applications TOWN OF QUEENSBURY t
(Space inside block to be filled in by
WARREN COUNTY, NEW YORK Building Inspector)
Application for Application No. .
Permit Issued 19.
BUILDING AND ZONING PERMIT p(.1 Expires. 151_
7.(3nin;; District
• \ :due of \!'orl $
THREE (3) Copies of a PLOT PLAN, Drawn to scale Aiil "'c'cl 1w
showing the actual dimensions of the lot to be built Rcinai)f
• upon, The exact size, and location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION. �.®WN OF QUEENS.,,,.
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. . .?0Ci. .fr. . . HEOME3 .
DATE - • . .
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FEB 2
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK '�-8- j
A.M. J ems- /"eCp ,ftCcl
ANSWER ALL OF THE FOLLOWING. A.M.
0011N12i112I3J4'S 6
The undersigned hereby applies for a permit to do the following work " . ' , . .
which will be done in accordance with the description, plans and specifi-
cations, and such special conditions as may be indicated on the permit. .../O 1 6Q,
The owner of this property is:
(NAME) (P.O.ADDRESS)
The person responsible for •supervision of the work insofar as the Building Code and the Zoning Ordinance apply is:
tiff>A-mf .' 42,4-77.4c t s el r r
(NAME) - (P.O ADDRESS)
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Name of Builder -''6 . . Address
Name of Plumber • Address
q Name of Mason Address _
' I Lot Number qt, •Unit Estimated value of proposed work 5 ti '4•'•`---
Name of Village a�'�elN3 , t?'2y
Name of Street 14'4/944`5 Die(►''°t Side of street: north `;'east 0, south 0. west El-/
Nearest Cross Street 111 ) ehgelq Distance from this -rocs street Ft.
Property is north dY:south ®;east El,west 0 from-Cross Street
If on Corner,which corner, northeast ❑, northwest ❑, southeast ❑. southwest
• (Designate by marking with an "X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY
L Construction of a new building. Main Btailtldng
❑ Addition=to a building. - - One-family dwelling El/
❑ Alteration.to,a building. Two family dwelling ❑
0 Demolition°.of a building. • . . . . . -family apartment house D.
Store building ❑
-car attached garage ❑
Other:
• Accessory Building
- One-car detached garage El
Other work. Describe: Two-car detached garage ❑
• Private chicken house - ❑
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-
NORTH posed buildings,and the location of all existing buildings.
Show proposed building(s) in dotted line and existing
building(s).in solid line.
Size of property /IV ft. x . . .0. . . . . ft..
Size and use of existing buildings, if any AV4
q.
in in
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tots , m Size of proposed building . . . ,,TY ft.x .;-b ft.
al E Height(from grade to ridge). • A ft.
Front yard • M • ft. •
Side yards ft. and 2 ft.
al t.,-(y).$ V.i.1ii-' Rear yard /SW ft.
SOUTH - If on corner,setback from side street ft.. .
Note: All distances are net, as measured from street side
r line to nearest part of building.
7-73—M .
I - (cont'd.) ,
BUILDING SPECIFICATIONS., - - ,
Kind of construction: Wood frame, fire safe, etc.?. . . . . • • • ` • • • • • • • • • • • • • •(. • • • . . . . . . . . . . . . . . . . . • • • •
Will any second-hand lumber be used? / C.) If so, for what
Material of foundation walls yr` z• ,r-,1'�c`/``i.'°i Thickness
Depth of foundation walls below grade l/ Continuous foundation? 1,/,-5
Will there be a cellar? ✓V/) If so, material of cellar floor
Type of roof: Sloped or flat? ., 4Cp6?. . . . • . . Material of roof .41-!1444-4'. . .Sit.it`if-
,Q.4/4 "x ",spacing "o.c., length
Size,wood studs � ft.
Size, floor beams, 1st floor . . . . .40. . . ."x • ", spacing "o.c., span ft.
Size, floor beams, 2nd floor 4/7:4 " x ", spacing "o.c., span ft.
Size, ceiling beams "x _ ", spacing "o.c., span ft.
Size, roof rafters or beam . . . .o'�-. . . . . r"x . . ., i • ", spacing •f' "o.c., span rib ft.
Exterior finish 1�'•��
s( ld recice 6' 77' With what material?
Finish of interior walls. . . . . .••:- E°rieerl-k •
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? es
Kind of heating system -.7.1 A i — "r`' ` C.- Oil burner or coal?
Will a flue-lined chimney be provided? /VP Depth of chimney foundation below grade
Height of chimney above roof
Will there be a fireplace? . +''/e7 Depth of fireplace hearth
Will a toilet be installed2 • of
Will a kitchen sink be installed and connected to water
supply?
/Is
Water supply(public water supplyor pump) .* %" f-s
Distance of cesspool from any private well a�7;, , feet
Will drainage system be provided with required traps, cleanouts,and vents? ft
Town of Queensbury AFFIDAVIT -
County of Warren
State of New York
I swear that to tt;•aac"a l of my knowledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, are a true and coa.•fete 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 th,proposed work shall,be complied with,whether specified or not,
and that such work is authorized by the owner. / • s
Sworn to before me this • Signature ' v'• �4
OWNER,OWNERS AGENT.ARCHITECT.CONTRACTOR
yk n2,b •- W. day of 19
NOTARY PUBLIC, WARREN COUNTY. N.Y.
SPECIAL CONDITIONS OF THE PERMIT:
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By •
TOWN OF QUEENSfURY .
BUILDING AND ZONING DEPARTMENT
HAY AND RAVtLAND ROADS, R, D . #1
GLENS NS 'ALLb, NEW /OR< 12U 0 .
°c P 'LICa iTIO1 FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE
A SEWAGE DISPOSAL SYSTEM WITHIN THE TOWN OF CU£EN1EURY
CCCt1PA T'S 1,TAO. N. of✓ ` tee err g _-_ ___ DDR S6. /0*/ .C4.4 s:'
TELEPHDNE_ Y 7aa , .. owNEt°S NAME _.. -..�
ADDRESS .ao ..�.. NUMBER OF BEDROOMS
GARBAGE GR!NDER'a° j{ __(YES OR NO) TOPOGRAPHY i4.-.; OLLING, STEEP, SLOPE, 'I
GENTLE SLOPE, OTHER
NATURE OF SOIL: CLAY,(ANDi LOAM, GRAVEL, ROCKS, ETC. 1404a2__
PERCOLg!TIO TEST WATER SUPPLY: UNICIPAL TELL OTHER
DIAGRAM OF PROPOSED SEPTIC SYSTEM
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OTHER P ERT .NENT INFORMATION
.11..1,14 --. --��a...e.. _.. .e. .......�. �.e...� .m._.v
IT IS MERELY AGREED THAT IF THIS APPLE ICATION AND PLANS APE APPROVED,
INSTP.L`r iTION OF SEWAGE DISPOSAL FACILITIES Tn'IL'L BE MADE IN ACCORDANCE
WITH ` ,TA.IIS SHOWN.
DATE � SIGNATURE OF A LgCANT T _..�.r
L .R: GEGRGt P :IRK COMMISSION APPROVAL: _�
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