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1987-626 T CERTIFICATE OF O CU- PAr.NC Y` TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date. 19 This is to certify that work requested to be done as shown by Permit No. 87-646 has been completed, This structure may be occupied as a ONE—FAMILY DWELLING Location 27 GLENWOOD AVE . { Owner DOUGLAS KENYON s I By Order Town Board TOWN OF QUEENSBURy Building & Zoning Inspector i I i BUILDING PERMIT TOWN OF QUEENSBURY No. 87- 626 � WARREN COUNTY, NEW YORK te PERMISSION Is hereby granted to Douglas Kenyon. 0 on property located at 27 Glenwood Ave . hl, QWNER of ro Street, Road or Ave. I r.3 —Famil in the Town of Queensbury. To Construct or place a One 3r 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. t- OWNER'SAddressis 7 Windsor Dr . o Glens Falls , N . Y . 12801 un su a� 2. CONTRACTOR or BUILDER 'S Name Same 0 0 3. CONTRACTOR or BUILDER'S Address D 4. ARCHITECT`S Name v 4'] n) ro D 5- ARCHITECT'S Address O 0 E]. 9 ro B. TYPE of Construction — (Please indicate by X) ( 4� Frame I ) Masonry '( 1 Steel ( ) 7. PLANS and Specifications No. 36 ' x 56 ' per plot plan specifications and application including septic system and attached two car garage m 8. Proposed Use One-Family dwelling �e d $5 , 00 C/O $ 164 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES April 1 , i9 $$ (if a longer period is required an ap plication for an extension must be made to the Building and Zoning inspector of the town of ClueenSbury before the expiration date.y Dated at the Town of Queensbury this 18th Day of Sept . 19 87 SIGNED BY 4:2 for the Town of Queensbury Building and Zoning inspector Xr )0`Gd TO BE COMPLETED BY BLDG . DEPT . �j / Application No . T0WN, C)F' C3(..dr` r;VSpII�*Y /[stun oueen Sbter Permit Issued 19 _ BUILDING and ZONINGDEPARTMENT Permit Expires 15 ' - ! i " � � Bay and HaWiland Road, R. D. 1 Sox 9a Zoning Designation t�r f2_ . its Oueensb New York 12801 / variance SEp Site Pl n Review ,`y�� // Appro cl OUIILDq%NG F1: APPLICATION FOR FUIEDING 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 : _ _01)Lt joa s [ k_t^ X0A1 P. O. Address 7 l�.J, . rls� r T�✓. Glens E�Llt 'ry - Tel 79.3 - 7x & Property Location : z j 6.1e! &}oz>dAL y Tax Map No . I0 6 / / ::'2- 3� Street number or building lot number Subdivision name ( if applicable) THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : 2 is y L . K/ed L+2�nj -7 GIeov.-5 l : /Is 7` - ZXS4� Nam P . O. Address Tel _ No . Name of builder /- e L/ ✓t' Address Tel . `5r 7 — 75-/5`</ Name of plumber_ erf- Address ;�;' gl7 G?5-3 / Name of mason fLr ,,� ', /�i S Address Tel . � 2- - Lp4� 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 LOCATION OF STRUCTURES AFFECTED . of water supply and location and configuration * of septic disposal area . COMPLETE INFORMATION REQUIRED BELOW . * Size of property t"3 f t X--ZP D ft . Existing building ( s ) Size ft X ft . PROPOSED BUILDING AND USE : * Existing building ( s ) Use Size of new structurei, , ft X�xi(�_ft Foundation-pier/slab/crawl/partial/ ul * Proposed building , distance from property line (circle one ) No . of stories (habitable space } * Front yard (u6 ft Rear yard��:W9+ £t Height { grade to ridge } �-r� £ L * Side yards se ft and s g _ £t If residential , no . of families * If on corner , setback from side street ft No , of rooms ( excluding baths ) OCCUPANCY INFORMATION No , of bedrooms ., x CB . of bathrooms PRIMARY BUILDING - N kgz L, One family dwelling Primary heating system gus - ,hodar,Lpy Type of fuel * Two family dwelling No . of fireplac s to be installed o Multiple dwelling / Number of units Will a wood stove be installed? * ✓'Permanent occupancy Central Air conditioning? Transient occupancy_ r� (; * 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 Cod Cottage Other * ACCESSORY BUILDING- 2`Slon Row Town House Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE } * . .—Attached garage/one car/ two car/� 2_ car * * * * * * * * * * * * * * * * * Private storage building `STIMATED MARKET VALUE OF Other `VSTRUCTION 4TION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETED ! A 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED BUILDING SPECIFICATIONS : Type of construction , wood frame , tire safe , etc . f 1L9L7+L3wyZc" Will any second-hand or ungraded lumber be used? If so , for what? ,yp Foundation wall material Ce YC✓Pica'- _ _Thickness Depth of foundation below grade ( to bottom of footing ) (.�=%, � Will there be a cellar ? Heated orvz�nheateoll Floor sq. footage /Z- W & sq ft Will there be a basement? Will any portion be used as living space ? lyr) ( If so , what portion? sq . ft . - - Type of use? Type of roof - A�o]5�d. , flat/shed/other Material of roof rGa4cf cc-, r/E �I oj��fL Shcr yr /r'� Size , wood studs 2 "X spacings o . c . length - < ft , Joists ( floor beams ) lst . floor 2� " X spacing "o . c . span ft , Joists ( floor beams ) 2nd . floor 2, "X�" spacing "o . c . span ft . Overlays ( ceiling beams ) � "3 y _ spacing_._2:�'o . c , span la - 3E ft . Roof rafters "X " spacing o . c . span ft . Roof trusses (pre-engineered) spacing �y "o . c . span_2.%'13w ft . Exterior wall finish C' Of what material? Interior wall finish— ^ � rlf V-a<- 4_ If a garage is to be attached , describe materials to be used for FIRE SEPARATION : �/{-' - , f e V'3l-eCT� `"�I7 F'[^`t`✓DC Imo' Fiie l fr r'e 0' elr Is there to be an opening between garage and dwelling? *" If so will a Fire-rated door , enclosure , and self-closing device be provided? lie `> Will a flue-lined chimney be installed? Height abov6 roof ft . Depth of chimney foundation below grade ft . Depth of fireplace hearth ft . in , Water supply - Municipal or private well L�ILI-lzy' ClAy SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties NA ft . (A separate application is necessary for any repair or new installation of septic system) Town of Queensbury A F F I D A V i T County of Warren STATE OF NEW YQRK 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, uEhether specified or not , and that such work is authorized by the owner , SWORN TO BEFORE THIS Signature_ _ �4�?�. ?� / rJwner , o ' s agent ,farcn ect , contractor day of 9 OV ROSE A. O'BEIRNE f POOTARY PUBLIC. STATE OF NEW YORK � �� ^• RC WC COMMISSION EXPIRES MARCH 30 19ZL UNTY No dry Public , Warren County, N . Y . * � '•, * r. * * * * * * * �- * �t �r at * � * +t ,r ,t * Ye * sk ,r * ie >4 * is yr * * * * * it * * * * +t at 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 : / r 1 , Gross floor area FDIC- / 2 , Type of heat— r25 hL? T GHQ V 3 , Is the building mechanically cooled ? G� 4 . Percentage of area of windows and doors c A , Over 16 % Only 1 . o value of gross area of wails , roof / ceiling and floors exposed to ambient conditions 2 . Floor over heated spaces YES T3O a . Are foundation walls insula-ted ? YES NO 1 , if YES , what is the ft value ? 3 . Slab on grade YES. .. " No a . If YES , what is the R va: lue of insulation around perimetez- of floor ? 4 . Is basement heated ? YES NO a . - 'R value of insulation. 5 � Type of insulation B , Under 16 % Only 1 , R value of roof and floors exposed to ambient conditions_ `) - 1 �2 , R value of exterior walls � rr 3 . R value of glazed area - L4 4 , R value of doors t ' t 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 s , 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 T . Thermostat maximum heat setting D . Duct Systems 1 . Is duct system installed in unheated spaces ? YES Q_ N_ © _. s a , If YES , R value of duct installation b . R value of duct in other areas E , Piping Insulation 1. Size of 'hot water or cooling carrying agent pipe fyC/yC, 2 . R value of pipe insulation. F , Service Water Seating 1 . Performance efficiency 2 . Temperature control setting maximum G _ For Swimming Pool Onl 1 , Maximum heating Telephone No . �/ Is�V �d ' ( p ica is sign t e ) 7own0 "eenj ary IQ CLUEENSBUKY TOWN OFFICE BUILDING .,4;zt,r r�s y BAY AT HAVILAND ROAD HIGHWAY DEPARTMENT QUEENISBURY, NEW YORK , 12801 TELEPHONE : (518) 792-5832 Application for Driveway Permit . ( Submit completed application to Highway Department ) Name of Applicant � ] 5 4t5 * Mailing Address _ `� .t.)iIgd.5vVo la _ 1Cj Q 1 ADDRESS TO BE INSPECTED 27 Gleev 4.yoad +-' e. The Superintendant of Highways . ']Gown of Queensbury , has reviewed the application of the above named resident to connect a driveway to the Town Road . The following action has been -taken : { } Premininary Approval ( to be followed by " Final Approval " ) ( } FIN L APPROVAL GRANTED { } REJECTED Culvert pipe size to be used ( if necessary ) ( ) 6 " - ( ) 8 ,� - ( ) 10 - ( ) 12 - ( } 24 " - ( ) 36 „ Dates Paul H . Naylor Superintendant of Highways Town of Queensbury SETTLED 1763 HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE r LOCATION OF PROPERTY FOR INSTALLATION 2.7 a�e,.}rzywd eL Owner's Name: L. Telephone: _ 7 49,E - j 45-6 Address: _ `7, " W6AIC(SL%## Y► Installer's Name: Telephone: Number of bedrooms (residential only) 44 Total daily flow (compute @ 150 gal per bedroom) Tapography: circle one: Flat Rolling Steep Slope 9Yo of slope Soil Nature: circle one: Sa r ' Loam Clay Other / Depth: _ feet Ground Water: At what depth? feet Bedrock or Impervious Material.: At what depth? i 14V IJ feet Percolation test: circle one Jot require required / rate min. inch. Domestic water supply: circle oney Munici Well Other T� IF domestic water supply is a Well: Separation: Watersupply from Septic absorption _ feet PROPOSED SYSTEM : Septic 'rank ^ gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench �5 ' feet / Total system length Z5- e-� feet SEEPAGE PIT(S); Number of / Size each feet by feet Size of stone to be used # j Depth or Thickness feet IMPORTANT ...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 showings 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 B. 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. c. 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: Dates 5 " 7 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 ``' flown of BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME I � {' ] 6 1., LOCATION !�+ Wc_3c.+ c.,p + tir-f _ Date / Permit No . lyl- 11vA6 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 . Fireproof ' g Door Closers Smoke Detect s Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECT CAL INSPECTION DRIVEWAY APPROVAL k /JFinal Building Survey Next scheduled inspection (call when ready }� Remarks-- Building Inspector 6/86 and-vl THE REIN YORK BOARD OF FIRE UN&DERWRIITERS BUREAU C7F ELECTRICITY k APRIL 19 a 1988 41 STATE STREET. ALBANY, NE W0'X<?l )% 7 +y Dote Application �'hu. on file a� 73� � -F / A 7413181 'f 41 �t"� 1 {'1 THIS CERTIFIES THAT / f! V4 �8 only the electrical e�qquuiiprt►eri9 " describo d below end introduced by the applicant named on the obooe application number in the premises of DOUGLAAS L. KENYONc 27 G]. t NWOOD AVENUEa QUEENSBURYa TNE"4 YORK. r. x OUTSIDE, 106 2 ' 3 in thefollowin,E � 1 �' Basement ❑ live Fl. C! $nd Fl. Section Block Lot was examined on and found to be in cornplionce .With the requirements of this Board. R)CruEE FIXTURES I RANGES COOKING DECKS I OVENSDISH WASHERS EXHAUST FANS U otLETS ElTACLES S%WCHES iNCA"Nscaw FLUORESCENT AMr. K. W. AMT. K. W. AMr. a[.w. AI K. W. AMT. H. P. 1 1 . 6 3 Flk ' DRYERS FURNACE MOTORS PITTURE AiPLIANCE PEEPERS IsPECIAL REC'PT TFME CLOCKS LWHT BOATERS MLR►TI-OUTLET DUMMRS SYSTEMS aJAT_ K. W. 41L H. P. I GAS I H. P. lms. IRAMvE Ftfi W, G. AMT. AMP. AMT. AMP$. Nh wMT_ H. P. NO OF FORT AMT. WATTS SERVICE DISCONNECT NO. Of S E R V 1 E AMT. NIP. TrPE UN 1 .e' 2W 1 1' 3w 3 X 9W S JI •W PER BCONU. aP CC. j # NO' OF Or NIdfG NO. Of NEUTRALS OK HWEi7 l4L OTNEE APPARATUS: L9 fi^' GFCI w ^tx,. 1 ... .r'Jl`{OKk. DETECTOR •i.;d ' '� , • — 68v 35 17fJllGLAS � . KENYON , 7 WINDSOR DRIVE �9 GLENS FALLS . NEW YORK 12801 d" BRANCH AIANACMR Pere This certificate must not be attered 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. .Down v� �+ tteer� 36ure� BUILDING and ZONING DEPARTMENT Bay and Hawitand Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPE(, TTOR ' S REPORT NAME LOCATION Date /Permit No . (i° CP r a * yr x * * x k w * * * ✓ = APPRC7VED - YES NC? Footing/Pier Forms Foundation waterproofing Backfill _ Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Parches Finished Floors Interior Trim Stairs 6 Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELEC INSPECTION INSPECTIO DRIVEWAY A P1OVAL Final Bui ding Survey Next scheduled inspection ( call when ready ) Remarks , ice' Building Insp ctor 6/86 and-vl 1 Igaw.� ' BUILDING and ZONING DEPARTMENT qe an aviland Road, R. D. 1 Box S$ Oue nsbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME i L.t LOCATION DATE le:0110tfy PERMIT NO. / SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES N Percolation rate - Min/Inch TYPE of SYST Absorption fi Id , total 1 th -�� Length of eac trench Depth of trenc es Size of gravel_ SEEPAGE PITS4NVer )Size- ft , X ) Gravel Size PIPING : Size T)Ap e Bldg . to tarok /T Tank to dirt , bo Dist_ box to fi la/ Openings Seale ? ES NO artial LOCATXON/SEPA TI r� Foundation t tank 1C3 , fto Foundation absorption ft , Absorption o lot line ft , Separation f pits t , LTxON SYSTEM ONPROPE TY (circle one ) Fr s R r - Left side - fight side - S : r SYSTEM USE APPROVED YES NO t: Building Inspector 01/86 and vl �?Otvtr o/ Quee4ns6ury BUILDING and ZONING DEPARTMENT Bay and Hawiland Road, R.D. 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME 00 V G LOCATION __ 67L &,v (yo C7 v Date �Z /�`/ Permit No . 0 (� ✓ = APPROVED - YES N0 Footing/Pier Forms Foundation waterproofing Backfill ,,"� Framing Roofing Siding Masonry Veneer )( Rough Plumbing Relief Valves r�xt . Porches Finished Floors Interior Trim Stairs & 'Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofi Door Closers Smoke Detector Chimney INSULATION Foundation Floors Walls Ceiling_ FINAL EIEC ICAL INSPECTION DRIVEWAY AP OVAL R Final Build g Survey Next scheduled inspection ( call when ready ) Remarks- y -� (y� j4� Building Inspec or S/8E and-vl r G� town cal Q"eenji"ry BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME j'� ��,,, � a,•_,yL,,,, LOCATION �? '� /� c � ,.. .�, Crv;�•�r� Date Permit IVO . r ) ✓ = APPROVED - YES NO Footing/Pier Forms u ondation roofing okfill Framing Roofing Siding Masonry Veneer Rough Plumb ' g Relief Valve Ext . Porches Finished Floor Interior Trim Stairs & Railings Cellar Brain 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- Building rl rl4fiector 6/86 md--vl L11 f I .J©eun o� �eeeen ,� deere�t BUILDING and ZONING DEPARTMENT f� Bay and Haviiand Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME , LOCATIC7N � # Date s ' / C� r�' Permit No * lf 4 voo t 1 ngJP i er Forms boo, APPROVED - 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 . Fireproofin 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-- 6J85 and-vl Build! g Inspector BUILDING, DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK 130ARID OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN RE DUI RED, TEIMP. s DATE CITY OR VILLAGE COUNTY TOWA15MfP `-. � _ : i STREET AND NO, OR ROAD AND POLE NO. BETWEEN WHAT TWO PO N . CROSS STREETS IS ,1 PREM! LOCATED? �, : I ECTlON OCCUPANT`S BLOCK LOT NAME `_!; i . fr BUILDING OWNERS NAME r y' OCCUPANCY AND ADDRESS � .i !t- f' y/ TEL # fI' .. f D / f! SUPPLie —' BY f/ BUILDING FROM THEIR r �r / ''f` .;,' OFFICE is NEW OLD ❑ W IS' NEW ORK e . (g DEFECTS AODIT1ONAL 0 REMOVED LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS Nu. of Fis Uwm ALamp Rerapfae/as MOTORS MEATERS BRANCH ITS OFFICE USE tion ONLY Cailiop side WAN R tt SwGhh P ndant smair [ No. Tvpo E� Na t No. Gouge INSPECTION side bbaso Baler ntanr 1st R. 2nd FI. 3►d Pl. REMARKS: LIST OTHER E im LECTR#CAL DEVICES NOT SET FORTH ABOVE: OD NOT USE THIS SPACE. ThiS MPPliestion is intanded to corer 1M aboY litted "mipment to In inspected but if ei time of i you are authorised to make the impaction an¢ ^° troo ' is found addlTioml a1'Piiprrrenl not above i"rsted, atry".ost the fee to sowtr the wcMisional egn,;Pn.ent. ■e Providad by the applicant. 512E OF MAINS ELECTRIC SIGN FEEDERS LAMPS WATTSAL OF WORK TER MEXPOSED GAS TUBE SIGN OF WOR CONCEALED TRANSFORMERS OF WORK TO BE VA STARTED COMPLETED SIZE OF RI SIGN 512E (CAPACITY} SERVICE OVERHEAD UNDERGROUND E#11TERS MAKER ILDI OF SIGN INSPECTION REQUESTED ON OR IE NEARARAS AS POSSIBLE NEW r—1 OLD MUST DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICAT{qN MAY BE RETURNED. DATE OF PRINT NAME Af�Llll ADDRESS APPLICATION NAME OF I '1 L{ ,s APPLtCAHT.. � ' fd.,;5 L P. o IA, ► SIGNATURE 1-2 y,,„. k OF APPLICANT_.._r `..c /�? STREET ADDRESS ' + I.f "�!= .,yr + TELEPHONE /z' CITY OR f'N .S �`'Fi POST OFFICE �� I 1 `? j`lI ZIP COOE LICENSE NO, W 4EN APPLICABLE 46 EL (REV. Ilae) A SEPARATE APPLICATION MUST Be FILED FOR EACH SEPARATE BUILDING I � 1 M1