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1987-904 •-. •-' L"i ;R'+iz�.cx*rs7Ki'!4'.•�'YS?�4:;. ..;-sS7T�n Y.s' ' > T4 '�� `. 5.; Y ;oc.. . '�,� ;nM air-' - '.:G�4'i$�x."y�B.AfW part ' .." "; , _e.. t e.: , { 7W + ' ! CERT114CATE OF OCCUPANCY i TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK I I Date May 11 , 19 88 This is to certify that work requested to be done as shoran by Permit No. 87--904 has been completed. j of Two Family Dwe l l i.ug This structure may be occupied as a i Location21 Elizabeth Lane - Queexi Victoria ' s Grant Owner Guyer Builders Inc . i f By Order 'Town Board ! PFOWN OF +QUEENSBURY Building d► Zoning lnapector l ' BUILDING PERMIT � TOWN OF QUEENSBURY 87-904 No. WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Queen Victoria ' s Grant 1 OWNER of property located at 21 Elizabeth Lane Street, Road or Ave. l 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 approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. CD 1 . OWNER'S Address is Guyer Builders ' 119Dunning St . Ballston Spa , N . Y . 12020 n r+ 2. CONTRACTOR or BUI LDEWS Name O rS Same w tr? 3_ CONTRACTOR or BUILDER'S Address � N rt Same 4. ARCHITECT'S Name fv 5. ARCHITECT'S Address N4 to Gs rot rot 6. TYPE of Construction — (Please indicate by X) r (K I Wood Frame I ) Masonry ( ? Steel I I 7. PLANS and Specifications N0. 34 ' x 43 ' as per plot plan , specifricatons and application including septic system and attached one car garage . MODEL J S. Proposed Use } of Two Family Dwelling H, $5000 C /O w $ 89 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July* 1 , 1988 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the `4 town of Ouaensbury before the expiration date.1 tz 30th December 87 Dated at the Town of Queensbury this Day of 19� I- w -SIGNED BY de for the Town of Queensbury Building and Zoning Inspector TO BE COMPLETED BY BLDG . DEPT . / Application No . .✓Ow1� - Oe� rt36�tI Permit Issued 19 11c� 13UILDING and ZONING DEPARTMENT Permit Expires 19 � � s Day and Haviland Road, R. D. 1 Box 98 Zoning Deegnatil #� � �f1TQ ]' � .; Quesnsbury, New York 12801 Variance Site PlanApproved �' � �y��pt/ APPLICATION FOR e -r � dQ BU i LIl I NG AND ZONING PERMIT A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING . Who 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 Tnc . P . O. Address 119 Dunning Street Ballston Spa , New York 12020 Tel . ( 518 ) 899-9161 Property Location : 21 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 . Guyer ITT ( 518 ) 899-9161 Nam __...._. P. C. Address Tel . No * Name of builder Guyer Builders , Ine .Address 119 Dunning Street Tel . ( 518) 899-9161 Name of plumber uuyer bujuffiersp 17ficoAddress 1 ,19 DWH=ng Street . - qlbl Name of mason Guyer Esullciersp nc .AddressStreet 'Tel . NATURE OF PROPOSED WORK : * ZONING INFORM+4TION : 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 LOCATION OF STRUCTURES AFFECTED . * of water supply and location and configuration of septic disposal area . * * COMPLETE INFORMATION REQUIRED E W . * oV size of property 100± p an ft X 120 ft . * Existing building ( s) Size ft X� /A ft . Model PROPOSED BUILDING AND USE : f o * Existing building ( s ) Use NIA Size of now strut e 34 ft X 43 ft * Foundation-pier slab crawl/partial/full * Proposed building, list nce rom property line c3.rcle one ) * see plot p an No . of stories (habitable space) 1 * Front yard 3Q+ ft Rear yard 3Gt ft . Height ( grade to ridge ) 21 ' '©" ft . * 'Side yards 5+ ft and 15+ ft If residential , no . of families I of 2 * If an corner , setback from side street ft No* of roome ( excluding baths) * OCCUPANCY INFORMATION Noo of bedaooms 2 Vo . of bathrooms * PRIMARY BUILDING - rimary }seating system se ar a ectric* --�TTwo woone family dwelling one pl�n�� �ie �fc�r w lype of fuel Electricity * family dwelling one i + Multiple dwelling / Number of units No . of fireplaces to be installed Will a wood stove be installed? No * 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 Gape 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/ 4 car • w * # • w w * r w * w w ++ * +► w * Private storage building ESTIMATED MARKET rVALUE OF * 'Other CONSTRUCTION $ v & _ ��LG&� INFORMATION ON BUILDING SPEC IO Se ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED ! "��orm BPA 4/86 and-vl } y BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc . wood frame Will any second-hand or ungraded lumber be used7 if so, for what ? no Foundation wall material concrete block Thickness Depth of foundation below grade (to bottom of footing ) " minimum Will there be a cellar? no Heated or unheated? Floor sqe footage sq ft Will there be a basement? no will any portion be used as living space? ( If so, what polcr . 1 Tsq. ft . - - Type of use? Type of roof - sloped flat/shed/other Material of roof Fiberglass shingles Size, wood studs "X 6 spacing 24 "o . c . length $ ft* exterior walls Joists ( floor beams ) lst . floor N/A "x " spacing "o . c . span N/A ft . Joists ( floor beams) 2nd . floor '"X spacing.."o . c , spanN A ft . Overlays (ceiling beams ) "x spacing 24 "o . c . span NIA ft . .Roof rafters 2 "x 1 "" spacing 24 o . c . span 12 ft . Roof trusses (pre-engineered) spacing 24 '•o . c . span 43 ' ft . Exterior wall finish stained of what material ? 5 / 84 " 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 garage end dwelling? Yes _ if so will a Fire-rated door , enclosure , and self-closing device be provided? es 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 ft . (A separate application is necessary for any re air or new installation of septic system) See S . P. E. D. S . permit # 0202525 Town of Queensbury F AV -- - ' _ 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 &o'wner . 40 SWORN TO BEFORE ME THIS Signatur Own r , owner ' s agen , a�t , contractor ELIZABETH K. LAND14Y Notary puNtillic 862b01, State f New York f Notary P bl� Warren Count N�ia. Y Qualified in Saratoga 1 6,ty y y ■ �.�� Commission Expires vane 1 $, 19-3y r r * w * * ,r _ w * r : ,e * : • * * r► * ,r r * * w * * * ,► * r ,r * �r * r * w • • ,� 1123 Square feet living 240 Square foot Sq ,garage one stall s3 @ $7 . 00/ 100 or part of $5 . 00 One stall garage MOO C/O permit Total ______________�..�. TOWN Or QUEENSBURY 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 followings ; . Grose floor area 1123 S . F . . 2 . Type of heat Baseboard electric 3 . Is the building mechanically cooled ? NO 4 . Percentage of area of windows and doors 1168% 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 YESg what is the R value ? 3 . Slab on grade YES KQ 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 Io R value of roof and floors exposed to ambient conditions,_„_ R-38 2 . R value of exterior walls XR R-23 . 5 ( U. =0 . 04+ ) 3 . R value of glazed area U. =0 . 30 4 . R value of doors R-14 . 9 (Uo =0v06 ) Lw 5 . R value of floors over unheated spaces R=30 6 . R value of slab edge insulation. - unheated slab NIA 7 . R value of slab insulation on heated slab 12 . 5 $ . 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 Co Controls 1 . Thermostat maximum heat setting D . Duct Systems NIA 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 X0 Piping Insulation N/A mft 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation r . Service Water Heating. - 1. Performance efficiency Monsoon NIA 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating N/A Telephone No . ( 518) 899-9161 ( appl cant " a sign ture ) APPLICATION FOR SEPTIC DISPOSAL PERMIT Ref : S . P. E. D. S . IIATE September 23 / 87 permit # New York - 0202525 MODEL J of LOCATION OF PROPERTY FOR INSTALLATION 21 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, li Total daily flow (compute +Q 150 gal per bedroom) 300 Topography: circle one: lat Rolling Steep Slope % of slope Soil. Nature: circle one: Sand Loam Clay Other / Depth: 8 ' feet + C�rround Water: At what depth? unknown' 8 feet + Bedrock or Impervious Material: At what depth? unknown feet posscolatu" m test: circle one: not require required / rate min. inch. Domestic vrater supply-a circle one: Municipal Well Other IF domestic water supply is a Well: Separations: Watersupply from Septic absorption N/A feet * PROPOSED SYSTEM: Septic Tank gal. (minimum size: 10000 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 * * ss * * ss * * ass * * s * * ssssssssssssss * * * * * * * * ss IMPORTANT * See S . P. E. D . S . ...Please...LIST NEW EQUIPMENT TO BE INSTALLED penni.t & attached ssss * ss * ssssssssss * ssssssss * sssss * * * * * * * * map . (over) Section II Seetic 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 propoped .location of the j*ystem Z.) location and distance to lot lines 3.) location and distance to structures 4.) location and distances to any water supply 5.) size and dimensions of all tanks, distribution boxes, the 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 rvgu latioas above and agree to abide by thane and all requirements of the Town of Queevwburyr Sanitary Sewage Disposal ,C]s•dinance. Signature of.responsible person: Date: Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1753 . . . HOME Of NATURAL BEAUTY . . A GOOD PLACF w ° c1s THE NEW YORK BOARD OF FIRE UNDERWRITERS to BUREAU of ELECTRICITY May 17 t 19e�II STATE STREET, ALBANY. NEW YORK 12207 Date �3 €3 Application N' . an file 0 0 2 6 6 2 / R $ A 7 1 9F; 4 2 THIS CERTIFIES THAT only the electrical equipment no described below and introdssced by the applicant named an the above application number in the pus cases arf Guyer nuilders iwo . # 21 Elizabeth Lane Queensburyr New y6 11of 2 fasn3.j-y 121 in the fallowing locat' no Basement 4 f ig �"' �] "� ❑ let FT. ❑ end Fl. Section Black (.aL was examined on and found to be in compliance with the req"irements of this Board. FIXTURE FIXTURES RAN Q*S 1COOKING DECKSI OV6N5 N DISH WASHERS EXHAUST PAS CUTLETS MCImPTACLES SWIITCHIM NCANDESCEHT Fr .MRT. K. W. ^MT. 1S 28 24 1. 2 4 T . DRYERS FURNACE MOTORS FUTURE "N"MCE FISDERS JSMCM REC"PT TLME CLOCKS �, U 0UIET IM NIT HEATERS MULT4TMMERS e�nT. K. W. pi H. P. GAS H. P. r. eMr. AMP, eMr. eev5. TRANS. AMr, �. F. SYSTEMS MkT. wens ra NO. OF MIST 1 SERVKX NSC:O*I Aa= NO. Of S E R V I C E AMT. AMP, TYlE 1 Ar 2W 4 X 31N 3 Ar 3W 9'N AW NO, FEC . CONM OF CC. CO. NO. ar HI-LEG pF HI•ltG Na. aF MUTKALS OF NEUTIIAt I 150 cb 1 X I 1 1 41 OYHER ATTARATM; Motors 4 / fr Elec . :Zoom Heaters : 3 / 2 ■ 1 / 105 ■ 2 / 1 . 0 ■ 2 / . 5 I -pant light 2 -gfc3. 1 -smoke detector Guyer Builders INc . yr 119 Dunning Sto Ballston Spar NY 12020 239 BRANCH ALANAGER r; 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. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNIER# Jocvn ofueen � 1ure�t BUILDING and ZONING DEPA14TMENT Bay and Hav[land Road, R-D. i BOX 98 Queenshury, New York 12801 UILDING IINSPECTOR ' S REPORT NAME + ./ LOCATION � � � OF �� Date / Permit No . � y ' APPROVED - YES NO Footing/Pier Forms -- Foundation Waterproofing 8ackfill F ranu.ng Roofing Siding Masonry Venee 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 INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL. INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ,((call*/when ready Remarks- ok J r"tom' ?,."c Bodingnspec'tLOY 6/86 and-wl _Jvwn v/ Queenig"ry BUILDING and .ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME �7"u i/ ems. LOCATION ! c►�. >Qit l/'r I7v+ is } / .�_ r� DATE / ,.7.� / � PERMIT NO. � 1 *9 SOIL TYPE an - Loam - Clay - PerColatio Test Required? YES - Percolation ate - Min/inch TYPE of SYST Absorption fie d , total len h Length of each trench Depth of trench s Size of gxL SEEPAGE PITS#N r of h/ Size- _ `ft. X _ f Gravel size PIPING : Size Type Bldgv to tank / /- �, -PVC Tank to disc . bo - _ 7PVCL List_ box to fi ld/p� � "R C- Openings Seale ? E NO Partial LOCATION/SE RATIONS . Foundation o tank £t. Foundatio to absorption fte Absorpti to lot line ft . Separat ' n of pits ft . LOCATI OF SYSTEM ON PROPERTY {circle one } Front ea - Left side - Right side - CCMM S : v 5a/ -n SYSTEM USE APPROVED ES NO Building n spector O1/86 and vl � ' ��� .✓e7eun o� q�I.tBert3 +6ttrt� 1 BuiLDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT e/ NAME LOCATION Date /- /� / Permit No . Fy- � ✓ = APPROVED - YES NO Footing/Pier Farms Foundation Waterproofing _ Backf ill Framing _ Roof ing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior "Prim Stairs & Railings cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofin Door Closers Smoke Detector Chimney ,,T SULATION : Foundation - Floors Walls Ceiling FINAL ELEC CAL INSPECTION _ DRIVEWAY APP OVAL _... Final Building Survey Next scheduled inspection (call when ready ) Remarks- A? rti i-oa4 r1� Building Inspector 6/86 and-vl ' L4 BUILDING and ZONIG DEPARTMENT g' Say and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 -' 16- .3VA BUILDING INSPECTOR ' S REPORT NAME ram, yC,�9 LOCATION �` G2� Date ,/�/ Permit Nam APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill C.�arni ng Roofing S idinC� onry Veneer cMough Plumbing L~ � Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railing _ Cellar Drain Ti e _ - - Concrete Floor Plbg . Fixture Gar . Firepro fing Door Closer Smoke Detec ors Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Rema rkcs- tiilding Inspector 6/86 and-vl BUILDING anti ZONING DEPARTMENT " Bay and Haviland Road, R. D. 1 Box 98 J Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION /5 - ]date`f4� Permit No . � A ✓ - APPROVED - YES NO Footing/Pier Forms Poundation Waterproofing Back£ill Framing Proofing Siding Masonry Veneer 4 ,&0ugh Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim StairA- a lings Cella Tile Concrors Plhg . es Gar . o ing Door Smokeors Chimn INSUI. FQundflexor FINAL f L3CTRICAL INSPECTION ORIVEWAY PROVAI. Final Building Survey. Next scheduled inspection ( call when ready ) Remarks- : 13ui ding Inspector 6/86 mci-vl awn o/ Queens 14rty BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT" NAME 6 LOCATION Date Permit No . ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Wa terproo f i ftel Sackfill Framing Roofing Siding Masonry Venee 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 INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRI AL INSPECTION DRIVEWAY APPRO Final Building Survey Next scheduled inspection (call when ready ) Remarks- Building nspectar 6/86 and-vl BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 96 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME �. f LOCATION Date / / Per mit 13c� . - LJ .-� APPROVED - YE Zoegoting/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railing Cellar Drain Ti Concrete Floor Plbg . Fixture -- Gar . Pireproo ing Door Closers Smoke Detec ors Chimney INSULATION Foundatio Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- Building Inspector 6/86 and-vl BUILDING DEPT_ COPY OF APPLICATION FORM 48-EL, NEW _YORK BOARD OF FIRE UNDERWRITERS. FILE Ti-11S COPY WITH BUILDING DEPT, WHEN REQUIRED, TEMP 1► - �.� VSU CITY OR bu� STREET E . STREET AND NO. on �;y ,� TOWNSHIP COUWTV BE E ROAD AND POLE NO. ��"';' +�-�I-T�i�'�. Warren CROSB STREETS S PR EMI ! TE POLE NO. OCCUPANT'S NAME BUILDING TION - BLOCK i LOT OWNER'S NAME 'OCCUPANCY AND ADDRESSf.� i, T„B Inc. SUPPLIED ' SY BUILDING '' FROM THESIR IS MEW O WRK `- OFFICE OLD © IS NEW IV DEFECTS LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED AL REMOVED E Lo4 NUMBER OF OUTLETS NIM,Lownp FR & tioo HEATERS CIRmc""a*gm MOTORS CUITS OFFICE USE Ceiling w N R '1* SwitCh Pandant Bracket No. TYa+ y.Watu A.WI ONLY Earoh t"fa Each Na ids Oar INSPECTION r Sub- be" Baer [neat rot Fl. 2nd Fl. 3rd FI. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT BET FORTH ABOVE: 00 NOT USE THIS SPACE. Thin oppficarioa is intended to CGVer the abo+ra-Iiated a apnlerat w bar intf/acted but it at bare of l You are aothor"Iod WO fnako the inspoCtion and,adjust tfia fee go ae+ear the additiorisI rlfP�aerlrotr dtarw a favrld sdditionN S12E OF equiprwanf� W proeided by the agtutaserlt eYot,ahaa�e hilted. MAINS j. } aP/dieaat ELECT ICSIGN CHARACTER FEEDERS a LAMPS TOTAL OF WORK .;s.r. �.�1L S`Llr'Xt'4.�n EXPOSED GAS TUBE SIGN WATTS a.s3 ca1a WORK TO BE CONCEALED TRANSFORMERS OF STARTED fNlNWBER1 VA SERVICE OVERHEAD COMPLETED SIZE OF SIGN ICAPACITYI ENRS T O#NG UNDERGROUND MAKER INSPECTION REQUESTED OF SIGN ON OR AS !NEAR AS POSS#B!E AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION, tt SPACES NEW � Ot0 Q MUST BE FILLED IN OR APPLICATION MAY BE RETURNEb.PRINT NAME AND ADDRESS �`� OF �+.,,�.� �* NAME OF APPLICATION mercy ���Ir AM`tfCANT SIGNATURE J OF APPLICANT STREET ADDRESS "� "� 9 t� # CITY OR ,1 � ,� ff��.,ewt� _.TELEPHONE ' POST OFFICE N Ycwk zip CDOE 12DW LICENSE NO E 46 EL (RV. r/s6) A SEPARATE APPLICATION IblUST BE FILED Fop c w,r.H crroAcrATE WM 1 UIL ATE Bi.JILDIIVC, 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'