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1987-257 CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBUR,Y WARREN COUNTY, NEW YORK ri Daft October 8 , 19 _7 Sq Sri This is to certify that work requested to be done -done as shown by Permit No. 87-257 has been completed. 3 1K '`� l YN9 This structure may be occupied as a One-Family IIA:Ing +lure C3 Lctcation}r�y,,pl Lot 51 Lvndon Road. Section 4 Ridge Chvner ► 1 1 +- I ' ' + 1 lL��en dell rlcKernon By Order Town Board TOWN OF QUEENSSURY 00, Building & Zoning Inspector F i BUILDING PERMIT TOWN OF QUEENSBURY No. 87-257 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Kendall McKernon OWNER of property located at Lot 51 Lyndon Road , Section 4 Street, Road or Ave- Rolling ng z ge ¢ in the Town of Queensbury, 7o Construct or place a One—Family Dwelling s" 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. ro r+j 1 . OWNER% Address is Canterbury Woods o Queensbury , New York 12801 2. CONTRACTOR or BUILDERS Name M/G Contractors O rt 3. CONTRACTOR or BUILDERS Address 13 Notre Dame Fort Edward , New York 4" ARCHITECT'S Name O 0 S. ARCHITECT'S Address rn ro n rt r• 0 fi. TYPE of Construction — (Please indicate by X1 Ix) Wood Frame ( I Masonry i ) Steel I } M 7. PLANS and Specifications 3200 sq . ft . dwelling per plot plan , specifications and No- application including sewage system and two car attached garage cIo ra S. Proposed Use One.-Family Dwelling 0 ro $5 . 00 C /o $ 234 . 00 PERMIT FEE PAID - THIS PERMIT 'EXPIRES December 1 19 87 (if a longer period is required an application for an extension must be made to the (Building and Zoning inspector of the `4 town of Queensbury 'before the expiration date-) Cy rD Dated at the Town of Queensbury this 14th Day of May 79 87 r• ,,I�j G — ^-' SIGNED BY for the Town of Queensbury Building and Zoning Inspector TOWN OF TO BE COMPLETED BY BLDG . DEPT % �] II Application No . _low" o/ Queen36urry Permit Issued 19 MAY 5 1987 BUILDING and ZONING DEPARTMENT Permit Expires 19 t Bay and Hawiland Road, R. G. 1 Box 98 Zonang Designation i BUILDING a CODE; DI Frr, Oueensbury, New York 12801 Variance No . ))) r f (� Site Plan Review No . Approved by : _ be p 01 APPLICATION FOR aagd A PUILDING AND Z_©NING PERMIT I Gu L � 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 : A::!::1// �' t P . O. Address_ !0 /4,AJ2 a r/'� el . L' / Property Location : 1 y d our .e ��,r' .Zr+.// of/ Tax Map No , . tweet number or bua ding lot number Subdivision name ( if applicable) ii�i r^ r [ .t-=— THE PERSOK� RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : Name P . cf, Address Tel . No . Name of builder Address /. ' A'rJ� Tel . .�'. _� 04�0 e Name of plumber Address rV f ' r Tel . F y • - .? r 3 Name of mason Address tr r r rr Tel . y L°(^ p NATURE OF PROPOSED WRK : * ZONING INFORMATION G' 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 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 v ft X C.�' ft * Existing building ( s) Size ft X ft _ PROPOSED BUILDING AND USE : 5 cam '= `r z, a Existing building ( s ) Use 7 r/ Size of new structure ft X J` 6 ft +% Foundation-pier/slab crawl artaa full * Proposed building , distance from property lane {circle one }} ,� 7- No . of stories (habitable space ) L Front yard ft Rear yard ft ft Height ( grade to ridge ) - [i ft . * Side yards C ft from side street ft t and (y If residential , no . of families % * If on corner , setback No . of rooms ( excluding baths ) F * OCCUPANCY INFORMATION No, of bedrooms .� Now of bathrooms "-- �. PRIMARY BUILDING - Primary heating system s �,. * 1G_Two family dwelling a ', r� * Two family dwelling Type of fuel �, /d e. ©iL * Multiple dwelling / Number of units No , of fireplaces to be -installed. Permanent occupancy Will a wood stove be installed? ,f/ Central Air conditioning? / * Transient occupancy �. Business BUILDING STYLE, PRIMARY STRU(TURE Industrial Ranch Contemporary Log cabin * Other Raised ranch o Duplex * If addition , what will use be _ Split. level Old style Bungalow Cape Cod Cottage Other * ACCESSORY BUILDING- Colonial Row Town House * Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE } * F/Attached garage/one car/ two cacar Private storage building ESTIMATED MARKET VALUE OF Other A7Tf / fy� yTJ � Ec.f� G7 f� CONSTRUCTION / ¢ INFORMATION ON BUILDING -SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEETr TO BE COMPLETEDI Farm BPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction wood frame fire safe , etc , Will any second-hand or ungr/aded lumber be used? If so , for what ? A f , Foundation wall material c�a,G✓',�'?� C�N6,ed�71AOThickness �' Depth of foundation below grade Cto bottom of footing ) , ,r7rT� Lv7 Will there be a cellar? ,� eate r unheated? Floor sq. footage /l *+'' 0 sq ft Will there be a basemen ? W3. any portion be used as living space ?_ ( If so , what Portia scl . ft . - - Type of use? Type of roof slope lat/shed/other Material of roof Size , wood stu s "X-.. spacing Ifs "`o . c . lengthft . Joists ( floor beams ) lst . floor :_z "X spacingo_Z.& ""o . c . span /y" ft . Joists ( floor beams ) 2nd . floor "X / t:> spacing _ "o . c , spanft . Overlays {ceiling beams ) „ �"X " spacing ll� '"o . c , span�e�ft . Roof rafters _"X spacing L4 o . c . spans- ft . Roof trusses (pre-engineered) spacing "o . c . span ft . Exterior wall finish ,� {/i Of what material? �V 'rvZ 5'r �irrJr� Interior wall finish If a garage _xs to be attached , descr a materials to be used for FIRE SEPARATION : Is there t6 be an opening between garage pqpqpq and welling? If so will a Fire-rated door , enclosure , and self-closing device be provided? ^ ,j Will a flue-lined chimney be installed.? j/r�`� Height aboverzoof. ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth ft " Water supply - Municipal or private SEPTIC SYSTEM Distance from NY private well ( including adjoining properties � ft . (A separate application is necessary for any repair or new installation of septic system) Town of Queensbury County of Warren A F F I D A V 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 . SWORN TO BEFORE ME THIS Signature ___/_+ r oee., . �� --____---- ,r Owner , owner ' s agent , arcnitect, contractor - J clay of r /' y 19 Notary Public , Warren County , N . Y . SPECIAL CONDITIONS OF THE PERMIT : , - - 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 wort . ANSWER ALL of the following : 1 , Gross floor area 2 . Type of heat 3 . Is the building mechanically cooled ? 'e5% .+'. 4 . Percentage of area of windows and doors � de 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 ? 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 B . Under 16 % only 1 . R val a of roof and floors exposed tof ambient conditions. S ze!?- f f 2 . R value of exterior walls 'oRd 3 . R value of glazed area r c� 4 . R value of doors f lJ 5 . R value of floors over unheated spaces A/ r, 6 , R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab G + � 8 . R value of heated basement/ cellar walls ( above grade ) 94 R value of heated basement/ cellar walls ( below grade ) 10 Type of insulation C . Controls 1 , Thermostat maximum heat setting Q 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 3�/fir r21?je 2 , R value of pipe insulation / r' F , Service Water Heating 1 . Performance efficiency .9i��" c ✓ ~ �' � 2 . Temperature control setting maximum G . For Swimming Pool only 14 maximum heating /�© AlZ _ Telephone No . ( applicants signature ) APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE � / �O,►�ti. r /Y� � .r� � LOCATION OF PROPERTY FOR INSTALLATION 46 � , 4' , g Owner's Name: Telephone: 2 2 Address: C J .E;?V/ 1�,/yc G �iu�ErYSc i7 / Installer's Name: Telephone: %! r' �L1 . Number of bedrooms (residential only) _ Total daily flow (compute @ 150 gal per bedroom) 7 Topography: circle one: 61.,� Rolling Steep Slope $'o of slope c CJ Sail Nature: circle one: and Lo m lay ther Depth: / '+� feet Ground Water: At what depth? $"Q feet Bedrock or Impervious Material: At what depth? r-- --� feet Percolation test: circle one: not required required / rate min. inch. Domestic water supply: circle one: Municipal ell ther _ IF domestic water supply is a Well: f Separation: Watersuppiy from Septic absorption / feet PROPOSED SYSTEM: Septic Tankgal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench feet / Total system length 2 C/ © feet SEEPAGE PIT(S) : Number of / Size each feet by feet s Size of stone to be used # 2, / Depth or Thickness 41M feet IMPORTANT ...Please.._UIST NEW EQUIPMENT TO BE INS7ALI.EI7 12 (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 $Z50.00. Co 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: Date: 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 . /ou/n 01 Quee" Ji " rey BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING IINSPPECTOR ''jS REPORT Ze NAME I+j dy L t�+� / ►� / /�/' e�ri?�✓/7 LOCATION aryl tY�Gy! tY Date /+ /_ Permit No . d / v ,s.► / * * * * * * * * ✓* * APPROVED* * YES * NO Footing/Pier Forms Foundation Waterproofing Back£ill Framing Roo f ing Siding masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings W Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECTRI L INSPECTION DRIVEWAY APPR AL Final Buildi Survey Next scheduled inspection ( call when ready ) Remarks- pm r Building Inspec or 6/86 and-V1 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRiGITY i • � 4f STATE STREET, ALBANY, NEW YQRK 12207 Llate October 16 . 1987 Application No. on file 017295187 A 989 M r THIS C:ERTlFIE51 THAT only the electrical equipment as described before and introduced by the applicant named on the oboes application number in she premisse of Kendall XcKeznov . Lyndon 'Ford , Q?1o: P. v1e; bury . New fork in the following location, Basement xE Ise Ft. ] Ynd Fl. ro u t rs i d e Section Bloch L,ot was examined on rz 4 / V 7 and found to be in compliance with the requirements of this Bawd. IIXTUREWW PIXTURIM RANGES COOKING ORCICS ()VENS MSff WASHERS RXHAfiST VANS CKMIFTS fACLES SWITCHES iNCANOESCENT rLUORESCENT AMT. K. W. AMT. K. W, AMT. I K.W. I AMT—It W. AMT. I 23 47 70 > '> 3. :3 Fr L DRYERS FURNACE MOT'0R5 RtTURE AINILtANCE /Ell1ERS SPECIAL RECPT TIME CLOCKS "LL UNIT HEATERS MUITI-OUTLET MA MERS SMAS AMT. K. W. pi H. P. GAS M. P_ MST. NO. A. W. G. AMT. AMP. AMT. AAv9. TRANS. AALT, M. P. AMT. WATTS t ►Wt � 0 s SERVICE DISCONNECT NO. Of rizer S E R V I C E AMT, AMP. TYPE' 1 ,9 RW 1 Iff ]IN I SAW !W 130 •W I Na OF PER*CONO. OF CC. CC&40. NO, Or Hl- EG ra,_.' F14. 8r NEUTRALS I x L 4 / 1 ] 2jG i OTHER AIPARATUS: 3 — [FC1 7. - :: raa4; �: Zsetecl: cr Ai f; n1: den , Inc. ANZ 13 Notre Fame Street F t . Edward , N e Sat `l is : it BRANCH MANAGER � Psr � i 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. 4 COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. o arn ©f Queen j ury //� • �� �0 BUILDING and ZONING DEPARTMENT "t Bay and Haviland Road, R.D. 1 Box 98 /f � ✓ pueensbury. New York 12801 �( SEPTIC DISPOSAL SYSTEM INSPECTION de LOCATION dT DATE I4'"7' PERMIT NO . SOIL TypE - Sand - Loam - Clay _ Percolation Test Required' YES - NO Percolation rate - Min/Inch _ TYPE of SY STEM : r7 cQ Absorption fie dsench total le Length of each Depth of trenches Size of gravel SEEPAGE PITS4NUmber Size- ft . X - Gravel size S Type ~� PIPING : Bldgv to tank Tank to dirt_ Dist, box to f ld/ ES N Partial Openings seal LOCATION/SEP RATIONS : `Z ft. Foundation tank ft . Foundation o absorption ft . Absorpt io to lot. line f t, separat! of pits LOCATION SYST ROPERTY (circle one) Front - ea - 00 f sid - Right side - CCMMENT SYSTEM USE APPROVED }' O Buil ng Inspector 01/86 and vl flown ©/ Queenagury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D, 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date (3/ Permit No . /� ?g' ✓ = APPROVED - YES NO PgrgrjPier Forms tion Wa Ping 1 X Framing Ik 1.41s p Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproof ' g Door Closers Smoke Detect rs Chimney INSULATION Foundatiori Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final. Building. Survey Next scheduled inspection (call when ready3 Remarks- Building Inspector 6fSEs rnd-vl 71 / ; BUfLDING and ZONING DEPARTMENT J� 7 ' Bay and Haviland Road, R. D. 1 Box 98 f Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME1�it .rZGi LOCATION �y�''T �.J J� r�_�..�'�.d►-�✓-1,��C" Date�� /�- PermOit No . :� ✓ — APPROVED - YES NO Footing/Pier Farms Foundation Waterproofing Backfill v7�rami ng Roofing Siding M sonry Veneer. ugh Plumbing Relief Values Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Firepra ing Door Closer Smoke Dete tors Cb imn ey INSULATI AAN4 Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey 9 157 , l ,/JS %P f,,c� gAl7 Next scheduled inspection ( call when ready) Remarks- ir Buil ing Insp c ar 6/86 and-vl P, �.lown o/ Queens ury 6UILDING and ZONING DEPARTMENT Bay and Haviland Road, R-D, 1 Box 98 oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME. /t �' wx d ltk !�!� jhd [► er h 6 h jeo // r ft ,;firWi 4 s't LOCATION Lp7- S"/ L,, 05 dc►vz Permit No o } ' APPROVED 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 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 wk►en ready ) Remarks- - tf rz •'ern ���? sid i ding Inspector 6/86 and-vl . /OtAV" O/ BUILDING and ZONING DEPARTMENT Bay and Havdand Road, R. D. 1 Box 98 Queensbury, New York 12801 R-aL,G/N'Cg P. 6 D 45Z!�- BUILDING INSPECTOR ' S REPORT NAME �� � A / L O C A T I O N �f�PCPA r Date . 2- 9_7— Permit No . a6l ✓ APPROVED - Y NO 101Faating/Pier Farms foundation waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim E 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- f5 ~ ice Buildi Inspector 6/86 and-vl BUILDING and ZONING DEPARTMENT Bay and Havifand Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTORtS REPORT NAME C.r't'I /CMG c 0401 LOCATION 1/6 CLIAI Qi to 645 Date / � Permit No . ✓ = APPROVED YES No Footing/Pier Forms Kroundation )(Waterproof in }(Backfill Framing Roofing Siding masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim St s & Railings � r ellar Drain 'file 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- Suil ing Inspec or 6/86 and-vl MEOW ,lown o uPe►zs6ur BUILDING and ZONING DEPARTMENT Bay and Hawiland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION /,07 ,/ i V- ► it rii',;,. ,ref',' ✓� Wf Date }� ,/�.�� Permit No . ` erg asp' .000 ooting/Pier Forms y APPROVED - YES NO Foundation waterproofing Backfill Framing Roofing ;. Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Parches Finished Floors -' Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar , Fireproofing Door Closers Smoke Detectors Chimney INSUTATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTIfJN DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- eiA r' Building Inspector 6/86 and-vl BUILDING DEPT. COPY OF APPLICATION FORM 40-EL, NEW YORK BOARO OF FIRE UNDERWRITE R'S. FILE TH1S COPY WITH BUILDING DEPT. WHEN REQUIRED, - K GILTE y.,- CITY t7R TOWNSHIP STREET AND NO. OR COUNTY Ck, ROAD AND POLE ND- BETWEEN WFIAT TWO - POLE Idol CROSS STREETS IS PREMNSE L TEQT SECTION BLOCK LOT OCCUPANT'S NG NAME el IAAd'ANCY OWNER'S NAMIf1�, f...- _._.• "� L_ 7 - AND ADDRESS TIE L. SUPPl IED 8Y + : '`t_. 't. �� �i t.t FROM THEIR Y L.. OFFICE BUILDING -- ry�,,r 1--� IS NEW I_yr OLD LI DEFECTS Its NEW ADDITIONAL REMOVED 0 LIST BELOW ALL EQUIPMENT-WI YOU INSTALLED NUMBER OF OUTLETS No aR Fintrrw 8 BRANCH Lace- I.aswp Ratspsaalse MOTOAtC HEATERS CIRCUITS OFFICE LASE tiaw ONLY comWan RM,+NOftWoess rsp Swri{ab PMdwH Bracket No. T*pe NN Na- Each Nq- INSPECTION Out- skle lll Sub- boa Base• rlrant HR R. 2nd PI. 3rd FI- R/EJMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ASOVE:. DO NOT USE THIS SPACE. This aPP&MAtion is intended to C r the abova-Irsted equipment to be inspecgd but iH as tNrle d iwsF+eipSow is Harwd additipyl sapriperetn not albre listed. You are autboritW W make the irgpatsiery and adjust Ure fee tip eoues the additiplal ayu:pmerse_ as psaaided by the appLi�- SIZE OF 4=f' .-. I=7 . ELECTRIC SIGN MAINS FEEDERS I SICaft TOTAL S WATTS OF V40R TEp ` EXPOSED GAS TUBE SIGN OF WORK [� -'t„s - ,ram CONCEALED TRANSFORMERS OF VA WORK TO BE STARTED - +I �.cy COMPLETED $12"L£R pF rrAGN 'CCA16PACITYI SERVICE OVER" AD UNDERGROUND ENTERS MAKER SUNL ING OF SIGN INSPECTION REQUESTED ON OR AS NEAR AS {� 1'OrrwS16LE New OtiD 1_I AVOID DELAY 8Y GI Vi NO FULL AND ACCURATE IN FOR NIATIO N. ALL .SPACES MUST BE FILLED IN Op APPLICATION MAY BE RETURNED- DATE . PRINT NAME AND ADDRESS APPLICATION APPAPPLICATION— NAME C^? G' A �{I) r`-,t.� �( ,10J (J XSIGNATURE r OF APPLICANTt.: Y'--•--� - �,x--' -. STREET ADORE55fJl�+✓ !� + [ {�-. ] f?, ? C,,., .,,;� f- �j !—��/ } / +�+ CITY OR TEs FMarWR aia—iL �rT 1'Y'/�...7 ('. POST OFFICE + - 'z Ij ZIP CODE !► 'l . 46 EL (RE . rfai I A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING