8251 BUILDING PERMIT
TOWN OF . QUEENSBURY 8251
No.
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Hallmark Nursing Home
OWNER of property located at Sherman Ave. Street, Road or Ave.
W
in the Town of Queensbury,To CtliNKIR or place a Demolition of dwelling
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.
N.
1. OWNER'S Address is C1
154 Sherman Ave. -
Glens Falls, New York
0
5
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2. CONTRACTOR or BUILDER'S Name •
Richard Kubricky
3. CONTRACTOR or BUILDER'S Address Hewitt Road R. D. #1
• Glens Falls, New York
•
4. ARCHITECT'S Name 5
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5. ARCHITECT'S Address (D
•
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications t7
No.
demolition of dwelling 23 'x27 ' per application
submitted. . H
r
r+
8. Proposed Use O•
Demolition of dwelling.
•
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$ 10. 00 PERMIT FEE PAID—THIS PERMIT EXPIRES 'June 1 19 84
(1)
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(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.) _ �
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Dated at the Town of Queensbury this 2.9th Day of • November - 19 83
SIGNED BY /41 a,C2 � f' t � for the Town of Queensbury
Building and Zoning Inspector'-
e
TOWN OF QUEENSBURY
(Space inside block to lx. filled in by
WARREN COUNTY, NEW YORK Building Inspector)
• Application for Application No. : .
Permit Issued 19.
BUILDING AND ZONING PERMIT Permit F:xpires. 19.
',oiling District
\ alue o1 \\'c>rk i
-c,)etl h�
THREE (3) Copies of a PLOT PLAN, Drawn to scale \1►1n -
showing the actual dimensions of the lot to be built Itcmicc'Kf'
upon, The exact size, and location on the lot of the .
building to be erected or altered MUST BE SUB-
MITTED WITH ,THIS APPLICATION.
TOWN Ofi Q[lE—NS I; RY
0 Ell
DATE H E
E Y.,!
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK /, NC�V :� 8 .d9if:�
ANSWER ALL OF THE FOLLOWING. A P L / dO „ �,,(
The undersigned hereby applies for a permit to do the following work 7I8 j9114t1a'1?11 2 i P5'm.
which will be done in accordance with the description, plans and specifi- ' . I( +)a 1, I, L�
cations, and such special conditions as may be indicated on the permit. _ t
Theo n r of this property is: _
77 N l/Gl
(NA'4E) (P.O.ADDRESS) • • �
The rson responsible�fo •supervision of the work insofar as the Building Code and the Zoning Ordinanc 'dpplv`is:
. G/Gf r''' dl 0/3.4e c c —.A 2 i,� /7/2 �G4:�,�! . G��". ,iU. . .'. . . . . . . . . . . . . . . . . . .
(NAME) / / (P.O.ADDRE�)
Name of Builder :4 Address
Name of Plumber /it./1 Address
Name of Mason frl Address
Lot Number . Unit Estimated value of proposed work 3
Name of Village -
Name of Street Side of street: north 0, east 0, south 0. west ❑
Nearest Cross Street Distance from this cross street Ft.
Property is north ❑,south ❑,east i 1, west ❑from Cross Street
If on Corner, which corner, northeast ❑, northwest ❑, southeast ❑, southwest
. (Designate by marking with an "X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY '
❑ Construction of a new building. Main Building
❑ dwelling Addition to a building. „ . One-family r, El
ClAlteration to a building. Two-family dwelling ❑
Demolition of a building. -family apartment house ❑
Store building ❑
-car attached garage ❑
• Other:
• Accessory Building
���� ,fI One-car detached garage ❑
0 Other work. Describe:. : / rl Two-car detached garage ❑
k °� �� �/*-- 7 '
a Private chicken house El
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, size and setbacks of pro-
posed buildings,and the location of all existing buildings.
- NORTH Show proposed building(s) in'dotted line and existing
• s k „L A1 huilding(s) in solid line. .
) (r1 2 Sh-A Size of property ft x ft
j.1n-1--, i. Size and use of existing buildings, if any
F. N
s w Size of proposed building ft.x ft.
----------)N9) Height(from grade to ridge) ft.
Front yard
ft.
(cont'd.)
BUILDING SPECIFICATIONS.,
Kind of construction: Wood frame, fire safe, etc.?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Will any second-hand lumber be used? If so, for what
Material of foundation walls Thickness
Depth of foundation walls below grade Continuous foundation?
Will there be a cellar? If so, material of cellar floor
Type of roof: Sloped or flat? Material of roof
Size, wood studs "x ", spacing "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 "x ", spacing "o.c., span ft.
Site, roof rafters or beams "x ", spacing "o.c., span ft.
Exterior finish With what material?
Finishof interior walls
If garage is to be attached, of what material is wall between garage and main building to be constructed?
Is there to be an opening between garage and building?
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 installed?
Will a kitchen sink be installed and connected to water supply?
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
State of New York
I swear that to tt b j of my know,ledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, are a true and coa plete statement of all proposed work to be don n the described p sea and that all provisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertain' to the sad wo 11 be complied with,whether specified or not,
and that such work is authorized by the owner.
Sworn to before me this Signature ...
410 N R S A T, CHITECT,CONTRACTOR
day of 19
NOTARY PUBLIC. WARREN COUNTY, N. Y.
SPECIAL CONDITIONS OF THE PERMIT: