1987-725 BUILDING PERMIT �
TOWN OF QUEENSBURY �
No. 87-725 a
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted. to Michael Thompson
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OWNER of property located at Dawn Rd . Street, Road or Ave. o+
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in the Town of Queensbury, To Construct or place a Demolition—Mobile Home c
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.
t. OWNER'S Address is
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2. CONTRACTOR or BUILDERS Name
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3. CONTRACTOR or BUILDER 'S Address
4. ARCHITECT'S Name
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6_ ARCHITECT'S Address
S. TYPE of Construction — (Please indicate by X)
l ) Wood Frame ( ) Masonry ( ) Steel I I
7. PLANS and Specifications
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No. Demolition of 10 ' x 50 ' Molhile Home o
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8. Proposed Use N•
Demolition p
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$ 10000 PERMIT FEE PAID — THIS PERMIT 'EXPIRES May 1 ' 19 89 �
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(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Ciueenshury before the expiration date.)
Dated at the Town of Queensbury this 28�th vDay of October fg 87
SIGNED BY E f u -e eX for the Town of Queensbury
Building and Zoning Inspector
TO BE COMPLETED BY BLDG . DEPT .
// Application No .
a[u►: a ueen�!6u/'e� Permit Issued 19
BUILDING and ZONING DEPARTMENT Permit Expires 19 d d �-
Bay and Haviland Road, R.D_ 1 Box 98 Zoning Designation U '
Queensb ry, New York 12801 Variance No . OCTSite Plan Review No . OC 117�3Q0 7
r Approved by : "` F. Lllf r„ ^< ;:; :; . ' ;. sE ;
APPLICATION FOR *100etcpnpo
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 : C 2L
P . O. Address `� W ] e. L y j [ Tel
Property Location : Tax Map No .
Street number or building lot number
subdivision name (if applicable)
THE PERSOyN'� RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS :
L //b x+-) c2 S co y7 G rF1 Y (V 9 ,0 ce jG p c�
Name P . O. Xddress Tel . No .
Name of builder Address Tel .
Name of plumber Address Tel .
Name of mason Address Tel .
NATURE OF PROPOSED WORK : ZONING INFORMATION :
_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
whether interior or corner lot . Show location
FOR DEMOLITION PERMIT , STATE SIZE AND of water supply and location and configuration
LOCATION OF STRUCTURES AFFECTED . of septic disposal area .
* COMPLETE INFORMATION REQUIRED BELOW _Size of property 15-z) ft X s"�7
C:5 y ft .
Existin`�,building s ) Size ft X ft .
PROPOSED BUILDING AND USE , __. 4 ou- �!� CWA—�
Existing building ( s ) Use
Size of ne cture � ft X�ft
Foundatio ier/ lab/crawl/partia /full Proposed building , distance from Property line
(circle one } Front yard ft Rear yard ft
No . of Stories (habitable space) � Side yards ft and ft
Height (grade to ridge ) ft ' If on corner , setback from side street ft
If residential , no . of families
No . of rooms ( excluding baths) * OCCUPANCY INFORMATION
No . of bedrooms PRIMARY BUILDING -
No . of bathrooms One family dwelling
Primary heating system * Two family dwelling
Type of fuel Multiple dwelling / Number of units
No . of fireplaces to be installed '
,� Permanent occupancy
Will a wood stove be installed? Transient occupancy
Central Air conditioning?
Business
BUILDING STYLE, PRIMARY STRUCTURE Industrial
� Other
Ranch Contemporary Loci cabin If addition , what will use be?
Raised ranch Mansion Duplex
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/ car
* * * * * * + * a * * * * * _Private storage building
ESTIMATED MARKET VALUE OF Other
CONSTRUCTION
INFORMATION ON BUILDING SPECIFICATIONS , ON REVERSE SIDE OF THIS SHEET , To BE COMPLETED !
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe , etc .
Will any second-hand or ungraded lumber be used? If so , for what ?
Foundation wall material Thickness
Depth of foundation below grade (to bottom of footing )
Will there be a cellar? Heated or unheated? Floor sq . footage sq ft
Will there be a basement? Will any portion be used as living space ?
( If so , what portion? sq. ft . - - Type of use?
Type of roof - sloped/flat/shed/other material of roof
Size , wood studs '"x it spacing "o . c . length ft_
Joists ( floor beams ) lst . floor "'X to spacing toO . C . span ft .
Joists ( floor beams ) 2nd . floor "x '" spacing "'o . c . span ft .
Overlays ( ceiling beams ) "'x "' spacing '"o . c , span ft .
Roof rafters "'X "' spacing o . c . span ft .
Roof trusses (pre-engineered) spacing "o . c . span ft ,
Exterior wall finish Of what material?
Interior wall finish
If a garage is to be attached , describe materials to be used for FIRE SEPARATION :
Is there to be an opening between garage and dwelling? If so will a Fire-rated
door , enclosure , and self-closing device be provided?
will a flue-lined chimney be installed? Height above roof ft _
Depth of chimney foundation below grade ft .
Depth of fireplace hearth ft . in .
water supply - Municipal or private well
SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties ft .
(A separate application is necessary for any repair or new installation of septic system)
Town of fu ry
County of warrenarren NEW A F F I D A V I T STATE OF NE 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 specified or not , and that such work is
authorized by the owner .
SWORN TO BEFORE ME THIS Signature ,— � ---
Owner, owner ' s a nt , arcni ect , contractor
day of 19
Notary Public , Warren County , N . Y .
SPECIAL CONDITIONS OF THE PERMIT :
By------_ _----------- -
MIDDLE DEPARTMENT.-,INSPECTION AGENCY, INC.
goo Haddon ^v*nu . cotnngrw+W0,11JER E16108
oattr September 9 , 1938
�QCttfllr�i that the electrical equipment listed has been examined acid is approved as being in accord
with the National Electrical Code, applicable governmental, utility and Agency rules.
Owner: i': i.�;e Tlionfljstln C7Ctupanoy. Pool
Occupant: ;i izt7C
Location: Dawn Road , Queensbury (W jrren Co) � Thla certificate COyera the aletlrt4d fquipmant and inalefka[ion Inspected ibis
date. If edditionsl equipment shopM be introduced or allerations made to
existing system this cartlfiCate srystl be null and Void, and app1iCAtWn for
1 Re 4 e n t ac 1 e ; i Pump inspection should be submitted prpaipay to this Agency_
QfJlprylenf: bolder of ibis Certificate should present same to his property insurance carJief
(agent or company)ase IdenCa W certifiGabon of electrical aquipment ePPfoyed
as specified.
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Applicant: 26 'Western '%Venue No . 1.5 -024559
Clens Fails , FY 121801 � .
Verse No. Nla EL I-"
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