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1987-933 .,CERTIFICATE OF CHCCUPANCY TOWN OF +QUEENSBURY WARREN COUNTY, NEW YORK Date May 30 19 89 This is to certify that work requested to be done as shown by Permit No. 87- 933 has been completed. This structure may be occupied as a of Two Fainily Dureliing Location 11 Margaret Drive Queen Victoria ' s Grant Owner Guyer Build►Rrs Inc , By Order Town Board TOWN OF QUEENSBURY f Building & Zoning Inspector BUILDING ING PERMIT 0-3 TOWN OF QUEENSBURY � Na. 87-933 WARREN COUNTY, NEW YORK • PERMISSION is hereby granted to Queen Victoria ' s Grant N OWNER of property located at 11 Margaret Drive Street, Roar! or Ave. l 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. 1 . OWNER'S Address is Guyer Builders Inc . 119 Dunning, St . 4 Ballston Spa , N . Y . 12020 C 2_ CONTRACTOR or BUILDER 'S Name Same � rr 0 �-i N• w_ a CONTRACTOR or BUI LOER "S Address m Same w r a. ARCHITECT'S Name 5. ARCHITECT'S Address 47 6. TYPE of Construction — (Please indicate 6y X1 � fi fK4 Wood Frame { ) Masonry f 1 Steel I 1 rt to rt ]. PLANS and Specifications No. 32 ' x 48 ' as per plat plan , specifications and application including septic system and attached one car garage . MODEL. J a. Proposed Use � of Two Family Dwelling 4 h-1s $5 . 00 Cf4 N $ 89 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 1 , 1g88 0 0f a longer period is required an application for an extension must be made to the Building and Zoning inspector of the W town of Oueensbury before the expiration date.) d w Dated at the Town of Queensbury this 31st ,c�Day of December 19 87 •c SIGNED BY X;? ?4 ,,,,nG, Z2 � r �•�-X- /' for the Town of Queensbury Building and Zoning Inspector ./cam Application No . 5ou•n a/ Q"eenji"ry Permit Issued 19 LdU16C4NQL&nd ZONING DEPARTMENT Permit Expires 19 i .� F Flay and Haviland Road, R.D. 1 Box 98 Zoning Designation U u OMueensbury, New York 12801 Variance Now site plan review No . Approved by . -S--, rr© APPLICATION FOR ' L- 4. ' C/t! BUILDING AND ZONING PERMIT ° 1011100100 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 hermit . The owner of this property is . Guyer Builders Inc . wo ,P. o. Address 119 Dunning Street Ballston Spa , New York 12020 Tale ( 518 ) 899-9161 Property Location : 11 Margaret Drive Tax Map NO .121 /�1 2 Street number or building lot number Subdivision name (if applicable) Q 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 Tale No . Name of builder Guyer Bu.ildexs > Inc •Address 119 Dunning Street Tel . ( 518) 899-9161 Name of plumber yet 130I.Eaers , Ine .Address g Sfreet Tel . Name of mason Guyer builaera , c •Address g Street Tel . NATURE OF PROPOSED WC)RK : * ZONING INFORMATION : X CAnstruction of a new building 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 DEMOLITION PERMIT , STATE SIZE AND * whether interior or corner lot . Show location FOR DEMOLITI LOCATION ON PER * of water supply and location and configuration STRUCTURES AFFECTED. of septic disposal area . COMPLETE INFORMATION REQUIREDpfEl OW " Size of property 100± plan ft X 120 ft . * Existing building ( s) Size ft X �ft . PROPOSED BUILDING AND USE * Ofl _T » Existing buildings ) Use NIA Size of new strut a 32 ft X 48 ft yard Foundation-pier slab crawl/partial/full * Proposed building, diet nce from property line circle one ) * see pfot plan Now of stories (habitable s �. ,p) 1 * SideFron yards- - 15�.�+ ft Rear yard 30+ ft * y +ft and 15+ ft Height (grade to ridge) 1 ft . * If on corner , setback from side street ft If residential, no. of families No . of rooms ( excluding baths) OCCUPANCY INFORMATION kNo. of bedrooms 2 Moo of bathrooms 2 * 'PRIMARY BUILDING - LPriwary heatingsystem Baseboard elect ric" One family dwelling Mss� Me �r „ =Two family dwelling Type of fuel EIectr].c t * Multiple dwelling / Number of units Now of fireplaces to be installed Permanent occupancy Will a wood stove be installed? �0 " No * Transient occupancy. Central Air conditioning ? wwwpmww� Business BUILDING STYLE, PRIMARY STRUCTURE * Industrial ,� Other Ranch Contemporary Lo bin 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 cart car ( CIRCLE ONE PLEASE } * ,X-Attached garage/one car/ two car/ pig car * • w * r t r r w • w * �r rr • * * Private storage building ESTIMATED MARKET VALUE OF " wwwwwwdw,w0ther CONSTRUCTION INFORMATION ON • BUILDING SPECIFICATIONS, ON REVERSE SIDE of THIS SHEET. TO HE COMPLETEDI Form SPA 4/86 md-vl 13UILDING PERMIT APPLICATION CONTINUED - WILDING SPECIFICATIONS Type of construction, wood frame , fire safe , etco 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 ) 4U"' adni.nium Will there be a cellar? no Heated or unheated? Floor sqo footage scj ft Will there be a basement? no Will any portion be used as living space? ( If so, what por ° 7 uq. ft . - - Type of use? Type of roof - sloped flat/shed/other Material of roof Fi rg ass s ` n es Size , wood studs "X 6 spacing 24 "o . c . length S ft* exterior walls Joists ( floor beams ) 1st . floor 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 of spacing 24 "o . c . span N/A ft . Roof rafters 2 six10 '• spacing L% o . c , span 14 ft . Roof trusses (Pre-engineered) spacing 24 "o . c . span 42 'ft .Exterior wall finish stained of what material? 5 /8" x 4 ' x 81 texture 111 Interior wall finish paInt 1 / Z s +e+etrock 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 tan.d 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 NIA ft . Depth of chimney foundation below grade NIA ft % Depth of fireplace hearth N A ft . in , Water supply - Municipal or private well anx-icipal 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 Queenbr suy County of Warren A F F I D A V I T STATE OF NEW xaRK 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, cotoplate 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 sjRec1fIed or not , and that such work is authorized by the owner . SWORN TO BEFORE ME THIS Signature _ oo � Owner o er ' s agent cnirect actor tom# day of 6-C:�-►-.�l.k_.Y 19 k') _ PALiL-A CH��sT Q� }lotary vv York Put.1IlC, 'State of NeGvun Y �~ Qualified in Schenectady Notary Public , Warren county, N . Y . Commission Expires july7 19 t ! i # # • # # * . �► # # • * * # # # # # it # # # # # # tt # # # # # # # # # # # # ye # # # # • SPEC{" CONDITIONS OF THE PERMIT : TOWN OF QUEENSBURY rr�rr WARREN COUNTY , NEW YORK &pplication for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . "O"BIi ALL of the fallowing : 1123 S . F. "S grass floor area 2 . Type of heat Baseboard electric 3 . Is the building mechanically cooled ? No 4e percentage of area of windows and doors 11 . 8� 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 - Mp 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 fir . Under 6 % only 1 . R value of roof and floors exposed to ambient conditions_,_„ R-38 2 . R value of exterior walls XRKM R-23 . 5 U. + 3 . R value of glazed area U. =0 . 30 4 . R value of doors R-14 . 9 (U. =0 . 06) L 5 . R value of floors over unheated spaces $-3n 6 . R value of slab edge insulation - unheated slab N/A 7 . R value of slab insulation - heated slab 12 . 5 S . R value of heated basement/ cellar walls ( above grade ) N A 90 R value of heated basement/cellar walls (,below grade ) N/A 1p . Type of insulation Fiberglass Co Controls 1 . Thermostat maximum heat setting D . Duct Systems N/A 10 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 MEW 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 Onl 1 . Maximuue heating NIA �wlephoa�e Mo . ( 518) 8999-9161 L. ' ( applicant ' s gn ure ? r APPLICATION FOR SEPTIC I3LSP©SAL PERMIT Ref : S . P.E . D. S . DATE October ,7 87 permit # New York - 0202525 ` MDDEL .T of a jJ LOCATION OF PROPERTY FOR INSTALLATION 11 Margaret Drive Owner's Name: Guyer Builders , Inc . UUMMUMMM Telephone: ( 518) 899-9161 Address: 119 panning Street , Ballston Spa , New York 12020 Installer's Name: Guyer Builders , Inc Telephone: ( 518) 899-9161 2 A, Co E, I , J, K, L, M Number of bedrooms (residential only) 2 3 F , G, H . y a • Total daily flow (compute @ 150 gal per bedroom) 300 Topography: circle one: lat Rolling Steep Slope 96 of slope Soil Natures circle Dire: 9 -: Loam Clay Other / Depth:' 8 ' feet + Ground Waters At what depth? untawwn 8 feet + Bedrock or lmperviouss Ulaterial: At what depth? unknown feet Percolation test: circle one: not require required / rate minx. inch. Domestic water sazpply: circle one: q Municipal Well Other IF domestic water supply in a Well: Separation: Watersupply from Septic absorption N/A feet * PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1,000 gal.) TILE FIELD: Each Trench N/A feet / Total system length N/A feet * SEEPAGE PIT(S): Number of / Size each feet by feed * Size of stone to be used / Depth or Thickness feet I M P 0 R T A N T * See S . P. E. D. S. ...Plea,se...LIST NEW EQUIPMUNT TO BE INSTAXI - permit & attached * * * * * * * * * * * * * * * * s * * * * * * * * * s * * * * * * s * * s * * * s Mai,. (over) Section U Septic System inspections$ A. All applications for septic system installation, alteration or repairs as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building Department at least 24 hours before start of constructions and shall include a plot plan showing: 1.) the proposed .location of the gystem 2.) location and distance to tot lines 3.) location and distance to structures 4.) location and distance to any water supply 5.) size and dissensions of all tanks, distribution boxes, tile fields and/or drywalls B. 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 $260.000 cs 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 worm. 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 regulations above and agree to abide by tbese awl all. requirements of the Town of Queensbury Sanitary Sewage Disposal CkidinancAm, Sigxiatu a of.responsible person: Date: Town of Queensbury Building and Code Department Bay at Haviland Road Queeswburys New York 12801 (518) 792-5832 c �= n 17Rq HnuF nV u +r11as1 APA117Y . _ - A rnnn P1 ArF Tn i Q.'L'.nJt4rV . ,own Of L7 -PAS TMENT SUILWNG and 2pi�f4NG €3aY and Haystiand Road. R.'D, Box 98 o New York 128D1 ueensburY. SEPTIG DISPOSAL- SYSTr iA15PEGTiON NWIFE v it BATE _ Clay -- �~ Sand Loam SAIL ' ' qui Test red? 'YES - N Percolation _ 14ir►/1nc'h Percolation rate of SYSTEM tal lengt �,--- TyPE Yion field , t p burptr en ngtY' of eac Le cities_ - �-- tlti of txen Dep --� � Size of e gravl a �� - --- ~ r-- -- SEFpAGE FITS{Nn er �--~ � - Si z4=~ t. a Type Gravel Size � - PIPING : - - Biag • to Yank Tank dish p Pa�~ st«box to f d�d/YES al openings sea AFA'TIC11S s f Y. y pCATIf33L3/S to tank f t.. Foundatia to absorption ft- dat i. n Foun to lot line ft. Absorpt on ion of Pitt �cixcle one Separa SYSTEM COPROPER side Loc;%.`T C7t3 _ Left side Rig gron Fear C TS ; CF3't SYSTEM USE APPROVED XE5 � BWaa l g Inspector Ol/SS and vl ry QWI`I C]F QLb CUD S DEPARTMENT AND 5 BUIL& HAVIrANp �R VORK 128(}+k 2_5832 QUEENSS N , { 518 ) S ? FQtR'r TE PRONE WILDIOG 1IlsyecCQ � INSPECTION RECEIVED RE�1E5T FOR INgPEC � NAME IT # 1 �APPROVED LOCATION P YES NO DATE OpMS FOOTrN xIVIS C P�jUR F OFSNG MONO ATrONIDAMP HAjN]DA L P'PPR.OVAL ROUGR P2 MOING ,l1 FRAM].NG aoLIGH I mo~ ELECTRICA INSULATION: , FOUNDATION FLOORS ° �— WALLS -- C ,LINGINSVEC TION = CI-12MNEY ErGHT R DING CHESlS E5 XTVRNlA2 RA CE IEF ALVE HrArxs��LFIXT RE$IREL DOO PLUM H C7R TRIM/P IVACY _----. INTE FLOORS_ VINTSVED IgEPR £ING_--- GAR F AGE SEg { 5 �r -� r-- �-1 VTECTORS SMOKE L CQ~N ~O TZON .FINAL EF pROV O 8 - -� FINAL AP jUpANCY 5T FORE IFICATE OF O CC D ARTME T BE A SIGNED FROM THE 8 OCOUPrED'! BTA PREMISES ARE �MAgKS � � C�UEE �SE�DE 'romn AND COPDES PARLMHNT -BUILDING ROADS x2804- BAY & IIAVILANEW YORK QUEEN5BORY . 792_ 5832 TELEPHONE ( 51'8 ) R. pC7PT p }ILDIN�'' II3�PEGTO L� ON RECEIVED REQ(1ES7 FOR INSPECTIol ON NAME ��w LOCATION PERMIT # APPROVED DATE YES NO NGIPIERS FOOTr C POUR FORMS R xN �_--�~�- MONOLI TION/ DAMP FOUNDA APPROVA -BACICFI PLUMBING ROUGH t FRAMING* ROVGH�TN� - ELECTRICAL �1��f� xNsaLATxON : FOUNDATION- FLOORS F WALLS CEILING INSPECTION = ICHSMN£X HEIGHT d ���- - a0OFING�----�`- ~~ SIDING PORCH�%5/STEPS ExTERNALjcB & R AILS_�� --� - -�" STAIRS-CL�EI RE5/RELIEF VALVE -- PLUMBING TRI 3/PRIVACY DOORS_ INTERIOR RS �-- - FINTFIRE OOFINGf - -� "'� GARAGECLOSER s ) -� -"�--- — -SMOKE DETEC RCS loSP-'�"'EC ON SMOKE TION FINAL ELEC" Rr OF CONSTRuC ���__---• FINAL AF'FROVA _�-- ~SST BE OF OCCUPANCY BEFORE STIFICA U IN+G DF: A SIGNED PARTMENq' CER -BTAINED T PREMI XSS ES A THESE ARE OCC11PxEDI o Zoe ~� �JINSPECTOR a �e.ceer+ s � ur !f 1 7own of oN�n�G p�Pac�-v"Et4T and Z I Box g8 gUtLDINHav�land Road, R-f) . Bay and t4ew York 1280 � pueensbury. r3l} � L.DIfYG I NSPE TOR ' S R,EPORI 64 N+0.N4E L.DCF+ t ON Lf � . J -/ AFFRO'I 'sCES L3{] Fo+� tin9/Pier Farms ion .---- �,Q,�dat g aclti ill �� Siding -veneer_ �._-- Ma uonr gp, PIY'in9 -- 1 Relief valves Eater - 1',rcy es Finished Floors Intl-er Sd& Il ings Stair rain Tile CQncree Floc ss Ply ixure Gar Firelarocfin ram SM 2 r eoei'C`ct`fir' 4)' '114s LATxC'N - Fox"IndaC ion -Floors walls - ---' � --- ceiltri _._ C CAL I.ta5YEC F,LS 'T'R F IN AL V 73uA-1. ins -- '" glcral Il when ready) action CCa insp � �dtC. /" Sr,emarks- .'9 14 guildyn9 lnspect�or i 6/86 n"3"'vl cc�-� Qaseen � � rere�F ex _low► Of -rnn�r4Y { 1 t BUrt[t�raG and ZCIjRoa R.D, 1 Box 98 ►,+� J( Bay and Havifand New York 1280i ' Queensbury, RUILOING 105PECTOR ' S REPORT NAME perm't Date ---- o APPROVED - YES Foating�Fier Forma grundation Waterproofing eackflll Framing Roof ing siding er Masonry V -�-- Rough Plum g Relief valve �-- Ext . porches Finished Floor Interior Trim Stairs & Railln S cellar Drain Til "eeonc re to Plbg Fixtures Gar . Fireproof ' Door Closers Smoke Detecto Chimney -JN SU JLAT I ON Foun dart ion Floors walls Ceiling f7�ICAL I235PECT ON ^� F IN AL ELE DRIVEWAY APPItC1VAL�—�' Final 9uilding Survey - - yeSLt scheduled insP action (call when ready ) Remarks~ Bull d� InspectOr 6�6� md_v1- IT If a"'. I 'bCueen sd urea 1 MEN IaUILDING and ZO Road, R.D .PT Box 9a Bay and Hau;land ew York 12'BO1 pueensbury, SEPT I C p I SpOSp L SY STEM I iVSPECT I ON - � IIC LOCATION "� � c PE42MIT NO . - � DATE `� - Clay -- ----�" -Loam YES sC3IE TYPE ~ an Test Re�3red percolatioIII" e�15 n rate - Min/=nalx Percolati.en TYPE of SYSTEM total AbGoxpt�or► field r Length of each tx ch Depth Of trenches Size Of gravel er of) SEE72AGE P ITS414 f 9 size- ft. S _ v Gravel size 1 Size Type .r � riG P IP Yr3G : 0; cr Sldg • to tanK s. TanK to disc. to fie d/ I30 Paxtial nist- baX Baled YE O.enings s SE A TION51 ft. I,,pCAT1aM/ tanK Foundation t ft . absoxptidr' ft. Foundation lot line ft. pb orption /f oral (circle Separation of pits CN PROPER circ �yCpT7(�13 � SYSTEM side Rig t side Front ear ,., 41,0 r YES NO SYSTEM USE APPR�jVED Building Inspector 01/936 and v1 _ 7vt4Vr3 ou � rrxL3etr ih BUILDING and ZONING DEPARTMENT J ? Bay and Haviiand road , R D . 1 Sox 98 (]ueensbury, New York 12801 I3UII_ D1NG INSPECTOR ' S REPORT NAME LOCATION Da � No - APPROVED t� * * * - L:S LNO A,F'pLtt�VLD Y Looting/Pier Forms �r yr5�uxt da t ion Waterproofing L3ackfilI praming Roof ing Siding Masonry Veneer Roucjth plumbing _ Ltelief Valves xxt . Porches L' inishtd k'lorsrs Interior 'trim Stairs & Mailings Cellar Drain Tile Concrete Floors plbg . r' ixtures Gar . Fireproofin Door Closers Smoke Detectors Lhimney IN s CS I J1'T I ON Foundation floors Walls Ceiling- FINAL V1 f C`L"RI. AL Ii35PECTION_!__-,._- AL L)RIVEWAY APPR V Survey ~� Final Buildin ;=,chedule. d in6P ectien ( call- Next irhen ready ) Remarks- f L3uil ing In,pector CIP16 rn6-V1 �.JourRi o� �e,it #'e �r3 � �er`� BUILDING and ZONING DFPARTMLNT Bay and fHav'sfand Road , R . D. 1 Box 98 C)ueensbury, New York 12601 BUILDING INSPECTOR ' S REPORT NAME LOCATION 612- Date .__/ Permit NCr . ,r APT'ROVI:D Ming/Fier Farms Foundation waterproofing Back £ ill Framing Roofing Siding Masonry Venee Rough Plumbing ` Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofin Door Closers Smoke Detector Chimney INSULATION : Foundation Floors walls Ceiling FINAL ELE TRICAL NSPECTIO[1 DRIVEWAY A PROVA Final Build urvey�� Next schedul d ins ...... n ( Call when re�— Y ) - Remarks- -- Building Inspector 6,/86 rnd-vl BUILDING DEPT. COPY OF APPLICATION FORM 46-ELe NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT, WHEN REQUIRED_ TEMP_ f DATE f . CITY OR .' VILLAGE QueenBy,,yµnr TOWNSHIP ..._.- [ Lyben sbury COUNTY X*3xxen STREET AND ism 0" ROAD AnD POLE NO_ iJ.. MBI �t DrI +� POLE NO. BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION ../ I BLOCK LOT OCCUPANT'S BUILDING NAME OCCUPANCY ANDADDRESSE �PYB JnC .L e ,L7pp SI.. M*t TEL. # CURRENT SUPPLIED X _ _y' ;+ J�.: y :. FROM TH F4 ,r': .---''� OFFICE BUILDING �. . ^^y�p� WORK . M .. DEFECTS IS NEW (2 OLD ❑ IS I NEW jv ADDITIONAL ❑ REMOVED ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS Lamp FIR✓p ds MOTORS HEATERS CIRCUITS OFFICE USE Loear ONLY Yew CelTiw/ AtecWt HP. Wetes A.W.G.vmmch Penn lte so Type E No 15 Na INSPECTION Gem" Oat bow be/e Baw I wtett Ise R. Zad R. Sad Fla REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. This application n intended to t>over the aba listed equipment to be inspected but if at time of inspection [hats it found additional equipment not above listed. You are auihovird to make the inapectien and adjust tha foe to cover the additional equipment, as Provided by the applicant. SIZE OF ELFCTR IC Sl Gtn TOTAL MAINS 50 Ampei FEEDERS LAMPS WATTS CHARACTER EXPOSED GAS TUBE SIGN OF WORK oer%dCONCEALED TRANSFORMERS OF VA - WORK TO BE (NUMBER} (CAPACITY( STARTED COMPLETED SIZE OF SIGN SERVICE OVERHEAD UNDERGROUND MAKER ENTERS OF SIGN ILDING INSPECTION REQUESTED I—� PON OR AS OBLE NEAR AS SSI W �I 7 .�& -t VftM 3ceady New OLD I_I AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES DATE OF _._� MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.. APPLICATION 1■,rira T 7 PRINT NAME AND ADDRESS NAME OF �( SIGNATURE APPLICANT Guyer a-i o X OF APPLICANT ,�r�,y STREET ADORES& 119 Dqpp'ALqS Street TELEPHONE CITY OR PI.�J u ZIP yy r�s.,�..�}r�r�S ryLICENSE OL(CABLE POST OFFICE f CODE a,�LtJL�4/ .e F (""- t/oa) A SEPARATE APPLICATION MIDST BE FILED FOR EACH SEPARATE BUILDING QUEEN VICTORIA'S GRANT QUEENSBURY, N.Y. SHUTOFF MARGARE T CLEAN OUT TO GRADE E�-0 DIAMETER 9=0 DEPTH REFERENCE DRAWINGS 5 SITE UTILITIES SEPTIC I! WATER VanDUSEN t STEVES SURVEY PLAN MARGARET DRIVE PLOT PLAN 4 SEPTIC SYSTEM GUYER BUILDERS/ INC • QV- 14 DWN ; I;W ►0-8 S'y I ScoIQ : Ii20'-0