1987-928 I
CERTIFICATE OF O CCIJPA N%.O"�'
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
k D* October 20 jig88
f
This is to certify that work requested to be dare as shown by Permit No. -
28
has been eotmpleaed.
This structure may be occupied as a of Two Family Dwelling
1A)Cati 1 Margaret brave - Queen Victoria ' s Grant
on
OwnerGuyer Sunders , Inc .
I
By Order Town Board
I TO%" OF QUEENSBURY
Building & Zoning Vs tar
BUILDING PERMIT
TOWN OF QUEENSBURY 87_928 .
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Queen Victoria ' s Grant:
.N
OWNER of property located at 1 Margaret Drive Street, Road or Ave. l
in the Town of Oueensbury, To Construct or place a } 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 Oueensbury Building and Zoning Ordinance.
1 . OWN E R'S Address is fe
Guyer Builders Tnc . ro
119 Dunning Street
Ballston. Spay N . y . 12020
S'>
r'Y
2. CONTRACTOR or BUI LDER'S Name 0
ri
F-4
Same
v�
c�
3. CONTRACTOR or BUILDER'S Address
N
Same
rt
4. ARCHITECT'S Name
r-•
5. ARCHITECTS Address
rl
0�4
W
rH
ro
S_ TYPE of Construction — (Please indicate by X) n
d
( XI Wood Frame f ) Masonry I } Steel I 1 �•
7. PLANS and Specifications
No. 34 ' x 43 ' as per plot plan , specifications and application including
septic system and attached one car garage . MODEL L
8. Proposed Use
� OF Two Family
r�
r
rh
5 . 40 C /O V
75 . 44 PERMIT FEE PAID — THIS PERMIT EXPIRES July 1 , 19 88
$ w
(If a longer period is required an application for an extension must be made to t h a Building and Zoning inspector of the w
town of Oueensbury before the expiration date_}
Dated at the Town of Clueensbury this 31 s t Day of December 1987
,y N
SIGNED BY / ez;p _ for the Town of O.ueensbury
Building and Zoning Inspector
TO HE COMPIALTLD by nLUU . uxwelxv
IIi
/ Application No .
Awe aeeBQreib"l"� Permit Issued 19 (� '
BUILDING and ZONING DEPARTMENT Permit Expires 19 () CT 2 1987
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation
Ciueensbury, New York 12801 Variance No . East l €L`
Site Plan Review No . _ ?d•zlo
Approved by :
APPLICATION FOR
6/
BUILDING AND ZONING PERMIT
� e rr it +F ar ,>t it � +w +► *• +r �r it a it * * a• s e * e � �► ,:► *' * �► +r e * +r e e +r a :rw
A PERMIT MIDST 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 119 Dunning Street Ballston Spa , New York 12020 Tel . ( 518 ) 899-9161
Property Location : 1 Margaret Drive Tax Map No .
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 . Nov
Name of builder Guyer Builders , Inc .Address 119 Duruting Street Tel . ( 518) 899-9161
Name of plumber yes EU11clers , rnc .Address ng Street 'Tel .
Name of mason Guyer BuIlMrs , nc .Address n9 StreetTel . -
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
LOCATION OF STRUCTURES AFFECTED. * of septic disposal area .
* COMPLETE INFORMATION REQUIRED BETpW .
* plou
Size of property 100_ p an ft X 120 ft ,
* Existing building ( s) Size ft ]C �ftModel .
PROPOSED BUILDING AND USE : of L
FIT . * Existing building ( s ) Use NIA
Size of new strut a 34 ft x 43 ft "
Foundation-pier slab crawl/partial/full * Proposed building , sddiistee p�onceplan
om property line
circle one ) * Front yard 30+ ft Rear yard 30+ ft
No . of stories (habitable space ) 1
Height (grade to ridge) * Side yards ft and 15+ ft
g g 2'1 _0 ft ' If on corner , setback from side street ft
If residential, no . of families of 2
Nov of rooms (excluding baths ) - * OCCUPANCY INFORMATION
No* of bedrooms � 2
* PRIMARY' 'BUILDING -
No. of bathrooms one family dwelling pss m%k heei r
Primary heating system se ar a ectric* �-TO family dwelling �r
Type of fuel Electricity * Multiple dwelling / Number of units
)10. of fireplaces to be installed Permanent occupancy
Will a wood stove be installed? No * Transient occupancy
Icentral Air conditioning? No "
.. Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Other
Ranch Contemporary Lo cabin If additions what will use be?
Raised ranch Mansion Duple
Split level Old style Bungalow
Cape Cod Cottage Other * ACCESSORY BUILDING-
colonial Raw Town House '" Detached garage/one car/ two car/ car
Attached garage/one car/ two car/ 2m car
( CIRCLE ONE PLEASE ) _ xL
* „ „ * * * * * * ,e * * • # * * * '� Private storage building
ESTIMATED MARKET VALUE OF * Other
CONSTRUCTION
~ RFIATION ON - BUILDING SPECIFI 5 ON REVERSE SIDE OF THIS SHEETi To BE COMYLETEDI
HPA 4/66 md-vl
BUILDING PERMIT APPLICATION CONTINUED - ,
BUILDING SPECIFICATIONS *
Type of construction , wood frame , fire safe , etc , woad frame
Will any second-hand or ungraded lumber be used? If so , for what? np
Foundation wall material concrete block Thickness $"
Depth of foundation below grade (to bottom of footing ) minimum
Will there be a cellar? no Heated or unheated? Floor sq. footage $q ft
Will there be a basement? na Will any portion be used as living space?
( If so , what por ? sq. ft . - - Type of use?
Type of roof - sloped flat/shed/other Material of roof Fiberglass shingles
Size , wood studs "X 6 to spacing 24 "o . c . length $ ft. exterior walls
hoists ( €lour beams ) 1st . floor N/A "x " spacing "o . c . span N/A ft .
Joists ( floor beams ) 2nd . floor "X ' spacings 'o . c . spanl3 A ft .
overlays ( ceiling beams ) "X ON
spacing 24 "o . c . span N/A ft .
Roof rafters 2 "X 1 " spacing�4 O . C . span 12 ft .
Roof trusses (pre-engineered) spacing "o . c . span 43 ' ft .
Exterior wall finish stained Of what material? 5 /8" X 4 ' x $ ' texture 111
Interior wall finish Fain s eetrock
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 land dwelling? yes If so will a Fire--rated
door , enclosure , and self-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 NIA ft .
(A separate application is necessary . for an re air or new installation of septic system)
See S . P . E. D. S . permit # 026252
Town of Queensbury
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 to
the proposed work shall be complied with, whether specified or not , and that such work is
authorized by the -owner ,
e>
SWORN TO BEFORE ME THIS Signature _ __ __[��� --- --
Aa � � Owner , owner ' s agent , a�t , contractor
2. 1-St day of ;3 `-19 Eq PAULA CHRISTOPHER
Notary Public, State of New York )
r Ouali#ied in Schenectady County
F LA.. - No. 4864727
Notary Public , Warren County , N . Y . Commission Expires July 7 191ce
* * * * * * * * * _ * * * * * * * * * : * * * * * * * : it * * * * * * !. * ON
SPECIAL CONDITIONS OF THE PERMIT :
njn 963
square. foot sar"a, ' or" $ta11
288 @ $7 .00110014 or part of
1224
One atal l &AraeA
CIO . Pt
Total
By
TOWN Or QUESNSHURY 1hL++
WARREN COUNTY + NEW YORK
Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORRK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work .
yy
�►1}(iMRR ALL of the following :
, + Grose floor area 936 S . F.
. type of heat BasebNEEMEoard electric
3 . Is the buildings mechanically cooled ? No
46 Percentage of area of windows and doors 15 . 9%
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 an grade YES Li.Q
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
� . Under 16 . Only
i . R value of roof and floors exposed to ambient conditions.
R-38 0 . =0 . U26
2 . R value of exterior walls )2E9XX R-23 . 5 U. =0 * 04+
3 . R value of glazed area U. =() . 20
4 . R value of doors R-14 . 9
�.
5 . R value of floors over unheated spaces L NIA
6 . R value of slab edge insulation -- unheated slab NIA
7 . R value of slab Insulation - heated slab 12 . 5
V . R value of heated basement/ cellar walls ( above grade ) N A
98 R value of heated basement/cellar walls (below grade ) N/A
100 Type of insulation Fiberglass
Co Controls
1 . Thermostat maximum heat setting
D . Duct Sxstema N/A
10 is duct system installed in unheated spaces ? YES No
a . 119 YES , R value of duct installation
b . R value of duct in other areas
s . PlEing Insulation N/A
1 . Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulation
ro Service Water Heating
1 . Performance efficiency, N/A
2 . Temperature control setting maximum
G . For Swimming Pool Only
1 . Maximum heating NIA
telephone No . ( 518) 89"161
( applicant ' s s ature )
APPLICATION FOR SEPTIC DISPOSAL PERMIT
Ref : S. P. E. D. S .
DATE October. 9 ► 87 permit #
New York - 0202525
MWEL L of WE
LOCATION OF PROPERTY FOR INSTALLATION 1 Margaret Drive
Owner's Name: Oyer Builders , Inc . Telephone: ( 518) 899-9161
Address: 119 Dunning Street , Ballston Spa , New York 12020
lastaller's Name: Guyer Buders , Inc Telephone: 51$) 899-9161
il ,
2 A, Co E, I , it Ks L, M
Number of bedrooms (residential only) 2 _ 3 F, G , H
Total daily flow (compute @ 150 gal per bedroom) 300
Topography: circle one: lat Rolling Steep Slope 9N6 of slope
Soil Nature: circle one: Sand Loam Clay Other f Depth: $ ' feet +
Ground 'Water: At what depth? ulkmwn 8 feet +
Bedrock or Lapervious Material: At what depth? unknown feet
Percolation test: circle one: no# require required / rate min. inch.
Domestic water svpplyx circle one: Municip 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 Treach NIA feet I Total system. length N/A feet
* SEEPAGE PIT(S); Number of f Size each feet by feed
* Size of stone to be used # f Depth or Thickness feet
IMPORTANT * See S . P. E. D. S .
eeePlease...LIST NEW EQUIPMENT TO BE INSTALLER permit & attached
► * :tsssses * se * s * s * * * s * ,� e * * * * * * sss * s * s * * * * * map , .
(over)
Section ll SePtic System Laspectionss
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
l.) the proposed .location of the gystem
2.) location and distance to lot lines
3.) location and distance to structures
4.) location and distances to any water supply
5.) size and dimensions of all tanks, distribution
boxess tile fields and/or drywalls
B. No system shall be covered before inspection and approval by the building
Lzspector. 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.
1 have read the regulations above and agree to abide by these and ,all requirements
of the Town of Queestrsixury Sanitary Sewage Disposal C*djnance.
Signatures of.responsible person:
Dates
Town of Queensbury
Building and Code Department
Bay at Havilaad Road
Queensbury, New York 12801
(518) 792-5832
� /y Y39 FJ R141 ] 1T11l am nV • iiTW A �^1'y.'t nl AP IC 11'1 Y i
,...J'ou,re o� �ueer: s6ur+�t
BUILDING and ZONING DEPARTMENT
Say and Haviland Road, RX). 1 Sox 98
pueensbury, New York 12801
1 " BUILDING INSPECTOR ' S REPORT
NAME
LOCATION
Date Permit No .
-* * *
Footing/Pier Farms APPROVED YES No
Foundation
Waterproofing
Backfill
Framing
-'hiding
Masonry Veneer
Rough Plum3oing
Relief Valves
Ext . Porches
Finished Floors
interior Tr±m _
Stairs & Railings
Cellar Drain Tile
Concrete Floors ZO'
Plbg . Fixtures
Gar . Fireproofing
Door Closers , .
Smoke Detectors
Chimney
INSULATION -
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
URIVEWAX APPRO'VA
Final Building, Surrrey�=
Next scheduled inspection (call when ready }
Remarks-
Bu4v1j Inspe for
6/86 and-vl
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
Sod Haddon Avenue Coningewood, K.J. 08108
October 14s 1933
Cie [fz that the electrical equipment Iisted has been examined and is approved as being 1n accord
with the National Electrical Code, applicable governmental, utility acid Aigency rules.
Owner Guyer Builders Inc A
s'.`DCcupancy '�� Dw e l l i u
Occupant: Sing;1e $ anily
P r *""Ny
Location. 1 Margaret Drive , Queeusb=�rY t 4arren a 49O SY This eertilicate I the elecfricd equipment and inets list ion inspected this
date- 11 additional equipment should be mtroduCrid or alterations made to
_ existing system this Cefliiicata ahI be null and void: and application for
_ in shoutd ¢e suhmitted prOhlptly to this Agency.
Equipment: S 7 Outlets ; 30 Rec ep t:ac le s ; 12 F' LX G 4r es a Holder p1 this cartlficate angtlkl piasent same to his property insurance carrier
(agent or company)as evidence of certification of electrical eq ui p men l approved
150 Amp Service ; 7 Appliances asspecilied. , '
. 1..., M
i1! ice. •' e `_
Applicant: Guyer Builders Inc 0 . 15 -02�� 2�6
119 Duna ain Street J ,:
LBa1ls Lan S - NY 1232 J
Fat[n No. M EL f-68
flown of Queenjl "ry
BUILDING and ZONING DEPARTMENT
Bay and Hariland 'Road. R.CD_ 1 Sox 98
Queensbury. New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION r7
Date�f Per it Now -
��/
y s APPROVED - YES NO
Footing/Pier Forms -- �—
Foundation
waterproofing
Backfill
Framing
ing
Roof ing
Siding
Masonry veneer �—
Rough plumbing��
Relief Valves
Ext . porches
Finished Floors
Interior Trim —�
Stairs & Railings
Cellar Drain Tile
concrete Floors
plbg , Fixtures_ -
Gar . Fireproofing 1�—
t.
Door closers
Smo]ce Detectors
Chi ey
SULATION e
Foundation
Floors
Walls
ceiling
F INAI. ELF CTR.ICAA-L IL3 SPECTI ON _
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled insip,ectivn (call when ready )
Remarks-
Building nspector
6/86 and-vl
BUILDING and ZONING DEPARTMENT
Bay and Havifand Road, R.D . 1 Box 98
m Queensbury. New York 12801
BUILDING INSPECTOR ' S REPORT
NAMED,
LOCATION
Date 9 _ �� Permit No .
APPROVED YES NO
Foot ing/Pier Farms
Foundation
waterproofing
Backf it l
Framing
}goofing
Siding
Masonry neer
!Y,Rough PI ing—_��.��
Relief Valy r
Ext . Porches
Finished Flaa
Interior Trim
Stairs & Railing
Cellar Drain Tile
Cc-jncrete Floors
111bg . Fixtures
(;ar . Fireproofihtg � -
Door C.lasers -
Smoke Detector s —
Chimney
IN SUI.ATION
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION _
I)RIVEWAy APPROVAL
Final Building Survey
l3ext scheduled inspection Ccall when ready )
Remarks-
{
Sui ldi nsp+ectar
GfE3E� and-VI
�Jacun o� �ueen � � ur�
BUILDING and ZONING DEPARTMENT
Bay and Hauiiand Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAMES
J
LOCATION /.
DATE „ 7 / ! V PERMIT NO.
SOIL •"TYPE - Sand - Loam - clay -
Percolation Test Required? YES No
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorpti field , total ength
Length of ach trench
Depth of tr nches
Size o£ gram 1
SEEPAGE PITS4 umber f)
Size- ft. _ fto
Gravel size
PIPING : Size Type
Bldg . to tank
Tank /30.
c , x
Dist. field pit
Openial ? ES NO Partial
LOCAT RATIONS :
Foundo tank ft.
Foundto absorptiAbsorto lot line ft.
Separf pits ft.
LOCATSYSTEM ON PRO ERTY (circle one )
Front - Left side - Right sideCnMME
SYSTEM USE APPROVED YES N
Hualdi g Inspector
01/86 and vl
aavn o/ Queens6ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM IINSPECTIO,N�L
NAME �..GR .j am'
LOCAT I ON cl 4 c
DATE *af-A:5z PERMIT NO ..
SOIL TYPE - and Loam - Clay -
Percolation Test Required? YES - ]
Percolation rate - min/Inch _
TYPE of SYSTEM:
Absorption fieldr total length
Length of each t1n
ch �----
Depth of trench.5
size of gravel ---
SEEPAGE PITs4Number of) T
Size- _ft. X -9 ft.
Gravel size
PIPING : ze TYpe� �, ��
Bldgm to tank
Tank to dish.. 'box
Dist. box to field/ `/ "
ppenings sealed? E NO Partial
LOCATION/SEPARAT ONS :
Foundation to t ]� ft.
Foundation to sorption ft.
Absorption to of line ft-
Separation of Pits ft.
LOCATION OF STEM ON PROPER (circle one]
Front - Rear - Left side - Right side
CC94KENTS :
&A. 7'oZ
SYSTEM USE APPROVED YES NO
Building Inspector
01/86 and vl
_J'uurre 101 Queens ury
BUILDING and ZONING DEPARTMENT
Bay and Havifand Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME �
LOCATION
Date /L7 / Permit
* * * * * * * * * y * APPROVED* -* YE+* . NO
footing/Pier Forms
Foundation
Waterproofing
liackfiIl
Framing
Roofing
Siding
Masonry Veneer _
Rough Plumbin _
Relief Valves
Ext . Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Til
Z,,�ncrete Floors
Plbg . Fixtures
Gar . Fireproo ing
Door Closers
Smoke Detec ors
Chimney
IN s L3 LAT I O
Foundatio
Floors
Walls
Ceiling
FINAL E CTRICAL INSPECTION _
DRIVEWAY PROVAL
Final Building; Survey^
Next scheduled inspection (call when ready )
Remarks-
Building Inspector
6/86 and-vl
,_ftlturt o� upen3trurt
BUILDING and ZONING DEPARTMENT
Bay and Hauiland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPOR
NAME
LOCATION � . '' �r
Date /�1�� -� 7 permit
APPROVED* -* YES* NO
Footing/ pier Forms r
L.�ndation
Waterproofing
Backfill
Framing
Roofing �.
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext . Porches
Finished Floors
Interior 'Trim
Stairs & Railings
Cellar Drain Til
Concrete Floors
Plbg . Fixtures
Gar . Fireproo ing
Door Closers
Smoke Detect rs
Chimney
INSULATION :
Foundation
Floors
Walls_
Ceiling
FINAL ELECT CAL IN
SPECTIC7P3 c.
DRIVEWAY APPRQ
Final Building, Survey*
Next scheduled inspection ( call wt►en ready )
Remarks-
Build ' ng Inspector
S/86 and-vl
/own Of Q"Oen31 ssry
BUILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R.D. 1 Box 98
oueensbury. New York 12801
BUILDING INSPECTORfS REPORT
NAME 1 9 �'iy'L-
LOCATION
L1ate�� Permit No *
fir'" APPROVED - YES NO
�ng/Pier Forms
Foundatio
Waterproo ng
Bac'kf i.l l
Framing
Roofing
Siding
Masonry Venee
Bough Plumbing
Relief Valves
Ext . porches
Finished Floors
Interior Trim
stairs & Railings
cellar Drain Tile
Concrete Floors
Plbg . Fixtures
Gar . Flreproofi
Door Closers
Smoke Detecto
Chimney
INSULATION
Foundation
Floors
Walks
Ceiling
FINAL EL TRICAL INsPECTION�_�- -
DRIVEWAY APPROVAL,
Final Bu kding Survey.
Next scheduled inspection (call when ready )
Remarks-
Build! g Inspector
6/86 and-vl
BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF 'FIRE UNDERWRITERS.
FILE THIS COPY WITH BUS LOING DEPT. WHEN REQUIRED.
TEIIiw x DATE
CITY OR t����
�'"�
VILLAGE �LAss- 's7 TOWNSHIP COUNTY ` r " '
STREET AND NO. 00
ROAD AND PALE NO. 1. Nwwg=et DrIY@ ..._.—. POLE NO.
BETWEEN WHAT TWO
CROSS STR E ETS IS
PREMISES L TEO? T14N BLOCK LOT
OCCUPANT'S BUILDING
NAME OCUPAMCY
OWMEROS E TEL. 899F-916
1
AND ADDRESS } ' e11p T71ring StreetCURRENT
SUPPLIED ;t._, FROM THE OFFICE
BY '�aqDEFECTS
IBUILDIh1G _ NEWXJ OLD D ISO " NEW IP AQOITIGNAL D REMOVED D
LIST BELOW ALL EQUIPMENT WHICH Q IN
Ne. of Fi:twr 5 MOTORS HlA7ERB.'� GBRRdNCH OFFICE USE
NUMBER OF OUTLETS Lamp Reaptedrs ONLY
Loan- -7
tion ffiide Ateaeh't H.P. Watts A.W.p.
C.Bbw War Reap h Staitoh Pe.mene B ■e Ne 'Tvve Each Na. , Now B� INSPECTION
put•
Sub-
ber
Berm
ittent
i 1st p{
Snd FI
9rd FI,
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE..
This application is iotended to comer the above- ad equipment to be inspaeted but it at time M inspection there is foal nd additional equ Wunsttt not show Iotna,
you are authorized to make the inspection and adjust the fw to cover the additional equipment, as Provided by tM applitant. ....
STYE OF EL ECT R rC SIGN TOTAL
MAINS 150 Awo, FEEDERS LAMPS WATTS
CHARACTER EXPOSED GAS TUBE SIGN
OF WORK ROUghIn „..�� gIBJrqrJCe CONCEALED TRANSFORMERS OF VA
WORK TO BE INUMBERI ICAPACITYI
STARTED CINOPLETED SIZE OF SIGN
SERVICE OVERHEAD UNDERGROUND MAKER
ENTERS OF SIGN
ING
INSPECTION REOUESYED
OW7SSIBAE NEAR AS NEW � OLD � q
AVOID DELAY BY GIVING FULL AND ACCURATE INFDRMATIO . ALL SPACES DATE OF 10¢ 6.,.. 7
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION-
PRINT NAME AND ADDRESS
NAME OF SIGNATURE
APPLICANT OF APPLICANT
t
STREET ADDRESS _. 1 .3-911 AwAxingSt roi6t- TELEPHONE
CI 3Y OFFICE CODE 12= WHEN SE Mo.
PI AAPPLWASLE
AG EL (REV. f/86) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
QUEEN VICTORIA'S GRANT
QUEENSBURY, N.Y.
CLEAN OUT
TO GRADE
-.. 99.
M
Mq RGA RF T
6-0 DIAMETER
9=O DEPTH
2000901
pR\\JE
VN
v
1�
REFERENCE DRAWINGS
5 SITE UTILITIES
SEPTIC ( WATER
VonDUSEN t STEVES
SURVEY PLAN