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,June Ig 1968
James Ellsworth R, P.
Dream Lake, East of Bay Road, Queensbury
Exibting house Dream Lake
Bedroom extra living_spAqe .. .,
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zoning Inspector
Form # 4
TOWN OF QUEENSBtJEY
Warren County, New York
Office of the toning Inspector
AppLtCATION IM AA NptfnDING PERKM
Location of Property. a' 1L� . .h.t�s-1 rs... . . . . .Eoad, Street, or Avenue
Application No.
. . .. . .Fit ..� ..19.��. .
Plan No. .. ... • . . . .. ..... . . .. . . .. ...... .... ..1... .1P No. . .... . .... ...
Ornes.. . . Y. .. . . ... ....'�. .�4�� . ..... ..
Builder. . . . 1� r jy%/• •T�n�✓•�y�• rf �✓� . .�;. .BLt j•�r.... • i. . . .• • e•
Q�` /SCCCI V Jam' �• . s•.i ..... • . .•.• e••
Type of Building... . .... • . •
Building -to be.i. .. j*•% .Feet Wide.. .. . .l. .Foot Long. . . . . . ...stories High
EatLrted Cost of building. . .?�.: .,r��j •.%.•• ••. •• . . . • . . • • . •.•. .
Proposed Use of Building. . .�-. / � R.:..� � `��.-a�.. .. ... . . . . . . . . . .
Are There Any Other Buildings on the PrGMises?. . ....�::.. . .... . . . . .... a .
Is Any Esisting Building to be Demolished?.... . !:: .... . . .. . • . . .. . e.
Is the Work NeweCvns , SOP&LOws or 1_ingZ�= • .. . . . . . . . . . . .
Date Building Permit Shall Expire. . . . . . . . w . . . . . . . . .. . ... . . .. .. w. ..19. a .
T1►vM& copies of a plot plan draws to scale showing the actual dimen-
sions of the lot to be built upon, the exact size and location an the
lot of the building and accessory buildings to be erected are attached
to this application.
The undersigned hereby agrees to co0ply in the said construction with
all the provisions of the Zoning Ordinance as adopted, of the Town of
Qnsensbury.
(If permit is granted it will be on condition that 'building or al-
terations shall be completed at date to be fixed by Zoning Inspector,
and if not so completed permit shall be revoked by him.)
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11�� .. . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . .. . . . . . . . . . . . . . . .. . . . . . .. .
• • e • • . . s . . w • . • e a . • r • e • • • w . . • • • • e . . • e e . s o 0 o a . • a.• . . see • • o . o • . . . . a e • o e a o 0
• • . • . • n • • • • . e e • w • + r . o • • . + • r • • e r • . . . c • a • a s • a s • • • • .. w e o • e o. • m • . s • o . s • o a o
I hereby agree that all work and materials will be in strict con-
formity with the laws governing building in this Town, and further agree
to post conspicuously a copy of the wilding Permit, protected from the
Vftr, pal tjrprewisas affected.
G 7 Signature
9a ye 0
�.
/ � �� O�uc Contractor, Architect or Agent
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(Strike out inappropriate Provision)