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1987-625 'i 1 +CERTIFICATE +CIF OCCUPANCY CY TOWN OF +QUEENSSURY WARREN COUNTY, NEW YORK Date_ / 19 D. "C 87 625 This is to certify that work requested to be done as shown by Permit No. has been completed. This structure may be occupied as a OifE FAMILY DWELLING ti Location THISTLEWOOD ( STONEHURST SUBDIVISION) Owner SAMMEL & GAIL BUTTO By Order Town Board TOVVN OF QUEENSDURY Building & Zoning Inspector it BUILDING PERMIT TOWN OF QUEENSBURY 87-625 Na. WARREN) COUNTY, NEW YOrRK � PERMISSION is hereby granted to Samuel & Gail Butto 1 OWNER of property located at Lot #29 Thistlewood ( Stonehurst ) Street, Road or Ave. o in the Town of Queensbury, To Construct or place a One—Family 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. i _ OWNER'SAddressis RD # 2 Box 418 ~ Granville , No Y . 12832 =� 2. CONTRACTOR or BUI LDE R S Name N FLA SameW rr rt 3. CONTRACTOR or 8UI LDE R'S Address 4. ARCHITECT'S Name t-' O W n rr 5. ARCHITECTS Address C r-3 as ri rt m rt B_ TYPE of Construction — (Please indicate by X1 CD 11 { }Q Wood Frame { ) Masonry f 1 Steel { 1 CEO CL , tJ 7_ PLANS and Specifications o rt No. 28 ' x 40 ' per plot plan , specifications and application including � . septic system and attached two car garage . 8. Proposed Use One—Family Dwelling 1 $5 * 00 C/O $ 185 , 00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 1 , 19 88 (it a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Queensbury before the expiration date.) m r-A FLO Dated at the Town of Queensbury this 17th Day of Sept . 19 87 �• UQ SIGNED BY for the Town of Queensbury Building and Zoning Inspector + °' _ TO BE COMPLETED BY BLDG , DEPT , �C� 3 Application No . 1 yy y ,DE )UFF. -Nlg8URY _Jowre oelkLsrtn#rt Permit Issued 19 11 BUILDING and BONING DEPARTMENT Permit Expires 19 �� } Bay and Haviland Road, R. D. 1 Box 98 Zoning Designation `r - ' 0 Queensbury, New York 12801 variance No . SEP 8 t�V Site Plan Review No , Approved by : BUILDING fit. CODES DF1F'7 APPLICATION FOR BUILD I NG 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 p-is : P , O , Address r� . !t7lS Cyr FhUlf i 1 @ / .� Tel , Property Locat ion : or c d1!-�E' �# S Ll1j r "'Tax Neap No Street number or building lot numbe ,l '� Subdivision name ( if applicable) S' re) ')e hues r THE PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES IS : ob e I) oeok' w/d? Name P . O. Address Tel , No • Name of builder_ fxc3ress Tel . Name of plumber _Address Tel , Name of mason 1 Address Tel - NATURE OF PROPOSED WORK : ZONING INFORMATION : i/ 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 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 REQQUIRED BELOW * Size of property t cf __,ft XW,3Gn' k� ft . Existing building ( s) Size ft X ft . PROPOSED BUILDING AND USE : Existing building ( s ) Use Size of new structure - _f t X �+�- Foundation-pier/slab/crawl/partia full / Proposed building , distance f omjProperty line ( circle one ) a 6r`"o� `— Front yard Fa yard ft £t R No . of stories (habitable space) C;k Side yards ft and �� ft Height ( grade to ridge) ft * If on corner , setback from side street ft If residential , no . of Tamil es No . of rooms ( excluding baths ) �l (? OCCUPANCY INFORMATION No . of bedrooms 'rJ` y No , of bathrooms y. - PRIMARY BUILDING One family dwelling - Primary heating systenp iIt P✓ * f�" �. Two family dwelling Type of fuel frAe,. Multiple dwelling / Number of units No . of fireplaces to be installed 1 Permanent occupancy Will a wood stove be installed? Ny � � 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 C Cottage Other " ACCESSORY BUILDING- alonial Row Town House Detached garage/one car/ two car/ car ( CIRCLE ONE PLEASE } ✓Attached garage/one car/ two car �Z 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 SUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame , fire safe , etc ._ JJ Q7 0 will any second-hand or ungraded lumber be used? If so , for what ? }(f (f Foundation wall material 0+U Thickness 4, Depth of foundation below gr de (to bottom of fo Will there be a cellar . N eated or unheated?Floor sq. footage sq ft Will there be a basement? will any .portion be used as living space? r[!G+ ( If so , what portion? sq . ft . - - Type of use? Type of roof - sloped/flat/shed/other S/voed Material of roof �- Size , wood studs__ "X & spacings"__-._-. o . c . length __,E�ft . Joists { floor beams } lst . floor _�"X p spacing c , span / ft . Joists ( floor beams ) 2nd . floor ,2 "X ! CJ " spacing, "o . c . span 14Z ft . Overlays ( ceiling beams ) "X " spacing "o . c . span ft . Roof rafters "' X No spacing o . . span�ft . Roof trusses ( ere spacing" o . c . span .YIPS' ft . Exterior wall finish Of what material ? 0200D Interior wall finish ` iAe.� -if a garage is to b attached , describe materials to be used for FIRE SEPARATION : eat' ADC; qs Is there to be an opening between garage and dwelling? CS If so will a Fire-rated door , enclosure , and self-closing device be provided? Will a flue-lined chimney be installed? es Height 4bove roof L2 ft . rY1rsJ . Depth of chimney foundation below grade Depth of fireplace hearth fto in .^ f/ Water supply - Municipal or private well �j�`IUIF �' E � SEPTIC SYSTEM _ Distance from ANY private well ( including adjoining properties ftyO ft . rjoif., (A separate application is necessary for any repair or new installation of septic system) Town of Queensbury County of Warren AA V I T STATE OF NEW YClRx 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 clone 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 spe ified or not , and that such work is authorized by the owner . ,� —. SWORN ❑ BEFORE ME is Signature __ _ _____ _ ________ __ ___ -Owner, owner ' s agent . arcnirect , cont ac or y of 19 Notary Pub Yi c , arren County , N . Y . Nk SPECIAL CONDITIONS OF THE P IT : Fµ TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK Application for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION CODE A permit must be obtained before beginning work . ANSWER ALL of the following : 1 . Gross floor area " S 2 . Type of heat Ha7A �> 0 �'1 3 . Is the building mechanically cooled ? �✓ S / 4 . Percentage of area of windows and doors A . Over 16 % Only 1 . Ua value of gross area of walls , roof/ ceiling and floors exposed to ambient conditions 2 . Floor over heated spaces YES NO a . Are foundation walls insulated ? YES NO 1 . if YES , what is the R value ? 3 . Slab on grade YES NO a . if YES , what is the R value of insulation around perimeter of floor ? 4 . Is basement heated ? YES NO a . R value of insulation 5 . Type of insulation B . Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions_ 1Z'O0F `z _ 3: en� r- L. 0 (< Vim. 2 . R value of exterior walls T{ - -7� C7 3 . R value of glazed area � - 4 . R value of doors _Z - t�4 5 . R value of floors over unheated spaces 6 . R value of slab edge insulation - unheated slab 7 . R value of slab insulation - heated slab s . R value of heated basement/ cellar walls ( above grade ) 9 . R value of heated basemenit�-/cellar walls ( below grade ) 10 . Type of insulation ' L + C . Controls o 1 . Thermostat maximum heat setting D . Duct Systems I . Is duct system installed in unheated spaces . a . If YES , R value of duct installation b . R value of duct in other areas E . Piping Insulation I . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water 1 . Performancee efficiency_ 2 . Temperature control setting maximum //%no G . For Swimming Pool Only 1 . Maximum thte�a (tIng Telephone No . "�' ( ajYpllca s signature ) 10AM7e 00arn ofQdAtoy APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE / g LOCATION OF PROPERTY FOR INSTALLATION �,,,ti�4�L(�Sf �� -'�jJU -'580A3 kei 0- �27 Owner's Name: Y49- ](,(d v��WItFe Telephone: Address: qb e:002 A0)C �lf c:V74OW1110 Installer's Name: rjy�(GL 44 . } at� Telephone: S'i�7rf7[' 1�3 ff Uc Number of bedrooms (residential only) .tf _ Total daily flow (compute (9P 150 gal per bedroom) Topography: circle one: Fl Rolling teep Slope % of slope Soil Nature: circle on Sand Loam ,} Clay Other / Depth: ,,.> feet Ground Water: At what depth? feet +Bedrock or Impervious Material: At what depth? i +-� feet M r 4u Percolation test: circle one: not requirec�iryquired /_mate 1� min. inch. / lwi� ^u Domestic water supply: circle one: Municipa Wel Other IF domestic water supply is a Well: ,, Separation: W atersupply from Septic absorption j4V&-, t • feet PROPOSED SYSTEM: Septic Tank /d d _ gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench %5 0 feet / Total system length „4 p-O feet SEEPAGE PIT(S) : Number of / Size each feet by feet Size of stone to be used # Depth or Thickness 1 + feet (YI r IMPORTANT ...Please...I.IST NEW EQUIPMENT TO BE INSTALLED (over) Section II Septic System Inspections: A. All applications for septic system installation, alteration or repair, as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building Department at least 24 hours before start of construction and shall include a plot plan showing: 1 .) the proposed location of the system 2.) location and distance to lot lines 3.) location and distance to structures 4.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, the fields and/or drywells B. No system shall be covered before inspection and approval by the building Inspector. Failure to comply with this requirement may result in the uncovering of the system by the installer and a fine of up to $250.00. Co An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. I have read the regulations above and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ckdinance. Signature of resp nsible person: Date: ' Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . HOME OF NATURAL BEAUTY A GOOD PLACE TO LIVE �7 . lawnpk aeteerrs6urt� O v BUILDING and ZONING DEPARTMENT C Bay and Haviland Road. R.i] , 1 Box 98 Clueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME M y T aC: S- O-Alt, i� v T� LOCATION �2.. ry 7i 457 +�G( �r'1r� l:LZ _ Dat / Permit I3o . I r * * * * * * * * * * * * APPROVED - YES NO Footing/Pier Forms Foundation waterproofing Backfill Framing 71k Roof ing K Siding Masonry Veneer v*tRough Plumbing )" Relief Valves `, (Ext . Porches ,?k Finished Floors ;G,3nterior Trim ,Stairs & Railings Cellar Drain Tile Concrete Floors )K Plbg . Fixtures }( Gar _ Fireproofing )( Door Closers ')< Smoke Detectors Chimney INSULATION : Foundation 12 �14 Floors walls Ceiling FINAL ELECTRICAL INS ECTION� DRIVEWAY APPROVAL )(Final Building 5urve /Next scheduled inspection ( call when ready ) Remarks- UP C-/ o S11-44 Cyr Buildin nspectar 6/86 and-vl THE NEW YORK BOARD OF FIRE UNDERWRITERS `Z BUREAU OF ELECTRICITY arxua ry l E; , 1 �3g +j� ](41 STATE STRE ET, ALBANY, NE W YO {[�� ("��[ Date .. Applirarinn -No. nn fife / tf A R V 4 Y V 4 THIS CERTIFIES THAT named an the above application n manbar in the pn++nise a of garage outside in the follosoinA locati ; Basement E 1st Fi. 2ad Fl. S 54 7 ection Block Lot 29 was examined on -- 5-8$ and joand to be in compliance with the regecirementa of this Board, RXTURE B�TACLES S1AlFTCF1E5 FIXTURES RAP40ES COOKING COCKS GIVENS DISH WASHERS EXHAUST FANS OUT tNCANpESCENT FUJONSCFHT y AMT, K, W. AMT. K. W. ANT, K.w. MAT. K. W. MAT, H. P- 26 J3 28 ? 4 y L 6w3 3 it ... DRYERS FURNACE MOTORS FU'I AM IANCE PIERCERS SPECIAL MC 11 TIME OLMUS IECILI UNIT WATERS AIULTb,DUTL" DIMMERS AJY4T. K. W, 01l H_ P_ GAS H. P. T- NO. A. . G. AFT. AlMP. AMT. AMPS. TRANS. ANT. H. P. O. OF FORT AMT. WATTS NO. OF FAT Ftmc`~ FT 0 1 drove # 10 SERVICE DISCONNECT NO. OF S E R V I C E AMT. AMP, j TVFE W. a -0 2W 1 0 3W 3 A' 3W 3 A' iW I "ob 0�4%rCONO- CX CC t&,O. NO. OF 0"49G �'M.� No. OF Nt4n/ALS of 1, G� AL 1 200 Cb i x 4I0 2 /01 1 OTHER AT"IM <^3iR C:if.�. c34' C:�ti: CC31" S z VI N J F f silmuel J . autto RD 2 Sox 413 ft �-�j c� 7 ••-`+ Gr'aiLdvt1l.e . NY 12632 ` BRANCH MANAGER Per This certificate must not be altered in any manner, return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER_ Down IQ BUILDING and ZONING DEPARTMENT Bay and Naviland Road, R.D. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME E U777 LOCATION ' �r57GJ Date /' go Permit No . -1 z? � ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney Lam ! INSULATION : Foundation Floors walls rt ./ Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- [-�/'i.e„p"Q�r/r' �__`'�-- Building Inspector 6/86 and-vi Joeurt a/ Queeris ury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. Q. 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTORS REPORT NAME 1; P1-0� --s- / 4 LOCATION 275 // 5 yer,!../�s p __ Permit Date /� 0 Z.5 iz PermitrrCNo . tl �✓/ ram ✓ = APPROVED - YES NO Footing/Pier Forms Foundation Waterproofing Backfill ,f Framing Roofing Siding Masonry Veneer Rough Plumbing Relief Valves Ext , Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors Plbg . Fixtures Gar . Fireproofin Door Closers Smoke Detector Chimney INSULATION Foundation Floors Walls Ceiling FINAL ELECTRICAL INSPECTION DRIVEWAY APPROVAL Final Building, Survey Next scheduled inspection (call when ready ) Remarks- + -•. E..7 �+`� AC�(:D.. Building Inspector 6/86 and-vl e / I BUILDING and ZONING DEPARTMENT r� Bay and Haviland Road, R. D. 1 Box 98 Oueensbury, New York 12801 BUILDING INSPECTOR ' S REPORT !NAME '000< LOCATION Date Permit No . J ✓ = APPROVED YES NO Footing/Pier Farms Foundation Waterproofing Bacicfill �aming Roofing Siding Masonry 'Veneer Hugh Plumbing Relief Valves Ext . Porches Finished Floors Interior Trim Stairs & Railings Cellar Drain Tile Concrete Floors / Plbg . Fixtures _.... __. Gar . Fi reproof i g Door Closers Smoke Detector Chimney IN SFJLAT ION Foundation Floors Walls Ceiling L L FINA EECT CAL INSPECTION DRIVEWAY AP RCIVAL Final Build ng Survey Next schedul d inspection ( call when ready ) Remarks- Bui ding Inspector 6/86 and-vl n lot� vi? .lown of Queens ury d � BUILDING and ZONING DEPARTMENT f Bay and Haviland Road, R. D. 1 Box 98 O ensbury, N,e,�' York 1280 //� x�2 SEPTIC DISPOSArL SYSTEM INSPECTION f NAME LOCATION DATE M15 ! 67' PERMIT Np ._Q l of r SOIL TYPE - Sand - am Percolation Test Re e O Percolatio rate - Min/ ch -� TYPE of SYS Absorption eld , t al length �'� Length of ea tre h 570 Depth of tren hes Size of gravel: SEEPAGE PITS4N er of ) Size- ft. ft . Gravel size PIPING : Size Type Bldg . to to k --�1�r �C] f Y�- Tank to di t. box SEhhrrds �y�� Dist. box to field/p 04ZM;ani'e Openings sealed? No Partirals LOCATIO /SEFARATIQNS : .,r- Founda ion to tank �ft+' Found ion to absorption ear to lit line �ATYleircle f S t . - Separation of pits t. LOCATI SYST QP one) Front deeft `sid Right side - COMMENT S : SYSTEM USE APPROVED YES NO Budd g inspector�� 01/86 and vl -N /own v Queeer3heer�r BUILDING and ZONING DEPARTMENT 5 ` �' AW Bay and Haviland Road, R.D. 1 Box 98 +Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION -4r;v` 0�9r Bate J�97 Permit No . 1e' = APPROVED - YES NO FootingfPier Farms �.�..Fa.oundation VsW.aterpr frog Back£ill Framing Roofing Siding Masonry Venee Rcwgh Plumbing Relief Valves 40 Ext . Porches Finished Floors Interior Trim Stairs & Railings )fiellar Drain T11a Concrete Floors Plbg . Fixtures Gar . Fireproofing Door Closers Smoke Detectors Chimney INSULATION : Foundation cr /Q - L7 Floors Walls Ceiling FINAL EL TRICAL INSPECTION DRIVEWAYJAPPROVAL Final Building Survey Next scheduled inspection (call when ready ) Remarks- �lwz f 9?&9� Bull ' ng Inspec or 6/a6 and-vl . own o/ Q"CenyIurry BUILDING and ZONING DEPARTMENT Bay and Waviland Road, R.D. 1 Box 98 Oueensbury, New York 12801 BUILDI It-4,5PECTORIS REPORT NAME a � LOCAT ION Date f(G+ / permit N<> . ✓ = APPROVED - YES NO ` voting/Pier Forms ,/ Foundation Waterproofing Backfill Framing Roofing Siding Masonry Ve er Rough P1xaml� ng Relief Valv Ext . Porches Finished Floo s jr Interior Trim Stairs & Rail! s Cellar Drain Ti Concrete Floors Plbg . Fixtures Gar . Fireproofin Door Closers Smoke Detector Chimney IN SUI AT I ON Foundation Floors Walls Ceiling FINAL ELECT CAL INSPECTION __.... DRIVEWAY APP OVAL Final Building Survey Next scheduled inspection (call when ready Remarks-- ?( Of,,? Building Inspector 6/86 and-vl BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED. . a DMTE L rOWNsrI1P COUNTY ,I J 57VEET AND NO. OR f.��.y� - ROAD AND POLE NO. f IL � �-� fiC�`(,C.7 y} ,� w ' %if POLE NO. BETWEEN WHAT TWO CROSS STREETS IS •"'" PREMISES LOCATED? JIB/ ICI E.3C ) G .�J� '.�''- t�l�'3' f i, ' SECTION BLOCK LOT 5 D2 , NAMEOCCUPANT'S LDING ,%�,-? ; :/c' /f: OCCUPANCYOWNERA S ! TEL 4pLf .ANDADDRESS .r 07 SLIPP IEb �,r+ ■ BY %!Ca/' I(� ly�t FROMTNEIR � OFFICE B OLD BUILDING NEW © WORK DEFECTS IS NEW to ADDITIONAL ❑ REMOVER ❑ LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED ANCH NUMBER OF OUTLETS �nowspo sm MOTORS HEATS RS clRCum OFFICE USE Lash ONLY lion Side Asrah'x O.P. Watts OPS190 WAN Restpla iWissh Prndrrt Bnekae No- typo £rpll Na Ewh INSPECTION SDid�i sub- Irw BAP rr..we tat Ft. and FI Srd Fl. REMARKS_ LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DO NOT USE THIS SPACE. This applieation is intended to wear the above l'sRM rguonuw4 to be inspected but if at tinm of irspaet:an there a Ieund additional equip�t not above listed, vW ire opthorLwW to make the Rixpowdl and atljual ttie fro to caear the}dditMral aquipMovat. as proridad by tote"vpjk i t. St2E OF ELECTRIC SIGN TOTAL MAIN$ FEEDERS LAMPS WATTS CHARACTER E%POSED GAS TUBE SIGN OF WORK CONCEALED TRANSFORMERS OF VA WORK TO BE (NUMBER) ICAPACITYI STARTED COMPLETED SIZE OF SIGN SERVICE OVERHEAD UNDERGROUN MAKER ENTERS OF SIGN BUILDING INSPECTION REQUESTED ON OR AS NEAR AS POSSIBLE NEW OLD AVOID DELAY BY OF NO FULL A ACCURATE INFORMATION. ALL SPACES DATE OF MUST BE FILLED IN R APPLIC O MA E RETURNED. APPLICATI PRINT NAME A ADDR NAME OF X SIGNATURE APPLICANT ` + OF APPLICANT_ ,r ._. STREET ADDRESSkok t '0 0� - �� " /rl } • L TEEPHONE # f '� f CITY OR i " ZIP LICENSE NO_ POST OFFICE - "� CODE tr"! =__WHEN APPLICABLE 46 EL (REv. tl86) A SEPARATE APPLICATION JUST BE FILED FOR EACH SEPARATE BUILDING MAP REFERENCE STONEHURST SUBDIVISION BY VanOusen d Steves IN 1983 ` FILED NOVEMBER 21 , 1983 DRIVE oD STLEVvO�3° TNI n! �t Lit � !�I -711 I � 3 ` •` r of qt y I LOT 29 1.131 A CREST - - J - j MAP MADE FOR J SAMUEL J. & GA IL E. SUT TO TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK SCALE' I" = 20' DATE : AUGUST 26 , 1987 A/ $ S 2 2 ' w VonDus en & Steves LAND SURVEYORS, GLENS FALLS, NEW YORK N.Y. STATE LIC. NO. 35617 5';,- �7- Z? 0-7- 377- - G