applications r
TOWN F QUEENSBURY -
(Space inside block to be filled in by
WARREN COUNTY, NEW YORK Building Inspector)
Application for _ Application No. :
Permit Issued _19-
BUILDING AND ZONING PERMIT _ p,z-� ,it Expires. .1J.
7,unin;. District
. . - \ Ateul Work
THREE (3) Copies of a PLOT PLAN, Drawn to scale \I'I)t<)"•`I by
showing the actual dimensions of the lot to be built. Itc•mztr)CS-
upon, The exact size, and location on the lot of the .
building-to be erected or altered MUST BE SUB-
MITTED WITH THIS APPLICATION.
ei gl,- 2 - a. . 6 3ja..318C� TOWN OF QUEENSBL1RY
DATE �1
PERMIT . [ii
MUST BE OBTAINED BEFORE BEGINNING WORK v7
A ��
0
ANSWER ALL OF THE FOLLOWING. {Ada . .9 )
The undersigned hereby applies for a permit to do the following work , qkl; W Per-Pe
which will be done in accordance with the description, plans and specifi-
cations, and such special conditions as may be indicated on the permit. `4 Ai, _` " . ` a
et
The owner of this prois:
,. � Ut114 � -tre
.r./7 . R 4�^iL . a � 1�) IPO ADDSSI ) . . . . . .
The perso, responsible supervision of the work insofar as the Building Code and the Zoning Ordinance apply is:
(NAME) ,p ` _ (P O ADDRESS)
Name of Builder. . . M - /'..• Address "
Name of Plumber is Address • '
Name of Mason
`e Address
Lot Number I &. . . . Unit Estimated value of proposed work$ . . . .
000
e Name of Village
( ' 1 Name of Street . •�
,JAS. h Side of street: north 51, east ❑, south ❑. west
c Nearest Cross Street . . P„P _ Distance from this cross street Ft.
Property is north - ❑,south ❑,east • i ',west. ❑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
❑ Addition to a building. - . . . . _- , One-family dwelling . CI
IAlteration to a building. Two-family dwelling
❑ Demolition of a building. family apartment house ❑
Store building El
. . . ].r -car attached garage
Other:
Accessory Building
. . • One-car detached garage ❑
Other work. Describe Two-car detached garage 0
- 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
P' size of the property, the location, size and setbacks of pro-
-!-' Lor . posed buildings,and the location of all existing buildings.
NORTH Show proposed building(s) in dotted line and existing
. building(s) in solid line.' ' '
Size of property ./ ft. x 14E ft.
[,2:6,3L /CEi 0
Size and use of existing buildings, if any
I- Q, F-
ul
W i it
w Size of proposed building . . . . . ft.x 2-6 ft.
��pp Height(from grade to ridge` . .
ft.
l-4`— Front yard .4 1 1- ft.
Side yards . . .• . .f -. ft. and 16 ft.
. Rear yard 4-- ft.
SOUTH If on corner,setback from side street ft..
Note: All distances are net, as measured from street side
line to nearest part of building.
(OVER) '
7-73-M . .
�f_
m Y _
4/1
(coned.)
BUILDING SPECIFICATIONS., .
`
Kind of construction: Wood frame, fire safe, etc.? " `ber t-Aw.,_
Will any second-hand lumber be used? 14D If so, for what?
Material of foundation walls
.if • — - Thickness )Z "
Depth of foundation walls below grade Continuous foundation? .I.y, . .
4. z..646.a /
Will there be a cellar? '� If so, material of cellar floor
Type of roof: Sloped or flit? . ... . . Material of roof .. < 1t.f( �
Size,wood studs " 'Z• . "x - • ",spacing 24. . . ."o.c., length 61 ft.
", spacing ft.
Size, floor beams, 1st floor � •"x • • •f� p g /Cr'.Cam• . • •"o.c., span . . . .�.�``�
o_
Size, floor beams, 2nd floor " x . .a ", spacing ./ . . . ."o.c., span . . . /'3.�-e
.62� ft.
�,Z. . . " x . .6 ", spacing . . go . . . 1 r . ft.
Size, roceof beams ! ", spacing . . ./. "o.c., span . . . . o. . . ft.
Size, roof rafters or beams tt ��e�� x
Exterior finish . . I$ .t2. /r• • • I M--' With what material?
Finish of interior walls 1l7-.tc "g
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 garagg anpli building?. _
Kind of heating system . . . .. �° •4. •VifOQ Oil burner or coal? ,
Will a flue-lined chimney be provided?1 \-MS . Depth of chimney foundation below grade 7
Height of chimney above roof -2-
Will there be a fireplace? NO Depth of fireplace hearth
Will a toilet be installed?
Will a kitchen sink be installed'and connected tow r`su..ly? Y •
.?" a-'
Water supply(public water supply or pump) .: . . 1
Distance of cesspool from any private well . feet
Will drainage system be provided with required traps, cleanouts, and vents? F.6 •
Town of Queensbury AFFIDAVIT
County of Warren
State of New York
I swear that to tt•b j of my know,ledge and belief the statements contained in this appli n,together with the plans and specifications sub-
mitted, area true and co.n.p lete statement of all proposed work to be done on a desert pre , . and that aprovisions of the BUILD-
ING CODE,THE ZONING ORDINANCE,and all other laws pertaining the posed r s . complied with,whether specified or not,
and that such work is authorized by the owner.
Sworn to before me this Signature
OWNER.O NER'S A .ARCHITECT,CONTRACTOR
day of 19
NOTARY PUBLIC, WARREN COUNTY, N. Y.
SPECIAL CONDITIONS OF THE PERMIT: -,
•
•
4
By
TOWN OF OUEFNSBURY
BUILDING & ZONING DEPARTMENT
SEWAGF DISPOSAL PERMIT APPLICATION
1. Owner ' s Names iL(
Address , ��J !`k ��te_k!'�1 ; '$e�
Telephone No. en-Z4(7
2. Property location La 1 L 7 t,W; .
3 . Name of person or firm responsible for installing system
T O^6 Telephone No. -75e-/ 33
Address '7 t4S
4. Number of bedrooms (residential buildings only) 3
5. Daily flow l C° gallons/day
6.- Septic tank capacity ) fly gallons
7. Topography:.! 0 oiling, steep
% of slope
8 . Nature of soil and depth f�k...ikltt
9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? ' - ft.
10. Percolation test: A is required
B is not required
C If required what is the rate minutes/inch
11. Water supply muni ' a ell, other
12.. Type of system proposed: drywel le feld other
Any contractor, corporation, individual, etc. engaged in the construction
of a sanitary sewage disposal system who covers the same before inspection,
does not have an approved permit, or varies from the approved application
will be subject to a penalty of $250 as provided f i Section 6 . 010 of the
Queensbury Sanitary Sewage Ordinance.
Date 3-2 -84 „
s ' naturelof ' plicant
On separate sheet of paper submit a diagram of the proposed septic system
with all dimensions, including distance from any structure, distance from
property line and domestic water supply, etc. Include all dimensions of
the system itself.
Form 3-82 .