4728 BUILDING PERMIT
TOWN OF QUEENSBURY No. 4728
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Lena and Leonard Dumoulin
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OWNER of property located at Moon Hill Road Street,Road or Ave.
in the Town of Queensbury,To Construct or place a One-Car Detached Garage
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is
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R. D. #1 a.
Lake George, New York
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2. CONTRACTOR or BUILDER'S Name O
Same
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3. CONTRACTOR or BUILDER'S Address
Same
4. ARCHITECT'S Name p
x
5. ARCHITECT'S Address ~'
O
6. TYPE of Construction—(Please indicate by X)
4C)Wood Frame ( ) Masonry ( I Steel ( 1
7. PLANS and Specifications
24' x 30' per plot plan, specifications and application o
No. submitted. r
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8. Proposed Use N
One-Car Detached Garage
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$ 6.00 PERMIT FEE PAID —THIS PERMIT EXPIRES Jan. 1 1978 O.
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the f,)
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 23rd Day of June 19 77
9
77
SIGNED BY � ��ti G � for the Town of Queensbury
B ding and Zoning Inspebtor
TOWN OF QUEENSBURY (Space inside block to be filled in by
WARREN COUNTY, NEW YORK Building Inspector)
Application for \pplicatiou No. .
Pe•nnit Issued 19
BUILDING AND ZONING PERMIT Pet mit Expires . Ig
/t,nint2, District
. \ dim. (II Work%
THREE (3) Copies of a PLOT PLAN, Drawn to scale \1)1>r„"•`1 by
showing the actual dimensions of the lot to be built R, i>>.iiXS
upon, The exact size, and location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
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A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK `;
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ANSWER ALL OF THE FOLLOWING. c (e E'- P?M.
The undersigned hereby applies for a permit to do the following work 7�g�g'1Q�1 5`6
1�12i1�2�3�4�
which will be done in accordance with the description, plans and specifi-
cations, and such special conditions as may be indicated on the permit. 1 A
The owner of this property is:
%` . /11 .1,
(NA,,G) (P.O.ADDRESS)
The person responsible for supervision of the work insofar as the Building Code and the Zoning Ordinance apply is:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
�-^(NAME) (P 0 ADDRESS)
Name of Builder •5.- Address
Name of Plumber Address
Name of Mason Address
Lot Number /� Unit Estimated value of proposed work S 2723d•/2)
Name of Village C.gb`
Name of treet . . . . . • • - `/I • Ed-
,
Side of street: rt r'th 0, east south O. west 0
42
Nearest Cross Street , Distance i:•c:=a: the, Asoss street . . . .3.071 ? Ft.
Property is north ❑,south 0,east i 1,west 0 from Cross Street
If on Corner, which corner, northeast 0, northwest 0, southeast 0. southwest
(Designate by marking with an "X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY
1= Construction of a new building. Main Building
❑ Addition to a building. One-family dwelling ❑
Two-family dwelling ❑
❑ Alteration to a building. . , . -family apartment house ❑
❑ Demolition of a building.
Store building ❑
-car attached garage
Other:
Accessory Building
One-car detached garage CA./,. ,,.., lt ---
❑ Other work. Describe: Two-car detached garage ❑
Xceey ,,/ed. /.,A if- e. . �3.. . Private chicken house ❑
�- • Private storage building ❑
/0.' I!mil BC,-- " 77e— / 2" . . Other;
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ZONING SPECIFICATIONS.IONS. Fill i�#nebuilding, or addition t'to�sting 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 building(s) in dotted line and existing
I uilding(s) in solid line. / 'lc le *
Size of property 59 4 ft. x / S' r4J ft.
Size and use of existing buildings, if any
m w t l� ,-2( ft.x . 3.Q ft.
Size of proposed g
Height (from grade to ridge) i 3 ) ft.
Front yard 4 0' ft.
Side yards . 1 <a ' ft. and . . . .3.S??• • • • . ft.
Rear yard 3 O ' / ft.
SOUTH If on corner,setback from side street . . • ✓�/•t0 ft.
Note: All distances are net, as measured from street side
line to nearest part of building.
(OVER)
7-73—N
(coned.)
BUILDING SPECIFICATIONS.,
Kind of construction: Wood frame, fire safe, etc.?. . . . . . . . . . . • • • • . • • • • • • • . . • • • • •
Will any second-hand lumber be used? N If so for what?
Material of foundation walls �'` `"` 'r S Thickness
Depth of foundation walls below grade Continuous foundation?
Will there be a cellar? 1, If so, material of cellar floor _
Type of roof: Sloped or flat? • . cam- Material of roof -e"---
Size,wood studs
" x ¢ ", spacing "o.c., length 8•. ft.
Size, floor beams, 1st floor "x ", spacing "o.c., span ft.
x " spacing "o.c., span
Size, floor beams, 2nd floor ft.
Size, ceiling beams '2— "x • • • 1 e, • • • • • • ", spacing 4 "o.c., span ft.
Size, roof rafters or beams "x • • aSS ", spacing "o.c., span ft.
Exterior finish With what material?
Finish of interior walls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If garage is to be attached,of what aterial is wall between garage and main buiAing to be constructed?
Is there to be an opening between rag nd 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .p
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?
AFFIDAVIT
Town of Queensbury
County of Warren
State of New York
I swear that to th A, of my knowledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, are a true and complete statement of all proposed work to be done on the described premises and that all provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertain' to the propo work shall be complied with,whether specified or not,
and that such work is authorized by the owner. J
Sworn to before me this Signature ��tt��
OWNER.OWNER'S AGENT.ARCHITECT,CONTRACTOR
day of 19
NOTARY PUBLIC,WARREN COUNTY. N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
By
( 4" 3 . /2 ) / (-4r c c4
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date /1 j .07
Name i A.
Location /J-" e "it} /f> 1/ .()
Permit No. Weather
Per Cent
Complete Remarks
Excavation
Footing Forms
Footing & Piers
Foundation f i
Cement Coat
Waterproofing
Backfill
Final Survey 7'
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg. r`
Rough Valves
Wall Board
Ext.Porches
Finished Floor \
Interior Trim
Stairs&Railings
Cellar Dr.Tile
Concrete Floors
Plhg.Fixtures
Gar.Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval
Building inspector
RE ARKS
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