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1987-923 pin .'' + ,-S: ai�i,6 :i¢ck r} : r ` h I i CERTIFICATE , OF O CCUPAMCel"Y ± TOWN OF QUEENSBURY I WARREN COUNTY, NEW YORK i Date May 5 lq 89 8 7-9 2 3 This is to certify that work requested to be done as shown by Permit No. i has been cotnpieted. ] of Two Family Dwelling; This structure may be occupied as a J M� 15 Queen Anne Court -- Queen Victoria ' s Grant Owner Guyer Bullaers , Inc . 1 By Order Town 'Board TOWN OF QUEENSBURY a Building N Zoning inspector f t I i I BUILDING PERMIT TOWN OF QUEENSBUR'Y'' No. 87-923 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Queen Victoria ' s Grant N l OWNER of property located at 15 Queen Anne Court Street, Road or Ave. in the Town of Queensbury, To Construct or place a i 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. t. OWNER'S Address is Guyer Builders Inc . 119 Dunning Street Ballston Spa , N . Y . 12020 - a ro 2. CONTRACTOR or BUILDER'S Name Same C r• n ri 3. CONTRACTOR or BUILDER'S Address Same 'o w v� G7 4. ARCHITECT'S Name rt 5_ ARCHITECT'S Address ln B. TYPE of Construction — (Please indicate by X) c! M ra (X ) Wood Frame { I Masonry { I Steel ( 1 7. PLANS and Specifications (o No. 32 ' x 48 ' as per plot plan , specifications and application including � septic system and attached one car garage . MODEL J 8_ Proposed Use +� of two Family dwelling v $ 5 . 00 C /O $ 89 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 1 i9 88 0 {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.) Y• F-• (Dated at the Town of Queensbury this ,r 31 s t pay of f�] December 19 87 � SIGNED BY for the Town of Queensbury Building and Zoning Inspector TO HE COMPLETED BY BLDG . DEPT. ` Application No . A ` awn v/ QW,04'►' ig"ry Permit Issued 19 ! Cam BUILDING and ZONING DEPARTMENT Permit Expires 19 ' Say and Maviland Road, R.D. 1 Box 98 zoning Designation ' ` tf OT 2 1937 Queensbury, New York 12801 Variance No. Site Plan Review No . f ; r _ Approved by . APPLICATION FOR ��- UU I L.D I NG 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 property is : Guyer Builders Inc . P . O. Address 119 During Street Ballston Spa , New York 12020 Tel . ( 518) 899-9161 Property Locations 15 Queen Anne Court Tax Map No .12I- /.Lj 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. D. Address Tel . No . Name of builder Guyer Builders , Inc -Address 119 Dunning Street Tel . ( 518 ) 899-9161 Name of plumber yer a rs , nC .Address 119 LknlnaMg streeE Tel . Name of mason uyer Bullders , c -Address ng Street 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 dissensions 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 REQUIRED $F .OFd . * size of property 100± pSTRp ft X 120 ft . * Existing building ( s) Size N1A ft X Wx'ftModel PROPOSED BUILDING AND USE * of * Existing building ( s ) Use _ NIA Size of new strut a 32 ft X 48 ft " Foundation-pier slab crawl/partial/full * Proposed building , sdeisp4ontcepfrom property line circle one ) 1 * Front yard 30+ ft Rear yard 30+ ft No . of stories (habitable spa I ,� Side yards Height ( grade to ridge ) 1`� � �,� ft . + ft and 1 + ft if on corner , setback from side street + ft If residential , no . of families_,,,.5 Qf 2 * No of rooms ( excluding baths) OCCUPANCY INFORMATION N4 of bedrooms 2 „ PRIMARY BUILDING - e One family dwelling s e - far Nab +of bathrooms Pr ry heating system Baseboard a ectric* - Two family dwelling � s�e �u! Type of fuel Electrx�clty ultiple dwelling / Number of units Noe of fireplaces to be installed P Permanent occupancy Will a wood stove be installed? No No * Transient occupancy Central Air conditioning? Business BUILDING 'STYLE, PRIMARY STRUCTURE * Industrial Other Ranch Contemporary Lo cabin If addition, what will use be? Raised ranch Mansion Duple Split level Old style Bungalow " Cape Cod Cottage Other * ACCESSORY BUJLDING- Colonial Row Town House * Detached garage/one car/ two car/ car { CIRCLE ONE PLEASE ) * u.x.Attached garage/one car/ two car/ one 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 , woad 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 ) 48PT nAnimLun Will there be a cellar? no Heated or unheated? Floor sq, footage sq ft Will there be a basement.? no 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 Fi rg ass shingles Size , wood studs "x 6 " spacing 24 "o . c . length 8 ft. exterior walls Joists ( floor beams ) 1st . floor N/A "x spacing. _"o . c . span NIA ft . Jo.ists ( floor beams } 2nd . floor "x is " spacing "o , c , span N A ft , Overlays (ceiling beams ) "x " spacing 24 "o . ew span N/A ft . Roof rafters 2 "x " spacing 24 o . c . span 14 ft . Roof trusses (pre-engineered) spacing 2 O . C ." span 42 ' ft , Exterior wall finish stained Of what material? 5 /8" x 4 ' x 8 ' texture 11l Interior wall finish pain s etrock If a garage is to be attached , describe materials to be used for FIRE SEPARATION : l /2" type "X„ sheetrock Is there to be an opening between garage -4and 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 ft , (A separate application is necessary Y for an repair or new installation of septic system) See S . P. E. D. S . permit # 0202/5/25 Town of Queensbury County of Warren _._._..._A F F D AI T -- - STATE OFrNEW YORic 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 ecified or not and that such work is authorized by the owner . SWORN To BEFORE ME THIS Signature _ __ __ _ _ _ __ ^-=--- Owner, owner ' s age , cnitect, contractor day of le'� 19. PATRICIA E. FURPHY 1 :o„ ry Public, State of Now York �y Quaiiiic3 in Schenectady County Notary Public , Warrz�? , N , Y . 4717048 <D{/ Commission Expires Sept. 30. 19C1.0 SPECIAL CONDITIONS OF THE PERMIT : r .* By......---.—_..-....._.r.,----------_......_ ...... TOWN OF QUEENSBURY „i„ 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 . &MTKit ALL of the following : 40 Gross floor area 1123 B . F . 2 ■ Type of heat Baseboard electric 3 . Is the building mechanically cooled ? NO 4 * percentage of area of windows and doors 11 • 8% A . Over 16 % Only 1 . Uo value of gross area of walls , roof /ceiling and floors exposed to ambient conditions . Awns 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 K0 . as If YES , what is the R value of insulation around perimeter of floor ? 4o is basement heated ? YES NO as R value of insulation 5 . Type Of insulation 8 . Under 16 . Only 1 . R value of roof and floors exposed to ambient conditions. Rs-38 2 . R value of exterior walls XKK= R--23 , 5 ( U4 =0 , C)4+ ) 3 . R value of glazed area U . =O . 30 4 . R value of doors R-14 . 9 (U* =0o ?6) 5 . R value of floors over unheated spaces 6 . R value of slab edge insulation - unheated slab NIA 7 a R value of slab insulation - heated slab 12 . 5 V . R Value of heated basement/cellar walls ( above grade ) N A 90 R value of heated basement/cellar walls ( below grade ) N/A 106 Type of insulation Fiberglass Co Controls 1 . Thermostat maximum heat setting D . Duct systems N/A 1s 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 . Pining Insulation N/A 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating 10 performance efficiency NIA 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating N/A 0 V' 4g�� Telephone No . ( 518) 899-9161 ( applica is signat e ) s _. tam �� 1 � r 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 15 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 Builders Inc Telephone: ( 518) 899-9161 2 A, C , E , I , J , K, L, M Number of bedrooms (residential only) 2 - 3 F , G , H Total daily flow (compute @ 150 gal per bedroom) 300 TopoUaphyx circle one*. ( Flat Rolling Steep Slope 96 of slope Soil Nature: circle one: Sarni Loam Clay Other / Depth: 8 " feet + Gwound 'Water: At what depth? 'unk"I 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: Municip Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption N/A feet * PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench NIA 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 . ...Ptease...LIST NEW EQUIPWENT TO BE INSTAIA.ED permit & attached map , (over) 1 ■ ti Section 11 Septic System lnspectionss 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 Z4 hours before start of constructions and shall include a plot plan showings 1.} the propoped .location of the f4ystem Z.) 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, tiles 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 $250.00. C. 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 installations, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. I have read the regulations above and agree to abide by these and all requirements. of the Town of QueezLebary Sanitary Sewage Disposal ice, Signature of.responsible persons Date: t Town of Queensbury Building and Code Department Bay at Haviland Road Queensburys New York 12801 (518) 792-5832 SETTLED 1763 , . . HOME OF NATURAL BEAUTY . . . A GOOD. PLACE TO LIVE MIDDLE DEPAIRTIAE TJON AGENCY, INC. I 10 ,'''�_.._� I� R (►--�--'--t{.�,,,__ �"-.� [tat" May 9 , 1989 �Ccrtifle� that ��� uipment listed has beenZxaP�rad a approved as being in accord with the National Elect plicable governmental, utility and, envy S. X Owner: Sin Fami. l Guyer Builder c p ejaing Occupant., Single .>r• 12 Location: 15 Queen An C.. lot Q ry eertificale l is uipment and installation inspacled this �' date. IT addlliorral qqu merit sh be introduced or alterations made to existing existing system thif ice be null and void. and application for 70 Outlets , ce tacleS ; ��Fixtux f�7 tli �lspec,ionandirld aWmitt p ly to d,is Agency. LGgtliprrtent: Gder of xhis ce icafa td rrt same to his property insurance carrier 150 Amp gLrv3c agent orcom yy esatil wification of electrical equipment eppro�d as specified. FGuyer Butl er 51 CE #1983 Apptfcant: 119 Running Stre 0 . 15-021535 L. Ballston Spa , NY 12 f sane Ho. rna ri +.as - TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY 4 HAVILAND ROADS OTELEPHONEy' ( 518 )NEW Y792-5832ORK U� BUILDING INSPECTOR' S REPORT REQUEST FOR I PECTION R CEIVED NAME ' LOCATION +sy^ ,rjr,J .PERMIT # DATE APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATIONIDAMP^PROOFING BACKpILL APPROVAL ROUGH PLUMBING FRAMING ' ELECTRICAL ROU H—IN -- V INSULATION: FOUNDATION FLOORS r WALLS CEILING FINAL INSPECTION : CHIMNEY HEIGHT ROOFING SIDING Y EXTERNAL PORCHESYSTEPS."�—�—�— z SfiAIRS�CLEARANE & RAILS PLUMBING FIX RERIURCED '�` INTERIOR TR P RS FINISHED F s GARAGE FI EPROOFING DOOR CLO ER (S) gMOKE D TECTORS FINAL ELCTRICAL INSPECTION1r^_ FINAL AP .ROOVAL OF CONSTRUCTION OF BE A SIGNED IINED FROM TH2'sABUTE ILDINGC T DEPARTMENT BEFOREOB TA THESE PREMISES ARE OCCUPIED REMARKS : INSPECTOR rr rI Lr a^ Q UL .t *7 �# 4 Date ~' i s actor 7 constitutes certification that the above installation , but not the equip- ment itself, has been visually inspected as of this date pursuant to the applic- able codes. If additional equipment should be introduced or alterations made to the existing system or struc- ture, application for inspection should be submitted promptly to this Agency, i TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAV.XLAND ROADS QUEENSBURY, NEW YORK 12804- TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED_ , ` NAME LOCATION _� DATE PERMIT # / ,. . APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR ORMS FOUNDATION/DAMP— OOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN 1,00pINSULATION,- FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT wj ROOFING SIDING EXTERNAL PORQWESISTEPS STAIRS—C'LEA NCE & RAILS PLUMBING FI TURES/RELIEF VALVE INTERIOR TWM/PRIVACY DOORS FINISHED FrPS GARAGE FrOOFING DOOR CLOSR (S) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OP OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: I TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVXLAND ROADS QUEENSBURY, NEW YORK I2e0g, TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME 1111 LOCATION `4 :E 6� _ DATE -tea ! PERMIT # 1S APPROVED YES NO FOOTXNGfPIERS + MONOLITHIC POUR FORMS FOUNDATIONIDAMP-PROOFING F#B CKFSLL APPROVAL OUGH PLUMBING. LRAMING % f ELECTRICAL ROU .H-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES/BELIE VA VE INTERIOR TRIM/PRIVACY RS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER {S) SMOKE DETECTORS FINAL ELECTRICAL INSP CTION FINAL APPROVAL OF CO STRUCTION NE 1. A SIGNED CERTIFXCAtuXLDXNG OF OCCUPANCY MUST BE OBTAINED FROM THE DEPARTMENT .BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR awn O/ Q+ ifs!een36ury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAIVE LOCATION i?ate / Permltt No . I ` qA ►+"' APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Sackfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Exit . Porches Finished Floors r Interior Trim _....._.. Stairs & Railings Cellar Drain Tile Concrete ` Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors walls T Ceiling FINAL ELECTRI AL INSPECTION_ _ DRIVEWAY APP VAI.,,� __ --, Final Buildin Survey Next scheduled in eetion (/call when ready ) Remarks-- �..r 4`. 8ui ing Tnspec or 6/86 and-vl 90urn 0/ Quee4" s1rxrV BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 4ueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION./ X nATE PERMIT NO. SOIL TYPE - Sand Loam - Clay - Percolation Test Required? YES - 140� Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , total length Length of each trench Depth of trench s Size of gravel SEEPAGE PITS4N er Of Size- ft. X ft . Gravel size ZPW - PIPING : Size Type Bldg , to tank /✓C' - Tank to dist. box �f Dist. box to fie It P/ Openings sealed YE NO Partial LOCATION/BFPO TIONS : Foundation t tank fto Foundation absorption ft . Absorption o lot line ft. Separation of pits ft. LOCATION SYSTEM ON PROPS Y (circle one) Front - R am - Left side - R1 ht side - CCIKMEN i'S �.� �c.[i'L'1. C.�t9""x•4'.ascln'�'? Ca-�-e..cc,,,.� [t, carr SYSTEM USE APPROVED YES N Bu dingy Spector 01/86 and vl Y', �%� `7otVrr 401 Qucenj1t4ry RUILDtNG and ZONING DEPARTMENT P9� Bay and Haviland Road, R.D. 1 Box 98 Queensbury" New York 12801 BU i S_ D I NCB INSPECTOR ' S REPORT NAMU, LOCATION Date /��/ (�/ _ Permit No . is it * � w ,ir � • + � t yr • re � • t w • * . k ,r *+' APPROVED - YES NO 7'oo inrlfPier Forms oun<3a t i oai Waterproofing Hackfill Framing Roo f i_n g Siding Masonry Veneer ROLIgh S' lumkaing Relief Valves i:xt . Porches Finished Floors _ Interior "Prim _. "hairs & Railings Cellar Drain 'l'ile concrete Floors I711)9 _ Fixtures Gar . fireproofing Doer Closers smoke Detectors c li i mri e y )( INSUI .7 TION : Kpoun tla t ion UIclors walls Ceiling FTNAL ET TION I)R1VEWAY APPROVAL Final Building Survey Next. Scheduled Inspection (czl. l when ready ) Remarks- 1 kiui ding Inspect r BUILDING and ZONING DEPARTMENT B ay and Haviland Road . R . D. 1 Sax 9$ C]ueensbury, New York 12801 E31JI 'LD I NG INSPECTOR ' S REPORT NAME12 . x 1 LOCATIONf' Date Permit NO . r✓ APPROVED YISS NO otiny/Pier Forms J Foundation Waterproofing 13ack f i l 3 Framing Roo f i n g Siding Masonry Veneer Rough Plut Ming Relief Val es Ext . Porch('_ Finished Flo rs Interior Tri Stairs & Vail ' s Cellar Drain T e Concrete Floc s 141bq . Fixtur s Gar . Firepr ofinc3 Door Close s Smoke Det ctors Chimney - IN SU I.ATI N : Foundati n Floors Walls ceiling FINAL F ECTRICAL INSPECTION_ DRIVEWAY APPROVAL Final Building Survey Next ;clieciuled inspecCion ( r aill when ready ) Remarks- r ritii ldin3 7iisl�cci<nr r. is3f> �isri -v t BUILDING DEFT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS, FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. TEMP. 0 DATE CITY OR VILLAGE TOWNSHIP (x76aes71Rbury COUNTY ' STREET AND NO, OR 1.�. } ROAD AND POLE NO. #IS Queen Ame Court POLE NO. BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATE Of SECTION F BLOCK 40T OCCUPANT'S BUILDING NAME OCCUPANCY OWNER'S NAME AND ADDRESS r Btt Zders I= 119 Dmwx ng Street 7E4,.CURREN SUPPLITED BY ,"oI-� FROM THEIR .. j OFFICE BUILDING NEW ❑® OLD )WORK DEFECTS ) NEW ® ADOITIONAL D REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS Laomp R"opuclas MOTORS HEATERS BRANCH OFFICE USE Lora. ONLY Side Ataaeh't H.P. Warta A.W.G. Calling Sid* Recep'M Switch PsrWant Bracket No. Type Each No. EKh Me. Gatge INSPECTION Out- side Sub- base Baer ment let FI. $nd FI. 3rd FI. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE_ This application Is intended to corer the aboV"isted equipment to be inspee led but if at lime of impeetion there is found ►dddit ional equipmew not above listed, you arm authorized to make the inspection and adjust the fee to cover the additional equipment, as provided by the appliepnt. SIZE Of: ELECTRIC SIGN TOTAL MAINS I d5n Amp, FEEDERS LAMPS WATTS CHARACTER EXPOSED GAS TUBE SIGN OF WORK HpLuzh 1n and zervIce CONCEALED TRANSFORMERS OF VA WORK TO BE (NUMBER) (CAPACITY,} STARTED COMPLETED SIZE OF SIGN SERVICE OVERHEAD UNDERGROUND MAKER ENTERS SUALDING OF SIGN INSPECTION REQUESTEDON OR AS POSSIBLE PEAR AS W:L t call when ready NEW jJ OLD El AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION, ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.. PRINT NAME AND ADDRESS NAME OF CANT GuyerDU Y�as a DATE OF '�^op _ APPLICATION U STREET ADDRESS 119 Dunning Street TELEPHONE #E' �3'E72 CITY OR U$ � MW 'i3fysJl,k ZIP 17(= LICENSE NO. POST OFFICE ¢ CODE WHEN APPLICABLE 46 EL (REV_ I(BS) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING �q 4 , a, 0 OOP 0 O o �s oe QUEEN VICTORIA'S GRANT QUEENSBURY, N.Y. ANNE f f f LT f f 3.5 8'-0 DIAMETER 9'- 0 DEPTH �T 0 o 35' �yof ,y5 100, looll M 87.71' 2000 9a I 1000, .101 120.0� .r- REFERENCE DRAWINGS SA SITE UTILITIES sEpfIC A WATER Von©usEN 4 STEVES SURVEY PLAN