1989-477 ,y .w, _•ear :'W'��L'�'�"'�!'_.rq,.f•� ._�r_+..?r,�..+"-�.-,ag,.)'S:,e .. ..:n;�;vy'�F, •37:�F,�1F5�'f7.:�°iC!IIT„'.,. .rmlR.,_F'"'_.R re.n �!'K.sY'�S�,f. ... . . I,fZ91p�+F�,tr . %QiyM� . , .-.q ..
4 I �
CERTIFICATE ;Id' ►F +C NCCUPA1 ICN.Ne r
s
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Ategritet 91.5 . y19 8.4
This is to certify that worm requested to be done as shown by Permit No, 89-477
has been completed.
This structure may be occupied as a — Single Family Modular Dwelling
Location � t f..s 1 . . r. ....`
(]Miner Todri 5 .pv�ncnn
By Order 'Town Board
TOWN OF QUEE SOURx
/L-
Director of Bldg. do Code Enforcement
A BUILDING PERMIT
TOWN OF QUEENSBURY No. 89- 477
WARREN COUNTY, NEW YORK - ;'
PERMISSION is hereby granted to Todd Stevenson
OWNER of property located at El 1 sworth Road Street, Road or Ave.
in the Town of Queensbury, To Constructor place a Single Family Modular
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
t. OWNER'S Address is
51 Lamplighter Acres
Fort Edward , H . Y . 12828 v
rz
2. CONTRACTOR or BUI LDE R'S Name ^_
Lamplighter Homes
a CONTRACTOR or BUILDER'S Address
r_
RD#2
Fort Edward ,N . Y . 12828
4. ARCHITECT'S Name
r
5_ ARCHITECT'S Address c
a
C
6. TYPE of Construction — (Please indicate by XI Q
C
i 1 wood Frame I Masonry 1 1 Steel f 1
7. PLANS and Specifications
No. 26 ' x 48 ' Single Family Dwelling ( Modular ) as per plot plan ,
specifications , and application .
B. Proposed Use =
cc
Single Family Modular
0
$ 144 PERMIT FEE PAID — THIS PERMIT EXPIRES January 1 19 90 4
{If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.) c
Dated at the Town of Queensbury this Da f Junei9
SIGNED BY for the Town of Queensbury
Building and Zoni6g Inspector
/0W40141 0/
BUILDING and ZONING DEPARTMENT TOWN OF OUSEN$sURY
Bay and Haviland Road, R. D. 1 Box 98 RECEIVED
Queensbury, New York 12801 L '
JUN z 3 1999
Approved
FORAPPLICATION FO
. . h CODE DEPT,
BUILDING AND ZONING PERMIT z
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 -
The owner of this property is : �"E) JA
P, O. Address / O,'L T ri! s,' .nC rf .+ '7 Tel .
sroperty Location ; �1f 1-z,) QAer7 .4 ft p ja d _._..---•. Tax Map No
Street number or building lot number
Subdivision name. (if applicable)
1112 PERSON RESPONSIBLE FOR SUPERVISION OF 'WORK AS REGARDS BUILDING CODES IS ;
';---
Name P. O. Address Tel a No .
Naive of builder 4 P(' G Address le �2. Cdr� Tel .
Name or plwnber Q / Address im. _} �'? 4!5 •� Tel . 7 g 1 - .T 3
Nam4 of rtxason .�J � � Address _ 4? . i`> .�,- >�-? ' _.f-�rcr+ TTeI . 7 9 3 - 7 9 5
NATURE OF PROPOSED WORK : � ZONING INFORMATION :
Construction of a new building * TWO PLOT PLANS MUST BE PREPARED AND SUBMITTED ,
Addition to a building drawn reasonably to scale and attached hereto ,
Alteration to a building * showing clearly and distinctly all buildings ,
(no change to exterior dlwenslons )' * whether existing or proposed and indicate all
Other work (describe) " sat-back dimensions from property lines . Give
* street and number or lot number and indicate
FOR DEMOLITION PERMIT• , STATE SINE AND
* whether interior or corner lot , Shaw location
LOCATION OF STRUCTURES Al"FOCTED , Amof water supply and location and configuration
of septic disposal area .
*
* COMPLETE INFORMATION REQUIRED DCLOW .
* Size of property % ^ 1 f t X S 'eft -
* Existing building ( s ) Size: ft X fte
*
PROPOSED BUILDING AND USE :
Existing building ( s ) Use:
Size of new structure f t x.��r!��� :
Potuidat ion-pier/slab/crawl/partial full * Proposed u%]. ' n , die ratnce from property line
(circle one ) * DCeti
No , of stories (habitable space) er * Front r 6� � �' Rear yard_ cx/ ,� j9' ft
* Side yar s ,� 3 /' ft and f. � ft
Height ( grade to ridge ) /55 ft , If on corner , � � _
If residential , no . of families i * , setback from side street
Noe OF rooms ( excluding baths. ) Z * OCCUPANCY INFORMATION
No, of bedrooms j
No . of bathrooms '� . PRIMARY BUILDING -
Primary heating s . u . . � One family dwelling
Type of fuel �., * Two family dwelling
No , of fireplaces to be installed * Multiple dwelling ./ Number of units
Will a wood stove be installed? permanent occupancy
Centr..el Air conditioning? LI • Transient occupancy
* Iiusin[:ss
BUILDING STYLE, PRIMARY STRUCTURE * ' Industrial
Fcanch Contemporary Log cabin '� Other
Raised ranch Mansion Duplex * If addition , what will use be?
Split level Old style Bungalow
Cape Cod Cottago Other * ACCESSORY BUILDING--
Colonial Row Town House Detached garage/one car/ two car/ car
( CIRCLE ONE, PLEA.�;E ) * Attached garage/one car/ two car/ calm
* * " * * * * * at * "` * * '�' '* ''� Private Storage building
ESTIMATED MARKET 'VALUE OF * �t7ther
CONSTRUCTION
$ -. -fir-'
INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED I
Form BPA B/aG and-vl
UUILDING PEIgUoIll' AIPPLS+Ch'VION CONTINUED
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe , etc . AG100 �+ /`r 4'
Will aeay secondhand or ungraded lumber be o used? if so , for what ? 0
Foundation wall material C C, ' c. r2 e T -e Thickness sk r
Depth of foundation below grade (to bottom of footing ) ���
Will there be a cellar?`yoJ Heated or unheatad? iA , e £ loor sq. footage_ J yr ' sq ft
Will there be a basement . , ,. ` . Will any portion be used as living ::pace ?
( If so , what portio ) sq, . ft , - - Type of use?
Type of roof sloped lat/shed/other Material. -of roof
Size , wood studs �i"x—(f-- "` spacings"o . c . length .7�x t .
Joists ( floor beams) 16t . floor "3c�_ spacing"o . c . span r 3 ft .
Jolsts ( floor beams) 2nd . floor pox " spacing '"o . c . span ft .
Overlays (ceiling beams ) "x of spacing "o . c . span ft .
Roof rafters "x " spacing o . c * span ft .
Roof crusses (pre-enginaered) spacing"O . ce span�3 ft .
Exterior Wall finish ZAP L ,J . • G _ of what material?� !.�'4 r. yK �
Interior wall finish T / a rt-grt r /cz
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 :calf-closing device be provided?
Will a flue-lined chiinney be installed? Haight above roof ft .
Depth of chimney foundation below grade ft .
Depth of fireplace hearth ft . in.
Water supply Municipal or private well frr2
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)
Town of Queensbury A F F .'I D A V I T 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 witty the plans and specifications aubtitted , are a true and
enmple:te statement of all proposed work to be done ,on the described premises and that all
provitilons of the BUILDING CODE. , 11iE ZONING ORDINANCE , and nll other laws pertaining to
the: proposed worst shall bu complied with, whether specified or not , and that ;acts work is
authorized by the: owns=r . . _-�� _,.� � _
SWORN 1' ME BEFORG E THIS Signature _ __ __ �
i-'
__ r , GWner ' .:a �iai .:lrCfYlt ect , contr T to;
day of ly
Notary Public , Warren county , N . Y .
x w x • x f" : s * ar k rt w xk /" 'k yr rt x r ,r * x s +" x x * it ye yr
SPECIAL CONDITIONS OF THE PERMIT :
Ely_ _....____ ______
TOWN OF QUEENSBURY C(
WARREN COUNTY , NEW YORKLJ �
Application for : BUILDING PERMIT IN COMPLIANC9 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 / r
2 * Type of h e a t W! s ?' a,.J 4 I--e k1k.- 4 'k c�
3 . Is the building mechanically cooled ? r4 � �
4 . Percentage of area of windows and doors
A . Over 16 % Only
i . 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
•3 . R value of glazed area
4w R value of doors
5 . R value of floors over unheated spaces
6 . R value of slab edge insulation - unheated slab
? . R value of slab insulation - heated slab
e . R value of heated basement/ cellar walls ( above grade )
9 . R value of heated basement /cellar walls ( below grade )
10 Type of insulation e` n 'F
C . Controls
T . Thermostat maximum heat setting, 942
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 y
1 . Size of hot wat. er ' or cooling carrying agent pipe
2 . R value of pipe insulation
F . Service Water Heating
1 . Performance efficiency
2 . Temperature control setting maximum
G . For swimming Pool Only
1 . Maximum heating
Telephone No . '? 7 � 23 2'
( applicant ' signature )
le -
�at�r7lt. [J V�"t��f3.�r.•{!'r� I]AT
APPUCATJON FOR SIZPTIC D SPCaSAL FR11MIT 10111fiG L 11LDil CODES DINE.
1UVM or cturrI41lulty
LOCATION C}lv Pnopi: nTY FOR INSTALLATION a
ea d
Ownr r'a Name: Telephone:
AdtlrNsS• -� ! 5
In't:.11er's Name: _T-a d ,77 e i..r &,. Y0 . Telephone:
Number of bedrooms (residential only) .�
Total daily flow (compute 0 150 gal per ballroom) ffS�
Topop.ruphy: circle one: rl Rolling Steep Slope 9; of slope
Suit Natsara:: circle ossr: Stan Loans C
lay Other J 17epth: feet
C.rourad W:attw: At what depth? f-�/ y�4 feet
liu�la-pck ur fuxlaerviuu:: Matt:rial: At what depth? _ ,. r�/,a feet
PurcOL'Ition test: circle one: of req re%)r,ecluired f rate min. inch.
Douxesti►: water supply: circle one: Municipal ell Other
11' domeatie w" ter supply is a Well:
Scl3ar:atioxa: w atemaupply from Septic .absorption �Ze' ----x-' feet
PROPOS,C'U SYN'rl::M : Septic Tank / � o c] Leal. (113inimum size: 1 ,000 a:sl.�
TILI* FlELD: Each Trench 2570 feet / Tot:al system lenoth feet
Sl~LPAGE PIT(S) : Numbee of / Size each feet lij feet
Size of :atone to t,4* u:.•i:Lt li / Depth or `Vhicknesa feet
a * * ir * s s + � ; : ac � ssracvss * s � sas * a * ss � sara► asrss * ors t
IMPORTANT
N1;W L•`(Z []LNivVLNal*TO Un IWSTALI. vD
a a i a s �s i s * + i a a �► � ass i a s a � �► i ai ♦ ^� a► i # * F a a of � a a ae iK a
(over)
SacCion II S4ptis Syst ,,+�n InartsecCions: '
A. All applications for septic system inst:all:. tion. alteration or repair, as
requie•+id by t1,L Town of Quccnsbowy Sanitary 5uwa};r Ordinance, ala:ali
L4 Submitted to tlu, Building U&.4jjart1xa0tat :at least i:-1 hourx; LefUra• staa•t
Of Ca►nsta'uCtion alld shall iJ 1CIL&LiC :a plot plaea :;hGWiI%g.w
1 .) the proposed location of the system
2.) locations :and distance to lot lines
3 . 1 location and distance to structures
4 .) location and distiance to :any W"%"& supply
5.) siie and dimensions of :all tank::, distribution
Loxes, the yields andlor drywells
B. No system shall be covered before inspection :and approval by the building
Inspector. Failure to comply with this requiaretnent may result in the
un4.:crvering of tlau sytAval by the: installs r .and a fin.: of up to CZ50.00.
C. An approved copy of the plot plan shall lie available on the construction.
site. Failure to produce said plat plan at tinge of iilspr=ction enay result
in an imnaediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation.
alteration or a-a:laaie of an approved aysta:en, a new pralaosal must bay suLallittcd
tea the Queensbury Building De par tma=nt liefarrr further construction.
l have mead the regulations above and agree to abide by these 'und all requirements
of thu "Town of Qua:entbury S«uaitary Sewage I]i::lao:::al Ordinance.
Signature o(. responsihle person: 4-qe - - -
� M•
Town of Queensbury
Building and Code_ Dep:trtment
rMay at Haviland Road
Queensbury, New York 12801
(518) 792-583 -2
TOWN OF QUEEN SBURY
BUILDING AND CODES DEPARTMENT ' `/
BAY IsHAVXLAND ROADS
!2vFvNSBURY, NEW PORK 2$O�
TELEPHONE (528 ) 792-5832
BUILDING INSPECTOR' S REPORT
RES.)UEST FOR INSPECTION RECEIVED_
NAME
LOCATXON
G ) FgRMIT #
DATE APPROVED
1 YEs NO
FOOTINGIPIE UR FORMS
MONOLITHIC
FOUNDATTONIp �'IFROOF�7NG� --
BACKFILL APP Ax'
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
(,,,FINAL INSPECTXON:
CHIMNEY HEIGHT
ROOFING UI
SIDING TEPS le
,EXTERNAL PORCHES/
STAIRS--CLEARANCE & RAIL VALVE_
PLUMBING FXRTUR SIRELIDOO
INTERIOR TRXMI
RIVACY FINISHED FIFO FIND ~--
GARAGE FXREPR �—�
DOOR CLOSER ( )
IRSSMOKE DIE
FINAL ELECTR AL ISNSTRUCN
C
FINAL APpRO L OF CONSTRUCTION
A SIGNED OCCUPANCY MUST
CERTIFICATE OF pARTMENT BEFORE
BE
OBI�ENPREMI M THE I L]DXNE'U 'F;
THE
REMARKS :
}+ ovt 0" ? rr7c of ,�
lfo
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 1280&
TELEPHONE (518 ) 7' 92- 5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED _
NAME
LOCATION S'e '�
_ "^_�, -� RMST #
efy
DATE
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATIONIDAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-rN
INSULATION:
FOUNDATION
FLOORS
WALLS
INEILING
AL INSPECTION:
CFIIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEPS
STAIRS-CLEARANCE & RAILS
PLUMBING FIXTURESfRELIEF VALVE
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSERS)
SMOKE DETECTORSINSPEC
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
11
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED'
11
REMARKS
G
INSPECTOR
s a .? gun cr/ Queenji" Poy
BUILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R_D- 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL. SYSTEM INSPECTION
NAME
LOCATION �y
DATE / PERMIT NO.
SOIL TYPE - Sa am�.r C:laW -
Percolation Te t Required? YES - NO
Percolation ra - Min/Inch
TYPE of SYSTEM:
Absorption field total 1 gth
Length of each nch
Depth of trenches
Size of gravel
SEEPAGE PITS4Number f) ; '
size- ft. X _ t ,
Gravel size
PIPING : ze Type
Bldg . to tank E • ply
Tank t0 [3Yst . boxrr tf
Il i St. box to fielL�/ � ' ! 7
Openings sealed? .�� O Partial
LOCATION/SEPARAT2C7Ns :
Foundation to tags ft.
Foundation to aboorption t .
Absorption to lc� t line r}
Separation of p,fts ft .
LOCATION OF _SYj!EM ON PROPERTY (ci cle one )
Front - ear Left side - Right. sx e -
C:CRMENT
e
SYSTEM USE APPROVED IVO
Bui ng Inspector
01/86 and vl
TOWN OF QUEENSBURY
Bay at Havlland Road, Queenshury, NY 12804-9725-518-792-5832
00
top
Q I lew .,.C.-�-�
"HOME OF NATURAL BEAUTY . . . A GOO PLACE TO L E"
ETTLED 1763
rFErf r
air
MIDDLE DEPAHTIVIE[+, TANSP%TION AGENCY INC. t f ` "
9OffQ Had
171"veihw�.C4 llin- 0 woo ,i�1 �408
-- _ . Dat*,L July 307 IC3C
Cerritir'z that t e tricai equipment listed has been examined andlis approved as being in accord
with the National Elects" Comi applicable governmental, utility and Agency rules.
:onni a Steve n +: s . � F y Dwej inry C
C]wner. • 7
C3ccuparit. Same s j T� '§� `�..
Ellsworth R t�legns�lxy a�exf�dG�s��
LOCatJor7 h certlticare carat the electrical equipment and rust auation inspxtee this C,
date, It additional equipment shay be invoduceo or aitetahons made to
Q'Q Limp ,cie CE. �";,•, exis#ing system this carttficoft be nuts and void. and application for
Equipment,' �, .i in apect inn shaula tss submitted prae+puy to this Agency,
3 $ h= ?" .,Kr i ; „„ ,� ,Wolder of thrs Cartii'rcate ahouid ygSenl some to his property insurance carrier
lagent arcompany] as evid"Cof$0x6rtifiCatt"of electrical equipment approved
as specd„ad-
F'Lampli, ghter Ii , . ,; C
Applicant: Saratoga Road _ .-4-. . ' t _=: - _..
, `' No - 15 - 23965
Ft Edward , &TY I2828 : . ,. C
tr....r tee 'M'+ F4 i.aa
TOWN OF QUEENSBURY
BUILDING AND CODES DE1°AR7M,SNT
BAY & HAVILAND ,ROADS
QUF*ENS'BURY, NEW YORK 128Ug.
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUEST FCJR-- I-NSp CT2O1V ECEIVEb
NAME 4� 7 I
LOCATION
DATE
APPROVED
FOOTING/PIERS YES NO
MONOLITHIC POUR FORMS
`�&'FOUJVDATYON/DAMP-PRODS ItyiC '
GwIIIII KFILL .APPROVAL
ROUGH PLUMBING
FRAMING
RLECfiRSC'AL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCH,E,g�rST
STAIRS-CLEARANCE S ,
PLUMBING FIXTURES H I
INTERIOR TRIM/PRI ACYIEF bpO LIVE
FINISHED FLOORS
GARAGE FIREPROO Na
DOOR CLOSER (S) --�--
SMOKE DETECTOR
FINAL ELECTRICA I'NSPECrXON - ~
FINAL APPROVAL F CONSTRTJCT20N ~~
A SIGNED CERTI 2CATE OF OCCUPANCY MUST BE
OBTAINED FROM HE BUILDING DEPARTMENT .BEFORE
THESE PREMISES ARE OCCUPIEDI
REMARKS:
1VSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
SAY & HAVTLAND ROADS
QUEENSBURYr NEW YORK 12802 ZOO
-
TELEPHONE (528) 792-5932
BUILDING INSPECTOR' S REPORT
REQUEST FOR TNSPECTION RECEIVED
NAME �^
LOCATION
DATE �i - , � PERMIT # ey ��
APPROVED
YES NO
FOOTINGIPTERS
4o.L.ITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACXFXZL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH"�+,YN
TNSULATTON.&
FOUNDATION
FLOORS
WALLS
CEILING .'
FINAL TNSP CT TON:
CHIMNEY HEIGHT
ROOFTNG
SIDTNG
EXTERNAL PORCHES/,STEPS
STAIRS-CLEARANCE 0'& RATLS
PLUMBING FTXTUREA"/RELIEF VASE
XNTERTOR T22IM/P$XVACY DOORS
FINISHED FLOOR
GARAGE FIREPR FING
DOOR cLOSER (s)
SMOKE DETECTO S
PTNAL ELECTRTCA INSPECTION .
FTNAL APPROVAL F CONSTRUCTTON
A .SIGNED CERTT CATE OF OCCUPANCY MUST BE
OBTAXNED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPTEDI
REMARK,( /
- `
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY 6 HAVILAND ,ROADS
OUEENSBURYP NEW YORK 12802- 1q
TELEPHONE (528) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSP{'ECTZON ECEIVED
NAME
LOCATION
J
DATE 1 PERMIT
.APPROVER
YES NO
�TING/PIERS
NQLITHIC POUR FORMS
FOUNDATIONf P-PROOFING
BACXF"SLL APP VAL
ROUGH PLUMBING,
FRAMING
ELECTRICAL ROUGH N
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION ,
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE /STEPS
STAIRS-C.LEARAN E & RAILS
PLUMBING FIX RES/RELIEF VALVE `
INTERIOR TRI PRIVACY DOORS
PXNISHETI FLO RS
GARAGE' FIRE ooFING
DOOR CLOSER S)
SMOKE DETEC RS
FINAL ELECTR AL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS: /
rr
INSPECTOR
SE1_ECT BUSINESS FORMS (609) 848-5203
APPLICATION FOR ELECTRICAL INSPECTION
PLEASE BEAR DOWN YOU ARE MAKING (4) COPIES
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.%I�1/ -�1A .
-- National Headquarters
900 Haddon Ave., Collingswood, N.J. 08108
.{ , / Date : :rS
City, Town or Township e u 4>� .t icy.
� Caunty„!",!.!',�-:;ir2'i�' ,f'.�-� State
Location/Address e� ' i at
( if Located in Rural Area - Please Attach Directions) Pole #
Owner _1�0 .-L d- -7 -P r1 .d ti . ,,..._ Permit #
Occupied As G�
Occupant .moo rL d n4p :/ p Building; New[ Old �]
Work Area in Building Floor #, etc. ) :
App. for: Wiring Q Service Q or: Ready for Inspection :
Fee Remitted - $ Cash Q Check Q M. O. Q Make Payable To: M.D. I.A.
2500 2]50 3000
Number of Rough Wiring Outlets Elect- Heat 500 250 I00p 1250 1500 1]5o 2000 2250
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:
K40TOR.S H-P. 1/2 1/12 1/30 1/8 1/6 1/4 1/3 112 3/4 11 1 1 1 5 ]N2 10 1 15 1 20 25 30 40 50 75 1Q0
Marls Number
of Each Size
Applicant's l,r
Signature j .✓g.�.�`�'�.+K.-� .hr' cs .d.�e �''�l' License # Permit #
T/A Utility : ^) �.� l
Applicant's Address: r-Z- b - ro Air (NAME F C L OCH r
(City),v►c1" �_ + ,4,s,G- GI (State)_.,a >9 (zip) Service Request #
Phone * Electricians
• DATE RECEIVED: DATE INSPECTED:
Correct Location -. Same as Above Q or :
Red Notice Label Q
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, 1/2�0 1/12 1/10 1/8 1/6 1/4 3/4 1/3 1/2 1 LVx 2 3 5 7+fs 1D 15 20 25 30 40 150175 11001
Mark Number
of Each Size
500 F50 1000 1250 1500 1750 2p00 2250 250012750130001
0 2]5a 3000
Elect. Heat
RTifICA71aM! USE FOR INITIAL VISIT ONEY d NOTIFIED DATE CORRECT
FEE FEE PAID
Q RW Progress: Inc. [] LKD Q Contractor
Q CFT Violation : Work Comp. [ 1 Inc. 0
Q L/A Owner CASH 71
[] L/A Fee CH K #
sl
IPA Municipal Due MO
INV #
Date : Other Side 0 Utility Applicant Q
Owner (�
Cut in Card Q Temp # Date
--------------
cr- 2vo
y� 7. Pe J' /D
Ale
i
i y,�aff
i
i
i
,J
TOWN1 A 1 ii J� ���i o
TOWVN OF QLEENSB RY a r4 C
LE
j ,Zoning Adminis# or
lie . . .
Fe LP S � ..� WO E ` A d
7q. 4V
MOLENS
OR8E ENGINEERING
August 15 , 1989
allLOWER DIX AVENUE FALLS, NY 1200I
Town of Queensbury
Building & Codes Department
Bay at Haviland Road , Box 98
. Queensbury , NY 12804
RE : Lamplighter Homes Modular Home Inspection � �� � %10�
Gentlemen
In compliance with New York. 'State regulation Morse Engineering
has conducted an on- site inspection of a ontory single family
modular duelling located -at •-Stsevanao T n Road ,t own of Querensbury ,
at the request of the current owner , Lamplighter Homes , Inc .
Said inspection included visual examination of the foundation for
possible damage from placement of the modular eectione , main beam
connections and column support , as well as roof structure
connections .
Foundation - 0 . K . - 8 " poured concrete ; no crackle , chips , or
spalling .
Main Center Beam - O . K . - level and straight ; all
connections tight ; 9/'16 " bolts at 5 ' - 0 " o . c .
Columns - Q . K . - 3 " steel columns at 8 ' oven with steel
plates top and bottom .
Roof System - 0 . K . - connections tight ; ridge level and
straight .
All components , connections and supports inspected were
acceptable .
N . Y . S . D . H . C . R . Modal Approval Data :
Insignia Serial No : 28594
Mfr . Name : Rita-Graft Corp . of PA .
Plan Approval No . : N . Y . 0182
Model Designation : Birchwood 26 x 48
Mfr . Serial No . : 0201882201 AB
Date !3f fi . : 1/29/88
Yours truly ,
MURSE ENG SBR
Ma k A . Dean
Codes Speclallat
MD . zg
cc : Mr . Jack Liberty , Lamplighter Homes , Inc .
RICHARD 3. MORSE , P. E. Phone ( SIB) 792 - 5382