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1987-951
CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK October 31 19 88 Dow This is to certify that work requested to be done as shown by Permit No, 87-951 has been completed. This structure may be o"upied as a of Two Family Dwelling Locerion 47 Margaret Drive - Queen Victoria ' s Grant Guyer Builders ,, Inc . Owner By Ord" Town Board TOWN OF QUEENSBURY Building & Zoni "'W, -------- -- BUILDING PERMIT TOWN OF QUEENSBURY No. 87-951 � WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Queen Victoria ' s Grant r✓ I OWNER of property located at 47 Margaret Drive Street, Road or Ave. in the Town of Queensburyr To Construct or place a j 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_ t_ OwNER'S Address is Guyer Builders Inc . 119 Dunning St . ,D Ballston Spa , N . Y . 12020 m 2. CONTRACTOR or BUILDER'S Name Same n rr 0 F+• 3. CONTRACTOR or BUILDERS Address Same °0 4'3 H w 4. ARCHITECT`S Name rt 5. ARCHITECT'S Address V B. TYPE of Construction — (Please indicate by Xi 't Oo W (x) Wood Frame ( I Masonry ( I Steel rt t7 7. PLANS and Specifications 4 No. 31 ' x 46 ' -6" as per plot plan , specifications and application includin ^' septic system and attached one car garage . MODEL I B, Proposed Use ] } OF Two family dwelling v rr, 82 . 00 July 1 , $$ $ PERMIT FEE PAID -- TEAS 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 town of Ousensbury before the expiration date_) phi N. Dated at the Town of Queensbury this 31st +pay of `_" December yg 87 SIGNED BY _ v c for the Town of Queensbury Building and Zoning Inspector Application Noe [)Wn O/ "Oe"44"ry Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 v Bay and Haviland Read, R. D. 1 Box 98 Zoning Designation ©usensbury, Now York 12801 Variance Noe Site Plan Review Novalo Approved by : _ r /40 � APPLICATION FOR Ell I L.D I NG 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 : Gu er Builders Inc . P. O. Address 119 Dunning Street Ballston Spa , New York 12020 Tel . ( 518 ) 899-9161 Property Location : 47 Margaret Drive Tax Map No . 121 / 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 CODE'S IS : Richard He Guyer III ( 518) 899-9161 Name P . O. Address Tel . Na . Name of builder GuYer Builders , Inc .Address 119 Durniing Street Tel, . ( 518) 899-9161 Name of pill er yer rs , InCoAddreaS 11V 1ALUULL118 ree Tel . Name of mason Yer ers , nc •Address ng ree Tel * Ms ) 599=VT61� 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 areas * COMPLETE INFORMATION REQUIRED $EOW . * Size of property 100± plan ft X 120 ft . * Existing building ( a) Size ft K— —€t Model. » PROPOSED BUILDING AND USE : raP .- " Existing building { s ) use N A size of new struc a 31 ft ]C 46 ' - t Foundation-pier slab crawl/partial/full * Proposed building, seispr�Unteplan property line circle one ) * Front yard 30+ ft Rear yard 30+ ft No . of stories (habitable space ) 1 + ft and 15+ ft t _ * Side yards Height (grade to ridge ) 19 6 ft • * if on corner , setback from side street ft If residential , no & of families I of 2 No . of rooms (excluding baths) �� * OCCUPANc:Y INFORMATION No* qk bedrooms Z * PRIMARY BUILDING - Noe pf bathrooms One family dwelling This rm l� nl9or Prirfary heating system se ar a ectric* =Two family dwelling b Type of fuel Electricity * Multiple dwelling / Humber of units Noe of fireplaces to be installed * Permanent occupancy Will a wood stove be installed? — Transient occupancy Central Aix 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 Attached garage/one car/ two car/ 2ne car CIRCLE ONE PLEASE JX_ { ) * Private storage building 11 ESTIMATED MARKET VALUE OF * Other CONSTRUCTION evve _e . 41 XAFOSMATION ON - BUILDING SPECIFI ATIONS , ON REVERSE SIDE OF THIS SHEETr TO BE COMPLETEDI Form SPA 4/86 md-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS Type of construction , wood frame , fire safe, etc . woad 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" minimm 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 7 sq . ft . - - Type of use? 'type of roof - sloped flat/shed/other Material of roof Fiberglass sFangles Size , wood studs "x 6 spacing 24 "o . c . length 8ft. exterior walls Joists ( floor beams } 1st . 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 IN spacing24 "o , c . span N/A ft . Roof rafters "x " acing 4 o , c . span N/A ft. Roof trusses (pre-engineered) spaci.n�� "o . c . span4 ' =6'ft . Exterior wail finish stained Of what material? 5 /8" 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 4and 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 rrn.*,3cipal SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties N7X ft . (A separate application is necessary for an re air or new installation of septic system) See S . P. E. D . S . perma.t # 0203252� Town of Queensbury County of Warren AF F I D AV I T STATE of NEW xoRx I swear that to the best of my knowledge and belief the statements contained in this applica tlon , 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 sp i€ted or not , and that such work is authorized by the -owner , � SWORN TO BEFORE ME THIS Signature Owner , owner ' s agent , arcAlc �, contractor� 2- a# day of r �t PAULA CHRIST€7PHER )aa�<f F t-fL4t t 4 _•- rryy Pui*c, State of New rock CkialWad in Schenectady County Notary Public , Warren County, N . Y . No. 4864777 Qwnmirrio�n Expames i V 7 1 # # # ! # # OF # * _ # * • * # # * # * tit # * Nor * * * * * * * * * * * # # * * * * * * # SPECIAL CONDITIONS OF THE PERMIT : a . . 1040 Square feet livi.n8 ' 240 � Square foot garage '" ac'e OL"' -- 1280 @ $7 ,00/ 1()0 or part of 5 .00 C/o pexnkit Total By--------------------------------------- TOWN OF QLEENSSURY 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 . AN4"99 ALL of the following : Gross floor Area 1040 S . F. • 20 Type of heat Baseboard electric 3 . X6 the building mechanicaily - cooled7 No 4a percentage of area of windows and doors 14 . 3% � . Over 16 • Only 10 vo value of gross area of walls , roof /ceiling and floors exposed to ambient conditions 2 . Floor over heated space '& YES NO a . Are foundation walls insulated ? YES NO 1 . If YES # what is the R value ? 3 . Slab on grade YES 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 $ . Under 161 Only, 1 . R value of roof and floors exposed to ambient conditions+ R-38 (•U. =0 .026) 2 . F. value of exterior walls XK d= R-23 . 5 (U. =0 .04+ ) 3 . R value of glazed area U . =0 . 30 4 . R value of doors R-14 . 9 (U. =0 .06) 5 . R value of floors aver unheated spaces_ )bbywx R_30 6 . R value of slab edge insulation - unheated slab NIA 7 . R value of slab insulation - treated slab 12 . 5 s . R value of heated basement/cellar walls ( above grade ) N A g . R value of heated basement/cellar walls ( below grade ) N/A 10 . Type of insulation Fiberglass C . Controls 1 . Thermostat maximum heat setting p . 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 E . piping Insulation N/A 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insuiatiori F . Service water Heating 1 . Performance efficiency NIA �l ;, 2 . Temperature control setting maximum G . For Swimming Pool Only 10 maximum heating N/A Telephone no ( 518) 899-9161 ( applicant 0 si tore APPLICAT30N FOR SEPTIC DISPOSAL PERl41T Ref : 3. P.E.D.S . UATS October .7 87 permit # New York - 0202525 ` ,MODIE ,, I of rr11 LOCATION OF PROPERTY FOR INSTALLATION 47 Margaret Drive Owner's Name: Guyer builders , Inc . . . Telephone: ( 518) 894-9161 Address: 119 2jMLr!& Street, Ballston Spa $ New York 12020 Installer's Name: Guyer builders * Inc Telephones (518) 899-9161 2 A, C * E* Is Jr K* L, N W umber of bedrooms (residential only) 2 3 F * G* H • • Total daily blow (compute 0 150 gal per bedroom) 300 Topo~ys circle one: let Rolling Steep Slope 9i of slope Sion Nat a circle one: Loam Clay Other / Depth$' 8 ' feet + y +Grr and Waters At what depth? unknown 8 feet + Bedrock or Imperwic as Materials At what depth? ,unknown feet Percolation test: circle one: uat require required / rate min. inch. Drcamestic water amply: circle ones Ndunicipal�Well Other IF domestic water supply is a Wells Separation: Watersupply from Septic absorption NIA feet * PROPOSED SYSTEM: Septic Task gal. (minimum &&met Isom gal.) TILE FIELDS Each Tres►ch NIA feet / Total system length NIA feet * SEEPAGE PIT(S)s Number of / Size each feet by fee}+ * Size of stone to be used Depth or Thickness feet ♦ s * * s * * +s * essssas * ees +ss +* sssssss * s * s * s * s • * * IMPORTANT * See S . P.E.D.S. ...Please...LLST NEW RQUMPMBNT TO BU INSTALLED permit & attached s► say * * s * * s * * * s * * * * * * ss �s * * * * * * * s� ♦ s * ssssse * * map. (over) Soctioa 11 Seetic system "IDectionst A. An 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 showings 1.) the propcoad .location. of the System 2.) location and distance to lot 4 nes 34 location and distance to structures 4.) location and distance to any water supply 5.) size and dimensions of all tanks. distribution boxese We fields and/or drywalls S. No system shall be covered before inspection and approval by the building Inspector. Failure to comply with this requirement stay result in the uncovering of the system by the installer and a fine of up to $250.00. Co An approved copy of the plot plan sball be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems durir construction prevent proper installation, alteration or repair of an approved systemp a new proposal ,must be submitted to the Queausbury Building Department before further construction. 1 halt* read the regula►tums above and agree to abide by these and all s+equiromeots of the Town of Quecnabu" Sanitary "Wage Disposal ;••"400 Signature of.responsible persons Date$ Town of Queensbury Building and Code Department Bay at liaviland Road QQueensbury, New York 12801 (518) 792-5832 �. A- MIDDLE OEpARTM �P , C ON AGENCY, INC. 9w Ica f�xp� ITUSPIecr *, Date October 260 1988 �fCXlflP� that 4e talT a ulpment listed has been xaffnl approved as being in accord with the National Elect r' applicable governmental, utility and, e � S. Owner Guyer Builders ,,,� ! P .. Occupant: Single Fan [ e bu t ..yr�csxe wrsle 10 ufpmsnt and installation Inspecled this Location: 47 Margaret +� 3 doe. H additional a4u40 Wnt�sn be Int■ooucsn Of elterattons made io i } g G g,, existing System ihY� ca►LtaCallR be nulM end vobd, and appllcetlon !or 77 Outlets ece tac1e8 ; , � 'yC: l. � �3� fnspwarofOtion io,deq� S tm tWiotoho Jhft sncr Equipment: I? f.,. i loiter or om OOV)OM O . Aldo. of 1 trjoaj qq Insuranee r*ve r 150 AMP Service ; 7 , 1ianCE s CagentarcampanYlaawi IneStwnotelxtrieslaquipmantappraved as apadfiad.r-' �' r Guyer Builders � � + " �� .._•.-- Applicant: 119 Dunning Street On Z5-024112 L. Ballston Spa, NY 12020 Fstras too. 740 EL r-p _J'otun o� �ueens�ur� BUILDING and ZONING DEPARTMENT Bay and Waviland Road, R-D. 1 Box 98 Queensbury, New York 12801 V BU ] LDING INSPECTOR ' S REPORT NAME LOCATION Date f Permit No . ✓ = APPROVED - YES NO Footing/Pier Farms Foundation Waterproofing 8ackfill 4,10-�Kraming Roofing Siding Masonry Veneer ,,,Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar. Drain Tile Concrete Floors 111bg . Fixtures Gar . Fireproofing Dcx3r Closers Smoke Detectors Chimney INSULATION Foundation Floors walls Ceiling FINAL ELECTRICAL IN PECTION I)RIVEwAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- .5 u Buil l Inspector G/86 and-vl ✓act�se O� ��[E"k"ridh�+fr�t BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Sox 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME e %oop LOOK rG'I<' L©CATION " 4112 46 Date- /�P.rm i t N. . '7_�1 _ ✓ APPROVED - YES NO Footing/Pier Forms Foundation Waterproof inig Backfill Framing Roofing Siding Masonry Veneer. /A)Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trice Stairs & Railings Cellar Drain Tile ,pConcrete Floors Plbg . Fixtures Gar , Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL- Final Building Sur y Next scheduled inspection (call when ready ) Remarks- Zding Inspe oar 6/86 and-vi � /4I7J /e:f9 Jf 4161+' BUILDING 7 and C]M1IING DEPARTMENT T NT Bay and Haviland Road, R. D. 1 Box 98 ] r Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATIONi" ' ' Date 42 /Z7 Permit No . ✓ = APPROVED - YES NO l�ggting/Pier Farms 4,,e6u'ndation Waterproofing F3ackfi ll Praming Roofing Siding -- Masonry Venee Rough Plumbing Relief Valves Ext . porches Finished Floors Interior Trim Stairs & Railing Cellar Drain Til Concrete Floors Plbg . Pixtures Gar . Fireproof ng Door Closers Smoke letectq s Chimney INSULATION . . Foundation floors Walls Ceiling_ F4INAL PI ECTRTCAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled Inspection .( call when. ready ) Rema rks-- Hui ding Inspector 6/fl6 and -vl BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING I N SPECTOR ' S REPORT NAME LOCATION �� Date /Z /0 / t 2 ermit No , 1 . L. ooting/Pier Fox.Trvs APPROVED - YES NO Foundation Waterproofing Sackfill 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 . Fireproofitg Door Closers Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECTRIC INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( nail when ready ) Remarks- `� 7j - T pOTt .uG S 2 +E + Im3 &C iAd 1=YcA Crz /tV-s0 6�-, ruilding Ins£aector +6/86 and-vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS , QUEENS.BURY, NEW YORK 12801 TELEPHONE (518) � 792-58.32 BUILDING INSPECTOR ' S REPORT REQUEST FOR SPECTION RECEIVED MIME LOCATION DATE y� J PERMIT # APPROVED YES I NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFTZL APPROVAL ROUGH PLUMBING FRAMING ELECTRrCA ROUGH-rN INSULATION FOUNDATr© FLOORS WALLS LFTErLING NAL INSPECTrO CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ S STAIRS-CLEARANCE & RA PLUMBING FIXTUR "/RELI VALVE INTERIOR TRIM/ IVACY D FINISHED PLOD - GARAGE FIRED FIND DOOR CLOSER ) SMOKE DETE RS FINAL ELECT rNSPECTrO FINAL APPROVAL OF CONS TRUCTrO A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDrNG DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS ' QUEENS,BURY, NEW YORK 12801 TELEPHONE (518) 79.2-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED ,+ a NAME _ LOCATX0N — - DATE PERMIT APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS __.... FOU DATXON/DAMP-PROOF XNG BAC APPROVAL _ ROUGH P MBING FRAMING ELECTRICAL OUGH-IN INSULATIONc FOUNDATION FLOORS WALLS CEILING 4. hAL INSPECTION_ CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ PS STAIRS--CLEARANCE LS ... _........ - PLUMBING FIXTURE /REL F i LVE INTERIOR TRIMfP VACY RS FINISHED FLOOR GARAGE FIREPR FIND DOOR CLOSER (S ,' SMOKE DETEC S FINAL ELECTRIC INSPECTION v FINAL APPROVA OF CON,ST'RUCT ION A SIGNED CERT FICATE OF OCCUPANCY T BE OBTAINED FRO THE BUILDING DEPARTMEN BEFd THESE PREMIS S ARE OCCUPIED; t REMARKS: _ OwACs t 6t1C C ©W.11 . 7QaCC} �j /w.0,04', 4coolq& INSPECTOR �vwrt o� �eteer+.f6urr� BUILDING and ZONING DEPARTMENT Say and Haviland Road, R. D. 1 8ox 98 , 7') Queensbury, New York 12801 f BUILDING INSPECTOR ' S REPORT NAME LOCATION Date ✓ = - Footing/pier Forms APPROVED YESNO Foundation Wa terproo f.ing gackfill y _F-yami ng 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 Floors Walls Ceiling FINAL ELECTRICAL I SPECTION DRIVEWAY APPRdVA Final Building Survey. Next scheduled inspection (call when ready ) Remarks- Bu di g Inspector +6/86 and-vl I MMMMM ._/own o/ Quee"A"rry BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. 0, 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATIONr r� Date Permit Na . j� "7 ` ✓ = APPROVED - 'YES NO Footing/Pier Forms Foundation Waterproofing Backfill teaming Roofing Siding Masonry Veneer Rough P1 Ing Relief Valve Ext . Porches Finished Floors Interior Trim Stairs 6 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 (calir {when ready ) Remarks- --,JPf + TCA-s-r- Budding Inspector 6/86 and-vl �ourrx i7� �tteen.3 +lautrt� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date/ Permit No . ' - l '^` ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing r Roofing Siding Masonry Veneer Rough Plum2a g Relief Valve Ext . Porches Finished Floo s Interior Trim Stairs & Railings Cellar brain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney )VINSULATION : 1 Foundation 1 Floors Walls Ceiling FINAL ELEC RICAL INSPECTI -- DRIVEWAY PROVAL —� Final Bui ing Survey Vext scheduled Inspection ( call when ready ) Remarks- Buil I ector 6/86 and-vl mmmmmmommmmommuk �r � �owt: a� �ueen�Ihur,� aUlLD1NG and ZONING DEPAlRTMENT Bay and Ha►riland Road, R. D. 1 Box 98 OUeensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME � '� r1 2.. LOCATION r �7 -5/�' - DATE ._ 7 /� PERMIT NO. SOIL TYPE an - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , total Length Length of each trench Depth of trenches Size of gravel -- - SEEPAGE PITS{N er of) Size- J5�ft. X ft. Gravel size PIPING : Size Bldg. to tank Type Tank to disc . boxes Dist. box to field f it OPenings sealed? S NO Partial LOCATION/SEPARATIONS : Foundation to tank ft. Foundation to abs o tion <," ft � b S- orption to lot ine ft. Separation of pi ft. LOCATION OF SYS ON ' PROPE ,TY (circle one) Front - arm} eft side - %"—ht side COMMENTS : - SYSTEM USE APPROVED Bu ding inspector 01/66 and vl HUILOING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS, FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED, TEMP aF DATE �. VILLAGE TOWNSHIP '! STREET AND NO. OR .' ROAD AND POLE NO. BETWEEN WHAT TYPO POLE NO. Pp PREMISES LEETS IS TED7 OCCLPANTIS CTI N BLOCK LOT NAME BUILDING OWNER'S NAM / _ ` OCCUPANCY AND ADDRESS /r TEL U / ! SUPPLIED AI BUILDiIiKi FROM THEIR OFFICE WORK IS NEW OLD © IS NEW AIDEFECTS DDITIONAL REMOVED LIST BELOW ALL EQUIPMENT WHICH YOU STALLED NUMBER OF OUTLETS No. of Flxtur & BRANCH Loa LAI RooIP» w MOTORS HEATERS CIRCUITS OFFICE USE Hm ONLY G1YIns Mall R g ae Switch Fandent Breekat No. TVPe E No. ell No. AW , Lee Cause INSPECTION Out- Aws sub- Ba.. Inset list Fl. 2nd Fl. 3rd fl. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO MOT USE THIS SPACE. This application is in tandad to cover tbs abor Iiatad equipment to be inapeeted but if at time of i you are authwmed to make the Ingfection and adjust the fee to corer the additional ttspaetion there a found edditiovel spniPmeni not ebore Iittad, SIZE OF equipment, as provided by the applicant. MAINS FEEDERS ELECTRIC SIGN TOTAL CHARACTER ` ["'� LAMPS WATTS OF WORK. F - f } J^�.,. "} ,[ 'J EXPOSED GAS TRANSFORMERS OF UBE SIG WORK TO VA STAF TEp COMPLETED UNIIMeERI (CAPACITY) SERVICE OVERHEAQ SIZE OF SIGN U ERG ENTERS ROUND MAKER UIL ING OF SIGN INSPECTION RE DUE T r ON OR AS NEAR AS j f POSSIBLE i ._ t-t... ' ';{__..}"!_yr ,,r � ' • 01 • OLD ly @yy AVOID DELAY BY GIVING FULL AIYD ACCURATE INFORMATION. ALL SPACE&MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. DATE OF G} PRINT NA AND ADD SS APPLICATIONAME OF N - LK:ANT� '-' C.- � [r! f...` '�i. ` .J ,fig SIGNATURE OF APPLICANT STREET ADDRESS 1 Gr '�/ gf ,I f ,.r 3 t _ TELEPHONE # " /' �(„_•i J CITY OR j yr LICENSE Iep, POST OFFICE -"�-. �/ .`+ ( ll;' r 2lP CODE �'_ i �NHENAPPLICABLE 46 EL (REV, Ils6Y A SEPARATE APPLICATION MIDST BE FILED FOR EACH SEPARATE BUILDING I -- ---- --- - - _ - — -_ 1 l 1_ QUEEN VICTORIA'S GRANT QUEENSBURY , N.Y. Mq �,GA RE r O .._ 6= 0 DIAMETER 8=0 DEPTM 1000901 CLEANOUT /— TO GRAM °- 47 OR\v E REFERENCE DRAWING 5A SITE UTILITIES SEPTIC $ WATER VonDUSEN 4 STEVES SURVEY PLAN ." C