application 2o- /-42-
TOWN OF QUEENSBURY ) (Space inside block to lx. filled in b,
WARREN COUNTY. NEW YORK Building Inspector)
Application for \I,plication NO.
PP Permit Issued 19
BUILDING AND ZONING PERMIT l.'.rmit Expires
%.i,nim: 1)'stric t
\Am'"1 \\'4nrk i
THREE (3) Copies of a PLOT PLAN, Drawn to scale \I'I"""'41 1i
showing the actual dimensions of the lot to be built ltun),i)KS'
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 QUEENSE:Ur ,
9 ° - I 7 /
. . . . 7. .7. nATE. i-
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK 19� =J
ANSWER ALL OF THE FOLLOWING. JUL
The undersigned hereby applies for a permit to do the following week A.M. if /('` P.M.
which will be done in accordance with the description, plans and specifi- 7IW110I11I1A1-P 3141516
cations, and such special conditions as may be indicated on the permit.
The owner of this property is: D t VG1 hn Q n
r/� ad. r t✓f.Rho.. I�Nv%l/C. 0 . 1 a . . . 07(Wig. . . . .
1 1 C �#Ct.4" . . . .. ) 1V1A . . 1. . . .��. . . . . . (P.O.ADDRESS) . . \
INA 'f) 1
The person responsible for supervision of the work insofar as the Buildipg.Code and the Zoning Ordinance apply is:
„_,_c l'e'
(NAME) (P.O ADD�RRESSS)
Name of Builder. . . ..;j' ,Srrnr72O/OS Address-.ittMttiPd'Pt •. . .kl i7- 4.5 . .
Name of Plumber Address
Name of Mason Address . . .
Lot Number.OrA Unit Estimated value of proposed work S /O. a. . . . . . . . . . . . . . . . . .
Name of Village � ,
Name of Street . '(ar. • .R / y-' z Side of street: no-th 0, east ❑, south 0. west .er--
Nearest Cross Street Distance from this -ross street Ft.
Property is north 0,south 0,east i i, west ❑from Cross Street
If on Corner, which corner, northeast ❑, northwest 0, southeast 0 southwest
(Designate by marking with an "X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY
❑ Main Building
Construction of a new building. One-family dwelling (E-
❑ Addition to a building. Two-family dwelling ❑
❑ Alteration to a building. -family apartment house ❑
❑ Demolition of a building.
Store building ❑
. .-car attached garage ❑
Other:
Accessory Building
One-car detached garage C
Er Other work. Describe:. . P•C-� Two-car detached garage C
Private chicken house C
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
ttuildings► in solid line.
Size of property ft. x ft.
Size and use of existing buildings, if any
..3 x O k to . .- _
F N
i m 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 oOi corner,setback from side street ft.
Note: All distances are net, as measured from street tide
line to nearest part of building.
(OVER)
7-73—N
(coned.)
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
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 "A ",spacing "o.c.,span ft.
Size, floor beams, 2nd floor ,, ", spacing "o.c., span ft.
Size, ceiling beams "A ", spacing . . . . . . . . . "o.c.,span ft.
Site, roof rafters or beams "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 building 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 chirnney 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 be provided with required traps,cleanouts,and vents?
AFFIDAVIT
Town of Queenshury /
County of Warren
State of New York
I swear that to tr liai.of my knowledge and belief the statements contained in this application,together with the plans and specifications sub.
mined, are a true and co...ilete statement of all proposed work to be done on the described premises and tha an • • of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertaining to the proposed w shall m " specified or not.
and that such work is authorised by the owner.
Sworn to before me this Signature
OWNER.oiliwEws AGENT.ARCHITECT,CONTRACTOR
day of 19
NOTARY PUBLIC. WARREN COUNTY. N. Y.
SPECIAL CONDITIONS OF THE PERMIT:
By