8691 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 8691
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Roland Surprenant
OWNER of property located at Lot 80 West Mountain Road Street,Road or Ave.
Section 4 Land O'Pines Subdivision
in the Town of Queensbury,To Construct or place a One-Family 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.
1. OWNER'SAddressis 6415 Dixon Road
Glens Falls, New York
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2. CONTRACTOR or BUILDERS Name �
Tim Chase Construction Co. ro
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3. CONTRACTOR or BUILDERS Address :3
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Lake George Road
Glens Falls, New York
4. ARCHITECT'S Name CO h
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5. ARCHITECTS Address
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6. TYPE of Construction—(Please indicate by X) G
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A Wood Frame ( )Masonry 1 )Steel ( ) O r
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7. PLANS and Specifications 56'x26' per plat plan, specifications and N o
No. application submitted including two-car attachedru
garage and sewage system.
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8. Proposed Use
One-Family Dwelling
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$5. 00 C/O Paid V 0
$ 108. 00 PERMIT FEE PAID—THIS PERMIT EXPIRES March 1 19 R Fi_ N
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rI
town of Queensbury before the expiration date.) p�
Dated at the Town of Queensbury this 14 th Day of August 19 84 N
SIGNED BY K N for the Town of Queensbury
Building and Zoning I F.,
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