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1987-905 . : aL :' j sY }' CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK i Date 19 This is to terrify that work requested to be done as shown by Permit No. 87-905 has been completed. This structure may be occupied as a of Two Family Dwelling LrPCatiut► " 3 Elizabeth Lane Queen Victoria ' s Grant Owner Guyer Builders Inc . By Order Town 'Hoard TOWN OF QUEENSBURY I Dnilding & Zoning Inspector i i pL BUILDING PERMIT TOWN OF +QUEENSBUR`M' No. 87-905 0 WARREN COUNTY, NEW YORK ; [v PERMISSION is hereby granted to Queen Victoria ' s Grant OWNER of property located at 23 Elizabeth Lane Street, Road or Ave. in the Town of Oueerrsbury, 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. r. fa 0 t. OWNER'S Address is Guyer Builders , Inc . -ei 119 Dunning Street Ballston Spa , N . Y . 12020 0 ri r• 2_ CONTRACTOR or BUILDERS Name Same un is rt N r� 3. CONTRACTOR or RUILDER 'S Address n Same 4. ARCHITECT'S Name r.5 W 5. A R CH ITECT'S Address r` r• N Q. N 1'r B. TYPE of Construction — [Please indicate by X) N 131 Wood Frame I ) Masonry I I Steel ( I m 7. PLANS and Specifications No_ 32 ' x 37 ' as per plot plan , specification and application including septic system and attached one car garage . MODEL I cr 8. Proposed Use � of Two Family Dwelling 0 m $5 , 00 C / o $ 82 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 1 , 19 88 � (if a longer period is required an application for an extension must be mede to the Building and Zoning inspector of the town of Oueensbury before the expiration date_) Dated at the Town of Queensbury this 30th Day of December 18 87 SIGNED BY / �/' /42 L2 for the Town of Queensbury Building and Zoning Inspector to isC . . �jj Application No. eft ddal 461" "O elzdiddrif Permit Issued 19 y �� l t J BUILDING and ZONING DEPARTMENT Permit Expires 19 Bay and Ha+viiand Road, R.D. 1 Box S8 Zoning Designation �� UT` Queensbury, New York 12801 variance No . Site Plan Re ew o . r - r' A Approved b S� AFi"LICATION FOROf '!$ / s� BUILDING AND ZONING PERMIT �, ' , sv 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 . ii ! .w.nrw wwwww,w w4—w.w.w Wwwwww �.wwwwwwww�ww wwww wwwwww.w ww W w—riiw' rwwww—r—.s w y w..w.w..w � The owner of this property is : Guyer Builders Inc P- O* Address 119 Dunning Street Ballston Spa , New York 12020 Tel . ( 518) NO 899w9161 Property Location : 23 Elizabeth Lane Tax Map No .121 / 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. au er III ( 51$) $99-9161 Nawe Pao* Address Tel . Nov Nameof builder Oyer Builders , Inc -Address 119 Dunning Street Tel . ( 518) 899-9161 Name of plumber yer Fs , nc .Address ng ree Tel . Name of mason uyer LIU Iders , ncoAddressStreet Tel . ( 5-183 NATURE OF PROPOSED WORK : * ZONING INFORMATION : X Construction of a new building A PLOT FLAN 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 REQUIRED �E�LQW - * Size of property 10(}± Pee J ��gt rr X 120 ft . * Existing building ( s) Size ft X�ft . PROPOSED BUILDING AND USE : Model of * Existing buildings ) Use NIA Size of new strut a 32 ft X 37 ft " Foundation-pier slab crawl/partial/full * Proposed building , list nce from property line circle one } * see ptot pan Nov of stories (habitable space) 2 * Front yard 3C)t ft Rear yard 3(]+ ft Height ( grade to ridge) 21 " Side yards 15+ft and 15+ ft - 5"' ft - * If oncorner , setback from side street ft If residential, no . of families I of 2 No* of rooms ( excluding baths) OCCUPANCY INFORMATION No . Of bedrooms 2 * PRIMARY BUILDING - No. of b rthrooms one family dwelling 1,e 4 , Primary eating system Baseboard a ectric* He sstl� e �r * TX-Twc family dwelling Type Q#efuel Electrlelty * Multiple dwelling / Number of units Nov of fireplaces to be installed * 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•-Colonial Row Town House " Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE ) " _ r .Attached garage/one car/ two car/ ene car * * * * * ,� w • * ,� w * w * * * * * Private storage building ESTIMATED MARKET VALUE OF * other CONSTRUCTION awjMW"TION ON - BUILDING SPEC w T ONS ,,ON REVERSE SIDE OF THIS SHEET, BE COMPLETEDt fBPA 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 8IIIIII " Depth of foundation below grade (to bottom of footing ) minimum Will there be a cellar? nc) 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 por ? sq. fte - - Type of use? Type of roof - sloped lat/shed/other Material of roof Fiberg ass shin; es Size , wood studs "X b " spacing 24 "o . c . length 8 fto exterior walls Joists ( floor beams) 1st . floor N/A "x " spacing '"o . c . span N/A ft . Joists ( floor beams) 2nd , floor —"X��" sacing�+b"o . c . spana�Zk�E't . Overlays (ceiling beams ) 2 "x " spacing t'E "o. ca span lb ft . Roof rafters 2 „x 1 " spac3`ng 24 o . c . spare+ ' -31 t . Roof trusses (pre-engineered) spacing 2 "o , c . span N/A ft , Exterior wall finish stained of what material? 5 /8" x 4 ' x 8 ' texture III. Interior wall finish pain sheetrock 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 }and 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 , Dept N A f h of chimney foundation below grade t ,' Depth of .fireplace hearth NIA ft . in . Water supply - Municipal or private well 11Aix' Icipail SEPTIC SYSTEM _ Distance from ANY private well { including adjoining properties NIX ft . (A separate application is necessary for an re air or new installation of septic system) See S . P. E. D. S . perms.t # 026252� Town of A F F I D A V I IT STATE of NEW CORK een�ury Warren County off Warren I swear that to the best of my knowledge and belief the statements contained ixx 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 s ecif , d or not, and that such work is authorized by the owner . r SWORN TO BEFORE ME THIS Signature ___ :____ _ -Owner, owner ' s agent rc� ilf cc�ct, contractor' .day ELIZABETH K. LANDRY f Notary Public. State of Now York Notary c Warren +Count N . Y . No. Saratoga l y + Y+ Qualified in Saratoga Count_yC e • * * 3k rr * ,r • Or ye * Mr * r ,r # * t * tt t !t CjpNMtNsiy}n gxgjre£ J10n& 1 %0 �- * r * * * * w * t s s r SPECIAL CONDITIONS _ THE PERMITS 1040 Square feet living 240 Square foot garage - one stall 1280 @ $7 ,00/ 100 or part of $50 0 one stall garage $5 . 00 C/o pert Total oY.........._......_________ __. * TOWN OF QUEENSSURY 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 . ANSWER ALL of the following ; 1 . Grows floor area 1040 S . F . 20 Type of heat Baseboard electric 30 is the building mechanically cooled ? No 4 . Percentage of area of windows and doors 14 . 3% 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 ? 30 slab on grade YES NO a . If YESr 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 1 . R value of roof and floors exposed to ambient conditions R-38 M =0 . 026) _ -- - 2 . R value of exterior walls Me= R-23 . 5 (U. =0m04+ ) 3 . R value of glazed area U • =0 . 30 4 . R value of doors R-14 . 9 M =0 . 06) 5 . R value of floors over unheated spaces 2k JM R-30 6W R value of slab edge insulation - unheated slab N/A 7 . R value of slab insulation - heated slab 12 . 5 s . R value of heated basement/ cellar walls ( above grade ) N A 90 R value of heated basement/cellar walls ( below grade ) N/A lO . Type of insulation Fiberglass C . Controls 1 . Thermostat maximum heat setting D . puct systems N/A 10 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; . Pining 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 N/A 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating N/A A Telephone No . ( 518) 899-9161 ( applicant ' s gnaturs ) L APPLICATION FOR SEP'11C DISPOSAL PERMIT Ref : S . P . E . D. S . RATS September 23 / 87 permit # New York - 0202525 MDEL l of LOCATION OF PROPERTY FOR INSTALLATION 23 Elizabeth Lane Owner's Name: Guyer Builders , Inc . Telephone: ( 518 ) 899-9161 Address: 119 Dunning Street , Ballston Spa , New York 12020 Lastaliees 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 @ 150 gal per bedroom) 300 Topography: circle one: Qlat Rolling Steep Slope 96 of slope Soil Nature: circle one: Sand Loam Clay Other / Depth; 8 ' feet + C. ound Water: At what depth? ulknown 8 feet + Bedrock or Impervii nm Material: At what depth? unknown feet Percolation test: circle one: not require required / rate min. inch. Domestic water supply: circle one: Municipal Well Other IF domestic water supply is a Well: Separation; Watersupply from Septic absorption N/A feet * PROPOSED SYSTEM: Septic Tank ,gal. (minim" M 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 sssos ss �s � i * * * * asa � salr # sss � ssss * * * � * +s +ss +ltsssss IMPORTANT * See a . P. E. D . S . ...Please...LIST NEW EQUIPMENT TO BE INSTALLED permit & attached ssssssss * * * * * * * ss * ss * * * * * * * * ss * usessssss map , (over) Section U 1 Sel2tic System Inspections: A. AU 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: i.) the propo$ed .location of the gystem 2.) location and distance to lot lines 3.) location and distance to structures 40 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, l have read the smgaelatums above and agree to abide by these and all requirezments of the Town of Queensbtay Sanitary Sewage Disposal Ordinance. Signature of.responsibie person: Date* Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTI EO 17A , . , , HOME OF ^ TURAL BEAUTY . . . A GOOD PLACE TO LIVE ad Z7MINGDEPARTMV4 BUILDING Do x 98 " ' 12801Bay . C3ueensbUfY, Yo " INSPECTOR ' S REPORT BUILDING NAME LOCATION140 pate * * * * " * * * * * * * * **oe = APPROVED - YE No Footing/Pier Forms Foundation waterPrOOfing Bac}cfCill Framing Roofing Siding r Masonry ve bi g Rough Plum Relief Valves Ext . Porches Finished Floor Interior Trim Stains & Railing Cellar Drain Ti Concrete Floors Plbg • Fixtures V Gar . Firevroo ing cr Closers Smoke peter ors Ch imne`T INSUI-PATIO - Foundat.io Floors walls Ceiling INSPECT'- A L EL F IN CTRICAL „r URIVE.WAY p,PpRC1H Surve�_ Final Building eduled inspecCion (call when ready) l4ext sclz Remarks- I Inspector Buil 6/g6 md'Vl r , ' r Queensbury ,Pwn A � I , BUILDING and ZONINGL7EPAF1 Box 'S 100 Bay and Haviland Road, RX), t eensbury. Ne York 12801 98 ao BUILDING INSPECTOR ' S REPORT NAME - LOCATION 1�q 4 �/ _ 1� permit Date I * * * * * * * APPROVE - YES NO Footing/pier Forms Foundation Waterproofing sac3cf i ll Frami-ng Roofing Siding masonry Ven +er Rough Plumb 9 Relief Valve Ext . Porches Finished Floo s Interior Trim Stairs & Rail ' s Cellar Drain Ti_ ---�' - Concrete Floors " Plbg . Fixtures 1/ Gar . Fireproofi 9 Door closers Smoke Oetecto Chimney iN SU LATI ON Foundation Floors walls ceiling �-- , FINAL ELEC RICAL I13 SPECTIl3N L1Rl V EW AY +,l' OV AMLI�'�~� Final suilding Survey -�---�� Next scltedul+ed � i�fnsp action (call when ready) Remarks- V0 Building Inspector 6/S6 and-vl a,wn v/ Queen itury BUILDING and ZONING DEPARTMENT Bay and Maviland Road, R. D. 1 Box 98 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME U E'If +CGS"• LOC AT I Utd C..K c!a eH 1/.c /, r " "` `'• , °'�-�, •"" � DATE / .a I PERMIT NO * _ SOIL TYPE - an - Loam - Clay - Percolation Test Required? YES Percolation rate - Min/inch - TYPE Of STEM: Absox-Pti field , total length Length o ch trench Depth of r ches Size of 9Y'a _ -- SEEPAGE PIT$# umber of) size- R ft, Gravel size # PIPING : S e Type Bldg . to tank Tank to disc_ bOx � Dist. box to field it 4y, _ openings sealed.? ES NO Partial LOCATION/SEPARA IONS Foundation to ank ft. Foundation t absorpt on ft. Absorption lot line ft . Separation of Pits f C ft_ LOCATION SYSTEM ON P PERTY (circle one) Front - ea - Left side - . Right side COMMENT : dRo-00 +I-S SYSTEM USE APPROVED ES NO Building Spector 01/86 and vl 1 BUILDING and ZONING OEPAfRTMENT gay and Hav4iand Road, R .D. 1 Box 98 C)ueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date AppROV ED* - YTS NO Footing/pier Forts Foundation Waterproofing Backfill ami ng Roofing Siding Ma onry Venee ugh Plumbin Relief Valves Ext . porches Finished F100r Interior Trim - ----"� stairs & Rai ings ---- Cellar Drai7 T11e�^ ---- �_ ~-- Concrete F ors_, ---' plbg . F ixt re s Gar . Fire roofing Door Clos rs smoke 'De ec to rs Chimney INSULATT N ! Foundati Floors walls Ceiling FINAL ELECfrRlCAL li DRIVEWA'y APPROVAL Final Building, Survey rL y3 Next sck5eduled 3.ns;section ( call wlrer � Remarks- 14t3 ling Iras}7 Ctc� r i + (. BU.IL/DING and Zt7NM []SPAR T8Ox 98 Bay and bnd New York� l28D1 (�ueensensbury, BUILDING INSPECTOR ` s REP (7R; NAME LOCAT I ON , r Permit No , 6 vats * * Ik " APPROVED - YES NO Footing/Fier Farms Foundation Waterproofing Backfill Framing Roof in9 Siding Masonry Veneer Rough Plum]Ding__-- �- Relief Valves -- Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg • Fixtures Gar . Fireproofing Door Closers smmo�ke Detectors ey NSL3LATIdN Foundation Floors x, . Walls Ceiling AL INSPECTION�J�� FINAL ELECTRI WAY 'FP V AL f]RIVE Survey � Final Build , $ f Inspect On L�a31 when ready ) Next scheduled Kemar'ks- oe - 38 c=ec 12 "`� f ector Builain9 6/ 86 and-vl DEPARTMENT 1 fl1 ' E3UILGiNG and ZOt*IING 1 Box 96 ..} gay and, Havifand Ne york G12601 " C)ueen$bury, Bull- DING INSpECTOR ' S REPORT NAME LOCATION !f/ � � Perrr+ it T3© . [Date * * * * * APPFLOV-CD - YES LSfJ Footing/'Fier Forms Foundation Waterproofing aack� ill Framing Roofing Siding Masonry Veneer 46"ILefugh plumbing Relief Valves Ext. lJorclIes Finished Floors Interior `rrz-m Stair_; & Railings Cellar Drain 'rile Concrete Floors p1bg _ Fixtures L+oor Closers srpoke Detecto s Chimney IN SL3LATION Foundation floors Walls ceiling FINAL F ji TRICAL IN$pECTI -- 11lt1VEWAY APPROV �- -� --- Final Building SurveY Next scheduled insp ection {call when ready ) Remarks- . kui ding inspector /F3F and-vl Queervit " rif [rW1! Of L7EPAfiTMENT 5uju0jNG and ZOWNG i Box 98 Bay and yiavwyand Road. R'D Queensbury. {flew york 12g0i le REPORTgul Lf3ING ItyS 'PEC� DR ' S N AME � f` Z LOCAT I LN f r�7 Permit No Date C * * * * * * NO * * * * * * * * * - APPROVED - YES Fcyotin9/r'rer For Foundation WaterPxcx'f in'3 Sack.fil� F r aminc3 Roof ing Siding Masonry Veneer Rougl' plumkzin9__ Relief Valves txt . Porches Finished Floors Interior Trim stairs F� Railings Ce11ar 'Drain Tile concrete Floors Plbg • Fixtures Oar . Fireproofing Door Closers 5rna3ce petecr-ors r4himney 'rN S[3LA'r ION Foundation Floors Walls Ce i 1 in'3 1N SPECT10t, FINAs ELECT CA3 '17R1Vvwx,y p,PPROVP`L Final Building survey Next scheduled insP action (call when ready) Roma rk.s- Buildi•n9 speo or 6/gs mrnd-vl c-� cteen3Iur+j Dawn of DEPARTSJIENT NG BUILDING and ZDNIoad. t Box cis and Haviland A Vork 1 (0ueensbury. t3ew TR 5 REPORT 5UILDING� INSP 'F ( NAME Of �j LOCATION Da1G1~ * * * * * * ppPR(3VEn S L3O * �,tin9J'/E'rE`r gor.' Fo�dation Waterproofing aackf ill Framing Roof ing Siding _-- a,sa veneer__-- Na nry ---- _ son Plumbtnc3,_�- �-- _- - Relief valves hes Ext . Porc Finished Tx'`?m s Interior s Stairs a gailin�3 Cellar Drain Tile Concrete Floors P1b9 . - fixture s Gar . Fireproo n9 Door Closers SmoKe Detec rs Chimney IriSUT P•T7,ON - Four,dat i.o Floors Walls --- Ceiling ECTRIC. TNSPECT ION �----- F WS AI DR7�VEW Y A£'YRaV ldis►$ Survey Final ui ection (call wh,an ready } Next scheduled insP Remar]cs- Building Inspector t Fi/S6 rnd-vl BUILDING DEPT, COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. W"EN REQUIRED. TEMP- i DATECo on :� .•-' VILLA E Q burf TOWNSHIP �''"`'"y COUNTY Waxven STREET AND N8 NO. OR +f .� qAr�'� POLE _ROAD AND POLE no fI/�2 �3 th BETWEEN ""AT TWO /. PREMISES EP-M IS SECTION '`_ BLOCK. LOT OCCUPANTS BUILDING I . OCCUPANCY . . OWNERS NAME �l s �r 119 � SS►Cl8at TEL # 6P. �. AND ADDRESS Guyer _ LU—Ri[rfa - OFFICE SUPPLIED _ .r" .. FROM THEIR . . - _ - - BY ��—gg 11—''-11 f�--1I BUILDING ��--++p{�' fYMSORK NEW �{s ADDITIONAL 1_i REMOVED 1_l IS NEW L._'FE OLD Q LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED No- of Fixbsrla & BRANCH OFFICE USE NUMBER OF OUTLETS Lenat Reaapfadul MOTORS HEATERS CIRCUITS ONLY Lose- tiorm Sidr Axbd�'t Sww� ant �&t Na. TV" Each No, E"h No. A INSPECTION CNlify Wall necepru Out side Sulr aeaa Barr neent let FL Zed FI. r ARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DD NOT USE 7Fi i'S fiPAC E. This application is intmndod to corer the lbove-Iistld aq n ulpmet to be insec pted but it at tiro! of inePeCt at lan tfiere is found ode "onal *W'Pne rtW abo"t I'sted, you are euYlar+red to make the inspection and adjust the fee to cover the additinnai ertu 1potertt, s prorded bV the epplseatts. ELECTRIC SIGN TOTAL SIZE Of FEEDERS LAMPS WATTS MAINS CHARACTER EXPOSED GAS TUBE SIGN OF WORK pqq& in and mervlm CONCEALED TRANSFORMERS OF VA W ORK TD BE (NUMBER$ (CAPACITY$ RTED COMPLETED SIZE OF SIGN OVERHEAD UNDERGROUND MAKER � OF SIGN G ION REQUESTED �.,,a.�SNEAR AS C� 'aRilaOYa NEWEI OLD E .�l AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES DATE OF r Ge {' `� MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION PRINT NAME AND ADDRESSa,_._. -�1��,,., i SIGNATURE ANAME OF PPLICANT , Es'43*,�e .�ys ldersS Im X OF APPLICANT STREET ADDRESS A19 DtWWdm , Street TELEPHONE # 89"161 CITY OR sm3x$'o, spa,, New YDrk CODED' LIC N APPLICABLE POST OFFICE as EL (ltEv. I/as1 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'