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1987-794 —•-dv . JII 1 CERTIFICATE OF OCCUPANCY If TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Late March 4 , I9 88 87- 794 This is to certify that work requested to be done as shown by Permit No. f has been completed. This structure may be occupied as a of a two family dwelling Location b Elizabeth Lane, Queen Victoria's Grant, Model I 1 Genet. Guyer Builders, Inc. I By Order Town Board € TOWN OF QUEENSBURY Building & Zoning Inspector BUILDING PERMIT y TOWN 4F QUEENSBURY No 87_ 794 4 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Queen Victoria ' s Grant N OWNER of property located at 6 Elizabeth Lane Street, Road or Ave. i 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. 1 . OWNER'S Address is 119 Thinning St . Ballston Spa , N . Y . 12020 2. CONTRACTOR or BUILDERS Name C W Guyer Builders rt W a CONTRACTOR or BUILDER 'S Address do Same W rt 4. ARCHITECT'S Name 5. ARCHITECT'S Address qo-- rn [+7 6. TYPE of Construction — [Please indicate by X1 I--' N IXI yl/ood Frame 11 Masonry I I Steel I I ro r+ 7_ PLANS and Specifications C N N0. 31 ' x 46 ' as per plot plan , specifications and application including septic system and attached one car garage . MODEL I S. Proposed Use } of Two Family Dwelling 0 rro 82 . 00 June 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 Building and Zoning inspector of the town of Queensbury before the expiration date.) r• November 87 '- Dated at the Town of Queensbury this 27th Day of 19 SIGNED BY �' "-� - for the Town of Queensbury Building and Zoning Inspector �. �J / Application No . ✓17�W1i P f+RIt t7fi1'I Permit Issued 19 i U � '' BUILDING and ZON64G DEPARTMENT Permit Expires � Bay and Hawiland Road, R.O. 1 Box 88 Zoning Designati t. � T cry Queensbury, New York 12801 Variance No . Site Plan Revs .ti psi Approved by s Y`� P � ar7 APPLICATION FOR ,//Cr/rf BUILDING AND ZONING PERMIT it +�► �r a e it * it it �r �r it a aw ,rr �r► �► � it * r �r � e e * ak ir' a � � �► it it * * e e .r�r 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 asmay be indicatedon the-Permit __ NO VOOI The owner of this property is : Gu er Builders Inc . ( 5113) $99-9161 P. O. Address 119 Dunning Street Ballston Spa , New York 12020 Tel . Property Location : 6 Elizabeth Lane Tax Map No . 121 /� 2 i7 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 ISO 899-9161 Richard H . gu er III Tel . No . NA P . O . Address Name of builder Guyer Builders , Inc .Address 119 Dunning Street Tel _ ( 518 ) FB99-9161 WIP Name of plumber yer rs , c .Address ng ree Tel . Name of mason. Guyer BuildersIs nc •Address g 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 " stowing clearly and distinctly all buildings , (no change to exterior dissensions ) * 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 . y COMPLETE INFORMATION REQUIRED $E40W . * Size of property 100# plane €t X 120 ft . * Existing buildings} Size ft Xl K —fIt PROPOSED BUILDING AND USE : �ofl * Existing building s ) Use N/ A 46 ' - " » Size of now struc a 31 f t t di x stance from Property line lFouridation-pier slab crawl/partial/full * Proposed building , see plot pan circle one ) * Front yard 30+ ft Rear yard 30+ ft No . of stories (habitable space) 1 * Side yards + ft and 15+ €t Height (grade to ridge} 19 6 ft . * If on corner , setback from side street ft If residential , nom of families Of 2 No * of roome (excluding baths ) " OCCUPANI:Y INFORMATION No. of bedrooms � — * PRIMARY BUILDING - No. of bathrooms One family dwelling �1is f r Primary heating System se ax a ectric* w-�T,� family dwelling "riei sRa6%i ��• Ty of fuel Electricit OOOOOII* Multiple dwelling / Number of units Uof fireplaces to be installed! * permanent occupancy ll a wood stove be installed? Ho Transient occupancy Central Air conditioning? NO * Business BUILDING STYLE, PRIMARY STRUCTURE * r-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 BUILDING- * Detached garage/one car/ two car/ car Colonial Row Town House one car ttachad garage/one car/ two car/ c ( CIRCLE ONE PLEASE } * �..A ara - ft Private storage building ESTIMATED MARKET VALUE OF Othier TRUCTION TION ON • BUILDING SPECIFICATIONS . ON REVERSE SIDE PA 4/86 md-vl BUILDING PERMIT APPLICATION CONTINUED = w t WILDING SPECIFICATIONS : r Type of construction, wood frame , fire safe , atco 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 ) mininnun 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 por o sq. ft . - - Type of use? Type of roof sloped. flat/shed/other Material of roof Fiberglass shingles Size , wood studs •'x 6 " spacing 24 "o . c . length 8 ft* exterior walls Joists { floor beams ) 1st , floor N/A "x spacing_ .. ^"o . c . span N/A ft . Joists ( floor beams) 2nd . floor _ .; "]{ spacing "o . c . span N A ft . Overlays (ceiling beams ) "x �• spacing 24 "o . c . span N/A ft . Roof rafters "x to spacing 24 o . c . span N/A ft . Roof trusses (pre=engineered) spacin�g "o . c . spa�2 ` - 6Tt . Exterior wall finish stained Of what material? 5 /8" x 4 ' x 8 ' texture 111 Interior wall 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 garage -and dwelling? yes If so will a Fire-rated doer , 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 NIA ft . (A separate application is necessary for an re air or new installation of septic system) See S . P . E. D. S . perinit # 026252� Town of Queensbury County of warren A f f1 c n r T STATE of NEW YC3RKT� 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 ORDINALVCE , and all other laws pertaining to the proposes'!. work shall be complied with, whether specified or not , and that such work is authorized by the owner . OA SWORN TO BEFORE ME THIS Signature ,�----�-�- Owmer, wner ' s a n ~rarcnitect , contractor Ss�day of �, 192n ELIZABETH K. LANIDR'Y � NOWFV puNo, S ene of Now York Clu�a4Ffied in Saratoga County Notary. P ' c , warren County, N . Y , commission Expires June 16 1 Y t w ► w * w At It * . * fr * * * * ♦ se * BOB �* a sr ar sr w # r k * ie * t t rt * • * * * * * s • s SPECIAI, CONDITIONS OF THE PERMIT : 1040 Square feet living 240 Square foot garage - one stall 1280 @ $7 .00/ 100 or part of 5 . 00 One stall garage $5 . 00 C/O permit Total 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 . ANSNgit ALL of the followings � . Gross floor area 1123 S . F . 2 . Type of heat Baseboard electric 30 Is the building mechanically cooled ? Nla + . Percentage of area of windows and doors 11 . 8 A . Over 16 % Only 1 . Uo value of gross area of walls , roof/ ceiling and floors exposed 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 N.Q 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 - so Type of insulation $ . Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions_,_,,, R-38 2 . R value of exterior walls XKX= R-23 . 5 We =O 04+) __- 3 . R value of glazed area U. =0 . 30 4 . R value of doors R-14 . 9 M =0 . 06 ) 5 . R value of floors over unheated spaces &M R-30 6 . R value of slab edge insulation - unheated slab N/A 7 . R value of slab insulation on heated slab 12 . 5 B . R value of heated basement/ cellar walls ( above grade ) N A 9 . 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 NIA 1s size of hot water or cooling carrying agent pipe 2 . R value of pipe insulations F , Service Water Heating 10 performance efficiency N/A 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating N/A Lephone No . ( 518) 899-9161 of APPLICATION FOR SEPTIC DISPOSAL PERMIT Ref : S . P. E. D. S . DATE September 23 j 87 permit # New York - 0202525 MODEL I of LOCATION OF PROPERTY FOR INSTALLATION 6 Elizabeth Lane Owner's Name: Guyer Builders , Inc . Telephonet ( 518) 899-9161 Address: 119„ Dunning Street , Ballston Spa , New York 1202(? Installers Name. Guyer Builders , Inc Telephone: ( 518) 899�9161 2 A, C , E, I , J , K , L, M. Number of bedrooms (residential only) Z 3 F' G , H Total daily flow (compute Q 150 gal per bedroom) 300 Topography: circle one: Flat Rolling Steep Slope % 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 Percolation test: circle one: not require required / rate mire. inch. Domestic water supply: circle one: Mun ace palWell Other IF domestic water supply is a Well: Separ-.atioa: Watersupply from Septic absorption __.. N/A feet * PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1 .000 gal.) TILE FIELD: 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 arar * � * ari # arat # ararar * a� arar >* ar * s * * .� * arasa« ara� * * ara� iariarari 11l P O R T A N T See S . P . E . D . S . ...Please-..LIST NEW EQUIPMENT TO BE INSTALLED permit & attached IRTar # * sks ,s * sk * ems * r * * aa * s * * r * ems ssss * * si � * s map , (over) Section 11 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 Z4 hours before start of construction and shall include a plot plan showing: l.) the propo$ed ,location of the gystem Z.) 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 Be 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 $250.000 Co. 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 trust be submitted to the Queensbury Building Department before further construction. l have read the regulations above and agree to abide by these amd all requirements of the Town of Queensbury Sanitary Sewage Disposal [Ordinance. Signature of.responsible person; Date: Town of Queensbury Building and Cade Department Bay* at Haviland Road Queensbury, New York 12801 (518) 792-583Z SETTLED 1763 . . . HOME OF NATURAL #BEAUTY . . . A GOOD. PLACE TO LIVE �owii ©� �ueens � ur+� EMILDING and ZONING DEPARTMENT Bay and Haviland Road , R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION ! ( zr r Date f Permit lain . APPROVED Footing/Pier Forms_,____ Poundation waterproofing ii3ackf 111 Framing Roofing siding Masonry veneer Rough Plum ing Relief `J`aly s Ixt * porches rinished Flo s Interior Trim Stairs & Rai s Cellar Dr Til Concrete F oars _�-- P1bg . Fix res Car . F'i r roofing Door Cl o ers Smoke D tectors C'himne INSULA ION : Founda ion Floors Wa11s Ceiling_ FINAL EI TRICAL INSPECTION DRIVEWAY APPROVAL nal Building Survey Next scheduled inspection (Call when ready ) c Remarks- frll Euilding Inspector 6/86 and-vl kc��1n�44 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 41 STATE STREET, ALBANY, NEW YORK 12207 70536 ^ + �] Date February12 , 1988 Application No. on file A E 4J 1 � � {�c } THIS CERTIFIES THAT ersly the electrical egaipmtut ae described below and introduced by the applicant nonsad Oft the above appilration na+nber in the Pemarnises of Guyer Builders Inc . ,06 Ellzabettll Lane ,Queensbury . NewYork s inthe followingn location; ❑ Basenset ® let Fl. ❑ $nd Outside Ft. Sectio&21 Block ll Lot wes examined on 2 /5 /88 and forand to be in cootpiiance with the requirements of this Board. "a FIXTURE FIXTURES OIONti RANGES CO DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS ETA•�•�ES SWITCHES INCAMESCE MT FLLKWSS[ENT I MI ^I K. W. I AM-V I K. W. I AMT_ I CWM AMT. K. W. i T. IH. ►. s 12 27 18 8 4 1 4 . 6 3 Fr - DRYERS FURNACE MOTORS KITURE ANWANCE FRIOM ISFECMENCIPPI TIME CLOCKS IFIEII NPMT HEATERS MIATI-OUTLET AMT. K. W. Olt H. P, GAS H. P. AMT- &tj A. W. G. AMT. AM►, AMt. AMPS. TRANS. AMT. W P. SYSTEMS "T. WATTS Ho.OF FRET z 1 SERVICE DISCONNECT MN ETHe U E R V 1 C E AMT. AMP. TYPE ELF. 1 .X 7W 1 .I 3W 9 X atv 3 X iW w'd. OF CC. CQNP. ti W. 1Ma. Or Ht•LEG F - e NO. OF NEUTRALS Pts r OF cc. cr&"lo- os lil•LECr aF ih urGlitws. $ 1 150 CIi 1 x 1 210 1 11+7 = OTHER AMARATW- _ 1-- Her . Motor 3— G . F , CC , l , 1 - Smoke Detector Electric Room Heaters , 4--2 . 0kw ,.1-1 . Skw ■ 2- . 5'kw Guyer Builders , lNc . 119 Dunning Street /• r► ' Ballston Spa ,NY , 12020 BRANCH MANAGER Per This certificate must not be altered in any manner; return to the of its of the Boord if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ����1 pensb THE fJau.r: v� { �gUfLilfNG and ZONINGCIEPARE3UX 98 J Bay and Havifand Road. R.D . �( C}ueensburY• New York 12601 EjU 1 LD I NG I NSpECTOR ' S REPORT NAME LOCATION �/ Perin t NO . q Date * * * * * * * * * *p,* - APPRoVED - YE No Footing/Pier Forms Foundation Waterproofing 13ackfill F raining Roofing siding Masonry Veneer Rough Plumbing - -� Relief Valves Fxt , Porches Finished Floors Interior Trim Stairs & Railing Cellar Drain Til Concrete Floors .1bg , Fixtures Fireproofing -----'-'- - Car . ofing Door Closers Smoke Detectors Chi ey Lo�kvsuLATION : Foundation Floors Walls Ceiling_ F IN Al, EI BCT -CAL IN SpECTION.,___ DRIVEWAY A,P I (OV LL ~ --- Final Build ng Next scheduled insP action (Call when ready ) Remarks- ---. Fsuxlding Inspector 6/s6 and-VI locvre o Que¢ nsur� 13LJIL.DING and xONiNG DEPARTMENT 98 Bay and HavifandRe dyork. 8 [) . A Bo Clueensbury. 2801 BUILDING INSPECTOR ' S REPORT LOCAT I ON 1 permit No . * * * * * * * * * NO * * * * * * * * • ApppOVED - YES looting/pier Forms Foundation Waterproofing i3ack£ ill �1'raming Roofing Siding MasonrY Veneer ,,&oug}7 plumbing._ Retie£ 57alves _ ---- Lxt . Porches Finished Floors Interior "Tr i-Tn Stairs & Rai-lings Cellar Drain Tile Concrete Floors Plbg • Fixtures Gar . Fireproofing Door Closers Smoke Detector's Chimney INSULATION = Foundation Floors Walls Ceiling_ FINAL EI EC RICAL IN SPEC TION ORiV'EWAY pRl7VAL Final Bui ding Survey action (call when rea Next scheduled dy ) insP Remarks- Build ng ins actor G/86 and-vl flown p/ Queens6ury BUILDING and ,ZONING DEPARTt+{ENT Bay and Havi48nd Road, R.D . 1 Sox 98 Queensbury. New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCA 11 ON Date�ok � Permit iVc+ . * * * * * * * * * * APPRC>VED - YES NO Fc,ating/Pier Forms Foundation Waterproofing Backfill Framing Roof ing Siding Masonry Veneer (tough 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 ELECTRICAL IN SP'ECTI N� DRIVEWAY APPROV S rvey Final Building —�-�- insp action all when ready ) Next scheduled Remarks- Building Inspector 6f8Fi and-vl gtylLplNCa and ZO^N--�I�NG DEPARTMENT RTME 98 Bay and Haviland Road, R Queensbury, New York 12801 BUILDING INSPECTOR ' S REPOft� NAME 4 LOCATION '' r,• fi !-� "` Permit No . Date L APPROVED - YE5 NO Footing/Pier Forms Foundation waterproofing Backf ill X Framing Roof ing Siding Masonry Veneer Rough Plumb]-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 INSUIJ ATION Foundation Floors walls Ceiling FINAL ELECT CAL INSPECTION DRIVEWA."y AP )VALE Final Building Survey��� ction (call when ready ) Next scheduled inspe ✓ Remarks- C' rt , WA44L �� au Co c AA4- •e 8 ilding I spec r f,1'43H and-vl _ Town of Queens � +urY BUILDING and ZONING, DEPARTMENT Bay and Haviland Road, R .O. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME ' LOCAT ION— � �G' f Date / '=jPermit No . �IKL * * * * * * * #I �* APPROVED* -* YES NO Footing/Pier Forms Foundation waterproofing Backfill Framing Roof ing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim _ _— Stairs & Railings Cellar Drain Tile - Leoncret+e Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION - Foundation Floors walls Ceiling FINAL ELECT CAL INSPECTI N - DRIVEWAY AP RovAL Final Buil ng Survey — Next scheduled inspection (Call when ready ) Remarks- Building Inspector 6/86 and-vl _. Jotvn cr� ueen lhure �' J IJIF�t711dG and Z43iRG DEPARTMENT Bay and Haviland Road, R.0- 1 Sox 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date Permit NON . - * APPROVED - YES NO Footing/Pier Forms — --- Foundation waterproof! g Sackful Framing Roofing siding L;a:M�,as my Venee uqh Plumbing -- Relief Valves Ew . Porches Finished Floors Interior Trlm Stairs & Railings cellar Brain Tile concrete Floors plbg . Fixtures Gar . Fireproofin Door Closers Smoke Detector Chimney INSULATION Foundation Floors walls f Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APP1tOVAL Final 'Building Survey Next scheduled inapeCtian ( call when ready ) Remarks- s Building In pector 6/g6 and-vl �ueeny � u►'� SUILOtNG and ZONING p -o . -I Box 98 Bay and Hawiland w Ya h 12801 Qu,eensbury, BUILDING INSPECTOR ' S REPORT NAME �! � LOCAT I ON G 9' / _d_G-- i.t Perm I�7o . Y Date * * * * * * PPPROVED f�p6"otinS/Pier YES / . 140 Forms Foundation WaterProofing Backfill Framin goof ing Siding My Ve eer asonr Rough Plumb 9 Relief Valves Ext . Porches Finished Floors Interior g�ilings Stairs Tile Drain Concrete Floors Plbg . Fixtures Gar . FireProofin Door Closers Smoke Detecto Chimney INSVLATION - Foundation Floors Walls Ceiling CAL IN5PCTI[7N INAI BLECTRI E ._ . DR Survey tppROV Survey ~ Final Building Next scheduled insP ection (call when ready ) Remarks- Building Inspector 6/aS and-vl NINE BUILDING DEPT. COPY OF APPLICATION FORM 46-EL. NEW YORK BOARD OF FIRE UNDERWRITERS. F1LE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. P. � t,,_'�.,p DATE CITY OR �blary COUNTY VILLAGE TOWNSHIP STREET AND NO. OR r1 �� Y � pOLE NO, ROAD AND POLE NO. 1'ii .4mae BETWEEN WHAM TWO CROSS STREETS IS SECTION "� BLOCK LOT PREMISES LOCATEPT OCCUPANTS BUILDING ,- _ ..' ,, NAME !l 11 hn OCCUPANCY _ ..p . L. F Z'�i'�FEFf� SUPPLIED r'"j FROM THEIR -'.{° , t__r ' j : OFFICE BY " BUILDING ryp� ryryryry DEFECTS IS NEW ® OLD 0 IWORK NEW !�1 ADDITIONAL ❑ REMOVED_ mm LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED No- of Fixtures, & BRANCH OFFICE U R c HEATERS SE NUMBER OF OUTLETS Lamp aeeptaes MOTORS CIRCUITS ONLY tkm Silo ASEkh't Switch Pe ant Bracket No. Typo E� No. E� No, A.W.G.a INSPECTION Ceiling ypcl RacaP'A side $b� Bane mant fat Fl, 2nd FI, Srd Fl. REMARKS: LIST OTHER ELECTRICAL DEVICES NPT SET FORTH ABOVE: DO NOT USE THIS SPACE. This application is intended to coeor line above-hewed equipment to be Inspect ted but if at time of inspection them is foci nd ektditionuel equipment not above Iisted. you are autharited to make the inspection and adjust the fee to cover the additional equipment, as pravidad by the applicant. c� ELECTRIC SIGN TOTAL SIZE OF 150W41 FEEDERS LAMPS WATTS MAINS � CHARACTER EXPOSED GAS TUBE SIGN CH CH N F WORK CONCEALED TRANSFORMERS O VA WORK TO BE INUMBERI ICAPACITYI STARTED COMPLETED SIZE OF SIGN SERVICE OVERHEAD UNDERGROUND MAKER ENTERS OF SIGN BUILDING, INSPECTION REQUESTED ON OR LASS NEAR AS w 7 Y call vbanireadY NIPW O OLD AVOID BELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. PRINT NAME AND ADDRESS �t�r 21r 1987 { TiTYaP S1si'1 [ PT"�aATE OF NAME OF Inc,� " APPLICATION APPLICANT 1�LI �t ,1,. .9 TI I �; cv + �'� TELEPHONE # R73fT'7 i7i STREET ADDRESS �.�aa,�y��r��� CITY OR yyn-� +a �+��y CODE 1�'r( M'� LICENSE APP4ICA BLE POST OFFICE .�St[ 3 '"''t^" 46 EL (REV. 1/eS) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING t