1987-420 BUILDING PERMIT �
TOWN OF QUEENSBURY No 87-420 �
t WARREN COUNTY, NEW YOR K o
PERMISSION is hereby granted to William E . & Marcia St . Jahn C�
a
OWNER of property located at 57 Dixon Rd . Street, Road or Ave. Co
in the Town of Queensbury, To Construct or place a Addition — Deck
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.
t. OWNER'S Address is
57 Mixon Rd .
Queensbury , N . Y . 12801 M
2. CONTRACTOR or BUILDER'S Name
Same
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a CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name :r
Cam,
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5_ ARCHITECT'S Address
6. TYPE of Construction — !Please indicate by XI
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(X*Wood Frame ( ) Masonry ( 1 Steel ( i
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7. PLANS and Specifications
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Na_ 12 ' x 30 ' deck per plot plan , specifications and application
8. Proposed Use y.
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Addition to one family dwelling-deck . "eN-r`
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$ 10a00 PERMIT FEE PAID — THIS PERMIT EXPIRES February I 198R ty
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the �
town of Qusensbury before the expiration date_I +"r
Dated at the Town of Queensbury this 6th Day of July 1987
SIGNED BY Cam - for the Town of Queensbury
Building and Zoning Inspector �/
TO BE COMPLETED BY BLDG . DEFT. y�� � `
�^�. Application No .
a Jowr! a/ 'Queensgury Permit Issued 19 �rJl
BUILDING and ZONING DEPARTMENT Permit Expires 19
Bay and Haviland Road, R.D. 1 Box 98 zoning Designation JUL 1
Oueensbury, N w York 12801 Variance No .
Site Plan Review No gf�U1� iL/DIi�IG �QE pgP3-
jf JJ Approved by :
APPLICATION FOR
BUILDING AND ZONING PERMIT
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 .
/
The owner of this property.
i.s :_ 1 & � +� • d ►,yl
u
P. O. Address 1 rAe0of :Rd/ Tel . !2 :PJ
Property Location : ,r'G7../Xg4e� Tax Map No
Street number or building lot number
Subdivision name ( if applicable)
THE PERSON RE NSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS :
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Name P . O. Address Tel _ No .
Name of builder Address Tel .
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 ,
,I (no change to exterior dimensions ) whether existing or proposed and indicate all
// Other work (describe) set-back dimensions from property lines . Give
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 .
Size of property Ft X�ft .
Existing building ( s ) Size .,� a f t X eZ f t .
PROPOSED BUILDING AND USE : * Existing buildings ) Use
Size of new structure ft X ft "
Foundation pier slab/crawl/partial/full Proposed building, distance from property line
(circle one )
Front yard ft Rear yard
No . of stories (habitable space) ft* 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 ( excludi.ng baths ) * OCCUPANCY INFORMATION
No * of bedrooms PRIMARY BUILDING
No , of bathrooms
One family dwelling
Primary heating system
�. Two family dwelling -
Type of fuel Multiple dwelling / Number of units
No . of fireplaces to be installed x
Permanent occupancy
Will a wood stove be installed?
�, 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 ow
Cape Cod Cottage ACCESSORY BUILDING-
Colonial Row Town House Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * Attached garage/one car/ two car/—.car
Private st agr 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 I,