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1992-130 t oCERTIFICAT E OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date 0/"/)v jg 6: This is to certify that work requested to be done as shown by Permit No. 92-130 has been completed. This structure may be occupied as a Plod l ar $i nq�a Faini ly Location Lot 07 Big BAy Rd Owner By Order Town Board TOWN OF QUEENSBURY Director of Bldg. & Code Enforcement -i a BUILDING PERMIT x 3 a TOWN OF QUEENSBURY o No. 92-130 WARREN COUNTY, NEW YORK � N I N I PERMISSION is hereby granted to Trevor Barber V OWNER of property located at Big Bay Road Street,Road or Ave. in the Town of Queensbury,To Construct or place a Modular Single Family Dwelling 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. a 1. OWNER'S Address is Cr CD 12 Spring Street Y Glens Falls, NY 12801 cD 2. CONTRACTOR or BUILDER'S Name p AJH, INc Ballston Spa, NY 3. CONTRACTOR or BUILDER'S Address W tB W 4. ARCHITECT'S Name 1< a 5. ARCHITECT'S Address r 0 C+ V 6. TYPE of Construction—(Please indicate by X) 3 C (X)Wood Frame ( ) Masonry ( )Steel ( ) C a 7. PLANS and Specifications � N No. 1008 sq ft Mudular Single Family Dwelling as per plot plan specifications Ga, and application rD 8. Proposed Use a Modular Single Family �. $ 120.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 15, 19 93 (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 15th Day of April 1992 SIGNED BY for the Town of Queensbury wilding and Zoning InspectoSE i i TOWN OF QUEENSBURY APPLICATION FOR SEPTIC DISPOSAL PERMIT *Permit # et IMOF70IMNSBUH RECErVED Date: -T / Reviewed B APR-4-992 LOCATION OF PROPERTY FOR INSTALLATION: < c' EPT. Owner' s Name: F �`�,�C/f� �✓ A-2 �� Owner' s Mailing Address: /.7- ���-> e� �. • �-�;-Ls P Installer' s Name: Phone #: Jj 7-7,/ 7 J Number of bedrooms (if residential ) : Total daily flow (residential-compute @ 150 gal . per bedroom): Topography-Circle One: Flat Rolling Steep Slope % of Slope Soil Nature-Circle One: Sand Loam Clay Other /Depth: Ground Water-At What-Depth? Feet Bedrock or Impervious Material-At What Depth? Feet Percolation Test-Circle One: Not Re u' Required/Rate Min. Per Inch Domestic Water Supply-Circle One: cipal ell Other If domestic water supply is a we - Separation: Water supply from any septic absorption feet PROPOSED SYSTEM: Septic Tank 16161 e) gal . (Minimum size: 1,000 gal . ) Tile Field: Each Trench So feet//Total System Length a o feet � Seepage Pit(s) : Number o / Size each: ft. Size of Stone to be used: Depth or Thickness eet HOLDING TAN�I��S�` E�FI IF REQUIRED No. of Tanks ��' Size\of Each _ a-1 . Alarm system and associ_ tom" electrical work to be insRee be_—y a certified agency. ---- - I ha ead the regulation on t everse side of this and agree to abide b hese and all requiremen the Town of Queen y Sanitary Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: DATE: - 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: TOWN OF QUEENSBURY L REVIEWED BY: QUEEIVSBL;kr `CEIVED FEE PAID:41: 1 f APR 8 1992 PERMIT NO. : r 6 �z 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:­_ .�, �/�2 ,3 fa p?,E �� �� P.O. Address: : �✓� ��� c'�s �� _ ,r PHONE/ /S /GJ Property Location: i > ,� �� Tax Map No. \ Has there been any split of this property since October 1, 1988? Yes No If yes, Planning Board Review is necessary. Subdivision Name, if applicable: Lot No. �- THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS: �BT NATURE OF PROPOSED WORK: * ESTIMATED MARKET VALUE OF THE . X Construction of new building * CONSTRUCTION: $ / 5� Addition to building Alteration to building * COMPLETE INFORMATION REQUIRED BELOW: (no change to exterior dimensions) * Size of Property: I ft. x ft. Other work (describe) * Existing Building Size: * ft. x ft. * Proposed building - distance rom GROSS AREA OF PROPOSED STRUCTURE: /o"r-'— * property line: 1st Floor 11 �- Sq. Ft. * ��Front Yard /J ft. Rear yard //s ft. * i� LSi de Yards ft. and j-7a-r-ft. - 2nd Floor Sq. Ft. * If on corner, -setback from side street- * ft: Other Floors v/ Sq. Ft. (not cellar or basement * OCCUPANCY INFORMATION: * TOTAL FLOOR AREA: Sq. Ft. * Primary Building - � * ,�( One Family Dwelling ASize of New Structure: � ft. x � ft. * Two Family Dwelling u Foundation:. * Multiple Dwelling/No. of Units _ Pier/Slab/Crawl/Partia /Full (Circle One) * Business * Industrial No. of stories (Habitable space) �� * Other Height (grade to ridge) /a ft. If -residential , no. of. families: * If addition, what will use be? No.-of rooms (excluding. baths):. * - No. of bedrooms: No. of bathrooms: / * Accessory Building: Primary heating system: 7 7/4c, * Detached Garage - One/Two Car Type of fuel :. 2 C_ * Attached Garage - One/Two Car No. of fireplaces to be insta.11ed: X,10 * Private Storage Building Will a woodstove be insta-l-led?: . u * Other Central Air Conditioning: Yes No (OVER) --- I _ 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: -' ® a-4- 0 Depth of Foundation below grade (to bottom of foot*n ) : � � (2®x Will there be a cellar? ��S Heated nheated Gi/U Floor Sq. Footage 1°°a Will there be a basementlam-arry-Krti on If so, what portion-?- Type of Roof: Sloped/Flat/Shed/Other Material of Roof Size, wood studs if x "; spacing " o.c. ; length ft. Joists (floor beams) : 1st Floor if x if; spacing If o.c. ; span ft. Joists (floor beams): 2nd Floor is It; spacing o.c. ; span ft. Overlays (ceiling beams): If x "; spacing o.c. ; span ft. Roof rafters: If 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 doo 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: f (A separate application is necessary for any repair or new- installation of septic. system. ) ..L NAME OF BUILDER & ADDRESS: PHONEAJ,7 7� r NAME OF PLUMBER & ADDRESS: PHONE NAME OF MASON & ADDRESS: PHONE NAME OF ELECTRICIAN & ADDRESS: PHONE DECLARATION To the best of my knowledge and belief the statements contained in this application, together with the plans and specifications submitted; 'are a true and complete statement of all proposed work to be done on the described premises and that all provisions of the BUILDING CODE, THE ZONING ORDINANCE, and all other laws pertainin th proposed work sh, be complied with, whether specified or not, and that. such work 's o ed by the owner. Signatu '.-Owber, owners agent, architel' contractor ------------------------------------------------------------------------------------------- SPECIAL CONDITIONS OF THE PERMIT: By: Code Enforcement Officer TOWN OF QUEENSBURY 531 BAY ROAD QUEENSBURY,_NEW-PORK 12804 TELEPHONE, (51b) 745-047 BUILDING INSPECTOR'S REPORT FINAL INSPECTION REQUEST FOR INSPECTION REECEIVEED NAME _/,ri1'°�.- o /✓Gs /� LOCATION DATE b PERMIT# TYPE OF STRUCTURE_ S- � �,� RECHECK&,] g� _FIRE MARSHAL APPROVAL (COMMERICIAL STRUCTURE) _FOOTING FOUNDATION BACKFILL FRAMING _ROUGH PLUMBING FINAL ELECTRICAL_ SEPTIC INSULATION WOODSTOVE/FIREPLACE REMARKS APPROVAL N/A YES NO CHIMNEY HEIGHT/LOCATION B VENT/LOCATION PLUMBING VENT ROOFING SIDING- DECK/PORCH/STEPS/RAILINGS / RELIEF VALVES FURNACE/HOT WATER OPERATING / INTERIOR TRIM/PRIVACY QOORS / FINISH FLOORS: a d BATH/KITCHEN WATERTIG OTHER FLOORS SWEEPABLE / OTHER FLOORS CARPETED N STAIR CLEARANCE/RAILINGS SMOKE DETECTORS 1 DOOR CLOSERS ;Y BATHROOM FANS ALL PLUMBING FIXTURES OPERATING GARAGE FIRE PROOFING DOOR CLOSERS d OTHER FIRE SEPARATION FIRE/DEMISE WALLS FINAL ELECTRICAL 6 OK TO ISSUE C/O OR C/C � COMMENTS: L ;l1�ek5I,J11"(4 (� Tv P`o n i �,v T7j�'r►���LAB' mil"LJ4 --1 ARRIVE .� d DEPART 6v INSPEC R ELECTRICAL INSPECTIONS / DUPLICATE MUNICIPAL RECORD Permit/Io. L Owner 'A Occupat Location l r 1d'�7 016 No. Streel Town or City State Installation as itemized on reverse side has been visually inspected pursuant to applicable Codes. X Installed by U Date_ W ��j �� C for MIDDLE DEPARTMENT INSPECTION AGENCY INC. , FORM NO.18 EL. 900 Haddon Ave.,Collingswood, NJ 08108 ROUGH WIRING OUTLETS H.P.AIR CONDITIONER ' OUTLETS WIRING &CONTROLS FOR BURNER RECEPTACLES H.P.PUMP FIXTURES 1 K.W.OVEN DAMP.SERVICE EQUIPMENT H.P.GARBAGE DISPOSAL UNIT AMP.SERVICE CONDUCTORS K.W. DISHWASHER K.W.SURFACE UNIT K.W. DRYER K.W.RANGE AMP. RECEPTACLE K.W.WATER HEATER FRAC. H.P.VENT FANS .MOTORS R.P. 11/20 1/12 1/10 1/e V6 % 1/z %z '/ 1 1%z 2 3 1 5 7%z 10 115 120125.130140150 75 10 HARK NUMBER IF EACH SIZE 4PPARATUS 1 ppppp- TOWN OF QUEENSBURY ✓. J 531 BAY ROAD QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 745-4447 BUILDING INSPECTOR'S .REPORT FINAL INSPECTION, REQUEST FOR INSPECTION RECEIVED ) NAME f/ii. l1 .tf S(ff/r its LOCATION DATE PERNIT# TYPE OF STRUCTURE �'� RECHECK A /&a, ��� �, . _FIRE MARSHAL APPROVAL (COMMERICIAL STRUCTURE) _FOOTING FOUNDATION BACKFILL FRAMING _ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC INSULATION WOODSTOVE/FIREPLACE REMARKS APPROVAL N/A YES NO CHIMNEY HEIGHT/LOCATION B VENT/LOCATION PLUMBING VENT ROOFING SIDING ; !. DECK/PORCH/STEPS/RAILING. RELIEF VALVES FURNACE/HOT WATER OPERATING,` INTERIOR TRIM/PRIVACY DOORS'" FINISH FLOORS: '4 BATH/KITCHEN WATERTIGHT; . OTHER FLOORS SWEEPABLV OTHER FLOORS CARPETED, ? STAIR CLEARANCE/RAILINGS SMOKE DETECTORS v $. DOOR CLOSERS i" BATHROOM FANS I ALL PLUMBING FIXTUR S OPERATINy GARAGE FIRE PROOFI G DOOR CLOSERS OTHER FIRE SEPARA PION FIRE/DEMISE WALLS FINAL ELECTRICAL OK TO ISSUE C/O OR C/C COMMENTS: ARRIVE DEPART IASPECYOR TOWN OF QUEENSBURY 531 BAY ROAD QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 745-4447 BUILDING INSPECTOR'S REPORT " FINAL INSPECTION REQUEST FOR INSPECTION RECEIVED 6 -s 9 NAME_ ' r LOCATION DATE C' PERMIT# TYPE OF STRUCTURE14,,i, t L, RECHECK FIRE MARSHAL APPROVAL (COMMERICIAL STRUCTURE) FRAMING _ROUGHNPLUMBINGDATIOINA�LECTRICAL t sEPTIC INSULATION WOODSTOVE/FIREPLACE . REMARKS /i / , APPROVAL N/A YES NO CHIMNEY HEIGHT/LOCATION B VENT/LOCATION / PLUMBING VENT I / ROOFING / SIDING / DECK/PORCH/STEPS/RAILIC�G� �- RELIEF VALVES FURNACE/HOT WATER OPERATING INTERIOR TRIM/PRIVACY DOORS FINISH FLOORS: BATH/KITCHEN WATE}t IGH OTHER FLOORS SWE. PABLE� OTHER FLOORS CARPETED 1 STAIR CLEARANCE//RAILINGS SMOKE DETECTORS' DOOR CLOSERS / L BATHROOM FA 1 ALL PLUMBINq FIXTURES OPERATING GARAGE FIRE PROOFING i DOOR CLOSERS 1 OTHER FIRE SEPARATION FIRE/DEMISE WALLS FINAL ELECTRICAL 1 C OK TO ISSUE C/O OR C/C 1 1 COMMENTS: 7 i 1415 2 /t rz St,i a r r i 5-rA-c1Z l A-6AO CL E +r1,4,cJr�r `filzL W, S:r P�o er CMrt rzG- � P05�' T i o ?�� I-'t.vcStfiG(C�Iy 2- ARRIVE DEPART =� f P;L INSPE TOR Jocun o� ueen�6urt� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME -1 Z-Q W (L LOCATION ,71 DATE.- fQ / q7—.PERMIT NO. qz—/ SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: f Absorption field, total length 2c)() Length of each trench -5 0 Depth of trenches 2-4T Size of gravel -- _ SEEPAGE PITS{Number of) Size- ft. Gravel size PIPING: Size Type Bldg. to tank J�q(�{-7 �'tf Tank to dist. box !'q vo C_ Dist. box_ to fieldC it G{ (f C Openings sealed? ES , ;+` NO Partial ,r a LOCATION/SEPARATIONS- ;� C)-)Cnn^. _ Foundation to tank ' ft. �L�9zo Foundation to absorption ft. P/19� i Absorption to lot line ft. Separation of pits y£ A/M--,ft. LOCATION O_SYSTEM 0I4 ROPERTt(circle one) Front - Rea - eft side - Right,. side - COMMENT SYSTEM USE APPROVED S N Building In pector 01/86 and vl 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 �RECEIVVEED NAME 4r 9 0-1 n� V LOCATION DATE p PERMIT # 9 Z— 3 c, TYPE OF STRUCTURE 14D 0cli1j-lam RECHECK APPROVED N/A IYES NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTECTION FROM FREEZING FOR 48 HOURS FOLLONING 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. JOIST HANGERS JACK POSTS/14AIN` BEAM 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 REMARKS° � �C� RUC ref-1 E✓rkNt� Pasnof,'(.Lrrn t� 'L L ARRIVE /0 3G DEPART �� L INSPEVTOR TOWN. OF QUEENSBURY (Ttz p� BUILDING AND CODES DEPARTMENT 531 BAY ROAD . QUEENSBURY, NEW YORK 12804 �- TELEPHONE (518) 745-4447 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED , Ala NAME �jL�!/�i•1�, %/fi� LOCATION DATE r PERMIT TYPE OF STRUCTURE RECHECK APPROVED N/A YESI 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 1 FOUNDATION/DAMPROOFING i BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/VENTS- IN -PL CE- 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 EXTERIOR R- " FLOORS r R- WALLS R- CEILING R- DUCT WORK OR PIPING IN UNHEATED;, SPACES f REMARKS: 0 f Pc ov ARRIVE DEPART if .30 r� zi INSPVCTOR MIDDLE DEPARTMENT INSPECTION AGENCY, INC.= ..�.. j National Headquarters 1337 West Chester Pike,West Chester, PA 19380 APPLICANT COMPLETES • Date:Zl— City, Town or Township ' 1 '=tee' County State Location/Address i ) . / lsiz�- _ (If L cated i' Rural Area lease Attach Directi ns) Pole # v f' is.✓� 62 t,; x2, Owner f/� yCo � ,��� ' Permit # Occupied As Building: New❑ Old El Occupant 2e`, Work Area in Building Floor #,etc.): App. for: Wiring❑ Service❑ or: Ready for Inspection: Fee Remitted-$ Cash❑ Check❑ M.O. ❑ Make Payable To: M.D.I.A. Number of Rough Wiring Outlets Elect. Heat 500 1 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 1 - 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 1112 2 3 5 711, 10 15 20 25 1 30 1 40 50 75 1 100 Mark Number of Each Size Applicant's Signature License # Permit # T/A Utility: (NAME) (OFFICE LOCATION) Applicant's Address: (City) (State) (Zip) Service Request # Phone # Electrician: •%A • DATE RECEIVED: DATE INSPECTED: Correct Location: Same as Above❑ or: Red Notice Label ❑ 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/z 10 15 20 25 30 40 50 75 100 Mark Number of Each Size Elect. Heat 500 1 750 1000 1250 1500 1150 2000 2250 2500 2750 3000 CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECT FEE PAID ❑ RW Progress: Inc.❑ LKD❑ Contractor ❑ CFT Violation: Work Comp.❑ Inc. ❑ ❑ L/A Owner CASH ❑ Fee CH K # ❑ L/A Due MO # ❑ IPA Municipal INV # Date: Other Side❑ Utility Applicant El Cut in Card ❑ Temp # Date ❑ Final # Date INSPECTORS SIGNATURE C E R T I F I C A T E O F I N S U R A N C E ISSUE DATE (III[/DD/YYYY); 3/27/1992 ------------------------- -------------------------------------------------------------------------------------------------------- PRODUCER THIS CERTIFICATE IS ISSUED AS A HATTER OF INFORMATION ONLY AND CONFERS 110 Contunity Ins,Agencies,In RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, P.O. Box 1369 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, So. Glens Falls , N.Y. 12803 ----------------------------------------------------------------------------------- C O D E SUB-CODE C O M P A N I E S A F F O R D I N G C O V E R A G E INSURED COMPANY LETTER A: USF & G A.J.H, Inc. COMPANY LETTER B: dba Leisure Time Sales COHPAIIY LETTER C: 2714 Route 9 COMPANY LETTER D: Ballston Spa MY 12020 COMPANY LETTER E; = COVERAGES TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELON HAVE BEER ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMSRT TERM OR CONDITION OF Ally CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE RAY BE ISSUED 0R MAY PE�TAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES, LIMITS SHOUN RAY HAVE BEEN REDUCED BY PAID CLAIMS. -------------------------------------------------------------------------------------------------------------------------------- CO TYPE OF INSURANCE POLICY NUMBER POLICY POLICY EXPIR- ALL LIMITS IN THOUSANDS LTR __- EFFECT. DATE ATIOM DATE 11I1/DDlYYYY MH/DDIYYYY --- ---------------------------------- --------------------------- ------------ ------------- ---------------------------------- GENERAL LIABILITY GENERAL AGGREGATE $ [ ]COMMERCIAL GENERAL LIABILITY PRODUCTS-CORP/OPS AGGREGATE $ [ ]claiits nade [ ]occurrence PERI1, &1R�DVERTISING $ [ ]OSINERS & CONTRACTORS PROTECTIVE EACH OCCURRENCE $ [ ] FIRE DAHAGE (ANY 011E [ ] HEDICAL)EXPENSE (ANY $ 011E PERSON) $ --- ---------------------------------- --------------------------- ------------ ------------- ---------------------- ----------- A AUTOMOBILE LIABILITY 1AG133121197 5113/1991 5/13/1992 COMBINED SINGLE LIMIT $ 500 AIIY AUTO BODILY INJURY ALL OWNED AUTOS (PER PERSON) $ SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (PER ACCIDENT) $ NON-OPINED AUTOS X GARAGE LIABILITY PROPERTY DAMAGE $ --- ---------------------------------- --------------------------- ------------ ------------- ---------------------------------- EXCESS LIABILITY EACH OCCURRENCE AGGREGATE fOTHER THAN UMBRELLA FORM $ $ -� 9---- ----___-------------------- -------_------------------ -------- _-. ------------- _---------------------------------- WORY,ERS' CORPENSATION STATUTORY — — - AND $ EACH ACCIDENT) ERPLOYERS' LIABILITY DISEASE-POLICY LIRIT� I DISEASE-EACH EMPLOY, OTHER -------------------------------------------------------------------------------------------------------------------------------- DESCRIPTIONS OF OPERATIONS/LOCATIONS/VEHICLESP�S/SPECIAL ITEMS .Above policy includes Garage Premises and Operations_Liab�i-lity.-.Home buyer: Trever & Victoria Barber-, Big Bay Road, Queensbury; NY `T280a = CERTIFICATE HOLDER ____________________________ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town Of Queensbury EXPIRATION DATE THEREOF, THE ISSUING C014PANY STILL ENDEAVOR TO RAIL Town Clerk 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Bay Road BUT FAILURE TO RAIL SUCH NOTICE SHALL IRPOSE NO OBLIGATION OR LIABIL- Queensbury, MY 12804 ITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. -------------------------------------------------------------------------------- AUTHORIZED REPRESENTATIVE -----------------------------------------------------------------------------------, ---- - ----------------- AGORD 25-8—(3/88) - --- — - — - -- — - - ACORD_is—a-egis-tered_traletiark_of ACORD Corporation_ `..•i 5.8G �� . .i-----�..� 1 l I M�1�, �g" ?.,Ea. ;:-osT GaAVIE .' µ\ � •. �— $oX. QREcAS"f GowG. MF4• B`t �otLT J•-; ` � , CNo'fE: CA¢¢FuL 1N 5'CAurAT�o'+ 1S 1rn Q�RT,►►�T -sti; lK�uRE r `` Q.trE E c�VA� DtSTR� �T,a+ E— S715TR��uTbftS —S\1A.LL $� o-F w%T•K •Q` i ' MA?t Lscw4�H QE2 L�aE o� 6e ' t Lo �olj F- ToTA` B SSE 7 5' 1"� ►� P'EQ. .. LAB RATE T'A ,,_ .r j --= 0 L�A�GT►� of V\$TPvVNrr*fz5 SHAu. 8E At �ou.owS, 2'33 \ '' /a 4 1. 2 S3¢o RoeM Hovsro — 12.5 T,1 ; at Grp, 3 „ .. 16'7 y 2 �— m ErJ 1 2. •'' _3 rn a �WW. w L�AcN LNG PtT$ — 1�vST i3E 56P►�alA-r�D B� z T�MEs � 00 o TArm VZ?Tg4oF PiT JSE.D� ING�.vo�w►q SToMES• 3 7': cd LU CAW $E u S E D oN 1..oTs 1 Z 3 t N o . `� =0 , 4, G,7, v 1 ti f Z•1 p TtIE. 9UMSSIZ of Pt-rS A•' No StZE'� SHAv� gr AS '�roL\.DW C:CVF lik - Z. PL'rS 6' I-- 6 QLu9 T2.wc4 (.%F SrrWRM Z 41 I .� I �}- •• Z ice' x B ' — }�E,1R `t REDS 'OJ r-..o� -r•` -- �} -- i -- 1U t� - , Gu-CT�N o r L,TNT S _ 0 97 f� _. 32,6Z376c. W • \_ I ;1�� - �o-,r z L-�•NG* -PIT SeP'C�c -VAox �iEtS -M �E ,AawczA-rE 8 fA `� ' ;. ` 8`( ME.Asu1ZstAsl--- s rrt-PL% gu%.Aswic- IL rrou..o►.T..i�. T• / o —1 ov�v� oP6N80 p+No A% NEE � /� �_ '� �: �• � l i 1 � '3° - $£ $v!f'l,.�te.t1 ►+ lao�E cwt,JE2 e`( B Yl TOWN OF QUEF SBURV ✓ • yr; 45' �- �l' o(,'o - - j Zoning f��i ipistrator GEtkrso-v 4,,, ®�t® �•"�* (aQoa-r i '4 4^�' MtA• PR`Suw 94°�, }• ,u t1®�.T'o��. . 4 .•. ,, � TA 76• Z I °0 / ! PST L@ SS ► • w+�.w S eA k- •0 .� 7y7.0L"1 3 rH S + ` ` ' APPW -'' . � / eZ ` c.v+. p.o a4-rEl� of 5J►n+.YA�t.`� - to T�lll1.