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1987-912 f k`CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date May 19 , 19 88 87- 912 This is to certify that work requested to be done as shows by Permit Nop has been completed. This structure may be occupied as a of Two Family UDcation 37 Elisabeth Lane queen Victoria ' s Grant Owner Guyer Builders , Inc . BY Order Town Board TOWN OF QUEBNSSURY Building & Zoning Inspector a BUILDING PERMIT � TOWN OF QUEENSBURY 140 87-912 WARREN COMM NEW YORK r rJ Queen victorla ' s Grant l PERMISSION is hereby granted to l 37 Elizabeth Lane Street, Road or Ave. OWNER of property located at 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 CD G approved and in compliance with the Town of Queensbury Building and Zoning Ordinance, 1 . OWNE R•S Address is Guyer Builders , Inc . n 119 Dunning St . o Ballston Spa , N . Y . 12020 " 1 F4 N 2. CONTRACTOR or BUI LDER"S Name Same ti W rr 3. CONTRACTOR or BUILDER'S Address Same 4. ARCHITECT'S Name w y ref 1..� tq N Ca 5. ARCHITECT'S Address it rt r m F7_ TYPE of Construction — (Please indicate by XI (o (R ) wood Frame { ) Masonry I I Steel i 1 PLANS and Specifications �. No. 34 ' x 43 ' as per plot plan , specifications and application including 00 s$:tx septic system and attached one car garage . MODEL J a B. Proposed Use } of Two Family Dwelling w $ 5900 C/O July 1 , 1988 $ 89 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES (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 30th Day of December 19 87 for the Town of Queensbury SIGNED BY Building and Zomgn inspector t 'li7 2i.C: C:CJIXY1.aC:'1'L':1J tSZ .kS.4.dJl� . ULGY'1'. " r.n ; .. Application No . s �j" 1c i ' lI J '� • ...�0'ii'��Ii � ar Permit Issued 19 y BUILDING and ZONING DEPARTMENT Permit Expires 19 � c' 93 T �. „ a Say and Hav�iiand Road, R.D. 1 Box 98 Zoning Designation T C}uesnsbury, New York 12801 variance No . , - ; Site Plan Rev w N Approved b APPLICATION FOR BUILDING AND ZONING PERMIT le7O N A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLO4ING . 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 . U. Address 119 Dunning Street Ballston Spa , New York 12020 Tel ( 518) 899-9161 Property Location : 37 Elizabeth Lane 'Tax Map No . 121 / 4 ,+ 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. Gayer I1I ( 518 ) 899-9161 Name P . O. Address Tel . No . Naas of builder 'Guyer Builders , Inc -Address 119 DLuuzing Street Tel . ( 518) 899-9161 Name of plumber CUyEer Builders , nc .Address 119 LXnuixngYee Tel . Name of mason GTyer TUIlUers , nc .Address 119 Dmirang 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-]pack 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 s $oEIPW . e * size ref property 100± p anp ft X 120 ft . J - * Existing building ( s) Size �P7�+ft X ft . Model 2774 PROPOSED BUILDING AND USE : of * Existing building (s ) use NIA Size of new struc e 34 ft X 43 ft Foundation-pier slab crawl/partial/full Proposed building , distance from property line circle one ) * see plot plan No . of stories (habitable s{Dace ) 1 * Front yard 30+ ft Rear yard 30+ ft Height (grade to ridge ) 21 ' `0s' ft . * Side yards 15+ ft and 15+ ft If residential, no . of families I of 2 * if on corner , setback from side street + ft No * of rooms ( excluding baths) �— * OCCUPANCY INFORMATION Noo of bedrooms � 2 * PRIMARY .BUILDING - No+� of bathrooms one family dwelling Zhis e f r Primary heating system Baseboard a ectric* -�- c+ne s de bei% ..n.g. TyVe of fuel Electriczt * Two family dwelling No. of fireplaces to be installed * Multiple dwelling / Number of units Will a wood stove be installed? ND * Permanent occupancy Central Air conditioning? No * Transient occupancy „ Business BUILDING STYLE . PRIMARY STRUCTURE * Industrial Ranch Contemporary Lo cabin » Other Raised ranch Mansion Duple * 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 X.Attached garage/one car/ two car/ One car r « * * * * * * * * * * * * * * Private storage building ESTIMATED MARKET VALUE OF 'Other CONSTRUCTION INFORMATION ON - BUILDING SPECIE*CAT1LNhSo2O1N REVERSE SIDE OF THIS SHEET, To BE COMPLETEDI Form BPA 4/86 and-vl e BUILDING PERMIT APPLICATION CONTINUED WILDING 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 ) " miningam Will there be a cellar? no Heated or unheated? Floor sq. footage sq ft Will there be a ]casement? no will any portion be used as living space? { If so , what part ' ? sq . ft . - - Type of use? Type of roof - sloped flat/shed/other Material of roof FiUiiFgass Shingles Size , wood studs "X 6 spacing 24 "o . c . length 8 ft . exter}or walls Joists ( floor beams ) 1st , floor N/A "X " spacing_ "o . c . span N/A ft . Joists ( floor beams ) 2nd . floor -� 'Ix -" spacing "o . c . span N A ft . overlays (ceiling beams ) "X Dopa scing 24 "o . c . span N A ft . Roof rafters 2 "X 1 " spaci�ing 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 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 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 NIA ft . (A separate application is necessar . for ©26252 air or new installation of septic system) See S . P . E . D . S . �pe Town of Queensbury County of warren AF F I D A V I T STATE OF NEW Yc,Rx I swear that to the }test 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 . SWORN To BEFORE ME THIS Signature ____-_ _�_ _____ __ Owner , owner ' s a en a n�t, contractor- �.c*. day of�.��c- y.�19 $ eLizABETH K. LAND�iY Notary Punta 4$62e Of New York Quaiified in Sarraat� County Notary( Publ arren County, N . ' Commission Exp' • w w * w *r r , * w w * w w * w w * w * w w w * w * * w w w + to Ar w * w w w w w r s r 1123 Square feet living 240 Square foot garage - one stall 1363 @ $7 . 0Q/ 100 or part of MOODne stall garage $5 . 00 C/O permit Total TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK Application fort BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . ANBWEit. ALL of the following a � . Gross floor area 1123 S . F. 2 . Type of heat Baseboard electric 3 . Is the building mechanically cooled ? No t . Percentage of area of windows and doors 11 . 8% A . over 1 +6 % 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 on grade YES N9 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 ./ . Type of insulation s . Under 16 % only, 1 . R value of roof and floors exposed to ambient conditions _„_ R- 38 2 . R value of exterior walls R-23 . 5 (U. =(l . (34+ ) 3 . R value of glazed area U. =O . 30 4 . R value of doors R-14 . 9 (U. =O . Qfi ) 5 . R value of floors over unheated spaces NSM R--30 6 . R value of slab edge insulation - unheated slab N/A 7 . R value of slab insulation - heated slab 12 . 5 B . R value of heated basement/ cellar walls ( above grade ) N A 90 R value of heated basement/cellar walls ( below grade ) N/A 10 . Type of insulation Fiberglass C . Controls 1 . Thermostat maximum heat setting D . Duct Systems N/A 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 pipe woomo 2 . R value of pipe insulation F . Service Water Heating 1 . Performance efficiency NIA TR,r.....�.. 00000000 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating N/A ;;� z:7 lip Telephone No . ( 518 ) 899-9161 1r ( applicant ' s ig ature ) APPLICATION FOR SEPTIC DISPOSAL PERMIT Ref ; S . P. E. D. S . DATE September 23 / 87 permit # New York -- 0202525 MODEL J of LOCATION OF PROPERTY FOR INSTALLATION 37 Elizabeth Lane 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 (9 150 gal per bedroom) 300 Topoaraphy: circle one: Flat Rolling Steep Slope % of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: 8 ' feet + Ground Water: At what depth? unknown $ feet + bedrock or Impervious Material: At what depth? unknown feet Percolatku test: circle one: not require required / rate min. inch. DrsaYestic 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 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 # / Depth or Thickness feet +r * * �s * sR * �s * * saa � se :ees * aysysa * as * a +s * �e * ss �esa� �a * * s IMPORTANT * See S . P . E . D . S . ...Please...LIST NEW EQUIPMENT TO BE INSTALLED permit & attached map . (over) Section II 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: 1.) the propotled .location of the System 2.) 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, tile fields and/or drywells Be 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 $250.00. Co An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. I have read the regulations above and agree to abide by these mod ^11 requirements of the Town of Queeusbury 'Sanitary Sewage Disposal Ordinance. Signature of.responsible person: Date: i Town of Queensbury Building and Code Department Bay at Ilaviland Road Queensbury, New York 12801 (518) 792--5832 SETTLED 1763 , ISO' " 4TURAL BEAUTY . . . A GOOD. PLACE TO LIVE °° z °i THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY tta at STATE STREET, ALBANY, NEW YORK 12�207ry Date May 2 3 t 19888 APPlirorion No. on file 0 0 '7 6 4 .3 / 8 8 THIS CERTIFIES THAT 4 w 71, 7232 ! 7 2 3 2 onl�r the e1e4etrical eq"ipnsent as dee+crib,ed below and " M I i'� a G. Guyer Builders Inc . # 37 EPsra 'tT ttaTed"ruteen$rupy, a+nbarin t1►epreenisea of olloavin focatfon: II--�I � of two f ami ly in the if 6 0 Basement _1 fat Fl. ❑ $nd F7. Section 12 lock 4 was examined ore "' 1 1 — '$ Lar and found to ire in comPli nce with the req"aresnen is of this Board. OT RXTURES RANaES COOKING EIECKS OUTLETS FTAeEEs swITCHES OVENS oISH WASHERS EXHAUST FANS _ 114CANCE.$CEM FLUORESCEM 14 32 20 1 8 5 3 fr DRYERS FURNACE MOTORS FUTURE AFRIIINCE fE[OERs sFECtwL ItEC'Fi TIAAE CLOCKS EiEEr UNIT HEATERS Ml1LTF-i?liT1!'f plµ��.MAT. X W. OIL il. P. GAS M_ P. T. A. +kMT. AMp. AMT. MarE- TRANS. SYSTEMS �y AMT. H. ►. NO. OF FEET AMf. WATT$ 1 drye # 10 l SERVICE DISCONNECT NO. of AMT. AMp. Ty," METER S E R Y I C E EpUIF, I X 2w 1 ►' 3w 3 X 3w 3 X aw NG. OF Cc. CONS, NO, OF NI-IEG A. W. G. A' OF CC. CONO. OF M-LEG NO. OF NEWTRAL>iA. W. �. 13 cb 1 ac OTHER AFFARATtlS- E] ec . Room Eeatersr 5 / 290 , 1 / 1 . 5 , 2 / . 5 1�Ic+tor f3 . 1 � 1 -1008t light 1 -gfci 2-smoke detectors Guyer Builders INC . 119 ounninq St. . -7r Ballston Spa , NY 12020 239 / BRANCH MANAGER Per This certificate must not be altered in any manner return To the office of the Board if incorrect" Inspectors may be identified by Their +credentials. AWANKM COPY FOR BUILDING DEPARTMENT, T"IS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. .✓i7tt�st o� '4`uE'E'+r3 �ur� BUILDING and ZONING DEPARTMENT y and Maviland Road, R. D. i Box 98 aQUeensburY, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION 00, Date Permit Permit Nei . -c * * : Footing/Pier Forms APPROVE[) � 1'>aS NO Foundation Waterproofing Back£ill Framing Roofing Siding Masonry Ve er Rough Pl Relief ValV Ext . Porches Finished Floo ,6 }-- Interior Trim Stairs & Railings Cellar ))rain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofi Door Closers Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECT" CAL INSPECTION DRIVEWAY APPR VAIN_ �- Final Buildin S u rvey Next scheduled inspection (call when ready ) Remarks-- 6/86 and-vl Building Inspector �ourn o� �� een .� htrrr ^ BD1LDlNG and ZC)IV1NG DEPAIRTM�ENT d Haviland Road, R. D. 1 Box 98 0 ensbury, New York 12801 8U G INSPECTOR ' S REPORT NAME LOCATION Date 51_ ,ram Permit No . FootirigfPiex Form APPROVEDs XES NO Foundation Waterproofi g Backfill Framing Rooting Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Pibg - Fixtures Garr . Fireproofing Door Closers Smoke Detectors Chimney 4- ULATION Foundation Floors Walls Ceiling FINAL ELECT ICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( lI when ready ) Remariks- ui li ding Inspector 6/86 and-vl 'BUILMNIG ancr!!Z©NIING DEPARTMENT Bay and Haviland Road, R. D. I Box 98 Queensbury, New York 128ol BUILDING INSPECTOR P S REPORT NAME LOCATION Date - Permit * * * * Footing/Pier Forms APPROVED - YES NO Foundation Waterproofing C -;Ba�kfill ' rarning Raof in gr Siding M�a onry Vene r Qugh Plumbin Relief Values Ext , porches Finished Floor Interior Trim Stairs 6 Rasling Cellar Drain Tile Concrete Floors Plbg - Fixtures Car . Fireproofs Door Closers Smoke Detector Chimney INSULATlc>N : Foundation Floors Walls Ceiling FINAL ELEC ICAL INSPECTION DRIVEWAY AP ROVAL��_ Final Building Survey Next Scheduled inspection ( call where ready) Remarks- Building Inspector 6/86 mci-vl awn BUIfNG and ZpNyNG DE '� 6ure�r Ba DEPARTMENT Y and Haviland Road, RID, a Box 98 OueensburY, New York 128ol SEPTIC DISPOSAL SYSTEM INSPECTION NAME too LOCAT I ON . 3 37 dK DATE n' f PERMIT No. -T— y'f SOIL TYPE lestaxn - Clay Percolation Percolation rate Required ? YES - No Min/Inch TYPE of SYSTEMa W AIasCsrptioIn fi ld , total length Length of each trench Depth of trenc s Size of gravelr — SEEPAGE PITSo(NI of) Size- -ft. X f Gravel size PTPING : Bldg _ to tank Size TypeTank to disc. � 4 .. r ✓C '!'to x ` box to f eld/pit Openings seal d ? ` 6 ES O Partial OCATXON/SE ARATXCINSr Foundation o tank Foundation to absorption lot line o to line ft Separatio Pt . LOCAT:roK of Pits ft. SYSTEM ON PROP>,ront a Left ERTY (circl one) CCt4MENTS : side - Right side Peel Sd�plt. t wsy l .r n crsi o-r S y 54 Wo►t ,nt SYSTEM USE APPROVED YES NO BetiZding Inspectcar 01/86 and vl 270 t"w*? Road ,a BUILD)NG and zI �IrVG hurt DEpARrr ENT Bay and Haviland R Road, R. D. 1 80x 98 00eensbury, New York 128o1 BUILDING INS P>~CTOR r S REPORT NAME LOCATIO Da t e _ --" ' -____ _— * * * * * * Fuca t in ✓ - * * * * » gfPier Forms A`i'i'ROVEI7 r'ouilda t_ion YES No waterproofirig Ba ck f i l l Framing roofing Sj din 9 Masonry Veneer ugh Plumbing filly Relief Valves Ex t . 2'0rch es F'riished Floors In terior Trim stairs & Railings -- -Ce l l a r --� - ---_ Concrete, ploors lbg , Fixtures car . Fi reij,roo f n Door Closers g smoke Detect s Chimney INSULATIDN , bCF'aundation PI oo rS Wali 'L; Ceiling FINAL ELECT RIC4L INSPECTION DRT'VEWAY Ai'1° RQVAL Final Building Survey Next sched -1ied Remar �� inspection Cca -1 when ready) At Iiuilciing In. , 5/F3Fi n,d_ � i ector [ It 11 ,_.Ju '7 C'� 1 twn o/ Queensb " r BUILDING and ZONING DEPARTMENT Say and Haviland Road, R . D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT r� NAME LOCATION DateZ�, Z-f;L/ Permit No . ✓ = APPROVED - YES NO �tirig/Pier Farms. Foundation Waterproofing Backfil l Framing Roofing Siding hyasonry Veneer P Rough Plumbing ,; � F3 c-C-Cwe. / Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Firaproofin Door Closers Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRI L INSPECTION DRIVEWAY APPROVA Final Building Survey Next scheduled Insspectio(n� ( call when ready ) or 4-T-l4A AA6 (rV [ L/ ./ r / Building Inspec, Lor 6/86 and-vl ✓C1�,r p Q y�/'J �/�J ,�/ 13(JIL "JfNG f "C ltPt� ry �G7lts Gr and ZC7d4fNCa DEPARTMENT Bay and HaVi+and road. R. O. 1 Box 98 oueensbury. New York 128d1 BUILDING INSphCTOR r S R EAOl2 r NAME LOCgTION Date )/ L ----- ,� Footing/pier Fr !✓ - APPRpVED * 'Foundation rms $ No Naterproo fin. Backfill Framing Roofing ti Siding Masonry Veneer Rough Plumbing Relief Valves Ext , Porches Finished Flacrrs Interior Trim .Stairs & Railing Cellar Drai n Ti a ---- Concrete Floc rixtu Car. F?.repr ofin Door Close s 9 Smoke Det oars Chimney INSULATI Na Foundat ' on Floors walls Ceiling FINA-L ELECTRICAL, xNSpECTION 'V,r wax APPnOVAA Final Building Survey Next Scheduled Inspeetio Remarks- n (call when ready ) 6/86 md,vlBuilding Inspector /'� Aee ,n ybure� own o C� ,PASTMF BUyUDING and ZONING i BOY, 98 Bay and Fiaviland frloa Yo128(]1 Queensbur'Y• New BUILDING INSPECTOR RBP4R� ' S NAME L o C A T I [73tif Apermit I3o . � * *APPRCNEL}* _* YE NO Ming/pyer Foams Foundation WaterProafing gac3cf i ll Fxamin9 Roofing Siding --- - Masonx]' veneer__----- Rou9h plumbinq_��- �-- Relief Valves ------_' E7tt . porches Finished Floors Inert r & Railings sta Trim irss ain Tile Dr _------- Cellar a loons Co'nc7rete Plbcj - Fixtures --.-_�--__ Gar - Fireproofing Door Closers Smoke Detectors Chimney Foundation Floors Walls Ceiling 114 sPECT1014 _ �_---- FI£3AL ELECTRICAL y ppPAQVAL. --�- DRIV EW A ey �-- �---� Final Building Sur t4exC scheduled insp ecCion CGaLI when` ready ? Remarks`- . guildi nsf,ectax BUILDING DEPT. COPY OF APPLICATION FORM 46.EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT_ WHEN REQUIRED. 7EiAIP.#� DATE CITY OR QLwwmsbuxy Warren TOWNSHIP Qmmwisbury COUNTY STREET AND NO. OR #37 M{ th lisne ROAD AND POLE NO POLE NO. IsETMVE£N wMALir TMMO CposS sraEETs IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT-g SUILOING NAME OCCUPANCY . . AND ADD Fll,iitisaT-Ry Sx]C. 139 �ILTrRTin r L TEL. # 899-91.61 SSiCURRien IL d FROM THEIR �y OFFICE 1— IBUILDING FECTS NEW OLD ❑ Is WORK NFW ! ADDITIONAL � REMOVEO O LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUM WR OF OUTLETS NLasp Raalp'latlw MOTORS HEATERS CIRCUITS OFFICE USE Loa ONLY tfow Ssde Atuwh'x p.ilnM y MWWpIf Swg** Plindmot Brskst N Two . Estt Na E Ne. 'GUMP INSPECTION Out fllla lm tr baaa Err mant tat F#. Atd FI 3M Pl. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. Tixs APPSiut+on m inuormsed w cwar the abwsWted quipxnrM to be inlsprexad but it rt tkno of intprc"i thaxr is found addixional o4vmwpnlanl not *tt listed, Vn era suU/ mod fo make the brpection and odl..st the fee to carer thr a/StliVwmuO rquiPnwm4, r III I bT the *MW ntt. SIZE OF ELECTRIC SSG" TOTAL MAINS 150 FEEDERS LAMPS WATTS CHARACTER EXPOSED OAS TUBE SIGN OF WORK ROU& to arid service CONCEALED TRANSFORMERS OF VA WORK TO BE (NUMBER) (CAPACITYI STARTED CONIPt.ETED SIZE OF SIGN SERVICE OVERHEAD UNDERGROUND MAKER ENTERSy OF SIGN BUILDING INSPECTION REQUESTED ON OR AS NEAR AS POSSIBLE lull rtmil 1 3&03 rjaeKlyMEW OLD AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES DATE OF MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION PRINT NAME AND ADDRESS NAME OF l dAt,fd xSIGNATURE APPLICANT— ,IF I= OF APPLICANT - STREET AODR ESS 1� � � e, TELEPHONE # 1� CITY OR nn 11�pu Y =k CODE 'IqwS���xxe�7��xr�� MIEN APPLICAME POST OFFICE al ���,! irC.sJ+I+xJ 4e EL (REV. ItWO) A SEPARATE APPLICATION !MUST BE FILED FOR EACH SEPARATE BUILDING QUEEN d VICTCRIA'S GRANT QUEENSBURY, NY. CO-T.G. i CLEANOUT TO GRADE) .1� _ NMEMO 100. SC/ cU / 18' _4-- LCT 1 33 Lu cr 3 'D lm N 1 � M SHUTOFF 1 105.00' 1 ELIZABETH 0 i 2000 gol 102.001 08 52 i O 7 LOT � I 1 (V 1 1 1 ►02.00/ 1 LOT 41 I m � 1 1 92.00 LANE C.O.T. G. i LOT I 43 I REFERENCE DRAWINGS S SITE UTILITIES SEPTIC E~ WATER VanDUSEN $ STEVES SURVEY PLAN 8'- 0 DIAMETER 9'- 0 DEPTH