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1987-894
1 �♦ 4 { CERTIFICATE OF %O+CN CUPAN CY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date February 5 , 19 'This is to certify that work requested to be done as shown by Permit No. $ `� 4 has been completed. of: Two Family Dwelling This structure may be occupied a. a Lncarion i Elizabeth Lane Queen vl-ctoria T s Grant Guyer Builders Inc , Owner By Order Town Board TOWN OF QUEENSRURY ie Building N Zoning Inspector BUILDING PERMIT � TOWN OF QUEENSBURY �,-� �� No. , WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Queen Victoria ' s Grant I OWNER of property located at 1 Elizabeth Lane Street, Road or Ave_ in the Town of Oueensbury, To Construct or place a i of Two Family Dwelling at the above location in accordance to application together with plot plans and other information hereto filed and o approved and in compliance with the Town of Oueensbury Building and Zoning Ordinance. ra m 1. OWNER'S Address is Guyer Builders 119 Dunning Street n Ballston Spa , N . Y . 12020 0 K r• 2. CONTRACTOR or BUI LDER'S Name _ Same w +t m 3. CONTRACTOR or BUILDER 'S Address rt Same 4. ARCHITECT'S Name r- t� H- N KL+ 5. ARCHITECT'S Address W ro R N 6. TYPE of Construction — (Please indicate by X} N I x) 'Wood Frame [ } Masonry { I Steel I } 7. PLANS and Specifications No_ 32 ' x 48 ' as per plot plan , specifications and application including �»= septic system and attached one car garage . MODEL J o rh B. Proposed Use } of Two Family* Dwelling 0 $ 5 . 00 CIO $ 89600 PERMIT FEE PAID — THIS PERMIT EXPIRES July 1 , 19 88 �4 cj Ilf a longer period is required an application for an extension muss be made to the Building and Zoning inspector of the � town of Gueensbury before the expiration date.} r. F+• Dated at the Town of Queensbury this 29th Day of ]December i9 87 M SIGNED BY !2 for the Town of Queensbury Building and Zoning Inspector TOWN OF gUEENSBURx WARREN COUNTY , NEW YORK Application fora BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work. . &NSWZFL ALL of the following : x . Gross floor area 1123 S . F . 2 . Type of heat Baseboard eiectri{c 3 . Is the building mechanically cooled ? NO 4 * percentage of area of windows and doors 11 . 8% A . Over 16s OnIY 1. Up 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 ? 40 Is basement heated ? YES NO a . R value of insulation 5 . Type of insulation so Under 16 % only 1 . R value of roof and floors exposed to ambient conditions. R-38 2 . R value of exterior walls NDMSX R-23 . 5 (Us =0 . + 3 . R value of glazed area U . =0o30 4 . R value of doors R-14 . 9 (Us .06 ]6) 5 . R value of floors over unheated spaces AX9X- R=30 6 . R value of slab edge insulation - unheated slab N/A ? . R value of slab insulation - heated slab 12 . 5 Be R value of heated basement/cellar walls ( above grade ) N A g . R value of heated basement /cellar walls ( below grade ) N/A Joe Type of insulation Fiberglass Co 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 Be piping Insulation N/A 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation Fe Service Water Heating 1 . Performance efficiency N/A 2 . Temperature control setting maximum G . For swimming Pool Only 1 . Maximum heating N/A 40 Telephone Noe ( 518) 899-9161 ( ap li antes gnature ) TO BE COMPLETED BY BLDG . DEPT. IV 7k 3 Application Pao . ,_ / +n l eti�e ►t 61tt I Permit Issued 19 BUItD)NG'and ZONING DEPARTMENT Permit Expires 19 V ti,T 2 1937 Bay and Haviland Road, R.D. 1 Box 98 Zoning Despigna ❑ueenabury. New York 12801 Variance NSite Plan 777 /7Approved b hs Vol', 'r" APPLICATION FOR BUILDING AND ZONING PERMIT 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 : 1 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 He Gu)rer III ( 518 ) 899-9161 Name F . G. Address Tel . No . Name of builder Guyer Builders , Inc .Address 119 Dunning Street Tel . ( 518 ) 899-9161 ww�Name of plumber yet 1 ers , nc .Address ng StreetTel . ( 518) 599_jTurww� Name of mason yer rs , nC •Address StreetTel . - TJTUTwwwwwwww 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 REQUIRED lot * Size of property lam- P ip ft X 3-20 ft . * Existing building ( s) Size £t x�► ^ft . PROPOSED BUILDING AND USE : Model * Existing building ( s ) use NIA size of new strut e 32 ft x 48 ft " Foundation-pier slab crawl/partial/full * Proposed building , dirt nce from property line circle one ) * see pot plan No , of stories (habitable 1p �'ace ) 1 * Front yard 30+ ft Rear yard 30+ ft "" * Side yards 1 + ft and 15+ ft Height (grade to ridge ) ? ft ' * If on corner , setback from side street ft If residential, no . of families No of rooms (excluding baths ) OCCUPANCY INFORMATION No .. a bedrooms 2 * PRIMARY BUILDING - No. f bathrooms 2 One family dwelling This ei f r Primary heating system se at a ectrie* -- -1 family dwelling one S?ae Type of fuel ElectraClty * Multiple dwelling / Number of units Now of fireplaces to be installed permanent occupancy Will a wood stove be installed? No �wwwwww No * Transient occupancy Central Air conditioning? Business BUILDING STYLE, PRIMARY STRUCTURE Industrial * Other Ranch Contemporary Lo cabin If addition , what will use be? Raised ranch Mansion QDuple " 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 * * * * * * x * * x * * * * * * * Private storage building ESTIMATED MARKET VALUE OF * other CONSTRUCTION $ -� _ _ * -- - - - - G INFORMATION ON . BUILDING SPECIE_ ONSs ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETEDI Form SPA 4/86 and-vl w AP 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 $" Depth of foundation below grade (to bottom of footing ) 4814 minina m. 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 rg ass shirxf;les Size , wood studs "x b spacing 24 "o . co length ft . exterior walls ,joists ( floor beams ) lat . floor N/A "X , " spacing_ "o . c . span N/A ft . Jolsts ( floor beams ) 2nd . floor "X_ _ _" spacing_ "o . c . span N A ft . Overlays (ceiling beams ) "X spa cing 24 "o . c . span N/A ft . Roof rafters 2 "X " spacing �4 o . c . span 14 ft . Roof trusses (pre-engineered) spacing� '" o , c . span 42 ' ft . Exterior wall finish stained Of what material? 5 / 89 " x 4 ' x 8 ' texture 111 Interior wall finish pamt 172 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 }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 . Depth of chimney foundation below grade N A ft .' Depth of fireplace hearth N/A ft . in . Water supply - Municipal or private well music]-pal SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties NIA ft . (A separate application is necessary for any repair or new installation of septic system) See S . P". E. D , S , _perfnit #f 0202525 _ Town of Queensbury County of warren IC R F F I D R V I T STATE OF NEW YOR 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_ ____ __ _ Q. Owner , �owne ' s agertir, arclaxcect , contractor - y EUZABETH K. LANDRY da o f +s �firS i 9 i Notary Public, Sate of New York J 01 Qualified in Saratoga County Notary P Warren County, N , Y , Commission Expires June 7 _ 1123 Square feet living 240 Square foot garage - one stall 1363 @ $7 . 00/ 1O4 or part of �5 . 00 One stall garage 5oOO C/O permit Total Of " 6wy APPLICATION FOR SEPTIC DISPOSAL PERMIT Ref : S . P . E .D . S . DATE Septefnber 23 / 87 pern:i.t # New York - 0202525 MODEL i of LOCATION OF PROPERTY FOR INSTALLATION #1 Elizabeth Lane Owner's Name: Guyer Alders , Inc . Telephone: ( 518) 899-9161 Address: 119 Dunning Street , Ballston Spa , New York 12020 Installer's Name: Guyer Builders , Inc Telephone: ( 518) 899-9161 2 A, C , E , I , .I , K, L, M Number of bedrooms (residential only) 2 S F * G , H Total daily flow (compute 0 150 gal per bedroom) 300 Topogxaphy: circle one: Flat Rolling Steep Slope % of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: 8 ' feet + Ground Water: At what depth? unknown 8 feet + Bedrock or Imperviaus Material: At what depth? unknown feet Pesvolation test: circle one: not require required / rate min. inch. Domestic water amply: circle one: Municipal Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption � N/A feet * PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1.000 gal.) TILE FIELD: Each Trench N/A feet / Total system length N/A feet * SEEPAGE PIT(S): Number of / Size each feet by feet * Size of stone to be used # / Depth or Thickness feet +s * sus * aY * * ss * * ss * * s * s * * say * * * * * * * * * sasssssss _ IMPORTANT * See S . P . E . D. S . _..Please...LIST NEW EQUIPMENT TO BE INSTAIJ permit & attached * s * * * * * * * * sa * * ae * * * * * say * as * * * * ssss * arsss * s * e map . (aver) Section U Septic System Inspections: A, All applications for septic system installation, alteration or repair, as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building Department at least Z4 hours before start of construction and shall include a plot plan showing: 1,) the propo$ed ,location of the gystem Z.) location and distance to lot lines 34 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 $250.00. C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. Do Should unforeseen problems during,, construction prevent proper installation, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction, l have read the regulations above and agree to abide by tLese and all regturennenta of the Town of Queensbury Sanitary Sewage Disposal Ck% inawm. Signature of_responsible person: Date: Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury. New York 12801 (518) 792-5832 SETTLED 1763 . . . HOME 0F NATURAL BEAUTY . . . A GOO D. PLACE TO LIVE awn n/ �cteen36ttrt�t BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. i Box 98 Queensbury, New York 12801 XUILDING INSPECTOR ' S REPORT NAME /&.Z z a �� LOCATION O / Date ./ ermit No V . ✓ APPROVED YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Venee Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg , Fixtures Gar _ Fireproofing Door Closers Smoke Detectors Chimney INSULATION Foundation. Floors Walls Ceiling NRi ELECT AL INSPECTIOI3 1'IVEWAY APP VAL _ Fina u Survey Next schedul d Inspection ( call wlie�n rea ) Remarks- Bu i g Inspector 6/86 and-vl awn o QlAve n j " r y BUILDING and ZONING DEPARTMENT Say and Haviland Road, R.D . 1 Box 98 pueensbury, New York 12BOl SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION Uteft DATE 490�1 �{$ PERMIT 140. b + � �� SOIL TYPE _ an Loam - Clay - Percolation Test Required? YES - Percolation rate - Min/Inch TYPE of 'SYSTEM: ,AbsorPtion f leld�r.trench total len tYx Length of Depth of tre hes Size of grave SEEPAGE PITS N er of size_ a ft, _ 9 f Gravel size Size "T'r Pe PIPING : Bldg . to tank Tank to disto bOx it ywG Dist. box to fie d NO Partial Openings sealed LOCATION/SEPA TIONS : ft. Foundation t tank absorpti ft ' Foundation ft . Absorption o lot line _ft. Separation of Pits G�7 PRO R;rY (circle One) LOCATION SYSTEM night side - Left side - Rig Front - COMMENTS : '`' '9/�� SYSTEM uSE APPROVED 2ding NOInspector 01/$E ma vl MMMMMMMPI BUILDING and ,ZONING DEPARTMENT Bay and Haviland Road. R. D, 1 Sax 98 C)ueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME-- AME -- OF LOCATION DATE ��/.,E-- PERMIT NO, SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - No Percolation rate - Min/Inch TYPE of SYSTEM : AbsOrpti.on fiel , total length--- Length of each ench Depth of trenche - Size of gravel SEEPAGE PITS{Ntunb of) ---- Size- ft. X ft. Gravel size PIPING : ize Type to tank Tank to dist . box Dist . box to field/ i - Openings sealed? YES / C Partial LOCATION/SEPARAT S : 1•/ Foundation to t k ft. Foundation to a sorption ft , Absorption to of line ft . Separation of its ft. LOCATION OF S STEM ON PROPER (circle one ) Front Rear Left side - Ri ht side COMMENTS : ,r-+ /40 SYSTEM USE APPROVED YES NO .n 9 Sui ding Inspect 01/86 mc3 vl ./�� own o� ueensttrt� f ?BUILDING and ZONING DEPARTMENT do 'Bay and Haviland Road, R.D. t Box 98 ✓ Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION ZBate � ermit No . y ' APPR EU >'YES NO Footing/Fier Fo Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floor Interior Trim Stairs & Rai ngsJ Cellar Drai Tile _ Concrete F ors Plbg _ Fix res Gar . Fir roofing Door Cl ers Smoke tectors Chimn 4376SU TION ; Foundation Floores Walls Ceili.ng - FINAL ELECTRICAL INSP ION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- t� Building Inspector 6/86 and-vl /I�"r �r ./ocun © u �en � tere�r r /�7 BUILDING and ZONING DEPARTMENT ` //" " Bay and Haviland Road, R- D. 1 Sox 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME �a LOCATION Date // C7/ 2 "j Pearmit No . _ '� -E J�q ✓ = - Footing/Pier Farces APPROVED YES NO Foundation Waterproofing Backfill l Framing Roofing Siding Masonry Veneer Laugh 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 APP VAL Final Build g Survey "— Next scheduled inspection {call when ready ) Remarks- IZO cap R ALA ilding or 5/86 and-vl i F 4 c9�'yQ�n o� �ueen � bur ` l M end zONING OEPART 41 BU%LDjt4G p. 1 Box 98 Bay and Hg.riland �c'a York } 280ti �Ueensbu"Y, New ISSSPECTrJR i s REPS✓ 'y BUILDING t4AME k oCAT I ON J No Date , I3C) * * * * * * * * *r/* - APPROVEID �S Footing/Pier Forms Faundati or, Waterproofing Backfill F raining Roof ing Siding --- ?,tasorlrY Veneer �___----- Relief Valves__. Ext . porches Finished Floors- --`�� — - Interior Trim Stairs & Railings Cellar ryrai.n Tile Concrete Floors plbg • k fixture s Gar _ Fireproofing Door 'Closers Smoke petectors GhimneY INSULATION Foundation Floors Walls Ceiling INSpECTI[3C1��_.--- F KN pj, ELECTRICAL DIt-iVEWAY APPRO'VAL_�-�� Final Building 5urve9 inspection call when ready ) Next scheduled Rernnarks_ (1 Y1,/s 0 f" 141A "Cc" 04L�o � L ding I 'spec >" 6/$E' and-ul af T f 7w�}t i1hlC' a� A ff id �} Bulk4k�Haa4ijand Boa ,jerk 'A V BaV ari env% urY • ,t4e pue $�} 11 D1N 1N`3F' � C C N}jME KO 1,jaj�e �� '� f * Pier �,,04r in<3 - Z _ -~ VOCI g,acK�i 11 Roo' ---- -1-- sidi-r"3 ,Ten er.__� Y)A Yl e pa chi 5j: ..r'S Fi ri FT 11 De'lla e Vloor oncr Gax - 7r CIO GY+ineY 14 SU ' 10 Flood!' CeiliX'`3 G. gxG�`I' t3KaEGYC7E3 Final �uildinS S'lx tifln call Wy,en re ec adY� eduled ynsp tlext sch iLernaXs` E _ . ,e 4r Wdooc " j r NT pWnofpEPARTM ? ' an d ZaNfNG 98 t BU%LO%v4 Road , 0" Qax Day and Haviland �eW Yark 1250� c)ueensburV S dR� BUILDING Ih1SPP.C� OR ' REP Da�•� /' *� x * * p,F'PFtC7VE'D -' YES JA° * * p.00[ in9/pier parYns F,oun datian �.._- w a terPrao f Bacicf ill1-- F" rasnin9___-.-- Roof ins SidinE3 NasonrY in9 ---- � pleb _-- Ext- • Yo�yes Finisne Floors inter io&stajLr �7 in�3s Ce11-arte eraa n T she Floor concr p x lures plb9 a F ' 9 Gar - ire roof y>00r Closer to s Smoke De,Gac Chimney 113 SUL 1�xS0[3 Foun'lat ion F 'oors walls Tt�SPEC' -IM4 Ce it in() CAT, �- CT R 3 i3 ASa V AL llRIVRX4 A1py uYyey ��'"�� __.--- F final S"j f.1d ing Ne�� so�eduied titan inapec Coa1.1r a `�'� RemaXksr 'r xn5�,�� guildin43 6/ E mr3-vl �ueeriy � ear� � ,�vw+'i � D�EpARTM�1`1 �tylLpyNG and ZC)N%N R'D 9ox 9S ("I� r BaV 'and } {aviland New York A2801 e r'Y Jig Quensbu • Bul L'DIvAG INSPECTOR ' � PdFtT NAME LOCAT ION NC x ootin�3fPier Fob �Fo,�,d,,ation waterPx�f ing F rani n9 goof in9 siding ---- -_ _�- �asonrY �''eneex______-�------"umbi- ._-- .Rough Fln _--- Relief Valves t . Poxche5 Finished Floors xnLexior Trim n s stairs r gaili 8 cellar Drain Tile Concrete locyrs F ixtuxe s Plb9 - rooting G a �ir`aP r - �yoor Closers petea tors Smoke �..� CYO+ ey 114sor ,T1ar� Foundation gloors Walls Ceiling C P.I g1C . 1135PEV-IC^fi2GsN�__-- - ET�E ��. RIV WAY A D ing SV ey F3na1 Buildur _. en r �dye (call h 13eXt scheduled insecti ¢n R ltemarlcs � ��? t v--- 3y 7 g tla.ldin9 1nsPectox ,d_Vl BUILDING DEPT. Cr0`PV14D APP II�CAT N SV1L46-EL, NEW YORKARD OF D NG DEpT. %*MF-N RECKAREDIRE IfNDERWRITERS. T E ! TEMP. ik COUNTY CITY OR TOWNSHIP VIiLAGE PALE NO. ROAf1 ANp PDLE NO. E TION BLOCK BETWEEN WHAT TWO A EMiSFT RLEETS,I,�D� BUILDING . . OCCUPANCY �ry yy {.y QCCUPANT'S y7 AA TEL. #� J-�L plysiJER'S NAME ( '�y 'AI:; Y Pe 1 AND ADDRESS OFFhGE \ U _ ¢ FROM THELR RDEFECTS EMOVED l—I SUPPLIED - - % rr----II TRK hill �, ADDITIONAL ❑ r Jill. : pLO L� I5 BUILDING NEW 1�' r5 LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED BRANCH OFFICE USE No- of Fisctotae & MOTORS HEATERS CIRCUITS ONLY NUMBER OF OUTLETS Lalnp Reeantedee p.W.G- INSPECTIQN oomH.P. No. Ee No. Gauge tion Side Atymh't Switch ParMatrt Bracket No. TYPe Each '�.. Oiling Walk Reap 1s Out- side Soh- bale Beer rnent let Ft. 2nd Fl. still FI. OO NO7 USE THIS SPACE. NIL FA ABOVE: REMARKS; LIST OTHER ELECTRICAL PEViCES NOT SEY Fd ecsad but if at time of insPeation there is Ioutrd add itianaii ey.oiPment not abora fisted, ui ent to be iRSP m ruwithad by she aPDricartt- This aPPlicateon is intgnrrad to cover the above•liated W Wn TOTAL you are authotizad to Make the iropactia avid adN+st tfie Ise to cover the additional ELECTRIC S16N WATTS LAMPS SIZE OF 150 FEEDERS MAINS JL+ ei CONCEALED D GAS T Ulu RA SFO VA 4� •, ��i CONCEALED TRANSFORMERS OF (CAPACITY} CHARACTER in and (NUMBER} OF WORK SIZE OF SIGN WORK TO BE COMPLETED STARTED UNDERGROUND MAKER SERVICE OVERHEAD �r,�e► OF SIGN ENTERS OLD INSPECTION OR ASON REGUESTED NEW POSSIBLE AVOID DELAY BY GYVING FULL AND ACCURATE IN F O Fill I0N. ALL SPACES MUST BE BFIN OR APPLICATION MAY 6E RETURN NEAR ASFILLED PRINT NAME AND ADDRESS APPLICATION NAME OF APPLICANT TELEPHONE # LICENSE NO. STREET ADDRESS ZIP �__WpIEN APPLICABLE CODE _ CITY OR POST OFFICE A SEPARATE APPLICATION MUST BE FILEDFOR EACH SEPARATE BUILDING <e eL (REV. 1105) CLUEEN VICTORIA' S GRANT QUEENS BURY, N.Y. 01 C.O.T.G. 42 1 i ELIZAt3t Irl 8'-0 DIAMETER 9�- 0 DEPTH )00 qaI. 126.82� REFERENCE DRAWING: 5A SITE UTILITIES SEPTIC it WATER VanDUSEN � STEVES SURVEY PLAN C.O.T.G. (CLEAN OUT TO GRADE) 221 o NJ 1, 315, 7, 9,11 ELIZABETH LANE PLOT PLAN E SEPTIC SYSTEM GUYER BUILDERS INC Qv .. DWN : *:SA! q• is-871 Scale = I' : 2C(- 0