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1987-882 . _ x '�"`• .�„'�. ` 1 :.*`r*Y i ,:r�fAt. :^"?v+L':'S ,'r�-Y' . ,� ,r,'. :,,�.,er fi^ y[}:tl�s. f.a'p�,'... .',Lc"., •si.,r.:.,F F CERTIFICATE (.3}1F 0CCUPA.NC`)L7 TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK .Tune 27 , 1988 Date q ~ J� This is to certify t t work requested to be done as shown by Permit IN 04 8 7- &8 2 has been completed. This structure may be mneckpied ss a One Family Dwelling IT 1,.ation 4ve+ "�7 i�� Pleasant St . Hidden Hills Owner Joe ftaulier , Inc . By Order Town Hoard TOWN OF QuzzmavRy Building & Zoning inspector BUILDING PERMIT � TOWN OF QUEENSBURY 87-882 � No. WARREN COUNTY, NEW YORK PERMISSION is hereby granted to 'Joe Roulier , Inc . un Lot # 78 Pleasant St . Hidden Hills OWNER of property Located at Street, Road or Ave. in the Town of Queensbury, To Construct or place a One Family Dwelling at the above location in accordance to application together with pilot plans and other information hereto filed and approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. c. 1 . OWNER'S Address is Box 301 � Cleverdale , N . Y . o 2. CONTRACTOR or BUILDER'S Name r4 Same w n 3. CONTRACTOR or BUILDER'S Address Same 4. ARCHITECT'S Name t" O x N• Ka A co. c. 5. ARCHITECT'S Address n) twd ac � r• w M W � w m � S. TYPE of Construction — (Please indicate by X et En rs I a Wood Frame i 1 Masonry { I Steel { } 7. PLANS and Specifications No. 43 ' x 24 ' as per plot plan , specifications and application including septic system and attached two car garage . —B.—Proposed Use Ay One Family dwelling $5 . 00 C/O m M . �0 ~ Jul 1 , 88 �. $ PERMIT FEE PAID — THIS PERMIT EXPIRES y S9 (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_) Dated at the Town of Queensbury this 23rd Day of December fg 87 SIGNED BY Z57F AfCZw� = = ? for the Town of Queensbury Building and Zoning Inspector TO BE COMPLETED BY BLDG . DEPT. / Application No . .JGriuri LYiieen9l7ieri�t Permit Issued 19 iUlufV � . BUILDING ana ZONING DEPARTMENT Permit Expires 19 } �r� ; - Bay and Haviland Road, R,D, 1 Box 98 Zoning Designation ' S �� f � Queensbury, New York 12801 variance No. � ; Site P Rdview O E G 181987 ilppr EF'-r ( +/ APPLICATION FOR BUIL➢ ING AND ZONING PERMIT A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING . The under:,;geed hereby applies for a Building Permit to do the following . woxk 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 : / P. O. Address Zv W W <zrm •e.+y / .. . .}+ Tel a?- G r'C - a ,'Yry Property Location : rS G -ar Tax Map tio . / / . .._.... Street number or building lot number Subdivision name (if applicable) , eeeesr' ff3 .. .ems-.r . . � THE PERSON RESPONSIBL& FOR SUPS IS ION OF` '/WORK A5 gREGARDS BUILDING ,C1013ES IS : g Name P. O . Address .Tel . No . Name of builder'. Address .T#43* O 74tm Tel . .v0*e! Z%X Name of plumber �._. ,Address . L!s Tel , y y y - s'c i 3 Name of mason s , r tr�.�r Address `/�� x, Tel 00 72 NATURE OF PROPOSED 4rC7RiC : ZONING INFORMAATION Construction of a new building „'� A PLOT PLAN MUST BE PREPARED AND SUBMITTEDr 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 Or STRUCTURES AFFECTED. of water supply and location and configuration * of septic disposal area . * * COMPLETE INFORMATION REQUIRED BELOW . Size of property ,ro e o ft X t . * Existing buildings ) Size ft x ft . PROPOSED BUILDING AND USE : * Existing building (s ) Use Size of new structureft �{w.�___ � * •-,-• Foundation-pier/slab/crawl/partia * Proposed building , distance from property line (circle one ) * / •Front and le Noo of stories (habitable space ) "� * y' ft Rear yard 7C ft Height ( grade to ridge ) A.* "0'40 ft , * Sides yards ' " :�-% i7�' Pt and _- " r,� - ft If residential , no . of families » if on corner , setback from side street ft No , of rooms ( excluding baths ) ' * OCCUPANCY INFORMATION No . of bedrooms No * of bathrooms y„ ,► PR314 RY BUILDING - �- * " One family dwelling Primary heating sysstPm - Type of fuel -- .` * Two family dwelling L- r�s / Number of units NO . of fireplaces to be in Multiple dwelling stalled (permanent Occupancy Will a wood stove be installed? _ " p y central Air conditioning? * Transient occupancy �. Business BUILDING STYLE, PRIMARY STRUCTURE -.Industrial Ranch Contemporary Log cabin * Other Raised ranch Mansion Duplex If addition. , what will use be? - Split level Old style Bungalow - ua e Cod cottage Other * ACCESSORY BUILDING- Crz ollonial Row Town House DetaGj1aj1 qA. age/one car,/ two ar/ car ( CIRCLE ONE PLEASE ) * ttached cgara one ca two car car * * * * * * * * * * * * * * * * * Private storage building ESTIMATED MARKET VALUE OF * Other CONSTRUC`i' ION INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETE?D ! Form BPA 4/86 znd- vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe, etc . Will any second-hand or ungraded lumber be used? If so, for what ? Foundation wall material- - ,+ "C.� Thickness .e Depth of foundation below grade ( to bottom of footing ) _-- - �-- Will there be a cellar? ..-✓'a Heated or unheated? Floor sq, footage sq ft Will there be a basement? +es Will any portion be used as living space?_ ( It so , what portion? sq. ft . - - Type of use? Type of roof - s. .a ed lat/shed/other. Material. -of roof Size , wood studs_" spacingg:ngg..''o . c . length , r ' ft . .joists ( door beams) lst . floors "X ,rn spacing."o , c . span.,ea f t . .s .joists ( floor beams ) 2nd . floor .,"X �,. spacing ,�G ."o . c . span �/ �f �. Overlays (cei ling beams ) "X. _" spacing "o . c . � F Roof rafters "SG "" spacing o . c . span fto Roof trusses (pre-engin Bred) spacing.44„_1*0 . c . spank-ft , Exterior wall finish r Of what Interior wall finish + z �, � -, 4r If a garage is to be atta , had , describe, materials to :b/e used for FIRE SEPARATION : --- ,pp 'we Is there to be an opening between garage and dwelling? ^oro If so will a .Fire-rated door , enclosure , and self-closing device be provided? Will a flue-lined chimney be installed? 4V Height above roof cogft . --. Depth of chimney foundation below grade Depth of fireplace th � .1 ft . in . Water supply �icipa or private well SEPTIC SYS PEri! _ Distance from ANY private well ( including adjoining properties r✓ ♦y f t . (A separate application is necessary for any repair, or new installation of sep is system ) Town of Queensbury County of Warren A 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 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 -.uthorized by the owner . SWORD? TO BEFORE ME THIS Owner , owner ' s ent , arcnxtect , contractor � day of � 19 Notary Public , Warren County , N . Y . SPECIAL CONDITIONS OF THE PERMIT : By TOWN OF 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 following : 11 Gross floor area " � ^ ' e# /Z! a 2 . Type of heat. /^Oa.S a - . 3 . is the building mechanically cooled ? A/o 4 . 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 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 B . Under 16 % Only 1 . R value of roof/and floors exposed to ambient conditions _ ./T" ,dam 2 . R value of exterior walls e 3 . R value of glazed area ! ...�► s I 4 . R value of doors 5 . R value of floors over unheated spaces ape j 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab 8 . R value of heated basement/ cellar walls ( above grade ) 7 9 . R value of heated basement /cellar walls ' ( be/low grade ) o 10 . Type of insulation ��.9/ r C . Controls a 1 . Thermostat maximum heat setting Dv Duct Systems 10 is duct system installed in unheated spaces ? YES7 a . If YES , R value of duct installation b . R value of duct in other areas E . Piping Insulation 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating 1 . Performance efficiency "00 OF 2 . Temperature control setting maximum jI G . For Swimming Pool Only 1 . Maximum heating` 40 Telephone No . / ^ LirL - 3 ►'`'/N ( applicant ' Usignatu e ) Voyown df aetwxmwy APPLICAT70N FOR SEPTIC DISPOSAL PERMIT DATE LOCATION OF PROPERTY FOR INSTALLATION � I.f.4 ^..' / - Owner's Namer /' • w�,,..^.�,. Telephone:: sle 4r - d i G - 3` i 'VV Address: /� + sr . 2 a' � y Gr L e . . . Installer's Name: /, a, G� "`r C-� + as ,. c _ Telephoner 7 X�*� Number of bedrooms (residential only) _r,3 _ Total daily flow (compute @ 150 gal per bedroom) Topography: circle o Fla olling Steep Slope `35 of slope _ Soil Nature: circle one: San oam Clay Other / Depth: feet Ground Water: At what depth? ..r + ? feet Bedrock or Impervious Material: At what depth? �+/�—/ feet Percolation test: circle one: not required required / rate min. inch. Domestic water supply: circle on unicipal ell Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption _ feet PROPOSED SYSTEM: Septic Tank / a-^■+-v- gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench %.s o feet f Total system length „.v o -v feet SEEPAGE PIT(S) : Number of / Size each feet by feet Size of stone to be used # / Depth or Thickness cz�z feet IMPORTANT ...Plea.se...LIST NEW EQUIPMENT TO BE INSTALLED (over) Section II 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 24 hours before start of construction and shall include a plot plan showing: 10 the proposed location of the system Z.) location and distance to lot lines 30 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 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. 1 have read fhe regulations above and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. 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, PLACE TO LIVE ` ..Jnwn o� �ueer� s � ur+e� / f BUILDING and ZONING DEPARTMENT ! ' • [ Bay and Haviland Road, R.D. 1 Box 96 Queensbury, New York 12601 BUILDING INSP E OR ' S EPDRT NAME v/F LOCATION � �','� J"r✓ff Rol [late Permit No . �- * * * * * * * * * * * * * APPROVED - YES NO Footing/ Pier Fo r'n5s Foundation waterproofing BackfiII ]Framing ROQf ing Siding Masonry verse Rough Plumbin Relief valves I.xt . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing [7C7i) Z' Closers ms.�ke Detcc rs Chimney INSUI.ATI0 Foundati Floors walls_ Ceilin . FINAL LECTRICAL, INSPECTION )1LIVEWA APPROVAL Final Su ding Survey Next scheduled lnsp ection (call when ready ) Rc:xnarks� 1p i Builjrf ; rnigInspector (,ff36 and-vl _town of Queenshury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 96 Oueensbury, New York 12801 �CK�11�JNG INSPECTOR ' S � f2EP{712T N LOCATION Date / Permit NO . lv /+ APPROVED - YES G7 Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief valves v,xt . Porches Finished Floors Interior Trim Stairs S Railings S Cellar. Drain Tile Concrete Floors Plbg _ Fixtures Gar . Ftreproofin fir+ 1)a(3r Closers Smoke Detector- Chimney INSULATioN : Foundation Floors Walls Ceiling FINAL ELECT ICAL INSPECTION R.IVEWAY AP ROYAL Itial Build ng Survey* `I3ext scheduled inspecti { call wtxen ready) on Re.marks- All Building Ins ector G/UG and-vl NEW S 4057381 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY Fa 41 STATE STREET, ALBANY, NEW YORK 12207 Ants July 5 . 1998 Applicati,orz 'Nu. on file � � � 5 p THIS CERTIFIES THAT Q00429 / � � F F3 only the electrical equipanent as described before and introduced by the applicant nor ned on the above a ppUcation nuanber in the pre,nises of rRoulier Construction Co . 78 Pleasant T ane Glens Falls , New York in thefailowing location; 0 Basement let Fl. 1j] 2wwd Fl. garage out,glde Section Block Lq8 was examined on 6 . 2 2 ~813 an+d"found to be in compliance with the requirements of this Board. FIXTURE I FIXTURES RANGES COOKING BECKS OVENS D15H WASHERS RXHAV57 FANS OUTLETS klICEPTACLRT' #UV ICHE# IPICANDESCEPn j FLUSMESCENT AMT. II. W, API K. W, AMT. K.W. T. K. W. AMT. H. ►, 26 1 63 28 1 24 2 1 1 1 1 1 1 3 fr DETERS FURNACE [MOTORS FUTURE APPLIANCE PEEOERS SPECIAL RECOPY TIME CLOCKS REu UNIT HEATERS AI$rTT-otiT►E1' DIMUYIERS AMT, K. W. 011, 11. P. GAS H. P. AMT. NO. A, W. G. AMT. AMP. AMT. AMPS. TRAM#. AMT. H. *. NO. OF PEET AMP, WAT M et Saw OLSf3©NNECT NO.aP S E R v I C E AMT. AMP. riff ' 1 0 4MI S Ar 31M S / sW 3.e AW 'II �R'�,e,C47Nb. GF C CdJb. NO, OF HI.IEC; ��H1-L*GW. . Na. OF NEIITRAIS OF NEUTRAL 1 200 1 Cb 1 x 4 / 0 2 / 0 OTHER APPARATM; Elec . Room Heaters : 3 / 2t . 0 , 4 / 1 . 5 , 2 / . 75 , 2 / . 5 3 / 2 . 0 3 �g £ci 2 -smoke detectors "Era 'ElectricCo . R04 339 -F Casndleberry Prive 7'le n s Falls , NY 12801 + } BRANCH 6"NA(MR ./ Par This certificate must not be altered in any manner, return to the office of The Board if incorrect. Inspectors may be identified by their ' cred -als. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. �C � �ueea3 �strr� o wrr � PA BUILDING and ZONING DEPARTMENT Say and Haviland Road, R.D. 1 Box 98 Queensbury. New York 12801 BUILDING INSPECTOR ' S REPORT NAME 1 w LOCATION ^� �$ .LorL � '_ Date * * �/ * * * * * * * * * * * * '+ 5* *N0 r APPROVED Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing S ;ding Masonry venue R.ugh Plrmtibin Relief valves Ext . Porches Finished Floors Interior Trim Stairs & Railing Cellar 'Drain Tile Concrete Floors P1bg , Fixtures Gar . Fireproo£in poor Closers Smoke Detectors Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECT AL IBTSPECTI N �.... DRIVEWAY APPR VAI. Final Buildin survey - Next scheduled inspection (call when ready } Remarks- ii in Inspector 6/86 tad-vl Cl �F .lawn o/ Q"eensbacrY BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 BOX 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPO RT NAME ,/, ,Y4- -7 dY�o`oG 6 LOCATION - Date �, r-•f Permit N .�.�•- * � APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill F rami.ng Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches u / Finished Floors interjor Trim vi Stairs & Railings Cellar Grain Tile Concrete Floors Plbg . 'Fixtures Gar . Fireproofing Door Closers smoke Detector chimney IN gULATION Foundation Floors Walls Ceiling FINAL EL TRICAL INSPECTION DRIVEWAY APPROVAL rvey Final Bu lding - Next scY►eduled inspre/ctio_n (call w�hyen ready Remarks- ©i JilBJA ing inspector 6/86 and-vl n a ueens6rxr a BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.O. 1 Box 98 Clueensbury, New York 12801 BUILDING INSPECTORt5 REPORT NAMEir ' LOCATIO � Date?: __ rff— Permit No . Zr/ �_ ✓ APPROVED - YE NO ,rF'ooting/Pi. er Foams Foundation (/ Waterproofing Backfill F raming Roofing Siding Masonry Vene r Rough Plumbin Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railing Cellar Drain Tile Concrete Floors Pllbg . Fixtures Gar , Fireproofing Door Closers Smoke Detectors Chimney INSULATION * Foundation Floors Walls Ceiling FINAL ELECTR CAL INSPECTION DRIVEWAY APP VAL Final Bulldin Survey Next scheduled inspection (call when ready ? Remarks- AB%valdlngWeor 6/85 and-vl �.�•�� ,�pWll O"� �,�,t,BB173�1lI'� III MENT (� BUILDING nd Havi and Road R c] yT Bay a s°% $ Queensibury, New York 12801 SEPTIC DISPOSAL SYSTW. INSPECTION NW'M1E_ � LOCATI oil 1]ATE � PERMIT N(7. SOIL TYPE - Sand Loam - Clay - ired? YES - O percc7lation Test 'Rem Inch percolation rate - Min/ _ TYPE of SYS total 1 gth Absorption f e . v nch Length of ea Depth of tren hes Size of grave f) _ SEEPAGE PITS4N ft. Size- ft. Gravel size Size T pe, PIPING -* �- Sl c1g . to tank Tank, to list . x Distv box to field ,NO artial Openings sea, ea? LC]CATION/S AFATIONS : „ ft. 17 Foundatio to tank t . Foundatio to absorptio Absorpti to lot line Irft. Separatl pS1TEt'M ON PROP TY (circle one) WCATI _ g ht side - Front ear Left side CAE S SYSTEM USE APPROV YES Bu ' ng inspect 01/86 znd vl ....ter or �lrturrr I3 ILCDING and ONING DEPARTMENT Ba and Haviland Road, R,0J 1 SOX 98 f 14 ueensbury. New 'York 12801 115 P, V ram! U1LDiNG INSPECTOR ' S REPORT NAME LOCATIC}N07` r7 Date .f/r_/ 'Pc_ 't�No y/ APPROVES) - YES NO Footing/Pier Farms Foundation waterproofing Sackfill Framing Roofing siding Masonry Ven er tj;b6�gh Plumbi g 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 EloECT IC AL INSPECTIONDRIVEWAY APPROVAL_ --- Final Building, Survey scheduled inspection Ccajll, when Remarks- � � iwl+ a read—Next BuAnispect 6/66 and vi cr f fl . 7)tu►t of Qceeienj ury F• 13UILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date-� � /fL��Permit No . 1✓ � APPROVED - YES NO Footing/Pier Farms cpooundatian Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . porches Finished Floors Interior Trim stairs & Railings Cellar Drairl Tile Concrete Floors Plbg . Fixtures Gar _ Fireproofin Door Closers smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceilinq FINAL r:LECT ICAL INSPECTION DRIVEWAY APP OVAlJ— Final Bxiild g Survey Next scheduled inspection (call when ready ) Rema rk�s- .f E3uilding nspector G/86 and-vl �O�'It o� �tt ,p� n3burr� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.0. 1 Sox 98 Queensbury, New York 12801 BUILDING INSPEC OR ' S REPORT NAME 4/�, At LOCATION_ � / !`'rr1/�t� �.fi'W+9 '�" Date Permit Nov APPROVED - YES NO Footing/Pier Forms Foundation waterproofing Backfill ' Framing Roof ing Siding Masonry V'en er Rough Plumbi g Relief Valves Ext . Porches Finished Floor interior 'trim_ Stairs & Railing Cellar Drain Til Concrete Floors Plbg . Fixtures j Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION - Foundation II Floors i f �all. s 1 Baling F NAL ELECTRI AL INSP ION DRIVEWAY APPR VAL. - Final Bu ildi g Survey Next sched ed inspection ( call w en ready ) Remarks- ,e/ Building Inspector 6/86 and-vl _Jowrl o/ Queerlit " ry BUILDING, and ZONING DEPARTMENT Bay and Haviland Road, R. Q. i Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME L 4 C A T II Date�'� -' � — Permit No . ✓' — APPROVED - Np oting/Pier Forms " Foundation Waterproofing 3ackfill �' Framin Roofing Siding MasonryWh Rough Pi Relief V Ext . Por Finisheds Interior Stairs & i s Cellar DilConcretesPlbg . FisGar , FiringDoor CloSmoke. Des Chimney TNSL3LATIO Foundatio Floors Walls Ceiling FINAL IECTRICAL INSPECTION DRIVEWA APPROVAL Final Building Survey. Next scheduled inspection (call when ready ) Remarks- Suilciing Inspector 6/86 and-vl BUILDING PEAT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS- FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED, TEMP. ti DATE le CITY OR VILLAGE ! / "— rOWNSHIP e:5z4, = 1 r STREET AND NO- OR _ _ " . � �_ . . � COUNTY ROAD AND POLE IMi ee. - f ..�''3 { a- > . .-=- ^,.. fa/- - ''� " •!�t�, PALE NQ. BETWEEN WHAT TWO _ CROSS STREETS MS PREM rE07 .!� 4• ',/ OCCUPANT'S +.. f .. „ C . .� .CG TION BLOCK LOT MANE OCCUPANCY BUILDING OCCUPANCY OWNER$ NAME ANO ADDRESSCURRIFNT TEL. # jS - . r 'C `<.f SBtYPPL1Ed F.. .,I+ �.. .�•.� '�. , ,,r •� r BUILDING / FROM THEIR -� G . /- .-x C f`3 OFFICE IS MEW OLD ❑ WORK - DEFECTS IS NEW ADDITIONAL ❑ REMOVED Cl LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS Ne_ O1 FIx4lrea 6 BRANCH fiott I•attlP Racetrtaeles MOTORS HEATERS CIRCUITS OFFICE USE ONLY WNI ReMap'Is SMaitph Pomkwt Breeltet Na Typo Each Nw aM No. Aw uG. Gauya INSPECTION Z"Il SSulb me.rt 1st FI- 2nd FI Jrd FL REMARKS: LIST OTHER ELECTRICAL DEVMCES NOT SET FORTH ABOVE; DO NOT USE THIS SPACE. This apgigiion is inttrnUed to cower the +pore-listrd rquipOssnt tO pa inaprC qd put if et time Of 1 You are altdtorixael tq makr the inepactirn and ad- napevd b ttlere is found additional equipment rwt agora li lust ltte tee to cover the additional 51o . S12E OF equipment, as prpwirled py the rppliunt, MAINS ELECTRIC SIGN TOTAL FEEDERS LAMPS WATTS CHARACTER EXPOSED GASTUBE SIGN OF WORK WORK TO BE CONCEALED TRANSFORMERS OF VA STARTED COMPLETED SIZE (CAPACITY$ OF SIGN SERVICE OVERHEAD UNDERGROUND ENTERS MAKER AMI-LDING OF SIGN INS AS TEQ OR AS MII ON OR AS NEARAN AS POSSIBLE NEW � OLD AVOID DELAY BY GIVING FVLL ACCURATE INFORMATION. ALL MUST BE FILLED IN OR APPLICATI^TI SPA CES ON MAY RE RETURNED_ DATE OF PRINT NAME AN ESS APPLICATION ! �- NAME OF 1/ OF NATURE F APPtICS /'4 � F Apt ADDq CITY O ESS164 . . ., v �.3 i , TELEPHONEZIP #_, "�''�-• /_ L" - 2 ./ sr" CITY OR _,•�,/ r G " ! POST OF FfCE _s rtf CCI - LICENSE PLI • •- — C'�„f�✓-L=yam WHEN APPLICABLE 4e EL (It". 1/06) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING r r FAy� '► e �b N � f fr .ti � sr