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1987-375 + y CERTIFICATE OF OCCUPANCY I TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK 9'i 'Date December �']21 lg P This is to certify that work requested to be done as shown by Permit No. €37 375 has been completed. Voayw)tl �/,�+-'1� fa�mliv welling This structure maky be occupied as a - 1 -M1� J' Thistlewooi ter. . ( Stanaksssrst ) Location Owner I onn1e Benl;gare By Order Town Board TOWN OF QUEENSBURY Building d► Zoning Inspector *--- BUILDING PERMIT TOWN! OF QUEENSBURY No. 87 375 � WAR RE COUNTY, NEW YOR K z PERMISSION is hereby granted to Ronnie Benware 0 u, OWNER of property located at Lot 47 N. Thistlewood Dr . (Stonehurst) Street, Road or Ave. in the Town of Queensbury, To Construct or place a 1 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. [2. OWNERS Address is 38 Grove Ave . Glens Falls , N . Y . 12801 CONTRACTOR or BUI LDE RZ Name p Same to E w 3. CONTRACTOR or BUILDER'S Address m 4. ARCHITECT'S Name r 6 r'r rf7 r7 �- S. ARCHITECT'S Address C3 i fd r�w sr rt P4 rr F'• G. TYPE of Construction — (Please ind'ecate by x) oni.�. t3 M (X ) VVood Frame { I Masonry I ) Steel { y CIA ic 1-4 pw 6 cw 7. PLANS and 5 y pecifications W •C C1 �i 28 ' x +64 r p �No. per plot glen s ecifications & application including 2 car attached garage & septic system 8_ Proposed Use One family dwelling $5 . Oo C/o $ 171 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES January 1 , Iggg rn (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.) `-C Dated at the Town of Queensbury this 22nd pay of Tune 19 87 E ro SIGNED BY � 40 �+• -an_ for the Town of Queensbury Y Building) and Zoning inspector ua TO BE COMPLETED BY BLDG . DEPT. Application No . - oWI? OCIPFI? 3OflM� Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 I r0VVVN C); .. , EE,ti4t = y Say and Haviland Road, R. D. 1 Box 98 Zoning Designation L ! f ry �- Quensbury, New York 12801 Variance No . I +I 0 I'� 5j j ,yl�} t''Y�[l Site Plan Review No . Ll L1 f +kE ��� L 1. 1 l r { Approved by : Li 1 a APPLICATION FOR BUILDING & CODE DEPT 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 : Ronnie N . Benware P . O. Address 38 Grove Ave . , Glens Falls , NY 12601 Tel . 798 - 1561 Property Location : Lot 47 , N . Thistlewood Drive Tax Map No . 54 . / 7 /47 Street number or building lot number Subdivision name ( if applicable) S tonehur s t THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : Robert J . Benware 38 Grove Ave „ Glens Falls , NY 12801 798 - 1561 Name P. O. Address Tel No . Name of builder R . Benware Address 38 Grove Ave . Tel . 798 - 1561 Name of plumber same Address same Tel . same Name of mason same Address Same Tel . same NATURE OF PROPOSED WORK : ZONING INFORMATION : XX Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED , _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 FOR DEMOLITION FERMI , STATE SIZE AND whether interior or corner lot . Show location LOCATION OF STRUCTURES AFFECTED . of water supply and location and oonfiguration � of septic disposal area . * COMPLETE INFORMATION REQUIRED BELOW . Size of property 195 ft x 221 ft . * Existing buildings) Size N t x ft . * PROPOSED BUILDING AND USE : * Existing building ( s ) Use NONE Size of new structure 28 ft X 64 ft Foundation-piaL�}-s3aba/c. v-awlf}�artia-1/full * Proposed building, distance from property line (circle one ) Front yard 50 ft Rear yard 135 ft No . of stories (habitable space) 2 Side yards 58 ft and 63 ft Height ( grade to ridge) 26 fto if on corner , setback from side street N A ft If residential , no . of families 1 No . of rooms ( excluding baths ) 9 * OCCUPANCY INFORMATION No. of bedrooms 4 PRIMARY BUILDING Pr r - of bathooms 2Z * Primary heating system electric XX One family dwelling Type of fuel Same * Two family dwelling No . of fireplaces to be installed 1 * Multiple dwelling /' Slumber of units Will a wood stove be installed? yes * XX Permanent occupancy Central Air conditioning? no * Transient occupancy p 1' * Business BUILDING STYLE, PRIMARY STRUCTURE industrial 4kAAq:�Wx aeabdxxx * Other If addition , what will use be? 7�Sf�t1�3L� I �aC 17�'lPsl[MK#� .Sj§1j2XgD#qG0X f C7S $ H4.'FA'�j8f.]SpFi{xx xapwlma ACCESSORY BUILDING- Colonial %cam Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE } * XX Attached garage/YWkK tYa?§ / two car/ car * x * * * * * * * * * * * * _Private storage building ESTIMATED MARKET VALUE OF * _Other CONSTRUCTION INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED ! Form BPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of constructione wood frame , fire safe , etc . wood frame Will any second-hand or ungraded lumber be used? If so , for what? no Foundation wall material poured concrete Thickness g " Depth of foundation below grade ( to bottom of footing ) 8 ft Will there be a cellar? Heated or unheated? no Floor sq. footage N/A sq ft Will there be a basement? 'ye s Will any portion be used as living space? no ( If so , what portion? sq . ft . - -- Type of use? Type of roof - slo edVXXdbYrA'6i9dV�6ISK Material of roof asphalt shingle Size , wood studs 24PX 4 " spacing 16 "o . c . length 8 ft . Soists ( fioor beams) 1st , floor 2 "X 10 " spacing 1 "o . c . span 14 ft . . Joists ( floor beams) 2nd . floor 2 "x 10 " spacing1 "o . c . span-'14—ft . Overlays ( ceiling beams ) 2 "*x 6 " spacing 16 "o . c . span 14 ft . Roof rafters 2 " x 8 OF spacing 16 o . c . span 14 ft. ROaG t . Exterior wall finish clapboard Of what material? pine/ Spruce Interior wall finish sheetrock If a garage is to be attached , descr a materials to be used for FIRE SEPARATION : f irecode sheetrocic s �(Is there to be an opening between garage and dwelling? yes If so will a Fire-rated door , enclosure , and self-closing device be provided? yes W111 a flue-lined chimney be installed? Yes Height above roof i3 ft . Depth of chimney foundation below ade '7 fft . Depth of fireplace hearths uft . in . Water supply - *RiXi jp*k private well SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties 100 ft . (A separate application is necessary for any repair or new installation of septic system) Town of Queensbury A F F I D A V I T County of Warren STATE OF NEW YORK I swear that to the best of my knowledge and belief 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 not , and that such work is authorized by the owner . SWORN TO BEFORE ME THIS Signature __ G .- .� r .5? -------------------- _ Owner , ownerele agent , archxr ect . contractor / day of 19 < Notary Public , Warren County , N . Y . * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * SPECIAL CONDITIONS OF THE PERMIT : TOWN OF QUEENSDURY WARREN COUNTY , NEW YORK Application for : BUILDING CONSERVATION PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY A permit must be obtained before beginning work . ANSWER ALL of the following : i . Gross floor area 2240 sqft ft . 2 . Type of heat electric baseboard 3 . Is the building mechanically cooled ? no 4 . Percentage Of area of windows and doors 15% A . Over 16 % Only 10 Uo value of gross area of walls , roof / ceiling and f oors 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 floor ? 4 . Is basement heated ? YES NO a . R value of insulation 5 . Type of insulation 8 . Under 16 Only 1 . R value of roof and floors exposed to ambient conditions. R - 38 2 . R value of exterior walls R - 27 3 , R value of glazed area R - 3 . 3 4 , R value of doors R - 1 5 , R value of floors over unheated spaces XXSXX 6 . R value of slab edge insulation - unheated slab N /A 7 . R value of slab insulation - heated slab N/A B . R value of heated basement/ cellar walls ( above grade ) R - 11 9 . R value of heated basement/ cellar walls ( below grade ) R - 11 tO Kc ers footing 10 Type of insulation fiberglass batty , IX j sheathing C . Controls 80 1 . Thermostat maximum heat setting D . Duct Systems 1 . Is duct system installed in unheated spaces ? YES NO a . If YES , R value of duct installation N/A b . R value of duct in other areas N FTA E . Piping Insuiation A 1 . Size of hot water or cooling carrying agent pipe N/ 2 . R value of pipe insulation N /A F , Service Water Heatin% 93 1 . Performance efficiency 140 2 . Temperature control setting maximum 6 , For Swimming Pool OnlyN/A 1 . Maximum heating I Telephone No . 798 - 1561 _ � � - r ( appli t s signature ) APPLICATION FOR SMMC DISPOSAL PERMIT DATE 6 / 16 / / 87 L(]CATION OF PROPERTY FOR INSTALLATION Lot 47 , N . Thistlewood Drive Stonehurst SubCIvIslOn Owner's Name: Ronnie N . Benware Telephone: 796 - 1561 Address: 38 Grove Ave . . Glens Falls , NY 12801 Installer's Name: Robert J . Benware Telephone: 798 - 1561 Number of bedrooms (residential only) 4 Total daily flow (compute @ ISO gal per bedroom) 600 Topography: circle one: BONN Rolling; Soil Nature: circle one: Sand Loam Clan (3tH6XXXX3iXX) Depth: 5 feet Ground Water: At what depth? unknown feet Bedrock or Impervious Material: At what depth? unknown feet Percolation test: circle one: required / rate 7 min. inch. Domestic water supple; circle one: be 2jDQj Uj Well CAURk IF domestic water supply is a Well: Separation: Watersupply from Septic absorption _ 100 feet PROPOSED SYSTEM: Septic Tank 1000� gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench 60 feet / Total system length 360 feet SEEPAGE PIT(S) e Number of N/A / Size each feet by feet Size of stone to be used # 2 / Depth or Thickness , feet I M P O R T A N T ...i'lease...LIST NEW EQUIPMENT TO BE INSTALLED (over) Section II Septic System Inspections: A. All applications for septic system installation, alteration or repair, as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building Department at least Z4 hours before start of construction and shall include a plot plan showing: 1.) the proposed location of the system 2.) location and distance to lot lines 3.) location and distance to structures 4.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, tile fields and/or drywells B. No system shall be covered before inspection and approval by the building Inspector. Failure to comply with this requirement may result in the uncovering of the system by the installer and a fine of up to $250.00. C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. I have read the regulations above and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Signature of responsible person: „mot Date: �' 7 / f Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . HOME OF NATURAL BEAUTY . . . A GOOD- PLACE TO LIVE THE NEW YORK BOARD OF FIRE UNDERWRITERS € i I� BUREAU OF ELECTRICITY 47 STATE STREET. ALBANY. NEW YORK 12207 J Date " dpplicatinn NO. on fife I THIS CERTIFIES THAT only the electrical equlPment es described below eesd introduced by the applicant nansed an the abase application number in the Premises of in thefollowind location; ❑ Basement ❑ lot FY. ❑ End FY. ' Section Block Lot was examined i and found to be in compliance with the requirements of this hoerd. T OUTLETS ACUIS SWITCHES FIXTURES TLE�TS RA►hrOES COOKING DECKS OVENS DISH WASHERS EXHAUST FAMS INCANDESt1FNT FLVORESCEN7 OTHER AMT. K. W. AMT. K. W. AMT. K,W, AMT. K. W. AMT. F F � i DRYERS PURNACE MOTORS FUTURE AIFFUAIMCE 1 E 11*5 SMIAI REC"PT TIME CLOCKS EARL UNIT HEATERS MUITI4X"1ffT LMMMRRS AMT. K. W. OIL H. P. OAS H. P, AMT. NO. A. W, G. AMT. AM►, AMT. Ahvs. TRANS- Amt. M. P. SYSTEMS NO. OF FEET AMT. WATTS SERvrcE DISCONNECT No. of S E R V r C E METER AMr, AMP. TYPE !f ltflF. r X 2W 10 3W 3 X 3W 3 X �w #OQ�NQ. Of A. No. OF Hbttc A. W. C.. Na. Or NEL/TRiWS AM-AL OF HI-LEG OTHEE AFMARATU11z { V. . . i. , € BRANCH MANAGWR ,r Per This certificate must not be artered in any manners return to the office of the Board if incorrect. Inspectors may be identified by their credemMiols. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. _ TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT ' BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12801 TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT y REQUEST FOR INSPECfT1ION RECEIVED 3 NAME Q L OCATION DATE 40p PERMIT # APPROVED �] YES I NO FOOTINGfPIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—PROOFING, BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN INSULATION: FOUNDATION FT.00R,S WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS ,STAIRS—CLEARANCE d ' RAILS PLUMBING FIXTURESIRELIEF VALVE INTERIOR TRIM/PR,, VACY DOORS4 : FINISHED FLOORS:' GARAGE FIREPROOPXNG -14 DOOR CLOSER (S) SMOKE DETECTORS /FINAL ELECTRICAL INSPECTION V FINAL APPROVAL . OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS : INSPECTOR J � . lrr. a/ QuQeastfury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION � fee��� ]late%�/ f '! _ Permit No . ✓ = APPROVED - YES No Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior "Prim Stairs & Railings Cellar Drain Til Concrete Floors Plbg . Fixtures Gar . Fireproo ing Dock- Closers Smoke Detec cars himney INSULATIO ; oundati (" loors Walls Ceiling FINAL ELECTRICAL INSPECTIO DRIVEWAY APPROVAL. Final Building SurveyT Next scheduled inspection ( call when ready ) Remarks- Building Inspector 6/B6 and-vl r �r o ueenjuer aM ILDING and ZONING DEPARTMENT Bay and Haviland Road, R, D, I Box 98 4 QLJeensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Sle ed A:::; a W Da t e ��/—y-- Permit Now = - Footing/Pier Forms APPROVED YES NO Foundation Waterproofing Sackfill ,gaming Roofing Siding Masonry Ven er >kough Plumbi g Relief 'Valve Ext . Porches Finished Floes Interior Trim Stairs & Railing Cellar Brain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door closers Smoke Detectors himney SULATION : Foundation Floors Walls Ceiling FINAL FLE RICAL INSPECTIO DRIVEWAY PROVAL Final Bui ding Survey Next scheduled inspection (call when ready ) Remarks- /, G y-o I � d Flu ' Inspector 6/86 and-vl r (� I(�f �J`occrn crueens Fiurt�r BUILDING and ZONING DEPARTMENT Bay and Waviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME___,. �y� LOCATION Date Permit No . ✓ =Footing/pier For s APPROVED - YES NU mil''"oundatian Waterproofing Backfill Framing Roofing Siding Masonry V eer Rough Plum ing Relief Valy s Ext . Porches Finished Floo s Interior Trim Stairs & Railin Cellar gain Tile Concrete Floors Plbg . Fixtures Gar . Fireproof ` g Door 'Closers Smoke Detect s Chimney INSULATION -. Foundation Floors Walls Ceiling FINAL ELE TRICAL INSPECTION DRIVEWAY A OVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- and -vl Building Inspector 36 rl 4�} 7 ©ul y1 © Qtdeenj / BUILDING and .ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 • OLieensbury, New York 12801 SEP,TTIIC� DISPOSAL �SYSTEM INSPECTION NAME LOCATION DATE // / PERMIT NO. 02K SOIL TYPE - Sand - Loam. - Clay Percolation Test Required? Y - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , total 1 �th Length of ea trench Depth of tren es Size of gravel SEEPAGE PITS4N� er of Size- ft. X f . Gravel Size PIPING . Siz Type Bldg . to tank p.L ' Tank to dirt . box Dist . box to field/ ' t Openings sealed? ES NO Partial LOCATION/SEPARATI S : Foundation to taut ft. Foundation to abs rption t . Absorption to to line f Separation of pi s ft LOCATION YST ON PROPERTY (a l' rCl a one ) Front r L ft side - Right 01de COMMENT SYSTEM USE APPROVED ES NO Building Inspectors 01/86 and vl awn O/ Queenshury BUILDING and ZONING DEPARTMENT Bay and Haviiand Road, R.D. 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date 1D / Perms- t No . ✓ = APPROVED - YE NOi �ting/Pier Forms Foundation Waterproofing 8ackfill Framing Roofing Siding IL Masonry Veneer Roughs. Plumbing Relief Valves East . Porches Finished Fl000rs Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproof! Door Closers <"S� Smoke Detecto 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 BUDDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Sox 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAIVE . P LOCAT I SON " Date'" / Permit NO . ✓ APPROVED - YES No Wooting;/Pier Forms .. Foundation Waterproofing Backfill Framing Roofing Siding Masonry Vaneer Rough Plumb. Relief Valves Ext . Porches Finished Floor Interior Trim _ Stairs & Railing Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors ChimneyL. INSULATION Foundation Floors walks Ceiling FINAL EL RICAL INSPECTION DRIVEWAY APPROV Final. Building Survey Next scheduled inspection (call when ready Remarks- .r UOOOO Building Inspector 6/86 and-vl _loran ©� �urc�nn .f6urc�^ BUILiNNG and ZONING DEPARTMENT Bay and Haviiand Road, R, D. 1 Box 98 Queensbury. New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION — 97f DATE / = PERMIT NO. SOIL TYPE - Sand oam - C1 Percolation Test Requ S _ NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , tal length ( Length of each tren Depth of trenches Size of gravel_ SEEPAGE PITS4N er of Size- ft. X ft. L Gravel size - PIPING : S • a Type Bldg . to tank 0 Tank to disc . box - vim --- Di t. box to field/p Openings sealed? S Partial LOCATION/SEPARATI S Foundation to tan Foundation to ab rption f Absorption to I line ft . Separatio is ft. LOCAT N OF TEM cK PROPERTY (cit a one ) Front - ear Left side - Right side COMME:N 0U A/C' r SYSTEM USE APPROVED XES Build ng Inspector 01/86 and v1 � own 0/ QuBenj "rry BUILDING, and ,ZONING DEPARTMENT Bay and Haviland Road, R.D . 1 Box 98 Oueensbury, New York 12801 a ,y BUILDING INSPECTOR ' S REPORT NAME LOCATION Date ] / Permit No ✓ - APPROVED - YES NO `�.�.00ting/Pier Forms '� ,r-'"r QU1l C�8t14I1 i It*aterproofing 4Backfill Framing Roofing { Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches i Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg _ Fixtures Gar . Fireproofing Door Closers jr IL S Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRI L INSPECTION DRIVEWAY APPROVAL. Final Builds Survey Next scheduled inspection (call when ready ) Remarks- ! �- k Building Inspector `r 6/86 and-vl ...../nwl" o/ �ueens�urt�t BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME ,( LOCATION -L Perm-it No * , �-- e VA4 ✓ � APPROVED - YES NO � ooting/Pier Farms Foundation Waterproofing Backfill Framing Roofing Siding Masonry veneer Rough Plumbing Relief valves Ext . Porches - �:�A 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 FINIAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL. — Final Building Survey Next scheduled inspection (Cali when ready Remarks- � - - ^^7/6 �, ,,� � d- Buildin actor 6/86 and-vl BUILDING DEPT, COPY OF APPLICATION FORM A8-EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED, j T w. ! DATE ""` �/ F.,/�5 CITY OR VILLAGE QURIMSBURY TOWNSHIP STREET AND NO ORCOUNTY -lam'E ROAD AND POLE NO. 47 N A THZSTLENOOD DRIVE VE BETWEEN WHAT TING POLE N PREOM STREET$7E R 7 RIDGE RD * P MMSTOMEMRST DR OCCUPANT'S E TION 5� BLOCK 7 LOT7 OINNNAAE BUILDING sic1 is Fawll dreilin OCCUPANCY OWNER'S NAME AND ADDRESS Rounie no .Souwa,re TEL. � 79ta-i �1 BSYPPLIED slal alrat K*ha<Vk BUILDING .- 7P FROM THEIR r OFFICE DEFECTS IS NEW � OLD © IS NEW Rk ADDITIONAL REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS No- e1 Fixtena ! BRANCH Legs- Lamp RemsptAales MOTORS HEATERS dRCUITS OFFICE USE Uew ONLY Cooky de psxesd ttt Swiseh PMMr t Bract No, Type Ewch Na Wash No. A.w,6. gasye INSPECTIONr Ou! aidA Star• Or w Baas• trnt 1st FL 2nd FI. Ul- R KS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE! DO NOT USE THIS SPACE, piiytfoo is intended to Cover the abovedistad oquipsnent to be inspectad but if at time of insprerion there is found ■dditi000f equipment not above IisRed, VOW are authorized to make the inspe"nn And edfuet the fee to a the eddixionel equipmAnt, x provided by the a- dM -t_ size MAINS ELECTRIC SIGN TOTAL FEEDERS LAMPS WATTS CHARACTER EXPOSED GAS TUBE SIGN OF WORK CONCEALED TRANSFORMERS OF VGA WORK TD BE INt.IhlgERl STARTED COMPLETED 512E OF SIGN {CAPACITYI SERVICE OVERHEAD UNDERGROUND MAKER ENTERS BUILDI OF SIGN INSPECTION REG' TED PXXISJSLION OR AE NEAR AS NEW ❑ OLD AVOID BELAY BY GIVING Fy LL AND ACCURATE INFORMATION. ALL SPACES DATE OF MUST BE FILLED IN OR APPLICATION MAY BE RETURNED_ } PRINT NAME e AND ADDRESS APPLIC N da �LICANT 2 '0ber iv J a Benva re NIP SIGNATURE OF APPLICANT rr STREET ADDRESS '� rl 'Qy� � e • TELEPHONE # _ l51 $ ) 798s 3 J56 Z CITY OR POST OFFICE Glenn Fe3is , ' ZIP 1280I LICENSE NO, CODE WHEN APPLICABLE as EL- (REV_ Ifas) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING i � � S .WE I0o0 CiFli.� sePvv,swra�: � j 67 s� U � � 1 .,0 5SS 5 pEUNE ..Y , h� I U � [ � 4 v - r, s CJ DER PLOT t),Ani -LOT 47 TNISTILGIOObkIUr C7h F_ J T NISI N SCALE: ,� _ H-7 APPROVED BY: DRAWH.BY �DATE: REV �C�3-1 DRAWING NUMBER /" T79YM All 4-`7 7