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1987-950 a { F CE11TIFICA71E OF OCCUPANCY CY TOWN OF QUEENSBURY f WARREN COUNTY, NEW YORK 6 F Da tC Ocrobe- r This is to certify that work requested to be done as shown by Permit No. 87--950 has been completed. i This structure may be occupied as a of Two Family Dwelling 45 Margaret Drive — Queen Victoria ' s Grant I ^cation Owner Guyer Builders Inc . i By Order Town Board TOWN OF QUEENSBURY i r Building & Zoning inspector BUILDING PERMIT H TOWN OF QUEENSBURY No. 87-950 WARREN COUNTY, NEW YORK � C> PERMISSION is hereby granted to 'Queen Victoria ' s Grant _ ry Drive Margaret OWNER of property located at 45 Mar g Street, Road or Ave. in the Town of Queensbury, 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 guilders Inc . .o 119 Dunning. St . p Ballston Spa , N . Y . 12020 w 2_ CONTRACTOR or BUILDERS Mama h Same rwt 4 + f >v_ qJ 3. CONTRACTOR or BUILDER 'S Address G'3 �t Same Q' p rr 4. ARCHITECT'S Name 5. ARCHITECTS Address it rs 6. TYPE of Construction — (Please indicate by X) pia rt CD X Wood Frame ; I Masonry ; } Steel ; ) ' ty rR 7. PLANS and Specifications C ro No. 31 ' -6" x 39 ' as per plot plan , specifications and application includin septic system and attached one car garage . MODEL M a. Proposed Use } of Two Family 0 $5a0O C/o $ 96 • 00 PERMIT FEE PAID — THISPERMIT EXPIRES July 1 1988 c+ fIf a longer period is required an application for an extension must be made to the 8u1Iding and Zoning inspector of the town of Qusensbury before the expiration date) Dated at the Town of Queensbury this 31st pay of December 19 87 SIGNED BY i for the Town of Queensbury Bu1ldlog and Zoning Inspector O'Coor TO BE COMPLETED BY BLDG . DEPT . ., ff Application No . ' 0-.��/JJ oun o/ Queen •sburry Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 15 Bay and Havdand Road, R.D. 1 Box 98 Zoning Designation 9 T M [' 17 Gueensbury, New York 12801 Variance No . ' ` ` ` " Site Plan Review No . - Approv/edby : de sr/,e10 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'. Permtt 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 Dunn-ing Street , Ballston Spa , New York 12020 Tel . 899-9161 Property Location : 45 Margarrt Drjvp 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 H. Guyer III 119 Dunning Street , Ballston Spa , NY 12020 899-9161 Name P . O. Address Tel . No . Name of builder Guyer Builders , Interdress 119 Duruiing Street Tel . 899-9161 Name of plumber Address T19 UKRUlIng Street Tel ' 699-91451 Name of mason Guyer Builders , n%ddress 119 Dunning -Street Tel . $99-9161 NATURE OF PROPOSED WORK : ZONING I NFORMAT ION : 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 EQU RBD BELOW . Size of property 1'00± Pg ft X 120 ft . * Existing building ( s) Size, NCg ft X TNLA�ft . Model PROPOSED BUILDING AND USE : ofl/M Existing building ( s ) Use _ N/A Size of new structure 31 ' -6'ft Foundation-pier/slab/crawl/partial/full Proposed building, distance from property line (circle one ) No . of stories (habitable space) 2 * Front yard 30 ft Rear yard 30 ft Height {grade to ridge) 25 ' -014 Side yards 15 ft and 15 ft ft , * If residential , no . of families Of 2 * If on corner , setback from side street 30 €t aw of rooms ( excluding baths) ^ 5 * OCCUPANCY INFORMATION o . of bedrooms 2PRIMARY BUILDING, - to . of bathrooms 2 * One family dwelling rimary heating system Electric baegbo+ard * 7 " Two family dwelling Type of fuel Electric be Multiple dwelling / Number of units { No . of fireplaces be installed _ * permanent occupancy 4 Will a wood stove be installed? Central Air conditioning? 'I`1O Transient occupancy i * * 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 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/ car +► * * * * * * * * * * ,� * * * * * * Private storage building ESTIMATED MARKET VALUE OF * .other CONSTRUCTION INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETEDi Form BPA 4/86 and-vl BUILDING PERMIT APPLICATION CONTINUED - 'F 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 80" Depth of foundation below grade (to bottom of footing ) 48'" Il7lI11mt]R1 Will there be a cellar? no Heated or unheated? Floor sqo footage sq ft Will there be a basement? no Will any portion be used as living space? ( If so , what portion? sq . ft . - - Type of use? Type of roof - sloped/flat/shad/other Material of roof fiberglass shingles Size , wood studs 2 "x 6 spacing 2 "o .g _ length 8 ft . Joists ( floor beams ) lst . floor N/A "x " spacing "o . c . span ft . Joists ( floor beams ) 2nd . floor. �w'X " spacing 16 "o . c . span 18 ' 4"ft . Overlays ( ceiling beams ) NIA "x '" spacing "o . co span ft . Roof rafters 2 "' X 1 spacing�4" O . C . span ft . Roof trusses (pre-engineered) spacing 7+" "o . c . span 20 ' ft . Exterior wall finish Of what material? Interior wall finish If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 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? Will a flue-lined chimney be installed? no Height above roof ft . Depth of chimney foundation below grade N A ft . Depth of fireplace hearth N/A ft . in , water supply - Municipal or private well municipal SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties NIA to (A separate application is necessary for any repair or new installation of septic system) See S/P/E D 5 permit # Q 025g25` r r Town of Queensbury F F 1 Yi Y 1 STATE OF NEW YORK County of Warren 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 c,ONING 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 . o0<11�0. SWORN TO BEFORE ME THIS Signature 9- ' � /� _ ' Owner , owner ' s agent , ns.arcr t , contractor e*- 1-:51 day of !) C F..la.ex 19 F' ! }iAULA CI.1R1S7OPF#ER Notary Public. State of New Vbo* Otiatified in Schenectady County Notary Public , Warren County, N . Y . No 486472-7 SPECIAL CONDITIONS OF THE PERMIT : 1253 Square feet living 264 Square foot garage w000re stall @ $7 . 00/ 100 or part of 5 . M One at311 garage $5 .00 C/O permit Total By .......... TOWN OF QUEENSBURX „M„ 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 : 1 . Gross floor area 1253 2 . Type of h ea t Electric baseboard 3 . Is the building mechanically cooled ? No 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 R-38 2 . R value of exterior walls R. 23 . 5 U. =0 . 04t 3 . R value of glazed area. U . =0 . 30 4 . R value of doors R. . 14 . 9 (U . = 460) 5 . R value of floors over unheated spaces N/A 6 . R value of slab edge insulation - unheated slab 'N/A 7 . R value of slab insulation - heated slab 12. _ 9 8 . R value of heated basement/cellar walls ( above grade ) N/A 90 R value of heated basement/ cellar walls ( below grade ) N/A 10 . Type of insulation Fiberglass Co Controls Moo 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 E . Piping insulation N/A. 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe .insulation F . Service Water Heating 1. Performance efficiency N/A 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum heating N/A Telephone No . ( 518 ) 899-9161 ( applicant ' s si at e ) t APPUCATION FOR 5&PTIC DISPOSAL PERMIT Ref: S . P.E.D. S , UA'Tii October. 7 / 87 Permit # New York - 0202525 M of M/I LOCATION OF PROPERTY FOR INSTALLATION 45 Margaret Drive Owwea0s Names Guyer Builders . Inc . Telephones (518) 899-9151 Address: 119 Dunning Street , Ballston Spa , New York 12020 Justaller's Names Guyer Builders . Inc Telephones ( 518) 899-9161 2 As Cs Es Is Jo Ks Ls M Number of bedrooms (residential only) 2 3 F s Go H r. Total daily flaw (compute 0 160 dal per bedraam) 3fla Tapagraplsys circle awe: lot Rolling Steep Slope % of slaps SoU Nature: circle ones (9i Loam Clay Other / Depths 8 feet + Cwvuud Waters At what depth? unknown 8 feet + Bedrock or ImpeMom Materials At what depth? unknown feet Pbtr+calatiasa tests circle ones not require required / rate shin. inch. Domestic rater supply: circle one: lydusaicip Well Other IF domestic water supply is a Wells Separations Watersupply from Septic absorption N/A feet * PROPOSED SYSTEMt Septic Tank ,gal. (minimum sizes lsdDa dal,) TILB FIET Each Trench N/A feet I Total system length N/A feet * SEEPAGE PIT(S)ee Number of / Size each feet by fen * Size of stone to be used / Depth or Thickness feet • s * * a * ease +lra► ae * * ae-a► aeaeaeaeaiaear * * s +ri * +ssaesea� ae * ssaF * * IMPORTANT * Sae S . P. E.D.S. ...Pl+ease...LIST NEW SOUJPIrrENT TO SS INSTALLED permit & attached +saRaeaea< * aRsae * �► * �s * +sus * * es * * t► * * asa� as �sar * * �s �s �rs * * as * * map,, (over) i3ection II Septic System Insnectionst Joe All applications for septic system installation. ,alteration or repair, as required by the Town of Queensbury Sanitary Sewage Or4inance, shall be submitted to the Building Department at least 24 hours before start of constructions and shall include a plot plan showings 1•) the propo"d ,location of the a}ystem 2e) location and distance to lot ilivaee 34 location and distance to structures 4e) location and distance to any water supply Se) size and dimensions of all tanks, distribution boxes, till fields and/or drywells Be No system shall be covered before inspection and approval by the buildin Inspector. Failure to comply with this requirement may result in the uncovering of the system by the installer and a fine of up to 8250e00e Ce 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. I have read the regulatkwa above and agree to aba" by it A" all Wuai>R,eame�sts of the Town of Queensbwy Sanitary Sewage Disposal Ordinance.. Sig"tuare of.responsible persons Date& Town of Qureensbury Building and Coder Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-583Z flown Of �uee+rrs6ter� BUILDING and ZONING DEPARTMENT Ilnnrr �• ' ' Bay and Haviland Road. KID- i BOX 98 Queensbury. New York 12801 BUILDING INSPECTOR ` S REPORT NAME LOCATION Permit No , k2�� - YES NO &/' APPROVED Footing/Fier Forms Foundation waterproofing Backfill Framing ✓ Roof ing ✓ Siding ✓ Masonry Venee Rough Plumbing� Relief Valves Ext . porches Finished Floors Interior Trim Stairs & Railin —. J— Cellar. Drain ,T' e_�--� Concrete F100 .� Fixtur C,ar . F' irepr Ping r)c)or Close s Smoke i3e ctors ChimneY I N SU I.AT I ON Foundation Floors_ walls i Ce l ing FINAL ELECTRICAL INSPECTION f}R1V'EWAY APPROV Survey Final Building _ ection (call when ready) Next scheduled insp Remarks- Buil ing I s ector 6/86 mci-vl MIDDLE DEPARTM ENCY, INC, -A R oeu, September 29 , 1988 ,r. =sty. l :.•�. __ _ ___ _..- ,.. ._ .-._.._,,,� ��.` `• . r approved as being in accord �frtifie� that tiiEi`electridar equipment listed has been dxarrt rta an lag? pp Witt) the National Electr a Co[le`, applicable governmental, utility and /kg+Qrngcty tiles. ^� jo Cyr c Gayer auzlders e t, :s ' k3a pan C1wnEr: a .Yx°3 1 i {!/$ Sictie 1 Cttnz�'�1 - l i 5 N"— r��?rE.' t#'�r .V�P..n z ' +� , , y'-baryfica[e coven eh! efeefs uiP wri"r and d Of alter inspected n) .� �.. UCs3[1C7 f 1: data If addltiorfs equipment ;ahW1A be rntfoducev or alterations mane to exiaHng system this caYiaica}'s aFa@R be nu11 arcd road. and application for a to this Agency. �w L L n� _ (� (,e 4 �',�t a+� 1,+'�-]{t F3xE'S j inspection shoi+ld Aa sub�mifrad p[x7nDb Y t insurance carrier �j•7 F ' � C Nddef or this certificate a'houfd Prdsent same to hit Proper Y h? Lr]kJ+ft177 t?f!f 5, - r t ` [ypent or companyk aaeviclertce cf Certlliufton o4 a lecir&cai aquipmen l approved 3- � � _ is :aervit: e ; [� ypliatices aaspeciied. , C Ne 1 .. rGuyer 13u11der8 II?G r ' : l _ 1+IO . 15 -024111 �, AK7{�1rc:ar+r 119 lluuiLiitg Street . : �^ a' nal-I, Lori SPa, z3Y 12020 :. #v .l ,&.... flown a/ Qrreena aery BUILDING and ,ZONING DEPARTMENT 13ay and Haviland Road, R-D. 1 Bax 98 QUeensbury. New York 12801 BUILDING INSPECTOR ' S REPORT NAME C'�t a, S LOCATION Date y / permit No 7 � w yr - APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backf i l l Framing Roofing Siding Masonry Veneer Ro gh lumbing R ief aloes Ex It . Porches Fin hed Floors =y te ' or Trim Stairs & Railings Cellar Draixi Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Wails Ceiling FINAL ELECTR A N ICL INSPECTION ON APPROVAL Final Building Survey Next scheduled inspection (call when ready} Remarks- —�— d ' g nspector 6/86 and-vol _./'ocur� o� �u ¢en3heere� BU1LOING and ZC)NING DEPARTMENT Bay and Haviland Road. R.D, 'I Box 98 oueenSbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date Perynjt AppRaVED YES NO Footing/Pier Forms ^ Foundation Waterproofing Backfill . Kraming Roofing siding Masonry Veneer ugh 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 Ili SULATI ON : Foundation Floors Walls Ceiling FINAL ELECT CPsL INSPECTI DRIVEWAY AP OVAL Final Build ng Survey Next scheduled inspection (call when ready ) Remarks- BuiI g n5p=ct 6/86 and-vl _been Q/ Queens etrey BUILDING and ZONING DEPARTMENT Say and Haviland Road, R. D. 1 Sox 98 Queensbury, New York 12801 SEPTIC D I SPOSAL ySYSTEM INSPECTION NAME LOCATION _ 5� 'Iwwizr-'ee DATE _ PERMIT NO . SOIL TYPE - and3, - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch - TYPE of SYSTEM : Absorption field , total length Length of each trench Depth of t nches Size of gra el_ SEEPAGE PIT Number of �. Size- --6, -fto X _ f Gravel size PIPING : Size Type Bldg . to tank 47' Y-6 Tank to dirt _ bo Dist,. box to fiel pit Openings sealed? S NO u Partial LOCATXON/SEPARA IONS Foundation to ankt ft . Foundation to sorpti n .�S ft . ,e_ Akisorpti.on to lot line ft . Separation o pits _ft. LOCATION OF YSTEM ON PRO RTY ( circle one) Front - a Left side - ght side - COMMENTS : i s SYSTEM USE APPROVED 4Y . Bu ' ding inspector 01/86 and vl y rypWl+ v �a[ueen3� ur� BUILDING and ZONING DEPARTgpX $8 pueensbury, Bay and Haviland New York i 28Ui BUILDING INSPECTOR ' S REPOPT NAME L(ICAT I ON Permit NO * Date « ----- * * * * HNoAPPROVER - xis ✓ Footing fPier E'arzns Foundation Waterproofing Bacicf i l l Framing Roof ing Siding Masonry Veneer -- -�-�. 0 ough Fluokbin9__-�---�- Relief Valves -- Ext . Porches Finished Floors 'Interior Trim Stairs & Railings Cellar Drain 'Pile %,,T,c,ncrete Floors Plbg . 00fing FiXtu Gar . Fireproof Door Closers Smoke Detectors chimney It3 SOLAT:[0N Foundation Floors Walls ceiling :EN SPECTIOi3�_� FINAL, ELECTR=C DRIVEWAY APPitOV urvey Final Building Next scheduled 3_nap ection (.call. when ready } Remarks_ d rispector 6A'8fa md�vl �! owe 0/ Qmeers4ury 8ING —ONING DEPARTME NT� 6A) ay and Hate+land Road, R.L). I Box 98 4ueensbury, Now York 12801 j I E3U 3 LD I NG I NSpECT ©R ' S REPORT " 3 NAME LOCATION {� fermi t L3cs . APPROVED - YES No Footing/Pier Forms Undation Waterproofing 13ack.f ill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain 'file Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney IN s u LLAT I ON Foundation Floors Walls Ceiling_ FINAL EI ECTRI AL INSPECTION I)RIVEWAY APPRCI Final Building Survey Next scheduled insp ection (call when ready ) i Remarks- 1 i a I I ui ding Inspector R i ! 6/86 and-v1 1 1f [ '� JUwrt U Queen ilriaPy BUILDING and ZONING DEPARTMENT Bay and Harnland Road, R. D_ 1 Box 98 Clueensbury, New York 12801 BUI L. DI NG INSPECTOR ' S REPORT 6. 5 d-4 rJ NAME. I I LOCATIONr Date 11 1,,r/ ermit No . �LL V / ✓ = APPROVED - YES NO ooting/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough. Plumbing Relief Valves Ext . Porches Finished Floors Inferior Trim Stairs & Railing Cellar Drain Ti e Concrete Floor Plbg . Fixture Gar . Firepro fing Door Closer Smoke Detec ors Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION J DRIVEWAY APPROVAL I Final Building Survey Next scheduled inspection (call when ready ) Remarks- - 'S - IZ> `i3 -cc>«! r K k, n*-i-, A. 4� , 04Z � ► 2� - C7 1C Building Inspector j 6/86 and-vl k BUILDING DEPT. COPY OF APPLICATION FORM 46-EL. NEW YORK 80ARD OF FIRE UNDERWRITERS. + FILE THIS COPY WITH BUILDING DEPT, WHEN REOUIRED. TEMP. s CJTY OR WLLAGE F'. - r' .. r tr TOWNS P`. : I� .,.. .0 ;COUNTY STREET AND NO, on 1 ! ROAD AND POLE NO. i - )�, /f i' •f ''r,,r+k'/ BETWEEN HAT TO POLE NO. W YP CROSS STREETS IS PREMME.F LOCATED? SECTION BLOCK LOT OCCUPANT'S BUILDING ��... ._ NAME OCCUPANCY - OWNER^S NAMAr 1i / /�" ✓ ,r i ANDA DRE ,f'�1+ ' l 1 ! 'fl �{ J' �" ' 'S f' f�yr " TEL CUR iak'L 7' SUPPLIED _ BY - - FROM THEIR „ :� � . ._ . Z . � �._-- OFFICE BUILDING'' WORK DEFECTS IS NEW OLD El is NEW ADDITIONAL ❑ REMOVED LISP" BELOW ALL EQUIPMENT WHICH YOU IIIISTALLED NUNIBER OF OUTLETS No. of F41WAM 6 BRANCN Loos- Lamp RACoptoolN. MOTORS HEATERS CIRWITS OFFICE USE ONLY tlen Ae �s H.P. watb Oellkq SWall ide St" Rttaltaa,•ls Seafch Pendant Bredtet Nw TVPe Eae6 No. Each No. Gaupe INSPECTION Out- Sub- base Some, mane 1st Fl. 2rld FI. 3rd Fl. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE, This application is intended to cmar the abor"fisted equipment to be inspected but if At time of inspection them is found oddit)anM equipment net above listed, you are Authorized to make the inspection and adjust the fee cover crr the edaisional equipment, as Proridrd by the applicant. S12F OF }} ELECTRIC SIGN TOTAL MAINS FEEDERS LAMPS WATTS CHARACTER/ i I N." ' 1( l `fir C..l .+% + EXPOSED GAS TUBE SIGN 4F WORI�C f •� CONCEALED TRANSFORMERS OF VA WORK TCI SE INUMSERI {CAPACITY) STARTED COMPLETED SIZE OF SIGN SERVICE OVERHEAD UNDEFIGROUN6 ENTERS MAKER BUIL IN OF SIGN ]INSPECTION REQUEST ON OR AS NEAR AS POSSIBLE x.--'( 1- y / (..f, I .�.Y"."- J . ,"i ri NEW 1—I OLD AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION, ALL SPACES DATE OF MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. PRINT NAM"ND ADDRESS l APPLICATION - NAME OF / "',( t, ,�. -! Y , {.,,)' ..� SIGNATURE APPLICANT -'i-^t /-+ �.^�� x OF APPLICANT STIR EET AODR •CITY OR /JF „-,y7.)�.. d 47 r T`- ..� '� TELEPHONE # -" ! ;JY��_•-+-"` POST OFFICE ' �`. S - ' +11) 1`'r..r:�sl' �� , LADE � �L-+'- WHELICEN APPLOICABLE ae EL (REV. Voe) A SEPARATE APPLICATION MUST 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