application TOWN OF QUEENSBURY (Space inside block to be filled in by
WARREN COUNTY, NEW YORK ' , Building Inspector)
Application -for Application No.
pP Permit Issued 19. .
BUILDING AND ZONING PERMIT I°,vi uit Expires. Id.
%Awing District - .
• \ aim. i'I Work,$
THREE (31 Copies of a PLOT PLAN, Drawn to scale .\i'I"."`" by c�1
showing the actual dimensions of the lot to be built Remar)CS /"
upon, The exact size, and location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
1 3/ — i ' DATE TOWN OFr,7 �`
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK ,+, ,l
FS r b i
ANSWER ALL OF THE FOLLOWING. rF >
__The undersigned hereby applies for a permit to do .the following work eg" a
which will be done in accordance with the description, plans and specifi- ,A.1,, e °„„, ,1 ., -t3
cations, and such special conditions as be indicated on the permit. ell 7� ,,�9 S),t.'! ;j t ;1`;i`,k d r d
The owner is property is: . ; b 6/ ,:i'
" ' (NA'4E) (P.O.ADDRESS) '
The person r ns•_i or 9 superv• 1n of the work in far as the Building Code and the Zoning Ordinance apply is:
P (NAME) IP 0.ADDRESS)
Name of Builder Address
Name of Plumber Address
•
Name of Mason Address'
Lot Number Unit Estimated value of proposed work 3 . . Z.✓-- ' (1'°
Name of Village •
Name of Street Side of street: north 0, east 0, south 0. west 0
Nearest Cross Street Distance from this cross street Ft.
Property is north ❑,south ❑,east Ar, west. 0 from Cross Street
If on Corner, which corner,-northeast ❑, northwest ❑, southeast DI. southwest
(Designate by marking with an "X" in the correct space.)
• NATURE OF PROPOSED WORK OCCUPANCY
❑ Construction of a new building. Main Building
One-family dwelling ❑
❑+ Addition to a building. ❑
Alteration to a building. Two-family dwelling
-family/141
apartment house ❑
❑ Demolition of a building. • Store building ❑
• -car attached garage ❑
Other:
• Accessory Building
One-car detached garage ❑
0 Other work. Describe:. . .C
2� /�� f Two-car detached garage ❑
Private chicken house 0
Private storage building ❑
Other:
ZONING SPECIFICATIONS. Fill in for new building, or addition to existing building,or a change of occupancy.
Indicate on the plot plan street names, the location and
size of the property, the location, size and setbacks of pro-
posed buildings,and the location of all existing buildings.
NORTH Show proposed buildings) in'dotted line and existing
• huilding(s) in solid line.
-.. Size of property . .-/I /• t x ft.
Size nd use of existing buildings, if any ✓ s
la
Itt • it Size of propose building ft.x ft.
Height(from grade to ridge) ft.
Front yard ft.
Side yards ft. and ft.
Rear yard ft.
SOUTH If on corner,setback from side street ft..
Note: All distances are net, as measured from street side
. . line to nearest part of,building. •
(OVER)
7-73—M
(cont'd.)
BUILDING SPECIFICATIONS.,
Kind of construction: Wood frame, fire safe, etc.
Will any second-hand lumber be used? If so, for what?. . . �L G
Material of foundation walls Thickness
Depth of foundation walls below grade Continuous fou a ton?
Will there be a cellar? If so, material of cellar floor
Type of roof: Sloped or flat? . . .r��l..4 .. . • • • . Material of roof
Size,wood studs /R• xe•Qev 3, •"�,,pacing "o.c., length • ft.
Size, floor beams, 1st floor ' x , pacing "o.c., span ft.
Size, floor beams, 2nd floor " x ";;, spacing "o.c., span ft.
Size, ceiling beams r j'�/a• 5f,1 �✓ spacing 'o.c., span ft.
Size, roof rafters or beams ��'' x , ",.spacing "o.c., span ft.
Exterior finish With what material?
Finish of interior walls
If garage is to be attached, of what material is wall between garage and main building to be constructed?
Is there to be an opening between garage and building?
Kind of heating system Oil burner or coal?
Will a flue-lined chimney-be provided? . Depth of chimney foundation below grade
Height of chimney above roof
Will there be a fireplace? Depth of fireplace hearth
Will a toilet be installed?
Will a kitchen sink be installed and connected to water supply?
Water supply (public water supply or pump)
Distance of cesspool from any private well feet
Will drainage system be provided with required traps, cleanouts, and vents?
Town of Queensbury AFFIDAVIT
County of Warren
State of New York
I swear that to tt hc;r of my knowledge and belief the statements contained in this application, ther with the plans and specifications sub-
mitted, are a true and co.l.•lete statement of all proposed work to be do on they described p ses and that all rovisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertaini, f*the proposed work complied wdtl Iether specified or not,
and that such work is authorized by the owner.
r�jLL �1r �'
Sworn to to before me this Signature,/
ER.OWNER' AGENT,AR ECT,C TRACTOR
day of 19
NOTARY PUBLIC. WARREN-COUNTY, N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
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By