Loading...
1987-851 '3?e' "'r' ." YP!r..eTt,;;"y�+ � . •,., .•[: ur�gi,•q_-;[°..: '• ?ts:6 CERTIFICATE OF C►CC+C MANLY' ? TOWN OF QUEENSBURY i WARREN COUNTY, NEW YORK Date _ August 28 1989 SDI t2b - 2 ` 1 This is to certify that work requested to be done as mhowm by Permit No, has been completed. This structure may be occupied so a 3£ of a two family dwelling Location 30 Queen Anne Court, Queen Victoria's Grant, Model L Owner _ Gu-ver Builders, Inc. � _r i By Order Town Board TOWW OF QUEENSBURY f Building 6 Wing Inspector i BUILDING PERMIThp TOWN 4F QUEENSBURY No. 87-851 0 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Queen Victoria ' s Grant r OWNER of property located at 30 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. a t. OWNER'S Address is Guyer Builders Inc . 119 Dunning St Ballston Spa , N . Y . 12020 w rti 2. CONTRACTOR or BUILDER'S Name Guyer Builders W 3. CONTRACTOR or BUILDER'$ Address rS W Same ids 4. ARCHITECT'S Name w 0 5- ARCHITECT'S Address r Ir ro m �y 6- TYPE of Construction — (Please indicate by X) ro 1 2 Wood Frame ( ) Masonry ( ) Steel I l r5 0 C ri 7. PLANS and Specifications rt No- 34 ' x 43 ' as per plot plan , Specification and Application including septic system and attached one car ,garage . MODEL L $. Proposed Use } of Two Family Dwelling �. a rn $5 . 00 C/o 00 75 . 00 88 r $ PERMIT FEE PAID — THIS PERMIT EXPIRES July 1 , 19� (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.) Dated at the Town of Queensbury this 9th Day of December 19 87 r-� SIGNED BY C:W� -�� for the Town of Queensbury p` Building and Zoning Inspector To $E COMP"'1'k:11 131 aaJuu . ,•++• • • Application No . [ f1 ► own a Qee1?enjgury Permit BUILDING and ZONING DEPARTMENT Permit Expires 19 Say and Fiaviland Road, R.[]. 1 Box 98 zoning Designation i OCT 3 $ ` Oueensbury, New York 12801 Variance No .Site Plan Review oe. S1 ! ' ; 4r<' % C, Approved by * p APPLICATION FOR /� /,J y'.friL1 Ell I L.D I NG AND ZON I NG PERM I T 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 : Gu er Builders Inc . P . O. Address 11g Dunning Street Ballston Spa , New York 12020 Tel , ( 518) 899-9161 Property Location : 30 Queen Anne Court Tax Map No . 121 / 4 / 2 Street number or building lot number Subdivision name { if applicable} Queen Victoria ' s Grant ISO THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES $99~916I Richard H. Guyer III Tel . No . Name P. O . Address Name of builder Guyer Builders , Inc -Address 119 Thinning Street Tel ( 518) 899-91b1 Name of plumber Yer Iders , nc .Address niU Yee Tel . Name of mason Guyer rs , McFeAddress ►g ree Tel . NATURE OF PROPOSED WORK : * ZONING INFORMATION : x Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED , Addition to a building drawn reasonably to scale and attached hereto , Alteration to a building * showing clearly and distinctly* all buildings , (no change to exterior dimensions) whether existing or proposed and indicate all other work (describe) set-back dimensions from property lines . Give " street and number or lot number and indicate * whether interior or corner lot . Show location FOR DEMOLITION PERMIT , STATE SIZE AND * of water supply and location and configuration T,=ATION OF STRUCTURES AFFECTELI. * of septic disposal area . * COMPLETE INFORMATION REQUIREDp$>~ - * Size of property loot pgan ft x NT'12 ft . L * Existing building ( s) Size ft X� ^ft . P'RDPOSED BUILDING AND USE : ofl 1 * Fisting buildings } Use � N/A Size of new strut a 34 ft X43 ft distdncefrom property line Foundation- p p pier slab crawl/partial/full * Proposed building , see of an cErcle one ) * Front yard 30+ ft Rear yard 30+ ft . Noe of stories (habitable Zpac�}e) 1ft . * Side yards I + ft and 15+ ft Height ( grade to ridge) 1 if on corner , setback from side street wwatt If residential , no * of families _ * OCCUPANCY INFORMATIONNo . of rooms (excluding baths ) Now of bedrooms 2 * PRIMARY BUILDING No . of ,,bathrooms one family dwelling This PiC�e J?e y.I{i1I�ll�r Prima heating system se ar e ectric* =Two family dwelling a� s * Number of units Type Iff fuel Electricity * Multiple dwelling / Noe of fireplaces to be installed No * permanent occupancy Will a wood stove be installed? No * Transient occupancy Central Air conditioning? * Business BUILDING 'STYLE, PRIMARY STRUCTURE * Industrial * Other ganc,h CvntemporaryL in If addition , what will use be? Duple Raised ranch Mansion * split level old style Bungalow * ACCESSORY BUILDING- Cape Cod Cottage Other * car Goiania) Row Town House Detached garage/one car/ two car/ Otte car { CIRCLE ONE PLEASE } * _Attached garage/one car/ two car/ * * „ * : * Private storage building ESTIMATED MARKET VALUE OF �� * other CONSTRUCTIONZt s . ./ FORMATION ON - BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET ■ To BE COMPLETEDI I3�I Form SPA 4/86 md-vl BUILDING PERMIT APPLICATION CONTINUED - :• ,• BUILDING SPECIFICATIONS : Type of construction , wood frame , fire sa.fe , etc , wood frame Will any second-hand or ungraded lumber be used? If so , for what ? na Foundation wall material concrete 'block Depth of foundation below Thickness $ Will there be a cellar? no rode (to bottom Of footing) of m2[lin7t]7n Will there be a basement? no Heated or unheated? Floor sq . footage Will any portion be used as livingspace? ft { If so, what port ' ? s p _ q, ft . - - Type of use ? Type of roof - sloped flat/shed/other Size , wood studs Material of roof F] rg ass shin les "x f " spacing 24 "o . c . length $ ft . exterior walls JOists ( floor beams ) 1st . floor N/A " .� .joists ( floor beams) 2nd . floor 4 — x spacing_ "o . c . span 11T/A ft , Overlays (ceiling beams ) x �.x F' spacing s"o . c span N A fto " spacing 24 o . c . span N/A ft . Roof rafters 2 '•x } " spacin 24 Roof trusses (pre-engineered) spacing 24 c11aspan 100 span 43 ' ft . Exterior wall finish stained Of what material ?Interior wall finish pain s eetrock 5 /8 x r x $ texture 111 If a garage is to be attached describe materials to be used for FIRE SEPARATION : 1 /2" type "X" sheetrock Is there to be an opening between +garage fond dwellin ? es door, enclosure, and self--closing device he ? - - -- If so will a Fire-rated Will a flue-lined chimney be installed? Na provided. yes IIIIIIo Depth of chimney foundation below grade N A fte1ght above roof N A ft . Depth of fireplace hearth N A ftt . in . Water supply oo Municipal or private well axUli.cipa2 SEPTIC SYSTEM Distance from ANY private well ( including adjoining (A separate application is necessarygy p g properties ft . See S . P . E . D, S , rrriito# (]ZU252]air or new installation of septic system) Town of Queensbury n n ► f r County of Warren A F F I D A V I T 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 too the proposed work shall be complied with, whether s ified or no authorized by the owner . and that such work is SWORN TO BEFORE ME THIS Signature _ __ _ Owner , owner ' s a "-'' - day of Ck' �r�+ lg g . a nitect , contractor ' yPublic, PATRICIA to a of N w Notary i'ublic, State of New York 7 Quatified in Schenectady County Notary Public, W _ 4717'048 # * * * * * * r * . * * * * � * • *Com*is*o*E*it*s Sep*. 30, 1'9. * • * * * * * * * * * yr ,r r t SPECIAL CONDITIONS OF THE PERMIT : Id �• .� 963 Square f"t living 288 Square foot 9"age -- ow stall 1224 @ $7 ,00/100" or part of 5 .00 One stall garage §5 .00 C/0 ATMX=i L Total By TOWN OF QUE' uNsouRY WARREN COUNTY . NEW YORK ,application for = STATExENERGYNCONSERVATIONIT IN ACODENCE FIIT�i THE NEW YOR1C A Permit must be obtained before beginning work . ALL of the following : , toira L 936 S .F . t Grass floor area d Baseboard electric Z . Type of heat No 30 1e the building mechanically cooled ? 15 . 9 4 . Percentage of area of windows and doors �► . over 164 0n1 1 • a0pVaedetofagross mbientaconditions of lsr roof / ceiling and f Does 24 yloor over heated spaces YES NO a . Ire If ouY # what is the R dESasSlvalue ? YES NO 3 . Slab on grade YES 10,0 AV 3f YES . what is the R value of insulation around perimeter of floor ? 40 is basement heated? YES NO a . R value of insulation so Type of insulation p . Under 16 � Only 1 . R value of roof and floors exposed to ambient conditions, R-3$ 2 . - R value of exterior walla XMXXX R-23 . 5 UA =0 . 04+ 2 . R value of glazed area 4 . R value of doors 8-14 . 9 5 . R value of floors over unheated spaces,_ N t► - f, , R value of slab edge insulation - unheated slab NIA lation - heated slab 7 „ R value of slab insu 12. 5 8 . R value of heated basement/ cellar walls ( above grade ) N A g . R value of heated basement/cellar walls (below grade ) N 100 Type Of insulation Fiberglass c « controls �. Thermostat maximum heat setting D . Duct ,Systems NIA aces ? YES NO Is duct syst 1 . am installed In unheated spaces ? a . if YESO R value of duct installation b . R value of duct in other areas E . Pipi�,�n9 1ng ulation NIA carrying agent pipe 1 . Size of hot water or cooling 2 . R value of pipe insulation g . Service water Heating NIA ,. •,.':v . 1 . Perfornance efficiency 2 . Temperature control setting maximum G , For Swimming Pool only NIA 1 . Maximum heating .� IN Teiephane No . ( 51$) 899-9161 ( ap,plicant ' a set na te1 TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT �`L1 BAY & HAVILAND ROADS 128pg QVEENSBURY, NEW D TELEPHONE (5I8 ) 792-5832 BUILDING INSPECTOR' S REPORT RE,QiJEST FOR INSPECTION RECEIVED NAME , ,r 1 Z440CA IN DATE -�-A PERMIT # � APPROVED YES NO FOOTING/PIERS MC)NOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH� IN XNSULATION- FOUNDATION FLOORS WALLS f ,CEILING VFINAL IN'SPECT=Ok: % CHIMNEY HEIGHT ,ROOFING -- -..�.....� SIDING EXTERNAL PORC E / EPS STAIRS-CLEA NRES&& ILS VA— PLUMBING LVE INTERIOR RI /PRIVACY RS FINISHED F ORS GARAGE IR ROOFING DOOR CLbSE (s) SMOKE 45ET TORS FINAL 814EC ICAL INSPECTION FINAL AP P VA OF CONSTRUCTIO A SIGNED CERTIFICATE OF OCCU'PAN MUST BE OBTAINED FROM THE BUILDING DEPAR ENT BEFORE THESE PREMISES ARE OCCUPIEPI REMARKS: L I SPECTOR TOWN Or QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1280&1 TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT �j REQUEST FOR INSPECTION RECEIVED NAME / IACATION (2 ie .r- DATE 7 PERMIT # APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FLEC INGTRICAL ROUGH-IN LATION: FOUNDATION FLOC7RS WALLS CEILING - FINAL INSPECTION: CHIMNEY HEIGHT — ROOFING SIDING EXTERNAL PORCHESI S Psi .STAIRS-CLEARANCE 6 S PLUMBING FIXTURES/REAEF. VALVE INTERIOR TRIMJPRIVAqi' RS FINISHED FLOORS ' GARAGE FIREPROOFI DOOR CLOSER (S) SMOKE DETECTORS FINAL ELECTRICAL NSPECTION FINAL APPROVAL O CONSTRUCTION_ A SIGNED CERTI ICATE OF OCCUPANCY .;MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISE ARE OCCUPIED! REMARKS: INS ECTOR TOWN OF QUEENSBURY pjv) . BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, YORK 7g2-58320 TELEPHONE { 5�) BUILDING INSPECTORS REPORT REQUEST FOR INSPECTION RECEIVED A7 NAME Y LOCATION DATE �7 IT dd APPROVED YES 1 NO FOOTING/PIERS MONOLITHIC POUR FO S_ FOUNDATTON/D MP-PROOFING BACKFILL APP VAL ��- ROUGH PLUMBIN FRAMING ELECTRICAL ROUGH'"wXN IJSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION : CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ TEPS_ STAIRS-CLEARANCE & RAILS LL PLUMBING FIXTUR S/RELIEF VALVE INTERIOR TRIM/ RIVACY DOORS FINISHED FLOG S GARAGE FIRED FIND DOOR CLOSERf ) SMOKE DETEC RS FINAL ELECTRI AL INSPECTION FINAL APPROVA OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED ? REMARKS: � c INSPECTO TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I280g4 TELEPHONE (518 ) 792-5832 BUILDING INSPECTOR' S REPORT ( � REQUEST FOR INSPECTION RECEIVED 7S 1 NAME LOCATION _�C� � ,G1} i t 11_17_ - r . � �[y1_• .�3{�� �L�/ DATE a, f PERMIT 00 d 7— APPROVED YES NO FOOTINGfPIERS MONOLITHIC NUR FORMS FOUNDATSC7Nf -PROOFING BACKLL AP F'I' AL ROUGH PLUMBING '+, ✓FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING 4` ,FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING ,°' EXTERNAL PORCHESIS2rEPS STAIRS-CLEARANCE I RAILS., PLUMBING FIXTURFJ1RELIEF VALVE INTERIOR TRIM1P IVACY DOOiS FINISHED FLOOR GARAGE FIR PR FING DOOR CLOSER (S .SMOKE DETEC S FINAL ELECTRIC L INSPECTION FINAL APPROVA OF CONSTRUCTION _ A SIGNED CER IFICATE OF OCCUPANCY MUST BE OBTAINED FRO THE ,BUILDING .DEPARTMENT .BEFORE THESE PREMIS S ARE OCCUPIED! REMARKS: IN ECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HA VILAND ROADS QUEENSBURY, NEW YORK 1280* TELEPHONE (518) 792~5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION DATE _ (� T PERMIT (/ "�J ^ APPROVED YES NO FOOTING/PIERS pp MONOLITHIC POUR FORMS FOUNDATTO N/DAMP--PROOFSNG BACKFIL.L APPROVAL 4.-ROUGH PLUMBING FRAMING ELECTRICAL ROUG,P!-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE RAILS PLUMBING FI,X'TURS/RELIEF VALVE INTERIOR TRIMIP IVACY DOORS FINISHED FLOOR GARAGE FIREPR FING DOOR CLOSER (S - SMOKE DETECTC#ZS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION f A SIGNED CERT -FICATE OF OCCUPANCY MUST BE OBTAINED FROM '. THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR _larun o/ Quee►ns6ury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D_ 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME & Jee�& LOCATION ,30 � �'t. ,y� Date Permit No . ✓ = APPROVED - YES NO Footing/Pier Forms L.F,wdndation Waterproofing Back€ill Framing Roofing Siding Masonry Vene r Rough Plumbin Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar. Drain Tile Concrete Floors Plhg , Fixtures Gar. . Fireproofin Do(> r. C Iosers Smoke Detectors Chimney L1 I,A T I ON Foundation II' Floors Walls Ceiling FINAL ELECT ICAL INSPECTION I)RIVEWAY AP ROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks-- Bu 1 ng nspector C>/f36 mc1-vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAN ROADS QUEENSBURY, NEW W PORK I2$0& 7 TELEPHONE (518) 792-5832 / BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPE TION RECEIVED NAME [ •,. LOCATIONAyap / DATE PERMIT # G1L.� ,APPROVED YES ffo FOOTING/P-FERS LwNOLITHIC POUR ` ORMS FOUNDATION/DAMP- OOFING BACKFILL APPROVA ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-I INSULATION: FOUNDATION FLOORS r WALLS CEILING Jp FINAL INSPECTION.- CHIMNEY HEIGHT NZ ROOFING SIDING EXTERNAL PORCHES/STE STAIRS-CLEARANCE & ILS PLUMBING FIXTURES'/ ELIEF VA VE -- INTERIOR TRIM/PR ACY DOORS FINISHED FLOORS GARAGE FIREPR ING DOOR CLOSERS SMOKE DETECT S FINAL ELECTRI L INSPECTION FINAL APPROVA OF +CONSTRUCTION A SIGNED ITIFICATE OF OCCUPANCY MUST BE OBTAINED M THE BUILDING DEPARTMENT BEFORE THESE PREES ARE OCCUPIED! REMARKS: C INSPECTOR own IQ BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R-D, 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION r Date/ Permit No . � � ✓ = APPROVED - VEc No ooting/Pier Forms ("Four da t io n 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 i INSC]I.ATTON : Foundation Floors walls Ceiling FINAL EEECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- Inspector 6/86 and-vl ...../vwn o/ �ueen36ur� 130LDING and ZONING Dr=PAFiTMENT Bay and Haviland Road, R. D. 1 Sox 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOcAT r oN1t''0 �, y _ DATE /d / PERMIT NO. SOIL TYPE - an Loam - clay Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , total iength Length of each trench ;r' Depth of trenches s Size of gravel:_ SEEPAGE PITS4Numb pf) Size- .2 -ft . X ,oft. Gravel size PIPING : Size Type .Bldg & to tank; 4 — � Tank to dis x bo . �----- Disto box t fi.el / Openings s4kaled? YES No ' Par al LOCATION,,�SEPARATIONq : Foundation to tank Foundation to alasoxpt ft . Absorption to lot l3 ft . Separation of pits i f LOCATION OF SYSTEM PROPER circle one) Front;.,' - Rear - Left ght side CCIMME.NTS SYSTEM USE APPROVED Y BuildWInseckor 01/66 and vl flown o/ Queens6ury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME QAA1 LOCATION &Q± 3 2 OLt.b'w Gla(G',I �l �---- DATE ._J PERMIT NO. SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , t tal length Length of each tren Depth of trenches Size of gravel_ f , SEEPAGE PITS4Number of) ry r Size- ft. X _ ft. ". S Gravel size ' r PIPING : S ze Type Bldg . to tank Tank to dist.r? E Dist . bax to t Openings sealS NO Partial LOCATION/SEPAFoundation toft. Foundation toion ft . Absorption toe ft. Separation offt. LOCATION OF SPROPERTY (circle one) Front - Rearide - Right side - CCHMENTS : SYSTEM USE APPROVED NO Suilclin . nspector 01/86 and vl I� BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS, FILE THIS COPY WITH BUILDING DEPT. WHEN RECNIIRED. it pA� l CITY OR TEMP. �y� y.� r } . _ VILLAGE isbu 7 TOWNSHIP ] p, ,�@ sy.�. Warr STREET AND OR AA,�,,.���� �,�.r �'-` usbur COUNTY dye,, ROAD AND �E NO. #30 � AmlC Court BETWEEN WHAT TWO POLE NO. CROSS STREETS IS PREMISES L OCATEDt SECTION BLOCK LOT OCCUPANTS NAME BUILDING OCCUPANCY OWNER'S NAME jh1j .L AIO f" . AND ADDRESS sF 1]rxG. 119 Durad g treet TEL_ # i u R 89"161. SUPPLIED BY .+' i " BUILDING FROM THEIR ��� _ �_,- OFFICE .;, � . .. . �- I � � . IS NEW OLD © V IWSORK NEW 13A DEFECTS a DDITIONAL REMOVED LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS No. of Fixturas & BRANCH Loca- Lamp Reeeptaelee MOTORS HEATERS CIRCUITS OFFICE USE don ONLY Ceiling Wall Recop'le Switch Pendant Bi- at No. TVPe E� NO. E� Ne. A. Oauyege INSPECTION Out- side Sub- bbowat Bear ment let Fl. 2nd FI. 3rd PI. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. This application is intended to carer the above-I fisted equipment to be inspected but if at time of i cli on there is found ou are authorized nsPe additional equipmerxt not above lisxed, Y o-1rixCyefd+yyto make she impaction arMl adjust the fee to covey the additional equipment, a Provided by the applicant. SiZr MAINSF 1N • FEEbER$ ELECTRIC SIGN LAMPS TOTAL {r WATTS OF WORK CHARACTER 4� � EXPOSED GAS TUBE SIGN 8exVice CONCEALED TRANSFORMERS OF VA STARTED S TO BE 41YUMBERP ICAPACITYI TAR COMPLETED SIZE OF SIGN SERVICE OVERHEAD UNDERGROUND ENTERS MAKER tLOIN 3= OF SIGN INSPECTION REQUESTED POSSSIBLE weave AS Will cell - NEW ❑ OLD Q AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION PRINT NAME AND ADDRESS ALL SPACES MUST BE FILLED iN OR APPLICATION MAY BE RETURNED, NAME OF {�'PL CANT Guyer Bui dersg �a DATE Of � ,p p�,,�,,, APPLICATION �LTm87 STREET ADDRESS 119 �g Street r. 1 61 �} -I �.i1..f3 TELEPHONE # CITY OR POST OFFICE �! B81ton �' " York 120M LICENSE ND. CODE WHEN APPLICABLE 46 EE (REV. )/as) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING