application �„r-.;�f G� lO OFFICE USE ........"".".."""..
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PERMIT NO •• , .€. .
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RECREATION ENGINEERIG �I!r 1 r'1 7007
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PRIN
CIPAL STRUCTURE;
APPLICATION FOR ZONING APPROVAL & BU
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CON ILDING PERMIT
CONSTRUCTION. APPLICATION IS SUBJECT TO
REVIEW BEFORE ISSUANCE OF A VALID PERMIT F R CONSTRUCTION.
APPLICANT/BUILDER: ,��`'� ��
OWNER: .---
ADDRESS:
ADDRESS: Vo
PHONE NOS. -1a77
PHONE NOS. 7
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE: `
PHONE:�.ol -2%-_ (,o
LOCATION OF PROPERTY: 015 L
,,7._
SUBDIVISION NAME: c
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT Z
APPLY TO YOUR O
PROJECT Op
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SINGLE FAMILY
TWO-FAMILY IIIIIIIIIIIIII
MULTI-FAMILY
(NO. of UNITS ) .11111111111111
TOWNHOUSE IIIIIIIIIIIIIIII
BUSINESS OFFICE
RETAIL-
MERCANTILE
Do 5C 15j
FACTORY OR /
INDUSTRIAL (X'
a-loop oZ :1 V 64
ATTACHED
GARAGE(1,2,3)
OTHER
IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS: .t-Zec-rNe- 7c:)\.&
ESTIMATED CONSTRUCTION COST: l I -� `
`��i � �9 FUEL TYPE: `—"'—
HEAT TYPE: ----
*HOW MANY FIREPLACE(S): AND/OR WOODSTOVES(S):
ZONING CATEGORY:L- -- ( ARE THERE WETLANDS ON THIS SITE? ''k•D�
IS THIS A HISTORIC SITE? .D.�
PROPOSED USE OF BUILDING OR ADDITION: bfl\---Ck.0 e
*Please complete a separate Application for"Fuel Burning Appliances& Chimneys"available in our office
CA�/�����.��� B 3-LGL 11-05
Town of pndh,,r„ r. ,,,..,......,. :.. 1.. ,-r__. , — _.. ._.:'A C)iw
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? -Dcz,
•
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 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:
is
BUIL G & C ES OVAL ZONING APPROVAL
—1D1120DATE DATE
J
QUESTIONS? CALL 761-8256 OR EMAIL
codesAq ueensbu ry,net
Jffice Use Only VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
Jperating Permit Issued: Yes No
)ccupancy Type: �`��Q � � I Construction Classification: 7
kssembly Occupancy Limit: Special Conditions:
tTown of Queensbury• Community Development Office • 742 Bay Road, Queensbuny, NY 12804