1617 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19 7d,
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 4(1274- I'Ve7/1/7-f
Location Fee5/0,17/AW
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Owner i
By Order Town Board
TOWN OF QUEENSBURY
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'"/ Building & Zoning Inspector
BUILDING PERMIT
TOWN OF QUEENSBURY No 1617
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Frederick T. Hay
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OWNER of property located at Lot 98 Dixon Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Dwelling Sewage System
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. O8
1. OWNER'S Address is 0
Quaker Road
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name Cif
Colony Homes U'
3. CONTRACTOR or BUILDER'S Address
Same as above. .
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
(0 Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No.28'XC O' as per plot purrs and speci deal *a; submitted enc.
sewage system d
8. Proposed Use . 0
One-Family Dwelling 1 car attached garage Sewage System o
$ 30.00 PERMIT FEE PAID —THIS PERMIT EXPIRES 7-1- 19 72 O
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the c}
town of Queensbury before the expiration date.)
co
Dated at the Town of Queensbury this 16 Day ofFebruary 19 72
SIGNED BY Q � �Q for the Town of Queensbury
�/� B lid-Frig and Zoning I pector (-41W/JAI
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• TOWN OF QUEENSBURY
(Space inside block to Ix' filled in by
WARREN COUNTY, NEW YORK Building Inspector)
• Application for ‘pp►icatiun No..
Permit Issued - Pt
• BUILDING AND ZONING PERMIT Permit Expires 19. .
"totting District
' Value ut Work S
THREE (31 Copies of a PLOT PLAN, Drawn to scale .\PI"'('d IW .
showing the actual dimensions of the lot to be built keniarks
upon, The exact size, end location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION. .
j , /€ /q72 TOWN Ol= CU f.7 N S 17dl R Y
_L/ u
DATE V �I� l�r
U ,r 1
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK -I j :Z f=c�
—
�,. 75/�uyl�__J
ANSWER ALL OF THE FOLLOWING. f 't 1 0 1972
The undersigned hereby applies for a permit to do the following work A.M. . P.M.
which will be done in accordance with the description, plans and specifi- 7I8I 1,01-01A 1 12131415!6
111111
cations, end such special conditions as may be indicated on the permit. A,
The owner of this property is: ` .
(NA''tE) (P.O.ADDRESS). .
The person✓responsible for •supervision of the work insofar as the Building Code and the Zoning Ordinance apply is:
J (TIAME) (P.O.ADDRESS)
Name of Builder. . .0 CI r,, r17. 734. c J Address . . . t t.�r�7.M.,. . . /l C
f _;,t
Name of Plumber Address .
Name of Mason / Address
Lot Number. . . . . . c... . Unit Estimated value of proposed work$ / 42 6
Name of Village �, J - •
Name of Street . . . . dI ''
./ �''j ✓`1 ` Side of street: north 0, east ❑, south 0. west 0----
Nearest Cross Street Y/'1,e Crsa r7 Distance from this cross street (3 Ft.
Property is north 0,south El;east i l, west 0 from Cross Street
If on Corner, which corner, northeast ❑, northwest ❑, southeast 0, southwest
(Designate by marking with an "X" in the correct space.) .
NATURE OF PROPOSED WORK OCCUPANCY
1Construction of a new building. Main B.uBtiing
. ❑ Addition to a building. One-family dwelling �---
❑ Alteration to a building. Two-family dwelling ❑
• ❑ Demolition of a building. -family apartment house ❑
Store building [1--
• . . . . i -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 building(s) in dotted line and existing
huilding(s) in solid line.
Size of property . . . . . . . .�.9. ?. . . ft. x. . . ./.2 O. . . ft.
a
r' Size and use of existing buildings, if any . . .. v). 0 l • .
w
W f' <
V m Size of proposed building . . . . .s . . ft..x . . .Q. . . . ft.
��! t; Height (from grade to ridge) ' �' ft.
e Front yard ft.
�� Side yards Q ft. and 3 d ft.
•
Le J Rear yard :3 d ft.
SOUTH If on corner,setback from side street . .. .3 t1. ft.. ..
Note: All distances are net, as measured from street side
line to nearest part of building.
(OVER)
(cont'd.) •
BUILDING SPECIFICATIONS.,
Kind of construction: Wood frame, fire safe, etc. J
Will any second-hand lumber be used? ,Fi/': If so, for what?
Material of foundation walls . . . . . . . i�'/1 Thickness //‘) '
Depth of foundation walls below grade . . �+ Continuous foundation? . Cc.:?z-e s7.
Will there be a cellar? t( � If so, material of cellar floor C=t~sic; '
Type of roof: Sloped or flat? . . . . . A.1.'7 2 . U!/r-Material of roof . . . 54 I;-r
Size,wood studs c "x ", spacing i C "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 f Y 1!5 c'"x ", spacing ?5( "o.c., span ft.
Size, roof rafters or beams . . . x ", spacing "o.c., span ft.
Exterior finish /-'mot With what material?
Finish of interior walls. . . . /Inc 1ii,
If garage is to be attached, of what material is wall between/J(garage and ain building to be constructed?
Is there to be an opening between garage and building? 410II
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 installed2 ✓Will a kitchen sink be installed and connected to water supply? S->
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 done on the described premises and that allprovisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertaining to the proposed work shall be complied wi ,whether specified or not,
and that such work is authorized by the owner.
Sworn to before me this Signature �OWNER, NER'S AGENT.A C ITEC .-R ETOR
day of 19
NOTARY PUBLIC, WARREN COUNTY. N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
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BEDROOM BEDROOM �WI LNING ROOM
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4824 R B-G
COLONY HOMES
Quaker Rd. P. 0. Box 435
GLENS FALLS, NEW YORK 12801 ,
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