6987 BUILDING PERMIT
TOWN OF QUEENSBURY No. 6987
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Alma R. Hurwitz
OWNER of property located at Gunn Lanp on Take George Street,Road or Ave. W
in the Town of Queensbury,To Construct or place a Dock
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. 0
1. OWNER'S Address is 827 Jamaica Road N-
ft'
Schenectady, New York N
2. CONTRACTOR or BUILDER'S Name
John A. Mason
3. CONTRACTOR or BUILDER'S Address
P. O. Box 86
Cleverdale, N. Y.
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4. ARCHITECT'S Name
N
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( )Masonry ( )Steel ( )
O
0
7. PLANS and Specifications X
5'x55' stake dock per plot plan and
No. application submitted
8. Proposed Use
Dock
$ 10. 00 PERMIT FEE PAID—THIS PERMIT EXPIRES Nov. 1 1981
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 13th Day of July 19 81
SIGNED BY t �gi) for the Town of Queensbury
Building and Zoning In or
TOWS OF QUEENSBURY (Space inside block to Ise tilled in b.
WARREN COUNRTY, NEW YORK Building Inspector)
Application for .\,P,PlicJtiuf
Permit Issued 19
BUILDING AND ZONING PERMIT l'i nit Expires Ig
Y.i.iun: District
\ Am..) Work'
•THREE (31 Copies of a PLOT PLAN, Drawn to scale Item;u\iitornt•tl he
e
showing the actual dimensions of the lot to be built
Kr
upon, The exact size. and location on the lot of the . .
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION. '
TOWN-OF QUEENSBUIav
naiE ' EDEN VE 3
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK MAY f 1981
ANSWER ALL OF THE FOLLOWING. MA, rnG'4,'�'�(i r ��i.
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The undersigned hereby applies for a permit to do the following work 71e19opi►�l1�131415i�
which will be done in accordance with the description, plans and specifi- 4 +
cations, and such special conditions as may be indicated on the permit.
The own r of this property is:
I- to l4 R. :--; ti.; :ry c. •/,/ i1 /y /:z ? .
IBA'EI IP 0 ADDRESS)
• The person responsible for supervision of the work insofar as the Buildipg•COde and the Zoning Ordinance apply is:
>J�;,(-f ni A. (NAME)13S.a!y" �. +,• . ��,trh. : .C.•. . CC..
c c. .�.e.`.i)f:t.t. .c: . ., r .
(v 0 A00RESS1
Name of Builder.. . .`J O H N ' siPAC (''tj Address r •Name of Plumber Address
Name of Mason Address
Lot Number. . .:.Li.. A,2 Unit i ))�i' • ; ,"s.f•j`Estimated value of proposed work S
Name of Village (- t 'E7k • 't d(wjrt' .
t.
Name of Street (.`s- N• • I ��/t!c'
Sick of street: no-th O, east O, south 0. west 0
Nearest Cross Street . . 1.-`'•1'4 .( .11 (_G . ., ,: . Ft.
Distance from this �ross street `ice'
Property is north 0,south ❑,east 5,west Strom Cross Street
If on Corner, which corner, northeast ❑, northwest 0, southeast 0 couthwe;t
(Designate by marking with an "X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY
Main Building
C--1 Constructionof a new building. One family dwelling
❑ Addition to a building. Two-family dwelling ❑
❑ Alteration to a building. -family apartment house f
LiDemolition of a building. Store building l
-car attached garage Li
Other:
Accessory Building
One-car detacher+ garage C
(E1, Other work. Describe:. -I . . r'.s.tr 4'T ` , (t.L("K. Two-car detached garage
Private thicken house t-
Private storage building C
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 an(
size of the property, the location, size and setbacks of pm
posed buildings,and the location of all existing building'
NORTH Show proposed building(s) in dotted line and existin
l;uilding's) in solid line.
Size of property ft. a f
Size and use of existing buildings, if any
5E (;,�i&(. h 'c_ Pala)% F
N
• i m Size of proposed building •ft.a . • • • . • . . . t
Height(from grade to ridge)
Front yard
• Side yards ft. and , • • •
• Rear yard
sour. If opt corner,setback from side street
Note: All distances are net, as measured from street jh.
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?
Material of foundation walls Thickness
Depth of foundation walls below grade Continuous foundation?
Will there be a cellar? If so, material of cellar floor
Type of roof: Sloped or flat? Material of roof
Size,wood studs "x ",spacing "o.c., length ft.
Size, floor beams, 1st floor "x ",spacing ••, "o.c.,span ft.
Size, floor beams,2nd floor "x ",spacing "o.c.,span ft.
Size, ceiling beams "x ",spacing "o.c.,span ft.
Site, 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?
AFFIDAVIT
Town of Queenshury
• County of Warren
State of New York
I swear that to tt bk,i of my knowledge and belief the statements contained in this application.together with the plans and specifications sub-
mitted, are a true and co.,. 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 pertaining to the proposed work shall be complied with,whether specified or not,
and that such work is authorised by the owner. ` 1..
Sworn to before me this Signature - 9!!
OW ER.OWNER'S GEN .ARCHITECT.CON RACTOR
' '/-' day of '7e i 19.. .1
NOTARY PUBLIC. WARREN COUNTY. N. Y. - -
SPECIAL CONDITIONS OF THE PERMIT:
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.PROJECT t 557-10-0416-81 •
APPLI CAW T= John Mason (Hurwitz)
-
YETt.tnV TO U OTT FICAT70IV ISSUER: Joseph C. Prall
Regulatory Affairs, Region 5
Hudson Street Extension
Warl-ensbtr-g Naw- York 12885
r . f EC.Tft.-V May 29, 1981
Ys {'��2/� L�CiC1C�L.1.{OILC"t j?yCfi.i.. OIL c_p ;S v V..Ja -LCx2.Ll:.f.4-Lecc
CI d ,V r,C1;ut-F. 9 d
No ,i,u` eat RPrr-tuurn r v 15 1981-.
Co'r-'ant : (A -t_ach. -sheet .f.6 Wore -Apace ii, regrz. ec j _
Signatuite tl �
AGEflCY RESP;1WIIIG: Town of Queensb ury
DEC PROJECT NO.
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
ENVIRONMENTAL ANALYSIS—PERMIT CLEARINGHOUSE 3-5
DEADLINE FOR REVIEW COMMENTS(Comments received
NOTIFICATION OF AVAILABILITY FOR REVIEW after this date will of be considered)
sy 4zr
'RINT IN INK OR TYPE
This notice is to inform you that the Department is now reviewing the project described below.If your unit has any comments,please take appropriate action.
I. NOTIFICATION ISSUED BY DATE ISSUED
0 Office of Environmental Analysis ulation Unit, Unit iii . 1
y �Re g � .���.7 f 5"f
!. PURPOSE FOR NOTIFICATION— Specify type ❑ Information Only
❑Environmental Review (Department Regulatory Permit
C ft`.e- r- /5
❑Corps of Engineers Project
0 Other
❑Other
This application is subject to Department Permit Clearinghouse review procedures.
The Office of Environmental Analysis will coordinate the review of this project The unit which will issue the permit is
and provide the Department response.
I. OTHER IDENTIFICATION NUMBERS
I. APPLICANT(Include(Include/ccontact person if appropriate)
�6 l;n /��t7 ?
C.....41 = --t.„‘61/4— ill 7‘7"--) .1
Town or City I County
i. BRIEF PROJECT DESCRIPTION
-7;,2,24;- - _75 / _
. ..6,-!--4
6. DETAILED PROJECT LOCATION �n
'L �yz-t _,, �2 l { `' ` 'tip,,
„A1..,4"1.1.-'i
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Town or City ,, County/
7.
(Copy of project description is attached
0 Project information is available for review in Permit Clearinghouse
8, DISTRIBUTION
0Office of Environmental Analysis ❑ (- j-. '` / C- iy� .J✓
[]x Regulation Unit, Region 0 f [, e- Le:6.4: r2-r...a" ''4"7-/�
❑ f i . s ,' ❑
14-12-2(12/76)
Formerly EA-4
NEW YOR,K STATE DEPARTMENT OF ENVIKONMENTAL CONSERVATION ✓ , lG J (f4'` J/
APPLICATION FOR P
ALBANY, NEW YORK 12233 PERMIT
APPLICATION NO.
Reao instructions on back before completing this application. Please type or print clearly in ink. Use separate
addenda and exhibits to provide all required data and explanations for which space on the form is inadequate. I~
0 ARTICLE 15, TITLE 3 (CONTROL OF AQUATIC INSECTS. WEEDS, OR UNDESIRABLE FISH) _ V -Pn
dal ARTICLE 15, TITLE 5(PROTECTION OF WATERS)
0 For the construction, reconstruction, or repair of a DAM or other impoundment structure. MAY i 1981
For the construction, reconstruction,or repair of any permanent DOCK, pier, or wharf; and any dock, pier, or
wharf, built on openwork supports, which has a top surface area of more than 200 square feet. REGULATION ION UNIT
❑ For the disturbance of a STREAM BED or excavation in or fill of navigable waters. r,r.
❑ARTICLE 15, TITLE 15 ❑ WATER SUPPLY ❑ LONG ISLAND WELL REGION 5
❑ARTICLE 24(FRESHWATER WETLANDS) ❑ Permit ❑ Letter of Permission ^J A' g T r ENS3URG N v
❑ARTICLE 25 (TIDAL WETLANDS)
1. NAME OF APPLICANT: John A . Mason
2. APPLICANT IS A/AN (21 Individual 0 Partnership 0 Association 0 Corporation ❑Municipality ❑ Governmental Agency
3. NAME &TITLE OF John A . Mason
Ori
OFFICIAL SIGNING APPLICATION PHONE
STREET ADDRE .C, Box 86 Cleverdale NY 12820
OR P. O. BOX POST OFFICE STATE ZIP CODE
4. NAME & ADDRESS OF OWNER Alma R. Hurwitz PHONE
(If not applicant) 518-377-1183
RPS O82,7 Jamaica Rd. Schenectad NY 12309
P.. O.. BORES
OX POST OFFICE y STATE 0 ZIP CODE 3 9
6. WILL PROJECT UTILIZE
5. PROJECT LOCATION: STATE OWNED LAND?
a) Cityor Village of Cleverdale NAME
OF STREAM OR OTHER WATER BODY:
(If appropriate; if un-named, show on gf Yes 0 No
Town of Queensbury map- See Item 5b)
County of Warren Lake George
b) Specific project site or area is marked on U.S.G.S.or equivalent map, attached as Exhibit No.
7. PROPOSED USE: [X Private 8. PROPOSED STARTING DATE: 9. APPROXIMATE COMPLETION DATE 10. FEE OF $ 5 ENCLOSED
Public ❑ Commercial 5/7/81 5/7/82
11. PROJECT DESCRIPTION: (Feet of rip-rap new channel;cubic yards of material to be removed;draining,dredging,
filling, and location of disposal sites; type of structure to be installed; height of dam; size of impoundment;
capacities of proposed water sources; extent of distribution system;etc.)
To construct a 5' x 55' stake dock
12. This project will require the following additional permits, applications for which are the responsibility of others:
❑ DAM ❑ DOCK ❑ STREAM DISTURBANCE 0 SPDES/NPDES ❑WATER SUPPLY 0 L. I.WELLS ❑ FRESHWATER WETLANDS 0 TIDAL WETLANDS
13. NAME AND ADDRESS OF OFFICIAL NEWSPAPER OF LOCALITY WHERE PROPOSED WORKS ARE LOCATED;
The Post Star
Glens Falls, NY 12801
14. IS ANY PORTION OF THE ACTIVITY FOR WHICH A PERMIT IS SOUGHT NOW BEGUN OR COMPLETE? 0 Yes pp No
If "YES", explain in addenda, giving reasons and dates, and show existing work on drawings or map.
15. CERTIFICATION:
I hereby affirm under penalty of perjury that information provided on this form and all attachments submitted here-
with is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A
misdemeanor pursuant to Section 210.45 of the Penal Law. As a condition to the issuance of a permit, the applicant
accepts full legal responsibility for all damage, direct or indirect, of whatever nature, and by whomever suffered,
arising out of the project described herein and agrees to indemnify and save harmless the State from suits, actions,
damages and costs of every name and description resulting from the said project.
May 7, 1981 �-�
DATE SIGNATURE
95-19-2(4/80) —SEE REVERSE SIDE—
PERMIT ADMINISTRATOR
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