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1989-266 x r. +CERTIFICATE OF p+�CUPA►.NCY TOWN OF +QUEENSBURY WARREN +COUNTY, NEW YO►RK August 3 , 89 This is to certify that work requested to be done as shown by Permit No. $9-266 has been completed. This arructure may be occupied as a LocAdon Omer sterling Quality Nooses Sy Order Town Board TOWN OF QUEEMSURX - - Director of Bldg. & Code Enforcement ,a BUILDING PERMIT z TOWN OF QUEENSSURY No. 8g_a6i5 ,� WARREN COUNTY, NEW YORK u r � PERMISSION is hereby granted to Sterling Quality Homes ~ A OWNER of property located at Nathan Street Street, Road or Ave_ in the Town of Queensbury, To Construct or place a $i ngl @ Fani l iydl�l ar Dwel 1 i ng at the above location in accordance to application together with plot plans and other information hereto filed and approved and in compliance with the Town of Queensbury Building and Zoning Ordinance_ 1 . OWNER'S Address is 2 Bronk Drive lr Queensbury. N . Y _ 12804 r a 2. CONTRACTOR or BUI LDER`S Name f A . D_ Tellier c c a 3. CONTRACTOR or BUILDER% Address r 5 4. ARCHITECT'S Name S. ARCHITECT'S Address 6. TYPE of Construction — IPlease indicate by XI 5 w ) Wood Frame I I Masonry 11 Steel I I iL 7. PLANS and Specifications r r No. 24 ' x 48 ' Single Family Modular Dwelling as per plot plan , specifications , and application including septic ,attached one car garage , and driveway . B. Proposed use LICENSED PROFESSIONAL ENGINEER_ + SINGLE FAMILY MODULAR DWELLING ' c/o incl . $ 169 no PERMIT FEE PAID — THIS PERMIT EXPIRES Der-liimbe11= I 19_RU_.__ s III a longer period is required an application for an extension must be made to the 8u1IdIng and Zoning inspector of the r town of Queenshury before the expiration date,I r Dated at the Town of Queensbury this 041.9% Day of 111ni r SIGNED BY for the Town of Queensbury Building Zoning Inspecte Ion C � 7l I79 TOWN OF QUEENSBURY APPI. TCATTCIN FOR BUTLI) TtlIG • AN'D ZONING PERMIT � .! rr.LtC- Peciev ed i A Reu %ewed oe Fee. Paid fi r-AJILDING AND CODES . UI .1'ARTPtF..Hr Vate 7aaued DAY and IIAVX L AJVD ROADS RD .I BOX PUEENSBURY, NEW YORK 12804 Pe.nmtt No . <2 l ^u' Tel . (528) 7+32-5832 Ext -204 * * * w R * * * I * * * 4 • * * * * / • * Yr • d 91 • Yi R A ! tw >• 1 * R !' z A PERMT MUST 114 {OBTAINED BEFORE BEGINNING CONSTRUCTION . NO INSPECTIONS WILL BE MADE UNTIL APPLICANT IIAS RECEIVED A VALID BUILDINC PERMIT . All applicable spaces on this application must be completed and the sipuatune of the applicant must appear on the reverse side of this sheet . * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 'rhe owner of this Property is : LH w f'FziJC � L A E c, r+T - I7RFI - , LX.L) JyC� PmO . Address e "$ rz-' 13 K' rDfet V 1-3 TEL . 11oollwou 7 ! ? - 4 iat I roperty location ��_-r- " � u '7- R r !t� Ad. tLo2 uac TAX MAP NO . I__•2 l 5",.,./_�r-3 Has there been any split of this property since October 1 , 1988 ?� " CD yes no if yes , Planning Board Review is necessary . SUBDIVISION NAME , IF APPLICABLE 'Carr LOT NO . ;;t_ -} 3 •i' he ,]person- ^rresponssipble for supervision of work as regards Building Codes is ; F-l P d ! C L I R( C NAME P . O _ ADDRESS TEL . NO . nlAoAce L +4iZ. Te1 �, fy- +336 - 1f Hume of builder ,, , c S r- jjnrue Address hi n tx , ang n xl �_ uame of Plumber f.36 'Fa+-ljr&i7- CorJjrP.ddress rc cs Tel Name of Mason If + r Address r r jot Tel r It f1ATURk' OF PROPOSED 6OR>t : „ ZONING INVORAIATION ( O1`fice use only ) _ Oonscrucciorr of a Paw building ; ZONING DESIGNATION OP PROPERTY Addition to a building # PERMITTED PRINCIPAL PERMITTED ACCESSORY llolookooll'Altur:ation to a 1:.uilding All � (HO clwring.: to oxcurior dimensions) ' REVIEW REQUIRED - PLANNING BOARD ZONING BOARD Ocher work (dascribu) ' SITE PLAN REVIEW # APPROVED DATE CROSS AREA OP PROPOSED, .TRUCTURE VARIANCE # APPROVED DATE 1st Floor /U 5�' --sq f t . Remarks 2 nd Floor sq f to COc4[°1. UTO IMPOftMATION 14CQUIUED UL:L hl . Other Floors sq Ft . ' ^ai`xo of Proirurty. �� y ft x 1t ft . 5i-u i' L % ( Pat cellar or basement ) ' I�aciuting lauii�dist�] ( :rl rt . * t L _ ;dm TOTAL FLOOR AREA sq f t • • exiscing building(y) Uuu Lixu of new structur.s _ _eft ft •t•ouard;ation-pier/ slaL/crawl/Loa Casa u " Vropossad building, disttancu front L.,rQtaortY kina tic irclu one ) * Front yard � C> f t Roar yard 3 � f t Na . of stories (h:albit"bla space ) - Iiuight (grado to ridcl,a) t -Lj I- ft . . 5id4 yards 2� ! ] _ let .and If on corner, ::c rb"- a:k .from Si ri: .MWA —_-tc if rosiduntial, no, of families I '" No * of rooma ( exclud£ng 1b"thzal Nowl ' OCCUPANCY INFORMATIQN Eto. of bedrooms .; � PRIMARY BUILDING eM No . of b stlAroouia: ypn �, fan"ly dwelling primary ha:acLi SkU 9ya:cvter •l'wu gamily dwelling •ryypts of fucl�r - Fv ?t c- — Multliple dwelling / Number of units_ No . of firoplaCW4 to bC: inZtalled t•340 pr� i'exuwnont occup:uscy Will :a wWar1 aL'OYt3 bu irr tt:allud7 F+" ers e " Tran"Ulkt OCCUPUACY C:untr"l Air cosulitiuning:' 00 tis r? ausinuss W BUILDING STYLE, PRIKNRY .STRUCTURE , Ind"strial ochermllm �astcla cont.:mlaor:arey Lto? cabin � if :addition, whut will w s. d ranch m"na;fust Dul,li x '" ui>lit l .rv. l Old scyla Uutrrl.alow t':ajau Cod Cott"Qa Ocher RCCCSSORY BUILDINC- Coloni:,al Ecow Town }louse ' L)otachad yariago/ono:Ing r/ two c:sr/ car ( CIRCLtr: Oils: PL.1:A1E 1 it ActFachr:il [lu.CU9U leisr two G:ar/ cur w w w • s s a >t • . w w w x r * • r Pr.ivato storugo bu LS 'rIMATI. D MARKC:'D* VALUE OF ' �iOthawr ry o N tj'r k u c•io I o N ; ] NVOriMATYON ON BuIL.DING SPC:CIFrCATTONS . ON REVERSE SIDE Op TiiiS SFIL•:ET, '1'+0 Be COMPLM-EDI Form DPA 20/88 ul .. _ . . . ... ..r =.i BUILDING PERMIT APPLICATION CONTINUED BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe etc . -i> Will any second-hand or ungraded lumber be used? If so , for what ? ( 1ri._) A Foundation wall material 0<12. *--Thickness AB � { Depth of foundation below grade (to bottom of footing ) L Will there be a cellar? Heated or unheated? ax _Floor sq. footage / �j� sq ft Will there be a basement? VAS Will any portion be used as living space? ejjQ ( If so, what portion? "� sq. ft . - - Type of use? Type of roof - sloped/flat/shed/other �Af3L"c Material . of roof ,pr �g L T Size , wood studs ^��X `" spacing :o . c . length ft. Joists ( floor beams ) 1st . floor '�X�._„ spacing_J L- 'lo , c , span ft . Joists ( floor beams) 2nd . floor "x " spacing "o . c . span ft. Overlays (ceiling beams ) -"x, spacing "o . c . span ft . Roof rafters "x " spacing o . c . span ft . Roof trusses (pre-engineered) spacing"o . c. spars- �ft . Exterior wall finish D ^u.O [,F_ 151, N Of what material? �+ y C A 1 1 x r Ter S i 'G Interior wall finish �� �} r{ p �� _ ��l� _ Trl�'FD g SA+upf y 2L lAl - ,f If a garage is to be attached , describe materials to be used for FIRE SEPARATION: T- � ,[1G- Is there to be an opening between garage and dwelling? i 1If , so will a Fire-rated door , enclosure , and self-closing device be provided? Will a flue-lined chimney be installed? � Le5 Height above roof ft . Depth of chimney foundation below grade ., r" f t . -7--0 a r3o v 6, G- rz q 1> Q C-� Depth of fireplace hearth ft . in . ,tea vz. r- u 'r £ e C 6- s3S Water supply - Municipal or private well inn ,A W cd . G I r.} !q- 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 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. Signature ' d /rr Owner, owner's ent, 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 : 1 . Gross floor area 3"A N<. " e 2 . Type of heat 3 . Is the building mechanically cooled ? - ' 4 . Percentage of area of windows and. doors ^ 125 ± JI *5 cZ47 CJ . 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 basement heated ? YES NO a . R value of insulation 5 . Type of insulation B . Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions _ 2 . R value of exterior walls If 3 . R value of glazed area H-r - ENE;Z,6> ' ;Z 4 . R value of doors T lr&chf + / 4 ` - 5 . R value of floors over unheated spaces '(. ` f9 6 . R value of slab edge insulation - unheated slab ,r.._it4 7 . R value of slab insulation - heated slab " #Ll s . R value of heated basement / cellar walls ( above grade ) Ndq 9 . R value of heated basement /cellar walls ( below grade ) xfa 10 Type of insulation � qT - rT C . Controls 1 . Thermostat maximum heat setting 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 ,, , 3/4 , 1 . Size of hot water or cooling carrying agent pipe }�a 42!; 2 , R value of pipe insulation jq jj IYlOUg rL SL - 3L - q- F . Service Water Heating 1 . Performance efficiency FLcc-i4 ( cAt- !SdLL �4t- Fkcr PODS. PsH - RAE 2 . Temperature control setting maximum is G . For Swimming Pool Only 1 . Maximum heating fs Telephone No . �r4 v gSl3y t_�1r9 YV�a r- ( applint ' s signature ) TOWN OF QUEENSBURY ; WARREN COUNTY , NEW YORK Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSER.V'ATION CODE A permit must be obtained before beginning work , ANSWER ALL of the following : 1 . Gross floor area y<w' 2 . Type of heat 3 . Is the building mechanically cooled ? rTl� 4 . Percentage of area of windows and doorsw f }, off 4•—fCD -5rkD = t 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 basement heated ? YES NO a . R value of insulation 5 , 'Type of insulation B , Under 16 % Only ( 0 ) / qL+ -15� � 1 . R value of roof and floors exposed to ambient conditions _ t_ r jj C — F2 - R - I "1 2 . R value at exterior walls_ ;e `7. 3 , R value of glazed area I-Jt, W N 6 06- 'e NPgP5C 10 4 , R value of doors 4 tt cL0 - ALA - L1 C 51 R value of floors over unheated spaces. PR - / 4 6 , R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab_ t C, ,r,_} 8 , R value of heated basement / cellar walls ( above grade ) ti, ,► �e 9 . R value of heated basement /cellar walls ( below grade ) rt.ko *j lob Type of insulation ff 7 nS + 41 - ;�' a D - / 0 - L+ 5- C , Controls 1 , Thermostat maximum heat setting f-:; 5- D . Duct Systems 1 . Is duct system installed in unheated spaces ? YES CNO 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 ppyyto (j 2 F1_E.re. _ rz - u G;)eR- i j F , Service Water Heating 10 Performance efficiency ri-,g.L, )Vp<C- ArQS ASAI -RA�E -5bA 2 . Temperature control setting maximum G . For Swimming Pool Only 1 , Maximum heating r.af Telephone No , 6 --$e5 ( appl ant ' s signature ) CERTIFICATE OF INSURANCE ISSUE GATE (M/M M DIYYI PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Van Dyke Agency , Inc , NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, 6 E . Washington St . EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Glens Falls , NY 12801 COMPANIES AFFORDING COVERAGE COMPANY A LETTER National Grange Mutual COPE SUB-CODE g 31 -896 COMPANY INSURED LETTER �' COMPANY c Andrew D. Tellier d/b/a LETTER Northeast Construction Services COMPANY D 2 Brook Drive , RR 6 LETTER Queensbury ., IVY 12804 COMPANY LETTER E COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS LTR DATE (MWDDIYY) DATE (MWDDIYY) GEN ERAI, LIABILITY GENERAL AGGREGATE $ 2 * ❑❑❑ 0.0MMERCIAL GENERAL. LIABILITY PRODUCTS-COMPIOP$ AGGREGATE $ 2 * ❑❑0 CLAIMS MADE 1Ar OCCUR- unass igned 1 0/27` 88 I CV27 89 .. PERSONAL 3 ADVERTISING INJURY $ 1 * ❑❑❑ OWNEWS &CON*RACTOR'$ PROT. EACH OCCURRENCE ; 19000 FIRE DAMAGE (Amy one tkre) S MEDICAL EXPENSE (Any one pore n) $ AUTOMOBILE LIABILITY COMBINED SINGLE S ANY AUTO LIMIT ALL OWNED AUTOS BODILY SCHEDULED AUTOS INJURY ; (Per person) HIRED AUTOS BODILY INJURY ; NON-OWNED AUTOS (Per accIdent) GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIAENUTY EACH AGGREGATE OCCURRENCE S $ OTHER TRAIN UMBRELLA FORM VMVWF.WY CaMPENSATION STATUTORY A AND unassigned 1 ❑/27/a8 10/27/89 s 1100 (EACH ACCIDENT) $ 500 {DISEASE—POLICY LIMIT) `WPLfDVt o LIAIBJTY ; 1011 (DISEASE—EACH EMPLOYEE OTHER DESCRIPTLON OF OPERATIONSILOCATIONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS cnmpletian of modular homes carpentry, electrical . etc . CERTIFICATE HOLDER CANCELLATION Sterling-Quality Homes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE P . On BOX 811 EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Glens Falls , NY 12801 MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY qP'AjJY KIND UPON THE COMPANY, ITS AGENT5 OR REPRESENTATIVES. AUTHORIZ REP SENTATIVE A99RD 2 88) CORPORATION 1988 TO OF UEENS E U R Y f-i� APPLICATION FOR ✓xy11j SEPTIC DISPOSAL PERMIT DATE LOCATION OF PROPERTY FOR INSTALLATION /,,gyp.,-f- " A b.. C� '7 Owner's Name: LA41g_rsNf.E R . LRRS �,+V Telephone: ? fi —85 13 Address: a Ro N K R 1 RJ E Installer's Name: !G tC L Telephone: ,;> Number of bedrooms (residential only) 3 Total daily flow {compute (d 150 gal per bedroom ) C3 Topography : Circle one: (119,0 Robing Steep Slope of Slope Soil Nature: Circle one San Loarn Clay Other /Depth; Feet Ground Water: At what depth? 30 — C#o Feet Bedrock or impervious Material; At what depth ? _ �3cs 06, Feet Percolation test : Circle one: not required required rate min. inch. Domestic water supply: circle one ;NEIunicipal Well Other If domestic water supply is a We Separation : Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank loon gal. ( minimum size: 1 , 000 gal. ) TILE FIELD: Each Trench 105-o �feet/Total system length -r940 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 Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON : f 3 0 r � DATE: �5b "` 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 submirted 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 Canks , distribution boxes , rile fields and / or drywells B . No system shall be covered before inspection and approval by the tWildizib ln; puctor . Failure to comply with this requiremenC may result in the uncoverin -P of the system by the installer and a fine Ut up to $ 250 . 00 . C . An approved copy of the plot plan shall be available on the construction site , Failure to produce said plat plan at time of inspection may riesult in an immediate work stoppage . i) . Should unforeseen problems during construction prevent proper installa— tion , alteration or rop,4ir of an approved system , a new propusal must t,u submittud Co the Qu.� vnsbury building Department before further CuiIstructian . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 lip:marks : , TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVTLAND ROADS QUEENSBURY, NEW YORK 1219 ¢p JJ �r""ff TELEPHONE (518) 792-5032 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED _ NAME LOCATION DATE " .,.•---£'ERM2T #�a! APPROVED YES NO FOOTXNGIPIERS MONOLITHIC POUR FORMS_ FOUN.DATIONfD —PROOFING BACKFILL APPROV ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—T XNSULATION: FOUNDATION FLOORS WALLS CEZ,UXNG F L INSPECTION: CHIMNEY HEIGHT ROOFING ! SIDING EXTERNAL PORCHES/STEPS STAIRS—CLEARANCE' & RAT PLUMBING FSXTVJ7 ES/RELIEF ALVE INTERIOR TRZ*IPRRIVACY DOO FINTSHED FZOORS GARAGE F17?EPROOFXNG DOOR CLOSER (S) .SMOKE DETECTORS FINAL ELECTRICAL XNSPECTXON FINAL APPROVAL OF CONSTRUCTION A .SIGNED CERTXFICATE OF OCCUPANCY ST BE OBTAINED FROM THE BUILDING DEPARTME BEFORE THESE PREMISES ARE OCCUPIED! REMARKS. e INSPECTOR BUILDING and ZONING DEPARTMENT Bay and Havifand Road, R. D. I Box 9,8 ©ueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME � .f � / //r X W. LOCATION DATE / PERMIT NO. c _ SOIL TYPE -- Sand. - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM : Absorption field , total length Length of each trench Depth of trenches - Size of gravel_ SEEPAGE PITS{Number o °) .maize— ft. X ft .; � Gravel size PIPING : sizer Bldg . to tank Tank to dirt , box Distv box to field/pit Openings sealed? YES N � Partial LOCATION/SEPARATIONS : 3 Foundation to tank Ile ^�. Foundation to absorption/ ftd Absorption to lyts ft_'`... Separation of pft. `r LOCATION OF SYSOPERTY (circ^ e one) Front - Rear - - Right side - CCMMENTS : Lit.' � /? Vl 14 SYSTEM USE APPROVED YES N Building Insp ctor 01/86 and vl BUILDING and ZONING DEPARTMENT Bay and Hauifand Road, R. D. 1 Box 98 OueensburY, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME — l OCAT ION doe DATE PERMIT NO* vf(® SOIL TYPE - Sand - Loam - clay Percolation Test Required? YES Percolation rate oo Min/Inch TYPE fMo of „c' 7. I'+bsorptxon eld p ffi total. length /] j r Length of ea trench d Depth of trenc es � Size of gravel_ SEEPAGE PITS#N - r of} Size- ft. X ft7?, , Gravel size - P IP ING : e . Size T Bldg _ to tank. yP Tank to dist _ box -� Dist* box to field/ �- Openings sealed? YES No P r rtial.al LOCATION/SEPARAT Foundation to t k Foundation to t' Absorption to tolineon ft . Separation of its t' LOCATION OF S ST " Front ppgRTY (c cle one) - Rear - eft side CCIMMENTS :., Right ide 71 SYSTEM USE APPROVED YES NO Build n Inspectcr 01/86 and Vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVIt. AND ROADS QUEENSBURY, NEW YORK 128 O+I f+ TELEPHONE (528) 792-58.32 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME - �•- fL LOCATION J DATE a G PERMIT # - APPROVED YES NO FOOTING/PIERS MONPLXTHIC POUR FORMS LZ �ATXON/DAMP-PROOFSNG ACKFSLL APPROVAL / ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: r `- CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHE fSTEPS STAIRS-CLEARAN E & RAILS ' , PLUMBING FIXT S! ESIREZXEF V*, LVE INTERIOR TRI / RIVACY DOOR.S� FINISHED F R11, GARAGE FIRF�ROOFING DOOR CLOSEA (S) SMOKE DET4CTORS FINAL ELECTRICAL. INSPECTION FINAL APPRO�AL OF CONSTRUCTION A .SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: 3 INSPECTOR TOWN OF QUEENSBURY lolZor BUILDING AND CODES DEPARTMENT SAY & HAVILAND ROADS QUEENSBURYo NEW YORK 1280iL TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION /R�E``CEIVED 4 / NAME �T�{!! C Awcv-n5 z e 2 LOCATION /sl�r DATE PERM # .Gi C APPROVED .YES NO OOTING/PIERS OLITHIC POUR FORMS [3yfL? �,7 FOUNDATION/DAMP—PROOFING ti -- BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS—CLEARANCE & RAILS PLUMBING FIXTURES/RELIEF VALVE T NTERIOR TRIM/PRIVACY DOORS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL. INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR SELECT BUSINESS FORMS (609) a4a-5203 APPLICATION FOR ELECTRICAL INSPECTION PLEASE BEAR DOWN) YOU ARE MAKING (4) COPIES f MIDDLE DEPARTMENT INSPECTION AGENCY, INC. National Headquarters ~ 900 Haddon Ave., Collingswood, N.J. 08108 • • Date : ,$ City, Town or Township U e G IV S 10 y rZ � County LA-114 Q !Crr ti- State 1` r Location/Address VI L3 S I' 4r I Y'1 W- LI LL' R i' PII V III ( If Located in Rural Area - Please Attach Directions) Pale # Owner LA RSA a.3 17 S A GTe Kk 1 PG- � a (1 ALJ "r V M:n+es. Permit # Occupied As 4�r � F 0IIII i •77w0, L. L. iVC^- Building : Newh< OldO Occupant Work Area in Building Floor #, etc. ) : App. for: _Wiringl = ServiceFSL or. Nt li Ready for Inspection : IIII I/ ta '! Fee Remitted - $ Cash L�j Check Q M.O. = Make Paya ie To : M_D. I .A. 20aa p2S0 25aa 2i5a 3aaa Number of Rough Wiring Outlets Elect, Heat 5a0 750 la00 125a 1500 1z50 Switches n - a pC2 Amp. Service Surface Unit Dishwasher Range Lighting 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: / W !I IA.. 0I/jDAE III1AL MOTORS "'P• 112 1112 1/10 1/8 1/6 1 1/4 1 1/3 112 3/4 11 1 1Vh 2 15 1 211 1 25 30 40 50 75 100 Mark Number of Each Size Applicant's Signature �1..4�._ License # Permit # T/A Utility . i +4G IC Applicant's Address, _ � 1I6 rZ0 1 1; T� 12 (NAMEI OEFIC LOCATION (City) r L @ I.rC F A. ..L.. 5 (State ) lt-r (Zip) Service Reque t # Phone # ? �r� — S5 ! 3 Electrician / w! � • DATE RECEIVED: DATE INSPECTED : Correct Location : Same as Above [::] or: Red Notice Label [] Rough Wiring Outlets Surface Unit Oven Switches Range 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. 1/20 1/12 1/10 1/a 1/6 1/4 1/3 1/2 3/4 1 1V2 27 5 171110 15 20 25 30 40 50 /5 1100 Mark Number of Each Size Patrick d Ilashttalr sect. Heat 500 'So iaaa 12Sa 15oa 1750 2aoa 2250 2500 z75o 3aoa x 3ry 12833 Htldsat a7 V 34 3 fLECTHICAI. INSPECTOR CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECT FEE PAID Rw Progress : Inc. 0 LKD Q Contractor CFT Violation : Work Comp. Inc. Q L/A Owner CASH El O L/A Fee CH K # Due MO # Q IPA Municipal INV # Date : Other Side = Utility Applicant Owner Cut in Card Q Temp # Date Rsv sew ; f,EC3RGF aSAKA P. E . 9/1 /g9 i CR BUI SINGG SYSTEMS CONSULTANT TOWN OF OUEr 13 ARBUTUS DRIVE , ,;}yY CUEENSBUBY, NwY. 12M RECEi}f (51 S ) 793- 7194 . 13 ARBUTUS L7R1vF BLDG. & ! . , L O IEENSBURY. N. Y. 12904 BUTLDING nISP,E7CTOR TOWN OF QIJEEI kSBURY re : Factory Manufactured Home TOWN HALL — BAY ROAD 1nstallatlon Certification. QUEENSBURY . NY 129C14 Attention: DAVID HATIN Dear sir. This is to certify that I have observed and inspected the installation of a ,,Factory Manufactured Home" , as defined by the New York State Uniform Fire Prevention and Building Code , Chapter D - MANUFACTURED HOUSING , Article 2 - FACTORY MANUFACTURED HCIMES , as applicable to your local building regulations ; there appeared to be no apparent structural damage to the units , due to or attributable to the transportation or loading/unloading of the units , herein- after described as follows : Date of installation : �r Site Location: .ti' i+�►.K /�1 '�"++ "��,y �' � Community : TO';'VN OF QUEENSSURY County: 11VARREN Manufacturer/Supplier : ✓ i',.��S'�,¢_ ��.: �r ' "",.5► -- Address : lns jignia Serial No. Plan Approval No,. Vee ' Manufacturer ' s Model/Component No. : Date of Manufacture: ' � ,/� Installer/Supplier : I have also examined the approved Plans & Specifications for the abovementioned 1fFac Eory Manufactured Home" , and to the best of my knowledge and belief , this "Home" has been installed in accordance with these approved Plans & Specifications , and all other applicable laws codes , ordinances , standards &/or regulations . QF NjE7 RESPECTFULLY SUBMITTED . h_ bra KURO& ,�- _ c O cc : �aa Ro. asBeg ,a{' *LUZ uEORG.E KUROSAKA JR . P . C . 'dp�rs10K¢� N t n 9 I S+-t'`IS t �y N!"', '. Tim >N R ' �- s . �. 9 R 1't+ •*aSTiY�^ _�. �f!� x It ..•. A � � "V� • , �iV . (•{ .. �'P�. Y5 p _ ✓. - ! ti , rr J `�, Rry� . *! '.NY- 'R ? terF r* a 'c.b r aS r. 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