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1989-773 ` 04 s F. CERTIFIC ►tE OF OCCUPANCY J TOWN OF QUEENSBURY j WARREN COUNTY, NEW YORK 1 Date October 2 14 90 This is to certify that work requested to be done as shown by Permit No. 89- 773 has been completed. i This structure may be occupied as a Location __ 'T7ST'�-�-rf Ma n 7 ,a n r i L.o 111 i i i Owner Stephen Kelly s By Order Town Board TOWN OF QUEENSBURY Building Zoning inspector �r `4 k 40 BUILDING PERMIT TOWN OF QUEENSBURY No. 89_773 WARREN COUNTY, NEW YORK G, s PERMISSION is hereby granted to Stephen Kelly OWNER of property located at Lot 74 Maple Drive Street, Road or Ave- in Family 'Dwelling ' M in the Town of Queensbury, To Construct or place a g 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 , OWNEWSAddressis M M 11 Willow Road lr— Queensbury . N . Y . 12804 2- CONTRACTOR or BUI LIDER5 Name CAM C+ m T's Self M 3. CONTRACTOR or BUILDEWS Address Same 4. ARCHITECT"S Name r S. ARCHITECT'S Address c7 e-r V .p, V QI S. TYPE of Construction — (Please indicate by X) 4 rf? ]('XKWood Frame i ) Masonry ( ) Steel L. t i. PLANS and Specifications No. 28 ' x 64 ' Single Family Dwelling as per plot plan , specifications , and application , including septic , attached two car garage , and driv way . 8. Proposed Use Single Family Dwelling cn J L� -J $ 71 co PERMIT FEE PAID — THIS PERMIT EXPIRES May 1 19 90 � (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the M town of Queensbury before the axpi rat ion date.) SC Dated at the Town of Queensbu D y of October 19 89 � ram— SIGNED BY for the Town of Queensbury Building and Zoning inspector tt=y TOWN OF i' UIMMSBURY C REVTE WED BY FEE PAIDG; N OF G s M UEENSSLj PERMIT NO% RECEIVED BUILDING PERMIT APPLICATION .� �P i .EL BLDG. R CODE DEP-r, A PERK1T MUB'T BE OBTAIXED BEFORE BEGINNING CONSTRUCTION. NO INSPECTIONS WILL BE MADE UNT L APPLICANT HAS RECEIVED A VALID BUMDQIG 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. * * * * * a ■ * • * * * * * • a * * * • * * * * * * a * * a * * * a * * a e * a * The owner of this property is: P.O. Address ,// Lr. /,/Q a. v led ocr ee4j �w .s . Tel. Property Location .4 o ?4 le © /u e avu ee4 s ; ,t Tax :Map No. Has there been any split of this property since October 1 , 1888 ? If yes Planning Board Review is necessary. yes no SUBDIVISION NAME, IF APPLICABLE 1,15 LOT NO. II`-yr THE PERSOlf RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS: MATURE OF PROPOSED WORK : Es r MATED MARKET VALUE OF _Construction of a new building „ CONSTRUCTION: S Addition to a building ' COMPLETE INFORMATION REQUIRED BELOW: * Size of property_...._ ft x X-5 it. Alteration to a building " Existing Buildings( 3 ) Size ft. x ft. (no change to exterior dimensions} • Other work (Describe) # Proposed building - distance from property tine: Front yard 4,14 ft . Rear yard • Side yards :2 ft. and ."t ft. GROSS AREA OF PROPOSED 'STRUCTURE • If on corner, setback from side street ft. tat Floor / y' , , �t " s ft. 1 �c OCCUPANCY INFORMATION 2nd Floor sq. !t. „ Primary Building Other Floors sq, ft. • One Family Dwelling (not cellar off mit) . Two Family Dwelling TOTAL FLOOR AREA ! - i►t, • Multiple Dw *Wnjr/Nufhber of emits --•- i4* FawBwdation-pie+e/slab/erawri/pert; � .�` ' .. .� � . A A4,�Industrir� (circle ara) • Other i. "SIM �1 ft w6 taken* i►f `w: R ..� ' iai'�:f 'E YL - !- .�3 4-a- - d .;� .VM i'6.i. ...tea i 7'IA 12% ♦ is ei - ReNsm lit to Video) „ , / � ft, a If add'ItIM14 what w iu use beta' If residenti" no. of famin4o / No. of rvonu�dexcluaiug baths) lb a l8ok of badtaaras ..&- a �petaAaClfrsA Gsrrap O�iRrl"Ii10 WOO of bathreea w ♦' Prleaary lMatllrt� sFse c ,f5'r. + '� AtUwtbrd Car"* O C+�l� Type of anwt "' � Private stormse buUdhW No* of rh4vaftovs to be installed / Will a wend "Ova be lnaftHod �� CerKrai Air ecwmlltiening l7 o OVq* Bit BUILD (NG PERMIT APP ;. IC" .ATION oti , I �' � c � - BL' ILD [NG 3PECiF1CATI0 :1 5: T% pe of construction, wood frame, fire safe. etc. A� 400 W i I I any second-hand or upgraded Ito mber be used? If so, for what ? Foundation wall material / OG Re cal? C'1?eA -2 Thickness Depth of foundation below grade (to bottom of footing) 14fa r Will there be a cellar ?� [-seated or unheated ? V[ Floor sq, footage sq ft , Will there be a basement ? �' W ill 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, wood studs x " spacing /Gv " o. c. lengths� ft. Joists ( floor beams)` lst floor c- "x /6 " spacing 16 "o.c. span I fto Joist (floor beams) 2nd floor "x Ifspacing "o.c. span ft, Overlays (ceiling beams) Ft " spacing." o,c. span ft, Roof rafters "x " spacing o.c. span ft, Roof trusses (pre-engineered) spacing" o. c, span ,R & ft. Exterior wall finish of what material? Interior wall finish 5-w e e -If a garage ft to be attached, describe materials to be used for FIRE SEPARATION: P.]`r _ Is there to boa an opening between garage and dwelling? W If so will a Fire-rated door, enclosure. self-closing device be provided? �y c5 Will a flue-lined chimney be installed? Height above roof 2-ft. FIP Q- Depth of chimney foundation below grade ft. t Depth of fireplace hearth ft , in. rfar Water supply - Municipal or private well / 7-cf0 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 2eaGa A4//71 ADDRESS AVV, 1,411 AV TEL. NO. 2,P3. a w-:;z_- NAME OF PLUMBER rf ADDRESS TEL. NO. rr NAME OF MASON ADDRESS TEL. NO. NAME OF ELECTRICIAN // ADDRESS TELe NO. . ,..J i .`• it .r -. �[ !Y � - n L^, . -_�_ _ .� _. . . � — _ Wit •,_ .!`:{!# f DEC AJtA' a �a�VK-- -_. fIr To the bast of eny kne !wise and-b*Uef the statements contain 99 - togeitTt+ii w[th the P6WV&w4":SO"dirstion&xubmitted, are a true and co statement of &U Proposed on to to dww an the described premises and that an provisions of the SUILDtNG DE. THE ZONING ORDWAI40E, &" oU ather laws pertr bt t to the p 4*fted work shall be complied ith, whether specified nee and drat such wm* is authorised by the owner. . iii�lature . . Dwnes'r �Iel�i its ar4 t tdr RPECtAL CONDFIVIUM OF 'Tug ! 1111"l'i` � .It 8Y .; TOWN OF QUE . V5BUR _ 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 h e a t �/ rT,9�r��/ �Ile 3 . Is the building mechanically cooled ? A / a / 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 - 3 spaces YES NO a . Are founda, t on walls insulated ? YES NO 1 . if YES . what is the R value ? 3 . Slab on grade YES NO 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_ JfF 99- 2 . R value of exterior walls yv 3 . R value of glazed area �2 Is 4 . R value of doors G'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 8 . R value of heated basement/ cellar walls ( above grade ) 9 . R value of heated basement /cellar walls ( below grade ) la . Type of insulation Co Controls 1 . Thermostat maximum heat setting Ile Do Duct Systems 1 . Is duct system installed in unheated spaces ? CYES) NO a . if YLs . R value of duct installation 0/0 b . R value of duet in other areas E . Piping Insulation 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating 1 . Performance efficiency 2 . Temperature control setting maximum_-- eLjVFS G . For Swimming Pool Only ommunnow 1 . Maximums+ heating (;?� ZZ Telephone No . / � �r� �� app ant ' s gna +r ) TOWN OF QUEENSBURY APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE LOCATION OF PROPERTY FOR INSTALLATION o eZI 7 ��� �. Owner's Name: P / �'1 � !/J' / _ I' Telephone: M % 1� 2 '� 2- — Address: //` dz. f r�/G GYc 0 / } 0G C�'i�''A,,e hone: 7 X Telephone* Installer's Name: P Number of bedrooms (residential only) Total daily flow (compute (d 150 gal per bedroom) �Q Topography:. Circle one; 1 Rolling Steep Slope % of Slope Soil Nature: Circle ones an Loam Clay Other. /Depth: Feet Ground Water: At what depth? f1 _Feet Bedrock or Impervious Material: At what depth:' J7At, Feet Percolation test: Circle one: not required required rate min. inch* Domestic water supply: circle one: Municipal Well Other If domestic water supply is a well: Separation: Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank /(J647 gal. ( minimum size: 1 , 000 gal.) TILE FIELD: Each Trench feet/Total system length feet SEEPAGE PIT(S): Number of�7 �I 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 Sa ry Se age Dispos O dinance. SIGNATURE OF RESPONSIBLE PERSON: 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 S . ) 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 Inspector . Failure to comply with this requirement may result 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 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 Lau submitted to the Queunsbury Buildtn €; Department before further construction . Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York L2804 �:�n�arks .r,rr�.a.U�ir'•+w.Gcra���rawn�:rwar,�f�t'i. +r�" Y 'a MIDDLE CIEPARTMZNXJUZAKQXI0N AGENCY, IINC. 96 (Err �T- _---- oats February+ 24 , 1990 (E rrtlf[ e0 that eleClri�'al,"equipment listed has been exarf 6d- an ei6 approved as being in accord with the National Electr' Gc is applicable governmental, utility and'Agepoy k es. Owner: Steve Kelly ' f,, p -Y`I Wdl3.'Zn Occupant.• Single Fam € Location: Lot 74 NiaF 1 a Q y " n^ rtiticate i� Itf"iec 1c ulpmant and installation inspected this Is If addilipnat aptugment It be introduced or atteranons made to " existing sysiem thi( cart Ica be null and void and If , application for Equipment: 110 Outlets 1)l icecdptacl.es ; .tic ti} $$$$,,s *t3 inspection should qe submit[ p thy to this Agency- 2200 Aiti ] Servic 3 A 1i.an, S ' $k1t1v�n01 S1 tl to „Holder at this certificate ah td ent same to his property insurance carrier t i PF s 7agenl or com paiiy}as evl erti fkcahon of electrical equ i p ment Opp roved as specified..,' ! r Steve Kell Vo Applicant: Willow Road ;.ar I _; �lQ . Queensbury , 1280 r �ex:r ; .. 15 -030889 �✓ V V FaKfn fso. Ida EL t.63 ' TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1 2809- TELEPHONE (5I8) 792-5832 �f BUILDING INSPECTOR' S REPORT ��LI REQUEST FOR INSPECTION RECEI ED NAME LOCATION DATE' � G7 -" PERhlT #fit ! / APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING f BACKFILL APPROVAL ROUGH PLUMBING FRAMING E,LECTRICAL ROUGH-IN 4..-`INSULATION. FOUNDATION FLOORS WALLS CEILING FINAL INSPECTIONx p" CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/S PS .STAIRS-CLEARANCE RAILS PLUMBING FIXTURE /RELIEF VALVE_ INTERIOR TRIM/P VACY DOORS FINISHED FLOOR - GARAGE FIREPR FING DOOR C LOSER ( SMOKE DETECIRS FINAL ELECTRI AL INSPECTION FINAL APPROV L OF CONSTRUCTION A SIGNED C RTIFICATE OF OCCUPANCY MUST BE OBTAINED F OM THE BUILDING DEPARTMENT BEFORE THESE PREM SES ARE OCCUPIEDI REMARKS: ' f INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY 6 HAVILAND ROADS QUEENSBURY, NEW YORK 22801& TELEPHONE (sss) 792-5e32o } � BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION R EIVED Af NAME `/ ZoOCATIO/N / 7,, �J DATE PERMI 1' (# APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—PROOFING F ILL APPROVAL PLUMBINGNG ELECTRICAL ROUGH^IN INSULATION: r FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SID-rNG EXTERNAL PORCHE /'STEPS STAIRS—CLEARANC & RAILS PLUMBING FIXTU ES/RELIEF VALVE INTERIOR TRIM/ RSVACY DOORS FINISHED FLOG S GARAGE FIREPR FING DOOR CLOSERS SMOKE DE WC S FINAL ELECTRIC INSPECTION FINAL APPROVAL F CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST Jhe OBTAINED FROM THE BUILDING DEPARTMENT BEPaRE THESE PREMISES ARE OCCUPIEDI REMARKS: IN TOR _ ." o ueens6ure�r BUILDING and .ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Clueensbury, New York 12801 or SEPTIC DISPOSAL SYSTEM INSPECTION NAME eA. may+ LOCAT I ORS DATE PERMIT NO . SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch s - TYPE of SYSTEM : Absorption field , total length Length of each trench Depth of trencheI - Size of gravel SEEPAGE i? ITS4Wumbe of ) i �r Size- ft. X ft" �— Gravel size - PIPING : Size Type Bldg . to tank Tank to list . box Disto boa: to field/pit �'- Openings sealed? YES NO Partial LOCATION/'SEPARATIONS : t Foundation to tank fto Foundation to abscrp,,ionm ft . Absorption to lot 1yne ft . Separation of pits ft. LOCATION OF SYSTEM ON PROPERTY (circle one) Front - Rear - Left side - Wkght side COMMENTS : 2 SYSTEM USE APPROVED YES NO Building Insp c r 01/86 and vl r awl" 0/ Q"eenjiury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME ,4cey!t A: LOCAT I ON ';Y' c .�` Y•G. DATE /•'' / c2//OPERMIT NO. SOIL TYPE - Sand - Loam. - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM : r Absorption field , total length � 1 Length of each trench v e> Depth of trenches Size of gravel SEEPAGE PITS{Nnmber of) Size ft. X ft. Gravel size - PIPING : Size Type Bldg_ to tank Tank -to dist. box Distw box to field/pit Openings sealed? YES NO Partial LOCATION/SEPARATIONS : Foundation to tank ft. Foundation to absorption ft. Absorption to lot line ft. Separation of pits ft. LOCATION OF SYSTEM ON PROPERTY (circle one) Front - Rear - Left sidle - Right side - CCMMENTS SYSTEM USE APPROVED CYE§ NQ Buildin I Spector 01/86 and V1 I IBM LOT 74 srniL c�J�'Am% ul IIT OF HE r� 91 97. 3 0SA'{�,;i,t' TY EN ;iP3EER 7.70 ° 97.89 Q BAH 9 �99Q , fiL�Y � ice, QATE 97.74 97 p f F, ,liii••ii! 7.95 LOTry 1000 GAL a.la + , t 9A. SEPTIC TAN �581i ' Io i p T I 97" 98. f 6 PLOT PLAN MADE FOR TOWN OF QUEENSBURY p BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS �FY/ QUEENSBURY, NEW YORK 12809, TELEPHONE (518) 792,5832 BUILDING INSPECTOR ' S REPORT REQUEST PW INSPECTION RECEIVED NAME LOCATION �j — rI /� DATE / I'J /yY J, z � PERMiTT # A/, ! 3 APPROVED YES NO FOOTING/PIERS ONOLITUXC R FORMS �/FOUNDAT.rONfD —PROOFING . BACKFXLL APPROM L ROUGH PLUMBING FRAMING ELECTRICAL ROUGH- INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHINNEY HEIGHT ROOFING SIDING EXTERNAL PORCH S/STEP STAIRS--CLEARA CE & RAT S PLUMBING FIX RESfRELIE* VALVE INTERIOR TR M/PRIVACY D6PRS FINISHED F RS GARAGE FI PROOFING DOOR CLOS R (S) .SMOKE DE EC TORS FINAL ELEC ICAL INSPECTION FINAL APP VAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: I SPECTOFd TOWN OF Q BUILDING ANDD CODES DEPARTMENT BAY & HAVILANLt ROADS 92UEENSBURY, NEW YORIC 128 p& TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST INSPECTION RECEIVED NAME LOCATION // c - DATE � _y PERMIT #—, JL2 A APPROVED YES NO OCJTXNGJPIER.S .MONOLITHIC POUR FORMS FOUNDATIONJDAMP—PROOFING BACKF'TLL APPPOVAL ROUGH PLUMBING FRAMING ELECTRICAL ROU H—IN INSULATION: FOUNDATION FLOORS WALLS CFsTLING FTNAL INSPECTION: CHTNNEY HETGHT ROOFING SIDING — EXTERNAL PORCH SJSTEPS. STATRS--CLEARA E & RAILS PLUMBING FIX RESJRELIEF . VALVE INTERIOR TR JPRIVACY DOORS FINISHED F RS GARAGE FIR PROOFING DOOR C (s) SMOKE DET CTORS FTNAL ELEC ICAL INSPECTION FTNAL, APPR VAL OF COIVSTRUCTION A SIGNED Chl?TIFTCATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: &T1/6 AJL*'��a ae INSPECTOR � — TOWN OF QUEENSBUR'Y BUILDING AND cODES DEPARTMENT BAY & HAVSLAND ROADS QUEENSBURY, NEW YORK 12809- If TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR .INSPECTION RECEIVED NAME avip LOCATION ry DATES CJ PERMIT # APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FO S FOUNI7A2"It7N/DAME-PR FIND BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH- INSULATION: FOUNDATION XFLOORS ff WALLS CEILING FINAL .INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/S PS r STAIRS-CLEARANCE XLS PLUMBING FIXTURES R IEF VALVE INTERIOR TRXM/P A DOORS FINISHED FIAORS GARAGE FIREPR ING DOOR cLOSER (S) SMOKE DETECTO S R;_,�...., ...., FINAL ELECTRIC L INSPEC ION Y' FINAL APPROVA OF CON ST UCTXON OK TO ISSUE /O OR C/C A SIGNED C TIFXCATE OF CUPANCY MUST BE OBTAINED F M THE BUILD G DEPARTMENT BEFORE THESE PRE XSES ARE OCCUP ED! REMARKS: ARRIVE IDEPA.'RM INSP TOR IYII0O LE" ie1RTlEN ': ECTJ+ Flf1A ' � � b National Headquarters . 9M Haddon Ave:`, Collingswood, Mi 06108 s Date: ... .+ ,"` City,.Town or Township County 4'#WJ WA'P440' State k Deaf_ ion/Address /!° Ace / ,p * 'r _j C)''w' ot* a (If Locatqd in Rural Area - Please Attach Directions): Pale # Owner. ,. .,.; . •s /1/ �, ./ PermPt.k i Occupied Ag sS E-%H1-. _'�' *� Building:- yyl�"'�'�Old � r` W Area in Building Floor #, ate.):. for: Wirin rvice or. Flea for Iris on: Fee Remittad�= " =. , = Cash 0 Check F1 Ii Ab P • atale ` dt : M:D. I.A. Number of Rourwhin I utFetss - a" maso 2aoo 2sao a000aam lo Elect. Heat Switches ,as ; Lighting Amp. SeritieF.4 —rzf ace Unit Dishw bevt ; mange Raoap#acles Water Heater Air Conditioner Draper ; y Pump w. . . Nu �; :�,.. ,_ - _ 4ven arB'IS"„ ...,;Qiffbaga Disposal Wlnrag;and t,1�p15 fqr„�� Burner, M. < ___- A .'JRas:el#ta Nz st Fractional H.P. VenE t -:;f 3f r , `a, ::; , r ', Other Equipment: 4 MOTORS ii,R: 1!2 3Ii .1lx ' 1/a 1/6 1!4 x r3 1!2 3ra 1 1Yr 2 3 . s 7W xa 15 20. . 25 3a +io, �0 75 lzro Mark Number x i- _ of Each Size L. Applicant's Signrture License Formit TIA �# a Jt}lity: z Appiicant's.'Address: r. - +/ >. r • . .: ( FJV. T ti i 'F t e4044 (State) #Zip jteorZ Service: Requesttr- Phonll ' ElsFtriciaw Y$ RECEIVEb: , GATEINSPE0iED: Correct Locart"iesri Same as Above �J or: - Reid Notice Label . Rough Wiring Outlets Surface Unit Oven Switches Range ' T - G ' DISPbSip Receptacles Water Heater sYl` er Gj FixUlres A)t°Cond'itloner ' - Am . Service Equipment Burner, LWrAsgi& Contedis for Am i F1 cbe 1-1 Amp. Service Conductors Pump. Vent Fans. MOTLIRS Fi.P. JUM 1l12 1l10 1/8 1 1/4 1/S 1/2 3! ',T Yz 20 15 20 25 5S- d : . Mark Number 3 of Each Size Elect. Heat' soo Asa a000 a21so ■aoo ■7co 2aoo 2sao aaoo ss a�wa - ~ .. > x [] RW Progress: Inc. LKO �] contractor Ej CFT Violation: Work Comp. 0 Inc. 0e- C] L/A owner CASH Fee CHIC [ - 1-IA _..p� 1 . . . IPA Municipal MO #" 11V'V' Date: Other.Side � _. . Lk -. Cut in Card Q :ternp # Data _ , .; r i u T� � ti.al Date WII,ASP-s� -.�F' a . APPLICATION IM$4M NO. 2"0 r=L° ''`= - ' _. >. ft..t rr 4 95. 92 .21 Y t O e L J� 1 , 0 z e = 0 J N W Y ir (� M ! p ¢ p G < ~ $I TOWN OF QUEENSBURY Zoning Adm'nistrat Date- 0 to R