application ° a'j-- �C OFFICE USE ONLY "�"1?/1''1�
TAX MAP NO. �. 1 -( - /, I • <
PERMIT NO. t�� • i ; �, OCj� � ,�,�, 1
FEES: PERMIT RECREATION v 1 n 2007
ENGINEERING : ' ,k b r. m I
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(If applicable) �T `J+d'N Osr OCTiE ,;;,
PRINCIPALS ,��t�f� -cuG�s�y TRUCTURE:
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: `—crr-L� CA
C--� � '� -7e�� �. OWNER: � '�rl�e ,
ADDRESS: (o -(a a�,., G' ADDRESS: cF( )
PHONE NOS. " 7c/ -7,P71 PHONE NOS. --79. `f 7Lf
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE:
PHONE: nl a
LOCATION OF PROPERTY t ,..)6.- 15cc'
SUBDIVISION NAME: LL'Zei-v.e �ct ., -c _ CE,
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT z
APPLY TO YOUR z 1 CC O a a w
PROJECT 0 00 0co
W -ILL u W ¢ tl = =
W 0 J 11 d z C'J F=- ~ O Z
z < ¢ .- cn N � O �i I—u El_ 206
SINGLE FAMILY ,
TWO-FAMILY
MULTI-FAMILY
(NO. of UNITS )
TOWNHOUSE
I
BUSINESS OFFICE
RETAIL-
MERCANTILE
ao41S5
FACTORY OR
INDUSTRIAL U-lpoc3 a'-.1 ? i ' (.0U
ATTACHED
GARAGE(1,2,3)
OTHER
IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS: \., Z r es.e \(•
ESTIMATED CONSTRUCTION COST: -pt 0O0,� FUEL TYPE:
HEAT TYPE: *HOW MANY FIREPLACE(S): AND/OR WOODSTOVES(S): '--
ZONING CATEGORY:L-1-- t N ARE THERE WETLANDS ON THIS SITE? \Dr,
IS THIS A HISTORIC SITE? ::). �
PROPOSED USE OF BUILDING OR ADDITION: S� cie.
*Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in our office
t"!C-N
� B 3-LGL 114
Town of C)uoonchiirsi • ('nn iint,Nf f-ti 1l07i01n-yia.4- (Minn . 741 Dn.. A.....J c.v. ..�..i....... A r-i a n or,n
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? \' ...-
•
ARE THERE EASEMENTS CN PROPERTY? ' ' \_
4
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, 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 su ce of a certificate of occupancy.
I have read and Tee to the - • e.
Signed t ,`�►�
giejl
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:
L__
B NG & CO S APPROVAL
ZONING APPROVAL
DAT
DATE
d
QUESTIONS? CALL 761-8256 OR EMAIL
codes aueensbury net
Once Use Only VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensbury net
Operating Permit Issued: Yes No
Occupancy Type: ,`j — Construction Classification:
Assembly Occupancy Limit:
Special Conditions:
,'. Town of Queensbuny • Community Development Office • 742 Bay Road, Queensbury, NY 12804