1989-129 CERTIFICAT'IF, EDF OCCUPANCY
'
i 1
TOWN OF QUEENSBURY j
! j
WARREN COUNTY, NEW YORK �
June 19 89
Date 19 —
This is to certify that work requested to be done as Shawn by Permit No.
has been completed, �1 �1
This structure tray be occu d as a
Location L o L 7 `� { � 7 ) 1' i v i
I' Owner Ian"�
i
By Order Town Hoard
TOWN OF QUEENSOURY
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Director of Bldg. do Code Enforcement
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BUILDING PERMIT
TOWN OF +QUEENSBURY No. 89 - 129 �
WARREN COUNTY, NEW YORK z
a
PERMISSION is hereby granted to Masullo Brothers �—
t�a
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OWNER of property located at Lot 7" 4 2 7 Ferris Drive Street, Road or Ave. l�
w
in the Town of Queertsbury, To Construct or place a Single Fami 1y Dwe l l i nq %1D
at the above location in accordance to application together with plot plans and other information hereto filed and �o
approved and in compliance with the Town of Queensbury+ Building and Zoning Ordinance_
1 . OWNER'S Address is
RX 3049 Broadway
Schenectady , . N . Y . 12306
6'4
9+A
2. CONTRACTOR or BUI LDE R'S Name $$
l8C
Same
I:D
3. CONTRACTOR or BUILDER 'S Address �
N
F-'
Same o
td
4. ARCHITECT'S Name d
DD
8. ARCHITECT'S Address
t7'
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$. TYPE of Construction — {Please indicate by K}
N
XK)f Wood Frame I Masonry i } Steel
7. PLANS and Specifications 'Xi
(D
No. 34 ' x 481 single family dwelling as per plot plan , n
specifications , and application , includi. ng septic and attached En
S. Proposed Use two CUT: garag0a
a
n
Single Family Dwelling
rn
25 . 00 c/o r„
$ _ 27:, nn PERMIT FEE PAID — THIS PERMIT EXPIRES November 1 19 89
(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 hefore the expiration date.}
Dated at the Town of Queensbury Day of _ Apr i I 19 69 Pi
SIGNED BY for the Town �4
of Queensbury "G
Building and Zan inspector
C7
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TOWN OF QUEENSBURY APPLICATIONFOR BUILDING AND ZCININCi PERMIT
-
!'ecieveti TOWN OF OUEENSBURY
t� 1 Reu i `e RECEIVED
f Fee Paid •. �' ' C_,IG�
MAR 31 1989
WILDING AND CODES LHOPART!"+FIN"r Va.te. Iedued BLDG. ,& CODE DEFT.
I)AY t.nd 11AVILAND ROADS RD 1 BOX 98
0UE'ENSDVR Y, NEId r0f K 12804 Pe nxlt l t Na
Tel . ( 518 ) 792-5832 E'xt -204
R ! R k R * fR R • * * R ! R ! R * * * * * R * ♦ • • R A R * R R R ■ * k
A l' MMIT MUST U4 OBTAINED AEFORI; EECINHING CONSTRUCT .[ ONe ND INSPECTIONS
l".' ILL BE HADE UNTIL APPL. ICAMT [ [AS RECEIVED A VAL. 1D DUIL.DING PERMIT .
All applicable Spaces an this € pplication must be completed and the
S—; Ivuature of the applicant ntust al*tVcar an the reverse side of this slticct .
* * ak k x * * do It * x * k '!k * k * 1t k �k �k ik yt A Yk *
The owner of this property is : q�(1L1- � � f � � '
1" . 0 . Address .300 130AIWAY 41 fr 1.?3.a6 TE L . 3�4 rc�
'PRX MAP NO . �^
I " roperty location t1rjc r r
Has there been any split of this property since October Is 19887yes Ito
if yes . Planning Board Review is necessary . LOT NO .
!: Ut IVISION 14AME ■ TP APPLICABLE
'I' hc person responsible for supervision of work as regards Building odes isa
UGLd 30¢9 ,G� 1✓ �V�i&T�P�'y IIif
P . t1 . ADDRESS TE L . NO ,.
NA1•Il ; 4 Ji/ Tel 37t 1 oLy
IJame of builder II�j��C�IIvDS. J3f "+cldress III
rddress F1+7VVV .5T Tail 5
IJamc of Plumber I }- ov Tel
Ilaeauc of Mason P7& 1XVII7 504 �IJ+Q�7li✓143
I1A7URE OF pp.0poc.6i U WRK : W 20NI r1L: INFORMATION ( UFfi c +e use Only )
) Cronz:truetiart of a Itew building # ZONING DESIGNATION OF PROPERTY
NIIIII, --
Addition to a building * PERMITTED PRINCIPAL PERMITTED ACCESSORY
�AltvC"tion to a i;iuilding ` '
r REVIEW REQUIRED _ PLANNING BOARD ZONING BOARD
11%o cljcaiu] Lr to wxt � rior clilnonsions)
Utlier work (jescribk!) ' SITE PLAN REVIEW # APPROVED DATE
VARIANCE APPROVED DATE
iL: ItO ; S ANUA OJI P110110SE0. Sc T fit UCTU1tE
st; f t . Remarks
lyt Floor fCi >? w
a
2 n d Floor 1 d 6 A s q ft * ", Co1•IP 1.UTC . Tr11'oltM.ATION Itl:QUI14ED 111Z:'W 1 .
.r., i:r..: of pr0Vurty 4q0 ft X 2, S.3 ft .
other Floors sq ft . + LaciutArrg tii'*e ft: x ft .
( not cellar or baserncntl r
TOTAL FLOOR AREA.IIIIII 1t] 6 �sc1 ft " EXi :ciug builaain+l ( 1: 1 US+.s
'.' ixe of new utructure 'fib! ft s: ft "
1'cytsr�d:atian-pier/.laL/crawl/partirtl/toll * Yropossd building , di:scalnaal tram iaruliurty lulu
" ft
(cirt=lu one ) W Front yRard go��_ , r 1° t near yard�C 'f'
t1v . of stories lls:abattable )!race ) _ g2 - w Side yards JI ` ' -f, - ft and III�s ,F .. ft
Iluitllst ( tlrada: to ridgM ) ft • . If on cOrndr , s:utb:a+=k from5idu ::cr- aarst t >r
If residential , no . of families / OCCupAt 4Y INFQPJ'`rrlCN
tloe of room,41 ( excludintl baths)-- Q #
11o , of bedrooms t P1'lImARY BUILDING OWN
too . of bathroomnss 2 -�--� y�'L3no family dwelling
t'ri:lury lwatilstx s;y:;l' uus�I lsT - f'l . � � 7^reo f:asn.ily dwtslliny
Typo of fuelY("', _ Multiple dwelling / Number of units,!
[Joe of firelslacua to 13n installucl� 1 1'ainra;ynol%C accup:uscy
Ali11 a wt]a]at :-;toV+' b.: ine:t:allud? N M Tr;an::ia;rtt occupancy
contr:al Air Condition,111C1? 2 k CA r Purt P t businossas
BUILDING a7Y1_C, pRllMRY SIRUCTU12C „ lrsduscrial
other
lunch Conz%eml or.ary L.orr cabin ranch Kanaiolt Du
1: yt udditionk whet will u�a? b.l?
..■ i ::�t! l,la x
gIlli.t 1411 old style Uu,ay.alow
C�pu Cod Cot.t;aq ".: atla�r ^cr.": 'Soay BUTLOINC- car
olani"xl� !taw '1'oten )!oust: 'DatAehad y:ar¢acle/Ono Isar/ two car/ car
( CIl1CL1: DN1 PLF2ta1~ 1 " ri Attached gur:agu/Onaa es;r/ wo � �ci
■ R ■ ■ to o k w a A w IN * A # 1;r.LViat+2 storage building
kSt' IMA1" I: n HARK1.T` VALUE OP ' Other
t'' r.3" !; 1• RUC•!' I UN
1NrOR16iAT'I aN BUILDING SPECIE" ICATIONS , ON T VERLSE: SIDE or "ITS ^NEST, TO BE COMPLI~1'ER1
Form BPA 10/88 Vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe , atc . � 4%149 !• ►TJ
will any second-hand or ungraded lumber be used? If so , for what ? f!(G�•
ri /4
Foundation wall material � Thickness ` f
Depth of foundation below grade ( to bottom of footing ) 70
Will there be a cellar ? YF6 Heated or unheated? UVIU Floor sq . footage sq ft
Will there be a basement? Will any portion be used as living space?
( If so , what portion? sq . ft . - - Type of use?
Type of roof - o f�- let/shed/other 1Naterial of roof YS- O
Size , wood studs " X +G +. spacing M "o . c1 length
Joists ( floor beams ) lst . floor six Id is spacing lio" 11o . c . span ft .
Joists ( floor beams ) 2nd . floor _-�qrx�+ sq spacing I '"' „o . c , span ft .
Overlays ( cell ing beams ) ..six " spacing "o . c . span ft .
Roof rafters sixis spacing ft�o . c . span ft .
[roof trusses (pre-engineered) spacing e^4 "o . cm span ft .
E:xtericxr wall finish .5101#16 of what ma erial ?_fjJl✓yl.
Interior wall finish ,/]q;IVrW ■ i 4WA / r
- -
a arage is to be attached , describe materials to be used for FIRE SEPARATION :
'T X 6VP 4// FlI9E 1?AMVJ06VA crash -
Is there to be anopening between garage and dwelling? VE5 If so will a Fire-rated
door , enclosure , and self--closing device be provided? P6�_S
Will a flue -lined chimney be installed? Height above roof, ft .
Depth of chimney foundation below grade ft .
Depth of fireplace hearth ft . in .
Water supply - Municipal or private well
SEPTIC' SYSTEM _ Distance from ANY private well ( including adjoining properties ft .
(A separate application is necessary for any repair or new installation of septic system)
D E C L A R A T I 0 N
'i'o 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.
Signature4" 4 . / y 444&
Owner, owner's agent, architect, contractor
* * * * « * * * « a * * * * * * * * * * Its * k * * * * * tr « * * * * * • * * * * * •
SPECIAL CONDITIONS OF THE PERMIT :
A& f APPITIOVAL VoPh-, IF F//vrSN4/6 Oil Blt SAtW73 art Ailt-d7
01V F-1,/I.S 60 A pFA 00E5 &OT FAIL V/Vo" M AS VUO 43I9 2s V alt r,? oy0 &vAL
501101416 ,FPMrr. A sj_FPF4AT AFV M7� r us r ,�� ..ssr � ;a r OMF,0w111FR 7-0
C 014 �02� SA!V4 VORK
may_____________ ______ _______,
t ,
ruwr+ ur +r�u � ratssnua.x
WARREN COUNTY , NEW YORK
Application fort BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE .ENERGY CONSERVATION CODE
A permit must be obtained before beginnings work .
ANSWER ALL of the following :
1 . Gross floor area_ lfgb (2 Sao EC.
2 . Type of heat 21"Mllmw - -_ new
3 . Is the building mechanically cooled ? YES
4 . Percentage of area of windows and doors 1470
A . Over 16 % Only
1 . Uo value of gross area of walls , roof / ceiling and floors
exposed to ambient conditions See Attached
2 . Floor over heated spaces YES NO
a . Are foundation walls insulated ? 6ii> NO
i . If YES , what is the R value ? R-13
3 . Slab on grade YES
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 Fiberglass-
80 Under 16 % Only
1 . R value of roof and floors 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
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
Co Controls
1 . Thermostat maximum heat setting goo
D . Duct Systems
1 . Is duct system installed in unheated spaces ? YES NO
a . If YES , R value of duct installation
b . R value of duct in other areas
E . Piping Insulation
1 . Size of 'trot water or cooling carrying agent pipe � 3/4 Capper2 . R value of pipe insulation
F . Service Water ,Beating
1 . Performance efficiency
2 . Temperature control setting maximum
G . FQrSwim� Pool Only
1 . Max3.mum heating
Telephone No . 370-1058
Capp icant ' s signature )
off
APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE 777Atc h�
q
LOCATION OF PROPERTY FOR INSTALLATION OU 'senrj ?
Owner's Name: CJ ( O lGrOS - ISO i Wo borS .. O'r-Telephone:
Address: 441� ( /' rxad �. � ►! ■,{ SCh / 2. 3049
Installer's Name: S lk)M e- Telephone:
Number of bedrooms. (residential only)
Total daily flow (compute 0 150 gal per bedroom) '6 O O
Tcpography: circle one Fla Rolling Steep Slope 96 of slope
Soil Nature: circle one: Sand Loam Clay . Other / Depth: _ feet
C"around Water: At what depth? Ad , feet
Bedrock or Impervious Materials At what depth? ` ^ feet
Percolation test: circle one: not require required / rate min. inch.
Domestic water supply: circle one: unici a Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank / Zoo gal. (minim urn size: 1 ,000 gal.)
TILE FIELD: Each Trench 5y feet / Total system length 2Sa feet
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used #E / Depth or Thickness feet
IMPORTANT
...Please...]LIST NEW EQUIPMENT TO BE INSTALLED
(over)
Section Il 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 stark
of construction and shall include a plot plan showing:
1.) the proposed location of the system
2.) location and distance to lot tines
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_
Sign€.tore of responsible person:
Dale:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
�Off/IZ O� �f[�'BIi .3llti►'Lf
BUILDING and ZONING DEPARTMENT
Bay and Waviland Road, R. D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
DATEla
/ PERMIT NO.
SOIL TYPE Sa - Loam - Clay
Percolatio Test Required? Y - NO
Percolation ate -- Min/Inch
TYPE of SYST
Absorption f! d, total ngth �c�'7
Length of each txench
Depth of trench s
Size of gravel_
SEEPAGE PITS{N r )
Size- ft. X _ t.
Gravel size
PIPING : size /Type
Bldgo to tank {/C
Tank to diet. f/
Dist. box to f ' Id Ll
Openings seals ? YE O Partial
LOCATIC3N/SEF" TIOriTS ;
Foundation tank ft.
Foundation o absorption ft .
Absorption to lot line / £t.
Separatio of pits ft.
LOCATION SYSTEM ON PROPER ircle one)
Front - ear - - Left side - Righ side -
CCMMEN
*nsectox�,
SYSTEM USE APPROv E
01/86 and vl
THE NEW YORK BOARD OF FIRE UNDERWRITERS
ram- i BUREAU OF ELECTRICITY Zol
Date
4T STATE STREET, ALBANY, NEW YORK 12207 � 1
r-� r
i � ' ',. �' 3 . ' 1
THIS CERTIFlE3 THAT I ) f%'I 3 -r
only the electrical e9nipnsesaf as deecribed belaso and snirotdlsced by the applicant named on the above epplicatiom rs"nsber in the premises of
in thefoltoming tocation# Basement L_._{ let Fl, � Snd Fl. . . Section Block Lot
urea examined on r andfound to be in 'cornptiarsce with the requirements of this Board.
F&XTURE EATACLES SWITCHES �«
FIXTURES RANGES COOKING DECKS OVENS Dom
WASHERS EXHAUST FANS
'tW TLETs INCANDESCENT FLuew OTHER AMT, K. W, AMT, K. W. AMT- K.W. AMT, K. W. AMT. H, P-
J.
DRYERS MENACE MOTORS /VTURE ArML1A04CE FEEDERS SFECML RET:FT TIME CLOCKS �y UNIT HEATERS MULTI-0UTLET pLkUMERS
AMT, K. W- OIL H. ►. GAS H. P. AMT. NO. A. W. G. AMT. AMP, AMT. AMPS. /BANS. AM7, H. P. SYSTEMS AMT. wArTS
00. OF FEET
5 } !
SERVICE LNSOON- -5 No. CIF S E R Y I C E
AMT- AMU. TPPE � 1 ,aI 2W 1 ,W 311V' a / aLv SY 4w No. ar CC. COND. A. W. G. No. OF Hr-LEG OF.N NO. 4P NEUTRALS 4F HWE1frGlrAt
PER aV OF CC. COMD.
r' ! !
OTHER AITARATUS:
E ! ,
BRANCH MANAGER
Per
This certificate must not be altered in any mannerT return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT, THIS COPY Of CERTIFICATE MUST NOT BE ALTERED [MANY FANNER.
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
SAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12804"
TELEPHONE (5I8) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED -
NAME
LOCATION
DATE � PERMIT # 29
APPROVED
YES NO
FOOTINGIPIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPRO AL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUG .. IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT V
ROOFING
SIDING
EXTERNAL PORCHE /STEPS
STAIRS-CLEARA E & RA
PLUMBING FIX RES/RELI VALVE
INTERIORITR /PRIVACY D RSFINISHEDRS
GARAGE FOOFINGDOOR CLO )
SMOKE D TECTORS
FINAL EL TRICAL INSPECTION
FINAL AP ROYAL OF CONSTRUCTIO
A SIGNED CERTIFICATE OF OCCUPANC F MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS :
AA
OA
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12804-
TELEPHONE (518) 792-5832
L r r�r
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSEECTXON RECEIVED
NAME
LOCATION
DATE PERMIT
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
.BA+CKFILZ APPR AL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH=•IN
INSULATION:
FOUNDATION l
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCH S/STEPS
STAIRS-CLEARA$CE 6 RAILS
L �'k
PLUMBING FSXZ�1R I'ESfRELEF VA ; VE
INTERIOR TRX441PRXVACY DOORS
FINISHED FLOORS
GARAGE FIREi'ROOFING
DOOR CLOSE (S)
SMOKE DETE�TORS
FINAL ELECT4,TCAL INSPECTION
FINAL APPROfAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPXED1
REMARKS:
V
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS '
QUEENSBURY, NEW YO,RK 12809- t/
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST .FOR INSPECTION RECEIVED �5' � 3
NAME
LOCATION
DATE PERMIT # tS 2
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/ P.PROOFING
BACKFILL APP VAL
ROUGH PLUMBIN t
FRAMING
ELECTRICAL ROUGH=IN
�,/�'Ih7SULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION: t
CHIMNEY HEIGHT f
ROOFING
.SIDING r
EXTERNAL PORCHE4;4rSTEPS
STAIRS-CLEARANgf & RAILS
11
PLUMBING PXxTUIMSIRELTEF VAL
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLOODS
GARAGE FTREP#OOFING
DOOR CLOSER ('s)
SMOKE DETEC ORS
FINAL ELECTRlitAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED1
REMARKS:
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVSLAN ROADS
QUEENS'BU'RY, NEW
W YORIC 1280¢
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST POR rINSPECTSON RECEIVED S`-�`i —a
NAME �1/00 ,r -
LOCATION .mac :z r r�A' ?' .e .2
DATE 3 — c /� -PERMST #
APPROVED
YES NO
FOOTING/P RS
MONOLITHIC POUR FORMS
FOUNDATION AMP—PROOFING
BACKFILL , VAL —�
ROUGH PLUMBS
�RAMING
ELECTRICAL ROU H—SN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFSNG
SIDING
EXTERNAL PORCHES/ST S f
STAIRS—CLEARANCE &
PLUMBING FIXTURES/REL . F VALVE
INTERIOR TRIM/PRIVAC RS
FINSSHED FLOt7RS f - -
GARAGE FIREPROOFS
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL IN07PECT-roN
FINAL APPROVAL OF cpNS27RfjCTXO
I
r
A SIGNED CERTIFSCA,tpE OF OCCUPANC MUST BE
OBTAINED FROM THE (BUILDING DEPART NT BEFORE
THESE PREMISES ARC' O/C'CUPSED Jr
REMARKS:
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 1280-+
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECT.TON R
E
CEIVED
NAME
LOCATION
DATE `L ' /lc PERMIT #1 . fT Y ./rc94
.APPROVED
YES NO
FOOTING/PIERS
MO LXTHIC POUR FORMS
t. "OJUN ATION/DAMP—PRODF'XNG�
BACKFILL APPROVAL
ROUGH PLUMBI)G
FRAMING
ELECTRICAL ROUGH—IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION ,
CHIMNEY HEIGHT
ROOFING g,'f
SIDING
EXTERNAL PORCHES/S EPS
STAIRS—CLEARANCE RAILS
PLUMBXNG FIXTURE fREZXEF VALVE
INTERIOR TRIMf TVACY DOORS
FINISHED FLOG
GARAGE FIREPR PING
DOOR CLOSER ( )
.SMOKE DETEC RS
FINAL ELECTRI AL INSPECTION
FINAL APPROV OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE .BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
OX
r
INSPECTOR
TOWN OF QUEENSBURY r' 6 /
BUILDING AND COPES DEPARTMENT �i'
BAY & HAVI LAND ROADS
QUEENSBURY, NEW YORK 1280#- �/ i° /
TELEPHONE (518) 792-58.32
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME ! eA � L?
LOCATION
DATE ^y — f�+ e... PERMIT }/' �L�
APPROVED
YES NO
.�DT'ING/P2ERS n
MONOLITHIC POUR FC7EIMS
FOUNDATTON/DAMP—PROQFING
BACKFILL APPROVAL s.
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN 3
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/ST PS
.STAIRS—CLEARANCE & A?AXLS
PLUMBING FIXTURES ELIEF VArVE
INTERIOR TRIM/PRI ACY DOORS i
FINISHED FLOORS
GARAGE FIREPROOF NG
DOOR CLOSERS)
SMOKE DETECTOR a
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL CONSTRUCTION
.1
A SIGNED CERTI ICATE OF OCCUPANCY ST BE
OBTAINED FROM THE BUILDING DEPARTM T BEFORE
THESE PREMIS ARE OCCUPIEDI _
REMARKS:
INSPECTOR
46 EL (REV +rear A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
THE NEW YORK BOARD OF FIRE UNDERWRITERS CERTI FICATE Np,
DC+ NOT WRITE HERE - FOR OFFICE USE ONLY
BUILDING PERMIT NO
CITY OR uLI.AOE TOWTJSRIP G«iNTY
STREET AND NO OR ROAD ,� J POLE NUMBER
EN WHAT CR E IS PREMISES LOCITEW SECTbN BLDCk WT
mAr 4 C> iIm I I
OCCUPANT'S NAME BUILDING OCCUPANCY
Gvn1ER 5NAME 9 JADDRESS HOME TELEPrN?NE NUMBER
CUFF ENT SUPPLIEC SY FROM THEIR o"F* CE WORK trLEPHONE Ben
L7 —/c) �,'
BUILEKNG IS �/'�
NEW JiYP OLD I� VVOFK IS NEW ADDITKJNAI- L_. PEFEGTS REMOVED !_
LIST BELOW ALL LUUIPMENT WHICH YOU INSTALLED
NUMBER OF dUTLETS No. of Fixtures & MOTORS HEATERS BRANCH OFFICE USE
rSUE5�
Lamp Receptacles CIRCUITS ONLY
Bide Attach', H.P 'Wafts A W.G.
Ceiling WaH ReceP'Is Switch PendantrBrm4onF110 TYPe Each No. Each No. Gauge INSPECTION
MENT
15t
FL-
2nd
FL.
3rd
FL.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE.
THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED, BUT IF AT TIME OF INSPECTION, THERE IS
FOUND ADDITIONAL 'EQUIPMENT NOT ABOVE LISTED. YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER
THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT
SIZE Of M�.AII,+N�S � FEEDERS EL ECTP IC SIGN SlLAM PS
CHARACTER WORK! E%POSEO � '++°^� TU6E SIGN.TRAN SFORMERS OF �
Ae%2?WF !" f / F/'I�! f L` lf.✓ CGNCE/W.ED
DATE RK TG BE STARTED DATE COMPLETED SIZE OF S+GN INUMSERI CAPA[.ITV
5ERv E ENTEPS BUILOING MANUFACTUREF OF SIGN
_J OVERHEAD UNDERGROUND
DATE INSPE ION REOUESfED C VORAS NEAR AS POSSIBLE) MUST ENTER APPLICANTS Pow
�.7 IDENTIFICATION NUMBER
AVOID DELAYS BY GIVING FULL AND ACCURATE fNFORMATION. ALL SPACES MUST HE FILLED IN OR APPLICATION MAY BE RETURNED- +
PRINT NAME AND ADDRESS
NAM F APPLICANT DATE OF APPLICATION XSIGNATURE OF (CANT
STREET ADDRESS TEL E NIJ'-
17 o t c.� 35 AU
CITY t PAST OFF E ZIP CODE LICENSE NO. HEN APPLICA$LE
SC ' !Z
L 85 John Street 41 State Street G 584 Delaware Avenue C 217 Lake Avenue 202 Arterial Road
NEW YORK, NY 1DD38 ALBANY, NY 122CY7 BUFFALO. r 14242 ROCHESTER, NY 14608 i SYRACUSE. NY 13206
THE NEW YORK BOARD OF FIRE UNDERWRITERS
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