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1989-509 ` S I CERTIFICATE OF OpeupA1`�TCY ;s TOWN OF QUEENSSURY WARREN COUNTY, NEW ' YORK i Date ALJQLIS . 31 19 89 This is to certify that work requested to be done as shown by Permit No, 84-549 i has been completed. i This structure may be occupied as a r� fy s Location A & Z Drywall Owner By {order Town Board i TOWN OF QUEENSBURY j Director of Bldg. do Coda Enforcement �s k BUILDING PERMIT * � TOWN OF QUEENSBURY � No- 29 gee -" WARREN COUNTY, NEW YORK v� r co PERMISSION is hereby granted to OWNER of property located at Street, Road or Ave. in the Town of Queensbury, To Construct or place a at the above location in accordance to application t theroge with plans plot and of er information hereto filed and approved and in compliance with the Town of flueensbury Building and Zoning Ordinance. a t. OWNER'S Address is $� RR. # 2 BOX 528 N Granville, N.Y. d 2. CONTRACTOR or BUI LDE R'S Name Self r' r 3. CONTRACTOR or BUILDERS Address Same L—' 4. ARCHITECT'S Name o-- .ry 0 5. ARCHITECT'S Address " �-3 rd 1?1 M 6. TYPE of Construction — (Please indicate by X) ]KX1�ood Frame { ) Masonry I 1 Steel ( Y L—' LT1 7. PLANS and Specifications No. 1280 sq.ft. Single family dwelling as per plot plan, specifications, and application, including attached two car garage, septic, and urtvuw S. Proposed Use By' G: Single Family Dwelling $ 7 q7 Qp PERMIT FEE PAIR — THIS PERMIT EXPIRES FAQ rwary 1 lg.-_... (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the t town of Queenshury before the expiration date.) Dated at the Town of Oueensbury this Day of _ —19 ice-- k" t-' SIGNED BY C for the Town of {2ueensbury t4 Building and Zoning 1 11slYector . r r .,r, r -' 'ri 1 f T i I'^ r' iL .� r.f �. . • • �1 i L' t"' !? �, T T (D N © r' � UEE:�SB �' RY � _ /' oN O Fy Fz t'.UILDINC ,1hD CODES Ui .pt'1R17I1rE.f`..T 'DcLze IasuCd 004)4i�- p��r AY and ISAVILANO ROADS RD : DOX ?3 Pemm� t NU . .7dS nU£E'N59URY . NE1V YORK m2d04 ... Tel . ( 528 ) 792 - SS3 .2 £xt 204 a w w ■ ■ ! w ■ a ! ! a : a ! ■ ! w ! ■ ! ! ■ . w ■ • • R s ! ! h f' LItTtIT h1U5"C G13 c a 1'AI r, F: D 13EFORE LI; G INrfINC CC7NSTitUt:TIOIJ . N4 INSPi C'f IONS PILL QL plhDG UNTIL APPLICANT li1lS fl.T Ci IVr. D A VALID BUILDINC PERMIT . All appliCablc spaces •on . this application must be coral+ ide f the s nmature of the aPPliCanz must appear on th % reverse i * c * ° this ' * oxC * Yk k k a ve k k it k kl ♦e k fi w k yi K i1 •file owner of this Property is , Z� � ^" u 62 TEL r1 . 04 Address Lal AdWOU " 11,6( TAx MAP NO . P roper ty 1OCat ! On i1of NZ DA ej sf etas triers been any split of this property sin a Oct # ber Yes ` ri le yes . Planning Board Review is -negessar a r LOT NOm f4 y __` ,. � UFsL IYI5Ii7N C1elME . IP APPLICACSLE ZL2w�11 The person responsible eor supftrvision o work as regards Building Codes is : mm NAME r F . G . AD0RCSS , TEL . (2] ��dress Agzmeqd441df )I Tel ems. t4 arna or launder Tel " u,.me of Plumber 7.daress Tel N"Ma of Mrason�y,� 41�LdresS _ r�tiTURt OF l 'R4i'QSL"O LvORY. . * � llNli � t: iNI C3Rttrt"I' iC}i*I ( C, ftica use on2yJ ...." I b7t; D CS I CNA':ION OF PROPERTY '4.^.nn � truc [ icn of a riuw builraar�7 ' PERMITTED PRINCIPAL PERMITTED ACCESSORY ndrticicn to ;a U" la "q Jr_T^h ,1LuC Lion to " 1.uildinq REVIEW REgUIiICD - PLANNING BOARD ZONING IIOA'RQ� iOka Ck.114t) " to wxC � rior cla.anantionsi L3u : cr .iu�: 3 � SITE PLAN REVIEW t! APPROVED DATE Oclkur wore: VARIANCE # APPROVED ❑ATE � f* 05S AFCL" .1 l]L' PROVO' CD. : "IIsUt 'i" UEcE R s Q f t . Remarks : 7t Floor 6 _ '_' nd Floor sq £ t . CGtsPi.U'S"L: irli'Oi.rut'L'LaN lcrr�uI1sLD Isii1.+�� ,/ -fir ]r0 iurt L t X .7 r c sq Er .. " Si•r,.: of L L y�� _'rc . Other Floors ' L:xi� tlsccy "%AUI1LA49Lai 5a : .: 1: L x�-�---- lnot Collar .7r bdas4m %2nt ) TOTAL FLOOR AREA ,'' gQ f t Lxi +C lrig fa�. a LJ + fug L :. 1 U �+= iy . CrL'' nGw ur ructura f t X f * ��yL y�y� � r�y�r L, r411�vrLy ! Lra�u.d:+ tion-pier/ r,laL/ar.arl/L�art � a tui� * YrGl�osfccl Gusliainy , tcirr: lu oriel # Front y" rd ` 1' t Rear y�ar. d .7 � �,it Na . of r*Lorie, ( J&LL .►ic;aril.s sL)oceY �--_,•— R Side y"rdi: art IC.aighL tUr.adu to r' idq %A) 70 ft . If on cc,rnar , ,wry.,Clc from side: acruuc _ rt IC raulduALial , not, tat f;..mil mm. OCCWpANc:Y INFORMATICN ripm of roo,nyjaxcludinq b"cris1r, OF tlo . of bedrooms a pR,IM Y AR DUILDINQ No * or ri:athrooukt; ..,,,,,_,.. I one fastu.ly dwelling vriso;. ry IlwaLiluj sy�L �ru f ._.—� iwc t:.u.ily +dti+wlliny 'lypu i4f fuel Ault iplja .lwa:lling / Nusabe3r Gf units No * of firwplacwa; Lea 11W i.n:az"110A;d . L1,erA&&nws1oC accul^ wicy Mall :a wuwl si:or►c3 Lw iPgVULal%A1 � 1rC"nU1W9kc CauCulaiataty 4;.antr.al Air cor.alitiwnixrg 13usinusA WILDING STYLE, PRIMARY :TRuCTURE . Tnui►strial och=r .atactt It ,addiLiun , rrl '..at wall uwu lau"7 sv and ranch ttana+ic.{r DraL,lwx atlalat lwwvl OLCl sCyLa: Uu,rf.aloM ACCL;SsORY UUILDINC� rC�pu Cod COLt;Ag4 GGlusr L. t3Ch2t1 yrriaga/ono czar/ C1wlo,��il Car CCQ.Lonl"l 1coV `L'Awec House C.a ►' ( CIRCLI: ONE P1IENZE I ' ItLtacnuv c� ,aC"9"/oats Car twa c:sr/ ■ • s • ■ ■ ! a a ■ ■ ■ ■ is is t ! l'r11'.aty SLOC"g a bua.Iding L .`" TIMA'l` liA MARICF 'I' V Al. UL OF * DLYrwr C 0" %;0r k U C'1 I O N 1Nt'oRttA'CIQN ONWJTLDIIVC SPECLFICl►TIONS , ON rX- VERSE: EIon OF T11TS CHLER' , TO Be CQMPLL1kL7 : Form BPA 20/88 V1 SUta^ ING SPE+ZIFIC. rfQNS . ,YCrr cf construction , woad fra:re _ _ rz safa , ety . gill any seccnd- hand or ungradew 1 ..:.ILter he used : If so , for what ? i Fol:..dation wall material 'Thickness Depth of foundation below grade itc botto footzngY Will there be a cellar ? Pt - ated or reared ' Floor sr, . footage ^$ � : t Will there be a basement ? i/d- . will any portion to used as living space ?_ AJQ ( I F s o , what ? r -�- p .wily u sq - € t . - - Type of use ? _ Type of roo € sloped, let/shed/ot'r.er Material of roof woad stu s " x " spacing�. c . length tt . Joistsiflocr beams ! -1st . floor � - Jofists if loor beams ) 2nd . floor . X��rr spaC inq dlz� O . C . span f t . " x spacing "o . c . span £ t , uerlays ( ceiling beams ) "x spacing " o = c . span ft . Roof rafters " x " spacing O . C . span ft . Roof trusses {pre- engineered ) spacing- ," o . c . scan ft . Exterior wall finish Of what material ? ,!/ Interior wall finish AF If a garage is to ; be ttachd , describe ma tariai CO be used or FIRE SEP,ARA'TICN : 3` yr , Is there to be an opening between garage Bnd dwelling ? M4C If so will a Fire- rated door , enclosure , and self- closing device be provided ? Will a flue -lined chimney be installed? /1) 40 Height above roof ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth ft . in . Water supply - Municipal or private well a4) lallo, SEPTIC SYSTEM _ Distance from A14Y private well ( including adjoining properties ft . ( separate applicatic7n is necessary for any repair or new installation of septic system ) DEC LA RATION 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 ORDINANCE0 and all other laws pertaining to the proposed work shall be complied with , whether specified or not , and that such work is authorized by the owner. • �,,, Signature .4e �c �/� _ ��-.-,4 -"�—� Owner, owner's agent, architect , contractor e n t Or t ! * R fF R +r ! sr ar it ♦ * r r + t t w w w z ! : it ♦ w ,r rr k ! • It !r ! SPECIAL CONDITIONS OF THE PERMIT : By TOWN OF QiUEENSBURY 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 � (Ir 34 Is the building mechanically cooled ? 4 . Percentage of area of windows and doors Over 16 % Only 1 . U value of gross area of walls , roof / ceiling and floors o 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 value of insulation around perimeter of floor ? 4 , is basement heated ? YES NO a . R value of insulation . Type of insulation r �'} JVrca B . Under 16 % Onl 1 . R value of roof and floors exposed to ambient conditions 2 . R value of exterior walls #C ' 3 . R value of glazed area ,I 2 s 4 . R value of doors ( � 5 . R value of floors over t-.,.- e d spaces 6 . R value of slab edge insulation - unheated 7 . R value of slab insulation - heated slab 42 ment / cellar walls ( above grade ) g , R value of heated base ment / cellar walls ( below grade ) _._ 9 . R value of heated base 10 . Type of insulation C . Controls 1 . Thermostat maximum heat setting Do D u c t �e m S 1 . Is duct system installed. in unheated spaces � S NO a . If YES , R value of duct installation) b . R value of duct in other areas ) 42_ E . Piping Insulation IIII agent pipe 1 . Size of hot water or cooling carrying 2 . R value of pipe insulation ^' F . Service Water Heating Q�y 1 . Performance efficiency e1(-/ /�7 2 . Temperature control setting maximum G . For Swimmincr pool Only 1 . Maximum heating Telephone No . rj4y .& — ( applicant ' s signature ) J OWN OF QUEENSPURY APPLICATION FOR C� IO SEPTIC DISPOSAL PERMIT DATE ! " LOCATION OF PROPERTY FOR INSTALLATION Owner's Name: !I'relephone: Address: i Installers Name��. t Telephone: Number of bedrooms (residential only) Total daily flow (compute (d 150 gal per bedroom). 1,� Topography: Circle one lat Rolling Steep Slope % of Slope Soil Nature: Circle on Sand Loam Clay Other. /Depth : Feet Ground Water: At what depth? [I,LQzl , oAjad /Feet Bedrock or Impervious Material: At what depth? N!)�A.&3ZJ Feet Percolation test: Circle one: of require�jc required rate rain. inch. Domestic water supply: circle one: 4unicipal Well Other If domestic water supply is a well: Separation: Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank f 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 # /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 fnlueensbury Sanitary Sew�agge� Dispo' ssallOrrdinance. SIGNATURE OF RESPONSIBLE PERSON: DATE: • . OVER Septic System Inspections : A . z%ll 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 . ) _ che proposed location of the system 2 . ) location and distance t ❑ lot lines 3 . ) location and distance to structures 4 . ) location and distar�ce to any water supply 5 . ) size and dimensions of all tanks , distribution boxes , tile fields and /or drywells B . Nu 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 . O0 . 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 installa— tion , alteration or repair of an approved system , a new proposal must be submitted to the Queensbury Building Department before further construction . • Town ofr Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS 1 QUEENSSBURYr NEW YORK 128016 TELEPHONE (518) 792--583.2 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEXVED NAME •c �I`/Y J LOCATION --- DATE ��' PERMIT # i APPROVED YES i NO FOOTIN PIERS MONOLITH C POUR FORMS FOUNDATIO DAMP—PROOFING BACKFILL A PROVAL ROUGH PLUM NG FRAMING ELECTRICAL R GH—IN INSULATION* FOUNDATION FLOORS WALLS IZXNG INAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING .. EXTERNAL PORCHESIS S 41 --- STAIRS—CLEARANCE & ILS ._ PLUMBING FIXTURES/ EF VALVE C _ INTERIOR TRIM/PRI Cy RS FINISHED FLOORS G'r GARAGE FIREPROO NG E'y DOOR CLOSER (S) SMOKE DETECTO _........ FINAL ELECTRIC INSPECTION ...� FINAL APPROVA OF CONSTRUCTI A SIGNED CERTIFICATE OF OCCUPA , X MUST BE OBTAINED FROM THE BUILDING DEPAR ENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR J©con v� �teeer: .� �aeray BUILDING and ZONING DEPARTMENT TTyN Bay and Haviland Road, R. G. 1 Box 98 Queensbury, New York 128801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION / c-e._'*, F . DATE / � PERMIT NO . S Q SOIL TYPE Loam - Clay - Percolation Test Required? YES - No Percolation rate - Min/Inch TYPE of SYSi*EM: Absorption held, total length Length of eac)� trench Depth of trenches size of gravel:_ SEEPAGE PITS-EN m er of size- ft. x - fto Gravel size # PIPING : Size Type Bldg . to tank Tank to list. box / Dist. box to field/pit i . Openings sealed? < YES NO Partial LOCATION/SEPARATIONS : Foundation to tank G9ft. Foundation to absorption Wt _ Absorption to lot line ft. Separation of pits ft. LOCATION OF SYSTEM ON PROPERT (circle one) Front - Rear - Left side - Righ side - CCMMENTS SYSTEM USE APPROVED YES Ni3 Boil g Inspector 01/S6 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAIVD ROADS QUEENSBURY. NEW YORK 12804- TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST P R INSPECTION RECEIVED 9�- 3 NAME LOCATION 'Iey DATE J v iI PERMIT # APPROVED YES NO FOOTING/PIERS MONOLITHIC PO FORMS FOUNDATION/DAM PROOFING BACKFXLL APPROV ,r J/ROUGH PLUMBING FRAMING E,4, RICAL ROUGH— PNSULATSON: FOUNDATION FLOORS or WALLS CEILING r FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ TEPS STAIRS—CLEARANCE RAIL PLUMBING FIXTURE /RELIEF VALVE INTERIOR TRIM/PRIVACY DO FINISHED FLOORS ` GARAGE FIREPROO ING DOOR CLOSER (S) — SMOKE DETECTOR FINAL ELECTRICAL{ INSPECTION FINAL APPROVAL F CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY ST BE OBTAINED FROM MHE BUILDING DEPARTME BEFORE THESE PREMISES ARE dCC71Tx, I REMARKS: .. 1104 INSPECTOR �._ TOWN OF QUEENSSURY BUILDING AND CODES DEPARTMENT 'y�_�"✓ 1 BAY & ,H'AVILAND ROADS �I QURSN.SBURY, NEW YORK 128041- TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED _ NAME _ LOCATION 14 DATE PERMIT # APPROVED YES NO FOOTINGI IERS MONOLITH POUR FORMS FOUNDATrO /DAMP—PROOFING BACKFXLL PPROVAL ROUGH PLU ING 1- 'VRAMING ELECTRICAL OUGH—IN INSULATION: FOUNDATIO FLOORS WALLS CEILING FINAL INSPECTIO s CHIMNEY HEIGHT ROOFING, SIDING EXTERNAL PORCHES/ BPS STAIRS—CLEARANCE & TZS PLUMBING FIXTUR S/RE EF VALVE INTERIOR TRIMI IVACY OORS FINISHED FLOOR/ GARAGE FIREPRESOFING ,DOOR CLOSER ( ) SMOKE DETEC RS FINAL ELECTR AL INSPECTION_ FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY ST BE OBTAINED FROM THE BUILDING DEPARTM T BEFORE THESE PREMISES ARE OCCUPIED? REMARKS: R Y rNSP TOR �- - J TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT f� BAY & HAVXZAND ROADS r QUEENSBURY, NEW YORK I280k TELEPHONE (5I8) 792~5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME ZZ .0 LOCATION 1Q DATE - �/ PERMIT # G APPROVED ,YES NO L,I' 0TXNGfPIERS V MONOLITHIC POUR &6RMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS to 70 WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORC ES/STEP STAIRS-CLEA NCE & RA S PLUMBING FI RESfRELI VALVE INTERIOR TR M/PRIVACY D ORS FINISHED F ORS GARAGE FI PROOFING - DOOR CLOS R (S) 1 SMOKE DE TORS FINAL ELEC !CAL INSPECTION FINAL APPR VAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISE'S ARE OCCUPIED! REMA INSPECTOR - y TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT" BAY 6 HAVILAND ROADS J�'] QUEENSB'URYe NEW YORK 12804 TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUES FOR I SPECTION RECEIVED NAME LOCATION DATE PERMIT ##' APPROVED 0,we �7 YES I NO FOOTING/PIERS MONOLITHIC POUR FORMS L. .PtJUNDATTON/DAMP-PROOFXNG L �KFILL APPROVAL r ROUGH PLUMB NG FRAMING r ELECTRICAL R6pGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PO HES/STEIN STAIRS--CLEA NCE & RA L3 PLUMBING F TURES/RELI F VALVE INTERIOR T IM/PRIVACY D ORS FINISHED LCXJRS GARAGE FI EPROOFING DOOR CLO R (S) .SMOKE DE ECTORS FINAL ELEC ICAL INSPECTION FINAL APP VAL OF CONSTRUCTION A SIGNED C , RTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR TOWN OF QUEENS.BURY BUILDING AND CODES DEPARTMENT DAY S HAVILAND ROADS QUEENSBURY, NEW YORK 1280k TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION a�26 C`C DATE / / PERMIT # APPROVED YES NO FOOTINCIPXERS MO LITHIC POUR FORMS DATION/DAMP—PROOFING CICFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH IN INSULATION: FOUNDATION i FLOORS WALLS CEILING sl FINAL INSPECTION: CHIMNEY HEIGHT '' ROOFING ,SIDING EXTERNAL PORCHES STEPS, STAIRS—CLEARANC I & RAILS PLUMBING FIXTU S/RELIEF VALVE INTERIOR TRXMI RIVACY DOOR'S FINISHED FLOG S GARAGE FXREPR FING - DOOR CLOSER ( ) SMOKE DETEC RS FINAL ELECTRI L INSPECTION FINAL APPROVA OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPXEDI REMARKS: L INSPECTOR — � TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY. NEW YORK 1280k TELEPHONE (510) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED `-7 — f NAME LOCATION DATE / - PERMIT # APP VED YES NO L�OOTING/PIERS MONOLITHIC POUR FORMS FOVNDA TION/DAMP—PROOFING BACKFILL APPRO AL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH— INSULATION. FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION. CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHESISTXPS STAIRS—CLEARANCE & j RAILS PLUMBING F-rXTURES`,ofRELXRF LVE INTERIOR TRIM/PRIACY DOOR FINISHED FLOORS GARAGE FIREPROO ING _ DOOR CLOSERS) .SMOKE DRTECTO FINAL ELECTRICA INSPECTION FINAL APPROVAL F CONSTRUCTION A SIGNED CERT FICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMIS .ARE OCCUPIED! REMARKS. ; 's I SPECTOR I- C MIp0LE -QEPARTMEN.T IJSPUTlON. AGENCYS.111ce j National Headquarters 900 Haddon Ave.. Collingswood, N.J. 06108 City, Town or Township ' + y 7 f / County StateAdor Location/Address 0r / � 1 e+.� . . • 7 •1 � / ram. r {i f Located in Rural Area - Please Attach Directions) Pole # Occupied As ' i . � Permit # ►:`> Occupant dM Work Area in Buildin Floor #, etiG } :A . for: Wirirl Seruticte �] or• Read for In loll: • ~Fee. Remitted - Cash Check BLO. ~ Number o� Rough Wiring C7utlets Elect. Heart �aa ssa x000 xxso xso xaa+o xaoo xxaa xsos xrso s000 RRak�e Pa IIIa TO: AA.D.I.A. ft Switches Lighting / �-- Amp. �'r�i Surface Unit Dishwas}ter 40 9@ Ran Receptacles �' r Water Heater M !_r Air Conditioner Dryer; Pump Num r c&Fixtltr �� =` Oven -fao 4 f1arbage Disposal Wiring Controls and Contl f . Y / Burner ''Amp.jeceptacles . - .__Fractional H.P. Vent Fans Other Equipment: MOTOR$ H.F. 1/2 111 Y/le 1/a 1/6 114 113 112 3/4 1 1+{c 2 3 5 7�l: 10 15 24 25 SO 4e 54 75 1[1Q Mark Number of Each Size " Applicant's { Signature T/A License # € # Utility: - . � . Appricanis Address: �' r i1VA F G L 1 N (City (State), Phone # {Zip}`-/ Z_It T _ Service Request # Electrician ATE RECEIVED; Correct Location : Same as Above © DATE INSPECTED:or: / Red Notice Label Rough Wiring Outlets Surface Unit G Switches Oven Ran Garba Di 1 ece acres Water Heater sposal. : . ::e y°�Fixtures ' . ,rf Dishwashar�=; `' 04ifContiitionerr� Ap. Service Equipment Burner, Wi m ring Sc Controls for Arh* ^Reoept-aele Amp. Service Conductors Pump Vent Fans MOTORS P. 1120 1/12 3/le 3/8 116 114 1/3 112 314 1 1�J¢' . 2` S' 7Vz 10 15 2l? 25 Mark IV umL'xer -34 -40: !40 - 7'S . of Each Size Elect- Heat aoa isa xaoo nxsa xsso xasa xsoo an "'Q gppp a. Wiry •;.• 0 RW Progress: Inc. O LKD 0 Contractor CFT Violation : Work Comp. C] Inc. © `ter `� �' 0 LM -' _ .. L/A Owner CASH Fee CHK # IPA lwunicipar Due Iwo # G}aiEea Other Side ' Milliy Cut in Card ED Temp # Date + f " Date 'r.. t f' , ' ., t. 1131YATURE; APPE.ICATION FORM NO. �A fli Iss i I W J 0 Ai To" OF QUEENSBURY ZoningAdministrBt LOT41'411 1 WIpiers SCALE I 2 PSI REVISIONS DATE Cp 39 OWN ICIo AP'VO TITLE Me. N