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1987-659 +DER. 11FICA'TE OF OCCUPA►.NCIL TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK June Date i This is to certify that work requested to be done as ahawn by Permit No. has been completed- one—Fazuily Dwelling I 'This structure may be occupied so a .-3La1-- Wi-llow Std . (St . No . 4) The Pines o ueenabur Location � sti'itold & Natalia Trzaslta I Owen' ,I By order Town Board TOWN OF QUEENSSURY s � $uildi N Zoning Inspector I - � BUILDING PERMIT TOWN CIF QUEENSBURY No. 87- 659 z WARREN COUNTY, NEW YOiRK. c' Witold & Natalia 'Trzaska `o PERMISSION is hereby granted to I� 00 OWNER of property located at Lot 52 Willow Rd . (Ste No . 4) Street, Road or Ave. N The Pines of Queensbury in the Town of Queensbury, To Construct or place a 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. [2. OWNER S Address is 18147 Townsend Ct . r• Riverview , Michigan 48192 0 4 er• CONTRACTOR or BUI LpER'S Name Byron Rist h w i-- r• 0 3. CONTRACTOR or BUILDER'S Address RR 1 Box 1469 N Lake George , No Y . 12845 w ra s+s 4. ARCHITECT'S Name 5. ARCHITECT'S Address ..y S.n r• ns m rn tom• 6. TYPE of Construction — (Please indicate by X) r� �-, o (K4 wood Frame ( I Masonry ( 1 steel 1 � a SD • 7. PLANS and specifications us d Na. 36 ' x 64 ' per plot plan , specificationsand application including, c ry septic system , attached two car garage . 8. Proposed Use One-Family Dwelling + m I rn $5 . 00 C/ o 129 . 99 April 1 , 19$ 88 � $ PERMIT FEE PAID - THIS PERMIT EXPIRES (if a longer period is required an application for an extension must be made to the auilding and Zoning inspector of the town of Queensbury before the expiration date.) m r Dated at the Town of Queensbury this 29th Day of Sept ' 19 87 p �j as SIGNED BY for the Town of Queensbury Building and Zoning Inspector TO BE COMPLETED BY BLDG , DEPT . /►1� Application No , ouin o f q �t4�L+1t 3G1fl/"� Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 u 44Iji{y��;� rrt Say and Haviland Road, R. D. 1 Box 98 Zoning Designation Queensbury, New York 12801 Variance No , r✓p Site Plan Review Now C,Ep 2 91987 Approved by - ----- -..._ . 00 APPLICATION FOR L�r+i �A" — yi _ IStoe BUILDING AND ZONING PERMIT 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 : o P . O. Address k�-Il I T v �Jic�i ti/c 'rel . (� {, �s^ 3 st�l Le 7- 5� - y st �.� . .s rr�r. c� . 4t) Tax Map Na . Property Location -* 1�t�` ---�-- Street number or building lot number Subdivision name ( if applicable) THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK. AS REGARDS RDS BUILDING CODES IS 100 -��r �tEt 1 (v `l ! nk r Name P . O. Address Tel . No . {� s 1� Q� 5 ( Address_ Tel . Name of builder el . i 42 - 3a h 7 Name of plumberr Ta�P t� { M �� er�Address t}A "SIB ry .vt F t L � s� r i �•v+� Address A ✓I Tel . Name of mason - 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 set-back dimensions from property lines . Give Other work (describe) 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 13 C] ft X ( [ Q ft _ Existing building ( s ) Size bLv_ rJ ft X -.---_.—ft ' PROPOSED BUILDING AND USE : * Existing building ( s ) Use h1_ o cl - Size of new structure 2G ft X 1:, •4 f * distance from property line Foundation-pier/slab/crawl/partia full Proposed building , W ft (circle one ) Front yard {I5 ft Rear yard s $ No . of stories (habitable space) Side yards 2 ft and 3 ft Height ( grade to ridge ) t 't�' ft ' * if on corner , setback from side street ft If residential , no * of families t OCCUPANCY INFORMATION No . of rooms ( excluding baths) No. of bedrooms PRIMARY BUILDING - No . of bathrooms fOne family dwelling rt Primary heating system / - = f a 4 c2 Two family dwelling Type of fuel IV q * Multiple dwelling f Number of units No . of fireplaces to be installed iW Permanent occupancy Will a wood stove be installed?yQ._� Transient occupancy Central Air conditioning'?_ \ 0 Business BUILDING STYLE, PRIMARY STRUCTURE ~Industrial other — -- --_— ganch Contemporary Log cabin If addition , what will use be? Raised ranch Mansion Duplex Split level Old style Bungalow ACCESSORY BUILDING- Cape God Cottage Other car Town House * Detached garage/one car/ two cam/ Colonial Row car ( CIRCLE ONE PLEASE ) * � ''Attached garage/one car/ . Private storage building ESTIMATED MARKET VALUE OF * Other CONSTRUCTION ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED ! INFORMATION ON BUILDING SPECIFICATIONS , Form BPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS . Type of constructlon . Cwod f�raw fire safe , etc . Will any second-hand or un lumber be used? If so , for what ? o Foundation wall material Thickness ' Depth of foundation below grade (to butt o4;.�t coting ) Will there be a cellarp? Heated or heated?,; floor sq, footage 14 7 sq ft Will there be a basement? Will any portion be used as living space? ( If so , what portion? _sq . ft . - - Type of use? Type of roof slope flat/shed/other Material of roof Size , wood studs Z. -"'X.. L 10 spacing � "'o . c . length g ft . Joists ( floor beams ) lst . floor ",X_ L y IN spacing I (� '"o . c . span i s} ft . Joists ( floor beams } 2nd , floor "'x " spacing ""o . c . span ft . Overlays (ceiling beams ) "X spacing '"o . c , span ft . Roof rafters "'X " spacing o . c , span ft . Roof trusses (pre-engineered) spacing 7. '"o . c . span_,a -ft . Exterior wall finish 'fix y. {, Of what material? Interior wall finish If a garage is to be attached , describe materials to be used for FIRE SEPARATION : N Is ere to be an opening between garage and dwelling? y If $o will a Fire-rated door , enclosure , and self-closing device be provided71 Will a flue-lined chimney be installed? -,�Hei ht above roof. 2> ft . -- Depth of chimney foundation below grade (. ft . c - ^"°I 5 - A-, IL,�4 S rc��"L � u.- Depth of fireplace hea_rth __Z.__._ft . p in _ Cr water supply aicipal or private well SEPTIC SYSTEM Distance e from ANY private well ( including adjoining propertiesLu Cy £t . (A separate application is necessary for any repair or new installation of septic system) Town of Queensbury �5 County of warren A F F I D A V l� T I k 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 Signaturt�_ YC3�w day of 19 . o ergs agent , arcnitect contract 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 following : 1 1 . Gross floor area) �f L.L� _► .s� S 2 . Type of heat ,11/fr1 C CgA-� f``' /C 3 . Is the building mechanically coaledr> � ( 4 . Percentage of area of windows and doors A . Over 16 % Only 1 . Uo value of gross area of walls , roof / ceiling and floors exposed to ambient conditions 20 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 T Under lb Only 1 . R value of roof and floors exposed to ambient conditions Q !i 4 + l 2 , R value of exterior walls - Z2- 3 . R value of glazed area{ - • r 7 z 4 . R value of doors )Z - ` 5 , R value of floors over unheated spaces 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab S , R value of heated basement/ cellar walls ( above grade ) 9 . R value of heated basement / cellar walls (below grade ) 10 , Type of insulation 160 C . Controls r 0 1 . Thermostat maximum heat setting D , 'Duct Systems_ 19 is duct system installed in unheated spaces ? YES ; NO a . If YES , R value of duct installation - 7 b . R value of duct in other areas ysu E , Piping Inlation 1 . Size hot water or cooling carrying agent pipe 2 . R value of pipe insulation 9 F , Service Water Heating C 1 . Performance efficiency 2 , Temperature control setting maximum f G _ For Swimming Pool Only 1 Maximum heating Telephone No , ( app icant ' a.` signature } APPLI+CAT ON FOR. SEPTIC DISPOSAL PERMIT DATE LOCATION OF PROPERTY FOR INSTAL.LAT'ION L 0 � ) �c(� Owner's Name : W t :yc� + hXW ��. i�i�. /c�. sk�a. _ Telephone. S a Address: /V ; l C VLO Installer's Name: tr a ` Telephone: 64 31 Number of bedrooms (residential only) Total daily flow (compute (9? 150 gal per 'bedroom) 4 0 Topography: circle one Flat Rolling Steep Slope % of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: , feet Cmsund Water: At what depth? feet 1,40 Do �• � Bedrock or Impervious Material: At what depth? � feet /� U� t� � � 1 r � u � a A�) Percolation test•, circle on not requi� rimed f r uired / rate min. inch. Domestic water supply: circle on Municipal Well Other IF domestic water supply is a Well: Separation: Watersupply from. Septic absorption . *�, y feet PROPOSED SYSTEM : Septic Tank 1 , o c, C; gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench S 0 feet / Total system length _2 e a feet SEEPAGE PIT(S): Number of / Size each feet by feet Size of stone to be used # / Depth or Thickness Oft / `ter feet IMPORTANT ...Please...LIST NEW EQUIPMENT 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 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 $25U.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 Disposal Ordinance, Signature of responsible person: -r/ t 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 ILDING and ZONING DEPARTMENT Bay and Havifand Road, R. D . l Sox 98 Queensbury, New "fork 12801 BUILDING ffINSPECTOR. ' S REPORT NAME i �Q/D 1 " 2,rr9,5 JC/� LOCATION �� �/,.�1,/'/,G' ze.1 Date /��'�� Permit No . 4r #�l APPROVED YES *NO footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbin Relief Valves l:xt . Porches Finished Floors Interior Trim Stairs & Railing Cellar Drain Til concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors ch ' ey SUI TION Foundation Floors Walls ceiling FINAL EIEC RICAL INSPECTS�������������� DRIVEWAY A PROVAL Final gadding Survey Next scheduled inspection (call when ready ) Rema rk.s-- i3ui ,ding Inspector 6/86 and-VI _7ouln ©/ eteen36ure� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New � York 12801 3^ xr 01 ,t �LtS T� Cw,-r-.CA-c-T t? tZ. SSEPTIC DISPOSAL SYSTEM yIN►�SPECTION NAM E ?`` -I3c L(-,1 LOCAT ION_Wk LLQ1 J '' a DATE 2Z,/.8j� PERMIT NO . SOIL TYPE - Sanci - Loam - Clay Percolation Test. Required? YES N Percolation rate - Min/Inch TYPE of SYlST Absorption fi 8 , total le th 2Z Q] ) Length of each trench Depth of trench s 3 Size of gravel SEEPAGE { r Size- Gravel PIPING : Size Type ry Bldg . to tank 1 i S�=-ti `�D 1 V - Tank to diet _ x Q ' � -- Dist. box to field/ it fit-' -- Openings se ed? YE NO Partial LOCATION/ ARATIONS : Foundati to tank oz✓ ft- Foundat ' n to absorption f t .-}- Absorpt on to lot line £t .p ,._ Separa ion of pits PROPER , LOCATI SYSTEM ON PROPER , (circle once) Front Rea - Left side - Right side - COMMENT v SYSTEM USE APPROVED NO filling I sp ctor 01/86 and vl ' / ,,11 U �� • ._./r�►u,ss o �ueprrsbur� ' BUILDING and ZONING DEPARTMENT Bay and Havfland Road, R.D. 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION �L � .,��r Date/ Permit No . �Lly ✓ = APPROVED - YES O Footing/Pier Forms Poundation Waterproofing Backfill `*,,r rami ng Roofing Siding Mas ry Ven r ugh Plumbi g Relief Valves Ext . Perches Finished Floor Interior 'Trim Stairs & Railin Cellar Drain Til Concrete Floors Plbg . Fixtures Gar . Fireproo ng Door Closers Smoke Detec rs Chimney INSULA`T'IO Foundati Floors Walls Ceilin FINAL IECTRICAL INSPECTION DRIVEWAY APPROV L Final Building Survey Next scheduled) in*sped ion (ca11 when z eady ) Remarks-pa 024.) AA A' uyy+' ' Ke) F-cw TO J` Irk' C+ 2 OAWMLJI nn13ig Inspect 6/86 and-vl „ {✓ 1 ” � .�/c+uvn o ,eeeenshtsr [ � rr BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.0_ I Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date Permit. No . ✓ = APPROVED - Y NO Footing/Pier Forms Foundation waterproofing B kfill ami ng Roofing siding Masonry eneer Rough P1 ring Relief Va ves Ext . Porch s Finished Fl ors Interior Tri Stairs & Rail ' gs Cellar Drain T1 e Concrete Floors Plbg . Fixtures Gar _ Fireproofin Door Closers Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECT CAL INSPECTION _.......,_... DRIVEWAY APP OVAL Final Build ng Survey s^ Pr k AZ text scheduled in pection (call when ready ) Remarks- l C LkAfZjt sf A/C,&' 1O Lr's5r" M1f3C15s FAQ Building Inspect 6/86 and-vl Yde Own 0/ Q" eenj "ry � ' i (' ► BUILDING and ZONING DEPARTMENT J Bay and Haviland Road. R. Q. 1 Box 98 } ] ; J Queensbury, New York 12801 [ ` BUILDING INSPECTOR ' S REPORT NAME LOCATION a") 17ate /•� / / Permit No . J� ` APPROVED* -* YES* NO Footing/Fier Fo &viun da t ion Waterproofing ` Backfill Framing Roofing Siding Masonry Veneer Rough Plumbs ng 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 'ELECTRIC INSPECTION DRIVEWAY APPRO AU Final Building 'Survey Next schedule inspection (call w}1en ready ) Remarks- lwl��flll Build ' g Inspector 6/8£� and--+l BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 +Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME 7 AS fg:fA LOCATION �� �-� 7 _ �i{/1LL1Jcl �2l DateJCU/ _ Permit Pao . �" � ✓ = -APPROVED - ;xIF NO Footing/Pier Forms 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 INSULATION : Foundation Floors Walls Ceiling FINAL ELECT CAL INSPECTION DRIVEWAY AP QVAL Final Build ng Survey hText scheduled inspection call when ready ) i Remarks- Build' g Inspector 6/86 and-vl BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. I Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT I� NAME I . ! Z�J �C/ t LOCATION k)kt-LQ J An Date/ '7 Permit No . ✓ = APPROVED - YjQS NO )(Footing/Pier Forms " Foundation Waterproofing Backfill Framing Roofing Siding Masonry neer Rough Plum ing Relief Valy Ext . Porches Finished Floor Interior Trim Stairs & Railing Cellar Drain Tile Concrete Floors. Plbg . Fixtures Gar _ Fireproofi Door Closers Smoke Detecto s Chimney. INSULATION ; Foundation Floors Walls Ceiling FINAL EL CTRICAL INSPECTION DRIVEWAY PPROVAL Final Bur,ding Survey Next scheduled inspection (call when ready ) Remarks-- Building Inspector 6/86 and-vl awn o/ eeen49e4r� BUILDING and ZONING DEPARTMENT M Bay and Haviland Rabid, R.[>. 1 Box 98 Queensht4ry, NeW York 12801Q oe BUILDING INSPECTOR ' S REPORT / ,ro NAME ]L LOCATION Data (o Permit No #r' APPROV= - 'YES NO Footing/Pier Forms Foundation Waterproofing Backf ill Framing Roofing Siding Masonry Ven er Rough Plumbi g Re ief Valves t . 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 EL RICAL INSPECTION rinalEWAY PPROVAI . ,�„�Bu ding, Survey Next ache led inspection (call when ready Remarks- C\XeKe4 ��/f Building Inspector 6/66 and-vl Down o/ Quleens6ury BUILDING and ZONING EWPAATMENT Bay and Haviland Road, R.O. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION 0 Ar Date 1-�f�l ee Permit No . ✓ = APPROVED - YES NO Footing/Pier Forms Foundation W00115frproo f in Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain T! Concrete Floor Plbg . Fixture Gar . Firepro frog M Door Closer Smoke Dete ors Chimney INSUILATIO Foun dat i Floors WalIS Ceiling FINAL EL CTRICAL INSPECTION 1tIVEWAY PPROVAL anal Bui ding Survey I Next scheduled inspection (call when ready Remarks- 1 Building Inspector 6/86 and-vl APPLICATION FOR ELEQTR krA; ,f-NSPECTIImIOt _ PLEASE BEAR DOWN YOU ARE MAKING (4) CCWI ES MQi?tf.IMQARTMIENT MPECTIQN AGENCYjNC. National Headquarters OW Haddon Ave , C`ionllingswood, N.J. dB108 Date: City, Town or Township " +4 a 4%A tZ Y County JtJ l+ k 2 +e'.✓ State • ,�• Location/Address t. � Z' s 5 ► i t ..A") is i> . _' ' ' (If Located in Rural Area - Please Attach Directions) Pole # Owner N A-TVt j,,s, 4 IN A' a Ash is .A Pel''rnit Occupied AS i- fe.Jf e;C`t r. - r P G t � F /{ .iA , i C"S I � aJ`�r &r s Building:. New ![ - OldQ Occupant Work Area in Building Floor #, etc. ) : for: Wirin 2r Service Gir or Ready for Ins ection- Fee Remitted A. Cashes] Check M.17. Make-Payable To: M.D.I.A. Sep 75e lsed 1230' i'"M 1764 ROeO F25e ESOO 275e 8ese a' Number of Rough Wiring Outlets Elect. meat . Switches Lighting Amp. Service Surface Unit Dishwasher Range Receptacles Water Heater Air Conditioner Dryer Pump Number of Fix lures Oven .-_'Garbage Disposal Wiring and Controls for Burner Aimipp Recdptacles A Fractional H.P. Vent Fans Other Equipment: MOTORS H.A. t/2 1/12 I/1 1/a 1/6 1/4 1/3 1/2 3/4 1, 1+fx 2 3 5 7Y2 l0 15 20 25 3© 40 50 .79 Mark Numimr of Each Size d Applicant's 'r Signature . License # Permit # T/A - Y�Cu - .fir-s. - G e^.y. C �.srp .0 utility : / APPIjo *'t-Adr�rR7rs: s tX + 4� 4' AME (OFFICE LOCATION (City) "irp'"' Gc' riu'_t ,ter (State) .., - (zip) i'4 S- Service Request Phone # .aa I - ?5►.f' - 1 frll 1 Electrician: 142 ZfW./ DATE RECEIVED: DATE INSPECTED: r=N ' ion . Same as Above Q or: belough Wiring Outlets Surface Unit Oven AAA witches Ran Garbage Disposal Receptacles Water Heater ' Dishwasher Fixtures rpir olicrwonpr Dryer fr�iCr " giaipment "Burring s for :� Arnp. Receptacle Amp. Service Conductors Pump Vent-Fans MOTORS H.P. 1/20 x/12 1/10 1/e Y/n lf4 1/3 1/2 3/4 1 13h 2 3 ' S 151 20 25 30 '40 56 '75 100 Mark Numb of Each Size Elect. Feat ° asa 10*0 12sa 3soo 175e Zvuo lazaol zsoo 27910 aa0u Q RW Progress: Inc. Q LKD 0 Contractor Q CFT Violation : Work Comp. Q Inc. M Q LIA Owner CASH LIA Fee CH K # � IPA .. Municipal �' Due MO # LL . . r;L a s ,#a; INV # DateC ; .< . -,. _ _ r AppEicarxt Other Side "Utility Owner Cut in Card Temp I Date' © Final # Date _ INSPECTORS SIGNALTUPI ADPtICRTiON FORM NC3. 28 ELC�1 Tl1r6 . .. . , . + - - . _• . .' . - BVRVN ,a . RIST GENERAL CONTRACTOR TEL 518 / 798 - 1 $ $ 1 Joe t L z ti k a xr DwrE 0 1 L_o 4 AL Cr4L. CAD rl CY. CT�° : �:. Fw. 11 j I i 1 I . j : ! rf2GM. CLn Ri„i I I iL P y � IV cil S M a 5EP44 all 7j I i i 4 w 00 ._ 4Zi cc co pC C7 coLu I ; I t? r t i x� c� FIII, J T SVRON B . RIST GENERAL CONTRACTOR Jos TEL : 518l798 - 1881 DAIS Cot A " (,, Ar'k d of - rake Fart 4„+ fi cL Cx P,'P_S' �1r � ~ t { f I _ I � I arc k- ar " J { of .T . .