICAL E PLAN/VARIANCE REO. 7e7 17 FINAL SURVEY PLOT PLAN _ OK TO ISSUE C/O OR C/C /r TOWN OF QUEENSBURY ' ; BUILDING & CODE ENFORCEMENT �050 742 BAY ROAD QUEENSBURY NY 12804 ��jj (1 (518) 7611--8256 ARRIVE: /� ' ��S DEPART: / ^/ INSP: FINAL INSPECTION REPORT - RESIDENTIAL DATE INSP CTION REQUEST RECEIVED: l//LS NAME P?8/e� LOCATION .O'm' �� DATE it/Z-Vb-4" �--/ PERMIT # TYPE OF STRUCTURE J!"'� FOOTINGS FOUNDATION BACKFILL _ FRAMING ROUGH PLUMBING SEPTIC ULATION _ FINAL ELECTRICAL_ WOOD TOV^ OR FIREPLACE N/A YES NO CHIMNEY HEIGHT/B VENT/} IGIT PLUMBING VENT 1OOFING EXTERIOR FINISH DECK/PORCH/STEPS/RAILINGS RELIEF VALVES FURNACE/HOT WATER OPERATING INTERIOR TRIM/PRIVACY DOORS FINISH FLOORS: BATH/KITCHEN WATERTIGHT OTHER FLOORS SWEEPABLE OTHER FLOORS CARPETED STAIR CLEARANCE/RAILINGS SMOKE DETECTORS BATHROOM FANS PLUMBING FIXTURES / • (FOUNDATION INSULATION v/ GARAGE FIRE PROOFING DOOR CL S RS� �+ FINAL E CTR'ItAL `€t5 SITE PLAN/yAR(vsF REQ. FINAL SURVEY LOT PLAN 717 - OK TO ISSUE /O OR C/C MAW P5r5 TOWN OF QUEENSBURY FIRE MARSHAL QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 745-4424 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED NAME ie:kk,c) 4 D 1'4/ LOCATION gat., 1` DATE *I/0( PERMIT# U1 APPROVED N/A YES NO EXITS AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTING FIRE EXTINGUISH:'. AUTO. EXTINGU ' :TEM HOOD INST' ITION AUTO. S' ' NKLER S 110P M A 'AR YSTEM INTERIOR FINISHES STORAGE: CLEARANCE TO SPRINKLERS CLEARANCE TO HEATING UNITS REQUIRED SIGNAGE C�tIMNEY /g00DSTOVE ." FIREPLACE-MASONRY /fIREPLACE-FACTORY BUILT Z' REMARKS: [ 1 OK TO THIS DATE 2/015 PE TOR TOWN OF QUEENSBURY 4111164. BUILDING & CODE ENFORCEMENT O� 742 BAY ROAD QUEENSBURY NY 12804 (518) 761-8256 ARRIVE: 3130 DEPART: 3150 INS FINAL INSPECTION REPORT - RESID NTI DATE INSPECTION REQUEST RECEIVED:NAME A► 0Rall: ` P 2 fl L 1/Yl1 LOCATION RP‘`. 'f 0 DATE _ 9\16`gtc PERMIT r 963 n b TYPE OF STRUCTURE 6EV) 1 7 FOOTINGS FOUNDATION BACKFILL FRAMING ROUGH PLUMBING _ SEPTIC _ INSULATION _ FINAL ELECTRICAL WOODSTOVE OR FIREPLACE - N/A YES NO CHIMNEY HEIGHT/B VENT/HEIGHT PLUMBING VENT ROOFING .EXTERIOR FINISH / �/ ..X 1`�� To ( P J/ ;DECK/PORCH/STEPS/RAILINGS RELIEF VALVES FURNACE/HOT WATER OPERATING ,INTERIOR TRIM/PRIV1"Y DOORS ________/_____ FINISH FLOORS: BATH/KITCHEN WATER'*fIGHT OTHER FLOORS SWEEPA LE OTHER FLOORS CARPETE GCE-11_AP, STAIR CLEARANCE/RA \g//)( ;SMOKE DETECTORS ►sjER, ' -ELT Y BATHROO PLUMBING FIXTURES / FOUNDATION INSULATIION F \/ GARAGE FIRE 113 OR OFING blk _t..) � DOOR CLOSERS FINAL ELECTRICAL C� 1\i)rvC1 ./ SITE PLAN/VARIANCE REQ. QFINAL SURVEY.,fl OT P OK TO ISSUE C/O 0 /C FAQ ►J ° C=F\ C V0tAtT h -VD gEf)c \ F-Look, =1 Fou v. i c o13 t050L OL\ � 10 \‘ �9(0 Main Office 357 Elwyn Terrace — Manheim,PA 17545 96,.,(.{3. MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL 'anel Board No. Cert. N° 3 0 7r�9 8 Cut-in Card No. )wner �-N.. ;/ 4 __)�, 0�. �SKi )ccupant .ovation fry R. , caa� (-zip L/ nstallation Consisting of 63 ,fit r hi /e3e4—t P`',... c) c e ... /,PoAr - ,Rfrirz't70 eeii-.vGF Dii. +j.. r >P,...f. i.4` `.�-fin v�e �ee,�,,,,,,, cO A S r /i C c - ,1�,1 y6/L nstalled By :3 frr" C.-- Lic. # The conditions following governed the issuance of this certificate,and any certificate previously ;sued is cancelled:— This certificate only covers the electrical equipment and installation conditions as of date. Upon he introduction of additional equipment or alterations, application shall be promptly made for aspection. Inspectors of this Company shall have the privilege of making ' spections at any time,and if its ules are olated,the Company shall have the right to revoke h' c tificate. )ate... :1.7.q INSPECTOR ember N.F.P.A.,I.A.E.1. TOWN OF QUEENSBURY sib BUILDING & CODE ENFORCEMENT " � 742 BAY ROAD QUEENSBURY NY 12804 (518) 761-8256 ARRIVE: c J0,a) DEPART: 3a� INS FINAL INSPECTION REPORT - RES DEN DATE INS IO REQUEST RECEIV D: �j _ NAME L)oj Y ( \S r(i ,'CCil.k /` LOCATION V (' DATE _ 1 1 PERMIT N � p-OYS L TYPE OF STRUCTURE SC- FOOTINGS FOUNDATION BACKFILL FRAMING _ ROUGH PLUMBING SEPTIC INSULATION FINAL ELECTRICAL WOODSTOVE OR FIREPLACE ° N/A YV NO CHIMNEY HEIGHT/B VENT/HEIGHT PLUMBING VENT / ROOFING v EXTERIOR FINISH \ J/ DECK/PORCH/STEPS/RA IN=.S Y RELIEF VALVES FURNACE/HOT ER OPERAT NG VI INTERI' TRIM/PRIVACY DOOS FINISH FLOORS: BATH/KITCHEN WATERTIGHT OTHER FLOORS SWEEPABLE V OTHER FLOORS CARPETED �� OCrtr(jM Y J C.1.3--Ate '8T'f\C-1-)"� STAIR CL NCE/RAILINGS SMOKE DE TORs OGC ICJ tWC� \/ BATHROOM FANS f PLUMBINGXTURES \/ / FOUNDATI INSULATIO DDO, ,� ARAGE FIRE PROOFING(HEM-Y TTh1 4 DOOR CLOSERS / FINAL ELECTRICAL ,�// SITE PLAN/VARIANCE REQ. __L FINAL SURVEY PLOT PLAN (+ I OK TO ISSUE C/O OR C/C D Cot-AR cTE ,6101 tJG fl-V.--11-1\ Ak_i__ ETD t- o T t-\AVE Pao (DgACOE ocZ 9._EQo\c2- -n 5 i vw___ C.oN►P E ?Ef aoor\ Oootz1 t \ 5t t_ cot- 5 ocSCZ LCt -Tb) Ni \Q Yn (518) 761-8256 TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 64. 742 BAY RD. , QUEENSBURY NY 12804 l / l 1:rae_INSPECTOR'S REPORT: ARR! 1/) DEP / 'e� REQUE O INSPECTION RECEIVED: NAME LOC ION DAT i - PERMI TYPE OF STRUCTURE: RECHECK APPROVED N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN ACE THE CONTRACTOR IS RE, PONSI•LE FOR PROVIDING PROTE TION RO FREEZING FOR 48 HOURS FOLLOWING .''E PLACE- MENT OF THE CONCRETE. MATERIALS FOR THIS ' RPOS ON SITE FOUNDATION WALLP% R REINFORCEMEN' FOUNDATION/DAMPPROOFING BACKFILL APPROVAL PLU ING VENT/V NTS N PLACE NG L1-( , '-'-112 PRAMIING UNDER SLAB NG: JACK STUDS/HEADERS BRACING/BRIDGING JOIST HANGERS JACK POSTS/MAIN BEAM AIR INFILTRATION BARRIER 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 R- TOWN OF QUEENSBURY � Y/`) FIRE MARSHAL, QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 745-4424 C3 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED T--(;)-- (P 1111 NAME Cob Y `)S Ki ,r e_tO LOCATION `0J DATE r PER IT# (r) - oc APPROVED N/A YES NO EXITS AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTING FIRE EXTING AUTO. EXTINGUISHING SYSTEM HOOD INSTALLATION AUTO. SPRINKLER SYSTEM ALARM SYSTEM INTERIOR FINISHES STORAGE: CLEARANCE TO SPRINKLERS CLEARANCE TO HEATING UNITS REQUIRED SIGNAGE CHIMNEY WOODSTOVE FIREPLACE-MASONRY FIREPLA� .c ACTO,RY BUILT ti�t oC.e -�, REMARKS: OK TO THIS DATE 2 2/015 / INSPECT TOWN OF QUEENSBURY FIRE MARSHAL QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 745-4424 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED 7 29/g( NAME �/9d �,�vj / LOCATION AL ' DATE 0-i/7/ PERMIT# 70 [.�9-l?? ') . 3 ,!",:7 ', , APPROVED EXITS J N/A YES NO AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTING FIRE EXTINGUISHERS AUTO. EXTINGUISHING YSTEM HOOD INSTALLATION ' AUTO. SPRINKL YSTEf ALARM SY , INTERIOR FINISH $,' A , STORAGE: CLEARANCE TO SPRINKLERS CLEARANCE TO HEATING UNITS REQUIRED SIGNAGE 4HIMNEY WOODSTOVE FIREPLACE-MASONRY FIREPLACE-FACTORY BUILT REMARKS: [ OK TO THIS DATE -- /r/, . `r y"r//i��y, :>iL�_ ,2_, -, - i 5-- , %,. ..,-i, `r - y i 2/015 IN ECTO r iICM1 (518) 761-8256 TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 BAY RD., QUEENSBURY NY 12804 \ INSPECTOR'S REPORT: ARR/ 'LOEPAR/,_ `t REQUEST Oak INSPECTION RIVED: NAME YU S LOCATION 6E3 Ar DATE PERMIT A (9( O S 5 TYPE OF STRUCTURE: RECHECK APPROVED NO FOOTINGS PIERS MONOLITHIC POUR FORM REINFORCEMENT PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROT; TION FROM FREEZING FOR 48 HOURS FILLOHING THE PLACE- MENT OF THE CO CRETE. .` MATERIALS FOR T IS PURPOSE ON SITE FOUNDATION WALL'OUR REINFORCEMENT IN PLACE FOUNDATION DAMPPRIsFING BACKFILL APPROVAL PLUMBING VENT VENTS IN PLACE ROUGH PLUMBING PLUMBING UNDER SLAB FRAMING: 4 JACK STUDS/HEADERS BRACING/BRIDGIN JOIST HANGERS JACK POSTS MAIN BEAM AIR INFILTRATION BARRIER _ HATING ROUGH-IN INSULATION: 1017 FOUNDATION WALLS IN RIOR R- FOUNDATION WALLS E ERIOR R- FLOORS R- WALLS R- CEILING R- DUCT WORK OR PIPING IN UNHEATED SPACES R- 444_ Co _ 1( C)' (518) 7614256 TOWN OF QUEENSBURY Y-- BUILDING & CODE ENFORCEMENT 742 BAY RD., QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARR7 L DEPARTZ-2j INT -- REQUEST I SPECTION CEIVED: NAME LOCATION DATE -7"l ERMIT l TYPE OF STRUCTURE: _J RECHECK APPROVED N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FO,W REINFORCEMENT IN *LACE THE CONTRACTOR I. RESPONSIBLE FO PROVIDING PROTE ION FROM FREEZI G FOR 48 HOURS FOL OWING THE PLACE MENT OF THE CONC•ETE. MATERIALS FOR THI• PURPOSE ON TE FOUNDATION/WALLPO R REINFORCEMENT IN PACE FOUNDATION/DAMPPROO ING BACKFILL APPROVAL PLUMBING VENT/VENT PLACE ROUGH PLUMBING PLUMBING UND ' SLAB FRAMING: _ J•CK STUDS/HEAD •S .RACING/BRIDGING JOIST HANGERS JACK POSTS/MAIN B AIR INFILTRATION BARRIER IjEATING ROUGH-IN _ /INSULATION: FOUNDATION WALLS INTERIOR R- FOUNDATION WALLS EXTERIOR R- _ FLOORS R- WALLS R- - CEILING R- DUCT WORK OR PIPING IN UNHEATED SPACES R- Q\cciA 41:12n— (518) 761-8256 TOWN OF QUEENSBURY :PO I BUILDING & CODE ENFORCEMENT CI 742 BAY RD., QUEENSBURY NY 12804 11/ INSPECTOR'S REPORT: ARR,\'•z41 DEPART \-_L(c REQUEST FOR INSPECTION RECEIVED: 7 - NAME abY K l(ak' LOCATION A-C) DATE _L 9 PERMIT I 9 W_ORS TYPE OF STRUCTURE: 15 c RECHECK APPROVED N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE _ THE CONTRACTOR IS RESPONSIBLL FOR PROVIDING PROTE TION FROM FRE ZING FOR 48 HOURS FOLLOWING THE P .CE- MENT OF THE CONCRETE. MATERIALS FOR THIS PURPOSE ON S E FOUNDATION/WALLPOUR REINFORCEMENT IN PLACE FOUNDATION/DAMPPROOFING BACKFILL APPROVAL / PLUMBING VENT VEN S IN ACE ✓/ ROUGH PLUMBING A, - y 'c 0'��\ _- PLUMBING UNDER SLAB FRAMING: C ' y� JACK STUDS/HEADERS BRACING/BRIDGING JOIST HANGERS JACK POSTS/MAIN BEAM j AIR INFILTRATION BARRIER 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 R- TOWN OF QUEENSBURY �-�� BUILDING & CODE ENFORCEMENT) " n ) 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION '-)Name C) °yO ► 'Y\k Location (f ) Date-) P-1 -9 (i Permit # C)1( OKS SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORP ON FIELD: Total ength Length o each trench Depth of ` enches Size of sto - SEEPAGE PITS: Number- Size - t. x ft. Stone size PIPING: Size Type Bldg. to Tank 1.� z)LK) Tank to Dist. Box Dist. Box to Field!' Openings Sealed? a No Partial LOCATION/SEPARATIO° . Foundation to Tank gi feet Foundation to Abso ption feet Separation of Pit- feet Conforms as per P of Plan — Yes No ION OF SYS ?1 Oaf PROPERTY: cir.le one) Fron - Rear - Left Side - Right Side . '•dle Front - Middle Rear COMMENTS: ost • SYSTEM USE APPROVED: YES N0 Arrived: /2 - ZO Departed: /2 r_ c Building Inspector / 6-01.1 TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 BAY RD., QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARR." DEPARTZ 1 AO IN'1" . REQUEST F R INSPECTION RECEIVED: NAME 605/e( iJe LOCATION'' J DATE d PERMIT # �e_�� TYPE OF STRUCTURE: RECHECK _ APPROVED N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTE TION FROM FREEZING FOR 46 HOURS FOLLOWING THE PLACE- MENT OF THE CONCRETE. i MATERIALS FOR THIS PU OSE ON SITE FOUNDATION/WALLPOUR REINFORCEMENT IN PLACE FOUNDATION DAMPPROOFING i -T BACKFILL APPROVAL iLUMBING VENT TS IN PLACE !ROUGH BING 5/4- PLUMBING UNDER SLAB FRAMING: JACK STUDS/HEADERS BRACING/BRIDGING JOIST HANGERS { JACK POSTS/MAIN BEAM _ AIR INFILTRATION BARRIER 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 R- 6106 /5 , c."L o 4)C b F.-4JA., Uec4.- %d /WSSJR6- -Ili amdKie )uT aF I * TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 BAY RD., QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARR DEPARSi' IN'N'� REQUEST FOR INSPECTION RECEIVED: NAME tbDQkosl< I LOCATION /I 4-y ,& DATE �l L1/�C.7 PERMIT�II 91 C � TYPE OF STRUCTURE: -�/- LJ RECHECK _ APPROVED N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTE TION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACE- MENT OF THE CONCRETE. MATERIALS FOR THIS PURPOSE ON SITE FOUNDATION/WALLPOUR REINFORCEMENT'IN PLACE FOUNDATION/DAM*PROOFING BACKFILL APPROV.L PLUMBING VENT/VE.TS IN : ACE ROUGH PLUMBING PLUMBING UNDE' LA. FRAMING: ACK STUDS( ADERS BRACING/GRID ING JOIST HANGER' JACK POSTS/M,IN BEAM . AIR INFILTRATION BARRIER 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 R- (518) 761-8256 TOWN OF ODEEENFRC (01/ BUILDING & CODE ENFORCEMENT 742 BAY RD., QUEENSBURY NY 12804 C `E INSPECTOR'S REPORT: AR$�J� DEPART""./VINT -3 REQUEST FOR INSPECTION R�E/CEIVED: , / -'£1 NAME ( j, 1 • LOCATION DA4'EL + l; PERMIT # ( TYPE OF STRUCTURE: RECHECK APPROVED N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE _ THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTE TION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACE- MENT OF THE CONCRETE. MATERIALS FOR THIS •URPOSE ON SIT FOUNDATION/WALLPOUR REINFORCEMENT IN PLAC FOUNDATION/DAMPPROOFING BACKFILL APPROVAL PLUMBING VENT/VENTS IN PLA! ROUGH PLUMBING 9UMBING UNDER SLAB FRAMING: JACK STUDS/HE DERS--- J BRACING/BRID'ING - ✓/ JOIST HANGE•S JACK POSTS/MAIN BEAM AIR INFILTRATION BARRIER 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 R- 1. ALL 0 R.6CHaCK A &12 13/-0140/b TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION i ice\ Name y tf �� Y�� �� 1 , � A( Location 2y),),,,,1 �> Date p - Permit # 9(0 (� SOIL TYPE: and-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length/ 2,5 Length of each trench i 5-6 Depth of trenches Size of stone z./ SEEPAGE PITS: Num. -r- Size - ft. x ft. Stone size IPING: Size Type B l , to Tank fits$ Zac Tank to i.st. Bo // I t) � Dist. Box to F - d/' . � r--- Openings Sealed ' dip No Partia LOCATION/SEPARPaI Foundation to ank _feet Foundation to Absorption feet Separation of Pits j feet Conforms as p-r Plot an ` Yes No LO , ION OF YSTEM Of PROPERTY: - one) Front Rea - Left Side - Right Side e Fron - PM dd i e Rear COMMENTS: u - Kehl&c_t..4 OF qc0C6 lO TA/44< LLAi6 , c30$ it /�5-- gthi-To & PL�4� cc SYSTEM US E APPROVE© YES NO Arrived: 3 . Departed: Alksp Building Inspector '11441. R4/( TOWN OF QUEENSBURY0111 BUILDING & CODE ENFORCEMENT 531 BAY RD., QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARR . DEPARB I J IN/T.,1, L--- REQUEST FOR INSPECTION . EIVED: If/ f a1 �(-p NAME // GA wi�� G") • •A • c 4 LOCATIGN Ld1,�'. �Ji / 1 •tDATE • _ . RMIT M ,&P 01 TYPE OF TRUC URE: ' "' RECHECK , APPROV N/A YE NO IMOTINGS/PIERS MONOLITHIC POUR FORM ' / REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTE ON FROM FREEZING FOR 48 HOURS FOLL ING THE PLACE- MENT OF THE CONCRE E. Tli MATERIALS FOR THIS PJRPOSE 0 SITE FOUNDATION/WALLPOUR \ REINFORCEMENT IN PLA FOUNDATION/DAMPP OFING ' BACKFILL OVAL PLUMBING VENT/VENTS IN PLA0, ROUGH PLUMBING j j . PLUMBING UNDER SLAB \\,1 FRAMING: JACK STUDS(HEADERS BRACING/BRIDGING JOI-T HANGERS JACK POSTS/MAIN BEAM AIR INFILTRATION BARRIER 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 R- 1/4 hfrdf/T) TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 BAY RD. , QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARggs DEPART REQUEST FOR INSPECTION RECEIVED: ` _ k� NAME _ < 1 _5 4 , , LOCATION ,, DATE 2 9- C MIT # TYPE OF STRUCTURE: RECHECK APPROVED____ N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTE TION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACE- MENT OF THE CONCRETE. MATERIALS FOR THIS PURPOSE ON SITE FOUNDATION 'LLPOUR REINFORCEMENT IN PLAC 1 FO NDATION DAMP"00r NG 1 BACKFILL APPROVA Aiik& -V PLUMBING VENT NTS IN = ACE ROUGH PLUM:. G PLUMBING UNDER SLAB FRAMING: JACK STUDS/HEADERS BRACING/BRIDGING JOIST HANGERS JACK POSTS/MAIN BEAM AIR INFILTRATION BARRIER 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 R- TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 BAY RD., QUEENSBURY NY 12804 '•• INSPECTOR'S REPORT: ARR1004EPARMAL I 'i REQUEST FOR INSPECTION RECEIVED: NAME \DCCR\(��� LOCATION P)M 90pk) DATE 7 21112 PERMIT # 96-0� TYPE OF STRUCTURE:{{ RECHECK APPROVED N/A YES NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTE TION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACE- MENT OF THE CONCRETE. MATERIALS FOR THIS PURPOSE ON SITE FOUNDATION/WALLPOUR REINFORCEMENT IN PLACE _ .FOUNDATION/DAMPPROOFING CBACKFILL APPROVAL PLUMBING VEN VENTS IN PLACE ROUGH PLUMBINI _ Vr PLUMBING UNDER _ AB FRAMING: AIL CK STUDS. EADERS BRACING BRIi. ING JOIST HANGER` JACK POSTS/MAIN BEAM AIR INFILTRATION BARRIER 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 R- M6TIY rr:;\.<.,_ J 0 o�C� ee- t L-1� a,,, TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 BAY RD., QUEENSBURY NY 12804 INSPECTOR'S REPORT: ARR ' EPAR'E #INTJ,e REQUEST FO INSPECTION RECEIVED: 1�- q C1 (-f!) NAME _ re'C.JL-) LOCATION DATE PERMIT ?---%_ ::_p_S:E; TYPE OF STRUCTURE: RECHECK _ APPROVED _ N/A YESA NO "OOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTE TION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACE- MENT OF THE CONCRETE. f MATERIALS FOR THIS PURPCSE ON SITE FOUNDATION/ ALLPOUR REINFORCEMENT N PLACE FOUNDATION/DAMPPROOFING BACKFILL APPROVAL _ PLUMBING VENT/VENTS IN P ACE ROUGH PLUMBING 7/ _ __ PLUMBING UNDER SLAB FRAMING: JACK STUDS/HEADERS BRACING/BRIDGING JOIST HANGERS -- - " JACK POSTS/MAIN BEAM AIR INFILTRATION BARRIER 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 R- TOWN OF QUEENSBURY r DEP ARTMBNT OF COMMUNITY DL.VL.L.OPMBNT z APPROVE Application li BUILDING PERMIT NUMBER < I I iiii '" �+ APR - (�1� a r. r4 21996 I i q G - 0 g5" Ip,-,--w 0 Q 1. BASIC/BUILDING PERMIT INFORMATION: Zoning Admi 'strator I Applicant/Name & Address Agent/Name & Addre..s TOwN or n"GFNSBURY 1 n applicant agent 1-, H y - crT MAP NUMBER: • a�tit I`l�tiic ; 41�1tes,3 O7, —l — /5 1 c I p `rQS ► Yew A g ka - 34- 2. PROJECT DESCRIPTION: ___ _ _ -c.0 w 1_ �17 -- -- -- 111 . of plan (2 copies) IPI uilding plan (2) c'sewage disposal nergy code 3. PROPERTY INFORMATION: electrical inspection [driveway permit S ET EA C'I S REQUIRED ACTUAL, [rcompleted/signed 1:(FEE PAID Front Yard Mill Z,BEININSQ , Front ( if corner) �_� Side Yard (1) b `j, i/'•r ❑ NEW CONSTRUCTION Side Yard (2) � _,1�111EINEM11111 ❑ ADDITION Rear Yard M� �..• foSfine • ❑ ALTERATION Width IWMEIFMIIIIIIIIIIIIIIMII ❑ MODIFICATION De.th ❑ SION • YES NO A PROPERTY IS IN APPROVED SUBDIVISION Hattie im10. Meets depth, width & square footage requirements Preexisting, nonconforming lot with proper setbacks Required road frontage on public road Has required off-street parking Permeable area is adequate /[Required: 7s- % Building does not exceed maximum height / Max. Walla Required setbacks from stream, lake and/or travel corn.or meets requirement Buffer zones required Is lot in a Flood Plain Zone? 0 E' ER 4. STAFF DETERMINATION: As per Section(s) of the Zoning L I Sign ❑ Subdivision Ordinance Ordinance Regulations 5. REVIEW REQUIRED BY ZONING BOARD OF APPEALS: ACTION FILE NUMBER RESOLUTION DATE ❑ Use Variance ❑ Area Variance ❑ Sign Variance ❑ Other Comments: 6. REVIEW REQUIRED BY PLANNING BOARD: ACTION FILE NUMBER RESOLUTION DATE ❑ Site Plan Review • ❑ Subdivision ❑ Planned Unit Dev. ❑ Other Comments: FREVIE'13"'1'ED BY STAFF DATE COMMENTS Arlo � 3 ag No, Date erG 19_ COMMONWEALTH ELECTRICAL INSPECTION SERVICE INC. (Consulting and Fire Inspection Services) (Incorporated in the States of MAIN OFFICE:357 Elwyn Terrace,Manheim, PA 17545 • (717)664-2347 New York,Maryland,Pennsylvania,Delaware) 800-732-0043 LOCATION Please give full and accurate directions in order to avoid delay (Use back of sheet if needed) Desiring Certification of Approval, application is made for inspection of electrical installation in the premises described below.On demand,applicant agrees to pay for inspection service in accord with schedule of charges. PLEASE PRINT DATE Owner dvQ�..2G G- +4✓ ,C/2tOlf/ Type Bldg. ❑DWG ❑Other .. ... Occupant Building Permit No. .. � Job Location aAl 0• City.:4?c' i .£Q y State .,..... County WAIVE " Twp. Swimming Pool—New❑Old❑ Owner's Address Pool Permit No. Directions to Job Site tsC Al, /4 wvIT/ t J f`+` © 4 n`I Application For Rough Wiring❑ Fixtures❑ Service❑ or Work—New D Additional❑ Bldg.-New❑ Old❑ Ready for Inspection Fee Remitted Check ❑ Cash❑ Make Payable To C.E.I.S.,Inc. LIST ALL EQUIPMENT AND WIRING NUMBER OF ROUGH NUMBER OF ELEC.HEAT-AIR CONDITIONERS-BURNERS-DRYERS-HEATERS-RANGES,ETC. WIRING OUTLETS FIXTURES NUMBER TYPE OF DEVICE H.P.OR K W NUMBER TYPE OF DEVICE- H.P.OR K.W. SWITCHES MERCURY LIGHTING SODIUM RECEPT. FLUORESCENT ELEC.HEAT QUARTZ MOTORS:H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1.1/2 2 3 5 7-1/2 10 15 20 25 30 40 50 75 100 MARK NUMBER OF EACH SIZE OTHER EQUIPMENT APPLICANTS SIGNATURE LICENSE# PERMIT# PLEASE - - PRINT NAME PHONE# APPLICANTS NAME OF ADDRESS UTILITY OFFICE TO CITY STATE - ZIP CODE BE NOTIFIED ROUGH WIRING SPACE BELOW FOR USE OF INSPECTORS ONLY OUTLETS AMP SERVICE PUMP EQUIPMENT SWITCHES HEAT OVEN PUMP RECEPTACLES SURFACE GARBAGE UNIT DISPOSAL UNIT MEDIUM BASE RANGE FIXTURES MOGUL BASE WATER DRYER FIXTURES HEATER FLUORESCENT AIR AMP. RECEPTACLES FIXTURES CONDITIONER MERCURY VAPOR OR WIRING&CONTROLS FOR BURNER FRAC_H.P. QUARTZ FIXTURES VENT FANS MOTORS:H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1-1/2 2 3 5 7-1/2 10 15 20 25 30 40 50 75 100 MARK NUMBER OF EACH SIZE APPARATUS MISC.INFO. DATE INSPECTED RE- NOTIFIED POR- Q 0 FEE PAID DON LOVELAND TED z Electrical Inspector CON- TRACTOR TOTAL $ t' P.O.BOX706 WORK INSPECTED HAGUE,NY 12836 ❑R.W. ❑SERV OWNER CHECK NO. (518)543-6724 ❑FINAL OCCUPANT CHARGE j-800-562-9934 CERTIFICATE NEEDED AGENT CASH ❑YES ❑DUP ELEC. H.O. LT.CO. TEMP CARD# DATE INSPECTOR FINAL CARD# BP//9S27 Rev 1/95 APPLICATION EXPIRES ONE YEAR FROM DATE. WHITE/Office CANARY/Officer PINK/Inspector GOLD/Customer � ON GI � D LANDS OF 'j SUSAN R. WRIGLEY N ": D ( 73 7-39 ) hhf � :Z) S B/° _ 3 W 3' _ 36„ E 2a - v p h o PORCH FOOTING m v�� ;o • Li h ONLY WELL cQ to ~ 253.0' - I Z N 4 O 5.095± A c. Approx!"— DIRT C] o- N • �\ I Se tic Approx. D-Box Q I `� _-{F---• W ` N OO°-4/'-26" E 3 2s�.s' 0 I � 'O I 60.27� 2 `\ � I Approx. Location � A ion 9 a - — Tile Feld /v S t ° n e w a /I Poured Concrete Foundation N'�} O N B/ 16'-00 w I w/walls and Basement O 340 20 �� Stonewall..',, O m /V 8/0_ -Remains m 0p„ W I I 0 56 Remains 0 f � � Stonewall C o W r v � I i o J o LANDS OF JESSE L. JENKINS I O) I ( 724-245 ) I O I LANDS OF GEORGE GORE O 8 � THOMAS MCDONOUGH w ( 888-125 ) L N - - >> u Z jZ o oLl I J tWA Z m �� I m 00 „ J MAP OF SURVEY I 'R I of lands to be conveyed to W A )"IdDi E W T. L INDA A . D10BR0 SKl L EGEND• TOWN OF QUEENSBUR Y, WARREN COUNTY, 'VEW YORK 0 FOUND IRON MARKER C:ERTIF I CAT ION SCALE: 1" = 100' JUNE 97 1995 I hereby y Andrew T. and Linda A. UPDATED: MARCH 27 1996 - to show proposed house et O � SET IRON ROD W/TN CAP y certify o f t o TAX MAP No 28 - l - l5 P p house, et POINT assigns ask i , Al b an k FSR, its successors and/or �� ` L.916 P.102 UPDATED: APRIL 25, 1996 - to show foundation location, ���� R� .. assigns and First American Title Insurance Q P �� drive & well -- £— POWER L/NE Company of New York that this map has been �i3 °'�r UPDATED: JULY 9, 1996 - to show approximate location 000 STONE WALL prepared in accordance with the existing code * $ of septic system —x—x— FENCE of practice for Land Surveyors adopted by the New York State Assoc . of Professional Land 0 ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY Surveyors. a o.aso�a ti,.<,N � a MARKED WITH AN ORIGINAL OF THE LAND SURVEYOR'S EMBOSSED SEAL OR INKED STAMP SHALL BE CONSIDERED TO BE VALID TRUE COPIES. W. ✓. ROURKE,, ASSOCIATES 0 07109196 Z26—4. �`"''� _ L icensed Land Surveyors Unauthorized Alteration to this map is a William J. RnurE:e LS 490,38 � � �-�L-.--- 10264 Sorotogo Rood, P. O. Box /434 JOB N2 0 violation of Section 7209, Subdivision Z 2 of the New York State Education Law. WILLIAM J. ROURKE, LICENSED LAND SURVEYOR N949098 South Glens Fo//s, N. Y. /2803— 95-99 B m