1987-954 . . ... v .. ,:.y,` p^'
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CERTIFICATE OF OCCUPANCY a
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YORK
Date Novemher 18 lq 88
LJ Aw-1 ' G-,
This is to certify that worPrequested to be done as shown by Permit No. 7-954
has been completed.
This structure may be occupied as a of Two Fazni Iy Dwelling
30 Margaret Drive — Queen Victoria ' s Grant
Location
3
Guyer Builders Inc .
Owner
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' By Order Town Board
TOWN OF QUEENSBURY
Building & Zoning Inspector
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BUILDING PERMIT �
TOWN OF QUEENSBURY No. 87-954
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WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Queen Victoria r s Grant 1
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1
OWNER of property located at 30 Margaret Drive Street, Road or Ave.
in the Town of Queensbury, 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
approved and in compliance with the Town of Oueensbury Building and Zoning Ordinance.
1 . OWNE R•S Address is Guyer Builders Inc * A;)
119 Dunning St . y
Ballston Spa , N . Y . 12020
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2. CONTRACTOR or BUILDER'S Name
Same ^
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3. CONTRACTOR or BUILDERS Address
Same
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction -- (Please indicate by X) rrt
(x) Wood Frame ( i Masonry ( } Steel
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7. PLANS and Specifications
No. 32r x 48 ' as per plot plan , specifications and application including N.-
septic system and attached one car garage . MODEL J
B. Proposed Use y
� OF Two Family o
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5 . C/o ~
88 �c
$ 89000 PERMIT FEE PAID - THIS PERMIT EXPIRES July 1 , 19
{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 d ate.l
Dated at the Town of Queensbury this 31st Day of December 1987
SIGNED BY T,.� /Q L.[ !24_t� for the Town of Queensbury
Building and Toning I nspector � �.
�. TO BE COMPLETED BY BLDG . DEPT.
,r� Application No .
�.JOwJ� a/ i'k'Ii13E7"ry Permit Issued 19
A UILDING and ZONING DEPARTMENT Permit Expires 19
i F G
r Bay and Haviland Road, R. D. 1 Box 98 zoning Designation 1. i +3T
Queensbury, New York 12801 Variance No . OCT Z 4 1��71
Site Plan Review No . _ - -
%31 J [ , -
Approved by .
APPLICATION FOR
EUILDIN6 AND ZONING PERMIT f
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' bn the Permits
The owner of this property is : Gu er Builders Inc .
P. O. Address 119 Dunning Street Ballston Spa , New York 12020 Tale ( 518 ) 899-9161
Property Location : 30 Margaret Drive _ - Tax Map I3o .121 / 4 / 2
street number or building lot number
Subdivision name (if applicable) 'Queen Victoria ' s Grant
�Nd Mew
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS :
Richard H . Guyer III ( 518 ) 899-9161
Name P . O. Address Tale No .
Name of builder Guyer Builders , Inc .Address 119 Durwi.ng Street Tel . ( 518) 899-9161
Name of plumber"UUyef WELders , Inc -Address, ng Street Tel . -
Name of mason Guyer er8 , ric •Address ng StreetTel .
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 ,
trio change to exterior dimensions) * whether existing or proposed and indicate all
Other world (describe) * set-back dimensions from property lines . Give
Id " 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 $03OW .
s e p
* size of property 100t p an ft x 120 ft .
* Existing building ( s) Size ft xft .
Mo
PROPOSED BUILDING AND USE : de Of * Existing building ( s ) Use NIA
Size of now struan
t a 32 ft x 48 ft
Foundation-pier slab eraw1/4purtial/full * Proposed building , seespr6tepl m Property line
ircle one ) * Front yard 30t ft Rear yard 30t ft
No . of stories (habitable 1pa�e) 1
�J � * Side yards left and 15t ft
Height (grade to ridge ) ft . * If on corner : setback from side street + ft
If residential: now of families�2 *
Now of rooms (excluding baths ) OCCUPANCY INFORMATION
Now of bedrooms 2
* PRIMARY BUILDING -
No . of bathrooms 2 One family dwelling one 0C 0 e %.far
Pri ectric*mary heating system se ar a - Two family dwelling T]Ui
IType of fuel Electricity Multiple dwelling / Number of units
Now 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 -.x- ac
Atthed garage/one car/ two car/ D car
( } * . rie '
* * s * * * * s * w * * * * * * * Private storage building
ESTIMATED MARKET VALUE OF * .'Other
CONSTRUCT ION
INFORMATION ON . BUILDING ,SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET, To BE COMPLETED ]
Form SPA 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 $"
.Depth of foundation below grade (to 'bottom of footing ) 8"' mininx=
Will there be a cellar? no Heated or unheated? Floor sq. footage sq ft
Will there be a basement? no Will any portion be used as living space?
( If so, what par ? sq . ft . - - Type of use?
Type of roof - sloped flat/shed/other Material of roof Fiberglass shingles
Size , wood studs "x 6 spacing 24 "o . c . length 8 ftw exterior walls
3oists ( floor beams ) 1st . floor N/A -2"x " __-___spacing "o . c . span N/A ft .
doists ( floor beams ) 2nd . floor 'X spacing _"o . e . span N A ft .
Overlays (ceiling beams ) Box " spacing 24 "o . c . span N/A ft .
Roof rafters 2 "x in spacing 24 o . c . spars 14 ft .
Roof trusses (pre-engineered) spacing "o . c , span 421ft .
Exterior wall finish stained Of what material? 5/$" x 4 ' x 8 ' texture 111
Interior wall finish pain sFi&etrock
If a garage is to be attached , describe materials to be used for FIRE SEPARATION :
type "X" sheetrock
Is there to be an opening between garage land 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 wiLu^-icipal
SEPTIC SYSTEM _ Distance from ANY private well ( tncluding adjoining properties NTA ft .
(A separate application is necessary for any repair or new installation of septic system)
See S . P . E. D. S . pe d t # 0202523
Town of Queensbury County of Warren p F F I D A V I T STATE OF NEW PORK
I swear that to the best of my knowledge and belief the statements contained
iss 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 . 01
SWORN TO BEFORE ME THIS Signature '' - L__ - _- --------- �-
-owner , owner ` s agenxrect. contractor
Zi !�) day of PAt_jLA Hria6 i 04- t
Notary Public, State of New York
/") f a, Qualified in Schenectady County
f' h r f 41 Lju, No. pires July 7 1 S�?
27
Notary Public , Warren en CommissionCounty, N. CommissionExp
SPECIAL CONDITIONS OF THE PERMIT :
1123
Square feet Living
240 Square foot garage - one stall11
r
1363 @ $i . 00/ 100�or part of 1
5aOO One stall garage
y5 . 00 C/O permit
Total
TOWN Or QUEENSDURY
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 .
Air*MsR ALL of the following :
.` 1123 S, Fe
x0 y4rQ48 floor area
2 . Type of heart Baseboard electric
No
3 . Is the building mechanically cooled ?
4 . Percentage of area of windows and doors 11 . 8X
A . Over 16s 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 wall * insulated ? YES NO
1 . If YES , what is the R value ?
3 . Slab on grade YES NIP
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
R . tinder 16 % Only
L . R vailue of root and doors exposed to ambient conditions.
R- 38
2 . R value of exterior walls_ XN3CMX R-23 . 5 (U. =Q , Q4+ )
I.
3 . R value of glazed area Ue =Oe }
4 . R value of doors R-14 . 9 (Ue �0 * 06)
i
5 . R value of floors over unheated alpacas = It-3Q
6 . R value of slab edge insulation - unheated slab NIA
? . R value of slab insulation - h'eIated slab 12 . 5
8 . R value of heated basement/cellar walls ( above grade ) N/A
96 R value of heated basement /cellar walls ( below grads ) N/A
100 Type of insulation Fiberglass
Co Controls
1 . Thermostat- maximum heat setting
D . Duct Systems N/A
OMAN
1 . Is duct system installed in unheated spaces ? YES No
A * it YES , R value of duct installations
b . I. R value of duct in other areas
E . Pik-Insulation N/A
le Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulations
P . service water Heating r ;
1 . Performance efficiency
NIA
2 . Temperature control setting maximum
G . For Swimming Pool only
1 . Maximum heating N/A
<7
Telephone No . ( 518) 899-9161
( applicant " or * gnature )
Zkaft d"tC�i",L�idlyiliG
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APPLICATION FOR SEPTIC DISPOSAL PJMMIT
Refs S . P. E.D.S.
p L 10-15-87 . permit #
H w York - 0202525'
a of JIA
LOCATION OF PROPERTY FOR INSTALLATION 30 MargaretDrive
Owner's Names Guyer Builders , Inc. Telephone: ( 518) 899-9}.bl
m
A44resss 119 Dunning Street , Ballston Spa , New York 12020 . .. .
&n&tailer's Names Gu3 +" b lder$ , Inc, Telephones ( 518) 899-9161
2 A, C, E, I , Ji Ke L, H
Number of bedrooms (residential only) 2 3 F, G, H
: Total daily flow (compute 0 150 Sari per bedroom) 300
Torga'apbyt circle ones lot Rolling Steep Slope % of slope.
Sad Natures circle ones Sa�1 Loam Clay Other } Depths' 8 ' feet +,
Caraubd W&tess At what depth? unknown 8 feet +
R"bwd c or Lnpesvious Mateo "Is At what depth? unknown feet
INW% olatioo test: circle ass not req required / rate min. inch.
Damestiuc wsatear saxpplys circle aces Municipal Weil Other
IF domestic water supply is a Wells
Separatioas Watersupply from Septic absorption NIA feet
* PROPOSED SYSTEUs Septic Tank gal. (muumum sizes 1.000 Rol.) .
TILE FIELDS Each Tranch N/A (out } Total system length NIA feet
* SEEPAGE PIT(S)s Number of } Size each feet by fees
* Size of stone to be aced # } Depth or Thickness feet
* s * s * * * * * e * * ees * s * ss +re► eee * * � * * * * w • * s * • ese
IMPORTANT * See S .P.S.D.S.
.»Please....UBT NEW NQUIPMENT TO BE INSTALLED permit & attached
ssse * * e * se * ssesssere * s �see * e * * * ss • * * ss : ssa� * map .
(over)
SacOoo IS Septic System lnspectionst T
As All applications for septic system installation. alteration or repairp as
required by the Town of Queensbury Sanitary Sewage Ordinances shall
be submitted to the Building Department at least 24 hours before start .
of construction and ,shall include a plot plan showings
1.) the Propoped .location of the gystem
Z.) location and distance to lot l4nes
34 location and distance to structures
4.) location and distance to any water supply
5.) size and dimensions of all tanks; distributioa
boxes: tila fields and/or drywalls
b. No system sha11 be cornered 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 $260.006
Co 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.
3 bans sward the regulations above sad agree to abida by these awd all a�eq�ta
of the Town of Sanitary Sewage Dispoo W Ordince.
Signature of.respon"ble person:
>Astai
.
Town of Queens bury
Building and Code Department
Bay at Haviland. Road
Queeusbury, New York 12801
(518) 79Z- 583Z
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TOWN OF QUEENSBUR'Y
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12802
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION d5
DATE PERMIT
PROVED
ES NO
FOOTSNG f!'I ERS
MONOL.T HIC POUR FORMS
FOUNDA ON/DAMP-PROOFING _
BACKFIL APPROVAL
ROUGH PL BING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATIO
FLOORS
WALLS
/ CEILING
t / FINAL INSPECTOO
CHIMNEY HEIGHT ✓
,ROOFING
SIDING
EXTERNAL PORCH S/S PS
STAIRS-CLEA CE & ILS
PLUMBING FT URESrREL F VALVE
INTERIOR T IM/PRIVACY RS
FINISHED LOORS
GARAGE F REPROOFING
DOOR C SER (S)
SMOKE ETECTORS
FINAL ECTRICAL INSPECTION
FINAL PPROVAL OF CONSTRUCTION
A S GNED CERTIFICATE OF OCCUPANCY T BE
OB AINED FROM THE BUILDING DEPARTMENT E RE
TH E PREMISES ARE OCCUPIED!
REMARKS :
c'
INSPECTOR
flown o/ Queen36urry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801
BlI1LDING INSPECTOR ' S REPORT
NAME
LOCATION��J] _ J 0
Date 7 - r7 / J Permit Na . �r1 7�S
✓ = APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roof ing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves r'
Ext . Porches _
Finished Floors
Interior Trim E
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbq . Fixtures
C;ar . Fireproofing
Door Closers
Smoke Detectors
Ch ey
N SUI.ATION
Foundation
Floors_
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
I)RIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready )
Remarks-
Building Ijhspector
6/�36 mcI-vl
aw4n Q/ Queenjl ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME r
LOCATION ,30 "3
Date / Permit No . � ` 7
✓ - APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing ✓
Roofing
siding
Masonry Veneer
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 t
Floors
walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection ( call when ready
Remarks-
f
Bui d nspector
f/$6 and-vl
a tore o/ Q"een3i"ry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCAT I y
DATE ..
PERMIT No . ' I " �
SOIL TYPE an - Loam - Clay
Percola on eat Rego iced Y - NO
Percoiat n rate - Min/Inc'h -
TYPE of SYS
Absorption f ld , tot length
Length of each trenc
Depth of trench s
Size of gravel
SEEPAGE PITS4 of
Size- -�&_ft. ft.
Gravel size
PIPING : Size T'Ype
Bldg . to to
Tank to dts . box `r
Dist . box o
field/pit
openings sled? SE NO Partial
LOCATION EPARATIONS : f t.
Foundati n to tank ft .
Foundati n to absorption 6 ft.
bsorpti n to lot line t.
Separati n of pits
LOCATION SYSTEM ON PROPERTY circle one)
Front - Rear - Left side - Rig t side w
CCf4xENT S .
r Gam.
SYSTEM USE APPROVE `
B g pector
01/86 and vl
�f7WI'I< O� �L"f.@�I� 31lLtI'�
BUILDING and ZONING DEPARTMENT
Bay and Havitand Road, R. D. 1 Box 98
Oueensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME /7�r✓�
LOCATION _ 3
Date � � / Permit No . ! y
✓ = APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry VPn er
Rough 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 ELECTRIC L INSPECTION _
DRIVEWAY APPROVAL
Final Building Survey�
Next scheduled inspection (call when readryy
Remarks- -Flx f �IF'74 510404' SA4. C.•
41,0107
UV
Building nspectrar
6/86 and-vl
iII
/ vJrrwn o Queen .shur y
15 BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R . D. 1 Box 98
0 Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION
Date / ',�/ O Permit No .
✓ = APPROVED - YRS NO
Jio ' ooting/Pier Farms
Foundation
Waterproofing
B3ackfi ll
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Reiie £ Valves
Ext . Porches
Finished Floors
Interior. Trim
Stairs & Rail i s _
Cellar Drain i. le u
Concrete FI rs
P1bg _ Fixt res
Gar . Fire roofing
Door Clo ors
Smoke D tectors
Ch imne
INS jI IC7N
Found tion
P loo
Walls
Ceilin _ w
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection ( call when ready )
Remarks-
f
Build ng Inspector
6/86 and-vl
flown o/ 'Queenshury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Oueensbury, New York 12601
BUILDING INSPECTOR ` S REPORT
NAME C1
LOCATID JCS — ' z / " �/ �� OG r
a Date j �- _ Kermit No .
✓ = APPROVED - YES NO
Footing/Pier Forms
Foundation
Waterproofing
)(�ackfill
Framing
Roofing
Sldsng
Masonry Veneer
Rough PMD
ng
Relief s
Ext . Po
Finisheo s
Interio
Stairs ' ings
Cellar Tile
Concretors
P3Zg . Fes
Gar . Fiofing
Door. ClSmoke DorsChimney
INSULATFounda-tFloors
wads
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
i
I
Next. scheduled inspection. (call when ready )
i
Remarks-
Building Inspec '
6/86 and-vl
r
BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS.
r FILE THIS COPY WITH BUILDING DEPT, WHEN REQUIRED.
i
TEYP. DATE �.
CITY OR
STREET AND NO, OR ti /
ROAD AND POLE NO POLE NO.
BETWEEN WHAT TWO
CROSS STREETS IS
PREMISES LOCATED? SECTION BLOCK 40T
OCCUPANT'S BUILDING
NAM£ ANCY
OWNER'S NAME �. / r TEL_
AND ADDRESS I A. , ! { ) f ,{•' �• :. i; f
CURRENT
SUPPLIED FROM THEIR OFFICE
SUPPLIED
BUILDING WORK DEFECTS
IS NEW C ,fr OLD ❑ IS ME"
E ADDITIONAL Q REMOVED
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
ANCH
NUMBER OF OUTLETS Lamp R i%im ppnedr MOTORS HEATERS dRCLl1TS OFFICE USE
Loco QMLY
"oa BirN Attesb•t R P Watt A WAL
'aMn, Wall Reatpoh $wiiedr Pandarrt Bracket No. Typo Eaeb NeL Each No. saw" INSPECTION
title
been
Bast
moot
1st Ft.
2nd FL
3M F1.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE,
Thin application is intended to c"er the above listed agoipmenl to be irkspak:tad bot if ai tims of inspection dive is found sWlikkmd NW isimNTt not abotie listed,
you are s thori:ad to make the inspection and adjusl the fee to cover the additional eguipmavvt, AS provided by the MMicaM-
SIZE OF jJ _:" 'i ELECTRIC SIGN TOTAL
MAINS f.. + ._i ./ i FEEDERS LAMPS WATTS
CHARACTER EXPOSED GAS TIME SIGN
OF WORK i '+f k r + {'. `. +1i (_ .96NCEALED TRANSFORMERS OF VA
WORN TOKBt INU MBERI (CAPACITY}
STARTED COMPLETED SIZE OF SIGN
SERVICE OVERHEAD UND ROUND MAKER
ENTERS OF SIGN
ILDiNG
INSPECTION REOUESTEON OR 4 '{ ,t b _
POSSIBLE NEAR AS fJl...fl"-'i-- �%• r / f :..._.!'._._' t".� f` >z NE+W OLO ❑
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES DATE OF f jell <•
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION
PRINT NA J ND ADDRESS SIGNATURE
NAME OF 4. . ! , r ��
APPLICANT - OF APPLICANT
STREET ADDRESS . ff 17ELEPHdNEZIP # C
CITY OR CODE �' '"f L' `--�RFt M APPLICABLE
POST OFFICE 61.
46 EL (REV_ 1106) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
MARGARET
,.,,_ _ ,_ 87.00' tlo100.00'
/000�SHUTOFF,
i I I
I N
0:
R= 25 w '`� a l LOT LOT I
L= 3897 QI 31 32 34
33'
OT
io
QUEEN VICTORWS GRANT
QUEENSBURY, N.Y
C.O.T G.
1250 gal
17'
DRIVE
�I
I
N
LOT
I 36
I
17'
O
0
o�
N'
N
t�
100.00'
C.O T G.
(CLEAN OUT
TO GRADE)
6= 0 DIAMETER
8=0 DEPTH
REFERENCE DRAWINGS
5A SITE UTILITIES
SEPTIC 9 WATER
VanDUSEN 4 STEVES
SURVEY PLAN
30, 3Z 34,36
MARGARET DRIVE
PLOT PLAN SEPTIC SYSTEM
GUYER BUILDERS, INC. QV - 12
DWN : } ( p-i3-$ Scale ; I 20' 0