1990-224 .,. Y'; - 7 : 'C' V,.Id
._
k 7i ,
n CE,RnFICA.TE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY. NEW YORK
t
i
Date_ February 15 ■ 19 M j
i
This is to certify that work requested to be done as shown by Permit No. -224
i
has been completed.
MM4 structure tnay be occupied as a Additian in f1wailing `
l.ocativn 1 St. Andrews Drive
Edward & Gloria Allard
I
Owner
By Carder "Town Board
'TOWN OF QUEENSSUILY
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Director of Bldg. do Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY
No.90-224
WARREN COUNTY, NEW YORK
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PERMISSION is herebyranted to a'g ED WARD & GL[]RIA ALLARD ¢'
OWNER of ro ,p p perry located at 1 St. Andrews Drive Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Addition to 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
same >
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L—'
"fa
2. CONTRACTOR or BUILDER 'S Narne
AJS Enterprises Inc. tri
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3. CONTRACTOR or BUILDER'S Address >
6 Highalnd Avenue �
tZI
Queensbury NY 12804
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4- ARCHITECT'S Name
O
S. ARCHITECT'S Address
rn
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S. TYPE of Construction -- (Please indicate by Xl
C].
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( Wood Frame { y Masonr
r steel r )
ca
?_ PLANS and Specifications b
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No. 241x26' Addition to dwelling as per plot plans, specifications, and application.
8. Proposed Use
Addition to dwelling for family room and study.
$ 73.00 PERMIT FEE PAID — THIS PERMIT EXPIRES November 2
79 90
(If a conger period is required an application for an extension must be made to the Building and Zoning inspector of the �3 town of Queensbury before the expiration date.)
d
Dated at the Town of Queensbury ttrG — nd Da A&'
19 90 Z'
SIGNED BY BuNdi for the Town of Queensbury aq
ng and Zoning I nspector
TOWN OF +QUEENSBURY
REVIEWED BY
FEE PAM P
PERi1G'I' NO. own
► CilVN OF CUEF-USSUR4
(Epw BUILDING PERMIT APPLICATION RECEIVED
APR 2 7 1990
A PSRKrr MUST BE OBTAINED BEFORE BEG=NN NG CONSTRUC.'TIONOLMOMMISCMIOM
WILL BE MADE VhiT L APPLICANT HAS RECEIVED A VAUD BUILDQIG PERMIT.
A11 applicants spaces on this application MUST be completed and the signature of the
applicant :MUST appear on the reverse side of this application.
The owner of this property is: ,/ fr►7� � '4 v" /dhc2 �',/� cz�
P.O. Address l �v' l/ . 7 c+� e eer e� r Tel. 2,41 /C)
Property Location Tax Map No. 24LZ�I a
Has there been any split of this property since October 1 , 1988 ?
If yes Planning Board Review is necessary . yes
SUBDIVISION NAME, IF APPLICABLE LOT NO, r
THE PERSOkf RESPONSIBLE FOR SUPERVISIOK OF WORK AS REGARDS TO BUILDING CODES IS:
NATURE OF PROPOSED WORK: ESI":MATED MARKET VALUE OF
•
Construction of a new building . CONSTRUCTION: S ,4, a 0051
Addition to a building " COMPLETE INFORMATION REQUIRED BELOW:
Size of property ft x ft.
Alteration to a building * Existing Buildings( 3 ) Size ft. x ft.
(no change to exterior dimensions}
" Proposed building - distance from property line:
Other work (Describe) Front yard ft. Rear yard MUNWft.
Side yards ft4 and d ft&
w
GROSS AREA OF PROPOSED STRUCTURE
If on corner, setback from side street ft.
1st Floor C9 sq. ft. �, ` * OCCUPANCY INFORMATION
Ind Floor sq. ft. j * Primary Building
Other Floors sq, ft,
One Family Dwelling
(not collar or- b&ee menu) • Two Family Dwelling
TOTAL FLOOR AREA a sqe ft. • Multiple DwoUingl'N[umber of units
Size of new structure C I-/ it x 4i ft. * Busines's"
Foundation-pier/siab crawl/ iai/funMAPERNMENS
* Industrial
(circle one " Other
•
Noo of stories (habitable space), _
Height (grads to ridgo) ! ft* If addition, what will UM be! ' ^.,,f ,
unnni�n�� *
If residential, rio. of families ,1
'No, of roame(esciuding baths) � NNE, ,� Ac�ces y ��c,r
Noo of bedrooms 0 ..
Noo of bathroomw a r„`�Deteahed Garage ONX/TWO Car
Primary heatbW system � r,�.� • ,,,,,,,_AttacM�d Garage ONE/TWO Car
Type of fuel , "' �PPivate storage buUding
moo of fireplaces to be Installed *
# ��Qther
Will a rood stove be lnatall;ael�
Central Air camStioning
OV40 ER
SUfLDIN (c aER %11T APPLICATION CONTIN4ED
BUTLWNG ;PF. CIFICATIONS:
Type of construction, wood frame, fire safe. etc. woo
Will any second-hand or upgraded lumberbe used? If 50% for what ?
Foundation wall material B_ d f _;e &6&c�4 Thickness - / a 4
Depth of foundation below grade (to bottom of footing)
Will there be a cellar ? Heated or unheated?
Floor sq. footage Will there be a basement ? lfi�" Will any portiorE be used as living space ? ft ,
(if so, what portion ? sq ft . Type of use ?
Type of roof - ope flat/shed/other Material of roof " '
Site, woad studs al. "xi�f " spacing&,,." o.c. length Ft.
Joists ( floor beams ) 1st floor "x ;pacing/ "o.c. span ,� j ft.
Joist ( floor beams) 2nd floor "x " ;pacing "o.c. span ft.
Overlays (ceiling beams)_"x� spacing^_�" 0. c. span / L ft.
Roof rafters _"x_ / " spacing /� �'', o, c, span ,/eft.
Roof trusses (pre-engineered) spacing " o. c. span_��Pt.
Exterior wail finish (if/d 6d Ir . y� C wof what material?
Interior wal%l finish y
If a garage is to be attached, describe materials to be used for FIRE SEPARATION: .
Is there to txm an opening between garage and dwelling? /" If so will a Fire-rated door, encl
self-closing device be provided? osure.
Will a flue lined chimney be installed?er'�ieight above roof
ft.
Depth of chimney foundation below grade 1o� ft.
Depth of fireplace hearth = �ft..JLjn,
Water supply - Municipal or private well
SEPTIC SYSTEM Distance from ANY private well (including adjoining properties ft,
(A separate application is necessary for any repair or new installation of septic system )
NAME OF BUILD£ R � r �$-`7r? 5'r- 4DDRESS ��ta / ,,ram,r` c TEL. 3V0. 3'
NAME OF PLUMBER 70.4 1'Dh ADDRESS , ,�Gria NO.
C?
NAME OF MASON }
ADDRESS -- �� .,�ry �,7 TEL. No.
NAME OF ELECTRICIAN 4!2 , ,�►rr DRESS � �' a:�_ TEL. NO.
DECLARAIMON
To the best of my knowledge and belief the statements contained in this
plans and speCiflcatlorts submitted, are a true and cornpiete statement o[ aDai?pilea d wion, together to ee with the
iti� described premises and that ail peoYi:i+►s:": At the BUILDING CODE. THE ZONING OIRDINA be done on
NCE, al+tr!
Ch work is authorizedr to the P owner,
ed work shaW be Complied with. whether �cifled ar net, and that
by the owner.
Ow , owner's anent, archit contractor
SPECIAL CONDITIONS OF THE PERMIT:
BY
TOWN OF QUEENS $ URY
WARREN COUNTY , NEW YORK
Application for ; BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE , OWN OF QUEENSSURN
A permit must be obtained before beginnir QOM)(KD
ANSWER ALL of the following : APR 27 1990
.1 Gross floor area �lrl1
_ ..�..»
2 , Type of heat C//'h
02
3 . Is the building mechanically cooled ?
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
2 , Floor over heated spaces YES NO
a . Are foundation walls insulated ? YES NO
19 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
B . Under 16 % Only
1 . R value of roof, a d�rfl ors exposed to ambient conditions .
2 . R value of exterior wails
3 . R value of glazed area 4 7 -
4 , R value of doors / ,
so R value of floors over unheated spaces 31r
60 R value of slab edge insulation - unheated slab
r]t/
7 . R value of slab insulation - heated slab_ _ //
8 , R value of heated basement / cellar walls ( above grade )
9 . R value of heated basement/ cellar walls ( below grade ) lv
10 , Type of insulation
C . Controls
1 . Thermostat maximum heat setting
D , Duct _ Systems
1 . Is duct system installed in unheated spaces ?pp YE NO
a . If YES , R value of duct installation p1 .
b . R value of duct in other areas
E . Piping Insulation
1 . Size of hot water or cooling carrying agent pipe /.S
2 , R value of pipe insulation ZY
F . Service Water Heating .�-
1 . Performance efficiency. rl+ 4
2 . Temperature control setting maximum Cz
G . For Swimming Pool Only
1 . Maxim7ugmw heating
Telephone No . / l 5 d J r,-f/ y •/I~i"-s " -
—( applicant ' signature )
THE NEWYORK BOARD OF FIRE UNDERWRITERS F, T
Ifl ; ' { BUREAU OF ELECTRICITY
_ 41 STATE STREET, ALB N YORK 12207
Date kEBR4 :1Rh :'rt . 1 ".)�' I Appliratio o. onfiler:. . 1I;. u ..190 / 110 A Q -17 '77 .4
THIS CERTIFIES THAT .}C. ?[} 1
only the electrical equipment an described below and introclu cad y the appi t named on the' above application ;umber in tho prsmI of
EDW RD & GLORT A ALLART) . 3. sT 'j'J DRFk: s DR . . L 'TF-z , . y
in thefollossing location; ❑ Basement - r lst Ff. 0 Pnd Ft. Section Block Lot
Leas examined on FEBRI-A}25 .} ' � ]. �) �' 1 andfound to be in compliance with the requirements of this Board.
FIXTURE FIXTURES RANGES COOKING DECKS I Ova" I DISH WASHERS EXHAUST PANS
OUTLETS ECEPTACLES SWITCHES INCANr1E5CEM j rL1,101"CENT OTHER AM7. K. W. AM7. K- W, ANT. K.W, ANT, K- W, ANT. H. P-
ZI
1 F7 . ' L I T }
Y
S
x DRYERS FURNACE MOTORS FUTURE APPLIANCE PEEWEE SPECIAL RISC"FT TIME CLOCKS RYL, UNIT HEATRRS MIAT1430TLET DIMAWRS
AMT_ K. W. OIL H. P. GAS H. P. AMt. NO. A_ W. G. ANT- AMP. VAT. AMPS. TRANS. ANT. H. P. SYSTEMS AMT. WATTS
NO. OF FEET
SERVICE DISCONNECT NO. OF S E It V I C E
AMT. AMP. TYPE METER 1 0 2W 1 t 3W 3 0 3W 3.e 4W NO. Of CC. CCIER ,e ND. A. W. G ffa. Of NI.IEG A. W. G. NO. Of NEUTRALS A. W. G.
EQLHP. P Of CC. ID. Of wtao Or NEUTRAL
E OTHER APPARATUS%
s
JS ENJ R}' RTSE [
6 HIC,HLAND AVE CJw�
f; ]. ,E" F� FILLS :hit 1 r' 801 BRANCH MANAGER
Perad
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.
-- -- -- - — - -- - - -- -- -- -. _
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK I2806E-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S REPORT REQUEST FOR INSPEC SO p
EIVED 24
la I
NAME r
LOCATION 1
DATE PERMIT # 2 Q " 2� 2-4
APPROVED
YES
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP—PROOFrNq�
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN .
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL ,INSPECTION. f
CHIMNEY HEIGHT
ROOFING t-
SIDING
EXTERNAL PORCHES/ST S
STAIRS—CLEARANCE & I —�'
PLUMBING FIXTURES/RE I F VALVE_
INTERIOR TRIM/PRIVAC DOd7R5 L
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSERS)
SMOKE DETECTORS
)(FINAL ELECTRICAL INJPECON
FINAL APPROVAL OF CTION
OK TO ISSUE C/O O A SIGNED CERTIF ATFDI
MUST BE
OBTAINED FROM T E BENT BEFORE
THESE PREMISES ARE
REMARKS.
r
ARRIVE rr .^� ��
DEPART [ r ?C
IN PEC R
TOWN OF QUEENSBURY '
BUILDING AND CODES DEPARTMENT --
BAY & HAVILAND ROADS
QUEENSBURY,* NEW YORK 3280&
TELEPHONE (5I8) 92-58.32
BUILDIN INSPECTOR ' S REPORT
REQUEST FOR INSP TION REC D Z fiL
NAME
LOCATION
DATE PERM T # Q" 2.
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FO S
FOUNDATION/DAMP-PR FIN
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE 1STE
STAIRS�CLEARANC & RA LS ^_
PLUMBING FIXTU SIRE EF VALVE
4PREMXSE
IOR TRIM/ RIVACY RS
HED 1, OOR
E FT R PING • f
CLOSERS
DETECTO SLECTRICA INSPECTIPPROVAL F CONSTRUION
SSUE C/ OR C/CED CERT ICATE OF OCC PANCY MUST BE
ED FROM THE BUILDING PARTMENT BEFORE
PREMISE ARE OCCUPIED!
REMARKS. AID D -'upon tit re7— 6€1 P Q+ 2 Si`
0 87� xf tt ►u,grt. F Lam.
r>rp1 'a t
ARRIVE
DEPART
INSP TOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW Y RIC I280&
TELEPHONE (5l8) 92-5832 C
BUILD INSPECTOR' S REPdR
REQUEST FOR INS CTION RECEIVED
NAME
LOCATION
DATE PERMIT ##
APPROVED
YES I NO
FOOTING/PIERS
MONOLITHIC POUR F S
FOUNDATION/DAMP-PR FING
BACKFILL APPROVAL
ROUGH PLUMBING
dd
FRAMING
ELECTRICAL ROUGH-I
XINSULATION:
A FOUNDATION
FLOORS
WALLS F
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/S
STAIRS-CLEARANCE & XLS
PLUMBING FXXTURES/ EF VALVE
INTERIOR TRIM/PRIVA Y DOORS
FINISHED FLOORS
GARAGE FIREPROOFIN
DOOR CLOSER (S)
SMOKE ,'DETECTORS
FINAL ELECTRICAL I PE TION
FINAL APPROVAL OF ONS TION
OK To ISSUE C/o G C/C
A SIGNED CERTIFI TE OF CUPANCY MUST BE
OBTAINED FROM TH BUILD G DEPARTMENT BEFORE
THESE PREMISES OCCUP ED!
RE)WARKS:
ARRIVE,
DEFpaRm �.r �
INS ECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BA Y & HA ROADS
QUEENSBURyRYe NEW S'DRK I2806-
TELEPHONE (518 ) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATIONi Zj
DATE PERMIT # !
APPROVED
YES NO
U _ j
FOOTING/PISRS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP—PROOFING _
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTSRNAL PORCHES/STEPS
STAIRS_CLEARANCE & RAILS_
PLUMBING FIXTURES/RELIEF VA' —
INTERIOR TRIM/PRIVACY DOOR
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTS N
FINAL APPROVAL OF CONSTR TION
OK TO ISSUE C/O OR C/C
A SIGNED CERTIFICATE O OCCUPANCY ST BE
OBTAINED FROM THE BUI INGPIED<EPARTM T BEFORE
THESE PREMISES ARE OC
REMARKS :
DEPART INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT /yfi j
BAy & HAVILAND ROADS I ► `
QUE!ENSBURy. NEW yORK 12809-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S REPORT r
REQUEST FOR yNSPECTION RECEIVED
NAME
LOCATION
DATE PERMIT #
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC PO U FORMS
FOUNDATION/DAM PROOFING --
BACKFILL APPRO L
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUG IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/ PS
STAIRS-CLEARANCE & ILS
PLUMBING FIXTURES/ LIEF VALVE
INTERIOR TRTMIPRS Y DOORS
FINISHED FLOORS
GARAGE FIREPROOFI G
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL I SPEC ION
FINAL APPROVAL OF ONST CTION
OX To ISSUE {C/O O C/C
A SIGNED CERTIFY ATE OF CUPANCY MUST BE
OBTAINED FROM T BUT N DEPARTMENT BEFORE
THESE PREMISES RE OCCUPY !
REMARKS:
ARRIVE T
DEPAR
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURYx NEW YORK 1280g-
TELEPHONE 518) 792-5832
LCIING INSPECTOR' S REPORT
11
REQUEST FOR NSPECTION RECEIVED .1 � �(
NAME
LOCATION IL
DATE i C3 PERMIT #/ -
Z.
APPROVED
f 4 YES NO
FOOTING/PIERS
MONOLITHIC PO FORMS
FOUNDATION/D -PROOFING
BACKFILL APPRO L
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUG IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/ TEPS
STAIRS-CLEARANCE RAI
PLUMBING FIXTURES/ L FVALVE
INTERIOR TRIM/PRIV Y DOORS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL IN E SON _.......
FINAL APPROVAL OF NST CTION _
OK TO ISSUE C/o O C/C
A SIGNED CERTIFI TE OF UPANCY MUST BE
OBTAINED FROM T BUII.DIN DEPARTMENT BEFORE
THESE PREMISES RE OCCUPIE t
REMARKS:
f'cf
r v i GL 94 aOAa
�L
ARRIVE
DEPAW J 1* 2 -
NSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YOFZK 128 Usk Z, i
TELEPHONE (518 ) 792-5832 .�'/; �I
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVEDy� h J' ��(S
NAME P z ax ri +�
.LOCATION
DATE PERMIT �1,. � �F `
APPROVED
I YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION1DAMP—PROOFING��
BACKFILL APPROVAL
ROUGH PLUMBXNG
FRAMING i
ELECTRICAL ROU.30—IN
INSULATION:
ri
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECT.T
CHIMNEY HEIG
ROOFING
SIDING
EXTERNAL PORC 91STEPS
STAIRS—CLEARA & RAILS
PLUMBING FIX TU S/RELIEF VALVE
INTERIOR TRIM/ ,, IVACY DOORS
FINISHED FLOOR$ —
GARAGE FIREPROJ> NG
DOOR CLOSER (SY
SMOKE DETECT S
FINAL ELECTRICAA.. I PECTION
FINAL APPROVAL `OF C INSTRUCTION
OK TO ISSUE C/b OR C '
A SIGNED CERTZOICATE F OCCUPANCY MUST BE
OBTAINED FROMiTHE BU ING DEPARTMENT BEFORE
THESE PREMISE:, ARE OC UPIEDI
REMARKS:
. � E
i
ARRIVE.
DEPAR }
INSPECTOR
YOU ARE HEREBY REQUESTED TO
INSPECT AND ISSUE CERTIFICATES
FOR THE FOLLOWING ELECTRICAL
EQUIPMENT TO BE INSTALLED BY
THE UNDERSIGNED
TEMP. # DATE
CITY E f TOWNEHIP Iy CCXJNTY
r` POLE NUMBER
SiTIEEr OfNO. i>f}.BMO
J �+) �
BETWEEN WHAT TWO CRCIBSu STnEETS 15 PREMISES lOCAiEO? SECTION BLOCK LOT
/ ,g // f 6UI DING OCG�ANCY /�
occuPAr�s -f zij.+6.Y a `E '/�,I�/" 0 )r 1� //j��/ fd ./' Cf +.. e 1 A /tr.+"r.-aI rj f �7
OWNER'S NAME D A[}QI49E } 1 t S f/fti"/ f [/ if t f �N,
CURRENT SUPPLIED BV f �j FROM THER OFFICE WORK TELEPHONE NUMBER
$UILDING IS
O WORK IS J NEW Fk Aim-rio okL ❑ DEFECTS REMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OE OUTLETS No. oT Fixtures & MOTORS HEATERS BRANCH OFFICE USE
Loca- Lamp Receptacles CIRCUITS ONLY
tlon Ceiti 'W�Wall MBch t Swfth Pendant Bracket No Type Each NO EW No. Gam INSPECTION
^9 Side Anwh'ReceppIs
Otlr-
SIDE
sue-
BASE
BASE-
MENT
Is1
FL.
2w
FL.
3rd
FL.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE.
THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED, 'BUT IF AT TIME OF INSPECTION, THERE I$
FOUND ADDITIONAL EQUIPMENT N17T ABOVE LISTED. YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER
THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT.
SLZE OF MAINS //FLEJE EtlEaTRIC SIGNSIL/IMPS
•/F Q V
CHARACTER OF VWORK kPnREp GAS TUBE SKRVrRANSFTIRMER3 OF \'
L.J CONCEALED
❑ATE WORK TO BE STRR'1' PATE COMPLETED SIZE OF SIGN(NUMBER] CAPACITY
SERVICE ENTERS'BUILDI �--''��II MANLIFdY:rURER OF SIGN
❑ OvEIiHEA6 {d14NOERGROIIND w�.��� .�1� //y/ y J/ 1
OIaE INSPECTION RMUF_STED ON(O ,,M� PODSJ� 1 MIST �R API L[CA�M ad I 1 /r j iI 1 f { l
rft= pgLM t3Y GrAmp Ftm.L AND AOMRATE IN T.1-0 SPOIC MIDST FILLED IN OR APPUCATION INAY SE RE O.
PRINT NAME AND ADDRESS
NAME OF rPj4C*ANT, ,�.- *M J� DATE OF APPLICAUION T r.
STREET ADS7FjESS J I 7ELF jHr] EL}' t
CITY OR OFFICE �+ a ZIP CODE LICENSE ND. WHEN APPLI BLE
� y f4 /- f �' cry 1
❑ 85 John Street ❑ 41 State Street ❑ 570 Delaware Avenue ❑ 217 Lake AvenUH ❑ 202 Arterial Road
NEW YORK, NY 10038 1 ALBANY, NY 12207 BUFFALO, NY 142021 ROCHESTER, NY 14W8 I SYRACUSE, NY i3206
THE NEW YORK BOARD OF FIRE UNDERWRITERS
11
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101541
1
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This d.Mb his been WiWwwed y I „M DII, vmw 0 AIs .a
OR My DATA OR Owen "m
Caned. Unc. for project "�. «.M.�..R ...�
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low w 1RIi� i ' 1NCw - V TNN
4ev,e"lj;7 e7z-
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D eRls ss �Iicwii'IM.
.KAMYR H.C.
iiOWN OF QUEENSBURI
RECEIVED
APR 2 71990
Hof- L BLDG. & CODE DEPT.
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