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1987-139 i CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY { WARREN COUNTY, NEW YORK I Date June _12 19 &7 LP This is to certify that work requested to be done as shown by 'Permit No. 87613" has been completed. This structur�etnay be occupied as a li,etall Store No . 1 Buy —Low Carpet Cutlet C7�tl" i �685 Upper Glen. St . Cforrier Carswell. Bldg .LAWAtiOn ) i William Canale Owner By Order Town Board TOWN OF QUEENSBURY i i Buflding & Zoning Inspector I I { CERTERCArl + 7F C�CCZJI''ANCY TOWN Of +QUEENSBURY WARREN COUNTY, NEW YORK i i Date Sept . 15 , 19 87 f This is to terrify that work requested to be done as shown by Permit No. 87-139 f has been completed. This structure may be occupied as a Retall Stare ion . 2 (BODY BASICS) �- "€Jpper Glen St . if ormer Carswell Bldg . ) Location I William Canale i C7� By Order Town Hoard s irowN OF QUEENSBURY I i f f i Building &I Zoning Inspector i w BUILDING PERMIT TOWN OF QUEENSBURY No. 87-1. 39 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to William Canale 685 Upper Glen 5t . (former Carswell Street. Road or Ave. �; OWNER of property located at pp Bldg . ) a in the Town of Q.ueensbury, To Construct or place a Alterations for two stores g at the above Location in accordance to application together with plot plans and other information hereto filed and Ordinance- approved and in compliance with the Town of Queensbury Building and Zoning grdinance N ro FOwNEWSAddressis 21 Jerome Ave . Glens Falls , New York r3. ONTRACTOR or BU1 LDEIVS Name m ti..n G ONTRACTOR or BUILDER'S Address b cc K rorD 1103 4. ARCHITECT'S Name to rr r-n b S. ARCHITECT'S Address s m r'i n w 5. TYPE of Construction — (Please indicate by X) rwt cn ro I ) Wood Frame ( ) Masonry i } steel { 1 ce 7_ PLANS and Specifications C�- NO. Renovations to building for two stores as Per plans , specifications and application submitted . ,_ 8. Proposed Use r Retail Stores 0 m rs � sn rt n � r o a $10 . 00 2 CIOs 19 87 U) November 1 t" "' $ 300w 00 PERMIT FEE PAIC3 — THIS PERMIT EXPIRES rr O rr rs a (If a longer period is required an application for an extension must be made to the Building and Zoning inspector a t ro town of 4ueensburV before the expiration data rn D G N 19 €3 7 ~ Dated at the Town of Queensbury this � 10th day of _A>7ril I^ q r fV for the Town of queensbury aC SIGNED BY Building and Zonirg Inspector TO BE COMPLETED BY BLDG . DEPT . � Application No . ] `f�WTti [:►F �` r _Jowls nj Q"eenjolo"ry Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 i Bay and Haviland Road, R. D. 1 Box 88 Zoning Designation D � $ ,� a Queensbury, New York 12801 variance No . A v Site P Review NO ,. to OUIL DING,,.^& C00E DEPT, Ap r e`l` l 4 00 I APPLICATION FOR k G: ICJ Q T-/'v *::. &,A/ PUILDING 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 P,.e-r+mit . The owner of this property is : �,'� llleC AoI-1 G M �n�. y!. I Tel P . O. Address 21 .1f4atAc. � V ��y ( L-3- � [ . Ste. Property Location : [p r95 a �"_a&.� ' t�i Tax Map NDe f f Street number or building lot number Subdivision name ( if applicable) THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : lG A 1� . - Name LT, O, Address Tel ( No . Name of builder_ )eZP, a Address Tel . Name of plumber Address Tel . Name of mason 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. * of septic disposal area . 0 /A ° COMPLETE INFORMATION REQUIRED BELOW . * Size of property Existing building ( s ) Size� L aft X�7 ? ft ' PROPOSED BUILDING AND USE : * � 6 Existing huildin+g ( s ) Use 7i2x,?G1G_ Size of new structure -- ft X ft '" `3 Foundation-pier/crawl/partial/full Proposed buildingi distance from property line (circle one ) Front yardZee& ft Rear yard (y6PO - f't No * of stories (habitable space ) �� * Side yards—::::�I I ift and _ ft Height ( grade to ridge ) _ 'Z 3 ft . if on corner , setback from side street ft If residential , no . of families Noe of rooms ( excluding baths ) -- * OCCUPANCY INFORMATION No . of bedrooms PRIMARY BUILDING - No , of bathrooms One family dwelling * Primary heating system G7 * Two family dwelling Type of fuel Multiple dwelling / Number of units No . of fireplaces to be installed — * Permanent occupancy will a wood stove be installed? c Transient occupancy Central Air conditioning? 00 * Business * BUILDING STYLE, PRIMARY STRUCTURE * Industrial * Ot he r Ranch Contemporary Log cabin if addition , what will use be? Raised ranch Mansion Duplex Split level Old style Bungalow Cape Cod Cottage Othe ACCESSORY BUILDING- Colonial Row Town House Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE ) Attached garage/one car/ two car/ car Private storage building ESTIMATED MARKET VALUE OF " Other CONSTRUCTION $ 15'a cupr,G+ INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED ! Form BPA 4/66 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : TypeWill on construction , woad frame , fire safe , etc . yra=�41, 3�,. � } �5 �� Will any second-hand or ungraded lumber be used? If so , for what ? f""4n7 Foundation wall material Thickness Depth of foundation below grade (to bottom of footing ) „60mg_k�2 Will there be a cellar? tJO Heated or unheated? 7F �w q Floor sq , footage J © s ft Will there be a basement? r Will any portion be used as living space ? ( If so, what portion? sq , ft , - - Type of use? Type of roof <2 ao a la shed other ��� Size , wood studs f Material of roof AIIIIII�„ spacing "o , c . length ft , Joists ( floor beams ) 1st , floor „ spacing oven span ft , �.} I�[ Joists ( floor beams ) 2nd , floor " X spacing "oven span ft . Overlays ( ceiling beams ) "X spacing "o . cw span ft . Roof rafters "X " spacing o . c , span ft . of trusses (pre-engineered) spacing " a . c , span ft , Exterior wall finish �.Of what material? Interior wall finish a r � -I&f •�2�� If a garage is to be attac�hedd,,�zdesc describe as rzals to used for FIRE SEPARATION : Is there to be an opening between garage and dwelling? If sa will a .Fire-rated door , enclosure , and self-closing device be provided? _ pzA Will a flue-lined chimney be installed? /� Height above roof -- ft , Depth of chimney foundation below grade — ft , Depth of fireplace hearth ft , � in . Water supply - ' unicipa"I";g private well SEPTIC SYSTEM Distance from ANY private well ( including adjoining properties II ft , (A separate application is necessary for any repair or new installation of septic system) Town of Queensbury T� �■ I County of Warren A F f C I D A y l 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 . a SWORN TO BEFORE ME THIS Signature -___1! G _. _ - day of 19 , arcnizect Notary Public , Warren County , N . Y . * * * * * * * * * * * * * IF * * * * * * * * ,t * * * * * * * * * * * * * 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 t - . � r 2 . Type of heat �r pkLalo 3 . Is the building mechanically cooled ? 0 4 . Percentage of area. of 'windows and doors A . Over 16 % Only 1 . Uo value of gross area of walls , roof / cei. ling 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 5 . Type of insulation B . Under l 6 O n l y f� fL L�7 G El /1 ►`�Gi �1 a 7 G -f�.JA } AMC 1 . R value of roof and floors exposed to am lent ca it1ons� 2 . R value of exterior wallsT }Z - t � 3 . R value of glazed area 1Z = � 4 . R value of doors S . R value of floors over unheated spacesfi 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab P 8 . R value of heated basement/ cellar walls ( above grade ) _ [ + 9 . R value of heated basement/cellar walls ( below grade ) 10 . Type of Insulation pe?t2C;d .A0e, r C . Controls � o 1 . Thermostat maximum heat setting D . Duct Systems HIA i . 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 E . Piping Insulation fxIdolt,.j j, Te;, (L. 4{ lAir4 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating_ exlxjpt% , G, 1 . Performance efficiency 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating. H/A Telephone No . �i dl ( applicant ' s si ature ) TOWN OF QUEENSBUR'Y BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS C y' NEW YO T,ELEPHONE ( 518) 792-5832RK 0 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED. NAME LOCATION DATE _ ' �i7 r _PERMIT APPROVED YES NO f FOOTING/P ERS MONOLITHIC POUR FO FOUNDATSDNIDAMP-PROO NG`� BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS �FILING AL INSPECTION: CHIMNEY HEIGHT ,ROOFING SIDING EXTERNAL PORCHES/STEPS .STAIRS-CLEARANCE p RAILS PLUMBING FIXTURES/RELIEF. VALVE INTERIOR TRIMIPI;&VACY DOORS t ' FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER (S),; SMOKE DETECTORS FINAL ELECTRICAL. .INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSP TOR Q JOwn of Queenshury BUILDING and ZONING DEPARTMENT Bay and Havlland Road, FLO. 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR " S REPORT NAME f �� LOCATION ! .Syr / c Date,� �rr Permit No . ! rf 34 APPROVED*-*YES* NO Footi.ng/pier Forms Foundation waterproofing Sackfill Framing woof ing Lading Masonry venee Rough Pi in Relief Valves Ext . Porches LFrinished Floor %fnterior Trim. Stairs & Railin Cellar Drain Til Concrete Floors "Ibg . Fixtures Gar . Fireproofing Door Closers Smoke petectors �- Chimney INSULATION : Foundation Floors walls Ceiling tofINAL ELEC CAL INSPECTION " DRIVEWAY ROVAL _ Final Building Survey* Next scheduled inspection (call when ready Remarks-- 1V4a Building Inspector 6/86 and-vl /d tv I'i Ol Qi is ee n J A u r y BOILDING and ZONING DEPARTMENT Bay and Haviland Road, R ,D3 1 Sox 98 Oueensbury. New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION DATE 71&/ PERMIT NO . SAIL TYPE - Sand - Lo Clay am - - '�--- Percolation Test Required? YES - NO Percolation rate - Min/Inch _ TYPE of SYSTEM: Absorption field , total lens, �h Length of each trench Depth of trenches Size of gravel SEEPAGE VVTS4Number of) Size- t. X Gravel si size Type PIPING; : Bldg .a to to Tank to dirt box Dist_ box to eld Openings seal'e YES O Partial LOCATION/SEPARA so " fpft. Foundation to t ion Foundation to soft , Absorption to of li �. ft. Separation of its N S S pERTY (circle one) ZACATO FrontI - Rear ft side► Right side - CCMMENT ' PE 5T- v V. - jo SYSTEM USE APPROVED is /� NO guilBi g nspectoX 01/'86 and v1 THE NEW YORK BOARD OF FIRE UNDERWRITERS W " BUREAU OF ELECTRICITY r � � ;i3.:' : 191, i 41 STATE STREET, ALBANY, NEW tY"tK 7xiiH�7 Date Application No. on file aZ3 / ti(�/ .r�'� � { } ^] � � .} �. THIS CEWrIFIES THAT 4!'.YI r,..►1 if f! only the !gntricetl eggSP� aa rdwsgrEbed ba am snd3ras _rodewIW,�yr {#!jr0RVJ CdU%,V +s,rwrodon the above appUcatias rusrnber An the promises of ti r �! in the following locat6ary , r Basremsent ❑ lat ,Fl. ❑ 2nd Fl. .Section Black Lot wum examined on �Y an dja"nd to be in compliance with the requirements of this Board. NXTURE ACLES SWITCHES PIXTURE3 RANGES COOKING DICES OVENS DISH WASHERS EXHAUST FANS ONTIITS INGAHMSCENT FW ^Mr, K. W. AMr. K- W. AMT. K.W. AMT_ {(. W, r. . P. a_ M DRYERS FURNACE MOTORS MUM APFUANCE PRIMERS SPECIAL REV FT TIME MOCKS MI,H, UNIT HEATERS MULTI-OyTiIT DIMMERS. AMT. K. W. OIL N. P. OAS el- P- AMT. FKI. A. W. G. AMT. AMP. AMT. AM►S. TRANS. P. ,,T AMT. WATTS NO.SERVICE pSCONNEeCTC NO. S E it V 1 C E AMr. AMP, rTPE EOWF I ar nv L w 3W 9 X 9w s X Aw WG. OF Ct. coNo. A w. G, Ira. GF N4L@d A, w. G. IVrl. OF Ntursxls A, W. a- PER A Oi GC. COND. OF W'LEG OF NEUTRAL t OTHER APPARATUS: ,hh � n r . . 'i :1 'W : �' c. L .- :1 .3 t, iy} � YI1J BRANCH MANAGER irf t Per This certificate must not be ahered 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 MUST NOT BE ALTERED IN ANY MANNER. a _..J'awn o� �ieeens � urt� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME &2 Fs. LOCAT ION ro &44D (nNjj=Vj LAZ&Ct�& �4 DATE ^�7�I PERMIT NO. < i SOIL TYPE - Sand - Loam Clay - Percolation Test Regexxred? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM : Absorption fiel total lengt S Length of each ench� Depth of trench 7 Size of gravel SEEPAGE PITS#N_ r o Size- ft. X Grave PIPING : Size Type Bldg . to tank r P L S tl—!&:Q - ---- Tank to dirt , x V e"etiL 21n Dist_ box to field/ t `'f Cr openings se ed? Y S No Partial LOCATION/ PARATIONS : Foundati n to 'tank 442-ft. Foundat n to absorpti �ift . Absorp on to lot line Separa ion of }nits ft , LOCAT N OF SYSTEM ON PR ERTY (circle one) Front - Rear - Left side - Right side - COMME TS : SYSTEM USE APPROVED YES f.. B xrmilding Insp for 01/86 and vl 520wn nIQ "ee*fj1"J"y BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 aueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT 1,6-f} Iz, NAME f fJ+� w I /� L,l� !4!'�S t f✓ (rf[_ LOCATION Date +Permit NO : ✓ APPROVE - YES NO Footing/Pier Forms Foundation Waterproofing Backfill ,'Framing Roofing Siding Masonry Veneer 'Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs a Railin Cellar Drain T4 a Concrete Floa Plbg . Fixture Gar . Firepro ing 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- r`-5' et-A 440 Q1AC_ 0l2/M1' (AIS ( 41 5 I�L/VA3 pp t) -ry iD 5 - X Z an,&St,f "fi JZUC[Z. D Al ZVO )3 Ya i of rJ ,UGv UIA-a 5 Building Insp r 6/86 and-vl /ICJ Juurn vl QueenJ1UPy r� P*r"/ BUItD1NG and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 r Oueensbury, New York 12801 �f BUILDING INSPECTOR ' S REPORT NAME LOCATIONmay} ' Date/_ hermit No . / ✓ = APPROVED - YES NO FootingfPier Forms Foundation Waterproofing Sackfill LL oeaming 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 Wails Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAit Final Building Survey Next scheduled inspection (call when ready) Remarks- Building Inspector 6/86 and-vl •J Jy �� { ✓BUILDING and ZONING DEPARTMENT �I• B Road,and Haviland oad, R. D, 1 Box 98 y Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Bate to / `' ,�'"� Op' = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill . "rami ng 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 INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Building Inspector 6/86 and-vl + �rrty" o/ Qu eP►r 16ur� f BUILDING and ZONING DEPARTMENT 4 (I ay and Haviland Road, R.D. 1 Box g8 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME r, '22Z /''erg LOCAT I ON ;- AaeyVFP1.,00l2rJ� 7 Permit No . ✓ = APPROVED '- YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry veneer Rough Plumbing Relief valves Ext . Parches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile_ _ Concrete Floors P1bg . Fixtures_ Gar . Fireproofing Door Closers --- Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling .FINAL ELECTRICA INSPECTION DRIVEWAY APPROV Final Building urvey Next scheduled inspection (call when ready Remarks- C. Building Ans c 6/86 and-vl ..�/o urn o/ Qu een j "ry BUILDING and ZONING DEPARTMENT Bay and Haviiand Road, R.D_ i Box 98 Ckueensbury, New York 12801 BU LQING NSPECTOR ' S REPORT NAME If LOCATION Date ��" Permit No . --13 Opp' = APPROVED - "YES NO Footing/Pier Farms Foundation Waterproofing Backfill Framing Lwltoofing t.Btding Masonry Veneer Rough Plumbing 4R&Iief Valves Ext . Porches Finished Floors Interior Trim .airs & Railings NIL Cellar Drain Tile dZer1~crete Floors Lpl�bg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney. INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION FRIVEWAY APPROVAL inal Building Survey Next scheduled inspection ( call when ready Remarks- / Builds g ns a or 6/86 and-vl �fTWft CI� �Ltle'!e'►J3bt< F`E� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S RCPORT NAME LOCATION ,r"ffa,r��� Dates t 0� 9 / �� Permit No . `7 at �r w * w * w # * * w r► w w ,k * * w ft * * � ✓ = - Footing/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 Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Ar Chimney INsur.ATION . Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION dl'SRIVEWAY APPROVAL inal Building Survey Next scheduled inspection (call when ready ) ii VP F, r2& P1P&OVA-Z. C6-100fk 1Ao1 40A40 E-:rC AE -Alt 1�u ' d ng Ins ect r fi/86 and-vl V 7I yj 7 IY11*1 BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D7 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR " S REPORT NAME LOCATION Date/ f, permit No . - ✓ = Footing/pi APPROVEDer Forms YES NO Foundation waterproofing Backfill �( Framing Roofing Siding Masonry Veneer Plough .Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & .Railings Cellar Drain Tile _ Concrete Floors Plbg . Fixtures __.. Gar . Fireproofing Door Closers Smoke Detect©rs Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSFECTIpN DRIVEWAY APPROVAL _ Final Building Survey Next scheduled inspection (call when ready Remarks M4-1 Af (a lA ozA G F C46K` j U,AI C? Ply-Al I AJ jkj/z-k JZt 19 1tw Suil ing Insp q 6/86 and-vl BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN M REQUIRED_ {�/ t TEP. # DATE 7+� f CITY OR �e�' �C Vi LLAGE �'I �'Y/�y,X� � -f J /'. �_ TOWNSHIP �L/I v� �I V COUNTY STREETAND NO. OR LOAM JL` —�^ Ki""/1 6 ROAD AND POLE NO. POLE NO. BETWEEN WHAT TWO CROSS STREETS IS /#�,rd aG r,M / ,A PREMISES LOCATE 6* L4' I'1 K- 7t-+ 'f.�/i � ' _. SECTION , _ BLOCK LOT t-+C OCCUPANT'S { -- NAME .rsr BUILDING OCCUPANCY �yV1(iy OWNER'S NAME /� � �r +y AND ADDRESS ��'V�� il�Elkilr� i[.r �l% (�l TEL_ �^' BY SUPPLIED A ] ! 1 SUILOING ! '� f FROM THEIR (rye �r �^ OFFICE IS WORK DEFECTS+k NEW OLO F5 NEW ❑ ADDITIONALLY06 REMOVED ❑ LIST BE LOW ALL EOUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS No. of Fiabsres S BRANCH Laea- Letup Receptades MOTORS HEATERS CIRCUITS OFFICE USE tion Side Attecit't H ONLY GiBnp Well Raeap'ls Switch Pendant Bracket No. Type Eacch No. E� No. Gougee' INSPECTION Out- side Sbm Same- tit Fl. 2nd FI. 3rd FF. REMARKS; LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE; DO NOT USE THIS SPACE. This application is intended to cover the above•liatad equipment to be inspected but if at time of impaction there is found additional equipment not above listed you are authorised to make the inspection and adjust the fee to cover the additional equipment, as Provided by the applicent. MAINS SOZE F ELECTRIC SIGN TOTAL FEEDERS LAMPS WATTS CHARACTER EXPOSED GAS TUByy+ SIGN OF WORK CONCEALED TRANSFORMERS OF VA WORK TO BE /l $NUMBER) (CAPACITY$ STARTED ' 1 COMPLETEDi p�p SIZE OF SIGN SERVICE OVERHEA UNDERGROUND ENTERS MAKER BUILDING OF SIGN INSPECTION REOUESTED ON OR AS NEAR AS POSSIBLE Nsw F OLD AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED, PRINT NAME AND ADDRESS NAME OF APPLICANT IL/ILG 7 I! et ll e— DAEOF APPLICATION_ _ STREET ADDRESS " �. Js^' .!' - TELEPHONE #771k :5W CITY OR �A ! ) 0 LC s /' CODE /—LICENSE PLI POST OFFICE t 5F LICENSE EN APPLICABLE ae EL (REV. 1/05) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING