application Department of Community Development Reviewed By:
f�l1-
Building Code Enforcement .401.144ft Building H}spictor
Towrt-o f Queensbury IOW Permit No. C/ 5 - Li
742 Bay Roa 00
Queensbury, New York 12804 Fee Paid $ SO,
(518) 745-4447 Building Permit 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.
Applicant: Ify, 1 Owner: 640 �- ,
.Address: ILA DH, ftrl-ii15 PYAddress: LU .17 ? k LT-it, tiiicsbU O.'
Phone # ( ch, ) `34 2'frS Phone # (94 ) %- o /0
Property Location: 91) ti P `11) / 1 Q,/
Subdivision Name: Tax Map Number b �`f
�Scction Block Lot
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
New Building: CONSTRUCTION: $ 24000 . "O
residence / commercial
Addition to Building: ----
residence / commercial OCCUPANCY INFORMATION:
Alteration to Bu ' rig:"-'-. Primary Building - ---�i
residence ommerci - Single Family Dwellin viciD
Residence / Commercial Two Family Dwel ' Wi.1041-.*
no change to exterior size Family Dw 1
Office U� `�1�gg
Other Work (des ribe belo� Mercantile J
1'04j -ft- � 5 o . (opt ' 4. , 14 ' P Manufacturing ut3eti IS$U°
Other -OM LNG PNa COD
GROSS AREA OF PROPOSED STRUCTURE* ElkA
1st Floor ?Apo() . ft . If ADDITION, what will use
2nd .Floor sq. ft . of new addition be? :
Other Floors — sq. ft .
(not unfinished cellar or basement)
ACCESSORY BUILDINGS:
gi.AALCIO° Detached Garage 1 , 2 car
TOTAL FLOOR AREA: SQ. FT. Attached Garage 1 , 2 car
Private Storage Building
SIZE OF NEW STRUC RE : Commercial Storage Building
Other _
FEET X U FEET
Foundation Type : V2l-tlic- Will any second-hand or ungraded
Number of Stories : I lumber be used? If so, for what?
(habitable space only) iq
Height (grade to ridge) : feet TYPE OF HEATING SYSTEM:
Number of fireplaces nd/or woodstove (circle all h applies )
to be installed: Electric / Gas / Wood
Forced Hot it / Baseboard / Other
Person responsib e for /supervision pf wiNrk/ r garde toi' u 1c�,i g
codes is : w I u I lA)®do I tp i IMF- 1 `1' l Y
Naiie Addresss Phone
Builder: UNMer --
Plumber:
Mason:
Electrician:
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
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