1987-815 'g+.' ": -'".t2. �'4'"• :G: r{yw .n.:..e'�•+Te,'. q.: ' �+•'.ki . b.:: "yc'fi �Fs .;i .:y .^sue .^-s
4
CERTIFICATE OF C�►CCUPANCY
TOWN OF +QUEENSBURY
WARREN COUNTY, NEW YORK
October 4 19
IL
This is to certify that work requested to be done as shown by Permit No. 7_ 15
has been completed.
One Family Dwelling;
This structure may be occupied as a
Butler Pond Rd .
1..aK,atiortti
William LT . Maille
owner
Sy Order Town Board
OrOWN OF QUEENSBURY
Building & Zoning Inspector
BUILDING PERMIT �
TOWN OF QUEENSBURY
No. 87-815 z
WARREN COUNTY, NEW YORK
m
PERMISSION is hereby granted to William W . Maille Y
I
OWNER of property located at Butler Pond Rd . Street, Road or Ave. cam,
iv
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.
t _ OWNER'S Address is
121 Aviation Rd .
Glens Falls , N . Y . 12801
µ
SLS
2. CONTRACTOR or BL.11 LDE R"S Name
Cifone Construction
w
F+-
3. CONTRACTOR or BUILDER 5 Address
tD
P . O . Sox 684
Glens Falls , N . Y . 12801
A_ ARCHITECT'S Name
to
C
5. ARCHITECT'S Address n
m
H
ro
6
6. TYPE of Construction — (Please indicate by }Ca p.
( N Wood Frame ( 1 Masonry ( ] Steel {
7. PLANS and Specifications
No. 43 ' x 48 ' as per plot plan , specifications and application 3knimkudIng
8, Proposed Use
ro
One Family Dwelling
w
F
w
$5 . 00 C /0
$ 115 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 1 , 19 88 £
0
(If a tonger 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.) F�
"J
RO
Dated at the Town of Queensbury this 4th Day of December 1987
SIGNED BY R - r 9C Czrj �O' IC for the Town of Queensbury
Building and Zoning I nspector
TO BE COMPLETED BY BLDG . DEPT .
flc� /f Application No .
own v/ Queen36"ury Permit Issued 19
BUILDING and ZONING DEPARTMENT Permit Expires 19 o #4c £�! r 1i,`l t.
Bay and Haw and Road, R.D. 1 Box 98 Zoning Designation
'
Queensbury, New 'York 12801 Variance No ,
Site Plan Review No .
5- 1 - A 71 , 2 A Approved by : G• {t
APPLICATION FOR
FEU I LD I NG AND ZONING PERMIT
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 : ----
P , O, Address_ 121 Aviation Road t Glenw Falls , rt . Y . 12801 Tel . 792 0089
Property Location : _ Butler 1 bnd Road Tax Map No . / /
Street number or building lot number
Subdivision name ( if applicable) ITZA
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS :
Cifone Construction P Q Box 6B4 Glens Falls —.. 792
Name - P . O . Address Tel . No .
Name of builder Address Tel .
Name of plumber Address Tel .
Name of mason Address Tel .
NATURE OF PROPOSED WORK : ZONING INFORMATION :
x Construction of a new building A PLOT PLAN 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 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 ft X ft .
* Existing building ( s ) Size ft X ft .
*
PROPOSED BUILDING AND USE : * Existing buildings ) Use
Size of new structure ft X.,,.4Aft
Foundation-pier/slab/crawl/partial/full Proposed building , distance from property line
(circle one) * ft
Front yard ft Rear yard )! ( O
No . of stories (habitable space ) i * Side yards lFn ft and 1(j(] ft
Height ( grade to ridge ) 16 ft . If on corner , setback from side street ft
If residential , no . of families 1
No . of rooms ( excluding baths ) '� OCCUPANCY INFORMATION
*
No. of bedrooms 4 * PRIMARY BUILDING -
No . of bathrooms 2 *. x One family dwelling
Primary heating system Eu1eC tI' ic Two family dwelling
Type of fuel B eC I'
Multiple dwelling / Number of units
No , of fireplaces to be installed U Permanent occupancy
Will a wood stove be installed? no
,� Transient occupancy
Central Air conditioning?__ n n Business
*
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
,� Other
Ranch Contemporary Lag cabin if addition , what will use be?
Raised ranch Mansion Duplex
split level Old style Bungalow "
Cape Cod Cottage Other * 4C ESSORY BUILDING-
colonial Row Town Housf * Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * AWAttached garage/one car/ two car/ car
'other
storage building
'
ESTIMATED MARKET VALUE OF * Other
CON"STRUCTION
INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED !
Form BPA 4/ 86 and-vi
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe , etc . wood frarne
Will any second-hand or ungraded lumber be used? If so , for what ? no
Foundation wall material nnnn -rnta __Thickness in
Depth of foundation below grade (to bottom of footing ) 6 -rt
Will there be a cellar? ye 5 Heated or unheated? hien to dFloor sq. .footage 1 ,� 400 y sq ft
Will there be a basement? Will any portion be used as living space? no
( If so , what portion? sq. ft . - - Type of use?
Type of roof - sloped/flat/shed/others �. o�±e d Material of roof a s Dha ] shi 'I
Size , wood studs lox IF spacing y "o . c , length ft .
Joists ( floor beams ) 1st . floor "X " spacing "o . c . span ft .
Joists ( floor beams ) 2nd . floor "X Or spacing "o . c . span ft .
Overlays (ceiling beams ) "x OF
spacing "o . c . span ft .
Roof rafters " x to spacing o . c . span ft .
Roof trusses (pre-engineered) spacing " o . c . span ft .
Exterior wall Finish of what material ?
Interior wall finish
if a garage is to be attached , describe materials to be used for FIRE SEPARATION :
Is there to be an opening between garage and dwelling? If so will a Fire-rated
door , enclosure , and self-closing device be provided :
Will a flue-lined chimney be installed? Height above roof ft _
Depth of chimney foundation below grade ft .
Depth of fireplace hearth ft . in .
Water supply - Municipal or private well
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 flu amen ry
County of Warren A F F I D A V I T STATE OF NEW YORK
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 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 . � //_/.%
SWORN TO BEFORE ME "PHIS Signature .....' = �.��� .----- -
Owner , owner ' s agent , arcnicect , contractor
day of 19
Notary Public , Warren County , N . Y .
Ar ie it IF IF * * * * * rt Yr rr yr yr OF OF Ye OF * * * * yr
SPECIAL CONDITIONS OF THE PERMIT :
By..................... - -----------_ -_
TOWN OF QUEENSSURY
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. � �;
3 . is the building mechanically cooled ? q
4 . Percentage of area of windows and doors ( / /T „r�' ✓ (i /2�
A . Over 16 % Only
1 . Uo value of gross area of walls ,, roof / ceiling and floors
exposed to ambient conditions
2 , floor over heated spaces YES NO
a . Are foundation walls insulated ? YES NO
1 . If YES , what is the R value ?
3 . Slab on grade YES NO
a . If YES , what is the R value of insulation around
perimeter of floor ?
4 . Is basement heated ? YES NO
a . R value of insulation
5 . Type of insulation
B . Under 16 % Only
I . R value of roof and floors exposed to ambient conditions.
2 . R value of exterior walls
3 . R value of glazed area - 4�
4 . R value of doors c�2- �/J
5 . R value Of floors over unheated spaces jr- a
6 . R value Of slab edge insulation - unheated slab
7 . R value of slab insulation - heated slab ,—If +�
$ . R value of heated basement/ cellar walls ( above grade ) e
9 . R value of heated basement /cellar walls ( below grade ) Azeg
10 . Type of insulation_
Co Controls
1 . 'Thermostat maximum heat setting 7cr
D . Duct Systems W
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
1 . Size of hot water 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 fool only
1 . Maximum heating /tit
Telephone No . 3;;C�x7�mz
licant ' s signature }
R9—=Just
THE NEW YORK BOARD OF FIRE UNDERWRITERS
� BUREAU OF ELECTRICITY
iVLfi 41 STATE STREET. ALBANY. NEW YORK 12207
Date OCTOBER 40 € 988 tppiirarion No. on file 005868 / 97 A 7 ? 9 -J 4 3
THIS CERTIFIES THAT
only the electrical egssipment as described berlase awd isstroduced by that applicant named on the above appitaa"aft number in the preasis es of
ir . We MAd..LLE , BUTLER. POND ROA o QUrvEENSBURY , NY
in thefollowing location; � Basement ® Ist FC ❑ 2nd Fl. OUTSIDE Sectior,85 Block 1 Lot 18 . 23
was examined on 9 / 13 / 88 and found W be in compliance with the requirements of this Board.
FIXTURE ECElTA�LRS IIAttTCHIS FIXTURES RANGES COOKING MOCKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS rl+cwr,KsrsctreT PLuoKisceHr AMT. K- w. AMT. K. w. APAT_ K.W. AMt. K. W. AMT.
21 37 10 t 2 1 4 * 6 3 sly
DRYERS FURNACE MOTORS FIXTURE ArM1ANCE PRIMERS S►ICt11L RBC`" TIME CLOCKS . UNIT HEAT**$ M SYSTEMS DYAMERS
AMT, K. W. on H. P. GAS H. P. AMT_ PIO. A. w. G. AMT. AMP. AMT. AMPS. TRANS• wM/. H. r. NO. OF tarn AMT. wwrrs
v
L E[L,lT I0 €
rh,,RVICE CRSCONMECT No_ OF S E R V 1 C E
AMT. AMP. TTPE fir, 1 .e 2w 1 / 9W 9 L 7w 3 X /wRCOND. Ili CC Co. NS7. Of HI-lFG #HILE r NO- OF HEI1tR4L5 CIF
1 200 CB 1 x 1 4 /01 � / O
OTHER AMARATUS;
3- t;F CI a
2— SMOKE DXT .
121 AVA'Ti ION ROAD
AsirCTNS �'d�Lii LS � IVY 1. 2801 234.E BRANCH MANAGER
per it
This certificate must not be altered in any manner, return to the office of the Board if incorrect. Inspectors may 11 be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
.,.lvurrr ' si� y�cceen � 6urr�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
ageen bury. New York 12801
B ILDING INSP/E� R ' S REPORT
NAME / ✓t/ /
LOCATION i ✓ ,
Date
Permit N
APPR ED - YES NO
Footing/ ' er Forms
Foundation
Waterproof in
Backfill
r raming
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext . Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg . Fixtures
Gar . Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICA INSPECTION
DRIVEWAY APPROV
Final Building urvey
Next schedule inspection ( call when ready )
Remarks- 7
Building Inspector
6/66 and-vi
✓ou/n n/ 'Queens6ury
BUILDING and .ZONING DEPARTMENT
Bay and Havifand Road, R,D, 1 Box 88
Queensbury, New York 12801
BUILDING INSP TOR ' S REPORT
NAME C// /
LOCATION
Date Permit No f J
✓ = APPROVED YES NO
Footing/Pier F
Foundation
Waterproofing
Back.f i l l
Framing
Roofing
Siding
Masonry Veneer
ugh Plumbing
Relief Valves
Ext . Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg . Fixtures
Gar . Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION :
Foundation
Floors
walls
-
Ceiling
FINAL ELECTRI AL INSPECTION w
DRIVEWAY APPR VAL
Final Buildin Survey. _......._ _
Next scheduled 1nspect1-01P. (c ll when ready )
Remarks- ,
Buildin I Spector
5/8Fi and-vl
awn o� '�ueens�urr�
00
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R- D. 1 Box 98
Queensbury, New York 12801
SEPTIC I POSA ,YSTEM INSPECTION
NAME / Y`
LOCATION
DATE / P RM I T NO. �
SOIL TYPE - Sand Loam - clay
Percolation Test Wired? YE - NO
Percolation rate - Min/Inch
TYPE of SYSTEM :
Absorption field , t tal ngth
Length of each tree
Depth of trenches
Size of gravel:_
SEEPAGE P C24Numbe }
Size- X ft
Gravel s V
4# ,
PIPING : S T pe
Bldg . to tank
Tank to dist. x
Disto box to field/
Openings sea] ? YES Partial
LOCATION/SEF RATIONS :
Foundation tank, t.
Foundation o absorption 4
Absorption to lot line
Separatio of pits t,
SYSTEM ON PROP T (circle one)
F ont - ar - Left side - Right side -
SYSTEM USE APPROVED YES NO
Bulldin Inspector
01/86 and vl
awn n/ Q" eena6ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Oueensbury, New York 12801
BUILDING INSPE OROS REPORT
NAME
LOCATION
Date A
/ Perm±t No _ �
Ow' = APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
Sackfill
Framing
Roofing
Siding
Masonry Veneer
)K.,Roug h PI ing
Relief Valy s
Ext . Porches
Finished Floo
Interior Trim_
Stairs & Railin
Cellar Drain Til
Concrete Floors
P hg . Fixtures_
Gar . Fireproafin
Door Closers
Smoke Detector.
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL ELEC RICAL INSPECTION
DRIVEWAY AP ROVAL
Final Build ng Survey
Next scheduled inspection ( call when ready
Remarks-
Building Inspector
6/86 and-vl
aev" 401 ieeerxs6ttr
BUfLDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. i Box 98
Queensbury, New York 12801
BUILDING IN SPE R ' S REPORT
NAME
LOCATION
Dat t / Permit No .
✓ = APPROVED * * * * * �
Footing/Pier Forms YES NO
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Ven er
Rough Plumbi g
Relief Valves
Ext . Porches
Finished Floor
Interior Trim
Stairs & Railing
Cellar Drain Til
Concrete Floors
Plbg . Fixtures
Gar . Fireproo ing
Door Closers
Smoke Detect rs
Chimney
INSULATION :
FoundationIII
-�-
Floors ti
ally
ezling
F NAL EL T.R. CA INSP CTION
DRIVEWAY PPROVAL
Final Bui ding Survey^
Next scheduled inspection (call when ready
Remarks-
Buiidin I spe,ct r
6/8fi mc?-vl
awre n/ ueere s urt�r
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Qureensbury, New York 12801
BUILDING INSPECTOR ' S RjEPORT
NAME / 7
LOCATION
Date
/� hermit No .
✓ = APPROVED - YES NO
Footing/Pier Forms
foundation
Waterproofing
3ackfi11 r•
3'rami ng
Roofing
Siding
Masonry vene r
Rough Plumber g
Relief Valves
Ext . Porches
Finished Floor
Interior Trim
Stairs & Railing
Cellar Drain Tile
Concrete Floors
131bg . Fixtures
Gar . Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION
Foundation
Floors
Walls
Ceiling
FINAL EIECTR CAL INSPECTION
DRIVEWAY APP OVAL
Final Building Survey
Next scheduled inspection (call when ready )
Remarks-
and-vl F3u 1+1-ding Ins,peotor
6l8f�
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY Cr HAVILAND ROADS
QUEENSBURY, NEW YORK 1280#—
TELEPHONE (518) 792-5832 �—
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION L �oe
DATE ✓�` —. PERMIT # �
APPROVED
YES NO
FOOTING/PIERS
MONOLITHZC POUR FORMS
FOUNDATION/DAMP--PROOFING
BACKFSLL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH--TN
INSULATION:
,FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPBCTSON: f r
CHIMNEY HEIGHT iC
ROOFING
SIDING
EXTERNAL PORCHES/STEPS
STAIRS—CLEARANCE & RAILS_
PLUMBING FIXTURESfRELIEF VALVE
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLOURS
GARAGE FIREPROOFING
DOOR CLOSERS)
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:
INSPECTOR
TOWN OF QUEENSBURY
sU"ding department
Date
permkNam. Weat]►�mr
Y
R+ema r xs
Exca0a t7on-
Footina Forms ` -
Footinq & Piers
Foundation
Cement Coat -
Water roofin -
Ba clkf
I -
Final Su ey -
Framin -
Shea thl n
Roof Felt -
Roofin -
Si din
Masonry Veneer -
Rou h PIb .
Relief Valves
Wall Board -
Ext , Porches
Finished Floor
Tnteriar Trim
Stairs & Razlin s
Cellar Dr . Til
Cancrete Floor - -
Pl2x7a
Fixture
Gar . Fire r in
Door Cl osers -- --
Chimne
Water Meter Tnst .
Se tic A r val
Floors
Insulation POUndatit'n
Walls
Bulldjn Tns'� yDG"G"t OI
,REMARKS
�Yf BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Oueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION
Date Permit No .
✓ = APPROVED - YES NO
Footing/pier Forms
Foundation
{,�taterproofzng
&Mtec'kfiII
r
Framing
Roofing
Siding
Masonry Ve eer
Rough Plum ' ng
Relief Valy s
Ext . Porches
Finished Flo s
Interior Trim
Stairs & Rail ! s
Cellar Drain Ti
Concrete Floors
Plhg . Fixtures
Gar . Fireproof ' g
Door Closers
Smoke Detecto s
Chimney
INSULATI CAN
Foundation
Floors
Wa11s
Ceiling
FINAL ELECTIJICAL INSPE3CTIO
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection ( call when ready )
Remarks-
Building Inspector
6/$6 and-vl
awd" r0/ Queenshury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R, D. 1 Box 96
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME r/lil
LOCATION
Date / Permit No .
✓ - YE
(�t�ting/Pier Forms APPROVED NO
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry venee
Rough Plumbin
Relief Valves
Ext . Porches
Finished Floor
Interior Trim
Stairs & Railing
Cellar Drain Til
Concrete Floors
Plbg . Fixtures
Gar _ Fireproof ' ng
Door Closers
Smoke Detecto s
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready )
Remarks-
Bu ' pector
6/86 and-vl
BUILDING DEPT- COPY OF APPLICATION FORM dfi-EL" NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE TI.119 COPY WITIi BUILDING DEPT. WNEN REQUIRED.
TEMP. ( DATE
-�
STREET AND NO OR
ROAD AND POLE NO f
BETWEEN MMHAT 'fYYO POLE
CROSS STREETS Is 7 �- 'Y N
t` : ..
PREMISE _ .
OCCUPANT'S r . ''v'� ECTION BLOCK
-' ,.�/� BUILDING LOT
NAME L.lL-C1 C�G�G�/V G7"
OYYINER'S NAME „' OCCUPANCY
AND ADDRESS
TE L. #
SUPPLIED
BY I x� ' f
BUILDING r� FROM THEIR
OFFICE
IS NEW OLD ❑ WORK DEFECTS
IS NEW ADDITIONAL ❑ REMOVED Q
LIST BELOW ALL EQUIPMENT WFfICH YOU INSTAL LED
NUMBER OF OUTLETS No. of Fixtrea A BRANCH Loci Lei"W RecepbsdlM MOTORS HEATERS B R NCH OFFICE USE
tine
Coiling V%Wt R q'fi ONLY
Switch Pit nt Beardrat No. Type H-P• w4em
Each No. Eeeh No. .
Oda e,Gt' INSPECTION
eiW
Suls
base
Beer
m nt
of Fl.
god FI.
3rd Fi-
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE;
DO NOT USE THIS SPACE,
This application is intended to Covet the abova-listed equipment to hie inspected but if at time 4f i Ip"y
YOU are aptholil"d to make the inspection and adjust dte faa CO corer Me additional nap" t then is found additional equipment not above fisted.
SIZE OF i equipment, as provided by the applicant.
MAINS fry FEEDERS _ ELECTRIC SIGN TOTAL
CHARACTER LAMPS WATTS
OF WORK POSED GAS TUBE SIGN
WORK TO BE -? D TRANSFORMERS OF VA
STARTED ' f"'` COMPLETED (NUMBER! lCAPACITYI
SERVICE OVE EAD SIZE OF SIGN
ENTERS UNDWo ROU
-./"
ILbI Gr.r.r+e'^^' MAKER
IN$PECTIDN REQUESTED OF SIGN
ON OR AS NEAR AS
POSSIBLE
AVOID DELAY BY GIVI G FULL AND ACCURATE INFORMATION. ALL CES NEW OLD
SPA
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. DATE 6F
PRINT NAME AND ADDRESS NAME OF APPLICATION
APPLICANT 'y A r. ��"' SIGNATURE /
OF APPLICANT (k� � t'' ;
STREETADDIRESS _
CITY OR _ __ " TELEPHONE #
POST OFFICE ^. ! �y.%'`�f ~ y i t �{� j ZIP •,. LICENSE Nb.
CODE `�/ WHEN APPLICABLE
as EL (REV. I/eG) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
' N
4
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pa ZG. /979 a3/ /oz3 \ S bt oy 3o W g`"y h1AP OF A SURVEY MADE FOR
-- z WILLIAM W. & MARION MAILLE
TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK
SCALE : I" = 100' DATE : NOVEMBER 30 , 1987
VanDusen & Steves
LAND SURVEYORS,GLENS FALLS,NEW YORK
N.Y.STATE LC.NO.35617 I e.S.
r2oN Pert' fouov
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fit,/