Loading...
1989-263 PM d +CER.PnFICATT ;OF OCCUPANCY ` TOWNx OF QUEENSBURY WARREN COUNTY, NEW YORK 1 October 2 19 89 This is to certify that work requested to be done as shown by Permit No. 89-263 1 h" been cDMPieted. This structure may be occupied as ■ Single Family DWEILLM 1 Locatic r , - - . - { Steven do Sharon Mitchell By Order Town Board { TOWN OF QUEENSBURY i Director of Bldg. do code Enforcement i BUILDING PERMIT TOWN OF QUEENSBURY No. 89- 263 x WARREN COUNTY, NEW YORK e,. r+ +I PERMISSION is hereby granted to Steven & Sharon Mitchell go no OWNER of property located at Lot 60 Mohawk Trail Street, Road or Ave. in the Town of Queensbury, To Construct or place a Single Family Dwelliniz 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. [1:2A WNER'S Address is t7 Stuart Driveughkeepsie, N.Y CONTRACTOR or BUI LDERS Name O Douglas Bttrbridge ads 3. CONTRACTOR or BUILDER'S Address 22 Cederwood Drive MAX Ballston 4. ARCHITECT'S Name S. ARCHITECT'S Address 6. TYPE of Construction — (Please indicate by XI 1:04 V K)9od Frame I I Masonry ( } Steel 7. PLANS and Specifications C=7 No, 54t x 341 single family dwelling as per plot plan specifications, and application, x including attached two car garage, septic and driveway. 110 � $. Proposed Use Single Family Dwelling C z c/d i c% ncL $ 3 PERMIT FEE PAID - THIS PERMIT EXPIRES December 1 {If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the y town of Oueensbury before the expiration date.I t'a 19 Dated at the Town of Queensbury this 4th Day ofY -- Ky a SIGNED BY for the Town of Queensbury Building and Zoning nspector P-4 tow r TOWN OF QUEENSBU72Y APP1. ICATTON FOR BUTLPITIG AND ZONING PERMIT Vat C.- P ee.Ieu eL ;ry0� k'ev i ed TOWAr F Euee BBIiRY Fee Paid fi A(Ay 3 _ 1989 BUILDING AND CODES D1 :1'ARTi I Va to 14.6 ued StQC,- $ C00 Depr-• [?J1 Y and fJAVSI.ANl3 ROADS Rl7 1 Box 9d pURENSBURY t NEW YORK 12804 Pe nt t No . _ Tel . ( 518) 797-1 Ext -204 * * * * * * t* * r * * * * * * * * * * * w w * w w * w * • • w * * w R x A PERMIT MUST B4 OBTAINED BEFORE BEGINNING CONSTRUCTION . NO INSPECTIONS WILL MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDINC PERMIT . the All applicable spaces on this application must be completed and. s '� r* l:ta Lure of the appl icant must apear an the reverse side of this shft eet * 'S' lie owner of this property i s : ?1� ++' +� �✓ +¢fi/i7 t�""w�a ' �' "r� + ' i'' Poo , Address f� ► ^fir✓�a ,20, 1�a � +r �•/ Y- TEL kol' 6k> /"4Pf,eAWIl T� — us�� .47 TAX MAP NON/ / / Z./ I> roperty locat io n r�,� klas there been any split of this property since October 1 . 1988 ? yes/ no if yes , Planning Board Review is necessary . LOT NO . SUBDIVISION NAME , IF APPLICABLE NNN p jozsC. k'I 'Phe person responsible for supervision of work as regards Building Codes is : I Lit Noo NAME P . 0 . ADDRESS T]~ L . NO . !dame of builderf� Addresses Zp4co% el e �9 99! mG l>ddress All - Tel t3amo-, of Plumber Tel 7 7 �►L � Name of Mason h enA ► '� Addre3s p� .✓ �' J (4ATURE OF PP,OPo:(:O 6ORK : ZONING IN ):ORP)A,TION ( office use only ) X.Construction of a new buildings ' ZONING DESIGNATION OF PROPERTY Ad4iLkon to :a building * PERMITTED PRINCIPAL PERMITTED ACCESSORY �Altur:ation to a Luilding ' (eta CILII iglu to 0xe0riot gkilnonsinns) " REVIEW REQUIRED •- PLANNING BOARD ZONING HOARD Ocliar work Cdo cribttl SITE PLAN REVIEW # APPROVED DATE uRoSS AREA OF PROPOSED. sTnUCTURE VARIANCE # APPROVED DATE 1st Floor ,+ `� sq f t . ,s�_5_4 w Remarks : •�• ."Ind Floor S� ? s q f t . ) 40 COMPl.L•:'1'L: IrPdl'OjtM'P10N lcl:rt„sU 1 )tliD 1sl:LIJ�J . 1 � .:Sie. of proL3erty � f fc X r� ft . Other Floors s'i f "itiUing builali.wj (] ; ) Sio4a +, f1; % rt . ( not collar or basamentl IiclfV TOTAL FLOOR AREA f It . ' LytlsCii7g buildin.� ( ; ) Uma �' iZa of new &;LruCtUr%.: _eft x�ft ' �:'owLdat ion NIar/ r.laLlcrawl/partx wif full ' propo:;cd buildingso di:;tanca frouk property lint: {cirela: ones * Front yard �] ,� _rt Roar yard / ft Na . of ".tOi ie {1labit .ri1. sidco ) Silo yards . r t and _ 5'9 s e kl..:igllt ( tlradc to ridg") l ft . . if on curnar , tiumb:aek from side aereet -� - tt if ra:;idential , no . of families GICCUPAN+.Y 3NF01'+MATILriI No . of room a texcluding baths ) 10 ' 11oo, of budroomy PR1MARY IsUILD1NC NON No . of bathroom:.: family dwelling l'ritnary )u,:atiluU rY%;LRNI J( iap /Q-(!?= 3•wp family dwulliny Type of fuel �Ofl� -- Multjj, 10 Swelling / Number of units _ No . of firuplaces to isu irl::twlledw�� penn,;anent occupaabcy Will a wuu.l stpva Y+.: i.ILd.; L allud? 1j0 '1'ria#l•+i4:k1t occupancy Cuntral Air • uuslnuss BUILDING STYLE, PRIMARY STRUCTURE � Industrial ,� Ocher 1::+1►c)t Conc�lnlx.r'.ary Lo" cabin if •►ddition , w)aiat will u:;a be7 1c.aisa:d ranch dK:ansiuil Ouplax " 1Iplit leval Old style ULLALLl.alow ' u ,r Cod Cattaga OCl1er " ACCESSORY MUILDING- 'o l on l" itow rowra !louse " Lu cached y:.ar:agolon+la cur! two car! czar { c:aa CIRCLE ONL PLEASE ) � ^Act4chud giar.aol., �: Carl wo Car , w * x w * w * a w a a * A w w w '- ririv:at* st,oruge building Ls •rxelATi; sa HAR'KVT VALUU OF Ochac co" :;TRUCTION /ry C it - . 3N4`C]R>~1AfiTdJN ON CitIILDINC Shl?CIF' ICATICSNS , ON REVERES SIDE OF THIS f.lILE'!', To BE COd•WLCTL:p !Form BPA 10/88 V1 BUILDING PERMIT APPLICATION CONTINUER BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . 6('A>D C'> Will any second-hand or ungraded lumber be used? If so , for what ? Foundation wall material_ ?Ca0 cer ,.l r Thickness ems_ Depth of foundation below gr e (to bottom of footing ) �, '• Will there be a cellar? Bated or unheated? �-r q o sq. footage s ft Will there be a basement? ^`Will any portion be used as living space ? AL) 'p ( If so , what portion? _sq . ft , - _ Type of use ? Type of roof - loped fat/shed/other Material . of roof ;t�4&r&g{ / 5 ,�m✓G� � Site , woad studs it spacing " o . c . length _ ft , .foists ( floor beams ) 1st , floor 7=-�—"3s___'/Q" spacing j_'"o . c . span 14> ft . Joists ( floor beams ) 2nd . floor 'Z � " -- " spacing_"o . c . span 6 ft . } Overlays ( ceiling beams ) � • "}{ ! " spacing "o . c . span / ft . 2 �► • /a¢c. -Ir f � • �'+ t/ Roof rafters2L "X�"' spacing— / o . c . spa 2,%L> £t . Roof trusses (pre-engineered) spacing "' o . c . span ;2 d ft . Exterior wall finish i�A*1 _ Of what material ? Interior wall finish If a garage is to be attached , describe materials to be used for FIRE SEPARATION : Is there to be an opening between garage and dwelling? If so will a Fire-rated door , enclosure , and self-closing device be provided? 0 Will a flue- lined chimney be installed? _ Height above roof Depth of chimney foundation below grade- - ft . ' Depth of fireplace hearth wJ,. ft . ,, ,7 in . Water supply - Municipal ar private well Mu /J/CIpox- _ %Qcar �G+ F,C,tif�✓ti- � SEPTIC SYSTEM _ Distance from ANY private well ( includi.ng adjoining pro erties ft . (A separate application is necessary for any repair or new installation of septic system) DECLARATION 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 authoriz4ner, ner o ner Signature �s Ow 's age architect, contractor SPECIAL CONDITIONS OF THE. PERMIT : Hy----------- _ __ 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 2 . Type of heat OlLoo - 3 , is the building mechanically cooled ? . 1 ► 0 4 . Percentage of area of windows and doors J01 Z" 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_ / / )e .e2 — 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 So 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 _ 4 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� E . Piping Insulation 1 . Size of hot water or cooling carrying agent Pipe 31� / 2 . R value of pipe insulation 0 i�- F . Service Water Heating 1 . Performance efficiency 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating Telephone No , a licant ' s I s gnature ) r ■ TOWN OF QUEENSBURY APPLICATION FOR v � SEP017IC DISPOSAL PERMIT DATEJ�J� LOCATION OF PROPERTY FOR INSTALLATION / -1 60 MV+YAUfx, IAAIL� Owner's Name: .YOU6 " p-,S &COO h24 I Telephone: Address: �iZ 17q Lcrx f? y� f L AV,4!�,. Installer's Name: i ycr, r�r _AV 40 f-&t 4 Telephone: r 7.Z "� � ✓ � "" Number of bedrooms (residential only) % _ Q Total daily flow (compute Cd 150 gal per bedroom) Cz4 "[- - Topography: Circle one*aSand Flat ing Steep Slope % of Slope Soil Nature: Circle on Loam, 1 Clay Other /Depth: Feet Ground Water: At what depth ? N 0Af'�'' Feet Bedrock or impervious Material: At what depth ? A)v"wo'dFeet Percolation test: Circle one. 'ot required quired rate min. inch. Domestic water supply: circle one: Tunici al Well Other If domestic water supply is a wel . Separation: Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank /000 __gal. (minimum size: 1 , 000 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 # Zo- /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 Queensbur Sanitary wa isposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: is DATE : �1 // /r OVER Septic System Inspections : A . All applications for septic system installation , alteration or repair , as required by the Town of Queensbury Sanitary Sewage OrdZnance , shall be submitted to the Building Department at least 24 hour :; 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 FuSult 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 rusult in an immediate work stoppage , D , Should unforeseen problems during construction prevent proper installa- tion , alteration or rei3air of an approved systeLav a new proposal must he submitted to the Queensbury Building Department before further construction . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 k4naarks Certificate of tnsurz�rnce This CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE ceRTIFiCAT£ HOLDER. THIS CERTIFICATE JS NOT AN INSURANCE POLICY AND DOER NOT AMEND. EXTEND. ON ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. This is to Certify that lr MEnrr"y I Nlarne and ;me u s 2ILi;.. t.a £ E:c� �­ LLng Carp * address of 1624 Rt- 9 Insured. Chiron P"- rks i;Y 12065 iso at the issue date of this certificate, insured by the Company under the poiicylies) listed below. 'The insurance afforded by the listed policyfiasl is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued. TYPE OF POLICY CERT. EXP. DATE POLICY NUMBER LIMITS OF LIABILITY COVERAGE AFFORDED UNDER W.C. COV. B Roddy IniurY BY Aceia orrt LAW OF THE FOLLOWING STATES: WORKERS' 100 000 Ea_ Ace_ ' Bodily In1urY BY Disease COMPENSATION 1 / 23 /89 WC2 - 181- 962536 -018 NY 100 000 Ea. Pelson sodilY Injury By Disease POI, Limit General Aggregate ' Other than FeodYCtslComplatad Operations ProductslComPlamd Operations Aggregate 12000 , 000 �j s+� Bodily Injury and Property Damage LiabllitY FG 1 / 23 / 89 YY1-581 - 962536 - 048 1 , 0000000 pet occurrence CLAIMS MADE Personal and Ad"niaing injury per parsonif w organ)=anon AE 14a a+iE Other zEn pci OCCURRENCE w e—I x a w z SPECIAL/EXCL- ENDORSEMENTS U ® —�__......_._ $ 1 t 000 000 EACH ACCIDENT-SINGLE LIMIT•0.1. AND P.D. COMBINED pt; � OWNEDE+ 6 NON-OWNED 1 / 23 / 89 AS1 - 181 - 962536 - 038 $ EACH PERSON l..y EACH ACCIDENT EACH ACCIDENT 6 r_4 HIRED $ OR OCCt+RR ENCE $ OR OCCURRENCE LOCATiONISI OF OPERATIONS & JOB X Or Applicublcl nFSt"R1PTION OF OPERATIONS: Heating FilLurnhing 'NOTE: You will NOT be notified ann"Lly at the continuation of this caveraga. You wdl be notified if this Coberago is terminated or reduced- NOTICE OF CANCELLATION: THE COMPANY WILL NOT TERMINATE OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNLESS 30 DAYS NOTICE OF SUCH TERMINATION OR REDUCTION HAS BEEN it MAILED TO: +1 4 WA Town of Queensbury AUTHORIZED REPRESENTATIVE CERTIFICATE Bay. Rd ALBA HOLDER �r Glens Falls , NY 12801 -`I DATE ISSUED OFFICE This co tafiCabs is shieciated by LIa ERTY MUTUAL INSURANCE COMPANY as Isspecls such insurahCa as Ii allorded by Thai Company, it is smsulalt by LIBERTY MUTUAL FIRE INSURANCE COMPANY as teso"ts such insurar._a as is at forded by Thai Company, it is asecutad by LIBERTY INSURANCE CORPORATION as respects such insurance as Is aJ lorded by That CMiVp V- BS 772 . u�e��►. CERTIFICATE OF INSURANCE ISSUE3/10/89 YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. Wise Insurance Brokers , Inc . EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 10 Railroad Place COMPANIES AFFORDING COVERAGE Saratoga Springs , NY , 12866 COMPANLETTERY A Insurance Ccmpany of North America CODE P00180 sue-CODE COMPANY B LETTER INSURED COMPANY David Howard d/b/a LETTER ]3Iowards Excavations COMPANY R. D. #6 Peggy Ann Dane LETTER D Glens Falls NY 12801 COMPANY E LETTER „�_•__�T_..__ COVERAGES THIS IS TO CEIRTI I IFY THAT THE OF INSURANCE LISTED BELO HAVE 14EEN ISSUED TO THE INSURED NAMED ABVE FOR THE POLICY INDICATE[), NOTW THSTANDINGOES ANYIREQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICHROD TI IS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES ,DESCRI15ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSAND TR TYPE OF INSURANCE. POLICY NUMBER DATE (MMIDPIYY) 'DATE (MMIDDIYY) GENERAL AGGREGATE S GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY PERSONALL•& ADVERTISING ALGA EG ATE $ CLAIMS MADE OCCUR. PERSONAL & ADVERTISING INJURY .fi OWNER'S 6 CONTRACTOR'S PROT, EACH OCCURRENCE 5 FIRE DAMAGE (Any one fire? S MEDICAL EXPENSE (Any One Parson)COMBJNED S AUTOMOBILE LIABILITY SINGLE S S LIMIT ANY AUTO BODILY ALL OWNED AUTOS INJURY 3 SCHEDULED AUTOS (Per Pe(son) BODILY HIRED AUTOS - iNJURY S NON-OWNED AUTOS (Per accideno GARAGE LIABILITY PROPERTY $ DAMAGE EACH AGGREGATE EXCESS LIABILITY OCCURRENCE $ S OTHER THAN UMBRELLA FORM - STATUTORY WORKER'S COMPENSATION S 100 LEACH ACCIRE7JT) AND $ 500 , (DISEASE—POLICY LIMIT} A EMPLOYERS' UABILITY C29959110 1 12/15/88 12/15 /89 $ 100 f (DISEASE—EACH EMPLOYEE OTHER DESCRIPTION OF OPERAT(ONSILOCATIONSIVEHICLES(RESTRICTIONS!SPECIAL ITEMS Excavations CERTIFICATE NOLDER CANCELLATION , Town of Queensbury SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Building Department EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL 'ENDEAVOR TO MAIL 10..__ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Bay er Queensbury NY 12804 LEFT. BUT FAILURE TO MAIL 'SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORI ZED 4WPRES EII7ATI YE fro Nan .,..,s„>., • •P ..,�:a. w:'� i. .1 a.!'.A. ....J ACORD 25^S (WOO) f� J`+ (DACORD CORP0RATION 198& Lei PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, Pega Risk Mgrs . Tnc . EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 021 Western Avenue Albany , N . Y . 12203 COMPANIES AFFORDING COVERAGE A COMPANY LETTER A` Commercial Union COMPANY INSURED LETTER B Douglas Burbridge DBA ETTERNY c Cedarwood Homes COMPANY 22 Cedarwood Drive LETTER D Ballston Lake , N .Y. 12019 COMPANY E LETTER THIS IS TO CERTIFY THAT POLICIES OF INSURA NCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERFOO INDIC ATED, 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 CONDI- TIONS OF SUCH POLICIES. CO TYPE OF INSURANCE POLICY NUMBER P^tiCy EFFEC'IVE POLICY 'EXPIRATION LIABILITY LIMITS IN THOUSANDS LTR DATE IMMr DO,YVl (uiE IMMrpp,MYi E?.CI-+ I AGGREGATE CaC C U R RENCE GENERAL LIABILITY 6ODILY COMPREHENSIVE FORM INJURY $ PREMISE"PERAVONS PROPERTY UNDERGROUND DAMAGE $ EXPLOSION & COLLAPSE HAZAFID PRODUCTSICOMPLETED OPERATIONS CONTRACTUAL COMBINED $ $ INDEPENDENT CONTRACTORS BROAD FORM PROPERTY DAMAGE PERSONAL INJURY PERSONAL INJURY $ AUTOMOBILE LIABILITY INJURV ANY AUTO PFFt P ;PER PERSON} ALL OWNED AUTOS (PRIV. PASS.) BODILY ALL OWNED AUTOS (OTHER THAN) (PERpAWCENT. '$ (OTHER PASS I HIRED AUTOS PROPERTY NON•OWNED AUTOS DAMAGE $ GARAGE LIABILITY E31aPD COMBINED $ EXCESS LIABILITY UMBRELLA FORM GOMBINefl '$ $ OTHER THAN UMBRELLA FORM STATUTORY WORKERS' COMPENSATION $ IEACH ACCIOENTI A AND Unassigned 12/12/88 12/12/89 is IDISEASE-POLICY LIMM EMPLOYERS' LIABILITY $ [OISEASE,EACH EMPLOYEE} OTHER DESCRIPTION OF OPERATiONSILOCATIONSIVr=HICLESISPECIAL ITEMS All warn usual and incidental to the insured ' s business • . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- Ti7wll of ens PIRATI DATE THEREOF, T SSU�pI COMPANY WILL ENDEAVOR TO Queensbtu�y .Y r LEFT. B AiMAIL DAYS WRITTEN LURE TO MAIL SUCN�f I( 1. BHA PP6r E NO OBRIGATIOW OR LIABILITY OF ANY KIND UPON THE COMPANY TI AGENTS OR REPIW.SEKrATIVES. AUTHORIZED REPRESENTATIV0%/ ✓�-y - 1�, L3T � ' p THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 41 STATE STREET, ALBANY, NEW YORK 12207 " Date Application No. on file THIS CERTIFIES THAT only the electrical equipment as deecribed brrlose and intraefisead by the applicant nansed an the above application number in the prensieee of Id in thefollowing location; 0 Basement • ' © Ilet Fl. 2nd Fl. - Section Black loot waa ezarrs.inarl on t t arsdfound to be in compliance with the r"Wrementa of this Board, FIXTURE FIXTURES j RANGES COOKING DECKS i OVENS DISH WASHERS EXHAUST FANS OUTLETS RCRPTACLES SWtTCNES INCANDESCENT FLLIGKESCENT OTHER AMT. K, W. AMT. K. W. AMT. K.W. AMT, K. W. AMT. H. P. DRYERS FURNACE MOTORS FUTURE APPLIANCE fl9EDERf SPECIAL REC'1'T TUMCLOCKS EELL UNIT WATERS MULTI-OUTLET DUAM RS AMT, K. W. OIL H_ P. GAS H, P. AMT. NO. A. W. G. AMT. AMP. AMT. AAVS, TRANS. AMT. H. P. F. � AMY. WMTm I SERVK:E IMSL MNECT NO. OP S E R GG V 1 C E AMT. AMP. TYPE Ej 1 ,e' sw 1 X 3W 9 .I SW S 1 ew NG, Pm rccNb. OF CC CUPIa- NO. OF HI-I.EG �H�� Np. OF NEUTRALS aF A. Ei. 0. TRAL OTHER APPARATUS: BRANCH MANAGER Per- This certificate must not be altered in any manners return to the office of the Board if incorrect. Inspectors may be identified by their credentiols. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS OURENSBURY. NEW YORK 128041- TELEP NE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION O�r �,. }[� DATE _ CT �" � � I PERMFT # APPROVED YES FOOTING/PIERS r MONOLITHIC POUR FORMS ? r FOUNDATION/DAMP-PROOFING BACXFZLL APPROVAL ROUGH PLUMBING W FRAMING ELECTRICAL R GH-IN - INSULATION: � FOUNDATION r FLOORS WALLS CEILING t.-�'FXNAL INSPECTIO : CHIMNEY HEIGH % ✓ ROOFING SIDING T EXTERNAL PORCHBS STEPS STAIRS-CLEARAIICE 6�ri RAILS PLUMBING .FXYV(?URES1R'WZXEF VALVE INTERIOR T,MfPRIVAC�k DOORS FINISHED RS GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUC'TI A SIGNED CERTIFICATE OF OCCUPANCY MUST SE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED,{ REMARKS: I SECTOR TOWN OF QUEE.NSBURY BUILDING AND CODES DEPARTMENT BAY & HA VTLAND ROADS QUEENSBURY, NEW YORK 1280k TELEPHONE (518) 792-5632 BUILDING JNSPECTOR ' S REPORT REQUEST FOR INSPECTION R EIVED NAME LOCATTON DATE ry! PERMIT {# �' ��� APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATTQN/DAMP-PROOFING BACKFILL AP ROYAL ROUGH PLUMB G FRAMTNG ELECTRICAL RO GH-TN INSULATION: FOUNDAT2QN FLOORS WALLS { CEILING FINAL INSPECTTON: CHIMNEY HESGHT ROOFING SIDING EXTERNAL PORCHES/ TEP STAIRS-CLEARANC & RAIL. PLUMBING FIXTUR SfRELIEF , VALVE INTERIOR TRIMI IVACY DOORS FINISHED FLOO GARAGE FTREPR FING DOOR CLOSER { ) SMOKE DETEC RS FINAL ELECTRI L TIVSPECTION FINAL APPROVA OF CONSTRUCTIQN k A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISE'S ARE OCCUPIED! REMARKS: INSPECTOR �vwrt v� �ueeita16+etr� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 BOX 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME +�15"1 LOCATION p IIIIIIO e5; I DATE 21 PERMIT NO. Cr SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES,/ NO Percolation rate - Min/Inch TYPE of S TER: + Absorption field , total le Length of a ch trench Depth of tre ches Size of grave ' SEEPAGE PITS4 er of Size- ft. X f Gravel. size PIPING : S pe Bldgm to tank Tank to dist. box �f.•^ Dist. box to f ' el , Openings sealJ: YES O Partial LOCATION/SEPARA IONS : Foundation to k Foundation to bsorption ft_ Absorption to of line ft. Separation of pits ft. 1AXATION, STEM �? OPERT circle one) Front ea ft mid - Right side - COMMEN 4 ei SYSTEM USE APPROVED YE O i di g ITASpector 01/86 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS /i'fj/ QUEENSBURYy NEW YORK 1280& TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED 5;- - to NAME LOCATION n DATE APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—PROOFING BACK.FILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN i,,� INSULATION: FOUNDATI FLOORS WALLS CEILING FINAL INSPECTIO CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES PS STAIRS--CLEARANCE RAILS PLUMBING FIXTURES ELIEF VALVE INTERIOR TRIM/PR V Y DOORS FINISHED FLOORS k - GARAGE FIREPR ING . DOOR CLOSERS) SMOKE DETECTO S — FINAL ELECTRICA INSPECTION FINAL APPROVAL F CONSTRUCTION A SIGNED CERT FICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: 0-qt�u peg IN PECTOR Town OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEEN.SBURY, NEW YORK 1284k TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION DATE _ ra I ` PERMZT`r y#__� � �S APPROVED " { YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING -- BACKFILL APPROVAL ROUGH PLUMBING FRAMING!. ELECTRI L ROUGH-IN ' INSULA TIo FOUNDATI FLOORS WALLS CEILING FINAL INSPECTS CHIMNEY HEIGH ROOFING SIDING EXTERNAL PORC TEPS STAIRS-CLEA CE RAILS PLUMBING FI RES/ LIEF VALVE INTERIOR T M/PRIVA DOORS FINISHED F RS GARAGE FI EPROOPING — DOOR CFA ER (S) SMOKE D ECTORS FINAL E TRICAL INSPECTION FINAL A ROVAL OF CONSTRUCTI A SIGN D CfiRTIFICATE OF OCCUPAN MUST BE OBTAI D FROM THE BUILDING DE PAR ENT BEFORE THESE REMISES ARE OCCUPIED! REMARKS k pt INSPECTOR � - TOWN OF QUEENSBURY $UrLDrNG AND CODES DEPARTMENT BAY & HAVILAND ROADS S2UEENSBUR'Y, NEW YORK 128ok TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR rNSPECTroN RECErVED NAME LOCATION DATE' `^ PERMIT #F, 2�7 APPROVED FOOTINGIP1ERS YES NO MONOLrTHIC \POUR FORMS FOUNDATrON/ p_Pl.'OOFING BACKFILL APP VAL Q�RAMrNG ELECTRXCAL ROUGH- INSULATroM. FOUNDATrON rZolORS WALLS CEXZ rMG FrNAL IN,SpECTrONa CBrMNSY H9.TGHT ROOFING SIDrNG EXTERNAL PORCHES/s7' PS STAIRS-CLEARANCE' & RArLs PLUMB-MG FIXTURES RELrEF VALp INTERrOR TRIMIP ACY DOORS F-rNISHED FLOORS GARAGE FXREpR rNG DOOR CLOSER (S) SMOKE DETECTO FrNAL sLEcTRrcA rNspECTrON FrlVAL APPROVAL F CONSTRUCTZO� IN _ A SrGNED CERTrxrCATE OF OBTAINED FROM THE .BUXZDTVG UfANCY MUST BE DEPARTMENT BEFORE THESE PREMISES ARE OCCUPrEDr REMARKSr INSP CTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT SAY & HAVILAND ROADS QUEENSBURYy NEW YORK I280& TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATIONZgvp 0 DATE 4- ._�/ -�c PERMIT #_ 37 APPROVED YES NO FOOTING/PIER MONOLITHIC POR FORMS C,r .FPdN'DA TION/D -PROOFING yACKFI.LL APPRO ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-I INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEP STAIRS-CLEARANCE & RA LS PLUMBING FIXTURES/RE EF VALVE INTERIOR TRIM/PRIVAC DOORS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSERS) SMOKE DETECTORS FINAL .ELECTRICAL INSPECTION FINAL APPROVAL OF CONS RUCTION A SIGNED CERTIFICATE O OCCUPANCY MUST Be OBTAINED FROM THE BULL NG ,DEPARTMENT BEFORE THESE PREMISES ARE OCCU IEDI REMARKS: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I2809 TELEPHONE (5I8) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME u IF OF LOCATION p r v DATE , ` " PERMIT # -,.�., -- APPROVED YES NO OOTINCARXERS MONOLITHIC POUR FORMS_ FOUND. T.Z`ONI DAMP-FROOFI NG BACKFILL ivpROVAL ROUGH PLUMA,�NG FR}YMING ELECTRICAL R GH-IN INSULATION: FOUNDA TION FLOORS WALLS CEILING FINAL INSPECTION: j CHIMNEY HEIGHT ROOFING SIDING, EXTERNAL PORCH SISTEP STAIRS-CLEARA E & RAIL.3p. PLUMBING FIX . RES/RELIEFVALVE INTERIOR TRI1 /PRIVACY DOORS`-. FINISHED FLOORS GARAGE FIREPROOFING ,. DOOR CLOSER [S) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE C)F OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED!. REMARKS: 2, v ff� � r IN PECTOR YOU ARE HEREBY REQUESTED TO INSPECT AND ISSUE CERTIFICATES FOR THE FOLLOWING ELECTRICAL EQUIPMENT TO BE INSTALLED BY THE UNDERSIGNED TEMP. # �E EITY OR VILDZE [-X ✓ �.. /'.'[1 ' t1 r�.- / 7l]INIM^uHIP / ,,y Od.IN'ry' / STREET AND NO. OR e-f o* POLE NUMBER BETWEEN WNAT TWO CFN:156 STREETS IS WPEMISESLOQVEDe SECTION DDEO�f)Nwrs�N✓■w au pING f/CCUPMICY t_J.'� YiRL. 4.` !' '�(/ /� �� Ilr l�i ✓cam DWrIER'9 NAME AND ADDRESS I ROME TEL yUMBER CURREN PUEDgY �ir� /.sr�/lll/tee ENf}M THEIR OFFICE WORK TE4EpP��{C'7���IE NUMBER BUILD"r is NEW OLD ❑ fr^" VVOfw IS LIST 13ELOW ALL EQUIPMENT WHICH YOU 1 ADDITIONALDEFEL iS REMcwEo ClLpca- NUMBER OF OUTLETS No. of Fixtures & STALLED tion Lamp Receptacjgs MOTr^i' RS HEATERS BRANCH OFFICE USE AnsichT CIRCUITS Ceiling S1Nel! Flecep'Is Switch Pendant Braciwt Na Type Each No. � Ne- A.WG. ONLY OUT- Gauge INSPECTION SIDE SUB• BASE BASE. MENT 1st r� 2nd f FL. 3rd FL. REMARKS: LIST OTHER ELECTRICAL DEVICES N075ET F4iFtTH 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 EFY THE APPLICANT. 32E OF MAM15 2 no 'FA e,J FEEDERS ELECTRIC SIGN&?LAMPB !! 1grAL'4WV"'f3 C st ER OF WORT( ff--�� h, •A � r.. ,'r . LV�s � �� r'A' TUBE SIGNfTRAN SFORMERS OF ,� EALED Qi WORK TOO BE STARTED I r GATE/COMyPLETED SIZE OF SIGN(NUMBER) -` 4 oj--c. A � f,'aYACRV SERVICE ENTERS BUILDFUG D MANUFACTURER OF SIGN OVERHEAD DERGROUNp mB'E WSPEyT�aK REOUFSI'ED DN IDR AS NF_AFl qS POSSIBI.EI IJL •• �r' t A momEMT6i_1IFPJJ6i11![TS .Nip, BY Ft! AND AQG1 MU FILLS IN AP (CAT N I BE I Y d PRINT NAME AND ADDRESS NAME F APPLICANT }� DATE OF APPLICAn CNN Srr't ET ADDFIE e[ /� .fit F.., r'r.: /,+..-'yrr T, x k _' ,'I(-4 f W TELEPHONE N CIt�Ft POST OFFICE - ZI P CODE LICENSE NO WHEN APPLICJM1BLE_ ' ❑ 85 John Street y�q/ FIOCHESTER, NY 14608 SYRACUSE, NY 1320 41 State Street C] 570 Delaware Avenue 0 217 f alkl# ,Avenue NEW YORK, NY 1003E � ' ALBANY, NY 122m BUFFALO, NY 14202 � rS Road 6 � 6 THE NEW PORK BOARD OF 2FlPE UNDERWRITERS i j Lu LU IN i I I - ho I 4y