2002-416 Building Permit Application
Town of Queensbury—Dept of Community Development,742 Bay Road,Queensbury,NY
(518)761-8256
A permit must be obtained before beginning construction. Permit File No.Qom—"i 1 p
No inspection will be made until applicant has received a Fee Paid $
valid building permit. All applicants' spaces on this Rea Fee Paid
id $
application must be completed and must appear on the Reviewed i
application form. :
Applicant: A/2,14 f'� W 41,11 Owner: -���G .ri=•,��`. S
Address: R I v- -^ Address: 277 eee �
Phone#{�h!} E-4/ Phone#( �-egp}
Email Address: Email Address:
Property Location: Lot Number: I House Number /
Subdivision Name: Tax Map Number: —C70/—
a New Building: -residence I commercial Estimated Market Value of Construction: $
❑ Addition: residence/ commercial If an Addition,what will use of new addition be?
❑ - Alteration: residence/ commercial
❑ No change'to exterior size: residence!com'1
❑ Other work(describe )
Check OccupancyInforniation l't Floor 2"d Floor Other floor Total
Below sq.ft. sq.ft. sq.ft. Square Feet
❑ Single family dwelling G
❑ Two family dwelling
❑ Townhouse
❑ Multifamily dwelling
#,of units
❑ Office
❑ Mercantile zu 77
❑ Manufacturing T 'I='"I" ' URY
❑ 1 car detached garage Ut l�ll�,'G f r,ry'° DE
❑ 2 car detached garage
❑ 3 car detached garage
❑ 1 car attached garage
❑ 2 car attached garage
❑ 3 car attached garage
❑ Storage building-
COlnmeicial
❑ Storage building-
residential
❑ Other led
a
What is the proposed height of the structure� �feet Q inches !
Will any second-Hand or ungraded lumber be used? If so, for what? __. N
Type of Heating System:..electric 7 oil / gas/wood I forced hot air 1 baseboard 1 other:/uf/�L
Number of Fireplaces to be installed Number of Woodstoves to be installed
List below the person(s)'responsible for supervision of work as regards to building codes:
Name Address Phone.Number
Builder �,.�L 7
Plumber ---
i
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 Uwe shall
submit,prior to a Certificate of Occupancy or Certificate of Compliance being issued,as requested by the Zoning
Administrator or D• ctoi of Building Codes,an As.Built Survey by a licensed surveyor;drawn to scale,showing actual
location of al w co
���� owner,owner's agent,architect contractor
Signs e• > S > � �