application 4f a� �c OFFICE USE ONLY ." "" "�"':"
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4
-7' r PERMIT NO. rtl- -¢ ` `
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FEES: PERMIT 2007
______ RECREATION I ;�r� 1 �1
ENGINEERING 2
(If applicable) T 74'Y h, r
PRINCIPAL STRUCTURE: - ''f:C,- 'ccrms ""•
APPLICATION FOR ZONING APPROVAL & BUILDING
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. PERMIT
REVIEW BEFORE ISSUANCE OF A VALID PERMIT NPR CONSTRUCTION APPLICATION IS SUBJECT TO
APPLICANT/BUILDER: ��� C��-
OWNER:
ADDRESS:
ADDRESS: `toy 7��
PHONE NOS. `7,2 77
PHONE NOS. �r � tf-7
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE:
PHONEo1 �,,�(o
'} f 6 F_.3LOCATION OF PRO RTY• --La_es-
SUBDIVISION NAME: c C_e..A"c\e_i-'
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT Z
PROJECTAPPLY O YOUR O O O
0 W U. u- w -' 0 = 2
W p Q , 0 O i FQ D U
Z Q `_ u) Nd 5t Pt x.WZ
SINGLE FAMILY
TWO-FAMILY
MULTI-FAMILY
(NO. of UNITS_)
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
ao5415
FACTORY OR
INDUSTRIAL ,Z7coQ D.77coll
(oU ATTACHED
GARAGE(1,2,3)
OTHER
1/4.‘ ( &e ¶-c>ce c
IF COMMERCIAL OR INDUSTRIAL- NAME OF BUSINESS: k...--L-1.Ze_c rse `c,,,.C.5
ESTIMATED CONSTRUCTION COST: Lip OC O-, FUEL TYPE: "-'—
HEAT TYPE: *HOW MANY FIREPLACE(S): AND/OR WOODSTOVES(S):
ZONING CATEGORY:L:I-` k ARE THERE WETLANDS ON THIS SITE? ���
IS THIS A HISTORIC SITE? _ •
PROPOSED USE OF BUILDING OR ADDITION: 5 \- U e
*Please complete a separate Application for"Fuel Burning Appliances& Chimneys"available in our office
^ B 3-LGL 11-05
I% Town of nvvov,ch„r„ • r,,,.—,...._:,... r.__ 1
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? V--j,
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 . •c e.
Signed _...ggdiprA____
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:
,
,
,
,
,
I I & CODES AP VAL ZONING APPROVAL
ATE
DATE
,
,
QUESTIONS? CALL 761-8256 OR EMAIL
codesaqueensbu ry.net
Dffice Use Only VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
Dperating Permit Issued: Yes No
Dccupancy Type: L3 — i Construction Classification: Z-b
kssembly Occupancy Limit:
Special Conditions:
ITown of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804