1987-602ir
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
y 19
88
Date
This is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may be occupied as a OneFamily Dwelling
Lot 35 Pinecroft Dr. (Sin® No. 1) Stonebarst Subdivi8ion
Location
Owner
Gary R. Jones
By Order Town Board
TOWN OF QUEENSBURY
007-ke/f/
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Building & Zoning Inspector
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 87-602
ma
WARREN COUNTY, NEW YORK
In
PERMISSION is hereby granted to Gary R. Jones
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OWNER of property located at
Lot 35 Pinecroft (St. No. 1) (Stonehurst) 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.
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1. OWNER'S Address is Star Route fa)
1 Pinecroft Drive
Queensbury, N. Y. 12801 0
2. CONTRACTOR or BUILDER'S Name En
Same
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3. CONTRACTOR or BUILDER'S Address W
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address H.
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6. TYPE of Construction—(Please indicate by X)
4 Wood Frame ( 1 Masonry ( )Steel ( )
7. PLANS and Specifications
No. 26' x 40' per plot plan, specifications and application, including
septic system, attached two car garage and driveway permit.a
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8. Proposed Use ct,
One—Family dwelling i
H.
5.00 C/0
164.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 1, 19 88
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.)0
Dated at the Town of Queensbury this loth
Day of September 19 87
SIGNED BY GZeZ for the Town of Queensbury
Building and Zoning Inspector
TO BE COMPLETED BY BLDG. DEPT.
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A i,. itz0Li r i
Application No.
ouii2 ol Queenitury Permit Issued 19
BUILDING and ZONING DEPARTMENT Permit Expires 19 CEP i imi
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation WagG '-','f. Ck:,:or, O
Queensbury, New York 12801 Variance No.
Site Plan Review No. Pam, /cL/
Approved y: Pi'a
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APPLICATION FOR c 0
BUILDING AND ZONING PERMIT eidie-N - i/6q'
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: K7-/-iky ,,, .. C/DA/
P.O. Address (-5,4, /C o r - /l ),O -e/?l? /2//E C 7 A /gc)1 Tel. 79 0 0-c
Property Location: / /qet/'G, r ,/Y C 20 7 ,-575) Tax Map No. / /
Street number or building lot number
Subdivision name (if applicable) c 7 )/k./ c5T
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS RE ARDS BUILDING CODES IS:
011,/ 5 O ,2 1607E /' c:;r FT / . , 79 7°z-
Naa( P.O. Address Tel. No.
Name of builder Address o Tel.
Name of plumber ( ° , , ,,.) Address Tel.
Name of mason Address Tel.
NATURE OF PROPOSED WORK: ZONING INFORMATION:
Construction of a new building
TU 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 5C0 ft X Z /O ft.
Existing building(s) Size ft X ft.
PROPOSED BUILDING AND USE:
t tJnl{`-
Existing building(s) Use
Size of new structure ,.Z ;i ft X4Oft
Foundation-pier/slab/crawl/parti fui ' Proposed building, distance from property line
circle one)
Front yard (v 0 ft Rear yard 70 ft
No. of stories (habitable space) Z Side yards 6, ft and ft
Height (grade to ridge) z ft. *
If on corner, setback from side street C ft
If residential, no. of families /
No. of rooms(excluding baths) 8 OCCUPANCY INFORMATION
No. of bedrooms 4 PRIMARY BUILDING -
No. of bathrooms 2j7, 1------One family dwelling
Primary heating system , 4'r C',_)-7EZ Two family dwelling
Type of fuel c /L
Multiple dwelling / Number of units
No. of fireplaces to be installed /
Permanent occupancy
Will a wood stove be installed? ,AJ(Transient occupancy
Central Air conditioning? A, )Business
BUILDING STYLE, PRIMARY STRUCTURE Industrial
Other
Ranch Contemporary Log cabin
If addition, what will use be?
Raised ranch Mansion Duplex
Split level Old style Bungalow
Cape Cod Cottage Other ACCESSORY BUILDING-
ColOnniaY Row Town House * Detached garage/one car/ two car/ car
CIRCLE ONE PLEASE ) L/Attached garage/one car/ctwo car/ --,car
Private storage building
ESTIMATED MARKET VALUE OF' Other
CONSTRUCTION co
Z 0, 000
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc. 4,4027
Will any second-hand or ungraded lumber be used? If so, for what? ,A00
Foundation wall material Os/C, E"7"ch "f '''` 'hickness
Depth of foundation below grade (to bottom of footing)7 ' -G
Will there be a cellar?('S Heated ofrunheated? Floor sq. footage 9''675- sq 'ft
Will there be a basement? Will any portion"be used as living space? A/`.
If so, what portion? sq.ft. - - Type of use?
Type of roof - sloped/flat/shed/otherj,Material,'of roof f'iAegGz,95')' .5, ,,,)/,/
Size, wood studs )' "X (, " spacing /(,,, "o.c. length C; ft.
Joists(floor beams) 1st. floor 1 "X /Q " spacing /(, "o.c. span /4 ft.
Joists (floor beams) 2nd. floor 2, "X j " spacing /6.. "o.c. span /¢ ft.
Overlays(ceiling beams) 2 "X 67 " spacing /G_,"o.c. span 27 ft.
Roof rafters > "X (, " spacing /G,o.c. span / ft.
Roof trusses (pre-engineered) spacing o.c. span ft.
Exterior wall finish 2t...4-/0r30,q-/) 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? Lies If so will a Fire-rated/
door, enclosure, and self-closing device be provided? / c" 5
Will a flue-lined chimney be installed? y 5 Height above roof ft.
Depth of chimney foundation below grade 7 ft.
Depth of fireplace hearth 2- ft. 6 in.
Water supply - Municipal or private well /i(,4 T45
SEPTIC SYSTEM _ Distance from ANY private well(including adjoining properties 7/ 0 ft.
A separate application is necessary for any repair or new installation of septic system)
Town of Queensbury AFFIDAVIT 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 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 THIS Signature (-- _ ;..
Owner', o er's ent,arcnitect,contractor
ft 'i day of) ,-7,/t i 19 oy
l
F.
T®
CT ! Notary Public.Stnto of New York
Warren County, N.Y.
Saratoga County
Notary Public,Y my c® Expires Merck 30.1 .--1
SPECIAL CONDITIONS OF THE PERMIT:
By
J:Wit e aeei4Qel
APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE C_.>
w T - 85- ' oa/E/*),es7-
fj
LOCATION OF PROPERTY FOR INSTALLATION / EC c % 2),e/1/6=
Owner's Name: 679, e jj/ti Telephone: -79J -8 9 Q z
Address: _/ 79Ce--S
Installer's Name: ,6 x Telephone:
T--
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) QQ
Topography: circle one: Flag Rolling Steep Slope % 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 required required / rate
5
min. inch.
Domestic water supply: circle one: Municipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption //O _ feet
PROPOSED SYSTEM: Septic Tank /000 gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench 3-0 feet / Total system length .2-5 0 feet
SEEPAGE PIT(S): Number of Size each feet by feet
Size of stone to be used #Depth or Thickness _ /feet
IMPORTANT
Please...LIST NEW EQUIPMENT TO BE INSTALLED
over)
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 24 hours before start
of construction and shall include a plot plan showing:
1.) the proposed,location of the system
2.) 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, 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.
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Ord ce.
Signature of responsible person:
Date: ZL7
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE
Ow/ V O Qbteen,JIbtly At-
ro-•
i
d h y I t
QUEENSBURY TOWN OFFICE BUILDING 17:74Y.M.1.2..744NO4t,
R
gin.w;.s'1.a•s .,._..
BAY AT HAVILAND ROAD
HIGHWAY DEPARTMENT QUEENSBURY, NEW YORK, 12801
TELEPHONE: (518) 792-5832
Application for Driveway Permit .
Submit completed application to Highway Department)
Name of Applicant }P j ,27,&le5
Mailing Address / 4,t/ /2oFT j94?/t'4 (7L1e_ 4)725 Cam•
Zf.3e)/
ADDRESS TO BE INSPECTED / iiJ C.PO ,/ (Sr55)
577972. &o TE K'C. s , ems /vy /Z8ol
The Superintendant of Highways, Town of Queensbury, has reviewed
the application of the above named resident to connect a driveway
to the Town Road. The following action has been taken:
Premininary Approval (to be followed by "Final Approval")
FINAL APPROVAL GRANTED
REJECTED
Culvert pipe size to be used (if necessafy)
6" - ( ) 8" - ( ) 10" - ( ) 12" - ( ) 24" - ( ) 36"
Date:
Paul H. Naylor
Superintendant of Highways
Town of Queensbury
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE
IU
1 r Down of Queenihary116UILDINGandZONINGDEPARTMENT
B y and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
4(17
ei\OJI ING INSPECTOR ' S REPORT
LOCA.T I ON , D 3 5 1:-Zrivy_7/74/--
Date V ff Permit No.
APPROVED - YES / NO
Footing/Pier Forms
Foundation
l Waterproofing
Backfill
Framing
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 S(
INSULATION:
Foundation
Floors
Ceiling
FINAL ELECTRICAL NSPECTION
DRIVEWAY APPROVAL
Final Building Survey 24(
Next scheduled inspection (call when ready)
Remarks-
ram,
Building Inspector
6/86 and-vl
INFORMATION FOR BUILDING DEPARTMENT
C i I
WE ARE IN THE PROCESS OF ISSUING A CERTIFICATE
OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION
AS COVERED IN AN APPLICATION FILED WITH OUR
DISTRICT OFFICE.
THE NEW YORBB lRD OF FIRE UNDERWRITERS
APPLICATION NO
76Cita- V , Zsi
LOC O'Nf
I'
I
DATE I CTOR
FORM IBD(REV.1/86)
1
awn o; Queeniilury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION
Date Permit No. °/ `(p
IO = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry neer
jugh Pl bing
Relief Va ves
Ext. Porch s
Finished Fl ors
Interior Tri
Stairs & Rail'ngs
Cellar Drain 'le
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
SULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELESTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Buil.ing Survey
Next scheduled inspection (call when ready)
Remarks-
Buildi g Inspector
Jouin of Queenitur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME 0-6,411-77,5
LOCAT I ON Me okri
Date fil/. Permit No. 11®1
APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
FINEackfill
raming AIWA
Roofing
Siding
z
Masonry Veneer 11111111111111_
Roughi PlumbingVlReliefValves
Ext. Porches 11111111111111=
Finished Floors
Interior Trim 4111111111111
Stairs & Railings A--
Cellar Drain Tile Aimmim
Concrete Floors —__
Plbg. Fixtures
Gar. Fireproofinu MIN
Door Closers 11111111
Smoke Detector:
Chimney
INSULATION:
Foundation
Floors
Walls 5111110111111111111111111MOI—
Ceiling
FINAL EI" CTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
el
iilding Inspector \
6/86 and-vl
TJocun of Queenitury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ,sz--
LOCATION 4tr, L CC.0 aka
DATE//3 /PERMIT NO. y-1 - Io1.u
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length -1
Length of each trench 6
Depth of tre.ches " 2'
Size of grave -
SEEPAGE PITS{ •er of)
Size-ft. ' ft. -----7
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box t(
Dist. box to field ,.r ' ilL
Openings sealed? (le) NO Partial
LOCATION/SEPARATIONS:
Foundation to tank / j ft.
Foundation to absorptiont.
Absorption to lot line I- ft.
Separation of pi s ft.
LOCATIO /'-0F\SYS ON PROPER (circle one)
Front Ream - eft side - Rigt side -
COMMENT ,,,
SYSTEM USE APPROVED YES NO
Build ng Inspector
01/86 and vl
1
awn of QueeniLry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME l 2 At&5
LOCATIONL6r ,
Date illy/ 7 Permit No. (F7 bP
T V = APPROVED - Y S / NO
Footing/PierlFormsYe.ti-
Foundation cA--i 6-
Waterproofing e¢Backfill Y
Framing CAI
Roofing
Siding
Masonry Venee
Rough Plumbini
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 ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
f-
7‘ c-,06
Bui r ng Inspector
6/86 and-vl
1 own of Queenibur y
11 6 BUILDING and ZONING DEPARTMENT
i
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION ,g
G)/
Date /i / 7 Permit No. f
APPROVED 7 YES / NO
tooting/Pier Forms 6121,4_ 4-,,.J
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Venee
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 ELEC RICAL INSPECTION
j\
DRIVEWAY A.PRQVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks- '1
ice J
ei 4,74?
Building hspector
6/86 and-vl
Jown of Q ee n Lu r y
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR' S REPORT
NAME 2,11 G/
LOCATION I'll
Date/ 2/ _ Permit/No.
AP'ROVED - YES NO
F o ing/Pier Forms
o ndation
r.A erproofing
L/gackfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
ellar Drain Tile _-=
Concrete Floor
Plbg. Fix . -es
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
1
191
Buil'
glad
Inspector
6/86 and-vl
A sown of QueeniLury
14 AO
ilt'
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR' S REPORT
NAME &
LOCATION %6—1
L
1661
Date /t2//6/F7 Permit No. ll /'6f0
ire/ = APPROVED - = S
L.--Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
MN
Ad
Siding
Roofing
Sid
Masonry Vene-.
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors111111111111M111111111
Interior Trim 1111111
1 Stairs & RailingsMINNIN111111111
Cellar Drain Tile VANIMI11111111
Concrete Floors _—_
Plbg. Fixtures
Gar.
Closers
11111111111
Closers
Smoke Detector 11.11111111
INSULATION:
Chimney
1111Foundation
11111111111111I
Floors
Walls 11111111111111
j Ceiling
FINAL ELEVTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
y ,
P
fJ5
c - =
Building Inspector
6/86 and-vl
11
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It... k THE NEW YORK BOARD. OF FIRE UNDERWRITERS c
BUREAU OF ELECTRICITY
41 STATE STREET,ALBANY.NEW igni411§5)7
Date :
4&17 10, 19.1-S Application No.on file ' A 71,f;:?-1 2'
THIS CERTIFIES THAT
4
5 only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of .- z
GA Ri R. JONES, 1 PINECROYT DRIVE, qUEENSBURY, NEW YORK
4.
in the following location; g Basement D' 1st Fl. 3 2nd Fl. Section "Block Lot
EP; - was examined on 4/26/8P and found to be in compliance with the requirements of this Board. 4
FIXTURE I FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS -1tr. OUTLETS RECEPTACLES SWITCHES
INCANDESCENT FLUORESCENT
MERCURY
AMT. K.WVAPORW.AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. '"--
s
31 47 23 j 4 ,.,5 3 VR cA
7.:
4
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
TRANS.LAMT. H.P.
SYSTEMS
AMT. K.W. OIL H.P. GAS H.P. AMTI /4454)%ct,7 A."G. AMT. AMP. MAT. AMPS. HOOF FEET AMT. WATTS fj 4
g - 1 UWT #13
t..... ,, 1 DRYEa
5" ,t
SERVICE DISCONNECT NO.OF S E R V I C E
METER
i. AMT. AMP. TYPE mum 1 iy 2W 1%3W 3 0 3W 3 0 4w NO.OFpEiCirCOND.OF AC ..1COND. NO.OF HI-LEG oVitt NO.OF NEUTRALS
otzaA,
r.I 700 CB 1 x 4/0 2/0
t-
U OTHER APPARATUS:
41 -v
la
2— GirCi
1— SMOKE DET1iY,,:20c,24„,1 --'1.
4 1.DATTA 4 0 'I C
0
f.,
t.
6
c. 71 / t. '
6
c. GARY R JONES 400—6
i PINECROFT DRIVE STAR ROUTE I .,14
4
GLENS FALLS, ENW YORK 12801 239 BRANCH v-ANAGN
4. 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.
E -7 7 "7 'I'Cr Ct'CI CI Cr CI'Cr lr Ct'Cr Vr VY 1r'Cr N/'Cr CY Cr Cr'Cr Cr Cr Cr Cr Cr Cr'Cr'Cr Ct Cr Ct Ct Cr Cr 1"/'Cr'Cr Ct Cr Ct 'Cr "t Cr N / Cr 1 / Cf Cf Cr 1 , c, .-. ,-.)-
nay rano mint mutt nr P APTUFRIT TI141K COPY OP CERTIFICATE MUST NOT BE ALTERED IN AMY MANNER.