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1987-940 AT CERTIFICATE OF OCCUPANCY TOWN OF QUEENSBURY i WARREN COUNTY, NEW YORK i DateNovember 1 14 88 F This is to certify that work reQueeted to be done as shown by Permit No._ 37-94C1 has been completed. This structure may be arracupicKl as a - 1 of Two Family Dwe l l lmn t_ Location 25 Margaret Drive — Queen Victoria ' s Grant i 04w er Guyer Builders , Inc , By Order Town Board 7OW14 OF QU&BNSBURY � r Building & Zoning Inspector i . BUILDING PERMIT TOWN OF QUEENSBURY No. 87-940 iz 0 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Queen V ictoria r s Grant I OWNER of property located at 25 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. .n 1 . OWNER'S Address is j?r?dl3rgxxAs>T[*zl11 Guyer Builders Inc . ro 119 Dunning St . Ballston Spa , N . Y . 12020 C 0 n 2. CONTRACTOR or BUILDERS flame rt Same O rx r- az c� 3. CONTRACTOR or BUILDER'S Address rf Same PO r+ 4. ARCHITECT'S Name 5. ARCHITECT'SAddress kn ri a� W rj 6. TYPE of Construction — (Please indicate by X) ro rr tz( A Wood Frame ( ) Masonry ( ) Steel ( I t7 C m 7. PLAINS and Specifications f No. 26 ' -6" x 35 ' - 7 " as per plot plan , specifications and application including septic system and attached one car garage . MODEL K B. Proposed Use } of Two family ., 0 rh $5 . 00 C / O 88 82 . O0 PERMIT FEE PAIL? -- THIS PERMIT EXPIRES July 1 , 1g $ ,y 0f a longer period is required an application for an extenswn must be made to t h a auiIding and Zoning inspector of the town of Queensbury before the expiration date.l F.a. `C Dated at the Town of Queensbury this ,r3lsst Day ro-f� December 19 87 7f SIGNED BY f u-'4 k L..�.• • �"� �� 7 for the Town of Queensbury Building and Zoning I nspector :L1.1 t7l`. 1, .4l1.LC • •r"-1.,GLJ 0A 93L5.0" . Aw b' i • .. . // Application No . tau --4 - Awn D/ V&00" 51,ury Permit Issued 19 - lr 9UiLDiNG and ZONING DEPARTMENT Permit Expires 19 L x J, Bay and HavHand Road, R. D. 1 Box 98 Zoning Designation ! i Oueensbury, New York 12801 Variance No . (I tjT 1G Site Plan Review No . Approved by der� /p _ APPLICATION FOR .+ w r7 r f ��� � Iq"'fi rG�G7 BUILDING AND ZON I NG PERMIT 'S s� 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 Poo* Address 119 Bunning Street Ballston Spa , New York 12020 Tel . ( 518 ) 899-9161 Property Location : 25 Margaret prjy 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 WORT{ AS REGARDS BUILDING CODES IS : Richard H . Guyer III ( 518) 899-9161 Ngnye P . O. Address Tel . No . Name of builder Guyer Builders , Inc -Address 119 Dunning Street Tel . ( 518) 899-9161 Name of plumber GCjyer LXAVrers , nc .Address m DWIMng Street Tel . - 9161 Name of mason uiuyer Builders3o InCoAddreSS 119 1IIkg 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 REQUIREDBETPW . * Size of property 100± getanp ft g 120 ft . " Existing building ( s ) Size ft Xft . PROPOSED BUILDING AND USE : Model -� *?;' -7" g [T Existing buildings ) Use N/A_ size of new strVilrocle 261 woI x ft Foundation-pierb crawl/partial/full * proposed building , sees� Q�ep m property line one ) 2 ,� Front yard 30+ ft Rear yard 30+ ft No . of stories (habitable space) Side yards 15+ ft and 15+ ft Height {grade to ridge) 23 6 ft . " if on, corner , setback from side street ft If residential , now of families of 2 440 of rooms ( excluding baths) ` 4 OCCUPANCY INFORMATION No. of bedrooms Z * PRIMARY BUILDING - o of bathrooms One family dwelling h • gs� � e f r Primary heating system se ar electric' -- One family dwelling one . Type of fuel Electrfcity _ Multiple dwelling / Number of units Noo of fireplaces to be installed __ * Permanent occupancy Will a wood stove be installed' No * Transient occupancy Central Air conditionings No Business BUILDING STYLE, PRIMARY STRUCTURE * Industrial other Ranch Contemporary I.o cabin * if addition , what will use be? Raised ranch Mansion Duple split level old style Bungalow Cape Cad Cottage [ether * ACCESSORY BUILDING- * Detached garage/one car/ two car/ Colonial Raw Town House car a One car CIRCLE ONE PLEASE �.._Attached garage/one car/ two cr/ ( ) * * * * * * * * * * * * * * * +. * * Private storage building * other ESTIMATED MARKET VALUE OF 7R CONSTRUCTION XNggRMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE of THIS STiEET , 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 8" Depth of foundation below grade (to bottom of footing ) 8"` mininxun. Will there be a cellar? -no Heated or unheated? Floor sqm 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 ft . extexic�r walls Joists ( floor beams) 1st . floor NIA "X •' spacing "'a . c , span IAA ft . Joists ( floor beams) 2nd . floor X�' " spacingJM�"o . c . spar "ft . Overlays ( ceiling beams ) 2 "'X spacing 24 "o . c . spanl2 ' -'E+ ft . Roof rafters 2 " X 1 '" spacing t+ a . c . spanTZ ' -`�'ft . Roof trusses (pre-engineered) spacing. " o . c . spJ'"`;�n-N/A ft . Exterior wall finish stained Of what material? 5 /8" x 4 " x 8 ' teacture 111 Interior wall finish pain s eetrock If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 1 /z" 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 municipal SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties NIA ft . (A separate application is necessary . for an re air or new installation of septic system) See S . P . E . D . S . permit # 026252 Town of Queensbury County of Warren A F F I D A V I T STATE OF NEW YORK 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 spobified or not, and that such work is authorized by the 'owner . 01 SWORN TO BEFORE ME THIS Signature ........ =-__ ___ �- Owner , owner ' s agent , ar narAli -- t , contractor alt�f day of �[-�±l 2c'*� Ig K2_ PAOLA CHHit > iUrrI _,: Notary Pubbc. State of New York � ' ct LL z SsL I a] Qualified in Schenectady County No. A$84'727 Notary Public , War en County, N . Y . ~ CwnmW=ionFj4Nf8sJ4Jly7 18� • IN * * * * • • * . * * * * * ,r * * * : » It * * * * * * * * * to * * * * * * * * • SPECIAL CONDITIONS OF THE PERMIT : r � Zo Se j& OAF a Str TOWN OF QUENNSaURY WARREN COUNTY # NEW YORK application fora BUILDXNG PERMIT IN COkIPLIAKCE WITH THE NEW YORIC STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . + M$Mpfi 71►LL of the followtng : y , • rjEass flour area Type of heat Baseboard electric NEW 1 . 1s the building meohanically .' cooled ? 12633% 40 percentage of area of windows and doors^ _...._..... as Over , 16 % OftlY Is Uo value of gross area of walls # roof /ceiling and floors exposed to ambient conditions. 20 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,0 a . If YES #` what is the R value of insulation around . , . perimeter of floor ? 4 . Is basement heated ? YES No a . R valise of insulation 5 . Type of insulation � . Under 16 ♦ Only 1. R value of roof and - floors exposed to ambient conditions R-38 2 . � R value of exterior walls_ )PAQQMX R-23 • 5 U* =0 . 4+ 3 . R value of glazed area U* =Ow30 4 + R value of doors R-14 . 9 (U�0 .06) x 5 . R value of floors over unheated spaces 6 . R value of slab edge insulation on unheated slab NIA 7 . R value of slab insulation - heated slab 12 . 5 s . R value of heated basement/ cellar walls ( above grade ) N A 9 . R value of heated basement/cellar walls (below grads ) N. A....i 100 Type of insulation Fiberglass C . Controls- 1 . Thermostat maximum heat setting_ 00 DDucSystems 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 NIA I0 Size of hot water or cooling carrying agent pipe 3 . R value of pipe insulation F . service Water Heating 1 . Performance Off' iciG +sacy _ „ / Z . Temperature control setting maximum G . For Swimmin4 Pool only NIA 1 . Maximum • h+satinq dd v Telephone No . ( 518) 894009161 •f ( apgllcant • s s g urel ,r APPLICAUGH FOR SEPUC DISPOSAL PERMIT Ref: S . P. E. D. S . Tg October . 7 87 permit # New York - 0202525 mom K of K/C LOCATION OF PROPERTY FOR INSTALLATION Owner's Name: Guyer Builders , Inc . Telephone: ( 518) 899-9161 Address: 119 M_m n_a Street , Ballston Spa , New York 12020 Installer's Naaaes Guyer Sunders, Inc Telephone: ( 518) 899-9161 2 A, Co Er I , J , K, L, M :dumber of bedrooms (residential only) 2 3 Fs G, H .� Total daily flow (compute Q 150 gal per bedroom) 300 Topaaaphys circle one: lat Rolling Steep Slope 9i'i of slope Saul Nature: circle ones �� Loam Clay Other / Deptht' 8 ' feet + Cw0und Waters At what depth? unknO'wn 8 feet + Bedrock or Impervious Materials At what depth? unknown feet Iisct"olatiou test: circle one: not requir required / rate min. inch. Domvestic ~rater wipplys circle one: Municipal Well Other IF domestic water supply is a Wellt Sep -rations Watersupply from Septic absorption NIA feet * PROPOSED SYSTEMt Septic Tank gal. (m nimum size: 10000 gal.) TILE FIELD: Each Trench NIA feat / Total system length N/A feet * SEEPAGE PIT(S): Number of / Size each feet by nowwwwwwww feet * Size of stone to be used / Depth or Thickness feet * +s i i * * * * * * # * � � �Ir Ir e � e * � �► * e * i s i � i * i # s a' s s s s s s I M P O R T A N T * See S . P.E.D. S . ...Please...LIST NEW EQUIPMENT TO BE INSTAL.LEZ1 permit & attached * * * * s * * ss * * * * * ss * sssssss * * * * * * sss * ens * ss map ' . (over) Section II 'septic System Inspection&$ A. All applications for septic system installation, alteration or repair. as required by the Town of Queensbury Sanitary Sewage C wdinance, shall be submitted to the Building, Department at least 24 hours before start of construction and +shall include a plat playa showing: 1.) the FIropo*ed .locatioU of the gystem 2.) location and distance to lot Lines 34 location and distance to structures 4.) location and distance to any water supply S.) size and dimensions of all tankso distribution boxes, the fields and/or dnywells B. No system shall be covered before inspection and approval by the buildiag Inspector. Failure to comply with this requirement may result in the uncovering of the system by the installer and a fine of up to $2SOvOO. 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 dwripg construction prevent proper installation, alteration or repair of an approved system, a new proposal roust be submitted to the Queensbury Building Department before further construction. I have read the regulation& above and agyee to Obide by these and all requiremestts of the Town of Queerns4uty Sanitary Sewage Dispanal +*_i snceft Signature of.responsible person: pater Town of Queensbury , . Building and Code Department Say at Haviland Road Queensbury„ New York 12801 (518) 792-5832 TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 1,780, TELEPHONE (518) 792--58.32 BUILDING INSPECTOR ' S REPORT REQUEST FO NSPECTIOJV RECEIVED ��r NAME _ �L�„�.�'' " L49CATSON DATE T - pRpjj& # r ` 7- F elU) APPROVED YES FOOTING/PIERS MONOLIT C POUR FORMS FOUNDATI /DAMP-PROOFING BACK-FILL PROVAL ROUGH PLUM G FRAMING ELECTRICAL RO -IN INSULATION: FOUNDATION FLOORS WALLS ILING INAL INSPECTION.- CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ST P STAIRS--CLEARANCE & RA r PLUMBING FIXTURES ELIE VALVE INTERIOR TRIM/PR ACY D „g FINISHED FLOORS GARAGE FIREPRDO ING DOOR CLOSER (S) .SMOKE DETECTO FINAL ELECTRIC INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERT FICATE OF OCCUPANCY T BE OBTAINED FROM THE BUILDING DEPARTMEN BEFORE THESE PREMISES ARE OCCUPIED! 4W INSPECTOR BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R, D, 1 Box 98 ,j Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date / / v Permit No . ✓ - - Footing/pier Farms APPROVED YES NO Foundation Waterproofing B�ckfill uo rami ny Roofing Siding Masonry Veneer Rough Plumbing Relief Values — Ext . Porches ` Finished Floors Interior Trim Stairs r Railings Cellar Drain Tile Concrete Flours I'Ibg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chi ey SUI.ATION : Foundation Floors Walls Ceiling FINAL ELECTRICAL Z SPECTI©N I)RIVEWAY APPROVAL ' Final Building Survey Next scheduled inspection ( call when ready ) Remarks- 4ingI Spector G/S� mc3-V1 -✓ciui+"+ cr� �ueend6ur�y BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. I Box 98 / j Queensbury, New York 12801 -�'ETC1l Lp I hJG INSPECTOR ' S REPORT NAME LOCATION Date_ - ,__/ Permit No . - 4 ✓ = - Footing/Pier Farms APPROVED YES NO Foundation Waterproofing Sack €ill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief valves Ext . Porches Finished Floors Interior Trim_ Stairs & Railings _ — Cellar Drain Tile Cc )ncrete Floors Plbq . Fixtures Gar . 1'i rel)rooPiug Door C,Ioscrs Smoke Detectors Chimney_ INSULATION Foundation Floors_ Walls Ceiling FINAL ELECTRICAL INSPECTION IN{IVEWAY APPROVAL Final Building Survey Next scheduled inspection (calll� when ready Remarks-- `� 1ono. . _ � 1+�.. V 1.++�✓` LV Aui ldi.n Insp+ecto �/!•3fa mt3 -wI , JrJtt�rt o� �trc-^craslaur� 9UILDING and ZON(NG DEPARTMENT Bay and Hiaviland Road, R7 D. i Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATI DATE /c'.._. PERMIT SOIL. TYPE - r _^, r� Loam - Clay - Percolation Test eqlaired ? YES - NO Percolation rate - Min/Inch I TYPE of SYSTEM: Absorption field , total 1 th Length of each. trench Depth of t nclies -- size Of grav 1 SEEPAGE PITS4 umber f ) size- �� ,_fto ft . Gravel size: PIPING : :;ize Bldg , to tank a Type Tank to disc . x -- Dist . box to eld pit Openings sea d? - NO Partial U�ATION/S ARATIONS Oundation to tank -,5- fto oundatio to absorptz n 1= �ft . '!SAbsorpti n to lot line' �r gt . / Separat n of pits CATIO ft. " O %STEM ON PR PEE-gytht (circle one ) F rc3nt Left side COMMENTS . side Coe .3 SYSTEM USE APPROVE YES N Bui ding inspector 01/86 and vi ._./noun o� '�ueens �ur� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D, 1 Box 98 M1 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME l_OCA7ION Date-`�l Permit No . I 7ro ✓ = APPROVED - YES NO Forms Foundation Waterproofing Sackf i l l 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. Fireproofi Door Closers Smoke Detector Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELEC CAL INSPECTION DRIVEWAY AP ROVALL� Final Building Survey Ne.xC schedu-}led 3nspecC3on (call when ready ) Remarks~���'�,�'�'s i ling Inspector 6/86 and-vl awn 0 ~~ � } BUILDINGand/QG DEPARTMENT ay and Haviland Road, R. D_ I Box 98 4] Queensbury, New York 12801 ILDING INSPECTOR ' S REPORT NAME / LOCA T I ON Date Permit No . �g4j0 APPROVED - YES NO Footing/Pier Forms 00" Foundation Waterproofing Backfill Framing Roofing Siding Mason Veneer Rough P ing Relief V ves Ext . Porc s Finished F oors interior Tr m Stairs & Rai ings Cellar Drain Ile LJC+ ncrete Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSU14ATION Foundation Floors Walls Ceiling FINAL ELECTRICAr4 INSPECTIONN DRIVEWAY APPROV Final Building urvey Next scheduled i pection ( call when ready ) Remarks- Bui1 g pec tor 6/86 and-vl l) I I ff f fAl, 0 fIT fown of �ueen �1614rry BUILDING and ZONING DEPARTMENT /7 Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT r NAME LOCATIONr , / Date f/ / Permit No . �1 ✓ - APPROVED - YES NCB Footing/Pier Forms rhKoundat on Waterproofing )( Backfill 1 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 Floors Walls Ceiling FINAL ELECTRICAL NSPECTION DRIVEWAY APPROVAL Final Building Survey_ Next scheduled inspection ( call when ready ) Remarks- Zlw - � Build ng Insppecto 6/86 and-vl `1p BUILDING ana ZONING DEPARTMENT r d Bay and Havifand Road, R. D. 1 Box 98 Queensbury, New York 1280)qo BUI LDING INSPECTOR ' S REPORTT� _� � I NAME .,y� c> i/ -:5� , c LOCATI ( N /� ? Date l/J}�/ Permit Nom /✓ - APPROVED - YES N0 Doting/Pier Forms aVotdidatlon Waterproofing Backf ill. Framing Roof ing Siding masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs 6 Railings Cellar Drain '.Pile Concrete Floors Plbg . Fixtures Gar , Fireproof ' g kk Door Closers Smoke Detec ors Chimney INSULATID Foundatio Floors Walls Ceiling FINAL 'ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- ' Building Inspector C, JRC m � -vl. BUILDING and ZONING DE fl RTME T Bay and Haviland Road , R. 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION rf Date fl : Permit. * ✓* * * * * * * * * * * * APPROVED - YES NO Go noting/Pier Forms Foundation Waterproofing Backfill Framing Roofing siding Masonry veneer Rough Plumbing Relief valves Ext . Porches Finished Floors Interior Trim Stairs & Railin s Cellar Drain T ' le Concrete Flan s plhg , Fixture Gar . Firepro fing Door Closer Smoke Detec ors Chimney IN suLATION . Foundatio Floors walls Ceiling FINAL EL CTRICAL INSPECTICSN� DRIVEWAY APPROV Final Bulilding Survey when ready ) Next scheduled insp ection (call Remarks- Building Inspector 6/8b and vl I. D OF F BUILDING DEPT. COPY O APPLICAT IS COPYION FORM VVI BUILD NG NEW YWHENRERD;RED IRE UNDERWRITERS, f CITY OR COUNTY Warren VILLAGE TOMRVSIfIP STREET AND NO. 01% POLE NO. ROAD AND POLE Ill 25 Yjar et DIVA BETWEEN WHAT TWO BL�K LOT CROSS STREETS IS qpq CROSS EMMES LQQ&VEQ7 OCCUPANT'S 6CC71.IPANGY NAME OWNEROS NAME ADDRESS 1� LdIders Im jig pLumika Street TEL. # 899"9161 AND . :- " 4: �':ice.-x;:./ OFFICE SUPPLIED �.,:' .- FROM THEIR ':,,,;:.e BY DEFECTS BUILDING i, IIWOVIK B r; NEW C$ OLD C� Is NEw REMOVED ADDITIONAL L7 LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED Na. of Fbiterla A HEATERS CIRCUITS USE NUMBER OF OUTLETS LownP Reelptmagaii ONLY °I0" side Att mwo Swig" rondalrl Braebat ha Tye Eauft N° �+3wr INSPECTION 001111111111 wen Raosp'h oat- smu 31Ar bar awoa Iaent !at Ft. 2nd FI. 3rd H_ REMARKS:. LIST OTHER ELECTRICAL QEVICES NOT S£T FORTH ABQNE' DO NOT USE THIS SPACE- This ae "Ib:an id TiS nwkd to ewe* the a mid a•listed a4U'IPMMt xa M insph"off od but :1 at xfsrread InsP+ct:en see :s ue addieiarnal apuiFtne++s not above listed, yrn, xa suMorized w mak* xlte irupacxiln and adjnsx t1+! lee w ewer the add+t6unY pnipweniL 1�t'eltd� TOTAL 512E OF �I ELECTRIC SIGN WATTS MAINS 50 �'e FEEDERS L/IMM^ 1 VXME SIGN CHARACTER POSED OAS CONCEALED TRANSFORMERSOF VA OF WORK C INLIMBERI (CAPACITY) WORK TO BE COMPLETED SIZE OF SIGN STARTED SERVICE OVERHEAD UNDERGROUND MAKER ENTERS O Swim F Sm BUILDiN INSPECTION REQUESTED OLD El ON OR AS NEAR AS _.�.t 9 NEW POSSIBLE Can AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES DATE OF MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION.J• PRINT NAME AND ADDRESS 1/ SIGNATURE MAME OF �^ 'FYs'I ' [ dim A OF APPLICANT APPLICANT 89"�I 11 STREET ADDRESS �i9 D1!'Ie'ii 7lO S},��t _TELEPHONE # iili , � � ZIP 4 +ivvR�'! LICENSE PL CITY OR 1L�LlIJs• MIHEN APDLMCABLE POST OFFICE .B LL inEv. I/ae1 A SEPARATE APPLICATION MAST BE FILED FOR EACH SEPARATE BUILDING QUEEN VICTORIA'S GRANT QUEENSBURY, NY 2000ga1, I 1 LOT 21 W� Q �t SHUTOFF 1 105.06 MARGARET 8� 0 DIAMETER 9'- 0 DEPTH CLEANOUT TO GRADE ._ 102.00 .._ .,.. 110.00` _ T DRIVE REFERENCE DRAWINGS 5 t; 5A SITE UTILITIES SEPTIC 4 WATER VonDUSEN 4 STEVES SURVEY PLAN 21, 23125,2 029, 1 MARGARET DRIVE VGG T PLAN 4 SEPTIC SYSTEM YER BUILDERS, INC. av- 16 N ; 4q o, ,1-87 Scole : 1"- 20`-0