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1987-839 r CERTIFICATE OF C7►CCUI'AN TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Dace_ July 19 Iq 69 This is to certify that work requested to be done as shown by Permit No r �� has been completed. This structure may be occupied as a _-M of a two family dwQ ling l orcationt 5Z Queen Anne Court, Queen Victoria's Grant Model J Owner _ Guyer Builders, Inc, By Order Town Hoard TOWN OF QUEENSBURY Building N Zoning Inspector BUILDING PERMIT � TOWN OF QUEENSBURY No. 87-839 � WARREN COUNTY, NEW YORK -� PERMISSION is hereby granted to Queen Victoria ' s Grant VQ .f .c- OWNER of property located at 52 Queen Anne Court Street. Road or Ave. in the Town of Queensbury, To Construct or place a j of Two 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. 1 . OWNER'S Address is Guyer Builders Inc . 119 Dunning St . Ballston Spa , N . Y . 12020 m 2. CONTRACTOR or BUILDER 'S Name C Same n rr 0 n tom• 3. CONTRACTOR or BUILDER'S Address �- m Same �s N D rt 4. ARCHITECT'S Name 5. ARCHITECTS Address N C T B. TYPE of Construction — (Please indicate by X)i 9 �s l Wood Frame { l Masonry { Steel { } fD 7. PLANS and Specifications p G ,n No. 32 ' x 48 ' as per plot plan , specifications and application including septic system and attached one car garage . MODEL J B. Proposed Use } of Two Family Dwelling O FFI $5 . 00 C /o H $ 89 . 00 PERMIT FEE PAIL] — THIS PERMIT EXPIRES July 1 , 1988 a (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Queensbury before the expiration date.) la t— Dated at the Town of Queensbury this 8th pay of December 19 fig 87 � t� SIGNED BY ; � GGC ,rC. °-�`--� for the Town of Queensbury Building and Zoning Inspector 0 av _ %Tj DZ C S:U 1YIAEWL'-U ZZ aL A.2 o / Application No . Wn O/ Q"een361ery Permit Issued 19 BUiLDiNG and ZONING DEPARTMENT Permit Expires 19 OCT 2 li 1987 Flay and Haviland Road, R.D. 1 Box 98 Zoning Deesignatio Ousensbury, New York 12801 Variance No, fl Site Plan Revi Nrr �7 �j/, '© lo Approved by ��.�L �. 1v APPLICATION FOR C SU I LD I NG AND ZONING PERMIT * * * a 0 * a Ile* 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 . Guyer Builders Inc P. O. Address 119 Dunning Street Ballston Spa , New York 12020 Tel . ( 518) 899-9161 Property Location : 52 Queen Anne Court Tax Map No .121 /� 2 Street number or building lot number Subdivision name (if applicable) Queen Victoria ' s Grant THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : Richard H. Guyer III ( 518) 899-9161 Name P. O. Address Tel . No . Name of builder Guyer Builders , Inc -Address 119 Dunning Street Tel . ( 518) 899-9161 Name of plumber Gqyer ers , a =Address 119 Dunning SEreet Tel . Name of mason yer I rs , rnc .AddreaQ g Street Tel . NATURE (3F PROPOSED WORK : ,. ZONING INFORMATION X 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 of water supply and location and configuration LOCATION OF STRUCTURES AFFECTED . * of septic disposal area . * COMPLETE INFORMATION REQUIREDp$9r - s e * Size of property 10Q± p an ft X 120 ft . * Existing building ( s ) Size ft X —ft . Model PROPOSED BUILDING AND USE : off * Existing building (s ) Use NIA size of new strut a 32 ft X 48 ft " Foundation-pier slab crawl/partial/full * Proposed building, sdiistt ee ptepg m property line circle one ) 1 * Front yard 3CIt ft Rear yard 30+ ft No . of stories (habitable sga ,e ) * Bide yards ft and 15+ ft Height (grade to ridge) 1y � fte * If on corner , setback from side street • ft If residential, no . of families � * Noe of rooms ( excluding baths ) OCCUPANCY INFORMATION 4ONow of bedrooms 2 * PRIMARY BUILDING - No . of bathrooms 2 One family dwelling �suinr , Primary heating system se ar a ectric* =Two family dwelling s It g h.e Type of fuel Electricity * Multiple dwelling / Number of units No. of fireplaces to be installed Permanent occupancy Will a wood stove be installed? I`10 " * Transient occupancy Central Air conditioning? No Business BUILDING STYLE, PRIMARY STRUCTURE * Industrial �, Other Ranch Contemporary Loa cabin If addition ■ what will use be? Rairsed ranch Mansion DL�uple, as 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/ ne car w w w +r • w w * * * w * * w * * * * Private storage building ESTIMATED MARKET VALUE OF ** � Other CONSTRUCTIONMUM INFORMATION ON . BUIL.DING SPECIFICATIONS „ ON REVERSE SIDE OF THIS SHEET , TO BE CQMPLETEDI Forms SPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe, etc * wood frame Will any second-hand or ungraded lumber be used? If so , for what ? no Foundation wall material concrete block Thickness 8" Depth of foundation below grade (to bottom of footing ) 4819 minim= Will there be a cellar? no Heated or unheated? Floor sq. footage sq ft Will there be a basement? na Will any portion be used as living space? ( If so , what po� sed/o e - Type of use? Type of roof - sloped flat/shed/other Material of roof Fi r ass shingles Size , wood studs '•x 6 spacing 24 "o . c . length 8 fto exterior walls Joists ( floor beams ) 1st . floor N/A "x " spacing "o . c . span N/A ft . Joists ( floor beams ) 2nd , floor _•' X �" spacing "•o . c . span N A ft . Overlays (ceiling beams ) •'x of spacing 24 "o . c . span N/A ft . Roof rafters 2 "' x " spacing 24 o . c . span 14 ft . Roof trusses (pre-engineered) spacing "o . c . span 42 ' ft . Exterior wall finish stained Of what material? 5/8" x 4 ' x 81 texture. 111 Interior wall finish Pain s eetrock If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 1 /2 00 type "X" sheetrock Is there to be an opening between garage Land dwelling? yes If so will a Fire-rated door , enclosure , and calf-closing device be provided? YeS Will a flue-lined chimney be installed? No Height above roof N/A ft . Depth of chimney foundation below grade N A ft . Depth of fireplace hearth N A ft . in . Water supply - Municipal or private well municipal SEPTIC SYSTEM _ Distance from ANY private well ( Including adjoining properties ft . (A separate application is necessary for an re air or new installation of septic system) See S . P . E . D . S . pernut rit 8n6252 AFF I DAV I — - - --- Town of Queensbury T County of Warren 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 s cifi or not., a d that such work is authorized by the 'owner . SWORN TO BEFORE ME THIS Signature_ _ _w. ���. _��: - - Owner , own e ' s agent , rctrfirect , contractor day of (y'L^ 3f !- erJ 19 PATRICIA E. FURPHY alic, State of New York Q=.:althea in Schenectady County Notary Publics W , N . Y . 4717048 Commission Expires Sept. ♦ • ♦ • * * yr w a _ • * r ,► * * * � ,► * rr ar * * rr w tt • rt * # rt * +k rt � r r * • • at : • SPECIAL CONDITIONS OF THE PERMIT : y TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK Application fora BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . *w4vuit ALL of the followings - ' 1123 S . F . gross floor area ^r°:. • 2 . Type of heat Baseboard electric 1 . Is the building mechanically cooled ? No 4 , percentage of area of windows and doors 11 • $X A . Over 16 % Only 1 . Uo value of gross area of wallas , 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 grads YES 40.. a . If YES , what is the R value of insulation around perimeter of floor ? 4a is basement heated ? YES NO a . R value of insulation so Type of insulation $ . Under 16 • Only 1 * a value of roof and floor * exposed to ambient conditions R-38 2e it value of exterior walls _ XKX= R-23 . 5 (U. =0 . 04+ ) 3 . R value of glazed area U * =O) 30 4 . R value of door * R-14 . 9 (U* -0 * 06) 5 . R value of floors over unheated spaces �C_ R-30 6 . R value of slab edge insulation - unheated slab N/A 1 . R value of slab insulations - heated slab 1295 B . R value of heated basement/ cellar walls ( above grade ) N/A 96 R value of heated basement/cellar walls (below grade ) N/A 10 . Type of insulation Fiberglass C . Controls 1 . Thermostat maximum heat setting 00 Duct Systems N/A 1 . 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 $ . PLE! ing Insulation N/A 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation 8 . Service water Heating 1 . Performance efficiency_ N/A ` 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . ltaxioaus+a heating N/A Tp rs ele hoe "o . ( 518) 899-9161 ( applicant ' s afg tore ) Uf APPLICATION FOR SEPTIC DISPOSAL PERMIT Ref : S . P . E .D . S . DATE September 29 / 87 permit # New York - 0202525 MODEL J of J/I LOCATION OF PROPERTY FOR INSTALLATION 52 Queen Anne Court Owner's Name: Guyer Builders , Inc . Telephone: ( 518) 899-9161 Address: 119 Dunning Street , Ballston Spa , New York 12020 Installer's Name: Guyer Buildeers , Inc Telephone: 51$) f $99-9161 2 A, C , E, I , J , K, L, M ,Number of bedrooms (residential only) 2 3 F , G, A : Total daily flow (compute @ 150 gal per bedroom) 300 Topography: circle one: lot Rolling Steep Slope 96 of slope Sail. Nature: circle one. Sand Loam Clay Other / Depth: 8 ' feet + Ground Water: At what depth? mown 8 feet + Bedrock or Impervious Material: At what depth? unknown feet Percolation test: circle one: not require required / rate min. inch. Domestic water supply: circle one: Municipal Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption NIA feet * PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench N/A feet / Total system length N/A feet * SEEPAGE PIT(S): Number of / Size each feet by feel * Size of stone to be used # / Depth or Thickness feet IMPORTANT * See S . P. E. D . S . ...Please...I.IST NEW EQUIPMENT TO BE INSTAI.I.ED permit & attached * * * * * * * * * * * * * * * * * * * * * * # * * * * * * * * * * * * * * * * * map (aver) r+. 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 propoped ,location of the gystem 2.) location and distance to lot lines 3.) location and distance to structures 4.) location and distance to any water supply 50 size and dimensions of all tanks, distribution boxes, the 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 $Z54.00. 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 in 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. l have read the regulations above and agree to abide by the mbd all requirements of the Town of Queensbury Sanitary Sewage Disposal Ckid_in an e. Signature of.responsible person: Date: i Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 79Z-5832 SET T V F D 1763 . . . HOME OF NATURAL BEAUTY . . . A GOO D. PLArF TO LIVE TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 32801- TELEPHONE (5181 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED 7/ /3 — NAME LOCATION 'r [ c 0-00 , [ • , DATE j f!7`/ d PERMIT #t �JS ,j APPROVED YES NO FOOTING/PIERS MONOLITHIC POU . FORMS FOUNDATION/DAMPTPROOFING -- BACKFILL APPROVAL 1` ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-XW FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: ,+ CHIMNEY HEIGHT ROOFING SIDING �f EXTERNAL PORCHES/STtPS ' STAIRS-CLEARANCE 6 TRAILS PLUMBING FIXTURES7RELIEF `,VALVE INTERIOR TRIM/PRX,(7ACY DOOPtS I toe, FINISHED FLOORS GARAGE FIREPROOL DOOR CLOSERS) .SMOKE DETECTOR FINAL ELECTRICA INSPECTION 1 FINAL APPROVAL t F CONSTRUCTION A SIGNED CERTIAffXCATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE TURSE PRERXSES .ARE OCCUPIED! REMARKS - 'lam INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12604- TELEPHONE ( 518 ) 792- 5832 BUILDING INSPECTOR ' S REPORT REQUEST R INSPECTION RECEIVED NAME .LOCATION d .v DATE PERMIT # / ! _ ' C APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ,Rb&GH PLUMBING �F AMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION : CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS--CLEARANCE & RAILS PLUMBING FIXTURES/RELIEF VALVE INTERIOR TRIM/PRIVACY DOORS 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: � � jr- S f r INSPECTOR TOWN OF QU EENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY. NEW YORK 12809- TELEPHONE ( 518 ) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION DATE PERMIT # ` 5 APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATI /DAMP-rPROOFING BACKFILL APPROVAL ROUGH PLUMBING t FRAMING ELECTRICAL ROUGH-- N INSULATION: FOUNDATION ` FLOORS WALLS CEILING i FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEP STAIRS-CLEARANCE & ILS PLUMBING FI3XTURES/R LIEF LVE INTERIOR TRIM/PRIV Cy DOO FINISHED FLOORS GARAGE FIREPROOF NG DOOR CLOSERS) SMOKE DETECTOR FINAL ELECTRICA INSPECTION FINAL APPROVA OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT FORE THESE PREMISES ARE OCCUPIED!' REMARKS : J� I SPECTOR TOWN OF QU £ENSBURY BUILDING .AND CODES DEPARTMENT BAY C. HAVILAND ROADS QUEENSBURY, NEW YORK 12804- TELEPHONE ( 518 ) 792- 5832 BUILDING INSPECTOR ' S REPORT IS I REQUEST FOR INSPECTION RECEIVED_ Z(c d AA NAME LOCATION DATE _=II _PERMIT APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING ,BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-XN XNsULATION: FOUNDATION FLOORS f WALLS CEILING FINAL INSPECTION : CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STE% S _ STAIRS-CLEARANCE & ILS; PLUMBING FIXTURES/ ELIEF ALVE INTERIOR TRIMfPRI ACY DOO�S FINISHED FLOORS GARAGE FIREPROO ING DOOR CLOSER (S) .SMOKE DETECTO S FINAL ELECTRIC L INSPECTION FINAL APPROVA OF CONSTRUCTIONu �- A SIGNED CE TIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED ! REMARKS: INSPE TOR ..Jourrr o� '�ue+ens � ttre� BUILDING and ZONING DEPARTMENT Say and Hawiland Road, R-0 . 1 'Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCAT ION DATE /q! PERMIT NO SOIL 'TYPE - Sand - Loam - Clay Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM *. Absorption field , total length Length of each trench Depth of trenches Size of gravel SEEPAGE PITS4NUmber of ) Size- ftw X _ ft. Gravel size PIPING : Size Type Bldg . to tank Tanis to disc. box Dist_ box to f igld/pit Openings sealed? YES NO Partial L.OCZ6.TIC)N/SERRATION S FoundatIn /to tank ft. Foundati. to absorption ft . Absorpt on to lot line ft. Separ ion of pits ft- LOCATION OF SYSTEM ON PROPER.TY (circle one) Front - Rear - Left Side - Right side - COO- d SYSTEM USE APPROVED YES NO Building Inspector 01/86 and vl _../,curl 01 Queensure� BUILDING and ZONING DEPARTMENT 3 Bay and Hav;land Road, R.D] 1 'Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME r� LOCATION il4d, ' G � fGG ��17 �i Date le le /1X�_ Permit * * * * * * * * * * * APPROVED* -* Y* * * NO �oting/Pier Forms Foundation Waterproofing Backf ill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves 1,xt . parches rinished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg , Fixtures Gar . Fireproof ! Door Closers Smoke Detector Chimney IN S U I,AT I ON Foundation Floors Walls Ceiling FINAL EJECT ICAL INSPECTION _ DRIVEWAY AP &L. Final Building Survey Next scheduled inspection (call when ready ) Remarks- 6r.,ll( 74 �Woe-, Building Spector 6/86 and-vl ._/ourre ©/ Queen .41 lry BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D- I Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCAT ION ,.aft QLk _f Q flpy i' � / PERMIT NO.�/� f SOIL TYPE - Sand - Loam - Clay -_ Percolation Test Required? YES - NO Percolation rate - Min/Inch _ TYPE of SY.St Absorption f ld , total leng' Openings Length of each% - trench Depth of trenches Size of gravel IiF SEEPAGE PITS4Number of) Size- _, ft. X 9 ft . Gravel size PIPING : 1ze Type Bldgo to tank Tank. to dist. box I Dist. box field/ f�Ca Upeings seaea led? E NO Partial F LOCATION/SEPARATIY S = Foundation to t k Foundation to a sorptio ft. Absorption to t line ft. separation of its f LOCATION OF SX TENT ON 'PROPER Y (Circle one) Front - Rear 4 Left side - Right side - r CC'MMENTS SYSTEM USE APPROVED YES O 'Suit into Ins ector 01/86 and vl L?Own 0 Q"eenss "rry BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING I NSPECTOR P 5 REPORT r' NAME L{}CA---T------I2a�N s 5 L Cate / Permit No . IL ' ✓ = APPROVED - YEWS / Footing/Pier Forams '(Foundation Waterproofing Y Backfill Framing Roofing Siding Masonry Veneer Rough Plumkaing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railing Cellar Drain Ti e Concrete Floor P1bg . Flxtur Gar , Firepr fxng Door Close Smoke Det tors Chimney INSULATI N . k'Foundati n loors Walls Ceiling FIBIAL £L TRICAL INISPECTZDN DRIVEWAY APPROVAL: Final Building, Survey Next scheduled inspection (call when ready Remarks- . f B ilding lnsldctor 5/86 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. ♦ DATE CITY OR VILLAGE Quiimnsbury TOWNSHIP QL*%nVdpUY COUNTY STREET AND NO. ILI OR NO 56 Queen �, �t POLE NO. ROAD AND PpL£ NO. *+L*a'�"G'�" BETWEEN WHAT TWO CROSS STREETS IS SECTION - +� BLOCK - LOT PREMISES LOCATED7 OCCUPANT'S BUILDING .. - NAME y OCCUPANCY AND ADDRESS E � ft lrt�l rso 3[nc0 3 119 DllCffs'�Tly '►`�St+�C@I�' t "{ TEL. # "'�16�. CURRIENT SUPPLIED FROM THEIR OFFICE By 1DEFECTS BSUILDING NEW EXI OLD 0 Its NEW EX ADDITIONAL ❑ REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED No. 04 FlssWra & BRANCH OFFICE USE NUMBER OF OUTLETS Lamp Receptacles MOTORS HEATERS CIRCUITS ONLY Bon Side Atueh't H.P. Watts A.W.G. Calling "oil Racap'4 f'� sot Bracket No. Types Each No. Each Na- Gam INSPECTION Out- aide bbaara Radio- Mont 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 corer the above-listed arwipment to be inspected but if at time of irspactiori there is found additional equipment not else" listed, you are authorized to make the jnspection and adjust the Ise so eovar the additional equipment, as provided by the appAicant. SIZE OF ELECTRIC SIGN TOTAL MAINS 150 Awa FEEDERS LAMPS WATTS OF WORK CHARACTER � ALT AR.i Ia@ COPOSED GAS TUBE SIGN CONCEALED TRANSFORMERS OF VA 9YO R K TO 831E I NU MB E R I ICAPACI TY I STARTED COMPLETED SIZE OF SIGN SERVICE OVERHEAD UNDERGROUND MAKER ENTERS ]�+ OF SIGN BUILDIN INSPECTION REQUESTED y� ON OR AS NEAR AS W.11 'c& when ram' NEW OLD POSSIBLE AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. PRINT NAME AND ADDRESS 9 22"7 NAME OF GuyerB1$ l dro Inc* DATE OF APPLICANT P APPLICATION �e�ys�1 yy C�y STREET ADDRESS y � 119 Dum u Stet TELEPHONE # 89 ""�161 ZIP .i..i. Q LICENSE NO, POST OFFICE ITY OR Y CODE WHEN APPLICABLE — na EL (REV. Oes) A SEPAAA4* L�*'I6N MUST BE FILED FOR EACH SEPARATE BUILDING REFERENCE DRAWINGS 2000 ga I CLEANOUT TO GRADE 8� O DIAMETER 9'-0 DEPTH QUEEN VICTORIA' S GRANT QUEENSBURY , NY. SA SITE UTILITIES * FIELD CHECK DIMENSION 1� ,56 QUEEN ANNE�COURT ( I PLOT PLAN & SEPTIC SYSTEM GUYER BUILDERS, INC • QV- 27 DWN : irSM id. 1-87 1 Scale : I 2V-0