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application - r.r 'U, � Permit No. Building&Codes Office-Department of Community Development-Town of Queensbury Fee Paid 1 T4 C 742 Bay Road,Queensbury,NY 12804 R creation Fed' } ttc0 Dave Hatin,Director codes@aueensbury.net !`Phone: -- (518) 761-8256 FAX: (518) 745-4437 �Q Principal Structure Building Permit Applicatio P, Application & Plans subiect to review before issuance of a valid permit for construction. Instructions: A permit must be obtained before beginning construction. No inspections will be made until the applicant has received a valid building permit. All applicants' spaces on this application must be completed and must appear on the application form. ��Applicant/Builder 1G�i� S C 'i.. Owner: C-1� 7� Address: 13 l wh Address: ,4J 5L_ u Home Phone: 9 3- Home Phone: Email Address: Email Address: Cell Phone: 3 !- e2£r3 Cell Phone: M viola, FAX Phone: FAX Phone: Person responsible for supervision of work with respect to building and codes compliance: MAR 3 0 2005 Name: 7'0"OF QUEEi�ISBURY Address: 3 c �-�s / P �INV AN _ Location of proposed construction: Lot No. Legal Address: Cl I Tax Map Number: :-Z9. 7 Subdivision Name: ✓) 16L_ ©ram /6F+. .'�5 Estimated Cost of Construction: or SP Proposed construction is for: Residential Use Commercial Use fTid,; p — n n �� / �t` �v �L 3 30 ,2ao Name of Business: e~� Road � ` If proposed construction is an addition, what will use of new addition be? New Addition Alteration Proposed Construction tit Floor 2nd floor Other Total Proposed structure (Occupancy Type) Sq. Ft. sq.ff. Sq. Ft. Square feet Height Ft.&in. Single-Family Dwelling Two-Family Dwelling Townhouse Multifamily Dwelling Number of Units: Office Mercantile Manufacturingi!f Other: 2X7 b40 1 C Attached Gara a 1, 2, 3 I?j( Type of Heating System: Electric, Oil, Gas, Wood, Forced Hot Air, Baseboard, Other: Jv�L If a fireplace and/or woodstove are being installed, please refer to a separate application. 1v1 A Applications are subject to Zoning Administrator, Code Compliance, and Structural Plan review. The Building and Codes Office will allow commencement of your proposed project only after issuance of your permit. Declaration: Please sign below after you have carefully read the statement: To the best of my knowledge, the statements contained in the 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 Codes, the Zoning Ordinance, and all other laws pertaining to the proposed work shall be complied with,whether specified or noted, a d that uch work is authorized by the owner. Further, it is understood that I/we shall submit prior to a Certificate cup_ c Certificate of Compliance being issued, as requested by the Zoning Administrator or Direc of it nd odes, an s-B urvey by a licensed surveyor, drawn to scale, showing actual location a[, n ti Date: 3z� —i Applicant/Builder Signa Jdrre- - the application of dated \ J and permission granted for the construction, reconstruction or alteration of a builc t,. re as set forth above. " Date: Authorized Signature: -:\Sue Hemingway\Buiiding.Permit.FORMS\Principal Structure Permit Application.doc Permit No. r_ Building&Codes Office-Department of Community Development-Town of Queensbury Fee Paid ?�2' —17)T4 �. 742 Bay Road,Queensbury,NY 12804 Recreation Fee Dave Hatin,Director codesQaueensbury.net Phone: (518) 761-8256 FAX: (518) 745-4437 Principal Structure Building Permit App licatio � � s Application & Plans subject to review before issuance of a valid permit for construction. i � ✓' Instructions: A permit must be obtained before beginning construction. No inspections will be made until the applicant has received a valid building permit. All applicants' spaces on this application must be completed and must appear on the application form. Applicant/Builder KC �� S ��� Owner: Address: 13 l .wj_ Address: Home Phone: J51 `71 3- Home Phone: Email Address: Email Address: Cell Phone: 3(,1- ak-3(o Cell Phone: FAX Phone: FAX Phone: Person responsible for supervision of work with respect to building and codes compliance: ® 2005 Name: �t� C_ ;� Tg NOFQUEENSBU Address: 3 c �- �� P DINGgN RY Location of proposed construction: Lot No. Legal Address: Tax Map Number: Id 7 Subdivision Name: ✓I Ia- Estimated Cost of Construction: $3 00 wo /GF v4N45 Proposed construction is for: _Residential Use Commercial Use I�I< Name of Business: L e%`r,�-- RC)C,6,�, � ���' 2 Cep- 3(30 r-lov J4 If proposed construction is an addition, what will use of new addition be? New Addition Alteration Proposed Construction 10 Floor 2nd floor Other Total Proposed structure (Occupancy Type) Sq. Ft. sq.ft. Sq. Ft. Square feet Height Ft.&in. Single-Family Dwelling Two-Family Dwelling Townhouse Multifamily Dwelling Number of Units: Office Mercantile Manufacturing Other: 610 y 1 S 70U 7 ev5 S Attached Garage 1, 2, 3 Type of Heating System: Electric, Oil, Gas, Wood, Forced Hot Air, Baseboard, Other: im v 13` ` If a fireplace and/or woodstove are being installed, please refer to a separate application. ,J/A Applications are subject to Zoning Administrator, Code Compliance, and Structural Plan review. The Building and Codes Office will allow commencement of your proposed project only after issuance of your permit. Declaration: Please sign below after you have carefully read the statement: To the best of my knowledge, the statements contained in the 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 Codes, the Zoning Ordinance, and all other laws pertaining to the proposed work shall be complied with,whether specified or noted, and that uch work is authorized by the owner. Further, it is understood that I/we shall submit prior to a Certificate cup c Certificate of Compliance being issued, as requested by the Zoning Administrator or Direc of it nodes, an s-BI urvey by a licensed surveyor, drawn to scale, showing actual location,of al, on tigfi. Date: Applicant/Builder Signa .ire, The application of // dated is hereby approved and permission granted for the construction, reconstruction or alteration of a building/and or accessory structure as set forth above. Date: Authorized Signature: L:\Sue Hemingway\Building.Permit.FORMS\Principal Structure Permit Application.doc V:12/14/04