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1987-711 i CERTIFICATE CJF OCCUPANCY" €. TOWN OF QUEENSBURY r WARREN COUNTY, NEW YORK -APyi I ES Date April 25 , 19 8(2 rN This is to certify that work requested to be done as shown by Permit No. £ ` 11 has been completed. a P 4W u p[JL l nq This structu pe occup mi d a uF Two Faly DW 1.n � �I z�c�k�tti 1 . Location .4 EliHtibeth 1.ane Queen victo ;- ia ' U Grant q C� Guy , r Iuilc er5 j4L y\(_' Owner By Order Town Board 'MWN OF QUEENSBURY i Building & Zoning Inspector CREk T1VE "lNSFA" ■ftINTlMG. GLEn+3 Fl.L!-g ft Y 12t01 Ali E1i9}.yR!• BUILDING PERMIT TOWN OF QUEENSBURY No. 87-711 WARREN COUNTY, NEW YORK z G? PERMISSION is hereby granted to Queen Victoria ' s Grant r.� OWNER of property located at 24 Elizabeth Lane Street, Road or Ave. I 1 in the Town of Queensbury, To Construct or place a of Two 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. t. OWNER'S ,address is Guyer Builders Inca � 119 Dunning St . (D Ballston. Spa , N . Y , 12801 � c 2. CONTRACTOR or BUILDER 'S Name Same r* 0 +-s w 3. CONTRACTOR or BUILDER'S Address to n �-t Pu rr 4. ARCHITECT'S Name 5. ARCHITECT'SAddress LTi F� In N 6. TYPE of Construction — {Phase Indicate by X) c' ro rt ( X) VVood Frame ( ) Masonry f ) steel i 1 �7a t� sv 7. PLANS and specifications No. 34 ' x 43 ' per plot plan , specifications and application including septic system, attached one car garage and driveway permit . B' Proposed Use MODEL K w 0 rn of Two Family Dwelling 4 $5400 C /O $ 82000 PERMIT FEE PAID — THIS PERMIT EXPIRES Mai' 1 , 1988 � r f+- (If a longar period is required an application for an extension must be made to the Building and Zoning inspector of the town of Queensbury before the expiration date-) t4 22nd October 1987 r Dated at the Town of Queensbury this Day of SIGNED BY / " r a"ca " e�' for the Town of Queensbury 04 Building and Zoning I nalDector 41V .AM k;U1gr1sC K L! 13i OL1.�a . LI,Gr"1 . �,. E r_3Yl fV x jY i `J � ';_''-+ : 1F,y3..: -.-...-.. Application No. (J S Jpi+vrt D/ Q"W e► 4$ "ry Permit Issued 19 i r1 BUILDING anr3 ZONING DEPARTMENT Permit Expires 19 J f+r r 4f% Bay and Havilan,d Road, R.D. 1 Box 98 Zoning Designation Ls iJU1 Queensbury, New York 12801 variance No _ � I , k4 r-t . r. ,r.f [�Ep'_r Site Plan view No . ,y Approve rr7 31111 APPLICATION FOR 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 fallowing 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 : Guyer Builders, Inc . P. O. Address 119 Dunning Street Ballston Spa , New York. 12020 Tel , ( 518 ) 899-9161 Property Location : 24 Elizabeth Lane Tax Map Noel�21 4 4 / 2 Street number or building lot number Subdivision name ( if applicable) Queen Victoria ' s Grant THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : Richard He g2yer III ( 518) 899-9161 �ygate F . O. Address Tel . No . Name of builder Guyer Builders , Inc .Address 119 Dunning Street Tel . ( 518 ) 899- 9161 Name of plumber Guyer Builclersp ncvAddress 119 LXuuilng StreetTel . ( 518) 899�91151 Nacre of mason uyer rs s n'C .Addressg ree Tel . - NATURE OF PROPOSED WORK : * ZONING INFORMATION : X 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) * suet-back dimensions from property lines . Give * street and number or lot number and indicate FOR DEMOLITION PERMITr SPATE SIZE AND * whether interior or corner lot . Show location * of water supply and location and configuration LOCATION OF STRUCTURES AFFECTED . of septic disposal area . * * COMPLETE INFORMATION REQUIIRRED $ETPW . anp] * Size of property 100± Plft X 124 ft . * Existing building ( s) Size WX ft Xft . PROPOSED BUILDING AND USE : Model �' * Existing building ( s ) Use NIA Size of new struc a 34 ft x 43 ft 1. Foundation-pier slab crawl/partial/full * Proposed building , diet nce from property line circle one ) * See pOt part 1 ,� Front yard 30+ ft Rear yard 30+ ft No . of stories (habitable space ) * Side yards+ ft and 15+ ft Height (grade to ridge ) 21 ' -0„ ft . * If on corner , setback from side street ft If residential , now of families Of 2 No * of rooms (excluding baths ) �0 * OCCUPANCY INFORMATION Now of bedrooms N of bathrooms * PRIb1FLRY BUILDING — • One family dwelling This m },e ; fgr Pr merry heating system Baseboard e ectrie "X-Two family dwelling one S 6 Tyre of fuel Electricit * Multiple dwelling / Number of units Now of fireplaces to be installed permanent occupancy Will a wood stove be installed? NO Central Air conditioning? No » Transient occupancy Business BUILDING STYLE, PRIMARY STRUCTURE * Industrial Ranch Contemporary Lo cabin * Other Raised Ranch Mansion Duple 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 I. CIRCLE ONE PLEASE } * _Attached garage/one car/ two car/ 2ne car Private storage building ESTIMATED MARKET VALUE OF * Other CONSTRUCTION INFORMATION ON BUILDING SPECIFICATIONSr ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETEDI Form BPA 4/86 and-vl HUILDING PERMIT APPLICATION CONTINUED - r BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe, etc . wood frame Will any second-hand or ungraded lumber be used? if so, for what? no Foundation wall material concrete block Thickness 8" Depth of foundation below grade (to bottom of footing ) 8`" minimum Will there be a cellar? 'no Heated or unheated? Floor sq. footage sq ft Will there be a basement? no Will any portion be used as living space? ( If SO , what port sq. ft . - - Type of use? Type of roof - sloped flat/shed/other Material of roof Fi rg ass shingles Size , wood studs "x 6 spacings"o . c . length 8 ft . exterior walls Joists ( floor beams ) 1st . floor N/A "x of spacing "o . c . span N/A ft . Joists ( floor beams ) 2nd . floor -"X �" spacing��"o . c . span N A ft . Overlays (ceiling beams ) `NX " spacing 24 ,O7 c . span N/A ft. ,Roof rafters 2 "X 1 " spacing A o . c . span 12 ft . Roof trusses (pre-engineered) spacing 2 "o . c . span 30 ft . Exterior wall finish stained Of what material? 5/8" x 4 " x 8 ' texture 111 Interior wail finish pain s eetrock If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 1 /2" type "X" sheetrock Is there to be an opening between garageAand dwelling? yes If so will a Fire-rated door , enclosure , and self-closing device be provided? 3TS Will a flue-lined chimney be installed? No Height above roof N/A ft . Depth of chimney foundation below grade N A ft . Depth of fireplace hearth N A ft . in . Water supply - Municipal or private well municipal SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties ft . (A separate application is necessary - for an re air or new installation of septic system) See S . P . E . D . S . yernu t 0 026252s Town of a A F F I D A V I T STATE OF NEW YORK 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 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 Owner , o - er ' a agent , nxcect , contractor 2? , ek day EUZABETH K_ LANDRY Notary Public. State of New York " No. 4862001 Oualifie in Notary c , Warren County , Corn N Cormission Expires June a C lfi 9�4ir SPECIAL CONDITIONS OF THE PERMIT : 1040 Square feet living 264 1 Square foot=�I garage one stall 1� 1304 @ $7 . 00/100"or part of $5 . 00 One stall garage _ $5 . 00 CIO permit Total By--------------------------------------- WARREN COUNTY . NEW YORK Application fort BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . ANSWER ALL of the followings 1 . Gross floor area 1040 S . F. 3 . Type of heat Baseboard electric 39 is the building mechanically cooled ? Ni°' 4o percentage of area of windows and doors 12 . 33% A . Over 16 % only 1 . U0 value of gross area of walls , roof /ceiling and floors exposed to ambient conditions 2 . Floor over heated spaces YES NO as Are foundation walls insulated ? YES NO 1 . If YES , what is the R value ? 3 . Slab on grade YES N.p 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 S . Under 16 . Only 1 . R value of roof and floors exposed to ambient conditions. R-38 2 . R value of exterior walls )4P(W R-23 . 5 Uo .0 * 04+ 3 . R value of glazed area U• =0 • 30 4 . R value of doors R--14 . 9 (U=0 . 06) LL 5 . R value of floors over unheated spaces, u=1C1 6 . R value of slab edge insulation - unheated slab N/A 7 . R value of slab insulation - heated slab 12 . 5 8 . R value of heated basement/ cellar walls ( above grade ) N A 90 R value of heated basement/ cellar walls ( below grade ) N/A 10 . Type of insulation Fiberglass Co Controls 1 . Thermostat maximum heat setting D . Duct Systems N/A 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 N/A 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation i . Service Water Heating 1 . Performance efficiency NIA 2 . Temperature control setting maximum G . For Swimming Pool Only 1. Maximum heating NIA w. Telephone No . ( 518 ) $99-9161 ( applicant " gnature ) APPLICATION FOR SEPTIC DISPOSAL PERMIT - Ref: S . P. E. D. S . DATE September 23 87 permit # New York - 0202525 MODEL K of C/K LOCATION OF PROPERTY FOR INSTALLATION 24 Elizabeth Lane Owner's Name: Guyer Builders , Inc . Telephone: ( 518) 899-9161 Address: 119 Dunning Street , Ballston Spa , New York 12020 Installer's Name: 'Guyer Builders , Inc Telephone: ( 518) 899-9161 2 A, C , E , I , J , K, L, M Number of bedrooms (residential only) 2 3 F, G , H Total daily flow (compute @ 150 gal per bedroom) 300 Topography: circle one ; Flat Rolling, Steep Slope 96 of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: 8 ' feet + Ground Water: At what depth? unknOwn 8 feet + Bedrock or Impervious Material« At what depth? unknown feet Percolatioo test: circle one: not require required / rate mia. inch. Xkm u+estic water supply: circle one: Municip�Well Other IF domestic water supply is a Well: Separation: Watersupply^ from Septic absorption _ N/A feet * PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench N/A feet / Total system length N/A feet * SEEPAGE PIT(S): Number of / Size each feet by feet "1P Size of stone to be used # / Depth or Thickness feet IMPORTANT * See S . P. E . D . S . ...P`lease...LIST NEW EQUIPMENT TO BE INSTALLED permit & attached * ss * ssss * * * s * * ssss * * * * ss * * s * s * * * sss * ss * ss map ' (over) Section U sutic System Laspections: 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 ppropoped .location of the gystem 2.) location and distance to lot Imes 34 location and distance to structures 4.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, We 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 bave read the regulations above and agree to abide- by these aad all requW"me nts of the Town of Queeasbury Sanitary Sewage Disposal Ck%ti*■ance. Signature of-responsible person, Date: Town of Queensbury Building and Code Department Bay at llaviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE .�./awri v� �uee►a .she�rc� BUILDING and ZONING DEPARTMENT Say and Haviland Road, R. D. 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME1. '& t LOCATION _ 7 /r i�; " Date Permit No . ,+ 7 ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Sackfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors V Interior Trim L/ Stairs & Railings v' Cellar Drain Tile C©ncrete Floors Plbg . Fixtures Gar . Fireproofing V� 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- 4 uilding Inspector 6/86 and-vl awn 01 QueenjAury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME f 'T 011 *t?tZ LOCAT I ClN S l,37. DATE .J • W PERMIT NO. SOIL TYPE - San - Loam - Clay - l Percolation Test Required? YES NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption fie l total length Length of each nch Depth of trenches Size of grave]:_ SEEPAGE PITS{Numbe of ) Size- � ft. X _ ft. Gravel size PIPING : Size Type Bldg . to tank - fu +r 7►'i/ C. Tank to disc. box EM r4r Dist . box to fief it dy, Openings sealed? YE NO Partial LOCATION/SEPA TIONS : Foundation t tank ft_ Foundation o absorption ft . Absorption to lot line t . Separatio of pits LOCATION F' SYSTEM ON PROP one ) Front ear - Left side - Right ' de - COMMENT SYSTEM USE APPROVED YES NO B x.lda.n nspector 01/86 and vl BUILDING antl ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, Now York 12801 BUILDING INSPECTOR ' S REPORT NAME 121 LOCATION Date z Y/ r Permit No . Footing/Pier Forms APPROVED - YES NO Foundation waterproofing Backfill Framing AMP jb Roofing Siding Masonry Vene Rough Plumbin Relief Valves Ext , Porches Finished Floors Interior 'Prim Stairs & Raili s Cellar Drain le Concrete I�lo rss Plbg . Fixt es Gar . Fire oofing Door Cla ers Smoke D Lectors Chimne _ L,4` 7SL1I 'r'It7ll : Faun ation Flo es Walls Ceil ir7(j FINAL L:LI CTRICAL INSPECTION DRIVEWAY APPROVAL �� Final Building Survey Next scheduled inspection �ca1.l when ready ) Remarks- . - ... 5 I I r f nuild.ing Inspector G/86 and- VI �,.. _Jvurr� v� �ueert36urr� r � BUILDING and ZONING DEPARTMENT Say and Haviland road, R. D. 1 Box 98 Queensbury. New York 12801 BUILDING INSPECTOR ' 5 REPORT �? � NAME LOCATION �� r Datez;i' J V / p Permit- No . APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill teaming Roofing Siding Masonry Vene h Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Doer Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls_ Ce i 1 inq FINAL VLECTRI AL INSPECTION DRIVEWAY APPR AL Final Building Survey Next scheduled inspection (call when ready ) Remarks- H 1 h I spec or 6/86 and-vl a 4001054 THE NEW Y© RK BOARD OF FIRE UNDERWRITERS' — BUREAU OF ELECTRICITY to 41 STATE STREET, ALBANY. NEW YORK 12207 Date April 28 . 1988 Application No. on file 030612 /87 � � � !�. � Z THIS CERTIFIES THAT only the electrical eq"JPmHrnt as As"Abed belase and introduced by the applicant nosed an Sher above app lieasian nuaEber in the peen.: " of Guyer Builders Inc . #24 ElEezabeth Lase Queenabury , New York 11% tow family dwelling in the follrnving location: ❑ Basement ❑ l st Ft. ❑ .brad Ff. SectioA 21 Block 4 Let was examined on -15-88 andfound to be in complionee with the r•egeairements of this Gourd. FIXTURE PTAC72T3 SWITCHES FIXTURES RANpES COOKINti 0*"S OVENS DISH WASHERS EXHAUST FANS OUTLETSfFPCANL1ESCtM FLIJapESCEMT AMT. K_ W_ AMT, K. W. AMT. K.W. APT. K- W, APT. H. P. 16 25 11 3 1 4 . 6 4 fr DRYERS FURNACE MAOTORS FUTURE APPLIANCE FEEDERS SPRCIALRECr"I TIME CLOCICS RELL LIMIT HEATERS MULTLOLITLRT DINLR+g SYSTEMMS APT. K. W. oPL H. P. GAS H. P. A1MT. wo. A. W G. AMT_ AMP. AMT. AMPS. TRANS. AMT. H. P. NO. OF FEET APT. WATTS T d�yr r 1Ll SERVICE dSCONNECT Ho, of S E R V I C E AMr. AMP. rrPE U j I .r 2W j 10 sW a x sW 3,6 sW ^b• Ek wcowo. oc cc cGoF+o. Ho. or He-LCG A. W. G. wG. of NEUrRALs GF r iJnIAL 1 150 cb1 1 2/0 1 /D OTHER APPARATUS: Elece Room Heaters : 4/2o0e 1 / 1 . 5s 2/ . 5 Motors : Vi 1-past light 3�gfcl 1�smoke detector Guyer BuIldere Inc a► - 119 Dunning Street Ballston Spas NY 12020 239 BRANCH MANAGER e;k3y Per 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. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. BUILDING and ZONING DEPARTMENT Bay and Hauiland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date _ Permit Na . Footing/Pier Forms ✓ APPROVED - YES No Foundation Waterproofing Backfill Framing Roofing siding Masonry Veneer Rough Plumhing Relief Valves Ext . Porches Finished Floors Interior Trim ��-- Stairs & Railings --- Cellar Drain Tile �ncrete Floors Plbg . Fixtures Gar , Fireproofin Door Closers Smoke Detector Chimney INSULATION .* Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVA Final Building Survey Next scheduled inspection (call when ready ) Remarks- I II L3 r L .� �► ( G ar G AXI 1 0 � 6/86 md_� lg ding inspect r Joctrn of �ueen36urat�t BUILDING and ZONING DEPARTMENT Bay and Haviiand Road, R. D. I Box 98 Queensbury, New York 128()1 BUILDING INSPECTOR ' S REPORT NAME L a cAT�o,� Date �_rr Z Permit No . / Footing/pier F rms APPROVED - YES No Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer u�h? 2- Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Til Concrete Floors Plbg . Fixtures Gar . Firepro. ing Door Closers Smoke Detec ors Chimney INSULATICl Foundatio Floors Walls Ceiling FINAL EL CTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready } Remarks- Buil ing Inspector 6f$6 rnd-vl awn 0/ Quee" i BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR " S REPORT NAME LOCAYION� Date /!I/ U /G Permit No . ✓ = APPROVED - YES NO Farms Foundation Waterproofing Backfill. Framing Roofing Siding Masonry Venee Rough Plumbing Relief Valves Ext . Porches Finished Floor Interior 'Trim _ Stairs & Railin XP llar Drainncrete Flo s bg . Fixtu es Gar . Fire oofing r oar CIO ers Smoke D tectors Chimne INSO TION : Found tion Floor Walls Ceiling FINAL ELECTRICAL I SPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- 6 Building Inspector 6/86 and-vl � ff ...��� �awrt o ueeny6ur BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R_ D_ 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION ' 4 r Data rZ Perm± t No . ✓ = _ Footing/pier Fox [�s APPRQVED YES NO I Foundation 11 XW Waterproofing Backfill Framing Roofing Siding -....... Masonry Veneer Rough Plumhing 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 Wails Ceiling FINAL ELECT CAL INSPECTION_ .DRIVEWAY APP OVAL Final Buildl g Survey Next scheduled inspection (call when ready Remarks-- Building Insp r 6/86 and-vl TOWN OF Q EENSBuRr Baildiat- oep+artntont hasp e e s Date Name Weatl,.ar Remarks Exca tzon Foot-in Forms �'ootin & Piers Foundation Cement Coat Water in Baclffi Il Final Sur Frami n Shea thin Roof Felt Roofin Sidin Mason.,r Veneer Rau h Pi Relief Valves Wall Beard Ext . Porches Fini shed Floor Interior Trim Stairs ev Railin Cellar Dr , Tile Concrete Floor PI Fixture Gar. Fire ro in Door Closers Chimne Water .Meter Ins t . Se tic A Val Floors Insulation �`oundation '� walls Ceilin Building Inspector 14SMA14'ICS e i BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. TEIUIR iI . . DATE CITY OR VILLAGE Queensbury TOWNSHIP COUNTY STREET AND NO, OR ry' 1f ,..� -'---^- ROAD AND POLE NO. #2I- i zabet)l lAme POLE NO. BETWEEN WHAT TWO CROSS STREETS IS _ PREMISE LOCATED? SECTION ! `" BLOCK LOT OCCUPANT'S BUILDING NAME OCCUPANCY OWNER'S NAME ['y�`'"a"� �� AND ADDRESS �^''`T }!7'I�i�s?'1"Sf Imo s 119 Durmim 'i�'t t TEL.CURRENT # SUPPLIED BY �" �' .:'' � ,i- FROM THEIR I1--�� / �.�.,�..• OFFICE Is NEW Lp OLD IWQRK NEW Ld ADDITIONAL ❑ REMOVED LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS L o. of Fiaturas A BRANCH Loea• amp Receptacles MOTORS HEATERS CIRCUITS `OFFICE USE ye„ ONLY Calling SiW Atcseh•t Switch Pattdam Bradt No. T E" p" No Each No, A W'G. wail Recelr'Ib �"' Each Each [ieatpe INSPECTION Out- side Bub- 130100 Bass Mani Yet Ft. 2nd Fl. 3rd PI. REMARKS: LOST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. This application is intended to cover the above-listed equipment to be inspected but if at time of inspection there is found additional equipment not above listed, you are auehgrixed to make the inepsctio0 end adjus[ the fas to cover the additional equipment, as Provided pro by the applicant. SIZE OF ELECTRICSIGN TOTAL 1 MAINS . FEEDERS LAMPS WATTS CHARACTER EXPOSED GAS TUBE SIGN OF WORK yqqsL1 in and servize CONCEALED TRANSFORMERS OF VA WORK TO BE (NUMBER) (CAPACITY$ STARTED COMPLETED SIZE OF SIGN SERVICE OVER ENTERS UNHEAD DERGROUND MAKER IL DING i i, OF SIGN INSPECTION REQUESTED POSE gAS NEAR AS Will .[ yty �, ❑ NEW OLD AVOID DELAY BY GIVINQ FULL AMC ACCURATE INFORMATION, ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. PRINT NAME AND ADDRESS {NAME OF ,I �y�e"4,, Of APPLICANT 01yeir 1*ti1LAa Trle� APPLEICATION 9R`7 STREET ADDRESS 119 Y1ltrnvlm street TELEPHONE # — 899aw.1763 CITY OR ZIP ry�*�� LICENSE NO. POST OFFICE Ballston NY CODE _ WHEN APPLICABLE 46_EL (REV. 1105) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING REFERENCE DRAWINGS �___.1 CLEANOUT 2000ga1 TO GRADE 9=0 DIAMETER 9' O DEPTH QUEEN VICTORIA S GRANT QUEENSBURY , N.Y. 5 SITE UTILITIES SEPTIC WATER V°nDUSEN STEVES SURVEY PLAN 18, 20, 22 , 24, 26, 28 ELIZA13ETH LANE 11 PLOT PLAN $ SEPTIC SYSTEM GUYER BUILCERS, INC. QV - 7 DWN ; 40(� �, ?,�, � Scale : I"- 20`-0