1985-647 .r
y
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 144�2 1 Q 19 2L
This is to certify that work requested to be done as shown by Permit No. F 4 '7
has been completed. U 1 P--1 70�,JjA
This structure may be occupied as a �' r _ �' r _ - 1 1.
Location Poo i r is , 4 n 2�5 LJ z-'�^- -RA
^ ` i<, 1 .1=, c 3 L � rE .er 1 i 1l R-l� irJV[
Owner
By Order Town Board
TOWN OF QUEENSSURY
BulaWng & Zoning Inspector
CRC^TIVC "INST M" rRIMTPM4. "LKMS FALLS N Y 12001 151e1703J54SG
BUILDING PERMIT
TOWN OF QUEENSBURY No. 65 _ 647
WARREN COUNTY, NEW YORK
PERMISS10N is hereby granted to M±chael Barber
N
OWNER of property located at Route 149 Street, Road or Ave.
s
iv
(D
in the Town of Queensbury, To Construct or place a One—Family Dwelling F-
at the above location in accordance to application together with plot plans and other information hereto filed and tz77
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. �
cr
t_ OWNER'S Address is RR # 1 Box 1564
Lake George . New York
x
a
2. CONTRACTOR or BUILDERS Name r�
rf
(D
Same
3. CONTRACTOR or BUILDER'S Address
Same4. ARCHITECT'S Name
5. ARCHITECT'S Address
t
6. TYPE of Construction — (Please indicate by X) @
fx ) Wood Frame k 1 Masonry { 1 Steel f 1 Pi
F+•
N
7. PLANS and Specifications t �
3 0 r 6 'r x4 0 r per Plot Plan , specifications and apPlicatiOn
Np subrnitted {using existing septic system ) .
F
8. Proposed Use W'
One-Family Dwelling
$ 5 . 00 C/o Paid
$ 98 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES Tune 6
flf a longer period is requ Wad an application for an extension must be made to the Building and Zoning inspector of the k,. -ro
town of Queensbury before the expiration date.) y l
Dated at the Town of Queensbury this 4th Day of November 19 85 Y+,P
SIGNED BY for the Town of Queensbury
Building and Zoning I nspector
TOWN OF QUEENSBURY SSpace insidc block to be filled in b%
W^RREN COUN"i'Y. NEW YORK Building Inxpinct4fri•1
Application for 1'c•lmit 14.rrrwtl 14
BUILDING AND ZONING PERMIT PcI mil F thirc+
%imm 1 )i+trirf
'w III ]r( 1% t'd Ir\'
Iowa l ) Copps of PLOT PLA drawn to scale It�•ir�:� i
showin the eafual dimensions a the lot to be built
upon. exact sire, and location o of of the
building to be erecte or Afama&:YAUST BE SU17J
d
( APPLICATIONS)
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK
ANSWER ALL OF THE FOLLOWING. OCT 3
The undersigned hereby applies for a permit to do the following work
which will be done in accordance with the description, plans and spacifi.
cations, and such special condition: as may be indicated on the permit. `7� $�$�i�x g
The owner of this prapiert
Ile IP Q /IDDF£ 1
The peraort responsible -for supervision of the work insofar as the $i�ilding ('ode and the Zoning Ordinan apply i+:
GGf' !t - , f7...3s'2 � 1Z- ry o nobr,esSr
INAMEI
ter'-,.�c.�,.��
Name of Builder .�1�,... .e: �Rt � . +� . . . �� 1. s2.--:- . , , . . . . . Address - - . . - .
Name of Plumber , . . . . . . . t .�. . , . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of Mason - . . . . . . . ! . w. . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . - - . . . -
Unit . - . . . . . . . Estimated value of proposed work f . ' :r - C . . t-� G •� , , -
Lot Number . . • . . . . //
NarneofVillage . �a rrs ' r3 . . . . . . . . . . . . . . . . . . . . . . . .
Name of Street . . . . I . . . . . . . . . . . • , . Side of street : north ❑. east i , south ❑ . west ❑
Nearest Cross Street - /�+�-� d d dDistance frc,m this cross street . . . . �!'•J�"jr,I +ram . . . - . . Ft,
property is north 0 . south (A . east LIT west Elfrom Cross Street
If on Carnet', which corner, northeast L1 , nrxrthwest southeast L'I, southwest
[Designate by marking with an "`X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY
Main Rw"ing
Construction of a new building. One-family dwelling
CJ Addition to a building. Twa-fami)V dwelling
0 Alteration to a bui}ding. - - . , I _family apartment house �
[] Demolition of a building. Store building 0
. . . -car attached garage
Other: . . . . . . . . . . . . . . . . . . . . . .
Accessory Building
One-car detached garage 0
0 Other work. Describe: . . . . . . . . . . . . . . . . . . . Two-car detached garage O
Private chicken house
. . . . . . • . . . . . . • . . . . . . . . . . . . . . Private storage building
Other: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ZONING SPECIFICATIONS. Fill in for new building, or .additivn to existing building, or a change of ixcupaM-
Indicate on the plot plan street names, the location and
size of the property, the location, site and setbacks of pro-
posed buildings, and the location of all existing buildings.
Nowrii Show proposed building(&) in dotted line and existing
%uilding(s) in solid line.
5;?_aC=. . . . . . ft, x . ,r'"�''' '. C . . ft.
Size of property r
Size and use of existing buildings. if any • . ? "'�
M : #t: . . : � � e I ft.
# L
Sire of proposed building •�- • . . x
I3eight (from grade to ridge) • • . y [t.
Front yard . . . . .� ' .� : . . . . . . . . . . . .
ft.
Side yards . . , . . . . ft. and . . . . . ' • . . ft.
~. . .
Rear yard . . . . . . .
C . . . . . . . . . . . . . . . . . . . . It.
a4 tiTN
�~ if on corner. setback from side street . . . . . . . . . . . . . . . ft.
j1FOfC . A11 distances are +a+rt, as na*r;atrard fra+n street side
line ru+ nearest dart of building,
(pVlR!
(cont'd.)
BUILDING SPECIFICATIONS,,
Kind of construction: Wood frame, fire safe, etc.? . . . . . +E. `? R� �? - 're C}�. . . �•s ["IC=CL
Will any second-hand lumber be /3 , 1, i . , . . . if sa, for what? . . . . _ . .
Material of foundation wallsT ,
. . .+. . . . . . . . . . . . .� . . . . . . . . "thickness
Depth of foundation walls below grade . ` d"
Tt-' • �j � � " . . . - . . Contin us foundation?
Will there be a cellar? . .i9 _ . . , . If so, materia of cellar floor
Type of roof: Sloped or at? /"L ., err? :?, -" . . . Material of roof . . . - . . , �} 5 4/�"- " .
Size. wood studs - . . . . . . . . .� . . . . . . x . . 1_f v. . . . . , _ . . . ", spacing . . . . .� 40. . , , . "ex., length . . . . . . . . . . . . . ft.
Sire. [loco beams, 1st floor . . . . . . . - "' x , . �/ LC- . . . . . . . spacing �! . --
o.c., span . . . /. ,ry : . . . , . . ft.
Size, floor beams, 2nd floor . , . . . . . . " x - • , spacing . . . "'o,c., a n lw.
Size, ceiling beams . . . . - . . . . e . " . " x . . /� it.
", spacing - . . , ,,� ox., span . . . . . . . . . ft.
Sire, roof rafters a beams Z_ . . " x /. '3-- , ", spacing; . . . . . p . . . . . "n.c., span . . _ _ . . 'S'�, . . . ft.
Exterior finish�.>r�rc . . . » 1j .� ,x�. • . . . . . With what material? . -G'. . 'cf • pry._ . . ,• .Finish of interior walls . .
. . . . . . . . . .
If
garage is to be attached, of what material is wall between garage and main buijding to be constructed?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
s there to be an opening between garage and building? . . . . . . . . . . . . . . . . . . . . . » , ,
Kind of heating, system, . . - , . _ . . . . . . . _ . . . . . . . . . . . . . . . . . . . . " Oil burner or coal ?
Will a flue-lined chimney be provided? . . . . . . . . . . . . . . . Depth of chimney foundation below grade . . . . . . . . _ . . .
Height o chimney above roof. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Will there be a fireplace? . . . . . . . . . . . . . . . . . . . . . . . . . Depth of fireplace hearth . . . .
Will . . . . . .
» , . , . . . . ,
ill a toilet be installed? . . . . . . . . . . . . . . . . . .
. . . . . . . . . '. . . . . . . . - , . . . . . . . .
x a kitchen sink be installed and connected to water supply? . . .
Water supply (public water supply or ppY p PpY pump; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Distance of cesspool from any private well feet
Will drainage system be provided with required traps, cleanouts, and vents? , . . . . . . . . . .
Town of Queenshury, AFFIDAVIT
County of Warren
State of New York
I swear that to tr. 4b6Fa jjrf my knowAodrs ,and belief the statemanu contained in L" appi"tiort, to�atlter with the
sWd Lr=Amitted, are a true and co.. ,ptese statement of ap proposed work to be dogs on the described premuea and that all Pee tSUILLD-
ING CODE, THE ZONING [ORDINANCE, and all other Iowa pertaining so the proposed work shall boo armptied wick, whether specifwd or
and that such work is authorised by the owner, not,
Sworn to before me this signature e gc.<
NE C3WMER"S �ARG Rt7ECT. CC3NTRAGTC7R. . .-. . . ... .
.. .. -. . . . say of. .. .. . . .. . . ...... .. . . . .. . ... . .. . . . . .. .. . . .. . . I9. -
NOTARY PUBLIC, WAteltaN COUNTY, N, Y.
SPECIAL CONDITIONS OF THE PERMIT:
By . ... .. . . .. .... .. ..... _ ... .. .... . _ . ..........
TOWN OF QUEENSHURY
WARREN COUNTY NEW YORK
Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work .
ANSWER ALL of the following :
1 . Gross floor area
2 . Type of heat r" < [ ti_
3 . Is the building mechanically cooled ? A4. �4C:
4 . Percentage of area of windows and doors
A . Over 16 % Only
1 . value of gross area of walls , roof/ ceiling and floors
�osed to ambient conditions
2 . Floor over heated spaces I YES C
a . Are foundation walls Insulated ? ¢E tiO
1 . If YES , what is the R value ?
3 . Slab on grade YES NO
a . If YES , what is the R value of insulation around
perimeter of floor ?
4o is basement heated ? ES NO
a . R value of insulai.
7
5 . Type of Insulation.
s+
'7
B . Under 16 % Only
1 . R value of roof and f oo s exposed to ambient conditions
2 . R value of exterior walls / � / fir` UEQe7r4 YG ■
3 . R value of glazed area yyam� '" .
4 . R value of doors /'C..Z "� !i► S
- -- I d
�/ ��
5 . R value of floors over unheated spaces - �`-T -- �
6 . R value of slab edge insulation - unheated slab Aj
70 R value of slab insulation - heated slab O&� w 17-
8 . R value of heated basement/cellar walls ( above grade )
9 . R value of heated bas .- went/ cellar walls ( below grade )
10 . Type of insulation
Co Controls �y
1 . Thermostat maximum heat setting
D . Duct systems
1 . Is duct system installed in unheated spaces ? YES N
a . _ if YES , R value of duct installation
b . R value of duct in other areas
E . Piping 2nsulation
1 . Sire of hot water or cooling carrying agent pipe /
2 . R value of pipe insulation /
F . Service /Water Heating
1 . Performance efficiency
2 . Temperature control setting maxi um
G . For Swimming Pool Only � +
1 . Maximum 'heating
Telephone No .
( applicant's signature ]
TOWN OF QUFF'NSBURY
BUILDING & ZONING DEPARTMFN'T
SEWAGF DISPOSAL PERMIT APPLICATION
1 . Owner ' s Name i rE 2 421 '
Address�e� l
! Telephone No . `j - z z,
2 . Property location �' `% —` �/ „13� ?" 15
3 . Name of person or firm responsible for .installing system�4�4aZ-rr
Telephone
Address
4 . Number of bedrooms ( residential buildings only)
5 . Daily flow. � t� c" - _gallons/day
6 . Septic tank capacity gallons
7 . Topography : flat , rollingo steep
of slope
r
S . Nature of soil and depth_
9 . If ground water , bedrock orbimpervious material is apparent at what
depth does it begin? r/cam`' ft .
10 . Percolation test : A is required
B r� _ is not. required
C if required what is th.e rate minutes/inch
11 . Water supply : municipal , well , other^ � " !' + z
12 . Type of system proposed : drywell , tile field , other 6 /Z
Any contractor , corporation , individual , etc . engaged in the construction
of a sanitary sewage disposal system who covers the same before inspection ,
does - not have an approved permit , or varies from the approved application
will be subject to a penalty of $ 250 as provided for in Section 6 . 010 of the
Queensbury Sanitary Sewage Ordinance . u
Date �-
- signature of app scant
On separate sheet of paper submit a diagram of the proposed septic system
with all dimensions , including distance from any structure , distance from
property line and domestic water supply , etc . Include all dimensions of
the system itself .
Form 3- 82
TOWN OF iQUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YOR.K I28O9-
TELEPHONE I8) 792-5832
BLJ ING INSPECTOR' S RE RT
REQUEST R I_ PECTION CEIVED
NAME
LOCATION
DATE Cy PERMIT
APPROVED
YES i NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP—PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN '
INSULATION:
FOUNDATION
FLOORS.
WALLS
liz, CEILING
INAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCH S/STEP
STAIRS—CrE srA E & RA LS
PLUMBING FIX RES/RE F VALVE
INTERIOR TRIM PRIVACY RS
FINISHED FLO S -
GARAGE FIRED DOPING
DOOR CLOSER }
SMOKE DETEC RS
FINAL ELECTR AL INSPECTS
FINAL APPROV L. OF CONSTRU ION
OK To ISSUE /O OR C/C
A SIGNED C TIFICATE OF OC PANCY MUST BE
OBTAINED F OM THE BUILDING EPARTMENT BEFORE
THESE PRE SES ARE OCCUPIED
REMARKS:
ARRIVE Za 3O
DEPART
INSPECTOR
rrol,11 OF QL}EE135Bi3RY irmENT
$UILDING AND CODES DEPAR
ILAND ROADS
BAY IiAV Z2B04
QUEENSBURY , NEW' FORK
TELEPHONE fSISJ 792"5832
BUTTDiNG INSPECTOR' S REPORT
INSPECTION
REQUEST FOR I
NAME ION L � �_-�,""��
pC.ai PERMIT #
/7 i7
,�-3-�' APPROVED
DATE
YES No
FOOTING1PIERS FORMS
MONOLITHIC P�oUp-PROOFING
FOUNDATIO pp
BACKFT PpROVAL
PLUMBING
ROUGH
FRAMING
ELECTRICAL ROCIGH TN
jWStjLATXGN
FOUNDATION
FLOORS
WALLS
CEILING INSPECTION -*
FINAL
CHIMNEY HEI60T
ROOFING
SIDING ^�-
EXTSRNAL PORC NCE &T RkxLS��---�--
STATRS-CFEARA V LVE
PLUMBINq FIXTURES/RELIEF -
INTERI
TRIMIPRIV`�'CY DOORS `.
FINISH D FLOORS
GARAG FIREPROOFING
DOOR LOSER (S)
SMOK DETECTORS
7RTCAL INSPECTION
LEC
FINAL O� CO�yTSTRUCTION
FINAL PPROVAL
OF OCCUPANCY MUST BE
A SIGNED CERIIFIE TE Bu.TJrVING DEPAR MENT BEFORE
OBTAIN D FRO ES ARE OCCUPIED!
THESE
REMARKS =
��-= �---
� INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND YO ROADS DS I28D�
QUEENSBURY, 5W 18 ) 792- 5832
TELEPHONE
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
c
LOCATION
7 _ � PERMIT #i
DATE f APPROVED
YES NO
FOOTINGIPIERS
MONOLITHIC POUR FORMS
pC7FING
FOUNDATXONI DAM�P-
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROTJGH�IIri
, ULATION: r
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION
CHIMNEY HEIGH
ROOFING
SIDING
EXTERNAL P
STAIRS-C RANCE & RAILS A_
PLUMBING IXTURESIRELIEF VALV ,__.�
INTERIOR TRIMIPRIVACY DOORS
FINISHED] FLOORS
GARAGE IOXREPROOFXNG
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILI3ING DEPARTMENTBEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS r e' /r J
��( INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURYI NEW YORK 1280k
TELEPHONE (5.I8 ) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR xNsPECTXON RECEIVED
NAME
LOCATION
DATE CI PERMIT
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATSON/DAMP-PRROOFI NG
BACKFILL A ROVAL
ROUGH PLUMB NG
FRAMING
ELECTRICAL R GH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL .INSPECTION_
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES STEPS
STAIRS-CLEARANC & RAIf�S _.._......
PLUMBING FIX TU ES/RELIEF.. VALVE
INTERIOR TRIM RIVACY DOORS
FINISHED FLO S
GARAGE FIRED OOFING
DOOR CLOSER S)
SMOKE DETE ORS
FINAL ELECTR CAL .INSPECTION
FINAL APPROV L OF CONSTRUCTION
A SIGNED CER IFICATE OF OCCUPANCY MUST BE
OBTAINED FRO THE BUILDING DEPARTMENT BEFORE
THESE PREMIS ARE OCCUPIED!
REMARKS:
INSPECTOR
TOWN OF QUEEN'SBURY
BUXLDXNG AND CODES DEPARTMENT
BAY & HAVXLAND ROADS
QUEENSBURYe NEW YORK 1280k
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FORy;l;wsPEc70N RECEIV /7 ,S-
NAME —
LOCATTON DATE ^ PERMIT # Lam" `"4y S 2 .-
APPROVED
YES NO
FOOTINGIPIER
MONOLITHIC PO FORMS_
FOUNDATION fDAM -PROOFING
BACKFXLL APPRO L
ro�9OUGH PLUMBING
4 JY AMXNG
ELECTRICAL ROUGH-
INSULATIONr
FOUNDA TXON
FLOORS
WALLS f
CEILING
FINAL XNSPECTXON:
CHIMNEY HEIGHT v'
ROOFING
SIDING
EXTERNAL PORCHES STEPS
_.
STAIRS-CLEARANC & RAIL
PLUMBING FIX TU S/RELIE VALVE
INTERIOR TRXMf RXVACY S
FINISHED FIOO S_
GARAGE FIRED PING
DOOR CLOSER ( )
SMOKE DETEC RS
FINAL ELECTR AL INSPECTION
FINAL APPROV L OF CONSTRUCTION
A SIGNET] C TIFXCATE OF OCCUPANCY MUS E
OBTAINED FROM THE BUILDXNG DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
i
i.
I SPECTOR _
TOWN OF QUEENSBURY
BUZLDZNG AND CODES DEPARTMENT A444r
BAY & HAVILAND ROADS
QUEENSHURY, NEW YORK 1280&
TELEPHONE (518) T92-5832
BUILDING INSPECTOR ' S. REPORT
REQUEST INSP ON RECEZVED
NAME
TACATION ,
DATE PERMIT # I— r� .—
Allm APPROVED
�J YES NO
y�'OOTING/PIERS'
YONOZXTHXC POUR FORMS
toor NDATXONIDAMP—PROOFING
CKFILL APPROVAL LJ
)JOUGH PLUMBING
Xoo4RAMZNG
ELECTRICAL ROUGH—IN
=NSULATION:
FOUNDATION
FLOORS
WALLS
CE=LING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOF=NG
SIDING
EXTERNAL PORCHES/STEPS
STAIRS—CLEARANCE;`& RAILS
PLUMBING FIXTUREGIRELIEF VALVE
=NTERIOR TR=MIPR2VACY DOORS
F=N=SHED FLOORSr
GARAGE FIREPROOFING
DOOR CLOSER (S) .
SMOKE DETECTQR$
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCT=ON
-------------
A SIGNED CSRTZFICATE OF OCCUPANCY MUST BE
Od�NED FROM THE BUXLD-I DEPARTMENT BEFORE
TH E PREMISES A-RE OCCUPIEDI
REMARKS
/r L I C tG, tom' ?' k&eJrAL !"47o T a�IP
C - weA
TOWN OF QUEENSBURY
Day at Havdand Fkoad, C�ueenshury, IVY 12804-9725-518-792-5832
Building & Codes Department
INSPECTOR ' S REPORT
S' 19
PROPERTY LOCATION
OWNER OR J�TENANT
BUILDING f SEWAGE SIGN OTHER
REMARKS :
Vw-
tr
//C-� G L- G d T� OMAL �r T Gu c7rs
oor
CONTACT THIS OFFICE WITHIN
INSPECTOR
-HOME OF NATURAL 13EAUTY _ _ . A GOOD PLACE TO LIVE"
SETTLED 1763
MIDDLE DEPARTM
%Q01til ACiENCYo INC.
P OZWO 8 - 5 '6
S00 ar 9�
`dkb�
...... Dates Citrtif irg that March 20P 1989
leck08ril equipment i Pment listed has been ex4rilin d -a ri approved as being in accord
with the National Elect_g.�,V% a by
applicable governmental, utility and
P
Occupant. Same 10
0 Ury Location 149 , Qued '
Owner: Anti Barber +r;
Rt 0 % a fe'n
t no uIpment and
date. If addinonat VI finals Nation inspected this
nt StL be introduced Or alIGM00"S Made 10
Equipment. 200 Armnp Sery e exisUng system Ihig icate hit nUIJ and Yvid, and appoicatdon for
Inspection should be surbAl tab P A PY 10 this Agency.
�Dolder of eh la qza 4 rfif icate qhQUId nit same to tsis property Insurance Car rear r4
[agent or so nri�pn 0 as evi d4" certificationia ner
so specified, certification OPefoOlOcafequipmenj apprwed
F�Bob Murtha
Appl,c8nl: Mannis Road 44
ts
Glens Falls , NY0 # 15 -021345
✓r'OfAI No. 70a
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 3280k
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S REPORT /� g
REQUEST FOR IN
SPECTION RECEIVED •' is7 /
NAME -- !_L� -
LOCATION
DATE PERMIT
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FO
FOUNDATION/DAMP -FAR ING
BACKFTLL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-TN
INSULATION:
FOUNDATION
.FLOORS
WALLS
CEILING
FINAL INSPECTIONr
CHXANEY HEIGHT
ROOFING
,SIDING
EXTERNAL PORCHES/STEPS
STAIRS-CLEARANCE & RA-T
PLUMBING FIXTURES/RELIVR
E'
INTERIOR TRIM/PRIVACY
FINISHED FLOORS i
GARAGE FIREPROOFING !
DOOR CLOSERS)
SMOKE DETECTORS
FINAL ELECTRICAL TNSPECTIO,.
- FINAL APPROVAL OF CONS 'RU ' ION
5 ^^
OX TO ISSUE C/O OR C,/C
A SIGNED CERTIFICATE O OCCLgPANCY MUST BE
OBTAINED FROM THE BUT ING 7EPARTMENT BEFORE
THESE PREMISES ARE O UPIEDP
REMARKS: `
ARRIVE_ .3•"" _ r,�///[��,/J/ ,.- ,�� ..�J�•%
aEpART.3. av
TNSPECTOR
BUILDING DEPT. COPY OF APPLICATION FORM 48.EL, NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILOING DEPT, WHEN REQUIRED,
TEMP, M DATE
CITY OR Cl f
VILLAGE
TOWNSHI
STREET AND hil OR COUNTY
ROAD AND POLE NO,
BETWEEN WHAT STREETS I f� ''} POLE NO.
PREM!ES LQ ATEO? /'C /4,/ f.+rr�'
OCCUPANT'S
SECTION BLOCK P LOT
BUILDING
OCCUPANCY
AND AQ A _ � � � r�
AND A DRESS ,/" 'r �!� T TEL.
SUPPLIED
BY /^� FROM THEIR /Xji„P/ } / OFFICE
BUILDING r 4VC}R K �I--YY
IS NEW DEFECTS
OLD Q IS NEW ADDITIONAL L1 REMOVED ❑
LIST BELOW ALL ECIUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS N4. 4f Fixt4 rer & BRANCH
Loco- Lenlp paceptaclar MOTORS HEATERS CIRCUITS OFFICE USE
ti0n Coiling Side A�h'lat ONLY
Wall R Switch Pendant Bracket Na. Type Each No. Erah N4. AG`;�"ya.' INSPECTION
Dui-
Out
Sub-
baseside
Barr
meant
lst Ft.
Y
2nd FI,
3rd FI,
R rMAR KS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE:
DO NOT USE THIS SPACE_
This application ja intended 10 cover the above-listed equipment to be inspected
you are auth4rjsed p Ted but it at time 4t inspection there b found Y to make the jnspection end idjuSY the fe0 ;4 COVBr the YdStjlianel pgYjpmpnto as provided b the a additional equipment not above listed,
V PAlican;,
512E ELECTRICSION MAINSS FEEDERS TOTAL
LAMPS WATTS
OF CHARACTER EXPOSED GAS TUBE SIGN
WORK ORK To BE CONCEALED TRANSFORMERS OF
W TO VA
STARTED COMPLETED �— UMBER) (CAPACITY
SERVICE OVER E D E OF� LINOERGRDV
ENTERS MAKER
BUILDIN OF SIGN
INSPECTION REQUESTED
ON OR AS NEAR AS I`—'}
PASSIBLE NEW � OLD ❑
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED_
PRINT NAME AND ADDRESS
NAME OF '}�J�/—.�,— /�/,.y� �/ ter/
APPLICANT
/ ",/?? _�r)r DATE OF
Cyr APPLICATION ) �^"
STR E ET ADOR ESS / 7q� yt!{"" /f TELEPHONE # �'
CITY OR �!
POST OFFICE CODE "ref - 'y ICENSE NO,
WHEN APPLICABLE
46 EL faEV, N Ilan) A SEPARATE APPLICATI MUST BE LED FOR EACH SEPARATE BUILDING
f � , Ti
f
G kAe '�