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1989-573 .-._.,.� .: „ ,..y r.; ^.';i., ,,,.,4�L.T,,:;y' .'�-°r`'•";' ,�'9i'� ..:"+te' ...,.,rr,:fy-R�-F.•.. . ;-°qq'T :d.s , CERTi�I+CA�T , + 7►F OCCUPANCY f TOWN OF QUEEN58URY WARREN COUNTY, NEW YORK pa,f January 26 .,19 96 i This is to certify thatwork requested to be done as shown by Permit No. 89- 573 k f i i has been completed. "Ibis structure may be occupied as a _ S i n a l e Family Dwelling 1 �G. - i riquoi s Drive 0wfter Michael Vasiliou I By Order Town Board 1 TOWN OF QUEENSSURY r i rDirector of Bldg. ac Cade Enf r' ement f I BUILDING PERMIT TOWN OF QUEENSBURY No 89-573 •" WARREN COUNTY. NEW YORK t co f V PERMISSION is hereby granted to� Michael Y8si l iOu + OWNER of property located at 1 of IZ 73 T ri Q ou 7 S Drive Street, Road or Ave. in the Town of Oueensbury, To Construct or place a Single Fami 1 +y 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 Oueensbury Building and Zoning Ordinance. 1. OWNER'S Address is 7a. 32 Willow Road emu'., Queensbury.N . Y . 12604 2_ CONTRACTOR or BUI LDE R'S Name r Self 3. CONTRACTOR or BUILDER'S Address Same 4. ARCHITECTS Name C w+ V W S. ARCHITECT'S Address �. -ii a 6. TYPE of Construction — (Please indicate by X) � O XX%Nood Frame ( I Masonry ( } Steel C rp 7. PLANS and Specifications No. 44 ' x 62 ' Single Family Dwelling as per plot plan , specifications , an applications including septic , attached two car garages a d 8. Proposed use CA Single Family Dwelling w CD $ � PERMIT FEE PAID — THIS PERMIT EXPIRES February 1 19 9) Mn (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the �• town of Oueansbury before the expiration date.) tC Dated at the Town of Queensburrgr,*lais 24th _ Da of Jul 19 89 91 for the Town of Oueensbury SIGNED BY to Building and zanirg Inspector Q YV 4N (Oro(OroQI UEE ,%*S � UR i Li ^In ♦ t „ n � 11 T t i � �/ fGt L'^ - Rev-��ucd� � N OF QUEENSBURY RECEIVED 14JJI LU I NC A kM CUDES U1 .PARODTEk-rr 04ice IksuCd JUl- a AY grid 11AyTLArVD ROADS RD 1 Dox 93 DE nUEzNSBURY , NEI+r YORx 1 ?d Q4 PCAM"I t No . _ BL.DG. & GoDEFT. Tel . ( 518 ) 792 - 54132 Fxc 4104 • a • a a a a ■ . • a a r • • • * a • • '• ■ • a • a a a d • • • • w a r A PEIMIT MUST DO OBTAINED uE1'ORE LECINtiI .N0 CONSTRUCTION . NO INSPEC'r16NS VI L BL MAOL UNTIL APPLICAMT HAS RECEIVED A VALID BL; ILDINC PERMIT . All applicablw spaces on this application must be completed and the iouaturc of the applicant must appear on the reverse sick of this shcat . a • x a A * ■ * '* a R A A a x ! a a * * ! rt a f ■ x * ar ■ * f '� at R x 7k The owner of this property is : e^ . D . Address Z /ALf-CJu1 TEL . + lroperty location TAX MAP NO . itas there been any split of this property since October 1 , 19aS ? y d S no if yes , Planning Board Review is necessary . LOT NO . SuBDIVI $ ION NAME , Ir APPLTCAaLE ' he Person responsible for supervision of work as regards Building Codes is : NAME F . 4 , ADORCES TEL • NO * of builder :jam* -� Tel 7 7:jam* �1c/'1i,Y�'"L. Itf�d/s'eas � Z L�.t � c.. cJuu aA-.c'+ _ ^, 1a mat o f P 1 umb.:r A ✓ l^d d r e s s .�• rr��-.c�. ,,rL,)y;/ar' To L mama of M"son � �iy.,.A�t AUdr4sa_ �E4cc' Y l# cram+ _Te1 7 .� - � fx C13Lc7 .. iATuRE Or PROi"'OSCO %nCRIK • * ZONINC: INI 01tolkiAI^ ION ( G> itica use only ) t:onz. trucci .:.r& of a jt4:wr Duildsn7 * ZONING. OGSICNATION OF PROPERTY AdJLcLon to :a b1Ji1J ;L1%9 # PERMITTED PRINCIPAL PERMITTED ACCESSORY AltwC"Lion to " L.uLlding ` ' � , ,o to uxc .: rLoc ULmQn4. Lon:33 * REVIEW REQUIRED ^- PLANNING BOARD ZONING BOARD, Uct.ur work i .3 .:scrLL�. 1 ` SITE PLAN REVIEW N APPROVED DATE kJSS hit1: .1 01` 13ROpoSCD. �, TaucTukE * VARIANCE I APPROVED GATE ` Remarks : St Floor /3 7 O sq ft to A, ' nd rloor 9w © sq FC • IoO . COmPLLTY In10O14w.'tr10K 14,LQPUL1sLQ 1j1;L6+.r . �. -� ' Si•s.� /'of propwrCy 5 0 tit x � a rt . ) char Flccrs sq ft • . _ [ not cellar or bA $QmanclMONO �,xi� ti�atj Lurl.l ., :�) fa1 51 -� rL x=�•,_rt . ['OTAL FLOOR AREAMZ 3 41' (2 Aq f C i Lx � .G ail Gus lllr��j [ :. l ua� mix.: rrx ntaw structure ''}'w ft x ez f�t ` µ'u+ard;atian-pier/ :laL/crawl/l�arcl.al/ �;�' ` S'rolyGmcd buLl +lanq , riL� e..ncw t rowu t.copurcy ilrwu (ulrclu onrsl Front yardC7 I• t near yurd �' ft era . of .tories (!� : c:abls up.c�al Z. �r' t :anr1 4 1' t Nwi he ( y rada to rid w ) Z � ft . Side Y"rdug �a g J ! * Ii� on cornsr , uw cL3.a.xk frora s.Ldu ae ruuC.r c k i rasirn^0 isl , no . at° tuachliaes� rya , of roou�x [ +axcLudin�,R LS:atha1 ' OCCUPAiVt:7 INFORMATION 110 . of bodrocin a * FRIMARY UUILOZNQ No* of faatl►rooawu + yt+ pnQ g �y�axy drelliag r•rimiary u""Cla q %iVL1 L%:uh 4:!FA4 L.yy y] yy drR4llLLn►� SIVIs" of fueL Multlpl" 3wu11i" / Number of units��� No. to U" in*t:.. Iwdoo r'' ` P0ss^sr.aAQ1%C occupia6cy rill :a wows[ seovo Low iltsi "LI%04 r f lr:ar►a:1welt L1�CY�si►i►�y C.sntrYL Air aonaLitacan+rkg:� '1✓�'S l3rss�nu�x * BUILOING STYLE, PRIMARY STRUCTLOM . Incsustrial lwr►ch cont*40rpor"ry L6a cabin • ocher 146& L2iw41 ranch Nanr, 'Qu�,.lrsx . II .,aq.2Ltiohs wiwG will urrU,s b.r7 — 31aL,Lc 1%tv.xl old mcylA fuuiu�wlow 4: .PQ cod C0t+[^."4J%9 Gcimar ACCESSORY UWILOINGoo CasaniiaL 140W Towrk douse * "CachaU yar:age/ono c4r/ carJc:av ( CIIi " CULP PLEA,:B �ttoch%j" Q .,aC"qu/ 04%4 Ciar,/ two r is a a a a * • a a a ■ • r ■ : • ; 1lrivfAc" stoc:,&94 building %P= TIrN ^TFwD MARKET VAIMUM,, Or * Othrwr mpar►tATTom ON Du iLolNc spccIF rc^TioNs . ON R.Cvr.RSE: ; Iar: OF ^TI[ IS S%HCE'r, To BE COMPLCTUD [ Forst' HPA 10/80 v1 ` 'j ^ c .: -. � 3ll � t ruction , woof' fra .E . f cnd- hand or ungra » C. W _ H „ A p sz - Fou=. d,ation wall material (_ C5 _ r re s s rr Depth of foundation below grade etc ;,ctt-m tfOr will there be a cellar ? )(e3 gaped or u:. 1 eace3 ? hr4;Fr4&0 Floor sq . footage 13 70 Sq ft Will there be a basement ? Av will ary portion to used as living space ? ,r,/ p ( If so , what portion? sq . ft . - - Tape of use ? --- Ti _ ve of roof - sloped/ flat/shed/otnerio�44tC .`!a -_ar al of roof As p,.fq.tZ: S *44e v* .4 ; � viler wood studs 2� " X G it spact :zc, fLa " o . c . length $ ft . Joists ( floor beams ) 1st . floor Z 1qX /0 spaclna / 4 .. C . C ." span ft . joists ( floor beams ) 2nd . floor " X /O spacing / " o . c . span / ft . , verlays ( ceiling beams ) " X 4:�. space:g A " o . c . span / 5 ft . Roof rafters Z " X, "' spacing le, o . c . sNan �04V £ t . Roof trusses ( pre- engineered) sr.ac :. r.c span ,ZL ft . Exterior wall finish [/. Of what material ? C''L"-0 ,4PPZ rrz>0 or Interior wall finish S.0 {- e!eoC 6::=- if a garage is to be attached , descr ;.be materials to be used for FIRE SEPARATION : ! k' r"l017d� Is there to be an opening between garage and dwelling ? .11o If so will a Eire - ratizd door , enclosure , and self-closing device ca provideJ? ffr� will a flue - Lined chimney be installed ? V&S Height above roof 2 ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth/ft . Ain . Water supply - Municipal or Private well .treetf'+fen, SEPTIC SYST'L••M Distance from ANY private well ( including adjoining properties 3 D ft . (A separate application is necessary for any repair or new installation of septic system ) D E C L A R A T 1 0 Y 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. Signature : f .� ^ . !! Owner, owner's agent , drehitect , contractor SPECIAL CONDITIONS OF THE PERMIT : 6y 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 . Gross floor area .3 .-3 49� 2 . 'Type of heat! �r'�� T /nc! .� 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 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 B . Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions_ 2 . R value of exterior walls 3 . R value of glazed area 4 . R value of doors 3 • 5 . R value of floors over unheated spaces 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab 8 . R value of heated basement/ cellar walls ( above grade ) ;E'—I-3 9 . R value of heated basement /cellar walls ( below grade ) OR o"--4X 10 . Type of insulation L47/ /C Cy C &LS. Co Controls g o 1 . Thermostat maximum heat setting D . Duct Systems 1 . Is duct system installed in unheated spaces ? YESo a . If YES . R value of duct installation b . R value of duct in other areas E . Piping Insulation 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating 1 . Performance efficiency 2 . Temperature control setting maximum G . For Swimming Pool OnIY 1 . Maximum heating [� Telephone No . r ! ' 3 � ,73 Y ( applicant ' s signature ) TO OF UEENSflURY APPLICATION FOR, SEPTIC DISPOSAL PERMIT DATE LOCATION OF PROPERTY FOR INSTALLATION ZC>-e' Owner's Name: Telephone: ::2 Address: 522> c.r✓1G.z [^SLt,I �p�-1� Installer's Name: 7D.1 ,ey Telephone:_��, x '~ 0 0 Z Z. Number of bedrooms (residential only) Total daily flow (compute (d 150 gal per bedroom ) Topography: Circle one: (Tlat Rolling Steep Slope 06 of Slope Soil Nature: Circle one: Sand Loam Clay Other �J `/Depth: le) Feet Ground Water: At what depth? 2n Feet Bedrock or Impervious !Material: At what depth ? Feet Percolation test: Circle one: not required required rate min, inch. Domestic water supply: circle one: unicipal Well Esther rt� If domestic water supply is a well: �r Separation: Water supply from septic absorption feet �C K PROPOSED SYSTEMs Septic Tank gal. (minimum size: 1 , 000 gal.) ^• �{�)`" 1 TILE FIELD : Each Trench feet/Total system length feet SEEPAGE PIT(S): Number of / Size each 4!53 feet by �7 feet Size of stone to be used # /Depth or Thickness AF9 feet I have read the regulation on the reverse side of this sheet and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: DATE: Zo f' OVER 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 24 hours before start of construction and shall include a plot plan showing : 1 . ) 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 cornered 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 installa— tion , alteration or repair of an approved system , a new proposal must be submitted to the Queensbury Building Department before further construction , Town of Queensbury RUILDTNG and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 I:enzarks : , TOWN OF QUEENSBURY ,BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280g TELEPHONE (518) 792-58.32 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTS N RECEIVED S F NAME aid LOCATION sy DATE PERMIT # /� l APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—P PI"NG BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH— INSULATION: FOUNDATION FLOORS WALLS / CESLING VorrNAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ E S _ STAIRS—CLEARANCE & ILS �.s' .......� PLUMBING FIXTURES/ LIEF VALVE INTERIOR TRIM/PRIV Y DOORS v FINISHED FI..00RS GARAGE FIREPROOFS DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL I SPEC ION FINAL APPROVAL OF ONST CTION A SIGNED CERTIFI TE OF CUPANCY MUST BE OBTAINED FROM TH BUILDIN DEPARTMENT BEFORE THESE PREMISES A#E OCCUPI I REMARKS: 0 Yoe, SPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280!1- TELEPHONE (518) 792-58.32 BUILDING INSPECTOR' S REPORT REQUEST FOR IN PECTION RECEIVED -% r� � - ____- NAME LOCATION ' ^� DATE �q jjg— �iZ PERMIT # APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION,(DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROWH-IN �„,�'15fSULATIONc FOUNDATION FLOORS ;+ WALLS - - CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING ,SIDING EXTERNAL PORCHESISTFPS SfiASRS-+CLEARANCE & RATLS PLUMBING FIX2URESIRELIEF VALVE INTERIOR TRIM1PRfVACY -DOORS FINISHED FLOORS ' - GARAGE FIREPR FING DOOR CLOSERS SMOKE DETECT RS ti FINAL ELECTR AL INSPECTION FINAL APPROV L OF CONSTRUCTION A SIGNED ERTIFICATE OF OCCUPANCY MUST BE OBTAINS FROM THE BUILDING DEPARTMENT .BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR awn p� �ueeens6urt� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. C}. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME --� - /,Gar LOCATION r� { DATE ��� PERMIT NO Io SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , total length Length of each` .trench Depth of trenches size of gravel SEEPAGE P ITS-ENumber Of) size- ft. X ft. �. Gravel size .. PIPING ; 9izyPe Bldg * to tank L 'f Tank to dist * box gist. box to field/ 7 � G _ openings sealed? S NO Partial LOCATION/SEFAFATIbN S Foundation to tank ft. Foundation to absorption f t- Absorption to X'ot Sine ft • separation of .'Pits _ft. pN pp SYSTEM ON pRopERTY (circle one) Front - Rear - Left side �- Right side - SYSTEM USE APPROVED Y N Bu ' ng Inspector 01/86 and v1 TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT �R -y BAY & HAVILAND ROADS J , C)UEENSBURY r NEW YORK 128 01¢ TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION y7 a DATE PERM T # APPROVED YEt I NO 4- wfoOTING/PIER MONOLITHIC PO R FORMS FOUNDATION/D -PROOFING BACKFILL APPRO L ROUGH PLUMBING FRAMING ELECTRICAL. ROUGH- N INSULATION,- FOUNDATION r FLOORS WALLS CEILING FINAL .INSPECTION : � CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES STEPS ,STAIRS-CLEARANC & RAI PLUMBING FIXTU ES/RELIE VALVE INTERIOR TRIM PRIVACY D RS FINISHED FLO S GARAGE FIRE OOFING DOOR CLOSE S) SMOKE DETE TORS FINAL ELECT ICAL INSPECTION FINAL APPRO AL OF CONSTRUCTIO A SIGNED CERTIFICATE OF OCCUPANCY ST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED ! REMARKS : INSPECTOR TOWN OF QUEENSBURY �� f BUILDING AND CODES DEPARTMENT pAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12804- TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVBD, � NAME �f C fG�- { . �� ,� � ! LOCATXO7 C] �- c DATE " P &MIT APPROVED YES NO FOOTING/ ERS MONOLITHI POUR FORMS 100�'FOUNDATTO DAMP—PROOFING �ACKFILL A ROVAL ROUGH PLUMS NG FRAMING ELECTRICAL R GH—IN INSULATXON.: FOUNDATION FLOORS WALLS CEILIIEN FINAL I : CHIMN ROOFI SIDIN EXTERES/ EPS .STASRNCE & TzsPLUMBURES/R IEF VALVEINTER /PRIVAO DOORS FINISRS GARAGE FIREPROOFXOG DOOR CLOSER (S) SMOKE DETECTORS . FINAL ELECTRICAL ,XNSPECTIO FINAL APPROVAL OF CONSTRUCT N A SIGNED CERTIFICATE OF OCCUPA Y MUST BE OBTAINED ,FROM THE BUILDING DEPARTMENT BEFORE TJIESE PREMISES ARE OCCUPIED!' REMARKS: -- INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 32801L TELEPHONE (528) 792-58.32 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECT ON RECEIVED NAME - LOCATION r SL DATE -G PERMITS . >' APPROVED YES 0&0 100�00TING/P RS MONOLITHIC UR FORMS AwZ FOUNDATION/' P-PROOFING BACKFILL APP VA ROUGH PLUMBIN FRAMING ELECTRICAL ROUG -IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH SfSTEPS STAIRS-CLEARA CE s- RAILS PLUMBING FIX FtES/RE'LIEP LVE INTERIOR TR M/ PRIVACY DCX)R - GARAGE F EPROOFING DOOR C SER (S) ENO K DETECTORS FINAL LECTRICAL INSPECTION FIN APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE TFIESE PREMISES ARE OCCUPIEDI INSP TOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVSLAND ROADS QUEENSBURY, NEW YORK 12804- TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPE TION CEIVED t NAME LOCATION DATE PE IT # APPROVED YES NO FOOTING/PIERS 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 EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES/RELIEF VALVE INTERIOR T'RXM/PRIVACY DOORS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSERS) _ SMOKE DETECTORS F_TNAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT" BEFORE THESE PREMISES ARE OCCUPIED! REMARKS wy� INSPECTOR YOU ARE HEREBY REQUESTED TO INSPECT AND ISSUE CERTIFICATES FOR THE FOLLOWING ELECTRICAL EQUIPMENT TO BE INSTALLED BY EMP, THE UNDERSIGNED T # CRY OR W DATE }l TOWNSHIP M sue. . /741/RJATl' J SRaEET MID NO. OR RCYIO I BETWEEIy MM1i<E TyM7 iL1FIDg3 SINEE'r3 r$ PR� •.LLy7 T � FOI..E NUMBER Loc 11 ,,r.�y r 3ECFK]N OCCURWT'3 NAME v C� � BUILDING.OCCUPXNIC/ OWNE ME AND ADDRESS > G �f/ of./ ME LI �• HO E ER C ENT PPED 6Y FROM THEIR OFFICE MIDAK LEPHC"EF NUMBER BNLDIN(3 1$ jrNEW I� OLD ❑ WORK NEW LIST BELOW ALL E(�UIPMENTT WIHICH YOU NSTALLECI naDrrKxval DEFECTS REMOvED C Loca- NUMBER OF OUTLETS ND. of Fixtures R tion Lamp RBceptades MOTORS HEATERS BRANCH CUT- E USE Ceiling wawu Rece ']$ Switch RendaM Bracket Na 'rype H.P Wad CIRCUITS �ONLY SIDE Each NO. n+a. Dam INSPECTION SUB- BASE RA,SE- MENT 9 FL, 3rd FL. REAMRICS: 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 IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLIC NTi , SVEOFMAWS FEEDER$ ELECTRIO O#aNS4_AMpS CHARACRER OF WORK TDML MKVM ID EXPOSED UAS TUBE SIGNARANSFpRMER5 OE tHTE WORK TO BE STARTED ❑ COI'1OEALED '.M+ DATE CX7MALETED SIZE OF SIGN (NUMB ERI SERVICE ENTERS BUILDING CAPACITY INS MANUEAC'-TURER OF SIGN ❑ NEARHEAD ❑ UNDERGROUND DAYE PECRKxu REWESTED ON k5 NEAR AS I'DSSIHLE) _ Mus f f ! I I I AYOtD YS IIiICi Fi1LL AND RAT + c.ATIldi DIP- PRINT NAME AND ADDRESS 3 BH OR T1414 MAY RE AI IED NAME OF APPLICANT As ^� y DATE OF APPLICATION gpNT STREET ADDRESS f CITY OR POST OFFICE RE TELEPHONE ND. ZIP CODE LICENSE NO, WHEN APPLICABLE ❑ 86 John Street ❑ 41 State Street ❑ 570 Delaware Avenue ❑ 217 Lake Avenue NEW YORK, NY 1403s ALBANY, NY 12207 BUFFALO, ri 142172 ROCHESTER, NY 146081 ❑ SYRACUSE, NY 132o6 THE NEW YORK BOARD OF FIRE UNDERWRITERS _ - Ow ih . Date City, Town or Township 4 A rm� 4C Couniy location/Address1a - ( if Located in Rural Area - Please Attach Directions) Pole # Owner r = .a Perrnl# Occupied As ` building:, New d Occupant ' Work Area in Bu1ldin Floor #, etc. : for: Wirin Service or: Read for Inspection : . - Fee Remitted - $ ; . Cash Check M.L]t Filake Payable Td: D: I.A (Plumber of Rough Wiring Outlets Elect. Meat 3pn TSe Leee 12pe IE50 1i5o 2DOD j�250 2650 1T5b 5aoo r .,r-U. . - .. , , rm Switches _ Lightirrg ; '•`Y Amp. SerW'de, i� - Surface .Unit Dishwasher Receptacles Water Heater Air Conditioner Dryer Pump:. Nu mbel' rds O�@n . . Garbage l]l p Wirino and Controls for ' . r. s- �,RtaeAss�1:.: r�cional H.P. Vent Fans •.. Id Other Equipmwnt: - MOTORS W.P. . 1/2Y 1/ 1/10 1/8 2/6 1/4 1/3 1/2 .3/4 1 1�/2 2 3 5 . 7% 10 15 2d 25 aC 4D y�o 7i5 leD. ! -� Mark Nur 9 of Each Size Awl lcant's -Siignature License TIA Utility: Applicant's Address: -- (City} (State# [::::: ip3 � Seevica Request +All JIATL g RECEIVEn- .R DATE INSPECTEOi Correct Location Same as Above Q or: Red otice. Label - Rough'Wiring Outlets Surface Unit- Oven z Slnritches `' Ran Gar. Disposal : Receptacles Water Heater j : . t7ish+Iw ' er Fixtures AirfCornditioner . . / ryel�" Ari1p. Service Equipment Burner, Wiring'& Corfttols for Amp. RecsptAale Amp, Service Conductors Pum Vent Fans MMOTORS T RSH.P /2U Y/12 1/1C1 1/e 1J6 Y/4 1/3 1/2 3f r Y - i'rIx ,a 7ii's 10 i5 20 25 d0a4a6� ' S0 � . t' of Each Size Elect. Heat 30o Tsa lnnil lsso 15(lo YTeo s?S4 sa,OQ �s aaoo ' 01L RW Progress: Inc. LKI� fl ?" ,: Contractor �o Q CFT Violation : Work Comp. 0 Inq, Q CASH L/A „ ;y. Cfwner Fee CHK # Due - IPA Ni0 ' ' INV # - - , i n7 Date: Other SIde:O . . Utility b,; : ? ' :Clwir !ru# in Car Temp # Finei # :_ le Nate : `: ,� .. ,... ; APPLICATION P'rJRIIA NO. 250'r3L�4'.