application • TOWN Of REVIEWED BY:
COMMUN IT d 0
BUILDING FEE PAID:
531 BAY ROAD
QU
QUEENSBUF.Y, NEW YORK PERMIT NO. -"
(518 ) 745-4447
B ERMIT APPLICATION
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. NO INSPECTIONS
WILL BE MADE UNTIL APPLICANT HAS RECEIVED A VALID BUILDING PERMIT.
All applicants ' spaces on this application MUST be completed and the
signature of the applicant MUST appear on the application form.
OWNER OF PROPERTY : Q9-
Mailing Address : exit �Il
Telephone Number( s) : Work Wo- Home Othe
PROPERTY LOCATION: / jy 4ie.
Tax Map Number: Section no Block / Lot 3.3 a
Subdivision Name : Lot No.
NATURE OF PROPOSED WORK: ESTIMATED MARKET yALUE OF THE
CONSTRUCTION: $ 84.50/ UZ
y. NEW BUILDI
RESIDENCE COMMERCIA OCCUPANCY INFORMA
ADDITION TO BUILDING: PRIMARY BUILDING PP `C� QED
RESIDENCE/COMMERCIAL Single Famil Dwel i+ng
ALTERATION TO BUILDING: Two Family D 291995
RESIDENCE/COMMERCIAL Family D e11T4i
(NO CHANGE TO EXTERIOR SIZE) Office
OTHER WORK (DESCRIBE BELOW) Mercantile TOWNOFQUEENSBURY
_ Warehouse BUILDING AND CODE
ManufacIuri
ye, _ Other - N a �toj
GROSS AREA OF PROPOSED STRUCTURE :
1ST FLOOR 19A9 SQ. FT.
IF ADDITION, USE OF NEW ADDITION:
2ND FLOOR SQ. FT.
OTHER FLOORS SQ. FT.
(not unfinished cellar or basement) ACCESSORY BUILDINGS :
Detached Garage - One/Two Car
TOTAL FLOOR AREA: 4164E1 SQ. FT. Attached Garage - One/Two Car
Private Storage Building
SIZE OF NEW STRUCTURE : Commercial Stora e Bu lding
)p Other ,C
FEET X S 1 FEET
Foundation Type: Cnit e Will any second-hand or ungraded
Number of Stories : lumbe be used? If so, for what?
(habitable space only)
Height (grade to ridge) : Ke feet Type of Heating System:
Number of fireplaces nd/or woodstove (circle all which applies )
to be installed: IIIR Electric / Oil / Gas / Wood
Fo ed Hot Air / Baseboard / Other
PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS RJ,GARDS TO BUILDING CODES IS :
NAME OF BUILDER/ADDRESS/PHONE : / iale /W,. ���//e /"'f °
NAME OF PLUMBER/ADDRESS/PHONE :
NAME OF MASON/ADDRESS/PHONE :
NAME OF ELECTRICAN/ADDRESS/PHONE:
DECLARATION
To the best of my knowledge the statements contained in this appli-
cation, 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 noted, and that such work is authorized by the owner.
Further it is understood that I/we shall submit prior to a Certificate of
Occupancy or Certificate of Compliance being issued, an AS BUILT PLOT PLAN
drawn to scale, showing actual location of ' ct on re
Signature S?_
(Owner, o e ' agent, ar ii ect, contractor)
FOR ANY SPECIAL PROVISIONS - SEE REVERSE SIDE :