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1985-716 G 1 +CERTIFIC,A TE OF 0CCUI'ANC'Y TOWN OF QUEENSBURY ` WARREN COUNTY, NEW YORK Date x. 'This is to certify that work requested to be done as shown by Permit No. has been COMPleted. ( e as a, i+ : - u *xi } �• . 1 t U :: i ) T�►i. structure �y} r _. eL �c.:rlbekrater LLi ..' 1 � i� to Ci L ' l�l'IC#t10t► 1y�r{/+J���;n1��[f�' C''�y��{�^�{ /''�'� .L'. L_ r� t a l...� L� S' .ice c T'.k:: I i._ . _, v�_Li]. J3iu�\ V*1 '�+f""�. �.J• • • , •'1j-•/t 7� Owner By Girder .Town Board TOWN OF QUEENSBURY 4P Building !Si Zoning Inspect cme MTIYE "IMST■'- PRINTING. GLENS fALLS N Y I ago 5 Is 6 e 17934SOSS S � CER'TIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY. NEW YORK p 311U A to G� Date .s L' ly 16 19 & C� This is to certify that work requested to be done as shown by Permit yy No. has been completed. T1�Q rn��� bwe k l *rW0_ Fam7 1-,, i)wr Ming ( Unit This structure may be occupied as a n � w tav 'Dci ek JL1U('ltvjk,'; j li-ta C_Or .Lt' v uLl'zeri7C_ li a Cf .`.i 11 1A)catiorl .-.r_ rTk �F' i'«Iilt S mic I;e `Yy 1 {� wil Owner By Order Town Board TI OF QUEENSBUR.Y .,.� �.✓ ' ,ram/ r; Bundins d Zr IIllFls Inspector CM&ATIVK "INSrw" PRIMT+n G. 0"NS ia' LLs N T � ii0+ Y�1QIif3lQSQ . _ _ v T 1i Y O R A R Y CEERrnFICATE OF O CCUPAN C'4Y TOWN OF QUEENSSURY WARREN COUNTY, NEW YORK Date_. J u l;y 7 14 86 "Dais is to certify that work requested to be done as shown by Permit No. has been completed. This structure racy be occupied as a 'Two—Family Dwelling Units A and B 1.4cation Lots 21 22 Walter Dombek Subdivision - corner Luzerne Road and Stephanie i.ane k'rarzk Siiniviie �1,vMer TEMPORARY CERTIFICATE OF OCCUPANCY FOR UNITS A AND h PENDING FENAL ELECTRICAL . Sy Order Town Board OWN OF QUEENSBURY Suildirgt & Zoning( aspeNctor BUILDING PERMIT TOWN OF QUEENSBURY No. 85-716 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Frank Simione OWNER of property located at Lots 21 , 22 Walter Dombek Subdivision Street, Road or Ave. corner Euzerffe Road ana Stephanle Lane .3q in the Town of Queensbury, To Construct or place a TWO—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. r t� w 1 . OWNER'S Address is 17 Brenda Drive ro Hud .s�u.,,y Falls , New York 2. CONTRACTOR or SU1 LDER'S Name same 3_ CONTRACTOR or BUtLDEWS Address same r rz o c r7 N w ro 4. ARCHITECT'S Name V N G N ¢1 S3. S. ARCHITECT'S Address r+ p m rt rt ty m 6. TYPE of Construction — (Please indicate by X) Q p ro 7G" F+ i X} Wood Frame f ) Masonry f l Steel ( T ro u3 G t" eY !ss 7. PLANS and Specifications p 0 42 ' x6O ' per plot plan , specifications and application submitted H. No. including sewage systems ( 2 ) and two-car attached garage En 0 $, Proposed Use Two-Family Dwelling E $1928006 C /°S twj $ PERMIT FEE PAID — TEAS PERMIT EXPIRES July 1 79 $6 0f a longer period is required an application for an extension must be made to the Building and Zoning inspector of the µ• } town of Queensbury before the expiration date.T Dated at the Town of Queensbury this 3rd Day of December 19 85 SIGNED BY for the Town of Queensbury a�v Building and Zoning Inspector TOWN OF QUEENSBURY (Space inside block tt, let• fill.wl in lad' W'^MwJJNl COUNTY. NEW YORK building Inspatrtt') Application for ,I, itrtito, :clan. PP l M-'a•r1tawt Itiaala�tl .___. BUILDING AND 24N1N6 PERMIT I't•rulit L+ .uuig; Ili.trirt % .Ahlt: woori. • PLOT PLAN, Drawn to scat* abowi0 tlta actual ditreansions of tho lot to be built It,•�n:,/ Kf' _ .— upoa. Tlta *xwct sizee and location an the lot of the buildinq to be aroctod or oltorad MUST BE SUB- MITTED WITH THJ$ APPLICATION,'~' TC]WN OF QUEENSSL• `: ' . .! ;� C C "� FEU A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK '44 U `v' f, - I ANSWER ALL OF THE FOLLOWING. z2 3 Wit-';r The satdersignod hereby applies for a permit to do the fallowing work l ` �ry����r� { which will be dose in accordance with the descriptions plans and spedfi- 7f8i$ .1'�'i"i . ] a ` 1516 cations. and such spacial cva¢itions as may be indicated on the permit. �7 y he owner of this property is. /" T ! S01 if r. . . . c✓oI o. ' /.� . . . .°!trC op a ADDR€ssl C r The ,person rosponsibic for supervision of the work in"ar as tlt4 Building e and the Zoning Ordinance apply is. f . . t 'Z �`? . . +"r'.Sft /�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . it a anon€ssi Nation of Builder . . , . . . . , / 0 . . . . . . Addres . . . . . . . . . . . . . . r , . , . . / + s[ NameofPlumber ./,—c ! r» . . . . . . . . .� /r. r, Nan-Wof Mason . . . � . . (' . , t �t.c l .rcr . , Address "p2lS - .r!T-t . . . /. .rr..�. . . . . . . . S Lot Number ,,2.1 04�: `41.Vs. . Unit .V4 rh let% u.`Estimated value of proposed work S I o ,3) vd o . . . . :ee St NameofVillage . L t�+ F'1'! F' �n,� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Street . . , . ,1 �? . /Fr^'d. . . . . . . . , . . . . . . . Side of street: north 0. east C#. aawih E7. writAM Nearest Cross Street IeCI . . . . . . . . . . . . . . . . Distance frr,m this :^Toss street . . . .G. t'? . . . . . . . . . . . . . Ft. Property is north south 0 . east is , west ❑ from Cross Street If oa Corner. which corner. northeast U . northwest 0 , southeast AF. southwest (Designate by marking with an "X"' in the correct space.) p 0mbL-e � � , �f'� .`3' kA16� NATURE OF PROPOSED WORK OCCUPANCY Construction of a new building. Main $tending Q © Addition to a building One-family dwelling © Alteradowto a building. Two-family dwelling I] Demolition -family aparlmettt Loupe of a building. Stare building 0 . , A;7� . . . -car attached garage 0 other: . . . . . . . . . . . . . . . . . . . . . . . . . » . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Amms ary Building C3 One-car detached ,garage Q Other work. Describes. . . . . . . . . . . . . . . . . . . . . . Two ear detached garage 0 3 � o. rt Private chicken house . . . � sT. . . . �. . . Private storage building 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ZONING SPECIFICATIONS. Fill in for new building, or addition to existing building, or a change of occupancy Indicate an the plot plan wrest nensas. the location and _ size of.the property. the location. sine and setbacks of prow / posed buildings* and the location of all existing buildings. MORTN Show proposed building(;) in donad line and existing hisilding(s) in solid line. Size of property ft. x Size and use of existing buildings. if any . . . . . . . . . . . . . . . . . . . . . . . . . . . . . All { to Size of proposed building x �° B• Height (from grade to ridge) 3 • • • - . . . . • . ft. ?� Front yard Side yards . . . / . . . . . . . ft. and . . . . . _ . . . . . r Rear y Ga ard . . .GIV, . _ +: , .E) . . . . . . . . It. m ^ / SOUTH I I on earner. setback from side street . . . . . . . . . ft. Nose: All distance# are slot, a# measured frost street rid* line to nearest part of bolding. foveae BUILDING SSPECIFICATIONS., (cont'd.) �r Kind of construction. Wood frame, fire safe, etc.? . '?t - -' Will any second-hand lumber be used? . . . !vC . . . . . . If so. for what? . . • . , . . . . . . . . . . . . . ♦ , . . . • . . . . . . . . . . . . . . . .Material of foundation walls7. _� fjl�u r e!�! . `fir. . . tn Depth of foundation walls below grade _ . . .;��7 . . , . . . Continuous foundation? . em . . . . . . . . . . . . . . Will there be a cellar? . . . . , U if so, material of rellxr. O.do.r. . . . . . . . _ . . Type of roof: Sloped or flat? . . . . . , . . . . . . . . . - . Material of roof . . . Size, wood studs . . . . . . . . . . . . . . . . . . . . " x . . . . . . . . . . . . . . . ". spacing . . . . . . . . . . . . . ."o.C.. length . . , . . . . . . . . . . ft. Size, floor beams, Ist floor . . . . . . _ . . . . . " x . . . . . . . . spacing '" .C., span . . . . o ft.Size, floor beams. 2nd floor x ", spaCsng . . . . . . . . . . ♦ . . ♦ "ts C., span . . . . . . . . . . . . . . ft• 'arise. ceiling beams . . . . . . . . . . . . . . . . . . .: x . . . . . . . . . . . . . , , ", Vowing . . . . . . . . . "O.C., span . . . . , . , SitGe, roof rafters or beams . . . . . . . . . . . . x . . . . . . . . . . . . . . ", spacing . . . . . . . . "ox., span . . . . . . . . . . . . . . ft. Exterior finish . . . . . . . . . . . . . . . . . » , . . . . . , _ . . . . . . , . . . . . . . With what material? . . . . . . . . Finish of interior walls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If garage is to be attached, of what material is wall between garage and main buUding to be Constructed? Is there to be an opening between 'a a and building? . . , . . . . . . . . . . . . . . . . Bind of heating system , .�.'.1c: s tr. <�r . . . Oil burner or coal? , . . . . . • . . . . . Will a flue-lined chimney be provided? +^ 'tG. . . , . . . . . • Depth of Chimney foundation below grade . . . . . . . . . . . . . . . . Height of chimney above roof. . . . • !' ;lam . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will there be a fireplace? . . . . . . . . . . . . . . . . . . . . . . . . Depth of fireplace hearth . . . . . . . . . . . . Will a toilet be installed? . w . . . . . . . . . . . . . . . . . '. . . . . - . . _ Will a kitchen sink be installed and connected to water supply? . . � .S . . . Water supply (public water supply or pump) . . �. ,+ /�. v Distance of cesspool from any private well _ . . . . feet Will drainage system be provided with required traps, cleanouts, and vents? . . . %" .'s . . . . . . . . . Town of Queensbury AVVIDAVIT County of Warren State of Now York at Gl newar that tp a f my knov4isdge and lae�w Ilsf tlss wtrterto acne m a is this sPP[iwtioa, trsa-din with dbe plans �� C are w true an Nalament ar[ dl prop rrorkp a lha &be dwrrilled pnad sad t ra+AEmprsw �s�hs g I ding CODE. THE is ORDINANCEbthe , s laws irr Il1hr wkstMr sad that ar;cb work is au.ehsn b!' ebs arrM l��` sprrifisd atr siose Swom so before mo this Sianrrtun .-- y O E 7, Aat:MITECT, CONTaACTCUI ... .. . . . . ... day of . . ..... .-- ... . ..... I9 .- .. N R7wAAY tuaLl G, WAawaN C4 N. Y. SPECIAL CONDITIONS OF THE PERMIT: 9r . .,,,... ........ .,,_............... .. . .. .. . . .... TOWN OF QUEENSDURY 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 ,rryC -� � 0 2 . Type of heat !� C �'C- orr C, 3 . Is the building mechanically cooled ? / uo 4 , Percentage of 'Prea of windows and doors �Q ♦ � A . Over 16 % O"niy 1 . Ilu value of gross area of walls , roof / ceiling and floors exposed to ambient conditions 2 . Floor over heated spaces YES NO a . Are foundation walls insulated ? YES NO 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 floors ? 4 . Is basement heated ? YES NO a _ R value of insulation 5 . Type of insulation B . Under 16 % only 1 . R value of roof and floors 4. xposed to ambient conditions 2 . R value of exterior wails ^` 3 , R value of glazed area G. 4 . R value of doors d 1 .._ . ,5! It value of floors over unheated spaces 6 . . R value of slab edAi4a""insulation - unh ,erd" slab _7 . R value of slabi"n"s_ ulation - heated slab 8 . R val�u�. heated base a cellar walls ove grade ) 9 . R va of heated basem! eIlar wall Ow grade ) 10 . Type of insulation s/ '/ /2� s1"1 ,�TS - C , Controls 1 . Thermostat maximum heat setting D . Duct Systems I . Is duct system installed in unheated spaces ? YES NO a . If YES , R value of duct installation b . R value of duct in other areas E . Piping Insulation 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation (, F . Service Water Heating 1 . Performance efficiency Q 2 . Temperature control setting maximum G _ For Swimming Pool Only 1 . Maximum heating Telephone No . ( appllcar, tls signature ) TOWN OF 4DUEYNSBURY BUILDING i ZONING DEPARTMENT SEF.TAGF DISPOSAL PERMIT APPLICATION 1- ti 1 . Owner ' s 'Name -- Address Telephone No . s / � 2 . Property location � �.y,�,;i, 3 . Name of person or firm responsible for installing system Telephone No . Rddres 2 GCr J� . zx ,, II 4 . Number of bedrooms ( residential buildings only) `"7L 5 . Daily flow ��'/ ctallons/day 6 . Septic tank capacity gallons 7 . Topography : flat , rolling , steep .��--- of slope_ 8 . Nature of soil and depth 9 . If ground water , bedrock or impervious material is apparent at what depth does it begin? f 10 . Percolation test : A is required B"- is not required C If required what is the rate minutes/inch r Il . Water supply : municipal , well , other 12 12 . Type of system proposed : drywell , the field , others -� 7 Any contractor , corporation , individual , etco 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 Sect on 6 . 010 of the Queensbury Sanitary Sewage Ordinance . Da te,&yz:: r '�1 " � s gn r o applicant On separate sheet of paper submit a diagram of the proposed septic system with all dimensions , including distance from any structurer distance from property line and domestic water supply , etc . Include all dimensions of the system itself . /goo � 7',, Aele. 01sr ,Ago x Form 3 - 82 '3 .. fo ��E��l.� IP��r� • 4197509 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 41 STATE STRE ET, ALBANY. NEW YORK 12207 Late August 21 r 19f36 Application No. on file 003477-86 THIS CERTIFIES THAT A 6615299 only sire eleetrscal equipment as tJescribed below used introduced by the applicaret naneed on the abase application number in the premises of FYank Si. Tdcaw or 1 Stephanje 7 a , Glens F'a13 S , New yoWk ire thefollowing location; Q Basement ® lar Fl. ❑ Snd fT. S3c-tr'a'qer Outsicka Section Block Lot was examined on 7/15/86 and found to be in compliance with the requirements of this Board. pXTURR CMJTLETS 110E"ACLES SWITCHIS FIXTURES RANGES CODKttrCii tfECK5 OVENS DISH tIYASNERS EXHAUST BANS INCANDESCEM rl41DMIESCem AMr. 1 62 3G DRYERS FURNACE M0TC RS FUTURE AtsMttINCE FlEOERS S►ECJAL REC'FT TIME C4OCK5 EEU I/NIT MEATElf MULTI-OUITLET Dy g AA4T. K. w. On H.`R. GAS H. R. wlNr. NC. w, w. G. AMr, wrW. wear. AM►S. TRANS. wwar_ H. R. SYSTEMS A,wr WAr'IS NO, Of I4BT �� °1�T MF• '� S E R u I C E wenr- wsr. ivnE Et Nlli, x Iry ,,r sw a .r sw t .�r �Iw ^�- „ca''+D. aR cc CdND. RED. GR Ht-LEG E G Ha. OR MIEUIRALS A ��e, NIE 2 200 Cb 2 x 1 4/0 1 2/0 OTHER AVIIIARATM 2-- q fcl 2- m")re cep T I�ctdoc Beat macs : 16- 1 . 5 kw 2- . a kw Kelth ,- Sweet W 26 F G].eTis Balls , NY BRANCH MANAGER Per This certificate must not be altered in any manner, return to the office of the Board if incorrect. Inspectors may be identified by their credantialr. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ir6tVN OF QUEENSBURY Building Department Rer►a+rt Date Locations . , 2 La ...i Pennidt N -•` c� •�— - r e vr y i [� �" �eatheat � 3 ?' ! &G".+K- /'&2� AkgrrO A/" R ema rxs ExcarYa is on ' Footi Forms Footing & Piers Foundation Cement Coat Water roofin T 8acicfi33 Final Survey .Framing ; Shea thin " Roof Feat Roof-in Siding G`+ C_ Masonry Veneer Rough pibg Relief Valves 0 t Wall Board Ext . Porches Fln.ished Floor b kG Interior Trim 4 g Stairs & Railings 4 Cellar Dr . Tile Concrete Floors Plbgr. Fixtures Ok , i Gar . Fireproofing 0 Door Closers Chimne Water Meter Inst . Septic Approval Floors 's Insulation Foundation Wa in f ; guIlding n. pector REMARKS � a �0 'e00f TOWN OF +QUEENSBURY Building- Department R°lioe! Date��� Name i .ecavan 7� Permk No, Weather Remarks Exca0at on Footing Forms Footing & Piers Foundation Cement Coat Water roafin Baclkfi 11 Final Surve Framing ,- Sheathing Roof Fel t Roofin SIdin Masonry Veneer Rough Plbgv Relief valves Wall Board Ext . Porches Finished Floor Interior Trim Stairs & Rall-incts Cellar Dr . Tile Concrete Floors P2bgr . Fixtures Gar . Fireprooflngr Door Closers Chimney Water Meter Inst . Se tic Approval Floors Insulation Foundation Walls Ceilin _� Buil ing Tnspector {wry/ REMARKS pi �../otus� rr� �eeeen36urt� BUILDING and ZONING DEPARTMENT Bay and Hawiland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date-V* -3 i* /C Permit No , _ f ✓ = APPROVED - YES NO Footing/Pier Forms Foundation waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim _-• _.._.. Stairs & Railings Cellar Drain Tile _..._ Concrete Floors Plbg _ Fixtures Gar . Fireproofing Doerr Closers smoke Detectors Chimney INSULATION : Foundation F10037S Walls Ceiling FINAL ELECTRICAL INSPECTION Final Building Survey Next scheduled. Inspection ( call when ready) Remarks- - < - z ' Building inspector 6/86 and-vl TOWN OF QUEENSBURY a oldinf Department InsPoctars R p rt Date Name & I .ocatsap �- t Z we Pamrtait Na. ' 7 IT" __ Weather Remarks Excatya t ' on Footing Forms Foot.ing & Piers Foundation Cement Coat Water roofin BackElll Final Serve Framing Sheathin Roof Pei t Roofin Sidin Masonry Veneer Rough Pl Relief Valves Wall Board Ext . Porches Finished Floor Sntexlor Trim Stairs & Rai in s Cellar Dz% * Tile Concrete Floors Pl Fixtures Gar . Fire xpofin .Door Closers Chimney Water Meter Xnst . Se tic Approval Floors xnsulatlon Found&tican _ Coil n ' Buildzn TnspnCtor REMARKS L 194+1.44 J5 r oLj(, Vi6Aoer lM PAgope�az PeTtt4 ,vdT i, " T-1 ArVo0S 7.Z, TOWN OF QL,IEENSBURY $U01diuff Department Inspectors Report Date6Name 4 ja Weather Remark-5 Excavation FootingForms Pootinq & P% ars Foundation Cement Coat Water roofin BacJkfil 1 Final Survey Framin Sheathing Roof Felt Roofi n Siding Masonry Veneer Rough PI Relief valves Wall Board Ext . Porches Finished Floor .Interior Trim Stairs & Rail!PUS. Cellar Dr . Tile Concrete Floors P1 . Fixtures Gar . Fire roofin Door Closers Chimney Water Meter Inst . Septic Approval Fl c' Insulation ✓ Foundation _ Nalls Ceilin - -Building Spector REMARKS TOWN OF QUEEN'SBURY Building Departmealt Ift"mc +a" " Date J b' l...0eaUG0 A.. 0 2 �rT - t 1r . Paeeut No, $g�'� � Vycatlter Rema.r.ks Exca�}a ti pn Footing Forms Foot-in & Piers Foundation Cement Coat Water s'oa fi n Bacitfill Final Survey Framin Sheath-in Roof Fel t Roof-in Siding Masonr Veneer or t Rough P.[ Relief Valves Wall .board Ext . Porches Finished Floor Interior Trim Stairs & Railings Cellar Dr . Tile Concrete Floors Pl . Fixtures Gar . Fire roofin Door Closers Chimney Water Meter Inst . S+e tic Appric yal Floors Tnsulation Foundation Walls _ _..... Ceilin Builds TnspeCtor ,,.-� REMARKS 1- r [ ! 17 ►-� f'w v �: r-1 ,�L .tA-1 Al TOWN OF QUEENSBU RY Building- Department NameDace_ 12 z . /P� ..iv Ren%a.rxs Ricca fra ti on . Footdng Forms Fcx> Eng & Piers Foundation Cement Coat Wa ter roofin BacJrfill Final Surve .F-ramina Shea thi n Roof Felt Roofin siding Masonr Veneer Rots h Pl Relief Valves Wall Board Ext . Porches Finished Floor Interior Trim Stairs & Railin s Cellar Dr , Tile Concrete Floors PIbqrw Fixtures Gar. Fire raafin Door Closers Chimney War ter Meter Ins t . Se tic A roval 3T [rtiL - F rs Insulation Fo tion C a[lIn At- Buildsi=� ctor ,� _. REMARKS TOWN OF QUEENSBURY Building Department Nieryec�+oer Ret DvAe1rr� '`z'` g�S-" — T� 13 Lnea+eim, Nor Pernat No._ . '515 - "7 j. �r Westb r Remarks Sxca�ya t on pootiEg Forms �FootlRz & Piers Foundation Cement Goat Water rrao€in Backfill Final Survey ` Framing sheathing Roo€ Felt Roofing Sidi j HasonrY Veneer Rough P1 bg Y [Go,✓ / eco Relief Valves Wall Board Ext . Porches Finished Floor Interior Trim stairs & Railings Cellar Dr . Tile Concrete Floors Pl _ Fixtures Gar . Fire E fi.n Door Close Chimne Water Metest , Se tic A l 1L10 p Floors Xnsulation Foundation Walls Ceiling �.._ .Building Inspector ,r REMARKS 0AI&I /Zw /140 w/ .or AO TOWN OF QU'EENSBURY 31Hdias- Department Pernik Nca.��f� _ W'aarthes Remy rJcs Excat}a ti on Foot.iliq Farms Footang & Piers Foundation Cement Coat Water roofin BacJkfill Final survey Fra,min Shea thincz Roof Felt Roof in Si din NAsanrV Veneer Rou h PI Relief valves Wall Board Ext , Porches Finisher? Floor Interior Trim stairs & Railings Cellar Dr , Tile Concrete Floors PI . Fixtures Gar , Fire , Fin Doerr CI osers Chimne water Meter Inst . Se tic A royal Floors _ Insulation Pounda tion Wells Ceilin Build nor lrnspector REMARKS CAI - 0P-4 tVewt4 - B j. ry ?3vrz,�/' _ 50 dT H S 4 s irs-+-. TOWN OF QUEENSSURY 8nildins Departaaent .�. , ea'mk lr.s. S - weatb,ar Remarks fisxcacYa t on PootIncr Forms Foottinq6 Piers Foundation Cement: Coat Water roafin i iz Final Serve Framing Shea thin Roof FBI t Roofi sldlnz Sasonr veneer Roe h PI Relief valves Wall Board Ert , Parches Finished Floor Interior Trim Stairs & Raili s Cellar Dr . Tl ,e i Concrete Floors Plbg . Fixtures Gar . Fire roofin Door Closers Chimney Water Meter Tnst . Se tic A royal • Floors Xnsulation Foundation Wa11s eili Bu ding 1'n4vpeCtor REMARKS a)4 /Im : -�OVV" OF QUEENSeuR Building DeWrtxnne,et Name � � ql { P �- d��r,� � w Remarks rxcarYa tiara _ Food Forms Food & Piers Foundation Cement Coat water rooiin BacJlr.fill Final Surve Fxami Shaw thin Roof Pei t Y Rocein _ maxi nr veneer Rau h PI Re.l valves wall soard _+ Sxt . Porches Fin.fshed Floor _ Interior Trim Stairs & Ra3lin s Cellar Dr . rile Concrete Floors _ PI III, Fixtures Gar . Fire roof _ Door Closers Chlranepi water a'tleter 1'nst . _ _ se tic ,� royal _ F1 csors .rnsul a ti on Founds tion W81— 7 s Cei I--~ ,t--" Bu 1d ngr Inspector REMARKS ;L - to c7 3 G4-r. S& rof- lt.- 0' . V) f d3 a A &� ItI t t iel �l Y41 k$ L�1�//?-.�'Gc,�'v� [.e. S / �+ 4 rn. 90 Wet et L I J�/'�J' !`f`, L 4 N {)G1 T S O .I1464CI4 ) l VLF 09V I&AI L..Q I/f rG... TOWN OF "UEEMSBURY auxildfa D*part eat tie 5114 III Pft&Mft '07 jC Remarks Exca11Ya t111 on Foo t.zn Farms Food & P£ers Founda t.ion cement coat Witter rorc+affn Dackfill Final Surve Pramin .Shea thin Roof Pei t Roofi S'idin Mason=- venc>.er Roes h Pi Relief Valves R►all Board Sxt . Porches Fini rshed Floor Xnterior Trim Stairs & Raili s Cellar Dr . Tile Concrete Floats F'2 - Fixtures Gar . Fire � )II Door Closers CW=ne r Water Meter Ins t , Se tiC A royal Floors .Insulation Foundation Walls aUaldzng Inspect REMARKS BUILDING DEPT, COPY OF APPLICATION FORM 46-E1 NEW PORK BOARD OF FIRE UNDERWRITER.$, FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. TEMR. Jt DATE - .�`•.••CfTY pR STREET AND NO, OR TOWNSHIP .? •rv,,. , r, ROAD AND POLE NO_ A'�-'''" COUNTY . BETWEEN WHAT TWO PREM SES EETB rw' > POLE NO. OCATED. ,rsv OCCUPANT'S- .' 'r rr C. L 5€CTION NAME BUILDING BLOCK LOT OWlill NAME OCCUPANCY AND ADDRESS SUPPLIED BUIL6ING FROM THEIR iS NEW Ef—�r 'WORN ..OFF.IC� ..... r.r. OLD LJ IS NEWDEFECTS LIST BELOW ALL EQUIPMENT WHICH YOU JN�STALLEpADOI dIUAL ❑ REMOVED C] NUMBER OF OUTLETS No. of Fixtures & lion Lamp Receptadee MOTORS HEATERS BRANCH Side Attach't CIRCUITS OFFICE USE pBlp€ Well Recap'la Snitch Pendant Bracket No. Type ONLY H.P. Each Na- Eadr Ne. A.W O: prn` Garage INSPECTION fide Sol ma t meat let Ff. 2nd FI. 3rd rill. REMARKS: LIST 0704ER ELECTRICAL DEVICES NOT SET FORTH ABOVE; it DO NOT USE THIS SPACE. This applicaxion is intended to Cover the above-Iisxed You are suxhoricad to make xhe in aqu ipment to 6e inspected but if at time of i Inspection and adjust the Fee to cover the additional r+spection ehare is fora nd additionar SIZE OF a9urpmeM, as provided by the a equipment not above listed, MALNS ppliynt. FEEDERS ELECTRIC SIGN CHARACTER LAMPS TOTAL OF WORK EXPOSED GAS TUBE SIGN WATTS WORK TO BE CdNCEALEO TRANSFORMERS OF STARTED INUM6ER1 ---' VA SERVICE OVE RHEA6 COMPLETED SIZE OF SIGN (CAPACITY) UI DING ENTERS UNDERGROUND MAKER INSPECTION REQUESTED OF SIGN PO L NEAR AS POSSISfBLE AVOID bELAIV BY GIVINGOLD PRINT NAME FULL AND ACCURATE IN M FORATION. ALL SPA NAME OF DORESS CES MUST BEnF1�O IN OR APPLICATION MAY BE RETURNED, L7 APPLICANT DATE STREET ADDRE.� I '�•--• APPLICATIQN CITY OR TELEPHONEC.# r POST OFFICE ZIP Ev- CO ) ,,� y LICENSE NO ae 1 Ia �/a5} s CODE �G�" ' t✓ WHEN APPLIC L.ASEi��� —�A SEPARATE APPLICATION MUST BE FJLED FOR EACH SEJ}ABATE BUILDING 3a�T' k 1 oo f j3G' LPI ) Oaf .2v� U ° � [3�1 f cr