Loading...
1987-696 a CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date 19 _ This is to certify that work requested to be done as shown by Permit No. 87-696 has been completed. This structure may be occupied as a Two Family Dwelling Location 26 Elizabtth Lane - Queen Victoria ' s Grant Owner Guyer Builders By Order Town Board TOWN OF QUEENSBURY Building & Zoning Inspector CRC^TIMC "INSTR" PRINTING GLENS F;665y M 1' ItiO} } IB1191-}i56 BUILDING PERMIT TOWN OF +QUEENSBURY No. 87- 696 WARREN COUNTY, NEW YORK o PERMISSION is hereby granted to Queen Victoria ' s Grant n a� OWNER of property located at 26 Elizabeth Lane Street, Road or Ave. N in the Town of Queensbury. To Construct or place a 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. 1 . OWNER's Address is Guyer Builders Inc . X> 119 Dunning St . Ballston Spa , N . Y . 12020 c 2_ CONTRACTOR or SW LDE WS Name n Same ^ a �s I� w 3. CONTRACTOR or BUILDER "S Address 0e Cn h't sv rr 4. ARCHITECT'S Name N 5. ARCHITECT'S Address t=i N r• N A� r tD 6. TYPE of Construction — IPleaase indicate by M I )kWood Frame I ? Masonry [ ) Steel C 1 m 7. PLANS and Specifications No. Model L of E/L 32 ' x 48 ' per plot plan , specifications and application including attached one car garage , driveway permit . B. PTOp°sed use Two family dwelling � a m a rYa $5e00 C / O $ 75e00 PERMIT FEE PAID — THIS PERMIT EXPIRES May 1 , 19 88 0 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Queensbu ry before the expiration date.) h+• N 19 Dated at the Town of Queenskaury this Day of October 87 $kGNED BY y-7I6th/ ! - '� 2� for the Town of Queensbury Building and Zoning) Inspector TO BE COMPLLTzu ZIX ni,w . ..,c; - , N �] Application Lao . ! 0 �1� ', ;3 ✓0 n v/ Q",04?e" A"*NNV Permit Issued �- � '"'�r y BUILDING and ZONING DEPARTMENT Permit Expires 19 li l 2 987 Say and Haviland Road. R. D. 1 Box 98 Zoning Designation ©ueansbury, New York 72$41 Variance _ , , ,�. . * ._ 'a site P1 Re sew . _ r7 ' `o - G' �U Aggro d- b Lam' r�ei ry e" .,S' APPLICATION FOR �� EU I LD I NG 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 and will ans be done in accordance with the descriptions p sP cb special conditions as may be indicated on the Permit . The owner of this property is : Gu er Builders Inc . P . O. Address 119 DumAng Street Ballston Spa , New York 12020 Tel . (518) 899-9161 Property Location : 26 Elizabeth Lane Tax Map N0 .121 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 : . ( 518) 899-9161 Richard H. Guyer III Name P . O. Address Tel . Na . Guyer Builders , Inc -Address 119 Dunning Street Tel . ( 518) 899-9161 Nam e of builder Y ree Tel . Name of plumber yer i ers , nc .Address _ Name of mason uyer EsaiLdero , nc *Address $ ree Tel NATURE OF PROPOSED WORK : * ZONING INFORMxATION * 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) 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 INFORRATION REQUIRED $� * Size of property 10I�± plop ft X 120 ft . * Existing building ( s) siMode re ft X �ft . PROPOSED BUILDING AND USE : ofl - * Existing building ( s ) Use NIA size of new strut a 32 ft X 48 ft Faundatien-pier slab crawl/partial/foil * Proposed building, seisgronteprm property line circle one ) * Front yard 30+ ft Rear yard 30+ ft No . of stories {habitable -1 1 1 Side yards 1 + _ft and 15+ Pt Height ( grade to ridge ) ft - if on corners setback from side street ft If residential , no , Of families No* of rooms (excluding baths ) " OCCUPANCY INFORMATION No. of bedrooms 2 * PRIMARY BUILDING - U.'� of bathrooms 2 One family dwelling 'This t We � ufl r Primary heating system se ar a ectric* ^ Two family dwelling one s 16u3 1, . Ty * of fuel Electricity Multiple dwelling / Number of units No, of fireplaces to be installed * Permanent occupancy Will a wood stove be installed? No * Transient occupancy Central Air conditioning? No Business * _ r BUILDING STYLE, PRIMARY STRUCTURE * Industrial other Ranch Contemporary Lo cabin If addition, what will use be? Raised ranch Mansion Duple Split level old style Bungalow Cape Cod. Cottage Other * ACCESSORY dUgara e/ Town House * Detached garage/one car/ two tax/ car Colonial Row one car Attached garage/one serf two car/ ( CIRCLE ONE PLEASE ) * _�L_ * * NO * AN * * * * * ,� * * ,� * * * * Private storage 'building ESTIMATED MARKET VALUE OF " Other CONSTRUCTION `?r�r��'_� � _f r INFORMATION ON . BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPI,ETEDI Form SPA 4/B6 and-vl BUILDING PERMIT APPLICATION CONTINUED BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etco wood frame Will any second-hand or ungraded lumber be used? If so , for what ? no Foundation wall material concrete block Thickness g" Depth of foundation below grade (to bottom of footing ) $" minimum Will therm 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 por sq. ft . - - Type of use? Type of roof - sloped flatlshedJother Material of roof F1 r .ass Shingles Size , wood studs "X 6 " spacing 24 "o . c . length 8fto exterior walls +Ioists ( floor beams ) 1st . floor N/A "X "" spacing "o . c . span N/A ft . Joists ( floor beams ) 2nd . floor '"X�� " spacing�r6 '•o . c . span N A ft . Overlays (ceiling beams ) "x '" spacing 24 "o . c . span N/A ft . Roof rafters 2 "X " spacing 4 O . C . span 14 ft . Roof trusses (pre-engineered) spacing 2 "o . c . span 42 'ft . Exterior wall finish stained Of what material? 5/8" x 4 ' x 8 ' texture 111 Interior wall finish palmt 1 / 2" 'sTieetrock If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 1/2 type "X" shee Crock Is there to be an opening between garage .0and dwelling? 'yes If so will a Fire.-rated door , enclosure , and self=closing device be provided? yes 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 N1W ft . (A separate application is necessary for an re air or new installation of septic system) See S . P. E. D. S . permit # �026252� Town of f eensbury Warren County of Warren A F F I D A Y I T STATE OF NEW YORK I swear that to the best of my knowledge and belief the statements contained in this applicationt 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 . m SWORN To BEFORE ME THIS signature _----- _ '__-- Owner , owners a renirect, contractor <- ^ day 19 c�,-) ELIZABETH K. LANDRY Notary Public, State of New York No, 4€362001 Qualified in Saratoga County Wcitar , Warren County, N . Commis�,ivr: Expires !une 160 19 # * Al * * * At At # * * # # * # # * # * * # * * * * !� * * * * * * Or # # * * * # ! SPECIAL CONDITIONS OF THE PERMIT : 963 Square feet living 288 Square foot ,garage - one stall 1224 @ $7 .00/100" or part of . $5 . 00 One stall garage y5 . a0 C/O permit Total By TOWN OF QUEENSOURY INLIN u 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 following t , 936 S . F . rd df = ': 1 . Gross floor area 20 Type of heat Baseboard electric 30 Ie the building machanically cooled ? No 4 . Percentage of area of windows and doors 15 ' 9% As Over 16 % Only 1 . U © value of gross area of walls , roof /ceiling and floors exposed to ambient conditions 2s 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 H.O as If YES , what is the R value of insulation around perimeter of floor ? 4 . Is basement heated ? YES NO a . R value of insulation 50 Type of insulation p . Under 161 only 1 . R value of roof and floors exposed to ambient conditions R,mm38 U 0 =d 026 2s R value of exterior walls XNXNX R-23o5 Uo .Oa 4+ 3 . R value of glazed area U- =O . 2O 4 . R value of doors R-14a9 5 . R value of floors over unheated spaces NIA 6 . R value of slab edge insulation - unheated slab N/A ? . R value of slab insulation - treated 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 100 Type of insulation Fiberglass Co Controls Is Thermostat maximum heat setting Ds Duct Systems_ N/A Is is duct system installed in unheated spaces ? YES No a . If YES , R value of duct installation be �. R value of duct in other areas Be piping insulation N/A 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation re Service Water Heating N/A ' is Performance efficiency ----- e■ 2s Temperature control setting maximum G . For Swimming Pool Onl 16 Maximum heating N/A Telephone No . ( 518) 899-91b1 -� ( applicant ' s 9nature ) R APPLICATION FOR SEPTIC DISPOSAL PERMIT Ref : S . P. E. D. S . DATE September 23 / 87 permit # New York - 0202525 MODEL. L of E/L LOCATION OF PROPERTY FOR INSTALLATION 26 Elizabeth Lane Owner's Name: Guyer Builders , Inc . Telephones ( 518) 899-9161 ' Addresses 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 Topogaraphys circle one: Flat Dolling Steep Slope 96 of slope Soil. Nature: circle ones Sand Loam Clay Other / Depth: 8 ' feet + Crauad Water: At what depth? 'uTlulowll 8 feet + >;.,d...ock or Impervious Materials At what depth? urdmown feet Percolation test: circle one: not require required / rate min. inch. aaaa Domestic rates xLgWIy: circle one Municipal Well Other IF domestic water supply is a Wells Separations Watersupply from Septic absorption � N/A feet * PROPOSED SYSTEM: Septic Tank gal. (minimum sizes 1,000 gal.) TILE FIELDS Each Trench NIA feet / Total system length N/A feet * SEEPAGE PIT(S): Number of / Size each feet by feet * Size of stone to be used # / Depth or Thickness feet - - -- - 1 'P# _ ,� See S . P .E .D . S . ...please...LIST NEW EQUIPMENT TO BE INSTALLED permit & attached ss say * * * * * * * * * * * * ss * * * * * * * * * * * * * * * ss * ss * * map . (over) r« Section U Sejatic 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: le) 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 installationg alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. 1 have read the regulations above and agree to abide by these and all requirements of the Town of Qkreenabury Sanitary Sewage Disposal. C*di ante. Signature of.responsible person: Date: L Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . HOME or NATURAL BEAUTY . . . A GOOD. PLACE TO LIVE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 41 STATE STREET, ALBANY, NEW YORK 12207 Applicati THIS CERTIFIES THAT ortlr the electrical equipment as deacrMod belote and introduced by the named on the abode application number in the pretnia v* of . :-,I3: F;1 I1 .I^T T 1 r ... .. in the following location: Q Boaemtent { ''S lat ,F7. 0 Snd Fl. . ' s • Section ! Block ? Lot was examined on f r - ; {. and found to be in compliance with the requirements of this Board. 14XTURE ACLES SYr17CHES FIXTUREs RANGE COOKINGIIVECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUCRESCENT OTHER ANT- K. W- ANT- K- W- ANT- K.W, ANT. K- W. ANT- N. P. k r DRYERS FURNACE MOTORS FUTURE APPLIANCE PEEPERS SPECIAL REC'PT TIME CLOCKS = UNIT HEATERS "LK.T1-OUTLET WMMERS SYSTEMS T. K- W. COL H. P. GAS H. P. AMT. HO. A. W. G. AMT. AMP. AMT. AMPS- TRANS. AMT. H. P, NO. OP fRET ANT. WATTS y Y SERVICE DISCONNECT No. S E R V 1 C E AMT- AMP. rrPE METER i A. 2w' X 9vu 3 Ir sW s X aw r«a. aP CC. conk+. A. ' .c- No. of HIAEG A. W. G. NO. OF NEUTRAu A, w. G- EQLtIF. PER O of cC. GOrrG- OF HIAEG CP H W MAL r OTHER APPARATUS: ;# f" 1 V r S BRANCH MANAGER Per. j _ This certificate must not be altered in any mannerr 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 SE ALTERED IN ANY MANNER. � � _ 9fl n i J T ll►I BuILDING and ZONING DEPARTMENT ay and Haviland Road, R. Q. 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME. LOCATION ,y' I P`-e=rrmlltl I No . � ! - yi4f APPROVED - YE5 NC7 Footing/Pier Forms Foundation Waterproofing Sackfill Framing Roofing Siding Masonry Vene r Rough Plumbin Relief Valves Ext . Porches Finished Floors l / Interior Trim ✓ stairs & Railings Cellar Drain 'file concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney i INSULATION Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready Remarks- BI ling Inspector 6/86 and-vl �C11[lYt U1F G.�L�E+C'11 .�L7LlI"L� BUILDING and ZONING DEPARTMENT Say and Haviland Road, R.D. I Box 98 Queensbury, New York 12801 ^ f�y,� SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCAT I pG1N C12 i $ I/ !i _ ,1! . S 7r. DATE .3 9 /—?—g PERMIT NI j 4767 SCIL TYPE - San - Loam - Clay Percolation Test Required? YES Np ] Percolatio rate - Min/Inch TYPE of SYST Absorption f! lde total length Length of each trench Depth of trenc es Size of gravel SEEPAGE PITS-N er of) -- Size- �,ft. X f Gravel size PIPING . 1�III e �. III Type Bldg , to tank .�� Tank to dirt . 1>0 go Dist. box to f ' ld 4*41 Openings seal ? YE O Partial %LOCATION/SE RATIONS : Foundation b tank t. Foundation o absorption f Absorption to lot line ft Separatio of pits ftw LOCATION SYSTEM ON PROPERTY (circle one ) Front Re r - Left side - Right side CCHMENTS I SYSTEM USE APPROVED YES NO B 11din nspector 01/86 ind v1 _ burn o� �ueerrs � ure� BUlt-DING and ZONING DEPARTMENT Bay and Haviland Road, R-0, 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION r` / Date ��.f+" "� / pI � Permit No . APPROVED - YES NO Fagoting/Pier Forms Foundation Waterproofing Backfill gaming Roof in Siding Masonry Venee Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Til Concrete Floors 1�lhg . Fixture - Gar . Firepro ing Doer Closer _ Smoke: Dete tors Chimney '>0INSULATI N : Foundat on Floors Walls Ceilinq FINAL ELECTRICAL INSPEC'T'IO DRIVEWAY APPROVAL Final Building Survey 13ext scheduled inspection Ccal. l when ready ) Remarks- I3u ing Inspector 6/H6 and-VI /D -: "�" BUILDING and ZONING DEPARTMENT I Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME �� LOCATION . 47/ /� / _ r� Date / lo G3 / Permit Ida . I (P 7 ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing B kfill arcing Roofing Siding zZM�a,�s,.ugYyer���ry Veneer Plumbing Relief Valves Ext , Porches Finished Floors Interior Trim Stairs & Railings Cellar Grain Tile Concrete Floors Plbg . Fixtures Gar , Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECT CAL INSPECTION 13RIVEWAY AP'PR VAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- SoW� 4 w I/ nd�ek Hui ding In fector 6/86 and-vl BUILDING and ZONING DEPARTMENT Say and Haviland Road, R. D. 1 Box 88 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date /.' / / 7_ Permit PIo . �/ " CG� `,1r APPROVED - YES NO Footing/Pier F r[ns Foundation Waterproofing Back£ill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile &.�C&ncrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION Foundation Floors Walls Ceiling FINAL 'ELECTRICAL NSPECTION DRIVEWAY APPROVAL, . Final Building Survey Next scheduled inspection (call [when ready ) Remarks- 7 � l V �CC)/l1 �— S / t'�( M,ST-612. B 4d. ng Inspect. r 6/66 and-vl .570Wn u/ Q"eerts urea BUILDING and ZONING DEPARTMENT Bay and Haviland Road, MD. 3 Box 96 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date / �f / Permit No . ✓ = APPROVED — YES No Footing/Pier Forms Foundation waterproofing Backfill Framing Roofing Siding Ma my Veneer ough Plumbing .4-- Relief Valves "- Ext . Porches Finished Floors Interior Trim_ Stairs & Railings Cellar Chain Tile Concrete Floors _ Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls. Ceiling FINAL ELECTRIC L INSPECTION DRIVEWAY APPRO AL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- and-ul Buil ing inspector 6/gC+ Jl3wn O QUeen36tery BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date ���� Permit No . ✓ = APPROVED - YES NO Footing/Fier Farms Mlpbun da tion Waterproofing "rackfill 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 ELEC +CAL INSPECTION_ DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- Building Inspector 6/86 and-vi �� �/174Vf'! L►� �tlPPlrl3�LtI'� '� BUILDING and ZONING DEPARTMENT 1 Bay and Haviland Road, R.D. 1 Box 98 Clueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME 74, LOCATION �y � Date f! / Permit Now ✓ = APPROVED - Y .S . NO ting/Pier Forms Foundation Waterproofing Backf i l l Framing Roofing Siding Masonry venue Rough Plumbin Relief valves Ext . Porches Finished Floors Interior Trim. Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofi Doer Closers Smoke Detector Chimney INSULAT�oN Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready Remarks"- . Building Inspector 6/86 md~vl BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FJi E THIS COPY WITH 13UILDING DEPT. WHEN REQUIRED. TEIYIP. DATE r CITY OR VILLAGE 9aWmab _�� STOCIET AND NO. OR ��R.��LL//YY��`��y7GG tt�.�� TOWNSHIP i ' COUNTY Warren ROAD AND POLE NO. Y4V Elizabeth Lane '— BETWEEN WHAT TWO POLE NO. CROSS STREETS ,5 OCCUPANT'S ATED7 SE TION /r BLOCK + LOT . . NAME BUILDING _ -' OWNER'S NAME OCCUPANCY - ANO AOOReSS GLWer ers* 119 Ihmn $tr4ee TEL.CU # +� ,� � SUPPLIED BY BUILDING "' r FROM THEIR i- OFFICE IS NEW ® OLD Is E . J DEFECTS S NEW AdDITIONAL ❑ REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS Ne. of Fixtures B Loos_ p Lang Rawsaales MOTORS HEATERS CIRClN11TS OFFICE USE lion Calling side Attombot ONLY Wei$ Rg 'J. Switch pendant Bracket No. TV" dNo. A.W.G.E Et EL" a INSPECTION out- side bub- bass Baas• merit tat FR. Znd Fi. $rd FR. REMARKS! L,ST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE, This application is intanded to corer the elsore-listed wquiPment to be inspect Red but it at time of i you are authorized to make the inspection and adjust the fee to c"w the additional ui meM, re Provided 6 the a Find additional equipment not above listed. W P P Y applicant. SIZE OF �+�t MAINS 150 AWe FEEDERS `� ELECTRIC SIGN TOTAL TAMPS WATTS CHARACTER OF WORK EXPOSED OAS TUBE SIGN CONCEALED TRANSFORMERS OF WORK TO BE VA STARTED COMPLETED INUMBERI !CAPACITY, SERVICE OVERHEAD SIZE OF SIGN ENTERS UNDERGROUND MAKER IL tNG OF SIGN INSPECTION RECKJESTEO ON OR AS NEAR AS POS3sBLE NEW OLD AVOID DELAY BY GI V,NG FULL AND ACCURATE INFORMATION.. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. PRINT NAME AND ADDRESS NAME OF APPLICANT DATE OF APPLICATION STREET ADDRESS CITY OR TELEPHONE f7�Jrr71i7� POST OFFICE ftlii4!`trrs cPa! Yra��•,� CODE LICENSE NO. WHEN APPLICABLE 46 EL (nev, 1r85} A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING