97-444 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
December 4 97
Date 19
•
97444
• This is to certify that work requested to be done as shown by Permit No.
;•
• has been completed.
RESIDENTIAL ADDITION (KITCHEN & BEDR00/1 )
This structure may be occupied as a
30 OAKWOOD DR.
Location -
.•
KELLY. SALLY N.
•. ".
Owner
•
TAX. HAP NO. 66 . -1-4 • • By Order Town Board
• • TOWN OF QUEENSBURY.
. •
Director of Bldg. & Code Enforcement •
•
•
BUILDING PERMIT
VALUE $ 60000 TOWN OF QUEENSBURY No. 97444
TAX MAP NO. 66 . -1-4 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to KELLY, SALLY N.
OWNER of property located at 30 OAKWOOD DR. Street. Road or Ave.
in the Town of Queensbury,To Construct or place a RESIDENTIAL AD1]TTTflN (KITCHEN & BEDROOM
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
30 OAKWOOD DR.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
FULLER CONSTRUCTION
3. CONTRACTOR or BUILDERS Address
9 JOHN CLENDON ROAD
QUEENSBURY, NY
4. ARCHITECT'S Name
NEW YORK BOARD
5. ARCHITECT'S Address
NEW YORK BOARD OF FIRE UNDERWRITERS
6. TYPE of Construction—(Please indicate by X)
RESIDENTIAL ADDITION
( )Wood Frame ( I Masonry ( ) Steel ( )
7. PLANS and Specifications
280 SOo.FT RESIDENTIAL ADDITION (EXTENION TO KITCHEN & BEDROOM)
AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
RESIDENTIAL ADDITION (KITCHEN & BEDROOM)
24 August 18 19 99
$ PERMIT FEE PAID —THIS PERMIT EXPIRES
(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.)
18 August
Dated at the Town of Queensbury this Day of 19 97
SIGNED BY ' C/k i for the Town of Queensbury
Building and Zoning Inspector
Department of Community Development Reviewed By: k-----'—
' Building & Code Enforcement: Building Inspector
Town o f Queensbury Permit No. '7 `-Li g Li
742 Bay Road ij
• Queensbury, New York 12804 Fee Paid $ 90
(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: /%,ge/- C-�s7F��i 7 �i ., y'n C. - Owner: Dr.vi/(' l' 56 74 /(e777
Address: / ,SoZ' ((~107 /�G( Address: 3 o 0c,/ werad Dr• (Pk ee-k s`�•�y
4)„ eeA_S4G•Yy
Phone # ( 57 ) 7T2 - ZQ.3_o_ Phone # (5K ) 75 g - /O 7
Property Location: 30 akwo�o{ .0c. (R,P0,-,..5-4`-- 46 / / 1 41
Tax Map Number -
Subdivision Name: Section Block Lot
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
New Building: CONSTRUCTION: $ , 6/ ezrzi —
residence / commercial
Addition - Building: ...-•• --� __ ___
r-esidence / commercial OCCUPANCY INFORMATION_: -_,------
Alteration to Building: Prit ary Building - ' ' - `- • . .
residence / commercial Single Family Dwelling
Residence / Commercial Two Family D:wel1Ilt 041997
no change to exterior size Family; Dwelling .
Office ;e`
Other Work (describe below) Mercantile _—..,._- .__.__.,_ -
Manufacturing .
Other
GROSS AREA OF PROPOSED STRUCTURE:
• If ADDITION, what will use
1st Floor F/5/c sq. ft . of new addition br :
2nd .Floor /LiiU sq. f L. A /� A y JPlr �
�Jc� /o h i C
Other Floors sq. ft.
(not unfinished cellar or basement)
. • ACCESSORY BUILDINGS:
Detached Garage 1 , 2 car
TOTAL FLOOR AREA: c,2J70 SQ. FT. Attached Garage 1 , 2 car
Private Storage Building
SIZE OF NEW STRUCTURE : . Commercial Storage Building
�i Other
/—(0 FEET X O FEET .
Foundation Type : Pvrt-via( C�c`•e7T2 Will any second-hand or ungraded
Number of Stories : .— lumber be use If so, for what?
(habitable space only) / CO
Height (grade to ridge): -2S feet TYPE OF HEATING SYSTEM:
Number of fireplaces and/or woodstove ( circle all whic ies )
to be installed: Electric / Oil Gas Wood
Forced Hot Air seboard Other
Person responsible fo�j// supervision ofq /work as re rd to building
codes is : Kris F,,-/lam g 70Z, c% r v,E', .76, 7`/a-2v30
N the Addresss Phone l
Builder: /-6,/�-e/ Cc iZ.S � �-, Cp. 1aG. .
Plumber: ,per '
Mason: JA--"tee • �/
Electrician : go4 71/b,,-/���/..ri-7 e. _.
DECLARATION
To the best of my knowledge the statements contained in this appli-
cation, 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
drawn to scale, showing actual location of project on premises .
_ -- -
Signature: 2-_,--V,
(owner, owner' s agent, architect, contractor)
ENERGY CODE COMPLIANCE APPLICATION
TOWN OF QUEENSBURY, WARREN COUNTY - 9000 HEATING DEGREE DAYS
Compliance Methods:
PART 5 - Acceptable Practice Method - 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
PART 4 & 6 - Compliance Methods Require Submission of Worksheets
D4AA'd 4 (fi,_ /(/ (( Oaki,),,,,/
APPLICANTS NAIL r PROPERTY LOCATION
PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE:
1. Gross Floor Area - (2 7U Sq. Ft.
2. Type of Heat - Elec. Base Board Other - 4 / A7 —
3. Is Building Mechanically Cooled? YES NO
4. Percentage of Area of Windows and Doors Over 17% Under 17%
THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND TO REQUIRED
THE R-VALUES SHOWN ON PLANS SUBMITTED!
Baseboard
5. Insulation Values: Actual Shown Elec. Heat Other
A. Roof & Floors exposed to ambient temperatures R 3 g d3 kgO
B. Exterior Walls R / q 2Jr" 19
C. Glazed Area R
D. Exterior Doors R z. 2.5 205
E. Floors over unheated spaces R' 25 iq
F. Edge of Slab on Grade (Heated Building) R 4r/A __Li_ __Li—
G. Basement/Cellar Walls (Above Grade) R 15
H. Basement/Cellar Walls (Below Grade) R / / __II —
I. Heating/Cooling - Ducts - Piping in Unheated Space R /'4
6. Service (Domestic) Hot Water Heating Device
A. Conforms to minimum efficiency per code YES NO
TEMPERATURE CONTROL MAXIMUM SETTING 140* - WILL NOT BE EXCEEDED
f // 7 71 - zo3o
APPLICANT'S SIGNATURE DATE TELEPHONE NUMBER:
INSPECTOR'S REMARKS:
REVIEWED BY
•
4ai.a?tiA,,l.�. a11..IJJ..•?.J.t4:,114.49A JJ,1:x,..,P.tiJ... .,PAC ,1tLJ4Z.),.tiS,,,,&:), J,..,_Q.n•In'J.,.l'J,..,S.CJ.,.._C'x,._:•',na tia:I:JJ.•?.,1 �,.t:X.SA,Q14A.0 a7,10!.�..4:.Aneg.le),.. ),.A�9cC7....1. eS•15t4C
J. rY
1. THE NEW YORK BOARD OF FIRE UNDERWRITERS '''' °' r° I.
f 56 }C 5�; BUREAU OF ELECTRICITY
71; r 111 WASHINGTON AVE., SUITE 704, ALBANY, NY 12210 a
-c Air `.j}71' BE 26,'�.;z,,�y `"',. 4 r%'�! ?'0 4.::''' 12 Y
• Date Application No. file r
1, 1. ...1 'l4c!
THIS CERTIFIES THAT i'.'11l! l`` ` '. f '
only the electrical equipment as described below and introduced by the a.. — named on the above application number in the premises of iY
p it
ti :{�t1 R) 6, ; f17 J E M T r .. 'if OAK WOOD(OD i yy . LOT t.1;77M{�1t Sry ` U17 ((11 'y
� ? I �' JS'7 4 i 1 d Y .1 . l 1L� �i p ,�JY'71;1A'h 4'J_!S.f I"•�! LY�� IT
,; t. r
,-,1, in the following location; 111 Basement ❑ 1st Fl. ❑ 2nd Fl. Section's° Blocky Lot ' to
tt, was examined on I Es and found to be in compliance with the National Electrical Code. i
I
r
•z' FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS ;:
(1. OUTLETS ECEPTACLES SWITCHES INCANDESCENT•FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT.
^' DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS ,r
iii•
SYSTEMS' AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS.MI H.P. NO.OF FEET AMT. WATTS '?
. ?AI
%; SERVICE DISCONNECT NO.OF I S E R V I C E r
I? AMT AMP TYPE METER' L 0 2W 1 03W 3$3W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A.W G. NO. NEUTRALS A.W.G.
t EQUIP. PER AY OF CC.COND. OF HI-LEG OF NEUTRAL ',
•
OTHER APPARATUS: 10
's; D.1;51'ii AL: I-1,' 1.;.W. . ,r
a pii
' i' TI A(..! 6t(sa1}IRi; l`41
r
►c 1r
1 y
.
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1 i ..-..ate r• r r
ril
'3 JO1t3 CLi�;l`3L;ON 110itt,.1 `•i j(4171 �,.i GENERAL MANAGER 1y
' - la - �. 3+ Per t
r
• This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. ;}
—740 reCraera1 et'i do'No liVii�`,al'7•i7eC raCr�Yet-ri�'7eCiU:Y.0 riCYii-ieniYAiniVral JaC iiWre�'.sf:1ifYe1 i�Y�CY�:Y•C riirrd rirTe.YiKiiii YA7Y�f 74i:I.�'YwY7AFYAY.YiYYeWiiAYYiY?e;ii?1
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
RESIDENTIAL FINAL INSPECTION REPORT
Office No. (518) 761-8256 top
Building &Code Enforcment Arrive: ,et,t‘Insp �_
Dept. of Community Development \1070
0
Town of Queensbury Date Inspection Request 'ec-. ed: /) -9 7
742 Bay Road
Queensbury, NY 12804 ,
NAME 61_ fit/► A�'l / PERMIT NO.LOCATION 30 ` d i%--e- DATE /�-'/- 9 7
TYPE OF STRUE 20-,46-j1 ern K/ w./Ac4 -n L
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" At
Exterior Handrails,,-B conies, ing 18 in. or more
Interior Handrails Stairs Si es \or More Risers
•
Grade 2% Away From Foun to \ I
8" Clearance To Sill Plate ., \ .t(
Gas Valve Shut-Off Exposed/Regula r 18\Above Grade
Gas Furnace Shut-Off within 30 Feet o wi ' Line of Site
Oil Furnace Shut-Off at Entrance to 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 More Than 3 Risers
Interior Privacy/Trim/Doors/Main Entrance 36" I
Floor Finish J
Bathroom/Kitchen Watertight /
Interior Handrails Balconies/Landing 18 in. or more
Railing Across Window in Stairwells /
Smoke Detectors: J
every level
every bedroom
outside every bedroom
inter connected '
Bathroom Fans /e .
Plumbing Fixtures d/
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 i
Final Electrical .
Site Plan/Variance Required
Final Survey Plot Plan
As Built Septic.System Layout Req.
Okay to Issue Temp C/O
Okay to Issue Permanent C/O i ____ __ _ _
Okay to Issue C/C
(518) 761-8256
TOWN OF QUEENSBURY '
BUILDING & CODE ENFORCEMENT Y
742 BAY RD., QUEENSBURY NY 12804 l.v
INSPECTOR'S REPORT: ARR DEPART\O, I
REQUEST FOR INSPECTION RECEIVED: 1AO
NAME +'
'_
LOCATION 1 0 P u3( () 1IF-0\T
DATE C1 I 1-i\.T1 PERMIT A r i�^1+L 1
TYPE OF STRUCTURE^ di
RECHECK 1 APPROVED
k". i/ N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORE ,%
REINFORCEMENT IN PLACE Ij
THE CONTRACTOR IS RESPONSIB FOR
PROVIDING PROTE TION F+'ROM FREEZING
FOR 48 HOURS FOLLOWIN THE'IlPLACE-
MENT OF THE CONCRETE. _
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALLPOUR ; _
f
REINFORCEMENT IN PLACE A , ______
s+
FOUNDATION/DAMPPROOFINGf '4
BACKFILL APPROVAL 71 ,
PLUMBING VENT/VENTS INi PLACE _
ROUGH PLUMBING , _ _
PLUMBING UNDER SLAB _
FRAMING: I L - _ mil
JACK STUDS�/HEADERS YY--»
BRACING/BRIDGING
JOIST HANtERS
JACK POSTS MAIN BEAM
AIR INFILTRATION BARRIER ,'
cp- 17. '
HE TING ROUGH-I
INSULATION:
FOUNDATION ALLS INTE IOR R-%% \ f
FOUNDATION WALLS EXTERIOR R- 1 _
FLOORS R- 1 -
Will.4AA) CD R- - 1
CEILING d R-`
DUCT WORK OR PIPING IN t
UNHEATED yS�'PACES R •-
1
fv H t -f \t3 e 0), VitAp'-P—.____
L-o c Wioi& 4R) -i ccte_
® eo 5L/AAA ‘t.. ?;;;;LC:-kELit E u.AO
(�`���� �FEV5 _ ct itahv c
n- 6KE. M�`ti` k
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`/ NEE V 4
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vJk-L 1, tipUI.R`V\oL i+ C'aLam_.
(518) 761-8256
TOWN OF QUEENSBURY 4+ `
BUILDING & CODE ENFORCEMENT
742 BAY;�'RD., QUEENSBURY NY 12804 '+`;r A'. .�.-.,:
I.
y 67
INSPECTOR'S REPORT: ARR i V, }DEPARTi�C�'��
REQUEST FOR INSPECTION RECEIVED: /�'
NAME 1 VEL& I L
11
LOCATION 1 _,,Pi ) VRi
DATE M PERMIT A 11 1 —y.44
TYPE OF ST•UCTU4E: g_E_, ,ur' ANV.
RECHECK I'r APPROVED
//N/A YES NO
ii
FOOTINGS/PIERS 1 a'
MONOLITHIC POUR l'ORM I ,
REINFORCEMENT INIPLACE
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TFION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLA6E—
MENT OF THE CONCRETE. J' _
MATERIALS FOR THIS PURPOSE OSITE
FOUNDATION/WALLPOUR /
REINFORCEMENT IN PUCE / _
FOUNDATION/DAMPPROOFhING I _-
— BACKFILL APPROVAL \ _ -I` -"
PLUMBING VENT/VENTS I LACE _
ROUGH PLUMBING
PLUMBING UNDER SLAB
FRAMING:
JACK STUDS/H DEI S _
BRACING/BRID ING _
JOIST HANGE S
JACK POSTS/LAIN BE
AIR INFILTRATION B RRIER
HEATING ROUGH—IN / \ _
INSULATION:
FOUNDATION WAILS INTERIOR R— \
FOUNDATION WALLS EXTERIOR R— \ _
FLOORS / Rli—
WALLS e-V'e-NVEIZ-1--, R— \ L
CEILING / R— ‘
DUCT WORK R PIPING IN
UNHEATED SPACES R—
1 `' � 18) 761-8256
mom""
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12804
-
INSPECTOR'S REPORT: AR PDDEPAR
REQUEST FOR INSPECTION RECEIVED:
NAME _. ,
LOCATION a a-10 'V V\\
DATE \ t Cq A- PERMIT A OV7 l LttkL
TYPE OF STR CTURE:
RECHECK APPROVED
N/A YES _ NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM _
REINFORCEMENT IN PLACE .
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZINI �
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE. ,
MATERIALS FOR THIS PURPOS IN SA_
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING _
BACKFI-LL- APPROVAL _ ,
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING _
PLUMBING UNDER SLAB _
FRAMING:
JACK STUDS/HEADERS
BRACING/BRIDGING _
JOIST HANGERS
JACK POSTS/MAIN BEAM
AIR INFILTRATION BARRIER _
HEATING ROUGH-IN _7
INSULATION: \5 (�_ it -%
FOUNDAATTIIO LS I1aTERIOR R-�5 3� ��
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R- •
e...\ „claLd06-1/) (518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 BAY RD., QUEENSBURY NY 12604 -" '�.-.
INSPECTOR'S REPORT: AR '4rDEPARPV7}J o {
REQUEST FOR INSPECTION RECEIV ►: • 1
NAME ( l\` \ IL
, .
�i
LOCATION 3 0 .�I.x� , r-O 1R)
DATTE( --i L 9 -7 PERMIT 0 9 7 -LjijL/
TYPE OF STRUCTURE: AeC, 1 AC)C).-A-t pr
RECHECK _ APPROVED
N/A YES NO
FOOTINGS/PIERS _
:;) '
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESP SIDLE FOR
PROVIDING PROTE TION F OM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALLPOUR _
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAli -- - "--"' - - "_._ _ --
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING _
P,r,�UMBING UNDER SLAB
_FRAMING:
JACK STUDS/HEADERS _
BRACING/BRIDGING
JOIST HANGERS t
JACK POSTS/MAIN BEAM - 4
AIR INFILTRATION BARRIER
HEATING ROUGH-IN �j ' b -
INSULATION: `2
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R- _
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN
UNHEATED SPACES R- •
•
V c L-1- fit_ t itAk..-- itAt-' .6 f�
. w e b; t-kp.f.: .
v 1 PV"V(518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT ' .
742 BAY RD., QUEENSBURY NY 12804 _
s c.
INSPECTOR'S REPORT: ARR9'ZcDEPART I." /
7 _ /
REQUEST FOR, INSPECT O. RECEIVED:
lir
NAME r,, i
v A,
LOCATION I /4�i�a _ ,� / LIM,y
DATE—ON
1 RMIT # t—t-- L
TYPE OF STRUCTURE: R \ 1
RECHECK APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR
) .
REINFORCEMENT IN PL CE •
THE CONTRACTOR IS RE ONSIHLE 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 _�
F NDATION/ANPPROOFINGL� _
BACKFILL APPROVAL --- -
PLUMBING VENT/VENTS IN PLACE
ROUGH PLUMBING
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- • ,
"a';3 0 (518) 761-8256
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT (Oki
742 BAY RD. , QUEENSBURY NY 12804
1,4
INSPECTOR'S REPORT: AR '=5i)DEPARTT4- '
REQUEST F R IN ECTION RECEIVED:
.� l:i
N
NAME e/ K�) 1
o�` L O c
LOCATION � � prme
S.
-C 1- L
DATE (� � � 1� PERMIT �
TYPE OF STRUCTURE: -eS - ) 9-N1
RECHECK APPROVED
N/A YES NO
OOTINGS/PIERS'
MONOLITHIC OUR FORM
REINFORCEM T IN`P A E _
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZING
FOR 48 HOURS FOLLOWING THE PLACE-
MENT OF THE ••NCRETE.
MATERIALS FOR T' S PU'OSE IN SITE
FOUNDATION/WALLPOUR
REINFORCEMENT IN PLACD
FOUNDATION/DAMPPROOFI G _
SACKFILL APPROVAL
/
PLUMBING VENT/VENTS IN PLACE
:SOUGH PLUMBING
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-
'--\y„,\)&0, ..mty- 1 u-yry)‘
- ., TOWN OF QUEENSBURY
XFIRE MARSHAL
.,,,,.,, , QUEENSBURY, NY 12804
a p ' -'T �� (518) 761-8205
FIRE MARSHAL INSPECTION REPORT.G� '
�J
REQUEST FOR INSPECTION RECEIVED / I 1
NAME (ik- S `1' NATi`e..SC) (
LOCATIOIP JG1 U -0 .)---6 ,
DATE PERMIT 7 L# PA 7 f 5L/Ll 1/
...
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS •
EXIT SIGNS
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
AUTO. EXTINGUISHING SYSTEM
HOOD INST LATION
AUTO. SPRINKLER TEM
ALARM SYSTEM
INTERIOR FINISHES
STORAGE:
CLEARANCE TO SPRINKL RS
CLEARANCE TO HEATING UNITS
REQUIRED SIGNAGE
CHIMNEY
WOODSTOVE
FIREPLACE-MASONRY
FIREPL E- FACTO Y BUI T ,7
v�.� ,r.(440/ ;yam ?
REMARKS: 4 "D'OK40 THIS DATE
INSPSLIP.PUB ' IN PECTOR
COMMONWEALTH ELECTRICAL INSPECTION SERVICE IN:
Main Office 357 Elwyn Terrace — Manheim,PA 17545 (.QC vg
MUNICIPAL CERTIFICATE - ELECTRICAL APPR V L
Panel Board No. Cert. 4 4172 Cut-in Card No.
Owner
Occupant ,
LocationLO rg-g-Lfr,R61-- A , C cteZ7V1/
Installation Consisting of.Ai- y szo/ 7-44 b s-pecep 7/6-1 res.
••,
lizte.,„ amct 6,—
la 0 A S eGailt&Cf:-. —
Installed By -67A1?-/I 6 67-6`C/ Lie. #
The conditions following governed the issuance of this certificate,and any certificate previously
issued is cancelled:—
This certificate only covers the electrical equipment and installation conditions as of date. Upon
the introduction of additional equipment or alterations, application shall p omptly made for
inspection.
Inspectors of this Company shall have the privilege of akj inspect• ns a any time,and if its
rules are violated,the Company shall have the right to revo t fs rtifica e.
Date 71 7-f 7 INSPECTO '
Mem er N.F.P.A.,I.A.E.I.
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