1987-910 f �
I
CERTIFICATE OF %0XCCZ.. P NCY
C TOWN OF QUEENSBURY
i
WARREN COUNTY, NEW YORK
Date June 17 , 19 88
u7- 9 ]. 0
This is to certify that woe requested to be done as spawn by 'Permit No.
has been completed.
6
This structure may be occupied as a of Two Family Dwelling
I
Location 33 Elizabeth Lane - Queen VIctoria ' s Grant
e der Guyer Builders Inc .
i
By Qrder Town Board
C -rOWN OF QUEENSSU tY
Budding ar Zoning inspector
a
BUILDING PERMIT
TOWN OF QUEENSBURY No. 87-910 - �
WARREN COUNTY, NEW YORK o
�e
PERMISSION is hereby granted to Queen Victoria ' s Grant X
OWNER of property located at 33 Elizabeth Lane Street, Road or Ave.
of Two Family Dwelling
in the Town of Queensbury, To Construct or place a
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.
F2CON
ER'sAddressis Guyer Builders Inc .
119 Dunning. Street o
Ballston Spa , N . Y . 12020 ro
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TRACTOR or 8UI LDER"S Name Same :1 Y
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a CONTRACTOR or BUILDER'S Address
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Same
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction — [Please indicate by %1 rr
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( x) Wood Frame C D Masonry I } steel
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FPt-ANS and Specifications
No. 34 ' x 431 as per plot plan , specifications and application including
septic system and attached one g$axgx car garage . MODEL L ,
ed Use
} o£ Two Family o
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E
0
%5 . 00 C/O 88
$ 75 . 00 July 1 , 19
PERMIT FEE PAID - THIS PERMIT EXPIRES r.
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
C
town of flueensbury before the expiration date,)
30th Da of December fg 87
Dated at the Town of Queensbury this Day
of
BY
V rJ/1 iiyJ for the Town of Oueensbury
Building and Zoning {
. AID �'Sl". 5..1.kMYLL" t'L' L1 D Dl.,N7 • y,:,r a . Y;i"3`1 .: - .. ,
r / Application No . k. . _ I
ddd, wet #� �eee�e►e 3 6�1tP� Permit Issued 19 . r
8UILDING 'and ZONING DEPARTMENT Permit Expires 19 �� , T bdd
r
Bay and Hawland Road, R. D. 1 BOX 98 Zoning Designation
Oueensbury, New York 12801 Variance No. m
Site flan iew No . "
Approved b CIO 6457
/ eAPPLICATION FOR / �'
BUILDING AND ZONING PERMIT `�'
a r * * iF * it * * * * e * * i a i! iF * iF � #k * e ik iF iF aF fF 10 * * +r Noe*
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 .
Poo* Address 119 Duxming Street Ballston Spa , New York 12020 Tel ( 518) 899-9161
Property Location : 33 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 CODE'S IS :
Richard H . Gu er III { 518 } 899-9161
P . O. Address Tel . Na .
dedd
,N
Name of builder Guyer Builders , Inc .Address 119 Dunning Street Tel . ( 518) 899-9161
Name of plumber uyer ers , nc .Address ng ree Tel .
Name of mason yer 1 rs , nC .Address g 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-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 REQUIREDsee
Sire of propertyplan
-
100± pl pan iiftlt�� k 120 ft .
L * Existing buildings) Size ft X
PROPOSED BUILDING AND USE : Moofl * Existing buildings ) Use N/ A —
Size of new strut e 34 ft x 43 ft
Foundation-pier slab crawl/partial/full * Proposed building . s�estOn� plan
em property Rine
circle one ) 1 * Front yardu 30+ ft Rearr yard 30+ dooddeddeft ,
Now of stories (habitable space) * Side yards lam+ft and 15+ ft
Height ( grade to ridge) 21 _0 ft - * If on earner , setback from side street ft
If residential , no . of families of 2
So . of rooms ( excluding baths) 5 " OCCUPANCY INFORMATION
Noe of bedrooms ��
* PRIMARY BUILDING -
Noe of bathrooms One family dwelling Ci i5 hui in r
primary heating system Two family dwelling This
TypV se ar a ectric* --of fuel_ Electr�.clty - Multiple dwelling / Number of units
No. of fireplaces to be installed
p * Permanent occupancy
will a wood stove be installed? No 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-
Town House * Detached garage/one car/ two car/ car
Colonial Raw One car
Attached garage/one car/ two car/
( CIRCLE ONE PLEASE ) * _�
* * * IN * IN * * * * * * * * * * * Private storage building
ESTIMATED MARKET VALUE OF * Other
Ir
CONSTRUCTION `"
Mae. Nof
INFORMATION ON BUILDING SPECIFICATIONSe ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETEDI
Form BPA 4/86 md--vl
BUILDING PERMIT APPLICATION CONTINUED - At •
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe, etc . wood franc
Will any second.-hand or ungraded lumber be used? if so, for what? no
Foundation wall material concrete block Thickness
Depth of foundation below grade (to bottom of footing ) 4949
minimum
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 ' sq . ft . - - Type of use ?
Type of roof - slo;!' ,,Xfd lat/shed/other Material o€ roof Fi r ass shin essize , wood studs 6 " spacing 24 "o . c . length 8 fta exterior walls
.foists { floor beams ) lst . Floor N/A '"x spacing "o . c . span N/A ft .
.foists ( floor beams) 2nd . floor --��'"X��-"' spacing—tW�"o . c . span N A ft ,
Overlays (ceiling beams ) "X " spacing 24 '"o . c . span N/A fte
Roof rafters 2 "x 1 to space' ng 4 0 . c , span 12 ft .
Roof trusses (,pre-engineered) spacin�4 "o . c . span 43 ' 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 garage4and dwelling? es 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 n unni.cipal
SEPTIC SYSTEM Distance from ANY private well ( including adjoining properties ft .
(A separate application is necessary . for an re air or new installation of septic system)
See S . P. E . D. S . runt # 02012529
Town of A F F I D A V I T STATE OF NEW YORK
ry
Warren County off 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 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 -_ - -- -
day of �m�C- 19 Owner , owner ' s ag t , cnize�,contractor �
�_ EUZABETH K. LANDRY
' u��iy �. � r� Notary Public, State of New York j •`
1Vo. 4$62007
NOtary 1 , _ arren County: N . Y: � Qualified in Saratoga County Sg
a Commission Expires June tB, 19�
* * At * it * * * .t . * It * * * * It It * * IN • * * rt * * * * * * * * ,t * * *
SPECIAL CONDITIONS OFF THE PERMIT .
963 Square feet living
288 Square foot garage - one stall
1224 @ $7 ,00/100" or part of
$5 . 00 One stall garage
$5400 C/O permit
Total
TOWN OF QUEENSBURY e.Lso
WARREN COUNTY , NEW YORK
Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work .
ANSWER ALL of the following :
Gross floor area 936 S . F .
2 . Type of heat Baseboard electric
3 . is the building mechanically cooled ? No
♦ * percentage of area of windows and doors I5 . 9%
A . Over 16 % Only
1 . U value of gross area of walls , roof / ceiling and ,floors
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a . Are foundation walls insulated ? YES NO
1 . If YES , what is the R value ?
3 . Slab on grade YES N,0
a . If YES , what is the R value of insulation around
perimeter of floor ?
4 . Is basement heated ? YES NO
a . R value of insulation
5 . Type of insulation
Be Under 164 Only
1 . R value of roof and floors exposed to ambient conditions.
R-38 U. =0 , 026
2 . R value of exterior walls XNXXX R-23 . 5 U . =0 . 04+
3 . R value of glazed area U . -0 . 20
4 . R value of doors R-14 . 9
5 . R value of floors over unheated *paces W NIA
6 . R value of slab edge insulation - unheated slab N/A
? . R value of slab insulation - heated slab 12 . 5
8 , R value of heated basement/ cellar walls ( above grade ) N A
90 R value of heated basement/cellar walls ( below grade ) N/A
10 . Type of insulation Fiberglass
C . Controls
1 . Thermostat maximum heat setting
D , Duct Systems N/A
1 . Is duct system installed in unheated spaces ? YES NO
a . If YES , R value of duct installation
b . R value of duct in other areas
E . Piping Insulation N/A
1 . Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulation
F . Service Water Heating
mmm1 . Performance efficiency NIA
2 . Temperature control setting maximum
G . For Swimming Pool Only
1. Maximum heating N/A
Telephone No , ( 51$ } $99-9161
( applicant ' s signature )
APPLICATION FOR SEPMC DISPOSAL PERMIT `
Ref : S . P. E. D. S .
DATE Septenibex 23 / 87 permit #
New York - 0202525
MODEL. L of E/L
LOCATION OF PROPERTY FOR INSTALLATION 33 Elizabeth Lane
Owner's Name: Guyer Builders , Inc . Telephones ( 518 ) 899--9161
Address: 119 Dunning Street , Ballston Spa , New York 12020
Installer's Name: Guyer Builders , Inc Telephone: ( 518) 899-9161 . r
2 A, C , E, I , is K, L, M
Number of bedrooms (residential only) 2 _ 3 F , G, H
Total daily flow (compute Q 150 ,gal per bedroom) 300
TbpcgpnaphV. circle one: Flat Rolling Steep Slope % of slope
Soil Nature: circle one: (Sand�3 Loam Clay Other / Depth.: 8 ' feet +
Ground Waters At what depth? urdcno' 8 feet +
Bedrock or Impervious ,Materials At what depth? unknown feet
Percolation tests circle one: not require required / rate min. inch.
Domestic water mggdys circle one: Municipal Well Other
IF domestic water supply is a Wells
Separation: Watersupply from Septic absorption NIA feet
* PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1 ,000 gal.)
TILE FIELD* Each 'Drench N/A feet / Total system length NIA feet
* SEEPAGE PIT(S) : Number of / Size each feet by feet •`
* Size of stone to be used # / Depth or Thickness feet
IMPORTANT * See S . P. E. D. S .
...Please.._LIST NEW EQUIPMENT TO BE INSTALLED permit & attached
* * * s * >« s * sss * ss * sss * * sass * * * * * * * * * s * * sss * map ,
(over)
4
Section 11 Septic System. lnspections:
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 propoped ,location of the sqystem
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
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 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 regubatious above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of,responsible person:
Date.
Town of Queensbury*
Building and Code Department
Bay at Havila.nd Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD. PLACE TO LIVE
Jc�wrr c►� ��eenshser�
BUILDING and ZONING DEPARTMENT
Bay 4 eensbury, NeYOf p 98
i 2801
gl.11LDIh1G INSPECTOR ' S REPORT
NAME -00001
LOCATION � 4a - `
Date _r/ �/ permit No
APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
gackf ill
F rasni.ng
Roofing
Siding
Masonry Venee
Rough Plumbin
Relief Valves
Ext , Porches
Finished Floor
interior Trim
Stairs & Railin s
cellar Drain Til
Concrete Floors
Plbg , Fixtures
Gar . Fireproof ng
Door Closers
Smoke petec rs
Chimn9Y
INSLTLATIO
Foundati
Floors
Walls
Ceili.n
LECTRICAL IN'aFECTXON
FINAL -
AR1VE AY AP]PRbVA7 Final Building Building Survey
(call when ready )
Next SC uled inspection
Remarks--
Bui g inspector
6/86 and-vl
III Jill III III! I
4001054 THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
41 STATE STREET. ALBANY, NEW YORK 12207
taLkate June 160 1988 Application No. an file
001645r88 A 71 ,9554
T141Si CERTIFIES THAT
only the efertrical equfptnemr as described below and introduced by the applicant maned on the above application number in the prerrsimm of
Guyer Builders # 33 Elizabeth bane Queensbury , NEw York ;j of t;W0 .Family
in the following Location; ❑ Basement ® ist Ft. ❑ 2nd Ft. outside Section l 2ck 4 Lot
was examined are f^y 8 — 8 8 and found to be in compliance with the requirements of this Board.
FIXTURE ECEPTACUES SWITCtRER NXTURES RANGES ICOOKING va S 1 OVENS I DISHWASHERS EXHAUST 'FANS
OUTLETS jINC^NMSMKT FLUORESCENT AMT. K. W. AMT. K. W. AMT. K.W. AMT. I K. W. AMT. H- P-
12 27 18 8 4 1 4 . 6 3 7C
DRYERS FURNACE MOTORS FIXTURE APPLIANCE POWERS 15MCIALRECOnj TUBE CLOCKS I RELL UFRT HEATERS MULTI-OUTUET DIMMERS
AMT. K. W. OIL H. P. GAS H. P. MIT. NO. A. W. G. AMT. AMP. AMT_ AMPS. TRANS. AMT. Ir. r. N. OF�T AMt. WATTS
SERVICE DISCONNECT NO. OIF S E R V I C E
AMT. AMP. T1'Pt RRaw 1 .sr 2w 1 0 sW 9 JI► aw $X 4W �� FPERCie'C�D. of L 0, Cp_ NO. of HI-1EG A.IW-G- NO. OF NEUTRALS OP P EUT!AL
2fU 4f0
1 15[ cb 1
OTHER APPARATUS:
Elec , Room HEaters : 4 / 2 . 4 , 1 / 1 . 5 , 2 / _ 5
m0iGoars 2 1h
1 -post light
3*Rgfci
2 - smoke detect:o r
Guyer Builders Inc . •
119 Dunning St .
Ballston Spa , Tw 12020 239 BRANCH MANAGER
Per
This certificate must not be altered in arty manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
Q�,� eeMl3barijN�own
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S�y��piN
G and I- ad. Fi,.D , 1 'Box 98
Bay and` Hauiland New r'orK 12aol
aueenst�ury
s g'TlC DISPOsp%%
SYs.Tem INSPECTION
fro
LOCAL CO No .
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percolation
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BkJ1LC11NG and ZopyyNG iJEPAR'fhAEl+3T
Biland Road, S.D. 1 Box 98
ay and Hav
C]ueensbury. tdew Yark 12801
BUILDING INSPECTOR ' S PEpoRT
NAME dr
LOCA.T ION 35
permit NO • -u----_' I
* *
APPROVED _ YES Nc7
Footing/Pier Forms
Foundation
W aterPr�f ing
ga,cxf i ll ��
Framing
Roof ing
Siding
Masonry veneer
p lxlmbing
Ro`'gr'
Relief valves_,
Fxt . Porches - ---
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain 'Tile
Concrete Floors
plbg - kfixtures
Car . Fireproofing
Dior Closers
Smoxe Detoctors
Chimney
�pINSULA"T'ItJN
Foundation
Floors
Walls
Ceilir�LECTRYCA INSPECT1014 �---
FINAL
17R1VEWA`I ApPRoV S ry - -
Final gui ldinS
inspection (Cal
l en ready )
Next scheduled
Remarks- �1 0 "`� �J
wilding Inspector
6/86 Md-Vl
�(� ,�y Q "eereur�}
R,p 1 Box 98
EIU 14'D I hYG
Bay and Navilar►d F�oad. � Z$4I
i
}ueensbutiy. { yew
BU I l_4 I NG
INSPECTOk2 ' S REPC7R�
hiAM'�
perTn
J
t3o
poot]SIX3 ier Forms
Q dat is n --
Waterproo
gacy -111
�ami.n'r3
Roof in9
S idin(3
gAasi my Veneer
4aSQr' Plunrbrn'3__�- -- �- �-
R =lief Valves_`-- - r-- ��-
' .Xt • porches
Finished Floors
lylter for Tr itn
Stairs F R?}ri ing
Cile
ellar prz' T
Concrete Floors
Fixtures
P1 3 Fire roofl.n9
Gar Closers
Oxe Cye.tectc"rs
Cn imn e-
jrjsul-j%T rs
goundetic,n
F lo,or s -
lAa 11 s -- --
Ce i 1 i n9 C rRICP.L IL�1saE ECTYClI3�
pINAL ELR
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Fined guildlr'E,
}zeduled insP
ecticn call VIA"
sc ready
lyexC
Rernarlcs�
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�] ueen3btar� r
✓� w►r yN I pEPAJR CTA N
and XpN 1 Box $El
qukt,'DING pad, '
Bay and Maviland R 12gp1
York
aueensbury .
flew
5 ORT
ICSSP � C� OR ` 12�.F'
pUlk- DI �`G
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gacic'� i l l
F ramin�3 �__.-----
raidin9
�`ls�'nr plum�rn
Vene
Pelf-ef Valve porches
Finished Floor
or 'rrrm
Ln cer i Railin
Cellar Drain Ti
~--
ncrete Floors
_ Fixtures
Clan . F it epr[ao£ rn9
Do Closers
or
De4.CC4Lor'S
Sl,
Chimney
SlysuLj!k"£=QN
Foy dat ican
Floors
Walls N
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CellinE!
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— _ n all w
Next scheduled specrlon �
P,emaf sy
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f � � � 4 .J� wn J t7�Pa�R�sAErs'T
l ll BUt1-DING and ZOWNG Box 98
L3ay and Havifand Bawd. R'D
Queensbury. New York 1280 ►
BUILDING
NSPE.CTC)R , S
NAME
Loco v ION
Permit
RC+ too
AP'P ROV
F'oVMs
Fodat ion
Water'Proof ing
Sa+cicf i l l
Framing
Roofing
Sidin�3 Veneer
tlasonrY - y"Gt^ ii c c e t.cl
FZoug'n Plumbyi.'g
Relief Valves
Porche
Finished Flo rs
Interior mil ngs
Stairs ryrain T ' le
Cellar Floor
Concrete
plx,g - Fixtures
Gar . Firepraofin ---'_
,poor Closers
^SM k.e Detector
Chimney
I13 SU JaAT x dN
F,pun dot ion
Floors
WallS
Ceiling CTRICFL INSPECTIO
1 FINAT, B�' ~~
i }DRIVEWAY Avp OV 5L� -� �-- �'
Final B ildinfi
ready )
scheduled -InSpectio
n (ea.il
Next /V''jLila =,
s ,v 4-•r,
Remark •" �-' � [ `�
43
/I ee
r ? r '
r. r nq Inspec t
� g ildi
Fi/8 and-vl
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LLt � (�uee,n y � ur�
�V w o
BtjjL0R4G and Zom%NG DE Ry Box 9$
Bay and Havlland Road, R•
Queensbury, New York 12801
iNSPEC 4 dR ` S REPOR -f'
BUILDING
NAME
211
LOCA-f 1014
1 permit NO
YES
Footing/Pier Forms
Foundation
Waterproofing
Bac'Stf i l l
g naming �
gaof ing
Siding
tgasonrY Veneer
u+3
Belief 'Va
yes
7C.t - por Gil£S
Finished Floors
Interior Trim
stairs & mailings ---
Drain Tile _- -
Cellar 1]r ,�.�--- .._----
Concrete Floors
F fixture s
P17x3 - roof g
Oar - Firep
,,poor Closers
smolte L]etect s
Chimney' r'
-INSULATION
Foun da4ti.on
Floors
Walls ceiling It3 SPECTIOt � -----
F I14 AL ov
FS,ECTRI
' pFFROV
DRXV EW AY
Final Building 8"Xvey
tyext scheduled inspection �
early)
ttemarks-
,l
I1 I
fto 'K p PAf�INSEiiT
BUDDING and Zot4ING
Bay and oaviland Road, Bax 98
C)ueensbury. flew Y ork 12601
ISPECTORIS PEPOR
gIfILDINGT
N
NAME L '
2—
LC3CAT ION ff
YI Permit No ' ddd4—��
Date 1 PPI�Rc tED* -* YES No
Footing/pier Forms
Foundation
Waterproofing
gackf ill
Framing
Roof ing
Sja ing
14asonry Veneer__�_.Rough _---
Plumbing___---
Relief Valves__ ..�—
Ext . porches � ---
Finished F10ors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg • Fixtuxes
?s Gar -
Fireproo ing
Door Closers
Smoke Detrec ors
j Chimney
ItdSULATdI =
Foun da.t i
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Final 'building Survey
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BUILDING DEPT, COPY OF APPLICATION FORM 40-EL, NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED.
i f ,
TEMP. i DATE rCITY ON
.
VILLAGE QY TOWNSHIP qmbqh--`sbury COUNTY
+R* -r AAND DroLe NOD. #33 :�'7 i mmsi eth � POLE NO.
BETWEEN REETS as
TWO
PREMI L TED? SECTION BLOCK LOT
OCCUPANT'S BUILDING J
NAME �,,_� 7 OCCUPANCY
APIOE ADDRESS ArS E r Bm tiers Inc. } 119 ��'inv Stx0st TEL. �. ..
CURREN? r -.•'' OFFICE
SUPPLIED FROM THEIR . ..
BY
�Ipp11 VI �'''7 DEFECT'S
BUILDING
IS .NEW 461 OLD IS NEW ADDITIONAL L_1 REMOVED ❑
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS LLanw Rgweehs MOTORS HEATERS d Dlwrs OFFICE ONLY E
t.a.I C"Wm SWall
� ,� Switch predaltt Bradlee Ne- Type Eetl� No. Esdt Irk b WI ra INSPECTION
Ck t-
side
mb~
bees
Br
mwM
tat FI.
III FL
Sly FL
RE.MAFIKS; LIST OTHER ELECTRICIDEVIG"MFOATH . DD NOT USE THIS SPACE.
This application K intended to GV~,,the aborslisted squ�pwlent to be hvq a ted but if at titrae of insPm=tkm there is found wIy ait' to *W'Plnent not show listed.
you are authorised to make the i on, and ■dittst the the to comer the additional equiptnerlt, as Provided be the applicant.
SIZE OF 1 C�fr�1 ELECTRIC SAID TOTAWATTS
L
MAINS 150 a FEEDERS
CHARACTER .,tt,,,,�,�, �,�,,,.,.��.a EXPOSED GAS TUBE SION
OF WORK d.La � smmvi " CONCEALED TRANSFORMERS OF VA
WORK TO BE CNLMMBERB ICAPACITY}
STARTED COMPLETED SIZE OF SIGN
III I I Q I I I I D UNDERGROUND MAKER
ENTERS u7[iC OF SIGN
BUILDING
INSPECTION REQUESTED
ON OR AS NEAR AS NEW OLD
POSSIBLEvIll
AVOID DELAY BY GIVING FULL AHD ACCURATE INFORMATION. ALL SPACES DATE OF
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION
PRINT NAME AND ADDRESS IV SIGNATURE
NAME OF OF APPLICANT
APPLICANT 'GL> � I _
61
STREET ADDRESS
TELEPHONE # �
y yy LICENSE NO.
CITY OR
PORT OFFICE yugi i atca LsF isaw YnT-k CCOpE .I,2j= WHEN APPLICABLE
66 EL (REV. 1/86) 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