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1987-947 f • 1 4IN f CERTIFICATE OF TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK i DateSept. 22, 19 88 This is to certify that work requested to be done as shown by Permit No. 87- 947 has been completed.. I This structure may be occupied as a at Two Family Dwelling 39 2�Margaret Drive - Queen 'Victarta ' s Grant 1 Location Owner Guyer BuIlders , Inc . j Ply Order Town Board TOWN OF QUEENSBURY Building & Zoning inspector { i l ` BUILDING PERMIT TOWN OF QUEENSBURY No 87-947 � WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Queen Victoria ' s Grant r-• s OWNER of property located at 39 Margaret Drive 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. 1_ OWNER'S Address is Guyer Builders Inc . 119 Dunning St . Ballston Spa , N . Y . 12020 2. CONTRACTOR or BUI LDEWS Name C Same rr Fj- 0 H Iv 3. CONTRACTOR or BUILDER'S Address un Same H m «7 rt 4. ARCHITECT'S Name S. ARCHITECT'S Address W H 6. TYPE of Construction — (Please indicate by X) xt+ I 4 'Wood Frame I ) Masonry ( ) Steel ty rt l-4 7. PLANS and Specifications C m No_ 26 ' -6" x 35 ' -7" as per plot plan , specifications and application including septic system and attached one car garage . MODEL K a. Proposed Use OF TWO FAMILY ' 4 f-3 $5 . 00 C/o $ 82 . 00 PERMIT FEE PAID — PHIS PERMIT EXPIRES July 1 , 198$ (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Qusensbury before the expiration date.) .� Dated at the Town of Queensbury this ✓�31 s t pay of December 19 8 7 SIGNED BY z / e �' for the Town of Queensbury Building and Zoning Inspector L iCat3.Oh No .it issued 19BUILDING and ZONING DEPARTMENT it Expires 19Bay and Haviland Road, R,D. 1 Box 98 ngDesignation Gueensbury, New York 12801 ance No . �11.IT 11 Plan Review No .oved by : APPLICATION FOREUILDING AND ZONING PERM IT CX'� � A PERMIT MIDST 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 . P_ O. Address 119 Dunning Street Ballston Spa , New York 12020 Tel , ( 518) 899-9161 Property Location : 39 Margaret Drive _ _ Tax Map No . 121 / 4 / 2 Street number or building lot number Subdivision name ( if applicable) Queen Victoria ' s Grant xf �� PP ' (Pgrx s* &Iss0It,% THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : Richard H. Gu er III ( 518) 899-9161 Name P . O. Address Tel . No . Name of builder Guyer Builders , Inc .Address 119 Duruxing Street Tel . ( 518) 899-9161 Dame of plumber yer t4n .Laersp nC .Address 119 D&Mng Street Tel . ( 518) 899-9161 Name of mason Guyer ers , rnic4Address 119 Unining StreeE Tel . NATURE OF PROPOSED WORK : * ZONING INFORMATION : Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTEDp 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 OF STRUCTURES STATEAFFECTED . of water supply and location and configuration * of septic disposal area . * COMPLETE INFORMATION REQUIRED p-FO W . * Size of property 100t p an I ft j . 120 ft . * Existing building ( s ) Size ft X_ —ft . Model PROPOSED BUILDING AND USE : * Existing building (s ) Use N/ Size of new struc e 26 ' -6'Tt x ft Foundation-pier slab crawl/partial/full * Proposed building , sdeestploncepfrroom property line circle one } an 2 * Front yard 30+ ft hear yard 30+ ft No . of stories (habitable s ace) Height (grade to ridge ) 23 �6„ ft . * Side yards�l +� ft and 15+ ft If residential, no . of families of 2 * If on corner , setback from side street ft Mao of rooms (excluding baths ) 4 ' OCCUPANCY INFORMATION . of bedrooms W • of bathrooms Z PRIMARY BUILDING - `Prima q y One family dwelling t Primary heating system Baseboard electric* � ss�de�i �'�? n$r Type of fuel Electricity * W�Tw'o family dwelling Flo. of fireplaces to be installed * Multiple dwelling / Number of units * permanent occupancy Will a wood stove be installed? Q * Transient occupancy Central Air conditioning? No Business BUILDING STYLE, PRIMARY STRUCTURE * Industrial Ranch Contemporary Lo cabin * Other Raised ranch Mansion T]uple * If addition , what will use be? split level Old style Bungalow " Caps 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 Private storage building ESTIMATED MARKET VALUE OF * Other CONSTRUCTION r INFORMATION ON BUILDING SPECIFICATIONS . ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETEDI Form BPA 4/86 md-vl r � BUILDING PERMIT APPLICATION CONTINUED BUILDING SPECIFICATIONS : wood frame Type of construction , wood frame , fire safe , etc . 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 ) ' minimum 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 porter sq. ft . - - Type of use? Type of roof - sl�opt flat/shed/other. Material of roof Fi rg ass shingles size , wood studs 1� r +`X b '* spacings""o - c . length $ ft . extelCi, Y walls joists ( floor beams ) lst . floor N/A " [ •" spacing "o , c , span 1� � ft , lZ--+�x�lL] F spaaing . c . s Joists ( floor beams) 2nd . floor p te12 � _4f Overlays (ceiling beams ) 2 "'X spacing 24 "o . c . s a ft . Roof rafters 2 •�X " spacing Z'4 o . c . span ` -91t . Roof trusses (pre-engineered) spacing+ "o . c , spa'' N/� ft . Exterior wall finish stained Of what material? 5 / $"" X 4 ' x 8 ' texture 111 Interior wall finish PH!n s eetrack if a garage is to be attached , describe materials to be used for FIRE SEPARATION : 112" type "X" sheetrock Is there to be an opening between garage Jand dwelling? yes If so will a Fire-rated door , enclosure , and self-closing device be provided? yes Willa 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'.I A ft . in . ittici 1 Water supply - Municipal or private well Ea ft - SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties (A separate application isI' necessary for an re air or new installation of septic system) See S . . E . D. S . rsrut # 02�Z52 Town of Queensbury A F F I D A V I T '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 ZONING ORDINANCE , and all other laws pertaining to the proposed work shall be complied with, whether ecified or not , and that such work. is authorized by the 'owner . SWORN To BEFORE ME THIS Signature _ � �=�- -er , owner ' s agent , rc t.+ect , contractor 2 3 day of ° } }k 19 ' ? PAULA CHRISTOPHER y Notary PuI State of Now Yolk } {i Clualified ;n Schenectady County �� CA� L%6 1. No. 4864727 Notary Public , warren Countyr N . Y. , ni Gcinn Expires JErFy7 19t : r sr • > ,� e * . * • * * * Is �, * * * * * it * * door * * it * • * * s. * * * * * * t Is t SPECIAL, CONDITIONS OF THE PERMIT : L TOWN OF QUEENSbURY BARREN COUNTY , NEW YORK A Application for. $ BUILDING PERMIT IN C014PLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . #N$N$Jt ALL of the followings gross floor airea 104(} S . F. 3 . Type of heat Baseboard electric 3 . Is the building mechanically . cooled ? No 4 * percentage of area of windows and doors 12 . 33% A . Over 16 + _ On-ly 1 . U. value of gross area of walls , root /coiling and floors exposed to ambient conditions 2 . Floor over heated spaces YES No a . Are foundation walls insulated ? YES No 1 . It YES , what is the R value ? 3 . Slab on grade YES N.P • a . It YNS , what is the R value of insul.4tion around per ime ter of floor ? 6 . Is basement heated ? YES NO As R value of insulation S . Type of insulation p . Under 16 % only 1 . A value of roof and . tloors exposed to ambient conditions Rem38 2 . -*.- A value of exterior walls )QPQWC R-23 . 5 U* =OoO'++ 3 . R value of glazed area U. =0. 30 d . R value of doors Rt 14 . 9 (U=0 *06) S . R value of floors over unheated spaces_ ___ _ R jq 6 . R value of slab edge insulation - unheated slab N/A T . R value of slab insulation em heated slab 12 . 5 B . R value of heated basement/ cellar walls ( above grade ) N A 90 R value of heated basement/cellar walls ( below grade ) N/A L0 . Type of insulation Fiberglass C . Controls 1 . Thermostat maximums 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 I. R value of duct in other areas N . Piping Insulation N/A 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water bleating 1 . pertora&nee� efficiency NIA 2 . Temperature control setting maximum G . For Swimming Pool Only 1 . Maximum • hsating N/A Telephone No . ( 518) 899-9161 Menem .�- ( applicant • a sign re ) earn df�� . R APPLICATION FOR SEPTIC DLSPOSAL PER1"LIT Ref : S. P.E.D.S. DATE October 7 87 Permit Mom, of c/K New York - 0202525 LOCATION OF PROPERTY FOR INSTALLATION 39 Margaret Drive Owner's. Names C uyer Builders , Inc* - • Telephones ( 518) 899-9161 Address: 119 Dunning Street , Ballston Spa , New York 12020 lastaller's Names GL'3►er Builders , Inc Telephones ( 518) 899-9161 2 A, Cs Es I , Js Ks Ls M Number of bedrooms {s-esidential only) 2 3 Fs G, H r Total daily now (compute 0 150 Sal per bedroom) 300 T9%K1W 1bhYt circle ones lot Rolling Steep Slope 9i of slope Soil Natures circle owes (. -) Loam Clay Other / Depths, 8 ' feet + C OL A Watan At what depth? unknown 8 feet + Bedrock or lzm rvious b"terials At what depth? unknown feet Pescalatsaw tests circle ones not require required / rate sour. inch. EkH=v*stic crater mWpplys circle one; Municip Well Other IF domestic water supply is a Wells Sepauratiaw►s Watersupply from Septic absorption NIA feet * PROPOSED SYSTEMS Septic Tank Sale (minimum sizes 10000 Sal.) TILE FIELD; Each Tirench N/A feet / Total system length N/A feet * SEEPAGE PIT(S)s Number of / Size each feet by feer * Size of stare to be used 0 / Depth or Thickness feet i * i +t +0" * ss * * * e * s * * * �tsss # si * i +M * +ri tisrsai "s * s * * * IJA P O R T A N T * See S . P. E. D. S . o"PleasesooUIST NEW H QUIPMENT TO BE INSTAirj permit & attached * �sa" "sss "sss "r * +s +M * +s * * * * • * +s * rl� sr +s * +1" * * ,ssarsss +IF * ss" * map . (over) section U Septic System imec�ti,onal Ilw. All applications for septic system installation, alteration or repaire as required by the Town of Queensbury Sanitary Sewage Ordnance, shall be submitted to the Building, Department at least 24 hours before start of construction and shall include a plot plan showing** 1.) the propo#ed ,location of the r}ystem ZJ location and distance to lot Mae* 3.) location and distance to structures 4.) location and distance to any Prater supply 5.) size and dimensions of all tanks, distribution boxest file fields and/or drywells B. No system shall be cornered before inspection and approval by the building, Inspector. Failure to comply with this requitmment 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 a€te. 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 Queeusbury Building, Department before further construction. ] bave read the regulation& above and, to ,abide by these a" all req■ Waments of the Town of Sanitary Sewage Vjsposal Ck+dinanc ._. Sig"ture ofxosponW le perswas Date& r S Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 awn Ht►rr_DrNG `-c 'r"re,�ros6urre� snd ZONING DCPAnTMENT Bay and Havifand Road, R. 0. Z Box 98 GlueensburY. New York 128d1 f�'J TLDING INSPECTOR ' S REPO RT + Oca T I ON Date * Perm t F000 t ing/p j er Forms � � APPROVE:,) *- *YES un d t io _` „ NCJ Walter f I n -_ $ackfill g Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves E.7[t - Porches Finished Fl(:aors Tnterior Trim Stairs & Railings Cellar Draln Tile Concrete Floors vi bg • Fixtures Gar . I,'i repre,G,fing I7oor CI os ers Smoke Detector-5 Chimney l INSTJIArlC Foundation � Floors Walls r Ceiling FINAL ELECTaICA INSpECTXOU "RIVEWAY APPROV --- Final Building S rvey Next scheduled inspection Re:narks- (call when ready) 6/E35 �u314ormd.vl BUILDING G and 2f7IVING 0EPAFITMENT $aY and Haviland goad, A. D. 1 8ox 98 QueensburY, New York �2801 BUILDING INSI'EC7QF2 ' S NAME REPORT �. �p COCA T I ON Date* * * * 1°e rm i t IVcr . r of I o�d�9zOn er Forms.,__4_- APPRC7`7ED � 32'ES NoWa ter�'>roof . '�'�---- Rackfill Frarnin9 Roofing Siding Masonry Veneer Rough Plumbing Relief valves Ext . Porches 1`"in ished Floors ~ -- Interior Trim Cell Stairs & Railings Cnn ar. brain Tile ? Crete Floors f l hg fixtures C.ar , vlreProofi Door Closers SznChiomnel7etectoz INSur .ATTC3N : Foundation Flokors walls -. Ceiling FINAL Zr EC ICP I I7VSp 1)RIVE'WAY Ap ECTION Final ROVA Bulld ng SurveY Next scheduled inspects©n Remarks- (call when reaclY) 6lF36 mci-vl $ux ng ins ctor h th JVA With $ ,M1latitf� hat n. 1 :iaeeejCY' tlVQ ocWu r• r lov YcrI�€ 1 electrical �.�aetrical E'4uip ' . . 4oca1 o"�" , S-i 2 e F r& ' Is.c apPlica+ble ent li teq has been Y l-icl YYrY.r[2V goverrr+t�$rtfal rr _: $+a �ePternb I.) !Y'[-x rni exa �4uiam D.J .f v utility $pa �e� and is �r IS I9 70 but p' °'uceexsb `;9ency ru $lalor©very as $ 4 r er e t s y rY u�' {W7 �ocu/'�no les being irr �'•zc �r_ xre r. v �Q ace .ZYlr nz- prry Irho t c eS ° ?� FY x.t U re a Ca Crate +�hnof System nr Nr[o equip �4ac p//Cc7r7P 33 E?2 13 ux k�rfn,•r$Of �u cry of Menr siri"jish *quoF'"nanr �n (agent ore this e., '�Z ,c^,, Li I1Y11 tY d rs xnC s 9pw °"nAanyI ocal r Pff hfit ia an4 sae"'ti�+rrecred r� �� 5, 8 x'@alo me rnAgency. Ana arwrica rxnwo °rw s 1jY -I2 rn� 'oo ar ar0Crr ny% a .'$.W.�,. [7{.O a4uryry�an ar'Rrova4 BUILDING and & zoruI+vc �'E�'aRT+u�rvr Bay and Havifand Road, R. D. 1 Box 98 QueensburY. New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date / FFoundationting/Pier Form,, ✓ * APPROVED - YES * NO Waterprooging Bac]cfill Xpraming Roofing Siding Masonry Veneer Rough Plumbing Relief '[halves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg , Fixtures Gar' Pirepruofing Door Closers Smoke Detectors Chimney c.--xf STULATIaN, Foundation Floors Walls Ceiling FINAL ELECTRS L INSPECTION DRIVEWAY APP VAZ�` Final Building Survey .�. Next scheduled Inspection Remarks— (call when ready) 6/86 rna_yZ 9 ns ctor ,� '�eeeen �hure�r BUILDfNG and ZONING DEPARTMENT Bay and Haviland Road, R. D. 9 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Ilate 41:76 _ 1 � n Permit No Footing/Pier Forms ✓ APPROVELl - YES NO Foundation waterproofing Sack€ill �1 Fraaii ng Roofing Siding Ma.sonrY 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 : Poun elation Floors Walls Ceiling FINAL ELECTRI AL INSPECTI(JN DRIVEWAY AP PR AL Final Build in Survey Next scheduled inspection (call when ready ) Remarks- E/86 and-vl Sua. n nspector mommok BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. I Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME �^���-'1 LOCATION _ BATE G / PERMIT NO. SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? .YES - Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field , total leng Length of each trench �— Depth of reaches Size of g ' SEEPAGE PIT fNutmber of) Size- ft X ft. Gravel' xe PIPSN+G : Size Bldg• to tan ZL, 'e Tank to dis bo {� Dist. box o fiel it _f- --- Openings salad? ES NO Partial LOCATION SEPARATIONS : Poundat on to tank cc3 ft. Founda ' on to absorptio _ft Absorp ion to lot line Separa ion of t ` pits ft. LOCATI N OF SYSTEM ON PROP Front Rear _ ircle one) - Left side / CC1hRMENT ' rght side - C./_./ Y SYSTEM USE APPROVED yE 0 Bui di Inspector O1/86 and vl awn 0/ Queen3hetry BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME cr: LOCATION? 3 49 DateALJ Permit No . / �0*' APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Ven 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 ELECT CAL INSPECTION _ DRIVEWAY AP ROVAL Final Build ng Survey Next scheduled inspection (car+ ll when re !adyy? Remarks- LTG B Wildln: qInspector 6/86 and-vl �Jocvrr rr� �urrerrshur•e�f t BUILDING and ZONING DEPARTMENT ,^ Bay and Ha%dland Road, R, D? i Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPO�RT�, ' / r NAME LOCATION - '� l � 7 G r rZ - / Date /ate / Permit No . � ✓ = APPROVED - YES NO Footing/Pier Forms �undatlon Waterproofing I3ackfiII Praming Roofing Siding Masonry Venee Rough PI %,=bing Relief Valves Ext . Porches finished Floors Interior Trim stairs & Railii �s _ Cellar Drain IN, I- Concrete Flcr rs Plbg . Fixtu es Gar . Firep oofincl Door Clos rs Smoke pet etors Chimney I N S U L.AT I Foundatio Floors Wails NIL Ceiling_ FINAL HIECTRICAL INSPECTION S)RI.VEWAY APPROVAL Final. Building Survey Next scheduled inspection ( call when ready ) Remarks- liuilcfinq 2nspecror r /Rc, and -V1 aeurr o een .s ur r� BUILDING and ZONING DEPARTMENT a-", Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME , r LOCATION -er r, r''L"' 1 Date ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfil. l Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches 11'inished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Vireproofin Door Closers Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling_ FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- , Buil ing Inspe or 6/86 and-vl � ,�..� ! _ �/'�'h �,Ju curt tti� �u ��►t 9 fa u r a� ` y BUILD�NG and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Sox 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT , NAME14o .� LOCATION Permit. No . ✓ APPROVED - YES NA noting/Pier Forms _ nundation Waterproofing Back£ill t Framing Roofing Siding Masonry Veneer Rough Pl ing Relief Va ves Ext . Porc es Finished F oor Interior T Stairs & Ra ings Cellar Ara ' Tile Concrete oa Plbg . Fi ures Gar . Fir proofin Door C1 sers Smoke etectors Chimne INSU LA ION : Founda ion F1007CS Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- pui. le3ing In sector 420c4vrl o/ ueen cured BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.I3, 1 Box 98 C)ueensbury. New York 12801 BUILDING INSPECTOR ' S REPORT r NAME LOCATION Dil o .__/ `6 Permit NO . APPROVED - YES NO (Footing/Pier Forms Foundation waterproofing Sackfill Framing Roof ing Siding Masonry Veneer Rough Plumbing Relief Valves 1.xt . Porches Finished Floors Interior Trim Stairs & 'Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofin Door Closers Smoke detectors Chimney INSULATTON : Foundation Floors Walls Ceiling FINAL ELECT ICAL INSPECTION DRIVEWAY AP ROVAL 'r Final Build i g, Survey Next sclz Willi ul lie cl inspection (call when ready ) Remarks- y Building Inspector 6/86 and-vl BUILDING, DEPT. COPYFILEF APPLICATION FORM 46lEL,THIS COPY WITH BUILDING NEW Yy RK BOARD OF IRE UNDERWRITERS. J,. s CITY OR VILLAGE k I7- TOWNSH s STREET AND NO. DR y hi ~ '` ji ��i POLE N AL ROAD AND POLE NO. n •� !.. . C ROSS STRE E SECTION BLOCK LOT TS IAT S O . PREMISES L TEOT ILOING OCCUPANT'S - tIPANCY NAME OWNER'S NA AND ADDRESSCURRENT SUPPLIED -i:° FROM THEIR OFFICE By DEFECTS BSUILDING !' •NEW OLD IYYSORK NEW .4aJ AbO1T14NAl Q REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED No. of Fbrturr & BRANCH OFFICE USE NUMBER OF OUTLETS Lame Reprptatfes MOTORS HEATERS CIRCUITS ONLY tendowe eh"s er H.P. No. Watt Ne. A WG. INSPECTION cooing Side Atte Side Raop'It. S..ftch Pr-' Browet No. TYPO Each Each Getge ewideE Sub- be sf "Want yet FI. mml FI. 3rd Fill REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE= DO NOT USE THIS SPACE. This appecation ie imendod to sower the abovefisted aquipmant to lee inspactod but if at time of inspection there is found additional equipment not above 'Wed you are autewised to mai.e irwpee.aon and adjust the fae to cover the additional equipment. as Provided bV the appl"Ort, ELECTRIC SIGN TOTAL SITE ,f'' FFEDERS LAMPS WATTS MAINSS 11 CHARACTER - + ^� :"+ - /` v.E OSEO GAS TUBE SIGN OF WORK ! f ? � °a w . / { (, CFALED TRANSFORMERS OF VA WORK TO BE B€ I fCAPACITYI STARTED COMPLETED SIZE12E O SIGN SERVICE OVERHEAD UN Ep R,rwROUND MAKER ENTERS "' OF SIGN BUI ING INSPECTION REOUEST€D "s ( } ON OR AS B NEAR AS !1 ..-�r-t r L .- _ ! NEW OLD I AVOID DELAY BY GIVI NU FULL AND ACCURATE INFORMATION. L SPACES DATE 01F MUST BE FILLED IN OR APPLICATION.MAY BE RETURNED. APPLICATION JE PRINT CANT NA ND ADDNAM // 'S � ,Pi . f,.- l SIGNATURE APPLfC+IkN "� OF APPLi [..,I i/F.3 !4 TELEPHONE # STREET ADbR . p ,{f CITY OR f } / J CODE -� �"'- LICE'EN APP LCABLE POST OFFICE 46 EL (REV. I,/86) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING. 8� 0 DIAMETER .9' 0 DEPTH LOT 33 w1 3 SHUTW MARGARET QUEEN VICTQRWS GRANT QUE-ENSBURY, N.Y. Vito REFERENCE DRAWINGS 5A SITE UTILITIES SEPTIC B WATER VpDUSEN 4 STEVES SURVEY PLAN 0 it 3303St37,39,41,43 MARGARET DRIVE PLOT PLAN 4 SEPTIC SYSTEM GUYER BUILMS, INC. Q.V-17 DWN �-� t Scale : I y W o