1989-763 ' x
x.::f. .�$Fid-{�::. ;k"r�5i1�[. As F«6� !`xF^'Y.ra,'" rw�v�,.ia:—r it M1
Tj}
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YORK
Daft December 15 1989
This is to certify that work requested to be done as shown by Permit No, 89- 763
Has been completed.
This structure may be occupied as a single Family Dwelling
Location _. 1 nt Pl Hi ciciPn Hills Drive -
Owner Fnract W nri Hnrnac
By C>rder Town Board
TOWN OF QUEENS$URY
J
r
Building & Zoning lfna for
BUILDING PERMIT
TOWN OF QUEENSBURY Ivo. 89-763 ` o
WARREN COUNTY, NEW YORK
u
PERMISSION is hereby granted to Forest Wood }comes
OWNER of property located at Lot 21 Hidden Hills Drive Street, Road or Ave.
in the Town of Oueensbury, To Construct or place a Single Family 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 SuildIng and Zoning Ordinance.
t. OWNER'S Address is
HC- 02 Box 286P o
Warrensburg , N . Y . 12885 m
2. CONTRACTOR or BUI LDE R'S Name
Self Q
3_ CONTRACTOR or BUILVEWS Address rr
Lr
Same
4. ARCHITECT'S Name
r
a
ry
5. ARCHITECTS Address �--'
S
Q
t17
m
6_ TYPE of Construction — (Please indicate by X)
XXX Wood Frame { ) Masonry { ) Steel { )
cr,
0
7_ PLANS and Specifications
No• 32 ' x 46 ' Single Family Dwelling as per plot plan , sepcifications , m
and application , including septic , attached two XXXX car garage
E. Proposed use and driveway *
Single Family Dwelling
s 207 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES May 1 19 90 rn
{If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of QueenSbu ry before the expiration date.)
r—
Dated at the Town of O ueensbur th is D a of
Y Y Q�finhp r 19_ 89_ o
a rn
SIGNED BY for the Town of Oueensbury
BQM
uilding and Zo kn or �"
QM
TOWN OF QuLrENSBURY
REVIEWED BY
CEL
FEE PAM f
PERMIT NO.
BUILDING PERMIT APPLICATION
A PERUrT MUST BE OBTADMD BEFORE BEGI'NN [NG CONSTRUCTION. NO INSPECTIONS
WILL BB MADE UNTIL APPLICANT KAS 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.
The owner of this property is: it W-A Wes 6J 1104*W
P.O. Address -
Property Location �� � , ■ a ... i!i S �j+r . Tax 1+[ap No. rI
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 _ 1�4 LOT NO. .,,wj
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS:
f o' r e S 7 y JUny J htpig .5
NATURE OF PROPOSED WORK : ESr:MATED MARKET VALUE OF
MEW
✓ Construction of a new building „ CONSTRUCTION: t 7 0
Addition to a building ` C0MPLETE INFORMATION REQUIRED BELOW:
• Size of property e, If WWOMOft x ' L`- ' ft.
Alteration to a building * Existing Buildings( 3 ) Size ft. x ft.
(no change to exterior dimensions) r
Proposed building - distance from property line:
Other work (Describe) Front yard 3S ft . Rear yard 4id6 ft.
•
Side yards ft . and ft.
GROSS AREA OF PROPOSED STRUCTURE + If on corner, setback from side street ft*
lit Floor L'i sq. ft. /0 * OCCUPANCY INFORMATION
2nd Floor aq. ft. � , Primary Building Ow
Other Floors sq. ft. — + OMMMMMMM0✓Once Family Dwelling
(not cellar or bwwmani= + Two Family Dwelling
TOTAL FLOOR ARRA_sq. ft. • Multiple Dwelling/Number of unitx
Sias of eeaw structure ft x , .eft. ' Bsreiaaela_
FoereMdrtWNWarlslrebJcre�er * LadwtsbM�
(circle oeee) i7'Ifa-ir�t�Ifull . Other
�*'~ at atarift ON01toble sp me)o »
Height (grads to rlro) , Z S n, ; If addition, what wM um bay!
If residsretlal, no6 at lamMgs�� •
Na. of roveees(exab ulft bathes) • —
Z�_ wecaaa,ery &didbW
No6 of badraems"„ .���..■ ` � Deta�Md Gore" � KZf MO' Car
Na■ of batleeooees J �-
� �...�..r1......�..■■ �,,.' A
l"a� llR "I i ttarchrrd GarageQ MQ Car
Y+ [3 u r ► ��
Ty" of r a" :A CA + Private storm b uUdit
No. at Hreplacas to be kwtallad ti w
• Ot�'1�
W lU a we" stove be Installed IN -
Centr.l Air canditionift `
Ovo EX
81_ [ LorNG PFR %TIT \ PPL1C -\ TZON : GN. TI 'r' r EZ) -
6C' 1LDfNG SPFCIFiChTIOYS-.
T} pe of construction, wood frame, fire safe. etc. zt,' fld ] 71 yzo
will any second-hand or upgraded lay m her be used? 1 f sa, far w ha t ?
Foundation wall material __rr 10 re Thickness-1 v u *e (
Depth of foundation below grade (to bottom of footing)--.- '
will there be a cellar ? nt} 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 -64�1 E 1Aat /shed/other :4aterial of roof
Size, wood studs o? "x�_" spacing." o. c. length _ft.
Joists (floor beams) 1st floor A, "x �"" spacing...14.0*o.c. span_ ft.
Joist ( floor beams) 2nd spacing l ( . "o. ca span ft.
Overlays (ceiling beams ) 'rx " spacing " O.C. span ft.
Roof rafters "x 'r spacing o. c. span ft.
Roof trusses (pre-engineered) spacing" O. C. span ft.
Exterior wall finish �L ; C.- ,y,. 4 -.Of what material? -
interior wall finish 4 ,.. r [� j
If a garage Fs to are attached, describe materials to be used for FIRE SEPARATION:
r° 11. I.-r E4e1j.
Is there to he an opening between garage and dwelling ? 4e f If so will a Fire-rated door, enclosure,
self-closing device be provided? V r = .
Will a flue-lined chimney be. installed? "L:> Height above roof ft.
Depth of chimney foundation trelow grade fL
Depth of fireplace hearth ft. in,
Water supply - Municipal or private well i
SEPTIC SYSTEM .Distance from ANY private well (including adjoining properties ft.
(A separation application Is necessary for any repair or new installation of septic system)
:.
NAME OF BUILDERS u )� e u� i ADDRESS r rWTEL.
NAME OF PLUMBER IWADDRESS
TEL. NO.
NAME OF MASON l ' r ' r r . : , ' : ADDRESS .'r-g�jt'I P . TEL. NO.
,I '
NAME OF ELECTRICIAN. , ADDRESS < ` : i ' € , . TEL. NO.
DEC,f.AIit IMM
To Me beet of My 1n@ jedge anwFt oaf the statements contained in thla appiteatiea- together with the
lints and specifleatiowts sWW"Itted. We a true and complete statement of &.iL wore to be done an
he drser'be'd premises grid that ail provisions of the BUILDING COOK. THE ZONING ORDINANCE9 and
dl other Laws prertainit to the PPOPOSed work shall be compiiedfwithe whether speetfled or net, and that
wch wore IN authorised by the owner.
n Owner, owner"s agwl arehrEtaf:t, contraetor
IPZCEAL CONDrrr we OE r"
woe.
BY -
TOWN OF QUE . NSBrJR .
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
i
2 . Type of heat
3 . Is the building mechanically cooled ?
4w percentage of area of windows and dooms
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 foundat� 3n walls insulated ? YES NO
1 . If YES . what is the R value ?
3 . Slab on grade YES NO
a . If YES , wl� . t 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 °- t �'
3 . R value of glazed area
4 . R value of doors
5 . R value of floors over unheated spaces fr
6 . R value of slab edge insulation - unheated slab
7 . R value of slab insulation - heated slab , v�r r
B . R value of heated basement / cellar walls ( above grade )
9 . R value of heated basement /cellar walls ( below grade )
10 . Type of insulation_..,_, aF: �E' . (ram
C . Controls
1 . Thermostat maximum heat setting i7'
D . Duct Systems
1 . Is duct system installed in unheated spaces ? lle NO
a . If YES , R value of duct installation a - !
b . R value of duct in other areas
E . Piping In & ul " 1 -1
1 . Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulation
F . Service Water Heating
I . performance offisiency Sri
2 . Temperature control setting maximum ) Yd „
G . For Swimming Pool only
10 14aximum heating
Telephone No . c)
a licant ' s signature )
TOWN OF QuEmtvsBurzy
APPLICATION FOR,
SEPTIC DISPOSAL PERMIT
DATE
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: Forts + Wad jrw_s Telephone: Z* 2 -4- 3 9711
Address:
Installer's Names. Telephone: 74), • 6*62 ;;L
Number of bedrooms (residential only)
Total daily flow (compute (a 150 gal per bedroom) ff�►a
Topography: Circle one: at Rolling Steep Slope % of Slope
Soil Nature: Circle one an Loam Clay Other /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? wI + - Feet
Percolation test: Circle one: require _ required rate min. inch.
Domestic water supply: circle one: ou lei Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEMe Septic Tank gal. ( minimum size: 1 , 000 gal.)
TILE FIELD: Each Trench feet/Total system length 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 and agree to abide by these
and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
r3 �
DATE:
OVER
1q
T OtiVN OF ND CO SDESS D DEPARTMENT
Z_
aUILDING AND CO
�k. & HAVILAND ROADS Z2$Q!�
QUEENSBURY. NEW YORIC
5832
TELEPHONE ( 518 ) 792- � V
BUIIDING INSPECTOR` S REPORT
INSPECTION RECEIVED
�„�
RES2UEST _.. ��[�
NAME
LOCATION r- PEPmrT #___ -L-----
DATE APPR VED
YES NO
FOOTINGIP.TE S FO
POUR
FOUNDA S
MONOLI TION/Dpj4p-PR F'INC
BACKFI APpOVAL
R PLUOUGH
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
,FOUNDATION
FLOORS +
WALLS
// CEILING TION :
yFINAL INSPEC
CHIMNEY HEIGHT
ROOFING
SIDING RCHESISTEPS
EXTERNAL PO NCE & RAILS_
STAIRS-CLEARA
PLUMBING FIXTUpEsIRELTE
TRIM/PRYVACY DOO LVE�_�
INTERIOR
FI F�ORs
NISHED r
GARAGE VIR'EPROOFING
DOOR CLOSER (S) ___-----�-
SMOKE DETECTORS INSI N
FINAL ELECTRICAL CTION
FINAL APPRD[rAPECT
r OF CONSTR
OCCUFANC MUST BE
A SIGNED CERTIFICATE OF IN G DEPART NT BEFORE
OBTAINED FROM THE 8UI
THESE PREMISSS ARE OCC
FIED! \
/►
REMARKS : 42
f ! �,�
-f J, j 'G' Gam '
x/l
INSPECTOR
JENT IPSPC710 AGENCY,
1NC.
�' 3
EPART
A D + Cunawo�, yosae
gas liaddonArrenu
oat. December 1220 1989
ment listed has Been examined and is approved as being in accord
applicable governmental. Utility and /4gencY rules.
(�QCtl�l�g that the electrical equip
with the tJationa, Electrical Code, p� slling
01Ccupency:
Wood tomes sea Yh s
F o r e$ t - r�. \ maM and Yrrstanation inspaC
owner: Single Family eenabury (Waxrete $IttadditlOASI 0s lP a"l'zoreeirYc#t anUiP Y+catiOn for
date. N addii4onal e44i,pmanl'ahouid be '*`trod U6ed or aiterations made to
anf: Hills Drive , a stem thin certificate shall be nun and rain. and aPP
Occup Lot 21 Hidden esiahng Y tt to th"' Ahisgr
rw¢ant Flame to his Pr6Pe Flyeq insuranccy e caor"d
pCaflOr7: 3D Ftxtures Move ahOLi4d be aubmittad PromP Y ment aPP
50 Receptacles , HUent0l lhia any)ias.,id Gato WeOff oertiricatiort of aloe
tricaleq +P
105 Outlets ; (a9enl nr company)esarid#rrc
EclLifpflf$nf: ,sjb+rylCC 7 APpliances as sPac4lied.
2C�D Amp
Hodges Electric
No . 15 .03Q884
�� �31 Tenth
Appitcanr: s on Falls , Ny
Hud 12a39
faun FW.
wmwmmv1wmmmF� of ,
C� Queere -5t 'ur
_JOWL O DEPAR-fMEN"T
aO1Lp1NG and ZONING q .C) . j Box 98 /
Bay and Havlland Read prk 128Oi f�'f
G}ueensbrury.
YST iN5PECTION
SEPTIC DISPOSAL 5
E-
9-
LOCATION Q .�.
PER1'+SIT N
pp.'TE Clay - _- ---�-
ana - T,oam YES - NO
SCSL Txf' 8 st Requ�r -
colation ,te _ Min ch
per
t ion r
-per
.r
zreol
Tv.pE of 3XSTEM: to lent3 r
AbeorP'tian ch
fiel
Length of �-- --
Depth Qf tr'er'ches
Size Of
ravel:
3 £1
51�Bpp,GE 711-TS-(1413�e ft .
size- ____�
ft . X
ize gize
Gravel S
PIpIHG to tank. k,
'ra.nIc to ii1St . }�O%
bob. to fxe tpE 0
pgen irlg s Seale ,
SEPP,RRTIOL35
Z�p,Txarz i
goundatioNn tG+ farik
to absr. rto o j .£t-
faur►c3aticn to lot line ft-
pbsorption of Pits r (circle
a one
SeparaLtiOn �y PR p'�RZ"1' Side
.r-LON OF Sy Le side lgh/t
vro _ gear I,e£ t Frc7nt
CCMM 'rS
i � S
v
r E A RC7VEY7 "�E -
S-Y STEM
pectorY
l d yl
C}1,/SG m
'C01dI�I OF QUEENSBURY
O BUILDING AND CODES DEPARTMENT
DAY & HAVILAND ROADS
QUsENSBURYp NEW
YORK 13204-
TELEPHONE (
BU T LIDING INSPECTOR' S REPORT a II
REQUEST FOR INSPECTI/O�N/R�EC¢E�I�VED
NAME
L,E}CATION PERMIT
DATE APPROVED
YES NO
FOOTINGIPIERS
MONOLITHIC '{POUR FORMS
FOUNDATION/�]AMP"PROC7F ING,
ACKFILL APJPROVAL
pOUGH PLUMB.I�4G v
(,. 'FRAMING
ELECTRICAL
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL Pa14cHE__syy`IsTEF'
STAIRS-CLEARAN4� & RAILg ��-
PLUMBING FIXTUj3?ES/RELIEF.��,
INTERIOR TRIMi/ V....�,A„„LVE
PRIVACY DO�Msy
FINISHED FLafSRS
GARAGE FIREPROOFING�_�^�
DOOR CLOSE (S) ,
SMOKE DETE TORS
FINAL ELECT ICAL INSPECTION
FINAL APPRO AL OF CONSTRUCTION
A SIGNED CERT'F7CATE OF OCCUPANCY MUST BE
OBTAINED AINED FROM THE
O THE I LUPIEDlEPARTMENT BEFORE
SE
REMARKS :
rrrsPECTaR
-MOWN OF QUEENSBURY �Fez�N
BUILDING AND CODES DEPARTMENT
SAY & UAVILANEW YORK Y280fk
OADS
TELEPHONE f
QE;EENSBVRYF 5E8J 792^5832
BUILDING II^NSPEC"1�R' S REPORT
REQUEST FOR INSPECTION RECEIVED �7
NAME
LOCATION PERMIT
DATE APPROVED
YES NO
FOOTING/PIERS —�
MONOLITHIC POUR FORMS
FOUNDATTONIDAMP PROOFING��
BACKFXLL, APPROV
ROUGH PLUMBING
FRAMING
E TRICAL ROUGH—
S LATIONs
FOUNDATION
FLOORS
WALLS
COILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/S EP ----�
STAIRS—CLEARANCE
RAI VALVE
PLUMBING FIXTURE
P VREL E VALVE
INTERIOR
ACY
FXNISUED FLOORS
FTNG
GARAGE FXREPR �
DOOR CLOSER (S�
,SMOKE DE TO INSPECTION
FINAL ELECTRIC L
FINAL APPROVAL OF CONSTRUCTION
A SIGNED OCCUPANCY MU
BE
CORT FICATE OF
OBTAINED FROM THE 'B ILDING OPARTMENT BEFORE
THESE PREMISES ARE
OCCUPI
REMARKS :
INSPECTOR
TOWN OF QU'EENSBURY
BUILDING AND` CODES DEPARTMENT.'
BAY & HAVILAND ROADIS
NEW ORK x28fl+r
�7UEENSBURY, 5 8 ) 792-5832
TELEPHONE �
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED _�___ -------
NAME YD2c. .Z/L �-
�
LOCATION PERMIT # QG?� ' ----
DATE /L7 _.---- APPROVED
YES NO
FOOTINGIPIERS
MONOLITHIC POUR FORMS
F MI'
OUNDATTON/DAJ-TVoFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH—I
INSULATION:
FOUNDATION
FoLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HExGHT
ROOFING
SIDING
EXTERNAL PORCHES/ST' S .�
el
STAIR ELIE VALVE_!__._..----- ---' '
PLUMBING FIXTURES�ACY D RS
INTERIOR TRIM/ _
FINISHED FLOORS
ING
GARAGE FIREPR
DOOR CLOSER Is)
SMOKE DETECT L INSPECTION
FINAL ELECTRI
FINAL APPROVA OF CONSTRUCTIO
ASIGNED C TIFICATE OF OCCVPAN
MUST BE
THE BUILDING DEPARTMENT BEFORE
OBTAINED OM
THESE PRE ISES ARE OCCUPIED!
REMARKS :
INSPECTOR
RY
TOWN LNG AND
Co ES DE p
BUILDING ANTI CODES DEPARTMENT
ppy & HAVILAND ROARS
gUEE!JSBURY, NEW Y�sx-583 �RK E74-
TELEPHONE ( 518 )
BUILDING INSPECTOR' S REPORT
REQUEST FOR •INSPECTION RECEIVED
NAME r
.LOCATION
�•-' r PEP-MIT #
DATE
APPROVED
YES NO
FOOTINGfPIERS
MO CITRIC POUR FORMS
OUNDATION/DAMP-PROOFING
BACKFILL AP OVAL y.
ROUGH PLUMBT ,
FRAMING
ELECTRICAL RO6VH-XN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PO
STAIRS-CLE NCE & RAILS�_�
PLUMBING XTURES/RELTEF6 , VALVE
INTERIOR RIM/PRIVACY DO(MS�_
FINISHED FLOORS
GARAGE TREPROOFTNG
DOOR C SER {S)
SMOKE ETECTORS
FINAL E ECTRICAL INSPECTION
FINAL A PROVAL OF CONSTRUCTION
A SIGNED CERTIFTCATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS :
fc!2 ; I �' INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVXLAND ROADS
QUEENSSURY, NEW YORK 3280k
TELEPHONE (5I8) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR .INSPECTION RECEIVED 142
NAME
t,OCATSON f� � A
DATE 2 S^ cS�-� PERMIT #
APPOOVED
S NO
�FOOTINGIPIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP—PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUG —IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCH /S EPS
STAIRS—CLEARA NU & ILS
PLUMBING FIX RES/ IEF VALVE
2NTERIOR TR M/PRIVAC DOORS
FINISHED F RS
GARAGE FI EPROOFING
DOOR CLO ER (S)
SMOKE D TECTORS
FINAL E CTRICAL INSPECTION
FINAL A PROVAL OF CONSTRUCTIO
A SI NED CERTIFICATE OF OCCUPANCY MUST BE
OBT INED FROM THE BUILDING DEPARTMENT BEFORE
THE E PREMISES ARE OCCUPIED!
REMARKS:
1�
INSPECTOR
�! YKAW, t
ationol , dquarters
311:t Iaddl3r �iYe,. Elfrinswrlot#;: Fi'J. OIf 08' COO
Date, s
Yvty�s,:,7`hwri or'TowvnshiP—�+�-'.-,�?1 t� # i# #�+
T _ County ar a° !' A0k —_State /
«Ls�tion�Address - - " -
(If Located in uraI Area • Please Attach 'Drreetions} # PoleOwner &tit one
#
Occupied As rSt7i#isiln —
Occupant Old o . .
- ,,.
for: :-Whin Ser�vaoe, ° ` or: a Rea for 1 ' '
k'. ' Xo �000 xs saoo sslss auoo P ebies.r �:
a;ka,
NtirlrF of iRrxr�h W#rlilg�C rat#ets Elect. Heat .. ,
:- . p��
`: Y .r rn4 . . Amp. Ser##Q RA r w.. - • ' .
1ilJltting ' : : � ,+- - #Fay Unit.. ." Dishw #+arar+9s ...'
ter Heater , Air Condit99 ioner Dryer t = Rump .
RPiacl ^� ^
age DISP [. 1Q(ging and .Gc+ntrols forte. �urrler
s :Ft�CE#I�tRf71111�.
s<a Fraet H:F Vent -Fans
Other .JEouipment:-
M, iaf1 6.. 14 r1/w. /415 26 a& 34 4e -50Ye. .
s Vim u+ ar�i ? ' L r3 n s?�yBrrriit_
a' se #
-t/A .r x airily, . ' tY ' ,.��. .`£ .
Applicant's Address: war r NAM
fCi 1 n (State l4e:aRr—� 4!pl +�� Sec ice Requext y1f
PnOne = - k ' III lecLIEICI n.. _ J 4 4
9
A' R1 t:E1VEl], DAYE IflISPSCY%% `` 3 v r-t
Location SglirM 4'7S AboYe pr: : #•' s ?. ;,$ n�i y._,
Red Notice "bei - r,:.. . • ` s Ir'
Rough Waran Outlets Surface Unit
Chen
an :,y t. g tfipeal�l _
star Heater
on slhwr'•-
l=ixtlrres Alr f on itioner . : "
An'1 . . 'ServiceEqui meat Burner, ring131orittrci#s for Amp `F{^ tacl+s - .
Amp, Service Conductors
kOrVRunrdRieP'` - 1J1 1/t4 .1/8 xJs 114 1J3 1Jg_ S/4 P 2 S vz 10 Y'3. 24 25 Vent Fads.
Of Each '.4'i1'e dy a .- _ � a .
_ r
..99, .. Elect. Heat Boa 750 lass Issa SSvo 1TSo xaoo zltaa revs xi6 :soon Y . . . .
a . ,
` Progress: Inc. LKb Cam' Contractor *,- "' C:7
0 CFT ',�; Violation: Work Comp. O Inc, ] `
Q L/A Owner CASH
LfA .
Hr CHK #
IPA _ M4niisi ... 1 �_ IIAC"F.yMr .,
Rate. a
€' r 9 r BlkFrer Sady4
Cut in Card . . Temp # _� bate
Q.rFinal aRr 7 . a '� Date % / � J - _ kmiSPEc r�PtS1t9
r +
APPLIC.ATIONr FORM MO_ 2$0 EL'4/00 - •".. r r, I - - �` r - - 9 9
r t
� . 1
err y _
/ , f� a
AIL
ok
+-r14r
*"0 1
AQWAftW
w1
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JOSEPH AMMIRATI - BUILDER Custom Built Homes (518) 623-3979
HC-02 BOX 286P
WARRENSBURG, NY 12885
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