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1987-607 CER.TIFIC�►TE OF OCCUPANCY TOWN OF QUEENSSURY WARREN COUNTY, NEW YORK DateI+ebruary 19 , 19 88 87^60 7 This is to certify that work requested to be done as shown by Permit No. has been completed. T'hi. structure may be occupied as a one—Family Dwe ll Ing Lot 40 (queens Lane ( St . No . 34) Var. aowe Estates location Classic Homebuilders Inc . Owner By Order Town Board TOWN OF QUEENSBURY Building & zoning Inspector BUILDING PERMIT TOWN OF QUEENSBUR''Y' No 87-607 WARREN COUNTY, NEW 'Y OR K a Or we Classic Romebuilders , Inc . PERMISSION is hereby granted to � 1 OWNER of property located at 50 Queens Lane ( St . No . 34) Street, Road or Ave. c in the Town of Queensbury, To Construct or place a One'Fama ly 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 . OWNER'S Address is Box 14421 Albany , N . Y . 12212-4421 H• 2, CONTRACTOR or BUILDER'S Name O Same CD v' 3. CONTRACTOR or BUILDER 'S Address a m �i m H 4, ARCHITECT'S Name 5. ARCHITECT'S Address t-' a rr 6. TYPE of Construction — (Please indicate by X) rt E ,pp ( X4 Wood Frame ( 1 Masonry i } Steel ( } OO rD 7. PLANS and Specifications ae r No_ 64 ' x 32 ' per plot: plan , specifications and application including septic system and attached two car garage . 8. Proposed Use One-Family Dwelling /J L o f ro $5000 $ 171 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 1 , 19 88 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of 4ueensbury before the expiration date.) m Dated at the Town of Queensbury this 14th Day of Sept . SIGNED BY for the Town of Queensbury ova Building and Zoning I nspector TO BE COMPLETED BY BLDG . DEPT . � J Application No . 70"/4" 01 Que2e►t j "r y Permit Issued BUILDING and ZONING DEPARTMENT Permit Expires "� Say and Havifand Road, R.D. 1 Box 98 zoning Designation t� (Fj) Lb Queensbury, New York 12801 Variance No .e: SGPSit Plan Review No . If I/ Approved N`":OUJLU�E n � . Coot� SFr 7 I APPZ,ICATION BUILDING A ND . .70N I NG PERMIT A PERMIT MUST BE OBTAINEQ BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING . The undersigned hereby applies fora 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 propertry+� is : C4A ; Ucr P . O. Address K P7 7 GG�I �" T'�'y"+�• Tel .© , *3 Property Location _ i V r_ Cl`!+� � "3 Tax Map No . 7 / Street number or building lot number d , Subdivision name ( if applicable} THE PERS N RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : :241 Lam` U jS W . L S D 4 �.'� 3� Name P . O . Address Tel . No . Name of builder ('�/ oress Q.5o 2 N� Tel . .52 �/ 7 G4,2" O Tel . Name of plumber C _ yy, _ �51 C - Address � Name of mason XildM4k/ Address " "64454 2& 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 number and indicate whether interior or corner lot . Show location FOR DEMOLITION P'ERMTT , STATE SIZE AND * of water supply and location and configuration LOCATION OF STRUCTURES AFFECTED ." [�A of septic disposal area . ,n COMPLETE INFORMATION REQUIRED BELOW . r rC size of property I ` f ft X ft . Existing buildings ) Size-[,At-_ft X ft . PROPOSED BUILDING AND USE : * Existing building ( s ) Use w114 Size of new structure (2-7 ft Xaz Foundation-pier/slab/crawl/partial ul Proposed building , distance from Property% line (circle one) Front yardk ft Rear yard ft No * of stories (habitable sp e) f and Q f t �{ Height ( grade to ridge ) _ Z 0+ Side yards ZQ t .ie'a ft • if on corner , setback from side street ft If residential , no . of families 1 '" No . of rooms ( excluding baths ) ui7 OCCUPANCY INFORMATION No . of bedrooms ; PRIMARY BUILDING - No . of bathrooms x One family dwelling Primary heating system "• ace 4. * Two family dwelling Type of £uel h�/'}'TL�'/!k. [ S Multiple dwelling / Number of units No . of fireplaces to be installed Q �� � Permanent occupancy d. Will a wood stove be installed? Transient Transient occupancy Central Air conditioning? '�+57 * Business BUILDING STYLE, PRIMARY STRUCTURE Industrial � Other Ranch Contemporary Log cabin if addition , what will use be? Raised ranch Mansion Duplex Split level Old style Bungalow Ca e Cod Cottage Other * ACCESSORY BUILDING- _olonia Row Town House * Detached garage/one ( car/ two car/_car CIRCLE ONE PLEASE ) * .__Attached garage/one car/ o ca cap' * * * * * * * * * * _Private storage building ESTIMATED MARKET VALUE OF Other CONSTRUCTION $ INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED ! Form SPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , <Od ram. , fire safe , etc . will any second-hand or ungra ed lumber be used? If so , for what ? Foundation wall material !"_� � /"Y l.y' Thickness io as - /:,t[1t._ Wm *A�"C! Depth of foundation below grade (to bottom of footing ) _ _ Will there be a cellar ? MAES Heated or(unheate Floor sq . footage ' sq ft Will there be a basement? Will any portion be used as living space? #4j5 ( If so , what portion? sq . ft . - - Type of use? Type of roof - log e flat/shed/other Material of �-_oof ��' Cam,' Size , wood studs_- It_'"X spacing_ "o . c . length i ft . Joists ( floor beams ) lst . floor Z _'"X_,r�"' spacing _"o . c . span �� ��/ yw l� Joists ( floor beams ) 2nd . floor ''X spacing.LA!;."o . c . span K ft!' �" •• �--� �SPacina "� r� . epees: ft , JVd4 ]Faft&C�--re tee 'SG ' : " nor-- -- o c ropa Roof trusses (pre�engineered) -spacing ,2�.."o . c , . spanZAq ft . Exterjor wall finish tp~ P � � T� �SIEVOt r Interior wall finish •f�'a [K�p�y r. ��' �y4Q � �--• A is ' If a garage is to be attac�w describe materials to be used for FIRE SEPARATION : Is there to be an opena.ng between garage and dwelling? If so will a Fire-rated door , enclosure , and self-closing device be` pravid''ea3 ? will a flue-lined chimney be installed? MJ Height above roof ft , Depth of , chimney foundation_ J>glow grade Depth of fire 1 ' rth ft , in .—� Water supply i i. cin or private well SEPTIC SYSTEM _ Distance .from ANY private well ( i.ncluding ' adjoining properties NA €�. (A separate application is necessary for any - repair or new insfallation of . septic system ) Town of ftu ry County of Warrenarren 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 an 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 BEFOR-E ME THIS S-ignature - {. +� ,+ �} ;y�Owneer , owner ' s Aglen , arcri sect , contractor day of e..�4 / 19 43 f C7�-�"J • CtASS+?'C` Notary Public , Warren County , N . Y . SPECIAL CONDITIONS OF THE PERMIT : By 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 followingz 1 . Gross floor area //►►CZ 2 . Type of heat ,f'�f'S Ae 3 , Is the building mechanically cooled ? 0 4 . percentage of area of windows and doors 1 405W A . Over 16 % Only 1 . U value of gross area of walls ,_ �pof / ceiling and floors exposed to ambient conditions __,^ 2 , Floor over heated spaces 6- NO a , Are foundation walls insuates]. ? YES oo NO 1 . If YES , what is the R value ? 3 , Slab on grade YES a , if YES , what is the value of insulation around perimeter of floor ? 4 . Is basement heated ? YES i +i`1OJ a . R value of insulation per- ' `� 5 , Type of insulation �""'! a 5% Sam -+ B . -' Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions _ 2 . R value of exterior walls J F. � 12 3 , R value of glazed area �w ww J •/rfy.• 4 . R value of doors RAN* 5 . R value of floors over unheated spaces_ - 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation T heated slab WA 80 R value of heated basement/ cellar walls ( above grade ) g . R value of heated basement/ cellar walls ( below grade ) -.NM 100 Type of insulation. E REE'CWsmn' � C . Controls 1 . Thermostat maximum heat setting Q� D , Duct Systems 1 . Is duct systeminstalled in unheated spaces ? YES NO a . if YES , R value of duct installation b . R value of duct in other areas E . PipincT Insulation ■ � 1 . Size of hot water or cooling carrying agent pipe /V 2 , R value of pipe insulation AAJIA F . Service Water Heating 1 . Performance efficiency : '- 1Ac ---- 2 . Temperature control setting maximum G , For Swimming Pool Only X ! 1 . Maximum heating. *Ji! [�•� Telephone Now • { �y �` id.l� ( applicant ' s sxgpaltur = earn cQezw4ry APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE "" 7I LOCATION OF PROPERTY FOR. INSTALLATION 570 S�_C / 14E Owner's Name: �/ I&IC Telephone: t *77 34 Address: 5f 44m Z i �! Installer's Name: GzA ,�. st& Telephone: � 1 Z 16' Number of bedrooms (residential only) 4 _ Total daily flow (compute @ 150 gal per bedroom) Topography: circle one: Fla Rolling Steep Slope % of slope z r � Soil Nature: circle oneC SandJ Loam Clay Other / Depth: feet Ground Water: At what depth? feet /� Bedrock or Impervious Materials At what depth? Iq/ A feet Percolation test: circle one: not required requfir�e rate min. inch. Domestic water supply: circle one Municip Well Other IF domestic water supply is a Weil: Separations Watersupply from Septic absorption feet PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench '�70 feet / Total system length feet SEEPAGE PIT(S) : Number of / Size each feet by feet Size of stone to be used # T'f 7b / Depth or Thickness Z 2 feet IMPORTANT ...Please...TAST NEW EQXJIPMENT TO BE INSTALLED (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 $250.00. C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. I have read the regulations above and agree to abide by these and ail requirements of the Town of Queensbury Sanitary Sewage Di r wpal Ordinance„ �Signature of responsible person: Date: Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . A GOOD PLACE TO LIVE THE NEW YORK BOARD OF FIRE UNDERWRITtR.S � 91 BUREAU OF ELECTRICITY 49 April IS , 1g$g 41 STATE STREET, ALBANY. NEW YORK 12207 Date Application .No. on fife y� THIS CERTIFIES THAT 026550/87 A 112942 only the electrical equipment as described&&lase and introdssced by the appllcans named on she above apphtcation number in the pr's'ntimes 4Rf Classic }tome Blunders Ince Lot 50 Queens Catle Glens 'Falls * New York in thefollowintt location; ❑ Basement ❑ let Ff. ❑ 2nd Fl. .Section 90114wh 9 Lot 50 was exarnin+ed an 2-19-33 and found to be in compliance with the requirements of this Beard. FIXTURE FIXTURES I RANGES ICOOKING DECKS I OVENS I DISH WASHERS EXHAUST FANS R OUTLETS RECEPTACLES SWITCHES INCAN SCEW1 FLUCRESCEM +� y AMT. K. W. AMT. K. W_ AMT, K-W. AMT. K. W. AMT_ H. P. 23 55 18 21 2 1 4 . 3 fr DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS JSPICML REC'PT TIME CLOCKS BELL UM1 WANES tMUL7T�sLE IM TT DMERS CNL 14. P. GAS k. P. ANSI. NG. G. AMT. AMP, AMT. AMPS. TRANS. AMT, H. P. NO. OF FEET AMT. WA7T5 21 y,e0 1 SS"Vwx DISCONNECT "0. OF S E R V ! C E AMT. ffAMP. TYPE EQIIP. 1 ,e �'W 1 JT 9W 8 I .!W 3 A' 4W NG. # CC, CCNND. A W. Ca. NG # A• W G• V40. OF NEUTRALS A. W. G. I'ER .N # CC. C O. C7F M►LEG OF NEUTRAL �. a C:b 1 x 4 2 /C3 � OTHER APPARATUS: 2-gf 1-smoke detector 3 Classic Ficlmale Builders Z1vc . s :kyy Boa. 14421 239 Albany , NY 12212 BRAMAN4GERJeer- 4 This certificate must not Ise ahered in any manner; return to the office of the Board if incorrect. Inspectors may be identifietheir credentiahs. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MIDST RIOT BE ALTERED IN ANY MANNER. Z130ILDING and ZONING DEPARTMENT Bay and Haviland Road, A.D . 1 BOX 98 Queensbury, New York 12801 lLD1NG INSPECTOR ' S REPORT AME LOCATION -, , r • '� S �f"� J" Date permit No . l � p/ APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing backfill Framing It Roof ing )�kSiding masonry Vene r Rough Plumbin k Relief Valves )(Ext . Porches )( Finished Flo ors Interior Trim X Stairs & Railings Cellar Drain Tile Concrete Floors )C,Plbg _ Fixtures K Gar . Fireproof ' g_ >( Door Closers X Smoke Detect s� Chimney INSUI.ATTONc Foundation Floors Walls Ceiling OX FINAL U X:CTRICAL SNSPECTI(�N DRIVEWA APPROVAL_ XFinal Bit lding, Survey -... Next scheduled inspection (Cal.i when ready ) Remarks- .t - Buildi inspector G/86 and-VI Q+ of �aeen36ure�f SUILD�NG and Z0N1NG DEPARTMENT Bay and viaviland Road,Queensbury, t,4e YorkD128011x 98 BUILDING INSPECTOR ' S REPORT NAME LOCAT I f"=— Permit No .� Date * * * * * * * * * * * * * * * * * * *jy'* s APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing Roof ing siding MaS4nry Veneer Rough Plumbing Relief Valves Ext _ porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg , Fixtures Gar . F!Yeproof in Door Closers smoxe Det ctor ><S:himney INS[i A ON Foundation Floors walls Ceiling CAL INSPECTIt723_�_. FINAL ELEC DRIVEWAY AP ROVAL Survey Final Suild ng Next scheduled insp ection (call when ready ) Remarks- - � I } gull ing Inspector 6/86 md-vl .' to ENT 7owr: oI Qw.. .Ishury gU1LD1iaG and Z4N11VG DEPAB�ggx 9$ Bay and liaviland Road, Queensbury, New York 12801 BU i L_ D l NG INSPECTOR ' S REPORT NAME � I� '� I L `,� vie. ►� 1� LOCAT I ON Date Permit I3o • * * * APPROVED - YES I3C] footing/Pier Forms I;o, ndation waterproofing Back€ il Framing Roofing Siding Masonry veneer Rough Plumbing Relief valves g.t . Porches Finished Floors interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . vireproo€ in Door Closers Smoke Detector Chimney ' ( INSULATION ' Foundation Floors walls I Ceding_ p L IN SpECTYO F IN AL EI ECT I)RIVEWA-Y APPROVAL �...�� Final Building survey ------ Next scheduled insp ection (call wY�en ready ) Remarks- r' f' . H F # fluildi g Inspector G/sG and-vl I Quvens +� ury /U[u11 0 DEPARTMENT + BUILDING and ZDNfNG E d D I BOX Q eensbu Y. New York 98 y BuI LDING INSPECTOR ' S REPORT NAME L V LOCATiON"� Date ' Pert No D YES Na APPROVE footing/Pier Forms foundation Waterproofing ]tfi11 g13aaming Roofing S id ing Mas ry Veneer agh Plumbing -- Relief Valves l.xt . Porches Finished Floors interior ''Prim Stairs & Railings Cellar Drain Tile Concrete Floors Pllbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney 1N S U LAT I Oft Foundation Floors Walls Ceiling_ 114SPECTION FINAL El ECTRICA DRIVEWAY APPROV Building . urvey �_�____� ' �- Final s h inspection C all when ready ) Next edule Remarks c rN ''lf '�- � � 13ui ding nspec'to 6/86 and-vl � ��► /j _lawn 01 'Queen .fiury l I BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R,D, i Box 98 Queensbury, New York 12801 �C SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION ,�f DATE A PERMIT NO . 6 / ' 6vP SOIL TYPE - Sand - Loam - Clay Percolation Test Required? YES - NO Percolation rate - Min/Inch - F TYPE of SYSTEM.: � Absorption f ' eId , total length Length of eac trench Depth of trenc s Size of gravel - SEEPAGE PITS4N er Of) Size- ft. X f t ' Gravel size PIPING : Size Type Bldg . to tank f? L)C Tank to dirt . box t � � Dist. box to field/p ' t Openings sealed? Y NO Partial LCCGATION/SEPARATIONS . Foundation to tank ft. Foundation to absor tion ft + Absorption to lot ine ft . o ! Separation of pit f 3ACATION OF SYS CH PROP TY (circle one) Front - Rear - ft side - ght side COMMENTS : SYSTEM USE APPROVED YES NO Building In Pe Or 01/86 ind vl r C� ,..lawn o� '�ueens ur�t + BUILDING and ZONING DEPARTMENT ' Bay and Haviland Road, R. D. i Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME rrcr,.- �•*�r�� i, �'�i S LOCATIONy� �p 1 �L�a�ra .. E, Comfy a Date // c fF permit NO Of * * * * w * * * APPROVED YES NO Footing/Fier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile LR6�ncrete Floors ` plbg . Fixtures Gar . Fireproofin Door Closers Smoke Detectors Chimney INSULATION Foundation Floors walls ceil 'inCJ FINAL ELECT CAL ILVSpECTION _... DRIVEWAY APPROVAT• IIIIII� Final Building Survey Next scheduled inspection {call wtxen ready ) Remarks- Building Inspector 6/86 and-VI 14 own of QU4919 "'y BUILDING and 2f1N1#VG DEPARTMENT Bay and hlaviland Road. R,D 1 Box 98 Queensbury, New York 12801 L 1 DING INSPECTOR ' S REPORT NAME le LOCATION Date �! d / (� Permit No . 4�° G; APPROVED YES NO Foating/Pier Forms Foundation Waterproofing ackf i l l 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 F.LECTR AL iNSPECTION DRIVEWAY APPROVAL Final Building Survey _ Next scheduled inspection (call when rdy ) Remarks- Building inspector 6/86 and-VI c7 4 � l� l9 Down of Quee" 31"rs� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Sax 98 Queensbury, New York 12801 BUILDING INSPEClTORr S REPORT NAME I ` vd[ rt, yiG fn+ /.ti � IT � LOCATIONy Date i(�) / 2-0 Permit No . * * * * * * * y * * APPROVED YE NO oozing/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 Pibg _ Fixtures Gar _ Fireproof-in Door Closers Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection Ccall when ready ) Remark.s- OCIIIe7 or /�tin Building Inspector +6/86 and-vl BUILDING DEPT. COPY OE ICATION WITH BUILDIEL, NEW DEW YORICWHE 1 0ARD OF IRE UNDERWRITERS. TEMP. Ii DATE CITY ORG { j"' 6 IC^ r .�./ / ' TOWNSHIP (, 1�(�,,,.r i"'R >�UP COUNTYVILLAGE Lr^i. +��•�^^�yy 1�P`yj -. } _ STREET AND BID.ROAD AND POLE OR LOT ..,:, c) Wit=-v 4.., POLE N BETMMEEN IBHAT TMO ��, "'y CROSS STREETS IS ,/ +��"�..� Et,Q I'77 ECTION vi1 BUILDING BLOCK LOT "�- POCCLIPANT'S T e- Gr DCCIJP,iI�NCY ✓ f NAME ERmS NAME //�„I,,/�"f'/f��`�c�- ■■,// j]y y f �+ AND OWNADDRESS �..% Cl/[�. _ I'� +�. l�Jf /�.,.. TEL.'#lk4, SUPPLIED FROM THEIR L/ ��'�"r"�" C`'� OPFkCE BY f-y DEFECTS BUILDING WORK NEW OLD 0 I NEW lJ- ADDITIONAL ❑ REMOVED ❑ IS LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED Ne. of Fhnutaa fi BRAN pf OFFICE USE NUMBER OF OVTLJETS Larwp p*sap>IaaMe MOTORS HEATERS CIRCUITS ONLY m H.P_ Wetb A-W.6. Comb" YWM Rataas'Is !n� aiiltit Fondant Station Ne. TYw Esch Ne. Essh No• OauOs iIVSPi:CT10N Oot- afde Sntr Bass Bast w"WA Ist Ft. 2nd FI 3rd FI_ REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: da NOT USE THIS SPACE. ;his application is intended to coaar the abovrtwtad eyoip.nent to be inspected but p at time of i nape ctfan throe is fond atjwtti o equipmons not ab a Iissad. n ar - , Yu e auAtori"d to make "m insp+ctlon and adjust the v fan to covet the ffi""onal equipment, as Proaidsd u ddi by the apWicent. ELECTRIC SIGN TOTAL SIZE OF FEEDERS LAMPS WATTS MAINS CHARACTER EXPOSED GAS TUBE SIGN OP WORK CONCEALED TRANSFORMERS OF VA NORK TO BE INUIMSERI ICAPACITYI STARTED COMPLETED SIZE OF SIGN SERVICE OVERHEAD UNDERGROUND MAKER ENT£RS OF SIGN i IN INSY EC;ION REQUESTED OM OR AS NEAR AS NEW 0 OLD /OISSIBL£ A ID BELAY SY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES DATE Of MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION - � °°- PRINT NAME AN ADDRESS,r i_ �,y� �r .�.. NAME OF ] ..?�t� N • ''I.-. fJ/� S �'!.�OF 'APPLICANT ... ! ., APPLICANT f�+f ,, f ,f� / f R,��/ ` T �-7 STREET ADDRESS ! -' / "7�' "T' �� 71 f-J�+-.' / � TELEPHONE / Czip ODE LICENSE NO. CITY OR POST OFFICE WMEN APPLICABLE 40 EL (REV. 1/60) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING \ f V Y / T Mp. / �l ie e4p Aoe VA -7reac.i.v of (�Rc�,F— -s/sl�v,t rf G/.•tarac .v GesAO'Awo r'tjop VATS. pew 3 a ru yA +��[' h '� � � �•'�.. � .Y. _]lt.+ _ / }.. 1 �. Yn-h, sJ Meg -. . ,... ... - - t . ..