application ,---7)
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' OFFICE
USE ONLY "•� �.....,......
TAX MAP N0. • -- �� z p i i
PERMIT NO. / ' : t
e
; FEES: PE- , tea¢ ;
',.-7.: 77)/-°F PE '.CREATIONENGINEERING , i �S #
. +C3uJ( iiVGS�Tti' �p/�II�.FgR .�4,Lt ./l (If�pplis able) ; S i.� .�
....................
PRINCIPAL STRUCTURE:
LICTLIRE:
APPLICATION FOR ZONING APPROVAL & BUILDING
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION PPLICATIOPERMIT
REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION. N IS SUBJECT TO
APPLICANT/BUILDER:
11/212eAzejl&g___S OWNER: .1232.,______
ADDRESS:II-- d%11/ " e' _i ' ADDRESS:
1h2Yt 1 1Ul y /22_0-3
� f1't-e
PHONE NOS._______ ---S2 ^ 4 _`d��, PHONE NOS,
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE:
Sjeflit5LPHONE: AO
LOCATION OF PROPERTY:
SUBDIVISION NAME: L 44 ,
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT z
APPLYC O YOUR O 0 cc d o
o 0 . 0 •
LLU T � � _
PRz < < i- w t,g oL o xwZ
V SINGLE FAMILY 49
0 01 1 22.c.-i4
L44 TWO-FAMILY
MULTI-FAMILY
(N0.of UNITS____
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACH •
GARAG--�'� 3) <---268
OTHER
Z�.�`
IF COMMERCIAL OR INDUSTRIAL—NAME OF BUSINESS:
ESTIMATED CONSTRUCTION DOST:
-FUEL TYPE:
HEAT TYPE: *HOW MANY FIREPLACE(S):apJ;bJc-AND/OR WOODSTOVES S
ZONING CATEGORY: � �'
ARE THERE WETLANDS ON THIS SITE? y_e5
IS THIS A HISTORIC SITE?
PROPOSED USE OF BUILDING OR ADDITION: & CO ' 'lib
*Please complete a separate Application for"Fuel Burning Appliances&Chimneys" •vailable in our office
B 3-LOL 11.05
Town ofQueensbury•
w, ' Q ry Communihj Development Office • 742 Bay
� Road, Dueensbur��. NY 1oan4
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? M )
ARE THERE EASEMENTS ON PROPERTY? 01'l /1+7 5, p,�
I acknowledge no construction actihitles shall be commenced prior to issuance of a valid
permit. I certify that the application, plans, and supporting materials are a true and
complete statement/description of the work proposed, that all work will be performed in
accordance with the NY State Building Codes, local building laws and ordinances, and in
conformance with local zoning regulations. I acknowledge that prior to occupying the
facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand
that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuancre of a certificate of occupancy.
I have read an'dree t
ago.the above.
Signed •
Director.of BuiJdmn
de ,-761-8266 kfor questions.regarding.Building Permits, construction
codes or septic systems
Zoning Administrator 761-8218 (for questions regarding required permits, the permit rocess
application requirements or to schedule an appointment) p
Permission is hereby granted to the above This application / proposed action
Applicant to erect or alter the buildingp ton described
described herein in accordance with aid herein is found to be in accordance with the
Application: zoning Laws of the Town of Queensbury.
IA w
BUILD ' &CODES APP-4VAL
ZONING APPROVAL
DATE
DATE
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QUESTIONS 7 CALL 761.8
codesll>�aUflsb • t--"D
VISIT OUR WEBSITE FOR MOR
vsflnrw.aueensbu
•
Tozcm o
f Queensbury• Community Development Office . 742 Bay Road,, Queensbury, NY 12804