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8312 BUILDING PERMIT TOWN OF QUEENSBURY No 8312 —WARREN WARREN COUNTY, NEW YORK PERMISSION is herebyMyron Rapaport granted to. • OWNER of property located at Assembly Point Road and on Lake Geo.Street, Road or Ave. in the Town of Queensbury,To Construct or place a Crib Dock 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. OWNER'S Address is 175 Bradley Place 0 Palm Beach, Fla. - o hi rt 2. CONTRACTOR or BUILDER'S Name • • Joe Roulier 3. CONTRACTOR or BUILDER'S Address Seeley Road Cleverdale, N. Y. - tn 4. ARCHITECT'S Name _ t7' 5. ARCHITECT'S Address 0 O l-'• rh 6. TYPE of Construction—(Please indicate by X) O ly ( ) Wood Frame ( )_Masonry ( )Steel ( ) 7. PLANS and Specifications crib dock U shaped per plot plan and co No. 'specifications and application submitted. �. CD 0 8. Proposed Use Fi O Dock $ 15. 00 PERMIT FEE PAID -THIS PERMIT EXPIRES Aug. 1 19 84 n N, (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.) 0 Dated at the Town of Queensbury this 31 st - Day of Jan. 1984 SIGNED BY • /rG -' o" ,J for the Town of Queensbury Building and Zoning Inspector TOWN OF QUEENSBURY (Space inside block to be filled in by WARREN COUNTY, NEW YORK • , Building Inspector) AppIication Application No. for Permit Issued. I9. . BUILDING AND ZONING PERMIT Permit Expires. ICJ. "Aiming, District . \ ;iIne ttl Work% • THREE (3) Copies of a PLOT PLAN, Drawn to scale •\1'1""``•d b showing the actual dimensions of the lot to be built IZcmarKf upon, The exact size, and location on the lot of the c.tfEr /aj '° It building to be erected or altered MUST BE SUB- 4. Tou,.v OF es e MITTED WITH THIS 65ej APPLICATION. / //�(/� ri,TOWN OF QUEENSBURY _ I I�P Z DATE Ca 1 . . 0 A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK JAN 3 .1 1984 ANSWER ALL OF THE FOLLOWING. l5 9 The undersigned hereby applies for a permit to do the following work A.M. which will be done in accordance with the description, plans and specifi- `7�8i9�M11-)12$1 011.1I5I6 P P , I ! 7 . 1 1 , , I cations, and such special conditions as may be indicated on the permit. The owner of this property is: —i"(fat-I . .S. .•.PApAV..0PT. l l s . Al?L . E-. \?ALt a. Er . 4 334 8 6 NA'••E) (P.O.ADDRESS) The personrs responsible for 'supervision of the work insofar as the Building Code and the Zoning Ordinance apply is: „`"' ' ' ' '.,€)(At_ (P.O ADDRESS) (NAME)ME) Name of Builder. .�d�' uLi-er Address . .s.e>: . . Re.). � .'P '4-G - Name of Plumber Address ' • Name of Mason Address Lot Number Unit Estimated value of proposed work 3 Name of Village Name of Street . AS51:!M6-1• • t'•t, 'PIP'. Side of street: north 0, east 0, south 0. west 0 Nearest Cross Street . 0—. Distance from this cross street Ft. Property is north south ,east i,west 0 from Cross Street If on Corner, which corner, northeast ❑, northwest ❑, southeast ❑, southwest i (Designate by marking with an"X" in the correct space.) NATURE OF PROPOSED WORK OCCUPANCY ' ❑ Construction of a new building. Main Building • ❑ Addition to a building. . One-family dwelling ❑ ❑ Alteration to a building. Two-family dwelling ❑ ❑ Demolition of a building. -family apartment house ❑ Store building ❑ -car attached garage ❑ Other: Accessory Building One-car detached garage ❑ O Other work. Describe:. ��-/7113 rit\ •.I ... . . 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, size and setbacks of pro- posed buildings,and the location of all existing buildings. NORTH Show proposed buildings) in dotted line and existing • Ituilding(s) in solid line. Size of property ft. x ft. Size and use of existing buildings, if any F y A W Size of proposed building ft.x ft. Height (from grade to ridge) ft. Front yard ft. - Side yards - ft. and ft. Rear yard ft. SOUTH If on corner,setback from side street ft.. Note: All distances are net, as measured from street side line to nearest part of building. (OVER) • 7-73-TMI• - (cont'd.) BUILDING SPECIFICATIONS., ` . ��1 Kind of construction: Wood frame, fire safe, etc.?. . .Y/Will any second-hand lumber be used? 140 If so, for what2 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. Size, 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 bui.1Qing 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 installed2 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-neir of my knowledge and belief the statements contained in this application,together with the plans and specifications sub- mitted, area true and co.i.pplete statement of all proposed work to be done on the described premises and that all provisions of the BUILD- ING CODE,THE ZONING ORDINANCE,and all other laws pertaining to e proposed.work shall be complied with,whejher specified or not, and that such work is authorized by the owner. Signature day of 2‘2" --A-- 19. yy��,� OWNER.OWNER'S AGENT,ARCHITECT. TRACTOR.l�... �.._ SPECIAL CONDITIONS OF THE PERMIT: • • By APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT OMB APPROVAL NO. 0702-0036 . (33 CFR 325) Expires 30 June 1986 The Department of the Army permit program is authorized by Section 10 of the"River and Harbor Act of 1899,Section 404 of the Clean Water Act and Section 103 of the Marine,Protection,Research and Sanctuaries Act. These laws require permits authorizing activities in or affecting navigable waters of the United States,the discharge of dredged or fill material into waters of the United States, and the transportation of dredged material for the purpose of dumping It into ocean waters. Information provided on this form will be used in evaluating the application for a permit. Information in this application is made a matter of public record through issuance of a public notice. Disclosure of the information requested is voluntary;however,the data requested are necessary in order to communicate with the applicant and to evaluate the permit application. If necessary information is not provided,the permit application cannot be processed nor can a permit be issued. One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this application(see sample drawings and instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application that is not completed in full will be returned. .APPLICATION NUMBER (To be assigned by Corps) 3.NAME,ADDRESS,AND TITLE OF AUTHORIZED AGENT SAM• !.NAME AND ADDRESS OF APPLICANT Telephone no.during business hours MVIZoN CA PA oei 17 S 13 12.A b L E y P L. A/C( ,) (Residence) A/C( ) (Office) PALM BEAI?H I FLA . 33A-sc� Statement of Authorization: I hereby designate and authorize. to act in my behalf as my born no.during business hours , bht in the processing of this permit application and to furnish,upon request, supplemintai information in support of the application. A/C(30.5) 6 et+ o I (Residence) SIGNATURE OF APPLICANT DATE A/C(30f) G=5-9 531 I (Office) 2�/�71it°,, /� •✓`/! /1. -6/134_ I.DETAILED DESCRIPTION OF PROPOSED ACTIVITY ' la.ACTIVITY CbNST EL) CT1C c-, TtMi3E1Z C Do • 3b.PURPOSE P2lvA7-E PLEA5u�F Uri • • 4c.DISCHARGE OF DREDGED OR FILL MATERIAL • N C') ts.1 • • _:NG FORM 4345,Apr 83 EDITION:CiF 1 OCT 77 IS OBSOLETE (Proponent: DAEN•CWO<N) • 5.NAMES AND ADDRESSES OF ADJOINING PROPERTY OWNERS, LESSEES,ETC.,WHOSE PROPERTY ALSO ADJOINS THE WATERWAY • Na H S1 - WESLEY A MAf .1E 1-_p 12.1NaTc' ASS 1=M f3 LY Po 1 r1TiL P_l) )• HA k ZIS BAY) LAKE aEa2d N,y. 5 p S I r"-_`' E, - G,u Y T MA / E, TeE L.L a ASoa E. M �'SI,U PT 0.. D, ) HARE IS F3AY 1 . �1 ('rZ�E, NY. • 6.WATERBODY AND LOCATION ON WATERBODY WHERE ACTIVITY EXISTS OR IS PROPOSED ' +ter . LAKE. GEorzGE N.Y. .. '°" .;...,710NNAIRE (SL.ppioli.,c:i to t:NL; Form 4345 NA g 1Z. IS SA Y S i r7 oi=` 'S> M f LY PT: is required) NAI f.o mi•201 is inclosod 7. LOCATION ON LAND WHERE ACTIVITY EXISTS OR IS PROPOSED ADDRESS: 3)ar O T No i r-H A F TE l I4N O)c 2 p ON A S 2) E i/�131---Y Pr C STREET, ROAD,ROUTE OR OTHER DESCRIPTIVE LOCATION A S Y F}r. IZr7 TOWN( OF (' U FNS8u �Y l WA22EN COUNTY STATE ZIP CODE C o I.)N I y I N.y, • 1 " T-OWN OF Q uEhNS BL E_y LOCAL GOVERNING BODY WITH JURISDICTION OVER SITE 8. Is any portion of the activity for which authorization is sought now complete? • ❑YES NO If If answer is"Yes"give reasons,month and year the activity was completed. Indicate the existing work on the drawings. - 9. List all approvals or certifications and denials received from other federal,interstate,state or local agencies for any structures,construction, discharges or other activities described in this application. • ISSUING AGENCY TYPE APPROVAL IDENTIFICATION NO. DATE OF APPLICATION DATE OF APPROVAL DATE OF DENIAL Now 10.Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar with the information contained in this application,end that to the best of my knowledge and belief such information Is true,complete,and accurate. I further certify that I possess the authority to undertake the proposed activities or I am acting as the duly authorized agent of the applicant. S NATURE OF APPLIEANTf DATE SIGNATURE OF AGENT DATE � • The application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly authorized agent if the statement in Block 3 has been filled out and signed. 18 U.S.C. Section 1001 provides that: Whoever,in any manner within the jurisdiction of any department or agency of The United States knowingly and willfully falsifies, conceals,or covers up by any trick,scheme,or device a material fact or makes any false, fictitious or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,fictitious or fraudulent statement or entry,shall be fined not more than $10,000 or imprisoned not more than five years,or both. Do not send a permit processing fee with this application. The appropriate fee will be assessed when a permit is issued. • r PS LONE /N� r • • Ise. I 1 • 4 l IO'-O��DOc.K:4 SET BACK. 1 f _ .l 9 \, • — )' HAI2QIS • a -��� +-I• ug. BAY Wd f RIVATE 1 -� O L DO QC._ , o4 43(.2.5 -i .,. PoTEGT r . VIC IN IT' Y MAP • • i. I ► 1 . "p o '/4• '/i. I M t. fA /. \,,,.., 2 0 C.1< "c�c► X CR, 1BS W . Z • j TorA,L Af2.EA ...-- \: 3.21b c�► • � • a WITH SUN ROOF • - O \ Gr0 N %, \j- I - d-o , z „ 33-0 • ��..j • eq< ifrf,C2- , • ur- 7.1c4..n....,If 42t- - ...1 e ELEVATION or DoC..k I-eg, •PROPOSED TIMBER CCLt a Dock . Q ji. SPS •11\I LAKE GEOIZGE „ WATER DEPTH 1 ", rI -e 5--o WAIZ12E'N COUNTY 1� NEW YOZ. K Ptzop OWN>< AAPPLICATION BY ; N.- W.A. HAeeINGT `�_oN MY EON IZAPAPORT S. - G•T• TF LLO 2C TAN '8 4 • • r . • • . ,l • 61 • • • • • • .;'`�: V E w ►= o iH 5d u tit •' • • ro• D• • • • I.' • it . • • • • • • A.r • - •• ' •- 1 • •►- tfr t Ify4• 'y )•A` i'ts,:myp•l' J,•' " ' _ ate. ' f w ,1,1gXL,e�- l. ' 7. _ • `•h''• ~a ' 1 ` '+00r ,1 1 , :'fit J' t•i• , :'ir' • '' ' • .. *.4,47".. ,::,i'•4 4 tr.lii.• i'• ..,•••°. 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