8631 BUILDING PERMIT
TOWN OF QUEENSBURY No. 8631
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Dorothy Hammond
OWNER of property located at Burch Road Street,Road or Ave.
in the Town of Queensbury,To Construct or place a Alterations to dtaalla IM
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. 0
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1. OWNER'S Address is R.D. #3 Burch Road
Glens Falls, New York
2. CONTRACTOR or BUILDERS Name
same
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3. CONTRACTOR or BUILDER'S Address
same
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4. ARCHITECTS Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( )Masonry ( )Steel ( 1
7. PLANS and Specifications
alterations to dwelling per plot plan,
No. specifications and application submitted. r'
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8. Proposed Use
Nr
One-Family Dwelling 0
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES February l 19 85 E
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the M
town of Queensbury before the expiration date.)
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Dated at the Town of Queensbury this l lth Day of duly 19 84 W
SIGNED BY A � for the Town of Queensbury
Building and Zoning Inspector C ,w
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1' TOWN OF QUEENSBURY . . I (Space inside block to Ix filled in by
WARREN COUNTY, NEW YORK Building Inspector)
Application for .\pplieation No.
IrN Permit Issued 19.
BUILDING AND ZONING PERMIT . Permit Expires. ►g.
%unin District
• • \ Ale (II Work$//�
THREE (3) Copies of a PLOT PLAN, Drawn to scale \i'►11( c•cl h
showing the actual dimensions of the lot to be built Itcniztrkr
upon, The exact size, and location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION. ==t,,IS'ra°sl^:`C
TOWN Or ALI°��_
DATE
i1 Sj /c' 01
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK :,,.,._ ,49-
ANSWER ALL OF THE FOLLOWING. ID-d') W.
The undersigned hereby applies for.a permit to do .the following work '�18191, - a ' : °A.-
A.-
which will be done in accordance'with the :description, plans and specifi-
cat t I Ig 1(' '''
ions, and such special conditions as may be indicated on the permit.
Theo er of this ropers 's: /n
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���J ^�� . " (NA ct 1 .O.ADDRESS)
The peon responsible for 'supervision of the work insofar as the B ilding Code an the Zoning Ordinance apply is:
( AME) (P.O.A D S .
Name of Builder Address
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Name of Plumber Address
Name of Mason Address •
Lot Number Unit Estimated value of proposed work S 3,6(0' En;
Name of Village
Name of Street / Side of street: north I , east ❑, south ❑. west 0
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Nearest Cross Street .( !C�t2L--i1,. . ..... ... . . . . . . . . . Distance from this cross street . ./o?.5 " Ft.
Property is north EKoitth ❑,east i 1, west 0 from Cross Street
. If on Corner, which corner, northeast ❑, northwest .❑, southeast ❑, southwest
. (Designate by marking with an "X" in the correct space.)
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NATURE OF PROPOSED WORK OCCUPANCY
❑ Construction of a new building. Main Building
cli...6.ddition to a building. . One-family dwelling fE�
Pr-Alteration to a building. Two-family dwelling ❑
• ❑ Demolition of a building. -family apartment house ❑
Store building ❑
-car attached garage ❑
Other:
• Accessory Building
One-car detached garage ❑
0 Other work. Describe Two-car •detached garage ❑
Private chicken house ❑
Private storage building E;--
• Other:
ZONING SPECIFICATIONS. Fill in for new building, or addition to existing building, or a change of occupancy.
' Indicate on the plot plan street names, the location and
size of the property, the location, size and setbacks of pro-
posed buildings,and the location of all existing buildings.
NORTH
Show proposed building(s) in dotted line and existing
building(s) in solid line.' _
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Size of property 17� ft. x . o • . . ft.
- -, . Size and use of existing buildings, if any
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tl t Ik`IJ) w Size of proposed building . . . J.A. . . ft.x o? ft.
• Height(from grade to ridge) ' ft.
Front yard ft.
Side yards •ft. and ft.
64..J ,". • ° _ Rear yard ft.
SOUTH If on corner,setback from side street ft..
Note: All distances are net, as measured from street side
line to nearest part of building. •
(OVER)
7-73—M .
(cont'd.)
BUILDING SPECIFICATIONS.,
Kind of construction: Wood frame, fire safe, etc.?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • • • •
Will any second-hand lumber be used? CCU If so, for what?
Material of foundation walls . . . . ........j lA Thickness
Depth of foundation walls below grade Continuous foundation?
Will there be a cellar? /U v If so, material of cellar floor
Type of roof: Sloped or flat? CX& Material of roof
Size, wood studs � x 7 ", spacing G , . ,"o.c., length • ft.
Size, floor beams, 1st floor ", spacing "o.c., span ft. ,
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Size, floor beams, 2nd floor r " x ", spacing "o.c., span ft.
. Size, ceiling beams " x ", spacing "o.c., span ft.
Size, roof rafters or beams `-' " x ", spacing "o.c., span ft.
Exterior finish t.��kP a- e.tryfri4vith what material?
Finish of interior walls 1 'c-=Y/Z o ck.—
If garage is to be attached, of what material is wall between garage and main bui,llting to be constructed?
Is there to be a opening between garage and building?
Kind of heating s em Oil r coal?
Will a flue-lined chim�tex be provided? Depth o chimney foundation below grade
Height of chimney above roo
Will there be a fireplace? Depth of fireplace hearth
Will a toilet be installed?
Will a kitchen sink be installed and co cted to ater supply?
Water supply (public water su or pump)
Distance of cesspool from a private well feet
Will drainage system-be provided with required traps, cleanouts, and vents?
AFFIDAVIT
Town of Queensbury
County of Warren
State of New York
I swear that to it bra i of my knowledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, are a true and co.h•lete statement of all proposed work to be done on the described premises and that all provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertaining 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 .... .. ... � '�
/ JJ OWNEF N 'S AGENT,ARCHITECT,CONTRA R
1� day of J i(.y 195,c( v
NOTARY PUBLIC, WARREN COUNTY, N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
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By
BUILDING DEPT.COPY OF APPLICATION FORM 46-EL,NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT.WHEN REQUIRED.
TEMP.# DATE
CITY OR !', "r %• �/-/1
VILLAGE �../� e',�( , �I- ;•f.��- TOWNSHIP ' ( G .. ,. !�,I,A iJ COUNTY /i(J`Cc_l / ..:
STREET"AND'NO.OR
ROAD AND POLE NO. � /` '�) )/,: n A /.., ,(��% _ POLE NO.
BETWEEN WHAT TWO
CROSS STREETS IS
PREMISES LOCATED? SECTION BLOCK LOT
OCCUPANT'S !/�.� — - �Jr' ^ BUILDING
NAME OCCUPANCY
OWNER'S NAME
AND ADDRESS TEL.# 1 r
1' 9 J J i
CURRENT
SUPPLIED BY FROM THEIR OFFICE
BUILDING NEW❑ OLD❑ IS
NEW ❑ ADDITIONAL El REMOVED ❑
IS
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS LampfRec ptacles MOTORS HEATERS BRANCH CIRCUITS OFFICE USE
Loca- ONLY
tion Side Attch't . . Watts A.W.G.
Ceiling Wall Recp'Is Switch Pendant Bracket No. Type Each No. Each No. Gauge INSPECTION
Out-
side
Sub-
base
Base-
ment
1st Fl.
2nd Fl.
3rd Fl.
REMARKS: LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE.
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This application is intended to cover the above-listed equipment to be inspected but if at time of inspection there is found additional equipment not above listed,
. you are authorized to make the inspection and adjust the fee to cover the additional equipment,as provided by the applicant.
SIZE OF ELECTRIC SIGN TOTAL
MAINS FEEDERS LAMPS WATTS
CHARACTER EXPOSED GAS TUBE SIGN
OF WORK CONCEALED TRANSFORMERS OF VA
WORK TO BE (NUMBER) (CAPACITY)
STARTED COMPLETED SIZE OF SIGN
SERVICE OVERHEAD UNDERGROUND MAKER
ENTERS "
BUILDING OF SIGN
INSPECTION REQUESTED
ON OR AS NEAR AS
POSSIBLE NEW OLD 1-1
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
PRINT NAME AN(9/)ADDRESS
/
NANI OFA DATE OF
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APPLE NT 1� t •�✓ n•^�.�-�/��.�.�'")'{ -,B� APPLICATION (1)C B Ja. /O — Sc"(-1
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STREET ADDRESS > / t lA.r Ate./ -., ,.L{" TELEPHONE#
k['*tITY OR ZIP �') ii� /LICENSE NO.
:POST OFFICE ��(-�. --r//i e � Gi_��L� -77/ CODE /r//J1"'J WHEN APPLICABLE
"• •46.EL(REV.1/84) A SEPARATE APPLICATION MUST BE FILED FOR EACH SEPARATE BUILDING
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