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1987-150 °l CERTI I CA,TE 1F OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date Sept • • 19 87 This is to certify that work requested to be done as shown by Permit No. 87-150 has been completed. This structure may be occupied as a one-Family Dwelling iocsrion _ Lot 46 Queens Lz ne ( Sta No 26) Stuyvesant Development Corp . Owner By Order Town Board TMVVN OF QUEENSBURY Building & Zoning lnapectar BUILDING PERMIT TOWN OF QUEENSBURY No 87-150 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Stuyvesant Development Corp c ro OWNER of property located at Lot 46 Queens Lane ( St . No 26 ) Street, Road or Ave. �6 v One-Family Dwelling " in the Town of Queensbury, To Construct or place aCD 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 Queensbury Building and Zoning Ordinance. o 1. OWNER'S Address is 1237 Central ave. m Albany , New York 12205 rt e-a 0 �s 2. CONTRACTOR or BtJI LDE R u Name Same 3. CONTRACTOR or BUILDER'S Address coo t' m o r� rr r-t F-� A O CT d. ARCHITECT'S Name p .C1 1~ S= m C � w m 5. ARCHITECT'S Address ,�YA7 Q g ro m tT a rt 6. TYPE of Construction — (Please indicate by X) rt rr Po rt � 11 Wood Frame i ) Masonry i T Steel I l m 0 rn . r.5 7. PLANS and Specifications 28 ' x66 ' per plot plan , specifications and application No. including sewage system and two-car attached garage . o m S. Proposed Use ny One—Family Dwelling F— �c $5 . 00 C/O $ 178 . 0() PERMIT FEE PAID — THIS PERMIT EXPIRES Nov ` l 1987 Y (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the r�town of Queensbu ry before the expiration date_) 07 Dated at the Town of Queensbury this , 14th Day of April 19 87 1 ' SIGNED BY . .ri" e..y for the Town of Queensbury Building and Zonirg Inspector �.QJr.._...— f _ TO BE COMPLETED BY BLDG . DEFT . JOttrn Er Berrdhtsrf*f Application No. ";OWN OF QUEc.i' SOJ� je- Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation U Queensbury, New York 12801 Variance No . A�TlriR $1 l / Site Plan iew No . ./_ n - - ` { 't' Approv BU1 DING �nP M .rAPPLICATION FORi �MklT E'e BUILDING AND ZONING PERMIT s { � A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING . �d 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 : - STLJ )VES7AgA17ww f 0Qi2: P L.. P. O. Address jZ / T L I'ti- � /V Y r !'( - 7• IZZ69 Tel . 7752 171 Property Location : }` oVJS4w;5' Tax Map Now Street number or building lot number Subdivision Haute (if applicable) E: iVrA ' i,. S THE PERSON RESPONSIBLE .FOR SUPERVISION OF WORK AS' REGARDS BUILDING CODES IS : sj;M "x3.: _ N ►asT- A51 !z3 '7 daNrP.,q Avre. . A-46AN. 14! y 'V5'1- 773J{ Name P. O. Address /} 'Tel . No . J�7'1.1 111IL�„Name of bull der5-rU A)V1" Z)F tl. Addr ess IZ37 i ap4 m4 L. A E. . IAey;3 . f1f.�Tel . L/ s q ] 73 V Name of plumber Address Tel . Name of mason Address Tel . NATURE OF PROPOSED WORK : ZONING INFORMATION : v 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 , wwwwwww (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 OC7 ft X 240 £t . * Existing buildings ) Size ft X ft . PROPOSED BUILDING AND USE : * Existing buildings ) Use &IJA Size of new structure ft X 40(.. ft Foundation-pierjslabjcrawl/partial ul * Proposed building , distance from property line (circle one) " No . of stories (habitable space) �'"u10 * Front yard ft Rear yard ft Height (grade to ridge} z13 ft . * Side yards £t and ft * If on corner , setback from side street ft if residential , no. of families dty No . of rooms ( excluding baths ) " OCCUPANCY INFORMATION No. of bedrooms Me FL No . of bathrooms 1 y * PRIMARY BUILDING - Primary heating system&j Vane family dwelling Type of fuel aL a &r fz! d * Two family dwelling No . of fireplaces to be installed ctda * Multiple dwelling j Number of units will a wood stove be installed? N g!: * Permanent occupancy Central Air conditioning? * Transient occupancy * Business BUILDING STYLE, PRIMARY STRUCTURE „ Industrial Ranch Contemporary Log cabin * Other ' Raised ranch Mansion Duplex r if addition, what will use be? Split level Old style Bungalow Ca a Cod Cottage Other '� ACCESSORY BUILDING- {r�cilonial Row Town House * _I�etaahec3 garage/one car/ two car/ car � ( CIRCLE ONE PLEASE ) * �/AttaChed garagejcane cart wo car car * * * * * * * * * * * * * * * * * * Private storage building ESTIMATED MARKET VALUE OF * Other CONSTRUCTION - - -r:- - - - - - - - - - INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETEDI Form BPA 4j86 md- vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction wood frame , fire safe , etc . __ /pca Will any second-hand or ungraded lumber be used? If so , for what ? p Foundation wall material ! 04'r' 1G . ai oe lK c, it Thickness '"po U TG'F L"oHfC' Depth of foundation below grade (to bottom of footing ) ALpp�_ �, 5- 1 Will there be a cellar?_Heated or unheated? Floor sq. footage sq ft Will there be a basement? YA.SWIll any portion be used as living space?NCB ( If so, what portion? sq. ft . - Type of use? Type of roof -- sloped/flat shed/other L.,� Material of roof A 5 t4pA1.'T 14 { Size , wood studs 2 "X " spacing ► (.v "o . c . length J?.__ . .__f t . ,r Joists ( floor beams ) 1st . floor Z •"x__LC) " spacings "o . c . span ft . Joists ( floor beams) 2nd . floor L lox I o '" spacing Jam._"o . c . span 3 - 4yft . Overlays (cei.lin beams ) . NIA '"X " spacing ""o . c . span ft . Roof rafters "X If o . c4 span ft . Roof trusses (pre-engineered) spacing—&.CL."o . c . span Zjff;� ft . Exterior wall finish SI'i im , Of what material? 1/1}y L LVMiAJVM pA ;et� Interior wall finish _ Sa# T12dCK� If a garage is to be attached, describe materials to be used for FIRE SEPARATION . 5sa TYPE. X zs il W F-rzae,< Is there to be an opening between garage and dwelling? YF5 if so will a Fire rated door, enclosure , and self-closing device be provided? v Yr= S Will a flue-limed chimney be installed? 4YC S Height above roof ft . Depth of chimney foundation below ade !v Depth of fireplace hearth 1 ft . *4 in . Water supply - Municipal or private well HLJAr re IPAL. SEPTIC SYSTEM Distance from ANY private well ( Including adjoining properties NIA ft . (A separate application is necessary for any zepair or new installation of septic system) Town of fa A F F .1 D v I T STATE OF NEW ]CORK County off 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 tree and complete statement of all proposed work to be done ion 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 Signatures_ r , owner ` s agent , arc#xizect , c tracar day of 19 Notary Public , Warren County , N . Y . * * * * * * * * Or * * * * * * * * * * * * * tt * * * * * * * * * * * * * * * * * * w * * * to SPECIAL CONDITIONS OF THE PERMIT : Hy-'--............... I 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 2. 3 52 2 . Type of heat S4,513, 4010ez) 3 . Is the building mechanically cooled ? /Vo 4 . Percentage of area of windows and doors ,4P'� X, a 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 ? 1 . If YES , what is the R value ? 3 . 4 Slab on grade 4- YES NO a . If YES , what is the R value of insulation around Perimeter of floor ? 4 _ Is basement heated ? YES d a . R value of insulation 5 . Type of Insulation. 8 . Under 16 % Only l _ R value of roof and floors exposed to ambient conditions oaar- w C) Fez 5 ,Z— / 2 . R value of exterior walls R / ! 3 . R value of glazed areaG z.L7 4 . R value of doors R - /5" 5 . R value of floors over unheated. spaces 6 . R value of slab edge insulation - unheated slab *A 7 . R value of slab insulation - heated slab IV104 s . R value of heated basement/ cellar walls ( above grade ) 9 . R value of heated basement/cellar walls ( below grade ) - to / ld , Type of insulation A/tab Ge444gf,5 Bo47 - C . Controls 1 . Thermostat maximum heat setting go d sr- D . Duct Sxstems 1 . Is duct system installed in unheated.. spaces ? Y NO a . If YES , R value of duct installation f� b . R value of duct in other areas i 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 Only 1 . Maximum heating /y / Telephone #No . Y rr' - 77 applicant ' s signature }- . `•`' •'� " `"�`P"' �'y APPLICATION FOR SEPTIC DISPOSAL PERMIT SUILD'NG af.d 200ONG DEPART&RINY Bey and Navitand Road. R_D. ! Box 98 _ oueensbary New York 128D1 DATE / - .• LOC , I JON OF PROPERTY FOR INSTALLATION �GP QIfJ��1flS44AIE OWNS R ' 5 NAME .STL/frL`.d•,5`,,�J.�JT �� y'aE1.a .s'�,r*'�'�.n/,',�'-' �'.t'� ADDRESS '7 .rt✓ 2 ' . ��-l3s�n� ,' u !, z = 773 INSTALLER ' S NAME Z)AA1 gzus,�.9 TEL2S1 - Z/SS Number of bedrooms (residential only) rCJl� Total daily flow { compute @ 1517 gal per bedrootsr} ede> Topograpby = (Fla'- Rolling - Steep slope - (circle one) % of slope Soil natures Sand Loam - Clay - other Depth ft . Ground +wate'r -At what depth7___ /,4 ft. Bed-rock or impervious al - At what depth? N / ft. Percolation Lest at require - Required - -Rate tsix�-inch . Domestic water supply Municipa - well - Dther Separation - hatersupply ( if well. ) from Septic absorption fte Proposed System : Septicc, tank gal ,{ 1s�4inimun size . 1000 )gal . ) ft . Jota2 system lea .� b Z5+01 ft See,aae pi t ! s 7 T un-,ber of Size each f t x f t Si4e c : star: & to be 1; seu Depth or thickness 2' ft4 r u ■ • s rt r r r r • r r # # ♦ # # # r } ! # ! # # ♦ • ! ♦ r # # ! r # # r On a separate piece of paper , submit a diagram of the proposed system with all dimensions shown ; including distance from any structure , distance from property 1 fines and from ANY DDY.£STIC WATER SUPPLY or share - line of lake , streb7n . pond or vet-landre. • Include sll dimensions of the system , Itself . r • * r • • . ♦ • r r • • rt • r # ♦ # # r r • # • # # # r # r r ♦ # ♦ ♦ r T ✓ 7; T +. f r: it Pr le C t o c ?: 4 c f : t } 7 7 recu i rerrent F cf The Tor.+se of (;urenebt+ ry Scn7 tcr, SEi• acc .� � s� osc 1" flrc.'s roriac . .� icr, cr . rr of r•• .- r :7 in" r � l• 2r �* rtr : On 05/ e6 and /v ] W1. Section II Septic 5 ste m. ,Tns ee: tLons : A . All applicationsd for septid system Installation , alteration or repair , as r,eauirod by the Town of Oueensbury Sanitary Sewage Ordinance, shall be submitted to the Buildina Department at Isaac 24_ hours before start of construction and shall include .a plot plan showjnq: 1 ) the proposed location of thee system 23 location and distance to lot Linea 3 ) location and distance to structures 4 ) 20ca Lion and distance to any water supply 5 ) size and dissensions of all tanks , distribution boxes , rile fields and/or drywells D . NO system shall be covered before inspectic n 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 . Co .An approved copy of the plot plan shall two available on the construction site. Failure to produce said plot plan at time of inspection may result In An Imnw Slate work stoppage. D . Should unforeseen problems during construction Prevent proper i.nstallatione alteration or repair of an approved system , a now proposal must be submitt4id to the Oueensbury Suildina © ePartrrent before further construction . rr 1 floty" Of Queer►� 31 "ry BUILDING and ZONING DEPARTM04IT 14b Bay and Fiaviland Road. P.D. 1 Box 98 10 ,n � Queensbury. New York 12801 p0 G INSPECTOM S REPORT UIL w . ION , �� Date Permit No . Ift 000" APPROVED - YES NO Footing/Pier Forms Foundation 'Waterproofing Backfill Framing Roofing Siding Masonry Veneer �-- P,ough Plumlbi �- Relief Valves Ext . Parches Finished Floor Interior Tr stairs Cellar Drain Til �- conerete Floors pl.g . Fixtures Gar . Fireproo ng Door Closers smoke DeteC rs Chimney INSuLATIO Foundatio Floors Walls Ceiling FINAL ELECTRICAL Ir78PECTICriI�� DRIVEWAY AYPROV nal 'Building Survey Next scheduled inalection (call when ready) Remark.s-- Bui ding nspectcar b/86 and-VI THE NEW YORK BOARD OF FIRE UNDERWRITERS B4 FREALJ OF ELECTRICITY Aoy . 41 STATE STREET. ALBANY. NEW YORK 12207 Date October 30 P 1987 Application ,No. "",file 008306/87 THIS CERTIFIES THAT only the electrical equipment as described behne wall istr"duc vd by the applicantrusEraad ore she sboae apfalicatsaEW number sea the pronaiaea of Stuyvasant DeVel.O lment Corp ,s fib Que-O7n.iB Lanes Glens Paellls s New York in the following location: $asement ® Iet Fl. 8nd Fl. Outolde Section 90 Black 9 Lot fib � and found to be m +ac� in copliae with tlLe regaairementa of this Board. vaae examined on FIXTURES RANGES COOKING DECKS OVENS OISM WASHERS EXHAUST FANS FIXTUREOUTLETS EPTACLES SWFITCHES JW.ANDESCENT rLUORESCtHT V MAY, K- W. AMT_ K. W. zs 43 23 FUTURE APPLIANCE FEEDERS $PEC1wL EEC'PT TIME CLOCKS RHJI UNIT HEATERS MULTI-CMJTLET O�{MIJAER DRYERS FURNACE NIQTORS TRANS. AMT. H. F. STS?EMS .u+t. wAT TS T�1 AMT. K. W. OIL H_ P. GAS H. F. AMT. NO. h- W. G. AMT- AMP. AMT. AMPS. NO.OF FEET . _ �}� 0a LQ SERVICE E115CONNE L7N J. 1r C7 •# S E R V t C E METER . Of Q, COHD. A, w. A. w. G. No. GP NEUTRALS AV AMT. AMP. TYPE , 11' Yw 1 1' Sw 9 .y 3'w S F 4W PER ; C1r CC. C0ND. NG. Or Ii1 LEG OF N1•lEG Gr NEUTRAL t: 200 eb 1 4/0 OTHER AMwRArUB= Electrlc Room HeAterEs 3 - 2 . 5 Kid 2 - 2 . KW �["['� - 5 - 1 . 5 KW � Py3'" = 3 -- l . O ICW ati A; .1')vr j� _ o I - Smoke Detector 400 Stuyvesant DeV . Corp . ? 1237 Central Avenue '� a q Albany P Nor York 12205 BRANCH MANAGER Per This Certificate must not be altered in ony manner; return to the office of the board if incorrect. Inspectors may be identified 'lay, lfleir creciantiols. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. .<,lvrun o `aCUeenshurrf (f {� 13UILDING and ZONING DEPARTMENT I Bay and Havifand Road: R,[7. 1 Box 98 �► oueensbury. New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION r ,r?r' I, -Z o ��•�----- e Permit Now #oe* * APPROVED YES NO ing/Pier Farms��,�,� Foundation Waterproofing Backfill gaming 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 ELECTRICAL INSPECTION DRIVEWAY APPRQvnr : f Final Building Survey _. ---- Next scheduled inspection (call when ready Remarks- _^ Suild ng Inspectr 6/86 and-vl �ueenshu�''� DEPARTM£t`�T ,UILCNNG and ZONING fox 96 l! L B8Y and 4 lavil8r►d �eW Yo o i k 12801 .++[ pueensburY. 8UILDING INSPECTOR ' S REPORT NAME L©CAT 1 ON permit 1IG . * * 'pate * * * _* �s No * * * * * * * * r APPRt]VEI7 Footing/pier Fortes Foundation waterProc)�f ing Backf ill Roofing Siding 14asrnry veneer 6p.0"gh Plumping_- - f Relief Valves_��--� FXt . Porches Finished Floors Xnteri-or Trim _ _ Stairs & RaiIingsl - Cellar Drain Tile��� Concrete Floors - - -� Plbg - Fixtures Gar . F ireproo£ ing, - Door Closers��_�-- Smoke uetectL4r5 Chimney INSUL,ATTON c Foundation Floors wails 3 Q Ce it ing INSPECTION��^1 FTNR FIECTRICAT. DRIVEWAY APPR'OV Final Building Survey CIleCalilea leap eCtion (.nail when' Next S read*]3 Remarks- lding Spector Bu 6/136 and-Vl _ !oWJ" a' I ueeres � ur`�1 6U4LC71S*lG and ZON;NG DEPART Bay and Haviland Road. } rik 1 8 , 9a B Queensbury, New York 12g0 BUILDING INSPECTORS REPORT Id NAME Pill a c A T i ON �� r ermit No 'YES i30 Fatting/Pier Forms foundation at-erproof ing ackfi11 Framing Roof ing S id ing Masonry Veneer Rough plumbing Relief Valves Ext , Porches Finished Floors Interior Trim F stairs & Railings ----�- r Cellar !]rain Tile___--. Concrete Floors 1'lbg - Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney It15S.]I,pTIOY3 Foun da t i tin gloors Walls Cell ' q FIt3AL kLECTRICAI. 114SPECTIO14 p4tIVEWAY AFPF'OVAL� �--- Final Building Survey �--�'- d insP ectton (call when 'Next schedule ready ) Remarks- r f� Fiuild� ng Inspector 6/86 and-vl �0evo n� BUjL0%NG and ZONING QSpAFtT 1 'Box +38 FiT Say and Haviland Road. R.I]• pueensbury, New `fork 128D1 BUILDING INSPECTOR ' S REPORT J � J2 NAME LOCAT I ON I3cr . el ^k per ' * * * * * * * * "` *�,,•• s APPROVEp - YES No Ming/r'ier Forms Foundation Waterproof ing Backfill Framing Roof ing Siding Masonry Veneer 1ZougY+ Plumbing Relief Valves Ext . porches Finished Floors Interior Trim stairs & Railings Cellar Drain Tile concrete gloors__ Plbg - Fixtures Gar . Fireproofing s poor closers Smoke Detectors Chimney Ifl SULATI013 Foundation Floors Walls Ceiling .rRSCAL IN PECTI aN �-- F-14A-L ELEc DIVEY Ap'PROV R WA ..-..---- RIVE Building Survey------- Final duffed insPeCtion call when read ) Next . ache i' Remarks- �r �� rt ,., i? A e Building Inspec+tcr Fi/Sfi md-vl ow v BUILDING and 7ONtNG DEPARTMENT Bay and Haviland 'Road, R,D- i Box ss pueensbury. New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION �►" CP � - Date t 3 Permit NO * �•� "/`��? * * * * * * * * * ** * * " * * * _* ,Y,E NO APPROVED kooting/Pier Forms Foundation waterproof i.ng Sackfill Framing Roof ing siding Masonry Veneer Rough Plumbing Relief Valves -----� - Ext . Parches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile concrete Floors plbq .. Fixtures Gar , Fireproofing Door closers Smoke Detectors Chimney INSULATION Foundation Floors walls Ceiling FIp1AL ELECTRICAL IN SPECTIC]i3_�_�_ DRIVEWAY "PROV —� Final building Survey Next scheduled inspection (call when ready -k Remars . 5 I 5 Soil in Inspector 6/86 and-vl BUILOfNG DEPT. COPY OF APPLICATION FORM 46-EL, NEW 'YORK BOARD OF FIRE UNDERWRITERS, FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. ' DATE CITY OR VILLAGE ',' o .'z ' .��. j• V. - !"l' L .. : ..: . . '$.TRE ET AND NO. OR ,. : T051YNSHIPE / i J- ,'1f f-�'xJ f COUNTY ROAD AND POLE NO. ,y !' i. r-_f�. !{.� - BETWEEN CROSS P R I - TE T OOCUPANT'S K Ldfi NAME BUILDING .. OWNER'S NAME •� } OCCUPANCY AND ADDRESS SE} AC Y ! TEL # e.."7.^ f BY 1} `• 1CN /i"�`LI ! �+'.yF Lr. FRd141 THEIR { f. /l �_r BUItWNG -7 '"7+� OFFICE IS NEW OLD C] WWORK s NEW ,.,_,,,.• DEFECTS LIST BELOW ALL EQUIPMENT WHICH YOU INSTAL LEQ NAL © iiEMOVED ❑ Loco- NUMBER OF OUTLETS Larrp Fixtural III Raeeptect" MOTORS BRANCH tion HEhTE RS Am OFFICE USE Calling WM RAec�rp•di Swlte►r Fbn,deRt Braekn No. TYp+ H'P' Wafts A.W.G. ONLY Each No. Each N'o- Gasge INSPECTION skis Sob how Baer rissint 1st PI_ 2nd fill, 3rd FI, REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE; DO NOT USE THIS SPACE. This application is i1111,1111111old to cover the alxove•lixtad Y 044 ue ao +q fee Igo t to be iral ad bxrt if at lima of Inspection there is sound additioryl i [herisad to Make the inspection and adjust ma fee Igo colrscr ms adds fionsl : *W pinenx not above lixted, SIZE OF KP+ Pe+ent, ad provided by the applicant. MAINS FEEDERS ELECTR SC SoOONS TOTAL CHARACTER LAAWP WATTS OF WORK EXPOSED GAS TUBE SIGN NSFORMERS OF- WORK TO BE CONCEALED TRA VA STARTED COMPLETED SIZE ICAPAC}TY} SERVICE OVERHEAD SIZE OF SIGN ENTER UNDERGROUNDIL low MAKER INSPECTION REQUESTED OF SIGN ON OR AS NEAR AS POSSIBLE AVOID DELAY BY 4 11YINII FULL AND ACCURATE 1N FORMATION. ALL SPACES NEYY dt0 SuU�SyT.Y, i.FILLED IN OR APPLICATION MAY 8E RETURNED. DATE OF l F NAME-AND 4 ADDRESS _ ._ APP T10N +N4FA'P4ICANT_�,�' yE,/jLL 1'`, / lj IJ" ► SlIGNATURE L, F APPUCAN -.—�Y�'�� STR E ET ADOR ESS l l "o- fl L....r - 1"f STlejoq L- _ I' -7 —' -_--'=_`-- ll CITY OR �ryry ,wJ f —._TEL ONE # r• / ! POSTOFFICE '�-�-/�. ,y .f ` 1 ! Yf fi+J �V' (Y7 '' ( CZIP OD.12 Zell LICENSE NO. WHEN APPLICABLE 46 EL (REV. 1/06) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING •LT V y^ . 1V N n p 0 0 as I er/7Pcs�� a CS fi�+Cy JS tr V 1 Lr lot . TZ Ip ftoT �G0.r ! oT �! L� SE'c r lots [ Wv 6CA � LAND SURVEYORS , GLENS FALLS , NEW YORK r N. Y. STATE LiC. NO. 35EE7