8563 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 8563 '
WARREN COUNTY, NEW YORK
PERMISSION is hereby
David Bertolino t'
OWNER of property located at Lot 15 North Church Lane
Street,Road or Ave.
and Pitcher Road
•
in the Town of Queensbury,To Construct or place a rt
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. �•
O
1. OWNER'S Address is
P. 0. Box 4033
Glens Falls, New York
2. CONTRACTOR or BUILDERS Name
Daniel Valente
Valente Builders Inc. r,
0
3. CONTRACTOR or BUILDERS Address rt'
Box 167 I-'
Cn
Lake Luzerne, New York u
4. ARCHITECT'S Name
h
rt
5. ARCHITECT'S Address fi
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6. TYPE of Construction—(Please indicate by X) �
(x)Wood Frame ( ►Masonry ( )Steely
7. PLANS and Specifications �ry
30tx56' per plot plan, specifiCat�ons and
No. application submitted including sewage system and c
two-car attached garage.
8. Proposed Use
7d
One-Family Dwelling O
ro
$5. 0 0 C/O Paid
$ 157. 00 PERMIT FEE PAID—THIS PERMIT EXPIRES January l
19 $5 p
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the M
town of Queensbury before the expiration date.) (
1
Dated at the Town of Queensbury this 13 th Day of June 19 84
w a �
SIGNED BY a4 k
for the Town of Queensbury d
Building and Zoning Inspector �
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