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91-516CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORKK DateAw'&ndt� 19 -ql This is to certify that work requested to be done as shown by Permit No. 91-516 has been completed. This structure may be occupied as a 1f Of FOurpleX 'Maple' Location 74 Old Ni 1 l Lane Owner C 5 L Realty/Masullo Brothers By Order Town Board TOWN OF QUEENSBURY Director of Bldg. do Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY WARREN COUNTY. NEW YORK PERMISSION is hereby granted to Masullo Brothers Builders No 91-516 OWNER of property located at 74 Old Mill Lane Street, Road or Ave. in the Town of Queensbury, To Construct or place a # of Fourplex "Maple' 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 C & L Realty 3049 Broadway Schnectady, NY 12306 2. CONTRACTOR or BUILDERS Name Masullo Brothers Builders 3. CONTRACTOR or BUILDER'S Address 4. ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction — (Please indicate by XI ( x Wood Frame ( 1 Masonry ( 1 Steel ( 1 7. PLANS and Specifications No. 1,399 sq ft % of Fourplex as per plot plan specifications and application 8. Proposed Use % of Fourplex $ 211.00 PERMIT FEE PAID —THIS PERMIT EXPIRES July 17, 19 92 (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of tbe town of Queensbury before the expiration date.) Dated at the Town of Queensbury this-= 17th Day gf July 19 91 /' 1 // //�-- SIGNED BY zsi <'T( for the Town of Queensbury Building and Zo,�1ng l nspector TOWN OF QUSENSBURY REVIEWED BY FEE PAID $ PERMIT NO. BUILDING PERMIT APPLICATION 0A,'N OF QUEENSSUH PFCEIVED J U L 16 1991 9LDG. & CODE DEPT. A PERMIT MUST BE OBTAOFED REPOSE BEGDi"a CONSTRUCTtoN. NO INSPECTIONS WELL BE MADE UNTIL APPLICANT HAS'RECEIVED A VALID BUILDING PERMIT. Ali appii"nts ieaces on this application MUST be completed and the' signature of the applicant MUST appear on the reverse side of this application. The owner of this property is: (.fL fiwL P.O. Property Location • • • • a Tax Map No. /_/ Has there been any split of this property since October 1, 1988? / X If yes Planning Board Review is necessary. // ybs no SUBDIVISION NAME, IF APPLIG'ABLE �/AON 1o)-3 LOT NO. . THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS IttdARDS TO -BUILDING CODES ISi NATURE OF PROPOSED WORKn Construction of a new building Addition to a building _Alteration to a building , (no change to exterior dimensions) Other work (Describe) • ESriNATED MARKET VALUE OF • CONSTRUCTIONr f SDOOO • COMPLETE INFORMATION REQUIRED BELOWs • Size of property/b!./3X/66.66 JeFRrrftx ft. • Existing, 8uildings(3) Size ft. x ft. • Proposed building - distance from property Ilne: • Front yard �ft. Rear yard 30f fI. • Side yards ft. and 0 ft. GROSS AREA OF PROPOSED STOUCTURE It on corner, setback from side street ft. 1st Floor ' Ulf"%' sag. ft'. qP • OCCUPANCY' INFORMATION 2nd Floor �9 sag ft 5C'i �1�r Primary Building - X One Family Dwell(nj Other Floors IVA aq. ft,- (not cellar -or ement t /. ..Two Family Dwelling TOTAL FLOOR AREA 1399 sag. tt. • _,Multiple DweWng/Number of units_ • _Business Size of now structureAft x 41 ft. Industrial Foundation.- ter/slob/crawl/partia Lg. • — (circle one) • Other No. of stories (habitable space) Z � Height (greda to Ndp) If residential no. of families No. of rooms(eucludirg baths) No. of "ooms, 3 No. of bathmnsl Z PMmary heathig system AIR. Type of fuel jAS No. of fireplaces to be Installed A Will a wood stow be Installed No .l • It addltlon, what will use be? • •. Accessory Building _ .Detached Garage ONEITWO Car a _Attached Garr NO Car • Privatestorage�buiilldiinng • • Other BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS: Type of construction, wood frame, fire safe. etc., Will any second-hand or upgraded lumber be used? If so. for what? /ie fiaVaL /N / Aik S;w Foundation wall materiel D,V>°,WIZ 0~ Thicckness Depth of foundation below grade (to bottom of footing) 4(1 gmly Will there be a cellar? lE Heated or nheat�ed Floor sq. footage 09D sq ft. Will there be a basement?_ iO Will any por101i be used as living space? A (If so, what portion? , sq ft. Type of use? Type of roof - slope flat/shed/other Material of roof ./eFAiT g MX X5 S/yOW Size, wood studs "x__L" spacingZ6 " o.c. length eft: Joists (floor beentsi !st floor "x /0 " spacing, /64 ."o.c.:SpeYi' ' j3 fC.;pR Joist (floor beams) 2nd floor Z "x /6 "spacing L "o.c. span 4, ft. A.gla5 Overlays (ceiling beams) _"x___L.'spacing W " o.c. span i2 ft. Roof rafters 2 "x 10 "spacing Ib a o.c. span %Zf ft. Roof trusses (pre-engineered) spacing 24 " o.c. span ft. $K 1d6s�I'Cap�AV Exterior wall finish KoRR�x1Dr^ Boom oCwha Watorial? 1191L Interior wall finish_ Y?" 19AMW 6W ,QDiVRp . If a garage is to be attached, describe materials to be used for FIRE SEPARATIQNt 7166 k �yP. %fR�• ARE Dao� W /Pca:E.t Is thereto bean opening between garage and dwelling?� If so will a Fire -rated door, enclosure, self -closing device be provided? Will a flue -lined chimney be installed? PI6 Height above roof ft. Depth of chlMoey,•foundatio beJow,grade ft. Depth of fireplace hearth ft:_in.. hf Water supply - Municipal or private well J 1DN91*1 SEPTIC SYSTEM Distance from ANY private well (including adjoining properties Ifoll N ft. (A sepnrnte et+I _ ___ toA !s necessary for any repair or new installation of septic system) NAME OF BUILDER �AS 110 8lii7FjEA5&llSj pDRESSYM SPADE AY n "t'E`]')E EL. NO. ,fQ'u/(7Jl NAME OF PLUMBERRN P40MON6 ADDRESS0 yap Avf. AWY TEL. NO., `t{J I - 011 YAME OF MASON hb] AX fWNA4 6 ADDRESS3�WA�.�nC�IK1J9UjTEL. NO. J70-ID B Dl FAME OF ELECTRICIANJP?? tz(`K_ADDRESS /71 *WADD U,&g TEL. NO. 3 `B/0D .lixr�oay DECLARATION To the best of my knowledge and belief the statements contained in this application, together with the Ions and specifications submitted, are a true and complete statement of alit proposed work to be done on to described promises and that allprovisions of the BUILDING CODE, THE ZONING ORDINANCE, and ll other laws pertaining to the proposed work shall be compiled with, whether specified or not* and that Ich work Is authorised by the owner.. ' Signature Owner, owner's agent, archititct, contractor PECIAL CONDITIONS 0! TUB PERMITt BY TOWN OF QUEENSBURY eL APPLICATION FOR SEPTIC DISPOSAL PERMIT �0''r.4 OF QUEENSBUH, DATE: / r7'�/ 6- /pI LOCATION OF PROPERTY FOR INSTALLATION 010 /'liU. zmx- JUL 1 R jq9 Owner's Name: LA 91ALTY aLpG& G&fe T. Address: %D2 9INfn�1DWO, &, NWFUAVD AN fAR Installer's Name: 4A/r kVMA f A%V Telephone: Zf��Zi�B Number of bedrooms (residential only) 3 �� Total daily flow (compute @ 150 gal per bedroom) 4k Topography: Circle one: la Rolling Steep Slope % of Slope Soil Nature: Circle one: and Loam Clay Other /Depth: Ground Water: At what depth? % Z�� Feet Bedrock or Impervious Material: At what depth? 7�I Feet Percolation test: Circle one: not required required Rate - Min. Per Inch Domestic water supply: Circle one: Municipal Well Other If domestic water supply is a wel . Separation: Water supply from any septic absorption feet. PROPOSED SYSTEM: Septic Tank Z0D0 gal. (minimum size: 1,000 gal) TILE FIELD: Each Trench feet/Total system length feet SEEPAkE PIT(S): Number of 4 /Size each 6-9 feet by feet Size of stone to be used N. 2 /Depth or Thickness 12" yDES 45ff&1 feet NO. of Tanks MOLDING TANK SYSTEM IF REQUIRED Size of Each Gal. syston and associated electrical work to be inspected by an approved agency. 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 Queensbury Sanitary Sewage Disposal Ordinance. 11 r� SIGNATURE OF RESPONSIBLE PERSON: VIIAN f DATE: /� HI Septic System Inspections: A. All applications for septic system installation, alteration or repair, as required by the Town of Queensbury Sanitary Sawa&e Ordinance, shall be submitted to the Building Department it least 24 hours before start of construction and shall include a plot plan showing: 1.) the proposad location of tho system 2.) location and distance to lot lines 3.) location and distance to structurso 4.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, the fields and/or drywolls B. No system shall be covered before inspection and approval by the uullding Inspuctor. Failure to comply with this requirement may result in the uncovering or tha 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 rasult 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 bu submittad to the Qusansbury Building Department before further Construction. k,:msrk; ft Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Naviland Roads Queensbury, Now York 12804 TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK �O'l,N' OF QUEFFENSBUk, Application for: BUILDING PERMIT IN COMPLIANCE WITH THE�fE,�7�RK STATE ENERGY CONSERVATION CODE IUL A permit must be obtained before beg1nniW wjk. ANSWER ALL of the following: 9LDG.& CODE DEPT, 1. Gross floor area 01q 2. Type of heat GAS HOT AIR 3. Is the building mechanically cooled? 4. Percentage of area of windows and doors MIN 8% A. Over 16% Only 1. Uo value of gross area of walls, roof/ceiling and floors exposed to ambient conditions 2 3 4 61 Floor over heated spaces YES NO a. Are foundation walls insulated? YES 1. If YES, what is the R value? Slab on grade YES NO a. If YES, what is the R value of perimeter of floor? Is basement heated? YES NO a. R value of insulation Type of inaulatiotl 1N insulation around B. Under 16% Only 1. R value of roof and floors exposed to ambient conditions_ R- 30 — 2. R value of exterior walls R- 3. R value of glazed are 4. R value of doors 5. R value of floors over unheated spaces R 19 6. R value of slab edge insulation - unheated slab na 7. R value of slab insulation - heated slab na S. R value of heated basement/cellar walls (above grade) na 9. R value of heated basement/cellar walls (below grade) na 10. Type of insulation FTorori Acc ❑ATT C. Controls 900 1. Thermostat maximum heat setting 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 1. Size of hot water or cooling carrying agent pipe 1 2. R value of pipe insulatioA F. Service Water Beating 1. Performance efficiency 2. Temperature control setting maximum G. For Swimming Pool Only 1. Maximum heating Telephone No. 370-105 5 (applicant's signature) TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED NAMED%�G(XX� LOCATION DATE Z�0�/ PERMIT i TYPE OF STRUCTURE RECHECK APPROVJ �h0011NGS/Y1tK1 MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTECTION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACEMENT OF THE CONCRETE. MATERIALS FOR THIS PURPOSE ON SI FOUNDATION/WALL POUR REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING �- BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/VENTS IN P CE_ PLUMBING UNDER SLAB FRAMING: JACK STUDS/HEADE S BRACING/BRIDGING_ JOIST HANGERS JACK POSTS/MAIN EXAM FIRESTOPPING WALLS CEILING FIREWALLS HEATING ROUGH - INSULATION: FOUNDATION, ALLS INTERIOR R-_ FOUNDATION'WALLS EXTERIOR R- FLOORS R- WALLS R- CEILING R- DUCT WO K OR PIPING IN UNHEATI SPACES ARRIVE DEPART (;401034- (/9 INSPECTOIF 100 OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD Q� TELEPHONE(518)NEW 0R4 92-5832 BUILDING INSPECTOR'S REPORT f j REQUEST FOR INSPECTION RECCEIVED NAME &Zd/:( 0f7 eLn !I / LOCATIONN l oy & DATE a / PERMIT / 9/-.5��2 TYPE OF STRUCTURE l( (d RECHECK APPROVED I N is I vcc I Nn MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONS BLE FOR PROVIDING PROTECTION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACEMENT OF THE CONCRETE. MATERIALS FOR THIS PURPOSE ON SI FOUNDATION/WALL POUR REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING '( BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/VENTS IN PLACE PLUMBING UNDER SLAB FRAMING: JACK STUDS/HEADERS BRACING/BRIDGING JOIST HANGERS JACK POSTS/MAIN BEAM FIRESTOPPING CEILING FIREWALLS - hEATING ROUGH -IN INSULATION: FOUNDATION WALLS INTERIOR R-_ FOUNDATION WALLS EXTERIOR R-_ FLOORS R- WA LL S R- CEILING R- DUCT WORK OR PIPING IN UNHEATED SPACES ARRIVE - DEPART r =• G� ��- - NSPECTOR _loom o/ Queensburty BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 oueensbury, New York 12801 SEPTIC DISPOSAL SYSTVX INSPECTION LOCATION DATE �/PERMIT NO. � SCIL TYPE - Sand - Loam - Clay -_ Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field, total length Length of each trench Depth of trenches Size of gravel_ SEEPAGE PITS4Number of) Size- _ft. X ft\ Gravel size PIPING: S ze Type Bldg. to tank Tank to dist. box Dist. box to field/pit Openings sealed? YES NO Partial LOCATION/SEPARATIONS: Foundation to tang _ft. Foundation to absorption _ft. Absorption to lot line _ft. Separation of pits _ft. LOCATION OF SYSTEM ON PROPERTY(circle one) Front - Rear - Left side - Right side - CCMMENTS: SYSTEM USE APPROVED (Yk ) NO B i ding In pector 01/86 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT yy� 531 BAY ROAD / QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT 2EQUEST FOR INSPECTION RECEIVED / f [AME .00ATION ',� )AT E-��PERMIT f TYPE OF STRUCTURE ZECHECK APPROVED 10NOLITHIC POUR FORM tEINFORCEMENT IN PLACE fHE CONTRACTOR IS RESPONSIBLE -OR PROVIDING PROTECTION FROM °REEZING FOR 48 HOURS FOLLOWING fHE PLACEMENT OF THE CONCRETE. 7ATERIALS FOR THIS PURPOSE ON SIT OUNDATION/WALL POUR ZEINFORCEMENT IN PLACE :OUNDATION/DAMPROOFING -� lACKFILL APPROVAL 20UGH PLUMBING -� 'LUMBING VENT/VENTS IN PLACE 'LUMBING UNDER SLAB"y RAMING: JACK STUDS/HEADERS BRACING/BRIDGING JOIST HANGERS 3 JACK POSTS/MAIN BEAM� `IRESTOPPING 1 WALLS CEILING -IREWALLS SEATING ROUGH -IN INSULATION: FOUNDATION WALLS IH ERIOR R- FOUNDATION WALLS EXTERIOR R- FLOORS R- WALLS R- CEILING R- DUCT WORK OR PIPING IN UNHEATED SPACES ARRIVE )EPART TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT tEQUEST FOR INSPECTION RECEIVVED (AME DD .00ATION 7� /�//�f�' 242Z a�d--x )ATE PERMIT t %/ �:% L TYPE OF STRUCTURE tECHECK APPROV I N/A I YES 10NOLITHIC POUR FORM ;EINFORCEMENT IN PLACE FHE CONTRACTOR IS RESPONSIBLE -OR PROVIDING PROTECTION FROM :REEZING FOR 48 HOURS FOLLOWING fHE PLACEMENT OF THE CONCRETE. 1ATERIALS FOR THIS PURPOSE ON SIT :OUNDATION/WALL POUR lEINFORCEMENT IN PLACE 'OUNDATION/DAMPROOFING SACKFILL APPROVAL =GH PLUMBING 'LUMBING VENT/VENTS IN PLACE_ 'LUMBING UNDER SLAB RAMING: JACK STUDS/HEADERS BRACING/BRIDGING JOIST HANGERS JACK POSTS/MAIN BEAM IRESTOPPING WALLS CEILING :IREWALLS iEATING ROUGH -IN NSULATION: ! FOUNDATION WALLS INTERIOR R- FOUNDATION WALLS EXTERIOR R- FLOORS / R- WALLS R- CEILING DUCT WORK OR PIP NG IN UNHEATED SPACES ! ARRIVE )EPART INSPECYUR TOWN OF QUEENSBURY 531 BAY ROAD QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 745-4447 BUILDING INSPECTOR'S REPORT FINAL INSPECTION REQUEST FOR INSPECTION RECEIVED LOCATION'y dfy 7kl Qi DATE_&/jA/9/ PERMIT// 6 /6 TYPE OF STRUCTURE / Lroul1 RECHECK FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE) —FIRE iFOUNDATION L�BACKFILL vFRAMING ROUGH PLUMBING FINAL ELECTRICAL e.SEPTIC :MSULATION WOODSTOVE/FIREPLACE REMARKS i > —T APPROVAL N/A CHIMNEY HEIGHT/LOCATION YES NO B VENT/LOCATION PLUMBING VENT SIDING DECK/PORCH/STEPS/RAILI ?Ts — RELIEF VALVES FURNACE/HOT WATER O; RA ING BASEMENT INSULATIOR/DUCTWOR INTERIOR TRIM/PRIVACY DOORS FINISH FLOORS: BATH/KITCHEN WATERTIGHT OTHER FLOORS SWEEPABLE OTHER FLOORS 'CARPETED STAIR CLEARANCE/RAILINGSS— HANDICAPPED (ACCESS SMOKE DETECTORS BATHROOM FANS/WHOLEH USE FA ALL PLUMBI G FIXTURES OPERA GARAGE FIFtt PROOFING DOOR CLOS RS OTHER FI E SEPARATION EPARA ICON FIRE/DEM SE WALLS DUMPSTER' SITE PLAN/VARIANCE EQUIREMI FINAL ELECTRICAL OK TO ISSUE C/O OR C/C Za ARRIVE DEPART — INS THE NEW YORK BOARD OF FIRE UNDERWRITERS r�•:,E l ;LCLU LOB, BUREAU OF ELECTRICITY 41 STATE STREET. ALBNAY. - YORK 12207 Date GE:"E?IBER P}-I ai App/icationi .onfl�l�'.:I 1/91 bGL9RG THIS CERTIFIES THAT PER"III .M1(C 91-51 f• only the electrical equipment as described below and introduced the appl' named on the &bow application number in the promises of c & L RE UT , 74 OLD "diLL LINE, 4ASCLLO BR(iO. BLDRS. I':C OGEEN'SBC�R'l in the following location; 0 Basement Q Ist Ft. El 2" Fl. G 3 R Sectionl I I Black Lot :� ? was examined on ', il\ E'I B E R :.".!')9I andfound to be in compliance with the requirements of this Board. FIXTURE ECEPTAGES SWITCHES SWITCHES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS INCANOESCENi iIIXTURE OTHER AMT. I K. W. I "T. K. W. "T. K.W. Mr. I K. W. MIT. M.I. OUTLETS 35 13 39 5 i 1..-I DRYERS FURNACE MOTORS IUTURE APPLIANCE F E RS ISPICIAL OC'PTI TIME CLOCKS I RHl I UNIT TRANS. MATE" I MULT$-MTIET SYSTEMS N NO"*" FELT WJAAMrS Ma. K. W. OIL M. P. GM M. P. Mr. NO. A W. G. MIT. AMP. AMT. AAVS. AMT. WATTS t I SERVICE DISCONNECT NO. OF S E R V 1 C E "T. AMP. TYPE METER IWIP. 1 p [W 1 a 3W 3 a 3W 30 AW NO. OF CC. [OND. A W.O` No. OF MMUG A W. G. No. of NEUTMLS A. W. G. PER a OF CC. CdID. OF MI-UG OF NEUTRAL OTHER APPARATUS: EI.:FC'. kclol HF JFRR':I I ILL. V Iri,a>g; ,.F H.F., I ".` 1].1'. DTSPO'AL:1-F !J.F.C.I:-5 "10VE DETECTOR: 1�;THOVF +;I;ZZ3R1'I I 0 . ULP . �9 Bl�Xh{ DkICE BRANCH MANAGER 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. COPY FOR BUILDING DFPARTMFNT- THIS COPY OF CFRTIFICATF MIIST NOT RF Al TFRFn IN ANY MANNFD 46EL(REV MOB) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING THE NEW YORK BOARD OF FIRE UNDERWRITERS CERTIFICATE NO. DO NOT WRITE HERE • FOR OFFICE USE ONLY BUILDING PERMIT NO TEMP N DATE CITY OR VILLAGE — TCANNsua, ^ �.�y •/ "�",�AQRFN SFREET AND NO OR ROAD _ POLE NUMBER OfMFH $N'T�Dp Gay 3049BRQWAY �ENmv NY 123ob " e1LLrvnDne xxMnvx CURRENT SUPP )ko NarY/NA1 FROM TARN OFFICE WOgN�� �Hf)NE [{UMBER 3 BUILDING IS ucwYl n �y FI.I]LL NAI FRIIIGRFMfNFR LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED �Ga' IIDn NUMBER OF OUTLETS No. of Futures 8 Lamp Receptacles MOTORS HEATERS BRANCH CIRCUITS OFFICE USE ONLY INSPECTION Ceiling Sitle Wall Atlach't Rece0la Switch Pantlant Bracket No. Type HP Each N. Walla Each ND A W.G. Gauge OUT SIDE SUB- BASE BASE- MENT — 1a R. znd FL. -- 3RI FL. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE. 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 MAINS `��AM ^ Y FEEDERS - _ ELECTRIC SIGNSM1AMPS - 101pL ANUS CIIARMIE�RT O,F/RN TVF%POSED GM NflE Sf,WmANSFORMERS OF VA Cy/ O� rG (� __ 1�CONCFALED DATEM IOBE E�7ED DATE COMPLETED SIZE OF SIGN INUMBER) CAPACITY SERVICE ENTERS BUILDING MANIJFACNRER OF SIGN ❑ OVERHEAD UNDERGROUND WE INSPECTION REQUESTED ON (OR AS NEAR AS POSSIBLE) MUST ENTER APPLICANTS ��I IDENTIFICATION NUMBER AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION_ ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. PRINT NAME AND ADDRESS ❑ 85 John Street I>i 41 State Street I ❑ 584 Delaware Avenue I ❑ 217 Lake Avenue I ❑ 202 Arterial Road NEW YORK, NY 10038 ALBANY, NY 12207 BUFFALO, NY 14202 ROCHESTER, NY 14608 SYRACUSE, NY 13206 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1 0 .p / rcl / JU . 16199