applicationTO BE COMPLETED BY BLDG.DEPT.
Application No.OWN OFQi ENSBURYTownofQueensburyPersieaoeed8EiVE
Bay and Haviland Road,R.D.1 Box 98 Zoning Designation _4j-
Queensbury,New York 12801 Variance No.
137-2-43 Boece rslonziara}4i518aAPPLICATIONFORElin
BUILDING AND ZONING PERMIT wh sheeeeeeeeer)
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION.ANSWER ALL OF THE FOLLOWING.
The undersigned hereby applies for a Building Permit to do the following work which will
be done in accordance with the description,plans and specifications submitted,and such
special conditions as may be indicated on the Permit.
The owner of thiq property is:Ds las bef
P.o.adaress_[LG bet 96 2-/rei.eaPropertyLocation:(ic Lows Lory Clin:bale,Ae mie Napiio.fs.7Steetnumberorbuildinglotnumbek
Subdivision name (if applicable)Rees cxceoncroce 9A cieen aim os ry wounine Dee Gow as
LasMnbs/)AboyRIClpsiall,2973 -GGI2_
Name J P.O.Tel.No.i Dw Meee aa ma LO GUD
Name of plumber,Address tel YORNameofmason{4c}SyalJque poocessHsBasle7—tel.797-09
NATURE-OF PROPOSED WORK:ZONINGeeAPLOTPLANMUSTBEPREPARED AND SUBMITTED,
drawn reasonably to scale and attached hereto,
showing clearly and distinctly all buildings,
whether existing or proposed and indicate all
set-back dimensions from property lines.Give
street and number or lot number and indicate
whether interior or corner lot.Show location
of water supply and location and configuration
of septic disposal area.:
struction of a new building“Addition to a building“Alteration to a building
(no change to exterior dimensions)
_Other work (describe)
FOR DEMOLITION PERMIT,STATE SIZE AND
LOCATION OF STRUCTURES AFFECTED.
COMPLETE INFORMATION REQUIRED BELOW.
Size of property.ft x ft.
=Existing building(s)Size ft X ft.
PROPOSED BUILEING AND AEEP RAPED tea2Seeplaws Existing building(s)Use d ee
Proposed building,distance from property lineSizeofnewstruMeOstx20re
Foundation-pier,lay)crawl/partial/full“cle one)
No.of stories (habitable space)/
Height (grade to ridge)g ft.If residential,no.of families
No.of rooms (excluding baths)
No.of bedrooms
No.of bathrooms
Primary heating system
‘Type of fuel
No.of fireplaces to be installed
Will a wood stove be installed?,Central Air conditioning?
BUILDING STYLE,PRIMARY STRUCTURE
Front yaraod>ft Rear yard AO ft
side yards OO ft and £Oe ttIfoncorner,setback from side streee———ft
OCCUPANCY INFORMATION
PRIMARY BUILDING -
One family dwelling
‘Two family dwelling
Multiple dwelling /Number of units
Permanent occupancy
‘Transient occupancy
THasingSrranetstar
Sorner SAF hac zTfaddition,what will usedber
||
Ranch Contemporary Log cabin
Raised ranch Mansion DuplexSplitlevelOldstyleBungalow oSCapeCodcottageotherACCESSORYBUILDING-
Colonial Row ‘Town House __Detached garage/one car/two car/__car
(CIRCLE ONE PLEASE )Attached garage/one car/two car/_____carteaRRHHHHHHHKHFPrivatestoragebuilding
ESTIMATED MARKET VALUE OF other.
CONSTRUCTION 5 (ed)
INFORMATION ON BUILDING SPECIFICATIONS,ON REVERSE SIDE OF THIS SHEET,TO BE COMPLETED!
Form BPA 4/86 md-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction,wood frame,fire wacoruen:
(AUAESipe
csssMade
Will any second-hand or ungraded lumber be used?If so,for what?
7Foundationwallmaterial(auyceert Thickness &
Depth of foundation below grade (to bottom af footing)OIE.Ee
Will there be a cellar?__Heated o€unheated?»Floor sq.footage 3a Ft
Will there be a basement?Ayj(QWill any portion be used as living space?(If so,what portion?Sa.ft.--Type of use?
Type of roof -sloped/flatSheg/other.Material of roof_S)EELSize,wood studs x *spacing___—"0-¢.length ft.Joists (floor beams)Ist.Floor spacing *0.¢.-span.ft.Joists (floor beams)2nd.fogs "x "spacing "6.c.span,ft.Overlays (ceiling beans)spacing ‘ove.span___‘ft.Roof rafterssy—gpacing,o.c.span ft.Roof trusses (pre-Ghgineered)spacin Gena okt.OEE PLANS
Of what material’Interior-wall finishIfGarageistobeattached,describe matsrils to be used for FIRE SEPARATION
Ig there to be an opening betweep-oéfage and dwelling?TE go wili-wFirecateddoor,enclosure,and self-closing device be provided?Will a flue-lined chimney~be installed?Height above-roof,fe.
Depth of chimney fouridation below grade eeDepthoffireplacehearthSt.ainy .<
Water supply -Municipal or private well
seo sveren __Distance from ANY privaté well(including adjoining properties ft.(A-Separate application is necessary for any repair or new installation of septic system)ar oF coePieswalsen AFFIDAVIT STATE OF NEW YORK
I swear that to the best of my knowledge and belief the statements containedinthisapplication,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 ell
provisions of the BUILDING CODE,THE ZONING ORDINANCE,other laws pertaining totheproposedworkshallbecompliedwith,whethey ,and that such work is
authorized by the owner.fe
SWORN TO BEFORE ME THIS Signature,ooityarchitect,contractor
day of 19
Notary Public,Warren County,N.¥.
SPECIAL CONDITIONS OF THE PERMIT: