applications TOWN OF QUEENSBURY. • (Space inside Mock to lie filled in b,
WARREN COUNTY, NEW YORK Building ln.spcctor)
Application for Application No.- . Permit Issued 19...
BUILDING AND ZONING PERMIT • Permit Expires. • IQ
'ion in;: District
alto• ul 1Vurk% -
THREE 131 Copies of a PLOT PLAN, Drawn to scale A.PPI•'ikeil by -
showingthe actual dimensions of the lot to be built Rent,ii'Kf ..
upon, Te exact size, and location on the lot of the . ; .
building to be erected or altered MUST BE 'SUB-
MITTED WITH THIS APPLICATION. " :' .. ' ' •
TOWN OF QUEENSBUr. --
1q61- 3 _ ? , Ij( 1 : R IE C I V E 'jjj
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK APR 161980
ANSWER ALL OF THE FOLLOWING. ' A.M. 5.° j-,,>✓ ,ciLt iP P.M.
The undersigned hereby applies for a permit to do the following :work. 7l g)9110)11112)112I 3 r 41516
which will be done in accordance with the description, plans and specifi- . ` ` , ` ` ` I ` ` ' ,
cations, and such Special conditions as may .be indicated on the permit. -
n"
IC '
The owner of this property is: �` •. _ .
f .•Th4- .. r. /s'a a er"-, Cd/�.r.:.S --.4// - %i7 r /4 /
( A•;c) (P.O.ADDRESS)
The person responsible for supervision of the work insofar as the Buildijg.Code and the Zoning-Ordinance apply is:
(NAME) • MOADDRESS)
Name of Builder 5 � r .iks'•.--•/ts.Qp. .,. . . Address.. . . . . ... Z e* ,�. •.st•S.e4?.4.m tq . •
Name of Plumber ,f f <,c o_,r Address G:.e tf.a t
Name of Mason re: re r.- Address /f i• f "I
Lot Number. . .ci. .S • • Unit / Estimated value of proposed Work S . :52f '®u . -
Name of Village
Name of Street G' 4'1-'. kk•1 -':y^ % l).R "a r ' Stile of,etreet: north Qit, east. 0, south ❑.:west' ❑
Nearest Cross Street .1).'18r..t/ I i"- 7 S'fe c'•t,`•{'•'. / • • • Distance From this ^ross street - Ft.
Property is north (R,south ❑,east i west 0 from Cross Street•
If on Corner, which corner,northeast 2, northwest ❑, southeast C 'southwest -
(Designate by marking with an"X" in the correct space.)
NATURE OF PROPOSED WORK OCCUPANCY . •
-
i Construction of a new building. Main Building
El to a building. • One family dwelling
❑ Alteration to a building. Two-family dwelling ❑:
❑ Demolition of a building. - • • -family apartment house . . 0
• Store building ❑
. . . .'."-car attached garage l N
Other:
Accessory Building
• One-car.detached garage . ❑
❑ Other work. Describe: 0
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
Isuilding(s) in solid line. -
Size of property •/• .•.1Z. . ft: x . . I.r..? •74 ft.
Size and use of existing buildings, if any '
1- 1- .
N N
W
a m Size of proposed building . .v?.4? . . ft.a .g.2.t . ft.
• Height(from grade to ridge) 1 '---- •' • ft•
Front yard --5 ft
Side yards . . . 4 . . . . . . . ft. and .. . . . . . . . . ft.
' Rear yard' /2. Z ' ft.
SOUTH . If op corner,setback from side street ft..
7Note: All distances are net; as nseasured from street side
• line to nearest part of building. ,
(ovEnt '
7-73—M
(cont'd.)
BUILDING SPECIFICATIONS.,
Kind of construction: Wood frame, fire safe,etc.) 4=A:;" ' ft '/3
Will any second-hand lumber be used? e e7. If so, for what?
Material of foundation walls Thickness ?"
Depth of foundation walls below grade iga Continuous foundation? . .
Will there be a cellar? . . . If so, material of cellar floor . .
... I >
Type of roof: Sloped or flat? 51/ P13 e4 Material of roof / Arad Ark.
Size,wood studs c2. "x 47/_.; ",spacing A Cp= "o.c., length • ft.
Size, floor beams, 1st floor "x ",spacing k:- "o.c.,span ft.
Size, floor beams,2nd floor 99 x ", spacing "o.c., span • ft.
Size, ceiling beams 99 x ", spacing e "o.c., span ft.
Site, roof rafters or beams . I g.ct.53* x ", spacing "o.c.,span Z g ft.
Exterior finish 0/4/Ze. r With what material?
Finish of interior walls r. "0_ //
If garage is to be attached, of what material is wall between garage and main building to be constructed?
-<• ce.2•4
Is there to be an opening between garage and building?
Kind of heating system k e Oil burner or coal?
Will a flue-lined chimney be provided? . Depth of chirimey foundation below grade .
Height of chimney above roof 2 •
Will there be a fireplace? y: Depth of fireplace hearth
Will a toilet be installed? y
Will a kitchen sink be installed and connected to water supply? X
Water supply(public water supply or pump)Distance of of cesspool from any private well feet
Will drainage system be provided with required traps,cleanouts, and vents? .
AFFIDAVIT •
Town of Queensbury
County of Warren
State of New York
I swear that to it ih:yrof my know,ledge and belief the statements contained in this application,together with the plans and specifications sub-
mitted, are a true and coa.plete 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 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
OWNER.OWNERS AGENT.ARCHITECT.CONTRACTOR
I. 14: . day of . i ""'"
. .
NOTARY PUBLIC, WARREN COUNTY. N.Y.
SPECIAL CONDITIONS OF THE PERMIT:
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