1986-781 BUILDING PERMIT
TOWN OF QUEENSBURY No 86-781
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to James M. Weller
OWNER of property located at Glen Lake Road and Ox Bow Hill Street, Road or Ave.
in the Town of Queensbury,To eagrxtiz1-place a Demolition of dwelling
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. m
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1. OWNER'S Address is P. 0. Box 996
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name rco
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Robert Ellsworth
3. CONTRACTOR or BUILDER'S Address
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Lake George, NY
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4. ARCHITECT'S Name N
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) p,
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( )Wood Frame ( ') Masonry ( )Steel ( )
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7. PLANS and Specifications
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No. demolition dwelling 30'x30' per application submitted.
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8. Proposed Use W
Demolition Dwelling
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 1 19 87
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(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rr
town of Queensbury before the expiration date.) 0H.
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Dated at the Town of Queensbury this 7th Day of November 19 86 SIGNED BY ( °,
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✓.A_(. G' for the Town of Queensbury
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Building and Zoning I Spector H`
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. TO BE COMPLETED BY BLDG. DEPT.
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No.
awn of QUC4Urea Permit Issued 19 7CANN OP Q
UEENSOURY
BUILDING and ZONING DEPARTMENT Permit Expires 19 f'°;
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation Queensbur New York 12801 Variance No. =( rf,
y' Site Plan Review No. NOV 6 ,I .
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Approved by: 0001. g /0 .C49 PAILAPPLICATION FOR e- v ¢ ®'d e 'e"•
BUILDING AND ZONING PERMIT i _...._ _.._._____��
*. * * * * * * * .* * .* * * * * * * .*. * * * * * * * * * * * * * * * * * * ..::.*
IA 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.
The owner of this prop�erty is:/� /0-a e.S , �b /2,11. /i "
P.O. Address 10, 1) ; a 0,4 �1�:�►-).5 rags g s . /0 y /� 1 'Tel.??3 3 5 v
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Property Location: Veil n /�Q/e e �.X. S tier D 90ty h•f.'I(' reco. Tax Map No. / A/ j/
Street number or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS:
Name P.O. Address Tel. No.
Name of builder epb-e,t F �a5 w ddress Tel. 2 2'o/D/ S 0
Name of plumber Address Tel.
Name of mason Address Tel.
NATURE OF PROPOSED WORK: . * ZONING INFORMATION:
Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
_Addition to a building * drawn reasonably to scale and attached hereto,
_Alteration to a building * showing clearly and distinctly all buildings,
(no change to exterior dimensions) * whether existing or proposed and indicate all
Other work (describe) * set-back dimensions from property lines. Give
De m A / T 1014 street and number or lot number and indicate
* whether interior or corner lot. Show location
FOR DEMOLITION PERMIT, STATE SIZE AND
LOCATION OF STRUCTURES AFFECTED. of water supply and location and configuration
of septic disposal area.
cn9 X 0 a S Tc)ny
' 4O e * COMPLETE INFORMATION REQUIRED BELOW.
* Size of property ft X ft.
* Existing building(s) Size, ft X ft.
*
PROPOSED BUILDING AND USE: * Existing building(s) Use
Size of new structure ft X ft *
Foundation-pier/slab/crawl/partial/full * Proposed building, distance from property line
(circle one) * ft
* Front yard ft Rear yard
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 bathd) * OCCUPANCY INFORMATION
*
No. of bedrooms '
* PRIMARY BUILDING -
No. of bathrooms * One family dwelling
Primary heating system
Type of fuel * Two family dwelling
* Multiple dwelling / Number of units
No. of fireplaces to be installed
Will a wood stove be installed? * Permanent occupancy
* Transient occupancy
Central Air conditioning? * Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Ranch Contemporary Log cabin * Other
* If addition, what will use be?
Raised'ranch Mansion Duplex
Split' level Old style Bungalow *
Cape Cod Cottage Other * ACCESSORY BUILDING-
Colonial Row Town House ' * Detached garage/one car/ two car/ car
1 ( CIRCLE ONE PLEASE ) * Attached garage/one car/ two car/ car
* * * * * * * * * * * * * * * * * * Private storage building
ESTIMATED MARKET VALUE OF * Other
CONSTRUCTION *
$ •
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form BPA 4/86 and-vl '
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BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc.
Will any second-hand or ungraded lumber be used? If so, for what?
Foundation wall material Thickness
Depth of foundation below grade (to bottom of footing)
Will there be a cellar? Heated or'unheated? Floor sq. footage sq ft
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.
Joists(floor beams) 1st. floor "X " spacing "o.c. span ft.
Joists (floor beams) 2nd. floor "k ',' 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 Vire-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 Queensbury AFFIDAVIT
County of Warren 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 '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 not, and that such work is
authorized by the owner.
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SWORN TO BEFORE ME THIS Signature
111 Owner, owner's agent,arcnitect,contractor
day of 19
Notary Public, Warren County, N.Y.
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SPECIAL CONDITIONS OF THE PERMIT:
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By