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1987-086 CERTIFICATE OF C %A`,."LJ"f PAN+�Y' ' TOWN OF QUEENSSURY WARREN COUNTY, NEW YORK Date June. 3 19 877 Thin is to certify that work requested to be done as shown by Permit No. 87--86 has been completed. This structure Imay be upied as a one-Family Dwell.ixx 1 Rxr �4� .�acarior. Lot 74 Pheasant Walk ( St . No . 17 ) Section IT Pheasant WaI Subdivision Owner Pro-Graft Inc . By Order Town Board TOWN OF QUEENSBURY Building & Zoning Inspector • CERTIFICATE t./ T E M P 0 R A R Y "� CEli L LL ' 1CATE OF �..i�✓ t./ L �L �F �� TOWN OF QUEENSBURY WARREN COUNTY. NEW YORK Date 28 I4 S7 I L4 I-clCP This is to certify that work requested to be done as shown by Permit No. ` '- �' has been completed. This struCtUicemay be occupied as a one-Farad} I3wellsig ] Phec rSp r k N)CO Location Lot 34 Pheasant Walk (Ste Now 17 ) Pro—Graf [ , Inc . Owner TIE,NlpORAJCt CERTIFICATE OF OCCUPANCY PENDING FINAL ELEGYRIC:ALA By Order Town Board TOWN OF QUEENSBURY I �1 Building & Zoning Inspector BUILDING PERMIT w TOWN OF QUEENSBURY No, 87-86 WARREN COUNTY, NEW YORK �d ri PERMISSION is hereby granted to Pro-Craft Inc . o 1 n OWNER of property located at Lot 3& Pheasant Walk (St No 17 ) Street, Road or Ave. W One—Family Dwelling in the Town of Queensbury, To Construct or place a at the above location in accordance to application together with plat plans and other information hereto filed and n approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 1 . OWNER•S Address is 11 Pheasant 'Walk Queensbury , New York 12801 2. CONTRACTOR or BUILDERS Name Same a rt two 3. CONTRACTOR or BUILDER'S Address Same 0 w co m R 4. ARCHITECT'S Name r as' to 5. ARCHITECT S Address rt 0 B, T'YPE of Construction — IPlease indicate by Xl V IX I Wood Frame I I Masonry I I Steel ( } T_ PLANS and Specifications 60 ' x38 ' per plot plan , specifications and application submitted o No- including two-car attached garage and sewage system. w 8. Proposed Use Br• One-Family Dwelling m r $ 5 . 00 C /O $ 115 . 00 October 1 PERMIT FEE PAID - THIS PERMIT EXPIRES �`� � (it a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Oueensbury before the expiration date.) March 87 Dated at the Town of Queensbury this 24th Day of a 19 SIGNED BY J / f —', ^✓ for the Town of Queensbury Building and Zoning I nspecto �s TO BE COMPLETED BY BLDG . DEPT , / Application No . Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 :l^JIV ` � QUE:=N.`.a b' jTy Bay and Havifand Road, R_D. 1 Box 98 Zoning Designation Queensbury, New York 12801 Variance No . r� lJ s� ]} ! # / u2 / f - 3� Site P rx Review MAR 2 3 1987 Appr ed b APPLICATION FOR BUILDING & CODE DEPT. FUILDING AND ZONING PERMIT / ' �)A,6, Crrcr A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING , The undersigned hereby applies for a Building Permit to do the following work which will be done in accordance with the description , plans and specifications submitted , and such special conditions as may be indicated on the Permit , �______._-_- The owner of this property is : f �2C) ,�1? ,g�-� k C n, P , O, Address Z/ Property Location : a 7 ZV r�G Sly ��I % Tax Map No . / f Street number or building lot number Subdivision name ( if applicable) `'L'E' S /) ., ') i I Z4L_ CC THE PERSON RESPONSIBLE FOR SUPERL7ISION �OF WORK AS REGARDS BUILDING CODES IS : /V Name P. O , Address Tel . No . Name of builder _Address r Tel ,, Y Gf / 3 .3 •3 Name of plumber 14 Address 74 �.rq Tel * s-k: -Z titer' / Name of mason *4 t Address (� ' .f = Tel . NATURE OF PROPOSED WORK : ZONING INFORMATION : /Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED , _Addition to a building drawn reasonably to scale and attached hereto , Alteration to a building * showing clearly and distinctly all buildings , � (no change to exterior dimensions ) * whether existing or proposed and indicate all Other work (describe) set-back dimensions from property lines . Give * street and number or lot number and indicate whether interior jr corner lot . Show location FOR DEMOLITION PERMIT , STATE SIZE AND of water supply and location and configuration LOCATION OF STRUCTURES AFFECTED , of septic disposal area , COMPLETE INFORMATION REQUIRED HEL.OWo size of property f 2ca „�( d? G _ ft X f , }(_ej t , / p" R, * Existing buildings ) Size ft X . ft . PROPOSED BUILDING AND USE : Existing building ( s ) Use Size of new structure ft Xft Foundation-pi.er/slab/crawl/partly ful Proposed building , distance from property link. (circle one ) No , of stories (habitable space ) / * Front yard Lf o ft Rear yard / �C] ' ft * Side yards 2 t� ft and v ft ft ,Height ( grade to ridge ) _ 1A — If on corner , setback from side street ft If residential , no , of families j No . of rooms ( excluding baths ) --� " OCCUPANCY INFORMATION No. of bedrooms 13 No * of bathrooms PRIMARY BUILDING - ?Y �` "1.-'C3ne family dwelling Primary heating system C' L_ 'Type of fuel --- * Two family dwelling Multipl ,� dwelling / Number of units No . of fiveplac: to be installed / Permanent occupancy Will a wood stove be installed? .rJ t Central Air conditioning? ,L/ t Transient occupancy Business BUILDING STYLE,, PRIMARY STRUCTURE industrial �ch Contemporary Log cabin If addition , what will use be? sed ranch Mansion Duplex '� Split level Old style Bungalow Cape Gad Cottage Other ACCESSORY BUILDING- Colonial Row Town House * Detached garage/one car/ two car car { CIRCLE ONE PLEASE ) * r.�ttached garage/one car/ t➢ds� �� car * * * * * * * * * * * * * * * * * Private storage building ESTIMATED MARKET VALUE Oe Other CONSTRUCTION $ . . r INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED ! Form BPA 4/86 and-vl ll► BUILDING PERMIT APPLICATION CONTINUED - BIALOING SPECIFICATIONS . Type of construction , od foram' fire safe , etc . Will -any second-hand or ungraded lumber be used? If so , for what? Foundation wall material QL. n C Jam" Thickness f e Depth of foundation below grade. ( to bottom footing ) ' Will there be a cellar?._.. � &- Heated or heated Floor sq. footage jy' ye+ sq ft Will there be a basement? � Will any pportlon be used as living space? ( I€ so, what portion? __sq . ft . LL - Type of use? 'Type of roof - o /flat/shed/other Material of roof f ,yrr,� t.' t wr^ size , wood studs 2 " X spacing�"o . c . length 5/ ft . Joists ( floor beams ) 1st . floor " X� rC spacing ^ Z6 FgOac . span 1 ,2 -ft . Joists ( floor beams) 2nd . floor "h spacing "o . c , span ft . Overlays (ceiling beams ) spacing "o . c . span ft . Roof rafters spacing O . C . span ft . Roof trusses (pre-engineered) spacing 2 y' r"o . c , span�ft . Exterior wall finish_ ,54,- .t r ,�, r; _ Of what material ? Interior wall finish /4f. 11 25 e If a garage is to be attached , describe materials to be used for FIRE SEPARATION : X 6 l J/"�d G_ ul 1 ?!-f t�1 f G `7" .�y, ram- .^� �'" � L�"T`r2' o x- Is there to be an opening between garage and dwelling ? Y s� if so will a Eire-rated door , enclosure , and self-closing device be provided? Will a flue-lined chimney be installed? - �� _ Height above roof ft . Depth of chimney foundation below grade --- ft . Depth of fireplace hearth 2- ft . in . Water supply - unicipl or private well SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties - ft . (A separate application is necessary for any repair or new installation of septic system ) Town of Queensbury County of Warren A F F I D A V I T STATE OF NEW YORK I swear that 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 authorized by the owner . SWORN TO BEFORE ME THIS Signature _ ` r = -Owne owner ' agentar, rec , contractor —day of 19 / �S /J(./j]i Notary Public , Warren County , N . Y . SPECIAL CONDITIONS OF THE PERMIT : TOWN OF QUEENSSURY 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 : f 1 . Gross floor area / / �/7 2 . Type of heat 3 * is the building mechanically cooled ? r 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 ? 3L 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 5 . Type of insulation a , Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions_ 3C7 2 , R value of exterior walls /� / 9 3 , R value of glazed area /e je . S 4 , R value of doors 2 : s- 5 . R value of floors over unheated spaces / 6 . R value of slab edge insulation - unheated slab /V,//7 - 7 , R value of slab insulation - heated slab oy2z - 8 , R value of heated basement/ cellar walls ( above grade ) 9 , R value of heated basement /cellar walls ( below grade ) 10 , Type of insulation �97;�C C . Controls 1 . Thermostat maximum heat setting D , Duct Systems 1 , Is duct system installed in unheated spaces ? YES NO a , if YES , R value of duct installation � 4 b . R value of duct in other areas E , Piping Insulation 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F , Service Water Heating 1 . Performance efficiency` / 2 , Temperature control setting maximum ,:gel G , For Swimming Pool Only 1 . Maximum heating Telephome No . Z' d / 2 37S Z• '2�^X •`7 cc -4e ( applicant ' s signature ) Jcawn o� �u�e►rs6ure�r . BUILDING and ZONING DEPARTMENT Hay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL PERMIT APPLICATION Owner s Name_ fiel Address /V 4'' Person/Firm installing systeir ,20 - C='( d /` r JrX0 Number of bedrooms ( residential only) 3 Total daily f low : ( compute @ 150 aa1 . per bedroom per clay ) Topography : flat - rolling - steep - ( circle one ) Degree of slope � Nature of soils : ' sand loam-clay- other- Depth ft . Ground water-- at what depth? - — ft . Bedrock or impervious material. - -at what depth? ft . Percolation Test me of rec�uir�P�Y_---,---��- ' equired -Rate min/inch . Domestic Water Supply Municipa >" Well - Other IMPORTANT ! On a separate piece of paper , submit a diagram of the proposed septic system with all dimensions ; including distance from any structure , distance from property lines and distances from any domestic water supply or shore - line of lake , stream , pond or wetlands . Include all dimensions of the system itself . Description of proposed system : Septic tank size 4217e7 gal . Tile field- Lenq'th of each trench_S1! ft . Total field ,:'G.� ft . Size of stone # -2- Seepage Pit ( s ) Number / Size ftX_ f t . Size of stone# Any contractor , corporation , 1nd1vidual , 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 Town of Queensbury Sanitary Sewage ordinance . Sign ure of A plint Bate 01 86 and vl Section ii Septic System Inspections : A . All applicationd for septic system installation , alteration or repair , as reauired by the, Town of Gueensbury Sanitary Sewage Ordinance , shall be Submitted to the Buildina Department at least 24 hours before start of construction and shall include a plot plan showing ; 1 ) the proposed location 4of the system 2 ) location and distance to lot lines 3 ) location and distance to structures 4 ) location and distance to any water supply 5 ) size and dimensions of all tanks , distribution boxes , the fields and/or drywells 8 . NO system shall be covered before inspection and approval by the Building Inspector . Failure to " comply with this requirement may result in the uncovering of the system by the installer ,and a fine of up to $ ? 50 . 00 . Ce An approved copy of the plot plan shall be available on the construction site . Failure to produce said plot plan at time of inspection may result in an immediate work stoppage . D . Should unforeseen problems during construction prevent proper installation , alteration or repair of an approved system , a new proposal must be submitted to the Oueensbury Buildina Departinent before further construction . THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ['A . y . 41 STATE STREET. ALBANY. NEW YORK 12207 �y cc �1 Mt. July 21 , 1987 APFZPrarion No. on file 0 0 FS 8 3 5 / 8 17 A f�U 8 C i 5 40 THIS CERTIFIES THAT � only the electrifeal equipment as described beltvw and intradaaced by the applicant nansed on the 0600e applicatian nuanber in Cho pramises q/ Prot-Craft , Inc . , Lot # 34 Pheasant Walk. , Queensbury , New York in thefollmeing locarian; L, Raaeansnt EJ Ise Ff. ❑ 2nd Fl. outside/ Garage Sectiote21 Black GO Lot34 to was examined on 61 3 / 8 ! mnd found to be in compliance with the "uirem..LLents of this Board. FLXTIIRE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS A OUTLETS INCNDESCENT fLUDMESCENT AMT. K. W. AMT, I[- W. AMT. KW- AMT. K. W. AMT. H. P. 18 48 21 1 16 1 2 1 1 . 5 3 FAR I DRYERS FURNACE MOTORS FUTURE APPUAMCR FiRpERS ISPICIALROCAPTI TIME CLOCKS iiRl UNIT HEATERS INULTI-OUTMT DIMMERS STEMS ,�. AMT. K. W- OIL H. P. GAS H- P. AMT. ND- >v W. G MP. AMT. A . AMT. AMPS, TRANS. AMr. H- P. NO OF FEET AM'L WATTS 1 Rang # 6 1 rye lf} SERVICE DISCONNECT NO. OF ]. -HwW # 10 s E R METERCC.. Y I C I AMT- AMP, TI►E I X ZW 1 �e 3W 9 X SW S X 4W ' #EECCNJD. OF CC. COND. ND. OF HI-tEa OF iIEG NCI. C7F PIEUrEALS OF A. W. 1 200 cb I. OTHER APPARATUS: 1 _ G . FeC . I . Electric eaters - 3 - 2P0 KW I. - Smoke Detector 2 -- 1 . 5 FUR 2 - 1 . 0 KW 4 - . 75 KW 1 - . 5 KV; s s a Pro-Craft , Inc . - 11 Pheasant Walk BRANCH MANAGER Glens Falls , New York 12801 This certificote must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. V Iqt-I 4- 47 ry, Iown of ` " e,er: 3bur+if SUiL.C}1fdG and ZC3NIN DEPARTMENT 98 Bay and Haviland Road. R.CI. pueensbufY. New York i2gQi SUI LDING INSPECTOR'S RE'F'ORT NAME r o � �- y - 4 LOCATION I 34< ht- 5 ^ `�' �"'1 at e YES 13C1 Fosating/Pier 'Forms Foundation Waterproof ing Backfill Framing Roof ing Siding masonry Veneer Rough Plumbing ---`- Relief Valves Ext - Porches 5` Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile concrete Floors i'll7g . Fixtures_�_�---- Gar . FireproOfin9_1-----� �--- Daar Closers Smoke Detectors Chimney .TN SU LAT I ON Foundation Floors Walls Ceiling FILIAL ELECTRICAL Il35PECTIOI3 nRIVEWA'Y APPROV SurveY��— Filial Bailding Next scheduled insp ectian (call when read�l Remarks- ��' r / . J, �' Ili fv'( • / }" T3uilding Inspector lye 5_ `atvn o Qf11ee ,zy BUILDING and ZONING DEPARTMENT [ 30 � gay and Haviland Road, R.D. 1 Box 98 Queensbury. New York 12801 SEPTIC C3ISP0SAL SYSTEM INSPECTION NAME Pr Q C LOCATION .� �'r P" ea sa "r AW 4115 13ATE h l_ -- PERMIT N0 . SCIL TYPE San - Loam - Clay - �- Percolation est Required? YES - NO Percolation rate - min/Inch TYPE of SYSTEM: total length - Absorpti.on field , -~ Length of each trench Depth of trenches Size of gravel:_ SEEPAGE P I'TS#N Sher of t, - Size- ft. X Gravel size Size Ty PIP:ENG = G . �— Bldg . to tank i=�=� - Tank to list . boas '- Dist. boas to field/YES NO Partial Openings sealed? LOCAT ION/SEFARAVE CN S = f t. Foundation to tank Foundation to absorption eft. Absorption to lot line ft. Separation of pits PROPERTY (circle one) LOCATION SYSTEM ON Front - ear Left side - Right side CCpo ENTS . , _. SYSTENf USE APPROVED ES NO Build-Ing Inspector 01/86 and vl BUILDING and ZONING ❑EPARTK4ENT Bay and Haviland Road, R.D. 1 Box 96 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION �j met 3�grv '� / fi�5 t / ,w, f� �� Permit No . (1 * Cv APPROVED YES NO Footing/Pier Forms Foundation waterproofing Backfill ,yc Framing Roofing Siding Masonry Veneer ??( Rough Plumbing Relief Valves Ext , Parches 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 Filial Building Survey Next scheduled inspection (call when ready) Remarks- Fsuilding Ins ec r 6/86 and-vl +, i ��� � ._Jvurrt o� ' y�uee+rl! dErttrt� "T BUILDING and ZONING DEPARTMENT 2 Bay and Haviland Road, R.D. 1 Box 98 J7 ,a Qu nsbury, New York 12801 SEPTIC} DISPOSAL SYSTEM. INSPECTION NAME i- w e �a T L,tO�CATION ,LoT 34/- DATA�/�_ PEPM T T NO . (} I c�l�c, SOIL TYPE - an - Loam - Clay - Percolation t Required.? YES N Percolation rate - Min/Inch _'_ TYPE of SYSTEM : Absorption field , total length �nL.r Length of each trench I Depth of trenches. So Size of gravel SEEPAGE P1TS4Nuumbar of _ Size- ft. X ft. Gravel size ' - PIPING : Size Type Bidg . to nk _^ Tank to dis box Dist. box to ' el / Openings seale ES NO Partial LOCATION/SEPARA Foundation to t nk _mft. Foundation to sorpti ft. Absorption to of line t4 Separation of pits ft. LOCATION STEM. ON PROPERTY (circle one) Front - ear Left side - Right side - CNT SYSTEM USE APPROVED DES NO r Building Inspector 01/86 and vl ....J�►wn v� �iseen .�6ur�c BUILDING and ZONING DEPARTMENT Bay and Havitand Road, RA). 1 Box 88 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME 4 LOCATION 3 �nid? � scisal` 4f Date_ J3 1 / Permit No . 8 /7 - b'(o ✓ = - mooting/Pier Forms APPROVED YES NO Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer -" Rough Plumbing Relief Valves Ext _ Porches Finished Floors -•_.._ Interior Trim " Stairs & Railings Cellar Chain 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- Buil ing Inspector 6/86 and-vl -�-o 6 ourL R ` 750, 10;- /4-� awn o/ Queen3hury �+ ✓ � BUILDING and ZONING DEPARTMENT Bay and Hawiland Road, R.D. 1 Box 98 4 / Queensbury, New York 12801 3/z:I; JZ '- tC�A•�-ti BUILDING INSPECTOR ' S REPORT NAME PX0 4,C, 1=7 � LOCATION" G-t3113 1PIRAS/AGrlC V►' /� �� Date= �� f Permit No ✓ = APPROVED - YES NO ,Footing/Pier Forms. Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough 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 INSPECTIO DRIVEWAY APPROVAL Final. Building Survey Next scheduled inspection (call when ready ) Remarks-- Building Inspector 6/86 and-vl BUILDING DEPT. COPY OF APfLICATION FORM 46-EL, NEW PORK BOARD OF FIRE UNDERWRITERS. FILE T+ S COPY WITH BUILDING DEPT. WHEN REQUIRED. s slim ypCITY OR �l `.3r. �.-'�'�✓ .. VILLAGE C ,! j' r4' ,Ft: "Ae TOWNSHIP C '1 COVNTY STREET AND NO. OR I O 7 ,ram ROAD AND PptE No. L- t/ 4,A .5-W eW7-- FaL,E ,wO, BETWEEN WHAT TWD CROSS STREETS IS PREMISES tOCATE07 �u�l � F- 1-r +�'� EEcrIDN #IL.00K LO'T 7 OCCUPANT'S p BUILDING NAME F. {i " OCCUPANCY 'j l /u x h OWNER'S NAME AND ADDRESS -j l"] "t/ �` TEL. U SUPPLIED s /f. �. /'" BY /t✓' FROM THEIR C„T . OFFICE BUILDING ii--11 DEFECTS IS NEW CO OLD ❑ IS MEW ADDITIONAL E—I REMOVED ❑ LIST 13ELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS No. of FIXtUree A Lamp Reoeptllelet MOTORS HEATERS CIRCWTS OFFICE USE 0041% CIN L V CaiRng Side Ae*aoll'e Switch Pansle.d Breeket Na Type Ea Wi No. E No,AP. Imme J`dli-� INSPECTION W Reesp9s Dot- side Iil e me1.e let FI, 2nd Fl, 8rd FI. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE This aptill"tion is intended to caves the above-listed equipment to be inspected but II at timer of iiltapectipn these is feasted n Ildditipnl aqulpvnevN not ep,eee listed, Vo are authorized SIZE hozed to melee the inspection and adjust the fee to covet the addilionW sttt equipnl , as proridad It11 Cho aPMrrtt ic+ . S '� f/'7 FEEDERS E MAINS SIGN MAINS +.% �'� /�'� LAMPS TOTAL WATTS CHARACTER EXPOSED GAS TUBE SIGN _ OF WORK CONCEALED TRANSFORMERS OF VA WORK TO BE I STARTED INUMBERI ICAPACITYI COMPLETEb $12E OF SIGN SERVICE OVERHEAD UNDERGROUND ENTERS MAKER BUILDING _ OF SIGN INSPECTION REOUESTED ON OR AS NEAR AS POSSIBLE NEW © OLD AVOID DELAY BY GIVING FULL ANp ACCURATE INFORMATION. ALL SPACES DATEMUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLI GHF CATION PRINT NAMENAME OF /,'PJJIMD ADDRESS _ APPLICANT / r C /�J/�,/r .I ' SIGNATURE ,,r � y,..-7 y� ,r ,e ` OF APPLICANT !'S,•t-.--�- STREET ADDRESS .f_L.._.+� ./,� L�"J7 J /SL.�! Ly„� t ,#'�' TELEPHONE #�'. .+' n'T 13 T 3 =• .— CITY OR �' POST OFFICE J 2N' / I� if LICENSE CODE EL[CABGE --�` . All s�' �, 46 EL (REV. 1/86) A SEPARATICAPPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING 9-; l t ;1 1 °V �Jm y o i i A£ 07 j i � � I I �a1 i tr �