97-721 „,;,,
Building Permit Application.
Town of Queensbury - Dept. of Community Development, 742 Bay Road, Queensbury, NY 12804 /761-82561
^' -OBUILDING & . CODE ENFORCEMENT
NOTICERequirements prior to issuance .
r of this permit: PERMIT FILE NO.ot 7-7a,J
A permit must be obtained before
beginning construction. No inspections d
will be made until applicant has received 1-7 ZoningFEE PAID$Zoning Board Action I 1
a VALID BUILDING PERMIT. MI Area /Use RECREATION FEE PAID$
applicants' spaces on this application
MUST be completed and the signature n Planning Board Action REVIEWED BY:•
of the applicant must appear on the
�ppllCatlOri form. 7Hmot lac SPR / Subdivision /Other Building Inspector J
�' l Recreation Fee Payment
Applicant: C3jar a -14 Owner: C'Z 'rflf illvoi St Ua1l 1,Pfr”
• Address: / Y/CAE( l,�Oc S ?D Address: fi dry, J)' /l/•41. i2.5 2.8'
C`i rroAPAl.6- N• '. /256'
Phone # ..('L -) g 5 - rla;,I al Phone #,( 7/6() gg5 -
Property Location: /59 I//67 nA/OS 'VP. 6'te 5 Alit/A y. f / /
co-
Subdivision Name: �'-""� � �. Tax Map Number VA Section Block I.lt
'
NATURE OF PROPOSED WORK: ESTIMATED MARKET VALUE OF THE
� � E
New Building: CONSTRUCTION: $ , C9-
residence / commercial
Addition to Building:
residence / commercial OCCUPANCY INFORMATION: `
Alteration to Building: Primary Building -
residence / commercial Single Family Dwelling
Residence / Commercial Two Family Dwelling
no change to exterior size . Family Dpue �• n..g..� �,
NXOffice11 :
Other Work (describe below) Mercantile
-WeeoAvSfRb�'rtaa0 r (aLb swto Manufacturing DEC 031997
Other
GROSS AREA OF PROPOSED STRUCTURE: Sra^�, f_ S H EDTOVW,' -• ,RY
tt
If ADD ITION, what.w '11.---1INLu,se - -
1st Floor �b sq. ft. of new addition be? :
2nd .Floor sq. ft.
Other Floors sq. ft.
(not unfinished cellar or basement) ACCESSORY BUILDINGS:
Detached Garage 1, 2 car
TOTAL FLOOR AREA: ZO O SQ. FT. Attached Garage 1, 2 car
-( Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building
Other
10 FEET X 2.0 FEET
Foundation Type: S'L-A? Will any second-hand or ungraded
Number of Stories : j �lumber be used? If so for what?
(habitable space only) / // 7.14i- 30)4,7 't"b '5L. US g b - i ou) S
Height (grade to ridge) : it..) 6feet TYPE OP; ATING SYSTEM: ,C10Aj r
Number of fireplaces nd/or woodstove (circle all which applies)
to be installed: Electric / Oil / Gas / Wood
Forced Hot Air / Baseboard / Other
Person respo sible for supervision of work as regards to building
codes is : ' o,e ie r r i., I i Picfv.c wbs, i�D ��r,,cirb ..)44 e•iv-e 1�)5 0/`4)9 0 %1,
Nam Addresss Phone .
Builder: ....oC , • Co tJ "ile&C:ON)
Plumber:
. Mason:
Electrician: . '
DECLARATION: Please sign below after you have carefully read the statement.
To the best of my knowledge the statements contained in this application, together with the plans
and specifications submitted, are a true and complete statement of all proposed work to be done on
the described premises and that all provisions of the Building-Code, the Zoning Ordinance and all
other laws pertaining to the proposed work shall be complied with, whether specified or noted, and
that such work is authorized by the owner. Further, it is understood that I/we shall submit prior to a
Certificate of Occupancy'or Certificate of Compliance being issued, an AS BUILT PLOT PLAN by
a licensed surveyor; dr wn to scale, sho • g ctual location of project on premises.
Signature:
(owner, ner's agent, architect, contractor) .
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