application GL e- OFFICE USE ONLY -- r�aa , �n -
TAX MAP NO. ��' -�, I9607 ;_J ��F iJ `—.
PERMIT NO ..4 ---' . ,N. �,.
FEES: PERMIT RECREATION ENGINEERING pCT 11 Q. _
(If applicable)
PRINCIPAL STRUCTURE:
APPLICATION FOR ZONING APPROVAL & BUILDING PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO
REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.
APPLICANT/BUILDER: ��k-A
OWNER: 'N-C._)1_ ,
ADDRESS: (C) -(0,. ?,.., c2Li ADDRESS: kcvvrt '‘'c---Gt j% O
PHONE NOS. g--7 c? ". -1v277 PHONE NOS. ' 79D ' Z`f7y
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE: t PHONE: &v' _(c
LOCATION OF PROPET �V-() `�
SUBDIVISION NAME: LLZ€--v-,e c . Ce
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT Z
APPLY TO YOUR Z 0 ec 0 •
Co a o w
PROJECT 0 < 00 0 co
o I- emu. emu_ CL w Q a = =
F- " z
z Q ¢ '- Cl) i� 0 Oui
c�
SINGLE FAMILY i
TWO-FAMILY
MULTI-FAMILY
(NO. of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE ao 51.
`54
FACTORY OR
INDUSTRIAL a7Ooo a--cod '' (ioU
ATTACHED
GARAGE(1,2,3)
OTHER
l.\ _`A- -fie -o rie f
IF COMMERCIAL OR INDUSTRIAL- NAME OF BUSINESS: \-1,--kter'v e tz:3\.•:: ,
ESTIMATED CONSTRUCTION COST: Lip,, Covc7,` FUEL TYPE:
HEAT TYPE: *HOW MANY FIREPLACE(S): AND/OR WOODSTOVES(S):
ZONING CATEGORY:LT--- t ARE THERE WETLANDS ON THIS SITE? �Da
IS THIS A HISTORIC SITE? kft. 7.-1-
PROPOSED USE OF BUILDING OR ADDITION: 5--\.zA t. e
*Please complete a separate Application for"Fuel Burning Appliances& Chimneys"available in our office
B 3-LGL 114
,.� • - . _ _ _..
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? \ ---D,
4 - •
4
ARE THERE EASEMENTS ON PROPERTY?' t
,
I acknowledge no construction activities 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, 1 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 : ' su- ice of a c-rtificate of occupancy.
I have read and - •ree to the - •-. e.
igle
Signed .111111r_ .`�.�_
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 This application / proposed action described
Applicant to erect or alter the building herein is found to be in accordance with the
described herein in accordance with said zoning Laws of the Town of Queensbury.
Application:
BUIL N & CODES ROVAL ZONING APPROVAL
0
DAT
DATE
J
QUESTIONS? CALL 761-8256 OR EMAIL
codesu
(a geensbury net
Office Use OnIV VISIT OUR WEBSrrE FOR MORE INFORMATION
www.Queensbuu net
Operating Permit Issued: Yes No
Occupancy Type: _____2 —I Construction Classification:
Assembly Occupancy Limit:
Special Conditions:
;„:� Town of Queensbury • Community Development Office ■ 742 Bay Road, Queensbunj, NY 12804