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1987-312 Id i MEN CERTIFICATE OF OCCUPANCY TOWN OF +QUEENSBURY WARREN COUNTY. NEW YC]R - October 29 19 87 Datel This is to certify that work requested to be done as shown by Permit No. $ ]- 312 has been completed* [ -� � This structure may be 'ed a. Addition is of f ice bui] dixtg l cscarion uuaa ce r� r Club Roads Cool Insurin Ag n (Ant cony NLushuta and iVeifeld) I By Order Town Board TOWN aF QUEEmsukY i Building N Zoning Inspector I i } T E M P U R A R Y CERTIFICATE OF C►CCUIPANC�' i TOWN OF QUEENSBURY ' WARREN COUNTY, NEW YORK Date Sept . 43 19 ` T1�is is to certify that work requested to be done as shown by Permit No. 87- 312 ices been completed. " i• structure may be occupied as`a Addition to Office Buflding I Quaker and Country Club Roads Location Cool Insuring Agency (Axithuny Mashuta & Ira Neifeld ) Clwcrcr By Corder Town Sward 7OW"NF OF QUEENSBURY i 8uildi !4' Zoning Inspector BUILDING PERMIT TOWN OF QUEENSBURY No 87-312 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Coal Insuring Agency (Anthony Mashuta and Ira Nelfeld) o rp OWNER of property located at Quaker and Country Club RoadsStreet, Road or Ave. 0 Addition to office building � in the Town of Oueensbury, To Construct or place a , rI at the above location in accordance to application together with plot plans and other information hereto filed and W F approved and in compliance with the Town of Oueensbury Building and Zoning Ordinance_ ci °Q » a va 1 . OVNVER•SAddrassis Box 2074 Quaker Road 0 z Queensbury , New York 12801 � c 0t m 2. CONTRACTOR or BUILDERS Name rp Barsons Construction Y rn m r-A 3_ CONTRACTOR or BUILDER''S Addren 1241 Kings Road Schenectady , NY 4. ARCHITECTS Name p w M ro rs S. ARCHITECT'S Address l� h 0 G D 6. TYPE of Construction — IPleese indicate by X) K C i XI Wood Frame I i Wtasonry I I Steel i I G c7" 7. PLANS and Specifications ;d 7320 sq . ft . addition per plot plan , specifications and application No. 8. Proposed Use Insurance Agency (additional office space ) Cu 5 . 00 C/O $ 900 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES Jan . 1 tg 88 rrr 0 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the P3 town of Ouaansbury before the expiration date„} rr CJ Dated at the Town of Oueensbury this 3rd Day of June 1987 0�- rr, SIGNED BY for the Town of Oueensbury m Building and Zoning Inspect c' i_j Fv Cf4 TO BE COMPLETED BY BLDG . DEPT . tt�� / Application No . ICJIN►� 0E- _lorun o/ Queen .shurey � iUEc�lI.Gati. Permit Issued 19 E � t.. -.. BUILDING and ZONING DEPARTMENT Permit Expires 19 Bay and Haviland Road, R U. 1 Box 98 Zoning Designatio Are Oueensbury, New York 12801 Variance No . i MAY f pp Site Plan Review No . M ZAi BU�LL3ING & 1987 Approved by ." ! 'CoDk� oE:P-i APPLICATION FOR { BUILDING AND ZONING PERMIT A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION , ANSWER ALL OF THE FOLLOWING . The undersigned hereby applies for a Building Permit to do the following 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 . _ ---------------------------- __--^____ -^--^----_........_-- ------------ __ __ ________------ The owner of this property is : Anthony Ma-ahuta and Ira Neifeld P . O. Address Box 2074 , Ouaker Rd Tel . 793-5135 Property Location : Glens Falls NY 12.801 Tax Map No . Street number or building lot number Subdivision name (if applicable) THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : Langer Dion Morse Architects , Rpl Tetclx _Park . `fm4', r.Rr 2R3-90nn Name P . O. Address Tel . No . Name of builder Barsons Cr_)nstr Cti.orAddress 1241 -Ki-ncfs Rd. ... Sch ` d . Tel- . 370-2761 Name of plumber Rug' 5; P1 jX4 ILt_g Address 22 Vics Ct Albv, NY, 122,05 'el . R69-8045 - Name of mason Kpn Baldw; rn Address Haddock Pond Rd . , Fort Anil T'el • 792-8860 NATURE OF PROPOSED WORK : ,, ZONING INFORMATION : _Construction of a new building A PLOT PLAN MUST BE PREPARED AND SUBMITTED , X Addition to a building '" drawn reasonably to scale and attached hereto , Alteration to a building * showing clearly and distinctly all buildings , (no change to exterior dimensions ) whether existing or proposed and indicate all Other work (describe) set-back dimensions from property lines . Give * street and number or lot number and indicate whether interior e_r corner lot . Show location FOR DEMOLITION PERMIT , STATE SIZE AND of water supply and location and configuration LOCATION OF STRUCTURES AFFECTED . of septic disposal area . COMPLETE INFORMATION REQUIRED BELOW . Size of property. 256 ft X 689 ft - '� Existing buildings ) Size 120 ft X 55 ft - PROPOSED BUILDING AND USE : Existing building ( s ) Use. `7ffIce Size of new structure _ 120 ft X_ ft Foundation-pier slab/crawl/partial/full " Proposed building , distance from property line circle one ) " No . of stories (habitable space) 1 Front yard nc) h rig _ ft Rear yard 4R0 ft ft . Side yards 70 ft and 60 ft Height ( grade to ridge ) 28 If on corner , setback from side street ft If residential , no . of families No . of rooms ( excluding baths ) " OCCUPANCY INFORMATION No . of bedrooms - - PRIMARY BUILDING - No , of bathr[aoms 2 One family dwelling Primary heating system split systems Two family dwelling Type of fuel�eleoi Multiple dwelling / Number of units No . of fireplaces to be installed -- Will a wood stove be installed? no X Permanent occupancy Central Air conditioning? yes * Transient occupancy Business BUILDING STYLE, PRIMARY STRUCTURE Industrial Ranch Contemporary Log cabin * Other Raised ranch Mansion Duplex If addition , what will use be7. nusiness,, same Split level Old style Bungalow a is ing _Cane-__Cod Cottage Other ACCESSORY BUILDING- Colonial Row Town House Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE ) Atta .�hed garage/one car/ two car/.car * * * * * * * * * * * * * * * Private storage building ESTIMATED MARKET VALUE OF Other i ONF, TRUCTION IRIFCRN7 SIDN ON pi.11LDINC. SFECIFICATIONSf ON REVER57E SIliE OF THIS SHEET , TO BE CCMPLETED ! BUILDING PERMIT APPLICF.TION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . wr- A frame Will any second-hand or ungraded lumber be used? If so , for what ? no Foundation wall material hickness 10e1 Depth of foundation below grade ( to bottom of footing ) 5' Will there he a cellar ? p© Heated or unheated ? N/A Floor sq . footage 7320 sq ft Will there be a basement? ran Will any portion be used as living spr -e? N/A ( If so , what portion? sq . ft . - - Type of use? Type of roof - sloped/flat/shed/other 51ot5ed Material of roof asphalt shingles size , wood studs "X (_ " spacing 16 " o . c . length 11 ft . .Ioi_sts ( floor beams ) lst . floor _ '" X " spacing " c . c . span ft . Joists ( floor beams ) 2nd . floor '" X - " spacing "o , c . span ft . overlays ( ceiling beams ) __ "X -- I spacing " o . c . span ft . Roof rafters -_ "'X " spacing o . c . span ft . Roof trusses (pre- engineered) spacing 24 " o . c . spar 40 ft . Exterior wall finish mason ry Of what material ? brick Interior wall finish painted sheutrock If a garage is to be attached , describe materials to be used for FIRE SEPARATION : Is there to be an opening between garage and dwelling? N A If so will a Fire-rated door , enclosure , and self- closing device be provided? Will a flue- lined chimney be installed? N/A Height above roof ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth - ft . in . Water supply - Municipal or private well Municipal SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties ft . (A separate application is necessary for TT��any repair or new installation of septic system) Town of f Warren A F F I D A v I T STATE OF NEW YORK County of Warren I swear that to the hest of my knowledge and belief the statements contained in this application , together with the plans and specif ' ::ations 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 not , and that such work is authorized by the owner . SWORN TO BEFORE ME THIS Signature �-�_�.r��� � -------- --- Owner , owner ' s agent , arenirec onrctoar ^ day of 19 Notary Public , Warren County , N . Y . * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * r SPECIAL CONDITIONS OF THE PERMIT : By TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK Application fore 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 7320 2 , Type of heat 3 . Is the building mechanically cooled ? es 4 . Percentage of area of windows and doors 10° A . over 16 % Only 1 . Uo 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 ? 3a slab on grade YES NO a . If YES , what is the R value of insulation: around perimeter of floor ? 4 . Is basement heated ? YES NO a . R value of insulation 5 . Type of insulation B , Under i6 % Only 10 R value of roof and floors exposed to ambient conditions, 41 2 . R value of exterior walls 21 3 . R value Of glazed area ----- 4 . R value of doors 6 5 . R value of floors over unheated spaces N/A 6 . R value of slab edge insulation - unheated slab 9 7 . R value of slab insulation - heated slab N/A 80 R value of heated basement/ cellar walls ( above grade ) N/A -- 9 . R value of heated basement/cellar walls ( below grade ) N/A 100 Type of insulation rigid at foundation }aat C . Controls 14 Thermostat maximum heat setting 82 ° D . Duct Systems_ 1 . 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 2 E . Piping Insulation 1 . Size of hot water or cooling carrying agent pipe_ 2 . R value Of pipe insulation 2 ro Service Water Heating 1 . Performance efficiency 90 2 . Temperature control setting maximum G . po+ swimming Pool Only 1 , Maximum heating N/A. Telephone No . 370-2761 - glicant ' s signatur own of Queen3it " ry BIJILD,T3G and 2owt4G ❑EpA'Rj-MENI Bay and 4iavyland goad. R.0- I Box 98 Queensbury. New York 12801 BkJI L-DING INSPECTOR ' S FtEP(7RT NArAE Lo c A.T ION permit Date 140 c APPROVED - YES Footing/'Fier Forms Foundation Waterproofing Sac)cf i l l Framing Roof ing Masonry Veneer__,___ Rough Plumbing _ -- gelief Valves Ext . Porches she CA Floors )C3nterior 'Trim ytStairs & Railings Cellar Drain Tile concrete bg _ tu Floors Fixre s Gar . Fireproofing poor Closers rnolke Detectors Chimney INSULATION - Foundation Floors Walls ceiling CAL INSPECTION FINAL ELECT Px OVAL 17RIVEWBui d ng Survey- �� ---��` � - Final .sled inspection call when ready ) sched ems- 2. Ytema r .- � .. 16 ? f 9�ilding Ins ector 5/g�' and-vl J09vn of Queendburey (��!/l BUILDING and ZONING DEPARTMENT !j Bay and liaailand Road, R.D. i Box 98 �I Queensbury, Now York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION / � Date �f Permzt Na . APPROVED -*YES* *NO w Footing/Pier Forms�� Foundation waterproofing ll B 4 raramie mir►g Roofing Siding Masonry Veneer Rough plumbing Relief valves Ext , porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors pl7bg . Fixtures Gar . Fireproofs. Door Closers Smoke Detector Chimney I33SC1LATION Foundation Floors Walls Ceiling FINAL ELECTRICAL INSkrz% I' N� DRIVEWAY APPROVAL Final Building, Survey Nextcheded inspection (call when ready ) Building inspector 6/86 and-Vl THE NEW YORK BOARD 4F FIRE UNDERWRITERS 4003259 BUREAU OF ELECTRICITY � j f 41 STATE STREET, ALBANY. NEW YORK 12207 Date September 23 . 1987 Application No- on file 014698-87 b954THIS CERTIFIES THAT a a+sly the efaw:trical equiprneMt ear described be1aw and fntradsrced by the applicars nsrrasd era the oboes egPplicstiaes number in the pre— --- of Cool Insuring Agency s Quaker Rd . , Queens bury s NY in thefollowinglocation; ❑ Basement ® !at Fi. ❑ $nd Ft. sttIc outelde Section 618lock 1 Lot 1 . 1 eras examined on 9/ 11 /87 and,jound to be in eotnptionce with the requirements of this Board. FIXTURE FIXTURES MANGOS COOKING *"xS OVENS DISH WASHERS EXHAUST FANS oI/TtS Errwcul5 SYMITCttES INCANDESCtNt FLUOtESCtNT A AMT. K- W. AMT. X. W. AMT- K,w, AMT- X. W. AMT, H. P, 97 ?$ 31 18 79 3 iEr DRYERS FURNACE MOTOR5 FIITIlER A!'ltfwNCE FEEDERS SrEp/yt REC'►T TIME CLOCKS EIEiI UWT HEATER; MULTI.OUTLET p1M,MEES AMT. X. W- OIL K P. GAS X. P- AMT. MO. A. W. G. AM7. AMP- AMT. AMPS. TRANS. AMT. M. P. 57STRM5 AMT. WATTS NO. OF Mal SE WICS DISCOPMECT M. � S E R Y I C E AMT- AMP. Tr" R I M ZW I 1 A 3W 130 3W 3.iE 4W NO. 0 CDC. CONO. OF CC C41VD. NO. OF HIALEG A- W: GG NO. OF NEUTRALS OF- WIMNEUTRAL 1 S00 eb 1 2 500 2 500 OTHER A"ARATUSt panels 4 40 200 3 20 100 2—Zfci x ,-��-,•, � Construction Coo '� "•"�R'' 1241 Xln ;s Rd * Scbenectedys NY 12303 BRANCH MANAGER _ I,, Per— X This certificate must not be altered in arty mannerm return to the officer of the Board if incorrect. Inspectors may be identified by their credemfals. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. � down o� �ueer� s �ure� BUILDING and ZONING DEPARTMENT Bay and Haviiand Road, R.Q. 1 Box 98 Queensbury. New York 12$01 BUILDING INS" PECT©R ' S REPORT NAME LOCATION ; Date `��~ T Permit NQ . / //* * APPRQVETJ* -AYES* NO Footing/Pies Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext* porches Finished Floors interior 'Prim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Gh�, imney ✓INSULATION Foundation Floors L44a11s �i 1 ing FINAL ELECTRICAL INSPEC' ION DRIVEWAY AF"PRO'VAL�. Final Building Survey Next scheduled inspection (call when ready) RemarkB- Building inspector 6/86 and-vl .. tvn o/ QueenJi"rry BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME L LOCATION Date- / / (y(�- / Permit No . , ✓ = APPROVED -- YES N4 Footing/Piet Forms Foundation Waterproofing Sack£ill .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 Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL -- Final Building Survey Next scheduled inspection (call when ready ) Remarks- town % a-NekA01c0 Bui ding Ins c r 6/86 and-vl P 010 1 70tv0l O/ QL4Fen36Lery BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date _9s77 Perrn * t No . ✓ = 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 Til J.o�oncrete Floors At. f7if Pibg . Fixtures Gar . Fireproofing _ Door Closers Smoke Detectors Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- Building Inspector 6/86 and-vl _Jow►� o� �uQen3burr� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date =s��� �� � � Permit No . �/��` L 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 _ C llar Drain 'file Lo oncrete Floors l�s Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors walls Ceiling FINAL ELECTRICAL INSPECTION I)RIVFWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- 3 Building Inspector 6/86 and-vl _70W" ©/ Queens6ury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D_ I Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME + LOCATION �,- Date E'__ Permit Nov ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer .Rough Plumbing 1 ,q ca Relief Valves Ext . Porches Finished Floors Interior Trim stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- Building Inspector 6/86 and-vl � 70W" O j Queei igur y BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box g8 Oueensbury, New Y ork 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION 71, Date / �7 Permit NO . A;2; _ ✓ = APPROVED - YES NO ting/Pier Forms toundationerproofing kfill 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 Door Closers Smoke Detectors Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready) Remarks- Building inspector 6/86 and-vl _5+ 131$7 ;Jowrr o ueerrshure� SUILDIN6 and ZONING DEPARTMENT Bay and Haviland Road, R-D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION U /,� � C� �+ ►/4d?�2�' L"Lf1�' �D Date;7� � _ Permit No . APPROVED - Y NO Doting/Pier Forms Foundation waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing_ Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors 1"1bg . Fixtures Gar , Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready Remarks- f Ffuilding Inspector 6/86 and-vl _ `_Jaavn n� �ueen .f � ur�l { BLIILQINt; and ZONING DEPARTMENT Bray and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME " r ox ✓ref ,YItw�� Ct�U�ll LOCATION Date. - Permit No . ✓ = APPeROVED - YES NO A"oting/Pier Forms Foundation Waterproofing Sackfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION IIRIVEWAY APPROVAL Final Building, Survey Nex duled inspection (call when ready ) Remark,;- Building Inspector 6/66 and-vl BUILDING DEPT, COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT& WHEN REQUIRED, CITY CPR TEMP s DATE VILLAGE _l STREET AND NO. OR TOWNSHIP COUNTY ROAD AND POLE NO BETWEEN WHAT TWO POLE NO. PREDM1 ETRL ET$ is OCCLIPANT'S �* CTION BLOCK LOT NAME �-��R.iI>f. BUILDING OwNER'S NAME OCCUPANCY AND ADDRESS cool TEL. # BYPPLIED BUILDFNG FROM THEIR lift is OFF#CE NEW OLD Q Y1iORK DEFECT$ IS NEiN � ADOI TIONAL LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED REMOVED [] NUMBER OF OUTLETS No* of Flaxturs & LanIP Reeaptedse MOTORS HEATERS BRANCH bw CIRCUITS OFFICE USE Camino Side Attsoh't ONLY WNI RsgrP•#s Swiew Pendant Bracket NO. Type EH.h No. YYatb A.W.G. Out- each Nn. Gauge INSPECTION t#d. Sub- be" Br. irml in FI. znd FI. 3rd FI. REMARKS: LIST OTHER ELECTRICAL Of V ICES NOT SET FORTH ABOVE; DO NOT USE THIS SPACE_ This apPlibtion is intended tp saver the above-listed v Or. ra Mrihorited to make the i equipmenttoinsPaei�ed iwR F# sf time Of inePeetion there :s 1"ml eddiliOnal nepeerlon end adjust tM for to corer the additional equipment, m Provided 6 a 'UiP' nt nor above listed, SIZE OF Y the PPiisynR. MAINS FEEDERS ELECTRIC SIGN LAMPS TOTAL CHARACTER WATTS OF WORK EXPOS GAS TUBE SIGN CONCEALED TRANS FORM E RS OF WORK TO 6E VA STARTED (NUMBER] SERVICE DVERFIE�Ap COMPL ETEO SIZE OF SIGN !CAPACITY) Bu NO UNbERGROVNO MAKER INSPECTION REQUESTED OF +SIGN ON OR AS NEAR AS POSSIBLE AVOID DELAY BY DIVING FULL AND ACCURATE INFORMATION. ALL NGW OLD MUST BE FILLED IN OR APPLICATION MAY B SPACES RETUgNEp E , DATE OF PRINT NAME AND ADDRESS NAME OF APPLICATION F APPLICANT �, V' SIGNATURE OF APPLICANTf� r STREET ADORESS CITY OR TELEPHONE +l'1y7 POST OFFICE 21P LICENSE NOCODE . ae EL (REV. IIBe) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING QUEENSBURY LABORATORY Queensbury Water Department R. D. 2, Box 386 Corinth Road Glens Falls, N. Y. 12801 518 793-8866 REPORT OF BACTERIOLOGICAL EXAMINATION Date Collected 5/ 19 /87 Sample No. 15521 Collected By Daniel Olson Time Collected 10 : 30 Sample Point _ Corn . of Quaker Rd & Glenwood Ave ( Plastic drain pipe } Address _ Town of Queensbu y Building Dept ( Bill, Queensbur ) 1 . Total Coliform ( */ 700 ml ) 2. Plate Count ( */1 ml) TNTC 3. Fecal Coliform ( 4*/100 ml) 2 4. Free Chlorine mg/1 5. Other Drainage ditch Procedure Used Total Coliform = Membrane Filter with LES Endo Agar Plate Count � 35c) C - 48 hr with Plate Count Agar Fecal Coliform = Membrane Filter with mFC Agar These results indicate that the water ( /was not) of a satisfactory sanitary quality when the sample was collected. l/ v Chemist TOWN OF OUEENSBURY WATER DEPARTMENT R-D. 2 CORINTH ROAD * QUEENSBURY, NEW YORK 72801 • Amerrrare W/M MEMBER PHONE ?93,�Cc Ms, e[rwbnn Yf MBER �VWV THOMAS K- FLAHERTY. G.E.T. Superintendent RALPH VAN DUSEN QUEENSBURY LAB Chief Operator-Laboratory Director The results of Our lab tests on the water sample submitted by you indicates that according to state standards , the coliform count is unsatisfactory for drinking water. Further information regarding possible corrective action may be obtained by consulting with : New York State Department of Health 21 Bay Street Glens Falls , New York 12801 Telephone - 793-3893 LW 00 c� l BARSONS Lr ll ur G3 OF CONSTRUCTION CU.I INC. 1241 Kings Road SCHENECTADY, NY 12303 DATE - Jon Nam, r � 518) 37��•�71 ATTENTION l 3 V MAC, 'DreA±A RE: WE ARE SENDING YOU r �Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE No. DESCRIPTION J L LC41LIt %7 K M . OWN THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval XFor your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints XFor review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS 4SMA4,41MO "b w L*A 4S W ( LeLw ' !;e llF /Ari ie I L r= 7' e� lIt ll,�f COPY TO SIGNED: PRODUC12463 �MC, RnRe Km OWL. if enclosures are not as natede kindly notlry us at ..a. BARSONS fL u` EEM OF CONSTRUCTION CO., INC. 1241 Kings Road SCHENECTADY, NY 12303 Joe ao (518) 370A2761 wrreNr: H RE: WE ARE SENDING YOU AroAo ttached ❑ Under separate cover via the following items: 0 Shop drawings ❑ Prints ❑ Plans ❑ Samples CI Specifications © Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION SZ vD AgocA . fr.1 5 L-4 or jr L.4 4 1 THESE ARE TRANSMITTED as checked below: For approval El Approved as submitted ❑ Resubmit copies for approval CI For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested 0 Returned for corrections ❑ Return corrected prints ❑ For review and comment 0 Q FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: ngoun N" wc. Gran.ohm 01471. If anciPauraa are not as noted, kindly notify us at onevoor COK insuring ncys ZT ^. Quaker Road I P.O. Box 2074 f Glens Falls, NY 12801 I Phone (518) 7793-5133 May 6 , 1987 Town of Queensbury Town Office Building Cor _ Bay and Havi1and Roads Glens Falls , New York 12801 Re : Cool Insuring Agency , Inc . Expansion Quaker Road , Glens Fails , New York Gentlemen : Please be advised that we are aware of the problems with our current septic system at our office building on Quaker Road . In view of the fact that Town sewers will be available within the next two years , we are suggesting a temporary solution to our overflow problem . We will be contracting with Sanitary Sewer Service , Inc . for the purposes of having our septic tank monitored on a weekly basis . We anticipate having the tank checked weekly and drained as necessary in order to avoid any overflow . I assure you that this will be done on a weekly basis in order to avoid any sanitary problems . SIn rely yours , By : Ir Me Vice President COOL, INSURING AGENCY , INC . IDN/c