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1987-944 .r,r -e n ....,.- ,. .rT'"?"n�'+:'F•' .ya�s..-..: . : .; .:,..�"w. -_ :r.-:: �":..'�.sr<.: ,. . :"R.:� .., � a i 3 CER.TIFIC 7 . OF OCCUPANCY � TOWN OF QUEENSBURY j WARREN COUNTY, NEW YORK i ' Date September 28 Iq SS I _ D VI This is to certify that work requested to be dune as shown by Permit No. 87 -944 has been completed. This structure may be occupied as a o Twoami3y Location 33 Margaret Drive - Queen Victoria' s Grant Owner Guyer Builders , Inc . � By Order Town. Board TOWN OF QUEENSSURY I Building 6 Zoning Inspector i ` BUILDING PERMIT TOWN OF QUEENSBURY � No. 87-944 WARREN COUNTY, NEW YORK 0 PERMISSION is hereby granted to Queen Victoria ' s Grant I OWNER of property located at 33 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 Quaensbury Building and Zoning Ordinance_ 1 . OWNE R*S Address is Guyer Builders Inc , .d 119 Dunning St . Ballston Spa. , N . Y . 12020 c r 2. CONTRACTOR or BUILDERS Name rt Same o r{ r+- w ar 3. CONTRACTOR or BUILDER'S Address �-S Same rr 4. ARCHITECT'S Name W w 5. ARCHITECT'S Address ri 04 Aa ti f� B. TYPE of Construction — (Please indicate by XI rr CJ ]Ax ) Wood Frame I I Masonry I i steel i I N C ro 7. PLANS and Specifications No. 34 ' x 43 ' as per plot plan , specifications and application including septic system and attached one car garage . MODEL L 8. Proposed Use � :j OF Two Family 0 a 75 . 00 July 1 , 1988 $ PERMIT FEE PAID - THIS PERMIT EXPIRES Ilf 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 date.) F. Dated at the Town of Queensbury this 31st Day of ,, �/� December 19 87 SIGNED BY G! - z '°� for the Town of Queensbury Building and Zoning I nspector TO BE COMPLETED BY BLDG. ONYT . awn No ,omw .Dawn a/ Q" eign ig"r y Permit Issued 19 BUILDING and ZONING DEPARTMENT Permit Expires 19 Lr� '.. _. Ba and Ma�iiand Road, R.D. 1 Box 98 Zoning Desi nation y g g Queensbury, New York 12801 Variance N© . UT � - ��+� t Site Plan Review No . _ Approved by : APPLICATION FOR {�t d'�� ao��� • cofley�&- e�l A4e CA 5-•aa BUILDING 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 . P. O. Address 119 fining Street Ballston Spa , New York 12020 Tel . ( 518 ) 899-9161 Property Location : 33 Marraret Drive Tax Map Now 121 / 1 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 He Guyer III ( 518) 899-9161 Name _ _. P . O. Address Tel . No , Name of builder Guyer Builders : Inc •Address 119 Dunna.ng Street Tel . ( 518 ) 899-9161 Name of plumber Yer Mulders , nc .Address StreetTel . Name of mason Guyer rs , Inc -Address 119 Dwuilng Street Tel . - 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 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 VEW . * sire of property 100± p pllf;tt X 120 ft . * Existing building ( s) Size ft X�'`ft . Model L PROPOSED BUILDING AND USE : Of FIT • * Existing buildings ) Use - N/ A, Size of new struc a 34 ft x 43 ft Foundation-pier slab crawl/partial/full * Proposed building , sddisttanncepfrnom property line Plotcircle one ) * Front yard 30+ ft Rear yard 30+ ft . No * of stories (habitable space ) 1 Side yards 15+ ft and 15+ ft Height ( grade to ridge ) 21 ' _000 ft - If on corner , setback from side street ft If residential , no . of families I of 2 Noe of rooms ( excluding baths ) 5 OCCUPANCY INFORMATION �STo6 of bedrooms 2 Ro . of bathrooms I PRIMARY BUILDING - *rims heating s stem se ar el ectri & One family dwelling This simrgk type r'Y 9 Y * -�Zy,ro family dwelling of fuel Electricity * Multiple dwelling / Number of units Noe, 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 ) * _Attached garage/one car/ two car/ 2ne car Private storage building ESTIMATED MARKET VALUE OF " Other CONSTRUCTION INFORMATION ON - BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , TO BE COMPLETEDI Form SPA 4/8+6 and-vl WAWe 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 8" Depth of foundation below grade (to bottom of footing } 8" 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 port * 1 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 ft * eaterAor walls 3oists ( floor beams ) 1st . floor NIA "'x spacing "o . c . span N/A ft . .foists ( floor beams ) 2nd , floor _ -_ mix t spacing ti: "o . c . spanN A ft . Overlays (ceiling beams ) "x " spacing 24 "o . c . span N/A ft . Roof rafters 2 "X l "' spaci--ng4 0 . c . span 12 ft . Roof trusses (pre-engineered) spacing� "o . c . span 43 ' ft .. Exterior wall finish stained Of what material? 5 /80 " x 4 ' x 8 ' texture 111 Interior wall finish paint 112 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 Land dwelling? yes If so will a Fire-rated door , enclosure , and calf-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 `IIIIN 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 NIX ft . (A separate application is necessary II for an Y repair or new installation of septic system) See S . P . E. D. S . permit # 02U2525 A F F I D A V I T - ---- Town of Queensbury -W.----- . - ATE 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 donelon 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 ified or not , and that such work is authorized by theeowner . SWORN T40 BEFORE ME THIS Signature_ • �� _ Owner , owner ' s agent , a n t, contractor S K;# day . of GE ^� t Y 19 9q PAULA CHRISTOPHF.R Notary Pubic, State of New York � Qualified in Schenectady County Notary Public , Warren County , N . Y . Commissi Non Expires xpiresJuly 7 199 to s w • s • r �► . * * +� # s w * r * * yr * * * * * * w * * * Or * * * • • * * * s SPECIAL CONDITIONS OF THE PERMIT : 963 Square feet JIVUIg - - - 288 Square foot garage - one stall 1224 @ $7 . 00/100"sor part of . §5 . 00 One stall garage $5 . 00 Cf0 permit Total ................................ ____ TOWN OF QUUENSBURY WARREN COUNTY . NEW YORK Application foci BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE a permit must be obtained before beginning work . awswNR ALL of the fallowing $ Est : � • Cocoas floor area 936 S . F. ? . Type of heat Baseboard electric 3 . Is the building mechanically cooled ? NO 4 . Percentage of area of windows and doors 15 . 9% A . Over 164 Orkly la I Uo value of gross area of walls , roof/ceiling and floors exposed to ambient conditions 1 . Floor over heated spaces YES NO a . are foundation walls insulated ? YES NO 1 « If YES . what is the R value ? 3 . Slab an grade YES N,G a . If YESE what is the R value of insulation around perimeter of floor ? 4 . Is basement heated ? YES No a . R value of insulation so Type of insulation A . Under 16 . Only 1 . R value of roof and floors exposed to ambient conditions, Reft38 U'. =o . 026 11 2 . R value of exterior walls XXXXX R-23e5 U. =OoO4+ 3 . R value of glazed area U• =0 . 20 4 . R value of doors R-14 . 9 5 . R value of floors over unheated spaces � N/A 6 . R value of slab edge insulation -- unheated slab NIA 7 . R value of slab insulation - heated slab 12 . 5 8 . R value of heated basement/cellar walls ( above grade ) N A 90 R value of heated basement/cellar walls ( below grade ) NIA Joe Type of insulation Fiberglass Co Controls 1 . Thermostat maximum heat setting p . Duct Systems N/A 10 is duct system installed in unheated spaces ? YES No a . If YES , R value of duct installation be 1, R value of duct in other areas E . Piping Insulation N/A 1 . Size of hot water or cooling carrying agent pipe 3 . R value of pipe insulation F . Service Water Heating 1 . Performance efficiency MW N/A x 3 . Temperature control setting maximum G . For swimming Pool Only 1 . Maximum heating NIA Telephone No . ( 518) 89"161 ZL2=z� ( applicant ' s si ture ) • T APPLICATIOW FOR SEPTIC DISPOSAL PERMIT Itef: S. P.E.D.S. "drX October, 7 , 87 permit # New York - 0202525 ` tjo= of LIE LOCATION OF PROPERTY FOR INSTALLATION 33 Margaret Brine Owner's Name: Guyer Builders , Inc . Telephones ( 518) 89"161 Address: 119 Dunntng Street , Ballston Spa , New York 12020 Installers Name: Guyer Builders , Inc Telephone: ( 518) 899-9161 2 A, C, Es I . J , K. L. M ,Number of bedrooms (residential only) 2 3 F, G, H • Total daily flow (compute @ 2SO gal per bedroom) Sao ToFaprapbys circle ones lat Rolling Steep Slope % of slope SoU Natures circle oae: Saari Loam Clay Other / Depth: 8 feet +, Cwound W&ters At what depth? unknOwn 8 feet + Bedrock or Impervious Materials At what depth? unknown feet Pwrcoaatioa test: circle ones not require4 required / rate mine inch. EkuDestic water samP19s circle nne: q Municipal Well Other IF domestic water supply is a Wells Separatloat Watersupply from Septic absorption NIA feet * PROPOSED SYSTEM: Septic Tank gal. (mul imum size: 1.000 galJ TILE FIELD; Each Trench N/A feet I Total system length NIA feet * SEEPAGE PIT(S)s Number of / Size each feet by feed * Size of stone to be used / Depth or Thickness feet arar * * * ararsaresrs * ac * iar * ar * ae * ar * arar * s� �se * arars * arararararar IMPORTANT * See S . P. E.D. S. ...Please...LAST NEW EQUIPMENT TO BE INSTAT -1r permit & attached r� araR �ia� s * * * iiaR ♦ agar * arMR ai �i �RrR * a� ararsararara� sars * a� �tsa� * map (over) Section U Septic Sxstem imectionss A. All 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 showing: 14 the propoped •location of the 14yatem 2.) location and distance to lot 4nesw 3J location and dist"d7a ltdstructures 4.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, tile fields and/or drywalls 8. 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. C. An approved copy of the plot plan shall be available an the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems duriau�g 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 r+egulatoas above awl agree to abide by these slid ail requiremrseota of the Town of Queemabury Sanitary Sewage Dill Ordinan"e Signature of.responsxible person: hate= Town of Quemmbury Building and Code Department Say at Haviland Road Queenabury, New York 12801 (518) 792-5832 gown o� �eeeQnshur� BUILDING and ZONING DEPARTMENT Bay and Haviland Road. R.D. 1 Box 98 pueensbury. New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION'. r Elate_! Permit No . h APPROVED* -* YES* NO Footling/Pier Forms Foundation Waterproofing Ba.ckfill Framing Roofing Siding Masonry Veneer - Rough Plumbing elief Valves xt . Porches finished Floors _ --- „ nterior Trim fairs & Railings ellar. Drain Tile oncrete Floors 4}1b9 . Fixtures kc r . Fireproofin r Closersoke Detector.r mney INSULATION : Foundation_ Floors Walls Ceiling FINAL ELECTRICAL INSPECTION _. I)RIVEWAY APPROVA�- Final Building Survey [Next scheduled inspection (call when ready ) i�etnarks- �� Building Inspector 6/86 xnd-VI MIDDLE DEPARTMENT .INSPECTION AGENCY, INC. 900 Haddl m Avish 4640"ti -0610* x -mow , may.. September 21 , 1988 rt - Data Cc rt- A l` Ccr�tifleo that the electrical equipment Iisted has been examined an ' is approved as being in accord with the National Electrical Code, applicable governmental, utility and Agency `r Iles, Owner: Guyer Builders , Tale Occupant: Single Family 1 ' + Location.' 33 Margaret Drlve , tlueextsbury (Warren C0 ,5 �e Ge 111eete COwdrY thRtileCwa ipmeni and malellalion inspa maaled This date It aedit,onel eOulpment ,shtllrid be introducetl or aHerations msde t0 ex.islinp system this certtfwate shot, be null and void, and aPPlicalion tar inspection should be submittl6 prpruplly to this Ape+mcy. Equipment: 79 Outlets ; 44 Receptacles ; 15 F Lx tru-re a ; � k'IHdlder of this certlhcste should pTibent same to his prppeny insurance csarier 1 �p Service ; ,� Appliances � l i arc e S iagent of compsnyY es svitleNYce aA Ceti ificatian oteiectrical equ,Rment approved as spscdied. f yd. r Guyer Builders Inc 119 Dunning Street. No. 15 -023851 Applicant: Ballston Spa , ICY 12020 BUILDING and ZONING pEPARTMENT Say and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME fIvIvX LOCATION i7ate�?5{_la Permit No i APPROVED - YES Footing/Pier Forms Foun dat i.on Waterproof ing Backfill Framing Roof ing siding Masonry Vene Rough Plumbin Relief Valves Ext . Parches Finished Floors Interior 'Trim stairs & Railings Cellar Drain T±l Concrete Floors Plbg . Fixtures Gar . Fireproo ing Door Closers Smoke Detec rs ChimneY `-' l INSULATION Foundatio Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL rvey Final Building ection (Gall when ready ) Next scheduled insP Remarks- gixi in I spector N/86 and-vl awn Of QjAee,nshury BUILDING and Zot4ING OEPARTME g Box 96 T ay and Viav+4and Road,York i Cpueenshury. f3e�'1 Yorki2$Cli BUILDING INSPECTOR ' S REPORT NAME LOCATION / permit No . Date_ r — " * APPROVED - 3E No Footing/pier Form g.oungatian ,Waterproofing E Llgxfill ing Roofing siding Nlas Veneer ugh Plumbi Relief Valves Ext . Porches Finished Floors Interior Trim Stairs s& Railings Cellar Drain 'Tile Concrete Floors pjbg _ F ixtures Gar . FireProofing Door Closers Smoke Detectors Chimney IN Su l'AT I ON Foundat:3 on Floors Walls Ceiling r L INSQECTIDN� ---- FINAL ELECTRI - DRIV'EWAY ALPPR4 AL rvey — Final Building Next sche duled inspection call when ready ) '" Bui g peetor 6/86 and-vl Cj1R B¢lZ�Dft / 0 Q� I3ff1" QSPAF�-VAR -T jk UILDING and Zo R p . 1 Box 95 Bay and "01I nd New York 128OA QUeensbury, SEPTIC a;SpOSAL SYSTf�"1 TNSPECTI09�1 J NO Sand Loan YEra _ I o SOIL TYPE Test- -I red? Pexc©la xate _ p+lin/xx,Ch F exoola TYFf, of SYSTEK6 l 1 If px,�orption ield . tote th th o£ each trench -Leng treriches rmpth a ravel . f) Size of 9ITS•ENuanhQr -- - � --- Size^ `--��'Type a Gravel Size r Fxp113G to to r *Tank to dis ieldlPii- paxti� a~ 17i5k . box to YES V0 pP , ing sea p,7RR 1(3I35 r23 f t. LOCy 'TxOt3/S to t X If Ito IF ndatio tQ as. Lion t. Fo�ndaCi to lot Ttie �� ^ft. n A]pSoxpt _�--�-� Cle one) Separa on o SYsi'T FRCJFE h� side ��,TI e de -- Itiq gax - Left $ Fronts CCF Ts ' / I35E APF�EI7 .�.� SYSTE14 gui 3i snspectc+x 01-/g6 and vl MENT BUIl ,otNG and ZONING oSPARTg Bo 98 Bay and Haviland Ro YorlcM AB Oueenshury, New 01 BUILDING INSFECTOR ' S REPORT NAME LOCATION K� +� permit No . �ypPRpVED L3C] rootinq/'Fier Forms L' Foundation waterproofing t3ackf ill 1^raminIg Roof ing Sidi%1 ,Masonry Veneer__ ---- gaugh Plumhin'911 � Relief valves�� �-� - Ext . porches Finished Floors Interior Trim Stairs &. 'Railings Cellar Drain Tile Concrete. Floors Plbg . Fixtures Gar _ Fireproofing Door Closers Smoke Detectors Chimney IN SULATT O'4 Foundation Floors Walls Ce it inIg PECTION FINAL FLT�CAL IN DRIVEWAY ApPROVA ~ Final Building Sure y ectian (call when ready ) Next scheduled i(ns L coo All ibs Evil ing Inspecto 6/936 and-vl flow" (Ace " 3tt4r!f BUIL.OtNG and ZoWNG DE RTKAE T Bay and Haviland 'Road , R- cja Queensbury, New York 128(]1 BUkLD1NG [ NSPECT0Ris REPORT NAME LOCATION pte�_ 5--"3 _.L1 h q---I tmj. Tao Pe * - * * * * * * No * * * * * * �tPPRC)V V.D - yES Footing/Pier Forms �L�c�undation waterVlrlof ing � 8aclsfill "' Eram� ng Roofing Siding Masonry Venee Rough Plumbing Relief Valves.___: Ext . porches Finis'ned vlQor ` Interior Trim stairs & Rail Cellar. Arai Tile concrete - F oors,--- -- ures Plbg • Fz roofirI3_�--- Gar . Fi P r)oor C Ise S____- ..�---- Sm.K+e e t ec tO rs.__,___��---_-�--- Chiron 114Sl3 TICK Found Lion Floors Walla Ceiling CAL INSPECTION - FSNAL k'.LjICTRS ~� k]RIVEwA`j A.PPRdVAL'-�'� Building Survey pinal dill when ready ) exr scheduled inspection t n ��f-� 1 Remarks- _T-� Lau i ldin<3 Ins�?�=ctor E,/86 and-vl C`s N CG DiEF � ft MV- BUILIMN�G and � Box '38 r! Bay and Havitand goad, 12801 aueensbury• su � �plN � NSQECTOP I s NAME L-OCAT ION If Pexm3L Vol — --- pr7tB ` ES NO /Fier F©rzas yyr,dat ion WaterPrc>Of ing 'aac3tf ill goq f incj Sidins3 Vene r Mason pluxabin Fsaug�"+ Relief Valves Ext . porches finished Floors Interior `Tr}'m ---- Stairs s. Railin �- Cellar Dra" Concrete Floti sue- --- Fl1oS - Fixtur s_-- -pirep'r ofin5 Gar . 00ONr Close s s smoke Oct ctor Chimney IssulAAT ON - Fqu.nda- an gloars Cell in ELECTRICAL INsprCTiOISI �---- ION Jim pinal� gui ding 5urve�' ectlon (call- wS3en Yeady )� tyext scheduled fyuil.din9 ;-r's��ector FILE THIS COPY WITH 13UIILDING D6PT. WHEN ggC1111REd. BUILDING DEFT, COP Y OF APPLICATION FORM 0.fr-EI NEW YORE BOARD OF FIRE LytyDERWRITER PATE TEMIN P, fI y l r - i J COUNTY CITY DR .'✓ .. -.�- ' --yy '\.� l._... W LLAGE .� ,r�"-.i. _ f r : PIryLE 140. SYRE£ Nil T AND NO- OR . f . . J Ili ' - LDT ROAD AND POLE ND. BLOCK SECTION BETWEEN WHAT TWO _ CROSS SIRE Eivis IS 1\13ulLD$ NCY PREMISE 1 OCCUPANS f- TEL- T NAM£ ` :+ d L 41 `7 A/ - . I- OWN£R'SNAME , .t � J _ OFFICE AND ADDRESS # 3 . I FROM THEIR r .. DEFECTS SLMWiIED WORK REMOVED ❑ 6Y NEW ApD1 . AL ❑ evILDING ly OLD IS is LIST BELOW ALL EQLIIpMENT y@Ii1Cii YQU 1 STALLED RANCH OFFICE USE NL�Rotedr MOTORS HEATERS CIRCUITS ONLY NUMBER OF puTL£Ts A.w.c. INSPECTION H.P. No- E� No. GMaOa two Geuiaw ■id* R�^Is SwNeh itiatdatrl SreeMet No. Type £aah Out- Oida Suir hw now mans Tat F1. 2nd FI. lid FI- DO NOT USE THIS SPACE. REMARKS: LIST OTHER ELECTRICAL DEVICES SPACE- NOT SET FORTH ABOVE: bon there is found edditional aAeipmeM not a4ow listed, ent to be inyPea.ted bill it et un.o oE��deel ii the apP"cani- tn cover the +Ito'+a-Intsd equipment additional equiPwnt• TOYAL Thrt AliCatian '_' 'mended die - Lion and adiuet the fee to caner t1.a ELECTRIC SIGN WATYS you are aatheaisa f t0 ma LAMPS SIZE OF �` FE£DE VA XPOSED MAINS � NCEALED GAS TUBE SIGN . Tr TRANSFORMERS OF yCAPACITYI CHARACTER S �" . 1 INUMSERI OF YWORK j FTCOMPLETED S12E OF SIGN WORK TO S ROUND MAKER STARTED UNDE ERFI OF SIGNFICTEIRS New �} SERVICE OVEAD i OLD A.� INSPECTION RE OU ESY } F'{ / ,,� NilDAYE OF ~~` ON OR AS NEAR AS 1 1 f 1 SPACE pOSSISLE APPLICATION AVOIUMUST RE FAILL£G Ipll OR APPLICAT QN MAY B£ RETUpINEDTIO ALLSIONATURE _ I? ADD - ss r , ' -� NO . . OF APPLICANT .-!i ! PRINT NA !I` " .tom ],..9✓ �,5� `f,J�' " NAME 0' APPLI NY �� ! .,/ .,{ '4''�- TELEPHONE LICENSE NO. STREET ADDRESS t ODEf 1 /rMl1'IEN APP4lGARLE CITY OR ' ` I POST OFFICE a6 e� (REV. tYf56S A SEPARATE APPLICATION Iyi1UST SE ILEi) FOR EACI'I SEPARATE gt,y{LL}IN 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