1256 1
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date__— _19
This is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may be occupied as a
Location
Owner
By Order Town Board
TOWN OF QUEENSBURY
Building & Zoning Inspector
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. 1256
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Charles F. Adamson o
OWNER of property located at Assembly Pthint Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a One-Family Dwelling
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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. CD
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1. OWNER'S Address is
Assembly Point
Lake George, New York
2. CONTRACTOR or BUILDER'S Name-
Same
3. CONTRACTOR or BUILDER'S Address
Same
4. ARCHITECT'S Name
Same
5. ARCHITECT'S Address
Same D
6. TYPE of Construction—(Please indicate by X) (n
(X Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications ►C1
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No•18tX241 Two Story as per plot plans and specifications
submitted.
8. Proposed Use p
Dwelling ¢
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$ 16,00 PERMIT FEE PAID —THIS PERMIT EXPIRES 2-1— 19 72
(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 18 Day of June 19 71
SIGNED BY /' • br the Town of Queensbury
Building and ing Inspector
TOWN OF QUEENSBURY
(Space inside block to be filled in by
WARREN COUNTY, NEW YORK Building Inspector)
Application for :Application NVo .v. v
Permit I'stit!(I.L) .� f.. 0 (
BUILDING AND ZONING PERMIT Permit Expires
\'alit,. lil work S
THREE(3) Copies of a PLOT PLAN, Drawn to scale '"I'I"•,Lull l"- _"....
showing the actual dimensions of the lot to be built ltcniarls,3JILDINC . .DN11NG INSPECTOR
upon, The exact size, and location on the lot of the TOvii,4 OF QUEENSBURY
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
ilT /O l j7/ TOWN OF QUEENSpsUR't
DATE D n�] -�
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A PERMIT MUST BE OBTAINED BEFORE EGINNING WORK �� t�z P ,8
ANSWER ALL OF THE FOLLOWING. J U N 18 1971
The undersigned hereby applies for a permit to do the following work - , A.M..
which will be done in accordance with the description, plans and specifi- 7 g g'Ioi11 12 1 2 3 4 5 6
cations, and such special conditions as may be indicated on the permit. ' I$ , 1 , t 'I 'I' I 'I' I ' I '
A.The owner of this property is: .
0/9fiaLES F. fio6N6 ,941
(NAME) (P.O.ADDRESS)
The person responsible for •supervision of the work insofar as the Building Code and thetJ Zoning Ordinance apply is:
0 J1/F-1 -, �SS c 16 j Pe i o!/ i ./�r2A--� G e.o lets-E
(NAME) (P.O.ADDRESS'
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Name of Builder 0 W ill E Address
Name of Plumber 0 vV N ill. Address
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Narne of Mason 0 Address
Lot Number . Unit Estimated value of proposed work$ ) ®-79'0
Name of Village
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Name of Street ��. i'1 B L y uo, iJ ' s Side of street: north ❑, east 0, south 0. west ❑
Nearest Cross Street Distance from this cross street Ft.
Property is north 0;south 0,east E i, west 0 from Cross Street
If on Corner, which corner, northeast ❑, northwest El, southeast ❑, southwest
(Designate by marking with an "X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY
D3 Construction of a new building. Main Building
❑ Addition to a building. One-family dwelling X
❑ Alteration to a building. Two-family dwelling ❑
❑ Demolition of a building. -family apartment house ' ❑
Store building ❑
-car attached garage ❑
Other:
' Accessory Building
One-car detached garage ❑
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, site and setbacks of pro-
-�---NORTH posed buildings,and the location of all existing buildings.
Show proposed buildings) in dotted line and existing�
/9556fS Pi-- g� • buildings) in solid line.
1I Size of property ft. x ft.
'V\ 4 41 Size and use of existing buildings, if any .
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t7n� i w /1 r. .. a,
(cont'd.)
BUILDING SPECIFICATIONS., -
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Kind of construction: Wood frame, fire safe, etc.?
Will any second-hand lumber be used? 41° • If so, for what?
Material of foundation walls• c\) •S T 141 I' Thickness
Depth of foundation walls below grade k 1 S.Ti Al 0 Continuous foundation? /�
Will there be a cellar? iJ0 If so, material of cellar floor
Type of roof: Sloped or flat? `GO/ Material of roof ./4'i/2-A "Y 6 LE-s
Size, wood studs " x `j ", spacing /j "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.
Size, roof rafters or beams "x ", spacing "o.c., span ft.
Exterior finish 4- RA) "" ' T 6 N With what material?4>Ci 4RAD L PA y ova d o
Finish of interior walls NQ /
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 A I=C T k) — 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 ss.
State of New York
I swear that to the best 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 . ne on the described premises and that all provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertain to the proposed work shall be complied with,whether specified or not,
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and that such work is authorized by the owner. .
Sworn to before me this Signature .# �
OWNER,OWNER'S AGENT,ARCHITECT,CONTRACTOR
day of 19
NOTARY PUBLIC, WARREN COUNTY. N.Y.
SPECIAL CONDITIONS OF THE PERMIT:
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