7901 BUILDING PERMIT
TOWN OF QUEENSBURY No. 7901
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Lyle Brockelsby
OWNER of property located at West Mountain Road Street,Road or Ave. td
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in the Town of Queensbury,To Construct or place a Addition to storage shed
at the above location in accordance to application together with plot plans and other information hereto filed and I1D
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approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is R. D. #2
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
same -
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3. CONTRACTOR or BUILDER'S Address
same 0
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address 0.1
6- TYPE of Construction—(Please indicate by X)
( ) Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications
8 'x12 ' addition to storage shed N
No. per plot plan and application submitted.
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8. Proposed Use 0
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Storage shed o
$5. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES January 1 1984
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(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.) fD
Dated at the Town of Queensbury this 10th Day of June 19 83
SIGNED BY �`}}��'' , • c� r/ for the Town of Queensbury
Building And Zoning Inspector h
TOWN OF QUEENSBURY (Space inside block to be tilled in by
WARREN COUNTY, NEW YORK Building Inspector)
Application for Application No.
Penn it Issued 19.
BUILDING AND ZONING PERMIT Permit Expires. 19.
Aiming District
. \ able o1 Work$
THREE (31 Copies of a PLOT PLAN, Drawn to scale APPI.',`c•cl by
showing the actual dimensions of the lot be built kc m:irKS-
upon, The exact size, end location on the lot of the
building to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
TOWN OF QUEENSBURY
•
la 3 . /- ?.i j"--; k.C. . . . .I. .9. :-.1'. . . H. EGEllVE 3
DATE
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK j U i\3 t) 1::/ti3
ANSWER ALL OF THE FOLLOWING. -A.M. P.M. -
The undersigned hereby applies fore permit•to do .the following work 71819110}1111 �1,2I3)4I5i6
which will be done in accordance with the description, plans and specifi- ' ' ■ ' . ' ' ' ' ! ea
cations, and such special conditions as may be indicated on the permit. �� : .
I..y/e 5,-cic. KGB/{Z y 5,/
The owner of this roperty is: . /
4, . , [ r r..-..li;.. �._, 6/ 6+/ S.s � . : : f. .k. :(. . . . . . . . . e I�__-
(NA`,E) IP.O.ALDR �.a
ESSI
The person responsible for supervision of a work insofar as the Building Code and the Zoning Ordinance apply is:
Sct 4,
(NAME) (P.O.ADDRESS)
Name of Builder Address
Name of Plumber Address •
Name of Mason
Address
e.
Lot Number Unit '� Estimated value of proposed work I . . .u��U ✓—
Name of Village •`O
Name of Street l—�o (l e 1" I L Q a p- Side of street: north 0, east Ai, south 0. west CINearest Cross Street We s-t-/KU u La),I.J . o?4(. . . • • Distance from this cross street Ft.
Property is north ❑,south ❑,east 5 , west 0 from Cross Street
If on Corner, which corner, northeast ❑, northwest 0, southeast D. southwest
(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-famil dwel
ling
dweng
❑ Alteration to a building. Two-family dwelling ❑
❑ Demolition of a building. -family apartment house ❑
Store building ❑
• -car attached garage ❑
/ � !�
Sx )Z. Gr r C 7 Si-r olr.sit,e, Other: Accessory Building
One-car•detached garage ❑
• Other work. Describe• Two-car detached garage ❑
-z- \{�U��Q Private chicken house ElG.C.ct.,G e /t
Private storage building LSI
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, sire and setbacks of pro-
. - posed buildings, and the location of all existing buildings.
HORrH Show proposed buildings) in dotted line and existing
Fc/NQ V / cov� building(s) in solid line.
,5/3 c Li ;, Size of property r ft. x ft.
E---- —"'r- Size and use of existing buildings, if any 1' x )
1-- 0 r1L- 1-
s .‹ m Size of proposed building 'ft.x /e5 ft.
4-- Height(from grade to ridge) ft.
Front yard ft.
3. 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.
.7 (OVER)
(cont'd.)
BUILDING SPECIFICATIONS., `A�
Kind of construction: Wood frame, fire safe, etc.?. . . . . . Yr. . . c(
Will any second-hand lumber be used? /V4 If so, for what
Material of foundation walls Thickness
Depth of foundation walls below gradeL
Continuous foundation?
Will there be a cellar? V If so, material of cellar floor
Type of roof: Sloped or flat? . .- (� (fir• • • • • • Material of roof -'% e /T I
Size, wood studs f " 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 . 7:-. " x ", spacing "o.c., span ft.
Exterior finish With what material?
Finish of interior walls
If garage is to be attached, of what material is wall between garage and main buiRling to be constructed?
Is there to be an opening between garage and building?
Kind of heating system / v. € 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? /..Zl P
Depth of fireplace hearth
P
Willa toilet be installed?. ... . . . . . . . . . . . . ?. . . . . . .
Will a kitchen sink be installed and connected to water supply? Al a
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? /rlm-te.
Town of Queensbury AFFIDAVYT
County of Warren
State of New York
I swear that to tr, h r of my knowledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, are.a true and co.+.p lete 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 the proposed work shall be complied with,whether specified or not,
and that such work is authorized by the owner.
Sworn to before me this Signature ` ���`2�(,�• _ j
OWNER.OWNER'S AGENT,ARCHITE . TRACTOR
v�iJ17 day of "/C 19 !�`3
_ _ ._ NOTARY PUBLIC, WARREN COUNTY, N. Y.
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SPECIAL CONDITIONS OF THE PERMIT ':
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