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1989-759 n t i CERT`IFICA►.TE OF 0CCUPA NfC,0xJLT TOWN OF +QUEENSBURY j WARREN COUNTY, NEW YORK Date March 9 14 90 I I { This is to certify that work requested to be done as shown by Permit No. 89-7 59 has been completed. This structure may be occupied as a -Single Family dwelling I Location -L...mr* -v-: Pleasant Lane Owner For c _ Wood Ham - S pp By Order Town Board i TOWN OF QUEENSBURY i i Director of Bldg. & Cade i l forcement l i X BUILDING PERMIT CIA �s TOWN OF QUEENSBURY No. R9-7FQ WARREN COUNTY, NEW YORK c r� PERMISSION is hereby granted to Forest Wood Homes F' OWNER of property located at Lot 94 PI asant Lane Street, Road or Ave. in the Town of Oueensbury, To Construct or place a Single Family Dwellinq 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. 'rl c� 1 . OVVNER'S Address is m r+t HC- 02 Box 286P Warrensburg , N . Y , 12804 0 2. CONTRACTOR or BUILDER 'S Name s O Self ; 3. CONTRACTOR or BUILDERS Address Same 4. ARCHITECT'S Name q --I 4p 5, ARCHITECT'S Address 1�rI cn b 6. TYPE of Construction — (Please indicate by %) yy � *X) wood Frame I I Masonry i ) Steel { ) rn i. PLANS and Specifications No_ 42 ' x 26 ' Single Family Dwelling as per plot plan , XXXXX specificati ns , and application , including septic , attached two car Vol age8. Proposed Use ' .�_. Single Family Dwelling M $ PERMIT FEE PAID — THIS PERMIT EXPIRES April 1 . 1st_ r (If a longer period is required art application for an extension must be made to the Building and Zoning inspector of the p town of Queensbury before the expiration date_) f"+'l r— r— Dated at the Town of Queensbu 26th )ay of XX September 19 89 SIGNED BY ' "y for the Town of Queensbury Building and ninq Inspector TOWN Or QuIrENSBUItY REVIEWED BY owN �PJ FEE PAM �iV p SSURY PER*Wr NO. . 2 r IEP . : .� �j BIL UDLNG PERMIT APPLICATION ct 13LL)G' & CODS A PERKrr MUST BE OBTAMED BEFORE BEGDfKLNG CONSTRUCTION. NO INSPECTIONS WILL. BE MADE UNTM APPLICANT HAS RECEIVED A VALLD OUQ.DDIG PERMIT. -- All applicants spaces on this application M L:ST be completed and the signature of the applicant .M (:ST appear on the reverse side of this applicationa s s s ■ w w w w w s rr w s s ■ s s w w +� * * * w w s a s a s w w r a s w s w s s r The owner of this property is: Fts r e sf N�RD� 4j) �n P.Q. Address Tel. Property Location ; ;- # is �?c Tax Map No. Has there been any split of this property since October 1 . 1988 ? ! 1/ 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 ISO w NATURE OF PROPOSED WORK: ESI':MATED MARKET VALUE OF Construction of a new building CONSTRUCTION: S L�1 e • COMPLETE INFORMATION NATION FI�EQUIRED BELOW: Addition to a building , r � � „ - 11.1 ' Size of property 71 ft x ' ` et. Alteration to a building ' Existing Buildings( 3 ) Size fto x ft. (no change to exterior dimensions) e Proposed building - distance from property line: Other work (Describe) ; Front yard 3 'E�- ft . Rear yard 7 `- ft. • Side yards K ftm and ft. GROSS AREA OF PROPOSED STRUCTURE If on corner, setback from side streex !t. 1st Floor "` i sq. ft. # OCCUPANCY INFORMATION 1nd1 Floor :y py sq. ft. / d # Primary Building Other Flaoes 3 w ✓One Family DwelUng (not cellar at msnt '�. Two Family Dwelling TOTAL FLOOR AR" IS ' sq. ft: p • Multiple Dw ellinN/"Nunamw of units Stow o[ oew suWt ere_ A ft s r ftt a ' loow�8atlaer-plst oaa►) �� * , - - r He4Mt (graft to Hft+r) e; S,_.....ten.. . If addLtbi% what win um If resideeetial, no. of famm" No. at rooene(escumi ft Oaths) J • Aoe�y Buildhig No. of woe�r �� �_Dotrel d Q+e ngs, OK&*'I WO Gar a No* at batMofWrs .. Primary h..mq +fin tt ci .G CHUM!M— -:r Type of feesi w� a ,Private stones bunew Nee of ftrepMess to be lnata ned • Omer Will a woesd stove be installed : *•—^ Central Air e:+oeedltienins ��_ Ovo Ell 8L' I1. D [VG PERMIT -% PP [. 1C .-, TIOti BUILDING 3PFCIFfCATIONS. Type of construction, wood frame, fire -safe, etc. ' Will any second-hand or upgraded lumherbe used? If so for what ? Foundation wail material C Thickness <7" , Depth of foundation below grade (to bottom of footing) r ' Will there be a cellar? Heated or unheated? L� Floor sq. footage ft . Will there be a basement ? '" W iIl any' portion be used as living space? ,. ��sq (If so, what portion9 IIIIIIIIIIIINUNNIsq ft. Type of use ? Type of roof - slope,J/flat/shed/other 'Material of roof r Size, wood studs . � "x '" spacing/ o. c. length 2 ft. Joists ( floor beams)- 1st floor 'N"' 'Ix 1 -" ;pacing. N I000••o.co span ft. Joist (floor beams) 2nd floor "x " ;pacing , s � "o.c. span ft, Overlays (ceiling beams) "x " spacing " o. c, span ft. Roof rafters "x " spacing o. c. span ft. Roof trusses (pre-engineered) spacing ow=' ; 9 .' O.C. span d ft . Exterior wall finish r s , dd of what material? - Interior wall finish r. If a garage Ps to be attached, describe materials to be used for FIRE SEPARATION: } Is there to be an operring between garage and dwelling ? 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 ft. (A separation application is necessary for any repair or new installation of septic system ) NAME OF BUILDER ADDRESS TEL. NO. -.( : . . . NAME OF PLUMBER ADDRESS TEL. NO. NAME OF MASON 11P ADDRESS NO. NAIVE OF ELECTRICIAN _ ADDRESS TEL. N©. DNC6AKA !lM To the treat of wry► 1W@a0iirdXG , d mil► hire staseme&ts aoetaieed is this *ws a d Spec fleettoM s�itteel. are a true �d cor^�piarte stat.enRe�nc of atl t3e�t. � with Me Me drrscMbrd peentiras arld that ail provisions of the BUILDING CCIDE. THE ZC1�`k- to an LU other laws p;ertaWft to the; proposed work shall be compU*d withe Whether och work is authorised by tho owner, sprcifled at note aM! that Sitnaturre • ; t Owner, owner's agent, a!C!dloCt, cowlra+ctoe iPECIALf CONDl'I ON/ OF Tin P'�,'kii r, By OF QUE _ 4SBUTta 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 . Groan floor area Sid 2 . Type of heat 3 , is the building mechanically cooled ? y 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 heat - d spaces YES NO a . Are foundat on walls insulated ? YES NO 1 . if YES . what is the R value ? 3 . Slab on grade YES NC1 a . If YES , wh . 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 wails 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 - heated slab S . R value of heated basement / cellar walls ( above grade ) 9 , R value of heated basement / cellar walls ( below grade ) 113 , Type of insulation Co Controls Y . 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 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation_ F . Service slater Heating 1 . Performance efficiency 2 . Temperature control setting maximum, G . For Swimming Pool only 1 . Maximum heating Telephone No . ( applica=at ' s signature } TOWN OF QUEENSBUPY C1 APPLICATION FOR -`E �_. }�, SEPTIC DISPOSAL PERMIT DATE LOCATION OF PROPERTY FOR INSTALLATION Owner's Name: 177e ?rt y '+ ti, iti, Telephones ; - _5 ' 7 y Address: Installer's Name: D rj J�, erg Telephones Number of bedrooms (residential only) Total daily flow (compute rd 150 gal per bedroom) 4 _ Topography: Circle ont:: Fla•t�Rolling Steep Slope % of Slope Soil Nature: Circle on . Sand Loam Clay Other /Depths Feet .. Ground Water: At what depth? Feet Bedrock or Impervious Material: At what depth? x' Feet Percolation test: Circle one: ot uir req required rate min, inch. Cn .. Domestic water supply: circle on Municipal Well father If domestic water supply is a well: Separation : Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank fE:) 0 0 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: .J DATE: 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 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 5 . ) 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 rusult 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 situ , 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 rupalr of an approved system , a new proposal must be submitted to the Queensbury Building Department before further construction . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland 'Roads Queensbury , New York 12804 a�+�i `a.V�Cs rD!`Pr+V/s°i6al+Vss�S1e7►+e'�vcl^w'v9�r'��cav-o-�uv-�-w��v�-+�� �/ . MIDDLE dEPAR7 AGENCY, INC. �f STAT 1PJ"_ _�w ZV oss+r Ma ctr 11 , 1990 Cl?'rtlflE� that t i iT uipment listed has been 0 -a r approved as being in accord with the National Elect plieable governmental, utility an ' s. Owner. Forestwood H p �w41 occupant: Single Famil Location: Lot 94 Pleas t ' - s e u ryficafe V I ipmerH and Installation inspacled this dale. If atldillo"I of 11 ah be Inlrodpcad of allefahons Ruda to axlsling syslarrl thi 4c ba null and void. and appkicshan for @C tacles inspect[on ahouftl Wbmal p tly to Wit Agency. Equipment: 110 t le N rV01der of lhls ea �liota a ni same to his praporly insurance oartiaf 200 Amp Servi App lances , Sagenlorcomp y}asevl rtlfkcaVVon atslsCtrlcal equipment approved as epacilletf. Hodges Electr - 5C E •1883 Applicant: 31 Tenth Avenue ""- -- -_..Y 01 15 -031003 Hudson Falls , NY 12 fe M0. 7W EL 1 aia TOWN OF QUEENSBURY ,BUILDING AND CODES DEPARTMENT J f BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280& TELEPHONE (528) 792-5832 BUILDING 1IINSPECTOR" S REPORT RgVUR,'",,T N,5"pEC'2'1'ON RE EIVE NAME b LOCATION DA TE\ � PERMIT # - a APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FOPJS FOUNDATIONIDAMP-PROGFXXG BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS. WALLS CEILING f�( FINAL FNSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ST STAIRS-CLEARANCE & ILS PLUMBING FIXTURES/ IEF VALVE INTERIOR TRIM/PRIVA !t DOORS FINISHED FLOORS t !L. - - GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS = FINAL ELECTRICAL IN#PEC ON ' V7 FINAL APPROVAL OF rONST CTION OK TO ISSUE C/o OR C/Csk A SIGNED CERTIFIC TE OF MUST BE OBTAINED FROM TH BUILDIJCUPANCY DEPARTMENT BEFORE THESE PREMISES A E OCCUPI9DI k REMARKS . �, �.7�i/[{� {�r( � ARRIVE ► : 00 DEPAR, � l( XNSPECTOR TOWN OF QUEENSBURY I BUILDING AND CODES DEPARTMENT I BAY & HAVILAND ROADS QUEENSBURY , NEW YO K 1.2 20k TELEPHONE (518) BUILDING INSPECTOR' S REPORT REQUEST INSPECTION RECEIVED NAME LOCATION-7n` / DATE , P f' ,. ..2/ PERMIT # pF ApPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKF'ILL APPROVAL ROUGH PLUMBING FRAMING gCTFtICAL ROUGH-IN CZ � 'JNSULAT ION F•OU,ND,x�xldN FLOORS I WALLS CEILING FINAL INSPECTION: CHIMI HEIGHT ROOFING SIDING EXTERNAL FORCHES/STEPSLS STAIRS-CLEARANCE & _ PLUMBING FIXTURES/ LIEF V LIVE�� INTERIOR TRIM/PRI CY DOOR FINISHED FLOORS GARAGE FIREPROO ING DOUR CLOSER (S) SMOKE DETECT S -- FINAL ELECTR.I L INSPECTION FINAL APPROVAL OF CONSTRCTCTIO A SIGNED CERTIFICATE OF OCCUP NCY MUST BE dSTAINED FROM THE BUILDING DE RTMENT BEFORE THESE PREMISES ARE OCCUPIEDC RETvA T2 KS: INSPEC R TOWN OF QUEENSBURY r "� BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY,r NEW YORK I28f77E TELEPHONE ( 518) 792-5$ 32 BUILDING INSPECTOR' S REPORT iv i REQUEST FOR NSPECTIONr, (RECEIVED NAME " LOCATION DA TE PERMIT APPROVED YES NO FOOTING/.PIERS mOjvOLITHIC POUR FORMS FOUNDATION/DAMP HOOFING BACKFILL APPROVA / d &�4 OUGH PLUMBING iIl�RAMING ELECTRICAL ROUGH-I INSULATION- FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES � S EPS - STAIRS-CLEARANCE RAILS -- PLUMBING FIXTURES RELIEF VA VE INTERIOR TRIM/PR ACY DOORS FINISHED FLOORS GARAGE FIREPROO ING DOOR CLOSER (S) SMOKE DETECTOR FINAL ELECTRICA INSPECTION FINAL APPROVAL F CONSTRUCTIONS -- A SIGNED CERTI ICATE OF OCCUPANCY MUS BE OBTAINED FROM THE BUILDING DEPARTMENT FORE THESE PREMISE ARE OCCUPIED !' r REMARKS: r ; INSPECTOR Town o/ uee,nshetry BUtk,oiNG and ZONING DEPARTMENT Pm Bay and Haviland Road, R.D . 1 Box 98 3 Queensbury, New York 12801 SEPTIC DI5POSAL SYSTEM INSPECTION NAME `Z � �L. ,041 LOCATi4N�i '"� � DATE A!?— f PERMIT NOO 3, s SOIL TYPE - Sand. - Loam - Clay Percolation Test 'Required? YES - NO Percolation rate - Min/Inch TYPE of 5Y'ST : Absorption fie d , total length Length Of each ench Depth of trench00 Size of gravel 'k ----- SEEPAGE i? TS-(Niunb Size- ft. X _ f Gravel size PIPING : Size "r Bldg . to tank 55 Tankk to oust . bo Dist- bo)= to fie d/ openings sealed 'YES NO Partial LOCATION/'SE'PA TIONS : Foundation to tankfFoundaticn t absorption ft - Absorption t lot line t- Separation its tt� o LOCATI y TEM ON PROPERTY (circle one) Front - ear Left side - Right side - cCHMENT : 6 / ) k SYSTEM USE APPROVED YES guil�3ing In odor 01/86 and v1 6 h�- a m�s TOVVN OF Q � Zont ti P Li�f 441 a � ac12 <-- as GARF�G t [ LuCt� 4/tA40 1 TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I2804- ,,r TELEPHONE (5I8) 792- 5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION ,DATE PERMIT # /c .+ APPROVED YES I NO FOOTING/PIERS MONOLITHIC POUR FORMS LFNDATXON/DAME-PROOFING4ra L, . CKFILL APPROVAL ROUGH PLUMBING - FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING pw FINAL INSPECTION : CHIMNEY HEIGHT + ROOFING SIDING EXTERNAL PORCHES/ST S STAIRS^CLEARANCE & ILS PLUMBING FIXTURES/ IEF VALVE _ INTERIOR TRIM/PRIV DOORS FINISHED FLOORS GARAGE FIREPROOFI G DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL NS'PE TION FINAL APPROVAL OF CONS UCTION M1 A SIGNED CERTIFI ATE OF OCCUPANCY MUST BE OBTAINED FROM T BUILDING DEPARTMENT BEFORE THESE PREMISES' RE OCCUPI'VD! REMARKS: C Oti/r z i w Pry e- s s C) CGr1r �'j� 1,41fo ' &AL. A i 3 car v t a f= WA-Cf, ,v0T-.,u�. 10,q-o - - r z � IN =OR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS ! QUEENSBURY, NEW YORK 2 2804- TELEPHONE (528) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST INSP CTION RECEIVED NAME LOCATION 7 �xlleP ,}f DATE PERMIT APPROVED ES NO ..�OTING/PIERs MONOLITHIC POUR ro FOUNDATIONIDAMP-PROD NG BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/S EPS STAIRS-CLEARANCE 41RAILS - PLUMBING FIX]RkERELIEF VA ' VE INTERIOR TRICY DOORS - FINISHED FLOGARAGE FIREP 'DOOR CLOSERSMOKE DETECTS FINAL ELECTRIC L INSPECTION FINAL APPROVA OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY ST BE OBTAINED FROM THE BUILDING DEPARTM T BEFORE THESE PREMISES ARE OC UPIED! REMARKS: �I INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY. NEW YORK 12801- TELEPHONE (51.8) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME 7� LOCATION DATE / PERMIT # `7 ` APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS wT'6UNDATION1DAMP— ROOFING *�ffACKFILL APPROVAL ROUGH PLUMBING, FRAMING ELECTRICAL ROUGH—I a INSULATION: FOUNDATION FLOORS Ll WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STE S STAIRS—CLEARANCE & ILS PLUMBING FIXTURES/ LIEFX INTERIOR TRIM/PRIVA Y DO FINISHED FLOORS _ GARAGE FIREPROOFIN DOOR CLOSERS) SMOKE DETECTORS FINAL ELECTRICAL I PECTI FINAL APPROVAL OF ,CONSTRUCTON ION N,, s• A SIGNED CERTIFICATE OF OCCUPANCY MUST 'VE OBTAINED FROM THE BUILDING DEPARTMENT BIWORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT DAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12801. TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME L[7CATXON DATE PERMIT # APPROVED YES NO TINGfPIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILI. APPROkVAL ROUGH PLUMBING ' , FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION t FLOORS y WALLS CEILING FINAL INSPECTION : CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PdRCHESfSTEFS STAIRS-CLEARANCE & RA S PLUMBING FIXTURESfRE EF V VE _ INTERIOR TRIM/PRIVA DOORS FINISHED FLOORS GARAGE FIREPROOFIN DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL I SPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED!' REMARKS: r t INSPECTOR NNE MIMSPIPARTM Natrona1 Head ivari9ers I - soo" iiWoi i�We.; i:+ f ire wao r ;�' [isi�os - - _ Date: , . - City, Town or Township !. e County J6 Lw state- Location/AddressAM _ elf Located in Rural Area - Pie Attach pirectiansl ' ;,_ .:.'._ :. . . Owner. % Occupied As, Occupant .c,.. w6rk Area in Builciinnm plao for: Wirin mice ear: . . Read for I Fee Remitted= = i ..- Cash Check . . *, ti , . . . . . MW Number of. Rou ri Ck►tIr- $ x Faso 2aDD zzso saDu z7ee apoo *a y y eta f=tact. H�i�t Asa k Switches ; - `x.: " - . •v -. . . .: Lighting . • : - � Amp. SerWdKt' i3S aca Unit DishwrfA Water Heater Receptacles A2r'Conditioner Dryer sJ ... ;�pu Numi�err `u '' Oven ; * . -- ='[;i3f" -"'r Dia{losar .. 4MP i � C41 �Qr. 4rt kk =.Recept Fractional H: _etI#'Fansy' d. Other Equipment: r : ; $ w~ S . MOTORS H P. /a� #,/1 . di% xla. . lJfi 1/4 1/F3 -; 2 a/a 1 i+rx 2 :s` ;7vs so is 2e] 2S So 4 �' 'Mark I4um4or r `'" of Each.Size * :y. lit . Applicant's Signature "{ '' ! 4isur. :. WPM- T/A tieaense'.#- Applicant's Address: tlrr y; (City) Phone-. tateZ - r r iq 8 Request -V ,/ ,. �A e'FIECEI'VED: / ! ." �f s DATE J SPE&j_. x ' Correct Location_ ,Same as Above 0 or: Red Notice Lat?e1 „ Rough Wiring Outlets Surface Unit Oyre{7` itches ' Range ; c- { Rece les Water. Heaver' r : - Fixtures Air �rrClftione eM Am . Service Equipt�ent Burner; irlh o s far. Amy. Am . Service Conductors Pump Vent Fans Mark GRSr P. 1/=6 1 llla 11e. I.ns 1/a 1> �1/z 3/ ' -3" • .� 3,. - 7�fi xa Ls 20 as g. . of Each Size _) aO0 7sa IOOp l2w letDO 1750 'pDDD Q2ei0 7TS0'D jr ED RW Progress: Inc. LKf) © Contractor009 Q CFI Violation: Work Comp. IncId L/A' IL Owner CASH C1A. Fee CHIC � IPP� Municipal Due MD * - � i d I -;a c �4 u "- . Dtihelr Bide C� l]tilitlyc. . , Cut in Card d Temp + i]ate3.:€ zs , .. e` r.r Q Date ` - . t . . w x+•Vwr rrr tz riamt ,,. APPLrCAt'FbNFe,7 RN{ rvo; E0 1 4pi'.� � > .• ._ - .. .. ,e -. .. , . . .,.ej,, ,r {, - ~ s FOREST WO*! HOMES INC. JOSEPH AMMIRATI - BUILDER Custom Built Homes (518) 623-3979 NC-02 BOX 286P WARRENSBURG, NY 12885 .� r