application Ate- V ' C OFFICE USE ONLY ''
TAXMAPNO. i1 -( -7 ( r
PERMIT NO. 4 r r • / '4 I: l ,*. . '�,::
FEES: PERMIT RECREATION 11
ENGINEERING Ii OCT 1 0 2 `", L1
(If applicable) ,
PRINCIPAL STRUCTURE, TOWN OF .",',`. ` DES Y
& COODES
BUILDING
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 FQR CONSTRUCTION.
APPLICANT/BUILDER: ` cLrr-`1 (Ad
��c , OWNER:
ADDRESS: CCD -- / ADDRESS: V.,/ 4
PHONE NOS. "7c/ 7 271 PHONE NOS. D ''7y19
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE:
(-GSM PHONET- 0% ..2%.Yo
LOCATION OF PROPERTB 4) 6�3
____LA.a_e_5-rNe___ (-2._e_\,. 5
SUBDIVISION NAME: L-L-CLe-- Ce_ s--
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT z
APPLY TO YOUR z 0 ix x d o 1-
PROJECT 0 00 H 00 w
ow -ILL � LLL w ¢ a = =
U
Z < < r- c N O LLL OIL R"W Z
I- LL a20,5
SINGLE FAMILY
TWO-FAMILY
MULTI-FAMILY
(NO.of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE a0>4 kS5
FACTORY OR
INDUSTRIAL a70CF abD r(u
ATTACHED
GARAGE(1,2,3)
OTHER
IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS: -a_t_c Ne_ �c •
ESTIMATED CONSTRUCTION COST: �pr (O0, FUEL TYPE: "—
HEAT TYPE: *HOW MANY FIREPLACE(S): AND/OR WOODSTOVES(S):
ZONING CATEGORY:,-1-I-- i ARE THERE WETLANDS ON THIS SITE?
IS THIS A HISTORIC SITE? V_7- --\\
PROPOSED USE OF BUILDING OR ADDITION: �7��c c5e
*Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in our office
B 3-LGL 11-05
Town of Queensbury • Community Development Office • 742 Bey Road, Queensbury, NY 12804
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? , ,
se
.ts
ARE THERE EASEMENTS ON PROPERTY?
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 ' su ce of a certificate of occupancy.
I have read and ree to the a e.
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 / 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:
BUIL & CODES OVAL ZONING APPROVAL
DATE112
DATE
QUESTIONS? CALL 761-8256 OR EMAIL
codesAqueensbury.net
Office Use Only VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
Operating Permit Issued: Yes No
Occupancy Type: �- Construction Classification: 7,
Assembly Occupancy Limit: Special Conditions:
:zw. Town of Queensbury • Community Development Office . 742 Bay Road, Queensbury, NY 12804