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1987-066 r rr lap CERTIFICATE OF 0CCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK I�atc January 20 ,s 19 This is to certify that work requested to be done as shown by Permit Now r has been completed. This structure may be occupied as a i rn Glenrair Drive - Stmiehurst Subdivisioll Location owner Douglas and Carol Beatty By Order Town Board TOW''N OF QUEENSBURY suilaina & zoning Inspector 4 BUILDING PERMIT TOWN OF QUEENSBURY No. 87_66 WARREN COUNTY, NEW YORK PERMISSION 1s hereby granted to Douglas and Carol Beatty OWNER of property located at Lot 40 Glenmar Drive ( Stonehurst ) Street, Road or Ave. t in the Town of Oueensbury, To Construct or place a One—Family Dwelling °R 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 Queensburyy Building and Zoning Ordinance. y 1 . OWNERS Address is 17 Potter (toad w Gansevoort , NY 12831 a7 ro 2. CONTRACTOR or BUILDERS Name Donald Harvey 3_ CONTRACTOR or BUILDERS Address xR. #1 Box 1385 Lake George , New York 12845 rn rr 0 CJ rt 4_ ARCHITECTS Name D ro � � a C m N rr ro 5. ARCHITECT'S Address cn C W Ga Y• d d �-I m G fi. TYPE of Construction — !Please indicate by XT p,, ro O ( 10 Wood Frame ( 1 Masonry i 1 Steel S ) 7. PLANS and Specifications 26 ' x55 ' per plot plan , specifications and application submitted No. including sewage system and two—car garage (under 8. Proposed Use One-Family Dwelling m E� Y• Y� $5wOO CIO $ 17lo OO PERMIT FEE PAID - THIS PERMIT EXPIRES October 1 1987 ty (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.) r• 0 16th Da March 19 87 °° Dated at the Town of Oueensbury this /J Y of SIGNED BY _ M � for the Town of Oueensbury Building and Zoning Inspe TOWN OF C. UEZNG3ur�' TO BE COMPLETED BY BLDG . DEPT . 5 r cc�� Application No . L i{fJ S1 *� _lawn o� ueens9ury Permit Issued 19 # MAR �983 BUILDING and ZONING DEPARTMENT Permit Expires 19 Say and Haviland Road, R.D. 1 Box 98 Zoning Designation j BUILDING & COC)C DEPT. +Queensbury, New York 12801 Variance No. f / �G Site an Review Q., ,7 � , d o mac, q` AP v� APPLICATION FOR {C� BUILDING AND ZONING PERMIT I - � 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 I ? pytfi? -r F el & agnfe 5 ✓cj: kkAw� �AI Tel . 7 y rA Property Location : i I* 4c, Tax Map No . Street number or building lot number Subdivision name ( if applicable) �t &aj .�A u k°= THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : Name P . O. Address Tel . No . Name of builder. (�oryc. fcl I7farl/L'�' Address ,?,a I 67K IJ95 k (5:• I1l, Tel . Name of plumber Address Tel . Name of mason Address Tel . NATURE OF PROPOSED WORK : * ZONING INFORMATION : —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 dissensions) 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 �395 ft . Existing building ( s) Size ft X ft . PROPOSED BUILDING AND USE : Existing building ( s ) Use Size of new structure ,�( - rt X ft Foundation-pier/slab/crawl/partial ful Proposed building , distance from property line ( circle one ) �. Front yard ,rlG' ft Rear yard '� .� �' ft No • of stories (habitable spacer � � Side yards _ :� 5 ft and f' cx> f'L Height ( grade to ridge ) 3 ' ft . If on corner , setback from side street ft If residential , no . of families J No . of rooms ( excluding baths ) OCCUPANCY INFORMATICN No . of bedrooms PRIMARY BUILDING - Na , of bathrooms r� * One family dwelling Primary heating system ple'efr jo`C Two family dwelling Type of fuel * Multiple dwelling / Number of units No . of fireplaces to be installed permanent occupancy will a wood stove be installed?w � �, Transient occupancy Central Air conditioning? Business BUILDING STYLE, PRIMARY STRUCTURE Industrial Ranch Contemporary Log cabin * Other ' If addition , what will use be? Raised ranch Mansion Duplex Split level old style Bungalow Cape Cod Cottage Other * ACCESSORY BUILDING- olonia Row Town House * Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE ) Attached garage/one car/ two car/ _ ' car * * * * * * * * * * * * * * * * * Private storage building ESTIMATED MARKET VALUE OF —Other CONSTRUCTION INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , To BE COMPLETEDI Form BPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . YYccar'/ Ala/yv Will any second-hand or ungraded lumber be used? If so , for what? doop�;2 Foundation wall material �'��� y�° ee-WZY if Thickness S Depth of foundation below grade (to bottom of footing ) 7 Will there be a cellar? Vey Heated or unheated? �jV _Floor sq. footage 753 -1 sq ft Will there be a basement? Will any portion be used as living space ? ( If so , what por on? _sq_ ft , - - Type of use? Type of roof lopeflat/shed/other Material of roof Size , wood studs "X6/ T`" spaci.ng�"o . c . length .S ft . Joists ( floor beams ) lst _ floor ""X " g /e6 "o . c . span / 3 ft . /i7 spacing Joists ( floor beams ) ?nd . floor "X a spacing Overla s (ceilin beams — „x f� �— am` "a . c . span ? ft . Y g ) spacing "o . c . span ft . Roof rafters "x spacing o . c . span ft . Roof trusses (pre-engineered) spacing '"o . c . span ft . Exterior wall finish Of what material? Interior wall finish s4.u ! 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? MO Height above roof_ ft . Depth of chimney foundation below grade �y _ft . Depth of fireplace hearth ft . in . Water supply - Municipal or private well Z'ioe SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties lCoO ¢ ft . (A separate application is necessary for any repair or new installation of septic system) Town of Queensbury T1 1r County of Warren A F F I D Y A 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 . r 11 . __ SWORN TO BEFORE ME THIS Signature .- 1C°l" _ _______ -Owner , o er ' s agent , arc nxrectT, c_ont_ractor day of 19 Notary Public , Warren County , N . Y . SPECIAL CONDITIONS OF THE PERMIT . TOWN OF QUEENSBU RY 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 : /} r It 1 . Gross floor area °E b 2 , Type of heat 3 . Is the building mechanically cooled ? — 46 percentage of area of windows and doors A . Over 1 +6 % Only 1s up 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 S . under 16 % Only_ 1 . R value of rao and floor--exposed to ambient conditions 20 R value of exterior walls _ 3 . R value of glared area.. 4 . R value of doors 5 . R value of floors over unheated spaces_ ,I __. 6 . R value of slab edge insulation -- unheated slab 1y /t 7 . R value of slab insulation -• heated slab JN A 8 . R value of heated basement/ cellar walls ( above grade ) 9 . R value of heated basement/cellar walls ( below grade ) f� 10 . Type of insulation FrAjvm /A5 co Controls eL5'0 A7 ` la5c' thcTart� y °'� 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 . "pining insulation 1 . Sire of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating N 1 . performance efficiency 2 . Temperature control setting maximum G . For swimming Pool Only 1 . Maximum heating !l < Telephone No . 2f 4;�' 3 ��� ( appli ant ' s signatur ) APPLICATION FOR SEPTIC DISPOSAL PERMIT BATE / LOCATION OF PROPERTY FOR INSTALLATION Owner's Name: I i� E"t� � 1� Telephone: Address: Installer's Name: Telephoner Number of bedrooms (residential only) _ �- Total daily flow (compute @ 150 gal per bedroom) Topography: circle one: Flat Rolling Steep Slope % of slope Soil Nature: circle one: Sand Loam Clay Other { Depthe feet Ground Water: At what depth? YZA feet Bedrock or Impervious Material: At what depth? _ !�/ A feet Percolation test: circle one: not required required / rate min. inch. 5 M1 N i Domestic water supply: circle one: Municipal el Other _ IF domestic water supply is a Well: Separation: Watersupply from Septic absorption /tryo r feet PROPOSED SYSTEM: Septic Tank ( ()00 gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench -ETC] feet / Total system length ; 5cD feet SEEPAGE PIT(S) : Number of / Size each feet by feet Size of stone to be used it i � feet / Depth or Thickness / IMPORTANT .._Please...LIST NEW EQUIPMENT 0170 BE INSTAI_T_ED (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: l .) 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 dryweils 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 $250.00. C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system , a new proposal must be submitted to the Queensbury Building Department before further construction, I have read the regulations above and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage I �:o a? Cordi�nalm e. Signature of responsible person: �Vr1 Date: Town of Queensbury Building and Code Department Bay* at Haviland Road Queensbury, New York 12801 (518) 792-5832 5E 'fTLEO 1763 . . . HOME OF NATURAL BEAUTY A GOOD. PLACE TO LIVE THE NEW YORK _ BOARD OF FIRE IJIVDERWR4TERS — . BUREAU OF ELECTRICITY f1A i#tlrcii lU , I # i3c 41 STATE STREET. ALBANY. NEW YORK 12207 !� Application .Va. on file THIS CERTIFIES THAT 0603nl37 A i 1 _+5 only the electrical o"ipmerst .. descraibed below oesd iatr educed by the eppliclens namedaae the raboee f id �.a wpplicatson numj er in thaprem"" of Douglas Beat*y Lot f4t-) :;relm%ar Drive ')ucpensbury ,, New Yes'- one fas,11 v dwejjjn;� in thefolloming Iodation; Q Basement El I,st Fl. ® tad Fl. i7T,}.Its1G'{ Section Bfoclr 7 Lot w i; was examined an 1--1 n and found to be in compliance :with the reg"irementa of thin Board. TU UEE AC1.ES SVWTCHES FIXTURES — OTUEIS RAGS INCAIJ ONOMKIN!Q DECIti OVENS DISH WASHERS EXHAUST FANS yy DESCENT FL WENT AMT. K_ 27 .^ DRYERS FURNACE MOTORS RJTUER AI*KlANCE FEEDERS SlEC1At lEC•hT TIME Cl4CK5 . UNIT HEATER$ AlUtT4XiUTE!'T DIAA AMT. K. W. 011 N. P_ GAS N. F. AMT. NrJ. A. W. G. AMT. 11MP. AMT. AMPS. TRAtMS. AMT, !,, /. SYSTE3A5 HIO. OF /'RIET AMT. WATTS "A . yer _ SERVICE DISCOMPOCT NO. Cw S E ft Y AMT. AMP. TYPE 1NETER f C E EOSA►, 1 Jr 2W 1 X 3W 3 Ir 3W 3 Jr 4W NO. OF CC. COND. A, w. G- OF NFI,EG A. W. G.PER A OF CC. COPM. OF �_ Na. Crt NElIiRA(,S OF F EIJ RKL 4 /0 $ OTHIM AIrARATUS: L' JeC Room ` Oat_+ers . 3 /<^ . 3 , +/ 1 . 75 , 2/142 1 - 1 -�;fci T DOU �,.Ias Beatty L f . L # It Potter T.'d . fir' ClanSeVOOrt , ^3e- w York 12FY 31 239 J _ BRANCH MANAGER e= 2x This certificate must riot be altered in any tnonnrar, return ro the office of the Board if incorrect. Inspectors Per — pact may be identified by their crecleatiols. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. BUILDING, and/ZONING DEPARTMENT Bay and Havifand Road, R. D. 1 Box g8 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION DaterG" Permit No . frJ Footing/Fier Forms APPROVED - ygS NO Foundation Waterproofing Backfill Framing Roofing , Siding Masonry Veneer Rough Plumbing Relief Valves Ext , Porches Finished Floors interior Trim Stairs & Railings 'cellar Drain Tile f Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers. Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELEC RICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( cal ). when ready ) Remarks- ,00 .r� , - A A f /� and-vl Building Tns ector 6/85 MEW f fi^ 1 b WILDING and ZONING DEPARTMENT 6 s gfiay and Haviland Road, R. O. 1 Box 98 Queensbury, New York 128ol BUILDING INSPECTOR ' S REPORT NAME f/ LOCATION Date �'�� Permit No . .. ls'fri! Footing/Pi APPROVEDer Forms � - YES NO Foundation Waterproofing Backfill 4.- raming Roofing Siding Masonry Venee �gh Plumbing � — Relief Valves -� Ext . Porches _ Finished Floors Interior Trim Stairs & Railings Cellar Drain Tale Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECT CAL INSPECTION DRIVEWAY AP OVAL Final Build g Survey y Next scheduled inspection (call when ready) Remarks- and-vl Building Inspector 6/86 1 40 O/ �/''J'� / BL1fLDlNG end Z 'QC uF'F'� 3bl"r Bay and Ha and Z ► ING ❑EPARTME T Queen Road, R. D. I BOX 98 Road,New York 1280, SEPTIC A[f4�,t�cU � _ NAME t7IS POSAL. SYSTE�l INSPECTS ON LOCATION / DATE PEw+a I T moo. SOXL TYPE Perco n SandLoam PQrcolatz n ate Requ d?Test Cl�S - latio �infxnch TYPE of SYST Absorption P 1 z d. total Length Length of Depth of trees Zench Size of ,dray e S � SEEPAGE el Size_ PITS{N Gravel sate t• X Bldg_ to tank Size Tank to disc . TYAe ,Dist• box to penings seal f eZd EEELOCATI-0 ES 'No Par NfSEP Foundation o RATION Foundation tank 1 z-- Absorptio tp abSorPt o eft• Separation to Sot line n ft • LOCATxO pits ft . Pront R STE261 ON CCr4MENT . ar Left side PERTY (cix'cxe one �, C Flight Side } J cf ` SYST USE APp ROVED YES No Euilding InsP'ector a-Lf86 ntd yl 13011LOING an �uf � rt ] ©ter Ray and d ZONING DEPART&4 HavNand Road. R D, 1 j3Ox 98 �Ueensbury n+ew York 12801 SEprrc 5PO r,� INSPEe rloN NAME .• • / s LOCATION LATE `= --- ERM I7 Np TYPE SOIL � _ � Percolatiori Sand - L,oain Test Re Clay Percolation ,rate Min/Inch YES NO TYPE of SYST.E� Ah �c7r ; ption Length of ea field, total len Depth f e f tre esench firth Size o SEEPAGE gravel Size PITS{N, er of PIP ING ; �--�� 13l d Tan `�' to tank S T k to disc . h0, Dist_ box Openin to afield/ 9S sealed? E LOCATXON/SZP NO Partial Foundation to T S : Foundation to k Ahsorptio t sorption ft. n SQparation lot line ft . IA21CATION p�. Pits ft. pront _ R SYSTEM ON p ft. G 'tEntTs: r Left side OP TY (c jrcl a one) �•''� 9ht side -917 1� SYST USE APPROV YES O . Euild �g sp~ tor rnd vI ��Wn tee!` �ucert.l6,Grr. SCNLDING ,and ZONING DEAgRTMI�NT 'Bay and Haviland Road QueensburY. New * R. D. 1 13OX 98 'York 12801 BUILI) ING INSPECTOR NAME PS R PORT c.'� L O CA T I f7,h,1 �.- � tea•' „�" Rom` Daoo te ' a 9r Pier -F-a "'r Foundd = APpRC)VEr) Water *X E"S NOproongckfill Praming Roofing siding Masonry Veneer Rl9h Ply inq Ext . of halves Porches Finished Floors QQ,, tex-zor 'Trim Sta- *'"Cell rs & Railings Co ar brain Tile concrete Floors Pl . Fixtures Gar. ire Door Closers Salo),, Detectors Chimney Foun da t ion Floors y,,a I'1s Ceiling P.r,NA.L E.LECTRXC7AL 2NSPECTSppp DRIVEWAY AI'p.Rov Final. Butld.in8 Survey Next scheduled Remarks- inspection tcsll when ready suij md'vl C Xng .rnspec x�� ~ 88UfLC7$NG and NINGE'QirJ(asiv� aY and Haviland R DCCPARTMENT 'Oueensber Road R.Q. 18ox 98 Y. New York 128(}i NAME BUILDING INs PECTORISRepURT � o LOCA T I ON '�' Date �+ No F© n dan� er F s = AppRUVED * * ** Lion YES a ter on f-, Nd rBae ckfilg pzaimin9 Roofing Siding Masonry Veneer Re]_ s s Plumbing Finis Porchesbed Sri ter zmrs Stairs & Cellax doncrte rn l z�e Rloo Pl bg , Fixtures s Ga - pl reproo s 9 Smoke Detect, chi mn e.Y rs rzrsUr-,ATxorv : Foundation Pl coca rs Walls Ceiling PXNAL RIVF 1 LECTF2rCAL INSPECTxON DRIVEWAY APPROVAL heal Buildinn Survey Rex [ scheduled Remarks_ 3nsPecGor, (Ca-1-1 when read}, 00000 6/a6 md_Vx BtA na q ar $C1+L411v a� `'� a'r �Err i#firr ed gay and fgavilan.} R ad lNG DE-PARTMNr Queensbury, N , R-YOrkD, 1Box gg 2801 NAME UI tbING INSRECTOR rS REPORT L QCA T I ON ~.---� jDa to * No * F oun da tierrz z ex Fo2ms ✓ * APpRoVe Waterproogin YES ND Ba ck fi 1 I B Erami-n g Roofing Siding "laRo sonry Veneer Rel gerx'Vau v ang m t s . Porche.S In n shed Ploors .stairs . { ,cellar Raiz Xngs oncretez�or ize Gaxh`� ' Fixtures s �br CI reprood f. ng Smoke C2iirttne� ors INSur gT7C7fV ; Fn u+3 da t ion Pl o©rs WaI1s Ceiling FINAL ELE l�RIVF,WAY CrI`xCAi, 2lV,sp,�c AP 'TxpN � Inal 8 PRO VAL wilding survey Next scf�e Remarks_ doled insl° eetion GCfIR � CcaZl when ready) �l8Farnd�vi Buz d ng -,nspeotor say andZO/VuP Janci u~ou Queen naviland Ro a p�RrMEnr� s bury, New ' P D 28d ax 98 '��Me UILDrNG INS pEC7-o'II � $L- 4C4 rlON $c3 k�z In9 ROVED S * NO 80o fin Sx d i..I al Finish tones Xntex-i dd F'.I Staars r zr'irn Ce'zzarr I oncrete rdzr7 ,z 9s 0 F a Ga .� Fz'ttu $ Door reProogi Smo Closer's Ch=� 'De tee hgxs xArSUZA �'a POLUI p ooi F na Bu Ap 0VA rMSpEC�Z jjj$ Sur.,vey n'�xr R so hedge ed emex-ks� �ztsF"e� t�on (c,3x7 dY) 4 anct Y and Haw - 20n��No DEP3� r� nd Gueer�sbury, �,�,,d; Fi. DAR Box 98 ork 12,90, $ Dl �- bING 71V SAME SPECrp,R ' S RepoRr ( CA r I ON ZVO ting Founda i P �r Fox- ✓*= APppo Wa p,i ��'ED Sa kfi .ing 'iS NO Pralning siding Rough fin - pel xt set Valves ---_-�— orches hxt e3?d I oox___ S tair rrirn s � Cel' xar conor�Y RazxI S in �' Ibg rete F 00 axe � ixt Cal s, uY'+e Boar Cox Se�xrs o �n'~-4 ch�ey c'tectors 1NSUI.AT.rgN: oundat . x �rs on Ing DR I INrF kz -1CTRICAL tNSPECTxC3h7 414 Building Surve~y `�^-� Next :s educed in - � ftel"ark�- speCtion (call when ready) 15/86 rnc3_vx fisuixding nsPector ""�r .�j � F3[.,rrL'Q�NG ariacres'�,ps fi $aY srtq H aGNING OLclagR NT ©ue Avila errsb,c.rry, ly�,w� k 2 R. b., 1 7 8ax 98 01 NAME U' I C. £) IAIG rrvsPEcroR ; s R EPOR r LOCA ON * * * _.4z 1. a t.io r Fo?'rns Ap wa It a ck f 1 o �� D gj ny`- -�� F3alrring ing Siding MaSOnry. V Rough p1 e- r xt P �aZves g=�"`� In es ?n te z hei or ck F oors Stair Triu� 4 ellax- Lrr 3iin9s Ga x- K t U x-e's k� �-2osex" oE smo jng -�' Chimney etqIzs PO U da t s2Cl�= 2 �-Va on i'azxs Cexzxng �zvfi W y plual 4 t�1g,YS ryey p r �e )Ct sclied� fed �ej+atks~ in$nec t.ion ( ca -12 zz h�+ �edy f'�� md`vl 8�xidin9 X nsp��to r 7 F atilt-DING Q and ,zQlvr ueeri urn eayUue Navilan�y ePART►N+E ensb y AleW d1/ r ' .I ox S$ MAME x � 4xnrc IN-SpECTa R S !2 �p'pR T ` D u t.0CATxotv aN � 4 Date * / llE WadoL ttl erer'-or, r Foz Baoklzx ooaFzrr k' SRooeing ves P1 PO ea rnte shed 2Qo`z- -�--� St a.l�$ qr�m --� ar 'Dr Con nor P ete Fx00saz e Car fii ture Door reProo p , � 64no a losers Ch 1 Qtecto$$��e a xx Wa3,is OrRZCAZ P n aZ g � �P'OirAy �[vS�' C2tp Ong Sure", Q?narIP ` IlIISdu Iy~I-s -- k�� pact#ori (cal When readJill J - `jf-' Jilli 86 n1d, z $d g 1 ns T Aec for BUtCD�lyC3 an © d �aY anp Havilan road EPARrAr Nx Q�xnsbry. Wew kp8�©X 98 Bt,rzt � 1NG NAME NSAEC �EA�R � t+e * * A9 * - � * * x R?.z t B wa to-r1ckf -Oro".F • ��W'ED ng I so z wing "�as4n Rxt le.f I g FAo s nzahe ches stair$oir xa z s Ce,I br Rai i-I s Canarete Fat n fijxe - 0 P xt�re rs yak �1 s�ZOO fzn9 Xihz a detect rs F o Clat . III. rs Walls 17RZ ELEC, y Y 1Vex.t achedule Remar1c., respect en ' ¢ call when r d L r 8aY arr �a v ur'e�t a Na� ad R.�E'Pq,�7 T ME r' �£'nsburY. Now YOrk 280 ax 88 BiUI Lp jN� 1VRlK NS E'EC TOR r REPOR T L O'CA T ION Oa t PO wa ter d� tzon Y F�'rxrrs APp,RO Sackr � zg __�_� EI7 - YES IV F2"am i n g " - -- _� Roo.fzn cr Siring -- --� 'RoughtY veneer Pej �ePPyaxr,es g E�n shp rch esIed e-1xaz Dr. �1,Z P2t Crete F`, Tj-Ze Gar 9 . i IjctzA es DOZ-s S E or C2 0 "ozn r_h o ue etecuors FO ado�rpNr ~ PI PrIVAE DRVW I �sEC7RICq — � itza1 $ui di�OV �Ve S1 ECTIpN -- Y ��'`-- . Relita r "Jed irrsPec >r of n Cca�� y,h en read F� i '86 "ra'v2 1i. I izng . _. Oo w� o B{111D1 H. 1 4 / DING and ZC)P41 f+�ur �aY and nsViland +Raced, Qu D�P�4+R r,�rEn,t r eer�sburY, Ne. ya I rk 28CH1OX 98 NAMb' (jI LDI ►VG INSPeCro, r 5 REA I, oCA rI O Da t * rmz t er B�krp 00 27 - YES r n9 Roogin� Siding Ext ` £ halves isherches Xnt St d io Cellar ajing s --� Dra x2creteploor$le Ga PlbJ, Fixtures eke users afing Ch; e �'tect0Y.s r�S��Arrcnv: o lotion xa+rs Ceiling. rIVAL �$7VEWA I SCCAL tZding SurvQYl'E Final But text eduled Reanarks_ iIll Is" pQC [ion (Call sI-'ec tar F 6 } F (f4 1 BUILDING DEPT. CQf+Y OF APPLICATION FORM 4B�L, NEW YQRK BOARD OF FIRE FILE THIS COPY WITH SUFLD114G DEPT. WHEN REQUIRED. UNbERyy BITERS. CITY OR TEJIR. # VILLAGE DATE STREET AND NO, 6R r ,7 1 ROAD AND POLE NO TOWNSHIP BETWEEN iiiillk I" ' - COUNTY P ISE CRdSS STR 'TS S O f: REM TE ? F QCCUPANT4S POLE FWD. NAME ECtI N OWNER'S NAME I ' j BUILDING 8LOCK LOT �C7 ANO ADDRESS / OCCUPANCY SUPPLIED BY TEL, # I BSt1fLDING , .f ✓ [_ .J ` FROM THEIR NEW OLD Q WORK " OFFICE LIST BELOWIs NEW DEFECTS LL EQUIPMENT W ICH YOU InIsrALLE�DNAL C] RE Cl Loea- NUMBER OF OUTLETS Nix ofFlxlvres & tion LAIMP ReeaPtaclea MOTORS HEATERS BRANCH Ceiling Wedlat Ra 'ls S Pendant CIRCUITS OFFICE USE CNABrealtet No. Type Each W ONLY okrEaGI No. all A.W. Sub- Eeeh No. A.W.O. INSPECTION s� Brpr. +Dent ler Pi- Zed Pi. 3rd F!. REMARKS: LIST OTHER R ELECT KCAL OEV ICES NOT SET FORT" ABOVE; DO NOT USE THIS SPACE. This application is intendaatI to Cover the `rbove-listed Va are aulhorked ro make the i equiptto c to IM in SIZE OF +vPactin^ end adjust the fee to c w� but If at time of i MAINS over the additional equ` IVpeceion there is [eund eddi tiottsl rMnent, as Pr2*kfed by the aPPlicant. etlu�Pment nor above lis red, CHARACTER FEEDERS EL ECTRIC SIGN OF WORK LAMPS TOTAL WORK TO BE CONEXPOSE GAS TUBE SIGN WATTS STARTED LED TRANSFORMERS OF SERVICE OVERHEAD COMPLETED (NUMBER) VA r ENTERS VIL IN UNDERGROUND SIZE OF SIGN [CAPACITY! INSPECTION REQUESTED MAKER ON OR AS NEAR AS OF SIGN POSSIBLE AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATIOE OF N. ALL SPACES MUST 6E Fl�b IN OR APPLICATION MAY 8E RETURN ED. PRINT NAME AND ADDRESS OLD APPLICANT STREET ADDRESS 13ATE OF APPLICATION z f F ! CITY OR POST OFFICE TELEPHONE j '• ' ZIP "•/' COD ae EL (REV. alas} A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING -- — (Z S S° -� W L . 3 K --... - S3 Au � � (� I - ��� �J .'�>Sdi?S;is?f;i3t1it5� �/ ' ( •� ��:ab � � � 6 � � rr,. o c \ \ LS Al