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1992-096 1 CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK Date A'4 ! ' 19 This is to certify that work requested to be done as show by Permit No. 92 "096 shown k E has been completed, This structure may be occupied as a ftndicap Accessible Bathrooms Loca �uaker Road D w trios Kolios/Quaker Diner By Order Town Board TOWN OF QUEENSBURY Director of Bldg. '& Code Enforcement ,y BUILDING PERMIT C TOWN OF QUEENSBURY No 92-096 WARREN COUNTY, NEW YOR K � tsl PERMISSION is hereby granted to Quak r Diner OWNER of property located at 117 Quaker Road Street, Road or Ave_ rD in the Town of Queensbury, To Construct or place a Addition to Building C! 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. -7 1 . OWNER'S Address is Dametri os Kol i os r V 2. CONTRACTOR at BUILDERS Name � C Ted Fall p' ro 7CI 3_ CONTRACTOR or BUILDER'S Address i� +6 Wings Falls Court a Queensbury, NY 12804 4. ARCHITECTS Name A C. .r. rl 5. ARCHITECT'S Address O ro 6. TYPE of Construction — (Please indicate bV X) �+• tS .a. {�( I Wood Frame I } Masonry I ► Steel I I t un 7_ PLANS and Specifications 7 No. 144 sq ft Addition to Building as per plot plan specifications and application 8. Proposed Use Handicap Accessible Bathroms $ 10000 PERMIT FEE PAID — THIS PERMIT EXPIRES March 26 , 1993 (lf 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 date.) Dated at the Town of Queensbury this 2 o March I992 SIGNED BY for the Town of Queensbury Building and Zoning spector TOWN OF QUEENSHURY REVIEWED BY : _ -may TOWN CIF QUEENSOURI FEE PAID : /'Zt' ` RECEIVED COIN PERMIT NO . . r MAR 2 1992 BUILDING PERMIT APPLICATION BL.DGm CODE DEPT', A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . NO INSPECTIONS WILL BE MADE UNTIL 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 . Owner of Property : c P . O . Address : -_ PHONE Property Location : 11? /Jt # crr )� Jb6".r Tax Map No . Has there been any split of this property since October 1. , 1988? Yes No If yes , Planning Board Review is necessary . Subdivision Name , if applicable : Lot No . THE PERSON RESPONSIBLE FOR SUPERVIzSION OF WORK AS REGARDS TO BUILDING CODES IS : ?4r ( -- fir NATURE OF PROPOSED WORK : * ESTIMATED MARKET VALUE OF THE Construction of new building * CONSTRUCTION : $ cEp 7 . {� -- �-' Addition to building Alteration to building * COMPLETE INFORMATION REQUIRED BELOW : ( no change to exterior dimensions ) * Size of Property * ft .ft . x / / ft . Other work ( describe ) * Existing Buildin Size : * 0�?C> ft . x ft . * 157oposed building - distance from GROSS AREA OF PROPOSED STRUCTURE : * property line : 1st Floor Sq . Ft , * Front Yard 7G7 ' ft . Rear yard ft . * Side Yards 25z> ft . and �5n= ft . 2nd Floor � p+, _ _ Sq . Ft . * If on corner , setback from side street- ft * Other Floors Sq . Ft . (not cellar or basement ) * OCCUPANCY INFORMATION : * TOTAL FLOOR AREA : Sq . Ft . * Primary Building * One Family Dwelling Size of New Structure : �Z- ft . x 1^ ft . * Two Family Dwelling Foundat ' n : * Multiple Dwelling/No . of Units _ Pier/ la Crawl /Partial /Full ( Circle One ) * ,.�' Business /Fu3� -" 'T °- - * Industrial No . of stories ( Habitable space ) * Other Height ( grade to ridge ) f,a ft . If residential , no . of families : -- If addition , what will use be ? No . of rooms ( excluding baths ) : -- * 1u�kc e k . ,<4d 2 s No . of bedrooms : No . of bathrooms : — * Accessory Building . Primary heating system : Detached Garage - One/Two Car Type of fuel : s * Attached Garage - One/Two Car No . of fireplaces to be installed : ZU * Private Storage Building Will a woodstove be installed ? : .n.3'C'3 . * Other Central Air Conditioning : Yes No ( OVER ) BUILDING PERMIT APPLICATION CONTINUED : BUILDING SPECIFICATIONS :Type of construction : wood frame , fire safe , etc . Will any second- hand or ungraded lumber be used ? If so , for what ? Foundation Wall Material : k-74t^J¢-fie if Thickness : fig ��� fir' Depth of Foundation below grade ( to bottom of footing ) : y /g . Will there be a cellar? /V b Heated or Unheated ? ,�. �_ Floor Sq . Footage : 1ri' Will there be a basement ? Vt) — Will any portion be used as living space ? ,�� If so , what portion ? -- Sq . Ft . Type of Ilse ? -� Type of Roof : Sloped/Flat/Shed/Other Material of Roofc{.�, { „J� Size , wood Studs � r r�i r' 7( { r' ; spacing " o . c . ; 1 ength ft . Joists ( floor beams ) : 1st Floor f/'. No x spacing " o . c . ; span ft . Joists ( floor beams ) : 2nd Floor N�=t� IF x spacing o . c . ; span ft . Overlays ( ceiling beams ) : " x " ; spacing It o . c . ; span ft . Roof rafters : It x z;;i - at ; spacing L o . c . ; span ft , Roof trusses ( pre-engineered ) : spacing r/ o . c . ; span ft . Exterior Wall Finish & of what material ? Interior Wall Finish : : rT : �scrc If a garage is to be attached , describe materials to be used for FIRE SEPARATION : C d' Is there to be an opening between garage and dwelling ? If so , will a Fire- Rated door , enclosure , self-closing device be provided ? Will a flue- lined chimney be installed? /j/�­ Height above roof ) ft . ' Depth of chimney foundation below grade : � ft . Depth of fireplace hearth : �f ,/b ft . , F;LA in . Water supply - Municipal or private well : Ib, yvtcj �- SEPTIC SYSTEM : Distance from any private well ( including adjoining properties : ,v ' ft . (A separate application is necessary for any repair or new installation of septic system . ) NAME OF BUILDER & ADDRESS : �7 Fez-s�. s fit. ef 13Y PHONE NAME OF PLUMBER & ADDRESS : PHONE � 1 NAME OF MASON & ADDRESS : SAkA0,0 / 1A}sovv1P,.y+ 1"-_) ,0y,� PHONE SSV- NAME OF ELECTRICIAN & ADDRESS : "rd+ �4t.,.c_. ^PHONE 2(pl- 6e: 9P DECLARATION 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 ORDINANCE , and all other laws pertaining to the proposed work shall be complied with , whether specified or not , and that such work is a thorized by the owner . Signature Owner , owner s agent , architect contractor SPECIAL CONDITIONS OF THE PERMIT : By: Code Enforcement Officer ENERGY CODE C014PLIANCE APPLICATION TOWN OF QUEENSBURY , WARREN COUNTY - 9000 HEATING DEGREE DAYS Coarpllance Methods4 PART 5 - Acceptable Practice Method - 1 & 2 Family Dwellings ( ONLY ) PART 6 - Thermal Rating - Component Trade Offs - 1 & 2 Family Dwellings ; Multi - Family Dwellings ( 3 Stories or Less ) PART 4 - Design By Component Performance - Commercial Buildings - Hi - Rise Residential PART 4 & 6 - Compliance Methods Require Submission of worksheets APPLICAN'f�6"5 KFJft LOCATION PART 5 METHOD OF COMPLIANCE BY ACCEPTABLE PRACTICE : 1 . Gross Floor Area Sq . Ft . �1 2 . Type of Heat - - - El ec . Base Board Other &A s -A i f 3 . Is Building 'Mechanically Cooled ? YES NO 4 . Percentage of Area of Windows and Doors Over 17% ✓ Under 17 % THE R-VALUES GIVEN ON THIS SHEET MUST CORRESPOND TO R E Q U I R E D THE R-VALUES SHO1N ON PLANS SUSN1TMI Baseboard 5 . Insulation Values : Actual Shown Elec . Heat Other A . Roof & Floors exposed to ambient temperatures R g B . Exterior Walls R Co Glazed Area R D . Exterior Doors R J- E . Floors over unheated spaces R - � F . Edge of Slab on Grade ( Heated Building ) R G . Basement/Cellar Malls (Above Grade ) R H. Basement/Cellar Walls ( Below Grade ) R I . Heating/Cooling - Ducts - Piping in Unheated Space R 6 . Service (Domestic ) Not 'Water Heating Device A . Conforms to minimum efficiency per code YES NO TEMPERATURE CONTROL RAXIMUM SETTING 1400 - WILL NOT BE E=EEDED _ _ CANT4S SIGNATURE DATE TELEPHONE MJMSEW� INSPECTOR' S REMARKS : TOWN OF QUEENSBURY BUILDING 53 D CODES ROAD DEPARTMENT 12$04 OUEENSBURY % NEW `CORK TELEPHONE ( 618) 745_ 4447 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEVEO NAME:. ?�- \ LOCATION ` PERMIT i DATE TYPE OF STRUCTURE APPROVED ---~-~~ APPROVED RECHECK � N A ACES KO FOOTINGS /PIERS _ MONOLITHIC POUR FORM REINFORCEMENT IIS RES PL PDNSIBLE THE CONTRACTOR FOR PROVIDING PROTECTION FRWING FREEZING FOR OF TH CONCRETE T14E PLACEME MATERIALS FOR THIS AURPOSE OR SITE FOUNDATION/WALL POUR REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFIN BACKFILL APPROVAL ROUGH PLUMBING PLUMBING PLUMBING EIAT /t4DEP SLAB I PLACE FRAMING : ,TACK STU[7S/k1EADERS, IN CG/BRIDGING BRA -- RAC "ANGERS tjol JACK POSTS /MAIN BEAU , H FIAT I ROUGH- IN INSULATION : pLLS I E R- FOUNDATION TER OR R- FOUNDATION WALLS R_ FLOORS R- WALLS R- CEILING UN EATED DUCT WORK OR P PING IN SPACES REMARKS : ejo ?'ems 00) - w ARRIVE DEPART rINSPE-CR THE NEW YORK BOARD OF FIRE UNDERWRITERS ` "" "" x BUREAU OF ELECTRICITY !1 � 41 STATE STREET, ALB Y. NEiYCI�RK 1i2Q7 Da y y .4pplicatia No. on fife ii THIS CERTIFIES THAT 3 only the electrical equipment as described below and introduced by the epplieant named an the above application member In the Premises of �-�y in thefollawin,ll l� $ �}t LJ Ist Fl. ❑ 8nd Fl. Section Black Lot aces examined on w and jnund to be in compliance with the requirements of this Board. FIXTURE rwCLES SMItTCHRS FIXTURES RANGES COOKING PECKS GIVEN IS S GH WASHERS EXHAUST PAfMS OUTLETS INCANIASCENT F UOUSCENt OTHER AMT. K. W. I AMT- t. W_ AMT. K.W- HAT, t. W. ^Mr, H. P. DRYERS FURNACE MOTORS FUTURE AFFLLANCE MM RS ISFRCLAt REC'FT TYKE CLOCKS RELL UNIT HEATERS MULWOUTIST DMAPARIM TEMS AJrST. iC. W. OLL H. P. [lA.s N. P. +MIT. NO. A. W. Ca. AMT- AM►. AM7- AMPS, TRANS. IUMT. H. r. NO7gDFw�T xMr. wxrns 0 SERVICE DISCONNECT No. Of S E R Y I CMETER E AMT. AMP- rm i X sw r aw a r aw a r Aw No. M A OF ctwawa. No. of HI-IKc at, : No. oP NEurnwls aF MWI AL OTHER A"ARAUM2 r 111•, p:Ni F; BRANCH MANAt3ER Per This certificate must not be altered in any manner, return to the office of the Board if incorrect. Inspectors may be identified by their credentia6. COPY FOR BUILDING DEPARTMENT. TH15 COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN OF QUEEMSBURY FIRE t4ARSHAL CeNSBURYNEW YOR 12804 QTELEPHONE � ( 518) 745- 4424 FIRE MARSHAL INSPECTION REPORT REQUEST FOR INSPECTION RECEIVED^_ NAME LOCATION PERMIT# DATE y �' yG ____� � '� APPROVED N/A YES NO EXITS AISLE IDTHS EXIT SIGNS EMERGENCY LIGHTING FIRE EXTINGU HERS AUTO , EXTINGU RING SYSTEM� �- HOOD INSTALLAT N AUTO . SPRINKLER YSTEM ALARM SYSTEM INTERIOR FINISHES STORAGE * CLEARANCE. TO SPRIN EUS CLEARANCE TO HEAT NITS REQUIRED SIGNAGE CHIMNEY lvIOODSTOVFIREPLA E FIREPLACE-A ONR IL ~�w� 1p 0K TO HIS DATE REgRKS �. OR iNsnCT 2/015 SOWN OF QUE MSS RY X ` ! 531 8AY PORK OAD 12804 QUEENSBURY + 4 [ TELEPHONE SPECTOR& S REPORL BUILDING IN FINALI RECEIVED � REQUEST FOR INSPECTION NAYE LOCATION � TYPE Of STRUCTURE ? RECHECK STRUCTURE )a (CO C XRAMING FIREMARSHA BAKFILL SEPTICC LUNDATOM ELECTRICAL FNO-T 4FIN11 NGWL5TDVEJFIREPL XSULATION _ /Il/ A X REMARKS APPROVAL N/A YES NO CIMNEY HEIGHT' /L0 TION H B VENTJLOVEt ION PLUMBING ROOFING S SIDING RA I I �-- ---"' DECK/ P0RC1iJ STEPS 1 t. _ ---- FURNACEI ROTE WA ER OP A NG TI r_---- TWORK.�— BASEMENT TRIP rPRIVAr OORS� —" INTERIOR FINISH FLOORS : BATH/FLOORS SW EPABL OTHER FLOORS G PETED OTHER AILING STAIR CLEARANCE/ HANDICAPPED ACC SS ..... INS SMOKE, DET'ECTfIR t10L FIOU E TING BATHROO►4 FANS / ALL PLUMBING MB N P F INGS OPER GARAGE DOOR CLOSERS A OT,RER FIRE SE FIREJOEMISE WALLS IS DUMPSTER SITE PLAN NC RE ANI FINAL ELEC RICAL OK TO ISSUE C10 OR C /C GOMME Ic� �� ARRIVE DEPART_.-� NS J TOMB OF QUEEPISI gUILUING ANU CODEROAOPARTMENT 5371 BAI 128dA QUEENSSURY > NEW Y4T92- 5839 TELEPHONE ( 5181 PORT OR SUiLfJIN6 11KSP'ECTPI ECEIVEO REQUEST FOR 11M SPECTIOf'k E � LOCATYOft1 f PEN+II DATE STRUCTURE, T'�PE OF APPROVED N /A YES NO RECHECK FdOTIN 51PIERS MONOLITHIC POUR FORM ---�"�~ REINFORCEMENT IN PLACE Tfifc SL Co KfRACTO'R IS RE5P0115 FOR PROVIUING�UOt3RS FOLLOr1ING FREEZYHG FORE COt1CRE�E • SIT E TF1E PEACEMEKT OF Mp,TERIALS FOR THp4UR RP05E dN FOUNDATION/WALL PLACE REINFORCEMENT IN � �- FOUNDATAMPROOFING IaN1D �_�.------- SACKF ILL. APPR04AL CE ROUGH PLUMBINGVENTS N PLUMBING VENT / SLAB PLUMBING UNUF FRAMING :JACK 5TU DSIHDERS�� -- ---"�" -� BRAC I NG18R ICYG I NG .��, JOIST HANGERS B EA AYN JACK POSTS /M FIRES TOPPING WALLS CEILING FIREWALLS HEATING ROUGH- IN INSULATION* YIAL.LS INTERIOR FOUNDA yyALLS EXTERIOR R- FOUNDATION R- F LOORS R- WALLS CEILING PI IN G IN UNHEA ED DUCT WORK aR SPACES REMARKS : Is 3r� 3 tC+G L f ' Gv I5 L z L�7 ARRIVE DEPART � � � INS T /4 / vk T OF QUESgURY BUILDING AND CODES DEPARTMENT 531 SAY NEW PORK 12804 QUEENgB13RY 7 A5- 4447 TELEPHONE ( 518) BUILDING l%SPECTOft' S REPDRT RE4UEST FOR INSPECTION RECEIVED NAME LOCATION " DATE TYPE OF S RUCTURE APPRO A YES NO HE. RECCK__�---� NS FOOTIN6SIpIERS MONOLITHIC POUR FORM- -- '� -- REINFORCE.MENT IN PLACES 8 E ppACTOR IS RES THE CONT pROTE[ ELF y6 FOR PROYIDI R 48 "OURS C�CRETE E2IH6 FUR THE FOR THIS PURPOSE ON S E THE PLpCF�NE'NT OF MATERIA► S WALL POUR FOUNDATIONI pLA E �-- - - �-- REINFORCEMENT IN FOUNDATIOAP I APPRDAKOVAL BACKFILL E ROUGH PLU�ENT 1 V'EN S I l$ P L PLUMBING PLUMBING UNDER SLAB RAMING: 51HEADER - ` JACK S BRACINGIBRIDGIN G � JOIST HANGERS JACK POSCSII A HEATING ROUGH- IN 0R INSULATION : AL1 S XTE IOR R_ FOUNDATION y{ALLS R- VOUNDATION FLOORS R- WALLS NHEATED CEILING P I IN DUCT WORK OR SPACES PLUM 4ffl LV ►'�-�-- Vj R i ARRIVE. DEPART NS'PEC OR 1OWN OF QUEENSBURY 531 BAY ROAD OUEENSBURY , NEW 518)O745RK t t 4441 TELEPHONE C REPO FIIiALLDING INSPECTION �, S REg1lEST FOR INSPECTION RECEIVE liA1�E LOCATION �o DATE P'ERIAIT# ,TYPE OF STRUCTURE -- - REC1iECK - COMMERCIAL STRUCTURE) FIRE MARS"AL APPROVAL BACKFILL SEPTIC 'FOOTING FOUNDATIFINA4 ELECTRICAL `INSULAY IONBING WO�STOV E/FIREPLACE REMARKS APP YES N❑ MIA CHIMMEY B V MTILOCATIONLOCATION PLUMBING VEIAT ROOFING /C SIDING DECK/PORCH/STEPS/RA I GS RELIEF VALVES FURNACE/HOT W ER O G / C TWORK BASEMENT IN5llLATIOAI OOR5 INTERIOR TRIM/ PRIVA FINISH FLOORS : tRTIG BATH/KITCHEN W EEPABLE OTHER FLOORS A PEIED OTHER FLOORSE�RAILINGS STAIR CLEARA CCES5 HANDICAPPED SMOKE OETE ORSNS AL Hp�UMB NG OM F FIXTUENs/w�ATI GARAGE F RE PROOF ING_ __�• - --� ODOR CLO ERS A N OTHER FIRE SEP FIREIDEMISE WALLS DUMPSTER EOUIREM N S SITE PLAN/VA FINAL ELECTRICAL � -- OK TO ISSUE CIO OR CIC � �-- COMM ;'�t C?Kz II 1 L � J ! S � +C ARRIVE -�, - flEPART TOM OF QUEENSBURY BUILDING A D BCOES AD RSADPARTt+4ENT QUETELEPHONE-ENSBURy NEW YORK } ( 518 ) 792- 58324 IS RE BUILDING INSPECTION REpaEsT FOR RECEIY£UPORT NAME !L LOCAT ION _ y o DATED— -PERMIT # _ y€[ f t. TYPE OF STRUCTURE APPROVED RECHECK N/A YES NO FOOTINGS/ IE 1,111111 MONOLITHIC POUR FORM REINFORCEMENT IN RESPOND THE CONTRACTOR FOR PROVIDING PROTECTION FREiEZING FOR 8 tjOUR-ME , FOL1 OWl" 4 THE PLACE14E+ T OF MATERIALS FOR THIS PURPOSE ON SITE FOUNDATION/WALL POUR REINFORCEMENT IN PLA FOUNDA:TION/DAMPROOFIBACKFILLOAPPROVAOLOFI ROUGH PLUMBING PLUMBING VENT/ VEN S N 'PLUMBING UNDER SLAB FRAMING : JACK STUDS /HEADERS BRACING/BRIDGING��JOIST HANGERS JACK POSTS /MAIN BEAM FIRESTOPPING WALLS CEILING FIREWALLS HEATING ROUGH- IN INSULATION : LS I ER R R' FOUNDATION W FOUNDATION LLS EXTERIOR R- FLOORS R- WALLS R- CEILING UCT WORK OR PI ING IN UN EA E D SPACES 4?c3AJ CIA ARRIVE, - ( � DEPART `'' r --- PEC R TOWN OF QUEENSSURY BUILDING AND CODES DEPARTMENT BAY & BAVILAND ROADS QUEENSBURY. NEW YORK I2809- TELEPHONE (518 ) 792-5832 Btj I LI]I NG INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED , NAME �"1 r • d L r4 1J L �- -- LOCAT7;Q DATE PERMIT # APPROVED YES NO P RS MONOLITHIC POUR FORMS FOUNDATSONIDAMP—PROOFING ,BACKFT L,L APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL. ROUGH—IN INSULATION: FOUNDATION FLOORS WALL S CEILING FINAL INSPECTION = CHIMNEY HEIGHT s ROOFING SIDING EXTERNAL PORCHES IS PIS STAIRS—CLEARANC & ILS PLUMBING FIXTU SIRE EF VALVE INTERIOR TRIM/ RIVACY OORS FINISHED FLOO S GARAGE FIRE P FING DOOR CLOSER ( ) SMOKE DETEC RS — FINAL ELECTRI AL INSF'ECTICJN FINAL. APPROV L OF CONSTRiJCTIOIP. A SIGNED CE TIFICATE OF OCCUPANCY MUST BE OBTAINED F M THE BUILDING DEPARTMENT BEFORE THESE PREM SES ARE OCCUPIED! REMARKS: ! ] 9 III I Z:) 171 Pum P &0 d cfl ►` R1S Qv C I i ip M o6 k CD rtJ r INSPE OR CA. i IIr ) TOWN OF gUEENSBURY BUILDING AND 531 BCODES AY ROAD PARTMENT 4TELEPHONE � ( 518)NEW 0745--4447 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVM.. . MANE LOCATION, DATE- ��CPERMIT # TYPE OF STRUCTURE v APPROVED RECHECK N A YES NO VOID''[ NGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE _ THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTECTION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACENENT OF THE COMCRETE. MATERIALS FOR 4UNDATION/WALLHPOURIS URPO +E ON SITE REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT PLUMBING UNDERVENTS SLAB IN PLAC FRAMING : JACK STUDS/HEADERS, BRACING/BRIDGING JOIST HANGERS HANGERS JACK POSTS/MAIN BE HEATING ROUGH- IN INSULATION . IN E iO R- FOUNDATION AL FOUNDATION WA S E?C RIOR R- FLOORS R_ WALLS R_ CEILING DUCT WORK R PIPING UN EA ED SPACES REMARKS ARRIVE = 3 w DEPART �� INSP CT R yOU ARE HERERY RFOUESTED TO INSPECT AND ISSUE CERTIFICATES FOR THE FOLLOWING ELECTRICAL rHEEQUIPMENT DER TC? RE INSTALLED SY F r THE UNDERSIGNED }�` 'J� . TEIAR M F A E coF i zcnlvr+srluP GFTy OR vILL 'E POLF NUMIBEH i STREET ANO NO-OR ROIAG BLOCK LOT SEr.TgN BEnNEFlJ WHAT TWO MOSS IS PREM1BEa LOfJiI'EO7 .. . BUlL.DWO 5CCLVIIIi4Y OCGUPANT"S NAME ° NOME TELEPNOFIE NUMBER OWNEH'S NAME AND Ar1ORESS yypR1('1'C-t.EPNONE NUMBER OFFICE FppM'TFIEIH CURRENT SUPPLIED BY SUw+NG Is 'AK7RK Is NEW ❑ ADOI'TICNAI pEFEGTS REMWED CJ NEW � V Lisr BEt QW ALL EC]UIPMENT W1i1CFi Yt7U lhiSTALLE OFFICE USE No. at Flxtures & MOTORS HEATERS CIRCUITS ONLY NUMBER OF Qt1TLET5 LaGa Lamp Receptacles H.P No. VI F h No. aGWs- Si INSPECTiC1N tion de Atmch't Swlich Pe"NJON Srackai No. TYPE Each Coiling }Nall ReI OUT- SIDE SUB- BASE BASE- MENT let FL. 8nd FL_ 3rd FL" 1 REMARKS: LIST OTHER ELECTRICAL DEVICES NO SET FORTH ABOVE. THIS APPLICATION IS INTENDED TO COWER THE ABCNE-LISTED EQUIPMENT - BE INSPECTED. BUT IF TIM E ME OF INSPECTION, THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED, YOU ARE AUTHOR4ZEDT0 MAKE THE INSPECTION AND ADJUST THE FEE TO COWER THE ADDITIONAL EQUIPMENT, AS PRQWIDED BY THE APPLICANT� E HAPs 'TClTAL INNO4'TS ua S42E OF MAW S C GAS TI-I V NITRANSFORMERS OF CH ER OF WORK NCEAL-EP CAPACITY PAfE 4"OAIPUTTTED 52E OF Sk3N 4NUMaERI r.'' C"E wy¢NUFACTLARER OF SIGN SE ENT Is BUILDING LNERHEAP UN.- "' NDEl GATE W R ON(OR AS NEAR AS PfJ651 E IN LL PI 1 OR APPLt TION IYIAY R T PRINT NAME AND ADDRES;"s I N NAME OF APP T TELEPHONE NU, STRE ADDRESS Jq 21P C LICENSE NO. WHEN APPL7CA9L'E CITY OFFICE ,/ F pp2 Arterial Road state Street 574 Delaware Avenue n RO Lake AveER, NY C� SYRACUSE, NY 13208 $5 John Street l T181 264-41<L'I (31 5) 463-8552 �Eyy 4R 700 1DQ38 I ALBA� N 222D7 1 (118) 88d-1115542()2 ROCHESTER, 1 14608 THE NEW YORK WC)A ID OF FIRE UNDERWRITERS Sold To Ship to ,6UAL1TY t . wnET5 Address Address PLAN APPROVAL SIGNATURES City, State, Zip City„ State, Zip A❑�vrs+orr OF rexwoao rnousrxres WC. City, Customer 603 BI STONE GAP Phone (H) ( — _ Salesperson DUNCANV LE, TEXAS 75137 Order Date Approx, Ship Date Date Color/Style j OTY. PRODUCT CODE CU. FT. 0 1 2 3 1 ? +R t 4 U) 2 w ' 7 wa 3 0 Q ITN N LL pl 10 0 IIJJ r 11 4 n� sr } 12 N # 13 a ., 14 5 ~ 15 WTI 17 18 19 7 1b �+ 20 �4 21 22 a t�A 23 24 rI 25 9 26 s 27 r 28 f 10 2s 30 11 CABINETS TOPS 12 APPLIANCES INSTALLATION 13 'ti `+ DELIVERY f SALES TAX 0 2 3 4 5 6 7 8 8 10 11 12 13 14 15 16 17 18 19 TOTAL RECOMMENDED SCALE- 112" = 1 FOOT SCALE 001-0290