Loading...
1987-674 i I ER TI d"N + OF OrmyN A `� Oy TOWN OF �QUEEN58UR Y WARREN COUNTY, NjEW yp RK r Date January 1� 7'hia is ! 3 613 � ceni -.�. has p c that work requested to be clone as shown by Pe corn Ic rntit Na. 87,674 This strucrurrt may be oc,uPid � a ©ry,� ' � Fam3lY ni3 I-ocari,orr een .Duna Lane _ U . E . �rwooc3 Clos Owner L . i)evc=:S � e Pun t l3y Of-der p +Boar TOWN OF QCJEENBB[T y Buildia� Qr Zotiitt� Ins p"r BUILDING PERMIT 3 TOWN OF � +QUEENSBURY - � WARREN COUNTY, NEW YORK No. 87-674 Z4 c� PERMISSION is hereby granted to D . E . C . Development ao I OWNER of property located at Lot #6 gueen Diana Lane P rn in the Town of Queensbury, To Construct or place a One-Family Dwelling Street, Road or Ave_ 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 Queenshury Building and Zoning ,Ordinance. T. OWNER'S Address is 184 Dunsbach Rd . Cohoes , N . Y . 12047 tv 2, CONTRACTOR or SUP LDE R'S Name C] Same ty fo C 3. CONTRACTOR or SUiLDER "S Address M r-� ❑ m O rt 4. ARCHITECT`S Name 5. ARCHITECT'S Address b tw rt sv 6 CCD 6. TYPE of Construction — (please indicate by X) O m R 0 ( xi Wood Frame { ) Masonry { ) Steel { � W ❑ Iv 7. PLANS and Specifications M lu r3 No. 26 ' 481 per plOt plan , specifications and application including r3 septic System and attached two Car ,garage . .� S. Proposed use One—Family Dwelling 5 . 00 C 0 ro � 150 . 00 � PERMIT FEE PAID - THIS PERMIT EXPIRES Kay 1 , 88 °7 (If a longer period is required an application for an extension must be made to the 8uIIdi ?9 town of Oueensbury before the a n9 and Zoning inspector of the ~ xpiration data.) Dated at the Town of Queensbury this 8th Day of October m 1987 SIGNED BY .r�.,....>�, tm Building and Zoni i n for the Town of Queensbury ny spector _ // TO BE COMPLE,ri D BY BLDG . DEPT * i vturt oueens6urrc I 'lOWIV OF G7Ui E��iSnii Application !, Permit Issuedd l9 3 ILi� ILi 13L11LQiNG and ZONING DEPARTMENTPermit Expires 1 Bay and Havilartd Road, R. D. 1 Box 98 Zoning Designation SEP 30 W7 Queensbury, New York 12801 Variance No . �+ry 4 site P1a iew No . UUILUi:NG F!c CODE DEiP'T, Apprav ✓ 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 propert-y;+� is : P. O. Address + � T/ IJLJ �ixS i/�iC.M Tel . 795-Z>4.34 Property Location : 4 C!o Q0=. m;o 'j'>I 01j4 'LA,0 Tax Map No . Street number or building lot number Subdivision name ( if applicable) A ,p 14te W� 0 a _16y� THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK 1 AS REGARDS BUILDING CODES IS : � a, SI -r-& J/ ry Name P . O. Address Tel . No . Name of builder 5,40E As r3.6,uc Address Tel . Name of plumber. Go.. , = Address CIOQt.'i6L. gT Ir�iijw Tel . Name of mason Address 7-K* . ivy 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 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 INFORMAATION REQUIRED BELOW . Size of property I 5. ft x ly ft . Existing building ( s ) Size ft X - ft � PROPOSED BUILDING AND USE : Existing building ( s ) Use r Size of new structure -lift X 9rBft Foundation-pier/slab/crawl/partial fu Proposed building , distance from property line (circle one ) No . of stories x Front yard �+', ft Rear yard /Gp —Ift (habitable space) ,� Height ( grade to ridge ) / $ ft . * Side yards ft and J 'p ft If residential , no . of families If on corner , setback from side street ft No . of rooms ( excluding baths ) * OCCUPP14 Y INFORMATION No , of bedrooms Q PRIMARY BUILDING No . of bathrooms ., Primary heating system ko` �One familydwelling �TKie1 rPwo famil dwellin Type of fuel - � - Y g No . of fireplaces to be installed Multiple dwelling / Number of units Will a wood stove be installed? k Permanent occupeuicy Central Air conditioning? n) p Transient occupancy H. .,,_,.._Business BUILDING STYLE , PRIMARY STRUCTURE Industrial Ranch Contemporary Lag cabin * _ Other Raised ranch Mansion Duplex If addition , what will use be? Split level Old style Bungalow Cape Cod Cottage Other * ACCESSORY BUILDING- Xffizm:�:k 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 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 . - Will any second-hand or ungraded lumber be used? If so , for what ? At.7 b Foundation wall mat eria hicknessiA:> Depth of foundation below grade (to bottom of footing ) Will there be a cellar? %I Heated or unheated? t )0/J#=-o-i;W Floor sqv footage sq. ft Will there be a basement? will any portion be used as living space? /VG ( If so, what port' sq. ft . - - Type of use? Type of roof l flat shed/other Material of roof Size , wood studs 11x"jP spacing /(a "'o . c . length ft . Joists ( floor beams ) 1st . floor _"X /C3 " spacing&"o . c , span,_,.1_3__ft . Joists ( floor beams ) 2nd . floor ��_"X_ _•' spacing i +� " o . c . span� ft . Overlays (ceiling beams ) "X " spacing " o . c , span ft . Roof rafters - ^''X_.�" spacing_.,L4�.. -o . c . span-.�7 ft . Roof trusses (pre-engineered) spacings '�"o . c . span ,(14 ft . Exterior wall finish JAJ11h. Of what material? f2ij , ,.. Interior wall finish {, E1le�4c7T &Qj::.k If a garage is to be attached , describe materials to be used for FIRE SEPARATION : - BG Is ' -thereTto be an opening between garage and dwelling? C If so will a Fire-rated door , enclosure , and self-closing device be provided? YAL.� will a flue-lined chimney be .installed? A) 4 Height above roof ft . Depth of chimney " foundation below grade - ft . Depth of fireplac rth ft .` in . Water supply - CM unicipa r private well SEPTIC SYSTEM _ 1stance 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 A F F I D A V I T STATE OF NEW YORK County of Warren I swear that to the hest 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 . SWORN TO BEFORE ME THIS Signature er , owner_7s age , arcnzc contractor day of i9 Notary Public , warren County, N . Y . SPECIAL CONDITIONS OF THE PERMIT : r TOWN OF QUEENSHURY 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 �[� 2 . Type of heat 3 . Is the building mechanically cooled ? 4 . Percentage of area of windows and doors 1p A . Over 16 $ Only 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 ? 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 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_ 5 . R value of floors over unheated spaces C� 6 . R value of slab edge insulation - unheated slab / )9 7 . R value of slab insulation - heated slab 8 . R value of heated basement/cellar walls ( above grade ) IVA 9 . R value of heated basement/cellar walls ( below grade ) }) 10 . Type of insulation Co Controls O 1 . Thermostat maximum heat setting_ D . Duct Systems 1 . Is duct system installed in unheated spaces ? YES NO Mg . If YES f R 'Value of duct in $ tallati. on b . R vale & of duct in other areas.- E . Piping ion F 1 . Sizee of of hot water or coaling carrying agent pipe 2 . R value Of pipe insulation 4 F . service Water Heating 1 . Performance efficiency 2 . Temperature control setting maximum Ar G . For Swimming Pool only 1 . Maximum heating TelephonC No . ✓ ( applicant signat ) APPLICATION FOR SEPTIC DISPOSAL PERMIT BUILDING and ZONING DEPARTMENT Bay and Haviland poa d. R.D. 16ox g8 Oueensbury, Nev. York 12801 DATE LOCATION OF PROPERTY FOR I NST. LLATION � + ��+ OWNER ' S NAME rV Ic rn rU ! ADDRESS .� %� r f y� r S- 'bra ,ma`s g[3 'c / 2c?,c{? T EL � INSTALLER ' S NAME TEL Number of bedrooms ( residential only) 4 � Total daily flow ( compute @ 150 gal per bedroom ) Topography : (Flat - Rolling - Steep slope - ( circle one) % of slope Soil nature ; San - Loam - Clay - Other Depth ft _ Ground water -At what depth? AabrV� ft Bed-rock or impervious material - At what depth? fto Percolation test ��Fot require - Required - -Rate / rrrr, ,;.,) min- inch , Domestic water supply unicipal Well - Other Separation - watersupply ( if well ) from Septic absorption ft . Proposed System ; Septic tank /DOC> gal . ( 'Minimun size , 1000 gal . ) Tim le Field - Each trench 6� ft . 'Total systems legnth 4;z Y-C3 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 proposed system with all dimensions shown ; including distance from any structure , distance from property lines and from ANY ]DOMESTIC WATER SUPPLY or share - line of lake , stream , Pond or wet - lands: • Include all dimensions of the system , itself _ 1 e7- Ci a ?. G"iG7' E & to abid& bjv th 6r se and a ? l requirements of The Tor.+n of Queenshurar. Sc1tY tar ✓ SEa." QOG Lisrosa7 Or' uir< anc' G . 4�i © ratter of rc � � onFibe nF � scY 05 / 86 and / vl Section It Septic System Ynspections : ` Ae All applicationO for septid system installation , alteration or repair , as required by the Town of pueensbury Sanitary Sewage ordinance , shall be submitted to the Buildina Department at least 24 hours t?efore 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 so V4o 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 $250600 _ 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 ¢ueensbury Buildina Department before further constructions . r 4002343 IIHE NEW YORK BOARD OF FIRE UNDERWRITERS I" tg BUREAU OF ELECTRICITY II 41 STATE STF2EET. ALBANY . NEW YORK 12207 oere January 27 r 1988 Application No. an file 032039/86 /� r THIS CERTIFIES THAT M t u 5 6 1 a only the electrical equipment ee deecribed below and Introduced d by the applicant named on thI application number in tha prensia" of Dec Development Lot #6-12 Queen Diana Lane Queens'bury , NY outside dwelling in the OROMPin location; � f B Bosemrnt � lst Ff. � 8nd Fl. section BleTek Lot wars examined on -13�88 and found to be in compliance with the requirements of this Board. 04XTUM EFTxCLES SMftTCHES FIXTURES pU�S RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS INCANDESCENT FLUDRESCENT y AMT- K- W- AMT. K. W- AMT- K.W. AMT. K. W. AMT- K. F. t3 47 18«. - 2 fr DRYERS FURNACE MOTORS FUTURE APPLIANCE FREDERS SPECIAL REC'FT TIME CLOCKS @&LL UNIT HEATERS WATP4DLFTLET DER AMT, K, W. OIL M. R. GAS NI. P. T. r'KJ. , G. AMT. AMP. AM7. AMrs, TRANS. AMT. N- F. �_ OF FAT AM7. WATrs 2 dryer #10 SERVICE DISCONNECT No. CW S E R V I C E AMi. AMP, TYPE R I ,e' 7W 1 JF 3W 3 AT SW 31 4W MD. OF GG. CCAVD. A. W. G- NIG. OF NI-LEG A. W- G. REe I OF GG- CQND. OF MAFG NO. Of NtUTRAlB DF NEUJTTRAI 1 200 eb 1 X 4I0 2/0 1 1 TtNtLAFFARATtiS! 1-amooka detector Richard. Rosetta. 423 New Kar1ner Rd . Albany, NY 12205 O BRANCH MANAGER Per This certificate must not be altered in any manner return to the office of the Board if incorrect. Inspectors may be identified by`fheir credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. awn v/ �uQen Spttrt� BUILDING and ZONING DEPARTMENT Bay and Haviland 'Road, R. D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME f J F f LOCATIONr C,rr 'C't tG /_ Gf DATE I� -I l c PERM I T NO. fl I ' fi® / - ------- SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - N Percolation rate - Min/Inch TYPE of SYS Absorption fi d . total length Length of each ench, Depth of trenche size of gravel SEEPAGE PITS{Numbe of) Size- ft. X _ t Gravel size PIPING : iz Ty Bldg . to tank Tank to dist . box Distv box to fie / Openings sealed? YES O 10hrtial LOCATION/SEPA TIONS : Foundation to tank ft. Foundation t absorption ft . Absorption lot line ft . Separation f pits t. LOCATION SYSTEM ON PROPERTY ircle one) Front - Re r - Left side - Righ side - COMMEAiTS SYSTEM USE APPROVED YES NO Buildi g Inspector 01/86 and vl U _Jv[urt o �eteen36urt�t BUILDING and ZONING DEPARTMENT LLL !!! Bay and Haviland Road, R-D. 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION 37ate hermit No . ✓ = APPROVED - Y 'S NO footing/Pier Forms foundation Waterproofing 13a kfilll arcing Roofing Siding Masonry Ve eer �1 Rough Plumb g Relief Valve. yl- Ext . Porches Finished Floor Interior Trim Stairs & Railing Cellar Crain Ti-1 Concrete Floors Plhg . fixtures_ Gar . Fireproofin Door. Closers Smoke Detectcars Chimney INSULATION : Foundation �/ Floors Walls CeilinAAVA FINAL L INSPECTION DRIVEWFinal 5urveNext si-n-spe ion ( call when ready ) Remarks- Building Inspector 6/86 and-vl 4002343 TIE NEW YORK BOARD OF FIRE UNDERWRITERS �`'� ol BUREAU OF ELECTRICITY � fY J = I nig 41 STATE STREET. ALBANY. NEW YORK 12247 QQ � teNovelolher 3 , 1487 Application .Yo. orsfile 032036 / 86 A JV THIS CERTIFIES THAT =3 only the electrscrl equiprrsesst ae described below &" introdraced by the o"Weent named on the abase elsplicstierw number in the promises of DEC Development , Lot 3 6 'QUeen Diana Lane ,, 'QUeenebury ,P New York in the follawing location; D BnEement J6:1 l st Fl. f%3 2nd F1, O u t a l d e Seetion Block Lot was examined on 10 / 2 1 / 8 7 and found to be in compliance with the requirements of this Board. OUTLET EPTACLES SWITCHES RXTURES RANGES COOKING DECKS OVENS IL11SH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLLX K* S ENT y AMT. K. W, AMT. K- W. K.W. AMT. K. W. AMT. M. P. 26 41 21 24 2 2 FR IDRYERs FURNACE MOTORS FUTURE A►*uANCE ►ENDERS Sr�CIA RECOPTI TUNE CLOCKS FELL UNIT HEATERS MULTI�CMRLET pllEUytERS AMY. K. W- OIL M. P. GAS H- P, AMT. No. A. W. G. 4MT- AMP. AMT. AMPS. TRANS. SYSTEMS AMT. WATTS RICE. C11F IRET x rp+sr 10 1 SERVICE WSCo"N@CT 40. OF S E R METER Y I C E � AMT. AMP. TYPE 1 X x4v 1 IT 3W 3 AT 3Wr 3 x IW No- OF CC. CDND. A. W- G. PER AV of CC. COND, No- Of MI-LEG ANO. OF NEUTRALS � W. u x NEUAL 200 Cb 1 x 1 kIp x 2 / 0 OTHER AMARATus,- 2 ..... (' F C 1 1 - Smoke Detector Electric Room Heater ' s : 3 - 2 . 0 Kw 4 - 1 . 5 KW 2 - 1 . 0 Kw 3 - . 75 KW Richard Rosettl _ 423 A New Karner Road tom„ Albany ,, New York 12205 ! BRANCH MANAGER Per ! . This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials_ __� T COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY WANNER. _ 8E a BUILDING and ZONING DEPARTMENT � ! Bay and Haviiand Road, R. D. 1 8ox 98 Queensbury, New York 128U7 BUILDING INSPECTOR P S REPORT NAME f LOCATION / Y ,4 Date /V ✓ APPROVED -F�ting/Pier Forms S NO undation v ;; erproofing Backfill Framing Roofing Siding Masonry Venee Rough Plumbin Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Til Concrete Flocsrs ---- Plbg . Fixtures Gar , Fireproof ' g "` - Door Closers Smoke Detect s Chimney INSULATION : Foundation Floors Walls, Ceiling FINAL EL EC RICAL INSPECTION DRIVEWAY A R©VAL4 -- Final Building Survey Next scheduled inspectiun [call when ready ) Remarks- Buil ng Inspector 6/86 and-v1 c%4 own queen sbur /40 BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. Q. 1 Box 98 ffJ % ON.Queensbury, New York 12801 SPECTOV S REPORT NAME L O C A T 10 N ' Date /a � J _ Permit No . * * * * * * * * * * * * * * ,. te/r` ✓ = APPROVED - NO 409coting/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Foe nRough PIbi-ngRelief Vves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbq . Fixtures Gar , Fireproofing Door Closers Smoke Detectors Chimney. INSULATION Foundation Floors Walls ceiling FINAL ELECT CAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks-- Building Inspector Inspector 6/86 and-vl NNW BUILDING DEPT. COPY OF APPLICATION FORM 464EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. 7'ETIIR s DAT�.� CITY an VILLAGE c- ,�,. Aeo T++W- S..Ip -� C{7[!NM •-,n_1 STREET AND NO, on ROAD AND POLE NO_ iy F ' « /ai0 Ari' cal W BETWEEN WHAT TWO T 1 .rJA LN POLE NO. PR SES TRIEETSTED7 # ,r ,ru J3' TCJ c aJ tG , ri,�;, lt4 - % CTIQN BLOCK LOT OCCUPANT'S BUILDING— NAME _ j „ OCCUPANCY OWNER'S NAME AND ADDRESS TEL u SUPPLIEDBy opw o BUILDING � FROM THEIR B � �ct y L, ,�I OFFICE Val IS NEW . OLD Q WORK ,,,iii�Tr111 DEFECTS IS NEW ADDITIONAL ❑ REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS LN.% Rieapteelee MOTORS HEATERS BRANCH Loer CIRCUITS OFFICE USE dao cagingONLY • Side Axt■ok•s Well Rrww'b Swetdt Pensions Bracket No, TYPO N.P. No. Each Ne. A.W.G.m" E aeh Ead+ SeuYe INSPECTION Out, owe 8ub- be" Baas• mane I st Fl. Znd Fl. gad Fl_ REMAq KS: LIST QTHER ELECTRICAL DEVICES NOT SET FORT" ^BOVE_ DO NOT USE THIS SPACE. This ePPlication is intended to cover the abor listed equipment to he inspected beet if at time of inspection there is found additional ui You era authorized to make the inspection and adjust eha Ise to corer the additional equipment, as proriRlad by the applicant, pmant not alsora fisiad, SIZE OF ELECTRIC SIGN MAINS CK G7 FEEDERS TOTAL LAMPS WATTS CHARACTER EXPOSED OAS TUBE SIGN OF WORK / LLB CONCEALED TRANSFORMERS OF VA WORK TO BE � {NVMBERI (CAPACITY) STARTED Ile COMPLETED S12E OF SIGN SERVICE OVERNEAD UND£RORDUNO ENTERS MAKER BUI DING OF SIGN INSPECTION REOUESTED � / i.. ON OR AS NEAR AS s-- POSSIBLE NEW O OLD O AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. DATE OF PRINT NAM NO ADDRESS APPLICATION NAME OF APPLICANT f �I— /7 � ty/ SIGNATURE APPLICANT OFAPP S/ ..1fLICANT— / CITY OR STREET ADDRESS _ ''! I..(�!/4I,Sy �.Jer ♦ !r7 .�'7� ,� i � TELEPHONE # l���� _ f^+lr1C �i �L/ ZIP LICENSE NO. POST OFFICE • CODE /212'n/ .�/ WHEN APPLICABLE ae EL (R"r I/ae) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING I I a 4 - P i F j , i ` �. i d L-Li Q I � I l..