Loading...
1985-753 ". t ..ta'- yr'':+"::3"' '" F'_.,7a.. �..' k' ? ' rc .-r.�. ,'-�.`r a'.y.. x+�;.n_ .. -.#'3'11 ?_. `-,-,';,.:-arr-'l .�: . P } 4 CERTIFICATE OF OCCUPANCY CY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Daft June 15 1985 - 1 -'.c This is to certify that work requested to be done as shown by Permit No. 85• 753 i has been oompieted. This structure may be occupied as a One-Foniily D ling r� ' S C y �iCS1lC�'+n3 gld Lot 103 1a Bedford Close Subdivision ( St . No , 4 ) L ocarion S . D . Carruthers Sores , Inc . owner By Order Town Board TOWW OF QUEENSBURY i ! Building & Zoning Inspector t - BUILDING PERMIT TOWN OF QUEENSBURY No. 85- 753 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to S • D . Carruthers Sons , Inc . OWNER of property located at Lots 103 , 104 'Honey Hollow Road ( St . #5) Street, Road or Ave. r� Bedford Cose , Section in the Town of Oueensbury, To Construct or place a One—Family Dwelling 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 r* 1 . OWNER'S Address is 1P . 0 . Box 37 zr CD Argyle , New York 12809 Ca cn 0 2. CONTRACTOR or BUI LDEWS Name Same. C7 3. CONTRACTOR or BUILDERS Address same r rtrt 0 rt m 4. ARCHITECT'S Name �4 r, a O W 1� r c� fi_ ARCHITECT'S Address bd rn[-. 0 p 0 (p H `C 6. TYPE of Construction — (Please indicate by X) C7 0 r� w (ir,} Wood Frame C ) Masonry [ 1 Steel ( } Cn p m � 7. PLANS and Specifications . 80rx38r per plot plan , specifications and application submitted >� No. including two car attached ,garage and sewage system . 8. Proposed Use One-Family Dwelling 0 ro I $5 . 00 C/O Paid N $ _297 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES July 1 19 85 • (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the `C town of Queensbury before the expiration date.) ty rP Dated at the Town of 0ueensbury this 31-st Day of December 19 85 w� SIGNED BY � -� for the Town of Queensbury Building and Zoning Inspector TOWN OF QUEENSBURY ? Space inside block to Ixg filled in bt WARREN COUNTY. NEW YORK Building Insrx"nr) Application for ppli( a, io[L No. 1'('1-11111 IN. lInsl 19 - BUILDING AND ZONING PERMIT P4 .1-111il EXI—Fires 1fI :!, 311iu� lli.,tri( 1 THREE ( 3 ) Copies of a PLOT PLAN. Drawn to scale 4i '1 "'+ rl ( cl I,01k' /`�f.�Gr'r1 showin the actual dimensions of the lot to be built upon, TU exact size, and loco+ion on the lot of the building to be erected or altered MUST BE SUB. MITTED WITH THIS APPLICATION. ATE A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK" L� V, A aiaV.- ANSWER ALL OF THE FOLLOWING. The undersigned hereby applies for a permit to do the following work which will be done in accordance with the description, plans and specifi- ����'�. I'�ISI6 cations, and such special conditions as may be indicated on the permit. ` ` ' " " ' f"� �^y TtV,owner oft -s property is: �+ _ �� 1� . , . . F? f�2c.�t`1:�4 "� ' . . . . . . . . -- - -� .0_ . t3e?K . ES35?' . . . . INR"'E! IP O. AUDR The person resp�ainsibie for supervision of the work insofar as ,the B� (Lilding,rC�ode and the ZoninF Ordinance apply i%: .Q . . . !�. !i� 1�.1��t•4 E) ISO i"z:L`►_ t C G7 }.( 0, -7� ' Name of Builder�.� .X> (H uR �?L-4 Q . ISOO� . 14P Address t` •.Lr% CJ DG7�jC-s} � .� .t. Name of Plumber . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . - . . • • • . Name of Mason . . . Address . . . . . . . --^7� . . . . . . . . . . . . . . . . . . . . . . . r_ Lot Number . ,(.CD I (0.�Unit . . . . . .�. . Estimated value of proposed work S G SD ` �► .- . . . . . . . . Name of Village .7.0 L.eV. Vl�' . . .�-. . 1 L�`�� ra L�SL� . . . (3 .cwr>,r , . < . PA Name of Street B-d. �. . Side of street : north ❑, east ❑ , south Q . west Q Nearest Cross Street . . . . . . . , , , . . . . Distance from this ^ross street . . . . . . . . . . . . . . . . . . . . Ft. Property is north Q , south Q , east c i , west ❑ from Cross Street If on Corner, which corner, northeast 0 , northwest 1] , southeast Q . southwest (Designate by marking, with an "X" in the correct space.) NATURE OF PROPOSED WORK OCCUPANCY 02 Construction of a new building, One-famil Main $uRding To I� Addition to a building. w4amI dwelling Q Alteration to a building. Tw fily dwelling Demolition of a building. -family apartment pause Stare building � - - ,� . -car attached garage L Other; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Accessory Building One-car detached garage Other work- Describe: . . . . . . . . . . . . . . . . . . . . . . . . . . Two-car detached garage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Private chicken house . . . . . . . . . . . . . . . . Private storage building Other: . . . . . . . . . . . . . . . . . . . . ZONING SPECIFICATIONS. Fill in for new building, or addition to existing building, or a change of occupancy. Indicate on the plot plan street names, the location and 4 size of the property, the location, size and setbacks of pro- I NORTH posed buildings, and the location of oil existing buildings. _�....-1 Show proposed buildingt s) in dotted line and existing tsuilding(s) in solid line. r-� E Size of property x ft. 1 +'-�' -.►- Size and use of existing buildings, if any . . . . . . . IF «-- � r W Size of proposed building , . . . A . . ft» x . . . . - ft. itaj 3 Height (from grade to ridge) . . . . . . . . . . . . ft, e rR k` +" L t „ Front yard . . . . . . . . . . . . . . . . . , , , . . ft. Side yards . . . . .4�450 . . . ft. and . . . /.3 . . . . . . . ft. Rear yard . . . . . . ./!CiL . . . . . . . . . . . . . . . . . . . . . . . ft- SOUTH � � If on corner, setback from side street 4 ". - e . . . . ft. Note: All distances are ntet, as measured from street side line ►o nearest Part of building. SdVERI (cont"d.) BUILDING SPECIFICATION'So Kind of construction: Wood frame, fire safe, etc.' . . . .� . . ' ''�� . . . . . . . . . . . . . . . . Will any second-hand lumber be)s3ed? . . . . .� C2x . . . . - . If so, for what? . . . . `.. . . . . . . . . . . . . . .�. e.? . . . , . . . . . . . . , . Material of foundation walls . . . (. "r�7ldt�' J ? u �' [." 7 . Thickness . . . . . . . . . Depth of foundation walls below grade . . . . . . • • • . . . . Continuous foundation? Will there be a cellar? . . - • If so, material of cellar floor Type of roof: Sloped or fl t? . . . .1�� Material of roof . . . . ! yf %r. . . .� . . . . . . . . . . . . . . . . . Size, wood studs . . . . . . . . . . . . . . . . / . ' x . . . . . . . . . . . . , , - "" s acin �� at . . ! ./," g p g /tv. o.c., length . . . . . . . . . . . , ft. Size. floor beams, 1st floor . . . . . . . . . . " x /' . . . . . . . . - . spacing . . - . . : . '"o.c., span . . . . . . . . . . . . . . ft_ Sim, floor beams, 2nd floor . . . . . . .r? . . "' x . . ./ .p. . . . . . . - ", spacing '"o.c., span . . . . . . . . . . . . . . ft, Size, ceiling beams . . - . . . . . . . . . . . , " x - . . .'k" - . - . . . . . ", spacing; - . ./. - "o.c., span . . . . . . . . . . . . . . ft. Sire, roof rafters or beams . . . s� . . . " x . . . .1- Q . . . . . . . ", spacing . . . . . �'' . . . . "o_c., span . . . . . . . . . . . . . . ft. Exterior finish (i#rA, /� . - . i �L . . With what material ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . Finish of interior weal �f'�! .� eQ.01e__1 . . . . !`. .L .41 . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . , , . . , , . . . , . . . _ . . . . . . . If garage is to be attached, of what material is wall between garage and main building to Ite constructed? /Jz[ +t' . . . Ric lc. . . . f ? I✓�-'!?4•. . . .4�,'i�:21 - - .emu. f. . . . . . . . . . . . . . . . _ . . . . . . . Is there to be an opening betwevit garagfey and bui) ing? Kind of heating system Will aflue-lined chimney be provided? . . . . Depth of chimney foundation below grade . . . . . . . . . . . . . . . Height of chimney above roof . . . ,�ra . � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . Will there be a fireplace? . . . . .YA� . . . . . . . . . . . . . . Depth of fireplace hearth . . - �. . . . . . . . . . . . . . . . . . . . . . . . . . . Will a toilet be installed? . . . . . . . . `/4..2 • . . . . • . - - - - Will a kitchen sink he installed an connected to water apply? . " . . . . Water supply ( public water supply or pump) _ . c L-e3c,�s . . . . . , - C:!/ . . . . . . . . . . . . . . . . . . . . . . . . . Distance of cesspool from any private well . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . / feet Will drainage system be provided with required traps, cleanouts, and vents? Town of Queenshury AFFIDAVIT County of Warren State of New York I swear that to it, bca iof my knowledge and belief the statemerits contained in this application, togedwr with the plane and wpecifications sub- mitted, are a true and oo.,, lete statement of all proposed work to be e on the deactibed premises and that all i don ons of the BUILD- ING CODE, THE ZONING ORDINANCE, and all other laws pertaining to the p work shall be wro wfth, whether specified or not, and that such work is authorised by the owner. �, �} ., a� Sworn to before me this Signstw+e `-". .. '/'' . . CIE . 4 NEF1' ItGE PRCHITI:C ,;Co 7R+a Oft.-. . . . .-. . day of.. . . . - NOTARY pu BLIC, WARRttN COUNTY, N. V. SPECIAL CONDITIONS OF THE PERMIT: By .... .. .... .. . ..... .. .... .. .,,,. . . . .... . . . . . . .... . . .-. . . . . .--- .-.-. . . . .. . . . . .-- - TOWN OF QUEENSBURY 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 s 0930 � ,� 2 . Type of heat �rx-"�" F�Vm �� c., + s 3w is the building mechanically cooled ? ye,-,6 4 . Percentage of area of windows and doors Z Z1d A . over 16 % only 1 . U value of gross area of walls , roof / ceiling and floors o exposed to ambient conditions 2 . Floor over heated spaces YES NO a . Are foundation walls insulated ? ES NO 1 , if YES , what is the R value ? 3 . Slab on grade YES NO a . If YES , what is the R value of insulation around perimeter of floor ? 4 . Is basement heated ? xis' NO a . R value of insulation 5 . Type of insulation Be _Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions_ � ;e) 2 . R value of exterior walls/c 3 . R value of glazed area n G 4 . R value of doorsT 4� J /� 4 G� 5 . R value of floors over unheated spaces 6 . R value of slab edge insulation - unheated slab) 7 . R value of slab insulation - heated s3ab �/.+� 8 _ R value of heated basement/ cellar walls ( above grade ) /' V 9 . R value of heated basement / cellar walls ( below grade ) low Type of insulation i a Gl.95 45 + I cl 2 e C . Controls o 1 . Thermostat maximum heat setting 78 D3 Duct Systems 1 . Is duct system installed in unheated spaces ? NO a . if YES , R value of duct installation = � b . R value of duct in other areas E . Piping Insulation 3� 10 size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation - -7Z.- F . Service Water Heating C� 10 Performance efficiency ! CT 2 . Temperature control setting maximum 0 G . For Swimming Pool Onl_ X 1 . Maximum heating pA Telephone No . 43 '� y )917 -77 ( ap�,t s signature ) TOWN OP ()ULi 1NSBURY BUILDING & ZONING DFPA.RTMFNT � S� FrV!�A,GF DISPOSAL PERMIT APPLICATION 1 . Owner ' s N,raame ` �' Address 4k �[� f Telephone No .5+ � s 2 . Property location 3 . Name of person or firm responsible for installing system Telephone No . Address _ 4 . Number of bedrooms ( residential buildings only ) 5 . Daily flaw 6Q0 . -- � '� gallons/day 6 . Septic tank capacity C? 2.9�0 - gallons 7 . Topography : , rolling , steep % of slope s . Nature of soil and depth 4S`A*z&( L " 3 5 9 . If ground water , bedrock or imp rvious material is apparent at what depth does it begin? ft . 10 . Percolation test : A is required g is�n� required . �C if required what is the rate minutes/inch 11 . water supply : u ifi cipal, well , other 12 . Type of system proposed : drywell , ti e field other Any contractor , corporation , individual , etc _ engaged in the construction of a sanitary sewage disposal system who covers the same before inspection , does not have an approved permit , or varies from the approved application will be subject to a penalty of $ 250 as provided fo in Section 6 . 010 of the Queensbury Sanitary Sewage Ordinance . Date �/ - 13cant On separate sheet of paper submit a diagram of the proposed septic system with all dimensions , including distance from any structure , distance from property line and domestic water supplyr etc . Include all dimensions of the system itself . OL �' �, - - - r3ox Form 3 - 82 0W11 Of ueena ctr+ BUILDING and TONING DEPARTMENT ay an d Havitand Road, R.I7. 1 Box 98 (]ueensbury, New York 12801 ; LOCATION j01 DiNG INSPECTOR ' S REPORTME 14 /49 - � � Q Permit No Late * * * * * APPROVED YES NO Footing/Pie Foams Foundation waterproof in y(Backf i l l gaming Roofing Siding Masonry veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors plbq . Fixtures Gar . Fi. reProofin - poor Closers Smoke Detectors GhimneY INSULATION : Foundation Floors Walls Ceiling FINAL e.LUCTRI AL IN SPECT10N 12IVEWAY AppRC7 survey Final Building wh Next scheduled fnspectlon (call en ready ) Remarks- �}-- � � y /�� / � Gr �i✓ t/� Tuilding Inspector Moo Mom Mod 4000306 THE NEW YORK BOARD- OF FIRE UNDERWRITERS [—j 4 BUREAU OF ELECTRIICiTY 1 STATE STREET, ALBANY. NEW YORK 12207 - Uate "' Cl: l3 , l�ai7 RPPiicationlYo. anfil�- �121571-'c",v T141S CEiRTIF1EES THAT 680631 only the etectr1ead egaiposent as deeeribed bedew and inatrodrrced by the epplicerst nansed on the oboes apptication member in the promisee al 10 . 0. Caruthers , I3oricy Uollcwar Rde e ��G��jlrens Falls , Y.T4ow Yor in the following locatio ; ''- oee"wnt LJ"lst n. E* Snd Fl. Otlt~�'.ldk-: f 7 ' Section Stock toot 103- 104 — was ezarn#nod on arse!foa m nd to be in compliance with the reguirensener of this Board. FIXTURE lCEFTACIES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST iAHS OUTLETS INCAAWESCEM FLUOeE3CtNnf AMT- K. W. AM7. k, w. MST. %.w- rm:vLn" AMr. IL r,5R g7' 73 1 83 6 2 10 . 5 rDRYERS FURNACE MTOTORS FUTURE APfaL1ANCE PEEPERS SHOAL RfivrT TIME CLOCKS moIy UNIT HEATRRS DIAU IERS .AMY, k. W all M- F awe N. /. AAtr. !b• A, W, a- AMT. M5►. AM7- AMJ'S. TRANS, AMi, M ►. AMT WATIS 21 1 #1Q 1 SERVICE DISCONNECT NO. ow S E R V 1 C E MAT. AM/. rvp2 METRR 1 -0 2W 1 Ar 9W S X JW 9 JE 4w NO. 6F CC, LOhID. A. W. G- A. w. 1}- EQUI'. rt+R 1 ar CC. CCWD. rdl'J, OF NI-LEG aF NI-It6 ND, of IVELIMALS alr MEu711Aa OTHER APPARATUS: — 2--10 kw electrie fiWnaae 3-gfci _ di rxlsa3 z 1/? hn arown BRANCH MANAGER 647 Cloru; 'Falls , TI&W York 12801 = Per This certificate must not be altered in any manners return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE rt fST N07 BE AL ERED AN _ r �--- ,/v ld c� town o/ 'Queen3t�/ ury BUILDING and ZONING DEPARTMENT Bay and Hawifand Road, R-07 1 Sox 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME �/r � ��/ �' -e � �► k�+ � +�'�"t 116 V LOCATION/ d.,a L7ate f 0°� P$rmit NO . C] APPROVED* -* YES* NO Footing/pier Forms Foundation Waterproofing Backfill Framing Roof ing Siding Masonry Veneer ' I!ough Plumbing < Relief Valves Ext , porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION__ DRIVEWAY APPROVAL Final Building Survey. Next scheduled inspection (call when ready ) Remarks- o P404e 4 0-e, Building Ins ct 6/86 and-vl d1* ilk flown of QuQen .iiury BUJI,DING and ZONING DEPARTMENT Bay and Haviland Road, R.D. I Sox 98 Queensbury, New York 12801 p, , � T> BUILDING INSPECTOR ' S REPORT NAME S 1'LA L,q s 163, LOCATION e� Yt � v �6 Date 11 1�1 a / *-- 'E rmit Nc� . '. *7 � * ApPRC1vEP* -*YES NO Foolting/Pier Forms Foundation waterproofing sackfill x Framing "r Roofing Siding Masonry veneer ,,ugh Plumbing Relief valves Ext . porches FinlShed Floors interior Trim Stairs & Railings Cellar 'Drain 'Fife Concrete Floors p17g . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION Foy dation Floors Walls Ceiling..- FINAL ELECTRICAL I13 SPECTI ON DRIVEWAY APPROVAL Final Building Building Survey��--� 5 UT- c () Kf Next scheduled inspection (call when ready Re y l°k ��rk L pFf ep Building Inspector 6/86 and-vl _Jow" 01 Queen .31 ury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME 4 r- , 2 d LOCATION ,ss 46 do � DATE go l PERMIT NO .,a SOIL TYPE an Loam - Clay Percolatio Te Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM : Absorption f field , total length Length of each trench Depth of trenches ' Size of gravel,imill 111111 -� SEEPAGE PITS4NuTnbe Size.- /(!) ft. X ft. GravelI -- Size —yPa B PIPING : � Bldg . to tank Tank to dirt. box 17ist . box to field �i -#r---- Openings sealed? YES N rma LOCATION/SEPARATIONS : �t. Foundation to tank _ Foundation to absorption V/ .� Absorption to lot line Separation of pits 1 man e ) LpCATION OF SYSTEM ON PROP Front - Rear -- Left sid - Right side CCMMENTS : SYSTEM USE APPROVE Y NO 4r. Suil i g Inspe tar 01/€s5 and vl . 3 TO1111rN OF QUEENSBURY Building° Department [wpecbore Report Date Name L.oeratiae POWNI. No. - W ec�atladr Remarks IIIIIIII Excasfa tzon Footin Farms Footin & Piers Foundation Cement Coat Water roo,fin Ba.akfill Final Serve Frami 5heathin Roof Felt Rva7Pi Siding Masonru vender Roo rh PI Retie€ Valves Wall Board ExIIIIIIW _ parches Finished Flay In'teripr Trim Stairs & Railin Is Cellar Dr . Tile Concrete Floors pl . Fixtures Gar . Fire roofin poor Closers Chimne Water meter Inst . Septic A roval Floors _ - Foundation Insulation Walls Ceili ti ` Building rnspector REMARKS 0N---t -au rx v c.-,ma`s. Cca. ►� -3 +b 1 �1 - T+C7WN OF +QUEENSSURY Building Department N�� Repowt ,� Data i �• 2 1 {k=L r40a cDr�+ Permit No. ._!3 C-A_ Wewthw Remarks ,Excatya is on Poo ting Forms �. Footing & Piers _ Foundation _ Cement Coat _ Water roofsn _ Backfill Final Surve ------- Framing sheathing _ Roof Felt _ Roofin Siding masonry Veneer _ Rough Pl _ Relief Valves _ wa.21 Board Ext . Porches _ Finished Floor _ Interior Trim _ Stairs & Railings _ Cellar Dr . Tile Concrete Floors _ PIN; Fixtures _ Gar . Fires roofin _ Door Closers Chimne Water Meter Inst . _ Se tic A roval _ Floors _ Insulation Foundation Walls Cei.2.in " Building Inspector REMARKS !-Unr4 461trL AI'TLSG 714W0 {n Ev- Wes) . e - y,• w'T, 4r:+e. ,��'yy .`. `.' ,N : .._..,y',L. 'Ar'` P s H.ryt r . .... ' yi�p'5`�,+ .yJlprTj'" `*iR^F"" r' 't`+.'«+'f'"c� . . '�yB.' IOFL y�''' 44 "' f �'}` q'✓ . �' - .,c's yy,, U ,x . :''t'r v � •�,r + n ' -s.: u6. n.r a s i? n Y . Y ` . W x iewrr�lc+tTE NO, B1YK- sic] � AF4 0fd: v 4lE C 9 � ,aa , ' +•� : .,4t $TAq 'E STR IF ALBANy N _ Voe 12207•,r,_ , , � T�av � .;5 . i, yJ !•n t 4� �.. S. y rp x s t y. : , aFy e' .'�'ti� .I y.. "i< #wVM ' a 4 + Y d -• 'tFs.-: , ---n•-,�,T ..: x . r_ _ i.T ?'..�«-ilC?LI/iRFIf!►11E'Br GIRIB'fi5D7i7 .. •:-.fl,.- ., • , ,. „ rcr AkafCCEl1?TfrIf;/17 E31aLad Pon THE EL iir1LDIf41i 1!Sf1Mfr f4D. fia0iiL01YAlIO Lccrrpw;At e r , - . - s . , ! . •e.`:; e*Lwwmrr to 6tlE HIRST ium ,h TEMP.t1 - j .. i, BATE -'.ri' ° '.t 9r:,t.x-rt•„IF a:+� R+ S*.•,,� r a.*fi-� s:tf�` 6 , t . : .y Il-e VILLAGE l^ :'' ? y7Y•E, is. `':?!5°E,'r -y,}F ... .� fi ,i lam. . . I;` + T4WM$HIP CONNTY'•;- , STREET ANO Nb. ORt.. . r' > >..e r , .;;,. i _ 4 .y._ .i ,:� .ao- )..;emu. A . ROAD AND POLE NO. • ++ .•'" i , , >. BETWEEN WHAT TWO -� „; ' or {.. . PRCROSSSTREET$i � ,." ' r �. F' ". '. :. 4 y,, :. h b :OCCUPANT .. . , b 1LDIMG-• �'A`+e .. `r-- :r UPANCY , -0 ,ry,:.g ,:�' yrlt 1'M '1 c - L—I j If. @L.;#iAp Ilk I •: .. P 4" SUPPLIED `.. • , `i 'r f . ?.. {., •FROM THEIR + ' {" "'rt'' OF FICE:1- L' BYk. BUILDING , . . DEPECT Er _ W IS LO NEW DDITIONAL © t REMOVED�-� } LIST BELOW ALL EQUIPMENT WHICH YOU 114STALLED j.. : ,,.:. �'�: Ro.of Fixttwia 6 B�RANCif ?' • . �`� . NUMBER OR.WJTLET*:,- • : ' Lantp Rwxpttdw MOTORS H€ATERS gRCUITS • ' •+i..r�' ©F,f Ice lJlFE If,-' U `Lest- r f -,< tiatl 'Clllilla ova ReesP'b ' SWhoh Psstdnnt Ereilt" No.:`, Tape . Sash No. L WLe�I N � y';' , IN$PECTIGN I, . j .•' » ik {' sideio - Sub-. .1,,.yp .i . .iw + Itese ' ..-x:..'` -.»._ . � ,-cam` 'c 4el iII. t Ys T lk lord Fr. a _ .._ . s . _ +.• .. 4-- IC L I L. ,•;£» i•. i .. :t: . .ram L L , X. a. REMARftS:- LIST OtHER LECTRfC ,D „YMC€f -r.$*T.FORTN ABOVE! P. •` 'S,' = aO IN O T USS THIS SPACE, 4, This eppiitatip ie intended to ewd-itte a4wLlie/eq e4uiWmeM.me be inspected Out d at time of intpe orkm liters is found additional aoitlipmovat;not tsd. Yw ere authorised to msko'ehe HrspecNon And adjust Otte fie to cower the additional equipment, as preeided bV lM rpplioanu SION TOJ;A So soars ' hau,. *#fSDERS �;. . ' 6LECTRICAMPS �T . . �. $ .e ,,WATT$• 'w.. CHARACTER '�:J' ` "`i 4� ..;.p: tr;.z= -."c .i.:.,is E%POSED:: GAS TU4E SION.: ' x�. .,+.+: aL . OF WORK '4 . ' r4."r'-`'- '." '.. CONCEALED 'TRANSFOR RS 01': - •.+'i" VA . . WORK TOM. h" . . ':. • , Q ..� vY�µ NNUMBER) - ; - c v: w ._ice: '<' fCAPAC11'Yf �.. STA}I D" s'<.. yam,_ .ti SE E 'W M1. MAR- . r T 7 ,'tT.#`-•:` ', ,y .. ENTERS:- 'T!•'. v y r, -�i . . r', r<t"'• OF'SION xY e x: INSPECTION REOIJESTEO: ,J . .. w: ; i '- s- Y, . 'd.: � « ' � ! .. ,�✓ :. � ` E ON OR AS NEAR AS - �`'�' ' POSSIBLE .�. NEW - -OLD r ^.} - - AVOID DELAY BY GIVING FY Al"p ACCUR ATE4W FORMIATI4N, "ALL SPACES MkWT BE,FILLED IN g1tFP1�JCJ1T1 'Y_BE EO ' "r PRINT NAMqIAp0 ADbRE ' ' : %L NAME OF •0L CAT10N - , r "i APPLICANT ,4T �, STREET ADbRfE85 • . T t "t _ ' Tic.LEPHONE i .-`; . CITY OR . r e • , . '.wr+. 'r`.'.i"r' J 21P ky y-'� LICE��ylBE NO: C WHE N . POST OFFICE APPLICABLE 44 EL (REV. Ilea) A SEPARAT APPLICATI N MUST BE FILED F011 EACH SEPARATE BUILDING r3f d' • Per � � •-_ OP do 410 m lot 1d CIA IV y t/1 Q 10 Dlp -�1 it t i+ Os a pep . , Sit ' - 1 ' O JL � .. CX OOPO r ? aw , G #t , M— re '4p olp 4e n7 - ---------- �i �� �#1 r �� ,ri FF,