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1989-909 y y , ERT`IFICA.TE OF C3+�CT`JI'Al`3+�'S�' TOWN OF QUEENSBURY WARREN COUNTI NEW YORK !late August 23 14 90 Thus is to certify that work requested to be done as shown by Permit Na. has been completed, This structure may be occupied as a L Masters Commn North - Lot #24 Hi and Park - Own,, By Order Town Board TOWN OF +QUEENSSURY Director of H1//dg. Lac Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No. 8911111,909 WARREN COUNTY, NEW YORK MIND a c« PERMISSION is hereby granted to I ni LO t #24 - Hi UFLtd— kStreet, Road or Ave, Aft OWNER of property located at Ma Ste rs G(]uui l .raft in the Town of Oueensbury, To Construct or place a Si nal a fam; 1 v riw¢11 i na I at the above location in accordance to application together with plot plans and other information hereto filed and 4bb approved and in compliance with the Town of Oueensbury Building and Zoning Ordinance. A. OWNER'S Address is 728 Northgate Center 2. CONTRACTOR or BUILDER'S Name V5 + Valente Builders , Inc . -a 3. CONTRACTOR or BUILDER'S Address C 4. ARCHITECT'S !~lame 5. ARCHITECT'S Address ut 6. TYPE of Construction — (please indicate by X) rn (X) Wood Frame ( ) Masonry ( 1 steel ( 1 7. PLANS and Specifications No. 49 ' x 68 ' single family dwelling with driveway and attached 3-car arc a as era lication , specifications and plot plan S. Proposed Use �Ne Single Family Dwelling ^� .ram $ !� PO M0p PERMIT FEE PAID - THIS PER EXPIRES _ NaWPmbeY" 2� , 19_�Q__ to Sit a longer period is required an application for an extension must be made to the Building and ,Zoning inspector of the ,on town of Queensbury before the expiration date.) 2C P" Day of Dated at the Town of C3ueenstau-ry this ,- 7�jtrl for the Town of Queensbury SIGNED BY C MI '��---� Building on i nspa'�[or rr'I 1— r TOWN OF QQEEI'iSBURY R EYTE W ED BY FEE PAID # TOWN OF �E .ait#R RECEIVED CL PERMIT NO. G? y BUILDING PERMIT APPLICATION NOV �4 BLDG. & CODE DEFT. A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO DISPEiCTIONS WILL BE MADE UINTM APPLICANT HAS 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: � Cie CQCC . P.O. Address i�� � �'� Tel Property Location /t' '� Gd�? xG."`S A160lk S/' 22 / ;r ~4, Tax Map No. :L4 I:ZI *� Has there been any spilt of this property since October 1 . 1988 ? I X If yes Planning Board Review is necessaryv yes no SUBDIVISION NAME, IF APPLICABLE k4 CPP�V 9/4—;C4• LOT NO. THE PERSOtf RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS: NATURE OF PROPOSED WORK : ESr: MATED MARKET VALUE OF CONSTRUCTION : S Z � V'Construction of a new building * COMPLETE INFORMATION REQUIRED BELOWV Addition to a building * tV4-e P Size of property C>"I= eft x ft. Alteration to a building * Existing Buildings( 3 ) Size 4 !� ft. x & e ft. (no change to exterior dimensions) Proposed building - distance from property Line: Other work (Describe) "' Front yard 1,> �� ft. Rear yard �9 q ft. * Side yards '�' S ft* and ft. * If on corner, setback from side street ft. GROSS AREA OF PROPOSED STRUCTURE • 1st Floor / ! sq. ft. ` OCCUPANCY INFORMATION r Znd Floor ' 3 -- sq. ft. 0 * Primary Building * t-^'"i33ne Family Dwelling Other Floors sq, ft. p" (not cellar or ement Two Family Dwelling TOTAL FLOOR AREA 3 9_q. ft. " Multiple Dwelling/Number of units Business Sian of new structurez. Ltt x Industrial Founcle►ttori-prirerlslak►I raw /pwrt;al f�Ll (circle one • Other r Noo of stories (Habitable space) " • �__ . > ;��. Height (grade to ridge) 3 1 ft. If addition, what will use �? If residential. no* of families / • SOWS No* of rooms(e=luding baths)��f' Accessary e essary Bull i ng No6 of bedrooms ` ' Detached Garage ONE/TWO Car No* of bathrooms • Primary heating system Cr )Jz' 4 sue• * t/_Attacheed Garay DNEJ'r1�10 Coe f Type of fuel 6_� " Private store" building No% of fireplaces to be in st&Uwd '� * Other Will a woad stove be C> • Central Air conditioning cis OV* ER y BL" ILD [ Nrj PERMIT APPLIC .NTION CONTINUED BUILDING ;PFCIFICATIOVS: Type of construction, wood frame, fire safe. etc. LUc�€� e7 y 2aocly,,� Will any second-Band or upgraded liamherbe used ? If :o, for what ? .n,/ 0 Foundation wall material ox.>041c4 'CA ` Thickness ` r Depth of foundation below grade (to bottom of footing) tea / Will there be a cellar ? �Z v' ' Heated or unheated? ',))/0? Floor sq, footage Will there be a basement ? s < Will any portion be used as living space ? (If so, what portion? sq ft. Type of use ? -� Type of roof - loped fiat /shed/other Material of roof Size, wood studs `fox (o " spacing" o. c. length Joists (floor beams) Ist floor 6!;L "x12 . ' spacing..A x "o. c, spans ft. Joist (Haar beams) 2nd floor "x 1 " spacing 16 "o. c. span /d ' ft. Overlays (ceiling beams) of ' spacing" o. c. span A ft. Roof rafters _"x / G7 " spacing Z— o. c. span { ft. Roof trusses (pre-engineered) spacing --' " o, c. span -- ft . Exterior wall finish &. V is y] of what material ? C'.4r4.�- Crce9c .- Interior wall finish u -Y � c.lL If a garage is to be attached, describe materiaLs to be used for FIRE SEPARATION: „ fir rc �r � Is there to he an opening between garage and dwelling? ycr w If so will a Fire-rated door, enclosure, self-closing device be provided? U 4:-5 Will aflue-Tined chimney be installed? � Height above roof Gs r� ft. Depth of chimney foundation below grade #v t ft. Depth of fireplace hearth ft. yin, . Water supply - Municipal or private well 0/1 SEPTIC SYSTEM Distance from ANY private well (including adjoining properties S4PwAe h4 (A separate application is necessary for any repair or new installation of septic system) NAME OF BUILDER 64,4 ADDRESS {a42 S4;` - rJ- +C c. NCI. ) '7k- fJ o NAME OF PLUMBER Qtatzaw T412 t., ADDRESS CCj ?"�y� ?Ar.c , TEL. NO. �7I 33 lJ NAME OF MASON r' Yl F ►'ii r-cm%-S f- _ADDRESS '. TEL. NCI. ', ' NAME OF ELECTRICIANI::"A G.01 " 4 ADDRESS TEL. NO. 6 fit' �r� � .1� �•- DECL.ARA770M 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 provisin er"Aos ,,,ie BUILDING CODE. THE ZONING ORDINANCE, and all Other Laws pertaining to the proposed work shall be compiled th, whether s such week is authorllt+ed by the Owner. pacified or not, and that 3lgnattue Owner, owners agent, architect, contractor SPECIAL, CONDITIONS OF THE PERMIT: BY TOWN OF 4UE NSB [C% . WARREN COUNTY . NEW YORK Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERJATION CODE A permit must be obtained before beginning work . ANSWER ALL Of the following : 10 Gross floor area 2 . "type of heat 3 . is the building mechanically cooled ? V�^s 4 , percentage of area of windows and doors rC-WOvi - f6 i'f A . over. 16 % Only 1 . Uo value of gross area of wails , roof / ceiling and floors exposed to ambient Conditions 2 . Floor over heat - 9 spaces YES NOYES NO a . Are foundat on walls insulated ? 1 . If YES . what is the R value ? i 3 , Slab on grade YES NO a . If YES , wh ' t is the R value of insulation around perimeter Of floor ? 44 Is basement heated ? YES NO a . R value of insulation 5 . Type of insulation. 8 . Under 16 � Only ._.—. 1 . R value2 � � of and f moors exposed to ambient coeditsons 2 . R value of exterior walls 3 . R value of glazed area 4 . R value of doors s , 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 ) g . R value of heated basement / cellar walls ( below grade ) 10 . Type of insulation C . Controls 9, 00 1 . Thermostat maximum heat setting D . Duct Systems NO 1 . Is duct system installed in unheated spaces ? YES a . if YES : 'R value of duct installation b . R value of duct in other areas E , P "Ili n4T/ Q Insulation i agent pi,P • I Size of hot water or coaling cart Yn g 2 . R value of pipe insulation p o Service Water H�eatinr� �" 1. performance efficiency 2 . Temperature control setting maximum Gm al Ong 1 . Maxiaium heating L�J� r Telephone No . nature ? ( applicant ' s sig TOWN OF QUEENSBURY BUILDING AND CODEOSADS FARTIHENT HAVI BAY & LAND QUEENSBURY. NE YORK 22801k 792-5832 TELEPHONE ( 51 BILD NG INSPECMR' S RT [3 REQUEST FOR INS ECTION RECEIVED NAME NATION PERMIT DATE APpROVED YES NO FOOTING/PIERS MONOLITHXC DAMP F OoFING DA FOUNTXONIAM BACKFTLL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-I INSULATION: FoUNDATION FLOc7R'a WALTZ CEILING Y pjXA,L INSPECTION: CHIMNEY HEIGHT ROOFING SIDING ,EXTEiRNAL ppRCHE5rS S Z' STAIRS-CLEARANCE & IMF VALVE PLUMBING FIXTURES/ E INTERIOR TRXM/PRS C DOORS ✓ ` FINISHED FLOORS GARAGE FIREPROOFS G DOOR CLOSERS) SMOKE DETECTORS •' FxNAx. ELECTR ICAL NSPEC ON FINAL APPROVAL OF C NSTR CTI N�� ��- or, To ISSUE C/o �.� NCy A SIGNED CERTIFI ATE OFtI CFANCY MUST BE OBTAINED FROM T E BurwDrN DEPARTMENT BEFORE THESE PREMISES RE OCCUPI D1 tip AFdUVE xxSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT SAY & HAVILAND ROADS oRX 2280� QUEENSBURY, NEW TELEPHONE (548) 792-5832 BUI ING INSPECTOR' S REPORT REQUEST FOR SPEECTIO RE EIVED-�� NAME LOCATION DATE P RMIT APPROVED YES NO FOOTXNGIPIERS FORMS MONOLITHIC PO -PROOF G p*DUt M DATION1DA BACKFILL APPRO L ROUGH PLUMBING FRAMING ELECTRICAL ROUG -IN .INSULATION_ FOUNDATION FLOORS WALLS CEILING FINAL INSPECT'ON: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES TEPS STAIRS-CLEARANCE RAILS�_____��_ PLUMBING FIXTURE RELIEF VALVE INTERIOR T'Z'M/P Cy DOORS - FINISHED FLOORS GARAGE FIREPROO IN DOOR CLOSER (S) SMOKE DETECTOR FINAL ELECTRICAL INSP 'ION 1- _ FINAL APPROVAL O CONS RUCTXO OK TO ISSUE C/O R C/C A SIGNED CERTIF CATE OF OCCUPANCY MUST BE OBTAINED FROM T E BUILD G DEPARTMENT BEFORE THESE PREMISES RE OCCUP ED ! REMARKS:/ ,ARRIVE�� DEPKRT,� INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280it- TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECT ON RECEIVED NAME I.00AT TON G�O� w+ PE IT {/ 1 � DATE - APPROVED YES NO FOOTINGIPIERS MONOLITHIC POUR FOR1*5 FOUNDATION/DAMP-PROdF'ING BACKFILL APPROVAL r ROUGH PLUMBING FRAMING ELECTRICAL ROU SNSULATION: Q FOUNDAT ON " FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIRING EXTERNAL PORCHES/S PS STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES . LIEF VALVE INTERIOR TRIMJPRI. Y DOORS- FINISHED FLOORS _ - GARAGE FIREPROOF�YN DOOR CLOSER (S) SMOKE DETECTORS$ d - FINAL ELECTRICAL - INS P TION FINAL APPROVAL OF CONAXRUCTION LAp Y A SIGNED CERTIFICATE or OCCUPANCY MUST BE OBTAINED FROM ;THE BUILDING DEPARTMENT BEFORE THESE PREMISE,.$°` ARE OCCUPIED! a REMARKS: i 33f 1� INSPECTOR - { TOWN OF QUEENSBURY pr BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURYr NEW YORK I280k TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT a REQUEST INS CTION RECEIVED 1J��1y NAME LOCA ION ou Ou4gfdo 6LLKVKffiAS nLo DATE &Ij6 &�PERMXT Wig 6t APPROVED YES NO FOOTING/ ERS MONOLITHIC POUR FORMS FOUNDATION/ -PROOFING BACKFILL P=QVAL ROUGH PLUMBIN FRAMING ELECTRICAL ROUGhN IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE & RAI PLUMBING FIXTURES/RELIEF VALVE INTERIOR TRIM/PRIVACY D S FINISHED FLOORS - GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL INSPEC ION _ FINAL APPROVAL OF CONS RUCTIO OK To SSSUE C/o OR C/ A SIGNED CERTIFICATE OF OCCUPA Y MUST BE OBTAINED FROM THE B ILDING DEPA TMENT BEFORE THESE PREMISES ARE CCUPIED! REMARKS: ARRIVE-' +-ir 3a INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280(E TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT ,may REQUEST FOR SPECTION RECEIVED NAME f/ LOCATION ,y DATE P' ERMIT ## 7 ` a APPROVED YES I NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOF NG BACKFILL APPROVAL ' ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOLTNDAT r N FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING *' SIDING EXTERNAL PORCHES/STE STAIRS-CLEARANCE & RA LS PLUMBING FIXTURES/REL EF ALVE INTERIOR TRIM/PRIVACY RS FINISHED FIAORS GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL INSP T ON FINAL APPROVAL OF CON TR TION A SIGNED CERTIFICAT OF CUPANCY MUST BE OBTAINED FROM THE UILDIN DEPARTMENT .BEFORE THESE PREMISES A OCCUPI D! 1 REMARKS: J INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT �,yJ BAY & HAVSLAND ROADS 'l +�' /I QUEENS$URY, NEW YORK 1280* TELEPHONE (518) 792-5832 BLIII.DING INSPECTOR ' S REPORT REQUES*NSPECT�ON, RECEIVED�s �6 NAME �1 LAC DA TEERMIT # APPROVED YES NO FOOTING/PIERS MONOLITHIC PO FORMS FOUNDATION/DAM PROOFING BACKFILL APPRO L ROUGH PLUMBING a( FRAMING ! ELECTRICAL RDUG IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ T'EPS STAIRS--CLEARANCE RAT PLUMBING FIXTURES LS VALVE INTERIOR TRIM/PRSV CY OORS FINISHED FLOORS _ GARAGE FIREPROOFING DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL INSP ION FINAL APPROVAL OF CON T UCTION A SIGNED CERTSFICATE OF CUPANCY MUST BE OBTAINED FROM THE B LDIN DEPARTMENT' BEFORE THESE PREMISES ARE CUPIE REMAR � j IASPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT Z^r ,BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12804- i'Jqf TELEPHONE (518 ) 792- 58.32 BUILDING INSPECTOR' S REPORT REQUEST FOR IN PECTION RECEIVED NAME 4� p� LOCATION DATE ' / ' PERMIT # — z APPROVED # YES NO FOOTINGIPIERS MONOLITHIC POUR FPRMS FOUNDATIONIDAMP—p TOOFING BACKFILL APPROVALT ROUGH PLUMBING t � FRAMING I ELECTRICAL ROUGH N INSULATION: FOUNDATION e FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING ' SIDING EXTERNAL PORCHESSTEPS STAIRS—CLEARANCE & RA S PLUMBING FIXTURE RE EF VALVE INTERIOR TRIM/PR A DOORS FINISHED FZoOORS GARAGE FIREPROOFI DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL NS CTION FINAL APPROVAL O CO*TRUCTION A SIGNED CERTI ICATE O OCCUPANCY MUST BE OBTAINED FROM THE BUIL NG DEPARTMENT BEFORE THESE PREMIS ARE OCCU IEDI' REMARKS . �7 INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK Z28O� TELEPHONE (5I8) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RFeCRIVED NAME LOCATION DATE / / PERMIT APPROVED YES NO �OOTING/PIER MONOLITHIC PO FORMS L.;ZNDATIONIDAM —PROOFING KFILL APPROV ✓ ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—I INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES STEPS STAIRS—CLEARANCE & RAILS PLUMBING FIXTUR /RELIEF. VA VE INTERIOR TRXMIP VACY DOORS FINISHED FLOORS _ GARAGE FIREPR ING DOOR CLOSER (S) SMOKE DETECTOR FINAL ELECTRICAL INSPECTION FINAL APPROVAL O CONSTRUCTION A .SIGNED CERTIFI ATE OF OCCUPANCY MUS BE OBTAINED FROM TH BUILDING DEPARTMENT FORE THESE PREMISES A E OCCUPIEDI REMARKS: ' INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVXLAND ROADS QUEENSBURY, NEW YORK 1.2809k- TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR S REPORT REQUEST FOR INSPE IDN�!RL�CEIVED G NAME a 64e?, L OCATION /� 0 DATE �r�^+y,7 PERMIT # 41E9 Z 7 � / APPROVED YES NO 4.wV`6OTING/PIERS w' MONOLITHIC POUR ;FORMS FOUNDATION/DAMP PROOFING BACKFILL APPROVAL ROUGH PLUMBING \\\\\\ FRAMING ELECTRICAL ROUGH— 1V INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/S EPS � STAIRS-CLEARANCE .RAILS PLUMBING FIXTURE RELIEF VA 7 VE INTERIOR TRIM/P VACY DOORSu FINISHED FLOORS "4 GARAGE FIREPROO ING DOOR CLOSER (S) SMOKE DETECTO FINAL ELECTRI"CA INSPECTION _.. FINAL APPROVAL F CONSTRUCTION A SIGNED CERTIF CATE OF OCCUPANCY MUST BE OBTAINED FROM T)TE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS.: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVIL.AND ROADS QUEEIVSBURY, NEW YORK 12804. TELEPHONE (5I8) 792-58.32 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME dJ`x7 ,0 ocATIONI_,�'�/r��, DATE /1L, PERMIT APPROVED YES NO G�C7TING/PIERS ,. , MONOLITHIC POUR FORMS FOUNDATZONfDAMP-PROOFING BACKFILL APPROVAZ ROUGH PLUMBING v FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDAT.ION FLOORS WALLS CEILING FINAL INSPECTION: t CHIMNEY HEIGHT ROOFING SX DXNG EXTERNAL PORCH S/STEPS STAIRS-CLEARA E & RAILS PLUMBING FIX RES/RELIEF VALVE INTERIOR TRI /PRIVACY DOoaF FINISHED F RS GARAGE FIRE ROOFING BOOR CLOSE (S) SMOKE DET TORS FINAL ELEC ICAL INSPECTION FINAL APPRO AL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE .BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: IJ ' AL'�F �vf f chi ' i 21VSPECTOR ,:> '<: aw' WOO } ; Y fir' on�i -Headquarters gd0 la�ol ve„ ico'llingswoodr 1 r 1. fl$T08 yy� " - �^goor E/C it AL Y S t r Date: City, Town or Township_:., N. __County [�s �State r Location/Address -4 T2 r Urn rk ., r /+f s� r' / f #` 2 .� yL L rk K , (!f Located in Rural Area - Please Attach Directions) Pole # Owner co �;41 C.l c -. . Occupied As wIr c.'fi �� 1?.�o PerriAit, # JIAA* Occupant ei c r,.,..ti -- Building:- N@he Work Area in Builds Floor #; etc.): for: Wirin Service or; Re for Ins Y ` • ` Fee Remitted - $ Cash © Check IVI.p. Nfaks i'ayable .To:Number of Rcaugh {yiring ,putlets Elect. Heat soo Aso i000 arbo Isao �a3c suoo ssao ssaaztao soonSwitches Lighting � c7 s7 Amp. Service Surface Unit Dishwliiher RReceptacles Water Heater Air Cqnditioner DryerpNumber n4Fixtur Oven " G6ba" Disposal Wirinig'and Controls for B4mp, -Receptar:fes Fractional H.P. Vent Fans Other Equipment: MOTORS H.P. 1/2 I/L Iylp 1/a Mark hium 1/2 3/4 . 1 1�lx 2 5. 7y� 10 15 20 25" 30 40 . . SA Nr ' :14D ber of Each Size c• Applicent..,a Signature r ' T!A License # Perrpit # :Utility: . Applicant's es Addrs: i AM I (City) (State) (ZiFF) a^ervice .Request # Phone . ` .. Eiectcit:iah; ' DATE RECEIVED: DATE IRtSP!~CTE[! y. Correct Location: game as Above [=] or: 4 Red Notice Label Wiring Outlets Surface tjhit_ Yen ` Switches Ran r Ga0 Lisposal Reca les . er.Heate �iwasher Fixtures Air'Con rlitiiiner p er Amp. Service Equipment Burner, iring & -Controls for Amp. Receptacle Am . Service Conductors Pump 1ferl# leans ,. ihdIOTORS H.P. I I/a 1 1/4 1/3 1/^d , $l4 lyg .2 7�h IO 15 2Q 25 G \ S 5..Mark Number of Each Size + Elect. Heat coo rso iono sxso zsoa itw aaoo xxso 23o A*zosoo ` 4 ` RL Progress L LKD [] !Contractor Violation Pt lrlc. ,; � " ` . Owner CASH Fee CHK # _ RAIn At ' i ,fF 3asf IN # ..a .. .ai : WW4 a � ' "0[�tar S!r!e 0 utility Applioa Owner ,... t ire Card .. 'temp # r l,; ,.fir• - Data I ,n.i, 1- ,r ...,rlc Final �k Date r _:. IC A'tl'il7hf i-"&AM ri o. 250 ii dy`J'e!1 •.. -' - . --� .. .. .. .. _. i . 03 ' 71 ' cp _ a o , p RTH