88-314-au„t of Queettilury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
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1.\ APPLICATION FOR
BUILDING, AND ZONING PERMIT
TO BE COMPLETED BY BLDG. DEPT.
Application No.
Permit Issued 19
Permit Expires 19
Zoning Designation
Variance No.
Site Plan Review No
Approved by:
TO, N Or.' 4DM;7r'
MAY WO
BUILDING & CODE DEF'
SC) 0F�
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. ANSWER ALL OF THE FOLLOWING.
The undersigned hereby applies for a Building Permit to do the following work which will
be done in accordance with the description, plans and specifications submitted, and such
special conditions as may be indicated on the Permit.
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The owner of this property is: 111V1 ("av /�cVGmS
P.O. Address Tel.
/n1
Property Location: %QS R 0?IvU'tzSC-'C ,",c IoPoS fi.I`S Tax Map No._/ /_
Street number or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLEFOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
Name P.O.
Address
Tel. No.
Name of builder %r CV'/ ��r�p,� Address
!-'�:c150��4 /'z:�IS
Tel. 7 '' 7 - N 3
Name of plumber Address
Tel.
Name of mason Address
Tel.
NATURE OF PROPOSED WORK:
*
ZONING INFORMATION:
of a new building
*
A PLOT PLAN MUST BE
PREPARED AND SUBMITTED,
_Construction
Addition to a building
*
drawn reasonably to
scale and attached hereto,
_
to a building
*
showing clearly and
distinctly all buildings,
_Alteration
(no change to exterior dimensions)
*
whether existing or
proposed and indicate all
Other work (describe) k�„ /'I", k'
*
set -back dimensions
from property lines. Give
_y� Lk ��`,�
*
street and number or
lot number and indicate
*
whether interior or
corner lot. Show location
FOR DEMOLITION PERMIT, STATE SIZE AND
*
of water supply and
location and configuration
LOCATION OF STRUCTURES AFFECTED.
*
of septic disposal
area.
COMPLETE INFORMATION REQUIRED BELOW. Y
*
*
Size of property O ft X / Q() ft.
*
-/
Existing building(s) Size ft X ft.
*
PROPOSED BUILDING AND USE:
*
Existing building(s) Use
Size of new structure (a ft X/"� ft
Foundation-pier/slab/crawl/partial/full
*
Proposed building, distance from property line
(circle one)
Front yard ft Rear yard ft
No. of stories (habitable space)
*
Side yards ft and ft
Height (grade to ridge) ft.
*
If on corner, setback from side street ft
If residential, no. of families
*
No. of rooms(excluding baths))_
*
OCCUPANCY INFORMATION
No. of bedrooms 5,
PRIMARY BUILDING -
No. of bathrooms
*
One family dwelling
Primary heating sy�em i
*
family dwelling ,
'type of fueld4�-
_Two
Multiple dwelling / Number of units
No. of fireplaces to be installed_
*
_permanent occupancy
Will a wood stove be installed? 44)
*
Transient occupancy
Central Air conditioning?-4/)
—
BUILDING STYLE, PRIMARY STRUCTURE
*
*
_Business
_Industrial
Other
Ranch Contemporary Log cabin
*
If addition, what will use be?
Raised ranch Mansion Duplex
split level Old style Bungalow
Cape Cod Cottage Oth
*
ACCESSORY BUILDING -
Colonial Row Town House
*
garage/one car/ two car/ car
( CIRCLE ONE PLEASE )
*
_Detached
_Attached garage/one car/ two car/__car
+ + + + + * + * * * * * * * * * It
*
_Private storage building
MARKET VALUE OF
*
_Other
XESTIMATED
CONSTRUCTION $ C'(
INFORMATION ON BUILDING SPECIFICATIONS,
ON
REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
M
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc.L,)C,-,
Will any second -)rand or ungraded lumber be used? If so, for what? I'JC). qcL
4, .40A,
Foundation waall material Thickness
Depth of foundation below grade (to bottom of footing)
Will there be a cellar? Heated or unheated? Floor sq. footage sq ff
Will there be a basement? Will any portion be used as living space?
(If so, what portion? sq.ft. - - Type of use?
Type of roof - sloped/flat/shed/other Material•of roof
Size, wood studs "X " spacing "o.c. length ft.
ms) 1o
Joists(floor beast. floor "X spacing "o.c. span ft.
Joists(floor beams) 2nd. floor "X " spacing "o.c. span ft.
Overlays(ceiling beams) "X " spacing "o.c. span ft.
Roof rafters "X " spacing o.c. span ft.
Roof trusses(pre-engineered) spacing "o.c, span ft.
Exterior wall finish Of what material?
Interior wall finish
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
Is there to be an opening between garage and dwelling? If so will a Fire -rated
door, enclosure, and self -closing device be provided?
Will a flue -lined chimney be installed? Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - Municipal or private well
SEPTIC SYSTEM _ Distance from ANY private well(including adjoining properties ft.
(A separate application is necessary for any repair or new installation of septic system)
Town of bury
County off Warren A F F I D A V I T STATE OF NEW YORK
I swear that to the best of my knowledge and belief the statements contained
in this application, together with the plans and specifications submitted, are a true and
complete statement of all proposed work to be done,Lon the described premises and that all
provisions of the BUILDING CODE, THE ZONING ORDINANCE, and all other laws pertaining to
the proposed work shall be complied with, whether specified or not, and that such work is
authorized by the owne . Y
S RN TO BEFORE THIS /(,Signature---`� -----------------------
Owner, s agen ,arcnitect,contractor
19
Nota/yy Public, War s'en County, N.Y.
x x x x x x x x x\* ■ x x x x x x x x x x x x x x x x x x x x x x x t x x x x x x +. x x x
SPECIAL CONDITIONS OF THE PERMIT:
By
B ILDING PERMIT ' � ''
TOWN 4F QUEENSBURY No.
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to $ may iwwm
OWNER of property located at x1mysma Aviiiiiiiew Street. Road or Ave.
in the Town of Queensbury, To Constrtict or place a )Y
at the above location in accordance toapplication together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. ONNE RS Address is
T 0eft w Atli
2. CONTRACTOR or BUILDERS Name -
3. CONTRACTOR or BUILDERSAddren—
Fans, lslro 12839
4. ARCHITECT'S Name
5. ARCHITECTSAddress
6. TYPE of Construction — (Please indicate by XI - -
1 1 Wood Frame 1 1 Masonry ( 1 Steel 1 1
7. PLANS and Specifications
No. Se = 12, Y pj" plaill, f=$ a" tam-.. -
8. Proposed Use - - -
$ 5.40 PERMIT FEE PAID —THIS PERMIT EXPIRES AMOS0 W 2 19 83
(If a longer period is required an a ;on for an extension must be made to the Building and Zoni rof the
town of Queensbury before tM -.. ion date.)
Dated at the Town of Queensbury this 31st Day of x" 19- &S
N4.
SIGNED BY for the Town of Queensbury
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