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1989-713 I , � y i CERTIFICATE OF OCCUPANCY TOWN OF {QUEENSBURY j WARREN COUNTY, NEW YORK rate November 22 19 fig This is to certify that work requested to be done as shown by Permit No, 89-713 has been completed. This structure may be occupied as a, Single Family Dwelling Location _��:: n' 4 Tree Ci rcl Owner A to Z Drywall 8y Order Town Board i } TOWN OF QUEENSBURY II I Director of Bldg. & Code Enforcement 4 _ - qr' x BUILDING PERMIT TOWN OF QUEENSBURY No. 89-713 4 WARREN COUNTY, NEW YORK t cs+ a PERMISSION is hereby granted to W or Street, Road or Ave. OWNER of property located at 1=nrJr1 v DwEI Llrrc in the Town of Queensbury, To Construct or place a , SIMILE LC 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 Box 528 RR 2 cam+ Queensbury , NaY . 12804 2_ CONTRACTOR or BUILDERS Name -+[ Self 17J 3. CONTRACTOR or BUILDiER`S Address Same r- cD 4. ARCHITECT`S Name Co co C7 5, ARCIilTECT'S Address X rr+ l'*1 rr. 6_ TYPE of Construction — (Please indicate by X) 70 4f A Wood Frame l ) Masonry I 1 Steel I } r� r+� 7. PLANS and Specifications No. 26 ' x 40 ' Single family dwelling as per plot plan , specifications , and application : including septic , attached two car ga age , drivewayo B. Proposed Use v Single Family Dwelling r n 119 90 $ 2�65 a 0❑ PERMIT FEE PAID - THIS PERMIT EXPIRES x r llf a longer period is required an application for an extension must be made to the Building and Zoning inspector of the r town of Queensbury before the axpi rat ion date_} C Dated at the Town of Queensbury this }1 Day of Sevtember 19 ' r r r for the Town of Queensbury SIGNED BY Bull ing and Zoning c[or TOWN OF QUEENSBURY r REVTE W ED BY t r1F�Y FEE PAM # {j ���' C-at PER MIT NO. �!'— '�! 9 BUILDING PERMIT APPLICATION B[ ©QA a GOpE PEAT A PERMIT MUST BE OBTAINED BEFORE BEGINWMG CONSTRUCTION. NO INSPECTIONS WILL BB MADE UNTIL. APPLICANT HAS RECEIVED A VALID BUILDING PERXffw All applicants spaces on this application MUST be completed and the signature of the applicant MUST appear on the reverse side of this application. s s � • s s a s s s s s s s w s +s s a w • s s s w s s s s s s s s w e s . a a w s The owner of this property is: c� P.O. Address_ S 7`, Tel. I C7 `C oft _ L Property Location �,o Tax Map No. �rrs � � �� �i" � I�! 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 12Q t?42 W" 1-1 � :S LOT NOo ` THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS: IE E 5 -1jP NATURE OF PROPOSED 'WORT{ : * Esr,MATED MARKET VALUE OF Construction of a new building ,. CONSTRUCTIC}N0 $ I )� I 1 * COMPLETE INFORMATION REQUIRED B Addition to a building * Size of property LJ ft x ft. Alteration to a building * Existing Buildings( 3 ) Size ft. (no change to exterior dimensions) Proposed building - distance from property line: Other work (Describe) " Front yard it. Rear yard 3 ft- * Side yards ft. and / ft. * If on corner, setback from side street ft- GROSS AREA OF PROPOSED STRUCTURE 1st Floor �/ LS `{ sq. ft. I�'� OCCUPANCY INFORMATION 2nd Floor r 0 sq* ft. f * Primary Building - Other Floors sq. ft. * r� One Family Dwelling (not ceH&r or basement * Two Family Dwelling TOTAL FLOOR AREA � L-)sq. ft. ' Multiple Dwelling/Number of units Business Size of new structure rf ft x [t. * Foun ial�dation=Verlslablcrawl/part ' Industrial (circle one) • Other No* of stories (habitable space) Height (grader to ridge) a2 �2 ft. * If addition, what will use be? If residential, nou of families 1 • Noo of rooms(excluding baths) Accessory Building Noe of bedrooms ' Detached Garage ONEITWO Car Now of bathrooms Primary heating system J eft c- R • —Attaci�ed C3aeag~a ONE WO Cain Type of final G =, * Private storage building No, of fireplaces to be installed C * Other • Will a wood stove be installed� Central Air conditioning 1'` ' OV* ER BUILDING PER -NIIT .ApprIC _kTIoN i- GVTI `rL" ED - BLvTLD (NG 3PECTFICATIONS. Type of construction, wood frame, fire safe. etc. 1r-Oo0 Will any second-hand or upgraded Irxmberbe used ? If so, for what ?�_ Foundation wall material f7t l3yj (►J Ca C rlh kness Jr Depth of foundation below grade ( to bottom of footing) f t I Will there be a cellar ? ` �� Heated or unheated ? L, t� �p�- .j Floor sq. footage y P g y sq ft . Will there be a basement ? � ev Will an portion be used as living spacer, (if so, what portion ? sq ft. Type of use ? Type of roof sloped fatJshed lJother-7`'` Material of roof Size, wood studs_ "x� " spacing 14 it o. c. length ft. .foists ( floor beams) 1st floor "x /'Q " spacing "O.c. span / ft. Joist (floor beams) 2nd floor '�x—Z ram- i, spacing '` /_ "o.c. span ,,/ gt . Overlays (ceiling beams ) "x it " o. ce span ft. Roof rafters it it" spacing a. c. span ft. Roof trusses (pre-engineered) spacing �^ o. c. span ft. Exterior wall finish l h,ay t j 30 )_1s.zs4.... of what material? I Y Interior wall finish tea---- t . '. If a garage N to be attached, describe materials to be used for FIRE SEPARATION: Is there to by an opening between garage and dwelling?self-closing device be provided" If so will a Fire-rated door, enclosure, 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 �gt, (A separation application is necessary for any repair or new installation of septic system) NAME OF BUILDER ADDRESS 2lZ �, 6-I! ry v � L ^ / fit +[� L. N(]. NAME OF PLUMBER r3 c"< 5 :�- ^LS s'-4` ADDRESS c�-lZttty v r ULjt TEL. Moo lyt -L NAME OF MASON LL `ADDRESS__ rA 10 Crt' 6-1) N� oL �L. NO. NAME OF ELECTRICIAN ADDRESS ,y- zt, l i x LJF- _TEL. NO. DECLARATIox 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 the described promises and that all proposed work to be done on &H other laws provisions of the BUILDING CODE, THE ZONING ORDINANCE, and pertaining to the proposed wank shall be such work is authorized by the owner. complied with, whether specified or not, and that Signature� ,_ , ,! Owner, owner's merit. architect, contractor SPECIAL CONDl"I'iONS OF THE PERMITS TOWN OF QUE VSSUM- : 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 : I * Gross floor area 2 . Type of heat_ S la {� 3 . Is the building mechanically coaled ? � ) `-' 4 . Percentage of area of windows and doors - A . Over 16 % Only 1 . U al vue of gross area of walls , roof / ceiling and floors o exposed to ambient conditions 2 . Floor over heat - . d spaces YES NO a . Are foundat on walls insulated ? YES NO 1 , If YES , what is the R value ? 3 . Slab an grade YES NO a . If YES , wh . t is the R value of insulation around perimeter of floor ? 4 , is basement heated ? YES ND a . R value of insulation 5 . Type of insulation B . Under 16 % only 1 . R val c+ f�roof and floors exposed to ambient conditions , 2 . R value of exterior walisi 3 . R value of glazed area 4 . R value of doors 1 ,r 5 . R value of floors over unheated spaces C11 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab s . R value of heated basement/ cellar walls ( above grade ) 9 . R value of heated basement / cellar walls ( below grade ) 10 . Type of insulation C . Controls -�7 4!:26 1 . Thermostat maximum heat setting D . Duct Systems 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 ing agent pipe 1 . Size of hot water ar cooling carry 2 . R value of pipe insulation g , Service Water Heating 1 . performance efficiency 2 . Temperature control setting maximum G . For swimming Pool Only 1 . Maximum heating Telephone No . - ( applicant ' s signature ) TOWN OF QUEENSBURY Cie APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE 3-1 L] LOCATION OF PROPERTY FOR INSTALLATION L 07�1 lb Owner's Name: { "� O '� Telephone: Address: 1 � "'-r+ G� fL Installer's Name: Telephone: Number of bedrooms (residential only) ' _ Total daily flow (compute (d 150 gal per bedroom) r7 Topography: Circle one: Flat Rolling Steep Slope % of Slope F�'- L. Soil Nature: Circle one: Sand Loam Clay Other ,j )0rY\J10 /Depth: ) 0 Feet Ground Water: At what depth? Gnen Feet Bedrock or Impervious Material: At what depth? ` -n C9 Feet Percolation test: Circle one: < not require required rate min. inch. Domestic water supply: circle one Municipal Well Other If domestic water supply is a we Separation: Water supply from septic absorption feet PROPOSED SYSTEM : Septic 'rank gal. ( minimum size: 1 ,000 gal.) TILE FIELD: Each Trench feet/Total system length feet �y SEEPAGE PIT(S): Number of -4c/ -41 . -/ Size_ each feet /low feet Size of stone to be used #.3./Depth dr Thick, 2 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: E7+ -- • 2 t .` �'_ 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 (3uilding 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 covered before inspection and approval by the Building InspQccor . Failure to comply with this requirement may result in cite uncovering; of the system by the installer and a fine ut up to $ 250 . 00 . C . An approved copy of the plot plan shall be available on the construction. site . Failure to produce said plot plant 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 he submitted to the Queensbury building Department before further construction , Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 ?iemarks : A TOWN OF QUEENSBUR.Y BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS OUEENSBURY, NEW YORK 1280& TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME Z.00ATION y ,RATE /J• F'��r� PERMIT # APPROVED YES NO I FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN ! INSULATION: FOUNDATION FLOORS WALLS CEI G F L INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/S PS STAIRS-CLEARANCE & ILS PLUMBING FIXTURES IEF VALVE_ INTERIOR TRIM/PR AC DOORS FINISHED FLOORS _......_ _.......... GARAGE F IR EPROO I NGu _ DOOR CLOSERS) SMOKE DETECTOR — FINAL ELECTRIGA XNSPECTION _ r FINAL APPROVAL F CONSTRUCTIO K -- s A SIGNED CERTIFXCATE OF OCCUPANCY MUST BE OBTAINED FROM THer^-BUILDING DEPARTMENT .BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: 4 INSPECTOR TOWN OF QUEENiSBURY y4s27 BUILDING AND CODES DEPARTMENT 1 SAY 6 HAVILAND ROADS QUEEN.SBURY, NEW YORK 12804. TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTrON RECEIVED NAME _ ��/ / 0; ,��'7.15/�,� LOCATSON 0 ; // Cam- DATE �/ — CJ PERMIT # APPROVED YES All NO ,P,6DT2NG,/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—PROOFING BACXF'ILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION.- CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORC S/S EPS .STAIRS—CLEAR LVCE & R TLS PLUMBING F"I7 �3`LIRES/RE XEF VALVE INTERIOR TR&N1PRIVACY 'DOORS FINISHED F40ORS �. GARAGE FI EPROOFING DOOR CLO R (S) SMOKE DE ECTORS FINAL ELEC RICAL INSPECTION FINAL APPROVAL OF CONSTRUCTIO A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT ,BEFORE THESE PREMISES ARE OCCUPIEDd REMARKS: N ECTOR _Down 0eYeen3bure� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Oueensbury, New York 12801 SEPTIC CCfJ DISPOSAL SYSTEM SYSTEM INSPECTION NAMEL f f 1 �L �G�. eyt�GGOIL1�._ . LOCATION C?14r �.�fl�C DATE Z - q ! PERMIT NOC `T ' /F 3 SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES NO Percolation rate - Min/Inch TYPE of SYSTEM : Absorption field , total le th Length of each trench Depth of trenches Size of gravel SEEPAGE #TS#Number ofA Size- ft: X L�� -- _ Gravel size - � PIPING * S i Ty Bldg . to tank Tank to gist . bo Dist . boa_ to fi d/ Openings seale O Pa 1 1 ' LOCATION/SEP TIONS : Foundaticn t tank ft. Foundation abscrptio�i Absorption o lot line t . Separation of pits f t. ION SYSTEM ON PRO$ERT (circle one) Front - R ar - Left side -' Right side - '�i�3'I±LJTS L. " 5 ti SYSTEM USE APPROVED YOSINO r Building Inspector 01/86 and vl MIDDLE DEPARTM ON AGENCY, INtC, Ird aoa aWUSP watt, October 3U , 1Certifice; that Ier;tyiVa1 equipment listed has been exam"rirlec a approJed as being inwith the National ElctOgioa applicable governmental , utility acid fiC }��y es. DOwner: A to 2Occupant: Single Fain f � � yyI.ot 108 0+ak ee r 'QiTl c' ll�y Qlt ns ca ate � t uipment and installation inisL(}caticfn. date. It additional ui anent ah be introduced or alterallooti:" existing system tho cqf Jea be null and void. and apr11� (]utl@tf3 tec.gptacles , Fixttvres inspection shouldbasrrbmatt p tlytothisAgency Equipment: US3 P F. (,T I [ �'Older of this mftiflcata a ld ant same Ie his property insuer200Amp Service ; pp lian.Fe.rs agent ar compFnyl as evi c aRlticaHo ofelaclriCal equipmd v F as apeclfied.,J r ' Joktxx Roberts . . _ .._._ ... Applicant. Box 528 , RR2 - €« ( �3 w a • 15 -029522 Granville , NY 12832 Fmwt Fln, 703 EL t TOWN OF QUEENSBURY BUT L K � DING AND CODES DEPARTMENT 10 IJ HpyVILAN ROADS A 4 POR 1280 QUEENNSBURY. 5 W 792-5832 TELEPHONE 28) WILDING INSPECTOR' S REPORT REQUESTINSPECTION RECEIVER [� / FCJ LOCATOXON DATE APPROVED YES I.Io FOOTINGIPIERS FORMS MONOLITHIC PO pROOF'ING��� FOUNDATX oNI DAM BACKFILL APFROvAz ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-I1 INSULATION: FOUNDATION FLOORS _ ! WALLS CEILING ,FINAL INS PEC TION : CHIMNEY HEIGHT ROOFING SIDING _ EXTERNAL PO �ANc' &TRAILS STAIRS 'CLE SIRELIEF VALvo PLUMBING FIX RTVACY DOORS , _ INTERIOR TRIM/ ,FINISHED F LOO SFING GARAGE FIREP DOOR CLOSER ( ) SMOKE DETEC ORSINSPECTION`� FINAL ELECTRI AL FINAL APPROT7 LOF OF CONSTRUCTION MUST BE A SIGNED CE ITC ATIF B[7 IOCCTjPANCy DEPARTMENT BEFORE OBTAINED FRO HE THESE PREMISES ARE OCCUPIED! REMARKS : INSPECTOR TOWN OF QUEENS1 URY BUILDING AND CODES DEPARTMENT BAY g HAVILAND ROADS QUJEENSBURY0 NEW YORK I2$O TELEPHONE ( 51.$ ) 792-5832 BUIL3]I13G INiSPEMOR' S REPORT REQUEST dR INSPECTION RECEIVED NAME ' ! LOCATION PERMIT # DATE J ~ APPROVED YES NO FOOTINGIPTERS FORMS MONOLITHIC +�UR _ OOFING FOUN77ATIDAPPR VAL BACKFILI. UG PLUMBING ' MING ELECTRICAL ROUGH IN { INSULATION= ' FOUNDATION �- FLOORS WALKS CEILING FINAL INSPECTION - CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHESf�TER. I PA STAIRS^CLEARANCE E VE��-- PWMSING FIXTURESfREL INTERIOR TRIM/PRIVACY DOORS FINISHED FLOORSS --- GARAGE` FIREPROOFI l DOt7R CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL NSPSCTION FINAL APPROVAL J CONSTRUCTION _`__-- FICATE OF OCCUPANCY MUST BE SIGNED CER OBTAINED FROM THE BUILDING DEPARTMENT BEFORE A SI THESE PREMISES ARE OCCUPIED ! REMARKS : �- INSPECTOR TOWN OF QUEENSBURY „n BUILDING AND CODES DEPARTMENT r% 4 BAY & HAVSLAND ROADS 1280� QUEENSBURY , NEW YORK Y TELEPHONE { 518 ) 792- 5832 BUIWING INSPECTOR' S REPORT REQUEST FOR IEC N RECEIVED NAME LOCATION . 7 PERMIT DATE 6 ` APPROVED YES NO OTxNG/PIERS ORMS MONOLITHIC POUR PROOFING J-- FOUNDATION BACKFILL APPROVAL r ^�- ROUGH PLUMBING . ,FRAMING C)UGTd-xN ELECTRICAL R ,3 s INSULATION! FOUNDATION FLOORS WALLS CEILING TION : FINAL INSPEC CHIMNEY 73EIGH7 ROOFING ,SIDING -� vXTERNAL PORCHES/STE ILS STAIRS- K CLEARANCE II' F VALVE PLUMBTNG FIXTURES/ RS INTERIOR TRIM CY _ FINISHED FLOORS GARAGE FIREPROOF NG DOOR CLOSER (S) -`- SZ40ICE ,DETECTOR xNSPECTION_� FINAL ELECTRICA FINAL APPROVAL F CONSTRUCTION UPANCY MOST BE CERT FICATE OF OCC DEPARTMENT BEFORE A, SIGNED THE BUILDING FROM OBTAINED FRO ARE OCCUPIED : THESE REMARKS = IA,TSPECTOR TQ1VN OF QUEENSBURY r BtjILDING AND CODES DEPARTMENT 1 BAY & HAVILAND ROADS 1280ar QUI;vENSBURY. NEW PORK TELEPHONE (5I8 ) 792-5832 BUILDING INSPECTQR' S REPORT REQUEST FOR INSPECTION RECEIVED�__._----- -- NAME LOCATION PERMIT # G1G7 - 'y! 4: DATE APPROVED YES NO FO©TINGIPIBRS OLITHIC POUR FORMS L,�OUNDATI NI PROVAL R__f-.-- OOFING BACKF".ILL ROUGH PLUMB3NG FRAMING ELECTRICAL RO H-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL IrygpECTION : rs CHIMNEY [ILA IGHT ROOFING SIDING EXTERNAL PORC ESISTE STAIRS-CLEA NCE & RAGS__----�- PLUMBING LVE Fr TURESIRELIke VA INTERIOR T IM/PRIVACY D[?�7 RS FINISHED VLOORS GARAGE VlkgpROOFING DOOR CLO SMOKE D TECTORS FINAL EL TRICAL INSPECTION �- FINAL AP + ROYAL OF CONSTRUCTIOI7 A SIGNEL> CERTIFrCATE OF OCCLDING UPANCY MUST BE OB ESE PREMISESINED FROM TARE OCCUPIED EPARTMENT BEFORE TH REMAR S : N.SPECTOR TOWN OF QUEENSBURY �y BUILDING AND CODES DEPARTMENT �L BAY & HAVILAND ROADS 1 QUEENSBURY, NEW YORK I290&- TELEPHONE (518 ) 792-5832 BUILMNG INSPECTOR' S REPORT REQUEST POP INSPECTION RECEIVED _/� NAME _ 11, I`J Tcx 11 +C )-4 {i L�iGC � [ LOCATION �c�l- I�7`�t ��, C} / �c '� PERMIT # DATE APPROVED YES'" N FppTING/PI S f� MONOLITHIC UR FORMS FOUNDATION/ P-PROOFXNG ` BACKFILL APP VAL ROUGH PLUMBIN FRAMING ELECTRICAL ROUG -IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTXON CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHE /STEPS STAIRS-CLEARAN E & RAILS- �^ PLUMBING FIXT ES/RELIEF. VALVE IN TERXOR TRI PRIVACY DOORST�._ FINISHED F RS GARAGE FIRE F2OoFXNG DOOR CLOSER S) SMOKE DETE TORS FINAL ELECTR CAL XNSPECTION FINAL APPRO L OF CONSTRUCTION i A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED ' REMARKS: IL INSPECTOR I Id National Headquarters a , Fia&idri /4Ve.; ICo[ ingsw8t�d, � . Date. Q —County iS j $fet City, Town or Township !,�' � `. tY�`.'�`'�`��. ' . Location/Address �- (if L ted in R ral rea --Please Attic irections) cl Owner C�aCupisd-As' if F Oraeelpani -4,, ' Wank`'iArea'Sn 8uilirr pI . . .pep'.for:. WSrS .. Ssrvioe' or: e for.. Fee S3eraitted=> % • Cash CSieck - M. � e * Mau : '750 COUP 'k,SPa a76 2000 2250 2MW ¢766 s } - NUmberFRoug�i W��itYgl�Ju[ietx �1ect. Heat Ott 1: � � ti uvitahas - ' .. „ ;ram Amps. Servx ± _rface Unit r►ishwid3�ie ram- �r Lighting- Air fie`oaPtacSes Water Heater Air Conditioner. t- Oven mb6°r ,. �y ! s- ,ro -" ' ` rt�j I21 r.{ I:� •"fk e. 'x'v. .'� r _ btber quilyc�lent. ' 2 [17�1' 1/8 1/6 1/4 '1l2 3/2 3/4 1 '1=!x2 t 5 7+& .lo . ],5 26 `2e y.. G•. of Each Sire } t . Appiictmt.'s _ 'r E `.. . 4JC@nS@. ` - . r r ; ...�. . Signature _rT i1 ' Applicant's-+4+,1dra�ss: _ - ICity} (State} ' '.+ fl Salviee itegilaat at i$ riE ii/EQx, . - DATE''i13SP x Correct 'Ltioation: Same as Above or: - '' `' " [3� Red Notice Label ..:5.:.; Rough Wiring Outlets Surface Unit r .. .-,��} 'u�rvltcheS - Range W.i eoeptacles Water Heater .nx Fixtures WwConditi6net * Amp, Service Equipment Burner. ring'n$e Cohtr s for R ' Amp. Service Conductors Pum " slat , Mark Number ° 1/12 1/18 1/e 1/r Y/4 Is 112 I 2 7 .xo 75 .2. pI 0 25 100= 30 of Each Size ^+ - Elect. He soa 7so ►qQ axxlo x55o al$o 2Poa 2sa AR a h l- a" L.. - �.� : . !f - LA ? . RW Progress: Inc. 1_]' CSC[ �" n: ractot CFT Violation : Work Comp. L/A Owner Fee- CHIC (� Acy IPA Municipal r{ .Oth�r 4 Ut3li' • I If ~CuY in Card ' Temp . Hai Final W* Date i F ! f P . .. '- APPU CAT ION FORM NO, 250 1=1-4;;* .. .i. a •a ;; , 3 fa �• �; } as' q yfffi s�zf + d � ,�' :sum✓ '�.,� ,� r 00 0o n ' O me m 7 m mm co �Q) 4 1 t 35 i Ak