application r ,
,2c2 1 OFFICE USE ONLY
TAX MAP NO. PERMIT NC2-006-(110 r . E V
FEES: PERMIT # 75 RECREATION ENGINEERING
applicable)
FEB 06 2008
(Ifa pp
TOWNBUILDING
4D NQGU& CODES y
PRINCIPAL STRUCTURE:
APPLICATION FOR ZONING APPROVAL & BUILDING PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION.APPLICATION IS SUBJECT TO
REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.O-
:t, i APPLICANT/BUILDER /A/SRLVj9`E ow,v/J�' ,OWNER d ,rtn.,5 4Y Dvrz '.
ADDRESS:3714,,awl, 2 ADDRESS: .. T':004 ar..Dtele L r4I/140"`
PHONE NOS. ,672.0.6.5a. "- PHONE NOS. i •‘..0 -A51*
CONTACT PERSON FOR BUILDING &CODES COMPLIANCE: 044.00/VigeiPHONE: SAY 1' '"
LOCATION OF PROPERTY: .t'.�d�.�r� r �"' L4kr.*Lair-tejfitaaly
SUBDIVISION NAME:- At ' .cu i 1,5sieivr
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT 0
APPLY TO YOUR p Or O O O _
PROJECT p }- L
� E d = 06
SINGLE FAMILY
TWO-FAMILY
MULTI-FAMILY
(NO.of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACHED
GARAGE(1,2,3)
OTHER 7 Gh'' TC I4 ' 144 .
IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS: 1 Y A
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? ! YQ
ARE THERE EASEMENTS ON PROPERTY? VII �-"�l'Ac/-5° �C?/—rriar r
o /
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans, and supporting materials are a true and
complete statement/description of the work proposed, that all work will be performed in
accordance with the NY State Building Codes, local building laws and ordinances, and in
conformance with local zoning regulations. I acknowledge that prior to occupying the
facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand
that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read and agre o the a ve.
Signed •
Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction
codes or septic systems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
Permission is hereby granted to the above This application I proposed action described
Applicant to erect or alter the building herein is found to be in accordance with the
described herein in accordance with said zoning Laws of the Town of Queensbury.
Application:
B i L N & CO S ROVAL ZONING APPROVAL
DA145-21 DATE
d
QUESTIONS? CALL 761-8256 OR EMAIL
codes( queensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
Office Use Only www.queensburv.net
Operating Permit Issued: Yes No