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1987-908 . , i '+Y { to CERTIFICATE OF OCCUPANCY TOWN OF CQUEEN58URY i WARREN COUNTY, NEW YORK i 1"Parch 11 9 68 This is to certify that work-quested to be done as shown by Permit No. $ -90$ i has been completed. f of Two Family Dwelling This structure may be occupied as a Location 29 Elizabeth Lane - Queen Victoria ' s Grant CGuyer Builders , Inc . f Owner By Order Town Soard i TOWN OF QUEENSSURY 1 i - i Building Zonins Inspector BUILDING PERMIT TOWN OF +QUEENSBURY No. $7--90$ WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Queen Victoria ' s Grant i 1 OWNER of property located at 29 Elizabeth Lane Street, Road or Ave. 3 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. ,o f. OWNER'S Address is ro Guyer Builders Inc . M 119 Dunning Street Ballston Spa. , N . Y . 12020 n n 2_ CONTRACTOR or BU1 LDE R 'S Name Same N. w ur 3. CONTRACTOR or BUILDER"$ Address Same w r3 rt 4. ARCHITECT'S Name N S. ARCHITECT'S Address ram+ w ro r-rr B. TYPE of Construction — (Please Indicate by X) r w ( Wood Frame ( ) Masonry [ i Steel ( 1 0 7. PLANS and Specifications No. 26 ' -6" x 35-711 as per plot plan , specifications and application including septic system and attached one car garage . MODEL J B_ Proposed Use of Two Faintly* a �n rr 0 $5 . 00 CIO $ $9000 PERMIT FEE PAILS — THIS PERMIT EXPIRES July 1 , 88 19 r- (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 ty 30th December $7 �-A Dated at the Town of Queensbury this Day of 19 F� ry- Oq as SIGNED BY for the Town of Queensbury Building and Zoning Inspector WU SE CUMPLLTBU HY rii.u[; . LJZirr . �] I Application No . M ✓off ►Z 17 *+ Lt#'Bn 1L��iP� Permit Issued 19 ' Lie j { BUILDING and ZONING DEPARTMENT Permit Expires Say and Haviland Road. R,D. 1 Box 98 Zoning Desi na -� [1� Oueensbury. New York 12801 variance No Z 7 ! Site Plan w N _ ' F) P Approved by : c/011�r�{,n�P�Pj': APPLICATION FOR C ! . BUILDING AND ZONING PERMIT f r ` ' e14' 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 . P . O. Address 119 Dunning Street Ballston Spa , New York 12020 Tel , ( 518) 899-9161 Property Location : 29 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. Guver III ( 518) 899-9161 Name P. O. Address Tel . No . Name of builder Guyer Builders , InC •Address 119 Dunning Street Tel • ( 518 ) 899-9161 Guyer Builders , nc •Address ng Tel . Name of plumber y Str eet Name of mason uyer Wilderss nC •Address 119 Ukinrung 5treet 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 FOR DEMOLITION PERMIT , STATE SIZE 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 REQUIIREDpPE4OW . * size of property 100_ plan ft x 120 ft . * Existing building ( s) Size ft X�^ft . PROPOSED BUILDING AND USE : Model '� )- * Existing building ( s ) use NIA 9 P -7" 1. Size of new struce 26 ' -6"ft x ft '� Foundation-pierA�slab crawl/partial/full * Proposed building , distance from property line circle one ) * see plot plan No . of stories (habitable s ace) 2 * Front yard 30+ _ ft Rear yard 30+ ft Height ( grade to ridge ) 23 'P644 ft . + Side yards 15+_ ft and 15+ ft if residential, no . of families of 2 + If on corner , setback from side street _ ft :o* of rooms ( excluding baths ) �^ * OCCUPANCY INFORMATION o. of bedrooms 2 _ Nb of bathrooms * PRIMARY BUILDING One family dwelling TLh ssie'� fgr Prima heating system Base ar a ectric* Primary * Two family dwelling Type of fuel Electricity * Multiple dwelling / Number of units.. No . of fireplaces to be installed * Permanent occupancy Will a wood stove be installed? No Permanent occupancy Central Air conditioning? Na * Business , BUILDING STYLE, PRIMARY STRUCTURE Industrial Ranch Contemporary LOQ cabin Other * If addition , what will use be? Raised ranch Mansion riuple split level Old style Bungalow " Cape Cod Cottage Other ACCESSORY BTJILDING- Colonial Row Town House * Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE ) * ,Attached garage/one car/ two car/ one car * . • * w * + • * * + * * * * * * * Private storage building ESTIMATED MARKET VALUE OF * Other CONSSTRUCTION INFORMATION ON • BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , To BE COMPLETEDI Form BPA 4/86 and-vl i y BUILDING PERMIT APPLICATION CONTINUED — `{ 4 BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . wood frao�e 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 ) " mininam 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 - sloped flat/shed/other Material of roof Fi r ass shingles Size , wood studs '"x 6 It spacing 24 "o . c . .length $ ft . exteor walls .Joists ( floor beams ) 1st . floor N/A ''7c " spacing"o . c . span A ft . Joists ( floor beams) 2nd . floor �"Xw spacing. ' "o . C . sRan1—"ft . Overlays (ceiling beams ) 2 "X spacing 2r+ too . c . sparxl2 ' -4 ft . Roof rafters 2 NIX " spacing 24 o . c . spanr2 ' -9''kt . Roof trusses (pre-engineered) spacing "o . c . span N/A ft . Exterior wall finish stalned Of what material? 5 /8" x 4 ' x 8 ' teXture 111 Interior wall finish pain S eetrock If a garage: 1isto be attached , describe materials to be used for FIRE SEPARATION : 1 / 21t type "X" gheetrock Is there to be an opening between garagekand 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 nuunicipal SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties NIA ft . (A separate application is necessary for any re air or new installation of septic system) _ See S . P . E . D. S . permit # 020252 Town of Queensbury - F D W T County of warren 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 specified or not, and that such work is authorized by the owner . a SWORN TO BEFORE ME THIS Signature _ Owner , owner ' s agent , arenarect , contractar day of 5,o �y .19 1 F-UZABETiH K. LANDRY Notary Public. State of Now York � No. 4862001 Notary - _ Warren County _ N . Y . _ Qualified in Saratoga County Commission Expires June 16, 19.5& * * # t �r it sr tr r * � s • * tk w t it * +k sr • * * * +k ie * * sr at * w 11 # W +r • • * * * tr !, f • 1123 Square feet living 240 Square foot garage - one stall 1363 @ $? . [)U/ 1W or part of 5 . 00 One st4ll ,garage $5 . 00 C/o permit Total By----.......--------. ---�- --- TOWN OF QUEENSSURY WARREN COUNWYs NEW YORK Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . &H$WEA ALL of the following : - 1 . Gross floor area 1123 S . F . 2 . Type of heat Baseboard electric 3 . Is the building mechanically cooled ? No 40 percentage of area of windows and doors 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 N.Q 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 - so Type of insulation P . Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions. R-38 2 . R value of exterior walls )30MRX R-23 . 5 (U. =Ow04+ ) 3 . R value of glazed area Us =Ow3O 4 . R value of doors R-14 . 9 (U. =0 . 06 ) 5 . R value of floors over unheated spaces- R-30 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 14 . 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 - 1. Performance efficiency NIA 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating N/A Telephone No . ( 518) 899--9161 ( applicant ' s nature APPLICATION FOR SEPffnC DISPOSAL P13R&UT Fief : S . P. E. D. S . DATE September 23 / 87 permit ## New York - 0202525 MODEL of LOCATION OF PROPERTY FOR INSTALLATION 2.9 Elizabeth Lane Owner's Name. Gayer Builders , Inc . Telephonez ( 518) 899-9161 Address; 119 Dunning Street , Ballston Spa , New York 12020 lastaller'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 'ISO gal per bedroom) 300 Topography. circle one: Lat Rolling Steep Slope % of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: 8 ' feet + Ground Water. At what depth? unknOwn 8 feet + Bedrock or ImpNervie s Material. At what depth? _unknown feet Percolation test. circle one. not require required / rate min. inch. Domestic crater supplysm circle one: Municip Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption NIA feet * PROPOSED SYSTEM; Septic Tank gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench NIA 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 I M P 0 R T A N T See S . P . E .D . S . ...Please...LIST NEW EQUIPMENT TO BE INSTALLED permit & attached * as * * s * * * * * * * * * as * * * s * s * * s * * s * * * * * * ass * s * * map (over) Section 11 5etic 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 constructions and shall include a plot plan showing* 1.) the propo$ed .location of the gystem 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 drywelis 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. 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. 1 have read the regulations above and agree to abide by these and axl requirements of the Town of Queensbury Sanitary Sewage Disposal Ckidinanc . Signature of.responsible person: Date. 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. PLACIE TO LIVE + BUILDING and ZONING DEPARTMENT 02 Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME ry icr �2 LOCATION 2C Date`! / �_ Permit No . ✓ = APPROVED - YES NO Footing/Fier Forms Foundation Waterproofin Backfi11 Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbq . Fixtures Gar _ Fireproofing Door Closers Smoke Detectors Chimney INSULATION Foundation Floors Walls Ceilinq FINAL ELECTRICAL INSPECTION DRIVEWAiY APPROVAL Final Building Survey. Next scheduled inspection ( call when ready ) Remarks- ..4k4 F Bui lding Spector 6/86 and- vl sr f , Id BUILDING and ZONING DEPARTMENT f Bay and Haviland Road, R. D. I Box 98 Queensbury, New York 12801 �BUILDING INSPECTOR ' S REPORT NAME LOCATION Date 0 — /0/0 a Permit No . ✓ = APPROVED - YES NO Forms Foundation Waterproofing Back€ill 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 N SL]LRT T ON : Foundation Floors Walls Ceiling FINAL ELECI'RICA INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- cct� ,1 _ J, Y7 _ 1-�t4,y f � Buil i Inspe or 6/86 and-vl /own 01 Qiueen awry BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION 6L7 Date Jy / Permit Nom ' poe APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill = Q Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Pibg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building, Survey Next scheduled inspection (call when ready ) Remarks- ui43ingln5p tor 6/86 and-vl ,,._,Town u� �ueenshurs� BUILDING and 70NING LIEPASTMEN1' Bay and Haviland Road, R-0- 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT LOCATION v�t� -� e r r 1 � CPC/ Permit Date Ab- /_. APPROVED - YLS Na Footing/Pier Forms Foundation Waterproofing Backf i ll KFraming Roofing Siding Masonry veneer k Rough Plumbing Relief valves Ext . porches Finished F Cm Interior Tr m Stairs & Rai ings Cellar Drain Tile. Concrete Floo s Plbg . Fixture Gar . Fireproof 'ng Door Closers smoke Detectors Chimney INSULATION . Foundation Floors Walls Ceilinq FINAL E:LECTR CAL. INSpE 1TION__ _ DRIVEWAY APP OVAL Final Surveyl Build ng '�- ready ) Next cSYed led inspection (call when R.emarks- Oj i ld ' L3 n`- F-Xwac C/Sr', and-v1 1 awn 0/ �uFe►t3 �dfAl� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R, D. 1 Box 96 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME u V Gde LOCAT I Ohl Qs 1 G E'h L G Itir r s+ �r.so DATE / r?p / PERMIT NO. SOIL TYPE - an - Loam - Clay - Percolation Test Required? YES Percolation rate - Miri/Inch TYPE of S STEM ; Absorption field , total le gth Length of a ch trench Depth of tre cites - Size of grave SEEPAGE PITS•{N er Size- �ft, X _ t , y Gravel size PIPING ; Size Type Bldg . to tank Tank to disto x Disto box to f el+d/pit Sf . 0 openings seal d? ES O Partial LOCATION/SE RATIONS : Foundation to tank Foundatio to absorption ft . Absorpt ' n to lot line fta Separa on of pits 1.� ft I.00AT OF SYSTEM ON PROPERTY (circle one) Front - ea - Left side - Right side - CCMMENTS : v?avrp 04/ Fcta LJh r l a o?►"�'3/+� S- a'�i - I G�/.2a6u,�fi S1`. SYSTEM USE APPROVED ES NO Building spector 01 /86 and vl flown o/ Queen3liury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queens'bury, New York 12801 A BUILDING INSPECTOR ' S REPORT NAME LOCATION Z Date 30 Permit No . qeg ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Tram Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors wails Ceiling FINAL ELECTRICA SNSPECTION �^ __. DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) Rema rks-- Building Inspector 6/66 and-vl awn O� �te �en3laa� re�r BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 128o1 BUILDING INSPECTOR ' S REPORT NAME ? iLOCATION le Date / vs Permit No . ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill F ram.ing Roofing Siding Masonry Veneer Rough Plumks ng Relief Valve . Ext . Porches Finished Floo s Interior Trim Stairs Railin s Cellar Drain Til L.Concrete Floors , Plhg , Fixtures Gar . Fireproofin Door Closers Smoke Detector Chimney INSULATION ; Foundation Floors Walls Ceiling FINAL E:LE TRSCAL INSPECTI!: DRIVEWAY A PROVAL Final Buil g Survey Next scheduled inspectlon ( call when ready ) Remarks- a r Building Tnspect 6/86 and-vl ( f 6�7 awn of Queenitury BUILDING and ZONING DEPARTMENT Bay and Haviland Road. R. D. 1 Sox 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT p / NAME LOCATIOfN 1J� 0Q' Date•z/�--r—/ 'Permit NO i '�� L — ►+' — APPROVED - YES NO Ming/Pier Forms Foundation Waterproofing Baokfill Framing Roofing Siding N}esonry Vene r Rpugh Plumbi Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECT CAL INSPECTION DRIVEWAY AP ROVAL Final Bull ing Survey �- Next scheduled inspection (call wkxen ready ) Remarks--'�J,'�f-.. �-L-- L. - � v� t 5tilding Ins egtor 6/86 and-vl ._louvre o� �ueen3heere�r BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION ! "� Date / //"a� f ermi t No . ��I� - %GNU ✓ = APPROVED - YES NO I„Pe,Tating/Pier Forms 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 w Plbg . Fixtures __... Gar _ Fireproofing Door Closers Smoke Detectors Chimney INSPECTION Foundation Floors Wails Ceiling FINAL ELECTRICA INSPECTION DRIVEWAY APPROV Final. Building urvey Next scheduled i epeeti©n (call when ready ) Remarks- 6/86 rnd-vl Building . .nspector BUILDING DEPT. COPY OF APPLICATION FORM 46-ELe NEW YORK. BOARD OF FIRE UfIIDERWRITERS, FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. DATTE CITY OR VfLLAOE STREET AND NO. OR TOWNSHIP C7alRwsalws} 31e COUNTY �Q L ROAD AND PALE NO. #29 E {'zkleth Lane BET EN WHAT TWO POLE NO- PRE�MISETRL ETST£D7 OCCUPANT'S SF TIdN $LOCK 'r NAME BUILDING LOT OWNER'S NAME �1 ^thy OCCUPANCY . AND ADDRESS *&er Alf cl/O,r,M* T * 117�1� .SUPPLIED J.Ra4 f street TEL BLYlf'PLIEb . BUILDING y� FROM THEIR `— IS � ry NEW EX OLD © WORK I--�I� IS NEW Q ADDITIONAL Q DEFECTS LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED REMOVED ❑ NUMBER OF OUTLETS Lamp No.1 ion IlP FRattac/ixtil & tL MOTORS HEATERS dRCU1T8 OFFICE USE Slglr Agtach'l Criflry WIIB Rree - Switch PwMant Brxket No. TYPr 1- Wrtfa ONLY Out- Each No• Eacfl Np, AOCi. INSPECTION ■Idr Bell beer ma t wgartR lit Pl. 2nd III 3rd F1. REMARKS; LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE; DO NOT USE THIS SPACE. youThis aepMre u is ingended 'c cover the abov"l fsrl puiPw*.nt to be inspeciad bug it at time of i esad to make inspection arrd atllllil the frr to cperr iM edditipnal flaPactiwn three it found Ilddi#iogl d equipment, as Provided 4 the a rquipmrnt not a61 lill 512E OF � _ Y Pylicant. MAINS .. FEEDERS ELECTRIC SIGN TOTAL CHAR M ACTER LAMPS WATTS OF WORK EXPOSED GAS TUBE SIGN CONCEALED TRANSFORMERS OF WORK TO BE . VA STARTED COMPLETED SIZE OF SIGN ICAPACITYI SERVICE OVERHEAD SIZE OF SIGN BUI DINO LI hIDERGROUNb MAKER INSPECTION REQUESTED OF SIGN CW4PO OR NEAR AS a y POSSIBLELE c�;.i J'`-� AVOID DELAY BY GIVING FULL AND ACCURATE INI lji NATION. ALL SPACES NEW ❑ OLD L__I MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. DATE OF PRINT NAME AND ADDRESS NAME OF APPLICATION 21 1-9087 APPLICANT 9—uye- r Builders ders I=r SIGNATURE STREET ADDRESS i7 I� 7nn c x OF APPLICANT ��ytryfa�yy 77 CITY OR _.TELEPHONE #POST i 7� 3 PST OFFICE �E_ _ 4Z,IP�_Z `J('I20 LICENSE No. WHEN APPLICABLE 46 Ez (REV. I/gil A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE B'UILDING 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'