1989-205 DER" IOATE )OF OCCUPANCY
TOWN OF QUEEN5@URY
WARREN COUNTY, NEW YORK
Date December 27 lqB9
'Phis is to certify that work requested to be done as shown by Permit No. 89-205
has been completed.
This structure ma be occupied as a Single Farm 1Dwelling
c4vner Joseph Sayer
By Order Town Board
TOWN OF QUBENSSURY
i
Director of Bldg. & C96 Enforcement
. BUILDING PERMIT �
TOWN OF QUEENSBURY No. 89_205 � 1
WARREN COUNTY, NEW YORK
w
a+
PERMISSION is hereby granted to JOSEPH SAYER
1
!
OWNER of property located at _ LOT #8 EQUINOX. DRIVE Street, Road or Ave. j�
in the Town of Queensbury, To Construct or place a
SINGLE FAMILY DWELLING �
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
t_ OWNER'S Address is
LAKE GEORGE DRIVE
DIAMOND POINT , N _ Y . p
r
'2, CONTRACTOR or BUI LDE R'S Name ,yCJ
JOHN MCCORMACK
3. CONTRACTOR or BUILDER'S Address
7 SARELLA STREET
GLENS FALLS , N . Y . 12801
4, ARCHITECT'S Name
5. ARCHITECT'S Address O
f'f
MIA
Ct
6, TYPE of Construction — (Please indicate by X)
G
I } Wood Frame l ) Masonry I 3 Steel
I�
4
N
7_ PLANS and Specifications
y
No, 72 ` x 57 ' 9" single family dwelling as per plot plan ,specifications , and application , including s,spCic , attacUed I"S. Proposed Use
Clar musty
SINGLE FAMILY DWELLING
89 �
25 . 00 C /o
$ 51q PERMIT FEE PAI ❑ — THIS PERMIT EXPIRES November 1 1s �
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the I]Q
town of Queensbury before the expiration dare.) ~
Dated at the Town of Queensbury this Day of .r A;aril
1989
SIGNED BY
for the Town of Queensbury ay
Building and Zoni ctor
f1
F
F
r
CIC
TOWN OF QUEENS$ URY APPLTCATTON FOR," BUILDING AND ZONINGRMiT
z'a .e
sec c ev erg _ TOWN OF QUEENSBUR'f
rev i ewe RECEIVED
xr
Fy d ' S i9 ,/+0 APR 1 1989
Fee F'a
BUILDING AND CODES I713PARI 7 Ntr Dante Iaaued BLDG. & CODE DEPT.
AY and HAVI LAND ROADS RD I B` 9-8 .p, i Na . _ - --�
t7UEENSBURY, NEW YORK 12807 .t '
Tel (518 ) 792-5832 Vxt 4204
A pERHIT MUST F.. 9 OBTA114ED BEFORE BEGINNING CONSTRUCTION . NO INSPL'• C'TIC7NS
VILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT .
A11 applicable spaces on this application must be completed and the
III i *g t � te of t * c * a*plica* t mustt *I�T� 'c *rya* the revers * 1 *e * o * this sheet .
ft
T1) e owner of this Property is : T r4 >
•+ " �.1.� �i E L .
1' . O . Address Y � 'r� t I �iJr �� ililas� ---
TAX MAP NO
Property location a 3Vtr.L 7x
since October 1 , 1988 ? /
llas there been any split of this propertyyes rib77
If yes , Planning Board Review is necessary . y Lam
SUBDIVISION NAME , IF APPLICABLE f
The Pierson responsible for supervision of work as regards Building Codes is :
�
+ r _
3 " ?Lfo1
N
NAME P . L . ADDRESS Tel
Name of builder lr` , ,t' -• Address 2 ; rt LI11 � Tel ` li
� � icy _ Address Tel
Name of Plumber -s ,y --
�Lr +Lr ti W. _ Address ? �i t�—4
Name a£ Mason -�:t�..,..i�=----_ — --�,
NATURE OF pRopocSED WORK ' „ ZONING INFORMATION ( Office use onlU )
* ZONING DESIGNATION OF PROPERTY
_ Construction of a now bui.ldirrg Ar PERMITTED ACCESSORY
Addition to " Building PERMITTED PRINCIPAL
AIL�r"Lion to a 1:,uilding ,� REVIEW REQUIRED - PLANNING BOARD ZONING BOARD.
(no clu,nqu to exterior climensions ) S11,E PLAN REVIEW # APPROVED [)ATE
other work {descr %4�cr1 .
VARIANCE # APPROVED DATE
GROSS AREA OF PRoPoSEDII STRUCTUFRE
R
s ft . +amarks :
lst Floor L1 -.t q
2 n d Floor , � s q f t . W COtdPLI~`PS INFO1u41LTION S+.F:r1U11o*CD 13L'irUti+t .
IAIIIIIIII� ft x =z r fc .
ft . Siv.e of prollerty� Cc x ft -
Other Floors Sri '* 7Gi -;tlriCJ Auilcli[;�3isl Sii'=
{ not cellar or basement )
TOTAL FLOOR AREA f , L. , sq f t . * s~xisting tauildiny {:s ) U5+
C'' iZe of new ltructure ft h. -+ ft f
►'ou��dation-pier/ slab/crawl/I�ar tiul ul proposed building , distance froGn I,rUi�arrty lino
ft
(circle one ) * ft hear yard
-•� * wont yard �_ � •-�, ft
No . of stories (k►abitable sPace) � - -- » Side yards _ � =[�{ ft and }
Il. fight ( grade to ride). ) �� ft . * If on corner , uL& cb:.+czk from side street £ t
1f residential , no . Of OCCUpp,p4CY INFORMATICN
No . of rocuns ( excludincl 1aatYts) i_
No , of bedrooms � � PRIMARY BUILDING -
f1o . of )]atliraain ; , fie family dwelling
i�ri[rwry YivaCincJ sy:%tu�ii �-! 7 " Two family dwelling
of
`Type of fuel � �, � ' � � � Multiple dwelling f Number units
NOO of firaplaCU4 to be xnstal. led ! Permanent occupancy
*
Will a Wood :jLovc Lc: insL"- 1lud? `i'rsn::iu[rt occupancy
Central Air conditioning:' = `' Business
RuILDING STYLE, PRIMARY STRUCTURE „ Industrial
�, ocher
l:.,i►clx Cant. +i�l X Y,". '`? catairti * =f adition . wl-Lat will u::e boo?
1 .aisud ranckl Manaltisx Duplex
!II leval Old sryla: UuA1LLJ% ow *Cod Cottay ACCI SSOFLY 23UIi.DIiVG-
Cape: . OcYiar
Colonial 1:aw town Slouse petached garage/one car/ twa car/ car
c:as
( CIRCLE ON] PLEASE ) * Attwched garaqu/one czar/ two car/r
* * * * 'w I'+ri.Vatc= storage building
E ST1MAT1`,. D MARKET VAI. UT. OF a .other
w
eo" :V10RUCTION
] NF'OR1*tATION ON 13UILDIZSC SPl?CIF ICATIONB , ON REVERSE SIDS, OF THIS SSIOET, TO BE Co,{�IPi.L;TE01
Farm BPA I0/88 v2
13UIL INC PEI414I41' 1.1ILIin'a'1011 C311TIGUED -
BUILDING SPEC FICAT )O1•iS :
4rYp, of construction , wa( od frame fire safe, etc
.
will ariy uccond-hand or -ru ed lumbar be used? If so , for what?
, 3
Foundation wall Material , Thickn#t::i 1
Do,pti-, of foundation below grade ( to bcsttc+ua of footing )
Will there be o Cellar? `i _� tleated Or Unheated? � ),. I'loax sc;. io3ta9e +�Sss sg ft
Will there bo a baseru..:rat? any portion b4to used ua livi "g upacq.:? tJ
( if so , what portion? sq . fr. . - - 'type of use?
'Type of roof - ' sloped flat/ahGd/other Mat+arial of root
,�.s`]. 'L c' , tyfp0<1 Stl1 �. L, ! " �" �n. ." 'spacin'�-LJsn2:,C7 . C . 14n�J 1C.17 �L't .
ioists ( floor b.,:"uLs ) l ;t . boor 7 i'_"+ spacing "o . a . spun �ti ft .
Uoiacs ( r'loor b� arsrs ) 2TLd . floor •` X spacinq� {�, "`a . c . sparr 1� ft .
Overlays (ceiling beam ) "x " spacing
lcaof rafters "x i J apactng { . o . c . spart_j f
1(oor tru ; aas (Pre-a:ngi zauure d) sia.acinr� ' c "owe * span� !2 ,�) ft .
Lxct.: rior wall finishh % � jil� f ►.►hat zztatcrial �� •'�
Interior wall finish
If a garage is to La ar:tachad , d4z;cribe matexialS a be usati for FIRE SEPARNI'lON :
}
IS th� ru to be :in opening bctwren garage and dwelling41 Ir' so will a Fire-rated
floor , +enclosure , and device be provided? �lr
Will a flue-lined chimnc:y be installed? `r eight Le v roo
r
oupth of chimney foundation below gade.. frw
h
Deptth or fireplace hearthw _ft . LJin .
water supply - Ciunici,ya or ,private well ft .
SEPTIC SYSTEM ❑istaric. from ANY private well ( ineludiraq ;adjoining properties
(/s sepsrate application is necessary for any repair or new iray tal lation of sel�tiC ::y :i ta:m)
D L C L A R A. T I 0 N
To the best of my ]Knowledge and belief the stateus0n"' contained
in t}pis application , togs t)anar with the plans and spr:cifications :ubitiutted , are a true rand
coeuplete scrat: ment or all propo:. ud work to be done 'an the described premises and that all
(rrovi :ions of the BUILDING C[]pl: , 't'1i14 �QNIUC oRIDINA.NCt: , and nll other laws l)ertairrincj to
Lfrc l�ropasac3 worm: L-Al"ll i:ru complied with , wh4the - i ciraud or not , and chat;,. ;ucir work is
.:,ucl ,oriwted Lry thi: own41: . �
Signature ----�
p a; i ownrur ' � uc� ent , :trcn t ;ct , contractor
f 1r * al' * Y, T H o An 'R ■ on * R * V * * * • R
sloCCIAL CONDITIONS OF WE PVf1 MIT :
f �
TOWN OF QuEENSHURY
WARREN COUNTY # NEW YORK
ST'ATE ENERGY CONSERVATION
IENMACODEWITH THE NEW YORK
ApplicatiOn for :
A permit must be obtained before beginning work .
ANSWER ALL of the following :
1 . Gross floor area fey
2 , Type of heat
3 , Is the building mechanically cooled ?.` L ..,
4 * percentage of area of windows and doors _ Al
A . over 16 % only
area of
1 , Uo value of gross 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 basement heated ? YES No
a , R value of insulation
s , Type of insulation
H , Under 161 Only
1 . R value of roof and floors exposed to ambient Conditions
2 , R value of exterior walls It ? [ 4
3 . R value of glazed area `7
4 . R value of doors
50 R value of floors over unheated spaces_
6 . R value of slab edge insulation _ - unheated slab
70 R value of slab insulation - heated slab
Be R value of heated basement/ cellar walls ( above grade ) r' - 7
g , R value of heated basement/cellar wails (below grade ) kZl _
10 . Type of insulation
C . Controls f
1 . Thermostat maximum heat setting - (,` L
D . Duct Systems
1, Is duct system installed in unheated spaces ? YES Ctd/
a . If YES , R value of duct installation ' .
b . R value of duct in other areas
E , pipinq insulation T( �
coaling carrying agent pipe
1 . Size of hot water 'ox
2 . R value of pipe insulation
F . Service 'Water Heating
1 . Performance efficiency
2 . Temperature control setting maximum
G . For Swimming Fool only
1 . Maximum heating
Telephone No . `7 =-�' �]�-F,�+�, •:- " '�..t.�. ' �1'°. ;(,,..' .A Vie'
{ zlplicant ' s sagnat re )
TOWN OF QUEENSBURY
APPLICATION FOR
Y7SEPTIC DISPOSAL PERMIT
r
DATE
LOCATION OF PROPERTY FOR INSTALLATION
Owner ' s 'Name : �i <, F �c "�3��s Telephone : �nC?) _4L \
Address : �_ �t � .� �^� 14C4r�� 4 1 C3t�l j^1
installer ' s Name : Telephone .
Number of bedrooms (residential only) `t
Total daily flow (compute @ 150 gal per bedroom) ---
Topography : circle one : Flat Rolling Steep slope % of slope
Soil Nature : circle one : Sand Loam Clay Other I Depth : __feet
Ground Water : At what depth? c _, feet
Bedrock or Impervious Material : At what depth? feet
Percolation test : circle one : not required required /rate _min . inch .
Domestic water supply : circle one : (T3unicipal7 Well Other
If domestic water supply is a Well :
Separation : Watersupply from Septic absorption feet
PROPOSED SYSTEM : Septic Tank jQ, y gal . (minimum size : 1 , 000 gal . )
TILE FIELD : Each Trench feet / Total system length feet
SEEPAGE PIT ( S) : Number of �j / Size each ^feet by J. i�.i feet
Size of stone to be used /Depth or Thickness x
feet
�kakyk�tic�ye�ciraFieik�4�icdcde*ie�tlki�akie�t*r�c�rikde�citdcdcdcicak�k�kiFir7k�k��evkdcorik9eik�r�k�k
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
Sewage Disposal Ordinance *
Signature of responsible V
Sig onsible person : OP
Date : �' l^
(OVER)
Septic System Inspections :
A . All applications for septic system installation , alteration ❑r 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 lot lines
3 . ) location and distance to structures
4 , ) location and distance to any water supply
5 . ) size and dimensions of all tanks , distribution boxes ,
tile fields and /or drywells
B , No system shall be covered before inspection and approval by the
Building Inspector . Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
of up to $ 250 , 00 .
C , An approved copy of the plot plan shall be available on the construction
site , Failure to produce said plot plan at time of inspection may
result in an immediate work stoppage .
D . Should unforeseen problems during construction prevent proper installa—
tion , alteration or repair of an approved system , a new proposal must
be submitted to the Queensbury Building Department before further
construction ,
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
Remarks :
TOWN OF CQUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURYr NEW YORK
TELEPHO1NE (5I8 ) 7992-5832D�
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION R IVED —
NAME
LOCATION ry r� r� arm
DATE � c.�--�CJ
APPROVED
YES I NO
FOOTIN+GIPIERS
MONOLITHIC POUR FO S
FOUNDATION/DAMP—PR FING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN
INSULATION :
FOUNDATION
FLOORS
WALLS
/ CEILING
,,,'FINAL INSPECTIONn
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEP
STA.I"RS—CLEARANCE S�------
PLUMBING FIXTURES/RE I F VALVEINTERIOR TRIM/PRIVAC
RS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS
dd
FINAL ELECTRICAL INS ECTION
FINAL APPROVAL OF C } STRUCT N
A SIGNED CERTIFICA E OF OCCUPANCY MUST BE
FROM THE UILDING DEP-hVTMENT BEFORE
OBTAINED
THESE PREMISES Al? OCCUPIED!
REMARKS
���ICS
y� grSPECTOR
TOWN{ OF Q
i3 EEN SBURY �
BUILDING AND CODES DEPARTMENT
BAY & HAVXLANNR ROADS
ORK I2801-
o"VUSBURY. 792-5828
TELEPHONE ( 5I8 ) ,(pl1
BUILDING INSPECTOR" S REPORT 1C ��-
REQUEST FOR INSPECTION RECEIVED
NAME ,
LOCATION IT
DATE :' `' - APPROVED
YES NQ
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOuNDAT APPROVAL
IO OOFING__��__� r'
BACKFILL '
ROUGH PLUMBS
FRAMING
ELECTRICAL ROU -IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION!
CHIMNEY HEIGHT"
ROOFING
SIDING
EXTERNAL PORCHE �-
STAIRS-CLSARAN E & RAILS
PLUMBING FIX poS/RELIEF VALVE
INTERIOR TRI R3RIVACY DOORS
FINISHED F
GARAGE FIRE ROOFING
DOOR CLOSE WSJ ` ---
SMOKE DETE TORS
FINAL ELECT ICAL INSPECTION
FINAL APPRO AL OF CONSTRUCTION '`
D CER IFICATE OF OCCUPANCY EN T BE
SXGNIED FROM THE BUILDING DEPARTMENT
A SIGNE BEFORE
OBTAINTHESE PREMISES ARE OCCUPII"
REMARKS :
0 ,2
INSPECTOR
./oWn o eens urell A 7 ' " !
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R-0- 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTETA INSPECTION
NAME
LOCATION
DATE ISq PEWI NO.
SOIL TYPE Loam - clay
- an
Percolation Test Required? YES - NS
Percolation rite - Min/Inch -
TYPE of SYSTEM: total length
Absorption field ,
Length of each trench ;`
nepth of trenches '
size of gravel "
SEEPAGE PITS4NU1n1ber, Of) _
Size- t "`
Gravel sate
PIPING : size Type
Ind! c
Bldg . to tank tr
Tank to disc . bo* y
Dist . box to field/Pit NO Partial
Openings sealed?
LOCATION/SBPARATIONS : ft.
Foundation to Tank ti � o ft_
Foundation to !absorp on ft.
Absorption to4lot line ft.
separation of :Pits �-
LOCATION OF SYSTEM ON PRQPERTY (circle one)
ont
Rear d. Left side - Right side -
ENTS :gai1
SYSTEM USE APPROVED YE
Building Ins ector
01/86 ma v1
TO�Vb1 OV QUEENSBURY 1 '
ND CODES DEPARTMENT
BUILDING A
BAY & HAVII ROADS
gUEENa'"BURY, NEt+1 YORIt I2gOg
TELEPHONE ( 57.8 ) 792-5832
BUILDING INSPECTOR' S REPORT
�) g s —
REQUEST FOR INSP CTION RECEIVED �__-------
NAME
LOCATION PERMIT # 77."-z
DATE APPROVED
YES NO
F'ODTINGIPIER 'S, FORMS
MONOLITHIC PL1 R -PROOFING
ACXFX L'
N D
B ApPRO AC KF
ROUGH PLUMBING
FRAMING- N
ELECTRICAL
IIIIIII
r/"INSULATION : .
FOUNDATION
FLOORS I
WALLS pp
CExx.ING�
C
FINAL INSPE _,�-
CHIMNEY "EIGHT
ROOFING
SIDTNG
EXTERNAL PORCHE6r NCE6T RAILS� -'
STAIRS-CLEAR; VE_
_
TRIM/
PLUMBING FIXTU PRIVACY DOOR
INTERIOR
FINISHED FLOORS --
GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS
ELECTRICAL INSPECTION
FINAL Olc CONSTI4UCTION
FINAL APPROVAL
OCCUPANCY MUST BE
THE BUILDING DEPARTMENT BEFORE
A SIGNED IER IFICATE OF
OBTAINED EFOOCCUPIED !
THESE PREMISES ARE
REMARKS
�` INSPECTOR ,
TOWN OF CQUEENSBURY
BUILDING AND 'CODES DEPARTMENT
SAy & HAVILAN''ROADS
BURY. C I280
T
ELEP HONE { 5Z8 ) 792- 5832
TELEP
BUILDING INSPECTOR' S REPORT
REQUESTFO INSPECTION
NAME
of jo�l
L,OCATXON _ �
DATE _ J AppROVED
YES NO
FOOTXNGIPXE
MONOLI UR FORMS
'1 P,PROO�.ING ---=�—
FOUNDATIOIONID ---
BACKFILL APP Az
ROU PLUMBING
opifI
ELECTRICAL ROUGH N
INSULATION:
FOUNDATION
FLOORS
WALLS
CEXLING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
P
L
ORCHESI EPS
EXTERNA
STAIRS—CLEARANCESI RAIL VALVE_ _�—
PLUMBING FXXTU
INTERIOR TRIM RIVACY D
FINISHED F S_----^^
GARAGE FIRE ROOFING
DOOR CLOS (S)
SMOKE DE CTORS
FINAL ELE ICAL INSPECTION`_
FINAL APP VAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY
ST BE
OBTAINED FROM
THE
OCCUPIEDdEPARTMENT BEFORE
THESE
REMARKS :
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVIL.AND ROADS
QUEENSBURYr NEW J5 2801 -
TELEPHONE
832
BU11 DING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED �
NAME
LOCATION � �
DATE {�pt�-� RMIT #�
APPROVED
` YES NO
FOOTINGIPI RSUR FORMS
MONOLITHIC -
FOUNDATTONID P-PROOFING
LJ�AKFJLL APPR VAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH �N
INSULATION :
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES STEPS
STAIRS-CLEARANC & RAILS
PLUMBING FIXTU SIRELIEF VAL
INTERIOR TRIM/ RIVACY DOORS_,
FINISHED FLDO
GARAGE FIREPR FING_�____
DOOR CLOSER ( )
SMOKE DETEC RS
FINAL ELECTRICAL INSPECTION_
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFOR
THESE PREMISES ARE OCCUPIED!'
REMARKS :
.IN ECTOR
TONG OF Q
BUILDING ANDD CODES
DE
DEPAR
BAY & HAVILAND ROADS
pUEENSBURY, NEW YORK 12 R i,. *mo 41 i i
TELEPHONE (518) 79.2-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
L OCAT IO
DATE i �j- / � _ PERMIT
T
A PP RO ED
YES NO
C jCP,0 ITING/PIERS
MONOLITHIC POUR ,FORMS
FOUNDATION/DAMP—,PROOFING
BACKFILL APPROVAIe.
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—X& {
INSULATION: '
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION: a'
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE /STEPS
STAIRS—CLEARAN & RAILS'E
PLUMBING FIXT ES/RELIEF VALVE
INTERIOR TRI /PRIVACY DOORS
FINISHED F RS
GARAGE FIRE ROOFING
DOOR CLOSE/S)
SMOKE DETr
TORS
FINAL ELECTCAL INSPECTION _
FINAL APPROL OF CONSTRUCTION
A .SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS: µ
I sPECTC7R
�� ARE HEREBY RECJr,/�cy-TEP TO
INSPECT ANL1 ISSUE CERTFF7CATL�g
Q PMENTULLC)W/NG ELECTR/CAL
THE UNL7ERS BE fNSTALLEL? BY
cl^7v�oR ll.LADE rGNED
1- a I rs 1-E7MP, ,y
9TREETaY'ti.7- z'_./ �
MM
t�.Ca�Jr ro^1jqd.r 7
6-.:�:r 5 R REE'r5 !S r+REMLgES l IXcFrE02 r �. Y ti C:WMry
� r11iM17 S NAj�}E'-+-'�'�_ SC{�;i10N POLE NLjMBE. .
I r1
OW BLOC14ER'S NAME AND AOpAE,3"" i-�+- }r .LL F O C N-�y"„-y K �C7
I,c RE Ni +�/t.C3
SIJPPLlED BY K
I ROU
BUILppyC �"�-1� TFlEIR I'IDIulE iFLEPFIf.WE NU
//--�� - OFFICE MaER
NEW i„yrr- N4Ak TE!-E 7
OLD � P!'bNE NUM♦3ER
Lucca- I+IUMBER OF OUTLETS Lr� SELOW ALL E Urp err IS NEW Ir''��
of Fixtures 8 ENT WI rICH YOLI ITV ADOMONAL EJ
CeII"Trig VI R ,h switch LaArP R�aPtacles MOTORS H S'iAR.LEB DErECIs REM .ED Q
(xi - EATERS BRANCH SIDE
1'enaarn Brarlo� No Tree H.R CIRCNUIC7'H�r OFFICE USE
Eagy Na 'iwarts _ ONLY
AS E E;k;ti ND. Ga G
r INSPECTION
asr
FL-
Pnd
FL.
3rd
FL,
REMARKS- LIST OTHER ELECTRICAL DEVICES NOT SET F
oRrH asal
THOV
IS APPL ADDITIONAL N I INTE'MENT
THE ADDITIONA1. EgU1PMENT, gSiQ COVER THE A8 4 YOU ARE AUTNORY2ED
NOT A6OV'E LISTED, E-LIST`ED EQUIPMENTgjci CTED,
SIZE OF MAINS ROVIDED BY THE APPLICANT TO MADE THE IN BUT 1F'AT TIME OF 1ION, S
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CHARACTER OF FORK PEEOERS ELECTRIC SPECTION AND ADJUST THE FEE TO COVER C-{;7AIC SIGNSILAMPS ER
CArE WORK To BE STARTED 0 EXPOSED A TU9E
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DATE !N$PECrX)N REOUES7EDON(OR AS NEAR AS POSSIBLE) "NDERGROV"D MANUFK."!'URE'A OF SIGN C'PAcliv
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PRINT INCif.F• AND RATE tIJFD YLI9T ENTER qp
NAME AND ADDIgESS AT . ALL �
NAME OF APP ICANT I f f
AP'P CATION 1 f
STREET ESS L+ MrAY 9ETURNEp.
/ /�, '�"' ION
'4.r r. DATE OF APPLICRTrOry
y, ILELEP NE No..
�- 85 John Street ! f , cNEW YlN ❑ tWeStreet z1P
One - LcENseT0o38 ALB NY 12207 584 Detaw are A No WHEN AP ICAaLE
SUFfiAt_U, IVY T4202 217 Lam
ROCHESTEp-p NY 146D8 ❑ 2?02 Arterial ROad
HE NEW YaRK BOARD p SYR
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ACUSr=v IVY 13206
ERWRITERS
r * ISSUE DATE (MMlDDIYY)
08 03 88
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS Edward C . Hughes Agency , Inc . EXTEND OR ALTERPN HEECOVERAGE RTIFICATE AFFORDED BY THE CERTIFICATE
BELOW.
AMEND,
152 Main Street
Hudson Falls , New York 12839 COMPANIES AFFORDING COVERAGE
COMPANY A EXCHANGE MUTUAL INSURANCE COMPANY
LETTER
INSURED LETTERNY PENNSYLVANIA GENERAL INSURANCE COMPANY
Steven Allen COMPANY
RD #2 , Sax 2021 LETTER C
Fort Edward , New York 12828 COMPANY
LETTER 0
COMPANY
LETTER
AD
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 REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONOi-
T OF SUCH POLICIES.
Co TYPE OF INSURANCE POLICY EFFECTIVE LIABILITY L(MiTS IN THOUSANDS
LT POLICY NUMBER DATE IWATOP ) DATE Y(M D Y r A- R AGGREGATE
[GENERAL LIABILITY C7CCURRENCE
i 19-2-67003 11 / 19/87 11 / 19/88 BODILY $ $
A X COMPREHENSIVE FORM INJURRY
PREMISESAOPERATUINS
UNDERGROUND PROPERTY
EXPLOSION d COLLAPSE HAZARD DAMAGE $ $
X PRODUCTSXOMPLETED OPERATIONS
CONTRACTUAL al APOED $ 300 $ 300
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY PERSONAL INJURY
AUTOMOBILE LIABILITY 8aLr
g ANY AUTO SA 0023843 02 06/ 18/88 06/ 18/89 WXRV $
ALL OWNED AUTOS (PAN PASS.) MER P
ALL OWNED AUTOS OTHER THAN) nr it Rr
PRIV. PASS l! PER Am-a" $
HIRED AUTOS
PROPERTY
NON-OWNED AUTOS PROPERTY
$
GARAGE LIABILITY
d Auto BOMB WED
EXCESS LIABIUTY 000
UMBRELLA FORM COMBINED ;S
OTHER THAN UMBRELLA FORM
A WORKERs• COMPENSATION 1 19- 3-67024 04/28/p8 04/ 28/89 srAruroRY
AND $ (EACH ACCIDENT)
EMPLOYERS' LIABILITY IOISEASE�POLICY LIMIT}
OTHER $ (DISEASE-EACH EMPLOYEE)
DESCRIPTION OF CWERATIpNSA.00AT1ONS/VEHICLEWSPECFAL ITEMS
• kgm
SHOULD ANY OF THE ABOVE DESCRIBED POLICES me CANCELLED BEFORE THE EX.
Rich Schermerhorn PIRATION D E THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
112- 1 /2 Crandall Street MAN �[] YS WRITTEN NOTICE TO THE CERTIFICATE IKILDER NAMED TO THE
LEFT, BQ F RE TO MAN. SUCH NO SHALL IMPOSE NO OBLIGATION OR LIABILITY
Glens Falls , New York 12801 OF ANY KIN TPIE COMPANY GENTS OR REPRESENTATIVES.
ALA IZEp RESENTA VE