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1987-553 i cER.TZFICATE OF +C'14CUI'AN C IL` TOWN OF QUEENSBURY l WARREN COUNTY, NEW YORK ' Date1'enbruary 19 _ - , S v M553 53 k 'Mis is to certify that work requested to be done as shown by Permit 1Vo. 1 has been completed. One.--Family Dwel.lirtg This structure may be occupied as A FF Q j If Amber ShieveSubdivision Leresdon .. i Owner Peter Benoit By Order Town 'Board TOWN OF QUEENSSURY Building & Zoning Inspector I r BUILDING PERMIT . H TOWN OF QUEENSBURY No 87-553 WARREN COUNTY, NEW YORK p, Peter Benoit PERMISSION is hereby granted to ^' -.x Amber Shire Subdivision Street. Road or Ave. OWNER of property located at in the Town of Queensbury, To Construct or place a One--Family Dwelling 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 . OWNE R'S Address is a RD 3 Pitcher Road m Glens Falls , N . Y . 12801 ri tz m 2. CONTRACTOR or BUILDER'S Name 0 G . Armando / Sonsulting & Management n 3. CONTRACTOR or BUILDER 'S Address Northwest Village K Glens Falls , N . Y . 0 n r}, 4. ARCHITECT'S Name w W rr ri � ro ro ua rt G 5. ARCHITECT'S Address Gt+ rL -e Y- ro rn �' cs 6. TYPE of Construction — (Please indicate by X) m �rt ( xl Wood Frame { ) Masonry { I Steel { } ty rK 7. PLANS and Specifications Nv. 34 ' x 36 ' per plot plan , specifications , and application including septic system and attached two—car ,garage . 8_ Proposed Use ro One-Family Dwelling $ 5 . 00 $ 157 . 0O PERMIT FEE PAID - THIS PERMIT EXPIRES March 1 , 19 $8 ' (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the 1-- town of Ousensbury before the expiration date.) ao Dated at the Town of Queensbury this 20th Day of , (August tg 87 SIGNED BY ae /+y'AuLX�� for the Town of Queensbury Building and Zoning I nspector „j,/ TO BE COMPLETED BY BLDG . DEPT , Application No . • ✓OW/? !1 �IIQFI? d bEt Mf�l Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 - Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation � � l ! A } I, - Queensbury, New York 12801 Variance No . fz Site Plan evi w No . AUG 18 1J8/ Approved bjr : — BUILDING & CODE DEPT v APPLICATION FOR J _ fL"J PA-, r' EU I LD I NG AND ZONING PERMIT G� +� [ �&ic C.- A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTIONS 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 . %y, r� r Tel . ?9? � -�71 Property Location : C0.0ceei ,owr -jam cAe -&-.0e 4K• *0--0w*"Txlr` rovT .r le, Tax Map No . Street number or building lot number Subdivision name (if applicable) 40#.WA 4rA S,Oe4roe4 ' THE PERSON RESFONEtIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : 7" .weCt. r •rCc� "Are G � Name P . O. Address Tel . No . Name of builder �t,.4,.e!to r.s-,dso Address Tel Name of plumber r �^ rp", r„�► .. rr Address Tel . Name of mason /1�-„�i /�r ,�,.,,-,t,- Address&jr,= 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 dimensions) * whether existing or proposed and indicate all Other work (describe) * set-back dimensions from property lines . Give * street and number or lot dumber 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 . x COMPLETE INFORMATION REQUIRED BELOW . * Size of property #O'?'o ft x Z:F'Ss." ft . * Existing building ( s ) size ft X ft . * PROPOSED BUILDING AND USE : * Existing building ( s ) use .Size of new structure ,. ft X '7;0.' ft Foundation-pier/slab/crawl/partia ull * Proposed building , distance from property line (circle one ) No . of stories (habitable space ) Front yard ft Rear yard ft Height ( grade to ridge ) e5 ft . * Side yards t ft and 3S" ft If residential , no . of families j * If on corner , seetback from side street cor3 ft No . of rooms ( excluding baths) ;J * OCCUPANCY INFORh1ATION No. of bedrooms PRIMARY BUILDING - No . of bathrooms Z * ?C' One family dwelling Primary heating system ,,yGAT"' �Gaw�,O * Two family dwelling Type of fuel ��'GJ'; Noe of fireplaces to be installed J7A * Multiple dwelling / Number of units Will a wood stove be installed? 4Ge� * eEPermanent occupancy Central Air conditioning? �fr'�-�- 2 * Transient occupancy ,. Business BUILDING STYLE, PRIMARY STRUCTURE * Industrial '" �'"'"""- Other Ranch Contemporar Lag cabin Raised ranch Mans on 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 } * _.jL _ ^Attached garage/one car/ two car/��car * "' * w + * * * * �► • * * + Private storage building ESTIMATED MARKET VALUE OF * 'Other CONSTRUCTIONv � INFOR ATTON ON BUILDING 6PF,CIFICATIONS , ON REVERSE 'SIDE OF TI;IS SFI'FET, TO BE CaMPLETED I � 4 BUILDING PERMIT APPLICATION CONTINUED - + BUILDING SPECIFICATIONS : ' Type of construction , wood frame , fire safe, etc . 40/e0e 417 000�~efr Will any second-hand or ungraded lumber be used? if soe for what ? ,440 Foundation wall material cia&cn 4eeded 4::vogoeo Thickness ,o/ Depth of foundation below grade (to bottom of footing ) �=Will there be a cellar? **v + . ' Heated or unheated? eVT"L7, Floor sq. footage �''ca2� C7 sq ft Will there be a basement? se"S Will any portion be used as living space? A000e ( If so, what portion? sq . ft. - » Type of use? Type of roof - s ape flat/shed/other Material of roof /�ie�rXCG.rsey' :" L'Co,T Size , wood studs "x- _" spacings"o . c . length _ g ft. Joists ( floor beams ) lst . floor !U "X 00 spacinge4gL."o . c . spanf�ft . Joists (floor beams) 2nd . floor 7~ "X /Z spacing No span/ ft . Overlays (ceiling beams ) "X_ �r " spacing"o. c . span .,oij;�.ft . Roof rafters Box " spacing Z19 c, . o . span / ft . Roof trusses (pre-engineered) spacing "o . c . span ft . Exterior well finish_J!:e� a rApv/w✓G of what material ? .Cd,**4dA7 Interior wall finish _ �* -rWe rxr7M40,':r.„ _..__ 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? errs' if so will a Fire-rated door . enclosure , and self-closing device be provided? y -�r Will a flue-lindd chimney be installed? Height above roof ft «o Depth of chimney foundation below grade ft .Depth of fireplace hearth ft . in . / ' '� rr�„ y ,0`CAe d ,,G'C4wAr Water supply - Municipal or private well .4 .cr6 •4rcr ogee SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties &oj!NeCa'¢"ft . (A separate application is necessary for any repair or new installation of septic system) Town of A F F I D A V I T STATE OF NEW YORK eensbury Warren 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 true and complete statement of all proposed work to be done ' on the described premises and that all provisions of the BUILDING COVE , 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 . f; SWORN TO BEFORE ME THIS Signature 19 OW er , owner SS a$ent , arcnirect. contractor day of Notary Public , Warren County, N . Y . * * * * * * * * * * * * * * * * tie * It IF * * w * » IN * * * +r yr * * * * * * * * • * to * * * * SPECIAL CONDITIONS OF THE PERMIT : B f 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 G�e� 3Z 2 . Type of heat +gJ' 3 . Is the building mechanically cooled ? 4 . Percentage of area of windows and doors Cl.,Ge,Earmt /6T.► A . Over 16 % only 1 . Uo value of gross area of walls , roof /ceiling and floors $xposed 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 value of roof and floors exposed to ambient conditions 2 . R value of exterior walls 4E Z SM 3 . R value of glazed area 4 . R value of doors , f 5 . R value of floors over heated spaces ,,72/�► 6 . R value of slab edge insulation - unheated slab �- 7 . R value of slab insulation - heated slab ^� 9 . R value of heated basement/ cellar walls ( above grade ) g . R value of heated basement/cellar walls ( below grade ) AeZy 10 . Type of i n s u l a t i o n_........ ,O 'r C,i/nc , X .-.,yZ:oc C . Controls 1 . Thermostat maximum heat settingfCJe D . Duct Systems 1 . Is duct system installed in unheated spaces ? YES NOS a . If YES „ R value of duct installation b . R value of duct in other areas JK"' E . Piping Insulation 1 . Size of hot water or cooling carrying agent pipe j/t 4iy 2 . R value of pipe insulation ,�.ti/ F . Service Water Heating i . Performance: efficiency_ -- 1;r" C'eck= 2 . Temperature control setting maximum . Igo 10 G . For Swimming Pool Only 1 . Maximum heating Telephone Nov `.-fie t+-+.40,48 ( applicant ' s signature ) /ZE.' e7 �.I'own o� '�uQc'n�bury BUILDING and ZONING DEPARTMENT Bay and Havifand Road, R.D. 1 Box 98 Dueensbury, New York 12801 SEPTIC DISPOSAL PERMIT APPLICATION Owner ' s Name_ G-"7.d:: C.flssT.�a 'T"+el . 7eZ" 77.o" M Address Person/F lrm installing system / +or' w►.�t• �,rrcG-k. Number of bedrooms ( residential only ) 2 Total daily f l ow : ( compute @ 150 aaI . per bedroom per day ) _ 3 40 4 Topography : fla -- rolling - steep - ( circle one ) Degree of slope Nature of soils : sand loam-clay- other- Depth ft . 1%al 4a rr -rr-, 5f Ground water- - at what depth? f t. .,4/inrrec• AK47 wr Bedrock or impervious material- -at what depth? ft . r�-�'� -"��' � 400 Percolation 'Test - Not required f Required -Rate G5 - 15r' min/inch . Domestic Water Supply -- Municipal - Well -- Other AWA&viVve,//,.ae IMPORTANT ! On a separate piece of paper , submit a diagram of the proposed septic system with all dimensions ; including distance from any structure , distance from property lines and distances from aTY domestic water supply or share - line of lake , stream , pondorlwetlands . Include all dimensions of the system itself . Description of proposed system : Septic tank size ,/. veo gal . Tile field- Length of each trench V 5' ft . Total field /3r ft . Size of stone # �e. - Seepage Pit ( s ) Number / Size ftX ft , Size of stone# Any contractor , corporation , individual , Etc . , engaged in the construction of a Sanitary Sewage Disposal System , who covers the same before inspection , sloes not have an approved Permit , or varies from the approved application , will be subject to a Penalty of $ 250 as provided for in Section 6 . 010 of the Town of +Queensbury Sanitary Sewage Ordinance , V,4VL 0 g f� Signature: of Applican Da e *#44&7v7' ,I iaL L3 + +w'dg+G 01 / 86 md /vl _/uturl 0/ Queerx3 (7 "ry BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING NSPECTOR ' REPORT NAME LOCATION Date Z '1 C/.'Permit No . ✓ = APPROVED - YES No Footing/Pier Forms Foundation Waterpro7ofIng Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tit Concrete Floors Plbg . Fixtures Gar . I'i reproD ng Door Closers Smoke Detect rs Chimney I N S U I,AT I ON Foundation Floors Walls _ Cei1inq FINAL 1-:LECTRICAL INSPECTION DR ,IVEWAY APPROVAL PK.nal Building Survey. Next scheduled inspection ( call when ready ) Remarks- Building spe toy G/86 and -vl THE NEW YORK BOARD OF FIRE UNDERWRITERS a ELECTRICITYBUREALA OF 41 STATE STREET. ALBANY. NEW YORK 12207 Late Application No. on fie 0'10622 / 8 7 r[7 ��ay; r" s THIS CERTIFIES THAT A F +. +� d' 94 only the etenctrieW equipns mt ee described below Omd introduced by the applicamt named on the above eplp"cetiaw number in she prewsieea bj �r94 :i:Y E4'F: till .� .w".1�x I; "C3$ �:� .EL:;li.'i I'ki.i. . S i r'LSf i' in the fotlowin,R location; Eff Basement l..J Tat F!. .4y"I FT. Section Block Lat was examined are and found to be in compliance with the requirements of then board. a FIXTUREOUTLETS ECE►TACtIS SWITCHES ' RANGES C4pKIN60EGK5 ClYENS DfSFlyl/rySNERS EXHAUST fllNli IMCAMbtSCEMT FLUORESCENT AMT, K- W. DRYERS FUIRNACE MOT4M FUTURE APPLIANCE P![DERS SPECIAL REC'►T TIME CUDCKS BELL t1tMT IIE#TERS MUITI.OUTI.ET DNNMERS . -. AMT. K. W- OIL H. A. GAS H. P. AM7- MO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H, P, SYSTEMS AMT Ww1'I3 u NO, Oi FEET SERL7CE DISCONNECT NO* Cw S E R Y I C E AMT. !411 fct) JVIVVRR 1X TW 1 ./ 3W 3I' 3tiM eXIW hIO. OF CC. CCAMb. TIO. OP e1eLEG A. W. G- IVO. GP NEUT1lAL$ A. W. O- PER x OP CC. COleb. OF WLEC* OP . WG-l ;,re Ll1 OTHER APPARATUS: 3 - .i ,l ,-a ! ;R sae e: .f LOLAg O . i+ -po .y0x ,4 i. t?;;1 :? BRANCH MANAGER PCr This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspoctors may be identified 6y . their credentich. _ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. _._.I'vtvn o� �uPend6ur+� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D_ 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION + rf'� 7 , Dat / Permit No . ✓ = - Footing/Pier Forms APPROVED YES NO Foundation Wate:rproofin 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 ELECTRSC L INSPECTION RIVEWAY APPRO AL - anal Building Survey Next scheduled inspection (call when ready } Remarks- Yee ,r ,1 lee tv 6/86 and-vl Building Inspector _Jown o/ Queenj Ury BUiLDiNG and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME �7 LOCATIONDATE �' -� MIT NO, SOIL TYPE - Sand - Loam - Clay - Percolation Test Required ? YES - NO Percolation rate - Min/Inch TYPE of S TEi�I: Absorption eld total l9n%tt c� Length of eac t ench � Depth of trenc IS07 Size of gravel -a SEEPAGE PITS-(N r of) Size- ft. ft- GravelSize PIPIi1G 0 iz Type Bldg . to tank Tank to list . box ,y Dist , box to field y Openings Seale ? -YES NO Partial LOCATION/SERA IONS ; Foundation to k / ft, Foundation to sorption 2Lft . Absorption to to line ft- Separation of pi LOCATION YS ON PROPERTY (clrcle one) Front -- ear Left side - Right side - CC7MMFNT SYSTEM USE APPROVE , YES 0 Buil n Inspector 01/86 and vl C TOWN OF QUEENSBURY BuIldi=s D+ep�rtmeat N Repat Datc___�'�i I� •.�_ ' Pamt No. � iFr i weather Remarks • Excaxya ti an - Footin Forms - Footin Piers Foundation Cement Coat water roofin - Ba ckfi 11 - Final Serrveg _ Framin - Shea thin Roof Felt - Roofi n Si din Masonr veneer Rou h Pl Relief Valves Wall Board Ext , Porches Finished Floor Interior Trim Stairs & Rail n s Cellar Dr . T le - Cancrete F rs Pl Fixt res -- Gar . Fire roofin Door Clo ers Chimne Water M ter Inst , - SE+ tic A oval Floors Insulation Foundation walls Cei l i n ._. Building Inspector ,� y,. REMARKS /� �� 7 �ou..rl o� �ueen� heere�r BUILDING and ZONING DEPARTMENT / Bay and Haviland Road, R.O. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME 9t LOCATION _� _ l•'� Date / /� Permit No . '/f ifs APPROVED - YES No E'aoting/Pier L.4?bundat3-on Waterproofing Backf ill Framing Roofing S:.ding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim ar stairs & Railings Cellar Drain T±Ie' 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- ' Build ng inspector 6/86 and-vl j � .`./ou.n o� �ueen�lhuref qf BUILDING anti ZONING DEPARTMENT cJ4 Say and Haviland Road, R. D. 1 Box 98 { i Oueensbury, New York 12801 /J E3UI L. DING INSPECTOR ' S REPORT � kk LOCATION Date ,�,r f�,c'/ Permit NOO APPROVED 1..�Oting,/Pier Forms NO .Foundation Waterproofing Backfill a , 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. Fireproof in Door Closers Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROV Final Building Survey Next scheduled inspection (Call when ready Remarks- 6J86 and-vi Building Ins ctor .✓tturn n/ eeren3fiurr� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury. New York 12801 BUILDING INSPECTORtS REPORT NAME a LOCATION Date / f 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 Trite Stairs & Railings Cellar Drain Tile Concrete Floors Plbg. Fixtures Gar . Fireproofin Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ,ELECTRICAL INSPECTION DRIVEWAY APPROV Final Building Survey Next scheduled inspection (call when ready Remarks- Syr r 6/95 and-vl Building Inspec r / ""C U f t'l�lus l 141fi, BUILDING and .ZONING DEPARTMENT- and Havifanc! Road, R. D. 1 Box 9a `Q ueensbury, New York 12801 r+' w LDING INSPECTOR ' S REPORT C AfE LOCH T I Ohd��� Cate /S: f Permit No . + - eh� r APPROVED ooting/pier Forms APPROVED 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 P, bg . Fixtures Gar , Fireproofing Door Closers Smoke Detectors Chimney INSUTATION . Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next sckteduled inspection (call when ready Remarks- Building Inspector E�/E36 and-vl SEEMS BUILDING DEPT. COPY OF APPLICATION FORM 464EL, NEW YORK BOARD OF FIRE UNDERWRITER S. FILE THIS COPY WITH BUILDING DEPT,WHEN REOIUIRED- TEMPI * DATE CITY OR VILLAGE ,� ZG'YS�S .a�..aftlr TOWNSHI �e,(,+,/S,J �,r„lry/ COUNTY 1.�,'i'T.+f,•�"',,,6�w" STREET AND NO. OR ROAD AND PDLE NO, BETWEEN WHAT TWO PULE ND. CROSS $Tq EETS IS PREMISES LOCATEQ7�i7/L�+iias'.r� LOT 4[OCCUPANT $ SECTION BLOCK NAME BUILDING 7 OCCUPANCY �c-.$;�e4o :for' ffload W4e OWNER'S NAME AND ADDRESS��r . TEL y y ;VeSUPPLIED T �c. f.t► lt+�'• L+ By BUILDING JY FROM THEIR �,f;�`.S f OFFICE IS NEW OLD 0 WORK DEFECTS iS NEW. 1w ADDITIONAL REMOVED LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS No, of Fixtures a BRANCH Loa- Lamp Rce es aptaol MOTORS HEATERS CIRCUITS OFFICE USE tiorT GJiny NRehSwl denx Brckat No. T NO. E W ONLY WI eczp'h G. Each Each Gauge INSPECTION Out- skim Sub- have Bvse- Inent tat FI. 2nd FI. 3rd FI. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: OO NOT USE THIS SPACE. This application is Intended I cover the above-Ihted equ 1pment to be inspected but if at lima of inspection them is found additional Vou are authorized to make the inspection and adjust the lee to cover the additional ui sent, as mwided b the equipment not above listed, '� P P Y applicant. SIZE ELECTRIC SIGN TOTAL MAINSS FEEDERS LAMPS WATTS CHARACTER EXPOSED GAS TORE SIGN OF WORK CONCEALED TRANSFORMERS OF VA WORK TO BE (NUMBER) {CAPACITY)STARTEQA0� 7 COMPLETED SIZE OF SIGN SERVICE OVERHEAp UNDERGROUND ENTERS MAKER ILDIN OF SIGN YNSPEC770N REOUESTED ON OR AS NEAR AS POSSIBLE NEW Ej_ OLD AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION, ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED, PRINT NAME AND ADDRESS NAME OF C y APPLICANT yyy +�! �r ,,,,.•� OF APPLICATION ,.'.,�r gd�' �J,� Jlrr STREET ADDRESS �I.r4 !►' �/''rj�+Cif�' ..r J�� 'E� TELEPHONE # / aT �- -- CITY OR �.+'�"� „�- _ ,,r _,,. ,�r r/ LICENSE NO, POST OFFICE 'C.T' �T' ZIP rr'r a CODE/ �X WHEN APPLICABLE 46 EL (REv. ,les) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING �.SwOn Act ■■ _.. :. . x , , , va ,...< ... ,. . a '. I fit^,. .. ... .... :,.. i.. Iti. .:- s � .. - ..:. G •.b 4.. x �.. '�. '+yMINI ..,... x.. .,. ..- a... .._ -' ...: _. .... ., ae. ,. 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