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1987-853 I 65 i CERTIFICATE OF CJfw.`.0 FANCY TOWN OF QUEENSSURY WARREN COUNTY, NEW YORK 1 Date July 7 19 88 C) [f� This is to certify that work requested to be done as shown by Permit No. t has been completed. This structure may be occupied as a % of a two family_ dwelling E 1,,Dc^tion 26 Queen Anne Court, Queen Victoria's Grant , Model C of C/K { f Owner Guyer Builders, Inc. i i By Order Town Board TOWN OF QUEENSBURY E { ' Building b ning Inspector E BUILDING PERMIT V-1 w,� p TOWN OF 'QUEENSBURY No. 87-853 WARREN COUNTY, NEW YORK o A r PERMISSION is hereby granted to Queen Victoria ' s Grant r I OWNER of property located at 26 Queen Anne Court Street, Road or Ave_ i in the Town of Queensbury, To Construct or place a j of Two Family at the above location in accordance to application together with plot plans and other information hereto filed and approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 1. O WNE R"S Address is Guyer Builders m 119 Running St . Ballston Spa , N . Y . 12020 n 2_ CONTRACTOR or BUILDER'S Name SAme H r+ m 3. CONTRACTOR or SUILDER"S Address C) r5 Same M 4_ ARCHITECT'$ Name 5. ARCHITECTS Address r rn .C} C Io rir 6. TYPE of Construction — {Please indicate by X) o { Wood Frame I ) Masonry I I Steel 11 m 0 7. PLANS and Specifications .*i N0. 30 ' x 30 ' as per plot plan , specifications and application including ^ septic system and attahbed one car garage . MODEL C S. Proposed Use of Two Family Dwelling �~ O t-h $5000 C/o 0 $ 75 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 1 , 1988 ilf 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.} Dated at the Town of Queensbury this 9th Day of December 19 87 t r SIGNED BY LlWk44 LZ ! _ for the Town of Queensbury F Building and Zoning I nspector Oa .. . .. ... 'LSJ i9�i �6:L71�LlC' . .r.iGL O ✓Qi.HIr,V• a.earw� a • I ..iYY[[ !V (4+Y' l.?I 1 :. ,.� �'} / Q/ 'y ! if Application No . WL L� (�, I_E, OfrJ# O �c�'�seer��6tt1� Permit Issued 19 l i� BUILDING and ,ZONING DEPARTMENT permit Expires 19 OCT 2 31987 '— } Bally and Haviiand Road, R.D. 1 Box 98 Zoning Designation c7f Ousenabury, New York 12801 variance No . �, t�k Site plan Review Noe Approved by . APPLICATION FOR G7 BUILDING AND ZONING PERMIT IF N r 0 * * Oh * * * * ;a * * * Ir +t it ar +r it rt * iF it �► * iF i► +t iF ar * e +F #! ,a tr+lr 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 : Guyer Builders Inc . emeow Poo* Address 119 Dunning Street Ballston Spa , New York 12020 Tel . ( 518) 899-9161 wwwwwwww Property Location : 26 Queen Anne Court Tax Map No ,121 / . �/ 2 street number or building lot number Subdivision name (if applicable) Queen Victoria ' s Grant THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGAPZS BUILDING CODES IS Richard He Gu emomr III ( 518) 899-9161 Name P. O. Address Tel . Now Name of builder Guyer Builders , Inc -Address 119 Dunning Street wwwwTel . ( 518) 899-9161 Name of plumber Guyer rs , nC •Address ng Streetwwwwwwww-Telm - Name of mason Guyer MUlders , rnHc-Address—IL9 lKirming SEreet Tel . 'IATURE OF PROPOSED WORK : » ZONING INFORMATION X Conetruction 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) sat-back dimensions from property lines . Give * street and number or lot number and indicate " whether interior or 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 REQUIeREDp�E�T . » Size of property IC)O+ plan ft x 120 ft . * Existing building ( s) Size wowft X� ft Model PROPOSED BUILDING AND USE : Of � * Existing building ( s ) Use NIA Size of new struc a 3af _ft Xlft Foundation-pier slab crawl/partial/full * Proposed building, diet ce from property line circle one ) * + see plot pan 2 Front yard 30 ft Rear yard 30+ ft Noe of stories (habitable space ) Side yards ate*�ft and 15+ ft Haight (grade to ridge) 22 ' - 6" ft • * If on corner * setback from aide street ft If residential, no. of families of 2 No. of roomas (excluding baths) * OCCUPANCY INFORM4TION Noe of bedrooms �AZ — * PRIMARY BUILDING - k330o of bathrooms 2 One family dwelling hIs e f r Primary heating system se board e ectriC" rse sdeLin 1 �, =Two family dwelling ! Type of fuel Electricity * Multiple dwelling / Number of units No. of fireplaces to be installed * Permanent occupancy will a wood stove be installed? Transient occupancy Central Air conditioning? No wwwwwomm* Business BUILDING STYLE, PRIMARY STRUCTURE » Industrial othey Ranch Contemporary Lo cabin * 1 addition , what will use be? Raised ranch Mansion Duple Split level old style Bungalow Cape Cod Cottage Other * ACCESSORY BUILDING- Colonial Row Town House * Detached garage/one car/ two car/ car Attached garage/one car/ two cart one CIRCLE ONE PLEASE car ( ) » _ .�_ Private storage building ESTIMATED MARKET VALUE OF Other CONSTRUCTION CONSTRUCTION we IdpoRMATION ON - BUILDING SPECIFICATIONS , ON REVERSE SIRE OF THIS SHEET, TO BE COMPLETEDI Form SPA 4/86 mxl-vl Who BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS . Type of construction , wood frame , fire safe, etc . woad frame Will any second-hand or ungraded, lumber be used? If so, for what? no Foundation wall material concrete block 'Thickness $" Depth of foundation below grade (to bottom of footing ) 48" minima Will there be a cellars 'no Heated or unheated? Floor sq. footage sq ft Will there be a basement? no Will any portion be used as living space? ( If so, what poxtia, sq. ft . - -- Type of use? Type of roof - sloped flat/shed/other Material of roof Fi rg ass shing es Size, wood studs "X b " spacings"o . c . length 8 fto exter ' or walls Joists ( floor beams ) 1st . floor N/A "X •' spacing "o . c . spanN/A ft . Joists ( floor beams) 2nd , floor 'Z X�� " spacing�'"o . c . span�'ft , Overlays (ceiling beams ) 2 "x " spacing 24 "o . c . span 14 ft. Roof rafters 2 "x io ONspacy�` rig r 4 a , c . span 14 f t . Roof trusses (pre-engineered) spacing + "o , c . span NIA ft . EXterior wall finish stained Of what material? 5 /8" x G ' x $ ' texture 111 Interior wall finish pan s eetrock If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 1/2" type "X." sheetrock _ 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 Will a flue-lined chimney be installed? No Height above roof N A ft _ Depth of chimney foundation below grade N A ft .' Depth of fireplace hearth N A ft . in , Water supply - Municipal or private well nauzici.pal SEPTIC SYSTEM Distance from ANY private well ( including adjoining properties ft . (A separate application is necessary for an re air or new installation of septic system) Tawas of Queens y See S . P. E. D. S . permit # .26252� -- A F F I D A V I T - STATE OF N bur EW YDRK County of warren 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 con3plete 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 ecif ' ed or not, and that such work is authorized by the owner . .a SWORN TO BR.FORE ME THIS Signature Owner, owner s agent ,�archltect , contractor day of ��. 19 PATRICIA E. FURPHY f1 Notary Public. State of New York Notary F'iibliC Qualifies in Schenectady County , y � . Y . fr kr 4717044E Ce f1 i ! * # ! t k 4 # . # * * I, * • * ft yCopMps " x )r4 Sjpt*30* 1 SPECTAI+ CONDITIONS OF THE PERMIT : -- 975 Square feet living 264 Square foot garage - one stall 1239 @ $7 . 00/100"or part of S5 . 00 one stall garage 5 .oo C/o permi.t Total TOWN OF QUEEMSBURY .. 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 . &NOWSR ALL of the followings � . Craw floor afire & 975 S . F . 3 . Type of heat Baseboard electric 3 . Ia the building mechanically cooled ? No * . Percentage of area of windows and doors A . over 16s Only 1 . U 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 N.p a . If YES , what is the R value of insulation aroused perimeter of floor ? 4 . Is basement heated ? YES NO at . R value of insulation 5 . Type of insulation � . Under 16 • Only 1 . R value of roof and . floors exposed to ambient conditions. R-38 2 . ; R value of exterior walls C R. 23 . 5 Ue =0 Q4 3 . R value of glazed area Ud1 . 30 4 . R value of doors R- 14 . 9 (U. =3 . 60) t % spaces5 . R value of floors over unheated spaces �R=19 6 . R value of slab edge insulation as unheated slab N/A 7 . R value of slab insulation - h'eated slab 12 • 5 V . R value of heated basement/cellar walls ( above grade ) N A g . R value of heated basement /collar walls ( below grade ) N/A Joe Type of insulation Fiberglass c . Controls 1 . Thermostat maximum heat setting D . Duct Systems N/A 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 Be Piping Insulation N/A Mob 1 . Size of hot water or cooling carrying agent. pipe 3 . R value of pipe insulation F . Service water Heating Nd 1 . Performance efficiency N/A Phenomenon 2 . Temperature control setting maximum G . For Swimming, Pool On_Zr 1. MaxImum - heating N/A �s- Telephone No . ( 518) 89"161 ( applicant ' s sign tore ) . e � � . APPLICATION FOR SEPTIC DISPOSAL PERMIT Ref : S . P. E.D. S . VATS October87 permit # New York - 0202525 DMEL C of 'C/K LOCATION OF PROPERTY FOR INSTALLATION 2tj Queen Anne Court Owner's Namet Guyer Builders , Inc . Telephones ( 518) 899-9161 Address: 119 Dunning Street , Ballston Spa , New York 12020 Installer's Name: [;buyer Builders , Inc Telephone: ( 518) 899-9161 2 A, Co E, I , ,70 K, L, M "umber of bedrooms (residential only) 2 _ 3 F, G , H • • Total daily flow (compute 0 160 gal per bedroom) 300 Topography: circle one iat Rolling Steep Slope % of slope Soil Natures circle ones Sand Loam Clay Other / Depth:" 84 feet + ' Ground Water: At what depth? unlaaown 8 feet + Bedrock or Impervious WlaterWs At what depth? unknown feet Fcx= latioaa test: circle one; t r q e required / rate min. inche Daumstic rater supplys circle one: Municipal Well Other IF domestic water supply is a Welk Separation: Watersupply from Septic absorption N/A feet * PROPOSED SYSTEM% Septic Tank gal. (minimum sizes 1,000 gal.) TILE FIELD% Each Trench N/A feet / Total system length N/A feet * SEEPAGE PIT(S): Number of / Size each feet by feed * Size of stone to be used. # / Depth or Thickness feet I Y P © R T A N T See S . P. E.D .S . ...Please...LIST NEW EQUIPMENT TO BE INSTALLED permit & attached * # # * * * s # # # # # # * * * * * # * * * * * * * * * * * # * * * # # # * # * # map , (over) Section U 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 24 hours before start of construction and shall include a plot plan, showing: l.) the propo*ed .location of the §ystem 2.) location and distance to lot lines 3J location and distance to structures 4.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, the fields and/or drywells 8. 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 S250.000 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. 1 have read the regulations above and agree to abide by the awl all requirements of the Town of Queemmaoxry Sanitary Sewage Disposal C*dinan e. Signature of.responsible person: Date: Town of QueenSbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 79Z-5832 S !763 . . . HOUF qF NATURAL f TY . . . A GOOD PLACE TO L ' MIDDLE DEPARTME,N�„Ty141 �N AGENCY, INC. - goo Haddon Aver i'1 3 0 Inalwr0001'* *04404 aril, July 7 , 1989 iA.QCtlf ll'4f that thelelectricel equipment listed has been examined a6d is approved as being in accord with the National Electr}oal Code, applicable governmental, utility and Agency rules. yN. � Owner. Guyer Bui 1r1t~;1:�' Occupant: Sol r ' .� 6 Queen. A n�, L,o FF r-�gg � Y � '�x � +- a � KT %"cer �fica7b d0�✓0 r$ the ial9clnc urpment and �n slalialibn ins ached INS Location >?�° t �LSee41StY4lry U 1�17 P Y, date. IF addllienal by ulprYlent !an�ykl be �nlrDduced or allera bans matleto '}{r � "'.:- ¢><isting gygfem Lnifl c t�4lcatQ g�' 11 b¢ nul} antl *.©i d, an❑ ap phca hon Per t, �L� y � � Q Rece jtac l es `J (] Y ,. �[ � ,�, inaP'acngn ghauhd 4e S+�bmil[gd p flY fa [hls Aflenc Y. Equipment: L : < l q } yT { p r�yo der of tnis urtiricafa ahpuiaenh 58 n61P ma prgp¢rty insurance Garner 150 Amp S e rV i A, ' 7 :�+p}1 l i-a n(� e, S {agent ar campMny) as evidlp5cp ertlticabon n}¢I¢ct lcah 9gwpmen( approved ..y'� as sPeclll¢d. " 7r C,lsyer TSl7f. lcler.: Tit+f;. Apphcanl: 11. `.: 1]1 uni.n BaIIS O11 Spa , NY 1202mSLree N{7 . 1S - [3 � 2 77 T"��� corn. No. ?W EL t.as TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12804- ' TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME Wei LOCATION L DATE �/ - („ r- 3 J PERMIT ## APPROVED YES NO FOOTINGIPIERS MONOLITHIC POUR FORMS _ FOUNDATION/DAMP-PROOFING BACKFXLL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUG -XN INSULATION: .FOUNDATION FLOORS WALLS CEILING 4�" AL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STE TAIRS-CLEARANCE & PLUMBING FXXTURES/R I VALVE _ INTERIOR TRIM/PRI VA Y D RS FINISHED FLOORS GARAGE FIREPROOFIN DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL I SPECTION FINAL APPROVAL OF CONSTRUCTION EEHEjjT 4.. A SIGNED CERTIF CATE OF OCCUPANCY MUS E OBTAINED FROM THE BUILDING DEPARTMENT BE RE THESE PREMISES ARE OCCUPIED! REMARKS: f f swo fy.- INS BC TOR rr �7otvn o ' ueertil"ry BUILDING and ZONING DEPARTMENT Say and Hawiland Road, R.D. 1 'Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S (REPORT NAME i� 3 _ sti s_ Q la UV"j=P LOCATION Cft Date `p / t 1 Permit No . �y " ���j ✓ = APPROVED - YES ,,No Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding- MasonrAFloor Rough Relief Ext . P Finish Interior Trim Stairs & RailAs Cellar Drain Concrete FlooPlbg . FixtureGar . Fireproo Door Closers Smoke Detector Chimney IN SU T&AT I ON Foundation Floors Walls Ceiling FINAL. ELECTR CAL INSPECTION DRIVEWAY APPR61VAL Final Building Survey. I3ext scheduled inspection (call when ready ) Remarks- Buil i g Inspector 6/86 and-vl TOWN �F QUEENSS E BUILDU-TLD D ING AND CODES .DEPARTMENT BAY & HA VXLAND ROADS t QUEENSBURY, NEW YORK I2809- TELEPHONE ( 5I8) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR IN PECTXON RECEIVED NAME LOCATION �V& e• xti DATE � fI PERMIT # APPROVED YES NO FOOTING/PIERS MONOLXTHXC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFXLL APPROVAL C,R6UGH PLUMBING L,FaAMXNG ELEC'TRXCAL ROUG'3f-XN XNSULA TXON: FOUNDATION FLOORS WALLS y' CEXLXNG FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STE S STAXI?S-CLEARANCE & XLS PLUMBING FXXTURESf LIEF VALVE INTERIOR TRIM/PRXV' CY' DOORS F XIVX SHED FLOORS GARAGE FIREPROOF G DOOR CLOSERS) } SMOKE DETECTORS ? FINAL ELECTRICAL NSPECTION FINAL APPROVAL O CONSTRUCTION A SIGNED CERTXFX TE OF OCCUPANCY MUST BE OBTAINED FROM THE BUXLDXNG DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: NSPE TOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS „� J QUEEN.SB7JRY, NEW YORK 12804- �✓ TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAMEQ/ti/� ' LOCATION DATE i /_ y Q PERMIT # '/ i � APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBIN FRAMING ELECTRICAL ROUGHIN ULATION: FOUNDATION FLOORS WALLS ] CEILING , 56 FINAL INSPECTION: , CHIMNEY HEIGHT ROOFING, SIDING EXTERNAL PORCHES/S EPS SfiAIRS-CLEARANCE RAI�--- PLUMBING FIXTUR /RELIEF VALVE INTERIOR TRIM/ RIVACY DO(4S FINISHED FLOG S GARAGE FIRE OOFING DOOR cr,asE (s) SMOKE DET TORS FINAL ELEC ICAL INSPECTION FINAL APP VAL OF CONSTRUCTION A SIGNED CERTXFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: l r INSPECTOR awn 0/ BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R, D. 1 Sox 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME ,•.-�,�i�2��ic,e'S LOCATION Date � t/ Permit No . ✓ APPROVED - yYE NO aoting/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 Door Closers Smoke Detectors Chimney I N SU LAT I ON Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTIC)N DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks - R 8uildin Inspector 6/B6 and-vl awn v/ �ueert Ihtsre� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Clueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION cif a, .4 y C 2, " DATE .i l PERMIT NO . SOIL TYPE and Loam - Clay -_ Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorptionk, f field , total length Length of each trench ° Depth of trenches Size of gravel '' .e SEEPAGE PITS-(Number/of) ze Size- X_£t. X 5P/' `ft. Gravel size PIPING : Size Type Bldg . to tank Tank to dist , &X tog / Disto box to field/ le .Y] Openings se led? �5 No Partial - LOCATION/ AIRATIONS : Faundati to tank Foundati n to absorptio ft . Absorpt ' n to lot line ft. Separat on of pits LOCATI OF SYSTEM ON PROPERTY ( circle one) Front Rear - Left side Right side - COMMEN Sc SYSTEM USE APPROVED YES N Buil ng Inspector 01/86 and vl TOWN OF QI Bs BUILD ING .AND conE CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280d- TELEPHONE (518) 792-5832 ILDING INSPECTOR ' S REPORT REQUEST FOR NSPECTION RECEIVED NAME LOCATION DATE PERMIT # APPROVED YES NO FOOTIIVG/PIERS 4- MONOLITHSC POUR FORM FOUNDATIONIDAMP-PROOF NG BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL, ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION. CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES1 TEPS STAIRS-CLEARANCE RAILS PLUMBING FIXTURE /RELIEF VALV INTERIOR TRIM/P VACY DOORS FINISHED FLOORS GARAGE FIREPR ING DOOR CLOSER (S) SMOKE DETECTO S FINAL ELECTRXCA INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CER IFICATE OF OCCUPANCY MUS BE OBTAINED FR THE BUILDING DEPARTMENT EFORE THESE PREM ES ARE OCCUPIED! REMARKS: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS ' QUEEN.SBURYr NEW YORK 1280$ TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION enin DATE PERMIT #�. ..d ^F'_ __ � 0 APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR ,'FORMS FOUNDATION/DAMP-.PROOFING BACKFILL APPROVAL &/ OUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE & RAILS ' PLUMBING FIXTURES/RELIEF 'VALVE INTERIOR TRIM/PRIVACY DOORS FINISHED FLOORS GARAGE FIREPROOFING i DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIEDL REMARKS; INSPECTOR �au.En ©� �ueensburr�r BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 SIE C DISPOSAL SYSTEM INSPECTION NAME LOCATION DATE 6522 / ,Ff PERMIT NO. ! , SOIL 'TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , total length Length of each trench. .Depth of trenches Size of gravel'',, SEEPAGE PITS*Number of) Size- ft. X ' ft. z {Gra-Vel Size R PIPING : Size Type Bldg . to tank Tank to dist, box Distw box to field/fpit Openings sealed? , YES NO Partial LOCATION/SEPA R�P.R'I ON S : Foundation to/tank ft. Foundation tp absorption ft . Absorption Vo lot line ft, Separation /of pits ft. .LOCATION SYSTEM ON PROPERTY (circle one) Front ar - Left side - Right side - CCBR4EN'I'S SYSTEM USE APPROVED YES NO Build nspector 01/86 and vl BUILDING DEPT. COPY OF APPLICATION FORM464EL NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. TEMP. ! DATE t' VILLAGE lji1C7P�Ll�t,iLtL }���� STREET AND NO, OR TOWNSHIP ], '""",`i,7 COUNTY %Rrxen A ROAD AND POLE too. BETWEEN WHAT TWO POLE NO PREM+5E8 EdCATEO'+ r OCCUPANT'S SECTION f BLOCK LOT NAME BUILDING OWNERS NAME 1 OCCUPANCY AND ADDRESS . CU ptyra... rs7'Jl 61 SUPPLIED V7'T BY BUILDING r' _ FROM THEIR _ � � � � �- "� � •� - OFFICE IS NEW OLD © WORKY �� DEFECTS fS NEW ® ADOITIONAL ❑ V REMOVED 0 LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS No. of Fixtures 6 BRANCH Luca- tamp Raceptactee MOTORS HEATERS CIRCUITS OFFICE USE hm Ceiling Bull Astaeh't ONLY wall Reepr'le Switch Pendent B++al[et No, TYM H.P• Watta A W.G_ O Each No. Each No, Gouge INSPECTION � Sb� flaw meet tat FL 2nd Fl, 3rd F!. REMARKS LIST OTHER ELECTRWAL DEVICES NOT SET FORTH ABOVE,: Dp NOT USE THIS SPACE, This applica lien is intended to cover the abova.listed equipment to be inspected but if at time of i Vcu are authorited to make the inspection and adjust the fee to cover the additional ns/stied b Mere +s found additional equipment not shove listed, SIZE OF �} ��t equipment, as prpvitled by the applicant. MAINS ICU% rA ♦ FEEDERS ELECTRIC SIGN TOTAL CHARACTER LAMPS WATTS OF WORK Rough In and service EXPOSED GAS TUBE SIGN TRANSFORMERS OF WORK TO $E CONCEALED VA STARTED COMPLETED SIZE (CAPACITY] SERVICE OVERHEAD SIZE OF SIGN ENTERS UNDERGROUND UILDIN MAKER INSPECTION RED U£STEO OF SIGN ON OR AS NEAR AS POSSIBLE NEW F1 OLD AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED [N OR APPLICATION MAY BE g ED. PRINT NAME AND ADDRESS r AMOF PPLICANT xu4�8 ,a„y,B..;.e GATE OF yy /��'I �p�} �f s� APPLICATION AtJ—+'�Ol STR E ET ADOR ESS 119 Pkp?g4 & Street TELEPHONE # $�'-'gl61 CITY OR +�xlaton SM Nr �! +y�n�i�r+r,POST OFFICE ! asi, 21P y,W,yy LICENSE NO, CODE WHEN APPLICABLE ea E� (REV. I/as) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING 8=0 DIAMETER 9'-0 DEPTH CLEANOUT TO GRADE c y�o QUEEN VICTORIA'S GRANT QUEENSBURY , KY nc�. REFERENCE DRAWINGS 5A SITE UTILITIES SEPTIC $ WATER VonDUSEN 4 STEVES SURVEY PLAN