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96-589 BUILDING PERMIT VALUE $ 90000TOWN OF QUEENSBURY Na 96589 TAX MAP NO . 30 . -- 1 - 22 . 1 WARREN COUNTY, [VEIN YORK PERMISSION is hereby granted to HUGHES * JOHN OWNER of property located at LOT 81 # 38 LEDGEVIEW DR * Street, Road or Ave. in the Town of Oueensbury, To Construct or place a SINGLE FAMILY DWELLING W / 2 — CAR GARAGE 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. t. OVVNF WS Address is % KELLEHER . JOSEPH 23 LEDGEVIEW DRIVE LAKE GEORGE . NY 12845 2. CONTRACTOR or BUI LOE R'S Name HUGHES ■ JOHN 3. CONTRACTOR or SUILDER °S Address 1 ROCKLAND RD . LAKE GEORGE * NY 12845 4. ARCHITECT'S Name COMMONWEALTH ELECTRICAL AGENCY 5. ARCHITECT'S Address PO BOX 706 HAGUEr NY 12836 6. TYPE of Construction — (Please indicate by X) SINGLE., FAMILY DWELLING I ) Wood Frame I I Masonry I I Steel I l 7. PLANS and SPeciflwtiorrs 180ello•SQ FT SINGLE FAMILY DWELLING WITH 2 - CAR ATTACHED GARAGE AS PER PLOT PLAN SPECIFICATIONS 8. Proposed Use SINGLE FAMILY DWELLING W / 2 — CAR GARAGE October 2 19 98 251 .� PERMIT FEE PAID — THIS PERMIT 'EXPIRES (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of xhe town of oueensbury before the expiration date.] 2 October tg 96 Dated at the Town of Qu�eeen'ssbbur'yy this --Day �of — ,� P l tom'_- A ,a for the Town of Queenshury SIGNED BY -$im„�no Zoning Inspector TOWN OF QUEENSBURY REVIEWED BY : COMMUNITY DEVELOPMENT DEPARTMENT FEE PAID ; BUILDING & CODE ENFORCEMENT 531 BAY ROAD 40L PERMIT NO . - � QUEENSBURY , NEW YORK 12844 ( 518 ) 745 - 4447 BUILDING PERMIT APPLICATION 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 completeai and the signature of the applicant MUST appear on the application form . OWNER OF PROPERTY : Mailing Address : Home Other Telephone Number ( s ) : Work PROPERTY LOCATION : 7 U c> ' Tax Map Number : Section 3U /- a1B ock �o� Subdivision Name : Lot No . NATURE OF PROPOSED WORK : ESTIMATED MARKET "VALUE OF THE CONSTRUCTION : $ qjz 4/ NEW BUILDING : OCCUPANCY INFORMATION : RESIDENCE /COMMERCIAL PRIMARY - ADDITION TO BUILDING : RESIDENCE / COMMERCIAL Single Family Dwelling ALTERATION TO BUILDING : Two Family Dwelling RESIDENCE /COMMERCIAL Family Dwelling ( NO CHANGE TO EXTERIOR SIZE ) 0 fice OTHER WORK ( DESCRIBE BELOW ) Mercantile Warehouse Manufacturing Other GROSS AREA OF PROPOSED STRUCTURE :/ /_ 1 ST FLOOR — zc�oc> SQ . FT . 3 IF ADDITION , USE OF NEW ADDITION : 2ND FLOOR SQ . , FT r� d OTHER FLOORS SQ . FT , ACCESSORY BUILDINGS : e ( not unfinishd cellar or basement ) Detached Garage - One /Two Car TOTAL FLOOR AREA : SQ . FT . ,, Attached Garage - One /Two Car Private Storage 'Building SIZE OF NEW STRUCTURE • Commercial Storage Building Other FEET X FEET . Foundation Type : cin Will any second- hand or ungraded Number of Stories : 1 lumber be used? If so , for what ? ( habitable space only ) — Height ( grade to ridge ) : .3v feet Type of Heat�nc System : Number of fireplaces and /or woodstove ( circle all which applies ) to be installed : Electric / Oil / � / Wood Forced Hot Air / e °ioar / Other PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS TO BUILDING CODES IS : NAME OF S3UILDER/ADDRESS /PHONE : _.�� A.++ }F��s NAME OF PLUMBER/ADDRESS /PHONE : NAME OF MASON/ADDRESS / PHONE : NAME OF ELECTRICAN/ADDRESS /PHONE : r DECLARATION To the best. of my knowledge the statements contained in this appli- cation , 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 noted , and that such work is authorized by the owner . Further it is understood that I /we shall submit prior to a Certificate of Occupancy or Certificate Of Compliance being i.s ued , an AS BUILT PLOT PLAN drawn to scale , showing actual location of ro ' ct ` pr ises . Signature ( Owner , ow ' s agen rchitect , contractor ) DE : FOR ANY SPECIAL. PROVISIONS - SEE REVERSE Ap��ixc # iu xxTIC DISPOS`.AL .I ERMII' sl'AMP ILI.CIU VI.41) >, t-0.-.� 1 _cwnliort tit' Irrr+lit:rty It or iiistaIhililln; .-.c...,�. Owner's Minlr: n, t I'1il Ai1'!' N �sI•- c, Owncr's Mailing Adclresr-: _ r an i ' vsfn wltxy h 'f rr�TI� �+.-�yJ 1'l-A. VAID { t Installer's Nanre: I'tlolic #. fx .7H? « 6 Con Idurttkrcr nr ltcdrnesnls (If reSlilelltl:lll : J 'I'ttlal daily Clow (resicicntild - cntllltulc CC# lSil g:tl. lice Ise cSrcxtttl ) : T- 'Topography: Flat [ Renting Q Steep Shipe 3`n c)rSlt+pc Soil Nature: Sand [start) © clay Q Qtllef /Repel: Clrourid Water: at what deptIO oeo ,* _ feet Bedrock or Impervitlue Mlalcri :tl : at what deltlll7 Feet P uri.:o1iltit1n Tcst: Ncil Itaclnircd 'C.� Etc•tl ui r C ell l t.n t c min. pc ia3t•1i 1.7t7n1estlC Walor :iul+l*Sy: Q h+lttrtit:ilt:t! �Q Well f)thcr If domestic water supply is a WIiL.i ^ watcr supply front arty septic absorption is fvct IV Ito P0%Itm SYS 7?A1� Septic lank: �.= BTi+l, (tnixxiiucilu xi-rc. 1 .000 gal. ) �jyyyx 1Y{I � �t�Jl2'+r. •file I°field: each trcncll rcct. real system lengilr/ feet. Seepage Pit(s): nutulier of ize each: ft. x ft. Size of sectnc to ITc uscd: # / depth or thickness feet I10LIDING TANK SY.TUIEM : (if required) Number or tanks: Sizc t>r each: gal. rllrxrnr .systr+xt rtlyd erssoriatell electrical )work !o be ilrspected by a certified agency. lo'or yoler pro-rec:liols, pleretse nrxte !hilt pr+rsxertlxt lrx Sectitirr 136-29 of the C'riocle of file I onvx of Q:iteelrsbury, rrny permit or a pprnt•rll grrextted ivlticlr is basest tepon or is tgrerrrted in relirrxtce trlxon airy +xratrrierl nrirrr. lxresrrrrrrtioxt or firilgtre to xxrake a x)rateriaf firer or circrum-Wance A--mioIrxr by or all behalfofnit rrpplic'rxnt, shall be void- I liesve read the regtllalioxrs tvilh respect to this it ppplictttlort and agree to abiele by these and rill regrdremews o f the *cili'll a f(lxteeis s�fbf�+rfrry .Sanitary SCH'etl,'r• "ispo.rrll Ordirrettice. / r - _. .__. .......... ........ _... .. ._ Sr`,grrature ofresprxxr.silr 'r person:prrsa : •�•� llrtlr: ./G' - ...2�.%� l ENERGY CODE COMPLIANCE APPLICATION TOWN OF QUEENSBURY , WARREN COUNTY ME 9000 HEAVING DEGREE DAYS Compliance Methods : 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 * Requires submission of worksheets APPLICANT ' S NAME ,• PROPERTY LOCATION : PART 5 METHOD OF COMPLIANCE SY ACCEPTABLE PRACTICE : 1 . Gross Floor Area - oinjo square feet 2 . Type of Heat - Electric Oil ✓�' � Gas Other 3 . Is building mechanically cooled? Yes No 4 . Percentage of area of windows and doors over 17 % ..-- Under 17 % 5 . R-VALUES FOR INSULATION GIVEN BELOW MUST CORRESPOND To R-VALUES AS SHOWN ON PLANS SUBMITTED : RS' a . Roof b . Exterior walls R - q R co Glazed areas - S/ d . Exterior doors R e . Floors over unheated spaces R f . Edge of slab on grade ( heated building ) R g . Basement / cellar walls ( above grade ) R he Basement /cellar walls ( below grade ) R i . Heating/ cooling-ducts -piping in unheated space R 6 . Service ( domestic ) hot water heating device Conforms to minimum efficiency per code _, / Yes No TEMPERATURE CONTROL MAXIMUM SETTING 1400 - WILL NOT BE 'EXCEEDED Apple a IFs S " n ure Date Phone Number INS TOR ' S RE RKS : (518) 761-8256 TOWN OF QUESNSBURY BUILDING & COVE ENFORCN som, 8 4 QL 742 BAY RD ' , Q�yLr,Lrri5BURY REPORT ARRJ±2AL- I xTiSPE'C'TOR 5 REQUES FOR INSPECTION REC ED ' NAME 3 LOCATION IT 1 _�---- DATE TYPE OF STRUCTURE : PP ROVE Y S NO N RECJlEGK ,.QUYr,NT Iti__PL $F''7L_ �.-._.-3•s:�.-� ,OUSIBLE FOR THIS COfiTRA'CTOR 18 RPM FRSSZI"G pR,OVipI{g4 PROTB NIp THE PLACE- - c_. .----- FOR 48 y1DUR8 FOCRETE • _ EpT OF TgE CO -_-_._ ----- T - -- wrNa• Rr•trrlFliT — F UND T•ION zNG VE�1�Iv- T-S P �� rY P U S NG U DER SLAB C' S STUD ' GING ------ '�` C S I N HE p R 3KF. g,A ON R ------- I E I NG R ------ U A I N ' 'K TL OUN ION A LS FXTEIiJR—R — W S R- -��"- IN OR 'PIPING IN DUCT WORK OR --`---- N T P RESIDENTIAL FINAL INSPECTION REPORT Office No. (518) 761-8256 Date inspection request received: 'Wamil Building & Code Enforcement Arrive � arnlpm Depart �Pm Dept. of community Development motor's initials Town of Queensbury 742 Bay Road Queensbury, New York 12804 �� J� PERJZT #I NAME yl he DATE G LOCATIDN TYPE OF STRUCTURE COMMENTS N/A YES NO Chimney HeightP'B" Vent/Direct Vent Location Fresh Air Intake plumb Vent through roof Roof Complete Exterior Finish Complete Interior/Exterior Railings 30" to 36" Is, balconies, landing 18 in. or more Exterior Handrails, nsers— Interior Handrails stairs tln sides 3 oirpeq Glade 20/0 away from four tion 8" clearance to sill plate Gas Valve shut-off exposed/re ator wit above grade Ghin Gas Furnace shut-off within feetrcer a line of site _ Oil Furnace shut-off at en ce to fuurnace rea FurnaceMot Water Hea operating Relief Valve(s) install Headroom. 6 ft. 6 in. on stairs Basement stairs, 6 ft- 4 in. Handrail exterior stairs both sides more than 3 risers Intenor privacy/trffWd00rs/main entrance 36" - Floor Finish Bathroom//' itcherk watertight 18 in. or more interior Handrails Balconiesll-ate chr�g Railing across window in stairwells Smoke Detectors: every level every bedroorrt outside every bedroom inter connected Bathroom fans Plumbing fixtures I.oundation insulation 3/4 hour fire doorldoor closer Garage fireproofing Garage penetrations sealed Furnace in separate MOMprotected (in g +ge) Light ventilation per room Safety glazing 18" or less from floor # Final Electrical site Plan/Variancc required Final Survey Plot plan As Built septic Svstem layout required Okay to issue C1C (Certif. of Compliance) Okav to issue temp. C10 (Certif, of occupancy)_ ent C10 (Certif. of Occupancy) Okay to issue pern�ar► 0000� ��4ttice ,EC+eTRICLIN5LV'ErArix' 1754s M4 �A f P �COM 357 E► sn Twrra � C'fRYCXL APPROVXL e� YCATE MUNICIPAL CERTYF / {� Cut-itt Card lyo. .. ...._...-• Ccrt. vF "' - � ................. _ ..-.. .-. ........-..... gttard l�iO {-...,.. panel � � .. Owner ..... ...... � ant ...,.... .... a ... D L...... ........ cuip I ctcatiat, _;. fp [ add U ! 1........... sisting tallatiart (,,l,J ,�.............. ... . ... .....-...-..._... Con ........... t ,.� 1..�.-""' ......., anon d any .:estil`icate P . ... ............................ of this certificate. ' s as of amade�fe}r the kssoance c an dt� 4somPJAY installed BY """" ��ltowinR Roverned meat and installution� The ponditions electrical equip a pitca and if its isssxed pncelled:— covers the t or attcrattons. P t Its at any time• ' . to on1Y en ins This cextifw of additional egt"tpm 0"Iepe of maktnR t e. the . Uoduction the P s . .. .. 4ns'PeGt�n' anY shalt have t to revoke .. . ny lnspon. of ibis Comp shstlt have She xiRlt •Fp.p„ 4.A..E.I. v fated, the Corn" xutes are tN54ECt'C `Tj►em6ear fl. Late .........., .ram is of au eClOiDs gsia�DR�URY FkIEksT 4 e0 x D U011, NG OUSSNSa NY JA2 BRY gi1 ' n PRR �NT� RgPOR'T ' IkiSFECT©F S IDkSPECTION RECEIti1 •1-__ R ;T i ,L.00RT Ott PE a ,STRuc rt3RE TYPE gECkIE'Cg ', I OgCE RT 4pgIFT!t R0 G kiTPA4' g HI T 6 ILYNG folk JLS of TVL au oR oK 19 OUGkI SL 3 R pS S ---- - ky13ARC? - • ' U K_ 13 l t1SUIa W Y S T O � U R Iat3 S 7o ID s s a— oft VjgjVG x 1CT "Q S S JA '9 (51s) '761-WL70 nowt+ OF QUEEoDEg�aFORCNY JLTB04 aU ILnIt1C* & QCyEENS9VRY 142 Spa RD • . xw g R.EPoRT REQUEST ppR I"SPECTl fiECEI1SF t w's Tl() F-� Fl RT1IT pT'TE URi: : TYPE C F STttUCT . RECtSE(::K � FORP-cG - - olass.aL'Gs7. +[� .ots Co +C.TO"xR TSd EFRo" pLp4'E- _�-- pR¢Vxv% IM HOURrs gOLLOMittO f — ---, FOR 4'O aleco O� r --� �.13G RD R A OU IF R- OR FIPiN� xN r 1}U G'C WORK 5 ,y ,s s 1 #0W\4j �� 761-8256 'TOWN OF '4UEEENFORCEISENT [7E 12804 gU I RD ,�, pUEENSaUR�" NY 742 DAY p`R �,7�INSPECTOR' S REPORT : REQUEST FO INS'PECTION RECEIV NAME LOCATION RMIT DATEUCTU G T,pz or $ RECIIECK 114 IS No IT C 0 I A R I F E OHS, FOR R IS g g6£ r!. ELT'iiG C010 C CH V'ao I. 'THE 7�,R ACB- OVIpltiti T8 gOLLOHIli6 xliS pR Ou pT O H THE NCR'E E • --- -�'�" P A O S O JA S O Fpy DAR� YtA W UN ELL UGkf PLUMaING ___.--.--- '.__---�-- pLIIMTiING U DER S g 114 1 a,IIPiFiLTRp4�' _.�"___.� •___�-� F:AT 114 ROUG IN — _ _ --- UL TION * _--� OUNDA .�_---- 'i F 0 F S IN OR PIPING IN _-- DUCT RK C HEA E 5 U i 3 S i i I] 3J 1 (518) 161-8256 ,rows{ orULJ 4UEEk3S8URCE!'lENT COPE L*Nl"O , NY 12 R gp4 BAY1 P •� QUEENSBUR ARR 1�d _-- DEPART_-___-- IyySPEC'TOR' S REP REQUEST FOR INSPEC��- N RECEIV D I,,OChT ION PER't9IT` � PATE OF STRU'CT TYPE REC1lECK O G wyps TRIG RF .14 ORC E FOR _ I g. RR NF`i Ez,040 PRQ'vI IN6 v vCTOVI.e xIN7,'1IO 6 FOR q8 HOURS Fdc A S g0R -- " "�- -- U R ON WlipOU _-� -- N P ROOF N FOUN ---- R� � rr APPR17'1 --- N V N V t7UGH PLUMB NG UMB N VOER SLR K BRAC?L G JN HE AT NG ROUGH- '-� IS Sr ION N W c FIFIN G G I 4 DUCT W EQK pRCE UNHER i �` � �(518) 761-g256 TOWN OF QUEENSBURY BUILDING , CODE ENFORCLF-;YE12804 742 BAY RD . , QSSEENSBi.1RY P ARX ,/� . INSPECTOR ' S REPORT : NSKECTIO14 RECEIVED : REQUEST FOR \ti"�y NAME I "� I,OCA I N PERMIT DATE TYPE OF STRUCTURE : R OVED N S RECIIECK _ � N FOQ�S PIERS --.-. OUR vF INF_Q_RC� E�-T ACE IN FOR 'THE +CONTRACTO x''`" I NS FRO14 FREEZING E gROV I V ING P TE T gI,ACE- ROURS ,FOS a THE S.OH �.----- _ FOR 4B RET t.!£NT OF THE CO" S I MATER LS F'OR THIS PURPOSE ON � . FOU DATION WRLLPQVR — -- REINFORCEMENT FOUNDATION DAMPP�I! A F 1, APPRL�VRL K VEIy VENTS IN P..�L -,16 CE---'J` ---"'� P UM NG R,OUGH PLUMBING ,DNy�ER SLAB PLUMBING ---- �"` �-- - S NG JACK STUDS EHEA'A'E �_ �----- .---"` -----"�`DGY NG ------- -.-. -- ACID BR Al �---- - �- JO 1'SI IAT !IN B AM JRCK POS 5 r_ ON BARRIER AI T1FILT RA --- - ---- 1SEATING ROUGH- 1N -- INSUL TION : -- R- �- WALLS INTERIOR - .--- FOUNDATION S EXTER R R- - - F�OI3L.1'- --- W LLS R` C ILI G PIPING IN ._----- DUCT WORK OR R� NHE TED SPACES �4 1 1 Towts OF C}U EENS aURY BU IR.DING 6 CODE ENFOy'CFt',4EY2804 713 BAY RD QUEENSBVR jt I N ARR `�_��_..J_-�J DEPAR'C IN5PECTOR ' S REPORT : - !, REQ UEST FOR INSPECTTO ECEIVE NAME LOCATION r Ou PERM T DATE TYPE OF STRUCTURE ! A OV 0 O REC}}ECK - v - - - - �{ TING S PIERS _, �----- C POUR FO r MnN ?tRI eft REv Yv .CEMEN IN PLACE RR6P SI9s/E FOIL THTHECOHT'RACTURL IST YOli FR 14 r.S`RS'E""o pgOVIUINO PROTOLLO HIHO HE/ FOR 48 HOURSCONCR'ETE ' - ---- --.~—` MIENT OF THE S I E ----- OR Tkf S PURPO N __---- wALLPOOR f FouNDA�r�.ar� RENFORCIMAENT PLAU .�_ I -- t]UNDATION D PP ROOF NG L=b APPS_._._ --�-' ___---- PLAC V ENT- y-v E N T 5 I N P xMn I NG ,�--- ------� ROUGH PLUMBING PLUY„1�UNDER S f AB FRAMYNG : SACK S 45 BftAC2 SR ING ..�---- AN F JOIST OSTS MA N B JACK ------' YNFILTRA f N BARRYER _�— HEATING ROUG ` IN INSU INTERIOR R- F NDATI N WRLLS X E IOR R- S --" F6UN T N TA --- -- �Wi C 'W PIPING IN 1 DUCT WORK OR RL- { UNHEA ED SPACES i i No. OQN LOWAAID [late 14 EUchical irlapectitor p.cl. Box 7W HAGUE* NY 12836 COMMONWEALTH ELECTRICAL INSPECTION SERVICE INC . (518) 543-6724 (Consulting aM Fire inspection Serviced 1-800-562-9934 MAIN OFFICE. 357 Elwyn Terrace, Manheim, PA i7545 • {7i7ry Bfi4 2347 (Incorporated In the states of 800.7324)043 New York, malyland, Penmyh+arfta Delaware) LOCATION Plumes give full and e cuura of sheer if s innee order dl to avoid delay s pesiring Certification of Approval. application is made for inspection of electrical installation ine5h i premises e Rersee Side below. On demand, applicant agrees to pay for inspection service in accord With schedule ofQ, Q ....,_. .,- PLEASE P,R11VT � �� ,'a c..S...... ............................... Type Bldg. El DWG f� Othe ... .., Owner ...�tt-h�.�.... ,wc. ..,.. Bldg. Permit Na ...... .. .. ...._ ... occupant........ts...........--0-1- .... tr..GlpfF ? ..u.r . ...... ....... r ersr.e�n2.,...lfl. y�v �d .... .... . ....1. City,-. � ...-.... Job Location ...L C c+k� Tw ....... Swinlnlinp l'��ti3} — New ❑ Old ❑ CLrunty ......-L....r.ld.r:G'G.n.?................... ...............--. ............... S'ool Permit No4 ............--...... . ...... Owner"s Address ........................... ................... ..,,...... . Directions to Job Site ........................ Application For Rough Wiring C1 Fixtures Ej Service for Ready 1c1r ln... ...can Check ❑ Cush 0 !vlake Pay able Tu C.E.l.S., Inc- Fee New M Old Work — New1� Additional ❑ Bid S - Fee Remitted ................... ...... ... ........ .. LIST ALt EQUIPM EN7 AND WIRING rip OR Kw NUMBER OF ELEC 14EAT AI'R CONOITtONN P$O9 K VYRS Nu rt+EP�EAT ETY E OF DEVICE NWIRa1NG OUTLETS FIX URE NUMBER TYPE OF IDEVICE SWITCHES MERCURY LIGHTING SODIUM RECEPT . FLUORESCENT ELEC. HEAT QUARTZ 5 7.112 30 15 20 25 30 40 Sd 75 100 MOTORS: N.P. 1/201112 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 1 .11 2 3 MARK NUMBER OF EACH S12E PERMIT dk OTHER EQUIPMENT LICENSE 0 APPLICANT'S NAME OF 1 NAT R UTILITY A LI CANT"S F ICE O A QRESS ZIP CODE BE NOTIFIED CITY STATE SPACE BELOW FOR USE OF IN AMP SERVICEONLY PUMP ROUGH WIRING EQUIPMENT OUTLETS µEA LIVEN SWITCHES PUMP SURFACE DISPOSAL. UNIT RECEPTACLES UNIT MEDIUM BASE RANGE DRYER FIXTURES WATER MOGUL BASE H ATER FIXTURES AIR AMP. RECEPTACLES FLUORESCENT CONQiTIONER FRAC. H P. FIXTURES BURNER VENT FANS MERCURY VAPOR OR WIRING & CONTROLS FOR QUARTZ FIXTURES 5 7.1/ 10 15 20 25 30 40 50 75 10 MOTORS: N-P. 1120 1/12 1/10 1f6 1/6 lf4 1/3 1/2 3/4 1 1-1/2 2 3 MARK NUMBER OF EACH SIZE APPARATUS DATE INSPEC . PO Z FEE PAID MISC:. INFO, NaTlFlec T 4 CON_ TOTAL $ TRACTOR CERTIFICATE ISSUED OWNER CHECK NO. R,VV, 0 DUP OCCUPANT CHARGE FINAL ❑ SERV . CASH PROGRESS 0 AGENT ELEC H.O. DEFECTiVE 0 LT CO INSPECTOR TEMP CARD !! DATE FINAL. CARD 0 p1ppLlCATION EXPIRES C3NE YEAR FROM DATE. IllBPIW527 Rev. 6J96 GOL010 ficer WHiTEIiNfice OAPIARY/Cusromor PlrJltllrrapE+ctcr im ---------- APPROED Appi'llVCation 7 07 LEDGEVIEW DRIvE