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2001-182 TOWN OF QUEENSBURY FILE COPY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building & Codes (518) 761=8256 CERTIFICATE OF OCCUPANCY Permit Number. P20010182 Date Issued: Thursday, August 23, 2001 This is to certify that work requested to.be done as shown by Permit Number P20010182 has been completed. Tax Map Number. 523400-295-011-0001-019-000-0000 Location: 61 SARA-JEN Dr Owner. GUIDO PASSARELLI Applicant: MICHAELS GROUP This structure may be occupied as a: By Order of Town Board Fireplace , TOWN OF QUEENSBURY i Garage - 2 Cars Attached Single Family Dwelling Director o ui ing& de rc ent TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010182 Application Number: A20010182 Tax Map No: 523400-074-000-0002-084-000-0000 Permission is hereby granted to: MICHAELS GROUP For property located at: 61 SARA-JEN Dr 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 Or Type of Construction Value Owner Address: GUIDO PASSARELLI 40 LEHLAND Dr Single Family Dwelling 189,900.00 QUEENSBURY,NY .12804 Garage-2 Cars Attached Fireplace Total Value 189,900.00 Contractor or Builder's Name/ Address Electrical Inspection Agency MICHAELS GROUP NEW YORK BOARD OF FIRE UNDEI SUITE 1 10 BLACKSMITH Dr MALTA.NY 12020 Plans &Specifications 2001-182 2513 SQ FT SINGLE FAMILY DWELLING WITH 2-CAR ATTACHED GARAGE AS PER PLOT PLAN SPECIFICATIONS $317.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday,April 24,2003 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town of ueensbury• Tuesday,April 24,2001 SIGNED BY for the Town of Queensbury. Director of Building&C<^rcernent Building Penn* it application Town of Queensbury - Dept. of Community Development, 742 Bay Road, Qireensbury, NY 12804 1761-82S6/ BUILDING & - CODE ENPORCEUENT Requirements prior to issuance of this permit: PERMIT PILE NO,— A permit must be obtained before �7 , beginning construction, No inspections PERMIT r.& ' AID $;31/ f �S will be made until applicant has received Zo�:it:g Bo�Z �tDT3� Va. a VALID BUILDING PERMIT. All Area /Use � �" :.�. RECRL'A`� N 1%EE A $ �% applicants' spwas on this application R �g MUST be completed abd the signature pla�tnl�tg rdPACliot�: 2001 REVIEWED liY. of the applicant-must nppear an the ►t�16 SPR / Subdi ibfi �t3t1r�F ��� DuildinG hurecmr plieation form. rat Recreation s mt ND Applicant; TV�E 1�1(2e(S (�teJC�uD Owner Address: Address: Phone # (5_� ) �� - (p3" 1 Pltotre # Property I.ocalion; 2,1 �'t� Subdivision Name:. Tax Map Number.-- ---�---- - Section Block' .I M NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE {� New Building: CONSTRUCTION: $ Me,ap)p _ residence / commercial Addition to 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 STRUCAE, 1st Floor. . . . . . . If ADDITION, what will use 2nd .Floor. • . . . . . • •.-� (,o Sq q .��� of ne addition be? : O( � � w w�- - Other Floors . . . . . sq. ft. (not unfinished cellar or basement) ACCESSORY BUILDINGS : Detached Garage 1 , 2 car TOTAL FLOOR AREA: SQ. FT. _2� Attached Garage 1, ca r Private Storage Bui SIZE OF NEW STRUCTURE : Commercial Storage Building Other _ FEET X FEET Foundation Type: �r-4 Will any second-hand or ungraded Number of Stories : �_ lumber be used? If so, for what? (habitable space only) *�A 0 Height; (grade to ridge) : 2 feet TYPE OF HEATING SYSTEM: Number of fireplaces and/or woo stove (circle all which a plies ) to be installed: Electric / Oil / as / Wood Forced Hot ':Air / Baseboard / Other Person responsible for supervision of work" as regards to building__ _ Na' e O A dre s ` oPhone _ l` Builder: Plumber: 2 dc�c Mason: Electrician: ' DECLARA7709• 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; wn to s le, slu .win ctual location of project on premises. Signature: (owner, owner's agent, arch sect, contractor) ' TOWN OF DUZENSBURY ' F BUT[DING & CODES DEPARTMENTOonL 0=����� r APPLICATION FOR', PORCHES-DECKS- P�r�7C��� � � DOCKS & BO8T|0US[S � ESt�x��s� � xL)O��C}� X PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. PLEASE ANSN lMO: � ^ The UDd8rSiyD2d here6« applle3 for 8 Building' Permit to do th8 fVllUwing work which will be done in accordance with the deScription , plans and specifications submitted , and such special conditions as may be indicated On the permit. TWO SETS OF STRUCTURAL PLANS J|V\LL UE 3U1311]TT[ WITH THIS APPLICATION. Owner of Property: P.O, Address Property Location Subdivision Name ( \f applicable) PERSON RESPONSIBLE FOR SUPERVISION OF 1401ZK AS REGARDS TO BUILDING CODES : Name: Address - Phon�# ' -------- BUILDING SPECIFICATIONS: ^ T«n8 of work to be done: Porch Dock 80dthOUSe (Circle one) \ 51Ze of Structure to be built (Square footage) : Foundation Material : Width Thickness ` Depth Of Footing , b8l/]w grade: Size of Posts Or Stu'ds: � � x x � Long Size of Floor Joists.: X x Span Decking OF Flooring Material : How will Porch Or Deck be fastened to building? If Roof W1l l Be Installed, AOSN8r FOl lONiOg ,OV8Sti0n3 : . ' Size Of Posts Or Studs - X X Long Roof Rafters : X Spacing Span Roof Trusses (pre-engineered spacing) : Span Type Of Roof: Sloped Flat Shed Other (Circle one) Material of Roof: ZONING INFORMATION: ' TNO �PLOT PLANS MUST DE PREPARED AND SUBMITTED , drawn reasonably to scale and a1tadh8d hereto , showing clearly buildings , whether existing or proposed and indicate all set back di0en' iVDs from property lines. Show location of water supply 8nd location and configuration 0f s8ptiC .di3pO3Ol a�28, Size Of Property: -ft. X ft. ExiStiD -5iZ�: . ----~�t`--� -~- - -` — -----------'--- 3iZ8 ----' ft. � ---- ft. Use of Existing building/S\ |---�- ----- Proposed structUre, distance_ from- property . ...^ . Front yard ft. Rear yard ft'. Side yards ---,---- ft. and If - If OO corner, setback from side street:- ft. DECLARATION To the best Of my knowledge and belief the statements contained in this applicntion , together with the plans and specifications submitted , are a true and complete statement of all proposed work to be dOOo on the described premises—and that all provisions of the Building Code , the Zoning Ordinance , and all other laws pertaining to thc proposed work shall be complied with, whether specified Or not and that such wor by tile owner. ' OAT[: SIGNATURE UwU8r` Vwner S xg8ncy` Architect, Contractor REVIEWED BY CODE ENFORCEMENT OFFICER, DATE SIGNATURE Application for Permit--Septic Disposal System Rowll of Queensbuly 742/3ayRvacl Qlieejrcbury, NY 12-104 (518)'76178256 1. OWNER INFORMATION: i.........................................._.......`....... .............. ............. l 4 Location of installation; (DI S � \ k era t1.J.1� 14 (�D�e,�g n II! File Pennit�R Tax Map No. / / I �'';O1fV/a�l OFFee Pa c1 Owner's Name:�1�� lG� cC `5 �'��� I —�vC�6ND C�'�D= •. f U n t\ y y ........... ...................................•.-,-_W .. ................................ Address: kC) 2. INSTALLER'S NAME ; C:&�Z PHONE N0. (,:2.3 f-A(Jfl 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate #bedroonr(s) and multiply It of bedrooms with applicable gallons her bedroom to equal total daily flow) long) Year of House: No of Bedrooms x Computation = Total Daily Flow 1980 or older x 150 gaVbdrni = 1980- 1991 x 130 gal/bdrm = _ 1991 -present x 110 gal/bdrm = _ L D Garbage Grinder Installed yes, / no Spa or Whirlpool Installed yes,___ / no 4. PARCEL INFORMATION: (circle applicable information & indicate nnoasui•ements) Tp ographv Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply 1�'la1' ecrr at what depth at what clepth ��rrenietl:al� Rolling loam et fee!Steel)slope clay if•well; watersupply �%slope other from anv.seplic-system depth: absatplion is other Percolation Test: (7'o he cr�mpleted by licensed pru%•ssioltal engineer ur architect)' ___~-____. hate: __..�..••._^_..mtntrtc per tech 5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designicd by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to(lie sirs of(lie septic tank and leach Reid f6r each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: 1 ; gallon`(min. size 1,000 gal) Tile Field; each trench_%t. Total System Length: 2 0 ft. Seepage Pit(s): number of size oJ'each; Size of Stone to be used: ll / clepth or thickness Bed System Size: z Alternative System: , length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: ! Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System,and associated electrical work must be inspected by a Town approved electrical 'inspection agency, 7. SIGNATURE & INFORMATION FOR RESPONSIBLE PERSON (please read) For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or circumstance known by or on belialf of an applicant, shall be void. I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbu Sanitary Sewage Disposal Ordinance. S"ggntur, esponsi le person ate Fire Marshal's Office 1•own of Queensbury. 742 Bay Road,Queenshun•,NY (518)701-3205 Application for Fuel Burning Appliances & Chimneys_ applicable to solid fuel & vented gas appliances Date 2000 .1 � C � . �.� �� yr-Tait N Application is hereb_),rn«deg to the Builcing& CoAP IA-c•P/ issn«nre gfa 13uildin card Use Pernnit pursuant to the New York State Fire'PreveutlTni le'T'' l nldurg (•ucllle. The«pplic•arrt or ottrer agrees to cony)l ttith all applicable lasts. ore inane" ; �lr `tl�r / ndltiors that are part o s I Y Pl ���` ��¢���. 1 l these requirenrenls and also will allow all inspectors to }rii,ct '1✓trimpforin required inspections. NOTE to applicant: Rough-iri and Final Inspections are required. Applicant Informatiob Fuel Burning Appliance Information (circle appropriate words) Name: Stove: w„ ood coal. pellet- gas ` f Fireplace insert Address: lcs� ?!Xc c:gmn i Y1.u.�. Fireplace, factory-built: tt-ood -gas (� Fireplace, masonry: wood gcis r Furnace, stood gas oil Phone: 95-f�31 If non-masonary applicance, please provide Owner: Manufacntrer Name: . Address: Model Number: Chimney Information Phone: (circle appropriate words) Masonry' block brick stone Flue the tee size: inches Exact Address: (.Pk of Construction Or installation Factory-Built LOT g� Manufacturer name: Model Number: .Vote: Listed By: Number: Construction /lrrstallation must con or•rn to NYS Fire Prevention d Building Indicate (circle) chimney material: Code. Consult available Town of Queensbury Handouts regarding required inspections. Double trill .- Triple nvall '/ Insulated / Direct treating Clrhnnet•Liner Caretb�er'�Z7epartmemt—TOWzsz of Qtueezz;Bbtizzy, Neaasr Yo_r-J r . Fire al«rshal Code Y S Collected 51Zehrnded Rcccit ed/i unr i � 5 crdch•css: ----- .a 1733389 (190) Public Safenr .4233 2655 (230)Alinor Saner White(Applicant) i Green(Fire Marshal) ! - Ye1tot,,••(B1dg. Dept.) Pink S Goldenrod(Cashier's Dept.) Fire liars11,11's Office Town of Queensbur}•, 742 13,iy Ro.rd,Queensburv, N1 (518)761-8205 Application for Fuel Burning Appliances & Chimneys: applicable to solid fuel & vented gas appliances Date ft W- :, 20 _ Permit Now[ j Applicalion is hereby Horde to.the Building d Codes: O ce )i,the issuance of*a Building and Use Permit piusuant to the Neu York State lire Prevention and Building Code. The applicant or owner agrees to comply with all applicable laws, or(linarrces,.r-tgcrlcrtiolts, and all conditions that Cue pul'I of these requirements and also will allow all irrspectoi s'to Bitter=premLses to perform required inspections. NOTE to applicant: Rough-In and Final Inspections are required. Applicant Information Fuel Burninc, Appliance Inf'oll-nation a 1�t (circle appropriate words) Name: ; �`�- , Stove: Wood coal pellet 0 Fireplace insert Address: Fireplace, factory-built: -Wood t r— — Fireplace, masonry: wood a Furnace: wood has oil Phone; '(Pik If non-masonary applicance, please provide O`vner: . Manufacturer Name: Address: Model Number: rtyA Chimney Information circle a to rate words) Phone: ( PP• P� _ Masonry block hrick. stone Flue tile size: inches Exact Address: t �� ,of constt-uction or installation Factory-Built Manufacturer name: Model Number: Note: Listed By: Number: Construction /Installation must con ortti to NYS Fire Prevention &Building Indicate (circle) chimney material: Code. Consult available Town of Queensbury Handouts regarding required inspections. Double troll ! Triple wall / lrrsulared 1 Direct ranting Chh'I ne r Liner ' f i G'AA a 11 ex',6r 4e gLr-em Uce-v2t-- Tovw�x x off'Qu e 4--rzA i Wbux-y, N4--xwr V-4c PrJr t Fire Alarshal Code# S Collected S Refirnded 6ecei .4 173 3389 (190) Public Safett• .4 233 2635 (330)Alinor•Sales f ' f, White(Applicant) i Green(Fire Marshal) ! - Yellow(131dg. Dept,)- Pink&Goldenrod(Cashier's Dept.) S X. C NTSL( RVA. ON CONTSTR MON CODE Rt �° ` PART S COMPLIANCE FORM APR 19 2001� Vy 8uilding Design by Acceptable Practice GAfV-L, ,. UMDING \ DDRESS: (Dt .' Q ...IQ� 1,, CT�' —DATE-- t-L.A,/OCI. COUNTY lRR � .RC T-=CT,ENGIN7-ER,OR )ONTPACTOR; THj5 Ngy,4 le2 G20UP PHONE: 5 t 8- ERMIT APPLICANT: PHONE: . HEATING DEGREE DAYS (Table 2-1) ❑ 50M-6000 X❑ 70M-9000 11. BUILDING DESCRIPTION (Pre-qualifying Conditions)* If the building does not meet all of the following pre-qualifying conditions, Part 5 of the Energy Code may not be used. fj Building is residential with-one or two dwelling units. - ❑X Building is-less than 5,000 gross square feet- Building is three stories or less in height. Ratio of glazing area to gross wall area is equal to or less than 179o. Ill. PROJECT TYPE 'X New construction ❑ Substantial renovation of existing building ❑ Addition to existing building ❑ Exempt(7810.6c) IV. HEATING SYSTENA TYPE ®Gas-fired Oil-fired ❑ Hcat pump ❑Electric ! h J . i Joint Sealing: 7814-10(i) Joint location Sealant Type Specified � P1an/Spec_ Reference Windows � Polycell Doors frames t,�-_atherstri pin Walls at roof/.ceiling i Walls at floors/found- Polycell Wall panels N/A Utility entrance weatherstripping Penetrations Polycell Other Other Air Infiltration Barrier: 7814.10'0) Location Required? ' Specified , Plan/Spec Reference Walls yes[no No-cedar Siding Other yes/no Fireplace: 7814.10(k), (m) Re mired I Specified Plan/Spec- Reference Outside combustion Yes- air duct with damper Flue damper with max 20 cfm, or damper < 20 c.f_m_ damper and non-combustible doors . Gas fireplace ignition No VI. HVAC PERFORMANCE: 7814.11 (Table 8-3) Equipment I Minimum Performance Specified Performance Plan/Spec.Reference Furnace 70% AFUE 90 Boiler Heat pump Central air conditioner GUN I 1-fCJL_ 7814.12 Temperature Control Required 1 Specified Plan/Spec-Reference Thermost2t cacti Yes dwelling unit - . . Shut off at each Yes terminal Unit Thermostat Required , Specified Plan/Spec-Reference Minimum rap-q:P Yes 45"F 85°F Deadband yes range ;-> 5' Automatic Yes capability VIII. DUCT SYSTEMS: 7814.13 Category I Required Provided Plan/Spec.Reference Duct ? I"thick N/A in conditioned space insulation R-33 in uneondtioned space . sverse Sealed yes, J�ts IX. VENTILATION SYSTEMS: 7814.14 System Type Required Specified Plan/Spec-Reference Supply Damper at envelope Yes Exhaust' Damper at envelope Y e s Supply on/off switch Exhaust on/off switch Yes ?C RIPING INSULATION: 7814.15 Piping Type Insulation Pro,-idcd Plan/Spcc_ Rcquircd Reference Heating distribution` N/A Ser��eb ��r- -Does not apply to ruaouts- "Does not apply to piping with a diameter less than or equal to tea"inch- XI. SERVICE WATER HEATING: 7814.21 ,(Table 5-4) Performance Requirements Wacer Heaters Minimum Specified Plan/Spec. Performance Performance Reference Storage EF' > -93 --00132v ! > _93 Instantaneous N/A 1 Pool N/A Controls Category - Required Control Control Provided Plan/Spec- Reference System automatic control Yes System Lemp.setting range 140 degrees max_ Pool heater RD N/A Pool heater on/off s«ztcb N/A Electric water heater separate sv.itch N/A °= . Gas/Oil water heater separate valve Yes XII_ ELECTRICAL POWER: 7814.31 Category :Rcquircd Specified Plan/Spec- Reference Electric meters Ea_ du,cllini unit ! `"e= - i EY:IEElioal S-,,,J.T OFA-CUE cR%KED VALL= rORKSHEE- R-Value > > R-Ya1ua In:ulaLa6 Construction Fcasstd Comeaftent ! Area 0.68 Ict. Air Film 0.68 ! t! { _45 1/2" Gypsum Bd. .45 111 l t 1 `•�: . 19.00 n:ulation 2x6 @ 16" o.c. 6-87 1 - - - --- -- - - --- Studs - - -- -- - - {{ -54 I 1/2 i ferwood _5 ---- --- . . Sheattlinq . . .. . . . . !! - . -65.. Vinyl :65 l . . . ... Siding . . _. . ... _ 0.17 0.17 £r t. m ..21:49 9 36 R-Total . ... . . .. . U (n:ulated Fractions Fraeea Fraction R-Total lnaulatac R-Total Frameo Rai .15 21.49 9.36 .056 11411 Stud Spacing Insulated Fracticn { Framto Fraction 12" O. C- .b� _17 16" O. C. .85 .15 ::4" O.C. .8b - 12 RASEM£NT/CELLAR WALLS: %ORKSNEE- @ stairwells R-Ya 1 ue R-Ya .with Ext.' i Coe►struetion .cith _ Insula'tion Coaoonsats Insulation xx + I � � 0.17 I 1 0.17 ' Ext. Air Fill .. .... . ' i 'i None - - .. _ - _- . � 'Ezteriotrini3h . . . . .- • . . . ..� Poured PO i _ ...... .. 81oet (Concretef ] :_1:_72 -. < � Core Insulation =s -- - ------ - any) i --•- ---- 1 f J(R-wax - -� insulation �• .......... (aXt. or int. ) 1 ..:....... None (aterior Fiaish .. ..... (tit /.ir FQ•ia - -1 . .... R-Totsl t .c R-T.ota 1 u -07 H Exp•oturc Above Crade Deptfl '6c1 o.c Graoa 4H " °ASEH£t(T/CELLAR WALLS: %ORKSHEE- ' R-Yaluc � � R-Yalce with £xt. l ccattructioa with int_ tnsulati.on Cowooaeats Insulation « 0:17 ( 0.17 '- £zt. Air file { None Eztcrior finish _ _ _ _ _ _ _ - . _ �• -� I 8" Poured Sl oct (Concrete) a ) Corc (nsulation any) l . . .. . . .. .. J lasulation o- �/--fly (ext. or int. ) .......... - latecior Fioish ...<...._ _a (nt. E;r- 4F:1ea m .l i - 13.57 R-Total .... .... . . 7 • • U - w R-Total U K 13 _57 CM 8 Exposure Above Grade - Depth 8eloK Graoe 48 OPACUE FRAKED Fz-50R: wORK5i'E---- 77-7 ! ' rl 4 ( R-Value R-Ya1ue f 1 Insulatao Construction Frameo i Area Ccrz:cnents Atea i 0-92* i 0.92* • j -. - F.x't. Air Film - --- - - - i 4 6" Batt19-00 ---- . . . . . . .. . . . . . Insulation . . . . . . . ; 11 7/8" TJ1's @ 24" 01 84 . ....... . .... Joists . 14:. . . 3/4" waferwood t . .:93.... . ... Sub-Floor ' - 1 carpet nyl . nZ:... . ... in. Floor - 0.9Z 0.92 lat. Air Film 21.02 R-Total 16.86 insulated Fraction" Framed Fraction""', v + 0 R-Total Insulated R-Total Framed _ .. u .95 .05 o _ t_..048 21.02 16.86 { For vented cra"l space, use R 0.17 for ext. sir files. _* Floor Joist Spacing Insulated Fraction Franey Fraction 12" 0_C. .87 { 73 16" O.C. _90 j 70 I 'ROOF/C£ILIHG iVE.HTE0,' �ORCSN£r: R-Yalve + R-Yalae i Insulated Construction t Franed _ area CowoanetiTa { f t 0.17 I Ext. hil- Filc 0.17 ; I . 30_00 9" Batt ---= 12_00 Over _ _ _-- - Insulation .i. - ---- �22x�4 2bott�•chord i 4.3 S ----- Joists 3 ....... 45 1/2`<-Gypsum Bd_ 45 l •'0.61 0.67 tat. Air •Filar._ 31:23 17_58 - _ .. �. R-To.ta1, . ..._ . (cisulated Fraction* Ftaued Fraction- u R-To.tal. :nsulatad 'R-Total Fraaed v _93 .07 . r _034 , 31.23 17.58 * Roof Joist 'S.paciny Insulated fraction Framed F�actiaii- .97 _13 -16^ -O.-C. .90, •10 214 0 C. ,.93 .07 j RESIDENTIAL.,FINAL.INSPECTION REPORT Office No. (518)761-8256 Date inspection request received: Building& Code Enforcement Dept. of Community Development Arrive pmL Town of Queensbury Inspector's Initials 742 Bay Road Queensbury,New York 112804 41-ket NAME PERMIT# 0 41 LOCATION DATE z: v TYPE OF STRUCTURE N/A YES NO COMMENTS Chimney Height/"B"Vent/Direct Vent Location Fresh Air Intake Plumb Vent through roof Roof Complete Exterior Finish Complete Interior/Exterior Railings 30"to 36" Exterior Handrails,balconies,landing 18 in.or more Interior Handrails stairs both sides 3 or more risers Grade 2%away from foundation 8"clearance to sill plate Gas Valve shut-off exposed/regulator 18' abov grade Gas Furnace shut-off within 30 feet or thin 1' a of site Oil Furnace shut-off at entrance to furn ce area Furnace/Hot Water Heater operating Relief Valve(s)installed Headroom,6 ft. 6 in. on stairs Basement stairs,6 ft.4 in. Handrail exterior stairs both sides mo 3 risers Interior privacy/trim/doors/main en 36" Floor Finish Bathroom/Kitchen waterti Interior Handrails Balconies/Landing 8 in. or more Railing across window in stairwells Smoke Detectors: every level every bedroom outside every bedroom inter connected Bathroom fans Plumbing fixtures Foundation insulation 3/4 hour fire door/door closer Garage fireproofing Garage penetrations sealed Furnace in separate room protected(in garage) Light ventilation per room Safety glazing 18"or less from floor Final Electrical Site Plan/Variance required Final Survey Plot Plan As Built Septic System layout required Okay to issue C/C(Certif. of Compliance) Okav to issue temp. C/O(Certif. of Occupancy) Okay to issue permanent C/O(Certif. of Occupancy) 9 RESIDENTIAL FINAL INSPECTION REPORT Office No.(518)761-8256 Date inspection request received: Building&Code Enforcement Dept.of Community Development Arrive&4un/pm Depart m" n/p Town of Queensbury Inspector's Initial 742 Bay Road Queensbury,New York 12804 NAME Tfi 1 CArX PERMIT LOCATION DATE J TYPE OF STRUCTURE �1 N/A YES NO COMMENTS Chimney Height/"B"VentlDirect Vent Location Fresh Air Intake Plumb Vent through roof Roof Complete Exterior Finish Complete Interior/Exterior Railings 30"to 36" Exterior Handrails,balconies,Ianding 18 in.or more va r S& Sad I f" Cor-e- J'�ick Interior Handrails stairs both sides 3 o re risers / Grade 2%away from foundations l 8"clearance to sill plate Gas Valve shut-off exposed/regulato 18" bove grade Gas Furnace shut-off within 30 feet wi in line of site Oil Furnace shut-off at entrance to ft mac area Furnace/Hot Water Heater operating Relief Valve(s)installed Headroom,6 ft.6 in.on stairs Basement stairs,6 ft.4 in. Handrail exterior stairs both m s m re than 3 risers ae Interior privacy/trim/doo en ce _ 36" Floor Finish Bathroom/Kitchen watertight Interior Handrails Balconies/Landing 18 in.or more Railing across window in stairwells Smoke Detectors: every level every bedroom outside every bedroom inter connected Bathroom fans Plumbing fixtures Foundation insulation 3/4 hour fire door/door closer Garage fireproofing Garage penetrations sealed Furnace in separate room protected(in garage) Light ventilation per room Safety glazing 18"or less from floor Final Electrical Site Plan/Variance required Final Survey Plot Plan As Built Septic System layout required 6J"'/I Okay to issue C/C(Certif:of Compliance) Okay to issue temp.C/O(Certif.of Occupancy) Okay to issue permanent C/O(Certif.of Occupancy) TdN'OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 BAY ROAD QUEENSBURY NY 12804 (518) 761-8256_ ARRIVE: DEPART: INSP: FINAL INSPECTION REPORT - RESIDENTI L DATE INSPECTION REQUEST RECEIVED: NAME LOCATION 47 �7 ��� DATE W PERMIT TYPE OF STRUCTURE rvVe FOOTINGS_ FOUNDATION BACKFILL FRAMING _ ROUGH PLUMBING SEPTIC INSULATION FINAL ELECTRICAL WOODSTOVE OR FIREPLACE N/A YES NO CHIMNEY HEIGHT/B VENT/11EIGHT PLUMBING VENT ROOFING EXTERIOR FINISH DECK/PORCH/STEPS/ ILIN S RELIEF VALVES FURNACE HOT WATE OP TING INTERIOR TRIM P ACY DOORS FINISH FLO BATH KITCHEN ATERTIGHT OTHER FLOORS WEEPABLE OTHER FLOORS dARPETED STAIR CLEARANCE ILINGS SMOKE DETECTORS BATHROOM FANS PLUMBING FIXTURE FOUNDATION INSULATION GARAGE FIRE PROOFING DOOR CLOSERS FINAL ELECTRICAL SITE PLAN VARIANCE RE . FINAL SURVEY PLOT PLAN OK TO ISSUE C/O OR C C RESIDENTIAL FINAL,INSPECTION REPORT Office No.(518)761-8256 Date inspection request received: Building&Code Enforcement Dept of Community Development Arrive/6��'am/pm Depart aliypm Town of Queensbury Inspector's Initialls2 742 Bay Road "7— Queensbury,New York 12804 ` NAMEMEmmaPERMIT# 0 LOCATION DATE TYPE OF STRUCTURE N/A YES NO COMMENTS Chimney Height/"B"VentlDirect Vent Location Fresh Air Intake Plumb Vent through roof Roof Complete Exterior Fin Complete Interiova ai gs 30"t 36" Exterior Handrails,balconies, anding 8 in.or more v Interior Handrails stairs both es 3 or ore risers G je �✓d�• ��rc Grade 2%away from foundati n 8"clearance to sill plate Gas Valve shut-off exposed/regulator 1 "above grade Gas Furnace shut ofwithin 30 feet or 4'thin line of site Oil Furnace shut-off'at entran to ce area Furnace/Hot Water Heater op ting Relief Valves)install,d Headroom,6 ft.6 in.on tairs Basement stairs,6 ft.4 in. Handrail exterior stairs both id more than 3 risers _ Interior privacy/trim/doors/mai11 trance 36" Floor Finish Bathroom/Kitchen watertight Interior Handrails Balconies/Landfik 18 in.or more Railing across window in stairwells Smoke Detectors: every level every bedroom outside every bedroom inter connected Bathroom fans LIA Plumbing fixtures Foundation insulation 3/4 hour fire door/door closer Garage fireproofing Garage penetrations sealed t Furnace in separate room protected(in garage) Light ventilation per room Safety glazing IS"or less from floor Final Electrical (� Site Plan/Variance required —pay". Final Survey Plot Plan As Built Septic System layout required Okay to issue C/C(Certif.of Compliance) Okay to issue temp.C/O(Certif.of Occupancy)_ Okay to issue permanent C/O(Certif.of Occupancy) 5 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 BUREAU OF ELECTRICITY 5 5 40 FULTON STREET — NEW YORK, NY 10038 5 5 5 CERTIFIES THAT �(� 5 5 5 Upon the application of upon remises owned b p PP p P y 5 5 FOREVER REVER ELEC/BOEL ELECT. * MICHEALS GROUP c5 5 5 2446 JAFFREY STREET 61 SARAJEN C5 SCENECTADY, N.Y. 12309, QUEENSBURY, NY 12804 5 5 5 5 Located at 61 SARAJEN QUEENSBURY, NY 12804 _ 5 5 5 Application Number: 1015624 Certificate Number: 1015624 5 S 5 5 Section: Block: Lot: Building Permit: BDC:A239 5 5 5 5 Described as a Residential occupancy,wherein the premises electrical system consisting of 5 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 Basement,First Floor,Second Floor,Attached Garage,Outside, 5 5 5 5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below,was SC 5 found to be in compliance therewith on the 20th Day of August,2001. 5 5 5 Name OTY Rate Rating Circuit Tvne 5 Alarm and Emergency Equipment C5 Sensor 7 0 Smoke c5 5 Appliances and Accessories 5 5 Air Conditioner 1 0 36k BTU C5 5 Bell Transformer 1 0 5 5 Dish Washer 1 0 5 Cooking Deck 1 0 3 KW 5 rj Exhaust Fan 4 0 C5, 5 Disposal 1 0 C� 5 Hydro Massage Tub,Residential 1 0 5 5 Furnace 1 0 Gas 5 5 Oven '1 0 3 KW 5 Cj Wiring and Devices ECj Fixture 44 0 Incandescent 5 5 Pole/Post Lighting Standard 1 0 Residential 5 Receptacle 1 0 30 Special 5 Receptacle 5 0 GFCI seal L5� 5 Receptacle 54 0 General Purpose 5 5 Continued on Next Page 1 of 2 5 5 5 This ertificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 o �Lp��iM�a�L�LpLj R�E��IMQ������LPLrQ2' ��������UP��������E���LP���� RI 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 5 SBUREAU OF ELECTRICITY 5 5 40 FULTON STREET — NEW YORK, NY 10038 5 CERTIFIES THAT 5 5 5 5 Upon the application of upon premises owned by 5 5 5 . 5 FOREVER ELEC/BOEL ELECT. " MICHEALS GROUP 5C 5 SCEN CTA Y, N.Y. 2309, QUEENSBURY, NY 12804 5 55 5 B Located at 61 SARAJEN QUEENSURY, NY 5 5 5 Application Number: 1015624 Certificate Number: 1015624 5 5 5 5 Section: Block: Lot: Building Permit: BDC:A239 5 5 5 5 Described as a Residential occupancy,wherein the premises electrical system consisting of S 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 Basement,First Floor,Second Floor,Attached Garage,Outside, 5 5 e5 5 5 was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below,was 5 found to be in compliance therewith on the 20th Day of August,2001. 5 5 5 Name OTY Rate Rating Circuit Type 5 Switch 40 0 General Purpose 5 Service S 5 1 Phase 3W Service Rating 200 Amperes 5 5 Meters: 1 5 5 5 5 5 S 5 5 5 5 5 5 5 5 5 _ Sea, 5 5 5 5 2 of 2 5 5 5 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 1p- �91 5 ���������������������������������������������RIEW�00N�OR� o FIRE MARSHAL TOWN OF QUEENSBURY QUEENSBURY, NY 12804 (518) 761-8205 FIRE MARSHAL INSPECTION REPORT REQUEST RECEIVED PERMIT /�go NAME LOCATION 1 , l SCHEDULE INSPECTION ON = Q/ / �MM ANYTIME APPROVED N/A YES NO EXITS AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTING FIRE EXTINGUISHERS FIRE ALARM SYSTEM FIRE SPRINKLER SYSTEM FIRE SUPPRESSION SYSTEM HOOD INSTALLATION INTERIOR FINISHES STORAGE: CLEARANCE TO SPRINKLERS CLEARANCETO HEATING UNITS REQUIRED SIGNAGE CHIMNEY WOOD STOVE FIREPLACE-MASONRY FIREPLACE-FACTORY BUILT REMARKS: (] OK TO THIS DATE k- INSPSURPUB INSPECTOR GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Queensbury Dept.of Community Development Date inspection request received: Building&Code Enforcement 742 Bay Road Queensbury,NY 12804 Arrive o pm D 7�a�rt or9s Initi NAME: . PERMIT# LOCATION: - DATE: / TYPE OF STRUCTURE: RECHECK :.N/A YE I-NO COMMENTS Footin s/Piers Monolithic our Form Reinforcement in Place The contractor is res ibl or providing protection om ing for 48 hours followin the pla ment of the concrete. Materials for this pu se on s' Foundation/Wallpour Reinforcement in Place Founda am Backfill v Plumbing Under Slab Plumbing Vent/Vents i Place Rough Plumbing Heating Rough-In Insulation Foundation Walls Inte 'or R- Foundation Walls E 'or R- Floors R- Walls R- Ceiling Duct work or piping in unheated spaces - Proper Vent,Attic Vent Framing Jack Studs/Headers Bracing/Bridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1,2,3,hour Penetration Sealed Fire Wall 2,3,4 hour Firestopping GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Queensbury Dept.of Community Development Date inspection request received: Building&Code Enforcement ! k 742 Bay Road Queensbury,NY 12804 Arrive am/pm Depart IV fl-Zam/p Inspector's Initials NAME: PERMIT# O\— LOCATION: l ")A k A- ;n� DATE: Z2 a TYPE OF STRUCTURE: RECHECK N/A YES NO COMMENTS 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/Wallpour Reinforcement in Place Foundation/Dampproofin Backfill Approval Plumbing Under Slab Plumbing Vent/Vents in Place Rough Plumbing 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- oper Vent,Attic Vent qF naming ; Jack Studs/Headers Bracing/Bridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1,2, 3,hour Penetration Sealed ere� 2,3 4 hour- goin . i GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Queensbury Dept.of Community Development Date inspection request received: Building& Code Enforcement 742 Bay Road ' .— Queensbury,NY 12804 Arrive am/pm Depart z �aa pm Inspector's Initials NAME: PERMIT# 0 LOCATION: kADATE: TYPE OF STRUCTURE: �1 RECHECK N/A YES-NO COMMENTS Footings/Piers Monolithic Pour Form Reinforcement in Place The contractor is responsib 6 for providing protection fro freezing for 48 hours following a placement' of the concrete. Materials for this purpose on site Foundation/Wallpour Reinforcement in Place Foundation/Dampproofing Backf ll Approval ' I Plumbing Under Slab Plumbing Vent/Vents in Pl ce Rou lumbing H ng Rough¢In ation Foundation Walls Interior R- Foundation Walls Exterior R- Floors R- Walls R- Ceiling R- Duc work or piping in eated spaces R- Pro r Vent,Attic Vent f ae Studs/Headers Bracing/Bridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1,2,3,hour Penetration Sealed a 2 3 4 hour stop in CHA-S6 tA) 13,e,1� Ctos61 � . w GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Queensbury f- / Dept.of Community Development Date inspection request received: (P 6 Building&Code Enforcement l 742 Bay Road C71 4- Queensbury,NY 12804 Arrive am/pm Depart ` I p Inspector's Initl s Z— NAME: PERMIT# 6— LOCATION: Iz,, ID r. DATE: fe I Is 0 TYPE OF STRUCTURE: RECHECK N/A YES-NO COMMENTS Footings/Piers Monolithic Pour Form Reinforcement in Place The contractor is re ible for providing protection o ezing for 48 hours followinj the acement of the concrete. Materials for this purpos on si Foundation/Wallpour Reinforcement in Place Foundation/Dampproofin Backfill Approval Plumbing Under "M � Plumbing Vent/V Rough Plumbing Heating Rough-In Insulation Foundation Walls Interior - Foundation Walls Exterior - Floors R- Walls R- Ceiling R- Duct work or piping in unheated spaces R- Proper Vent,Attic Vent Framing Jack Studs/Headers / Bracing/Bridging / Joist Hangers Jack Post Beam Air Infiltration Barrier Fire Separation 1,2,3,hour r1 - p Penetration Sealed f �� 02 PATc-- k Fire Wall 2,3,4 hour Firestopping FIRE MARSHAL TOWN OF QUEENSBURY QUEENSBURY, NY 12804 eL (518) 761-8205 FIRE MARSHAL INSPECTION REPORT REQUEST REC ED fw-APERMI NAME � 1 9 Q LOCATION SCHEDULE INSPECTION ON f " Zf _ A P NYTIME 0 lsfk zo APPROVED ° NIA YES NO EXITS AISLE WIDTHS EXIT SIGNS EMERGENCY LIGHTING FIRE EXTINGUISHERS FIRE ALARM SYST FIRE SPRINKLER SYSTEM FIRE SUPPRESSION SYSTEM HOOD INSTALLATION INTERIOR FINISHES STORAGE: CLEARANCE TO SPRINKL S CLEARANCE TO HEATING NITS REQUIRED SIGNAGE CHIMNEY 0- S VE FI E IREPLAC7-FA7CTORY BUILT _, REMARKS:`\ � �`�� OK TO THIS DATE 'RiN R INSPSURPUB INSPE R GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Queensbury Dept.of Community Development Date inspection request received: Building&Code Enforcement 742 Bay Rbad Quecusbury,NY 12804 Arrive am/pm Depart am/pm Inspector's Initial`s NAME: 6F-.q- PERMIT# O `� Z LOCATION: C, l DATE: l TYPE OF STRUCTURE: RECHECK N/A YES NO COMMENTS 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 c c Materials or this p se on site Founda w allpour Reinforce m nt in Plac Foundatio ampproo ng Backfill g�Vnde prPlumbin Slab Plumbing Ven s in Place Rough Pl ambin Heating Rou -In Insulation Foundation Walls tenor R- Foundation Walls E erior R- Floors R- Walls - Ceiling Duct work or piping in unheated spaces R- Proper Vent, Attic Vent Framing Jack Studs/Headers Bracing/Bridging ist Hangers Jack Posts/Main Beam Air Infiltration Barrier c-L top Fire Separation 1,2, 3,hour Penetration Sealed Fire Wall 2,3,4 hour Firestopping GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Queensbury Dept.of Community Development Date inspection request received: Building&Code Enforcement 742 Bay Road Queensbury,NY 12804 Arriv °2C)a�ts—pDector�'s epa n pm Initi 1 NAME: PERMIT _ 1 Z LOCATION: — DATE : — —� TYPE OF STRUCTURE: RECHECK N/A YES NO COMMENTS Footings/Piers Monolithic Pour Form Reinforcement in Place The contractor is responsible for �J , providing protection from freezing for 48 hours following he acement of the concrete. Materials for this purpo a on s' e Foundation/Wallpour Reinforcement iyn Foundatooi Backfill Approv P umbing Unde lumbing Vent/Rough PlumbinHeating Rough-Insulation Foundation Foundation Walls E R- Floors R- Walls R- Ceiling R- Duct work or piping in � ;G��� ���� unheated spaces R- �C l oper Vent, Attic Vent jaming Jack Studs/Headers Bracing/Bridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1,2, 3,hour Penetration Sealed Fire Wall 2,3,4 hour Firestopping J ' TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name L\ Cr Location O N, S( Date - Permit 4, SOIL TY �. San�d- a��-Clay- Results of Per colati Test- (if applicable) Rat in to/Inch TYPE OF SYSTEM: ABSORPTION FIELD: -T tat Le g t h Length of each trenc Depth of trenches ' Size of stone A, SEEPAGE PITS: Number Size - ft. x ft. Stone size PIPING: Size Type Bldg, to Tank " e-H Llu To �0�3� Tank to Dist. Box it p�i Dist. Box to Field/P' `j p%3c-ItU ee-F— Openings Sealed? es No . Partial LOCATION/SEPARATIONS: Foundation to Tank p feet Foundation to Absorption . feet . . Separation of Pits _ fe Conforms as per Plot Plan Ye No LOCATION OF SYSTEM ON PROP RTY: (circle one) Front - Rear - L - ight Side Middle Front Middle Rear COMMENTS: SYSTEM.USE APPROVED: AYES NO Arrived: _ Depar ; iIding rerctor GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Queensbury Dept.of Community Development Date inspection request received: Building&Code Enforcement P 742 Bay Road Queensbury,NY 12804 Arrive am/pm Depart/0 Inspector's Initials NAME: \),K,C,M I�-C-C-C� PERMIT# ©(— /ev LOCATION: DATE : c5 D TYPE OF STRUCTURE: RECHECK N/A YES NO COMMENTS Footings/Piers ^�:� I Monolithic Pour Form Reinforcement in Place The contractor is responsible for providing protection nonsit ing for 48 hours followinement of the concrete. Materials for this purpo Foundation/Wallpour Reinforcement in Place Fe&id ation/D ampproofi g VIBackfill Approv Plumbing Under Slab Plumbing Vent/Vents in lace Rough Plumbing Heating Rough-In Insulation Foundation Walls Intei ior R- Foundation Walls Exte 'or R- Floors R- Walls R- Ceiling R- Duct work or piping i unheated spaces R- Proper Vent, Attic Ven Framing Jack Studs/Headers Bracing/Bridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1,2,3,hour Penetration Sealed Fire Wall 2,3,4 hour Firestopping oo GENERAL INSPECTION REPORT ( 518 ) 761-8256 Town of Queensbury Dept.of Community Development Date inspection request received: Building&Code Enforcement 742 Bay Road Queensbury,NY 12804 Arrive am/pm Depart an>/ In Inspector's Initials NAME: Cc PERMIT# ni g�— LOCATI0 : _ DATE : O TYPE OF STRUCTI RECHECK N/A YES NO COMMENTS Footings/Piers Monolithic Pour For►n 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 Foun on/Dampproofing ckfill Approval �� C Plumbing Under Slab Plumbing Vent/Vents in Place Rough Plumbing 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- Proper Vent,Attic Vent Framing Jack Studs/Headers Bracing/Bridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1,2, 3,hour Penetration Sealed Fire Wall 2,3,4 hour Firestoppin GENERAL INSPECTION REPORT 3r, ( 518 ) 761-8256 Town of Queensbury Dept.of Community Development Date inspection request received: 7 Building&Code Enforcement 742 Bay Road Z Queensbury,NY 12804 Arrive am/pm Depart an�lpm Inspector's Initials sziC� NAME: s GVi s ' PERMIT# I Z DATE : Ve- LOCATION: TYPE OF STRUCTURE: RECHECK N/A YES O COMMENTS Foot- s Monolithic Pour Form Reinforcement in Place The contractor is responsible br providing protection from free ing for 48 hours following the plat ment of the concrete. Materials for this purpose on site Foundation/Wallpour Reinforcement in Place Foundation/Dam Backfill Approval Plumbing Under Slab Plumbing Vent/Vents in P ace Rough Plumbing 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- Proper Vent, Attic Vent Framing Jack Studs/Headers Bracing/Bridging Joist Hangers Jack Posts/Main Beam Air Infiltration Barrier Fire Separation 1,2, 3,hour Penetration Sealed Fire Wall 2,3,4 hour Firestopping _ w, p00 tD LO c� U-) I i 56'66� t LO � N J 00 4-91 CC N �1r V C,%jW Z 'y "I hav een or fWerved, or believe 1 saw evidence 0. l it oblec such as houses, wells,trees, fences, etc C' '5 shown on is document I also represent that l_h •O ® petonall` asure the ist ces set forth o, e dia -'' r SI VATURE �;� Z.AATE.". %K* ' i� i' AUG 24rO TOWN OF QUBBRlSSURY BUILD t : .. ^\-n c r Q D y eta y,.. ,_, .. � .•��. - ._.. :. � .' .-_ � - .... .. ._ - - - '