1987-955 fim'Ty,.. ,�.y '.:1 ( ,Nw?:�j'ix=1t. .. a-i� k _ _ 'u •. . k'r�Y'.* _ W! t
w � t
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YORK
Dane 19
�7y Thts is to certi that work requested to be done as shown by Permit No. 87- 955
has been completed.
This structure may be occupied as a -- -- of Two Family Dwelling
Location 32 Margaret Drive — Queers Victoria ' s Grant
Owner Guyer Builders Inc ,
By Order Town Board
TOWN OF QUEENSBURY
Building d Zoning Inspector
' BUILDING PERMIT
r
TOWN OF QUEENSBURY No. 87-955
WARREN COUNTY, NEW YORK a
PERMISSION is hereby granted to Queen Victoria ' s Grant >U
OWNER of property located at 32 Margaret Drive Street, Road or Ave. l
in the Town of Queensbury, To Construct or place a i of Two Fancily 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.
c
t. OWNER'S Address is Guyer Builders Inc . CD
119 Dunning St .
Ballston Spa , N . Y . 12020
N-
r�
0
2. CONTRACTOR or BUY LDER "S Name ►i
Same a~i
m
3. CONTRACTOR or BUILDER 'S Address pMi
Same rrt
4. ARCHITECT'S Name
w
5. ARCHITECT'S Address N
ro
�s
0
0
+rt
6. TYPE of Construction — (Please indicate by X) rrot
ty
( x) Wood Frame ( ? Masonry ( I Steel ( ! tl
C
ro
7_ PLANS and Specificatiorrs
No, 29 ' x 56 ' as per plot plan , specifications and application including
septic system and attached one car garage . MODEL A
S. Proposed Use rr
of Two Family o
$5 . 00 C /O o
82 . 00 July 1 , 88 w
$ PERMIT FEE PAID — THIS PERMIT EXPIRES 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the F.
town of Queens'burV before the expiration date.)
Crated at the Town of Queensbury this 31st Day of December 19 87
SIGNED BY , y� for the Town of Queensbury
Building and Zoning Inspector
Application N06 1 1
Permit Issued 19
BR11L014G and ZONING DEPARTMENT Permit Expires 19 r
Bay and Haviland Road, R.D. 1 Box 98 zoning Designation {) PTO 1937
Qussnabury, New York 12801 Variance No.
Site Plan Review No . "
Approved by : /� ,0' - 7•
APPLICATION FOR -, r./�:z`.••�� r��/� � s--- _-
BUILpING 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 .
F. O. Address 119 Dunning Street Ballston Spa , New York 12020 Tel . (518) 899-9161
OWE
Property Location : 32 Margaret Drive Tax Nap No . .16 / 4 / 2
Street number or building lot number
suIxUvision naive (if applicable) Queen Victoria ' s Grant
THE pZVXmo" RESPOS+ISIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS :
Richard He Guyer 11I ( 518) 899-9161
1Kaare P. O. Address Tel . No .
No" of builder Guyer Builders , Inc •Address 119 Dunning Street Tel . ( 518) 899-9161
Nam" of plumber utlyer s , 'r'►c .Addressstreet Tel .
Name of mason Guyer rs , nc .Address g 5treet Tel .
NATURE OF PROPOSED WORK ** * ZONING I NFORIMAT I ON :
CoTlStruction of anew building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED#
A44ition 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
�or work (describe) * set-back dimensions from property lines . Give
* street and number or lot number and indicate
OR DEMOLITION PERMIT , STATE SIZE AND whether interior or corner lot - Show location
FOR
* of water supply and location and configuration
OR DEMOLITION
'D STRUCTURES AFFECTED.
of septic disposal area .
*
* COMPLETE INFORMATION REQUIRED? E .
s e pLo
* size of property 10Dt I ft X 12d ft .
* Existing building ( ") Size Nix ft X� ft .
PROFOSED BUILDING AND USE * Model of
of * Existing buildl.ng (s ) Use NIA WOO
Sine of new at e �r
29 f t X 56 ft
Faundatiorx-pier slab crawl/partial/full Proposed building,NO seesto%eplan property line
c role one ) 1 * Front yard 90+ ft Rear yard 30+ ft
Daio * of stories (]habitable space ) * Side yards 15+ ft and 15+ ft
Hsi t (grade to ridge) 17 - 0000000
ft . * If on corner , setback. from side street ft
If residential, no. of families I of 2
No* of rac" (excluding baths) Z " OCCUPANCY INFORMATION
Na`) at bedrooms Z NO
* PRIMARY BUILDING"
Now of bathrooms One family dwelling s
Primary heating system e e ectric* - Two family dwelling � sm
Type of fuel Electricity Multiple dwelling / Number of units
No. of fireplaces to be installed
Will a wood stove be installed? N * Permanent occupancy
Central Air conditioning'? No : Transient occupancy
,. Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Ranch Contemporary Lo BE * Other
Poised ranch Mansion Duple �r addition , What will use be?
Split Level Old style Bungalow "
Capp 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
r At w r r s r * r w + * * * Private storage building
UST 134ATDED MARKET VALUE OF +► * Other
CONSTRUCTION
I111Q MATION ON -BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET, TO BE COMPLE:TEW
ram SPA 4/96 md-vl
WILDING PERMIT APPLICATION CONTINUED - a
Ave
alll ING SPEC I FI CATIONS :
Type of construction, wood frame , fire safe, etc . wood frame
Will any se+cand-hand or ungraded lumber be used? If so, for what? no
Foundation wall material concrete_ block Thickness 8"
Depth of foundation below grade (to bottom of footing ) "" minimum
Will there be a cellar? ' MO 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 par sq. ft. - - Type of use?
Type of roof - sloped lot/shed other Material of roofFiberglass s ngles
Size , wood stud "x 5 " spacing 24"once length 8 fto exterior walls
Joista ( floor beams ) lot . floor N/A � "x_ '" spacing. ."o. c . span N/A fto
,joists ( floor beams) 2nd. floor 0)tig.' ""x �" S cing "o . c. span N A fte
Overlays (ceiling beams ) "x spacing Zr+ "o . c . span N/Aft.
Roof rafters 2 "x 1 " spaair►g 4 once span ) 4 ft .
40of trusser (pre-engineered) spacing 7+ "o . c. span 42 fte
Exterior wall finish stained Of what material? 5/8" x 4 " x 81 texture 111
Interior wall finish R5675trock
If a garage is to a attached ,"tSheet e describe materials to be used for FIRE SEPARATION :
rock
Is there to be an opening between garage 4and dwelling? des If so will a -rated
door, enclosure, and self-closing device be provided? es
Will a flue-lined chimney be installed? No Height above roof N A fto
Depth of chimney foundations below grade N A ft :
Depth of fireplace hearth N A ft . in ,
Water supply - Municipal or private well mxnLic1ELal
SEPTIC SYSTEM Distance from ANY private well ( includi.ng adjoining properties ft.
(A separate application is necessary for re air or new installation of septic system)
See S , P, E, D, S . recant # 0626252
Town of rr A F F I D A V Y T STATE OF NEW YOR.K
w County off Warrenren
4 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 son 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 .
SbXAK TO BEFORE ME THIS Signatureass, _ _i .. _ �-7.__,
owner, owner ' s age: , arcnrect, CLQntIZl+Ctor
,4.1 St day yof Ga r #�� k- 19 yq PAULA ER
Notary Pub c, State o#New York
(� (( f(� { : + f �1 r ti Qualified in Schenectady Coua)ty�
�-' No. 48+64727
Vat&ry Public, warren County , N . Y . commission Expires Juiy 7 19
SPBCJ)4i. CONDITIONS OF THE PERMIT :
1420 Square feet living
264 Square foot garage - one stall '
1284 @ $7 . 00/100" or part of
$5 .04 One stall garage
eons
seen 25oOO C/o permit
Total
11
TOWN OF gUEENsaURx "All
WARREN COUNTY , NEW YORK
Application fors 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 :
X . Gross floor area 1020 S . F .
20 Type of heat Baseboard electric
3 . Is the building mechanically cooled ? NO
4 * percentage of area of windows and doors 10. 6%
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 * d 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
S . Under 16 % Only
1 . R value of roof and floors exposed to ambient conditions.
R-38
2 . R value of exterior walls X Re23 . 5 U. =0 . 04t
3 . R value of glazed area U. =0. 30
4 . R value of doors R-14e9 ( U. = . n0)- - - -
5 . R value of floors over unheated spaces g/A
6 . R value of slab edge insulation - unheated slab N/A
7 . R value of slab insulation - heated slab 12 . 5
8 . R value of heated basement/ cellar walls ( above grade ) N A
9 . R value of heated basement/cellar walls ( below grade ) N/A
Joe 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
be 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
re Service Water Heating
1 . Performance efficiency N/A jc
2 . Temperature control setting maximum
G . For Swimming Pool Only
1 . Maximum heating N/A
10,
i
Telephone No . { 518) 899r-9161
Lapp icant ' s gnature )
..
APPLICATION FOR SEPTIC ,DISPOSAL PERMIT
Reel': S. P.E.D.S.
UATE 10-15-87 f pei=' t #
New York - 0202525'
� o _
LOCATION OF PROPERTY FOR INSTALLATION 2 Marsr r lye
Owner's Nantes Guyer Builders , Inc . . ' Telephones ( 518) 899-9161
Address 119 Uunnin Streets Ballston Spa , New York 12020
„ .--
lpatal.ler's Names 04cr Builders, IDc Telephones ( 518) 89"161
2 A, C$ E, I $ J, K, L, M
Number of bedroom# "aWential only) 2 3 F , G, H
.,� Total daily flow (compute Q 150 gal per bedroom) 300
Taroaraphys circle +woe: lat Rolling Steep Slope 97i of aloper
Soil Na#�nreM0 circle one: Sand Lorin Clay Other j Depths' 8 ' feet +,
+Gwaund Waters, At what depth? U111=wn 8 feet +
."-�"..a..nn c or Imperviowr Materials At what depth? unknown feet
Pes^cds►tioo test: circle ones not regt ree �required I rate in" inch.
Dameatic crates mWplys circle cues MumscSpal )Weil Other
IF domestic water supply is a Wells
Separation* Watersupply from Septic absorption NIA feet
* PROPOSED SYSTEUs Septic Tank Sal. (maUUMUsn sizes 1,000 gal.)
TILE FIELD&* Each Trench NIA feet I Total systems. length NIA feet
* SEEPAGE PIT(S)s Number of / Size each feet by feet
* Size of stone to be used ! Depth or Thickness feet
ss * * e * se * * s * * * es * * >Ms * ems * ss +« • a► essssers * s +r : w
IMPORTANT * See S . P.E.D. S.
...Please...LIST 149W BQUIPMENT TO BE INSTAL.L.ED permit & attached
s * +r * * es * s * * s * ss * • eea� * �s * e * * * s * ss �r * ss► * sssse map.
(over)
Section 8 Septic Swom lnspectionst
Ae All application 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 construuction and *hall include a plot plan showings
1.) the Prapored .location of the glystem
2e) location and distance to lot lines
3.) location and distance to structures
4.) location and distanca to any Water supply
5.) size and dimensions of all tanks. distribution
boxes@ tilp fields and/or drywalls
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.
Ca An approved copy of the plot plan shall be available on the construction
sitee Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
A. Should unforeseen problems duriupg 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.
Y b.-awe re" the regulatao" above awl aWss to abide by *bass &" Ali r+e�gni�m+snts
of the Town of Quounsbwry Sanitary Sewage Disposal +Ckdinance.
Sig"tt" of.raraponsible persons
73atsi
Town of Queensbury
Building and Code Department
Bay at HavMand Road
Queeasbury, Now York 12801
(518) 792-6832
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW 792-5 28
TELEPHONE (518 )
32
BUIi3]-NC INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED ✓Q �'
NAME _
LOCATXON Y /
t. /7' PERM #
DATE _ ApFROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMSf�-
FOUNDATION/DAMP-pROOFING� �-
BACKFI LL APPROVAL_���-
ROUGH P,ZUMBING
FRAMING
ELECTRICA OUGH-IN
INSULATIONr
FOUNDATION
FLOORS
WALLS
CEILING
�r1wA INSPECT-TO
CHIMNEY HEIGH
ROOFING
SIDING
EXTERNAL PO HE T S LS
STAIRS-CLE 11 F VALVE -
PLUMBING F X
INTERIOR I PRIVAC
--
FINISHED LO RS
GARAGE F E ROOFING
DOOR CLO E (S)
SMOTE D 'TORS
FINAL ELE ICAL INSPECTXON _--
FINAL APP VAL OF CONSTRUCTIO
P�-
A SIGNED CERTIFICATE OF OCCUPANC Mus BF�1RE
OBTAINED FROM THE BUILDING DEPART NT
THESE PREMISES ARE OCCUPIED!
REMARKSr
INSPECTOR
Nix
7555
MIDDLE DEPARTM9N SP ON AGENCY, INC,
ow K+e�ae" �;M 1Qe
Via•.-- .
`{' ' `. E • �, ?"'i" ' y Data October 26 , 1988
rrt- �+y,° roved as being in accord
+rf,,.ert[f l E5 that thij We ,trFca1 equipment listed has been exatnt�ted an s approved 9
with the National Electrr i Cade, applicable governmentalr utility and qbe I ncy les.
f I '\ Y -.& "
Owner: Guyer Builders,.-Z'n� „,j ! 111SUb&Y
p
5b
Occupant: Single '�"dTtl * �a"'`''" Icate + j"r%tsckric Ipmani and IrWallaf ion inspec+ed thts
�CtCatIOR: 32 1targareZ.JP4ifT* , tlafa. I}Wdilipnal equi�llrunL !ah be tnirodueed or alteMuons made to
existing system thin 001MCM0 sMiif be null and void, and application for
n. $ „ inepection should be submitted pro%*My tC this ApenCy
EEquipment: .
6 a Outlets , ` G 11 ec e�t acl e s ; 17 F� 4 o� t:'k4n4dar of this Certitidata thoold prisant tame to hit property inaurence carder
`tagem Or Cam pen"as ew denCe ptyerti%vat Ion of electrical aq ui pment approved
150 :1mp Service ; prances aatpeclflad. . y
r Guyer Builders 0* 15 -0 24 108
Applicant: 119 Dunniri g Street
Ballston SPa, NY 12020
Few No. ?m Et- I-W -_.--
BUILDING and ZONING DEPARTMENT
Bay and 'Haviland Road. RX). i Sox 98
f ()ueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION r rf r
2 y_ permit Pao . —
Date_ —/
APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
Backf ill
Framing
Roofing
Siding
Masonry veneer!_-,__,.��-- = —�'
Rough plumbing
Relief Valves -
Ext . parches
Finished Floors__.-----+=-'r —�'-'-
Interior Trim
Stairs & Rai Lings ,_
Cellar Drain Tile
Concrete Floors
lilbg . Fixtures ! _ .�--�--
Gar. . Fireproofin
Door Closers
Srnoke ,Detectors
clt>wimney
Ns1�I.ATZO1�
Foundation
Floors_
Walls
Ceiling
FINAL ELECT ICAL INSPECTICIN
IIRIVEI3AY 1gppRdV Survey
Final Building
x
ection (call when ready)
Ne t scheduled insp
Remarks-
/` .
Buil n Inspector
6 /86 and-vl
IIN of Queen .sl ury
BUILDING and ZONING DEPARTMENT
9$
'Bay and "S"Wiland Road. R.U .
I Box Queensbury, New York 12801
BUILDING INSPECTORS REPORT
NAME &as
L.O C A T I ONLS � ^-----�
permit
APt'RrJVED - YES NO
Footing/Pier Forms
Foundation
waterproofing
Backf ill ✓
F raming
Roof ing
siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext . porches
Finished Floors
Interior Trim �,—
stairs & Railings
Cellar Drain Tile
Concrete Floors 19
Plbg * F ixture sue - -�
Gar . FireProofing
Door Closers
smoke Detectors
Chimney
INSDLATI4N :
Foundation
Floors
walls
Ceiling
CAL It1sPECTI�N�,• ....�-
FINAL ELECTRI -
pItIVEWAY APPELOVSurvey
Final Buildin8
ed insp
Next schedul ection (Cal when ready )
Remarks- `Iv i k- G �S 15*r
� '` `" `,
Bui d
nspector
6/86 and-vl
awn o� �eeeen �r6ur�
BbILDING and ZONING DF-PARTMENT
Bay and Haviland Oa p R,[).YOfk I BOX 98
Queensbury, Niew
01
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCAT ION r Gr ,
�_/�� P IT NOe. oq�� q�
DATE .-��`
L TYPE a L'w Clay
SDI - �—�--
Percolation est Required? -,NO
percolation rate - 14in/Inch _
TypE of SYSTEM: total ; engtY f
Absorption field ,
Length of each trench��
Depth of t enches
size of gr Val,
�r
SEEPAGE PITt��3umb ft)
°--
Gravel size
Size Type
PIPING . ,yam C'
Bldg . to tank ,.!
rt
Tank to disc. box it. d/
Dist. ox to fie
]b d -No partial
dpen3.ngs sealed
L,OCP.TION/SEpA TICN3S = G] ft.
Foundation t tank ft .
Foundation t absorption
to
sorption o lot line t.
/AnSeps-xration f pits
LOCATION SYSTEM C)N PROPERTY (circle one)
Front - Re
Left side - Right side
CC]MMENT S
c
SYSTEM USE
APPROVE �.
� g pectar
01/66 and vl
o+urT v1p
OIHLD{NG and ZONSfdG ICE .0- ' 13o%9S
Bay and Havxtiand Roa YprD128dI
oueensbury. New
idLllL[7IP1G I1d5P'EGTOR ' S REPORT
KgN1E
Joe
LOCATION
permit
pate * � —'* * * * * * * * YE* g 140
Footing/pier Eons
Foundation
Water.proof ing
ga,ckf ill
F ramming
Roof ing
s id3.ng
Monry veneer
as ��.
P
Rough r3
luinbin �---
geI . ef Valves
Ext . porches
Ein .
.shed Floors
Interior Trim
stairs & pa3.l3njS
Cellar Drain Tile �--�
y�concrete Floors
f P1kK3 - fixtures
Gar . F ireproof i g
Door closers
Smolte petectO
cr,imnt'-Y
�r�sux�.Txc�s
Four„dation
Floors
Wails
ce3.ling Gp3, I7.ySPEGfI
F Its W, FLFLC .
ROV .r-
DRIVBWAY A Survey
Final Building
pert scheduled insP
ecrian icall 'amen ready)
'` gecnar'ks-
g ild g
Insp'ec for
(./86 md�vl
�]o e.v� �� �u ee r� .S fi W ►' '�
51j4LDING and ZONING DEPARTMENT gay arld Havifand Ne YR-UU ' 30 9B
pueensbury.
Rr- pOP'T
BUILDIN
INSPECTCIR ' S
G
NAME v
LOCATION
Permit No * JJ
w *
✓ - hppRCIV ED
*
Footing/Fier Forte
Foundation
Waterpr�'o f inq
wackf ill
. FraMinq
Roof ing
siding ��--
masonry Vene r._-..-----
gough pluyftbin --
Relief Valves
Ext . porches
Finished Floor
interior Tarn
1 in -----
s t a i r s s Tta T e
Cellar Drain.
Concrete
P1Y,g , Fixtur
Gar .
Firero Ping
Licsox. Closer
smoke Dete ors
Chimney
Itys�LATiC3N
Founda'tic'n
f'1c7c7is
Walls
Ceiling
FI[lAL I'.LFC'rRZCAL
SIRIVEWAY XPV OV 16
Final Building Survey
eduled 1" P
ection (call when ready )
► e s
Rema rkc;�
B,i ldinq Inspec r
1
and-v1
}
� 7 ! �'7ueenJ �iur
_ Jorurt f
�} pUILC)1NG and ZONIN CSEPARTMEN7
F' 8 ay Qee sbury New dYark� 12801 98
6U I Lp I NG I NS pECTTOR ' S REPORT
NAME t {
J�e
LoCAT I C)N � �� l
�� Permit NoApppoVl-
otingfi' ier Forms
l��u=y da t ion
waterpr<�ofiri�
t
13ackf ill
1' raminy
Itoo f in g
,; icling
Masonry Veneer
ItougVI pj- UjRbi.ng
l -clief Vulvas
1 '.xt . T°orcltc:s
NitIisbCcl floors
yntcrior 2rxM
& Itai inys
; fair ---
Cellar L7rt' i
Concrete
111bg - Fix ures
Gar . Vir proofing
Donr C1 ,ers
sliftake L7 ' tcGtors
('hitxute
lNSEJI. F ' ION -.
Foun is ' ion
t' lnars
wall_
(IiIing_
F IN AL Y:I f:C i RT.C3L IN SF'ECTIQN_
S)KIVEWXY APPROV L Vey
Final Building
Sut
sclycduled insp
ecr ion (call- Wkxen ready )
Next
ltenrarlcs- :�e 41�
i
IIIII rig Inspector
Gff3C, mcl-v3
BUILDING DEFT. COPY
APPLICATION
COPY IRE UNDERWRITERS.
WITHH BUILDING DE PT, WHEN REQUIREI]
FILE THIS
TEMP DATE
CITY OR ` TOINIMSHI a ii•'r •+ COUNTY
VILLAGE i ,i
STREET AND OR r • ! r 1r ✓ v ,. .t �'e' .+j� . - POLE NO.
ROAD AND PDL£ NO.
BETWEEN WHAT TWO " BLOCK LOT
PREOM�RL E ATED� S TION
BUILDING . _
OCCLIPANT-S OCCUPANCY
NAME
O7YR11ER-5 N £
AND ADDR t
FROM THEIR OFFICE
'BY WORK �-7 DEFECTS
BUILDING OLO Q 1S NEW i, i ADRIT101JAL C1 REMOVED ❑
IS NE
LIST BELOW ALL EQUIPMENT WMICN YOU INSTALLED
BRANCH OFFICE USE
No. of Fixture & MOTORS HEATERS CIRCUITS ONLY
NUMBER OF OUTLETS Lan+P FlecePt+el*x
AM H.P. lifta a Not. A.W.O. INSPECTION
Oailinl Wee Raaap'lo Swiseb pendant "rocket Na Type Eaeh �Ii Eaah GOO"
Out-
side
Sub
bar
now
wtent
let P1.
Fi
9/d FL
REMARKS- LIST OTHER ELECTRICAL DEVICE'S HOT SET FORTH ABOVE_
DD NOT USE THIS SPACE.
That apadieation ix intended to corer dta above•lis tn
ted equlPenk to be inspm:ted I it at tkne of ittalMetien f
then is ound additional al iPnlsni rat abo�a 1mled,
n and adjust the Lae to wear the additional equllil , as Prarided by the apPlirenL
you are ell,o rixad to make the MAP"etto ELECTRIC SIGN TOTAL
WATTS
SITE DF � .. FEEDERS LAMPS
MAINS /
X NCEA GAS TUBE SIGN VA
CNARACTER !-, _ '-;l r ; (,._ NCEALED TRANSFORMERS OF
OF WORK,' '` € '' ICAPACiTYI
iNUMBERI
WORK TO BE _ COMPLETED SIZE OF SION
STARTED
SERVICE OVERHEAD UND$?GROUND MAKER
ENTERS �1, OF SIGN
IL I
1NSIF`ECTION REOIIESTED l { d ii -.
ON OR AS NEAR AS : } ! ..^� . OLD
pOS'SIBLE �( 'j
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACE'S APPLICATION v
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NA AND ADDRESS `� ; SIGNATURE
NAME OF ,rr ✓ OF APPLICANT f /
APPLICANT
r I ..k ./ [. err �/'.i'. '" TELEPHONE #I _
STREET AODRIII S LICENSE NO.
ZIP
CITY OR if' _{ '1 , . `.f' r' f CODEf '' � —'WI'4FN APPLICABLE
POST OFFICE 'P .
ar EL (RE+r.. /aa) SEPARATE BUILDING
A S ARATE APPLICATION MUST BE FILED FOR EACH
MARGARET
,.,,_ _ ,_ 87.00' tlo100.00'
/000�SHUTOFF,
i I I
I N
0:
R= 25 w '`� a l LOT LOT I
L= 3897 QI 31 32 34
33'
OT
io
QUEEN VICTORWS GRANT
QUEENSBURY, N.Y
C.O.T G.
1250 gal
17'
DRIVE
�I
I
N
LOT
I 36
I
17'
O
0
o�
N'
N
t�
100.00'
C.O T G.
(CLEAN OUT
TO GRADE)
6= 0 DIAMETER
8=0 DEPTH
REFERENCE DRAWINGS
5A SITE UTILITIES
SEPTIC 9 WATER
VanDUSEN 4 STEVES
SURVEY PLAN
30, 3Z 34,36
MARGARET DRIVE
PLOT PLAN SEPTIC SYSTEM
GUYER BUILDERS, INC. QV - 12
DWN : } ( p-i3-$ Scale ; I 20' 0