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1987--913 h i 'ERTIFI+ ATE { F CJ+CCUPA.N+CY + I - C1 TOWN 4F QUEENSOURY WARREN COUNTY, NEW YORK i -July Date July 20 19 88 )C) 87- 913 j This is to certify that work re+qurste I to be done as shown by Permit No. a I has been compieted. ' © t Two Family a This structure may be occupied as a i i * 39 E112�abeth Lane Guyer Builders , Inca Owner By Order Town Board TOWN OF QUEENSBURY Build iag & Zoning Inspector I i BUILDING PERMIT � TOWN OF QUEENSBURY No. 87-913 WARREN COUNTY, NEW YORK h.7 r Queen Victoria ' s Grant PERMISSION is hereby granted to OWNER of property located at 39 Elizabeth Lane Street, Road or Ave. in the Town of Queensbury, To Construct or }glace a 3 of Two Family Dwell i n g 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. rn m t. OWNER'S Address is Guyer Builders Inc . Mom, 119 Dunning St . n Ballston Spa , N . Y . 12920 0 lu_ 2. CONTRACTOR or SUI L13E R"S Name ,Same � C5 ri r5 t-r 3. CONTRACTOR or BUILDER 'S Address Same 4_ ARCHITECT'S Name c.a Ls] r—� 5. ARCHITECT'S Address tYa W cr' tc r7r 6. TYPE of Construction — (please indicate by X) r W M Wood Frame ( I Masonry f 1 Steel 1 Y 7. PLANS and Spec-ifications No. 29 ' x 56 ' as per plot plan , specifications and application including septic system and attached one car garage . MODEL A. o rn 8, Proposed Use of Two Family ' a $5 . 00 C /O ~ 82 . 00 July 1 , 7985 $ PERMIT FEE PAID — THIS PERMIT EXPIRES fit a longer period is required an application for an exteersian must be made to the Building and Zoning inspeCtor of the town of Queensbury before the expiration date.! 30th December 79 87 Dated at the Town of Queensbury this pay of SIGNED BY for the Town of Queensbury Building and Zoning Inspector TO BE COMPLETED BY ai�t)cd . urr'a' . ]v / Application No ;J#7►ttil� D fta'ere36rter t Permit Issued 19 3 ' BUILDING and ZONING DEPARTMENT Permit Expires 19 (1 ,R f y Bay and Haailand Road, R.D. 1 Box 98 Zoning Designa n ` 4Avw a' �1 ©ueensbury, New York 12801 Variance No . Site Plan Re iew o . r� r� e. Approved y ./J►�/"?�+/} APPLICATION FOR !!!! Gl�a BUILDING AND ZONING PERMIT k 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 : Gu er Builders Inc . P . O. Address 119 Dunning Street Ballston Spa , New York 12020 Tel . ( 518 ) 899-9161 Property Location : 39 Elizabeth Lane Tax Map No . 121 / 2 Street number or building lot number subdivision name Cif applicable) Queen Victoria ' s Grant THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : Richard He Guyer III ( 518) 899- 9161 Name P. Q. Address Tel . Noe Name of builder Guyer Builders , Inc -Address 119 Dunning Street Tel . ( 518 ) 899� 91+61 Name o£ plumber yer ers , nc -Address ng ree Tel . Name of mason Yer i ss , c .Address DunningStreetTel . - 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) " 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 INFORMATION REQUIRED PEEL#AW . Size of property 100_ p anpllft X 120 ft . * Existing building ( s ) Size WX ft )C­IMF -ft • Mode PROPOSED BUILDING AND USE : Ofl -�' * Existing building s ) Use NIA Size of new struc e 29 ft x 56 ft " Foundation-pier slab crawl/partial/full Proposed building , distance from property line circle one ) * see plot plan 1 Front yard 30+ ft Rear yard 30+ ft No . of stories (habitable space ) �, Side yards 15+ ft and + '� Height ( grade to ridge) 17 - OFF ft - * If on corner , setback from side street ft If residential , no . of families of 2 No . of rooms ( excluding baths ) Z '" OCCUPANCY INFORMATION No. of bedrooms Z PRIMARY BUILDING - No . of bathrooms One family dwelling This e u rmi f] r Primary heating system se Oar e ectric* TwD family dwelling art sc o 63 Type of fuel EleCtriclty * Multiple dwelling / Number of units N,:f of fireplaces to be installed * Permanent occupancy ti Well a wood stove be installed? NO Transient occupancy Central Air conditioning? NO * Business 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 BUILDING- Colonial Row Town House '� Detached garage/one car/ two car/ car { CIRCLE ONE PLEASE ) * .Attached garage/one car/ two car/ One car * * * * IF * * * * * * IF * * * Private storage building ESTIMATED MARKET VALUE OF oe * Other Ar CONSTRUCTION INFORMATION ON - BUILDING SPECIYd V4z:eXONS , ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETEDI Form BPA 4/86 and-vl BUILDING 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 }clock Thickness 8*" Depth of foundation below grade (to bottom of footing ) 481V ndnim un 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 ' 7 sq. ft . - - Type of use? Type of roof - sloped lat/shed/other Material, of roof Fi rg ass s 1es Size , wood studs ""X 5 of spacing 24 "o . c , length 8it . exterior walls Joists ( floor beams ) 1st . floor N/A '*X to spacing_ to spacing— span N/A ft . Joists ( floor beams) 2nd . floor '"X - -" spacing "o . c . span N A ft. overlays (ceiling beans ) ""X to spacing 24 '"o . c . span N/Aft. Roof rafters 2 "X 10 " spacing 24 o . c . span 14 ft . Roof trusses (pre-engineered) spacing24 *'o . c . span 42 ft . Exterior wall finish stained Of what material? 5 /81' 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 end 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 murA cipal 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 . p,erinit # 026252 Town of Queensbury County of Warren 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 - 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 . Z=� SWORl+i TO HEFORE ME THIS Signature --- _ .» __-___-_- C�wner, owner ' s ag _ rcn:Lrect , contractor ?� c2ti day of � 19 ju ELIZABETH K. LANDRY S -- Notary Public. State of New York No, 4862001 0oalified in Sans, ,o � County bli u , Warren County, N . Y . '�� . , .. : t: Notary �a .2& M.* # * * IF k s * * _ * * k ,e * * * rk Jr rr * * * * * * * * * w * SPECIAL, CONDITIONS OF THE PERMIT : 1020 Square feet living 264 Square foot garage one stall 1284 @ $7 .00/ 100l`2f or part of $5 00 One stall garage $5 00 C/0 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 . ANSWER ALL of the following : 1 . Grow floor area 1020 S . F . 2 . Type of heat Baseboard electric 3n is the building mechanically cooled ? No 4 . Percentage of area of windows and doors 10 . 6% 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 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 Be Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions. R-38 Mel 2 . R value of exterior walls )DEMX R 23 . 5 U =0 04t 3 . R value of glazed area U . =0 . 30 4 . R value of doors R-14 . 9 (U. = - '. 60) 5 . R value of floors over unheated spaces WA 6 . R value of slab edge insulation - unheated slab N/A 7 . R value of slab insulation - heated slab 12 . 5 so 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 F . Service Water Heating 1 . Performance efficiency N/A 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating N/A G 'telephone No . ( 518) 899-9161 ( applicant ' s signature ) APPLICATION FOR SEPTIC DISPOSAL iPER&MT Ref : S . P . E .D . S . DATE September 23 87 permit # AMMMMMMM New York - 0202525 MDDEL, A of A/J LOCATION OF PROPERTY FOR INSTALLATION 39 Elizabeth Lane Owner's Name: Guyer Builders , Inc . Telephones ( 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, 14 Number of bedrooms (residential only) 2 _ 3 F2 G, H Total daily flow (compute (Q 150 gal per bedroom) 300 Topasraphy: circle one: Fla# Rolling Steep Slope % of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: 8 ' feet + +Caoaad Water: At what depth? unknown 8 feet + Bedrock or Impervious Material: At what depth? unknown feet Percolation test: circle one: not require required / rate min. inch. Domestic eater suprply-. circle one: cipal 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 * Size of stone to be used # / Depth or Thickness feet sssssssssssssssssssassssssssssssssssss * sss IMPORTANT * See S . P. E. D. S . ...Please_..LIST NEW EQQUJPMENT TO BE INSTALLED permit & attached ssssssssssssssssssssssssssssssss * sasses * * * map ) (over) Section lI Septic System Lispections: 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 propoped .location of the §Ystem 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 $250.000 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 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 requu*e gents of the Town of Queensbury Sanitary Sewage Disposal ordinance. Signature of.responsible person: Date: Town of Queensbury Building and Code Department Say at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . , A GOOD_ PLACE TO LIVE ar's Of `c�',1Aeer' sLurey BUfLL31NG and �ONfNG DEPARTMENT Bay and Haviland Road. rtx). 1 Box 98 oueensbury. l+New York 12801 JA/4 13U1 LDING INSPECTOR ' S REPORT NAME LOCATION ]_/ r permit. I4ca i)akeYES �� pgpgpVED No Footing/Pier Farms Foundation Waterproofing Backfill Framing Roof ing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors pybg Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney :[N SU LAT I ON Foundation Floors Walls Ceiling CAL INSPECTION��_ �- F II AJ ELFCT fIRIVEWAY A}?P OVAL rvey Final Building Next scheduled insp action (call when ready ) Remarks- B n Inspector 5/8,6 and-vl 4001054 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY Ft 41 STATE STREET. ALBANY. NEW YORK t2207 Date July 27 , 1988 ApplicatiorL .Yo. art file 0 016 2 67 _9 � r ' 9 701 THIS CERTIFIES THAT G only the electricel equipment M described below and introduced by the applicant named on the alone erpplicatson ]b a r in the HQ Guyer Builders Inc . # 39 Elizabeth Lane Queensury , iNTew Yank �r]�twa �axrl'n�y� in thefollatoing location; ❑ Basement EXlst Ft. 0 2nd Ft. Qaarage outs iae Section 12 jjock -4 Lot waa examined on 7 - 1 3 — 8 8 anafounrl to be in compliance with the requirements of Chia board. FIXTURE FIXTURES RANGES COOKING DECKS OPENS bISH WASHERS EXHAUST FANS OUTLETS ECfFTACLES SWITCHES MCANVKSCENT FWOMSCENT +y y AMT, K. W. AMT. K W_ AMT_ KW. AMT. K_ W. AMT- UVI, ►_ 13 25 20 10 3 1 , f 4 Er DRYERS FURNACE MOTORS FUTURE A!lUANCE FEEDERS SFECML REC'FT TEME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DLMMERS AMT. K, W, OIL If. P, GAS H. P. AMC. No- A. W, G, AMT, AMP. AMT. AMPS. TRANS. NNT. X. �. SYS►EMS AMT. WATTS n HO. OF FEET w ft SERVICE DISCONNECT No. of S E R V I C E AMT, NAP, MPE 1 X 2W 1 AF 3W 3 Ar 3W 3 0 4W NO. OF C. CCWD, OF CC. OINU. P40. CIF W-tm 6i.IN.IG.IEG NO. Of NEUTRALS A. W. G. NotAL OTHER AMARATUS: E l e+c . Roorrl Heaters : 3 / 2 . D , 1 / . 7 5 , 3 / . .5 i`^Ic711Ror.s : 1 � Past llght 2 -gfci 2 -smokedetectors Guyer Builders Inc . 119 Dunning St . Ballston Spa ,, NY 12120 239 BRANCH MANAGER 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. flow" 0/ Q"ee" JILdry BUILDING and ZONING DEPARTMENT �[ Bay and Haviland Road. R. D. 1 Box 98 Queensbury, New York 12901 UILDING INSPECTOR ' S REPORT NAME LOCATION Date �7 � � Permit No . _ k �✓' - APPROVE - YES NO Footing/Pier Forms Foundation Waterproofs g' Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . 'Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Til Concrete Floors Plbg , Fixtures Gar . Fireproof ' g Door Closers Smoke Detecto s Chyme ey L SULATION Foundation Floors Walls Ceiling FINAL ELECT TCAL INSPECTION DRIVEWAY AP OVAL Final Buildi Survey Next scheduled inspection ( call when ready ) Remarks- Winspector Su ' d 6/86 and-vl �, Jotun o QUee BUILDING and ZONING DEPARTMENT If3ay and Haviland Road. R.D. 1 Box 98 Queensbury, New York 12801 P�7 BUILDING INSPECTOR ' S REPORT NAME LOCATION G-�" 7 Date.. M / / permit Pia . J r * * * * * * * * * APPRbVED* -* YES* NO � Footing/Pier Forms Foundation waterproofing Backfill 4,00faming Roofing Siding masonry Veneer L/Raugh Plumbing Relief Valve Ext . Porches Finished Floo s Interior Trlm Stairs & Rail! s Cellar Drain Ti e Concrete Floors Plbg . Fixtures Gar . Fireproof! Door Closers Smoke Detecto Chimney IN SU LAT I ON Foundation Floors Walls Ceiling FINAL. ELE TRICAL INSPECTION_ k1R.IVEWAY PPROVAL Final But ing Survey Next scheduled insPection (call when ready ) Remarks- i3uilding nspector 6/86 and-VI ._.J"oture a� Qieeeri3�urcf U1L.DING and ypN1NG D t.D. 1 x NT p 0)( Say and Haviland Ftoa York128 a 98 Queensbury. N SEPTIC DISPOSAL SYSTEM INSPECTION 33 " LOCAT ION , DATE Clay YES SCIL TYPE San Percolation Test Reclxi.red? IV4 Percolation rate - in/Inch M TYPE of SYSTIEMZ£ leld r total leng Ayesorption Len of each trench Depth of trenches Size of grave SEEPAGE PITS ON er a t. Size- _ r�- - Gravel size Size TS e Bldg , to tank --�- � Tank to disc. b f el Pit ¢ •. 17ist_ box to �p Partial openings seal d? ES OCATION/SE RA'i lCIL3 S . -f t. o tank gt. gount! n io gouncladatican to absorPt �ft. Absorption to lot line ft. Separation of 'pits circle cane) SYST� 00 PRQPER side - ;,pCATIC3i3 O Left side - Rig Front ON r COTS : SYSTEM USE Appp{OVED YES NC7 Building Inspector 01186 and vl rr /� flawn of �uQen .shure� 'BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R . D. 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME. LOCATION ,A . e7 I !� Date ty Z - / Permit No . � ✓ �✓ = APPROVED - YES NO Footing/Pier Fort* Foundation waterproofing Back£ ill Framing Roofing Siding Masonry Veneer {tough Plumbing ! / rS Relief Valves Ext , Porches Finished Floors Interior Trim - -- Stairs & Railin Cellar Drain T ' e _ �- - XConcrete Floor Ibg . Fixture Gar . Firepro Ping Door Closers Smoke Det+ec rs Chimney IAiSULATION KFoundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey _ Next scheduled inspection (call when ready ) Remarks- .�(, 1 VA* art ,�v,1�tJ g G Building in ector 6/86 and-vl ; � ! �./owrrr o� '�ueen36urr� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 ❑ueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME ��� LOCATION Date11 ' f Permit No . `� - : ✓ = APPROVED - YES NO Ming/Pier Forms Foundation Waterproofing Backfill Fra ring Roofing Siding l'asonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproof ng Door Closers Smoke Detect rs Chimney INSULATION : + Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) �Ll v7 — w� /f, N 8 ilding Inspec,,tor 6/B6 and-vl i ."lrtwn o� �ueerr .36urt�r BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME , LOCATION Date J � Permit No . / APPROVED - YES 0 Footing/Pier Forms Foundation Waterproofing ' Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain 'file Concrete Floors Plbg . Fixtures Gar . Fireproofin DOOr Closers Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- Building Inspector 6/86 and-vl _../own o� �uF'e+rr3bstrt� 13UILDING and ZONING DEPARTMENT Bay and Haviland Road. R. D. 1 Box 98 Oueensbury. New York 12801 BUILDING INSPECTOR ' S REPORT NAME { d LOCATION f � 2 Date �- /f Permi t No . f"� =sting/pier Form APPROVED s S NO Fo - nation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext - Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plug . Fixtures Gar . FireProofin Door Closers Smoke Detectors Chimney -TNGULATION , Foundation Floors Walls Ceiling FINAL ELECTRTC,AL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- � . . Building and-vl nspector Sl11L.bING DEPT. Copy OF APPLICATION FORM 41 NEW YORK BOARD OF FIRE UNDERWRITERS, FILE THIS COPY WITH BUILDING DEPT, WHEN REQUIRED. CITY OR AMP. [(SATE VILLAGE dv STREET AND NO. OR g,I� p TOWNSHIP � Z1 . ROAD2ETW AND POLE NO. #39 Fl i zabert T COUNTY ALL PR,EOMS STR WHAT 4�i •.+eiL� POLE NO. $ TED? UC[K R,APAhlNAME S CTIOIV O BUILDING _ BLOCK WN ER'S NAME OCCUPANCY AND ADLIRESS ; ^��YY +r' . jyer i f $SLYUIPPLIED ,a..IL7 ,L." S i.17Gs P r�la.+.i�Ct TEL. I. Is DING _ pp--�1 FROM THEIR r M OLD ❑ WORK OFFICE LOST BELOW A IS NEW ] ADDITIONAL DEFECTS I L Is WHICH Yf3U INSTALLEO ❑ REMOVED [] Leap NUMBER OF OUTLETS No. of Fixtunxt & tien Lattlp Reaeptwlae MOTORS HEATERS BRANCH hilinp Side Attecll't CtRCVITS OFFICE USE WYI Reyp',It Switch Na A.W.G.Oua. Panamint Bteeket Na. TV" H.P. Wat4 ONLY Eeah Na. aade EadS Q«y. INSPECTION Sul be= Bete- nial fat Fill Znd FI Sad Fill. REMARKS: LIST OTHER ELECTRICAL tJEVICES NOT SET FORTH ABOVE; DO NOT USE THIS SPACE. This appiication is i You are audtaeixed nxmake to cover the aboYe..listatl eV1A ipment to M inspactad but if at bola of i to make tM i*atpaar;on and odil i the tee to cawer the additional napaatiOrl t SIZE OF mqumcnant, as have a tend ►dditionrl MAINS P+wudad by the applicant, egwp.nernl not above listed, CHA FEEDERS ELECTR fC SIGN"ACT it OF LAMPS TOTAL + MIORK EXPOSED GAS SIGN TUBE WATTS WORK TO BE CONCEALED STARTED TRANSFORMERS OF SERVICE COMPLETED (NUMBER) VA ENTERS OVERHEAD UN SIZE OF SIGN (CAPACITY) IL G DERGROUND INSPECTION REQUESTED MAKER ON OR A$ NEAR AS OF SIGN POSSIBLE -1 Y i wifum AVOIDMUST DELAY BY GIVING FULL AND ACCURATE INFORMATION. All SPACES NEW ❑ MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. OLD Q PRINT NAME AND ADDRESS DATE OF y NAME OF IC � APPLICATION " ! APPLICANT X SIGNATURE STREET ADDRESS OF APPLICANT CITY OR LEPHONE yE' POST OFFICE 46 EL 'IRL�V_ ,/se1 A SEPARATE CODE LICENSE NO ZIP APPLICATION MUST BE FILE FOR EACH SEPARATE BUILDING QUEEN d VICTCRIA'S GRANT QUEENSBURY, NY. CO-T.G. i CLEANOUT TO GRADE) .1� _ NMEMO 100. SC/ cU / 18' _4-- LCT 1 33 Lu cr 3 'D lm N 1 � M SHUTOFF 1 105.00' 1 ELIZABETH 0 i 2000 gol 102.001 08 52 i O 7 LOT � I 1 (V 1 1 1 ►02.00/ 1 LOT 41 I m � 1 1 92.00 LANE C.O.T. G. i LOT I 43 I REFERENCE DRAWINGS S SITE UTILITIES SEPTIC E~ WATER VanDUSEN $ STEVES SURVEY PLAN 8'- 0 DIAMETER 9'- 0 DEPTH