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1987-348 CERTIFICATE C►F OCCU PAN C'x TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK [ % ov Date / November 18 19 87 F37--3�r8 This is to certify than work requested to be done as shown by Permit No�. , +�� {8 has been completed. ' �'Y"'t it �/LJ�-� k yj occu d as a �'' � 'e�--"�am�.l. Lhae Z1n r This structure may lac pee �� +_ �-L� off Birds:ail Road +�1�/}1 LADcation E . .AiYxi Russell E . any) V1 Owner By Order Town Board TOWN OF QUEENSBURY + r Building & Zoning insPector z BUILDING PERMIT TOWN OF QUEENSBUR'1f'' No. 87-348 WARREN COUNTY. NEW YORK Hy PERMISSION is hereby granted to E. Ann Russell OWNER of property located at off Birdsall Road Street, Road or Ave- one-Family Dwelling . in the Town of Queensbury, To Construct or place a r at the above location in accordance to application together with plot plans and other information hereto filed and a I approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. j 1 . OWNER'S Address is P . O . Box 607 Glens Falls , New York 2. CONTRACTOR or BUILDER 'S Name Lancette Const . Co . � a 3. CONTRACTOR or BUILDER 'S Address I'd P . O . Box 121 it res Hudson Falls , NY °0 ro r 4. ARCHITECT'S Name 5. ARCHITECT'S Address 0 r+, rt, Gcr w r� 6. TYPE of construction — !Please indicate by X) P. Cn t� { X) Wood Frame I ) masonry I I Steel I } H M 0 7. PLANS and Specifications w 24 ' x47 ' per plot plan , specifications and application including P" No. ,attached carport and sewage system . Per Var . 1198 S. Proposed Use One-Family Dwelling 0 to I ' $5 . 00 C /O $ 68 , 00 PERMIT FEE PAID - THIS PERMIT EXPIRES January 1 19 88 � (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the ..� town of Queensburyr before the expiration date_) rD ty '^•r' Dated at the Town of Queensbury this 15th Day of ,Tune 19 87 ~ r rH SIGNED BY L! , L7 for the Town of Queensbury °4 Building and Zoning Inspector TO BE COMPLETED BY BLDG . DEPT . Application No . _JottF►n o iteelld6�tre�[ Permit Issued 1'� ( TOWN OF QUEENSisi.: : BUILDING and ZONING DEPARTMENT Permit Expires 19 Bay and Haviland Road, R. D- 1 Box 98 Zoning Designation_ Queensbury, New York 12801 Variance Nov s /Situ, Plan Review No # JUN 5 119$7 Approved b ,,,� !? ._. +'� •- /� �, � A I'1' `�'' � `�� BUILDINfa $c CODE DEF"'I"- APPLICATION FOR LoZ6 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 . ----------------------- }} s The owner of this property, is : � x#f N .tj. n I l - r m t - q P . O . Address do c' " / r � U rd Tel . 7 + ' 14 � '7 Property Location Ff�5 { ' } r '4` C} FF r C Tax Map No . : � / w Street number or building lot number Subdivision name ( if applicable) THE PERSON RESPONSIBLE FOR SUPERVIS,•-I >ON OF WORK AS REGARDS BUILDING CODE'S IS S.iCVO ! A� , J S'� fi" t} �!1-�S / r . ;_ 2� c Name P . O. Address Tel , Nov Name of builder L }vc u-1; C,�N� Cd; Jf�Address ?: . _: j. r Tel . Name of plumber Address Tel . Name of masorK P , Ke_ .? ( I C1a 7wrfZ�G Addres �. , i L_ "sir E Can %- . -(''!(4C9- ) 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 . * * COMPLETE INFORMATION REQUIRED BELOWv size of property �C �/ ft X 4' 6 ft . * Existing building ( s) Size ft X ft . PROPOSED BUILDING AND USE : '7 * Existing building ( s ) Use Size of new structure _�L ft X 41 /� f Foundation-pier/slab/crawl/partial ull * Proposed building , distance from property line (circle one ) Front yard_ �3. ft Rear yard =� ` ft No . of stories (habitable spa e{) � � * Side yards _ 'f If t and _� ft Height (grade to ridge ) r,^Itl ft • if on corner , setback from side street ft If residential , no . of familiie"sI No . of rooms ( excluding baths ) i-j OCCUPANCY INFORMATION No . of bedrooms_ * PRIMARY BUILDING - No . of bathrooms f One family dwelling Primary heati n s stem F L 't'tc ' '�-�� :rsP�� 9 1 F!`�I * Two family dwelling Type of fuel 0d )-1 * Multiple dwelling / Number of units Nov of fireplaces to be installed �— Permanent occupancy Will a wood stove be installed? �, Transient occupancy Central Air conditioning? Business * BUI L NG STYLE, PRIMARY STRUCTURE * Industrial * Other Ranch Contemporary Log cabin If addition, what will use be > ised ranch Mansion Duplex Split level Old style Bungalow Cape Cod Cottage Other * 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 MARX T VALUE OF * -Otherr CONSTRUCTION � , QQ� '_ _ _ _ _ _ _ INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE 'SIDE OF THIS SHEET , TO BE COMPLETED : Form BPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . A1r � G, Will any second-hand or ungraded lumber be used? If so , for what ? - ` Foundation wall material_ ,o YL. Thickness Depth of foundation below grade (to bottom of footing ) Will there be a cellar? V F7 5 Heated or unheated? u t j- r 'y Floor sq. footage sq ft Will there be a basement? Will any portion be used as living space? 1a ( If so, what por ' sq . ft . - - Type of use? Type of roof sly /d" flat/shed/other material of k x0of �Sll) / .40CL I'*y Size , wood studs "X ` _•. ,_ i ifspacing_��'"o . c . length ft. JOists ( floor beams ) 1st . floor '"x JQ '" spacing "o . c . span " ft . .joists ( floor beams) 2nd . floor '"x „ spacing "o . c . span ft . Overlays (ceiling beams ) '"x '" spacing "o . c . span ft . °as' _�"x " spacing o . c , span. ft. of trusse (Pre-engineered) spacing"o . c . span_ �"1+1 ft . xter� ro wall finish �% pri? u -! f:f, N Of what material-pp Interior wall finish r k f •. �[ � £.� . If a garage is to7 be al LCI,•.'hedt descr� tae materials to be used for FIRE SEPARATION : Is there to be an opening between garage and dwelling? ?C If so will a Fire-rated door , enclosure , and self-closing device be provided? /F, S 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 - Municipal or private well LU f' 4 L 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 pp c I 1 T T County of Warren A f F � A V I 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 . 47 SWORN TO BEFORE ME THIS signature _ 2aGP� day of 19 Owner, owner ' s agent , ak&ljrect , contractor Notary Public , Warred County , N . Y . rt At k Ar * * ,t * �r * ,t * * is * 9t #r * * * * * ,ir t * x it * : Yr * * ,t w ,t it ,k 1t * ,k SPECIAL CONDITIONS OF THE PERMIT : 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 ?5 4 2 - Type of heat 3 . Is the building mechanically cooled ? / V0 4 . Percentage of area of windows and doors IG1SJ A . Over 16 % Only 1 - U value of gross area of walls , roof/ cell g and floors exposed to ambient conditions Wl ` ' 2 , Floor over heated spaces iYES; NO — a . Are foundation walls insuld'ted ? XEO NO Yle 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 50 Type of insulation B . Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions. 2 « R value of exterior walls 3 - R value of glazed area 4 - R value of doors " s . R value of floors over unheated spaces 6 . R value of slab edge insulation - unheated slab 7 - R value of slab insulation - heated slab 8 . R value of heated basement/ cellar walls ( above grade ) 90 R value of heated basement /cellar walls ( below grade ) 10 . Type of insulation ; f 6 F. 2 �� C . Controls ' 1 - Thermostat maximum heat setting D . Duct Systems 10 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 �/ I ., Size of hot water or cooling carrying agent p1pe., 3 2 - R value of pipe insulation F - Service Water Heating 1 . Performance efficiency 2 . Temperature control setting maximum tqof G - For Swimming Pool only 10 Maximum heating Telephone No . ( applicant ' s signfi. ture ) J :, ...II•W9L ��,�ElE�'dd� APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE / d LOCATION OF PROPERTY FOR INSTALLATION f iff ) !'eilyi-�, L w"y Qrr Owner's Nam�ex f,' jI o i /_ Telephone: 7212 / t (e Address: Installer's Name: ;f' owDD j cje. ,=- 1rvs KC *'• Telephone: '74f3 3G 3 Number of bedrooms (residential only) Total daily flow (compute @ 150 gal per bedroom) Topographyrc circle one: Flat Rolling} Steep Slope % of slope T Soil Nature: circle one: •`Sand Loam Clay Other elw+� / Dept h: Y feet Ground Water: At what depth? feet Bedrock, or Impexviaus Material: At what depth? _ _ feet Percolation test: circle one: not required required / rate min. inch. Domestic water supply: circle one: Municipal Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorpti __ feet or, PROPOSED SYSTEM: Se ') TILE FIELD: Each 'bench SEEPAGE PIT(S) : Number of _ / Size each ' feet by feet Size of stone to be used # M _ / Depth or Thickness feet IIIMPORTANT _..Please...LIST NEW EQUIPMENT TO BE INSTALLED (over) Section II Septic System Inspections: A. All applications for septic system installation, alteration or repair, as required by the 'Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building Department at least 24 hours before start of construction and shall include a plot plan showing: 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, tile fields and/or drywells Be 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 $250.00. Co 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 Queensbury Building Department before further construction. I have read the regulations above and agree to abide by these and all requirements of the Town of 'Queensbury Sanitary Sewage Disposal Ordinance. Signature of responsible person: Date: Town of Queensbury Building and Code .Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 HOME OF NATURAL BEAUTY A GOOD PLACE TO LIVE t'tl"Z DEPART WENT BIilLD1NG and ZON4NG R. ). 1 Box 98 Bay and liaviland Road, Queensbury, New York i280i gUI LDI13G INSPECTOR ' S REPORT NAME y Nzc> S � C UOCATION LN r 7 permit NO es f fdx Dat * • *p,QPR*GVED - YES No Footincj/pler Forms Foundation Waterproofing Back f ill F rami.ng Roofing Siding r Masonry Vene pj:lugh Piumbin Relief Values Ext - porches Finished Floors Interior Trim Stairs 'Si g,ailings Cellar Drain Tile Concrete Floors plbq - Fixtures Gar - Fireproofi g 1 oOr Closers Smoke Detector Chimney It3 SE]I,p,T I C3�3 Foundation Floors walls CeilinELECT CP+L -'NSPECT3: 0 1 3 �- � FIL3AL AFPR VAL DRIVEWAY Survey �~ x final Building call When ready ? t3ext scheduled inspection c � Remarks- I3ui1gec for ns 6/gE' md-VI Yip `. MIDDLE DEPARTMENT I*IgPECTICEN AGENCY, INC, 9w Kadn Avenurl. Gtaitln0 r N r 08108 ido ,.� Date November go 19=$7 as �CCrtIL � that t uipment listeHas, burr rn Eiectri }aficable governmeniu�Ai with tie National , bar "tt+` 1 s; Russell Owner: r +.r -`• == cGu - ceti}fica wan the al equiprnant end installation inspected this y� „.. `' date. IT addition k equl auw tra intrOduc:ad w flllefttYel'La rnadr to flC81l4 '�r',[gate aL� f ' Bir $8 a It be null and void: and applicatian for " exWIng syskerrl this pert , queens $ lqe ya inspection shpuYd be submnt prom ptiy 10 this Agency insurance carrier }" -' ' ` resent sarrre to his property . w i W. . Holder of kh Ya CePtilicate ekxO4ld p Equ7pment66_Gutlets ; 30:wReeeptaeles ; 20-Fixtures ; kagenz or coMpanyl aSav a}pertitication 01 electrical equipment approved Service; 1-Appliance; i-Protective Si$riSlingea apBcitied. C 200 Amp . , �:, z Device FRichard Lancette No . 15-016203 ,applicant. 105 Lwr . Dix 1�[ew� Yark. i280J1 Glens Falls , r'- F«m no. 71 LrL 1,8Y 42 BUILDING and ZONINGi}EPART$Ox 9$ Say and brd v12801 Queensensbury, New York SEPTIC DISPOSAL SYSTEM INSPECTION EOCAT DATE PERM IT NO* _ eapm t .- and _ NO SO1L TYPE _ Tes Re d? YES Percolation rate _ Min/Inch Percolation TYPE of SYSTEMZ 1d tots Absoxptio ch c I,e=-„gth of nches Depth of ac _ a el S ' 0 gr ITS Number of) S ' E �' - ft. X Sjzexes Gravel Size. S ZeTyPe PIPING :Slag , to tank Tank to dist . box � �_ Dist* box to f ield G 140 Partial pPenings Sealed? SEPARAT S ° �p_ft*- LflCATION/ k Foundation to t t.ion f t ` sorP f 4t , d l Foundation to a t line Absorption �r �ft. its (circle one Separation p5 STEM ON PROPER I pr, P,TIDt3 _ Left side t $1 Front - ea Lo r r ��A) SYSTEM USE APPROVED YES NO gty c7 in InsPe or 01/86 and vl 1 ISYLDING and zaNiNG DEPARTMENTBox TS y( / Ray and Haviland Road, R.D. QueensburY. New York 12801 BUILDING INSPECTORS REPORT NAME 'Zj, LOCATION fr 'i Permit Date- 4 0� * * * * * * * * * * * * * * * * * per - pppRp'S7ED - YES I30 Footing/Pier Farms Foundation waterproofing Backf ill Framing Roofing Siding Masonry Veneer Rol ie f Valves — ~� Ext . parches Finished Floors Interior Trim Stairs & Railings cellar Dxain Tile Concrete Floors plhg _ Fixtures (;ar . Fireproofing -` --- Door Closers_ Sra,oyCe Detectors Chimney INSULATION Foundation Floors r,,,ta11s Ceiling AL INSpFCTION�� F I'AlAL ELECT DRIVEWAY AY'PROV Final Building Survey .---�-� Next when ready ) scheduled inspection (call Remarks- ps VL*r1O V W ttL )DO e7 Huildi g Inspec 6/86 md,-vl f�ueen y � urt� ' flown Of �� J 8L1yLi71tIK, and d Road* G DE D BT f1jain Box 98 `b J Bay and HaNb.,'y,d Ne ~Cork 12601 oueensur BUILDING INSPECTOR ' S REPORT NAME �l',`.-^_.._ Permit t Dae _ xrs r10 * * * * * * AppRDvED Footing/pier Forms Foundation111111111111 Waterproofing �acryt�ill a�ning Roofing siding Masonry Veneer -..--- gbugh Relief valves��� -- Ext . porcYies_�-�- Finished Floors Interior Trim Stairs a Railings Cellar Drain Tile Concrete Floors plbg - Fixtures Gar . Fireproof ' g Door Closers smoke .DetectO s Chimney I14SULATI0N Foundation Floors walls Ce i 1 irtg -� FINAL FLFCTRICAL I13SPECTI �-� DRIVEWp►Y APPROVAL 'Final Building Survey Next ache insP ection [call when ready Remarks- Building Inspector 6/86 md'vl flaws: of BUILDING and ZC)NING DEPARTMENT 98 Say and Hal' New +{o k�12801 oueensbury. BUILDING TPfSPE OR ' S REpoRT NAME f_ ��--``^ LOCATION ON e),rF- � r Permit No . 4. Date! � * * * * * * * * * * * * * * 60e APPROVED* - YES L30 Footing/£'ier Forms Foundation waterproofing Back f i l l F raining Roofing Siding masonry Veneer Baugh Plumbing Relief Valves Ext , Porches Finished Floors Interior Trim stairs & Railings Cellar Drain Tile Concrete Floors pybg _ Fixtures 11..��] Fireproofing ar . -- Door closers Smoke Detectors Chimney -usvLATIONZ Foundation Floors walls Ceiling INSPECTIONS F IN AL ELECTP AL DRIVEWAY APPR4V survey Final Building tlext scheduled JnsPeotion tcall when ready) Remarks_ Building Inspector 6/s6 and-vl �uee +Ts �+�er� BL11LD1NG and ZQNIFJCx OEPAR"TMENT Bay and Hauiland Road, R.go ' Box 96 a�eensbury. New Vork 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION vt o ry ` ' / ` ,�T - Permit No • �-�~—* NO * * * * * * * * * ✓ APPROVED Forms ✓F00tinc3 Foundation Waterproof ing ,/gack.f ill Framing goof ing Siding Masonry Veneer p10,agyp Plumbing Relief Valves Ex1c . porches Finished Floors 'Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors plbg . F fixture s� -- — ---'� Gar . Door Closers �.�-- Smo]ce Detectors Chimney IN SULATION Foundat i! n ploors Walls ceiling IN Sp T'IG�t3`� — ...� FINAL ELkc- cAL DRT.V'EWAY AppROV ytnal Building Surve9.�----�- '~ Next scheduled inspection C call wrhen ready Remarks_ -ouilding 'Inspector 6/86 and-vl flown O l q�fi�'Erin� � �b[1 BL13LDIINCa andZdhifhSG DFpARTM04T gOx 9a Clay and Hauiland Soad. BID, pueensbury. New York 12adi BUILDING INSPECTOR ' S Re �0 /" k,1"�i°CJ NAME I •,,,,•r ..` D LOCATION I Perms t I3o - ' ' Dat `t6 * * * * * * * * # 8001 APPROVED - YES Na Ll - tin,/pier Forms poundation Waterproofing gackfill Framing Roofing Siding Masonry Veneer Rough plumbing Relief Valves Exte porches Finished Floors Interior Trim stairs & Railings cellar Drain Tile concrete Floors Plbg . Fixtures Gar . Fireproofing_ --- -�� Door closers Smoke Detectors Chimney 1,NS13I.A`i'ION Foundation Floors Walls Ceiling 'TRICAL INSPECTI€ N FINAL EY,EC D IVEWAY A?IPRQV Final Buildins Survey inspection (Gall when ready } 14ext scheduled +AA Remarks- Building Inspector 6/$6 mdd-vl BUILDING DEPT. COPYIO T P COPY WI F BUIL46 D Lo NEW DEFT. ORKWHE BOARD OFDIRE UNDERWRITER'S. LE- ,f rwfarl / ���.7,,,,.'7 .,. CITY OR L•.. TOWNSHIPV COUNTY bl// 1 "l ++• �-- AJ VILLAGE _ STREET AND NO. OR I 1L #' k-. i POLE NCI. ROAD AND POLE NO. / 1C � V/ r- ^�- B�EggTppWgSE.EN WHAT TWO ECTION BLOCK LOT 31 . p7lEM1SE$ L ETRE �TEQ7 BUILDING .r NAME NT'S E yl/ C� (w�„ oplP OCCUPANCY NAME r IMF TEL. # r OWNER'S NAME /} i s SE /tc AND ADDRESS f.J }, ,_,,I FROM THEIR i..3 '. . r .: .. ;-t' ! �.! OFFICE. SSUPPLIED 1�+'f A, fvf, .} �+ /'}r G�% I"+ ARK —y DEFECTS BUILDING NEW ADDITIONAL ❑ REMOVED ❑ IS NEWT OLD © IS LIST BELOW ALL E[lUIPMENT WFiICFi YOU INSTALLED No, at FieMit lL MOTORS HEATERS dR�1 ITS OFFIICE y SE NUMBER OF OUTLETS Lwnp R Loeer H.P. No. tMaxtm N,0. INSPECTION Lion Skle A;etelt't Switch Perrlerrt Bredtel Na Type III End[ Ceiling yi/W R+euP'IS ouv ewe Sub boom Bmw� r Ptdnt lilt FI. 7en1 Ft. 3rd Fl. DO NOT USE THIS SPACE. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: In[md mgniPwe*m to ttn iiwpe6ted but iF At time of inspection there ie Found erwitianat equipment not above lietad. Thrs eppkicetiun is intended to e:ower Ilse cleave- i the +M t0 ceYw' the mdditienel equipment, w Provided by the epplic bll yW mwe euthorited to melee the imMetion and edlur. ELECTRIC SIGN TOTAL WATTS SIZE OF FEEDERS LAMPS MAINS E XPdSED OAS TUBE SIGN VA CHARACTER CONCEALED TRANSFORMERS OF OF WORK INLMNBERI (CAPACITVI WORK TO BE COMPLETED SIZE OF SIGN STARTED SERVICE OVER" A UNDERGROUND MAKER OF SION ENTERS [[''''''�� BUILDING O OLD F1 INSi'ECAS H REQUESTED NEW Na ONO OLE NEAR AS l / '] AVOID DELAY $Y GIVING FULL AND AGCU RATE lNFORMAI'1PN.. ALL SPACES DApPLI1 N MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. SIGNATURE101 `+ PRINT NAME AND ADDRESS J' r V.. at f x ;NAME OF i x Y i/� OF APPLICANT_ F � _ f ,• APPLICANT "1 TELBPHdNE 3 _ "'Xl✓ *~rf # �/ STREET ADDRESS zip 3 LICENSE NO. CITY OR r-' !'t([ �iJ —. CODE J a MfHEN APPLICABLE POST OFFICE 14 "' d^l ae EL (R6V, 1/86'1 A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE 'BUILDING k° TOWN OF QUEWZI A//F enezzT P. ti/Ae 4 rzo rf y / 6'L A.f J �O h• / i��ll �y l:J L� ll I� �i ��J r`.••/fr9AC,t/EriC• :< (472/56L f✓5Lo/Ze�J t�U ry"/ �i/�,� 11.,. OCT C Iry^ q q 1987 GIE2/O/AA/ ��p / ETU N/f F uJeL.�.i�C� �i CODE DEPT.� ,re� r i,_-P-T f/oN o.E f�ro/C/,a_r.E.aF...aG.�.b�.\.✓0��ros�A//`�8. g�Ol'pPE,tOJ E,'O�.E''r�cpP'Oriylc✓Y rd`S L'/G�°E'ZPo�"�m'g wL:7 ro7413I4/90 A .13 i Q //; PE A Jqx 9 ' Q'gado, ;f b/cE � v.CE TEbDE r / /Z 110 [oaareo A/ZLei�.' �' 03GAC.vEJ�` ,Coo N. .a 6/21�e� -y �U'�Tky CLUB �.-/vvE' tl•L/G9.LOT ,S- �J'UBLo7- B3 DEED WPAFMEA/CE ' v �. .PO,(jmr.4. C eOJJ Q/ �/j 1 °yam tilAPy A. cPOJJ zw a To EL/ZAc4ETfi�AN�V,pUJJEGL • s,, 3l739 pG�:; O• 5�/g�/9d7 1n92�/075 ++++�r'F DF i1E`K y' • 5/Zo//987 ... y1gP/JA 1ENOc`O /LL�i9B/ To ,1'yv/V P.POPv.(ED '1PO.E'T 7 NEOW CEeT/Flro fL/ZABETf AWN PUJIELG� 6eeAlJFALLS SvQVEY ",4PB MAP A PC Q, ,LAN F DS O IX 421VA VZ BAt/K�T/c'UJT CO L104Vy ADO F/AfT A�Ek/C9�T/TLE 004 not / ► I �/ In/JUeAA/CE C'D. 01AI)/ T//9TT//ir�y/�JP CUgJ �2EP9CEOFeOt� 9�/ACTU//L Z-z/ , 6zT/-/ ,///V/(i ,l•U.2/!X 0A1 Th'.E G',e0lW-0, _1 AND X(JICVEVOA-S ® (Y+��+,�• S� /t/EW YO,QK '�C UV CJ L �. o G�LL//967 Tpu/N aF gaE�/usaoxy, WaKQEN COUNTY, 416w PORK 10 4V4.E' ZO T.iLlv'CO.P.liJ/lC�Y� -r (.0—Z-) Al s.'e&I MO.3/��9 SCALE /"=So' TAX MtP SLCT/Ol: BLOCK: t�0✓E 22 /4B7 � � �' T701