1819 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19 —
This is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may be occupied as a
Location
Owner
By Order Town Board
TOWN OF QUEENSBURY
wilding & Zoning Inspector
BUILDING PERMIT
TOWN OF QUEENSBURY
No. l R19
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Robert J. L Rouche a
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OWNER of property located at Lot 41 10 Maplewood Dr. Street, Road or Ave.
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in the Town of Queensbury,To Construct or place a Dwelling Sewage System
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
11 Bacon Street
Glens Falls, New York
12801
2. CONTRACTOR or BUILDER'S Name
Gaston LaFond
3. CONTRACTOR or BUILDER'S Address
S. Glens Falls, New York
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
X)Wood Frame ( ) Masonry ( 1 Steel ( )
7. PLANS and Specifications
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No.26'X69' as per plot plans and specifications submitted enc. co
sewage system -o
8. Proposed Use
One-Family Dwelling two car attached garage sewage system Q,
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1,
C/O 5.00
$ 80.04 _PERMIT FEE PAID —THIS PERMIT EXPIRES 1_1— 1973 <•
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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.l
Dated at the Town of Queensbury this 2 Day of June 19 72
SIGNED BY
� � for the Town of Queensbury
// Building and Zoning Inspector a) -"at)
IOWN OF QUEENSBURY
Spare inside block to Ix• Idled in by
`VAF.REN COUNTY, NEW YORK Building Inspet tor)
Application for :;•,)11(.,ti(,tt No.
Permit Issued. . . . . . . . . . . . I+,
BUILDING AND ZONING PERMIT „t I-wires . . 1(1
/+.;un: I),strirt . .
\ dim, nt \\',,rl.
•
THREE (3) Copies of a PLOT PLAN, Drawn to scale \i'I) ,''I by -
showing the actual dimensions of the lot to be built 16•n1;11l . .
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 OF QUEENSBURY
/ f7 D
DATR
Ju ✓. E rt7i 7 I,')
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK JUN I 1972
ANSWER ALL OF THE FOLLOWING. i. 'L,e
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The undersigned hereby applies for a permit to do the following work •
7igIgI1QIM12I1I2I314016.
which will be done in accordance with the description, plans and specifi-
cations, and such special conditions as may be indicated on the permit. A
The owne of his property is:
<& 1 -�� l,/./J t?es' i: . . : > '. -E- Ali c
INA .IEl IP 0 ADDRESS) "
The person responsible for supervision of the work insofar as the Building Code and the Zoning Ordinance apply is:
6- -s T o ✓v L-ii w ./ �S c� a r-- 6--G G S c G. S ill �`,.
AME) Z/it
� J IP D ADDRESS) ,/
Name of Builder �T �c " `lam / Address v . �T C f=�-S 79 C (-S !� �7
Name of Plumber. �.�. . . tJ. ft.f.r.c' . . . .Address c=G.Ce4—.cYt. e--e-a. ✓L/rt,./
Name of Mason. . 4ir4,S 170. itt. G g Cz5 it. b Address .S . �`.L 6i'... ./'75 C-L.. . ./I/ .
`Lot Number '-1 I Unit Estimated value of proposed work$ . . . .7‘)/ 6) 6) v
Name of Village Q E 141S 46.tl k c1
Name of Street / 0 _1 /'r'L t too '� b. Side of street: north `A, east 0, south 0. west 0
Nearest Cross Street t.t= 01 0 L' bDistance from this cross street . . . . ,/_..s--p Ft.
Property is north 0,south ❑,east X, west 0 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
0 Addition to a building. One-family dwelling N.
El Alteration to a building. Two-family dwelling El
❑ Demolition of a building. . -family apartment house 0
Store building . ❑
. . .2. .-car attached garage M
Other:
Accessory Building
One-car detached garage ❑
❑ Other work. Describe 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-
NORTH posed buildings,and the location of all existing buildings.
Show proposed buildings) in dotted line and existing
huilding(s) in solid line./
Size of property /7 t? ft. x / & ft.
Size and use of existing buildings, if any . . . . .,-E:--
I.- I-
'
m Size of proposed building . . . . .(9. . ft.x . . . ... t/. . . 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, es measured from street side
line to nearest part of building.
(OVER)
(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 J 0 '`
Depth of foundation walls below grade �j ! '� S Continuous foundation? . . .1'i"O
Will there be a cellar? . . �, If so, material of cellar floor
r�
Type of roof: Sloped or flat? 9"" p ,,,' Material of roof -
Size,wood studs . . . °°' x 4-1 ", spacing "o.c., length. . . . . ef• ft.
Size, floor beams, 1st floor . . . . . . . . . °' x i 0 ", spacing /to "o.c.,span ft.
Size, floor beams, 2nd floor " x / 0 ", spacing "o.c.,span ft.
Size, ceiling beams " x spacing "o.c., span ft.
Size, roof rafters or beams " x ® ", spacing r� "o.c., span ft.
Exterior finish CAA ✓ %? C '? :With what material?
Finish of interior walls '12�
If garage is to he attached. of what material is wall between garage and main bui{Iding to be constructed?
Is there to be an opening between garage and building?
Kind of heating system ,o{- .. 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 he provided with required traps, cleanouts, and vents?
Town of Queenshury AFFIDAVIT
County of Warren ss.
State of New York
I swear that to the best of my knowledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, are a true and complete statement of all proposed work to be done on the described premises and that all zrovisions of the BUILD-
ING CODE,THE ZONING ORDINANCE.and all other laws pertaining to the pro work shall be complied with,whether specified or not,
and that such work is authorized by the owner. • G
Sworn to before me this Signature :� �j�— ^
OWNER,OWNER'S AGE Tj.ARCMII"TttECT.CON ACTOR
day of 19
NOTARY PUBLIC. WARREN COUNTY. N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
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By .
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Q.:
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/V NORTHERN HOMES
HUDSON FALLS, N.Y. CHAMBERSBURG PA.
CUSTOM DESIGNED FOR :
REVISIONS DRAWN BY ALL RIGHTS TO THESE PLANS
RESERVED BY NORTHERN HOMES
DATE ORDER NO. PRINT NO.
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