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1988-196 • CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY; NEW YORK Date October 24 19 88 2/0 . 88-196' This is to certify that work requested to be done as shown by Permit No. has been,completed. This structure may be occupied as a Hiland Park Corp Lot 23 "Master Commons South Location Owner Hiland Park By Order Town Board TOWN OF QUEENSBURY Building b Zoning Inspector TEMPORARY T/ CERTI CA' �✓/�y�®\J CC \d PANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date Sept 21, 19 38 This is to certify that work requested to be done as shown by Permit No. RR-1 9fi has been completed. This structure may be occupied as a One Family Dwelling Location Lot 23 Master Commons South Owner Hiland Park Corp. TEMPORARY C/O By Order Town Board Permanent C/O will be issued when pump TOWN OF QUEENSBURY station -irerator is in operation. / // %,��_ Building & Zoning Inspector H = BUILDING PERMIT TOWN OF QUEENSBURY o No. 88-196 WARREN COUNTY, NEW YORK rn PERMISSION is hereby granted to Hiland Park Corp OWNER of property located at Lot 23 Master Commons South Street, Road or Ave. in the Town of Queensbury,To Construct or place a One Family Dwelling at the above location in accordance to application together with plot plans and other information hereto filed and approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. r• 1. OWNER'S Address is RR5 Box 481 w Glens Falls, N.Y. a, w n 2. CONTRACTOR or BUILDER'S Name Same r°I 3. CONTRACTOR or BUILDER'S Address 4. ARCHITECT'S Name 0 rt tv W 5. ARCHITECT'S Address C rt S Cl) n 6. TYPE of Construction—(Please indicate by X) 0 (x)Wood Frame ( ) Masonry ( ) Steel ( ) cn - - 0 7. PLANS and Specifications rt. No.58' x 78' as per plot plan, specifications and application including attached 2 car garage. (Town sewer hook-up) 8. Proposed Use One Family dwelling o co rj - w $5.00 C/O �. $ 213.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 1, 19 88 �c (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the t7 town of Queensbury before the expiration date.) m I� Dated at the Town of Queensbury this - 29th Day of April 19 88 crq SIGNED BY C • - � for the Town of Queensbury Building and Zoning Inspector �� TO BE COMPLETED BY BLDG. DEPT. , i' ' �] / Application No. Jo[un- of Queeniur1 • Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation Queensbury, New York 12801 Variance No. d Site Plan Review No. i Approved by: 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: ilUe,/.Z) ,AVi >o J/.?i7,, Z:WA �7i' Tel. 773 �7aGcD P.O. Address /f� � R� ��/ � � �C Property Location: J2)` cz3 Tax ap No. / / Street number or building lot number • • Subdivision name (if applicable) 0/.,,c F k. S 0/1 /Jfe.-7 0 e-e )---/,./ THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS: • �Naam��2 p�/�� P.O. Address �/� //' /, Tel. No. Name'd`f"bit 12er"`✓�A/44,01)4Rrl' �c 4d s�8- / (�ir��S,/i // Tel. � CSC�0 Name of plumber c4j9/IJA Address V / /Tel. ft" Name of maso • A/(ii,4_ 7 VS Address C/�dA ,//l ,/ ,7 Tel. 97_3 —9e9 7 3 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 FOR DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot. Show location LOCATION OF STRUCTURES AFFECTED. * of water supply and location and configuration * of septic disposal area. * * COMPLETE INFORMATION REQUIRED BELOW. * Size of property ' J ft X /9Y ft. * Existing building(s) Size ft X ft. * PROPOSED BUILDING AND USE: * Existing building(s) Use Size of new structure ft X2 ft * Foundation-pier slab ravel partia ful * Proposed building, distance from property line circle one) � No, of stories (habitable space) � * Front yard f f1 ft Rear yardJr . ft Height (grade to ridge) �� `)_ ft. * Side yards ' z ft and 4 ft If residential, no. of families / * If on corner, se ack' from side street ft - No. of rooms(excluding baths) '_ - * ' .• OCCUPANCY .,ANFORMATION No. of bedrooms' ` No. of bathrooms * PRIMARY'BUILDING. . ._ 1 * One family.dwelling Primary heatin s stem 6-1/9.. ' 'r-rt./•\ ' Two familydwelling Type of .fueli/�j-J /' C4 ems. * Multiple dwelling / Number of units No. of fireplaces to be installed ' / Will a wood stove be installed? ff/1 * Permanent occupancy S * Transient occupancy Central Air conditioning? Business * BUILDING STYLE, PRIMARY ST CTURE * Industrial Ranch Contemporary Log cabin * Other 7 Raised ranch Mansion Duplex * If addition, what will use be. Split level Old style • Bun alo�es,-- * . Cape Cod Cottage Other e4.j) .,* ACCESSORY BUILDING- Colonial Row own House * ' ' Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE ) * Attached garage/one car/ two car/ ,_g car * * * * * * * * * * * * * * * * * * ' 'Private storage building ESTIMATED MARKET 'VALUE OF ' * Other • CONSTRUCTION * $ L9_d,4 QQa . 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. L2 Oet > r2A-Al 6 Will any second-hand or ungraded lumber be used? If so, for what? !i k Foundation wall material ,D00 e) (2nr'.<4j,ch5. Thickness ,��� . Depth of foundation belo grade (to bottom of footing) d) i ./lJ/7" Will there be a cellar? K Heated or unheated? tiotti, Floor sq. footage 1.5'6z, sq ft Will there be a basement? Will any portion be used as living space? • -- (If so, what portio ? sq.ft. - - Type of use? • • Type of roof - sloped"flat/shed/other Material.•of roof, ,4,?y- k. /4.We Size, wood studs "X 4 " spacing i "o.c. length el' ft. % Joists(floor beams) 1st. floor , "X Jo . spacing /7, "o.c. span j' ft. Joists (floor beams) 2nd. floor "X �c7" spacing/ "o.c. span /eft. Overlays(ceiling beams) "X Ce " spacing/6 "o.c. span ,q; ft. Roof rafters 4— "X " spacing ) o.c. span / ft. Roof trusses(pre-enginee�r ), spacing "o.c. span ft. Exterior wall finish \J'/J1,,Y- L 2p,- j Of what material? c.�E1gA l)4,R. Interior wall finish 47,,,,g,a,, ,. -6 `A '[mq 9 f( hi -fri If a garage is to be. ttrched _describe/ok erials to,be used for EIRE SEPARATION: /CYR r.rhr> • ��` c. r • Is there to be an 'o e�iing between garage and dwelling? �'.j If so will a Fire-rated p • door, enclosure, and self-closing device be.. rovided? /. ,2 Will a flue-lined chimney be installed? y , .5 Height abg4re' roo,f 5' ft. Depth of chimney foundation below grade / ft. I.SP1v (1� � Depth offireplace hearth ft• in. .:� i'1� / ��� Water supply - Municipal or private well ,i , ,, C ; p 4 SEPTIC SYSTEM _ Distance from ANY private well(including ad'`oining properties / i ft. (A separate application is necessary for any repair or new installation of septic system) Town of Queensbury n F C q D !1 V I 'r . STATE OF NEW PORK County of Warren • Fi I 1 1J r1 V 1 • 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. (IL SWORN TO BEFORE ME THIS Signature • lta 1);:)/t).0.---.-- ' r Owner 'towner's agent;architect,contractor day of (L/ 1 19 W?/• � �I/ ySANDRA K.CONGEL 1 ��� flotar Public,State of New York t Warren County, No.490917 Notary Public, Warren County, N.Y. Comm.Expires on Oct. 19,19. , * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * SPECIAL CONDITIONS OF THE PERMIT: • • By • `CO BE COMPLETED BY BLDG. DEPT. c� Application No. R Vifi;:12 -r'.,..._ ' _loom of Queenihure� permit Issued 19 .4�-4 1Y.~ BUILDING and ZONING DEPARTMENT Permit Expires 19 - Ii I' r��7 f? , i Bay and Haviland Road, R.D. 1 Box 98 Zoning Designate /04W, ! 41 th Queensbury, New York 12801. . Variance No. 1/�/°1 APR 20 19 . 5 Site Plan Review No. /..-,0G IApproved by� t.f.--DING & CODE DEPT • 1-,\1Y , APPLICATION FOR G /G�f >� 'A/p . oop_,,,,, ...•.. . :. 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: , A9.('V , . ve_ a,e,,o, P.O. Address ,,de $-, ,G4isc Off/, C/kvS /Li4�4 _ Tel. 79.3-4? 604=7 Property Location: L//7 o:2-3 ,,e4i s Tax Map No. / / Street number or.,buuiilding lot number .. Subdivision name (if applicable) , • /% , tTE•�?S a��0� e $ ci7' THE PERSON RESPONSIBLE FOR SUPERVISION�� OF/��GWORK AS REGARDS BUILDING CODES IS: • -�, t/A /�O.ss s ft/�.9fr/� '"/C/ ;eeS 4Zx gee/ 79.3 - 'a Name P.O. Address ..:. Tel. No. Name of builder ff/tA,ufl 'ad Address dAc yo/, 47.4-, i1!Y Tel. 71r3-�.•-� Name of plumber`¢vq i4 v4 vy Address , Tel. 77".. .e3 Name of mason 4p,v/,t/ • Address,•047zeneof 4 4 /F oc Tel. ?AA-/37/ 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 FOR DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot. Show location LOCATION OF STRUCTURES AFFECTED. of water supply and location and configuration * of septic disposal area. • * * COMPLETE INFORMATION REQUIRED BELOW. *'• Si.ze of property ' /,75- ft X e.. ft. * Existing-building(s) Size ft X ft. PROPOSED BUILDING AND USE: * Existing building(s) Use' Size of new structure S"t ft X 7d'ft * Foundation-pier/slab/crawl/partial 0P * Proposed building, distance from property line (circle one) * * Front yard 0;0 ft Rear yard elrza ft No. of stories (habitable space) A * Side yards 5(3 ft and .633 ft Height (grade to ridge) ,gyp ft. * If on corner, setback from side street ft If residential, no. of families / No. of rooms(excluding baths) * OCCUPANCY INFORMATION No. of bedrooms Y * No. of bathrooms a.j * PRIMARY BUILDING - Primary heating system ,C * XOne family dwelling Type of fuel '61if•r * __Two family dwelling No. of fireplaces to be installed ' / * Multiple dwelling / Number of units Will a wood stove be installed? ,., * Permanent occupancy *. Transient occupancy Central Air conditioning? ,YE,S Business . * ' BUILDING STYLE, PRIMARY STRUCTURE *. . Industrial Ranch Contemporary Log cabin * Other ' Duplex * If addition, what will use be? Raised ranch Mansion Split level Old style Bun•alow * Cape Cod Cottage `!i ZED• * ACCESSORY BUILDING- Colonial Row - Town House Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE ) * 4>LAttached garage/one car/ two car/ A. car * * * * * * * * * * * * * * * * * * ' Private storage building ESTIMATED MARKET VALUE OF * Other CONSTRUCTION + �L O�� * INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED! • Form BPA 4/86 and-vl • . V BUILDING PERMIT APPLICATION CONTINUED - . BUILDING SPECIFICATIONS: • i . Type of construction, wood frame, f'ire safe,etc. Lt/D442 es:04We Will any second-hand or ungraded lumber be used? If so, for what? /1/O Foundation wall material p P/' . G�iQL� Gro,c.�C.P�/t' Thickness Depth of foundation below grade (to bottom of footing) g%p a Will there be a cellar? )t Heated or unheated? d/✓ Floor sq. footage /.S"oo 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 - sloped/flat/shed/other.ssy0. Material.'of roof / Ai. .Siyyvfesl' Size, wood studs "X y " spacing /e "o.c. length 7 ft. . Joists(floor beams) '1st. floor .2.- "X /p " spacing /6 ".o.c. span/le ft. Joists (floor beams) 2nd. floor .Z "X /o " spacing /[ "o.c. span/y ft. Overlays(ceiling beams) "X 6 " spacing /6 "o.c. span /,‘ ft. . Roof rafters .2. "X Zr " spacing /(' o.c. span ,es'ft. Roof trusses(pre-engineered) spacing "o.c. span ft. • Exterior wall finishe 7A/sV- a ' Of what material? e//.9.v'2 acwAr Interior wall finish 7�Qj,474 ayPsuy w4,� a w If a garage is to be attached, describe materials to be used for FIRE SEPARATION: '1' F/4t'cb.0E Xefego 4bo( Is there to be an opening between garage and dwelling?y S If so will a Fire-rated door, enclosure, and self-closing.device 'be.'provided? }/4C-S Will a flue-lined chimney be installed? AS Height above roof 2 ft. . Depth of chimney foundation below grade ft. /CAPE-f•4sf�irtt',eaugcc - TX00.44G s "%a Depth of fireplace hearth ft. in. Water supply - Municipal or private well .4°uHicejOocat 4 • SEPTIC SYSTEM _ Distance from ANY private well(including adjoining properties e .o.o ft. (A separate application is necessary for any repair or new installation of septic system) Town of Queensbury AFFIDAVIT STATE OF NEW YORK County of Warren • 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 doneion 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 _ /G N- t = l�A Owne , owner'.s agent;arcnitect, ntractor day of ilivila 198 SAt4DRA li CO�IGEL K �A,� Notary Puolic,State of tl5a York Wart/en Warren County,No.490917 16 otary Public, War n County, N.Y. Comm.Expires on Oct. 19, 19 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 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 areai7C3e` • • 2 . Type of heat $S •A0 — i — 3 . Is the building mechanically cooled? ) 1 S' 4 . Percentage of area of windows and doors ` E E / eRa ha �i� 0 41 A. Over 16% Only Y . P/4,4v 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? plifekq3 . . Slab on grade YES NO a. If YES, what is the R value of insulation around ^( � perimeter of floor? f 4 . Is basement heated? YES NO a. R value of insulation `v�p5 5. 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 r • • 5. 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) 9. R value of heated basement/cellar walls (below grade) 10. Type of insulation C. Controls 1 . Thermostat maximum heat setting 96". ° D. Duct Systems 1 . Is duct system installed in unheated. spaces? 41/10 , O a. If YES, R value of duct installation R 1-1 b. R value of duct in other areas • E. Piping Insulation 51 if ' r/ 1. Size of hot water or(ooling)carrying agent pipe 2. R value of pipe . insulation F. Service Water Heating 1. Performance efficiency 2. Temperature control setting maximum • G. For Swimming Pool Only • . 1. Maximum heating Telephone No. . " C2CJ 6 / / fl/ut ( plicant ' s signature) TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12801 TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT REQUEST FOR/INSPECTION RECEIVED NAME --"(.��:.= 14�� LOCATION 73 r2-gi12,S c 1,7,1A DATE , /tt�5' PERMIT # e`�--/je 1 APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING F BACKFILL APPROVAL ,f ROUGH PLUM'. NG vr,. FRAMING • ' ELECTRICAL RO ( -IN ‘4, INSULATION: ,t' FOUNDATION er FLOORS ,.,:r WALLS y CEILING / )(FINAL INSPECTION: X CHIMNEY HEIGHT �'''. ROOFING / 1/ SIDING f ,o� s-- EXTERNAL PORCHES STEPS ;i STAIRS-CLEARANCE & RAIL4 1/ PLUMBING FIXTUkES/RELIEF =VALVE 1� INTERIOR TRIM/PRIVACY DOOrT FINISHED FLOORS 'p, 1/ GARAGE FIRE ROOFING y �/ DOOR CLOSES) P SMOKE DET TORS FINAL ELECT ICAL INSPECTION FINAL APPR VAL OF CONSTRUCTION /� A SIGNED ERTIFICATE OF OCCUPANCY MUST BE OBTAINED ROM THE BUILDING DEPARTMENT BEFORE THESE PR MISES ARE OCCUPIED! REMARKS: INSPECTOR c� Jown of Queeniurty BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME f. „vivi> LOCATION /42. CJ Date .5� tgg Permit No. sy--/96 * * * * * * * * * * * * * * * * * * * * * * * V = APPROVED - YE1/ NO Footing/Pier Forms ✓✓ Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer X.Rough Plumbing pfig/Ail f - L0 ID9eZ Relief Valv-s Lo -C Ext. Porches Finished Floo s Interior Trim Stairs & Raili •s Cellar Drain Ti e Concrete Floors Plbg. Fixtures Gar. Fireproofing Door Closers Smoke Detectors Chimney INSULATION: Foundation Floors Walls Ceiling FINAL ELECTRIC INSPECTION DRIVEWAY APPROVA Final Building Survey Next scheduled inspection (call when ready) Remarks- Build n Insp6ctor 6/86 and-vl -<7 _/own o/ Queenitury aY04 J BUILDING and ZONING DEPARTMENT : '01 Bayand Haviland Road, R.D. 1 Box 98 / Queensbury, New York 12801 BUILDING INSPECTOR' S REPORT NAME ./; Jam" LOCATION A /- 02j Date 6- / Permit N• * * * * * * . * * * * * * * * * * * * * * * * ✓ = APPR• ED - YES / NO Footing/Pier orms Foundation Waterproofing Backfill k-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 ELECT' AL INSPECTION DRIVEWAY APP`OVAL Final Building Survey Next scheduled inspection (call when ready) Remarks- B 1-at Inspector 6/86 and-vl 1 ] • _Awn off QueenAury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT • NAME //://16/ 44/ LOCATION ) /2- di r Date 04_Permit No. wi ✓ = A$PRED YES / NO toting/Pier Forms 5 /q4 it yqu ;' Foundation 1 Waterproofing Backfill Framing Roofing Siding Masonry Ven:•er Rough Plumbing Relief Valve% Ext. Porches Finished Floo Interior Trim Stairs & Railin. . Cellar Drain Tile Concrete Floors Plbg. Fixtures Gar. Fireproo ing Door Closers Smoke Detect.rs Chimney INSULATION- Foundation Floors Walls Ceiling FINAL ELE4TRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready) Remarks- / t/.4(7H Building Inspector 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 REQUIRED. (TEMP.# IDATE CITY OR ,,,-77) / /l VILLAGE -�"lJ�,'/_-%�S uC!f TOWNSHIP l�e ‘✓�.%,fv /C COUNTY ' +� `. /Cr STREET AND NO.OR / f ROAD AND POLE NO. ..7ry'/'71/,<ZZ POLE NO. BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? CTION BLOCK LOT OCCUPANT'S BUILDING y � /J NAME OCCUPANCY :CSC// G//N4 OWNER'S NAME / -yp AND ADDRESS ,2 /r .�:✓it/ �"�!",'--L' ` r��=f� TEL.#' / /$ ` �� C.; ��CJ CURRENT SUPPLIED //ti/C,)BY FROM THEIR '_. "/_//1/5 /CA/. ( OFFICE UILDING NEW f OLD❑ SORK f f.NEW ❑ADDITIONAL❑ REMOVED S LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED No.of Fixtures& BRANCH OFFICE USE NUMBER OF OUTLETS Lamp Receptacles MOTORS HEATERS CIRCUITS Loca- • ONLY tion Side Attach H.P. Watts A.W.G. Ceiling Wall Recep'Is Switch Pendant Bracket No. Type Each No. Each No. Gauge INSPECTION Out- side Sub- base Base- ment 1st Fl. 2nd Fl. 3rd Fl. • REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. This application is intended to cover the above-listed equipment to be inspected but if at time of inspection there is found additional equipment not above listed, you are authorized to make the inspection and adjust the fee to cover the additional equipment,as provided by the applicant. SIZE OF ELECTRIC SIGN TOTAL MAINS • 7:�ii� /�l i'`�^'7 FEEDERS LAMPS WATTS CHARACTER • EXPOSED GAS TUBE SIGN OF WORK - CONCEALED TRANSFORMERS OF VA WORK TO BE (NUMBER) (CAPACITY) STARTED `+/f/`j COMPLETED;//, SIZE OF SIGN SERVICE OVERHEAD - UNDERGROUND MAKER ENTERS • BUILDING OF SIGN INSPECTION REQUESTED • ON OR AS NEAR AS POSSIBLE NEW ri OLD 1-1 AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACES DATE OF MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION PRINTNAME AND ADDRESS _ /,^ �/SIGNATURE NAME OF /2f'2/✓� / %J�.�;; C �:;io • /� APPLICANT t OF APPLICANT fJ _ STREET ADDRESS fl' � ��^�" ` TELEPHONE# ' 7.�"� CITY OR //, (— ZIP LICENSE NO. POST OFFICE ' �'- '" ,S i / CODE /� WHEN APPLICABLE 46 EL (REV. 1/86) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING