Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
1989-355
a CERTIFIC Li7l OF +CvX.I*1.CUI'AN+CY TOWN OF +QUEENSBURY WARREN COUNTY, NEW YORK Usce Sept . 27 14 89 This is to certify that work requested to be done as shown by Permit No. 89-355 has been completed. This structure may be occupied as a Single Family dwelling location n A P-1 ni on Pine _ Owner Bryan Brownyard By Order Town Board TOWN OF QUEENSBURY J � , Director of Bldg. lac Code n orcement BUILG► iNG PERMIT � TOWN OF QUEENSBUR.Y No. sg_.395 WARREN COUNTY, NEW YORK ntc wd sr ale PE R M ISS 10 N is hereby granted to_ Bryan Br afflya rd OWNER of property located at 30 Pinion Pines Street, Road or Ave. in the Town of Queensbury, To Construct or place a 5i ngl a Family 8we11 i rig 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 29 Windsor Avenue m Bright Water , H . Y . 11718 2. CONTRACTOR or BU1 LDER'S Name � Paul Potvin an 3- CONTRACTOR or BUILDER'S Address VC 219 Scotch Bush Read Blt 4- ARCHITECT'S Name S. ARCHITECT'S Address d• _1. 6. TYPE of Construction — (Please indicate by 'X) ) Wood Frame I I Masonry 11 Steel I I fd 7. PLANS and Specifications No- 24' x 68 ' Single Family two story dwelling as per plot plan , XJWKZXIX specifications , and application , including septics attached two car 8. Proposed Use garage and drivevivy Single Family Dwelling $ 235-6Bc/fa inc1PERMIT FEE PAID — THIS PERMIT EXPIRES 19 Sig (If a longer period is required an application for an extension musk be made to the Building and Zoning inspector of the town of Gueensbury before the expiration date.) 4< Dated at the Town of Queensbury this 30th Day of My 19 89 1? SIGNED BY 4d2i:zZi�2" ,l CL yy� for the Town of Queensbury 'Building Inspector �I�.� ZONING Sc BUILDING PCR111IT CII .: Cli LIST 1 . TY130C OF PERMIT REQUESTED A. �'' 14 W EUILDING ADDITION/ALTERA,TION 11, RESIE) CNT1AL COMMERCIAL C. SEWAGE DISPOSAL Do DECK / PORCH I] C] CI; Ea OTI I Z ?. BUILDING PERMIT APPLICATION COMPLETED de SIGNED — YIES NO 000000 A VPLOT PLAN (2 COPIES) P, &'ELECTRICAL INSPECTION LI . BUILDING PLANS ( 3 CO PI CS) r. C..�. IVEWAY PERMIT C. - C VAGF DISPOSAL G . C.. 'SVOIZKMEN'S COMP , CERTIFICATE FOR . CONTRACTORS NANTED D . .'NERGY CODE I1 . . E PAID 's . PROPERTY INFORMATION . IN APPROVED SUBDIVISION 2. MEETS DEP"I' II , WID'I' I1 k SCI . FT. REQUIREMENTS �:"€ RCi EXISTINiG , NON—CONFORNIINiC LOT& WITH PROPER SET BACKS 4 . ItEQUIRED FRONTAGE ON PUBLIC ROAD S . HAS REQUIRED OFF STREET PARKING !i . PERMLiARLE AItEA IS ADEQUA`I'L' _i7 . BUILDING DOES NOT EXCEED MAXIMUM [ MIGHT . IS LOT CONFORMING TO CURRENT ZONING ? YES - rc� 4 . PROPCRTY IS ZONED AS r�s �/ TAX NIAP NO. A . IS USE SPECIFICALLY ALLOWED IN :!ONI: ? YIiS } /IqO� I . P1, RMITTED PRINCIPAL Low✓ P1: RMITTED ACCESSORY ? a . SITE PLAN RFVIEIV TYPE: I TYPIi II INDICATED STATER ASON (QUO` H SF.CTION ) b. GON NG BOARD REV V USE AftrA CN INTrRPRE TION ` LE ONE) RCVIEIVED 13Y DATE i TOWN of ©UEENSBUAY 11 �. Zoning Administrat pat TOWN OF �lL1EENSI3U12Y APPI. ICATTON FOR BUILPIMC, AND 2C1N� G PFRMIT tutC - WN-1v OP /�ti'' QUIc ECt�i;r n�y ! l;ev i excre d x N Py "3 ^L7 S989 Fee Paid 4 a r Date Ta.a tied U ©�� 4D4e r WILDING ADD CODES u( :( ARTk'if=A !' 11AY and 4flAVYL9ND ROADS RD I -BOX 98 PUEENSB URY, NEW YORK 12 d O 1 PeJGtni t No . (� _ f Tel , ( 5.18) 792-5832 Ext •2O4 A PER?tIT MUSTGL 013Z'f� ItJE D i3E) OiIE BEGINNING CONSTRUCTION . NO INSPECTIONS - WILL BE MADE UNTIL. APPLICANT IiAS RECEIVED A VALID BUILDINC PERNITT . All applicable spaces on this application must be conipleted and the ti •� s1ltiat ►Fre of the applicant trust ailpear on the reverse sick of this shect . ak k Y: 3:. A fi Y[ 9c ah A 7c A A �k 7k k 3: is is ie yc Nc is yc k 7Y d: * �c x rc do :l' yc 7k 01' he owner of this property is : i' . O , Address rPL . f !-. r17 sp J � � { ! i r ) . Sr . � � t . �. z.Et 1° roper ty locat ion n � fa." s e rL' r�% J t " z 'PAX HAP HO . 7 1 teas there been any split of this property since October 1 , 1988 ?z Fto i if yes , Planning Board Review is necessary . SU13LsIVISION idAML•: r IL'' APPLICAL3LE LOT NO * The person responsible for sU'Rer sign of work as regards Building Codes = ,(? S l) Vie, 4: u !� 0r r - F . Oki , . TF. L . NO * / NAM ! � ,U"�.. r i O . ADDRC S , Tel ,f ' a �.. Address fs' ' ' A -n rf` : Jr .fit ,.F t1 ame of bua ide -- - --� Tel N:amc1 of Plumber:?� ni. 1MA"t ' ldcire SS . i 7 Name of Mason �� - r _ s ., . i Address r' c _•y�/ I i L:.., Tel 7 14ATt,.URE OF PROPOSL=D 60RK6 r Z0NjrjG INVORPI}tiTION to Fice use On1Vi [ on: tract iOrs of buildinrl * ZONING DESIGNATION OF PROPERTY Adrlic3.ort to �� bUildlilIg N PERMITTED PRINCIPAL PERMITTED ACCESSORY Altvr:at: ian to a t;uildtng . ' � [Eso clt.rtt+l. L[] . xt prior rliman : ions ) } RLVIEW REQUIRCO - PLANNING BOARD ZONING BOARD C)tk�tr work (da:cri bc.ft ) SITE PLAN REVIEW N APPROVED DATE * VARIANCE # APPROVED DATE. GROSS AREA OV LIROPOSCD. STRUCTURE - : 1st 1� l o o r �'' f t . „ Remarks 2 nd Floor 'T sq f t . co1•tinr_> r� zi'arr 't'xara s;t-r uzLti a ets Lca41 . Si.r4 of prolaurty rr j i t X 4: c rt . other f•loears sg Et , +� "iZ:t.i-e►Cj buiiJiFt.] l :; ) ai u 1' R X ct • ( not cellar ,ter b «asQmant ) it TOTAL FLOOR AREA sci f t . ' Lxl ::Ling tauil+linr� (:: ) Ltso: Li4e of new structures: ., 'L; ft X 'It i o.card:atian-pierfslaLfcruwl arci tulI laropoziud building , di:it:►ncu t rant laralaul' Cy lirtr ( circle one-. 1 at front yeArd f^ V` rt Rear Na . of F;toric:. (1r:a'Ui1t:4bl0 !:Jhacc ) e ,� Side yards � I" 2Ift :and � / .G' it It�ighc ( grade to ridg4: ) .-7 :� ft . If on corAar , ::crack .froth side tics et - - sc I c r0 aiduntl4l , no . of ftrmilie :: so No . of roour:; [ excludinil ' b:ath l C3CC1.fPFJi� Y 11nIFOl'JM1ATICN tler . of be4root+ts -�k' PRIMAF+Y LUILDINC - Noo oe b"chrOGsk l One Satttily dwelling Vrittury huatiFtrl syLL; u:W -` i 'Y Two i"If ly dw"IFi.n+I Typu of fuel !' rs * Multirals awullitul / tlutnbcr of units No , of fireplace:.c: to Le in::t::ailerl�-� _ # 1'erstwanctct accurs«urcy Will :� woad :31:4Va lau i1t:; L;All4sd7 /L ,1•ran :icr�t nucuL�:ar�c y L'untr:ai Air coixc4iticaniFc�{:'R C1,it — 11"slnuss [1U1LD1NCj 1TYL.C, PRIMARY Sl-RUCTURC lndusL rial OGYIcr s:ancti Cor►t4 +uL:ur..ry Log cabin It :addition , r Y'rut will u::u bul? t:.ri ::ad ranch M ►nsit„ t D"I Al...cx :ilali.t luVtil Old scylc LsuliLJ.aLow OF Cott coct"ga OCIu.: r '" ACCLSSORY t3llILDINC- Ctipony;,� 'sown Douse Lutachad quri4go/One: char/ two -- - ( CIRCL U O"E: PL.E:ASC ) Attia.:ttuet elar"Uu/oetr: car/ two caYf e�+ c ■ ■ x • ► ■ +r v yr i'ri4:aeu !;it4rU9Q ksui .lding L ; 'l' ittAR' Y. [J MARKLi'!' VAL. Ut: 1 ] i` * ^�Orh� r LNr`ORmATION ON nurL_DINC SPr• CI ICATIGNs , ON REVERSE SIDE- OF TLiTS StHL2ET, TO Dn COMPLETED ! Farm AP.A I0188 V.2 BUILDING PERMIT APPLICATION CONTINUED BUILDING SPECIFICATIONS : i Type of construction , ,wood frame fire safe , etc ._ [ i, ('^ e ^ I Will any second-hand or--jgra' ed lumber be used? if so , for what? ;n Foundation wall material [- c+ L'U " C' - ' - Thickness Depth of foundation below grade ( to bottom of-offooting ) / r Will there be a cellar?mot Heated or unheated? Floor sq. footag�j- IS- sq_ ft Will there be a basement?,s- 4 3 W :L31 any ;Fortson be used as living space? ci ( if so , what portion? sq . ft . - - Type of use? Type of roof - slope' flat/shed/other Material of roof s �M �/_ _ Size , wood studs '" X �" spacing / '" o . c . length ft . Joists ( floor beams ) 1st . floor -" X r r "' spacing_,"o . c . spanft . .joists ( floor beams ) 2nd . floor _ _ -"X ! c '" spacing"/_ span,} , ft . Overlays ( ceiling beams ) '"x spacing T'o . c . span - ft . Roof rafters '" x "" spacing - -o . c . span =T�%�of tr ss eu s re- engineered) spacing-"'o . c , span l c �ft . Exterior--W'd` i finish r �✓J f i z °� Of -; hat material? C, Interior wall finish .. _ j If a garage is to be attached , describe material is o be used for FIRE SEPARATION : T Is there to be an opening between garage and dwelling > y if so will a Fire-rated door , enclosure , and self-closing device be provided > S Will a flue- lined chimney be installed? 01 40 Height above roof ft . Depth of chimney foundation below grade, ft . Depth of fireplace hearth -- _ft1. _.--in . Water supply c~Municipa or private well SEPTIC SYSTEM _ Dis^tance from ANY private well ( including adjoining properties ft . (A separate application is necessary for any repair or new installation of Sept ' & s stem ) DECLAMATION 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. 7 Signature i r Owner, owner's dgerit, Architect, contractor SPECIAL CONDITIONS OF THE PERMIT : B � /fr 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 : ( / 10 Gross floor area 1 /� ] v /! 2 . Type of heat L 3 . Is the building mechanically cooled ? � e ' 4 . Percentage of area of windows and doors A . Over 16 % Only 11 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 a . R value of insulation 5 , Type of insulation B , Under 16 % Only /, j -*I) 1 , R value of roof d floors exposed to ambient conditions" ` 2 . R value of exterior walls 3 . R value of glazed area 4 , R value of doors c 5 . R value of floors over unheated spaces 1 ? 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 C . Controls 11 Thermostat maximum heat setting D , Duct Systems 11 Is duct system installed in unheated spaces ? Y_ ES ) NO a . If YES , R value of duct installation b , R value of duct in other areas - 1L1N. � t E , piping Insulation 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F , Service Water Heating CC , 1 . Performance efficiency 4 2 , Temperature control setting maximum - . . js 'jy G , For Swimming Pool Only 1 . Maximum heating ' Telephone N-: . 3 . -� r / �l� - �=�C t ..c r .... ._ 3 ( appl/icant s si ature ) 11 "OWN OF QUEENSPURY ---- w APPLICATION .FOR SEPTIC DISPOSAL PERMIT DATE ._ .ram LOCATION OF PROPERTY FOR INSTALLATION ,.,,: r �, ; U - Owner's Name: /`�' LTr� /_Y - z `> a" Telephone: Zia? ,'� J/ 70 —�7 Installer's Name: 0— Telephone: Number of bedrooms (residential only)_ Total daily flow (compute Cd 150 gal per bedroom) '. < , cf -- Topography: Circle one: Flat Rolling Steep Slope ab of Slope Soil Nature: Circle one: Sand Loam Clay Other /Depth : Feet Ground Water : At what depth ? Feet Bedrock or Impervious Material: At what depth ? Feet Percolation test: Circle one: not requir required rate min. inch, Domestic water supply: circle oner Municipal Well Other If domestic water supply is a we1lI — -- Separation: Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank ,,Int,-� gal. ( minimum size: 1 . 000 gal.) TILE FIELD : Each Trench � lb -feet/Total system length ._fir* - 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: ? n rLWw DATE : OVER // T- Jf Septic System Ins-,ections : 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 start of construction and shall include a plot plan showing. . 1 . ) the proposed location of the system » . ) 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 , the fields and / or drywells B . Nu System shall be covered before inspection and approval by the Luilding Inspector . Failure to comply with this requirement may result in the uncovering of rho syscern by the installer and a fine uI up to S _250 . 00 . C . Mtn 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 k,e submitted to the Queensbury Building Department before further cc.�zi �; truccion . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queonsbury , New York 12804 QEENSBURY OUILTOW BUILDINGNG AND COPES DEPARTMENT BAY & 0!L j2$ HAVILAN� ADS YORlC QUEENSBURY, 51$ ) 7921111115832128 TELEPHONE BUILDING INSPEECTQR' S REPORT RLyQUF;ST FOR INSPECTION RECEIVEF NAME LOCATION PERMIT -��•- DATE APPROVED YES NO FOOTING/PIERS MONOLxTHIC POUR FORMS FOUZ4DATION/DAMP^PROOFING BACKFILL APPROVAL ROUGH PId7MBI FRAMxNG ELECTRICAL ROU INSULATxON: FOUNDATION FLOORS WALLS CSXLING Ce4n0A,L, INSPECTION: CHIMNEY HEIGHT ✓ ROOFING SIDING EXTERNAL PDR HES/STEPS STAIRS-CLEA IN & RAI PLUMBING F TURES/RELIEF LIVE^ -� INTERIOR IM/PRIVACY DDO �- FINISHED LOORS GARAGE F EPOOFFING DOOR C SER (S) SMOKE D.&TECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE THE BUILDING DEPARTMENT BEFORE OBTAINED FROM THESE PREMISES ARE OCCUPIED? REMARKS: J INSP TOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURYr NEW YORK 128046 TELEPHONE (518) 792-58.32 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME _ LOCATION DATE a PERMIT # +�'_c? APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATZO N/DAMP-PROOFING .BACKFILL APPROVAL ROUGH PLUMBING P' FRAMING EL5PTRICAL ROUGH-IN SULATION: ; FOUNDATION o-7 FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH /SP9PS STAIRS-CLEARAN E & RAILS PLUMBIIFRTHE ES/RELIEF VALVE INTERIPRIVACY DOORS FINISHRS GARAGEOOFING DOOR CJ SMOKE RS FINAL HEL -INSPECTION FINAL APOF CONSTRUCTION A SIGNED CATE OF OCCUPANCY MUST BE OBTAINED HE BUILDING DEPARTMENT BEFORE TIESE PREMISLS ARE OCCUPIED! REMARKS. IASPE±CTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEEN.SBURY� NEW YORK 1280& TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED_ - 7 NAME LOCATION Z074 6v r 00 DATE PERMIT # s ' APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATXON,/'DAMP-PROOFING 8AeKFILL APPROVAL L- RROU+GH PLUMBING 174 AMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH S/STE STAIRS'-CLEARA E & RA PLUMBING FIX RES/RELI VALVE INTERIOR TRI /PRIVACY D6kORS FINISHED F RS GARAGE FIRE tOOFING - DOOR CLOSER'(S) SMOKE DETE&TORS FINAL ELECTRICAL INSPECTION 4 FINAL, APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCIh MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED: REMARKS: i� INS ECTOR TOWN OIL QUEENSBURY ' BUILDING AND CODES DEPARTMENT BAY ,& HAVILAND ROADS QUEENSBURYo NEW YORK 12804 TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCA TION DATE f t!© ,I _ PERMIT APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS POUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STOPS STAIRS—CLEARANCE & ;`RAILS PLUMBING FIXTURES/iRELIEF, VALVE INTERIOR TRIM/PRVACY DOORS FINISHED FLOORS GARAGE FIREPR PING DOOR CLOSERS SMOKE DETECT S FINAL. ELECTRI L INSPECTION FINAL APPROVAj OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: 70 s INSPECTOR awn 0 I IQ BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New `fork 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME_ i r•► r LOCAT I ON ,- b ti/Po toe DATE 7 I PERMIT NO. SOIL TYPE - Sand - Loam _ Clay Pereol tipn Test Required? YES - NO Percola ion rate - Min/Inch TYPE of S STEM: Absorption field , total length Length of e h trench Depth of tre Ines Size of gravel SEEPAGE PITS er of} Size- ft. X - ft« t{rn Gravel size t PIPING : rj-dl Bldg . to tank Tank to disc _ boDist. box to fieOpenings sealed? O Partial LOCATION/SEPAPATFoundation to tat«Foundation to ahft .Absorption to to �--ft.Separation of pi -flQPCATION C� SYSTR (circle one) Fr? t - Rear - Left side Ri t side - OCW4ENT;54 SYSTEM USE APPROVED R NO f Building Inspector 01/86 and vl TOWN BUILD G AND CODES ,BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280%. TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LocATION CJ 14 Q /r} DATE /" PERMIT # APPROVED YES NO FOOTINGIPIERS MONOLITHIC PQUR FORMS i. �`ll0,UNDATIONf DZLVP-PROOFING ACKFILL APPRO AL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH- N INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNJ(S) CHES/STEP ,STAIRSANCE & PLUMBIFIXTURES IEF ALVE INTERIMfPRiV Y DOFINISHORSGARAGEROOFI GDOOR CS)SMOKE TORSFINAL ELAL NSPECTION FINAL AP O CONSTRUCTION A SIGNED CATE OF OCCUPANCYAMUST BE OBTAINED FROM - THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS_ INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY� NEW YORK 1280k TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR' S REPORT y REQUEST FOR INSPECTION RECEIVED NAME LOCATION DATE �.� PEi4MIT # APPROVED YES NO C'�F60 TSNG/PIERS or MONOLITHIC POUR FORMS FouNDATXON AMP--PROOFING BACKFTLL APPROVAL ROUGH PLUMBI G FRAMING ELECTRICAL ROUCff-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHE.T/STEPS ' STAIRS-CLEARAN(* & RAILS PLUMBING FIXTUPES/RELIEF VALVE INTERIOR TRIMIPRIVACY DOORS FINISHED F R S GARAGE FIRE; FING DOOR +CLOSER S) SMOKE DETE TORS FINAL ELECTR CAL INSPECTION FINAL APPRO .AL OF CONSTRUCTION r A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR k 111�1�I 'T iij I LT71 I_Ldlizd, 0drd = I CiSu E L)Al L k rwi..1. ,L�. 1 4 1 r4 V ;j . ; dwl . 5/24/89 d L i 01 "I CERTIFICATE ff:+ ISSUED AS A MATTER OF INFORMATION ONLY AND CONFIEFIS Theodore LaVigna Agency , Inc . NO 111(itITS UPON THE crkrIFICAI E HOLOL-01- THIS CLTdITIFI UOJI NOT AMEND 27 No . Main Sto PO Box 7 0 EXTEND OR ALTER THE COVIEI ArtmOklUED BY THE POLICIES BELOW. Mechanciville , NY 12118 COMPANIES AFFOnDING COVERAGE d, ( 518 ) 664- 7367 COMPANY 1�� Lfi TT L f I A Hartford Cas . Insdaco , 71 � _� COMPANY Ntli INSURED __mddddd. LETA FIT Hartford ACC . & Ind . Co * mm Louis Morocco COMPANY dba Mar Lou Plumbing LL I II C Zurich Ins . Co . 81 Wineberry Lane COMPANY Ballston Spa . , NY 12020 i LET ,EH w COMPANY This certificate represents current policy i' ,d+ LET I ER status and is subject to changes by y tag ent orsem L mkIC "Aw �_ m,� THIS Jki TO CERTIFY THAT POLICIE!; OF JWWA^NC�- C-�D LEI HAVE BECII-di 11�-�UC70 TO -1 lliz 1;4,;01111(3 NAML 0 A�34j`Vk: f Od� I HL POL-ICY Ptirdilkd;L) INDICATED NOTWITH��TANUIIINQ ANY RVUU0di6:Mk:Imd1 1 , 1 ldm:k�M 0ii CONIA1 ION Odd: ANY COIJThAC-1 tlrdt 0 1 ia-34 t3id4 !U,.it r41 W1 I J I HA :%.tmd,�C I I k-b LVj &jCj I T j lj�dddp CLiddi I iVjCdmd. I L: I MA d 1%t: "dw ��wxmw �a:mdnimdlft L� �utl dU i 10 ALL jklZ I tI EXCLUSIONS, AND CONDIdd TIONS OF SUCH POLICIES. m, IAUILI I Y LIMi r s IN THOUSANDS CO! TYPE OF INSUI POLICY NUMEI LTR AC.UtlLuA I E THIS J k-mTT dr, L - - -------------- GENERAL LIABILITY 01 UEC VJ5129 Jj0L y dNju"y dd A X COMPREHENSIVE FORM 2/ 18/89 2/ 18/90 $ m PREMiSISJUPERATIONS _drm t F UNDUIGHOUND P�40F'l I r d, mmmmmmmm- EXPLO!d;JQN & COLLAPSLiKAZARD $ w ' Nor X PHOOLIC FS(COM PLF I C III) OPH(ADONS ja X CONTRACTUAL 750 1000 rid X INDEPENDENT CONTRAC101kS r mddm� qq j BROAD UOHM dd4iuPLFjIdf DAMAOf. X PERSONAL IN.,101Y ON AL INJURY $ MediI X -"-t E ea§�e. r mt 750 & Advertising U_q_k. __ AUTOMOBILE LIABILITY � k A $ ANY AUTO 01 UEC VJ5129 2/ 18/89 2/ 18/90 mmmmmmmmd ALL OW NI 0 AU T(JS I PLIN PASS 01 ALL OWNfU AUf(j6 (01tIER THAN FNV PASS J CItM A1x11.RhIl HIRED AUTOS PA NON-OWNED AUTOS DAMAGC mmmmmmmmm GARAGE LIABILITY 4:11 & PID [ x1C.omjQr,ehen_smidmve,.F.o,n 0wned and Scheduled Vehl Ies COMBINt.0 $ 300 EXCESS LIABILITY UMBRELLA FORM 61 & P0 ,m L) $ OTHER THAN UMBRELLA FORM WORKERS' COMPENSATION STATUTORY mot 11/119 2/ 18/90 1 00 (1 A�;H AC00[14 r�I B AND 01 WE CVT6776 211 EMPLOYERS' LIABILITY (DISEASE POLICY LIMIT)�Ir�) -�[ArL;f J,ACfl i r ILid�11 OTHER ...... DBL 1937229-01 continuous NY Statutory DEUCHIPTION OF OPERA I JONSITOCA TION SNEH IC L E'SiSPEC JAL ITEMS Paul Potvin SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13EFORF THE f X- 219 Scotchbush Road PIFIATIOk DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1 U DAYS WRITTEN NOTICE TO THE CE Brf IFICATE HOLDER NAMED TO THE Burnt Hills , NY 12027 UrFro BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIA ILI OF ANY K'N0.rUPW WCOI ITS.AGEW% 0 ENTATOVES, T r- �UT-�dioiizEo ET_-PfU7 F F d I'l �yyrW qTrr I V I F. - r N w d P r L 4 rr 'in, k YOU ARE HEREBY REQUESTED TO INSPECT AND ISSUE CERTIFICATES FOR THE FOLLOWING ELECTRICAL EQUIPMENT TO BE INSTALLED BY THE UNDERSIGNED r GfrY LLAGE .-yn SHIP CAT COUN� STREET . OR 7 ' POLE N BER BETWEEN TWO CROSS STREETS IS PREMISES L GCA ED7Q SECTION BLOCK 1 LOT OCCUPANT'S NAME % I.IPACY d BUILDING OGCN I N' bA ,� !7/ a &A-if Age I.AA74E 'S NAME AND AT HESS 4 HOME EAHONE NUMBER CURRENT SUPPLIED BY FF40M THEIR OFFICE x 91C1H TELEPHONE NUMBER 8 ILDING IS NEW OLD ❑ ,'WORK IS N ADDITIONAL DEEecm REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS No, of Fixtures & BRANCHOFFICE USE �- on LemPReceptacles MOTORS HEATERS CIRCUITS ONLY lion Skle Attach't H.P. A.V4G- , i Gelling wall Recap'Is Swfth Pendant Bracket Na Typo PROD , NO, - Ejech ND. Gauge INSPECTION OUT• v - SID Joe SUB- EASE BASE- MENT Im / . FL. , 3 . p.. f s F. F d 3rd l FL. REMARKS: L137 ER LECTRICAL DEVICES NOT SET FORTH ABOVE. � , r THIS APPLICATION IS INTENDED TO COVER THE ABOVE-IUSTED 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 52E OF MAINS y� FEEDERS ELECTPoC SIONSfLAMPS TOTAL NWTS 000% LJ CHAFPCrER OF WORK �,f �+ ExposED GAS TUBE SIGWMtA1NSPORMERB OF14 W Q .I� - NCEM.ED DME WDRK TOZ STAPTED_ oeTE COMPLETED 52E OF SIGN(NUMBER) CAPACITY SERVICE ENTERS BUILDING/I _ hNUFPGTURER OF SIGN ❑ OVERHEAD NDERGROUND WE: INSPECTION R EPUESTED ON TOR AS NEAR POSSIBLE) 1�$T APPLICANTS IOEEIrrrWMAT40N Iae M111ER �► AMP LAYS BY GFIVINO FULL AMP A0WRomTE 1NFDRMAT IIIE FILLED M OR APPUC&DOW MAY BE RETURNED_ PRINT NAME AND ADDRESS NAM AP, lPL NT d DATE OF APPLICATION all BE A7W STREET ESS H..�1 '�`' �_ +_G'r aiJ'�..� IO L►� TEL P CITY R POST CFF CE ZIP E LICENSE O, EN APPL "Ajfwr cog a ❑ 85 John Street 41 State Street 570 Delaware Avenue ❑ 217 Lake Avene El202 Arterial Road NEW YORK, NY 10C138 ElElALBANY, NY '12207 BUFFALO, NY 14202 I ROCHESTER,uNY 146C18 SYRACUSE, NY 73206 THE NEW YORK BOARD OF FIRE UNDERWRITERS TOWN OF QUEENSSURY � Zoning Administrator a t � � i ! i � k � f s %LI € Acp , 've r ORION III III III s 3 i