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application
Town of Queensbury Building &Codes PRINCIPAL STRUCTURE APPLICATIONApermitmustbeobtainedbeforebeginningconstruction Please read:*TBresoition 86-2013 1-28-2013);$850 recreation fe for new dwelingunits,including single-family ‘dwellings,duplexes r two-family dwellings,multiple familydwolings,aparments,condominiums,townhouses,andor manutackond ‘and modular‘homes,but not including mobile homes,This i in addition tothe permit fee. Date y' Applicant Rachor de Amber MchuaeyTaxMapIDf=I~3 2 Address Th BethebinestGeca,bay,Zoning Phone /E-mail Property Owner Richards Amber Me hwers Contractor/AgentAdress10BetteHillDeveAdressFedAnnMy(2827Phone/E-mail SIS 639-pe 3S™Phone /E-mail Contact Person for Building &Code Compliance: Day Phone:ee _aeearaeSeBuildingSteetAddress:22 Pia. Subdivision Name: Historic Site:_Yes __No Loti:Estimated cost of constuction:$_FO0W.0‘TypeofConstruction: ‘Check ail that apply.Please indicate measurements as required below:j j ‘4st Floor 2nd Floor Other Total Height “New Single Family Kae sts Two-Faniy Cqnvedsio}Y attlkieclad CRAOTeMull-Famiy (of LZivizp Soate :an lah beh|Limall “o.paras "Townhouse Business Office Retail-Mercantile Factory industrial Attached Garages (#__) Other ‘Town of Queensbury Building &Codes Principal Stucture Packet 518-761-8256 "commercial or industial indicate name of business |Proposed use of building or addition Chawttiwr on goroge &Feashs founSourceofheat(rele one) (Ges)on Propane Sol oteFreplce-complt separate ppaon ‘el Buning Appances &Chinneye —Yes _XNo ‘Ne there structures not shown on plot plan? wo‘Are thelr easements onthe property? woSiteInformation Stone ole LD acres.Is this a comer lot? NO ©Wil the grade be changed as a result of construction:—Yes _X No 4.Pubike water or Privat well Pobhe ©.Sewor or Pivato Septic System Sephec|Nae of al werk tobe perormed (labor and materiale $F Ihave read and agree to the above, Print Name:BgtheorySignature:Bika Cia :Date:2 ¥ FOROFFICE USE ONLY: Operating Permit issued:—Yes _NoOccupancyType: Construcfon Classification: Assembly Occupancy Limit =‘Special Conditions: ‘Town of Queensbury Building &Codes Principal Stucture Packet 518-761-8256