1988-847 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date January 26 19 89
-731- --3
This is to certify that work requ ted to be done as shown by Permit No. 88-347
has been completed.
This structure may be occupied as a One Family Dwelling
Location 120 OakTree Circle
Owner Rich. Schermerhorn
By Order Town Board
TOWN OF QUEENSBURY
;(in ; /
Building & Zoning Inspector
• BUILDING PERMIT H
TOWN OF QUEENSBURY
No. 88-847
WARREN COUNTY, NEW YORK 0
PERMISSION is hereby granted to Rich Schermerhorn `O
w
OWNER of property located at Lot 120 Oak Tree Circle Street, Road or Ave.
in the Town of Queensbury,To Construct or place a One 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.
1. OWNER'S Address is
Harrison Avenue
Glens Falls,New York 12801
cn
C)
2. CONTRACTOR or BUILDER'S Name co
rt
co
SAME n
3. CONTRACTOR or BUILDER'S Address n
0
SAME
H.
4. ARCHITECT'S Name
5. ARCHITECT'S Address
•
0
rt
N.)
6. TYPE of Construction—(Please indicate by X)
0
K))Wood Frame ( ) Masonry ( )Steel ( )
H
7. PLANS and Specifications co
co
No. 28' x 26' One family dwelling as per plot plan, specifications, H.
and application,including septic and attached two car garage. .�
8. Proposed Use ro
One family dwelling
0
CD
25.00
$ 235.00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 1 1989
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the N•
town of Queensbury before the expiration date.)
C-J
Dated at the Town of Queensbury thjs 7th Day of Novembe 1988
SIGNED BY C/ for the Town of Queensbury o4
Building and Zoni g Inspector
• . . . . .
I ,.... ' TO BE COMPLETED 13Y .BLDG. DEPT. TOWN OF QUEENSBURY
,--\---,.- .
.. -7L'iti-ii 0/) Qiieenitur, Application No. -- 'l ':a '..1 !:
'Permit Issued Vir19 ri'`''. ' - '
64.1ILDINel and ZONING DEPARTMENT Permit Expires 19 ' - r--...-•': 1 . 1988 •
Bay and Haviland Road, R.D. 1 Box 98 . Zoning Designation ,Sfirt-//) . • .
. .
Queensbury, New York 12801 Variance No.. .BUILDING &CODE DEPT.
q5 ---5 • . .• • 1 Site Plan Review NO.
. , . . Approved by://
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APPLICATION FOR • . , . ,/
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PUILDING AND ZONING PERMIT ' '
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* * * * * .* * * 4-, * .4 * it.' 4• * * 41.. * * . * * '7* if- * * * * it. * * * .-* * * *- * * * ;:.* • -
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. ANSWER ALL OF THE FOLLOWING. -
, . .
The undersigned hereby applies for a.Building Permit tO do the following work which will
be done in accordance with the description, plans and specifications'submitted,. and such '
special conditions as may be- indicated on the Permit. .. .
. - . . .
. , . .-. . .
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The owner of this property is ' R. -5clie..e m o,r 1, D. rtv . , • . . .: - . .
P.O. Address Ana-ri5 0 /4.) ' 'Ittita.• •a .F.. , ... ... , ' Tel 7p8'_06741
Property Location: , Lot •/2.6 ' GA V .71-re.e.-• C.;'Z'c'ci e-- . Tax Map No. / /
. - Street number-or building lot number
• . •
Subdivision name (if applicable) 4 i a 0 eil) /4 ;113 •
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. THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
RiCill -5e..hr'Asytkt.,44wor/V. 30 tl., r el OAJ Ai/ t., , 77S -061V .
Name . P.O. Address Tel. No. ' •
• ,I • . • -
Name- of builder R. 5 e.,Le...,Ir`Wie...r%WA /I/Address n */*i..50A1 - i0 ve, Tel. 7 7 so -04 7Y:
• . .r.- •
Name of plumber 16 . foohl . . Addresa . Au crAiu-}. jiln Tel 7 9 ro6 9
Name of mason ROL. 5ksotaJticA)c...' Address Aln/4,),,,,/,'"cij• ' . ' Tel.
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NATURE OF. PROPOSED W3RK: * • ZONING INFORMATION:
, • .
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)( Construction of a new building . * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
_Addition to a building' . -.- •: .4. drawn reasonably to scale and attached hereto,
_Alteration
to a building ' r '' • * showing clearly and distinctly all buildings, . .
•
(no change'to exterior .dimensions) ' * whether existing or proposed and indicate all
Other 'work (describe) . - .. * set-back dimensions- from property lines. Give
* street and number or lot number and indicate
* whether interior or corner lot. Show location
FOR DEMOLITION PERMIT, STATE SIZE AND * of water supply and. location and 'configuration
LOCATION OF. STRUCTURES AFFECTED. * of septic disposal area.
. .*
• * COMPLETE INFORMATION REQUIRED BELOW.
*
. Size of property ' •-: --- •t X 130- ft.
" - * Existing building S') S'h, . . ft X. ft. . .
PROPOSED BUILDING AND USE:
* Existing building(s) Use.
Size of new structure alg ft X2.4 ft * ' ' ' ' r
•
Foundation-pier/slab/crawl/partial/c1.13 * Proposed building, distance from property line •
— *
(circle one)
*. Front yard V5- ft Rear yard 15 ft
No. of stories (habitable space) 2_.
Side yards is . ft and /4 ft
Height (grade to ridge) gir. 25 ft. *
* If•on corner, setback from side street ft
If residential, no. of families / • -
No. of rooms(excluding baths)-: .. 7 ' * OCCUPANCY INFORMATION
No. of bedrooms 3 - • *
* PRIMARY 13UILDII‘IG -
No. of bathrooms i//L.
*.•is......One family dwelling
PriMary heating system Eje_cd46e,
* Two family dwelling . .
Type of fuel Life-Irk., .. .
* Multiple dwelling / Number of units
No. of fireplaces to be installedA/OWE =-
Permanent occupancy
Will a wood stove be installed? /t/6 * — • . , •* Transient occupancy .
'Central Air conditioning? AM. . •
. * Business -
BUILDING ,STYLE, PRIMARY STRUCTURE
- ,-,.. . Industrial
,
Ranch Contemporary .Log cabin * —If addition, what will use be?
Raised ranch Mansion Duplex *
Split level Old style Bungalow *
,.ape Cod Cottage Other * ACCESSORY BUILDING- ' ,
Colonial) . Row ' Town House * - Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) *- )( Attached garage/one car/ two car/ x car
* * * * * * * * * * * * * * * * .* * _.Pr.ivate storage building
ESTIMATED MARKET VALUE •OF * Other •• 1 .
CONSTRUCTION - * - '
'$ 1.1.q beta
-- -7 ,
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET; TO BE COMPLETED!
Form BPA 4/86 mcIvl . .
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BUILDING PERMIT APPLICATION CONTINUED -
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BUILDING• SPECIFICATIONS:
Type, of construction, ,wood frame, fire safe,etc. t„•ibQc ffow•.a
Will any second-hand or ungraded lumber' be used? If• so, for what?
Foundation wall material n,r,/�p T}�„ - ' Thickness /2. "
Depth of foundation below grade (to.: bottom of footing) . (p' '/ .
Will there be a cellar? q/p Heated or ., eated • . ' Floor sq. footage . 7 L 4 sq ft
Will there be a basement? As Will any portion be Used as living space? ma • -
(If so, what portion? sq.ft. - - Type of use?
Type of roof slope• flat/shed/other Material•'of roof rAywond , Ai S' -G/t, ?rZS •S"'vIGS
Size; wood -studs "X .( " spacing /( "o.c. length ' ft.
Joists(floor beams) 1st. floor Z "X /0 " spacing /G "o.c. span t ft. - ti
Joists (floor beams) . 2nd. floor 2' "X /o " spacing /(o "o.c. span 1;.9ft.
Overlays(ceiling beams) 2. "X V . " spacing Z. "o.c. span 2 1 ft. -
Roof rafters "X " spacing o.c. span ft.
Roof trusses(pre-engineered) ' spacing Z_ "o.a. span 2 1' ft.
Exterior,wall f.inish� V" Caa4 r c� % S Of what material? . ✓in y L
Interior wall finishe4roc,K '
If a garage is to be attached, describe materials to be used for FIRE SEPARATIOLJ: •
bl 1 F';c e,co d e, S he,edire c i •
Is there to be an opening.between garage and dwelling?. y/G S If so will a Fire-rated
door, enclosure, and self-closing device .be• provided? • - Ve, r
Will a flue-lined chimney be installed? A/0 Height above roof ft.•
Depth of chimp ey foundation below grade . . ft.
Depth of'fireplace, hearth ft. in. - •
Water supply -, Municipal. or private well )v10'I IBC,60 4.1
SEPTIC SYSTEM _ Distance from ANY private well(including adjoining properties /ttir- ft.
(A separate application is'necessary for any repair Or new installation of septic system)
•
Down of Queensbury • A FFIDAVIT STATE OF NEW YORK
County of Warren . -
I swear that .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 donelon 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.
1.__.:Z/ --Z-Z-..-L . .
SWORN TO BEFORE ME THIS Signature
i/2
Owner, owner's acjent,arcnitect,contractor
day of 19
(lotary Public; Warren County, N.Y.
* * * * * * * * * * * * *. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT: '
Dy
{ ✓_ , 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 /6 ITO /
2 . Type of heat &1e..cd > b a se, 40 a rC3
3 . Is the building mechanically cooled? NlJ
4 . Percentage of area of windows and doors /y %
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 NO
a. ' Are foundation walls insu ated? YES 41+
1. If YES , what is the R value?
3 . Slab on grade NO
a. If YES, wha� the R value of insulation around
perimeter of floor?
4 . Is basement heated? YES NO
a. R value of insulation
5. Type of -insulation A-Ater- lass
B. Under 16% Only
1. R value of roof and floors exposed to ambient conditions
roof - R--3$
2 . R value of exterior walls Ze Z5
3 . R value of glazed area y. 8
4 . R value of doors X — /3 •
5 . R value of floors over unheated spaces le - ZS
6. R value of slab edge insulation - unheated slab /L/74
7 . R value of slab insulation - .heated slab /V/A
8 . R value of heated basement/cellar walls (above grade) ,-Z5
9 . R value of heated basement/cellar walls (below grade) /l--/D
10. Type of insulation c { Q Q SS
C. Controls �J e
1 . Thermostat maximum heat setting $�p
D. Duct Systems
1. Is duct system installed in unheated spaces? 'YES NO
a. I'f YES , R value of duct installation
b. R value .of duct in other areas
E. Piping Insulation 3/
1. Size of hot water or cooling carrying agent pipe V
2 . R value of pipe insulation i/,A-
F. Service Water Heating �� d
1. Performance efficiency
2 . Temperature control setting maximum /Yo
G. For Swimming Pool Only X x x
1 . Maximum heating x X'
Telephone No. / (267 �
(applicant s signature)
f': •
APPROVED
O'VED
Oor1L/t- of OU?L/m(, r
DATrri
- APPLICATION FOR SEPTIC DISPOSAL PERMIT 2014I1i(1&0(DO COOLS OU?.
lowrtof QUEDt;t1l1ILY
•
DATE %>( /
•
LOCATION OF PROPERTY FOR INSTALLATION l p' /Zo o/E Ik
Owner's Name: _Kje-Al gc yte../Pvv1t_A-- o(A) Telephone: — 773 - O 6 7 II
Address: I7A✓'/'/•SOit) tle_d G f •
Installer's Name: S&P- : o.• �` �l Semi t,J�' Telephone: 7p . 7 Z 5 7
Number of bedrooms (residential only) _ 3 _
• Total daily flow (compute n 150 gal per bedroom) 7-4-0 •
Topography: circle•one: g Rolling Steep Slope % of slope
Soil Nature: circle one: Loam Clay Other / Depth:' feet
•
Ground Water: At what depth? . Aide feet •
. Bedrock or Impervious Material: At what depth? — g lff, feet
Percolation tests circle onenot require required / rate min. inch.
Dosuestic water supply: circle one: CM Well Other
• IF domestic water supply is a Well: •
Separation: Watersupply from Septic absorption . feet •
PROPOSED SYSTEM: Septic Tank ja p Q gal. (niinimum size: 1,000 gal.)
TILE FIELD: Each Trench feet / Total system length. feet
SEEPAGE PIT(S): Number of 3 / Size each 6 feet by r feet •
Size of stone to be used IF 3 / Depth or Thickness 9 feet
* * * * * * * * * * * * 4 * * * * * * * * * * * * * * * * * s * * * *
IMPORTANT
...Plea.....LIST NEW 1 QULPMEN'1"1'O BE INSTALLED
r` * * * * * 4 * * * * * * * * * * * * * * * * * * * 4 * * * .* 4 4 * 4 * * *
(over)
•
•
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Section II Septic System Inspections: •
A. All applications for septic system installation, alteration or repair, as •
required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to.the Building Department at least Z4 hours before start
of construction and shall include a plot plau showing:
•
1.) the-proposed location of the system •
Z.) location and distance to lot lines • •
3.) 'location and distance to structures
4.) location and distance to any water supply
5.) size and diiiiensions of all tanks, distribution
boxes, tile fields and/or drywells
B. NO system shall be covered before inspection and approval by the building
Inspector. Failure to comply with this requirement may result in the
uncovering of the system by the installer and a fine of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
•
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department.before further construction.
1 have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Si tiature of responsible person: . B ' Z-Z.-
•
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Date: Ae -3 •
Town of Queensbury
• Building and Code..Dep:rtment •
Bay at Haviland Road.
Queensbury, New York 12801
•
(518) 792-5832 .
o,---.... MIDDLE DEPARTMENT INSPECTION AGENCY;INC. f
) National Headquarters
900 Haddon Ave.,-Collingswood,'N.J. 08108
APPLICANT COMPLETES THIS SECTION Date: -) , 2 �.
1
City, Town or Township >_f .', � r j;�y t,.<_ '� .�J r
tr" � County � 'r=.''vt !�.�State `//
Location/Address ...,,Y -- / .5 / .r . `:` ,—//q?
(If Located in Rural Area -Please Attach Directions) Pole # 1
Owner t e_ ;,..i+ 0 (J ; Ci Permit # /J r8
Occupied As C r f, ,-- ,re:-., ,'/ Building: New ^ Old! 1
Occupant -
Work Area in Building (Floor #,etc.):
App. for: Wiring R''Service or: Ready for Inspection:
Fee Remitted-$ Cash❑ Check Ti M.O. n Make Payable To: M.D.I.A.
500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Number of Rough Wiring Outlets Elect. Heat -
Switches
Lighting Amp. Service Surface Unit Dishwasher Range
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:
MOTORS H.P. 1/201/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4' 1 11/z 2 3 5 71/2 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size -
Applicant's _
Signature License # �, Permit #_
T/A '75 u1.. I` ei ,�, yz. c, r Utility: (�67 v° /f. //P`/0 - G 1'4- ./'.z 7/S
]-_ 3 6 1NAME1" OFFICE LOCATION)'-"'
Applicant' Address: �.-' r r_: _
(City) 4 £; (State) (Zip) •% Service Request # , -„ .
Phone # Electrician:
MDIA USE ONLY
DATE RECEIVED: rr 9 0 DATE INSPECTED: • _ r i
Correct Location: Same as Above n or:
Red Notice Label
Rough Wiring Outlets Surface Unit Oven
Switches Range - Garbage Disposal
Receptacles i 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 1/8 1/6 1/4 1/3 1/2 3/4 1 11/2 2 3 5 71/2 10 15 20 25 30 40 50 -75 100
Mark Number i
of Each Size / .
500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000 -
Elect. Heat
CORRECT
• CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE FEE FEE PAID
❑ RW Progress: Inc. LKD❑ Contractor
El CFT Violation: Work Comp.I I Inc. I I. t �`
n L/A Owner CASH El
n L/A I Fee CHK #
Due MO #
n IPA Municipal P_
INV #_
. 0 :i 1 Applicant ❑
Other Side El Utility ' � Owner ❑
Cut in Card n Temp # Date 12
ft �.iatz... am :..:
/ INSPECTORS SIGNATURE
F..-Et 161 ## 2 a ,-x(,i . Date ,2 - /-� r )
APPLICATION FORM NO.250 EL 4/89 - - - -
—- •—*�. .
BUILDING DEPT.COPY OF APPLICATION FORM 46-EL,NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED.
•
TEMP.# DATE I
y,. _. ;
1,
CITY OR i 11 .
VILLAGE s(,_- J. ;il' �::�.II`_) TOWNSHIP COUNTY j.i--`_,, . - .'il
STREET AND NO.OR 1/ --T
ROAD AND POLE NO. ( ':;, fie I ''t I ...,� __ a rJ !-
POLE NO.
BETWEEN WHAT TWO
CROSS STREETS IS /L.
PREMISES LOCATED? SECTION BLOCK LOT •r
OCCUPANT'S p't - s 1 r BUILDING
NAME f'4 .;E' l ‘= 5 -
, 't'_" \ \t rt.„) OCCUPANCY
OWNER'S NAME f,F - �j >
AND ADDRESS i'' TEL.# ', .� d
C 6
CURRENT
SUPPLIED
BY i-' -,'•-s'°-• 'al,. �f i ° "t FROM THEIR OFFICE
. BUILDING ' WORK DEFECTS
IS NEW 0 OLD❑ IS NEW ADDITIONAL❑ REMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS No.
RFecepptacles MOTORS HEATERS CIRCUITS OFFICE USE
Loca- ONLY
lion Side Attach't H.P. Watts A.W.G.
Ceiling Wall Recep'Is Switch Pendant Bracket No. Type Each No. Each No. Gauge INSPECTION
•Out-
side • .
Sub-
base
Base-
ment
1st Fl.
2nd Fl.
3rd Fl. '
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE.
This application is intended to cover the above-listed equipment to be inspected but if at time of inspection there is found additional equipment not above listed,
you are authorized to make the inspection and adjust the fee to cover the additional equipment,as provided by the applicant.
SIZE OF ELECTRIC SIGN TOTAL •
MAINS • FEEDERS LAMPS WATTS
CHARACTER EXPOSED GAS TUBE SIGN
OF WORK CONCEALED TRANSFORMERS OF . VA
WORK TO BE (NUMBER) • (CAPACITY)
STARTED COMPLETED SIZE OF SIGN _
-
SERVICE OVERHEAD UNDERGROUND MAKER
ENTERS OF SIGN
BUILDING
INSPECTION REQUESTED .
ON OR AS NEAR AS �j
POSSIBLE NEW I I OLD 111
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES DATE OF _
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION - J ': _
, `- i
PRINT NAME AND ADDRESS /! /` ,/ t
NAME OF - i - . f t' . V SIGNATURE f //f / /
APPLICANT -tr,- 3., �-- f,. ' - .. .- - .' /�OF APPLICANT r l s'. ... -----_..
STREET ADDRESS >-r. . '} TELEPHONE# 7
CITY OR - = - ZIP _ LICENSE NO.
POST OFFICE CODE J'Z -• ` / WHEN APPLICABLE
•
46 EL (REV. 1/86) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
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-I.
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x, _,,' . . .. • . .. . .
.. i.w. .:.1.,!..1,•!..1.!..1.!.. .,...!". ....,.."..,_•,...,.. ..!. ..‘...!.. . .. . ,...!,.,•?. . . . ..1.•?...1...!. .. ..,...4..1... ..1.,..1...,.. .....?...,:•!,""..,•?..,..!..,•,..,•,..,•,.....!.."..1.._.1•?_1,!..1•?.).•! •
., THE NEW YORK BOARD. OF FIRE UNDERWRITERS 1.,.e.-:.F.
41()5481 BUREAU OF ELECTRICITY .Y12
F - 41 STATE STREET.ALBANY.NEW YORK.12207."
Date FFBRWLPY 14,18".) Application No.on fikr)'1,1 11.1:::.8,,. :s:,-,-; ' . . A
THIS CERTIFIES THAT . . . .
. 1 ...
a only the electrical equipment as described below and introduced by the applicant named on.the above application number in the premises of
= i ...7..
- raii:J-I.D ii0TRI.: 120 OAFTTEE CTR'.-21E 211.PN,Str05.0,-, N.Y. . ..,,,,.. - .. . :'
1
in the following location; El Basement El 1st Fl. El 2nd Fl. irr:IT. it jUT,
was examined on :17,N is '.T-:,Y 1‘,;, I I:•S':'
ECEPTACLESI SWITCHES ' FIXTURES
DISH WASHERS EXHAUST FANS
.. •
Section Block
and found to be in compliance with the requirements of this Board.
FIXTURE Lot
' RANGES COOKING DECKS OVENS
OUTLETS INCANDESCENT-FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT: K.W. AMT. K.W. - AMT. H.P.
• , .
I
AI DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BEU .UNIT.HEATERS MULTI-OUTLET DIMMERS
AMT. K.W. OIL H.P. GAS H.P. MAT. NO. A.W.G. AMT. AMP. MAT.' ..AMPS. TRANS. -AMT. H.P. NO.OF FEET MAT., WATTS
4.,.. _1, 1'. .. .
.§. •
SERVICE DISCONNECT NO.OF
METER ' ' S - 1- - ., .'- -R '
V -. I -- -.,•- C ' E, .
-
. I
_ AMT. AMP. F.7.-N 1• Y1_, , ,
i '1/(r.; . i TYPEi wimp. 1.2 2W 1 0 3W 3 If 3W 3.0 4W
1
.‘ NO.I OFpEiCirCOND. . A.W G.
. OF CC.co.
NO.OF HI-LEG ' ot•wo NO.OF NEUTRALS
• , .
t
....::/7)
OTHER APPARATUS: . . . . A.N1119
:.:00 G.
.
1 l',',NT] =
50 M
=
Ein .71
7 , • • .
fr, .F.C... 1--. --I.i, • , I
.
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f:',,Ki.?, DETUTOT.;:- ] : -:
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— —-.,• . . . . .
• , .
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' ?...77 II-4 ••..112.,..7 L-
KEN, i;AVW1; ELE'...3T
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RR 5 Bi-',7,3 155
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(A.,ENS, FlYJ4.:.;, fly, l'n(l'.1 . BRANCH_ MANAGER =
. .
• , , '•-•!I'f,' / I...,,,,,„........ r,
• . .. :.: . Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
.,:• 0-41-4,"41-140-(61--ferye"..,"re,\"(40--,61-4,--4,--4.--teye-i.v.r.N-4.-ye-4,"4."fe./40-4,-(4.-4 rEMIM n MinfigniM MiliM nwarimmeartirmormi.,
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT Al
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 1280 -
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED Q_
NAME
LOCATIONpT /c)?Q L%
DATE /— L/ PERMIT #
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION J
FLOORS
WALLS
CEILING
j( FINAL INSPECTION':
/\ CHIMNEY HEIGHT \
ROOFING
SIDING
EXTERNAL PORCHES/STEPS L/
STAIRS-CLEARANCE &I RAILS
PLUMBING FIXTURE./REDIEF VALVE
INTERIOR TRIM/PRIVACY 'DOORS
FINISHED FLOORS,1 �.
GARAGE FIREPROOFING
DOOR CLOSERS)
SMOKE DETECTORS \ v'
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED C 'RTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS::
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INSPECTOR
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TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12801 `�g�/J��
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED ,q-{S
NAME _ ,ll��'.��
LOCATION
DATE /2f7, PERMIT # re F�l !
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BAKFILL APPROVAL
PLUMBING r/'
MING /
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT !\
ROOFING
SIDING t
EXTERNAL PORCHES/STEPS
STAIRS-CLEARANCE & RA.I`LS
PLUMBING FIXTURES/RELIEF VALVE
INTERIOR TRIM/PRIVACY DOORS
FINISHEDjFLOORS
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:
INSP CTOR
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION / 11 r./o�(U O G
DATE /(f,- PERMIT NO. fit-( /
SOIL TYPE - Sand - Loam - Clay - J
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: ily,
Absorption field, total length
Kvv
Length of eac trench
D hepth of trenches - 2.52 v
SiZe of gravel_ J _
SEEPAGE PITS4Number of)
Size-\\ ft. X ft.
Gravel Size j
PIPING: / Siz T
•
Bldg. to to k ( i✓
Tank to dist. box
Dist. box to 'eld/pit.
Openings sealed. /YES NO Partial
LOCATION/SEPARATION\
Foundation to tank *ft.
Foundation to abs rption t.
Absorption to to line } Oft.
Separation of p' s \ AL ft.
LOCATION 0 TEM ON PROPER circle one)
Front - 44:110Left side - R'ght side -
COMMENTS
•
SYSTEM USE APPROVE YES NO
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Building Inspe or •
•
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11111.
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12801 J
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TELEPHONE (518) 792-5832 �/
C,r/I Iy��'
BUILDING INSPECTOR'S REPORT
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REQUEST FOR INPE�TION REC IVED
NAME �e 64'l71jek/, OZ 71- : /%
LOCATIOIyi(l/ / Z (/(„i'C ,7 /t///r
DATE // /(/7/ / ERMIT # j(JiO y' 1
J APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
UNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION ,
FLOORS
WALLS .f
CEILING A
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING A if
SIDING if
EXTERNAL PORCHES/STEW -
STAIRS-CLEARANCE & R LS
. PLUMBING FIXTURES/RELDF VALVE
INTERIOR TRIM/PRIVACY lOORS
FINISHED FLOORS {
GARAGE FIREPROOFING
DOOR CLOSER(S) , •
SMOKE DETECTOR
FINAL ELECTRICA/ INSPECTION
FINAL APPROVALS/OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!'
REMARKS:
INSPECTOR
' „JwN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12801
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUES I OR IN PECTION RECEIVED
NAME _k ' 1 `-ers,
LOCATION {�Q -, ,,,,a.J
DATE V\,*315 PERMIT # i`t'
il
APPROVED
gai6:0- YES/ NO
FOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP—PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN '
INSULATION:
FOUNDATION V.
FLOORS 11 i
WALLS 1v / .
CEILING I iI
FINAL INSPECTION: /(
CHIMNEY HEIGHT 1
ROOFING t i.i
SIDING •
EXTERNAL PORCHES/STE S %/
STAIRS—CLEARANCE & RAAES
PLUMBING FIXTURES/RELIEF VALVE
INTERIOR TRIM/PRIV/� Y D�aORS
A/
FINISHED FLOORS \1
GARAGE FIREPROOFPG 1
DOOR CLOSER(S) ;q/ X
SMOKE DETECTORAY
FINAL ELECTRICALfINSPECTION '\
FINAL APPROVAL OF CONSTRUCTIONS
i
A SIGNED CERT • ICATE OF OCCUPANCY MUST BE
OBTAINED FROM _HE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!'
REMARKS: `--"'
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INSPECTOR
.uWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12801
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPFTION RECC IVED
NAME ..5-7C` /i/F`/� ,./ .h,, // /
LOCATION Zi17/ .�J //LYn/,,/ / //�,/e
DATE //A f 7cer-PERMIT # S Cr'
APPROVED
YES NO
OOTING/PIERS t
MONOLITHIC POUR FORMS j
FOUNDATION/DAMP-PROOFING /
BACKFILL\APPROVAL /
ROUGH PLUMBING ING /
FRAMING /
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS \ /
CEILING
FINAL INSPECTION: \ !
CHIMNEY HEIGHT
ROOFING \
SIDING V
EXTERNAL PORCHES/STE S
STAIRS-CLEARANCE & LS
PLUMBING FIXTURES/RELIF VALVE
INTERIOR TRIM/PRIVACY DOORS\
FINISHED FLOORS/
GARAGE FIREPROOFING \.
DOOR CLOSER)
SMOKE DETEC •ORS \
FINAL ELECTRICAL INSPECTION \
FINAL APPROVAL OF CONSTRUCTION\
A SIGNED CERTIFICATE OF OCCUPANCY ST BE
OBTAINF/D FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
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INSPECTOR
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