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1987-920 a � l I ` S f T T T) CERTIFICATE OF C V PAN%f.`OY i TOWN OF +QUEENSSURY WARREN COUNTY, NEW YORK I Date July 7 19 89 87- 920 jThis is to certify that work requested to be done as shown by Permit No. I i has been completed. i 2 2 of Two Family This structure may be occupied as a i Lneation 9 Queen Anne Court - Queen niictoria ' s Grant. i Owner Guyer Builders I i I By Order Town Hoard TOWN OF QUEENSBUilY Building !ir Zoning Inspector 1 I 1 BUILDING PERMIT � TOWN OF QUEENSBUR'Y �. No. - 20 �y WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Queen Victoria ' s Grant I OWNER of property located at 9 Queen Anne Court Street, Road or Ave. in the Town of Queensbury, 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 Queensbury Building and Zoning Ordinance_ f, OWNER'S Address is Guyer Builders a 119 Dunning St . Ballston Spa , N . Y . 12020 c 2. CONTRACTOR or Bill LDE R'S Name name C3 rt a ri Y 3. CONTRACTOR or BUILDER'S Address Same °° H la r rt 4. ARCHITECT'S Name S. ARCHITECT'S Address v5 .C7 C ro ro 6. TYPE of Construction — (Please indicate by X) A ( 4 wood Frame 1 Masonry I ) Steel ( } ro n a 7. PLANS and Specifications ' 1 rt No. 32 ' x 37 ' as per plot plan , specifications and application including septic system and attached one car garage . MODEL E S. Proposed Use OF TWO FAMILY DWELLING a rt, 5 . C/o V 96 . 00 °' $ PERMIT FEE PAID — THIS PERMIT EXPIRES 1it ' 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_} F . ©axed at the Town of Queensbury this 31st pay of December 19 $7 m r-� SIGNED BY for the Town of Oueensbury � Building and Zoning inspector ,fir >Joefpl 0q av -'-•-• •..`.xaa- '"'"aarar rr rrraruwr r..,.r • r 5rC� n //� Application No , ow 01 Qu ►�eeabeerry Permit Issued 19 9wmNs wind ZONING DEPARTMENT Permit Expires 19 Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation OCT 2 1987 Queensbury, New York 12801 Variance No. Site Plan Review No . Approved by * 4114 APPLICATION FOR BUILDING AND ZONING PERMIT i► r► * * e e * w ` 0 0 * e e i e a * ar e * * * * * * * * * e ik i! • * * * # e w :?w 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 Bu_i.lders , Inc . P . or Address 119 Dunning Street Ballston Spa , New York 12020 Tel . ( 518 ) 899-9161 Property Location : 9 Queen Arnie 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 r�!dame P. O. Address Tel r Now Name of builder Guyer Builders , Inc .Address 119 Dunning Street Tel , ( 518) 699-9161 Name of plumber Guyer rs , nc .Addresa ng StreetTel . Name of mason Guyer buxldersq InCoAddress 119 Dunning Street Tel . NATURE OF PROPOSED WORK : ,. ZONING INFORMATICN : 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-hack 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 LOCATION OF STRUCTURES AFFECTED. * of water supply and location and configuration of septic disposal area . * COMPLETE INFORMATION REQUIRED roEEOL?W . * Size of property 100t pIyanplft X 120 ft . * Existing building ( s) Size ft X�—fC . de PROPOSED BUILDING AND USE : MoOfl Existing building ( s ) Use �_,_, NIA Size of new strut a 32 ft X 37 ft Foundation-pier slab crawl/partial/full * Proposed building, distance from property line circle one ) * see plot plan Nor of stories (habitable space ) 2 ,r Front yard 30+ ft Rear yard 30+ ft Height (grade to ridge) 21 ' - 6" ft * Side yards ft and 15+ ft if residential, no . of families Mof 2 * If on corner , setback from side street ft Nor of roome (excluding baths) ' 6'— . * OCCUPANLY INFORMATION No. of bedrooms 2 * pRlgRy BUILDING Rep Noe of bathrooms one family dwelling This }I,,e r Primary heating system Baseboard electric* -Two family dwelling one s�k bu nl i r Type of fuel_ Electric ty � Multiple dwelling / Number of units Nor of fireplaces to be installed * Permanent occupancy Will a wood stove be installed? No * Transient occupancy Central Air conditioning? NO Business BUILDING STYLE, PRIMARY STRUCTURE „ Industrial Ranch Contemporary Loqu cabin * Other Raised ranch Mansion Duple s If addition , what will use be? 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/..one car * r * w Private storage building ESTIMATED MARKET VALUE OF " Other CONSTRUCTION 4doo IdW0pj4ATION ON - BUILDING SPECIE A IONS ! ON REVERSE SIDE OF THIS SHEET . TO BE COMPLETEDI Form SPA 4/86 and-vl WILDING PERMIT APPLICATION CONTINUED - r 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 B" Depth of foundation below grade (to bottom of footing ) nuniaxun. 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 Fiberglass shipSles, Size , wood studs "x 6 spacing 24 "o . c . length 8 ft . exterior walls Joists ( floor beams ) 1st . floor N/A ' "x Is spacing "o . c . span N/A ft . Joists ( floor beams) 2nd . floor"x�r�" s cingWr6"o . c . span —Wt . Overlays (ceiling beams ) 2 "X Spac"U ofing "o . C . span 16 ft . Roof rafters 2 "x 1 spacin 24 o . c . spy ' -3Tt. . Roof trusses (pre-engineered) spacin4 "o . c . span N/A ft. p 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 Iis there to be an opening between garage rand dwelling? yes If so will a Eire-rated door , enclosure , and salf-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 Aft : 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 N1W ft . (A separate application is necessary for any re air or new installation of septic system) See S . P. E. D. S . permit # 0202525 Town of gueensbury County of Warren PI 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 cif ' ed r not, and that such work is authorized by the 'owner . a SWORN TO BEFORE ME THIS Signature ..___ �__ _ _ -- --� � owner, owner ' s agent , r . rect, ntractor day of 19 4 Notary Public , W , N . Y . * ♦ r # * r • x w - * * r * * * ar * * * r /r : tr sr * sr * * ► # k * * * it Is * Is it w * k Or SPECZAL CONDITIONS OF THE PERMIT : y i • TOWN OF QUEENSBURY INE" WARREN COUNTY . NEW YORK application far : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . "awsa ALL of the followings s x 3 . Gxoss floor area 127d S . F . 3 . Type of heat Baseboard electric 3 . is the building mechanically coaled ? No ♦ o percentage of area of windows and doors 13 . 3% A . Over 16 % Only t . UO value of gross area of walls , roaffaeiling 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 NO 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 p . under 16 % Only value of roof and floors exposed to ambient conditions. R-38 (U . =0 . 026) 2 . R value of exterior walls R R-23 . 5 U. 0 . 04 3 . R value of glared area Us =0 . 33 4 . R value of doors R-14 . 9 (U. �J . 06) 5 . R value of floors over unheated spaces N/A 6 . R value of slab edge insulation - unheated slab N/A 7 . R value of slab insulation - heated slab 12 . 5 8 . R value of heated basement/ cellar walls ( above grade ) WN A 90 R value of heated basement/ cellar walls ( below grade ) N/A 10 . Type of insulation Fiberglass Co Controls 1 . Thermostat maximum heat setting D . Duct Systems NIA 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 u . Piping Insulation N/A 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating o 1 . Performance efficiency NIA 2 . Temperature control setting maximum G . For Swimming Pool Only_ 1 . Maximum heating N/A v Telephone No . ( 518) 89"161 ( appl ant ' s s n s44r 1 APPLICATION FOR SEPTIC DISPOSAL PERMIT Ref: S . P. E . D. S . DATE October .1 87 permit ,# MODEL E of E/L New York - 0202525 LOCATION OF PROPERTY FOR INSTALLATION 9 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 1Vumber of bedrooms (residential only) 2 S F , G, H r Total daily flow (compute @ 150 gal per bedroom) 300 Topography* circle one: lot Rolling Steep Slope % of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: $ ' feet + Ground Waters At what depth? unknOwn 8 feet + Bedrock or Impervious Material: At what depth? unknown feet laercolatioa test: circle one: not require required / rate min. inch. Domestic water supply: circle one: QMiusi :c pal 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 N/A feet / Total system length N/A feet * SEEPAGE PIT(S): Number of / Size each feet by feeA * Size of stone to be used # / Depth or Thickness feet �ssss * * * * es� s * sssss * �sss +sss * s * s * ems * s * ,ss * * * s * IMPORTANT * See S . P.E.D. S. ...Please...L ST NEW EQUIPMENT TO BE INSTALI.F.D permit & attached map . (over) a Section U Seetic System Inspectionsi 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 constructions and shall include a plot plan showings l.) the proposed .location of the gystem 2.) location and distance to lot lines 3e) 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 8. 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 $250e00. co An approved copy of the plat 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 require,,,eats of the Town of Queensbury Sanitary Sewage Dispe"I Chdinance. Signature of.responsible persons Dates Town of Queensbury Building and Code Department Bay at Ha+viland Road Queensbury, New York 12801 (518) 792-5832 s 0 1763 . . . HOME 0F NATURAL HE AUTY . . . A GOOD. PLACE TO 1 " ,�/ MIDDLE DEPARTM79 AN PIGG,�IQN AC+ENCYr INC. � / - fT 9' 90Q.Hi►+tfi}4Ni'' 31 y1Pa}woaa; July 7 1339 �QCtlf[>C5 that lecgjcai equipment listed has been exa(n rigid an approved as being in accord with the National Elect r 1 Cpr�e, .applicable governmental , utility and Agency lea. Owner: Guyer Bu t Id ei liYr�` fi :�'' .. pan"�y �r S f rtg f t Ie l'akkk� Occupant: 5 } L.f7Catil7n: i �:;-18 Ei 17 i�.C717 �[A lI' ''G . i{l Mity Scer4i,G'ateLtiaclac ric uipmenl and installation inspected this date- N add+Donal ggW�jP`lent He be introduced of altefaNans made to existing system ffli# carlYicala be nutl and rfitd. and application for 7 r r Inepaction should 4o Subm,11" P tly to this Ageney- 7 - Oil F >_ 1.a t_ S a 5 �e C' e n l-r. �:. 7. 12 fi j ��: x;' �.�t= ��'.� a: � 6 enl aama to his property insurance earner Equipment: s a tr : a a .: T t C 1 t3 ,.Hader of tilts cartitlGale ahgi W A 150 :'Stop S e r V i:T 4M� J ��,7 ;'1,.]]��)� "�. i7 i l4=a .^.* [agent or company as evldenc�#e+tifiC&udn bt electrtCnl equipment approved as speclfied . '> Guyer Builder �C � :t1 [' L '1l3 �1'�l Applrcant: 1- 1. ` 19uk7ni a tre a- a s� k 0 - 15 - ©2261 -9SAN ` Ba l t s Y.nkr .i])a , r7`i' 1anil 2[ d ' w�. �a+� -- Pit Far+at flo, 7W EL 1-63 TOWN of qUEENSBxjWy BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBL�RY, NEW YORIC 32801- TELEPHONE ( 519 ) 792_5g32 .-LDING XNSPECIM S REQUEST FOR INSPECTION NAME {�. _� O)LO�-- LOCATIQNPERMIT # APPROVED DATE YES ITO FOOTING/PIERS �CQRMS__ ---- �"� --� � MONOLITHIC POVRP_PROQFIN+G FOUNDATION/DP M f-� --- - BACKFILL APPROVAL- - -� ROUGH PLUMB-ING FRAMING OUGH-IN E LECTRI T L C :R xrrsuLA FCryUNDATION FLOORS WA LS ILING INSPTION I INAL H�.IGHT CHIMNEY ROOFING SIDING ES STEPS E3STERNAL POR & R.AILs_�� - - --~ CLEARAN RELIEF VALVE STAIRS- pIXTU PLUMBING RI Cy DOORa^.----"__ INTERIOR TRIM/ FINISHEI? FLOO PING GARAGE FxRFPR DOOR CLOSER (S DE S SMOKE TECT �, INSFECTxON ,�_--- FINAL ELECTRic CONSTRUCTION FINAL APPROVAL OF T BE OCCUPANC TMENT EFORE CERTIFxCATE O F ING FROM DEPAR A SIGNED AM THE BUILD OBTAINED RgMISES ARE OCCC7PIED : THESE REMARKS ' . f I INSPECTOR OF QUEE"S"""gARTMENT TOti'� AND CODES DE7F' BUIL&I HAVILAND ROADS BAY NEW XoRK 1280%- QUEENSBURY • � >rx$ ) 792- 5832 TFLEpHONE pORT WILDING INSPECTOR S RE REQUEST FOR ------- NAME NAM E LOCATION _ y PERMIT #� APPROVED DATE YES NO FOOTING/p-TERS POEMS MONOLITHIC OUR ROOFING TNG FOUNDATXO NI DAMP�FBACKFILL ,APPROVAL �ZOUGH PLUMBING &�,,.FRAMTNG Gfi-IN ELECTRICAL RQ� INSULATION : FaUNDATION FLOORS WALLS CEILING pECTION : iJ FINAL rr'I HEIGHT _- -- --` CHIMNEX ROOFING SIDING STEPS EKTERNAL PORCHES RAILS STAIRS-CLEARANC Sm RAI VALVE-- -' PLUMBING FIKTU DOORS TRIM RIVACX INTERIOR O S FINISHED FLO FING GARAGE FIREP DOOR CLOSER { ) RS SMOKE DETEC AL INSPECTION FINAL ELECTRI ©F CONSTRUCTION FINAL APPROVAI OCCUPANCY MUST BE DEPARTMENT BEFORE A SIGNED CER'T'rFICATE OF BUILDING OBTAINED FROM THE ES ARE OCCUPIED !' THESE PREMIS REMARKS J Jam` Jf INSPECTOR Tows OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVXLA OYORK I2801-- QUEENSSURY , NEW � 92- 5832 TELEPHONE l 518 )BU ILDIh1G INSPECTOR' S REPQRT REQUEST FOR INSPECTION RECEIVED NAME 1,0CA2"ION PERMIT # - � DATE `.�.2- APPROVED YES NO gpOTINGIPIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING. FRAMING ELECTRICAL ROUGH-IN i• /"{NS UI.A TXON FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION = CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES ST PS r~� STAIRS-CLEEI'RANCEUR S/14ELIEF 'VALVE E PLUMBING INTERIOR TRIMIP IVACY DOORS _�---�- FINISHED FLOOR FING GARAGE FIREPR DOOR CLOSER (S) - SMOKE DETECTOR FINAL ELECTRICA r CONSTRUCTION 'ION,___,��- FINAL APPROVAL CONSTRUCTION 1 OCCUPANCY BE A ,SIGNED CERTIFICSATE BUI�ING DEPARTM�3'T BEFORE OBTAINED FROM THE THESE PREMISES ARE OCCUPIED! REMARKS : Zl- v INSPECTOR ,`.,fnte.rn o� �ueens � eert� BUILDING and ZONING DEPARTMENT gay and Haviland 'Road. R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOWS REPORT NAME c / LOCATION x7t� Date��_f Permit No . ; APPROVED - YES NO Footing/Pier Forms Foundation waterproofing Rackfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar. Drain Tile ,,y;cSnc r et e ..� I}lbg . Fixtures - C,ar . F i reproo f ing, Door Closers Smoke Detectors Chimney INSULATION Foundation Floors_ Walls Ceiling FINAL ELECTRICAL NSPECTION L)RIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Rema rks- Bui1 ink7t 6/86 and-vl �Jawn o� �u.eertsheere�t BUILDING and ZONING DEPARTMENT Bay and Hauiland Road, R.D. 1 Box 98 Clueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOC IT I ON / '--� - '+'[.✓G.i/R'L.r� �,.vl Ii.+r' r w�+� DATE )P�A219r PERMIT NO. I " SOIL TYPE - Sand - Loam - Clay Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption f iel , total length Length of each ench Depth of trenches - Size of gravel SEEPAGE PITS-(Number f) Size- ^ft. X _ t. Gravel size PIPING : i Type Bldgm to tank 6 /mod G Tank. to dist. box Dist. box to field/' � r� Openings sealed? NO Partial LOCATION/SEPARA CONS : Foundation to k ft. Foundation to sorption ft. Absorption t lot line ft . Separation o pits ft. LOCATION OF SYSTEM ON PROPERT {circle one) Front - Rea - Left side - R.ig t side - CCMMENTS : c -- 5= i -- SYSTEM USE APPROVED YES Bui Ins actor 01/86 tmd vl �OWIt [?� �ClPBi13r?L! I'r� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. I Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME . i LOCATION Date + � R � Permit No . I %J Iv' APPROVED - YES NO ( Footing/Pier Farms ((' 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 I INSULATION - Foundation Floors Walls Ceiling FINAL ELECTRICAL TT4SPECTION DRIVFWAY APPROVAL- Final Building, Survey Next scheduled inspection ( call when ready ) Remarks- uiiding spe or 6/86 and-vl awn n/ Quee" 39"rey BUILDING and ZONING DEPARTMENT Bay and Maviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR " S REPORT NAME �a(4? /C_ LCICATI { N t Date- �I�� / /_ Permit No . jf7- 9cg4O ✓ 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 6 Railings Cellar Drain Tile Concrete Floors Plbg , Fixtures Gar . Fireproofing Door Closers Smoke Detectors Ch i nin ey. 3 LATION : / oundation to Floors Walls Ceiling FINAL ELECTRICAL I SPECTION DRIVEWAY APPROVA Final Building Sur ey Next scheduled insp cCion ( call hen ready ) Remarks- `� Eau ld ' ng Inspector 6/86 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. i1F Y DATE - CIT � 111ry .- VILLAGE �y, STREET AND NO. OR r TOWNSHIP 'ok�T�r' COUNTY ROAD AND POLE NO, Aracc r". . _vw� BETWEEN WHAT TWO Wlli CROSS STR VETS IS POLE NO. PREMISE TED? OCCUPANT'S SECTION $LOCK LOT NAME BUILDING OWNER"S NAME OCCUPANCY _ AND ADDRESS $a'46mrB. Inc. Ing DLUITLing St I� BY PPLIED BUILDING FROM THEIR iS r_' . ..�- OFFICE NEW L+91• OLD ❑ WORK IS NEW in ADDITIONAL DEFECTS LIST BELOW ALL EQU IPINENT WHICH YOU INSTALLED ❑ REMOVED ❑ NUMBER OF OUTLETS No. of Fixturws & io�► L+uIN' Romptfmis MOTORS HEATS HEATERS BRANCH Attach' 'CIRCUITS OFFICE USE CoilingWNI R fat Switch Pendent Bracket Nm Type H-P. ONLY h Each No E No.armgGowan•Out- INSPECTION side fob- be" Rose Mont tst Fl, .2nd Ft. 3rd FI. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABDVY: DO NOT USE THIS SPACE, This ePPlication is intantled to cover the above.lieted equipment to Face inspected bug if of time of i You are aughorixed to make the impaction end adjust the fee to cover ehe .tdditional ^Fact"cn shore ie found adtlitionel SIZE OF equipment, a Provided by the a equiPmern not above listed, Pplicant, MAINS � �w ELEC TRIIC SIGN FEEDERS LAMPS TOTAL CHARACTER WATTS OF WORK .`..,,,.a EXPOSED GAS TUBE SIGN WORK TO BE �.Ri � CONCEALED TRANSFORMERS OF STARTED (NUMBER? VA SERVICE OVERHEAD COMPLETED SIZE OF SIGN !CAPACITY} ENTERS UNDERGROUND UI DING r MAKER INSPECTION REQUESTED � OF SIGN DONRO OR AS NEAR AS �`,/ POSSIBLY call 11be.n3 OLD AVOID DELAY GIVING FULL AND ACCURATE INFORMATION, FILLED IN OR APPLICATION MAY BE RETURNED_ PRINT NAME ANDD ADDRESS RMATION, ALL SPACES MUST B NAME OF Inc. tp �F APPLICANT [Tu+er � r r1ej*W` nc DATE OF ��,��� �I 19 APPLICATION STREET ADDRESS 1 Street yy��o�yy�������� ti CITY OR TELEPHONE # $TT' #..�ia, POST OFFICE zip y �/ryr�y�1 N LICENSE NO, CODE -a.atr 6r6H WH E APPL?CAB LE 4e er (REV- »�$� A SEPARATE APPLICATION MUST 13E FILED FOR EACH SEPARATE BUILDING REFERENCE DRAWINGS ANNE Ll ool 5A SITE UTILITIES SEPTIC 4 WATER Van DUSE N 4 STEVES SURVEY PLAN 1,3,5,7,9,11 QUEEN ANNE COURT PLOT PLAN 4 SEPTIC SYSTEM GUYER BUILDERS , INC . I GLV- 20 DWN ice! ►o- 2.97 1 Scale, 1 20'- 0