1999-581 BUILDING . PERMIT •
TOWN OF . QUEENSBURY
No. q
. .) -
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to - : : -013 & CANDY
OWNER of property located at 1"1\1'1E Street,Road or Ave.
in the Town of Oueensbury,To Construct or place a :17- hi NT 1A 3; -17::r3:A T
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.
1. OWNERS Address is
2. CONTRACTOR or BUILDERS Name
3. CONTRACTOR or BUILDERS Address
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X) --
S
( 1 Wood Frame ( 1 Masonry ( )Steel
7. PLANS and Specifications
ES DE NT T I,TE ":1ATHR C12.vi Ai
r li".:AT ON
No.
8. Proposed Use
si PA.
$
e r
PERMIT FEE PAID —THIS PERMIT EXPIRES .19
(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 Day of
19
SIGNED BY for the Town of Queensbury
•
Building and Zoning Inspector
Building Permit Application
92—(9'°
Town of Queensbury - Dept. of Community Development, 742 Bay Road, Queensbury, NY 12804 [761-8256J
I •O BUILDING & . CODE ENFORCEMENT
NUTICE, Requirements prior to issuance
A permit must be obtained before of this permit: PERMIT FILE NO.
beginning construction. No inspections r9 C1
will be made until applicant has received n Zoning Board Action
PERMIT FEE PAID$ ---i-,
a VALID BUILDING PERMIT. All • Area /Use
applicants` spaces on this application RECREATION FE
MUST be completed and.the signature Q Planning Board Action REVIEWED B :
of the applicant-must appear on the SPR / Subdivision /Other
Bui ing Inspector
••.lication form. �wt. Recreation Fee Payment
Applicant:war: 1,)---_, III •
Owner: `
•
Address: / i,, /L /b/ ` : .dress: 6 fa/Zh/Z 5/128 '
Phone # (57g) 1 J-2- -42 z Phone # ( 4JiZQ
Property Location: ,3.3 _.- f z
Subdivision Name: Tax Map Number_ ---�
Section Block Tot
NATURE OF PROPOSED WORK: ESTIMATED MARKET Vi -, E • HE
New Building: CONSTRUCTION: $ inne(102)
residence / commercial - D,
Addition to Building: )
residence '/. commercial OCCUPANCY INFORMATION:
Alteration to Building: Primary Building -
residence /, commercial Single Family Dwelling
Residence / Commercial Two Family Dwell-tg�. �
no change to exterior size Family Dwe $f1 1V
Office
\/ Other1 Work (describe below) Mercantile SEP 0 7 1999 uliKbu(13 ,
Manufacturing
Other TOWN OF QLJ ENSSURY
GROSS AREA OF 'PROPOSED STRUCTURE: • Bt11�-mINi l'i'lD CODP
If ADDITION, what will use
1st Floor 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: SQ. FT. Attached Garage 1, 2 car
Private Storage Building
SIZE OF NEW STRUCTURE: Commercial Storage Building
Other
FEET X FEET
Foundation Type: Will any second-hand or ungradfed
' Number of Stories: lumber be used? If so, for ;;silt t?
(habitable space only)
Height (grade to ridge) : feet TYPE OF HEATING SYSTEM:
Number of fireplaces and/or woodstove (circle all which applies) `
to be installed: Electric / Oil / Gas / Wood
Forced Hot Air / Baseboard / Other
Person responsible for supervision of work as regards to building
codes is: .
Name Addresss Phone .
Builder: •
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 i - thorized by the owner. Further, it is understood that I/we shall submit prior to a
Certificate o • c pancy..or Certificat; of Co.. p 1. ce being issued,,an AS BUILT PLOT PLAN by
a licensed -urve or; drawn . scale, how' ac• al location o project on premises.
Signatu iL®�J jM, Alt.t.
(owner, •y's agent, architect, contractor) -
UNAUTHORIZED ALTERATION'OR ADDITION TO MAP ,CLE-F E12.E43LE t • •
THIS DOCUMENT IS A VIOLATION OF SECTION " 11.3 5 P 1 RAT 1 0 1 1 P.•.214_- Sc DD I v 1 S 10 1J [(' 2 9
7209 SUBOMSION 2 OF 1HE NEW YORK STATE i.V
EDUCATION LAW. L - ouT PLAIT" PREPARED 13 ( %-t -.A.}.LEw� /-
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I certify to the following
that this survey hasbeen M O G K 1 G Slat) LAN�
•
prepared in accordancew
with
the Code of Practice for Land
Surveys adopted by. the I.Y.B. CSC R'o'`-'')
Association of Professional
Land Surveyors as last
revised.
RociER.Z' air_NfigT PREVoST
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ITS SUGcESSO RS AND/OR_ASSIG OS
GI4Ic_Aco T1TL_E IQS°RAt.]C.E CornPsa13Y '
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"ONLY COPIES OF THIS MAP SIGNED IN RED
` f"�/ICJ �,� INK AND EMBOSSED WITH THE SEAL OF AN
, 1 OFFICER OF C. T. MALE ASSOCIATES, P.C.,
' OR A DESIGNATED REPRESENTATIVE SHALL
G. ..1 ELF [= 01=1J LSO IJ PL.-5 4904.4 .DATE BE CONSIDERED TO BE A VAUD TRUE COPY'
Date RECORD OF WORK Appr. LOT 33 - MOc1t11JG81RD LANE.
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MALE ASSOCIATES, P.C. EE50 CENTURY HILL DRIVE, P.O. BOX 727, LATHAM, NY 12110 �LJJ
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(518) 786-7400 • FAX (518) 786-7299 Drafter: . .F. Checker: G J D ENGINEERING • SURVEYING • ARCHITECTURE • LAND PLANNINGZEE.gLANDSCAPE ARCHITECTURE • COMPUTE R SERVICES PP Y C
13 A r. b : Proj. No. q a .17 G S SCALE: 1" = -So' DATE: 140.4 . . 1, \S 9 2
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