application Department of Community Development ;,e Reviewed By: ii(A-- ..
Building & Code Enforcement �''V;• �j; (Ni'ding spe•l
Town. of Queensbury IMF ,JC iyai, Permit No. 10
742 Bay Road ' ;'; - :;c"4. C?j .
1>
Queensbury, New York 12804 "(J ,,,, Fee Paid $ ,
(S 18) 745-4447
Building Permit Application
A PERMIT MUST BE OBTAINED BEFORE •BEGI-NN-ING CONSTRUCTION. NO INSPECTIONS
WILL BE MADE UNTIL APPLICANT: HAS:.RECEIVEDA VALID BUILDING PERMIT.
All applicants ' spaces on this : appl:i6itioii•--M°UST be completed and the
signature of the applicant MUST a ar on the application form.
SAY
0 917,4.96
Applicant: Ott 4— L c., 2 L•e WI by . . Owner: /� rn
r`,
` i
Address: ?/� YJ'1 eo 1-� , 1 `(Z - —Address :�-.:.�.._ 4- 'e
Phone # ( 26/ ) 7 7 Phone # ( ) v Aityi. ,
Property Location: /
I Y 7 ° / / /���
Subdivision Name: ,���� � Tax Map Number
Section 131ock Lot
NATURE OF PROPOSED WORK: �, I:S'L'IMt 'L'ED MARKET VALUE T
New Building: OF THE
��(� � S.LI2�UCI.ION: $ � Q(��
residence / comr ercial, `) -_1/ t
Addition to Buil - ing : I/✓ ,c I)
residence commercial '. OCCUPtANCY INFORMATION:
Alteration to B ilding: ( j Pril►;�ry Building -
residence � commercial �� / ngle Family Dw-e.11ing
Residence / Com rcial ) , Two Family Dwelling 7 `-
no change to exterior size Family Dwelling' -__
Office
Other Work (descri below) Mercantile MAY 0.919
Manufacturing _ s
. < Other 6A-R14-6-4 ' . .
GROSS AREA OF PROPOSED STRUCTURE: -
If ADDITION, what will use
1st Floor 5D-3 sq. ft . of new. addition be? :
2nd .Floor sq. ft.
Other Floors sq. ft.
(not unfinished cellar or basement) ACCESSORY BUILDINGS:k Detached Garage 1 , 2 :::
TOTAL FLOOR AREA: 5' )-5/ SQ. FT. Attached Garage 1 ,
Private Storage Building
SIZE OF NEW STRUCTURE : Commercial Storage Building
Other
9- FEET X L/ FEET
Foundation Type : enekt4,� Will any second-hand or ungraded
Number of Stories : i lumber be used? If so, for what?
(habitable space only) Ne
Height (grade to ridge) : / 4, �l feet TYPE OF HEATING SYSTEM: /40/1/�
Number of fireplaces and/or woodstove ( circle all which applies)
to be installed: iVaiy4 Electric / Oil / Gas / Wood
Forced Hot Air / Baseboard / Other
Person responsible for supervision of work as regards to building
codes is : A-Kril, Z,iv''? , 7,11 ,O7o,✓ /i,// a , l,Wx,eitS ur!
Name Addres s s Phone
Builder: Pao nao J. f-I'/4i4 2 iVSeW ; R R 3, 8x 34.0lf , 7 ,--7`A yr •r'Yy e 37-55-6 7 .-
Plumber: /
Mason:
Electrician :
DECLARATION. Please sign below after you have carefully read the statement.
To the best of my knowledge the stateme►its contained in this application, together with the plans
and specifications submitted, are a true and complete statement of all proposed work to be done on
the described premises and that all provisions of the Building Code, the Zoning Ordinance and all
other laws pertaining to the proposed work shall be complied with, whether specified or noted, and
that such work is authorized by the owner. Further, it is understood that I/we shall submit prior to a
Certificate of Occupancy or Certificate of Compliance being issued, an AS BUILT PLOT PLAN by
a licensed surveyor; d wn to scale, sl wing actual location of project on premises.
Signature: AA zj, 0
l
(owner, owner's agent, arcl • ect, contractor)