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1987-937 Ll rx; - tt i I l CERTIFICATE OF OCCUPANC`Y' TOWN OF QUEENSBURY I WARREN COUNTY, NEW YORK I i Date .Tula' 27 , 19 88 1 ` { 87 --937 This is to certify that work requested to be done as shown by Permit No. 1 has been completed. Eof Two Family Dwelling j This structure may be occupied as a C lXOcation 19 Margaret Drive - Queen Victoria ' s Grant i Owner Guyer Builders , Inc . 4 By Carder Town Board TOWN 4F QUEENSBURY I Building & Zoning Inspector i s BUILDING PERMIT r TOWN OF +QUEENSBURY N©. 87-937 4 WARREN COUNTY, NEW YORK C> PERMISSION is hereby granted to queen Victoria r s Grant OWNER of property located at 19 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 Queensbury Building and Zoning Ordinance. C so 1 . OWNER'S Address is Guyer builders Inc . p 119 Dunning Street c Ballston Spa , N . Y . 12020 R Q 2. CONTRACTOR or BUI LDE R'S Name "t Same ' 4`r 3. CONTRACTOR or BUILDER'S Address Same 4. ARCHITECT'S Name 5_ ARCHITECT'S Address W �t 04 w 6. TYPE of Construction — ZPlease indicate by X) n ( x) wood Frame f ) Masonry l 1 Steel [ ) `-S C fo 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 %XHH } of Two Family Dwelling 0 75 . 00 $ PERMIT FEE PAID --- TEAS PERMIT EXPIRES July 1 } 19 $�` 0 0f a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Oueensbury before the expiration date.) I-� 31st December $7Ole r' Dated at the Town of Queensbury this Day of _79 SIGNED BY Q - ---___'For the Town of Queensbury Building and Zoning I nspector 0tworic, . TO BE COMPLETED BY BLL]G . L1L"'1• .V . +-1r Application No . 0"Oen 0/ Q"eend Mry Permit Issued 19 SUILOiNG and ZONING DEPARTMENT Permit Expires i - Bay and Navi(and Road, R.D. 1 Box 9$ zoning Designation Li _ i - 0usensbury, New York '12801 Variance No . 0CT J - 1097 Site Plan review No . r Approved by : APPLICATION FOR � ���'i� _e. BU I L.D I NG AND ZONING PERMIT * . * * * 0 * * * * * * * * * * * * * * ::. 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 Duming Street Ballston Spa , New York IZO20 Tel . ( 518 ) 899-9161 Property Location : 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 ( 518) 899-9161 Name P. D. Address Tel . No . Name of builder Guyer Builders , Inc -Address 119 Durazing Street Tel . ( 518) 899-9161 aaaaaaaaa,Name of plumber G2yer Builders , InceAddreas ng NtrEet Tel . Name of mason yer erS , nC .Address ng ree Tel . - NATURE OF PROPOSED WORK : ZONING INFORMATICN : 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 $EeW . * Size of property loot i�ganpllfggt X 120 ft . * Existing building ( s) Size ft X N/K ft , PROPOSED BUILDING AND USE : M°o`fl FIT . * Existing building ( s ) Use NIA Size of new struc e c34 ft X 43 ft line " Foundation-pier slab rawl/partial/full ' Proposed building, disc nce rom property crrcle one ) * see plot plan No . of stories (habitable s ace ) 1 r Front yard 3C}+ ft Rear yard 3[}+ ft . Height ( grade to ridge) 2P 04$ ft , * Side yards 15+ ft and 15+ ft If residential , no . of families of 2 * If on corner , setback from side street + ft No. of, rooms (excluding baths ) "— " OCCUPANCY INFORMATION No. og bedrooms � — No . of bathrooms * PRIMARY BUILDING - }, Se board a ectric* Drre family dwelling This �e bu nl in r Primary heating system * � Two family dwelling One s Type of fuel Electrlclty * Multiple dwelling / Number of units No . of fireplaces to be installed Permanent occupancy Will a wood stove be installed? Na 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/ ne c Car Private storage building ESTIMATED MARKET VALUE OF " Other CONSTRUCTION $ 0 / 00,9 Ii+ VORMATION ON BUILDING SPECIFICATIONS . ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETEDI Form BPA 4/86 and-vl BUILDING .PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of ConstxuCtion , 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 $" Depth of foundation below grade (to bottom of footing ) mittirrnun 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 ' ? sq.. ft . - - Type of use? Type of roof - sloped flat/s d hed/other Material of roof Fiberglass shingles' Size , wood stus "X spacing 24 "o . c . length 8 ft . exterior walls Joists ( floor beams ) lst . €loon N/A "X spacing. "o . c , span N/A ft . Joists ( floor beams) 2nd . floor �"X spacing "o , c . span N A ft . Overlays ( ceiling beams ) "x go spacing 24 "o . c . span N/A ft . Roof rafters 2 "x 1 " spaciY ng 24 O . C . span 12 ft . Roof trusses (pre-engineered) spacinn "o . c , span 431ft . Exterior wall finish stained Of what material? 5/8" x 4 ' x 8 ' 'texture ll1 Interior wall finish paln 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 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 municipal SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties 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 A F F i D A V I T STATE OF NEW YORK ry Warren Warren, County off 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 s ified or not , and that such work is authorized by the '6wner . SWORN TO BEFORE ME THIS Signature -Owner owner ' s agent , a nizect , contractor �I r day of � . � .y' 19 PAULA CHRI970¢ 4ER Nora+y Public, State of New York I� n o.ual'#led in Schenectedv County I " Y GI Ltllt _ t1 y�r :c2�+ z No. 4864727 exnrnission Eacpires JuMv 7 i9 Notary Public , amen County, N . Y . SPECIAL CONDITIONS OF THE PERMIT : TOWN OF QUEENSBURY ,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 heat Electric baseboard 3 . Is the building mechanically - cooled ? No 4 . Percentage of area of windows and doors f2 . 1 A . Over 16 % Only 1 . Uo value of gross area of walls , roof/ ceiling and floors exposed to ambient conditions 2 . Floor over heater] 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 8 . 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 Uo =0 * 04± 3 . R value of glazed area U . =0 . 30 4 . R value of doors R-14 . 9 (U . =60 ) \ N/A 5 . R value of floors over unheated spaces 1\ 6 . R value of slab edge insulation - unheated slab N/A 7 . R value of slab insulation - heated slab2 . 5 8 . R value of heated basement/cellar walls ( above grade ) NIA 9 . R value of heated basement/cellar walls ( below grade ) N/A 100 Type of insulation Fiberglass C . Controls 1 . Thermostat maximum heat setting D . Duct Systems N/A I . 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 . Pining Insulation NIA 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating N/A 1 . Performance efficiency 2 . Temperature control setting maximum G . For Swimming Pool Only N/A 1 . Maximum heating B Telephone No . ( 518) 899-9161 ( applicant ' s si ure ) too APPLICATION FOR SEPTIC DISPOSAL PERMIT Ref : S . P . E . D. S . DATE October 7 / 87 permit ##' New York - 0202525 MODEL M of I/M LOCATION OF PROPERTY FOR INSTALLATION 19 Margaet Drive Owner's Names Guyer Builders , Inc . Telephone. ( 518) 899-9161 Address: 119 Dunning Street , Ballston Spa , New York 120ZO Installer's Name: Guyer Bu lders , Inc Telephones ( 518) 899r9 'h1 2 A, C , E, I , J , K, L, M Number of bedrooms (residential only) 2 _ 3 F , G, H • Total daily flow (compute Q 150 gal per bedroom) 300 Top+ogr-apbV. circle one: Flat Rolling Steep Slope 96 of slope Soil. Nature: circle one: Sand Loam Clay Other / Depths 8 ' feet + Ground Watere, At what depth? mow 8 feet + Bedrock or Impervious Material: At what depth? unknown feet Percolation tests circle one; not require required / rate min. inch. Domestic water supply: circle ones Municipa�Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption N/A feet * PROPOSED SYSTEM: Septic Tank gal. (minimum sizes 1 ,000 gal.) TILE FIELD: Each Trench NIA feet / Total system length N/A feet SEEPAGE PIT(S): Number of / Size each feet by feel * Size of stone to be used # / Depth or Thickness feet * * s * * sssssss * s * sss * * * s * sssss * ss * ssss * * sss I M P O R T A N T * See S . P. E . D . S . ...Please...LIST NEW EQUIPMENT TO BE INSTALLED permit & attached map . (over) { Section U Septic System Inspections: 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: le) the proposed .location of the Mystem 2.) location and distance to lot lines 3.) location and distance to structures 4.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, tile fields and/or drywells Be 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 $250.00. c. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. l have read the regulations above and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Eduposal Ordinance. Signature of.responsible person: Date. L Town of Queensbury Building and Code Department Say at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . MOM 0F NATURAL REAUTY . . . A GOO D. PLACE TO LIVE flown of Q"een it "ry 13UILDING and ZOWNG OFPARTMENT Say and Hauiiand Road. R.D. 1 Box 95 (]ueensbury. New York 12801 BUILDLNG IA{$ P £C TOR ' S REPORT NAME LOCATION 10 permit Tao er * * * * * * * r #* * * * * *ppPR _ YES No OV EC? Footing/Pier Forms Foundation Waterproofing Sac)cf i l l Framing Roof i.ng Siding Masonry Ven er Rough Plumb ng Relief Valv L/ Ext . Porches Finished F100 LI Interior Trim . Stairs & Railin Cellar Drain Til Concrete Floors �, - plbg • Fixtures Gar . F!reproo Door Closer Smoke Dete ors Chimney INSULATI ,Foun,dat n Floors Walls Ceiling I� FINAL ELECTRICAL INSPECTICN �_ DRIVEWAY AP'PROVAI Final Building Survey ~� Next scheduled irtsp ection (call when ready ) Remarks- di47 Inspector 6/86 and-vl V " MIDDLE DEPARTMENT INSPECTION AGENCY, INC. 900 Haddon Avenue, Colpngswood, N.J. 08109 rrf- Date July 20 , 1988 Ce�rflfICO that the electrical equipment listed has been examined and is approved as being in accord with the National Electrical Code, applicable governmental , utility and Agency rules. Occupancy, ❑we f l i n g Owner-' Guyer Builders occupant: Same location: This certjficeta covers the electrical agwpment and Instaktat,on inspected rfies 1 9 Margaret Drive , qu e e n s b u ry ( Warren Co )C o ) date. It additional equ,oment erlould be introduced or anerations made to es45hng system this certilicate shall se nuil and void and appilcahon for inspection should be submitted promptly to this Agency Equipment:5 9 )u 't 1 et s ; 3 0- Receptacles , 1 1 — Fixtures Holder of Ih,s cell itkcate should present same to his property insurance career k aganl or company) as evi d&hcW df ce"mcat i on of electric ek eq u,p men approved 1150- Amp . Service ; 5 - Appliances as specified, I 44 Guyer Builders No . 15 - 021788 Applicant: l l 9 Dunning Street Ballston Spat New York 12020 Farah No. 7W EL 1-87 _}own o1 QueenJi "ry BUILDING and ZONING DEPARTMENT Bay and Haviland Road. R.D. 1 Box 98 Z � Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date tis_ � l' 4�_.. Permit NO . � APPROVED - YES NO Footing/Fier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Ve eer� Rough 'Plum ing�_—.--- Relief Va es�_,� Ext . Forc es Finished lours Interior im Stairs & ilings cellar Dra n Tile Concrete F1 Ors Flbg . Fixtu es Gar . Firepro f ng Door closers Smoke Detect Chimney ' 4 TN S13I AT ION - Foundation Floors Walls Ceiling FINAL EL CTRICAL INS CTION DRIVEWAY APPROVAL . Final Building Survey Next scheduled inspection (ca 1 when ready ) Remarks- 4LgBuispector 6/se and-vl �loeun o/ Qsseen hurry BUILDING and ZONING DEPARTMENT A4.1 Bay and Haviland Road, R. D. i Sox 98 t,r} Queensbury, New York 12801 1717) 1 BUILDING INSPECTOR ' S REPORT NAME LOCATION_ Date ( � e7 Permit �+ APPROVED ^ 'YES NO Footing/Pier Forms Foundation Waterproo ing Backfill Framing Roofing Siding Masonry Venee Rough Plumbing Relief Valves Fxt . Porches Finished Floors Interior Trim Stairs & Railings Cellar. Drain Tile Concrete Floors Vllbg . Fixtures Gar , Fireproofing 1 oc.rr Closers :;Make Detectors r ey NsuiwriON Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION _ DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call /when ready ) Remarks- J' r, OL G Z,.� Build Inspec 6/86 and-vl _J'own of Queen36ury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R-0- 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION e. Date ~)10 ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing kf B amii11 raming Roofing Siding M onry Veneer Vkeough Plumbing Relief valves Ext , Porches Finished Floors Interior Trim Stairs & Railings Cellar. Drain Tile Concrete Floors Plbg . Fixtures C;ar , Fireproofirr Or Door Closers Smoke Detector_ Chimney INSULATION : Foundation Flcaors Walls Ceiling FINAL ELEC ICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey _ Next scheduled inspection ( call when ready ) RfAinarks- BUYIding Inspector 5/86 and-vl 1 BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT �r LOCATION Date Permit No . * * * * * * * * * * * * * ✓ = APPROVED - 'YES NO Footing/Pier Forms Foundation Waterproofing Backfi.11 Fraird ng Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plhg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling FINAL ELECT CAL INSPECTION DRIVEWAY APPROVAL Final ,Building Survey Next scheduled inspection ( call when ready ) Remarks- Suildin Inspector +6/86 and-Zr'1 BUILDING and ZONING DEPARTMENT Bay and Maviland Road, R. D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME &uKw2 �i � ' LOCAT I(7N �.� DATE 3 .gr3 / So9 PERMIT NOW ~ "r2 SOIL TYPE - San Loam - Clay -_ Percolation Test Required? YES NC �— Percolation rate - Min/Inch _ TYPE of SY FM : Absorption f ld , total len Length of ea trench Depth of tren hes Size of grave SEEPAGE PITS4N er €) _ 4V Size- ft. _ �} ft. Gravel size PIPING : Size4o Type Bldg . to tank 1. P✓z-* Tank to disc . x0 ';:;P✓c� Dist . box to fief fait Openings se ed? E NO Partial ATION/ PARATIONS : Foundatio to tank ft. Foundati n to absorpti n ft. Absorpt ' n to lot line ft. Separat ' on of pits ft. LOCATI OF SYSTEM ON P OPERTY (circle one) Front - Rear - Left sid - Right side - CC]MMENT SYSTEM USE APPROVED YES Burlding,~ spec or 01/86 and vl QjeenJ ury q .t� BUILDING anc! ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION� _ r/ r ` Date . � / Permit No , _SJ_�� �✓' APPROVED - YES No Footing/Pier F rms y, Foundation Waterproofing )(13ackf i 11 Framing Roof ing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches finished Floors Interior `Prim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofin Door Closers Smoke Detectors i L mney SULATTON : undation Floors walls Ceiling_ FINAL ElECTRTCAL INSPECTION DRIVEWAY APPROVAL Final Building; Survey 13ext schedule¢i inspection (call wYien ready ) Remarks- z tiui lding I spe . tor f. /f7C) m+1 -V1 rr Z� Ju av►r U Qt4 ce n i l] BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. Df 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Dat v' /� � Permit No . / * r w � w w x * • r t � * * • * * � it * ,r APPROVED - YES NO ooting/Pier Forms Foundation waterproofing Back £ill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves _ ].xt . Porches Finished Floors Interior Trim ;stairs & Railings Cellar 'Drain Tile Concrete Floors 111bg . fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation Floors Walls Ceiling_ FINAL E:L.ECTRICA INSPECTION DRIVEWAY APPROV L Final Building � Survey Next scheduled inspection Ccal1 when reac!}r ) Remarks- [)Q ,Ill's C. -u- f NGFir '7 Buildin Sector £,/£if mci-vl j VA �r BUILDING and ZONING 'DEPARTMENT Ci f} Bay and Haviland Road, R. D. 1 Box 98 ,� IJ Queensbury, New York 12801 BUILDING IN FCTOR ' S REPORT NAME LOCATION DateZL hermit No rJ APPROVED - Yrs / NO oting/Pier Forms ooep ✓ — — poundation waterproofing Backfi11 Framing Roofing Siding Masonry Veneer hough Plumbing Itelief Valves I:xt . Porches Finished Floors Interior Trim Stairs s Raili s Cellar Drain Ile: _ Concrete Flo rs ----- I'lbg . Fixtu es Gar . Firep oofing Door Clos r. s Smoke Lae ectors Chimney INSULAT ON Poundat on Floors Walls Ceiling FINAL EI I CTRICAL INSPECTION J DRIVEWAY APPROVAL. Final Building Survey P3ex [ 4clxeduled inspecticxn {call where ready ) Remark.s- Iuilding nspector C.jF3Ci rnri -vl. BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW PORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. . • DATE ' - + ,:-: � pq CITY ORG my�sy,s.� TOWNSHIP `bur COUNTY VILLAGE F�^.'"�"'..77 STREET AND NO- OR 1I� POLE NO. ROAD AND POLE NO. 19 ve CETWEEN 1AT ROW STREETS IS O TION ..:-'� +r BLOCK LOT PREM ES L IEDI OCCLRANT'S OCCUPANCY BUILDING NAME ��3� y ��1I �I ��yy OCCUPANCY' ry y '' AND EADORESSWS £ 1"[�3AT,MaU z a 1 119 mumumoo S / TEL. ENTCUHHr . } . ;..�.../ OFFICE SUPPLIED - ..✓ v"-' .. ,x :^� FROM THEIR ":-.c . -r'.:� . BUILDING !; DEFECTS IS i�. NE OLP 0 WWORK MEW I� ADOITIONAL IJ REMIOVEDEJ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED Ntw. of NUMBER OF OUTLETS Lenyl Fix MOTORS MOTORSHEATERS dRW17'S OF ONLY w. ties LOSS" S� Realip'1s Switch Pendent Btaelkat No. TYP* Sam& Nei Bseh �OIlapt INSPECTION 1 out- amp Sdt' Items Bas► "not 1{t FI. 2 d Fl. 3rd Ft. Dd NOT USE THIS SPACE. REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: This APFl4c51100 is intended to ewer the slsosre•listed awipfm.nt to be inspacbd but if at time of itupaation thane is found tddittonal egoipnMent not show listed, you sea peahwksed to make H+a �nspeetion snd sdy'stst the tee to covet M+ allditiontl aquipllletsl. a prwit/Isl by the aplMiCMst. ELECTRIC Slam TOTAL S IZEOF FEEDERS LAMPS WATTS Y£R �,�,'y EXPOSED GAS TUBE SIGN � � CONCEALED TRANSFORMERS OF VA INLIMBEf11 ICAPACITYI BE COMPLETED SIZE dfF SIGN OVERHEAD UNDERGROUND MAKER OF SIGN G INSPECTION REOUESTEP ON OR A5 NEAR AS a9s � NEW OLD POSSIBLE iFi �D AVOID DELAY BY GI VINO FULL AND ACCURATE IN FOR MATT ON. ALL SPACES DATE OF lq MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. APPLICATION PRINT NAME AND ADDRESS '�( SIGNATURE NAME OF �I'II.'I'I dere• Inca �'+ OF APPLICANT APPLICANT � 16 STREET ADDRESS _. qq J.19 aitx a�� � t YELEPHONE ]• ZIP J,202� INCENSE NO. CITY OR CODE lFi1L��ii POST OFFICE tM'fEN APPLK:ABLE 46 EL (FitEV. 1/66) A SEPARATE APPLICATION MIDST BE FILED FOR EACH SEPARATE BUILDING QUEEN VICTORIA'S GRANT QUEENSBURY , N.Y. C.O.T. G. - (CLEAN OUT TO GRADE) LLOT OFF 15.00, AA 4 RG,q R Et 6'-0 DIAMETER 8=0 DEPTH ?50ga1 C.O.T. G. g1.84 w Ii �!w 19 �I I I1 pRj\JE REFERENCE DRAWINGS 5 SITE UTILITIES SEPTIC d WATER %tnDUSEN 4 STEVES SURVEY PLAN 13,15,17, 19, MARGARET DRIVE PLOT PLAN A SEPTIC SYSTEM GUYER BUILDERS, INC. Qv- 15 DWN ; A::�v b_ g.g-I Iscale 1'= 20- 0 (-?, q7