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1989-080 k +CERnFI�C�►TE OFC �CLTPAN�'� TOWN Of QUEENSBURY 'i WARREN COUNTY, NEW YORK y June 13 lq 89 :4 ;l This is to terrify' that work requested to be done as shown by Permit No, i has been completed. i 4 This structure tray be occupied as a . z i ny i t V ami Y �,z *7$ Fore: L Wood Drive Owner By Order Tawas Board TOWN OF QUEENSSURY I I ' I Director of Bldg. 8c Code Enforcement 'f BUILDING PERMIT w TOWN OF QUEENSBURY No. $ 9-80 WARREN COUNTYF NEW YORK 0 tin PERMISSION is hereby granted to Forest Wood $ es ' �"� 1 V'I OWNER of property located at Lot 69 Maple Dr1 Are Street, Road or Ave. I w in the Town of Queensbu rye To Construct or place a Single Fa�J.y DM1ae 77ing 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. t. OWNERS Address is }tJ HC-02 Box 286P O H Warrensburg , N _ Y _ 12885 SU w rt 2. CONTRACTOR or BUILDER 'S Name � D Self p� t7 3. CONTRACTOR or BUILDER'S Address H N• C Same � 4. ARCHITECT'S Name L~ 0 5_ ARCHITECT'S Address �G tv "O fi. TYPE of Construction -- (Please indicate by XI CU * 1 Wood Frame I ) Masonry 1 D Steel 11 C H }J 'C 7. PLANS and Specifications [� No. 28 ' x 69 ' single family dwellingas per plot plan , specifications , and appli.catlan , including attached -two car 8. Proposed Use garage v Single Family Dwelling 25 _ 00 C/o p $ 235 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES October l �g 89 t (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the p town of Qusensbury before the expiration date.) ti• H Dated at the Town of Queensbury this Day of ma Cb 19 9 k SIGNED BY d 1/�l_.L�- 5 �._.,�,��— for the Town of f2ueensbury r I Buildi g and Zoni inspector / 7L f h i T04UN 3F QUEENSI3URY APPLICATION FOR BUILDING AN ZCININ[; PERMIT Fee. PaLd WILDING AND CODES LJJ 31ARTr4t'T Date 1.6.6acd_ _ AY and IIIIVILAw17 ROADS RII z BOX �a p ,lt Nr� . I ' d1 PUESNSBURY o NEW YORK 12 S D 4 Tel . ( 518) 792-5832 Ext �2Q4 M w w �4 '� y • R w K ■ * .* * [ • w w * R > w W r. t ■ • w IN !i aF w w as f A PER11IT MUS'r B4 OBTAINEU BE- FoPtE BEGINNING CONSTRUCTION . No INSPECTIONS UNTIL APPLICANT HAS RECEIVED A VALID UUILDINC PERMIT . WILL BE MADE All applicable spaces On this applicarlon 1tklctrevex be scrsicledofn this esheet . sigUacure of the applicant must akn X ik Jc A A *M Yi 'i' ha owner of this property PwO . Address ��LI TAX MAP NO . ✓ Property location ssas there been any split of this property since October 1 , 198a ? ye1sGi/ n�� 1f yes , Planning Board Review is n ce nary . f LOT NO . 011 - SUBDIVISION NAME , IF APPLICABLE � [ � - I lding Codes is : The person responsible for supervision of work as regards Bui 3- F . O . ADDRCSS TEL . NO . N A twi E 7'e 1 tiame of builder Atl e�sjs '% � � i Name of Plu4nber�' _ t: `Pel 02- �+?•�� Name of Mason Addraas -' 1a11TURE OF PROrDSLD wars. . I ZONI JG JNFORt IATION ( 01 xflce usa, on' !) ) nxtrucGioY4 of a t4ew Uuildinry ;CONING DESIGNATION OF PROPERTY Addition to a builai44g PERMITTED PRINCIPAL PERMITTED ACCESSORY Alt4.:r"Lion Co " 14uilding 'REVIEW REQUIRED - PLANNING BOARD ZONING BOARD � ( 4ra c14aucg� to .:xG .= ricer ditnensians ) } APPROVED DATE C 0jer work SITE PLAN REVIEW # VARIANCE # APPROVED DATE c: kO � S AHUA OV PROPOSLD4 serrCue 'rulic sq t . % Remarks 1st Floor��,�_, f 2 nd Floor � sq f t . ( COitpr.L'i'S I}li'CSi,I'l14'PION Etta,?l 1LEom � LE:LLrii •� y/0 s ;eie - ! Ii f'Yar ft xlS3i1 fir • sq f t . sizo of Liropa rty� $S _ Ocher Floors ' LxistilYcl buil4lia4�) ( :; ) Si: +: 1' L ]S ft • Encst cellar or` biis .: rnenL } OTAL FLOOR ARRA�JJ4L 5q ft • Lixl::Gir1g 1]ulliiif443 (:i } U_ 4 :.' i4u of now structurO E`oascd:.4 Lion-p.icr/.lata/criawl/11arLial ul Yrapo:;ed building , cri:;tancL from Lar4�iac:rty line {cirelu one * Front ywrd 3� 1` t near yard �nC ft No . of starie Ehublc"*bl.: '4.:11ace ) r Side yards a ft aild fS" � ft ltuight ( Uradu to ridqu ) ft ' If on Corner , ::urbjAok from side: scr. uuc r' L If residuntial , no * of families oCCUP/ t4CY INFOPUeATION No9 of raarn:; l caxcludin+] 1~:+th : 1 ., f rice4 of bcdroo,4x4s -a PRY ftL1ILDINCnci - No . of b chrooui : ° Ona fancily dwalling i•risn:ary Eftatina� ;yjt. u4 s Two family dwollinq "rypQ of fu.: l 5 x Multiple: dwulling / Number of units No * of fjr4.!pla454ja to klu ireseialled_� ,_ PcYlnanar►t oCCUP4.440y will :x wood :;gave L, insL" 11G.; i? r10 # •i`r:an :ie rce OCCUPWICY Lunt.C"l Air Cor4tiiti.Un].r4CJ?w rice - LlusinL'SS EIUILD } NC STYLX. PRIMARY STRUCTURE Ynciustrial Other l;.rr4ch Coat4ju4po. e"ry Loe cabin It ,addition , wI'uat will usa bt ? 1wai :3ud ranch I.UAnuic„ 4 puiali:x w . t1plit 1vVe1 old aeyla 14uaee1.alow . ACCi3SOLtY LiUIL r3YlyG- C:a a Cod COttiaa� = Oti4�r car cJ iowr4 Clouse " putathe-ei aria�lCfone cur/ tw rJ Ccilanaia stow cue' [ CIitCLI» ONE; PLEASE } " �✓ httuChvtl gar,i UW,/aaia C& two c:�r ♦ } * * # '� • a y w * ■ �'�' iariViat.= „r.Cariag4 building L ; 'L` IMA'1' 1? D MARYrol' VAt. Ur OF " �Othe r _ CJT, Ga - INFORI•IAT'ION ON r3ClILDING SPRCIFTCATIONS , ON REVRRSE SID2 4F `PItIS SFiI?L"P, TO BE COJ`tPLS'l'I:DE Form DPA 10/88 v2 BUILDING; PERMIT APPLICATION CONTINUED - BUILDING O)PECIFICATIONS ; Type of construction , wood frame , fire sa£e , etc , lon Will any s; Pc�ond-hand or ungraded lumber be used? If so , for what ? ►10 Foundation wall material { py ? Thickness Depth of foundation below grade (to bottom of footing ) S / Will there be a cellar? VQ Heated or unheated ? Floor sq, footage sq ft Will there be a basement? Nte Will any portion be used as living space ? h0 ( if so , what portion? sq , ft , - - Type of use ? Type or roof - �a ec "flat/shed/other Material of roof Sine , wood v:tuds_-�_. ' x 1 " spacing f "o . c . length ft . , Joists ( f' l (,or beams. ) lst _ floor " X " s acin / ", I.5" '1 __..�` p g o . c . span -f t . joists ( flc car beams ) 2nd . floor ^ �`" �i �/ �?_ " spacing ^o . e . span_„ ft . Overlays ( t, oi. ling beams ) "K spacing "o . c . span ft . Roof raftE , rs " X " spacing O . C . span ft , Roof tru5r . ej-s (pre-engineered) spacing�q" o . c . span ft . Exterior troll finish V ` /� Of what material ? Interior wall finish n ,,_ If. a gcira,3fk., is to be attached , describe materials to he /used /for FIRE SEPARATION ; �'"e W 417 P'TH�Q/T � 71 'y� e of r 'Et ito ( . Is them t:Q be an opening between garage a d d el ing? Ve S I-so -will a Fire-rated door , c,nclo ; ure , and self-closing device be provided? y Will a flue - lined chimney be installed? +'kO Height akfove roof ft , Depth. of :: t,imney foundation below grade ft . Depth of t-ireplace� .h� - - ft , in , Water :;upply - riunicip�or private well SEPTIC Y .4_- TEM _ Distance from ANY private well ( including adjoining properties t . (A sept3r�, te application is necessary for any repair or new installation of se is system) D E C L A R A T I O N 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. r Signature Ownqt, pwndk"s agent , architect, contractor SPECIAL CONDITIONS OF THE PERMIT : By TOWN OF QUEENSBURY 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 : 11 Gross floor area 17L.1. 9 2 , Type of heat-- a ho am6 3 . Is the building mechanically cooled ? el () � -- 4 , Percentage of area of windows and doors, U -y jo ------- A . over 16 % Only 1 . U value of gross area of walls , roof/ ceiling and floors o 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 values 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 B , Under 16 % Only 1 . R v lue of roof and floors exposed to ambient conditions 2 . R value of exterior walls l( o- 12 3 . R value of glazed area. 4 , R value of doors 5 . R value of floors over unheated spaces 6 . R value of slab edge insulation - unheated slab 7 , R value of slab insulation - heated slab 8 . R value of heated basement/ cellar walls ( above grade ) 9 : R value of heated basement /cellar walls ( below grade ) 10 , Type of insulation l.�M"G 1 -' C , Controls 0 1 . Thermostat maximum heat setting D , Duct Systems__ 1 . Is duct system installed in unheated spaces ? ES NO a . If YES , R value of duct installation - La b , R value of duct in other areas E . Piping Insulation I . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation Fe Service Water Heating 1 I . Performance efficiency 2 . Temperature control setting maximum G . For Swimming Pool Only i . Maximum heating Telephone No . � 1�A ( a p1i nt ` s s gnature ) T O WNL OF QUEENSB URY APPLICATION FOR Y } SEPTIC DISPOSAL PERMIT DATE LOCATION OF PROPERTY FOR INSTALLATION 1 IV( l'" Owner's Name: Fy ]( b { �� Telephone: Address: Q f7 aW SJ Installer's Name: av r _ ail -r8f Telephoner Number of bedrooms (residential only) �) Total daily flow (compute (d 150 gal per bedroom) _ Topography: Circle one:d Rolling Steep Slope % of Slope Soil Nature: Circle one: Loam Clay Other /Depth: Feet Ground Water: At what depth? /} Feet Bedrock or Impervious Material: At what depth? Feet Percolation test: Circle one: z ott require required rate min. inch. Domestic water supply: circle one: arsxicip Well Other If domestic water supply is a well: Separation: Water supply from septic absorption feet PROPOSED SYSTEM: Septic Tank�4,jD66 gal. (minimum size: 19000 gal.) TILE FIELD: Each Trench feet/"Total system length feet SEEPAGE PIT(S): Number of T/ Size each� jjLfeet by I feet Size of stone to be used # /Depth or Thickness feet I have read the regulation on the reverse side of this sheet and agree to abide by these and all requirements of the Town of Queensbury Sanita ewage Disposal Ordinance. SIGNATURE OF RESPONSSIIBpL�Et PERSON: DATE : .rCI �G ' OVER 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 : 1 . ) the proposed location of the system 2 . ) location and distance to IOC lines d . ) 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 B . No system shall be covered before inspection and approval by the Building Iitspuctor . Failure to comply with this requirement may result i.n the uncovering of the system by the installer and a fine of up to $ 950 . 00 . C . All 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 installa— tion , alteration or repair of an approved system , a new proposal »ust be submitted to the Queensbury Building Department before further construction , Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland (toads Queensbury , New York 12804 K��uarks ` 4 e u ' '• 4 '+`R. v ,.*'. v 01l lly . __ ; Y -� 9 1: y ISSUE` O 6nTE (MhVQiYY} _ td. 1 : I� 1 1 /22 /2 ' S ' PRODUCER THIS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS .P Charles W . Merriam S 5 b n , nC . NO RIfiaY17S UPON THE CERTIFICATE HOLDER. 7H15 CERTIFICATE DOES NOT AMEND, E%TeNO OR ALTER THE COVERAGE AFFORO:kD BY THE POLICIES BELOW. - 701 Union Street , Box 1038 —. — — ;:;rt;:t Schenectady , NY 12301 CC3h1NAMES AFFOnDING COVERAGE yr]' t' ,A Ln��Y A Commercial union Insurance Co . COMPANY INSURED LETTER d Forest Wood Homes , Inc . COMPANY f' LETTER c /o Joseph Ammirati ' 1 13 Thunder Run COMPANY 0 ..r k LETTER Gansevoort , NY 12831 g;g COMPANY - - . Ap LETTER fk LL THIS 1S T6 CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BCFN I::SUCD TO THE INSURED NAMED A60VE FOR THE POLICY PERIOD INO1CATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY -., BE ISSUED OR MAY PERTAIN, THE INSURANCE. AFFORUED 13Y THE POLICik.S DE,S.:>r.fuED HE REIN i5 SUBJECT TO ALL THE 7EetMS, EXCLUSIQ[1S" ANG CUNDi- :$ 7IONS OF SUCH POLICIES. rr ' a ` " CO H,L.UY ii Fr:.T.JE PUk:t:Y E♦;i-IILS11rXkk LIAdILlTY LIMITS IN 7HOUSANPS TYPE OF INSURANCE POLICY NUMBFI3 p,;;r Ih^.r,LUUrriI LIA1F rrnr,t',i:];:YY EACrl AGODEGATI= 1 . ' : . ' LTR .� OCCURRENCE : , rr- GENERAL LIABILITY BODILY ' COMPREriENSIVE FORM PREMISESIOPERATIONS PFiOPENTv UNDERGROUND UAMAGE , ' , EXPLOSION & COLLAPSE HAZARD PRODUCTS/CONL10LETED OPfkATIUNS CONTRACTUAL aIa COMBINEDrr INDEPENDENT CONTRACTORS . . BROAD FORM PROPERTY OAMAUE iLLLL A ` PERSONAL INJURY PERSONAL INJURY r �AUTOMOBILE LIABILITY uLY mm—J� rr LPEA YY ANY AUTO PE0. aFFSauI:I "'.: .1 ALL OWd+ED kUrrOS IPRIV. PASS 1 ENIlII.Y' '. iWR A ALL OWNED AUTOS OTHER IhIAIJ 1 IN�. ACGIL'EHiI -'.; PRIV. I'ASS / HIRED AUTOS hii{7f'E+-`ITV . . ' DAMAGE NON-OLVNED AUTOS ¢ rk GARAGE LIABSLITYPO - -- �� COMBINED C OMBl3INED " F EXCESS LiAETILITY 1:1UMBHELI-A FORM COMBINED a $Q� OTHEIs THAN UI.IBRELLA FURl,1 ---- - j� r�I STATUrOf Y ^, WOR.(ERS' COMPENSATION IEACR ACCIDENT} A AND CJ89H0999b✓i9 4 /9 /8$ / /8 $ IDISLAS E•POL ICY LIMIT) EMPLOYERS' LIABILITY {OISGA;:E LA(;ls EMF'LOY£E) OTHER _ Pr . . DESCRIPTION OF OPtrRATIONS/LLCATlONS1VEHICLES,Si�ECIAL ITEMS —_... .. .._. _...._ .__.... ...._____—_ j ' _ y FSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ETown of Queensbury ! DATE THEREOF, THE 1.�SUiNG COMPANY WILL E"OEAVOR7O Building Dept �� DAY5 WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THEUT FA ILUHE TO LIAIL SUCK NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY ilk Queensbury , NY KIND UPON THE COMPANY, AGENTS OR REPRESENTATIVES. LD REPRE:.:ENTATIVEian H . Merriam m �/ Lk t..n .y 2, re.' �.f l n''1w^r < s i y4. MT. ISSU E DATE 11 / 21./88pIVYy ' Ye' PRODUCER +f` THIS CERTIFICATE IS ISSUED AS A hAATTER OF WF0krAATYON ONLY AND CONfEAS N4 Ri G,yTS UPON THE CERTIFICATE HOLOEH. THIS CERTIFICATE DOcS NOT AMEND, i� EXTEND LiH ALTER THt: COVERAGE AFrORAIED BY THE POLICIES OtELOW. s Avid Insurance AGency , Inc . 425 New Karner Rd , COMPANIES AFFOHDkh1G COVERAGE :. -d ;* Albany , NY 12205 LF T COMPANY �+ General Accident Ins . Co . c COMPANY INSUREDLETTER _ The State Ins . Fund �^�' G & C Plumbing & Heating Co . , Inc . COMPANY ��4;, LETTER + .. +. 130 Quail St . _.. ., Albany , NY 12206 COMPANY Lb i LETTER .: • i -:� COMPANY LE1-1 ER TMia IS TO CEkiTlt=Y THAT f'Li:_ICIcS G,= iriSUR:,ii' Li.STE❑ I;ELOW HAVE LEEr1 k:: ULDTO l ilL- INSURED NAt.,3-D :.0OVE FOR 7 HE POLICY FEFi:JU 1NDICATCD. NOTYfM ISTANDrNG ANY R.'"I c:;,.::r:T, TEI=i r.i C:, , C-,At7i-f1G.1 Gr= ANY G,-irwl rti.,i:: f :,i,+ Jl ttt(t DOCLlhi4ENT W11 ii titSPC;CT TO WRICH THIS C�f.RYI1-ICATc MAY1' ' DE ISSUED OR r.AAY PERTAIN, Tni= ii::�Ui-,ANCE L;D f V TFIC PbLlCit .; LSL:y,.Msi..uLD 11tAiLl,v IS SU"JEC.T To .AI_L I I iL TEHi:,S, EXCLUSIONS, AND CONU Y TIONS Or SOCH POLICIES. _ A '- L1ABIL1TY LIMITS iN "THOUSANDS . dd CO 1 {1''E Gi ri lt;Ui'IANT'c E _-- ,��i._'Y ;,U:.1ldkri r n � i i ' i , l.rr Yu' r ' r rii,li.r„ to � LTR L,�.: i Lvu:e r, 1]k1! �uJrYV] 0CCF i 1YrV``r� Ai.GrscGATs;GENERAL LIAWLITY $A F Il-Y J$ ��'EXPLOSION 3 COLLAPSE "cRr.TRAvSMP 701251-01 3/ 29/88 3/ 29/89 Lh EG 500 t 5a0iNUEr'ENDEN I ;:UNTFAACTUF:�6ROi.D FUFi6l r,A0rrLHTY Dn�,J.::1. tiPER!]ON .L 1,"iRY SL3NAL INJURY `$;:jAUTOMnOBiLE LIAWLiTY . :Y t i:u.liri i ANr AUTO A +.LL UVt NEU AUTO$ {PR!V PAt; .i w' i . .• f]1HER TriA i U .� t ALL iJVYNLU ALUT6;; ( PRIV. PAS5 ! it R lk iQUW l `. �• . } '.3 }( HHi>=fi AUTOS pupri:!ti Fr ;. . }( NOr-OLVNLD AUTOS BA 0019391 Ol 3/ 29/ 88 3/ 29/89 """" ` € GARAGE Li ABIT.JrY r5, t, YG CoMn 1iweD $ 750 , EXCESS LIABILITY --- p. UMBRELLA FOAM eoraaiN€n $ $ k ��"• ''�, OTHER THAN UMBRELLA FORPA Ej STnrurnf Y Wfl RKFwAS' COMPENSATION � $ (LACH ACC40ENT} $ AND To Fallow from The Stat Ins . Fund 82333E-3 IDiSLASE-POLICY Ll Mif) EMPLOYERS' LIABILITY •• i !y" {,DISEASE-FA(:H EI.M1PLUYf C} = .,„., OTHER AIL r `•� y DESCAIPTION OF OPCRATIO14SJLOCATIONSfVEHICLES;SPFCIAL ITEtAS Plumbing & Heating Contractor . Subject to conditions & exclusions of the policylk k r 1 Forest Wood Homes SHOULD r NY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- PJRATIJ8 DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR - TO 13 Thunder Run FRAIL 1LF DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAIAED TO THE Gansevoort , NY 12$31 LEFT, 15UT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR L!A&tLITY w;_.. OF ANY_ TiFPRFK414D UPON E COMAPANY I ACENTS OR REPRESENTATIVES. �. AUTHORIZED `N ATIVE 'irk r { + 3c n aa^'/ f w 4 a4..` ,,...+. �.rx a.�ie. �t� ,, {r:z >s - 'sue.- .. r 's� i'to;Y 'iYt. a' .: f�..:s•: _, �r.., 12 II i PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS EEXTRIGHTS UPON THE CERTIFICATE HLDER.END OR A ER THE COVERAGE AFFORDED BIY THE POLICIES BCERTIFICATE ELOW, AMEND, I WA AO Zr&suurarbm MaxA"mu♦ X=w COMPANIES AFFORDING COVERAGE - -- �Jr by, LLETTER Y A Iry"Y;lraxAce CXX4AwW Of NoXth " 1'� } 3` COMPANY B #� INSURED LETTER COMPANY c David Hammmid d/b/i LETTER COMPANY " RD #6 'JIYar.r.#,r AM Ebd* LETTER (Ammensb""y MY 320" COMPANY E LETTER - s ■ L. THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY AEQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE. POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONVI —� TIONS OF SUCH POLICIES. _ _ ---- "--------- ---- CIO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS �'"�'I"k LTR DATE [MMIOQYYI DATE iMW GENERAL AGGREGATE $ GENERAL LIABILITY !' COMMERCIAL GENERAL LIABILITY PRODUCTS COMPIDPS AGGREGATE ,'$ OC+ CLAILiS MADE � CURRENCE PERSONAL 6 ADVERTI$ING INJURY $ ' OWNER'S & CONTRACTORS PROTECTNE EACH OCCURRENCE L� FIRE DAMAGE ZANY ONE EIRB MEDICAL EXPENSE ZANY ONE Pk RSG[v „'$ E LIABILITY CSL ANY AUTO AUTOMOBIL $ At-L. OWNED AUTOS eODaY " NJuRY SCHfDtJLED AUTOS 1PER PERSON: HIRED AUTOS IhJOR, PER t NUN-UYVNED AUTOS ACCICEv*I W GARAGE LIABILITY PRU4'ER>!V C DAMAGE $ . .- ._ . .._ -_ILA .,. r.I� . EXCESS LIABILITY `""' ` OTHER THAN UME)HELLA FORM STATUTORY WORKERS' COMPENSATION ,F / rkAL'r+ �•,.w t;F•.-__ -. AND �,C � �,■pp 12/F15/ i f Jf 89 �+ �1,+ ~:: ara_r 1��,, _ EMPLOYERS' LIABILITY 7Tw+r9iiM �$ 100 OTHER € s DESCRIPTION OF OPERATION$I LOCATIONS)VEH IC LES I REST RICTIO NS I SP EC IAL ITEMS S • ■ 7AU ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX N DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO .DAYS WRITTEN NOTICE TO THE. CERTIFICATE HOLDER NAMED TO THE T FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO Ob:AGA I ,u`. •:.!I+ ��� ' F AIY KIND UPON THE CUMPANI . ,TS GENTS Gr<EP RLPRESCNTATIVE ,�.'� ,ti -+.-: �C.LC 41 t4V�11Y t�5 YV n'nf�S 1Gu�7 G{G-+ I f 7 ' APPLICATION FOR ELECTRICAL INSPECTION PLEASE BEAR DOWN YOU ARE MAKING (4) COP IES `'`• MIDDLE DEPARTMENT INSPECTION AGENCY, INC. National Headquarters 900 Haddon Ave., Collingswood, N.J. 08108 * Date : 17 7Locatio./Addrass.ka-4 - Township CountyState ( If L aay d in Rural Area - Please Attach Directions) Pole -V Owner.13 Permit # + — Building: NewE71 Did 0 Occupied As Occupant Work Area in Buildin Floor #, etc, ) : App. for: Wiring [] Service 0 or : Ready for Inspection : Fee Remitted - $ Cast] Check M.D, Q Make Payable To: M.D. I.A- 500 ]50 1000 1250 1500 1750 2000 2250 2500 2750 3000 Number of Rough Wiring Outlets Elect. Heat Switches Amp_ Service Surface Unit Dishwasher Range Lighting Water Heater Air Conditioner Dryer Pump Receptacles Oven Garbage Disposal Wiring and Controls for Burner Number of Fixtures Amp, Receptacles Fractional H.P_ Vent Fans Other Equipment: MOTORS Fi,P. 1/2 1/12 1/10 1/8 1/6 1/4 1/3 112 3/4 1 14z 2 3 5 71h 10 15 2i5 25 30 40 5� T5 lOD Mark Number of Each Sixe Applicant's License # Permit # Signature T/A Utility : INAMEI OFFICE LOCATION Applicant's Address : (City} (State) (Zip) Service Request # Phone # Electrician : r DATE RECEIVED: LATE INSPECTED : Correct Location : Same as Above 0 or: Red Notice Label [� Rough Wiring Outlets Surface Unit Oven Switches Ran a Garbage Disposal Receptacles Water Heater Dishwasher Fixtures Air Conditioner Dryer Amp. Service Equipment Burner, Wiring & Controls for Arnp. Receptacle Vent Fans Amp_ Service Conductors Pump MOTORS iri.P. 1/20 1/12 1/le 1/a 1/6 1/4 1/3 1/2 3/4 1 lUx 2 3 5 TO 11Y 15 20 25 30 AO 50 75 11J0 Mark Nu tuber of Each Size 500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 ��.., Elect_ Heat Patrick d Daslnalr Huaso a -211311 x 3 18/ -a s >�',CIBICAL ;TfSPECfOx CORRECT PFEE PAID CERTIFICATIONS USE FOR INITIAL, VISIT ONLY NOTIFIED ;,, . GATE FEE © RW Progress : Inc, fl LKD r Contractor CFT Violation : Work Comp. lnc, CASH Q L/A Owner Fee CFi K # [] LIA Due MO # C] IPA Municipal INV �* Applicant Date Other Side ED Utility Owner Cut in Card 0 Temp # Date r-'1 INSPECTORS SIGNATURE 1 Final +4P Date MIDDLE E ;;;;�1�YRE M5P ON AGENCY, INC. soaW June 7 , 1939 Cie That sec i i'a`��,equipment fisted has been exa d an :.�s with the National Elect , a licatsfe approved as being in accord pp governmental, utiIify and,,Coenc t' s. { , Owner: Forest Wood 8t4 p Lt r Occupant: Single Vasil q � �k Location. Lot 69 Maples NO id la _ e t ia�.rfc urPment and installation InEPectee thi5 dies, f1 e,, t rltrot e�utl exY;tiny aynpntjah he IntroyuCed or altera110fn made to ;te m C a bb pull arty void, and a Equipment: 101 Outlet e P tac le s - �� �� � �apection :ffouId qB 3 mutt" P ay to this Ayendy. PPlicaiian for 20C1 �F 3ervi A lances older of Ihi; ca cti Cyte ahotnd nt same to hie PrOparty in aurance cerner pp agent afied.. ny)aaevitlM nMicatlon pl eleCiriCat equkpmenl apprnvep an specifiefd..�./ / s~J/ I APp�+cant: � 36 Blvctis Bldr � � �-J r LGlens Falls , NY 12 O . 15 -(122017 Pane 1/e. 7W EL I." OIVN OE QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVSLAND ROADS QUEENSBURYr NEW PORK 1280* (!TELEPHONE (528) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR TNSp'VCTTC7N NAME - � ARECETVED lj Z0CATTON -- ~ DATE PERMTT {#�- APPROVED rOOTTNG/.PIERS YES NO MONOLTTHTC POUR FORMS FOUNDATTONf DAMP-PROOF'TNG BACKFTLL APPROVAL ROUGH LUFIBTNG FRAMIN ELECTRT ROUGH-TN TNSULATTO FOUIVDATT -_- rZOORS WALLS C LING TNSpECT2CJ CHIMNEY HEIGHT ROOFING SIDING STA1Rg_CAX-Ri1yAL PORC'HJFS s _ LEARANCE & . �..c PLUMBING FIXTURES/RE V TNTERTOR TRIM/PRT VA VALVE FINISHED FLOORS R' GARAGE FIREPROOF G DOOR CLOSER (S) SMOKE DETECTO �.c FINAL ELECTRIC V FINAL APPROVA TIVSPECTION _ L3F CONSTRUCTION A SIGNED CERTTFICATE OF OCCUPANCY MUST OBTAI2yED FROM THE BUTLDTNG DEPARTMENT B THESE E PREMISES ARE OCCUp1-ED? RE REMARKS: rnrspEcTOR BUILDING and ZONING D4FPARTMENT Bay and Haviland Road, R.D. i Box 98 Queensbury, New York 128C?7 SEPTIC DISPOSAL SYSTEM INSPECTION NAME �tJc LOCATION 74 S7A2' - -�� ' PERMIT NO. �j' " SOIL TYPE - and lay Percolation est Required?O yES - Wft Percolatipn rate - Min/Inch O TYPE of SY. TEM: V Absorption field , tota�� -may Length of each try -- Depth of tre s ��, Size of vel SEEPAGE ITS-(N © ) Size- £t. x ft. Gravel s ze PIPING . Size Type Bldgm to tank Tank to listw box f!G_ Disto box to Openingsfield --� Openngs sealed? -� S +] Partial LOCATION/SEFARA2'-T Foundation to to ryk Foundation toab6 f t. Absorption to � orphan ,> ftr{ t lineC.ft. Separation of rits LOCAT to ION OF SYSTEM ON PROPEERTTYY (circle one) Front - ar f Left side CCNME TS . - Right ht sic3 e SYSTEM USE APPROVED YES N Build In pector 01/86 and vi i TOWNOF QUEENSBURY BUILDING ING AND CODES DEPARTMENT ,SAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12804 , TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR XATSPECTION RECEIVEDZVI NAME rAJCATZON DATE a PERMIT # - 4;'o APPROVED YES NO FOOTXNG/P#'ERS MONOLITm,rd POUR FORMS FOUNDATXON�DAMP-PROOFING BACKFXLL A ROYAL ROUGH PLUMB 4VG^ r FRAMING ElECTRXC,AL RO H-IN NSULATION: FOUNDATION iJ FLOORS WALLS CEILIIVG FINAL INSPECTION: CHIMNEY HEIGHT .ROOFING SIDING EXTERNAL PORCHES/SEEPS STAIRS-CLEARANCE &r RAILS PLUMBING FXXTURESfRELrEF VA yE TNTERIOR TRXXIPR4 rACY DOORS FINISHED FLOORS GARAGE FIREPROO ,IF*G` DOOR CLOSER (S) if SMOKE DETECTOR FINAL ELF,CTRICAL INSPECTION FINAL APPROVAr. CONSTRUCTION 1 A S-TGNED CERTIFICATE C)fi OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT .BEFORE THESE PREMTSES ARE OCCUPIED!- REMARKS: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT SAY & HAVILAND ROADS /•✓ ` `- T QUEENSBURY� NEW YORK 32801. TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED - "- , ' NAME LOCATION .j DATE - � r"" PrE"RMIT ` J APPROVED YES NO FOOTING/PIERS MONOLITHIC FOUR FORMS FOUNDAT-rON/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING f" FINAL INSPECTI f CHIMNEY HEIGH ROOFING / SIDING EXTERNAL PORCH' STEPS STAIRS-CLEARA CE RAILS PLUMBING FIX RES RELIEF VALVE_ INTERIOR TR /PRIV CY DOORS FINISHED F ORS GARAGE FIR PROOFING DOOR CLOS R (S) SMOKE DE CTORS FINAL ELEC ICAL INSPECT N FINAL APPR VAL OF CONSTRU ION A SIGNED RT'IFICATE OF OCCU ANCY MUST BE OBTAINED FROM THE BUILDING D PARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR TOWN OF QUEENSBURY BUXLDXNG AND CODES DEPARTMENT BAD' & HAVXLAND ROADS -QUEENSBURY, NEW YORK 1280¢ TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR rXSPEC TON RECE'rVRD NAME LOCATXON ��/ liep DATH a5 t cY PERMIT APPROVED FOOTINGfP RS YES NO MONOLXTH.ZC UR FORMS FOUNDATXON/D P—PROOFING BACKF-rLL APPRO L 6, DOUGH PLUMP-TNG L. RRAMING ELECTRXCAL ROUGH— -TXSULATXON: FOUNDATION FLOORS WALLS CEILING FINAL rN,9PECTr N: CHIMNEY HEI HT ROOFXNG SXDING EXTERNAL PORCHES/STEPS STAXRS— LEARANCE & RAXLS PLUMBX FIXTURES/RELXEF VALVE XNTERI R T'R-TM/PRSV.ACY DOORS -- FXNXS ED FLOORS GARA E FXREPROOFXNG D CLOSER (S) SM E DETECTORS FXN ELECTRICAL rNSPECTXON FINAL APPROVAL OF COiVSTRUCT.ION A SrGNED CERTXFXCATE OF UPANCY JWUST BE 0"TAXNED FROM THE BUXLDX�CDEPARTMENT .BEFORE THESE PREMrSE.S ARE OCCUPIED! REMARKS: d°d' 4- C)eoq-w A IZ&h 24co� ' - SP 4 -r -)C?-,G.h C Acl XNSPE To ~` TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I260!& TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAMEmot` LOCATXON t�%,Y 701 DATE •L r- cP# APPROVED YES I NO i FOOTING/PIERS 1' MONOLXT.HIC POUR FORMS FO DATION/DAMP-PROOI ACKFXLL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH+ IN INSULATXON: �F FOUNDATXON f FLOORS WALLS CEILING FINAL INSPECTION: CHIMN,$Y HEXGHT ROOFING ,SIDING EXTERNAL POI4( I I III ,STEP STAXRS-CLEARAN E & RAI PLUMBXNG FXK RES/RELTEF VALVE XhTT ERIOR TRI /PRXVACY DOO2S FINISHED F RS GARAGE FIR F20OFXNG DCN CLL7S (S) SMOKE DET CTOR,S` F.TNAL' ELEC ICAL INSPECTION FINAL APPROVAL OF CONsTRUCTrO- N �r- A SXGNED C] RTIFICATE C)F OCCUPANCY ,MUST BE OBTAINED FROM THE BUXLDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPXED! REMARKS: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I2803- TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION ,og t_ _ DATE PERMIT APPROVED :YES O FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILz APPROVAL ROUGH PZUMBING FRAMING BLECTRICAL ROUGH-IN INSULATION: FOUNDATION r FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ BPS STAIRS-CLEARANCE & RAILS PLUMBING FXXTUR /RELIEF VALVE INTERIOR TRIM/ RXVACY DOORS FINISHED FLOO GARAGE FXREP FING DOOR CLOSER ( J SMOKE DETEC RS FINAL ELECTRI AL INSPECTION FINAL APPROVA OF CONSTRUCTION jI i A .SIGNED CERTiFXCATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: 1r 1 �AlAk'N' T6 fjo crs INSPEC OR e TOWN OF QUEENSBURY BUILDING AND CODES ,DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12801Q �— TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME �cfpe Ile LOCATION DATE �� RMST # APPROVED YES NO OOTING ERS . MONOLITHI POUR FORMS FOUNDA TION AMP—PROOFING BACKFILL AP VAL ROUGH PLUMBI FRAMING ELECTRICAL. ROU —IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT r ROOFING SIDING EXTERNAL PORCHES/ST PS STAIRS—CLEARANCE RAILS PLUMBING FIXTURE /RELIEF LVE INTERIOR TRIM/P IVACY Dp0 FINISHED FLOG GARAGE FIREP FING —` DOOR CLOSER S) SMOKE DETE TORS —` FINAL E'LEC? CAL INSPECTION " FINAL APPRO RL OF CONSTRUCTION — A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMZ'SES ARE OCCUPIEDI REMARKS: INSPEC R V,,dOr W d d �* iS i44 x ,i%d d. pp a t!W . a f ers. aP