2004-693 f ,
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (51H)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040693 Application Number: A20040693
Tax Map No: 523400-309-005-0001-001-000-0000
Permission is hereby granted to: DF,TRDRF, C MJTPSA
For property located at: 158 LUZERNE Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved-and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: D&G MANAGEMENT.LLC
PO BOX 224 Shed/Storage Sheds $3,249.00
Total Value $3,249.00
GLENS FALLS, NY 12801
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-693 DERWRE CHLUPSA 15 PINECONE DRIVE
160 SQ FT STORAGE SHED
$20.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, September 14, 2005
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Tod°'of eens e' ay, September 14, 2004
� s
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Building Permit Application
Town of Queensbury—Dept of Community Development,742 Bay Road,Queensbury,NY
(518)761.8256
Apermit must be obtained before beginning construction. Permit File No. •
No inspection will be made until applicant has received a Foe Paid $
I building permit. All applicants' spaces on this Rec.Fee Paid
application must be completed and must appear on the Reviewed By:
application form.
Applicant: rt2D/I� ' C,uc.a,�s,¢ Owner:
Address: /S' Prn -
,- nw, ,e Address:
C�usENs�wn.y, �y ,zso� .--
Phone#(Sl sr) - bro S Phone#(�)
Pro Location: Lot Number: / House Number
Property �rrvd.s Tax Ma Number:
Subdivision Name: /�UY�- _ P
o New Building: residence /commercial Estimated Market Value of Construction:$ . —t
G Addition: residence/ commercial If as Addition,what will use of new addition be?
0 Alteration: residence/ commercial
0 No change to exterior size: residence/eom'1
o Other work(describe )
Check Occupancylnformation 1' Floor V Floor Other floor Total
Below sq.ft. sq.ft. sq.ft. Square Feet
o Single farnily dwelling
v Two family dwelling
a Towmousc
o Multifamily dwelling
#of units ilm"I
o Office
o Mercantile
o Mauufactutin
0 1 car detached pra,ge QUEEN.Rptip,
0 2 oar detached garage 1 -
COD-0 3 car detached g=ge ..
0 1 oar attached garage
0 2 ear attached game e
0 3 car attached garage
0 Storage building-
commercial
Storage building-
residential
v Other
What is the proposed height of the structure _feet inches
Will any second-hand or ungraded lumber be used? If so,for what? /Va
Type of Heating System: electric/ oil / gas/wood /forced hot air/ baseboard/other:
Nu`ber of Fireplaces to be installed Number of agdsiovesito be installed
List below the person(s)responsible for supervision of work as regards to building codes:
Name Address- Phone_Number
Builder
Plumber
Mason
Electrician
Dselmlaoy: please sign below after you have carefully read the statement:
To the best of my knowledge 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 on 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 noted,and that such work is authorized by the owner. Further,it is understood that 1/we shall
submit,prior to a Certificate of Occupancy or Certificate of Compliance being issued,as requested by the Zoning
Administrator or Director of Building and Codes,angs Built Survey by a licensed surveyor;drawn to scale,showing actual
location of all new construction.
Signature: owner,owner's agent,architect,contractor
I