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1985-729 I I y CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK 19 37 Ts is to certify that work requested to be done as shown by Permit No. " ` ' hi has been completed. D � 1 4 This structure may be occupied as a Location ] ,.3I, CAL:is C t3: . t� ( t�. � o .[L�'x: ;``f��y :: _Li : llc ;:ul c i^v i .u , pr© ' cja 1 i Owner {` y By Order Town Board TOWN OF QUE}ENSBURY Building & Zoning Inspector CREATIVC -ANSTA-- PRINTINU. GLENS FwL LS. M Y *1001 ISIs4T+3-sass -------------- BUILDING PERMIT TOWN OF QUEENSBURY No. $5- 72s WARREN COUNTY, NEW YORK �a 0 a PERMISSION is hereby granted to P'ro—Craft , Inc . rt Lot 27 Grouse Circle ( St . No . 2 ) Street, Road or Ave_ r" OWNER of property located at .+ Phase easant a u ivision '� One-Family' Dwelling H in the Town of Queensbury, To Construct or place a 0 at the above location in accordance to application together with plot plans and other information hereto filed and 0 approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 1 . OWNER'S Address is Peggy Ann 'Road Glens Falls , New York 2_ CONTRACTOR or BUI LDER'S Name same r C 3. CONTRACTOR or BUILDER'S Address rr N same c� n C 4. ARCHITECT'S Narne to can Nt rx n 5. ARCHITECT"S Address rt rt B. TYPE of Construction — (Please indicate by X) C ( x? Wood Frame ( ) Masonry ( 1 Steel ( 1 r 7. PLANS and Specifications No 64 ' x26 ' per plot plan , specifications and application submitted including two-car attached garage and sewage system . ro 1 "2] >u S, Proposed Use N• One-Family Dwelling F �c tw ro Pax r 143 . 00 Tut 1 19 S6 $ PERMIT FEE PAID - TH15 PERMIT EXPIRES �- (If a longer period is required an application for an extension must be made to the Building and Zoning inspector o the oa town of 4usansbury before the expiration date_? 12th December 18 85 Dated at the Town of Queensbury this ��---Day of for the Town of Queensbury SIGNED BY Building and Zoning Inspector TOWN OF QUEENSBURY ( Space inside block to lw fillet( in b. WARREN GOl N"ry, NEW YORK Building Snspticrnrl ApplicatiOn f I ar ,, �,�1 ;< � %Nn No.i'e•rtulr ti,tical Ig' BUILDING AND ZONING PERMIT 1'44r111it F..pircti I . THREE ( 3 ) Copies of a PLOT PLAN, Drawn to scale ,i °1 rr+ + (A by showing the actual dimensions of the lot to be built itc ,n.Ir)CS upon, The exact size, and location on the lot of the building to be erected or altered MUST BE SUB. MITTED WITH THIS APPLICATION. DATEism A PERMIT MUSTBE OBTAINED BEFORE BEGINNING WORK ANSWER ALL OF THE FOLLOWING. A.M. / `{" �� 1 hJi. The undersigned hereby applies for a permit to do the following work 71819J10)11) I121 :) 415f 6 which will be done in accordance with the description, plans and specifi- cations, and such special conditions as may be indicated on the parmit, 0 The owner A this pSoperty is; . . . . . . . (MA ,E) Ip a AtJ[�RE55) The person responsibie for�/ supervision of the work insofar as the Building Co-de and the Zoning Ordinance apply is: ,rE° r7 .ram +� / r ..li✓ E� 7C F . . . . . . . . . . INAMEI . . . . . . . . ' IV 'O A00PESSI ,r--a Name of Builder . . /ICY C _ /'' I 4 . . . . . . . . . . . . Address . . `� - .• . . . . . . . . . . . . . . . . . . . . . . . Name of Plumber , . r.4 . . ' _ 7✓ �7✓ S - Address S' .� .fE s5! . . . . . . . . . . . . . . . . . . . Name of Masan . - . A0 /�•!6t[—Z-[s . . Cr .� 'er I ^�. ! . . . . Address . . . c J� Lot Number , . . . - "~. . Unit . . . . . . . . . . . . Estimated value of proposed work S Name of Village . . . 4er . e�;O./4,0.0/ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - . . . . . . . . . . . . . - . . . . . _ _ . . J ' Name of Street . . . . ::;7ddd` �-? ..$. 4t . . . �!. �r C. C. .'C"' . Side of street : north ©, east 0 . south CW west ❑ Nearest Cross Street . . . ! -�. � A,,4 .+- - -(.R-'. I . LA3(�istance fro rn this � rass street . . -+ r-' . . .�"'d ' n1,t . Property is north O , south , east X , west ❑ from Cross Street If on Corner, which corner, northeast V , northwest El , southeast C` southwest (Designate by marking with an "X" in the correct space.) NATURE OF PROPOSED WORK OCCUPANCY Construction of a new building. One-family d Bdu g Main ift ing Addition to a building. dwelling © Alteration to a building. T- I - family a rtment Crouse © Demolition of a building. -family apartment Store building 2-r-=car attached garage 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 size of the property, the location, size and setbacks of pro- NORTH posed buildings, and the location of all existing buildings. Show proposed building(s) in dotted line and existing tJ s [ 1 huilding(s) in solid line. ) Size of property . . . . . . . / . . ft. x / Size and use of existing buildings, if any ``` "' Size of proposed building . - - . ie for . . ft. x . . . . Height (from grade to ridge) . . . . , . . . . . - ,'e?. t . . . . . . ft- Front yard . . . . . . . . . . ft. Side yards . . . . . . . . . . .Y- ft. and . . . . . . ft. Rear yard ft, SO U T M If on corner, setback fratn side street . . . . . . - . . . . . . ft- Note: All distances are poet, as measured from street side line to nearest part of building. (OVER, 7 -73 —M (cont'd.) BUILDING SPECIFICATIONS., Kind of construction : 'Wood frame, fire safe, etc. ? - - - . . . . . . . . . . . . Will any second-hand lumber be used? If so, for what? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Material of foundation walls . . . . . . - ` 4 4AJ . . . . . f�e�,f!' .�, . . . . . . . . . . . . . . Thickness . . $. ". . . . . _ _ . . . . . . . . Depth of foundation walls below grade . . . . -4VA_ .t. . . . . . . - , Continuous foundation? . . . . Will there be. a cellar? . . . , ,e ✓� . - . . If so, material of cellar floor _ . , K=. 4'. .G . . . . . . . . . . . . . . . . . . . . . . . . . Type of roof: Sloped or flat? . . . . $.' t__4n Material of roof 6 G ^ . . . . . . . . . . . . . . . . . . . . . . . Size, wood studs . . . . . . . . . . . . . . . . 1 -. . " x . . . . . . . . . . . . . E�`" spacing . . . . . . . . . . , V,"o_c_, length . . . . . . . . Size, floor beams. Ist floor , . . , . . - . . " x . , , . . . , , . . . .!Q "', spacing . . . . _ . . . , ./. 6 . "o.c., spars . . . . . . . . , . _ d.ZJt. Site, floor beams, 2nd floor . . . . . . . . .'Z.--'= x . . , . . . - . . - - - ,rQ ", spacing . . . . . . . . . . ,1.6 , "o.c., span . . . . . . . . . . . /. L-ft. Size, ceiling beams . . . . . . . . . . . . . . . 'i+e u. rzx-e --z> , . . spacing x t¢- "o.c., span . . . . . . . . . . _ 2 felt. Size, roof rafters or beams . . . . . . . . . . . . '• x . . . . . . . . . . . . . . ", spacing . . . . . _ . . . _ . . , _ "o.c., span - . , - , ft, Exterior finish Z5"%;r > '0e N- G . . . . . . . . . . . . . . . . . . . . With what material? Finish of interior walls . . . . ,/ . r4 /.L ! +ram- . . . -.^Fr� T . �'o �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If garage is to be attached, of what material is wall between garage and main buijding to be constructed? ! i A r~. . .�4ogV ,r"cF- a . . , . .�7 'rrfz� ixT. een G .je- . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . is there to be an opening between garage and building? . . . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (find of heating system . _ . . . . . . . . L=7C;::r_' . . . . . . . . . . . . Oil burner or coal ? . . . . . . . . . . . . . . . . Will a flue-lined chimney be provided? j . . rf`E� . . . . . - Depth of chimney foundation below grade . . �.r . . . . . . . . . Height of chimney above roof . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will there be a fireplace? . . . . . ,Y . `.}. . . . . . . . . . - - . . Depth of fireplace hearth . . . . .. . ! . . . . . . . . . . . . . . . . . . . . . . Will a toilet be installed? . . . . . . , . . , , . , , - . . . . . . . . . . . . . . . . . . . . . . . . . Will a kitchen sink be installed and connected to water supply? . . . . X 4:S. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Water supply (public water supply or pump) . . . . jD4. d - t*: i - G.- - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . - Distance of cesspool from any private well . . . . . . _ ram' . . . . . . . . . . . . . . . . . . . feet g y p required traps, cleanouts, and vents? Y�"`-. .. . . . . . . . . . . . . . . . . . . . . . . . . Will drainage system be provided with r sired tra . . Town of Queensbury AFFIDAVIT County of Warren State of New York I swear that to m A�-.i+of my knawJedge and belief the statements contained in thin application, Whether with the plats and rpeeif"ycatione sub* mitred, area true and cu.t.plets statement of all prolwaed work to he done on the described p[etruaes and that an Provisions of the BUILD- ING CODE, THE ZONING ORDINANCE, and all other laws pertaining to the proposed work shall be complied with, wbether specified or not., and that such work is authorised by the owner. /� Sworn to before me this Signature . . .. -. . 4efl .do gyp . �15WNER'S AGENT. A NIT£CT, CON1 RTGfl� . . . . . . . . . 9 day of . . . . .. . �++-! 7z,".... .. ... . . . . 19. NOTARY PUBL#C, WARREN COUNTY. N. Y. SPECIAL CONDITIONS OF THE PERMIT: By .. . . . _ . _..... . . .. . . ..... . . ... .. . . . TOWN OF QUEENSBU RY 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 wor-k . ANSWER ALL of the following : 1 . Gross floor area { � 2 , Type of heath --. 3 . Is the building mechanically cooled ? 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 heated spaces YES No a . Are foundation walls insulated ? YES 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 ? YES NO a . R value of insulation 51 Type of insulation B . Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions. ' C2 2 , R value of exterior walls 3 . R value of glazed area�� 4 . R value of doors 5 . R value of floors over unheated spaces +6 . R value of slab edge insulation - unheated slab ±� ? . 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 ) 10 , Type of insulation C . Controls eP 1 . Thermostat maximum heat setting Q . Duct Systems 1 . Is duct system installed in unheated spaces ? YES NO a . If YES , R value of duct installation b . R value of duct in other areas 4eW E . Piping Insulation ! ' 1 . Size of hot water or cooling carrying agent pipe ,I 44 2 . R value of pipe insulation /C7 F . Service Water Heating 10, Performance efficiency. 2 , Temperature control setting maximum- d G . For Swimming Pool Only /✓ J � - 1 . Maximum heating Telephone No . f / -- /r S 3 ( appl ' ant ' s signs ure ) TOWN OF QUEFNSBURY BUILDING & ZONING DEPARTMENT SEWAGF DISPOSAL PERMIT APPLICATION 1 . Owner ' s Name Address 00 �--^� Cam .- Telephone No * %per 2 . Property location 3 . Name of person or firm responsible for installing system ,•'�i�'v C ee� .�.�^%- /.•Pr' Telephone No Address , l-- 4 . Number of bedrooms ( residential buildings. only) 5 . Daily flow gallons/day 6 . Septic tank capacity gallons 7 . Topography : flat , rolling , steep % of s . Nature of soil and depth 9 . If ground water , bedrock or Impervious material is apparent at what depth does it begin? f t . 10 . Percolation test : A is required B � is not required C If required what is the rate — minutes/inch 11 . Water supply : well , other 12 . Type of system proposed : drywell ,--e E le e� 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 for in Section 6 . 010 of the Queensbury Sanitary Sewage Ordinance . Date 12- i` ' signature of appllcan *a ' 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 supply , etc . Include all dimensions of the system itself . Forth 3 - 82 THE NEW YORK BOARD OF FIRE UNDERWRITERS yl BUREAU OF ELECTRICITY �f 17 r 0Cf 1 Flan 41 STATE STREET, ALBANY, NEW Yt7RK 12207 �y Date October 2 r 1986 Application NO. ""file 104600 - 85 THIS GEF>!'T!P!E£i THAT A 8 IF) 8 �?919r only the eleetrical equipment " deecribed below and introdaeod by the applicant nanaad an the above ejWlicaEien number in the prem "M of Pro - Craft Inc . , Grouse Circle , Queenshury , New York in thefallawing location; 51 Bame" esnt ® let Fl. ® 8nd Ft, Outs 1.de sectionl2l nCvch 9 Lot 27 Ivan "amined on 7/ 2/ 8 6 and.'foond to be in coEnpliance with the requirepteents of this Board. FDSTURI SCIE►TACLES SWITCHES S'.E FIXTURES RANGES COOKING DECKS OWNS DISH WASHERS EXHAUST FANS �TLETS IFICANDESNt FLUORESCENT y AMT. K. W. AMT. K. w, AMT. K.w, wM7. K, 24 41 16 22 2 3 FR DRYER'S FURNACE MOTORS FUTURE APPUANCE FEEDERS S/ECIAL REC`rT TUNE CkOfsSS K{t UFMT HEATERS MULTI-OUTUR DIMMERS AMT. K. W. 01L H. P. GAS H. P. AMT. NO. A. w. G. AMT. AMF. AMT. AMrS. TRANS, AM7. N, ►. SYSTEMS AM7. WATTS � No. of FAT r SERVICE DISUCII�INECT HOOF S E R V I C E AMT. AMP. rr" EQUIP. 1 -W 7w 1 Jr aw a JF 9W s X 4w Na. ( ee. eOIVil. A, w. NO. OF HI-LEG A. W. ea. PER !' CIF CC. D- OF HI-LEG NO. OF NEUTRALS OF NEUTRAL 1 200 CB 1 x 1 4/ 0 1 2/ 0 OTHER AFTAEATUS: 1 - G . F . Cvl * Eleiktr �rs : 3 - 2 . 0 kw 1 - Smoke Detector � yA` 2 - 1 . 5 kw SOY V 2 - 675 kw Frank A . Krinski Pro- Craft Inc . Peggy Ann Road ERANCH MANAGER Glens Falls , New York 12801 Per_ �� This certificate must not be ahered in any manner. return to the office of the Board if incorrect. Inspectors may he identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~ �ost,r� v� �eeeen3� ure� BUILDING and ZONING DEPARTMENT Bay and Haviland Road. R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME PAC) _ _ f� / -------- LOCATION Date� �/� Permit No . * at ,1� * x * * * ✓* � * * yr * � w * * * : « i APPROVED - YES NO F t ier Forms Foundation Waterproofing Sackfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors 1 Interior Trim :Q Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofin Door Closers Smoke Detectors Chimney INSULATION Foundation Floors 'Walls Ceiling FINAL ELECTRICAL INSPECTION Final Building Survey next scheduled Inspection ( call when ready) Remarks- Building Inspector 6/86 and-vl TOWN OF QU EENSBU RY Rujkldiex Department Iaspectom Report Dalte�==� �v Name ko L acatimm f=ed � L Permit Na Weather Remarks FxcatYatlon Foo ring Forms Footing & Piers Foundation Cement Coat Water roofin B+aarlkfi 11 Final Survey Framing - ICJ S C�TF L�.ti L?JE sheathing Roof Felt Roofin Siding Masonry Veneer Rough Pl b . Relief Valves Wall Board Ext . Porches Finished Floor Xnterior Trim Stairs & Railings Cellar Dr . Tile Concrete Floors PI . Fixtures Gar . Fire roofl n Door Closers Chimne Water Meter Inst . Septic Approval Floors Foundation xns ul a ti on --- Walls Cei I in Building ? spector REMARKS TOWN OF QUEENSBURY Building Department Inspectore - -- - Date_ Name Jr A4 Remarks Excat�a t Dn Foot-in Forms Footing & Piers Foundation Cement Coat Water roofin sa�arfill Final Surve Framing Sheath,ingr Roof Felt Roofin Siding Masonxy Veneer Rough Plbgq Relief Valves Wall Board Ext . Porches Finished Floor interior Trim Stairs & Railings Cellar Dr , Tile Concrete Floors Pl . Fixtures Gar . Fire roofin Door Closers Chimney Water Meter Inst . Se tic AEproval Floors Insulation ! Foundation Walls Cel 11 Build.ingr ]Inspector REMARKS r' YJCz `� a�'l" 'x -r 1C �, v •tTJrSTs 74 s� r - 1 V u f✓� It . T /J'PV ' fj ,�J� RI r .tic fa n-� 't I U` '/�'#�+'`C� 2 .. I=tun,L `7il r =G ciu �� TOWN OF QUUEENSBURY Building- Department Inftmw&w* Repmt Nwrne ;�-- LLacaeim LoT-- 7 Cp fZO05 0 .rt0Zd!T Feravit No, Walther Remarks ExcaeiFa on Footing Forms Footing 6 Piers Fcunda tion Cement Coat water roofi.n Final surye Framing Sheathing Roof Felt nsz Siding Masonry Veneer Rou<7h P1 Relief Valves Wall Board Est . Porches Finished Floor Interior Trim stairs & Railings Cellar Ar . Tile Concrete Floors P3 . Fixtures Gar . Fireproofing Door Closers Chimney Water Meter Inst . Septic A roval Floors ation Insulation Found Pound Cei[lI n Buildidp,r Inspector REMARKS TOWN OF QUEENSBURY Building Department ? Lr5& C CL Parimpit No. w e nth s - J Remarks Exca(pa tz on Footing Forms Footing ev Piers Foundation Cement Coat Water ra©fin BacJcfill Final Survey Framin Sheathing Roof Felt Ro : i-fln Siding Masonry Veneer Roug.rh P1 Relief valves Wall .board ext , Porches Fi ni stied Floor Interior Trim stairs & Railings Cellar Dr . Tile Concrete Floors PIL>gv Fixtures Gar , Fire roofin Door Closers Chlznne Water Meter Inst . de septic AEpzoval Floors Insulation Foundation -----••••— Walls _ r � � BUildlnq Inspector REMARKS �.` C] (j J� I �r fop 3{ 1i Pe- T-�o r i r woo NO IF Ar IF RR// IN IF IF IF \l . rn l � t AFT 1 Y \�' E ig.{fi r �*' �t.e ra Ll 19,E J t� A A, a� �' AT f J f; k E� \tX { rYtF �R,1d >Yy n "+ �'lixtY { � Y' rA °7 ..iy� �`P Fy r* ` 5` rh' F '�". '/° l � '`s �i: 'p+ � t�'� 1 •i! t4q({i�1�+L� t '+� 4" k Q ae� k� W)n Y :�yy ' 1Y F f 5�(f� } •} 'I x�6T' j J f 3.�• ' NO {1 ,r-L v , Yy ,F ... �j �y J . ). F..6'6, 'itTt 4�{ _kr cS'II PY; c +'.,.�: f i M'Fpt ' Y � 3. t JFP" b >.?P / r �i'= i�d JfS .'%'�Ivrt '41' wk,f' ':jw'` ,Z Y ' ,x k $� S :.y �, i z.` `.. .1 r„ +�ry,SA,ec=Viy Y..�,} 'b^C X� A: • + f' \t.. J .• ,•Y .S r'HFtAl�,Ai Per 4 k 43YM1 { t �`y�• Ltl Y4 W[* r••P? Y .� v .t ..kr .♦ fir . �...i �. 1 �. f u{l.'Wa. 1. 400 TOWN OF QUEENSBURY Building department In"wwbors Date_ / ?. ✓.7 Naane WIIIII C CA 157C L.ocati�o�n l� c.TS�r r +G' Permit No. 35 r 7 a Weather Remarks Excaiia t=an Footing Forms " ,V6 Pootinq & Piers Foundation Cement Coat Water roofin Backfill Final Survey Fraazl n Sheathing Roof Felt Roof-.n Siding Masonry Veneer SL Rou h Plbg Relief Valves Wall Beard Ext . Porches Finished Floor OL Interior Trim stairs & Railings Cellar Dr . Tile Concrete Floors PI , Fixtures Gar . Fire roofin Door Closers Chimney Water Meter Inst . Septic AppZoVal Floors Insulation Foundation Walls Cellin Buildin Inspector REMARKS +1 K ( (o 6) St o&.s Cq" �e G TOWN OFF COJEENSBURY Bualirnor Department b"We"We Report Date /I-- Name Lecatiaa_ Zgs i �_� ilia uS 65 Permit No. 9 = '7 �Z 9- Weather Remarks Excatoa tx on FootiEg Forms Footing & Piers Foundation Cement Coat Water roofin _ Bncj fill Final Serve Framin Sheathing Roof Felt Roo.flng Siding Masonry Veneer Rough PI Relief Valves Wall Board Ext . Porches 17 Finished Floor interior Trim Stalrs & Rallin s Cellar Dr . Tile concrete Floors Pl . Fixtures Gar . Fire roofin ^ Door Closers Chimne water Meter Xnst . Septic ApEroVal Y Floors insulation Foundation 1Mta13s Celli Huz.ZdizxA inspector REMARKS BITERS. ' APP CdPY WITH SUILDING DEPT' WFIfiN REOUiRED. gLIiLDING DEFT. COPY OF pppLiCATiON FORM 4fi EL. NEW YORK BOARD OF FIRE LINDE FILE pAT1E TEMP. P ' .✓ F. COUNTY TOWNSHIP / POLE NO. _ CITY OR / /,f �' {-r,z{✓' '.^ L VILLAGE OT K SL STREET AND NO. OR ROAD AND POLE MO. .+G;s. SETYWEEN yyH ITS TWO {'�"'T"�'} - :•:k BUILDING CROSS STREETS IS s A .I OCCUPANCY 'I � 3 PpiEMISES LOC Y -^ .�. TEL. # .� OCCUPANT'S �,,'„�" �� - . . { NAME OFFICE OWNERS NAME. f� .,,, �'' ''' <. THEIR 'f ' DEFECTS �--y ANT) ADDRESS ,/ . FROM �--5 REMOVED LJ7 C a} , rI" �" / � WQRK NEW ADDITIONAL O SUPPLIED l�.n iS By OLD © ENT WHICH YQIU INSTALLED 13UNLOING NEW EQUIPMENT BRANCH OFFICE USE IS LIST SELOW ALL CIRCUITS ONLY MOTORS HEAVERS fLy�R Y.�t,`�,rl.� A.W.G. INSPECTION NUNIBE It OF OUTLETS H.P. No- fi� Ne. GauPa ocs Side A"Rch"L Switch Pa"'I gsackat Nn. TYPO Each lion Col kill Wau sou is Out- side Selr Uwe Baas' meat let F1. 2Ad Fl. 3rd ft. 00 NOT USE THIS SPACE- TH ABOVE: REMARKS: LIST OTHER ELECTRICAL OEVICe' NOT SET FOR va listed. i if at tuna trf inspection there q fpu nd additiond e4t"PrAent not rba the applicant. listed e,gtnPMont to be MSPected hu Mom te Provided Uv TOTAL adjgst the fee to cover the eddi boned equ iP yy ATTS This aRPli"tom i% intended to cover poa nd ELEC7R IG STGN YOU ere authotiaed to make the Ynspec LAMPS j,- /� 44 GA TUBE SIGNMERS OF FEEDERS VA SIZE } 4: / 'rye J EXPOSED S INAINS CONCEALED 7RANSFflR OF ICAPACITYI CHARACTER INUMB£R5 OF WOR% COMPLETED $12E OF SIGN WORK TO BE MAKER STAFIY EO UNDERGROUND OF SIGN SERVICE OVERHEAT? OLD 0 ENTERS NEW oll gU1LO1N INSPECTION REOUESTED pp ON OR AS NEAR AS ,.- ` POSSISL£ N "r' Y GIVING FULL ANO ACCURATE INFORMATION. ALL SiF ACES MUST Se EOFAYE OFlHO R APPLICATION MAY SE RETURNED' AVOID DELAYN .� ,�. 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