1989-109 .. . . a ."'�'"'R`;3k' . . loam• :�'.*, c�,�ansx. ;:-afis. --:}: .. a . . .
CERT"'IFICA..Tt OF C7�G+C
s UPANC Y
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YORK
Date July 21 19 89
This is to certify that work requested to be drone as shown by Permit Na._
has been completed. SA1�4
This structure no,�yub�e ���a - . z -
L[LU 1 Ills
l'
Location .iLuac n vc2
By Order Town Board
TOWN OF QU8&NSHURY
r
Director of Bldg. r3c Code Enforcement
4W BUILDING PERMIT
TOWN OF QUEENSBURY
No. 89 - 109
WARREN COUNTY, NEW YORK z
0
PERMISSION is hereby granted to Wood
�o
w
. I
OWNER of property located at T E , q Street Road or Ave_t 7---- Ia c3�3 8 1-- 13� 6 S� i � I
in the Town of Queensbury, To Construct or place a `D
Si-tb'3 a 1} Bryetlzn�r r'
at the above location in accordance to application together with plot plans and o#her information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance,
1 . OWNER'S Address is
HC- 02 Box 286P
Warrensburg , N . Y . 12885 a
2. CONTRACTOR or BUILDER'S Name
L!]
Self
�3
0
3. CONTRACTOR or BUILDER S Address 0t )
Same
x
a
4_ ARCHITECT'S Name C!�
5. ARCHITECT'S Address C+
C]
t�
J
S. TYPE of Construction — (Please indicate by X) x
H
xtK
} Wood Frame ( 1 Masonry ( } Stee! ; I dC7
t1j
z
7_ PLANS and Specifications
x
H
No. 28 ' x 64 ' single family dwelling as per plot plan , L
specifications , and application , including septic and attache
S. Proposed Use two car garage . ' t]
5a
H
Single Family Dwelling
t•�
25 . 00 c/o
$ 20 3 - 00 PERMIT FEE PAID — THIS PERMIT EXPIRES
(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
Dated at the Town of Queensbury th' ? 4 t 1 , Day of ruler :^r h 79 g g
1 I,y
SIGNED BY
for the Town of Queensbury
Building and Z ng Inspector
t=3
C'
H
_ w
TOWN N orF QuEENsinjRY APPLICATION FOR BUTLDING AND ZONING PERMIT
Ilate / p
TOWINI OF QUEENSSURY
Reuis� � �/ p �tEC IVED
F!! __ vc
r
Fee Fa Ld ; _._ (�' MAR 2 3 1989
1'UILDING AND CODES U14TAWDq-: 4f Va.te T-saued SLOG. CODE i)EPT•.
1AY and IIAVXL4ND ROADS RD 2" Box 9a
PUESjVSBURy, HIRfJ r jVK 22801 PeA.m'i,'t No
Tel * (518) 792-5832 Ext -209
.. .* at ■ x * w 'w * � . ,t ■ * * . * ■ � : R : * w . w R ■ x . ■ R R ■ � +s n
A PERMIT MUST B4 OBTAINED BEFORE BEGINNING CONSTRUCTION . NO INSPECTIONS
WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BU- ILDINC PERMIT .
All applicable spaces on this application must be completed and the
sinlaature of the applicant must appear on the reverse side of this sheet .
'D` 11e yawner of this property is : Frs1= 44 Wood iT3�ll"
�!1�
t' , [3 . Address }� - C7 tt - II t, . TEL . c� �3 �
property location �v� �'? m ��+P1� i'/' 11s bx' : TAX MAP NO . _ l ( ate
alas there been any split of this property since October 1 , 1968 ? yesj no
If yes , Planning Board Review is necessary ., 4 �
SUBDIVISION NAM LOT NO .E , IF APPLICABLE }[ 1 � c D � S
The person responsible for supervision of work as regards Building Lades is :
Om
NAME F . o . ADDRESS elY' `r N J%'&�7
[Jame of builder 2 s { WG� Address - ��
Name of Plumber—���-'- ��-- l.ddress000 A
rr� E7�' Add `Pt:I 961 � - CSO�MasonName of Mason a t r {=ram✓� ress
IJATuRE OF PROPOSM 60P%K. ' ZONING IN1w'O11Hj%,01' I0N { Office use on1ui
vXronatruccior, of a now building + 'ZONING DESIGNATION OF PROPERTY
Addition to a DauiWing * PERMITTED PRINCIPAL PERMITTED ACCESSORY
AIC4.*C .Lion to a l;,uilding `
� ( ,to to .:xcLirior riitneni: ions) r REVIEW REQUIRED -- PLANNING BOARD) ZONING BOARD_
Utlte r %troy::. (JeE;cr!bo6 } r SITE PLAN REVIEW # APPROVED DATE
*
CROS `; AREA OF PFtOPOSCD, 5 'rCt1JC*D' D1I2E
r VARIANCE # APPROVED DATE
1st Floor 3A l s+q ft . } Remarks ;
2 nd Floor sq f t . COD�4rif.D 'D`D: IpiyQ1Q4"TIOH Sll:ilUlDtliD Lilil.CNrl .
* ;ice.: of nrol�urty Ir� c�i Cr K i 46!_rt .
Other Floors sc( ft . '► D+xissti�rr buLIJIMIC101) it;
( not collar or bas4ment )
TOTAL FLOOR AREA 3 cA 1oqs4 f to " > xiating buiiiiirltJ (:t1 Usv
t' ita oe new structure u i ft X �rt ft
#'uur�d:acion-pierl ;lat+/crawl/8'astsal full ' 1'xatsoa4d building, dit;tancu Prow t,roirerty titre
(circl4o: one ) r Front yard 33 f t Rear yard_ Ile _f t
No * of storiew (hal)it:ablo space) r r Side yards a "- r t :and ��k i c
11vight ( tirade to ridqu ) IS" ft • If on corner, uurbaak Crow side scr,;:Qt fc
if resid4ntial , no . of fumili.as� I _ -
No * of rooms ( excluding b"th:s ) <, ' OCCu1'fWCY INFOi'.MATICN
toos of bedrooms 3 # P Y BUILDING
No * of b"Chroota r �,__ . pn4 fantilY dwelling
i'rimary lrc;arinrj uy;t..:ru a :er- Two family dwulliny
'lYlse of f"el * Multiple dwelling / Number of units
No. of firapl .acwa to bQ ln::tiallud * 13ertarancrtt occupancy
will :a waxad s1:raVu k+u inat:allud? 'Pir:ansiertt occulaartc y
Cuntrul Air corutitic+ning'' f3usinuss
(Du ! LDlNG STYLE, PRLMARY STRUCTURE ■ InciustrDal
* Ocher
tinakt Cont+a+ulx+r;axy Lr;n cabin It ;addition, wluat will
l::alyi:d ranrclt M:anyiutt D�ulal::x. r .
upl.ic IUVQI Old :icyla U"4kLj"1Qwr *
C"Pu Cod cottaga GbGttu�r * ACCESSORY 13&UILDIWG^
C'oloni:+l DWW 'rown ]Douse ar Uc:Cachad rJ arzagrsjona earl C.wer^�s�_car
( CIRCLE•: GH�L: PLk:ASF ) r t./At.Lach4U rj ararlularl.a car
Ga ci.0 r'
■ R ■ ■ ■ is • R w R ■ R a tR '■ I D'ri V:a tt: atoratqa building .
ES 'D' IMA'D'l. D MhRKr.T VA1.U1; Or * Orh4r
] Nr'ORISATrorl [Ya p[] TLDrNG SPr:CIPTCATrONS , ON Ft> VERSE SIDS: OF TkITS SFID:ET, 7O BECOMPLE"rLDD
Perm FPA 20188 V2
W }
BUILDIIV ; L�','J2MIT APPLICATION CONTINUED -
BUI <_UING SPECIFICATIONS : r
Type of construction , wood frame , fire safe , avtc .�Will any �aocond-hand or ungraded lumber be used? If so , for what ? ►n �,._._._ ._
Foundation wall material Thickness ` * '
Depth off foundation below grade ( to bottom of footing ) # �
Will ther. be a cellar? y p Heated or unheated? Floor sq . footage sq ft
Will thcro be a basement? .Will any portion be used as living space? h
( If so , what portion? Isq . ft . - - Type of use?
Type of roof - kCop+edYflat/shed/other Material of roof + - S
Size , wood studs �� ?f_�- �` spacing_-_L6! "o _ c _ length i __ ft .
Joists ( floor beams ) lst . floor 0 " X "' spacing-j_jfr_"o . c , span ft .
Joists ( floor beams ) 2nd . floor "X "' spacing ""o . c . span ft .
Overlays ( ceiling beams ) '"X "' spacing '"o . co span ft .
Roof rafters " X " spacing o . co span ft .
Roof trus_; C:= s (fare-engineered) spacing-.1-4_""o . c . span ft .
Exterior wail finish V %yK vl of what material ?
Interior wall finishS�}� -O�� ,J �gt k ij cl d � y� �p + 'y+ 4e
If a garayu is to be attached , describe materials o be used or FIRE SEPARATION :
k
Is there to ]be an opening between garage and dw ing . Ji�- If so will Fire-rated
door , enclosure , and self-closing device be provided? .P l;
Will a flue- lined chimney be installed? t Height aba e roof ft .
Depth of chimney foundation below grade ft .
Depth of fireplace hearth ft . in . +
Water supply - municipal or private well wA W,%r% i€
SEPTIC SY{->,1'LM _ Distance from ANY private well ( including adjoining properties ft .
(A separauu application is necessary for any repair or new installation of septic 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 ull provisions of the BUILDING CODE, THE ZONING ORDINANCE, and all
other taws pertaining to the proposed work shall be complied with, whether specified
or not , sand that such work is authoriz the owne
ti r
Signature KAe's� /
Owrjjg$V, owner's agent , architect, contractor
SPECIAL CONDITIONS OF THE PERMIT ;
B
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 :
1 . Gross floor area � � L
2 . Type of heat : ^ F
3 . Is the building mechanically cooled ? x • : � 11
4 . Percentage of area of windows and doors f
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 ?
3 . Slab on grade YES NO
a . If YES , what is the R value of insulation around
perimeter of floor ?
4 . Is ]casement heated ? YES NO
a . R value of insulation
5 . Type of insulation
B . Under 16 % Only
1 . R value of roof and floor 's exposed to ambient conditions.
2 . R value of exterior walls
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
i . R value of slab insulation - heated slab fi
s . R value of heated basement/ cellar walls { above grade }
90 R value of heated basement /cellar walls ( below grade )
10 . Type of insulation
C . Controls
I . Thermostat maximum heat setting
D . Duct Systems
14 is duct system installed in unheated spaces ? YES NO
a . If YES , R value of duct installation
b . R value of duct in other areas
E . Piping Insulation
1 . Size of hot water or cooling carrying agent pipe
2 . . R value of pipe insulation
Fe Service Water Heating
1 . Performance efficiency
2 . Temperature control setting maximum
G . For Swimming Pool Only_
1 . Maximum heating
Telephone No .
rY ( licant ' s signature )
7'QLVN �O ` QUEENSBURY
APPLICATION FOR.
SEPTIC DISPOSAL PERMIT
DATE dlt Q
LOCATION OF PROPERTY FOR INSTALLATI[]NQ � � t��ln S A
Owner's Name: ore.51 pp„f hfps Telephone: ",
Address: k i4r.. ,I+I
46/
Installer's Name: rya I/ �Telephones� .' 10 L7
Number of bedrooms (residential only)
Total daily flow (compute Cd 150 gal per bedroom)
Topography: Circle one: Fiat Rolling Steep Slope % of Slope
Soil Nature: Circle one6s Loam Clay Ot�yher /Depths Feet
Ground Water: At what depth ? '�' Feet
end! . -It- ny.
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one: gia required required rate min. inch.
Domestic water supply: circle ones;:Unicipol ''Well Other
If domestic water supply is a well:
Separation : Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank - 60 Q gal. (minimum size: l . o00 gal.)
TILE FIELD: Each Trench feet/'Total system length feet
SEEPAGE PIT(S): Number of / Size each feet by `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 Sanitary Sew a a Disposal Ordinance.
SIGNATURE OF (RESPONSIBLE PERSON:
DATE :— C ,fit
OVER
Septic System Inspections :
A . All applications for septic system installation , alteration or repair ,
as required by the Town of Queen3bury 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 Clio system
? . ) location and distance to lot lines
3 . ) location and distance to structures
4 . ) location and distance Co any water supply
5 . ) size and dimensions or all tanks , distribution boxes ,
the fields sand /or drywells
B . No system shall be covered before inspection and approval by the
Uuilding Inspuctor . failure to comply with this requirement may
rut. ult in the uncoveririzt of Che systeirl by the installer and a fine
of up to $ 250 . 000
G . An approved copy of the plot plan shall be available on the construction
cite . Failure to produce said plot plan a [ time of inspection may
result in :zn immediate work stoppage .
D . Should unforeseen problems during construction prevent proper installa—
tion , alteration or repair of an approved system , a new proposal must
l. 0 submitted to the Quounsbury Building Department before further
is u11 `i CrucCiOl-1 .
Town of Queensbury
BUILDTNC and CODES DEPARTMENT
Say and llaiviland Roads
Queensbury , New York 12804
PrfTS:�, 'iY� .ki4" 6 "k�fi �
[ jjp u? ik •• : k ! - . ISSUE t7A^7'aE (h/.1oMEui7l7iYY�
fE1 S!:�.' i . Fv. _. M11761 �" U �. IS ";�y , a![ -.� 5 j.,u �Y'.,d'. 1 1 /L 2 f U U 1 h
PRODUCER d
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND C014FER5
Charles W . .Merriam & Son , Inc . NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEHO,
?Ul Union Street Box l038 EXTEND OR ALTER THE COVERAGE AFFOROEU 13Y THE POLICIES BELOW. "
Schenectady , NY 12301
COMPANIES AFFOAD1NG COVERAGE
pr LEETMTERIVY ACommercial Union Insurance CO .
COMPANY {'3.
INSURED -.-m LETTERRr
>x
Forest Wood Homes , Inc . COMPANY `
c/o Joseph Ammirat i LETTER
13 Thunder Run COMPANY
Gansevoort , NY 12831 LETTER
COMPANY ..
'44LtJ'fEA
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAIAEID ABOVE, FO" THE POLICY PERIOD INDICATED.
NUTWiTFIb TANDING ANY REQUIREMENT, TERM OH COt4OITION OF ANY CONTRACT OR OTHER DOCUMENT WITH HESPE.CY TO 1VHiCH THIS CkRT IFICATiE MAY
BE ISSUED OR MAY PERTAIN, THE. INSURANCE AFFGROIED BY THE POLICIES DESCRIBED HEREUN 1S SUBJECT TO ALL TrrE YCRrvi�, EXCLUSIOsilSp AND CONQI-
TIDNS OF SUCH POLUCiEs. _
i
CO PLII ICY Ixl STI.:T IUiJ _TYPEOFPOLICYNUMBER '—E.*Crf
DATE {YrIr&U0(YY3
ACCf]CG:ATE
GENERAL LIABILITY
COMPREHENSIVE FORM IFJIURY !
$ 7
PRE h}ISES/OPERATiONS F'FtgPEHTY ,
@,- UNDERGROUND n:.rdAGe .
FXPLOSIUN a COLLAPSE HAZARD $ $
PROOUCTSrCOMPLETEO OPFRAI IONS 1
. .L. CONTRACTUAI. Ho s VD
c:G ME31fJ E6
_ .� INDEPENDENT CONTRACTORS
BROAD FORM PRUPEFiTY DAMAGE
IJJUHY PERSONAL INJURY
: ' PErTS(]YJAL I
:o
a
I y<a AUTOMOBILE LIABILITY
ANY AUTO
� . ALL OUv'1NED AUTOS (PRIV. PASS.)
ALL UVOJEU AUTOS (OTHER THAN)
PF1V. PASS / irt:+ nF:vU0l3) .. '
.,; HIRED AUTOS . -----
PROPERTY -
ti,r LION-OWNED AUTOS DAMAGE
GARAGE LiAtSIHTY
t .
no
IfI s Pn
EXCESS LIABILITY
E 4'. U61BAELLA FORM l r1 :PC)
rGINED
m" OTHFR THAN UMBRELLA FORM F tr
W ORISIrR5' COMPENSATION FATuTOAY
c•;
174 A AND CJ89HO999649 4 / 9 /88 / 9 /89 -- i (EACH ACCIDFNF)
EMPLOYERS' LIABILITY $ {UI;{ASF-POLICY LIMIT):'. _
(Di Si ASF�E ACH LM1.IPLOYc E}
OTHER "
i
DESCRIPTION OF [7PEf3AT1(7NSILOCATIC]NSfVENICLESfSPEG[AL ITEMS
r.
Town of Queensbury SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
I� Bllildln 17e L PIRATIjb DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
g P MAIL 1 (.I DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE I LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IIAPOSC- NO OOLIGATION OR LIABILITY
Queensbury , NY OF ANY I'CIND UPON THE COMPANY , - AGE14TS OR REPRESENTATIVES. '
AUTHORIZEL7 Ei£PRI=SENTATIVE
Brian H . Merriam '} f f f ( 1 L'��
YlIj*I. i i • ■�i 77o }`� 1�'{
m
LL
;PeS apt+ Etr�",,, Y- _ �tJ +;
ui y
i
"TOWN OF QUEENiSSURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK I2804�-
TELEPHONE (518 ) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED.,
NAME ,._.t4C.-ttT
LOCATION
DATE ' I d PERMIT #
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATIONI DAMP-PZ2OOFING
BACKFILL APPROVAL .
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
G CE PEIN
AL INSPECTION: '
t
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE,SI.STEPS
,STAIRS-CLEARANCE' & RAI
PLUMBING FIXTURES/RELIE VALVE
INTERIOR TRIM/gRIVACY D RS
FINISHED FLOODS
GARAGE FIREPRboFING '• G�
DOOR CLOSER (d) k - &L_O
SMOKE DETECTORS
FINAL ELECTRICAL INSPECT3G7N_ _
FINAL APPROV . L OF CONSTRUCTIi7
A SIGNED C TIFICATE OF OCCUPANCY MUST BE
OBTAINED F OM THE .BUILDING DEPARTMENT BEFORE
THESE PRENkSES ARE OCCUPIEDI
REMARKS:
l'�)r fl Vs-T ' t Co ;C)o (s) rz T`> 67PX-A--6 C-�
r Lr3 5 6;xD 7n L I rT-1:Z44 ,
INSPEC R
MIDDLE DEPART FNJ 1OjNzQQQH_AGENCYm INC. �e�. �✓�}q
- 1pi Sp+E r
- � ,�'rY/ Oatra July 20 , 1989
(Certifito that I rt i i eq iu pment listed has been a a a approved as being in accord
with the National Elect applicable governmental, utility an s.
Owner: Forest Woad S44 a 1i
Occupant: Single Farm C)
Lot 97 Hidd 11CIs D e e -.
Location: fic Oimlac is uipment and installation inspacled this
dais- It additional ui ni all be introduced or alterations mane to
existing system thi is be null and void. and application far
Equipment; 110 Out t l e t S e c D t a.c l e s ' � napAction should s fbmih O Iy to 7h is Agency,
2 Q{} Amp Se ry 1 6 t5 f �,an # [ " �`�� P Molder of this ce fiCale ah Id of same to his properly insurance Garner
p p[> (agent or corn pphy)as evi ertificatlan of alactrical epu i p menf approved
a8 specified /" f
Boppitts Bui1 ��CE 19133
Apphcant: 36 Boulevard --- `"y K7 . 15 -022851
Queensbury , NY 1280r
fermi Nis. 703 EL A-aa -
cc�� eseeriybatre� �� ,
BUILDING and ZONING pEPARTMENT
Bay and Havriland Road. R.D. 1 Sox 98
Queensbury, New York 12801
SEPTIC DISPOSALS SYSTEM INS�P7ECTIO�N
NAME
LOCAT I ON:4
DATE PERMIT NO .
SOIL TYPE - Sand - Loam - C14Y - �-�--
Percolation Test Required? ACES No
Percolation `rate - Min/Inch
TYPE of SYSTEM" a . , .
Absorption fieV , total 1pngth
Length of each encYs
Depth of trenche
Size of gravel of� ti
SEEPAGE TS{Numbe 4'
size-SEEPAGE
X
Gravel ize 12 T
PIPING : �
Bldg , to tank l
Tank to dist. box
Dist . box to field S Q partial
openings sealed?
LOCATION/SEPARATICWS : t.
Foundation to taj)c t.
Founaat'lon to absorptionft.
Absorption to 'at line ft.
Separation of Pitsf
OF SYSTEM ON PROPERTY (ci cle
97WTS
one)
ear - Left side - Right r
r
YSTEM USE APPROVED YE N
� Building Insp
ectOr
1
i
1 and vl
cc--''��
_,/owr* o� `4Czeeens6kr
BUILDING and ,ZONING DEPARTM'EhkT�
Bay and Havliand Road, R.D . i Box 9
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
�l7
LOCATION
PERMIT NO.
DATE
SOIL TYPE - Sand - Loam - Clay
Percolation ;Test Required? YES - NO
percolation xate - Min/inch
TYPE of SYSTM r
Absorption fi :
:lplldr total length
Length of each trench '
Depth of trench s
size of gravel r of)
SEEPAGE PITS-I £
Size- ft. X
Gravel size size Type
pIpINGew
Bldg . to tank.
Tank, to dirt , box
Dist . box to fie' /Pit NO Partial
openings sealed? YE5
LOCATIGNISEPA
Foundation to ank ft.
Foundation It absorption £t '
Absorption t lot line ft.
separation f pits PROPE . TY (circle one)
LOC',ATION of SYSTEM ON ht side -
Front Re r - Left side g
CCNIMENTS
L
SYSTEM USE APPROVED YES
,axlding Inspector
01/86 and vl
TOWN OF QUEENSBURY ��f�,Q �•�"�'
BUILDING AND CODES DEPARTMENT `y
BAY & HAVILAND OARS 128 oltE
NEW !
QUEENSBURY, 792-Sg32
ORK
TELEPHONE f518 )
BUILDING INSPECrORIS REPORT
REQUEST FOR INSPECTION RECEIVED
NAME .
LOCATION pERMIT # -��-�--�
DATE APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS'
FOUNDATIONIDAMP-PROOFING
BACKF'ILL APPROVAL
ROUGH PLUMBING
FRAMING -
ELECTRICAL ROUGN�IN
�ULATION: r
FOUNDATION
FLOORS t L
WALLS ft
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
.SIDING
EXTERNAL PORCHESIST ^—�----'
STAIRS-CLEARANCE & ELIEfi VALVE
PLUMBING Fxx7vRESI
INTERIOR TRIMIPRI ACY DOQRS
FINISHED FLOORS
GARAGE FIREPROO ING t
DOOR CLOSER (S)
SMOKE DETECTO
PECTION
FINAL ELECTRICA FICONSTRUCTION
FINAL APPROVAL
BE
A SIGNED CERT THE BUILDIXCATE OFNGC DEPARTMENTTBEFORE
OBTAINED FRO
THESE PREMIS ISARE OCCUPIED ?.
REMARKS : --- -
r
rNSPECTOR
TOSVN OF CC�UEFNSBURY �
,BUILDING AND CODES DEPARTMENT I
SAY & HAVILAID ADS
NEW
I28
QUEENSBURY, EW YORK
pg�- 5832
TELEPHONE
WJ ILDING INSPECTOR' S REPORT
REQUEST FOR X� N SA'E'GTION RSCETVED8-
NAME
LOCATION LOC PERMI'.L' #�
DATE G� APPROVED
YES Np
FOOTINGIPIERS FORMS
MONOLITHIC POUR pROOFING��-
FOUNDATIOAPPRRI
BACKFILL
� L7GH PLUMBING
�, AM.TNG
ELECTRICAL ROUGH}IN--� '--
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING !f
SIDING
EXTERNAL PORCHES, STEP�fi LS°
STAIRS-CLEARANCE LIEF K,AL6'E
PLUMBING FIXTURESf
INTERIOR TRTMIPRIV All4CY DOORN..
FINISHED FLOORS
GARAGE FIREPROOF.VNG
DOOR CLOSERS)
SMOKE DETECTOR
INSPECTION_��_ -
FINAL ELECTRICAL
FINAL APPROVAL F CONSTRUCTION
BE
A SIGNED CERTIFICATE
THE BUILDING( DEPARTMENTUPANCY TBEFORE
OBTAINED FR
THESE PREM sFS ARE OCCUPIED!`
REMARKS :
INSPECTOR
TOWN OF QUEEN5BURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ,ROADS 12804ti
QUEENSBURY, NEW YORK
TELEPHONE ( 5] 8 ) 792- 5832
BUILDING INSPECTOR' S REPORT
PECTION ECEIVED -�
REQUEST FC3F4,`�VSq�
NAME may` q
LOCATION PERMIT ��X !_
DATE 7 ,APPROVED
q 7 YES NO
FOOTINGIPIERS
MONOLI THrC POUR FORMS^,-- -^--- -�-
FOUNDATIONIDAMP-PROOFING__1 0
BACKFILL APPROVAL =^�-
,ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EJfTERNAL PORCIIjtSISTEPS
SPArRS-CLEARA*CE & RAILS
PLUMBrNG FXXORESI RELIEF `,,VALVE
INTEPXOR TRIMI PRIVACY DOER'S-----^--
FINISHED F L bORS__,____�.---�-^--'�
GARAGE FIREPROOFING
DO,pR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY SST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!'
REMARKS :
INSPECTOR
TOW
RY
BUILDING
OF QD CODES I)
BUILDING AND CODES AEPARTMENT
SAY & HAVXLAND ROADS
[)UEENSBURY, NEW PORK 12809%
TELEPHONE ( 51.8 ) 792-5832
BUILDING INSPECTOR' S REPORT
}2EQUEST FOR INSPECTION RECEX 'E� I1
7
NAME
LOCATIONtf
DA TE `7 ice` t riS ' PERMIT # G/
APPROVED
YES NO
Ie ' FOOTXNG/PIERS
MONOL.TTHIC POUR FORMS r
FOUNDATION/DAMP-PROOFING
BACKFXLL APPROVAL -
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-
INSULATION:
FOUNDATION
FLOORS
WALLS f
CEILING
FINAL INSPECTION.
CHIMNEY HEIGHT
ROOFING
SIDING
,EXTERNAL PORCHESJSTE S
STAIRS-CLEARANCE + ILS
PLUMBING FIXTURESr ELIEF VA VE
INTERIOR TRIM/PRX ACY DOORS
FINISHED FLOORS
GARAGE FIREPROOF NG
DOOR CLOSER (S)
SMOKE DETECTOR
FINAL ELECTRICAL INSPECTION_���.
FINAL APPROVAL F CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED !'
REMARKS :
1z2I
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAy & HAVILAND ROADS
QUEENSBURYP NEW YORK 3280k
TELEpBONE (51 8) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FoR INSPECTION RECEIVED
NAME
LOCATION
DATE -Z I PERMIT #
.APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
`i j/o'OUNDATIONIDAMP-PROOFING
&jSACKFILL APPROVAL
ROUGH PLUMBI?k
FRAMING
ELECTRICAL ROUGH-IN `
INSULATION:
FOUNDATION a
FLOORS
WALLS JL
CEILING
FINAL INSPECTION'
CHIMNEY HEIGHT
ROOFING
SIDING `
EXTERNAL PORCHES , STEPS_°
STAIRS-CLEARANC{T 6 RAILS
PLUMBING FIXTU S/RELIEF LVE
INTERIOR TRIM/ RIVACY DOOR 4
FINISHED FLOG S
GARAGE FIRED DOPING
DOOR CLOSER ( )
SMOKE DETEC RS
FINAL ELECTRI AL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIEDI
REMARKS :
IN PECTOR
TOWN OF QUEENSBUR'Y
BUILDING AND CODES DEPARTMENT
BAY & H,AVILAND ROADS Z7
QUEENSBURY, NEW YORK 12809-
/
TELEPHONE (5I8) 792-58.32
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTIONf RECEIVED 1�
NAME a,54
LOCATION _ .7T f / ii`'.ty �,� �yrcyrd
DATE 7 `/ LJ PERMIT #
APPROVED
,��.. YES NO
vof'OOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP—PROOFING
BACKFILL APPROVAL
ROUGH PLUMB NG
FRAMING
ELECTRICAL RO GH—IN
INSULATION.-
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEPS `
STAIRS—CLEARANCE % RAILS'-.
PLUMBING FIXTURES;RELIEF VALVE
INTERIOR TRIM/PPvtVACY DOORS.
FINISHED FLOORS/
GARAGE FIREPROOFING
DOOR CLOSER (S)f,,
SMOKE DETEC17 S
FINAL ELECTRIC L INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE .BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIEDI
REMARKS:
/ 6 r k) -5 - 1
cf
INSPECTOR
SELECT all SINESS Fro RMS (6o9) 228. 7775
APPLICATION FOR ELECTRICAL INSPECTION
PLEASE BEAR DOWN YOU ARE MAKING (4) COPIES
p MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
National Headquarters
900 Haddon A Collingswood, N.J. 08108
APPLICANT COMPLETES THIS •
,�r++�� Date : f
City, Town or Township l7f GLJQ.e.ir4= � !y IF _County__� If� � s� �„�
Location/Address �S �
State • i
` ( If Loed�in�Rural Area - Please Attach Directions)
Owner YGS �, Pole 4k
Occupied As
it Permit #
Occupant Building: New= Old F)
Work Area in BuildingFloor #, etc. ) .
-
Fee , for: Wirin C] Service 0 or:
Fee Remitted - $ Read for Inspection !
Cash 0 Check M.O. Make Payable To : M. D. I,A.
Number of Rough Wiring Outlets Elect. Heat 500 750 tooq tzsq lsoq 17so x000 xxsa ssoo x7so sgga
Switches
Lighting Amp. Service Surface Unit Dishwasher Range
Receptacles Water Heater Air Conditioner Dryer Pump
Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner
Amp_ Receptacles Fractional H.P. Vent Fans
Other Equipment:
MOTORS H,P, 1/2 1/12 1/10 1/8 1/6 1
Mark Number 3/4 1 14x 2 3 5 7V2 10 15 1 2 F7 30 40 50 75 1 qpo
of Each Size
Applicant's -
Signature '
T/A License # Permit *
Utility :
Applicant's Address: _ (NAME F ICE L CATI N
(City) 04.00 _ (State M11 .
Phone # 3-- 97 �}0` } y — {Zip) Zmm, �� Service Request #
- _ Electrician :
MDIA USE ONLY
DATE RECEIVED:
DATE INSPECTED:
Correct Location : Same as Above 0 or:
Red Notice Label
Rough Wiring Outlets Surface Unit Oven
Switches Ran Garbage Disposal
Receptacles Water Heater Dishwasher
Fixtures Air Conditioner Dryer
Amp. Service Equipment Burner, Wiring & Controls for Amp. Receptacle
Amp. Service Conductors Pump Vent Fans
MOTORS H.P_ I/20 1/12 1/10 1/a 1/6 1/4 1/3 ll2 3/4 1 lYt 2 3 5 TNx 30 15 20 25 30 4p 50 75 300
Mark Number
of Each Siza
Erj RPI Patrick J VasMaw
Elect, Heat Sqn 730 1g04 i25q 15oq 175q 2ggp x25q 2500 x75q 304p
Box
iktdsa5i&aT;1=34 '2""
ELECTRICAL INSPECTOR
c>rralt�lisr wr�owr.. U" Pow WUTL^L vllgty
NOTIFIED olurE cap t sl&1l rwlti'
FEW
ED RW Progress : Inc. � LICD C] y 0 CFT Violation . Work Comp. (� Inc, [3
0 L/A CASHQ L/A Fee CHIC #[] IPA Due MO #INVDam' Other Side Applicant
Owner
Cut in Card Temp #
Date
INSPECTORS SIGNATURE
1 1 /
L a ►�
5% Atq F0Kai Wbyrol F6iv+e s
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