1663 BUILDING PERMIT
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TOWN OF QUEENSBURY
No.
WARREN COUNTY, NEW YORK N
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PERMISSION is hereby granted to_ R nhPrt c'hu 1 t 7. O
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OWNER of property located at Lot #7 Si immi t X
Lane Street, Road or Ave.
in the Town of Queensbury,To Construct or place a T)IATP 1 1 ; n n S eWR Q a v S t am
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.
12.
O WNE R'S Address is
105 Sunnyside
Glens Falls, New York
CONTRACTOR or BUILDER'S Name
Owner
3. CONTRACTOR or BUILDER'S Address
Owner
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
(X)Wood Frame ( I Masonry ( 1 Steel ( 1 Cn
7. PLANS and Specifications
No- 331X42t as per plot plans and specifications submitted enc. `+
sewage system
8. Proposed Use
One-Family Dwelling Sewage System
C/0 5.00
$ 79.00 PERMIT FEE PAID—THIS PERMIT EXPIRES _ 1 1 -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 11 Day of Anri 1 19 72
SIGNED BY 0 n the Town of Queensbury
Building and Zoning Inspe or
�/o P(j. 4-11-72
CERTIFICATE OF OCCUPANCY _
TOWN OF QUEENSBURY }
WARREN COUNTY, NEW YORK
Date November 28, 19 72
This is to certify ;that work requested to be done as shown by Permit No. .1663
has been completed.
This structure may be occupied as a Cin e-a arni ly Dwelling
Location _ Lot ; 7 Summit Lane
Owner Robert Shultz
By Order Town Board
TOWN OF QUEENSBURY
Building & 2Vning Inspector
7