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1989-653 .. . . � �'.y: :.ny;�x-. asircarri.�.•F«cs'w7.�. i: •=.Pi�r,�r�"",.. .�.''�,9w"Ty..o .._A-��+�r"..amac'. -'+lv'+��.�:. CERTIFICATE <)F- OCCUPANCY TOWN OIL QUEENSBURY WARREN COUNTY, NEW YORK pate November 16 19 89 This is to certify that work requested to be done as shown by Permit No. 89� 653 has been complettd. This structure mays occupied as a S i n a 1 e F am i 1 y Owe l 1 1 n q _. Location __ or-T Ai gnnnu i n Qri va punts Forest Wood domes By Carder Town Board TOWN OF QUERNSBURY - /' Director of Bldg. do Code Enforcement BUILDING PERMIT X X TOWN OF QUEENSBURY No. acb_ Fi S'1 0 WARREN COUNTY, NEW YORK t PERMISSION is hereby granted to Forest Wood HOMA,c tsr OWNER of property located at Lot 2,6 . AlgonQuin Drive Street, Road or Ave. ,r, Cx c in the Town of Queensbury, To Construct or place a Si ng l e Family Uwe l 1 i ng 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 HC-02 Sax 286P Warrensbury , N . Y . 12885 2. CONTRACTOR or BUI LDEWS Name a ^5 Qq u� Self `''' 0 3_ CONTRACTOR or BUI LDER'S Address Q O Same ro v~ d. ARCHITECT'S Name 5_ ARCHITECT'S Address r 0 c+ ND cn 6. TYPE of Construction — (Please indicate by X) Xx) Wood Frame f I Masonry I } Steel { ) o c 7. PLANS and Specifications No. 32 ' x 46 ' Single Family Dwelling as per plot plan , specifications , an - � application , including septic , attached two car garage and drivelway , m $. Proposed Use Single Family Dwelling $ 91 3 - 00 PERMIT FEE PAiD — THIS PERMIT EXPIRES March 1 1990 (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rr town of Q.ueensbury before the expiration date.) tb TI M Dated at the Town of Queensbury this 17th Day of August 19 89 SIGNED BY for the Town of Queensbury Building and ZoningTnspector r4 et2 TOWN OF QULENSBURY REVIEWED BY n TOWN OF 4UEENSBURY DECEIVED FEE PAID $ PERMIT N0 4 ••► W AUG 14 1989 c4t BUILDING PERMIT APPLICATION I�cLDG. & CODE DEPT.. . A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUC'PION. NO INSPECTIONS WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT. All applicants spaces on this application MUST be completed and the signature of the applicant MUST appear on the reverse side of this application. # R ale +R * ■ M yM yM M M # # Y k k * Me It yM +le R Me +F se Ir • # k * # * * � * * * # * t The owner of this property is. P.O. Addressd Tel. Property Location Tax Map No. Has there been any split of this property since October 1 , 1988 ? / If yes Planning Board Review is necessary. yes no SUBDIVISION NAME, IF APPLICABLE LOT NO. THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS: * NATURE OF PROPOSED WORK: * ESr;MATED MARKET VALUE OF � CONSTRUCTION: S.. Construction of a new building +► " Addition to a building * COMPLETE INFORMATION REQUIRED BELOW: r � .y� " Size of property 1 ft x ' s " ' bft. 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 ±a..ft . Rear yard ft. Side yards r ft, and ft. * GROSS AREA OF PROPOSED STRUCTURE * If on corner, setback from side street ft. 1st Floor sqw ft. fU * OCCUPANCY INFORMATION C7 » 2nd Floor Z- sq. ft. * Primary Building - Other Floors sq. ft. ,. '" One Family Dwelling (not cellar or basement) Two Family Dwelling TOTAL FLOOR AREA / <, : / -i st3- ft. * Multiple Dwelling/Number of units +F Size of new structure ::;�a ft x y' ,�- ft. Buslness Foundation-pierfslab/crawl/ rtf ' Industrial (circle one) ` - - - " Other No. of stories (habitable space) Height (grade to ridge) it, * If addition, what will use beg If residential, now of families „ No. of rooms(excluding baths) * Accessory Building No, of bedrooms No. of bathrooms t * Detached Garage ONE/TWO Car Primary heating system 1, t, * Attached Garage ONES!!0 Cam` Type of fuel INNW " Private storage building No. of fireplaces to be installed r_ > Will a wood stove be installed ; Other Central Air conditioning OV* ER Y BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS: Type of construction, wood frame, fire safe, etc. Will any second-hand or upgraded lumber be used ? If so, for what ? ; Foundation wall material Thickness Depth of foundation below grade (to bottom of footing) -� Will there be a cellar ? Heated or unheated? Floor sq, footage sq ft, Will there be a basement ? Will any portion be used as living space? (If so, what portion )' sq ft. Type of use? Type of roof - sloped/flat/shed/other Material of roof Size, woad studs "x " spacing " o.c, length 'r. _fte Joists (floor beams) 1st floor "x " spacing�l ' Ilo.c. span ft, Joist (floor beams) 2nd floor "x i{J "' spacing jb "to. c. span ft. Overlays (ceiling beams) "x " spacing." o. c. span ft , Roof rafters "x 'f spacing o. c, span ft. Roof trusses (pre-engineered) spacing " o. c. span ft. Exterior wall finish Iof what material? Interior wall finish - , If a garage is to be attached, describe materials to be used for FIRE SEPARATION; Is there to he an opening between garage and dwelling? r If so will a Fire-rated door, enclosure, self-closing device be provided? Will a flue-lined chimney be installed? Height above roof ft . Depth of chimney foundation below grade ft. Depth of fireplace hearth ft, in. Water supply - Municipal or private well SEPTIC SYSTEM Distance from ANY private well (including adjoining properties fte (A separation application is necessary for any repair or new installation of septic system) NAME OF BUILDER ADDRESS TEL. NOw i r' NAME OF PLUMBER ADDRESS TEL. NO, NAME OF MASON ADDRESS TEL. NO, NAME OF ELECTRICIAN ;` ADDRESS TEL. NO. DEC LARAIMON 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 sell other laws pertaining to the proposed work shall be complied with, whether specified or not, and that such work is authorized by the owner, Slgnatur��1'. Owner, owner's agent, architect, contractor SPECIAL CONDITIONS OF THE PERMIT: 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 . Gross floor area 2 . Type of heat 3 , Is the building mechanically cooled ? _ pt 4 , Percentage of area of windows and doors A . Over 16 % Only 19 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 % Oni f 1 . R val o roo and floors exposed to ambient conditions .2 . R value of a _ rior wall 3 . R value of glazed area - 4 . R value of doors 5 . R value of floors over unheated spaces 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation on heated slab 8 , R value of heated basement/ cellar walls ( above grade ) 9 . R value of heated basement/ cellar walls ( below grade ) low Type of insulation ► C . Controls 17 Thermostat maximum heat setting :�; (j D , Duct Systems 1 . Is duct system installed in unheated spaces ? 'YES - NO a . If YES , R value of duct installation X ' L-; b . R value of duct in other areas E . PJwp1n2 insulation 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F , Service Water Heating 1 . Performance efficiency -`It') 2 . Temperature control setting maximum / -) G . For Swimming Pool Only 1 . Maximum heating `7 Telephone No . -s " ' `% / _. .__ ( applicant ' s signature ) TOWN OF' QUEENSBURY . ;k_; _ APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE LOCATION OF PROPERTY FOR, INSTALLATION Owner's Name: } ;'r - fJ1r. . Telephone: Address: jL 2of f . t V Installer's Name: Telephone: Number of bedrooms (residential only) Total daily flow (compute (d 150 gal per bedroom) Topography; Circle one: ( Flat olling Steep Slope 96 of Slope Soil Natures Circle on Sand Loam Clay Other /Depth: Feet Ground Water: At what depth ? Feet Bedrock or Impervious Material: At what depth? Feet Percolation test: Circle on c ~not required'> required rate min. inch. Domestic water supply: circle one: �Municipa7 .• Well Other If domestic water supply is a well: Separation: Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank C)f, (-) `gal. ( minimum size: 1 , 001) gal. ) TILE FIELD : Each Trench _feet/Total system length C)00 feet SEEPAGE PIT(S): Number of / Size each feet by feet Size of stone to be used # /Depth or Thickness feet I have read the regulation on the reverse side of this sheet a d agree to abide by these and all requirements of the Town of Queensbury Sanitary age Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: -- __ DATE * OVER Septic System Inspections ; A . All applications for septic system installationp 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 srructures 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 ltuilding Inapuctor . Failure to comply with this requirement may result in the uncovering; of the system by the installer and a fine of up to $ 2,150 . 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 bu submitted to the Queensbury Building Department before further c a n s t ruction . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 �uivarks : ' j TOWN OF Q'UEENSBURY BU.rLDING AND CODES DEPARTMENT BAY & HAVILAND ROADS ] QUEENS-BUI? o NEW YORK I280* TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT RES UE.ST FOR XNSPECTION RECEIVED NAME ,r _ J ZOCATION DATE APPROV D FOO2'23VG/PIE �'ES NO MONOLITHIC OR FORMS FOUNDATTOAN P—PROOFr BACKFILL APP VAL ROUGH r'LUMBrN FRANrNG ELEC27RXCAL R hr,,rN rNSULATrON.r FOUNDATrON FLOORS WALLS L�jNALING L rNSPECTrONs CHrNNEY FIIs rGHT ROOFrNG SrDrNG E7LTERNAL PORCHES/ EP S2'AIRS—CZRARANCE S, LS PLUMBING FrXTURES/R EF VALVE rNTERrOR TRIM/PRIVAC DOORS F-rNTSHED FLOORS ~' GARAGE FIREPROOFING DOOR CLOSER(s) SMOKE DETEC2`ORS FrNAL RLECTRrCAL INSPE TION FINAL APPROVAL OF CONS RUCTr ~` �,+`�• A SIGNED CERTrFICATE O OBTAINED FROM T Na DE HE Bux ANCY^,WT BE THESE PREMISES ARE DEPARTMENT BEFORE OCCITPSED! REMARKS: ljot � fr I • 4 INSPEC R MIDDLE DEPART_ ffr, aN AGENCY, INC. �� � G�✓�� sao JIs�INo(ii+�nlrenuer.+s,.sQ��ino[+r��:� DOW November 13 , 1989 (Certlftco; that to lect11iequipment listed has been exa, end an approved as being in accord with the National Electrical Code, applicable governmental, utility and Ag cyyy 'I S. Owner bore stwood es 1 r' P Single Fami Occupant: S Y1 is Location. Lot: 26 A1ga uirt �iirit v Qur a c ca+e �loc tic uipmenx and installation ins petted I -Y , dole. It additional all nt !h be in+roduc*d or alterations mad* to exie+ing SySlem ih�� ma b* noll and Vold. and application for is l �n Spool loIt should t�s Subunit p fly to this Agency. Equipment: 140 Outlets,��" 60"ReG4ptaG left ; . Y�{Q aAX k13X k'old*r of this CO Fill sh Fd rn same to his property insurance carrier tP t.. lo $ I�uikl .Zrir't A _ty YJ+�.L.v .� 9 Ay Ixl i ant.e� {agent or CampAny}asevld}IfC *rti11ca7ion of*lectfic*l equipmont approved ilV 2311tC F't" as Specitiad,'- I J rForestwood Hollio lI Applicant: HC-02 Box 2061' -:sue o . 15 •-029114 AA Warrensburg, NY 1288 Form 06M 7= EL 1-4113 _J`tswrt O� �teeertJEretrt�e BUILDING and ZONING DEPARTMENT Bay and Haviland Road, iR,p. 1 Box 98 - Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION p� DATE �� PERM IT No SOIL TYPE - Sand - Loam _ Clay - Percolation Test Required? YES Percolation ]Cate - NO - Min/Inch TYPE of SYST - Absorption f.i d , total length Length of each trench Depth of trenc s Size of rgravel SEEPAGE ? ITS-(N� ex. of} Size- ..ft. X _ ft. Gravel size PIPING : Siz Bldg _ to tank Tank to cost. box Dist, boa_ to field/ Openings sealed? E NO Partial LOCAT TON/+S EPA RAT IONS roundaticin to tank . Foundaticn to abscrp ion l f t ft . Absorption to lot I ne ft * Separation of pits ft. r. ION ON P OPE TY (circle one) Frontront ear L t side - R ght side CCNIMENTS SYSTEM USE APPROVED yE Bui Ong Inspector 01/86 and vi i TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT RAY & HAVILAND ROADS QUEENSB'URY, NEW YORK 2280il- TELEPHONE (5I8) 792-58,3 BUILDING INSPECTOR' S REPORT REQUEST R xNSPECTION RECEIVED NAME LOCATION DATE PERMIT #, APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL Y L.00ROUGH PLUMBING �.,,+F`RAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES STAIRS-CLEARANCES & RAIDS PLUMBING FIXTURES/RELIEi-. VALVE_ INTERIOR TRIM/ RIVACY Do6Rls FINISHED FLOORS ` -- GARAGE FIREPROOFING DOOR CLOSER ($) SMOKE DETECx'C1RS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FRAM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPTEDC REMARKS: e- i A -t� LL1lf'� J "Rc" �r INSPEC R TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT" BAY & HAVILAND ROADS 2 QUEENSBURY, NEW YORK 32801� rI"' TELEPHONE (528) 792-5832 BU I MI NG INSPECTOR' S REPORT REQUEST �FOR { _INSPECTION RECEIVED _ NAME LOCATIONti'©7� DATEp RMIfi �ty AF`PROVED 'YES NO FOOTSNG/PIERS MONOLITHIC P UR FORMS_ FOUNDATIONfD P-PROOFING� f BACKFILL APP OVAL ROUGH PLUMBI FRAMING ECTRICAL ROUGH-IN SULAT'ION. FOUNDATION FLOORS + + WALLS ,CEI LING FINAL INSPECTI N.� t CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCH /STE S STAIRS-C EA RAN E & RA-SLS PLUMBING FIXT RES/RELXZ4 VALUE INTERIOR TRT /PRIVACY DOORS FINISHED F RS GARAGE FIRE ROOFING DOOR CLOSE (S) SMOKE DETE TORS FINAL ELECT CAL INSPECTION FINAL APPRO AL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: � r -� INFECTOR TOWN CAP QUEENSBURY BUILD.TNG AND CODES DEPARTMENT BAY 6r HAVILAND ROADS / QUEENSBURYr NEW YORK 128pg. TELEPHONE (528) 792 5832 BUILDING INSPECroR ' S REPORT REQUEST FOR INSPECTION JRECEZVED NAMES /�`. � L {f 5�1m-.wsro .�.�[7C. ATIQN 7 �F �t7 y� r! • _.R_� DATE b�—= ��' PE IT # � APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS "-'F��OUNDATION/ AMP-PROOFING L- CKFILI. AP VA ` ROUGH PLUMBS G FRAMING ELECTRICAL RO H-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTIONA CHIMNEY HEIGHT / ROOFING SIDING EXTERNAL PORCHE /STE STAIRS-CLEARAN E & RA u PLUMBING FIX RES/BELT a VALVE INTERIOR TRI (PRIVACY DOiQRS FINISHED F RS -- GARAGE FIR PROOFING DOOR CLOSE (S) SMOKE DET w7T2RS FINAL ELECT ICAL INSPECTION FINAL APPR AL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED,( REMARKS. _ INSPECTOR TOWN V Q(IE Y BUILDINGG AND CODES ODES DL'PARTMJ$NT BAY & HAVILAND ROADS r0 "7 , QUEENSBURY, NEW YORK 1280j& TELEPHONE (5148) 792-5$.32 BUILDING INSPECTOR ' S REPORT REQUEST FOyR" INSPE/CTI/ONV RECEIVED NAME LOCATXOyN DATE Q P IT # APPROVED YES NO A--FC.POTING/PIERS oA- MONOLITHIC POU FORMS F'OUNDAT TON/DAMP—PROOFING BACKFILL AP RCTVA ROUGH PLUMB FRAMING ELECTRICAL ROLUgH—IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL 21VS'PECTIONc CHIMNEY HEIGHT ROOFING SIDING EXTERNAL POR HES/STEPS ^r STAIRS—CLEA NCE & RAILS s ` PLUMBING F TURESIRELIEF fLLVE INTERIOR T IM/PRIVACY DOORS ' FINISHED yOORS GARAGE F EPROOFING DOOR CLO ER (S) SMOKE D TECTORS FINAL ELE TRICAL INSPECTION FINAL AP P OVAL OF CONSTRUCTION A SIGNED CERTXFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT ,BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: R INSPEC TOWN OF QUE.ENSBURY BUILDING AND CODES DEPARTMENT BAY &]Y�f+HAT�Vf�.ILAND ROADS QUEENSBURYr NEW YORIC 1,?8ofi TELEPHONE (518) 792- 5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTroAV RECEIVED NAME t..00ATIDQN DATEPSB�l22" # APPROVED I SS No TN /PIE �' MONO TH POUR FORMS FOUND 2(7N/DAMP-P,R'ppFING BACKFI APPROVAL ROUGH P BING FRAHING ELECTRICAL GH-IN ' IIVSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CH1rMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ST PS STAIRS-CLEARANCE ,� x PLUMBING FIXTURES/ ELIEF ALVE INTERIOR TRIHfPR2 ACY -- F.rNISHED FLOORS GARAGE FrREPRoo rNG DOOR CLOSER (S) SMOKE DETECTO S FINAL ELECTRIC INSPECTION FINAL APPROVA OF C01VS27t,[lCTION A SIGNED CE TIFICATE OF OCCUPANCY T BE OBTAINED F M .THE .BUILDING DEPARTME T THESE PRE SES ARE OCCUprEDd BEFORE 1 n.J R2, z T S TNSP Ton F5 SELECT BUSINESS FORMS (609) 228� 7775 APPLICATION FOR ELECTRICAL INSPECTION PLEASE BEAR DOWN YOU ARE MAKING (4) COPIES 'k MIDDLE DEPARTMENT INSPECTION AGENCY, INC. ��- National Headquarters 900 Haddon Ave., Collingswood, N.J. 088108 SECTIONAPPLICANT COMPLE TES THIS Date : City, Town or Township IXueL 1'1 t County hf i 4 ; r State fj94 Location/Address^ n yt � , � dY . C!� i[ (V Loca d in Fiklral Area - Please Attach Directions ) Pole # Owner_ZD1 £ T It 1 '3 i2 n t-Q iry, r Permit # - G 5 Occupied As Building ; NewQ OIdO Occupant Work Area in Buildin Floor #, etc. ) - App. for: Wiring C] Service 0 or: Ready for Inspection : Fee Remitted - $ Cash Q Check F7 M. O. Q Make Payable To: M. D. I.A. Number of Rough Wiring Outlets saD 750 iooD �zSD iSDD x7sD zoaa z25o 2soo z7sD aoaD 9 g Elect. Heat Switches Lighting Amp. Service Surface Unit Dishwasher Range Receptacles Water Heater Air Conditioner Dryer Pump Number of Fixtures Oven Garbage Disposal Wiring and Controls for Burner Amp. Receptacles Fractional H.P. Vent Fans Other Equipment: MOTORS H.P. 1/2 1/12 1/10 ilia 1/6 1/4 1/3 112 3,14 1 1312 2 3 5 7312 la 15 20 25 3p 40 50 75 100 Mark Number 0f Each Size Applicant's t . / Signature SJ License # Permit �# T/A Utility Applicant's address : H[C' LLb� 'bca-rc �.$ { INAMEI {OFFICE l OCATION (City) uaOL.X &wsbutv-g (state)%am (Zip)—},IN%&$ 5` Service Request # Phone # +fJa 3- 3 '� ') Electrician : S DATE RECEIVED: DATE INSPECTED : Correct Location : Same as Above ® or : Red Notice Label E:J Rough Wiring Outlets Surface Unit Oven Switches Range Garbage Disposal Receptacles Water Heater Dishwasher Fixtures Air Conditioner Dryer Amp. Service Equipment Burner, Wiring & Controls for Amp, Receptacle Amp- Service Conductors Pump Vent Fans MOTORS H.P. 1/20 1/12 1 1/10 1 1776 1/4 113 1/2 3/4 1 1 1+h 2 3 5 731z 10 15 20 25 30 40 50 1 75 100 Mark Number of Each Size Elect. Heat 5DD 1SD 1D00 1250 1500 i7S4 20DD 2250 25D0 2�50 30OD OILdffCT USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECT FEE PAID Q RW Progress : Inc. © LKD Q Contractor Q CFT Violation : Work Comp. Q Inc. Q Q L/A Owner CASH [] L/A Fee CHK # IPA Municipal due MO * INV # Date _ Other Side Utility Applicant Owner Cut in Card 71 Temp # Date 99 � k4' f 24 oy �. 34- 5d� 1Y L _ 1 0 4 a� :.,; y3. 2. i 1 . 07 g-7.J4. tj sl 1 7 T ,S7,f-1-. Btl-`+� YS,00 ' q• rec ..agx'.+. /. o$ ' 7'i�.'#cj ' i o z r o e t cue TOWN OF QUEENSB ..r� .rF - r f too 4W �. R. ru ....� aVrr i//r�rciiiF�!• j Jv "�+rql► *40 � e,► tit �5`� W o oI�► �-�-01�1.�`s � '�. +40 74 t"Yl C) V NT' t rl +�,,I be qt3!