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1989-703 41" lom y � CERTIFICATE OF GUPAN%.,0 TOWN OF QUEENSSURY WARREN COUNTY, NEW YORK Date t� t This is to certify that work requested to be clone as shown by Permit No. 89- 703 has been completed. This structure tnay be occupied as a Ads ' 'Ana tc 5ingl a Farai l y Location 61 Zena3 Drive der Joseph & Cathy Dufour By Order Town Board TOWN OF QUEENSBVRY r Director of Bldg. & Code Enfor' meet w . BUILDING PERMIT TOWN OF QUEENSBURY No. 89~703 Q WARREN COhUNTY, NEW YORK , ns I NO 1 PERMISSION is herebV granted to Joseph & C&tt Y 1fo ur r� OWNER of property located at Street, Road or Ave. in the Town of Queensbury, To Construct or place a _ Addition t0 r+i TI 1 P Fami 1 y 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 . OM1N E R'S Addresa is Same COTR NACTOR tG'�.rv7l or BUILDER'S Name z� a c+s fb Pete RuscioSao v 3. CONTRACTOR or SUI LDER'S Address c'7 98 Oak Street Hudson Falls ,id . Y . 12839 4. ARCHITECT'S Name 5. ARCHITECT'S Address r--� rDeD 6. TYPE of Construction — (Please indicate by X) ut Q ] wood Frame I } Masonry l 1 Steel c [b 7_ PLANS and Specifications No 161 x 201 Addition to single fmaily as per plot plan , specifications , and application . 8. Proposed use Addition to Single Family Dwelling a $ 24 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 1 79 90 a III 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 data.} Dated at the Town of Queensbury this 7th D y of September 89 -r Or SIGNED BY for the Town of Queensbury wilding and Za nirg Inspector 'C ` n Tr T •• 1 r . -. . n r{ TOWN OF QUEE:tiSBL : RY W: C � - 9- LIOLDG. OF ouEErvssuRv Rev RECEIVED =rs` ��} i:11I LD I NO AND CODES Li PARINI'"E*!T Data Iaa u; d & CODE DEFT, .% Y and nA VI' L�yAND R©ADS RD I DOx J3 � r1(JEENSBVRYaMCIJ YCRJ1 13dQ4 T7CJLllSa L' 1JU . _ Tol . ( 5I8 ) 792- 583 = Exr 204 ■ ■ . a • ■ : + r r r a r a r 01110 ■ a x r a a a r a ■ ■ ■ r ■ r ■ ar ■ A 11LFt11IT mus"r I; I3 QBTAItJFD BC- I� ORE CECiNtJING CONSTRU {CTIO14v NO INSPUCT IONS VILL 131 MADC UNTIL APPIC ICAMT l [AS R.LCLIVED A VALID BUILDINC PERMIT . All applicable spaces on this application must be completed and the �; innature of the appli4zant must apvar on the reverse side * o * this * s * ect * a * n w -Ax * * * a. * x k * -AA ^ * * * * a x T110 owner of !1this property , is ;: fir, ? q` a r bU � l' . G . Add re s s i� ! Wit-s Q L...tii r LT-I.- U CMI) { CJ l�..i "�. �" G. C T E L . ( � •'� +•.�" i• roperGy location �iS Cti��� � - TAx rtAP NG . l f ".a� " Has there been any tp1Lt or` this property since October 1 . lgg $ ' yes n� x Ie yes , Planning Board Review is necessary . LOT NO . ou ; USDIVI910N NAME . Ir APPL. ICADLE he ,person responsible for sup4jruision of wort: as regards Building Codes is : NAMt F . G . ADORCS. S TEL . NO . /`3 .T bra -ter'. Address. cy K ..,e. ,c+ y s H ■Snk] FA+! Te 1 "7ah'I - S a q :44mo of builder�mg 7gd5 -i ^ Tel ri.ama: of Plumber ► k%q l.daross Tel Tr.amw of Mw so n '°SFa �'Y'S.c-Y�°,I} Audre s 4ATuRE or pf:t] ascD 6uiJ %r. : wlZONING INf 0101.+ TION ( 0ttica usO On .Lv ) � Cnnatrucci4r of .+ iaww kluilclLn � No LONINC DESICNATION OF PROPERTY or PERMITTEDPRINCIPAL PERMITTED ACCESSORY kr Addicion to :a buil .ling ALty r! C Lion to a 1.uild "g • REVIEW REQUIRED - PLANNING BOARD ZONING SOARDr { DLO Clk"J1 ] to a:xc . rLJt ctllriQnS' Lana) Uch%: r work (1QrCrLbL: ) • SITE PLAN REVIEW M APPROVED DATE • VARIANCE 0 APPROVED DATE�� r ROSS ARLA 01' PROPOSLD. : 4ruucoruRr6 • Remarks . 5t Floor1. 3�C3 5q Ft .�� ,. nd Floor r5I(A s q f t . wcorqn r.L '1 t Irrl'Ot.r-1s1'L IOrs ici[_U I1cl:D LIl_ Lt/�r . Si•e.w of Izroi,urty fr x��_Ct . athcr Floors t`r sq ft ' Lxi:.ti+u3 Lu1-11i' k] ( u ) Sa 11 x rc . ( not collar or bssom.ant ) TOTAL FLOOR AREA 3 sq f t • * Lx1:.L a11q Awa LJLn�3 r :. I U5w :: i ::.: uC nLw SLIrr►Ctur%j 16^f L x 73Q l'u�sl.d . tion-r+ ier ;.1sL Cr.awi/LasrcL.al/ cull ' Yralaosxa bual .larlq , di:. t:ancw grout L. rrtlNwxrY 11'r1w cLrc:ic: one ) , Front yard r" c near yard ft Na . of acories (t"bi6c:rhlw tiusca ) �_ Sid+: yards Woomera 4A(4 re Ir0. i.ghc ( yradu to ridg" ) ft ' Ir' on curaar "A1; Cz"QK fcola SiiLr. �Lrwut fL IC ro:: i;talntiala no. of F:.mslLes i — APQCCWPANLY INPOr46ATION Nam of rcoln:s ( QxCludinu b:.chsl,_- t riov of budrooeaY t ,�,r„� � r p01ARY isUSLLYING: No . of tuactlroaw►;:�1�i %1L 1i,T1 - - w mono fpnLaly dwelling vriuury 1larwtiltii y;yL;44ui' } T t 'L'wo i"M.A ly dwlslliny 'iylaw uF fu.al i , K"IC4, al" .lwulling / truwbor Of NOW Of firu=�iacuu tr.1 11" inzt:rllc.o *s roof * �,_.: x �.� rr■. L $,S,7a.ar1Gtllt af•4'1ipiasieiy wail r wruu.I a:LOvrt tr. illlataliw.L7 i1e* - " :anui+sllt caucuL>:uccy L'rantr.a). Air coelaiiciun:.rlq:'� �1+�1 131ssinisxll UUILDING STYLC, PRINWRY STRUCTURE . Tnsiust:rial I :.1i1c?► COntomwlp �r#■ry Lon cl-*b&n O c t1aR r * 1 .►d.11L11}[1 + 1rl�.it Vlll YrSi b+s7� ,� t;.aaauGl ranch Dwr+lwx ! latY, L sslalat l"V41 old M&CYIQ U46AA%y.a1aw+ C�pv Cod CottCiCj%j OLI1wY " ACCL:aSOILY 1iUILDiNC- CoLGni.al WOW Towit )louse • I.I.sGActleu cjaC4&17C/On4 Cur/ tvo C:1r/ C;ar CIRC" CNL1 PLkASE ) + ACtachuv cj .CUQGJ/Q'14 car/ two C:irl��Cna ►` r r r a At r r • a a a a a r • • • + 1� rJ.v:aGw SLOr:aga building 11: STIM ^1*r0 MARKF'I• VALUE or i3Gl7ur $ _ _ _ 11%vowno.cv� � y � � � � 1Nr• OM4ATTON ON OUTLOINC sPT:CIFiCAT10NS + ON tZt'VCF 1 F. Ior OF 'TtrIS CtiL £"T + 'tO 9G CCI�PLCTL:D ! Form 8PA 10/88 V2 LIL? 4 , j SPEr= EFEi = Tt �NS : • s: c const r U C t 10n , Wood fra :N.Lll any sel-cnd- hand or ungraded F,DLL:dat; ion wall. 14raterlal c, It, T'': l.:- knesS r r: 4epth cf foundation beL�-w grade ; - c bottom of faotLng ) !rr �— Will there be a cellar ? grad or ur„-:eated ? _ � t � �-° � � Flour sq . footage � ��.•-,, s -. g Will there be a basement ? NU „ _ Will any cortaon be used as living space ? [ If so , what portion ? sq . ft . - - iy- e of use ? Type of roof -(sloped flat/shed/ot er Material of roof Size , wood studs Z- " x G,. IN spacing /6 " o . c . 14 ^gth ft . Jcists ( floor beams ) lst . floor NIX " spacing "o . c . span ft . Jo -Ls ts ( floor beams ) 2nd . .floor " x " spaCLng - " o . c . span ft . :,verlays ( ceiling beams ) z_ „ x spacing/ " Q . c . span ft . Roof rafters " x spacing��f G . c . scar £ t . Roof trusses ( pre-engineered) spac : r.g " o . c . s;an ft . Exterior wail finish 7C Of what material ? Interior wall finish 1r`/ ' ' G If a garage is to be attached , descr "be materlals to be used for FIRE SEPARATION . Is there to be an opening between garage -and dwelling? If so will a Fire- rated moor , enclosure , and self-closing device be provides)? 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 ft . ( A separate application is necessary for any repair or new installation of septic system ) D E C L A R A T I O N 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 011DIN ANCE, 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 er. Signature Owner, owner's agent , architect contractor SPECIAL CONDITIONS OF THE PERMIT : ^ TOWN OF QU £ `FSBUR< « 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 ? P%-} ( 4 _ Percentage of area of windows and doors W70 A , Over 16 % only 1 . Ua value of gross area of walls , roof / ceiling and floors exposed to ambient conditions 2 , Floor over heat 3 spaces YES N4 a . Are foundat on walls insulated ? YES 1 , if YES . what is the R value ? 39 Slab on grade NO a. . If YES , wh _ t YES the R value of insulation around perimeter of floor ? C7t 4 . Is basement heated ? YES NO a . R value of insulation _ 1Uf 5 . Type of insulation B , Linder 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 ( u r� • tea` 4 . R value of doors:_ + Y Q n) 1 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 "SF 8 . R value of heated basement / cellar wails ( above grade ) 9 , R value of heated basement / cellar walls ( below grade ) 100 Type of insulation C . Controls 6 I . Thermostat maximum heat setting o . Duct Systems system installed in unheated spaces ? YES 1 . Is duct a . If YES . R value of duct installation b . R value of duct in other areas E . Piping Insulation Aj 1 . size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation ■ F . service Water Heating A)/ 1 . Performance efficiency„ f1 2 . Temperature control setting maximum G , For Swimming Pool Only #G� 1 . maximum 22heating # Telephone No . � r �72 ( a plicatnt ' s signature ) 4 Proposed Addition to Residence of Joseph and Cathy Dufour SUMMARY OF TOTAL THERMAL RATING If the Total Thermal Rating is zero ( 0 ) or greater , the proposed design for the building envelope complies with the Energy Code. THERMAL TABLE AREA U-VALUE RATING USED A , ROOF / CEILING 3 0 _0L01 —r- 6- 2F B . NET WALLS 38.( sf 0---- =Co GLAZING 62 . 5 sf 0 . 39 0 6-3E Window & door Window Skylights Dl . FLOORS D2 . BASEMENT/ CELLAR WALLS Wall Perimeter Feet Exposure Above Grade Feet Wall U- Value Depth of Wall U-Value Below Grade Inches D3 . SLAB INSULATION Slab Perimeter _ 72 Feet Insulation R-Value _ 20 __ —} � ------ -+�_ --- E . INFILTRATION CONTROL Conditioned Floor Area Sq . Ft . F . SOUTH FACING GLAZING South Glass/Total Glass Percent Gl , Area/Gross Wall Area Percent Conditioned Floor Area Sq , Ft. TOTAL THERMAL RATING + 3 As per plans prepared by Raymond H . Irish , PE&LS , dated 8 / 31 /89 . e9 45 Taws or QUEENSBURY BUILDING DEPARTMENT HAVILAND ROADS BAY & QVEENSBURY,F NEW PORK 328D .� TBT,EPHONE (518 ) 792- 5832 ILDING INSPECTOR' S REPORT REQUEST FOR SPECTION RECEIV D 7 d NAME LOCA ION j?f�" PERMI # f+ DATE APPROVED YES NO FOOTINGIPIERS MONOLITHIC POUR ORMS --�-�- _ FOUNDAT'IONIDAMP-' ROOFING_ BACKFILL APPRO VA ROUGH PLUMBING FRAMING ELECTRICAL ROUGH- INSULATION- FOUNDATION FLOORS WALLS CEILING }( FINAL INSPECTION: / CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/S STAIRS-CLEARANCE & I EF VALVE PLUMBING FIXTURESI E C EF I INTERIOR TRIMI PRI - lls FINISHED FLOORS GARAGE FIREPROOFI G DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICA SPECTI N���-- FINAL AP PRO F ONSTRV IO1'1------ C/C `T CYIC O ISS CID �--- -� TE OF OC FANCY MUST' RE A SIGNED ERTIFI BUILDING PARTMENT BEFORE OBTAINED FROM TH OCCUFIED3 THESE PREMISES A E RFMARXS : y p/ ARRI E.� V-SPAR - INSPECTOR TOWN OF QUEENSBU1iLEPARTMENT BUSLDING AND CODES AVILAND ROADS BAY & H EWam, PORK 12801- QUEENSBURy. N ?R2-5$32 TELEPHONE C Bi3ILDIl' C; INSPECTOR' S FORT E TXON RECEIVEDy, REQuE R NAME L CATIO i 01 6 PERMIT # DATE APPROVED YES NO FOOTINOIPXElzs M lUR FOR MoNoLITHIc FOUNDATIO IH PKOO NG RO A B P ROUGjjMBING FRAMING ELECTRICAL ROT7GH"IN INSULATION: FOUNDATION F'Id7OR�+ WALLS CEILING i FINAL INSPECT'ON CHIMNEY HEIGHT R,OOF'ING SIDING RCHES/STEP ExTSRNAL PRANCE & RA LS -� STAIRS�CLEA EF LVE�� PLUMBING FXXTUPRYVAC F LV E INTERIOR TRIM/ - FINISHED FI"O'RSFSNG GARAGE FIREPROO DOOR CLOSER (S) SMOKE DETECTORS ECTXON FINAL ELECTI4ICAOF CSNSTRVCTS+ON FINAL APPROVAL E OF TO IS OCCUPAN y MUST BE A SIGNED CERTIFSC MENT BEFORE OBTAINED FROM THE BUILDING DEPA THESE PREMISES A OCCUPIED!' REMARKS: ARRIVE DEPART, / INSPECTOR TC7�VN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY 6 HAVILAND ROADS QUEENSBURY� NEW PORK 12804- SGfG� TELEPHONE (518 ) 792-S832 57 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED ,�_...------- NAME LOCAT SO Irl�i /� PERMIT # DATE APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATIONIDAMP-PROOFING BAIL APPROVAL ROUGH PLUMBING FRAM NG EL TRTCAL ROUGH~' S U,LA TION FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION' CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES STEPS STAIRS-CLEARANC & RAILS PLUMBING FIXTU SVACY DOORS INTERIOR TRIM/ R FINISHED FLOG S GARAGE FIREPR PING ,POOR CLOSER C ) 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 OCCUPIED! REMARKS.- INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I2e0llE TELEPHONE (518) 792-5832 BU I LDi NG INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME � 1) � " LOCATION DATE -PERMIT # i APPROVED YES NO FOOTING/PIERS MONOLITHIC PO i2 FORMS — FOUNDATION/DAMpP-PROOFING — BACKFILL APPROV L RQI;GH PLUMBING RAMING ELECTRICAL ROUGH- N INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES STEPS STAIRS-CLEARANC & PAX PLUMBING FIXTU ES/RELIEF ALVE INTERIOR TRIM PRIVACY DOO FINISHED F RS GARAGE FIRE OOFING DOOR CLOSE (S) .SMOKE DE T CTORS FINAL ELEC RICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: �_ INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280k TELEPHONE f518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED 9 - Q - NAME /T- c' r�"9�-�t LOCATION pj -y _ DATE _ . _Sri PERMIT' r I fc> APPROVED I YES INO FOOTING/PIERS MONOLITHIC POUR FORMS A+"'FQUNDAT-TON/DAMP-PROoF.T NG 1 .. ACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH--I ,ge,deINSULA.TION: 4,.. OUNDATION FLOORS 4 WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING .EXTERNAL. PORCHES/ EPS STAIRS-CLEARANCE RAILS PLUMBING FIXTURE /RELIEF VALVE INTERIOR n7RXM1PljlVACY DOORS FINISHED FLOOR GARAGE FIR PR FING DOOR CLOSER (S) SMOKE DETECTD S _............... FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR TOWN OF QUEENSBURY BUXLDXNG AND CODES DEPARTMENT �y2�-✓J BAY & HAVXLAND ROADS QUEENSBURY, NEW YOR1C 128ok TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED_, NAME - LOCATIXON� c?� DATE z APPROVED YES NO f/F`'C30TXNG/PIERS MONOLXTH..TC POUR FORMS F0UNDATXC7,W/DAMP-PROOFX NG BACKPXLL APPROVAL ,- ROUGH PLUMArNG FRANXNG r ELECTRICAL ROUGH-TN INSULATION: t FOUNDATION FLOORS WALLS CEILING FINAL XNSPECTXON: CHIMNEY HEXGHT ROOFXNG } SXDXNG EXTERNAL PORCHES/S P STAXRS-CLEARANCE RAX PLUMBING FIXTURE /BELIE VALVE I NTERIOR TRXM/P VACY PxNISHED FLOUR GARAGE FXREPR FXNG DOOR CLOSERS SMOKE DETEC RS FXNA-L ELECTRX L XNSPECTXON FINAL APPROV OF CONSTRUCTION A SXGNED CE TXFXCATo OF OCCUPANCY MUST BE OBTAXNED FR M THE BUILDING DEPARTMENT BEFORE THESE PREMXSES ARE OCCUPIED! REMARKS: XNS ECTOR YOU ARE HEREBY REQUESTED TO INSPECT AND ISSUE CERTIFICATES FOR THE FOLLOWING ELECTRICAL EQUIPMENT TO BE INSTALLED By THE UNDERSIGNED TEMP. / p TOWNSHIP f �•/ srREEr,wD rod oR AGAp �rti..0' 'r ,. �`x,, F L 1' COlIIV"IY BETWEEN WYfAT TlM1l7 CRdgS STREE 1 �"1 POLE NUMBER T'$IS PREMfvEg Lpt,�gEpT SEOT 7N O } ,�rrNT`3 NAME ` BI-OGk LOT eU1Lnr+9G+]CCUPAIK:tr OWNER'S NAME AN8 aODRESS \ s-J . i dME TELE di1RRENr SUPPLIED RV FROM THEIR OFFICE " 'F WORK TEL Buu.DrNc Isw�l _ � �N OLD C] HOOK1S -- LIST BELOW ALL NEW ADDITIONAL I_T DEFEGT^a AEMdVED ❑ Loca- NUMBER OF OUTLETS No, of Fixtures g C-CtU1PMENT WFIICH YOU INSTALLED tion Swe Lamp Receptacles MOTORS HEATERS BRANCH f�FFICE USE Caiflny 'IIVaE p yIs $Witch PwAam Brackat NaType H.P CIRCUITS ONLY OUT- Each NO. ONLY Na. ALWG SIDE Gauge INSPECTION sue- 9ASE SASE- MENT 1st FF FL. 2nd FL. 3rd FL. REMARKS, LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE THIS APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTS YOU TO BE INSPECTE�3'il, BUT IF AT _ F THE ADDITIONAL EQUIPMENT, AS D, U ARE AUTHORIZED TO MAKE THE I.N�hF'-EC770IV E� INSPECTION, THERE IS PROVIDED BY THE APPLICANT, UST THE FEE TO COVER SVE OF MAINS I' I \.. FEEDERS ELECUVC SIGNS9_AtyfpS CHARACTER OF WORK r� TOTAL NATTS LJ EXPOSED GAS TUBE SIGNrTRANS fEA3 OF DATE VvoRK TO BE STARTED ❑ OdNCEALED Yq DATE CAMPLETED SIM OF SIGN(NUMBER} SEPMCE ENTERS BUILDING CAPACITY ❑ OWEAHEAD MANUFACTURER OF SIGN D4iE INSPEC:TIDN REOVERTED ON PH AS NEAR AS PdSSIRLEJ �-I UNDERGROUND MUST ENTER APPLICANTS DELAYS B'tr . AI,I � EFWXMN NUMBER &I I f I RATE TKiN. ALE. M L I PRINT NAME AND ADDRESS 1 y� N OF APPLICANT _ GATE €1F APf7LICARON 'BMQMATE�RE STREET ADDRESS S f !i yF _.. C!T'r OR P'Oru OFFICE /` TEL NO ZIP CODE LICENSE NO. WHEN APPIACASLE ❑ 85 John Street ❑ 41 State Street v NEW YORK, NY 10035 I ALBANY, NY 12207 ❑ 570 Delaware Avenue ❑ 277 Lake Avon BUFFALO, NY 14202 ROCHESTER, 1VY 7480E I ❑ SYRACUSE, N 202 Arterial Yi7,320fj THE NEW YORK BOARD OF FIRE UNDERWRITERS TOWN Of QUENS@URY f S I �13011W Zoning Admin'Is 90 Dates NOW OR FORMERLY WNRIZEN C. Ct_.ARK PRQP0�5EC] REPUTED LEACH FIELD $ LOCATION AV � S�E�PI�TE D r�3$ LOCATI09 OF r DEsT{ BRVTI ON �`��j r box LAND5 OF RE PO-TEO 7HE C\TV OF GS G LOCA- i N , 6LEN 5 FALLS WINE TAX MAP � � � •� �, I UOT ?. 2 I LOT G0. Go OF !{ryl r CRE=5TH#%VER 4 �UBE�I �{5t0N4PL ZOMIN& DE57MICT OR EO oeawN ECKEO rALl pAsE MOJ. yea. KgDRAWT R . H . IRISH Lin1 � _ 330 0 -31-8 8gm645 ob TITL9 FLOT PUMA PR( P05ED #%=J - owe. lie. N CONSULTING ENGINEER {CkJ\ RES MWSEOFJC56P4 L l GLENS FADS, HEYMYOlIK VORXR ftNW tIF Q ` ` of