1987-919 I .i r., ' a T.h.s.s...",q: r a.
CERTIFICATE OF +CwC�CLJJPAN+CY
TOWN OF +QUEENSSURY
WARREN COUNTY, NEW/ YORK
Date. 19
ao
87-919
This is to certify that work requested to be darns as shown by Permit No.
has been completed.
# of Two Family Dwelling
This structure may be occupied asa
L.aorcation 7 Queen Anne Court. — queen Victoria ' s Grant.
Guyer Builders Inc .
Owner
By Order Town Board
PrOW N OF QU/E'E-NSBURY
eel17
Suiiding & ZoninE Inspector
BUILDING PERMIT �
TOWN OF QUEENSBURY TMo 87-919
WARREN COUNTY, NEW YORK
IV
PERMISSION is hereby granted to Queen Victoria ' s Grant
OWNER of property located at 7 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. CD
o
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1 , OW'NE WS Address is Guyer Builders
119 Dunning Street W
Ballston Spa , N . Y . 12020 n
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n
2_ CONTRACTOR or BUILDER'S Name "
Same
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3. CONTRACTOR or BUILDER'S Address Same
4. ARCHITECT'S Name
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5. ARCHITECT'S Address to
9
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6, TYPE of Construction — (Please indicate by X) O
G
( x) Wood Frame l ) Masonry { I Steel { } ff
7_ PLANS and Specifications
No. 32 ' x 481 as per plot plan , specifications and application including
septic system and attached one car garage . MODEL J 0
a. Proposed Use
} of Two Family
0
B
$5 . 00 C/o
$ 89 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 1 , 19 88
I I f 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 31 s t Day of December 19 87
SIGNED BY Ae /'(� 1Jr� / r for the Town of Queensbury
B��ning I nspector '0 9"�-..
'LV l3Z ULJ11WjjZl.ZV =1 na+w , WFMW a ,
Application No . {I
• '_ 50 F 11
• wn C/ Q"O �'njiurjo Permit Issued _ 19
BUILDING and ZONING DEPARTMENT Permit Expires `--
Bay and Haviland Road, R.D. 1 Box 98 zoning Designation 0I+T 2 ,� 1987
Queensbury, New York 12801 Variance No.
Site Plan Review No .
Approved by * 3 e/v
gtr/l ,
APPLICATION FOR
BUILDING AND ZONING PERMIT
• x rr .r a « �► +. ,w * « * +r � it e * +► « * * � �► ,w +r * * * .� � * * � * a at * • 2a�F
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 isx _Guyer Builders Inc
P. O. Address 119 Dunning Street Ballston Spa , New York 12020 Tele ( 518 ) 899-9161
Property Location : 7 Queen Anne Court Tax Map N0 .121 ,/.Lf 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 11 ( 518) 899-9161
Name P. O. Address Tel . No ,
Name of builder Guyer Builders , Inc -Address 119 Dunning Street Tel . ( 518) 899-9161
Name of plumber ydr buxlMrsp IncFAIddress T19 Duruilng SEreet Tel . -
9161
Na is of mason Guyer IMI rs , InCeAddress r'i$ riee 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
LOCATION OF STRUCTURES AFFECTED• * of septic disposal area .
* COMPLETE INFORMATION REQUIRED
* Size of property 100+ pgan ft X 120 ft ,
" Existing buildings) Size ft X��ft .
PROPOSED BUILDING AND USE : oModef �� * Existing buildings ) Use NI
Size of now strut a 32 ft X 48 ft * gg
Foundation-pier slab crawl/partial/full * Proposed building" seeesploteplanm property line
circle one ) * Front yard 30+ ft Rear yard 30+ ft
No , of stories (habitable l�abc�g ) 1 * side yards15*T ft and 15+ ft
Height ( grade to ridge) 9 ft . If on corner , setback from side street ft
If residential , no . of families Of 2
No. of rooms (excluding baths ) � * OCCUPANLY INFORMATION
Now of bedrooms 2 "
* PRIMARY BUILDING -
No, of bathrooms 2 One family dwelling one e y"r
Primary heating system se a ectrl& -' family dwelling tl
Type of fuel ElectrfEi - * Multiple dwelling / Number of units
No . of fireplaces to be installed * Permanent occupancy
Will a wood stove be installed? — Transient occupancy
Central Air conditioning? No
* 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 BUILDING-
colonial Row Town House * Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * .2L Attached garage/one car/ two cart one car
* * * * r w x * w * * * * * • * * * Private storage building
ESTIMATED MARKET VALUE OF " 'Other
CONSTRUCTIONbi
INFORMATION O BUILDING SPECI � , ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETEDI
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED
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 8"
Depth of foundation below grade (to bottom of footing ) $" minink m
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 port,i ? sq . ft . - - Type of use?
Type of roof -(^sloppppe f at/s Fiberglass
lhed/other Material of roof x ass shingles
Size , wood studs "x 6 " spacing 24 "o . c . length S ft . exterior walls
Joists ( floor beams ] lst . floor N/A "x " spacing "o . c , span N/A ft .
Joists ( floor beams) 2nd . floor "x �" spacing "o . c . span N A ft .
Overlays (ceiling beams ) "X " spacing 24 "o . c . span N/A ft .
Roof rafters 2 "x " spacin`g24 o . c . span 14 ft .
Roof trusses (pre-engineered) spacin�4 "o . c . span 42 'ft .
Exterior wall finish stained of what material? 5 / 8" x 4 ' x 8 ' texture 111
Interior wall finish pain 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 -3and 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 N7A ft .
(A separate application is necessaryr . for an re air or new installation of septic system)
See S . P' . E . D . S . permit # Q26252
Town of A F F I D A V --- --- -- - - ---
I T STATE OF NEW YORK
County off Warren Warren
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 rather laws pertaining to
the proposed work shall be complied with, whether ifi or not, nd that such work is
authorized by the owner . �,
SWORN TO BEFORE ME THIS Signature
+ ,17� Owner , owner ' s agent , a nr z re t, aantractcar
day of (y 19 7
Plm7R10A E. FURPHY
ti '.nta;y t'uWlc. State of New York
Notary Public, N. Y . C�usl :t�eo it Schenectady County ,
4717048
* * * * * * * * * , * * * * * * at * +iEQaermsson VtxpFre* 59APt*3S3k1 -•*
SPECIAL CONDITIONS OF THE PERMIT :
"' ' 1123 Square feet living
240 Square foot garage - one stall
1363 @ $7 . 00/ 100 or part of
$5oOO One stall garage
$5 .00 C/o permt
Total
u Y.'w4.a
By-�----------------------------- - -----
TOWN OF QUEENSBURY
�i Jar
WARREN COUNTY , NEW YORX
Application fors BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work .
AWBMKR ALL Of the followings
� . Gross floor area1123 S . F .
2 . Typo of heat Baseboard electric
3 . In the building mechanically cooled ? NO
40 percentage of area of windows and doors 11 . 8%
A . Over 16 % Only
1. wwwwww
Uo value of gross area of walls , roof /ceiling and floors
exposed to ambient conditions
2 . Floor over heated spaces YES NO
AV Are foundation walls insulated ? YES NO
1 . If YESf what is the R value ?
3 . Slab on 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
B . Under 161 only
1 . R value of roof and floors exposed to ambient conditions _,_
R-38
2 . R value of exterior walls X18C }( R-23 . 5 (U. -0 . d4+)
3 . R value of glazed area U. =0 * 30
4 . R value of doors R-14 . 9 {U. =O . O6 )
5 . R value of floors over unheated spaces �X R-30
6 . R value of slab edge insulation - unheated slab NIA
7 . R value of slab insulation - heated slab 12 . 5
Be R value of heated basement/ cellar walls ( above grade ) N/A
90 R value of heated basement/cellar walls (below grade ) NIA
10 . Type of insulation Fiberglass
C . 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
E . Piping insulation N/A
1 . Size of hot water or cooling carrying agent pip6anw
2 . R value of pipe insulation
F . Service Water ideating
1* performance efficiency N/A
2 . Temperature control setting maximum
G . For Swimming Pool Only
1 . Maximum heating N/A
Telephone No * ( 518) 899-9161
( applicant ' s sig tare )
. .Jtgrll. ���aGi�rl,�Ltl�jt.
r
APPLICATION FOR SEPTIC DISPOSAL PERMIT
Ref : S . P. E. D. S .
PATS October • 1 / 87 permit #
New York - 0202525
MODEL J of A/J
LOCATION OF PROPERTY FOR INSTALLATION 7 Queen nne Court
Owner's Name: Guyer Builders , Inc . Telephones ( 518) 899-9161
Address: 119 Dunning Street , Ballston Spa , New York 12020
"t&U4wes Name: Guyer Builders , Inc Telephone: ( 518) 899-9161
2 As C , E, I , J , K, L, M
Number of bedrooms (residential only) 2 3 Fs G, H
• Total daily flow (compute Q 150 gal per bedroom) 300
Topography: circle one: lit Rolling Steep Slope % of slope
So NaNatures circle one: Saari Loam Clay Other / Depth:- 8 ' feet +
il
Ground Water: At what depth? unknown 8 feet +
Bedrock or Impervious Materialx At what depth? unknown feet
Percolation teat: circle one: Caot require required / rate min. inch.
Domestic water supply: circle one: unicipal 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 feet
* Size of stone to be used 0 / Depth or Thickness feet
* * ee * * s * * * ss +r * sass * s * * s +s �ss� ess * * * ssss * ss �rs *
I M P O R T A N T * See S . P.E.D. S.
..eMeasse...L lST NEW EQUIPMENT TO BE INSTALLED permit & attached
s * * * * �rs �s * • s * * * * * * s * • * * * * * * * * * * * s * * * * * * * * * map .
(over)
. r
r
Section. Il 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 gystem
2.) location and distance to lot lines
3.) location and distance to structures
44 location and distance to any water supply
5.) size and dimensions of all tanks, distribution
boxesg tile fields and/or dryw ells
B. No system shall be covered before inspection and approval by the building,
Inspector. Failure to comply with this requirement may result in the
uncoverisas 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 installation,
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 requiareme "
of the Town of Queensbury Sanitary Sewage: Disposal Ordinaxwe.
Signature of.responsible person:
Dates
M
Town of Queensbury
Building and Code -Department
Bay at Haviland Road
Queenabury, New York 12801
(518) 742-5832
1 ,
' M . ten "^iAC hC' MATIln AI MCA11Tv A ff%nr% 00 ♦ f` C 4rf11 '"
MIDDLE DEPARTMFK' ON AGENlCY, INC. 7
Boo N _
Dot,, March2G , 1989
�I ELf14" that (e triaq Yquipment listed has been ex�Ittir�e a approved as being in accord
with the National ElectCQe`rapplicable governmental, utility an`tl, �icy les.
Owner:
Guyer Builder nl
Occupant. Single Famil +�4)
7 Queen Ann# Ourr- > Q�FI# n
Location: YY oaryfinata S ledrie uip mane and insSafiaunn inspected this
F 4,., data. IF edtliiYonal Ui meni�}stl be invod aced or allegations made to
` i exY Sling ayatam the c Icata ba nUll and rood, and appiicaimn }or
Equipment: 80 Outlets ; n eceptacles ; 20 Fixtures ; 15Qinapeahon ahaula ¢6 aut}mnlgNp lfy is Chia Agency.
Amp SE r V i C E Appliances �� �� { i� older o} Yhis ce;X�ifcale shp�lW nt soma to his property insurance carrier
i`egent or camp9nyl as auitlMc arliflcation of slgClrical eq u,pmenl applavetl
w- - as specie ied. . f,r"
�r
Guyer Bui ldet ',�.,j c
Applicant: 119 Dunning, St jrtt;i, ..
Ballston Spa , NY 12-0 Mi .l: $ =�.w� ` o 15 - 020570
� ct�'��'�'�arl� z�:e.�`it: � �.-.�.�aR..���n � .:�'le-3R�1�+� i� --- � -- � :R�.sa�•a,,....a -- -
TOW
RY
BURL OF AND
CODES
DE
BUILDING AND CURES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY. NEW
SIS1Y�92-58320
TELEPHONE
BUILDING INSPECTOR' S REPORT
REQUEST FOR INS ECTION RECFXVEDIIIIIII
NAME
LOCATION
DATE � '� -/I fn PERMIT # �'}��- --�---
APPROVED
YES LNO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATIONIDAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION4. ."
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHESpII "
STAIRS-CLEARANCE
PLUMBING FIXTURES/ ELIEF V' VE
INTERIOR TRIMIFRIVAOCY DO
FINISHED FLOORS
GARAGE FIREPROOFING��
DOOR CLOSERS) �-�-
�,
SMOKE ELECTRICAL
INS
CT CTION
FINAL ELECTRICAL INS CT N
FINAL APPROVAL OF C .
A SIGNED CERTIFI ATE OF OCCL7PANCY MUST BE
OBTAINED FROM T E BUILDING DI�FARTMENT BEFORE
THESE PREMISES RE OCCUPIED :
REMARK '
tSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
Ay & HAVILAND ROADS
QUEENSBURY, NEW YORK 12809-
TELEPHONE ( 518) 79211111,5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR I'N,SpECTIONN RECEIVED
NAME [ 1 c_J % E 4o �
� 7?p ��
x,OC,ATION , c�
DATE PERMIT
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS -
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVA
ROUGH PLUMBING
FRAMING
ELECTRI ROUGH---IN
INSULATIO
.VOUNDATX64V
FLOORS
X WALLS
,CEILING
FINAL INSPECTI
CHIMNEY HEIGH'•
ROOFING
SIDING
EXTBRNAL PORCHES TENS —
STAIRS-CLEA--- - - AAILS
PLUMBING FIXTURES/LIEF VALVE
INTERIOR TRIM/PR�, DOORS
FINISHED FLOORS
GARAGE FIREPR r ING —
DOOR CLOSER (S) �—�—
SMOKE DETECTO S
FINAL ELECTRIC L INSPECTION
FINAL APPROVA OF CONSTRUCTION
A SIGNED CE TIFICATE OF OCCUPANCY MUST BE
OBTAINED FIR M THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED?
REMARKS:
INS P CTOR
TOWN OF QUEEN SBURY
,BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK I280&x-
TELEPHONE (518) 792-5832
BUILDING INSPECTOR ' S REPORT
REQUES
LOCATION
R INSPECTION RECEIVED .
NAME
TION
DATE �_[ PERMIT #_ J /
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACYFILL APPROVA
H PLUMBING
I NG
ELECTRICAL ROUGH-IN`k
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEPS
STAIRS-CLEARANCE & RAILS
PLUMBING FIXTURES/RELIEF VALVE
INTERIOR TRIM/PRITIACY DOORS
FINISHED FLOORS
GARAGE FIREPROOFING
.DOOR CLOSER (S)
SMOKE DETECTORS; _
FINAL ELECTRICAL "INSPECTION
FINAL APPROVAL OE 1 CONSTRUCTION_
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
D
INSPEC OR
. J'own a/ Queen36ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION
Date-*T/ Permit No . � I
/r APPROVED - YE5 Nb
Footing/Pier Forms
Foundation
waterproofing
Backfill
Framing
Roofing
siccing
Masonry Veneer
Rough Plumbing
Relief Valves
Ext . 'Porches
Finished Floors
Interior Trim -
Stairs & Railings_-:�J,,___
Cellar Drain Tile
L.or�conerete -Fwl- s
411bq . Fixtures
C,ar. . Fi reproof ing
I7c�c�.r Closers
smoke Detectors
Chimney
INSULATION :
Foundation
Floors
walls
Ceiling
FINAL ELEC ICAL INSPECTION
I?RI V EWAY . APPRLIV AI.
Final Building, Survey
Alext scheduled/\/inspection Ccall when ready )
`4 t Remarks_ V
Building Inspj for
6/86 MCI-VI
_ Joeun o/ Q"een36ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
aw
NAME
LOCATIONp"--r-p {�
DATE ,/ PERMIT NO, f1
SOIL TYPE - 4&� Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of TEM:
Absorption field , total le th
Length of ea h trench
Depth of tren hes '
Size of gravel
SEEPAGE PITS4N er of
Size- eft. x f
Gravel size
PIPING : Size Type
Bldg . to tank 04"4(00 _
Tank to dist. bo � _ r
Dist. box to fi d/p ' t y c�
Openings Seale . Y NO Partial
LOCATION/SEP TIONS :
Foundation t tank fto
Foundation o absorptio ft.
Absorption to lot line ft.
Separatio of pits ft.
LOCATION SYSTEM ON PRO ERTY ( circle one)
Front - ear - Left side Right side -
COMMENTS
s
ld ' g pector
01/86 and vl
. y0 Qmf e•• JVNry
BUILDING and/ZONING DEPARTMENT
Bay and Haviland Road, R-D. I Box 98
Queensbury, New Yank 12801
-BUILDING INSPECTOR ' S REPORT
NAME
LOCATION �7 '
Date / Permit No . �r clef
APPROVED - YES NO
Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext , Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain 'rile
Concrete Floors
Plbg . Fixtures
Gar . Fireproofing
Door Closers
Smoke Detectors
Chimney
T I ON
�undation
Floors
Walls
Ceiling
FINAL ELECTRICAL XNSPECTION
DRIVEWAY "PROVAL__�__
Final Building. Survey��������
Next scheduled inspection (call when ready )
Remar cs-
Bui ing nspector
6/86 and-v1
✓awn c►/ ueend6ur
BUILDING and ZONING Dr 7
Bay and Haviland Road, R. D. 9 Box 98
Queensbury, New York 128C?1
BUILDING INSPECTOR ' S REPORT
NAME
00 or
LOCATION r�
Date �.
*� Permit Nc) .
%&0otin APPROVEI? * * "
9/Pier Forms � � NO
Foundation
Waterproofing
BackfiI1
Framing
Roofing
Siding
twtasonry veneer
Rough Plumb �3
Relief valves
Ext . Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Pl.bg _ Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled Inspection
Ccall when ready
Remarks-
Building Inspector
+6/86 and-vl
BUILDING DEPT. COPY OF APPLICATION FORM 46-EL4 NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT. WHEN RECHJIRED,
CITY OR
VILLAGE
STREET AND NO. 4R TOWNSHIP
ROAD AND POLE NO. COUNTwkrre
BETWEE WH47 TWO It
NMfSES LEETS IS
ATED•> POLE NO•
NAME
T'S SECTION
DD BLIlLOING BLOCK LOT OWNER'S NAME OCCUPANCY
AND ARESS r;
SUPPLIEDBy 1.1 Street TEt. #
89"161
BVILOlNG FROM T
15 NEW ® HEIR
OLD ❑ WORK � - � OFFICE
LIST BELOW ALL EQUIPM
is NEW 1>� ADDITIONAL ❑ DEFECTS
(�
Loot NU ER OF OUTLETS Na. of Flatrrraa ,& is
WHICH YOU INSTALLED REMOVED
Lion Lamp Recaptacla, MOTORS
Coiling Si ww Atgq�'t .. HEATERS BRANCH
CIRCUITS OFFICE USE
Raoap'h Swilpell Parldarll Bnackat No. TYpa H.P. WattsNLY [
skiisa Each N0. Each Np_ A.W.G. INSPECTION
Sub
Baoo-
moist
Tat Ff.
Ynd FI_
3rd Jai.
REMARKS: LIST OTHER ELECTRICAL OEV ICES NOT SET FORTH ABOVE;
DD NOT USE THIS SPACE.
This application is inlended to cower the abavp-listed equipmenx !o by in
You are au 111crized to make the jrApectian and adjust the f p
s'Poc tad 6u[ it at timr IYf inspection there is foonA additional aquipmpnt not abo
SIZE OF to crovar the additional equipment, as MA INS Provided by the pppfieant, w fisted,
CH
FEEDERS ELECTRIC SIGN ARACTER OF WORK LAMPS TOTAL
EXPOSED WATTS
WORK TD BE CONCEALED r'''i4S TUBE SIGN
STARTED TRA NS F G RM E RS OF
SERVICE OVERHEAD COMPLETED fNUNIBERI VA
ENTERS UNDERGROUND 512E DF SIGN fCAPACITY)
$LOIN
INSPECTION REOUESTED MAKER
ON OR AS NEAR AS OF SIGN
POSSIBLE w,e 7 T
AVOID DELAY GIVING FULL ANw+D�AC�C•URATE INFORMATION_ ALL SPACES MUST 8E FILLEDIN OR APPLICATION MAY BE RETURNED.
PRINT NAME AND ADDRESS
NAME OF
APPLICANT
+•'x+a�7."tE� r DATE OF
STREET ADDRESS APPLICATION
CITY
POST OFFICE TELEPHONEzip #
CODE _- ,Le ' r. LfCENSE NO
ae �` ' BSI A SEPARATE APPLICATION d WHEN APPL j;rAB LE
MUST BE 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