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1989-568 ... o '.•a+a:.wtµgMT�`' ra.^. ..,...�.r- .—.F".,;r. :�. �.�;�1"YiR°r r�yr� .... . .y�-ram.�iA�°," .. -,�w-;v . _ �.�: .. f A�I���•F ��■■■yam,■■� `({�,/yyJ■� T T/ ` ER r yicATE V V Y 1 Y VI PAN%C.%.w%JL7 TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date This is to certify that work requested to be done as shown by Permit No. 89- 568 has been completed, This structure may be occupied as a — S i a a 1 e F am i 1 y Dwe 11 i n g Location 1 *rj!9!=FQui nox ari va Chwner Roger Phinney By Order Town Board TOWN OF +QUEENSSURY r Director of Bldg. & Code Enforcement _ BUILDING PERMIT TOWN OF QUEENSBURY No 89 568 WARREN COUNTY, NEW YORK r+' ti ry PERMISSION is hereby granted to Roger Phi nney �—• OWNER of property located at Lot 12 Equi nox Dri ve street, Road or Ave_ in the Town of Queensbury. To Construct or place a 5i n 1 e fame 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 Queensbury Building and Zoning Ordinance. -v 1 . OtWNER'S Addresses McCormack Drive KKK*X6***#*XXKXXX rn Lake George , N . Y . 12845 2. CONTRACTOR or BUILDER'S Name O tt� Cil John McCormack Fandspecifications R or BUILDER"( Address 7 Sarella Street Glens Falls ,N . Y . 12801 'S Name r-- 4r ry 'S Address r" O X nstruction — (Please indicate by X) ► G ^S Wood Frame ( ) Masonry i ) Steel l Y C ti Specifications No_ 68 ' x 72 ' Single family dwelling as per plot plan , specifications , and applciation , including septic and attached two car xx cn 13. Proposed Use to ro Single Family Dwelling J. PERMIT FEE PAID — THIS PERMIT EXPIRES February `� $ �SZ+ti nn a (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.) 19 89 Gated at the Town of Queensbury this 2fth Day of July y uM [ for the Town of Queensbury SIGNED BY Building and Zon' Inspector TOWN OF QUEENSBURY APPI, ICATIaN FOR BUILDING AND ZONING PERMIT Vatic- RevI e- i ev etif A R :l Fee. Paid . : BUILDING AND CODES LI 'PAR7T4ar.r pate Iabued BAY and HAVILAND ROADS RD I Box 98 Pevtmtt NO . pUEENSBURY , NRW YORK 22804 � Tel . ( 518 ) 792-5832 1 -204 * * c * OBTAINED I31 FORE * BEGINNING* CONSTRUCTION . * NO INSpnc T IONS A i ERfAIT MU �$ WILL BE ]MADE UNTIL APPLICANT HAS RECEIVED A VALID 13L' ILleted n e PERMIT . All applicable spaces on this application tstreVermpsideofthissheet . sipMature Of the applicant *must *I' a* * * * x * * * * * * ft * * * * * * * * - Xy7 3 �f The owner of this ProPertY is : TEL . "Z A � P . O . Address TAX MAP NO . Property location Has there been any split of this Property since October 1 , 1988 ? yes/ no if yes , Planning Board Review is necessary . LOT NO . SUBDIVISION NAME , IF APPLICABLE The person responsible for supervision of work as regards Building Codes is : � - s� �S ( v !'.,�"t..r,�i_;4�. T E L . 110 . NAME P * O . ADDRESS Tel ,c r' r .s sc,1 Address `~ Tel Name of builder Address C1 5 ' -) - Name of Plumber- Zvi +�cCx = Tel Name of Mason , Address t NATURE OF pRopoe"E'- D WC]RK : ZONING IN ) ' ORPIATION ( Orf.ice use Only ) ..-� ZONING DESIGNATION OF PROPERTY . f on:jCructiOJL of a new buildiny * PER1lI'I PF.D PRINCIPAL PERMITTED ACCESSORY Addition to .:a building �Altur:a4ion to a 1�uild'ng REVIEW REQUIRED - PLANNING BOARD ZONING BOARD � ( no CIUiM1194'! to excuri.or climen:: ions ) SITE PLAN REVIEW # APPROVED DATE Other wort: (de;cr113a:) x # VARIANCE # APPROVED DATE GkoSS AREA OF PR.OPOsES): STRUCTURE + Remarks : 1st Floor Z ' sq ft . &-50eq * - t.- �c; sr3 If t . COKPL CT IHr�or<VATION jgtUQUlftED s1� w+�+ . � c 4 2nd Floor ft x f = c3 ft . 05 try i,i4�-$- Lr}.! '``l -l-- r .�"�l"!.eo O f Pr4ia L•r t"yf . q L` t . Other Floors L �i r� v —5 ft + ixisti tIIIU11L1irrg ( u ) Si :su f e XS ( not cellar or�-sr;entI TOTAL FLOOR AREA �r _ SDI f It . * txiaG inq building ( ZO Usv of nL-w uGr Uc fora: ft }. ! ft l•`c>us,dati4n-Icierf ::,lakt/crawl/martial fui"rl " NropoSed building , d.�sLanc4 urty line frouL 1.r.aFa (circle one ) Front yard I `% ft Rear yakd t r `j tJ 1 t No . of stories (jL abit.ahle sl3ace) � �'_ — * Side yard. A-1 ; r' t and ft t(. fight t9rade to ridgvu ) ft * If onearner , uurh"ck from sidt: street s" a if residential , no . of faMiIies�, I OCCUPANCY INFOWATION No . of roomij ( excluding b:.ths) � No. of bedrooms ; pRTMAItY FaUIT.DTNL: No . of battrroornu fami.lyr dwelling YiriFn. rry ixuatinq :;yst , u^ is �� 'i , Two family dwelling Typ of £u` i i= Lr . Multiple dwelling / Number of units�,��� Non of fireplaces to bo irl�trallicf t * perttvancnt Occupancy Will a Wood 5L" oV�: k,.: in:aLullc d? * 'jrr"n:xurtt, IuCculXar'cy [Lentr:al Air coratliCionirrg-' � .�_ * Husinr:ss PRIMARY STRUCTURE r Industrial BUILDING STYLE, Other aaa j"11CIV, ContuuPor.ary Lon. Cabin � If addition . be? F4ais4d ranch Man_5 �u4k_^ ._ i]uyla x !JpliL luvei {Old 5tyl. 1su,iy..low ACCESSORY IaUIJ.PYb1G- C:.N� Cad d aq.a i)ctkur tear )cow town House _ had y ari,geJonL' curt LwcP ciar/ cav Coiani:al . ttach�d yiaraq�/pna car/ two care ( CIRCLE ONO PLEASE ) A w A • w * IN W R A A t A ]� ri 11 * T'r )'.viat<: storage building i `F` I MA `l' !: D MA % K'Y% VALUE OFh F [�F * ��� c: r CON :;'1' kl1C'1` T Ui+l Be COMPLMED1 7NFORMATTON ON BUILDING SprCIFICATIONS , ON VERSE SIGH of THIS �FlikT , TO Form BPA I0/88 vI 1.sUILDIRJC: PEI4.1pIl'1' Oil C3tR'!'11SUC0 fsU 1 LD ING SPECIFICATIONS : Typ&4 of construction , (wood fraRuo4.; fire safa , eto * will way :; econd-"nd or ungraded lumber be used? If so , £or what? I%t i Poundation wall Materi"I 0` ': jj! ., Thickn.:::s Depth of foundation below grade ( to bottom of footing ) Yl:f ' will than: be a teller :' -yam Rl::...te.a or unheated? QA1 ) Floor sq « footaga �� sq ft will tlware be a basr~��eunt: ��Will any portion ba: used as living sp"Ce? � ( if so , what portion? sq . ft . - - Type of use? 41ypa of roof - slop,rdrfldt/shedJotYaar 'Material. of roof Sil* u , Wood stlSd�' r . '" X " spacing..L.0 lang th .joists ( floor bwcauu ) l :.:t . floor CL •`]t i ? " spacing t c� "'o . c • apan" I ft . ; Joists ( Pioor beams } 2nd . floor -7_ "X spacings"Oec . span��ft . Qvarlays (calling baann:: ) "X Li spacing "o . C . span fL . icoat rafters "X�ip, "' apacisrg�i c, o . c . span�ft . lauof trus:aas (pre-angirxa�rcd) spacing_� < f "rs . c . span� -1 ''--ft . L:xtcrior wall finish V c ^ of What waterlal? lnterior wall finish I t If a garage is to be attached , de:: scribe muaterials to be. used for F11ZE S iAitA'1'ION : Is tlla ra t0 be an openirjg be aeen g::aragas and dwelling? if so will a Fxrerraeesd door , enclosure , and davice be provided? Will a flue: --linad ch.i.uun�y ba: installed? , e 7- - - Height aLA.;Ivu roof � ft - Dwpth of chimney foundaLiort below gr<ade:� .ft . Depth of fireplace heartYa�_ft ., _in . Water supply or private well SEPTIC SYSTEM _ Distance from ANY private well (including adjoining prQperti."�ft - tA separaterapplication is nuca=osary for any repair or nc:w installation of septic y�;tuan) D E C L A R A T 10 N To the best of my knowledge :.and belief the statemL4nt:: contained in this: application , toga ther with the plans and spuoificationa sub fitted , are a true and cowplast:e statemc aat of all proposed work to be done ion tlZe3 described premises and that all I covi ions of the E3UILDTRRG CC71]1? . "1'1R1: ZONI14C ORDINA.NCI- , arrcl nil ath%.tr laws 13LArtaining to 1_he: proposed work sli"Il la.a colitlaliead with, or toot , and th S:, wayctw work is 13y the3 ownar.- . ( ,{ " -' Signature �«. _ �.__.__•. QWne -, OWlla: r " :. a[1 ant , ar�ll �. a:Ctr CC?ntractor MCCORMACK INDUSTRIES l Sarelia Street GLENS FALLS, NEW YORK 12801 x 1 * x * ae 1 1, * s" w ar '. • * at i ]Y * • * * ae * * 'lr ! w w i * iL' 1r i4 * * w * * * * a • SPECIAL CONDITIONS QI' THE' PFJ4.14I`T' : TOWN OF QUEENSBURY McCORMACK INDUSTRIES eet WARREN COUNTY , NEW YORK GLENS FALLS, NEW YORK 12BOI Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning workv ANSWER ALL of the following : 1 . Gross floor area '_r".+�- 2 . Type of heat -_ '" 3 . Is the building mechanically cooled ? 7 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 ? 4w 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. - a 2 . R value of exterior walls 3 . R value of glazed area J 4 . R value of doors 5 , R value of floors over unheated spaces _ � � F - 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab- /+ 44 4 8 . R value of heated basement/ cellar walls ( above grade ) ;= l 9 . R value of heated }casement /cellar walls ( below grade ) 10 , Type of insulation f 5 (� C . Controls 7 1 . Thermostat maximum heat setting_ 10 D . Duct Systems 1 . Is duct system installed in unheated spaces ? YES .) h30 a . If YES , R value of duct installation— /, ) b . R value of duct in other areas , l4, I E , Piping Insulation 1 . Size of hot water or cooling carrying agent pipe _ L 2 . R value of pipe insulation {� _ LE- UG F . Service Water Heating 1 . Performance efficiency � = 2 . Temperature control setting maximum G . For Swimming Pool only 1 . Maximum heating f . ... ,i d Telephone No . ( r ,. __ ( ap li. cant ' s signa ur f? 16YO* 'QAWV APPLICATION FOR SEPTIC DISPOSAL PERMIT MCCORMACK INDUSTRIES GLENS FALLS,,NW K 12WI DATE E YOR LOCATION OF PROPERTY FOR INSTALLATION L_c i _ } O "—')f . Owner's Name: t� ; ( � tiHlrhlnL� Telephone: G -i Co Address: lC Installer's Name: k4CCORMACK INj2uSTRIE,g Telephone: 7 c1 7 ` HareFla Street C. GLENS FALLS, NEW YORK 12801 Number of bedrooms (residential only) _ x' Total daily flow (compute @ 150 gal per bedroom) Topography: circle one: Flat ' Rolling Steep Slope % of slope _ Soil Nature: circle one: Sand Loam Clay Other / Depth: feet Cxroxmd Water: At what depth? C_,) feet Bedrock. or Impervious Materials At what depth? Cj feet Percolation test: circle one: not required required / rate I min.finch. Domestic water supply. circle one: Municipal Well Other _ 1F domestic water supply is a Well: Separation: Watersupply from Septic absorption €eet PROPOSED SYSTEM: Septic Tank_ _ gal. (minimum size: 1,000 gal.) TILE FIELD : Each Trench feet / Total system length feet SEEPAGE PIT(5) s Number of _ Z� f Size each '• feet by r : feetr -- Size of stone to be used # < 7 / Depth or Thickness r1t feet IMPORTANT ...Please...LIST NEW EQUIPMENT TO BE ]INSTALLED (over) Section II 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 50 size and dimensions of all tanks, distribution boxes, the 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 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 requirements of the Town of Queensbury Sanitary Sevvage Disposal Ordinance. Signature of responsible person: Date: Town of Queensbury Building and Code Department Bay at Haviland Road Queensburyo New York 12801 (518) 792-5832 SE 'I- TLED 1763 . . . HOME OF NATURAL BEAUTY . A GOOD PLACE TO LIVE TOWN OF QUEENSBURY Ad Bu-rLDING AND CODES DEPARTMENT BAy & HAVILAND ROADS QUEENSBURY, NEW YORK I280k TELEPHONE (528) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR SPECTION CEIVEDS NAME LOCATION �}�7 DATE PERM #J TJ 7 [2 - APPROVED YES I NO FOOTING/PIERS MONOLITHIC POUR RMS FOUNDATION/DAMP- FING BACKFTLL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALKS CEILING FINAL .INSPECTION: Z . CHIMNEY HEIGHT FtpOFING SIDING EXTERNAL ppRCHNSJSTEPS STAIRS-CLEARANCE & RAILS pLUMBING FIXTURSs/RELIEF LVE INTERIOR TRIM/PRIVACY DOO#S FINZSHED FLOORS GARAGE FIRNPR00FXNG_ ,DOOR CLOSJKR (S) SMOKE DETECTORS FINAL ELECTRICAL INSPECT N ,rxmAL APPROVA CONS T TI _ oic To I scum l CSC A SIGNED CERTIFICATE OF . OCCUPANCY MUST OBTAINED FROM THE BUILDING DEPARTMENT BE RE THESE PREMISES ARE OCCUPfIEDJ REMARKS: f c / , — ARRIVE DEPAItT , t r�Y INSPECTOR �Joeun n� �tteens � eirr� BUILDING and ZONING DEPARTMENT Ray and Haviland Road, R. D. 1 p4cVx 98 Glueensbury, New York 12 01 SEPTIC D SP©SAL SYSTEM IN ECTION NAME LOCATION ,yr DATE � I Q _ ERMIT NO* SOIL TYPE -- Sand Loam - C1 Percolation Test quired? S - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , t tal le th Length of each tren h Depth of trenches Size of gravel SEEPAGE P-xTS4N f fttlike/p f) - - size- ft . X Gravel size _ PIPING : S z T eC� Bldg . to tank Tank to dist . box Dista box to field/ Openings sealed? ES NO rtial LOCAT X ON/SEP ARAT I C N S : Foundation to tank ft- Foundation to absorpt onft . Absorption to lot lin ft. Separation of pits TION SYSTEM ON PRO Y (circle one) ont - ar - Left a de - Right side - CdNMENTAI SYSTEMS USE APPR ED Building Inspector 01/8+6 and ul TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QiUEENSBURY, NEW YORK 228064 TELEPHONE (5I8) 792-58.32 BUILDING INSPECTOR' S REP ORT REQUEST FOR INSPECTION RECEIVED s' NAME /r LOCATION Ced f v/I p DATE ' f-� �- PERMIT # Q � y APPROVED YES I NO FOOTING/PIERS MONOLITHIC POUR RMS FOUNDA'T'ION/DAMP-P OOPING BAC LL APPROVAL ` _ GH PLUMBING FRAMING ELECTRICAL ROUGH-I INSULATION; FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES/REL1r,4BF VALVE _ INTERIOR TRIMIPRIVACY bOORS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS i FINAL ELECTRICAL INSPECTIONS FINAL APPROVAL OF CONSTRUCT N Y A .SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPAXTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 1 BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 228046 TELEPHONE (518 ) 792-5832 f� BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED1 � `�( ~� JP 01. NAME ��'��' 11 LOCATION 1 !_._..._. Cy11 JrA (0 Y, i spl DATE I [ }� _ PERMIT" # APPROVED YES NO FOOTING/PIFrRS MONOLITHIC FOUR FORMS FOUNDATION AMP—PROOFING BACKFSLL AP ROVAL ROUGH PLUMBI)YG 1� FRAMING ELECTRICAL RO H—IN / fVSULATTON: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNWRA HES/ E S STAIRSNCE & ILS _ PLUMBITURES/ IEF VALVE INTERIMIPRI AC DOORSFINISHORSGARAGEROOF NGDOOR CS)SMOKE ORFINAL ELA INSPECTS NFINAL AP F CONSTRUC ION A SIGNED CER IFICATE OF OCCU NCY MUST BE OBTAINED FR THE BUILDING DE RTMENT BEFORE THESE PREMI ES ARE OCCUPIED: REMARKS : V,a APPCTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT f}- BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I280¢ TELEPHONE {5I8) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAMED LOCATION ��/- � -- DATE ./ �� tRMYTI # / fP f } APPROVED YES NO FOOTING/PIERS'' MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING X RAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING !i EXTERNAL PORCHESISTEPS STAIRS-CLEA & RAILS PLUMBING FIXTURES/RELIEF VALL INTERIOR TRIMI PRIVACY DOORS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICAL INSPECTI N FINAL APPROVAL OF CONSTR TION A SIGNED CERTIFICATE O OCCUPANCY MUST E OBTAINED PROM THE BUI ING DEPARTMENT B FORE THESE PREMISES ARE OC UPIEDI REMARKS: IL INSP TOR - TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT — y BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280+9- TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED \ — 1 c S f'4 NAME 3 �• � V LCiCATION DATE C! �. �....c ` PERMIT #� �� 5 APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS (,,FOUNDATION/DAMP—PROOFING L.-�g'A CKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION ` FP.00RS WALLS CEILING FINAL INSPECTION: + CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ EPS STAIRS—CLEARANCE RAILS _� PLUMBING FIX TURE /RELIEF VALfYC INTERIOR TRIM/P LACY DOORS FINISHED FICJORS GARAGE FIREPR FIND DOOR CLOSERS) SMOKE DETECTO S FINAL ELECTRICA INSPECTION FINAL APPROVAL F CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS. r 0 ,4 lope INSPECTOR TOWN OF QUEENSBURY , BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I280+R TELEPHONE {518) 792--5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION DATE _ _;? PERMIT # APPROVED YES NO OOTING/PIE , MONOLITHIC FORMS^ FOUNDATION/D -PROOFING BACK ILL APPRO L ROUGH PLUMBING FRAMING ELECTRICAL ROUGH- N INSULATION: t FOUNDATION �l <' FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH /STEPS STAIRS-CLEARAN E & RAXLS PLUMBING FIXr RES/RErArEF VALVE INTERIOR TRI PRIVACY DOORS FINISHED F RS GARAGE FIREF4ROOFING DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED1 REMARK'S; INSPECTOR YOU ARE HEREBY REQUESTED TO INSPECT AND ISSUE CERTIFICATES FOR THE FOLLOWING ELECTRICAL EQUIPMENT TO BE INSTALLED BY THE UNDERSIGNED TEMP N DATE � ,��+ 7 CITY pR NLtRGE TOWNSHIP CLTIMTY SIAEET AND NO OR ROAD POLE NUMBER �..�J1n10 X �i! 1�i .t Vim. eE1WEEN W1iIV l"WC] '•!`Jw, �CRp6SS EfS lS PFEM� { e ' +/ ' JT.. .^�E[:TID I'� BLOCK LOT OOC S NAME - G� (Cl fL OWNER'S NAME AND AC1Df $S ` HGME TELEPHONE NU MBER CURRENT SUPPLIED BY FROM THEIR OFFICE ' WORK TELEPHONE NUMBER RVILDINQ IS ` NEW I.S- OLD ❑ WORK IS NEW ❑ ADDRIONAL ❑ 0EFECTS REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED I Ma_ Lamp OF OUTLETS NO. Of Fixtures a MOTORS HEATERS BRANCH OFFICE USE [iron mR Receptacles CIRCUITS ONLY Ceiling SideL'Vall RAilach t SxnICI1 Pendent Bracket No. T H.P. Watts AWG- '� TYPO Each N0. Ea¢H No. Gauge INSPECTION OUT- SIDE SUB- BASE BASE- MENT 1st FL. 2nd FL. 3rd FL. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED. BUT IF AT TIME OF INSPECTION, THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED, YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND AaJUST THE FEE TO COVER THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT. SIZE UF'MAINS FEEDERS ELEOTA IC SIGN Ps TOTAL VAkTT$ CHARACTER OF WORK Cl EXPOSED GA:TUBE SiGNf TAN SFORMERS OF yp, ❑ CONCFALEV BATE WORK TO BE STASR ED DATE COMPLETED SIZE OF SAGN;NUMBERY .n r,APADyTy SEHVIGE ENTERS aVILVING MANUFACTURER Or SIGN ❑ OVERHEAD ❑ UNDERGROUND LATE INSPECTION REOVESTED ON(OR AS NSAR AS POSSIBLE) WEPT TII FENTER(A10PJACANTS R D DELA BY QIYINO FULLNND ACCURATE INFORMAT N. ALL SPACES MUST BE FILLED IN OR ASPUCATION MAY BE RETURNED. PRINT NAME AND ADDRESS NAME OF APPLICANT DAB-TE�L7F APP TON STREET ADDRESS f � TE l✓ CITY OR POST OFFICE ZIP COO LICENSE NO. WHEN APPLICABLE ❑ 85 John Street f 47 State Street f ❑ 5" Delaware Avenue I ❑ 217 Lake Avenue + ❑ 202 Arterial Road NEW YORK, NY 10038 1 ALBANY, NY 122M I BUFFALO, NY 14202 f ROCHESTER, NY 146081 SYRACUSE, NY 13206 THE NEW YORiK BOARD OF FIRE UNDERWRITERS 1%1 ----- 60 ------ 13 V • I.��I� ,P�FE-,Q�IUC� /eUDOG P/�/ T.��IMPOs Cf�, J.e BAN M 7 eFl/ti P0,- 'C,4" 7v A,V,0,e,EW 7- A f c COe,�,4C& Cy . 70AIA.1 ,E. M C CO•eMIgC�t OTO: /01/91/.984 66S/�99 ,eCd: 10122//.984 M//V/A,fl-J II LOT ..SIZE ,eE�9.e fQU/ �30, 000 sq- F1' is 20' 0 TOWN OF QUEENSBURY Zoning AdmiMtor/j, O 2S• o • L= •Z7 94 I � �_ 6!//LD/NG SLAT ACC' A./AO'' \ � I 12 -lk9/.5. 9 -S f7-7) I � I CPT (C TA► V-. f 50 I /A/ 84 - 2'- ,36 W /74 Q � / 1 s¢ DD Vf _ �5,r- w.9TEA; W L /N &7 w w OF L 4A1,0 TO BE MAPayPLOT PL4# Co vvEyE,0 .3y Cml[ ,E,e & M �CA�exmc K C L/CE�t/JEIJ LANO .SUi2l/EyDRS 4WDRfir JoPW,� ��i Co,�i�1�Gk GL FW I WL L, f , ,t/ErV -V-O e k0��"Q y ,CoQ�Ai�/� V-PPIWezy TOWN Of q)f Al-0UK.Y W I e,eEN C OU/t/T-y NE w s/a Jury 14 SCALE -� F .96 �