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1987-008 CERTIFICATE OF OCC V 1 AN(De x TOWN OF QUEENSSURY WARREN COUNTY• NEW YORK Pun to Date 19 _ T%i. :. to oer<iff that work requested to be done as shown by Permit No. has COMP&MV& (Dot MMI TMis structux* may be oocvqAe4 as a a..� Eat � G-I f c�� 9Y Order Town Hoard TOVVN OF QUEENSBURY Suildiaig & zoning inspector C wYATIVt "INyTA ' IRRMTING. OLCN! IA LL6 N Y R2�OR {f 1��2!}.y4s6 BUILDING PERMIT r S TOWN OF QUEENSBURY No. WARREN COUNTY, NEW `FORK w PERMISSION is hereby granted to Earl Gray I-� OWNER of property located at Lot 68 Willow Road ( St . No . 36). Street. Road or Ave. n ^•c in the Town of Queensbury. To Construct or place a �e Famil ]7we113n 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 Clueensbury Building and Zoning Ordinance. 1 , OWNERS Address is Box 694 Bolton Landing , NY 2. CONTRACTOR or BUILDERS Name r Gary Gray m rn .n 3_ CONTRACTOR or BUILDER'S Address `.-lam F Bolton Landing , NY m r (A o 0 E 0 4, ARCHITECT'S Name m rn to rn rt c7 5. ARCHITECTS Address o v 6. TYPE of Construction — (Please indicate by X) 1 31 Wood Frame I I Masonry I I Steel [ ) i. PLANS and Specifications No. 64 ' x42 ' per plot plan , specifications and application submitted Including two—car attached garage and sewage system . 0 B. Proposed Use One-Family Dwelling f4 w a r �e $5 . 00 C/O Au usC l 1987 $ 1 Q2 C)0 PERMIT FEE PAID — 'PHIS PERMIT EXPIRES ,�. (if a longer period is required an application for an extensio 19 n must be made to the Building and Zoning inspector of the m r town of O.ueensbury before the expiration date.) 19 87 °r Dated at the Town of Clueensbury this 3.3th Day of Samar y I _ I r for the Town of Clueensbury SIGNED BY Building and Zoning Inspector GJ { � TO BE COMPLETED BY BLDG . DEPT . � t- Application No . 7pwn lot Queeol i Q"r y Permit issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 r l Bay and Haviland Road, RID, 1 Box 98 Zoning Designation Queensbury, New York 12801 Variance Na . EC ]VEa ,fAN 1187 //� Site Plan Review No . � < ( L�� Approved by • 1 f ` 7 APPLICATION FOR ' BUILDING 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 : -I 1 Tel . P .O. Address ' Tax Map No . Property Location : r-+ Street number or building lot number Subdivision name ( if applicable) THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK REGARDS BUILDING CODES 5 eJ j L F F L ),4r / _ 2 / Name P . O. Address Tel . No , Tel- dress Name of builder,�s r� "'^" s _. "( ---- Ad /��' c L IC ,�/� `,' t Name of plumber Tel .1 Address Tel • Name of masoniv�=�. . Address �'< . �.` rx NATURE OF PROPOSED WORK : ZONING INFORMATION : i /fconstruction of a new building APLOT PLAN MUST B T' E PREPARED AND SURMITED , _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 J t ft X J /� ft . * Existing building ( s) Size ft X ft . PROPOSED BUILDING AND USE : I y `7`� � Existing building s ) Use Size of new structure ) ft X ft eft line Foundation-pier/slab/crawl/partial/f� " Proposed building , distance from property * (circle one) ,y Front yard LJ,6, ft Rear yard ft No . of stories (habitable space) * Side yard ft and _ rp f !�_ £t Height (grade to ridge) Z ft- • If on corner , setback from side street ft If residential , no . of families + OCCUPANCY INFORMATION No . of rooms ( excluding baths ) d No . of bedrooms PRIMARY BUILDING - No . of bathrooms 7 * v one family dwelling Primary heating system J 1 3 < {., y-ti"< Two family dwelling Type of fuel Multiple dwelling / Number of units * Now of fireplaces to be installed I * Permanent occupancy Will a wood stove be lnstalled?_,O.�Il:lIIIIIIII� Transient occupancy Central Air conditioning? ; L J Business BUILDING STYLE, PRIMARY STRUCTURE * Industrial Other Ranch Contemporary Log cabin if addition , what will use bet Raised ranch Mansion Duplex Split level Old style Bungalow Cape ,Cod Cottage Other * ACCESSORY BUILDING- Colon ial� Row Town House * Detached garage/one car/p('t d garage/one oar t mar CIRCLE ONE PLEASE ) * _Attache y* , * * * * * * x * * * * * Private storage building ESTIMATED MARKET VALUE OF * Other CONSTRUCTION $ ]�� . � �_ {. - - - - - - - - - - •- INFOP14ATTON ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS 'SHEET , TO BE COMPLETED ! Form BPA 4/66 md-vl BUILDING, PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc , 4v� Will any second-hand or ungraded lumber be used? If so , for what? Lu Foundation wall material r L4 F4- _ ?hickness Depth of foundation below grade (to bottom. of footing ) Will there be a cellar? , - Heated or unheated? Will there be a basemen oli in footage sq ft ( If so , what a "�"" Wi1Z any portion be used as living space ? ] I ~portion . i sq . ft . - - Type of use? - Type of roof - sloped/flat/shed/other yf Material of roof Size , wood studs _ }{ „ spacing y+ "O . c . length �__ft . Joists ( floor beams ) Ist . floor 7 " ) IN spacing Joists ( floor beams ) 2nd . floor ``- p g +` 6 '"o . c . span , ft . �,X '� spacing-Ill.,� Overlays (ceiling beams ) „X ` - I. —'�-- `��.,�— o . c . span i y �/c• ft . spacing "o . c . span ft .Roof rafters "?C " s acin P g o . c . span ft , Roof trusses (pre-engineered) spacing!„'' o . c . span L ft. Exterior wall finish ' - .! .' _ Of what material? Interior wall finish j, r If a garage is to he at Cached , describe materials to be used for FIRE SEPARATION : Is there to be an •'opening between gara and dwelling? IA 0> If SQ Will a Fire-rated door , enclosure , and self-closing device be provided? 1yl Will a flue-lined chimney be installed? Height abovV roof Depth of chimney foundation below grade - ft . ft . Depth of firepl th ft . in . �� Water supply cipal or private well SEPTIC SYSTEM _ Stance from ANY private well ( includin adjoining (A separate application is necessaryg J g properties ir '�`. for any repair or new installation of septic system) Town of gueensbury l V I iT County of Warren A F F ; D R 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 THIS Signature 7 _ c day of 9 Owner , owjher ' s agJnt , arcnnect , contractor � i �. � L 1 ,�y i. i Notary Public , Warren County , N . Y . it SPECIAL CONDITIONS OF THE PERMIT : If TOWN OF QUEENSBURY 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 C�' . 2 , Type of heat�"�2 ` C 3 . Is the building mechanically cooled ? 4 , Percentage of area of windows and doors A , over IL Only 1 , Uo value of gross area of walls . ro / cells. ng and floors ,expose o ambient conditions 2 . F loor over he"'a-t,ed space s YES NO a . Are foundatibl%., wall insulated ? YES No 1 . If YES , wha ' s the R value ? 3 . Slab on grade S NO a . If YESe wh is the R value insulation around perimete of floor ? 4 * is basem t heated.? "YES No a . R lue of insulation 5 . Type of insulation B . Under 16 % Only IV R value of roof and floors exposed to ambient conditions. 2 . R value of exterior walls 3 . R value of glazed area. 4 . R value of doors - - - --- ------_- .---,- 5 . R value of floors over unheated spaces 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab / 8 . R value of heated basement/ cedar walls ( above grade ) 1qq g „ value of heated basement/ cellar walls { below grade } 10 . Type of insulation C , Controls 1 . Thermostat maximum heat setting D . Duct Systems YES No 1 . Is duct system installed in unheated spaces ? a . If YES , R value of duct installation b . R value of duct in other areas E . Piping Insulation_ 3f 1 . Size of hat water or cooling carrying agent pipe� ,r 2 . R value of pipe insulation F . Service Water 13eatit+ 3 c C� 1 . Performance afficiancy� . �. . O 2 . Temperature control setting maxi. mum� _. G . For swimming Pool only 1 . Maximum heating Telephone No . ( app cant ' signature ) df QeAftd&*V APPLICATION FOR SEPTIC DISPOSAL PERMrr DATE LOCATION OF PROPERTY FOR INSTALLATION ( r Owner's Name: r� Telephone: Address: _ / J CP>Z-yi020 ( Installer's Name: "Telephone: Number of bedrooms (residential only) Totaldaily flow (compute (,'5h 150 gal per bedroom) _ C'i y Topography: circle one, * Fla 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 min. inch. Domestic water supply: circle ones Municipal :Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption feet PROPOSED SYSTEM: Septic Tank _ gal. (minimum sine: 1,000 gal.) TILE FIELD: Each Trench feet / Total system length _` feet SEEPAGE PITS) : Number of / Size each feet by " feet Size of stone to be used # / Depth or Thickness _ feet I M P O R T A N T ...Please...LIST NEW EQUIPMENT TO BE INSTAlAsED * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * (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 Ordinance, Signature of responsible person: f Date: 3 i Town of Queensbury Building and Cade Department Bay at Haviland Road Queensbury, New York 12801 (518) 7 9Z-5832 SETTLED 1763 HOME OF NATURAL BEAUTY . . . A GOOD. PLACE TO LIVE �� ` Jocure o� '�ueenshure� �1v� BUILDING and ZONING DEPARTMENT its Bay and Haviland Road, R.D. 1 Box 98 f oueensbury, New York 12801 �y BUILDING INSPECTOR ' S REPORT NAME � � y LOCATION 6!ie� (Vitt 0cef OffDate'' � Peranit No . -T ✓ = APPROVED - YES NO Footing/Pier Forms Foundation waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors P1}�g . Fixtures Gar . Fireproofin IL Door Closers Smoke Detector Chimney INSULATION : Foundation Floors walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVA '+ Final Building Survey Next scheduled inspection (call when ready Remarks- Building Inspector and-vl ._.I"eatcrn o� �ueens � ure� BUILDING and .ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDDIING INSSPECTOR ' S REPORT .- E+ NAM .5 ... Y. LOCATION �,//�► r� Date SZ Permit No . C7 _ ✓ = APPROVED - YES N(7 Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough PlumbingAV Relief Valves Ext . Porches Finished Floors Interior Trim >6tairs & Railings Cellar Drain Tile Concrete Floors Plbg _ Fixtures Gar . Fireproofing ><7oor Closers YCgA t r Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTR AL INSPECTION DRIVEWAY APPfOVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- �.� Building Inspector 6/66 and-vl [[ ,BUILDING and ZONING DEPARTMENT i Bay and Haviland Road, R. D. 1 Box 98 1 Oueenshury, New York 12801 [ SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCAT Iat� !rc'CJ /�G ' nATF ,� . PERMIT NO. k / - SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate Min/Inch TYPE of SYST Absorption f>_ Id , total length Length of eac trench Depth of trenc s Size of gravel:_ SEEPAGE PITS4N r of ) Size- ft. X ft_ Gravel size - PIPING : Size Type Bldg , to tank Tank to list . box Dist. box to field/ Openings sealed? YES NO Partial LOCATION/SEPARATIONS : Foundation to tank ft. Foundation to abso ion ft . Absorption to lot l ne t _ Separation of pits LOCATrontI ar ON de - RTY (cight le one) Front. - ear L t sicZe�- Right S e - COMMEN SYSTEM USE APPROVED 5YE NO Boil ing Inspector 01/86 and vl I/ � f4tfJt1 0 Qttc'erir3he� rs� 4/F BUIL-61NG and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL_ SYSTEM INSPECTION hJAME •- 3LAT I ON e Gz: p4 / PERMIT NO , SOIL, TYPE - Sand - Loam - Clay Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM : Absorption field , total length Length of each trench p Depth s trenche Size of grave7he SEEPAGE ITS{Number of Size- ft. X ft. Gravel siVYE - PIPING : Size Type Bldg . to to Tank to di t� G Dist_ ]box Openings NO Partial LOCATION/Foundatio f �" ft, Foundation to absorption �ft . Absorption to lot line ft. Separation of pits ft , LOCATION OF SYSTEM ON PROPERTY (circle one) Front - ear Left side - Right side - COMMENT OIL, 701 SYSTEM USE APPROVED YES N Bui ing Inspector 01/86 and ul IQ BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME l LOCATION DATE ll ,+[' / PERMIT NO. SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEMS f Absorption field , total length i . ly Z2 Length of each trench Depth of trenches --- Size of gravel SEEPAGE PITS{Number of) �~ Size- ft. x ft. Gravel size PIPINGS S:' e Bldgo to tank - Ve Tank to disc. box Dist, box to field/ Openings sealed? YES NO Partial LOCATION/SEPARATIONS : Foundation to tank £t. Foundation to absorption �ft . Absorpt ` n to lot line ft . Separ ion f pits ft. L.00AT ON STEM ON PROPERTY (circle one) Front - Rear Left side - Right side cCMM SS G t !!ll"rCr ILLh4e 0 SYSTEM USE APPROVED YES /fNIO 1A Ruildine I eC r 01/86 and vl _lawn o� �iceens6eert� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT �Ct r NAME LOCATION Date Permit: No . ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Brain Tile foc4oncrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney L INSULATION x Foundation Floors L'Wa 13 s [/Ceiling jot FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building; Survey Next scheduled Inspection (call when ready ) Remarks- 66 Building Inspector 6/86 and-vl ,.Down o� �ueen .s �esrr� BUILDING and ZONING DEPARTMENT Bay and Hawiland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME y C, Y y`v r LOCATION DateA Permit No . � o ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing ,Bac]cfill Framing oo f ing Siding asonry 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 ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building, Survey Next scheduled inspection (call when ready ) Remarks- Building Inspector t86 and-vl J'own 01 Q"eer?j1C4ry BUILDING and ZONING DEPAnTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING, INSP/E+ CTOR ' S REPORT NAME LOCATION C ► r/CJGt! / [ d � G{ Tate Permit No . tp7 _ 44P ✓ = APPROVED - YES NO Footing)/Fier Forms Foundation LAMterproo£ing �4 Eackfill Fra dng Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures f Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : LXileundation n. �^ Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (tali when ready ) Remarks- Building Inspector 6/86 and-vl � 7.01 o/ QuQefll urfy BUILDING,, and ZONING DEPARTMENT Bay and Haviland Road, R. D_ 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME � rxrj LOCATION �� f- � � G.►1 !/Qua' R u �—*�f Da ,JAA 'fc,./fir'/ Permit No . 0 ✓ = APPROVED - YE Nil K Footing/Pier Forms py q Q01 Foundation Waterproofing Backfill Framing Roofing Siding Masonry veneer Rough Plumbing Relief valves Ext . Porches Finished Floors Interior Trim Stairs 6 Railings Cellar Drain Tile Concrete Floors - Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL E ICAL INSPECTION DRIVEWAY APPROVAL ~ Final Building Survey Next scheduled inspection (call when ready) Remarks- Bu ing Inspector 6/86 and-vl / a BUILDING and ZONING DEPARTMENT Bay and Hawiland Road, R. D. 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT �4r NAME ' LOCATION G!c G6 �/�!'i' �'�G•' /" �'`�„P J �. Date l/ / Permit No . ij 6 ✓ = APPROVED - YES NO X Footing/Pier Farms Foundation 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 . Fireproo€ing 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- : Building Inspector 6/86 and-vl """'� Na'ClCrlil Haadquarbrx , . _ 9Do�-fAdr!oi►.�i`a.;,� .-�,.i�R �.J. �'�,ols 7;tjDC*tion/AdcjnI Township 'f-( - v ' Town or. County dam' �{? ro%iI � •/t.ocateed ire Rural Area - Please Directions)r • , ,,cuPied..AS " S e /�..� E^� P rt' ,`."U Occupant _: :PLL l3uildlnpj It. rr llle Q it .for: Win Service Wtirfl+ Mtea irl Bui�di Fhmr # etc �: Fee Remitted'= r�.. : Cash t�aeck Re for n 'flll.Ir * Number o slw .s.o' 13,1.A S�nlritclees �", �,,, '. :`;allts Elect: Heat _ 17sa aaoo ggso gIIOo g7sr sacra . . L1gl1t1resange Unit Amp. Seriri[:e - . ace Dishwasher Recept etc ` _ Water Heater €1rver � Rp�P Air Cor'lil+#iorrer IWMPPof F' Disposal Oven+. 6 LL Other Equipment: -� ' Wiring and Con trs r o✓irTfiera . t ;.? Burnet Awrip. R�p'taclaa, Fractional H.P. Vent Farm MOTORS fAP_ Mark Nur[ r 1/1 i/10 118 i Ajh* t/3 1/2 ' 3f4 i 1Vz 2 . 3 5 7�/r x0' 15 20 23 ' 30 ,Ail. 517 .73 lOp Mx of Each Size [ Amlicant's , _ Signature ' T1A [ C _ I License # rrreit ff APpiirnYs- Utility: A a A (City) (State) Phone Electrician: Service Request # - J � DATE RECEIVE[]: ��7 � DATE INSPECTED: CL� -- Correct Location . Sarre as Above [� or: ..:' , Rough Wiring Surface Unitrr tj -PI tango YJven - -'t]'dl' @wf rrnz Water Heater Disllwashiei y ihiY Conditioner Dryer ce equi ment BGr rtn & Controis for Arne. Service Conductorx pum M ORS H.P. 1/20 4/12 1/10 1/8 x 1 dr11 11er<' " Ma Number /3 1/2 /4 1 14a 2 3 5 �Nr 10 x5 20 25 30 5 5: of Each Size eat 1w40 750 IOQp '1gS0 E SQp 176Q 004 . LL s0"0 . ! t . . RW Progress: Inc. 0 K9 Contractor I r CFT Violation : Work mp. nc, 0 L/A Owner CASH �. L/A — �„ , - , . : Fee WI Q IPA _ _. - - Due- Municipal /Y fl r4V Date: rli?i fa ,. . . Rt9t Ae �" Utility. /" ... 11pol cant Dw,a r' Cut in Card . Q Yemp # Da�tq --`1�+ ' 1� �`,a 3 I [� Final # ° r{ :,. . _ o 'a. 3 . >- } ir, �yrars+[r 8 sF 4 Date �` - .. ATU#r . L APPLICATION FORM NO- 250� L x f8 ... : ' • .:� .1 ... . - ... r .... - . BUILDING DEPT. COPY OF APPLICATION FORM 46-ELO NEW YORK BOARD OF FIRE UNDERWRITER'S. FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. f` '. CITY OR ' _ VILLAGE STREET AND TOriTtSMIP COUNTY NO. OR ROA6 AND PW.E NO. �.: _ $ - BETWEEN WHAT TWO •- POLE" NO. PRIM S 4LOCATE IS SE_ D7 ,+. OCCUPANT S — - C..' �y�rf=� ECTION I NAME BUILDING LOT OWNER'S NAM OCCUPANCY AND ADDRESS i TEL. SU PPLIED 4. r BUILDING 1' FROM THEIR {/G�' t'�/}. �r OFFICE NEW OLD ❑ WORK DEFECTS ^I IS MEW ADDITIONAL ❑ REMOVED C,1 LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS No. of Nmumea & t� Lanrp Recaptedal MOTORS HEATERS OR CIRCUITS OFFICE USE Side Atlaeh't ONLY dilirq 'Waif Recell'It Swt/di Pendent Snadrat Na. Type H-P. No. We Na. -W.G. fWSPECTlO{11 Out- Each Mlle Sub- be SEW an III Fi. Ind FI 8rd FL REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE; DO NOT USE THIS SPACE, This application is intended to cover the abawe-listad equipment to be inapectad but if at time of i You are authorized to make dIe jegaection and adjust she fee to cover Mr addjtionai "Paet6on there is found edditipnal equipment not above IKtad, SIZE OF equipment, as provided by the applicant. MAINS FEEDERS E L ECTR ICSIONS TOTAL LAMPS WATTS OF WORK CO CEALED ED GAS TUBE SIGN TRANSFORMERS OF WORK TO BE _ VA STARTED COMPLETED (NUMBER) (CAPACITY) SERVICE OVERHEAD S12E OF SIGN ENTERS UNDERGROUND BUILDING MAKER OF SIGN INSPECTION REQUESTED ON OR AS NEAR AS POSSIBLE NEW AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACER OLD MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. GATE OF NAME OF — PRINT NAME AND ADDRESS APPLICATION APPLICANT Ne SIGNATURE _ OF APPLICANT STR E E T ADOR EBB CITY OR TELEPHONE # < POST OFFICE ZIP LICENSE IWO, CODE WHEN APPLICABLE 46 eL (REV. 1/86) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING r _� ..�� 2 _._�__._ _��.___� _a�__ __e__.__ __.N=�._._......._ .�.e_.._._�r_. R �9 ��' ��� .v f, ' .i�,e .�.., �� �, �� C ..u„�, 4 -� #� ,^�- �J .. ,� j � _.. E_�_...k _....... -�-f--� � � �I }� , T `Ie.q ,_. ____, -f"y>� �>-� 1 ��8._ 1 ".""'"" Y .,�. i "r.'r j 7 4.n°AL