2001-479 TOWN OF QUEENSBURY
f 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010479 Application Number: A20010479
Tax Map No: 523400-288-000-0001-048-000-0000
Permission is hereby granted to: INDEPENDENT WIRELESS ONE
For property located at: GURNEY LANE, OFF
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: TOWN OF QUEENSBURY Miscellaneous Structure 20,000.00
742 BAY Rd Total Value 20,000.00
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2001-479 CELL TOWER
20' X 20' FENCED IN AREA ON SLAB,NO BUILDING CONSTRUCTIONOF TOWER W/EQUIPMENT
$0.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,July 10,2002
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury ore the exp_ ation date.)
Dated at the Town o Quee � esd , ;,2001
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Building Permit Application
I'bwn of Qucensbury—Dept of Community Development, 742 Bay Road, Quecnsbury, NY
(518) 7G1 825G —CE E
D
A permit must be obtained before beginning construction. Permit File N�1-4 uL 0 2 2001
No inspection will be made until applicant has received a Fee Paid $c;Q°-%
valid building permit. All applicants' spaces on this Rec. Fee Paid $ TOWN'OF QUEENSeUp�1.
application must be completed and must appear on the Reviewed By: BUILDING qn/D CODE
application form.
pc CA0(136 l l�6
Applicant: j.Yl de-put (�Qvl� (kie e55 utoe Owner: Iaw,..) oC 0.veP� vc IAILkser d S r (4-
Address: 2-5 4 Weyk►1,,,,,+6,v, Ve Address: 82 2��f
A 11.1,4 ry N vee�Sl �� �, N`-( 9ZP,64
Phone# (5//, ) 4Se - 61100 Phone#(5/6 ) 7`13- e e)6G
,xa--U
Property Location: Lot Number: 2� / House Number / GAG( t`�
Subdivision Name: Tax Map Number: 3 - I — Z 5 i^
o 0
❑ '
New Building: residence /commercial Estimated Market Value of Construction: $ •a;OOO 3
cia., Addition: residence/ commercial o
If an Addition, what will use of new addition be? ^ cn,�
X Alteration: residence/ conuncrci. We ,I P CD vr►,•►1 r�N:ern; oove�r (1I►�'
S`)
• . o No change to exterior size: residence/com'l C I ^G
❑ Other work(describe ) /3I2 p in„ ° Qd .6
• Check Occupancy In formation I'r Floor 2" Floor Other floor 'Total
Below sq. n. sq. I'I. sq. fl. Square Feel
❑ Single family dwelling
o Two family dwelling
❑ Townhouse
o Multifamily dwelling
it of units
❑ Office
o Mercantile
o Manufacturing
• 1 car detached garage
O 2 car detached garage
❑ 3 car detached garage
❑ I car attached garage •
❑ 2 car attached garage
❑ 3 car attached garage
u Storage building-
commercial
❑ . _
Storage building- ----- -----�-- ——__-.
residential
X Other ( O e
Will any second-hand or ungraded lumber be used? If so, for what'? t O
Type of Heating System: electric/ oil / gas/wood /forced hot air/ baseboard/other: 0
Number of Fireplaces,to be installed Number of lvoodstones to be installed i(JO
•
List below the person(s)responsible for supervision of work as regards to building codes:
— —" -- — Name " Address_ —_--- Phone Number.Builder 5 pick k CC,ru54%(1/4)efi-.�,ti (b i1 iU 365- -5-C41
Plumber
Mason
Electrician `` I t ` t t
Declaration: please sign below rifler 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,arc 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 he complied
with. whether specified or noted, and that such work is authorized by the owner. Further, it is understood that I/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, an its Built Sur►er by a licensed surveyor; drawn to scale,showing actual
location of all new construction.
Signature: J �` owner, , architect,contractor