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1987-809 f!s --MJRWw-IMr if: .,r.,,,'i Wx 'IA .. .�, '4. �t s a:. . . . . _ k CERTIFICATE OF OCCUPAM�Y f TOWN OF QUEENSSURY WARREN COUNTY, NEW YCIRK j Date Su gust 12, 19 88 This is to certify that work requested to be done as shown by Permit No. 87-809 has been completed. This structure may be occv as a - One Family Dwelllnp Location srishops Court Van Howe Estates � Owner Classic Home Builders 3nc « i By Order Town Board i TDWN OF QUEEN$BURY i Building & Zoning Inspector 1 Ik I • BUILDING PERMIT TOWN OF QUEENSBURY No. 87-809 , WARREN COUNTY, NEW YORK ;D PERMISSION is hereby granted to 'Classic Home Builders c 0 OWNER of property 56 Bishops Ct . 1 P per#y located at �o S#reef, 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. 1. OWNERS Address is P . O . Box 14421 t� w Albany , N . Y . 12212 {0 crr W n 2. CONTRACTOR or 13U1 LDER'S Name o Bob Howard El W 3. CONTRACTOR or i3U1L1]ER 'S Address N ram.. 1770 Central Ave . f° rt Albany, N. Y . 12205 H 4. ARCHITECT'S Name n 5. ARCHITECT'S Address tn o• to N- tn 6. TYPE of Construction — (Please indicate by Xi d ao I ]j Wood Frame I ) Masonry f } Steel 1 I Ca) 0 s;- 7. PLANS and Specifications r-r No. 64 ' x 32 ' as per plot plan , specifications and application including septic system , attached two car garage and driveway permit S. Proposed Use One Family Dwelling G? iC $5 . 00 C/O aT 171 . 00 $ PERMIT FEE PAID - THIS PERMIT EXPIRES June 1 , 19 88 (If a longer period is required an application for an extension must be made to the Buildingand Zoning m g Spector of the town of Queensbury before the expiration date.) d E m Dated at the Town of "- Queensbury this 30th November Day of 1s 87 SIGNED BY r _ �} oa �� �--�'�'` •--�'--�-'�� for the Town of Queensbury Building and Zoning inspector ,/ - TO BE COMPLETED BY BLDG . DEPT . �] / Application No . _JUwn 014 QUeen3b"ry Permit Issued 19 fWN BUILDING and ZONING DEPARTMENT Permit Expires 19 !; 12 Say and Ha�riland Road, R. Q. 1 Box 98 Zoning Designation i Queensbury, New York 12801 variance No . NOV 16 +J�! Site Plan Review No . r _ G Approved by . APPLICATION FOR PUIL.DING AND ZONING PERMIT � 61v 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 , 4fL /_ /�.,[� 701-1 P . O. Address Tel . (_{e 11 Property Location : CIZ Tax Map No .gnf /44r Street number or bui yd�ing�jlooft number1 / Subdivision name ( if applicable) _�.(�-.c...r�F— id n THE PERSO SPONS BLE FOR SUPERVISION OF WORK AS REGARDS BUILDING= ,CODES I _ Name . O. Address T 1 . No . Name of builder Address Tel Name of plumb e Address Tel .. ? 3 Name of ma Address Tel . son 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 . x COMPLETE INFORMATION- REQU�,R.EDD B Size of property b ft X ft . * Existing building ( s )r Size ft X ft * * PROPOSED BUILDING AND USE : * Existing building ( s ) Use Size of new structure ft X t Foundation-pier/slab/crawl/partial/full Proposed building, distance from property line ( circle one ) * i 66' No . of stories (habitable space) ^y * Fide yard ft Rear yard ft Height ( grade to ridge ) a ft , * Side yards 1 �, ft and 16 ft If residential , no . of families ^� * 2f on corner , setback from side street ft No . of rooms ( excluding baths ) _ ' * OCCUPANCY INFORMATION No , of bedrooms_ 41 No . of bathrooms * P IMARY BUILDING - Primary heating system * One family dwelling Type of fuel .� rsan '► * ��''``''��Two family dwelling No . of fireplaces to be installed GI * Multiple dwelling / Number of units Permanent occupancy Will a wood stove be installed? � * Central Air conditioning? AD � Transient occupancy * Business BUILDING STYLE, PRIMARY STRUCTURE * Industrial Ranch Contemporary Legg cabin * Other Raised ranch Mansion Duplex If addition , what will use be . Split level old style Bungalow Cape Cod Cottage Other * ACCESSORY BUILDING- / -�3Erriial Row Town House * Detached garage/one car/ tw / car CIRCLE ONE PLEASE ) * Z177Attached garage/one car/ a ca f cagy * * * * * * * * * * * * * * * * * * Private storage building ESTIMATED MARKET" VALUE OF * —Other CONSTRUCTIt7N ._G?(� INFORMATION ON BUILDING SPECIfFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETES] ! Form BPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , od fra , fire safe , etco Will any second-hand or aded lumber be used? If so , for what ? Foundation wall material eim( _ RLQ1..Thickness_ �J )bL('�, 1,�\ Depth of foundation below de (to bottom of footing )i 1 Will there be a cellar? ated or unheated? UIM., UFloor sq. footage sq ft Will there be a basement? will any portion be used as living space? LA j) ( If so , what portion? _46sq ft . - - Type of use? Type of roof - pe flat/shed/other Material of roof Size , wood studs"X fQ - spacing f �a "o . c . length $ft . �} Joists ( floor beams ) 1st . floor c "X_ 1' * spacing (Q o . cm slan 4, Joists ( floor beams ) 2nd _ floor —"x__ ^1� j_,." spacing___"o . c . span_„_N_�-__f t . f y 14 cea. ling beams } "x " spacing "o . c . span ft . ` "x " spacing 1. o . c . span ft . Roof trusses (pre-engineered) spaqing "o . c . span t . Exterior wall finish 1 11 % Of wha t rial? 4'l� 11C�� Interior wall finish �k J If a garage is tq be t ached scribe materials to a sed fo FIRE SEPARATION : I Is there to b6 an opening between qardgW and dwelling? kj ,04r, If so will a Fire-rated door , enclosure , and self-closing device be provided? will a flue-lined chimney be installed? AAt) Height abbve roof, - - ft . Depth of chimney foundation below grade �Tt . Depth of fireplac arth ft . in . Water supply - 4Qjirc or private well SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties t . (A separate application is necessary for any repair or new installation of septic s stem) Town of Queensbury County of Warren A F F I D A V I T STATE OF New YORx 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 . SWORN TO BEFORE ME THIS Signature _ - ------- - __ ----____ ---� -- day of 19Owner , owner ` st ' cn+� l+� c{�� f p Notary Public , Warren County , N . Y . SPECIAL CONDITIONS OF THE PERMIT : By-------------------------- ------ TOWN OF QUEENSSURY 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 (��r+ s 3 . is the building mechanically cooled ? 0 4 . Percentage of area of windows and doors A . Over 16 % Only 1 . U value of gross area of walls , r / ceiling and floors exposed to ambient conditions GfJii6T�5 2 . Floor over heated spaces E NO a . Are foundation walls ins a. ted ? YES NO 1 . If YES , what is the R value ? 3 . Slab on grade YES ;)Value a . If YES , what is the of insulation around perimeter of floor ? 4 . Is basement heated ? YES /NO a . R value of insulat ' t 5 . Type of insulation Grs B . Under 16 % Only IV va �f goof an ov] O ,sex sed r ,so �b ,e� t 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 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 ) I 11 10 , Type of insulation C . Controlsyy�jC� 1 . Thermostat maximum heat setting // D . Duct Systems 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 E . Piping Insulation 1 . Size of hot water or cooling carry agent pipe_ 2 . R value of pipe insulationAl F . Service Water Heating 1 . Performance efficiency �� 2 . Temperature control settinglm-a imum G . For Swimming Pool Only y� / X 1 . Maximum heating illJ Telephone No . ( applicant ' s signature ) APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE f I LOCATION OF PROPERTY F011k INSTALLATION Owner's Name: ljy' eiepphone: VQ�� Address: _ 1 - ! 1 r A + V 4 zo LC Installer's Name: Oatlephone: Number of bedrooms (residential only) Total daily flow (compute @ 150 gal per bedroom) Topography: circle one: Fiat Rolling; Steep Slope of slope Soil Nature: circle one: nd Loam Clay Other / Depth: feet Ground. Water: At what depth? feet Bedrock or Impervious Material: At what depth? _� feet Percolation test: circle one: not requi required / rate min. inch. Domestic water supply: circle one: unit' al Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption _ feet PROPOSED SYSTEM : Septic "Tank gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench j! �: feet / Total system length feet SEEPAGE PIT(S) : Number of 1"1 f Size each feet by feet t i f /T— Size of stone to be used # �f f Depth or Thickness EJ �� 14=1q 4e4Q " 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 showing: l .) 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. l have read the regulations above and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Drisposal Ordinance. Signature of responsible person: Date: Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SECTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE fnurrf o/ teeer� i�urt BUILDING and ZONING DEPARTMENT Bay and Haviiand Road, R.D_ 1 Box 98 fr � Queensbury. New York 12801 0J 8UILDING INSPECTOR ' S REPORT NAME LOCATION C-1- Date-z ;f/^�/ _ Permit No . ✓ OV - Footing/pier Forms APPR E YES NO Foundation Waterproof ' ng Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing - Relief Valises Ext . Porches s r! z Finished Floors Interior Trim !r/' Stairs & Railin s Cellar Drain Tile Concrete Floo s Plbg . Fixtur Gar , Firepro fing Door Closer Smoke Dete ors Chimney IN SU LAT l p Foundatio Floors Walls Ceiling FINAL E ECTRICAL INSPECTION DRIVEWAY APPROV Final Building Survey Next scheduled inspection ( call when ready ) Remarks- di g Ins ector 6/86 and-vl 4057391 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [�ta 41 STATE STREET, ALBANY, NEW YORK 1220.7 Date AtzgLlSit 18 , 1988 Application No. on fide 0092271 / 68 � � ry y � � G THIS CERTIFIES THAT e �p�f#cyt� ttEE t1�e jorl�+ys 2 S pC� only tJs�.rlectricel Mi ."r.t an deae Bl b�L�erawad "" inrscsd bIf C1 LG'S SfYCl 3 C G1tlr C �Se t' LL1 J $ r E't1 Y OZt Clast=f c Hc7ina Ott ers inc . I�--yy IIC�II in the jollosnlng location; se Bamen! Lam" let Ff. L'J $nd Fl. outside Section Block Lot # 56 waa examined on 8 — 10 �8 8 and ound to be in corn liance with the r.l" p eQuirerrsenEs of this Hoard. FIXTURE ALES SWITCHES FIXTURES RANGES COOKswa 0*CKs OVENS DISH WASHERS EXHAUST FANS OVTLRTS INCANDESCENT F WOMSCEM► y AMT. C w- AMT. K- W. AMT- K.W. AMT. %. w. AMr. H, P. 26 43 18 26 1 4 ' 3 fr DETERS FURNACE MOTORS pLnu E APFLIANCE FR7IIRRS SPECIAL RRC'FT TIME CLOCKS REkL UNIT FIlA YRR$ MULTI-OUTLET DIMMERS AMU K. W- OIi H. P. GAS H. P. AM AMT, AMP. AMr. AMPS. TRANS. AMT. N P- SYSTEMS AMT. WATT$ NO. OF FlET dry r # 7. 3. SERVICE DISCONNECT NO- OF S ! R V L C E AMT, AMP. FYFE@QW. 1 .e' 2W 1 0 Sw 3 X 3w 9 .e' 1W nit OF CCMD CC CW+D. NO. OP M-tEG OF•H G No. of NEurfIALS A. W. . 2W � C X OTHER AP►ARATM " g C 1 - smoke detector Era Electric Co . �a• — - /.> _ `�RD #f 4 339 Candleberry Drive ! Glens Balls , New York 12801 239 BRANCH MANAGER Per 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. - -- - —. . . --- -- ---- -- — - - -- `---- --- - - -- -- .,--- -- - . .- .Joevre o� �ueer� s6urtf BUILDING and ZONING DEPARTMENT �t Bay and i R. L . 1 Box 98 Queensnsburyury, New York 72807 BUILDING INSPECTOR ' S REPORT NAME ` �r � 0 � .� /�'�J`XC �,�-w- --i• ,mac=s_c_ .a LOCATION_ Date s'/Of (c_. 7 Permit No . tf7 r :40F APPROVED - YES NO FootingfPier 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 . Fireproofing Door Closers Smoke Detectors Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECTRIC L INSPECTION _ DRIVEWAY APPRO AL Final Buildin Survey 1 Next schedule _/d_ ,i�ns(p�ection ( call when �"�ready ) Remarks- ,�+�J �t`�. aV } cry i4 r' )) v 0 r� 4Z. , Building Inspector 6f86 and-ul __fawn 0/ 'Qiueenshury BUILDING and ZONING DEPARTMENT Y Bay and Haviland Road, R. D. 1 Box 98 1 Queensbury, New York 12801 SEPrT. I,rC� DISPOSAL SYSTEM INSPECTION NAME I lrr^ Xrxe LC]CAT ION � j ar,es y4L --,� ,z_ _ DATE .S - f PERMIT NO .� '/�- ' SOIL TYPE Sand Loam - Clay - Percolation Test Required? YES -� Percolation rate - Min/Inch TYPE of SYSTEM : Absorption field , total length Length of each trench �] Depth of trenches Size of gravel SEEPAGE PITS-(Numb r of) Size- ft. X ft. Gravel size PIPING : w=iz Type Bldg . to tank �`� Tank to list . box Dist . box to field/p . t Openings sealed? NO Partial LOCATZON/"SEPARATIONS Foundation to tank eft. Foundation to abso Lion =ZMZ_ft . Absorption to lot ine f t. Separation of pit ft. LOCATION OF, SYST ON PROF* TY (circle one ) Front <ltea L ft side - ight side CCMMENTS : SYSTEM USE APPROVED YES NO AuiineagT n 01/86 and vl _.town v/ Queens ury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 ILDING INSPECTOR ' S REPORT A Ni E LOCATION - Late /& permit No . ✓ = 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 , Fireproofing Door Closers. Smoke Detectors Chu ey SULATION : Foundation Floors Walls Ceiling . :jf - FINAL ELEC tors INSPE TION DRIVEWAY A PROVAL Final Building Survey Next scheduled inspection ( call when ready Remarks- Building Insp ctor 6/86 and-vl - 40 BUILDING and ZONING DEPARTMENT B y and Haviland Road, R.D. 1 Box 98 Oueensbury, New York 12801 LF3ING INSPECTOR ' S REPORT NAME LOCATION OF Date Permit No . ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Rackfill raming Roofing Siding Masonry Ve er ough Plumb g Relief Valve Ext . Porches Finished Floo s Interior Trim Stairs & Rai.li gs Cellar Drain Ti e Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELTAR L INSPECTIC3N DRIVEWAY L Final Buiurvey Next schenspection. (cal when ready ) Remarks- V yam_ 162. F3 ding ector 6/85 and-vl .t7 ��� .�Jawr� o� '�ueen.s6urt� BUILDING and ZONING DEPARTMENT Bay and Haw"rland Road, R.D. 1 Box 98 Oueensbury, New York 12801 I L17ING INSPEC TOR ' S S REPORT NAME ' LOCATION L7atef�� Permit - Footing/Pier Forms APPROVED YES NO Foundation Waterproofing Backfill gaming Roofing Siding Masonry Vene r c.A[Sugh Plumbin Relief valves Ext . Porches Finished Floors Interior Trim Stairs & Railing Cellar Drain Tile Concrete Floors P1bg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRI L INSPECTION DRIVEWAY APPR AID Final Buildin Survey Next scheduled inspection (call when ready) Remarks- At' / &tA".� 0g ~) P� �►- .,fin-�c- ,�� 6j86 and-vl Building I ector f2o D ueen9h�tryt BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME..._ c/rY �f LOCATION ; 64 Dater A f Permit No . J � ✓ APPROVED - YES NO Footing/Pier Forms Foundation Waterproof '_ngXz Backfill Framing Roofing Siding Masonry Venee Rough Plumbing Relief Valves Ext , Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Til Concrete Floors Plug . Fixtures Gar . Fireproo ing Door Closers Smoke Detec rs Chimney INSULATION Foundatio Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Rema rks-- Building nspector +6/86 and-vl _7oty ur1�} BU,LptNG and ZONING DEPARTN x 98 Bay and Havilgvd Road,Q een�{ U y. New York G128� E3U1, ILU11* INSPECTOP ' S REPORT NAME LOCATION Permit No - Date /�� * * * « * * * * * * * * NO APPROVED - YE {Footing/pi r Forms foundation waterproofin Back£ ill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief valves I:xt . Porches Finished Floors Interior Trim Stairs & Railings Cellar Efrain Tile Concrete Floors P1bg - Fixtures Gar . Fireproofing Door Closers Smoke Detectors chimney IN SUI,ATION Foundation Floors Walls Ceiling_, M ECTRTC INSPECTION I]RIVEWA.Y APPROV u Final Building Srvey Next scheduled inspection < ca ll when ready ) Remarks- IZ ildi g Inspector fi/86 and-vl 01 � � ;� ..�../cicu�e o� �uee►rsfsur� fLDING and ZONING DEPARTMENT Bay d Havifand Road, R. Q. I Box 98 (r � � sbury, Now York 12801 ILDf INSPECTOR " S REPORT LOCATION Bate � � / Permit Nca - --0 ' CJ q {.I aotin APPROVED - YES NQ g/Pier Forms Foundation Waterproofing I3ackfill P rami ng Roofing Siding Masonry Veneer - Rough Plumbing Relief valves — Rxt , 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 EIECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks— h Building Inspect /$ and-vl BUILDING DE PT. COPY OF APPLICATION FORM 46-ELe NEW YORK BOARD OF FIRE UNDERWRITERS. F1LE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. TEMP. s DATE CITY OR VILLAGE91 TOWpISNIP cAila*IACOUNTY STREET AND NID_ OR ROAD AND POLE NO.BETWEEN POLE N CROSS STREETS Its PREMISE TEO. ~ 11 ,ON BLOCK LOT OCCUPANT'S BUILDING NAME OCCUPANCV OWNER'S NAM / AND ADORE TE L. SCURRENT UPPLIED layLe FROM THEIR OFFICE (BUILDING N r OLD ❑ IWSORK DEFECTS NEWIV ADDITIONAL ❑ REMOVED LIST BELOW ALL EQUIPMENT WHICH YOU N TALLED NUMBER OF OUTLETS NLMW Poee��ir MOTORS HEATERS CIRCUITS OFFICE USE Loco ONLY cook" y :_ n.`o •k` s..rrll. P.,,u.,R Bracket aye. TyP. Each No. E� Ne. Gamma' INSPECTION Do*. sire sus beat ere- ,fatMt . n�r-ti 7rt Ft. Fl. ( f 3rd FL �H REMARKS. LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. This appKcation is intended to C.OMOr' the ab l fisted equiprnant to be inspected but it at Time of i ntpreNwt Sheer 4 found additional epuipmen7 not abanr fisted, you are authoriead to make the irspecTion and adjust the fee to cover the additional equipment, as pna bled by the applicant. STYE OF ELECTRIC SIGN TOTAL MAINS FEEDERS LAMPS WATTS CHARACTER EXPOSED GAS TUBE SIGN OF WORK CONCEALED TRANSFORMERS OF VA WORK TO INUMB£fU SCAPACiTVI STARTE CUREPLETED SIZE OF SIGN SERV#CE ? OVERHEAD UNDERGROUND MAKER ENTERS 'IL 1 OF SIGN INWECTIOft FlEdUESTED ON OR Ag AS I POSSIBI_ NEW OLD AVOID Del 06 AXMY GIVING FULL AND ACCURATE IN FO RMATJON. ALL SPACES TE Op MUST B ILLEO Y U OR APPLICATION M BE RETR"Ed. AP111117 E PLICA N PRINT N,AMEtAN IADDRMS 1 - _ NAME OF 3 SIGNATURE , rr" APPLICA ,rwr�s f, 1- SIGNATURE APPLICANT STREET A { i/ U" [ � TELEPHONE POST OITY N ! 'I �� ZIP OOOE LW #EN APPLICABLE Ae EL (RV. 't/f,6] A SEPARATE APPLI AT�,D�1 MUST BE FILED FOR EACH SEPARATE BUILDING 144 - T . ? � a e ti tJ.ard-- = Alor/r clBs C !eo , /*fo -7 V[x► Dusen & S' te v+es LAND SURVEYORS GLENS FALLS , NEW Y ©RK N. Y. STATE L1C , NO, 35617