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1987-909 f WON CERTIFICATE OF (DC CUP A, N(".". 'Y TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Gate March 11 1987- 909 SF This is to certify that work requested to be done as shown by Permit No. has beers completed. This structure may be occupied ss a of Two Fatai ly Dwelling ]aocation 31 Elizabeth Lane - queen Victoria 's Grant Guyer Builders , Inc . Owner By Carder Town Board TOWN OF QUEEN5SBURY Building & Zoning Inspector BUILDING PERMIT TOWN OF QUEENSBURY No 87_909 � WARREN COUNTY, NEW YORK z 0 PERMISSION is hereby granted to Queen Victoria ' s Grant n r OWNER of property located at 31 Elizabeth Lane Street, Road or Ave. in the Town of Queensbury, To Construct or place a of Two Family 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. r~ ra t . OWNER'S Addressis Guyer Builders Inc . 119 Dunning St . C Ballston Spa. , N . Y . 12020 n rt 4 2. CONTRACTOR or BUI LDE R'S Name r• Same m 3. CONTRACTOR or BUILDERS Address h Same 4. ARCHITECT'S Name w r- r N 5. ARCHITECT'S Address pr m r B. TYPE of Construction — {Please indicate 6y X} rp (X ) wood Frame { ) Masonry I 1 Steel ( } 7. PLANS and Specifications ws• Na_ 30 ' x 30 ' as per plot plan , specifications and application including o septic system and attached one car garage . MODEL A 8. Proposed Use E a } Of One Family Dwelling r n F W I1 $ 5 . 00 C/o $ 82 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 1 , 19 88 m (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.) dv Dated at the Town of Queensbury this 330tth Day of December 19 87 SIGNED BY _ �'r .' - �C:r /� for the Town of Queensbury Building and Zoning Inspector / Application No . ��ib+Il p �aeen Mary Permit Issued 19 } 4 1 8UJL0iNd a04rZQNiNG DEPARTMENT Permit Expires 19 a 'i '- -., Say and Haviiand Road, R. D. 1 Box 98 Zoning Designatio Qi,T 1931 ©ueenebury, New York 12801 Variance No. Site flan Rev w N +"!: /'� -- .r Approved by �`�'�" APPLICATION FOR BUILDING AND ZONING PERMIT' A PERMIT MUST BE OBTAINED BEFORE BEGIWING 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 Dunning Street Ballston Spa , New York 12020 Tel . ( 518 ) 899-9161 Property Location; 31 Elizabeth Lane Tax ,Map No 121 4 / 2 Street number or building lot number subdivision names (if applicable) Queers Victoria ' s Grant THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : Richard H . Guyer III ( 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 yer Wilders , =Address 119 DWYrUngstreet Tel . - Name of mason yer rs , nc .Address g r'eee Tel . - NATURE OF PROPOSED WORK : * ZONING INFORMATION : 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 FOR DEMOLITION PERMIT , STATE 512E 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 VEI,OW . ' lo Size of property lqp± plan ft X 120 ft . * Existing buildings) Size lql=ft X��fC . PROPOSED BUILDING AND USE Model Of * Existing building (s ) Use ._.. NIA Size of new strut a 3D -f t X...aQf t Foundation-pier slab crawl/partial/full * Proposed buildings diiseestt pflot p ncef from property line circle one ) 2 * Front yard 3Q+ ft Rear yard.--30+ ft . Noe. Of ,stories {habitable space} Side Ards 13�+ ft and i5+ ft Haight (grade to ridge) 22 " - 6" ft * * If on cornerssetback from side street ft If residential , no. of families of 2 kNo. of Xooma (excluding baths ) * OCCUPANCY INFORMATION No. of bedrooms Z � * PRIMARY BUILDING - No * of batter--Dome 2 One family dwelling g e r t Primarg ":eating system baseboard a ectr.ic* -Two family dwelling � $ Type o. :eel Electrlcit3r N * Multiple dwelling / Number of units o . of fireplaces to be installed Will a wood stove be installed? No * Permanent occupancy * Transient occupancy Central. Air conditioning? �'� Business BUILDING STYLE., PRIMARY STRUCTURE Industrial Ranch Contemporary Lo cabin * Other Raised ranch Mansion Du le * 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 Private storage building ESTIMATED MARKET VALUE OF A,_ " Other CONSTRUCTION ' $ .jL INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET, TO BE COIMPLETEDI Form SPA 4/66 and-vl F 4%A BUILDING PERMIT APPLICATION CONTINUED - v M 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 Depth of foundation below grade (to bottom of footing ) ee minimum Will there be a cellar? 'no Heated or unheated? Floor sqo footage sq fit Will there be a basement? no will any portion be used as living space? ( If so, what p0� ? sq. ft . - - 'type of use? Type of roof - sloped flat/shed/other. Material of roof F`i rg ass shingles Size , wood studs "X 6 '" spacingsd'o . c . length 8 ft. exterXor walls flo Joists ( floor beams) lst . or _",/A •"X spacing "a . c . spanN/A ft . Joists ( Moor beams.) 2nd . floor ;�""X�T"' spacing` -„o . c . spank ft. overlays (ceiling beams ) 2 '"X spacing 24 "'o . c . span 14 ft. Roof rafters 2 "X 10 " spacing 24 o . c . span 4 ft . Roof trusses (pre-engineered) spacing + ""o . c . span NSA ft , p Exterior wall finish stained Of what material? 5 /80" x 4 ' x U ' texture 111 Interior wall finish pain s eetrock If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 1 /21" type. "X" sheetrock Is there to be an opening between garage }and dwelling? yes If so will a Fire-rated door, enclosure , and self-closing device be provided? s Will a flue-lined chimney be installed? No Height above roof WA ft _ Depth of chimney foundation below grade N A ft .' Depth of fireplace hearth_ALA 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 for an re air or new installation of septic system) See S . P. E. D. S . pernu_t # 026252 Town of Queensbury County of Warren q 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 donelon 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 . ekk4! 5iA1QRN TO BEE'ORE ME THIS SignatureOrenitect, cantractor' day af� _r,F`g� t 19 g'1 ELIZABETH K_ tANiDRY Notary (Public, State of New Y"k l No. 4662001 ountV No Y' Pub , Warren. County, N� �..� Qo ssionin Expires CI6f I Y Commission ExpireaJune 16, t$wW s IN Al r r �r rt : , * • * a * * tlr * rr * k * k w "t +, Or * Or Or SPRCTJ Ia CONJ31TIONS OF THE PERMIT : 1020 Square feet living 264 Square foot garage - one stall 1284 @ $7 .00/100" or part of S5 . OQ _ Oae stall garage $5 .00 C/O permit Total BY___________________�___________ 11 Al l • TOWN OF QUEENSB [3RY 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 : 1 . Gross floor area 1420 S .F . 2 . Type of heat Baseboard electric 3 . is the building mechanically cooled ? No 4 . Percentage of area of windows and doors 10 . 6% A . Over 16 % 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 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 a . Under 16 % Only I . R value of roof and floors exposed to ambient conditions R-38 2 . R value of exterior walls R_. 23 . 5 U. =0 . 94± 3 . R value of glazed area U . -Q . 3Q 4 . R value of doors R-14 . 9 (U. = ". 60) 5 . R value of floors over unheated spaces A`/A 6 . R value of slab edge insulation - unheated slab N/A 7 . R value of slab insulation - heated slab 12 . 5 V . R value of heated basement/ cellar walls ( above grade ) N/A 9 . 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 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 insulations r . Service Water Heating 1 . Performance efficiency N/A 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating NIA Telephone No . ( 518) 899-9161 / a 4pplicant s si nature ) OF y APPLICATION FOR SEPUC DLSPOSAL PERMIT Ref : S . P. E. D. S . DATE September 23 / 87 pest # New York - 0202525 MODEL A of A/J LOCATION OF PROPERTY FOR INSTALLATION 31 Elizabeth Lane Owner's Name: Gayer Builders , Inc . Telephone: ( 518) 899-9161 Address: 119 Dunning Street , Ballston Spa , New York 12020 Installer's Nance: 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 Q 150 gal ,per bedroom) 300 Toppogs`aphy: circle one: tat Roiling Steep Slope % of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: 8 ' feet + Ground Water. At what depth? "IlluzoWrl 8 feet + Bedrock or Impervious Material: At what depth? unknown feet Pewvdlation test: circle one: Cnot require required / rate min. inch. I3omeatic grater supply: circle one: qMunicipal Well Other 1F domestic water supply is a Well: Separation: Watersuppiy frown 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 IMPORTANT * See S . P. E. D . S . ...Pl+ease...tJST NEW EQUIPMENT TO BE INSTALLED permit & attached * * * * * v * s s s # * s s # s s * # s # * * s s * * * * * s s * * # s * s s s s map . (over) Section Il SeRtic 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 prop ped ,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 Queensbuxry Building, Department before further construction. 1 have mead the regulations above and agree to abide by the and all requirements of the Town of Queeasbury Sanitary Sewage EdAponai C*&dinance. Signature of.responsible person: I?ate: Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD. PLACE TO LIVE / _ lvwtt 0 Q+" Qerrstte►'c� (/ ' tusk BUILDING and zONING DEPARTMENT ` Say and Haviland Road, R.D. i Box 98 Queensbury, New York 12801 13UILDING INSPECTOR ' S REPORT NAME �, �+►!C / LOCATION Date1! / ^ _, Permit No * * As * * * * * * * APPROVED - YES NO Footing/ I'ier Forms Foundation waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves F.xt , Porches Finished Floors Interior `Prim Stairs & Railings Cellar Drain T' le Concrete floors Pl'bq . Fixtures Gar _ Fireproof ± g p Donr Closers Smoke De'tectO s Chimney INSUI.A'TION Foundation Floors Wa ] Ce i 1 ins; FINAI. ELECTR'CAL INSPECTION DRIVEWAY AppROVSurve y Final BlAilding itilext sched,led inspection ( call- when r �' �dy � Remarks- vTiuilding Inspector 6/86 me3—vl ' flcc--77 oLvn © ueerrs urea 1 BUILDING and ZONING DEPARTMENT I Bay and Haviland Road, R,D. 1 Sox 98 Queensbury, New York 12801 BUILDING INSPECTOM S REPORT NAME LOCATION Date -- mg / Permit No . 'q0 APPROVED - YES NO Footing/ pier Forms Foundation Waterproofing Backfill rarning JRoofing Siding v Masonry Veneer Rough plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & RaLlings Cellar Drain Tile Concrete Floors Plbq . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECTRICA INSFECTION� LIRIVEWAY APPR Survey Final Building Naxt scheduled insp eceion (call. when ready ) Remarks- Building Inspector 6/86 and-vl THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 41 STATE STREET, ALBANY. NEW YORK 1220-7 Date F. 61 4pplica Lo o: nn fide THIS CERTIFIES THAT T' t ` anly the edactrieal equiprnent as described below and introdsaced by t 0112 Lit coed a,ra the aboae applications number in the preneises of in the following location: ❑ Basement lat Ff. LJ Fred FY. .Section Block I Lot was ezomined an r, r, ` . - and foeand to be in compliance with the requirements of this Board. FIXTURE ---------- SWI1CFSEs FIXTURES FM KA $ COOKMlri DECKS OVENS DISH WASHERS EXHAUST FAMS Ackils OUTLETS INCANDESCENT FLLICalESCENT OTHER AMT, K, W. AMT. K, W- AMT. K.W. T. K. W. AALT- DRYERS FURNACE MOTORS FUTURE A"UANCE FEEDERS SMCIAL REC'PT TIME CLOCKS EEI,I, UNIT HEATERS RRUITI-CUTLET DIMMERS AMT. K- W- CHL H. P, a" H. I. AMT, N PS 0, A. W. G. AMT, AMP. AMT. AM . TRANS. AMT. H. ►. N SYSTEMS AMT. WATTS O. of FEET I SERVICE DISCONNECT MD.OF S E R Y I CM"NE E AMT. AMP. TYPE EQUIP, 1 .eX 2W 1 0 3W 3 X rAr 3 J' 4w NV, CIFPER Cr1u IHQ, pF CC 41NQ, NrJ. OF NI-LECa '�� No. CM NEUTRALS OF F W. R OTHER AFTARATUS: 1 ., T. -, I f- ` *' i •. BRANCH MANAGER CF .. Per This certificate must not be attered in any 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. own BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 IKpueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT UUU NAME LOCATION ,Ir r� Permit No . -'e 0 APPROVED YES NO Footing/Pier Farms Foundation Waterproofing Backfill Framing Roof in 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 J01SULATION Foundation Floors Walls Ceiling FINAL ELECTRICAL NSPECTION DRIVEWAY APPROVAL Final Building S vey Next scheduled i spection (call when ready ) Remarks- Bui , ing spect 6/86 and-vl flog" of Queen 3l "ry BUILDING and ZONING DFPAA€i MENT 9F1 Bay and Haviland Road, R•D. 1 Box Queensbury, New 'dark 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date Permit Lan . f=.�L=� APPRfJVEC]* - YES NO Footing/Pier Forms Foundation Waterproofing Back£ill yFraming Roofing Siding Masonry Veneer k Rough 'Plumbing Relief valves Ext . Porches Finished Floor lnterior Trim Stairs & Railin Cellar Drain Til Concrete Floors plbg _ Fixtures Gar . Fireproof ' g Door Closers smoke Detec rs Chimney IN SU IL-AT I C5 Foundati n Floors Walls Ceiling FINAL ELECTRICAL INSPEC ION DRIVEWAY APPROVAL Final Building Survey Next scheduled insp ection (call When ready ) Remarks- Ur► �-� 7-o ,�.,,Ccxue •�i:p5 O�'Aar ---f"' -'Sig Zld ' g Inspector 6/86 and-vl flown o/ Queensgury BUILDING and ZONING DEPARTMENT Bay and Maviland Road, R. D_ 1 Sox 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCAT I ON tpa,,e- E'h DAATE / .24�:O / &V PERMIT N0. SOIL TYPE - an - Loam - Clay -� Percolation Test Required? YES Percolation rate rate -- Min/Inch - TYPE of SYSTEM: Absorption field kn��ch�. l length Length of each Depth of trench Size of gravel_ SEEPAGE PITS{3+lU ) Size- �` ft. X . Gravel size PIPING : Size Type Bldg . to tank 'Pyc Tank to list . box Dist . box to field/pit 'P C. openings sealed? E NO Partial LOCATION/SEPARATION Foundation to tan ft. Foundation to ab rption ft. Absorption to 1 line ft. Separation of is ft. LOCATION OF S TEM ON PROPER (circle one) Front - ea Left side - Ri ht side COMMENTS : o'y�+vs 40 Jr�s/ si /C Uh .'1s SYSTEM USE APPROVED E5 0 Building nspector 01/86 rnd vl awn o/ �ueeris +� uref BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME .-L LOCATION Date/ Permit No . ✓ = APPROVED - YES NO Ming/Pier Forms Foundation Waterproof! Backfill Framing Roofing Siding !Zsonry Veneer ugh Plumbing _ I �r c c C✓ Relief Valves Ext . Porches Finished Floors Interior Trim Stairs 6 Railing. Cellar Drain TiI Concrete Floors Plbg , Fixtures Gar , Fireproo !ng Door Closers Smoke Detec ors Chimney INSULATIO Foundatio Floors Walls Ceiling FINAL ELECTRICAL INS'. ECTION DRIVEWAY ,APPROVAL Final Building Survey i Next scheduled Inspection (call, when ready ) Remarks- c?vw. 671� C1 �! £�rN� �)'Z ,tl /5l:wjv Building Inspector � 6/86 and -vl �Jvwn tr� �uec�rts �urt� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDfNG INSPECTCIR ' S DEPORT NAME LOCATION 3 / r DateAp ,>4;yl C Per/m' it No . Fl � f( q =Footing/Pier Forms APPROVED -kSNFoundation waterproofingBackfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors ---- P bg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling INAL ELECTRICAL INSPECTIC}N DRTVEWAY APPROVA Final Building 5 rvey Next scheduled intspectlon ( call when ready ) Remarks- ,Buildin Inspector 6/86 and-vl J©cun cr I �teen6 �cr BUILOIN,G and ,ZONING DEPARTA4ENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury. New York 12801 BUILDING INSPECTORrS REPORT NAME LOCA T ION Date ` i * * ermit No , 'Lwoclotingr/Pier Forms °PROVED - YES NO Foundation Waterproofing Backfill Fran i.ng Roofing Siding Masonry. Veneer Hugh Plumbing Relief Valves Ext . Porches Finished Floors lnterior Trim Stairs & Railing- s Cellar Drain Tile ---�-.� Concrete Floors Plbg , Fixtures Gar . Fireproofing Door Closers. Smoke Detectors Chimney INSULATION ., Foundation Floors Walls Ceiling FINAI ELECTRICAL INSPECTION DRIVEWAY APPROVAL 4-- Final Building Survey NexC scheduled ins Remarks- pection ( call When ready ) Building nspectar� G/gU and-VI BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. . a BIIk1'E f CITY DR VILLAGE ((1]y����, 1�., ` STREET AND NO, OR TOIYVNSIi1P Quoum `"'� COUNTY Warren ROAD AND PPLE ND. 31 g CROSS ENN INHAIFE TWO PREMI IS L T£ POLE NO. NNAAMUPAAIT"S BLOCK BUILDING OWNERS NAME OCCUPANCY AND ADDRESS a_� �/ y �y I P61ED .�xai�' .r 119 SL r TEL. III By -61 BUILDING FROM THEIR IS I� M1/dRK EW 1 - _- OFFICE N DLO 1--�V DEFECTS IS NEIAt EIX ADDITIONAL ❑ DEFECTS ❑LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED N UMBE R OF OUTLETS Nr. of FIIItimm & Lew- LMW a"—"- ' HEATERS tim '�"rr+s+es kgTORS BRANCH OFFICE USE Sldr Atgell"s Coilingyyall RawP'h SvA" Paedrd $fallaat No. TTne E.P,` No. Matz II. ONLY Na. LM_w- INSPECTION baft Bass• roan£ la FI_ 2nd FI_ S.d Fl. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. V b aPPlication is irrtanded to tour the above-fist. a�M�ip�Mnt M M i ISPaCbd but it at Now M i YOY are arrfbes ited fa r»akr qta i+srgsaetion and ad*sf the fee to cobar the additional wPaCboin f1rara is found +additional Sii+2E OF erlra�Prtretrt„ as pevidpl bF tlra aP�t_ �WrriWrrant not a4gae liabd, MAINShmp FEEDERS ELECTRIC SIGN CHARACTER LAMPS TOTAL OF WORK EXPOSED GAS TUBE SIGN WATTS WORK TO BE CONCEALED TRANSFDRIMERS OF STARTED "NUMBER) VA SERVICE COMPLETED SIZE OF SIGN (CAPACITY) ENTERS OVERHEAD UNDERGROUND iLDING MAKER INSPECTION REQUESTED OF SIGN ON OR AS NEAR AS POSSIBLE " WIU &-ftl s when AVOID DELAY BY GIVING FULL ARID ACCURATE INFORMATION. ALL SPACES NEW O OLD El MUST BE FI LLEO IN OR AppLICATION MAY BE RETURNED, OWTE OF PRINT NAME AND ADDRESS NAME OF APPLICATION 9 221^87 ,s^.,,� APPLICANT tiaal e1: Aai "I tipret * 'V SIGNATURE a..a. ��tlMet A OF APPLICANT STREET ADDRESS CITY OR LEPIIONE ># - POST OFFICE 'ZIP 40 LICENS'E ND COD£ VAIEN APPLICABLE as e� (RLII.. Ilea) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING QUEEN VICTOPIA'S GRANT QUEEN'SIBURY , N Y. Q�- ol c; L'i I C--C,' DIAIYIETE--i '-C r)F7PTH C.0 T G, 2CCC jrjI C L E A '�('[j T TC C-C'.TG. 13 4. .�, -- CA REFEkEf,iCt- FRAWIN(S 5 SITE UTILITIES SEPTIC W-41TER VonDUSEN cTEvES SuRvIfy FLAN 21, 2 3,2 �, 2 7, 2"), 31 ELIZABETH LANIt [PLCT PLAN !, SEPTIC '--,Y--ITEM GUYED BUILDERS , INC. QV - 37 2 C'- C VD W N'