Loading...
1987-085 I r CERTIFICATE OCCU ANC TOWN OF QUEENSSURY : WARREN COUNTY, NEW YORK Hare July 2 9 , 19 8_ I , This is to certify that work requested to be done as shown by Permit No, I has been completed. l This structure may be occupied as a 0n F m i 1 X Dw&-o l l i n g i Lot 29 Willow Road ( St . No . 43 ) 1he Pines pf Quctensbury Location Owner homacs ,and Lisa Fera•r. i ' By Order Town Board TOWN OF QUEENSBURY i Building & Zoning Inspector I l I _ 1 E M P U R A R Y CERTIFICATE C►F C]+ +CT�JI'Al' TC'Y' TOWN OF QUEENSBURY WARREN COUNTY. NEW YORK hate July 24 , 19 8 -1 Tmis is to certify that work requested to be done as shown by Permit Na. 87- 85 has been completed. This structure may be occupied as a ONE--RAMILY DWFLLING Lot 29 Willow Road (St . No . 43 ) The PiLIes of Queen3Lury Locatkm Thomas and Lisa Ferarl Owner TEMPORARY C /O lssu : ) FOR 30 DAYS By Order Town Hoard Pj�,N 3I NG ELECTRICAL I tiSPECTION . TOWN OF +QUEEIVSBURY C Bu ing Inspector f BUILDING PERMIT _1 TOWN OF QUEENSBURY No. $7_$5 � WARREN COUNTY, NEW YORK w Thomas and Lisa Ferari gad PERMISSION is hereby granted to r, Fl. to OWNER of property located at Lot 29 Willow Road ( St . No * 43) Streetr Road or Ave. w Wj in the Town of Queensbury, To Construct or place a One—FamilyDwelling P4 at the above location in accordance to application together with plot plans and other information hereto filed and w approved and in compliance with the Town of Queensbury Building and Zoning Ordinance_ 1 . OWNER'S Address is 0 0 2. CONTRACTOR or BUILDER 'S Name H Martin C . Mosher m tin N• N- 3. CONTRACTOR or BUILDERS Address M C 26 Sugar Pine Road 0 : Queensbury , New York 12801 w � ca. 4_ ARCHITECT'S Name c' N . 1-1cn C � z c o 5. ARCHITECT'S Address r- w 6. TYPE of Construction — (Please indicate by XI ( X) Wood Frame ( ) Masonry ( ) steel ( ) C5 7. PLANS and Specifications 26 ' x70 ' per plot plan , specifications and application submitted `i No. including two-car attached garage and sewage system . W r r-� 8, Proposed Use C One—Family DwellingQ m I� r N• $5 . 00 C /o ao $ 171 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES October 1 107 (lf a longer period is recluired an application for an extension must be made to the Building and Zoning inspector of the town of Queensbury before the expiration dare.) Dated at the Town of Queensbury this 24 th Day of March 19 87 SIGNED BY - for the Town of Queensbury Building and Zoning Inspector TO BE COMPLETED BY BLDG . DEFT . 47own a u[�ert � EauM Application No . TOWN OF QUE�Nb:'Jt , , Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 1 Say and Hawiland Road, R. D. 1 Box 98 Zoning Designation ©ueensbury, New York 12801 Variance No. MAR 2 3 �I SiterReview N .- Appr BUILDING $c CODE DEP'I: APPLICATION FOR BUILDING AND ZONING PERMIT 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 : i_c" L> P . O. Address �� �� Tel . Property Location : .- 9 �f . 4CefC4 tee + 7 Tax Map No . Street number or building lot number Subdivision name ( if applicable) /7 t r/ c , . t L_@� [_THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : A3 GC 7 �' � � f� � <�-.cz_ 1(� Ca 4(0 ��z t �j ';` 7 ? ,�2 - / '2 Name P . O. Address Tel . No . Name of builder , A- Address Tel . Name of plumber Jw(.& Address Tel . Name of mason _-- L �. � - - Address 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 or corner lot . Show location FOR DEMOLITION PERMIT , STATE SIZE AND * of water supply and location and configuration LOCATION OF STRUCTURES AFFECTED. F of septic disposal area . COMPLETE INFORMATION REQUIRED BELOW . Size of property I ,3t ft X J ro ft - * Existing buildings ) Size ft X ft . a PROPOSED BUILDING AND USE : *' Existing building ( s ) Use Size of new structure �7& ft X 7zC ft_.__. Foundation-pier/slab/crawl/partial /rff�ull .. Proposed building , distance from property line ( circle one ) * > ft Rear yard / S' —ft No . of stories (habitable space ) Front yard* Side yards .,z c ft and r -/ 0 ft Height ( grade to ridge ) ft * If an corner , setback from side street ft If residential , no , of families / No . of rooms ( excluding baths ) ' * OCCUPANCY INFORMATION No , of bedrooms `r° No . of bathrooms One family dwelling ,� ',/.� * PRIMARY BUILDING - Primary heating ,system 441- CIL �* * � - � - * Two family dwelling Type of fuel ��t d * Multiple dwelling / 'Number of units No , of fireplaces to be installed / will a wood stove be installed? r * Permanent occupancy Central Air conditioning? Transient occupancy * _Business BUILDING STYLE, PRIMARY STRUCTURE * Industrial Ranch Contemporary Log cabin * Other Raised ranch Mansion Duplex If addition , what will use be .' Split level Old style Bungalow — Cape Cod Cottage Other * ACCESSORY BUILDING- olnnial Row Town Douse * Detached garage:/one car/ two car/ car ( CIRCLE ONE PLEASE ) * /I Attached garage/one car/ two car/ ' car * * * * * * * * * * * * * * * * * * Private storage building ESTIMATED MARKET VALUE OF * Other CONSTRUCTION INFORMATION ON :BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED ! Form BPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATICINS : Type of construction , wood frame , fire safe , etc . Will any second-hand or ungraded lumber be used? If so , for what ? LICc- Foundation wall material /G1� _ Thickness Depth of foundation below grade ( to bottom of, footing ) 670 Will there be a cellar ? x' ideated or/,�*heated? ' Floor sq. footage / C �-> Z' sq ft Will there be a basement? Will any portion be used as living space? ( If so , what portion? sq , ft . - - Type of use? Type of roof - b aped/flat/shed/ether Material of roof 0 � . L, l _c � .c _ (tip _4 .i . .• Sine , wood studs " x ` spacing / L�, '"o . c . length ' ft , - .Ioists ( floor beams ) 1st . floor r�z "X ft' spacing /3/r "o . c . span J ft . .joists ( floor beams ) 2nd , floor C:;2r "X fr "' spacing 1 "o . c . span i :wi ft . Overlays ( ceiling beams ) =2 "X spacing O . C . span ft . Roof rafters '"X .3 " spacing f �I. o . c . span- I-L £t . Roof trusses (pre-engineered) spacing "o . c . span ft . Exterior wall finish !f,2 ` Of what material ? CC2-- Interior wall finish 'J•a If a garage is to be attached. , describe materials to be used for FIRE SEPARATION : ti Is there to be an opening between garage and dwelling? ` JrG If so will a Fire-rated door , enclosure , and self-closing device be provided? Will a flue-lined chimney be installed? �Lt Height above roof ft . Depth of chimney foundation below grades " # . Depth of fireplace hearth ft .Z�L_inft water supply - Municipal or private well SEPTIC SYSTEM _ Distance from ANY private welZ ( inc luding adjoining properties ft . (A separate application is necessary for any repair or new installation of septic system) Town of A F F I D A V I T STATE OF NEW YORK ry Warren County off Warren I swear that to the best of my knowledge and belief the statements contained in this application , together with the plans and speci. fications 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 c. e C' Jti �- __ s-. /4c Owner , owner ' s agent , arcnirect , contractor day of 19 Notary Public , Warren County, N , Y . It It It * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * It SPECIAL CONDITIONS OF THE PERMIT : By •POWl1 4F QUEECi IIRY Ay WARREN COUNTY * NEW YORK / �'t.t �.-•tiLzcw � � Application far � l�i7I3.DI �GN'RxG� COri6ERVhTiUNRC4C1EwITli TIME laEw YOR1c - TP STATE work A permit most be alatainea before be gissning KINSM=R ALL of the f of louring = �� d c-,> ~ 1 , Gross floor area III 20 hype of heat r mechanically coaled ? I . Is the building ,� . Percentage of area of windows and doors __ x . Oval . 6 '� y onl roes area of walls , roof / ceiling and floors 1 . U value of g exposed to ssnbient 1eonditians �.�. ■Cea YES NO ND Z . Floor over heated Sp yns a , Are fion Whatwalls theaRlvwltie7 __,____,_,.� 16 Iff YES YESF. 3 , Slab can grads YES NO AV if YES , what is the R value of insulation around perimeter of floor ? YES NO � . 6s bRsment hevalue Ofainsulation 5 , Type of insulation g . under 16 % Only floors exposed to ambient conditions 10 R value of roof and 2 , R value of exterior walls 3 . R value of glazed area 4 g value of doors S , R value of floors aver heated spaoes � � — 60 R value of slab edge insulation VV. unh +eated slab - heated slabIIIIVIIIIIIV 1m g value of slab insulationreds } g , R value D ! heated basement / cellar w+s11a ( above g . sament / cellar wall ( below grade ) jP95 R value of heated be 100 Type of insulation C , Controls y Therm maximum heat setting DoDuct Systems unheatad 1 , Is duct Systlem� install!sduct installatiances ? YE a . if YES . R value of b , R value of duct in other Areas E . Pi�ine Insulation carrying agent piPe � sizes e f hot water r cooling 2 . R value of pipe g , service Water Neat in 10 perform of maximum ZV-0 2 . Temperature control setting . W2 . GO For swimrnin Fool only 1 _ Maximum heating. .- -- '- signature ) � 1 leant • s �s Te l ephon * NO * r �I"oun o urpnC> urY APPLICATION FOR, SEPTIC DISPOSAL PERMIT BUILDING lint$ ZONING DEPARTMENT Bay and Haviland Road , R . [D, 1 Box 98 ©ueensbury, New York 12801 DATE I 7 LOCATION OF PROPERTY FOR INSTALLATION L I . �. OWNER ' S NAME ADDRESS TEL I NSTALLER ' S NAME `� � � __ , � t c e TEL 7 A.P Dumber of bedrooms ( residential only) Total daily flow ( compute @ 150 gal per bedroom) Topograpby : Flatl- Rolling - Steep slope - ( Circle one) % of slope Soil nature : CSand )- Loam - Clay - Other Depth ft . Ground water -At what depth? ft . Bed-rock or impervious material - At what depth? ft . Percolation test - Not required - Required - -Rate min- inch . Domestic water supply - Municipal - Well - Other Separation -- Watersupply ( if well ) from Septic absorption ft • Proposed System : Septic tank tb� L f gal - ( 731nimun size , 1000 gal. ) Tile Field - Each trench tom' G) ft . Total system legnth = 5 G' ft . Seepage pit ( s ) Number of Size each ft X ft Size of stone to be used # Depth or thickness ft . IMPORTANT ! On a separate piece of paper , submit a diagram of the praposed system with all dinensions shown , including distance from any structure , distance from property lines and from ANY DOMESTIC WATER SUPPLY or shore - line of lake , strea-m , pond or wet - lands . r3nclude all dimensions of r the system , itself . « .k « * w « : • . * « � * « ,. « « « « * tit + « s « +i * « « « « a « ♦ * « « -1 have read the reaL� Zaticns or the rGvGrse side of this s3< eat and ac? ree to o ?- ide bp these cnd cxZZ rer� uirer: erits of The Tc,; rr of Qaeeens urx Sanitary OraznO ' ce . Sicrat -" re of resPonSiL16 Person � ? (� C� 01 Section II Se tic S ste>m ? nspections : A . All applications for septic system installation , alteration or repair , as reouired by the Town of Queensbury Sanitary Sewage ordinance, shall be submitted to the Buildina Department at least. 24 hours before start of construction and shall include a plot plan showinc , - 1 ) the proposed location of 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 P • fI40 system shall be covered before inspection and approval by the Building Inspector , Failure to comply with this regui.rement may result in the uncovering of the system by the . .installer and a fine of up to S250 . 00 , e - An approved copy of the plot plan shall he available on the construction site . Failure to produce said plot plan at time of inspection may result in an immediate work stoppage , � - Should unforeseen problems during construction prevent proper installation , alteration or repair of an approved system , a new proposal must be submitted to the Oueensbury Building Department before further construction . Y f THE NEW YORK BOARD OF FIRE UNDERWRITERS 4000532 BUREAU OF ELECTRICITY j f 41 STATE STREET. ALBANY, NEW YORK 12207 ry August 12 a 1987 ,IPPlicacion No. an fife 01U989- 87 6913 Date THIS CERTIFIES THAT icar"t n »►ed on the wbow& apple 'emir in thepromimm Of only the electrical equipment na described below woad intrad.ceed by the eppl a Martin Mosher . Lot # 29 W3.11Crcta GISnO Fa11e0 NY Section Block toot in the follawfnA locatlon; 191 Basement FXJ outside Ist Fl. K 2nd Flo iance with the req xaire tents of this Roe.rd. 7 /'Z7 /$7 and found to be in compl .ass examined an pXTURES RANGES COOKAM ING COCKS OPENS DISH WASHERS E7[tiAUST F RXTURR ACLRS svATCHES H,ACANDf$CENT FU,)OftSCENT AJMT_ K. W- A�MT, K. W, AMT. K. W. AMT. ounsts 1 1 •8 21 39 26 DRYERS FURNACE MOTORS 'RfTURE AFN.IANCE FERCERs s/RCIAL REC'Ft 71ME CLOCKS REU. UNIT HRATlRs fMt7t.T1-i71Flt,/T DIMfYIERS 51ISTRMIs ArMx. wArrs TRANS. HALT. H. P. Np, t7F FiRT 7G AMT. K. W. OIL M.P. GAS H. P. IIM►. MO. A. W- G. AMT. IMtiP. A�MT. AAtPS- �F 1 Aryd%vl 19101 E R V t C E S A- w. G. No. of NtuTULs A-W- G. SER47CE WSGO*MVECT NG. aF CC. CpND. A W- G. PIO, aP HI-LEG Of FH•LEG OF NtUT.AL AMT. AAW. TrPfMr, t F tW ; t'w t X �W s Is cw Pf.l # GF C. coND. 2/ kL 4/0 1 200 eb 1 1 5 OTHER ^"ARATUS: 1-gfci -smoke detector rhous�e p� � I swn W • Co BRANCH /MANAGER 11 'Potter Rd , Cansevoorto NY 12831 r ,Per be identified by their credentials. be chered in any manner, return to the office of the Board if incorrect. Inspectors may This certificate must not COPY FOR BUILDING DEPARTMENT. TF115 COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER- -. - foam ofueenshiere BUILDING and ZONING E)EPARTMENT Say and Havifand Road, R.D. 1 Box 98 oueensbury, New York 12801 BUILDING INSPEcTCIRtS REPORT NAME LOCATION Date �'._ 41 Permit No . APPROVED - YES NO Footing/'pier Forms Foundation waterproofing Backfill Framing woofing Gidi.ng Masonry Veneer Rough Plumbing Pgelief valves 18xt . Porches L Finished Floors L-Interior Trim stairs & Railings cellar Drain Tile Concrete Floors Leplbg . Fixtures E'G_ar . Fireproofi Door Closers ISmoke Detecto te#Ch imney INSULATION : 4 L.Pnundat ion Floors walls ceiling FINAL ELE TRICAL INSPECTION Rr 0 VEwAY APPROV Survl y teal 'Building Next scheduled inspection (call �when r� ready Remarks- 61 /1o�� Building Inspector 6/86 md-vl elA 1 aLin-DING and .ZONING 'DEPARTMENT V J p�F3ay and Hauiland Road, R. Q. 1 Box 98 If% Queensbury, New York 12801 sfl� V SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCAT I ATE �/ PERMIT NO , SOIL TYPE - Sand - Loam - Clay Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption f ield r total length t (4 6 Length of each trenchy 5 . Depth of trenches_ x Sizes of gravel --- SEEPAGE PITS4Nuinb of) Size- ft. X y - Gravel Size ` PIPING - Bldg . Sizee "jYpr to tank j Tank to di st_ box Dist_ box to field/ Openings sealed? YES NO Partial LOCATION/SEPARATION Foundation to tan ft' Foundation to ab rption ft - Absorption to 1 line ft VI Separation of is ft. LOCATION OF S TEM ON PROP RTY (circle one) Front - Rear Left side - ight side - COMMENTS SYSTEM USE APPROVED YE NO f Bu lding Ins ec r 01/86 and Vl BUILDING and ZONING DEPARTMENT Bay and Hawiland Road, R. Ct. 1 Box 98 Queensbury, New York 12801 BUIL ❑ ING INSPECTOR ' S REPORT NAME I.A d 1•. 4 S � I- ll !- ! LOCATI ON La }J Date & h? f _ Permit No . ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing o � Relief Valves Ext . Porches Finished Floors -� Interior Trim Stairs & Railings-� Cellar Drain Tile )( Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSUTAATION : Foundation Floors walls Ceiling FINAL ELECTRICAL INSPECrft0N DRIVEWAY APPR.OVAI,_,�_ Final Building Survey Next scheduled inspection (call when ready Remarks- Bu3. ding Inspector 6/86 and-vl cel /ke dze G 19"At7 �P/q)n , w$7 o/ Quee," I Urc� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R- D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME , PA T 101, .� T y a to Perm- No . ✓ *Footing/Pier Farms APPROVED � 'YES NO x'aunda tion Waterproof 3--ng Sackfill Framing Roofing Siding Masonry Veneer ' Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railyngs Cellar Drain Tile Concrete Floors Plbg - Fixtures, Gar . Fireproofing L>oor Closers Smoke Detectors Chimney INSULATION Foundation Floors Walls Ceiling FINAL E.LZCTIZICAL INSPECTION DRIVEWAY APPROV Final Building Survey Next scheduled inspection (call when ready Remarks ,-�- � _ oy(k Jim Bui ding I sn pector 6/86 and.vz BUILDING and ZONINGTHE 8'a DEPARTMENT Y and Naviland Road, R. C1. 1 BOX 98 00eensburY, New York 12801 BUILDING IMSPECTOR ' s REPORT NAME LOCATION h cy- �� � Date Permit No . r�s Posting/Pier Fc ✓ * " rms APPROVED -L"oundation YES NO i"qa terproofinc, 411&a�ck fi I I Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext , porches Finished Floors Interior Trim stairs & Rail ing s Cellar ')rain Tile Concrete Floors Plbg. ,Fixtures Gar, Fireproofing Door Closers Smoke betectors Chimney INsurATloN : Foundation Floors Walls ceiling FINAL bRI ELECTRICAL INSPECTION VEWAY APPROVAL Final Building Survey Next scheduled- inspection Remarks. (call when ready) 8uilc2y� 6/86 and-vl `7 Inspector f Jvurn 0/ Queenj UI bure�t "77 BLDING and ZONING DEaAnTMENT Bay and Haviland Road, R, D. I Box 98 Queensbury, New York 12&DI BUILDING INSPECTOR ' S REPORT NAME 1_,f h '01 'rt ' 40L r 1 LOCATION �-OA T y Gca owe Date Permit g �y r+ Footing/Pier Forms - APPROVEb - , Foundation NO Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plying Relief Valves Ext , porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plb9 " Fixtures Gar , Fireproofing �.- Door Closers Smoke Detectors Chimney INS U+LATI ON Foundation Floors Walls Ceiling FINAL ELECTRICAL INSp TION DRIVEWAY APPRC)VAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- /86 "" {'`di -inspector nspector Fi xrtd_vl '" BUILDING DEPT. COPY OF APPLICATION FORM 46-EL. NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT, WHEN REQUIRED. TEMP. BATE .. CITY pR VILLAGE STREET AND NO. OR - TCIYVNEi'RP CJ�' .y. ROAD AND PQL.E NO, , BETWEEN WHAT a P CROSS LE N STREETS IS ,i/� PREM SE EO7 ++" /'� a. OCCUPANT'S TON RL K NAME BUILDING L Arab apnwEss 1 ` ./ ; TEL. BV ILDING +r u.• FROM TH 81R ''�• '/ / OFFICE I$ NEW OLD 0 WDRR {,{--I� M MEW ADDITIONAL 1_I DEFECTS LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED REMOVED I J NUMBER OF OUTLETS No- of FIX" # LSD "Mp III i s MOTORS HEATERS BRANCH CIRCUITS OFFICE USE tABlwy sk% A�tt S ONLY WaE R Mloh Pendent 13 t No. T Ne. Walri A.W.G. EaoM IVe. Oaape INSPECTION Ida bus hale BaeF ntent 1st F1. 2nd FI_ 9rd Fl. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE; DD NOT USE THIS SPACE. This oppli"tion in intended to cover the sbova-listcd @geiPmant to he krlipac It: d but kF at Nm► ar i you are momithOritad t4 make the irrspaetlon and adjust the fM to neYM the additional OW"Joetion them a foent additionN • SIZE OF Wolp+nenm, as Prprkdad �6Y she applicant. qsl isalteat not show latex, MAINS FEEDERS ELECTRIC SIGN TOTAL CHARACTER LAMPS WATTS OF WORK EXPOSED OAS TUBE SIGN WORK TO BE CONCEALED TRANSFORMERS OF STARTED (NI.marRI VA SERVICE OVERHEAD COMPLETED SIZE OF SIGN !CAPACITY} ENTERS UNDERGROUND UI DING MAKER INSPECTION REQUESTED OF SIGN ON OR AS NEAR AS POSSIBLE NEW � OLDcl PRINT NAME AN ADDRESS ALL SPACE AVOID BELAY BY GIVING FULL AND ACCURATE INFORMATION. S MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF APPLICANT PATE qF _ APPLICATION ,.y STREET RODPIESS TELEPHONE # 7 Q� `" I X40 clrY OR POST OFFICE Iv ZIP CODE ((Jf f) � g"h f LICENSE NO CO 46 EL IR4:4. 1{841 A SEPARATE WHIEN . APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING l� -------------- r 1 fV t