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;OFFICE USE ONLY nil 4 tax wap No__2041-1stat PERMIT NO._it Novas 2005 {FEES:PERMIT.21 AECREATION,ENGINEERING.i STOWNo t i (lf ae SHSENSSURY| PRINCIPAL STRUCTURE: APPLICATION FOR ZONING APPROVAL &BUILDING PERMIT APERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION. APPLICANTBUILDER:ogadise Renesa ors OWNER:DP \ni\Tacks George Don ghy ADDRESS:>Wowuy Ch c\chan Soi ADDRESS:_\c>Widen AY PHONE NOS.5)8\Z04-USO.PHONENOS._G2 3FE3 CONTACT PERSON FOR BUILDING &CODES COMPLIANCE:Groeg eS Nengly PHONE:304 USO, Location o propenty:__/0_Hollen.Avenaat—Qewons mit A SUBDIVISION NAME:BP 200k 53S"Adimeleck PAM Tne. ; 7 a a |PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW: CHECK ALL THAT 6 -| :a APPLY TO YOUR zie «£g a Ee PROJECT fi é BE on o OL2/5)6 ge me wi BES5:we2/2]2 28 NS St fre ‘SINGLE FAMILY | | e ese |TWO-FAMILY | =| |MULTI-FAMILY ||(No.of unrTs___) TOWNHOUSE BUSINESS OFFICE 4 Sona |C RETAIL-|gl"[MERCANTILE |ime us|FACTORY OR ||l INDUSTRIAL L ATTACHED GARAGE(1,2,3) OTHER ||J IF COMMERCIAL OR INDUSTRIAL NAME OF BUSINESS:La ans Ae lasek ‘Please complete a separate ApplicationESTIMATEDCONSTRUCTIONCOST:S\F ooo od for “Fuel Burning Appliances &Chimneys” HOW MANY FIREPLACE(S):_()__AND/OR WooDSTOVES(S):_C_available in our office ZONING CATEGORY:__ARE THERE WETLANDS ON THIS SITE?_\\©. IS THIS A HISTORIC SITE?yc __:, PROPOSED USE OF BUILDING OR ADDITION:is \hi ole Se ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN?Yio Town of Queensbury *Community Development Office =742 Bay Road,Queensbury,NY 12804 AREATHERE:EASEMENTS ON PROPERTY? yep) eee|acknowledge no construction activities shall be commenced prior to issuance of a valid permit.|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 inconformancewithlocalzoningregulations.|acknowledge that prior to occupying the facilities proposed,|or my agents will obtain a certificate of occupancy.|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 issuance ofa certificate of occupancy. |have read and,agree to the above. Signed Director of Building &Codes:761-8256 (for questions regarding Building Permits,construction codes or septic systems) Zoning Administrator:761-8218 (for questions regarding required permits,the permit process, application requirements or to schedule an appointment) Permission is hereby granted to the above Applicant to erect or alter the building described herein in accordance with said Application: This application /proposed action described herein is found to be in accordance with the zoning Laws of the Town of Queensbury. ‘QUESTIONS ?CALL 761-8256 OR EMAIL codes@queensbury.net VISIT OUR WEBSITE FOR MORE INFORMATION yaww.queensbury.netee Q Town of Queensbury *Community Development Office *742 Bay Road,Queensbury,NY 12804