1986-864 •
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date j" 19
This is to certify that work requested to be done as shown by Permit No. 36-364
•
has been completed.
This structure may be occupied as a One '�,a##. v Dt::-silin.; (Mod u1, - •
l opt P CI.Arr RJL.
Location Lot 5 itchal Road (Amilerah5:e
V"\ C NA- 0 b i bSo r.
O
r :11cnc.e1 Gibson •
•
• By Order Town Board
•
. TOWN OF QUEENSBURY
•
•
Building.& Zoning Inspector
CREATIVE •'INSTA'• PRINTING. GLENS FALLS. N V 12801 13181793-S6S6
BUILDING PERMIT A .
TOWN OF QUEENSBURY
No. 86-864
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Michael Gibson
OWNER of property located at Lot 5 Pitcher Road (Ambershire Subdivi$on Street, Road or Ave.
co
in the Town of Queensbury,To Construct or place a One—Family Dwelling — Modular
at the above location in accordance to application together with plot plans and other information hereto filed and or
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. o
0
1. OWNER'S Address is RD #2 Gurney Lane
Glens Falls, New York 12801
2. CONTRACTOR or BUILDER'S Name
same
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3. CONTRACTOR or BUILDER'S Address v,
)7/
r•
rt.
n
4. ARCHITECT'S Name
r•t
7y
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W
a.
5. ARCHITECT'S Address
a,
1-1
co
6. TYPE of Construction— (Please indicate by X) K.
to
(x)Wood Frame ( ) Masonry ( )Steel ( ) ___ - G
a.
7. PLANS and Specifications H.
No. 28'x48' per plot plan, specifications and application submitted
including sewage system. -
8. Proposed Use (see letter with stipulations attached)
One—Family Dwelling THE ATTACHMENT OF THE TWO PARTS MUST BE APPROVED BY A o
LICENSED PROFESSIONAL ENGINEER. o m
a. I
tr �
$5.00 C/O
$ 119.00 PERMIT FEE PAID —THIS PERMIT EXPIRES July 1 19 87
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the ry
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 19th Day of December 19 86
SIGNED BY 0-4 • ��� for the Town of Queensbury
Building and Zoning Inspector a
G Zcf-°%f TO BE COMPLETED BY BLDG. DEPT.
// Application No.
acun of Queen iur, Permit Issued 19 T( WN OF QUEENSBU Y
BUILDING and ZONING DEPARTMENT Permit Expires 19 A
Bay and Haviland Road, R.D. 1 Box 98 Zoning Designation I
�
C!ueensbury, New York 12801 Variance No._ T
Site Plan Review No. iz 7,_ 8 yy ,/
Approved by: A.M.
APPLICATION FOR e 1819 16 11.X) 1I I g Ia a
,.
�s -/
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 is: ry). 16,0` A (7'\ksor,j A'
P.O. Address 9� O-42- En2. J ( L-4'tc�V�, & e... s'.`�-I P.IV,/ Iwo( Tel. 'WI a-149r �
Property Location: Pi'LC ea. . Lo 'S fL 4rn6 ashlre_e. Tax Map No.. / /
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 Address Tel.
Name of plumber Address Tel.
Name of mason L,F, /(i3uoar Address ( ASI;,► tCYZT, Ail Tel. '74,; -gglAt
NATURE OF PROPOSED WORK: * ZONING INFORMATION:
/onstruction 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
FOR DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot. Show location
LOCATION OF STRUCTURES AFFECTED. * of water supply and location and configuration
* of septic .disposal area.
*
* COMPLETE INFORMATION REQUIRED BELOW.
* Size of property J(L,f ft X /;gib ft.
* Existing building(s) Size ft X ft.
PROPOSED BUILDING AND USE: * 0/16
* Existing building(s) Use
,
Size of new structure 8 ft X 48 ft * AA.VV6
Foundation-pier/slab/crawl/partial/full * Proposed building, distance from property line
(circle one) *
ft
No. of stories (habitable space) * Front yard .5 Q ft Rear yard fj;�
Height (grade to ridge) ft. * Side yards3 ft and /� ft
If residential, no. of families
* If on corner, setback from side street ft .
No. of rooms(excluding baths) * OCCUPANCY' INFORMATION
No. of bedrooms 3 *
* PRIMARY BUILDING
No. of bathrooms * One family dwelling
Primary heating system E1 r i
, e _; * _Two family dwelling
No. of fireplaces to be installed _t�� * Multiple dwelling / Number of units
Will a wood stove be installed? ',00 * Permanent occupancy
Central Air conditioning? NO * usinesst occupancy
'B
* Business
BUILDING STYLE, PRIMARY STRUCTURE *' ' Industrial
'Ranch . Contemporary Log cabin * Other
Raised ranch Mansion Duplex * If addition, what will use be?
44plit level) Old style Bungalow *
Cape Cod Cottage Other * ACCESSORY BUILDING-
Colonial Row Town House * . Detached garage/one car/ two car/ car
( CIRCLE ONE PLEASE ) * Attached garage/one car/ two car/ car
* * * * * *. * * * * * * * * * * * '1-7—Private storage building
ESTIMATED MARKET VALUE OF * +Other
CONSTRUCTION *
$--- --312000
INFORMATION ON BUILDING SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form BPA 4/86 and-vl
4
BUILDING PERMIT APPLICATION CONTINUED -
•
BUILDING SPECIFICATIONS:
•
Type of construction, wood frame fire safe,etc.
Will any second-hand or ungraded lumber be used? If so, for what? .A/e)
Foundation wall material Thickness
Depth of foundation below grade (to bottom of footing)
Will there be a cellar? )./e5 Heated or unheated? Floor sq. footage / "�0 sq ft
Will there be a basement? Will any portion be used as living space?
(If so, what port'.n? sq.ft. - - Type of use?
Type of roof - slope.► flat/shed/other Material. of roof PletriQbt/}$S
Size, wood studs "X " spacing "o.c. length ft.
Joists(floor beams) 1st. floor V.— "X " spacing /C "o.c. span / ft.
Joists (floor beams) 2nd. floor 1 "X •jn " spacing /(, "o.c. span ► 1 ft.
Overlays(ceiling beams) "X " spacing "o.c. span ft.
Roof rafters "X " spacing o.c. span ft.
Roof trusses(pre-engineered) spacing 2JV "o.c. span , ft.
Exterior wall finish \HA W. S/A'AJ&- Of what material?
Interior wall finish , HELI:4I/217 PmAfr
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 Fire-rated
door, enclosure, and self-closing device be provided?
Will a flue-lined chimney be installed? Ale, Height above roof ft.
Depth of chimney foundation below grade ft.
Depth of fireplace hearth ft. in.
Water supply - 1 or private well
SEPTIC SYSTEM _ Distance from ANY private well(including adjoining properties S-0 0 ft.
(A separate application is necessary for any repair or new installation of septic system)
Town of Queensbury AFFIDAVIT STATE OF NEW YORK
County of Warren
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
proVisio s of the BUILDING CODE, THE ZONING ORDINANCE, and all other laws pertaining to
the propo d work sh 11 be complied with, whether specified or not, and that such work is
authorized y the o ner. ��//
SWORN TO BEFO THIS Signature )�
Owner, owner's agent,arcnitect,contractor
day 19 r6
Notary ublic, Warren ounty, N.Y.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS. OF THE PERMIT:
By
r -
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: /4'
1 . Gross floor area 2�
2 . Type of heat E-„L-,L er7A-t, l
3. Is the building mechanically cooled? Adiv
4 . Percentage of area of windows and doors
A. Over 16% Only
1 . Uo value of gross area of walls , roof/ceiling and floors
exposed to ambient conditions
2 . Floor ove heated spaces YES NO
a. Are foun ion walls insulated? YES NO
1 . If YES, t is the R value?
3 . Slab on grade YESp.�
a. If YES , what is the R va of insulation around
perimeter of floor?
4 . Is basement heate. YES NO
a. R value o - insulation
5. Type ... insulation
B. Under 16% Only
1. R value of roof and floors exposed to ambient conditions
2-3 / —
2 . R value of exterior walls a- 2_®
3 . R value of glazed area
4 . R value of doors
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
8. R value of heated basement/cellar walls (above grade)
9 . R value of heated basement/cellar walls (below grade) ;
• 10 . Type of insulation /26- 4,4ss
C. Controls
1 . Thermostat maximum heat setting
D. Duct Systems
1 . Is duct system installed in unheated spaces? YES
a. If YES , R value of duct installation
b. R value of duct in other areas
E . Piping Insulation %,l� \
1. Size of hot water or cooling carrying agent pipe
2 . R value of pipe insulation
F. Service Water Heating
1 . Performance efficiency .-5 0
2 . Temperature control setting maximum / LF-d •
°�
G. For Swimming Pool Only
1 . Maximum heating
•
Telephone No. ??o° - 4/9WQ c//2 4Xe � v
(applicant ' s signature)
.own of Queeniurty
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL PERMIT APPLICATION •
Owner 's Name f' ei\cA.e\ � 6SOc3 Tel. ing•`1Aca°
Address. Arrlber2_41‘ve. Pcka 1�,RQa1 lleeN RI N yl
Person/Firm installing system..? SU3QC
Number of bedrooms (residential only) •
Total daily flow: (compute @ 150 gal.per bedroom per day) �-$G( C ca7►-
Topography: MD - rolling - steep - (circle one) Degree of slope %
Nature of soils: sand loam-clay- other- Depth_ 1600 ft•,
Ground water-- at what depth? 70 ft.
•
'1�•HX�r`e��O`�bd!['1 ���PRII!•IW�IIP�.��
Percolation Test - of require•b .f Required -Rate min/inch.
Domestic Water Supply - y unicipal - Weal. - Other
IMPORTANT!
On a separate piece of paper , submit a diagram of the proposed septic
system with all dimensions; including distance from any structure,
distance from property lines and distances from any domestic water
supply or shore-line of lake, stream, pond or. wetlands. Include all
dimensions of the system itself.
Description of proposed system: •
Septic tank size 1000 gal.
Tile field- Length of each trench ft. Total field 900 ft.
Size of stone # •
Seepage Pit (s) Num er / Size ftX ' ft. Size of stone#
Any contractor, corporation, individual,Etc. , engaged in the
construction of a Sanitary Sewage Disposal System, who covers the
same before .inspection, does not have an approved Permit, or varies
from the approved application, will be subject to a Penalty of $250
as provided for in Section 6. 010 of the Town of Queensbury Sanitary
Sewage Ordinance.
i%2/41.0f/ Z P.-// /
Signature of Applicant Date
01/86 and/vl
•
•
. Septic System Inspections:
•
A. All applications for septic system installation,
alteration or repair, as required by the Town of _
Oueensbury 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 zf 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, tile 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. • _
C. 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 Oueensbury Building '
Department before further construction. •
J. .
^J ..,•R e�a)•1 ti.!,-1 Ja!,�I-..ti, i a i.,.,.L,•.t..ka.i. to�"-I..r-.19.S), i. .i,a.y-�a c.i �.,.�•i.a•!,._,...1 13513_.�1. ..r.�)_,-4.,.-1.f--1.,-a.,•a.,.1.r„,-,. .,.?.,.,, ;-,,..,„:1,. , , !--1 C.` 5�-
f : url THE NEW YORK BOARD. OF FIRE UNDERWRITERS
J, BUREAU OF ELECTRICITY
-= -4r, F 41 STATE STREET.ALBANY.NEW YORK 12207 N-,' Decemis>r9, 987 013024/87 r r,el el
-' Date Application No.on fileg _
A
THIS CERTIFIES THAT a o
onlythe electrical equipment as described below and introduced bytheapplicant named on the aboveapplication number in thepremises of0
4:
o —
1
t, Mocheal Gibson,Gibson,232C Pitcher Road, iil1eens ?Zt'ry1New or'��
in the following location; ❑ Basement ❑' 1st Fl. ❑ 2nd Fl. fat G1:ide Section Block Lot 5 `�
7:77, �' was examined on 7/30/37 and found to be in compliance with the requirements of this Board.
1,
�' FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
�. OUTLETS ECEPTACLES SWITCHES INCANDESCENT-FLUORESCENT MERCURY
C
VAPOR AMT. K.W. AMT,y, K.W. AMT. K.W. AMT. K.W. AMT. H.P.
�, 3 7 `'). .
f- 3' DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS SELL UNIT HEATERS MULTI OUTLET DIMMERS ' —
SYSTEMS:
-� 1� AMT. K.W. OIL .H.P.. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. N OF FEET AMT. WATTS >v
_j 1.
FE
.„ 1 SERVICE DISCONNECT NO.OF S E R V I C E
E.
�' U . AMP. TYPE EQUIP. 1,B'2W 1 JM 3W 3,B'3W 3,A 4W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A•W G• NO.OF NEUTRALS A.W.G.
=' �, PER.9 OF''CC:COND.. OF HI-LEG OF NEUTRAL
4 1 230 C.3, 1 1 4/0 1 2/0 -
4, OTHER APPARATUS: {'
-V �L W t �d :..sal . 1^I `.-� 'i�; l�.;'IT ice'f N MO
I i
....: _,.
4_,...
1. .•
E.,
1
, .. 1=1 =
-C' .S 4::i1.1C:.r R'cha d i / o :7:7
...., _,,
.a3
.....___.; �' Kinney Road • ;BRANCH]MANAGER
-<' ri_vie,l.de5' ,I2809 f so
-Q a.. F
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. '
▪ -1"' - urr irvir dines rnvinarlanarvinat uvrvuwnirnaTvrnsi v lat nterveir ��4rrhwvrvrAtrwr
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
awn of Queeniur1
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
BUILDING INSPECTOR ' S REPORT
NAME
LOCATION Pcrc _ A.
Date ] l� / Permit No. a `�1, c�
* * * * * * * * * * * * * * * * * * * * * * *
✓ = 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
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTR AL INSPECTION
, DRIVEWAY APP'OVAL 4�� ✓/
)(Final Building Survey /
Next scheduled inspection (call when ready)
Remarks-
1 W&1-7(1111-
CiL-rA (/ IzDcIl
*12. 7-71 '1/
Building spector°
6/86 and-vl
OP// attin o� Queensbury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME A't((< 1 S&AJ
LOCATION—Pck-cti. r I2 e A p
Date 7/22_/ 5?-7 Permit No. 0 /'10
* * * * * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
Foundation
Waterproofing
•
Backfill
Framing
Roofing )(
Siding 5C
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interior Trim )�
Stairs & Railings X
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures 24c
Gar. Fireproofi • •
Door Closers /M
Smoke Detecto •s
Chimney
INSULATION: ,
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
)(Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
�?;} 40P/4/2z/el
f-cre e"
/10/
I
Building Inspector
6/86 and-vl
,jl 1 a Jown of Queenitury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTIONI
NAME q1 1 vV1 cte l Q , 5 a
LOCATION L 0 r c I I t 2 v 1 6 a4
lle
►l' DATE IA / ,Y'7 PERMIT NO. (, - '(py
SOIL TYPE - and Loam - Clay -
Percolation Required? YES e
Percolation rate - Min/Inch _ p- 5j
TYPE of SYSTEM: r
Absorption field, total length J-JO
Length of each trench 5Q/ 3% '/c 3G7/ cip
Depth of trenches "
Size of gravel 4 2.
SEEPAGE PITS-ENumber of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank WI (1D
Tank to dist. box _
Dist. box to field/„-it
Openings sea ed? YES NO Partial
LOCATION/SEPARA S:
Foundation to tan to ft.
Foundation to abso p 'on 9.0 ft.
Absorption to lot ine ow f t(-
Separation of pits i ft.
LOCATIO SYSTEM ON PROPERTY(circle one)
Front - Lef side - Right side -
COMMENT-.
a'-Ti A 02-/V47
SYSTEM USE APPROVED NO
_ &/4I3
Building Inspector
01/86 and vl
Jown of Queen bur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ,,/W, f ce�4.7.-
LOCAT I ON'67 ✓-
DATE, /1/c 7PERMIT NO.S6—e4V71.1.
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS{Number of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank /ar�
Tank to dist. box
Dist. box to field/.
)(Openings sealed? Aril NO Partial
LOCATION/SEPARATIONS:
'Foundation to tank 6
Foundation to absorption ft.
Absorption to lot line t.
Separation of pits
LOCATION OF SYSTEM ON PRO ERTY(c'rcle one)
Front - Rear - Left sid - Right 'de -
COMMENTS:
•
SYSTEM USE APPROVED YES NO
Building Inspector
01/86 and vl
own 0 f QuQendbur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
�Q/ueensbury, New York 12801
�VJ.
BUILDING INSPECTOR ' S REPORT
1 �
NAME /'I C rJS LOc
LOCATION A, --"D_C c I2Jakr)
1� ate 8� 07
IU / l Permit No. .fe//7114
* * * *• * * * * * * * * * * * * * * * * * * *
✓ = APPROVED - YES / NO
Footing/Pier Forms
1/ Foundation
Waterproofing
p/Backfill
Framing
Roofing
Siding
Masonry Veneer
,Rough Plumbing U.l vint 5,-A.R
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures \\/,,
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection (call when ready)
Remarks-
PLu4vt
`Building Ins vector
6/86 and-vl
_lou,n of Quceniturt,
BUILDING and ZONING DEPARTMENT
Bay and Haviland.Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME ���✓
LOCATION p
x.,24„._,
•
Date l( . / Permit No. ,, ��_ RAY
� ✓ = APPROVED - YE / NO
CiFooting/Pier Forms e3/
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
1\N/
Relief Valves
Ext. Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile \\)
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
Final Building Survey
•
Next scheduled Inspection(call when ready)
Remarks- -
Building Inspector
6/86 and-vl
call.€{ Rla9/86 7 Pk?,
awn o/ Queenit4ur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING INSPECTOR ' S REPORT
NAME 1< a ,12s c
LOCATION PPrc.C,. 4 a - ier Sir
Date 7/3o /d(, Permit No. s(p- g6L-/
* * * * * * * * * * * * * * * * * * * * * * *
So/ ROVED - YES / NO
,(Footing/Pier Forms L ��
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext. Porches
Finished Floors
Interibr Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION:
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
Final Building Survey
Next scheduled Inspection(call when ready)
Remarks- - " Gr 1/:erz"..16
roe
erzfL .
Building Inspector
6/86 and-vl
GEORGE KUROSAKA JR..P.E.
94 BUILDING SYSTEMS CONSULTANT
POET OFFICE BOX NO.660
GLENS FALLS.NEW YORK 12801 ,•
(518)792-1522
13 ARBUTUS DRIVE
QUEENSBURY, N.Y. 12601
PHONE 51B 792-1522
BUILDING INSPECTOR
Town of Queensbury re: Factory Manufactured Home
Town Hall Installation Certification.
Queensbury, New York 12801
Attention: Mack Dean
Dear sir,
This is to certify that I have observed and inspected the installation of a
"Factory Manufactured Home"; as defined by the New York State Uniform Fire
Prevention and Building Code, Chapter D - MANUFACTURED HOUSING, Article 2 -
FACTORY MANUFACTURED HOMES, as applicable to your local building regulations;
there appeared to be no apparent structural damage to the units, due to or
attributable to the transportation or loading/unloading of the units, herein-
after described as follows:
Date of Installation: ' "'}7i' 3 ,( h f
Site Location: (2 82 C) P N-• S I she,,
Community: Town of Queensbury
County: Warren
Manufacturer/Supplier: Eczg 57-c2_- l"'lgal_I4 Pat
Address: L _
ST&414/-cl, � 01266 G1- ,4
Insignia Serial No. i E5 4-Z3 'c,E Zia S?�
Plan Approval No. /4 0 44'6
Manufacturer's Model/Component No.: S cj_ r247. SU1A1':o�v•5-�
Date of Manufacture: • -i- — g f; 7
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-- Installer/Supplier: � s' - � " "t
I have also examined the approved Plans & Specifications for the abovernentioned
"Factory Manufactured Home", and to the best of my knowledge and belief, this
"Home" has been installed in accordance with these approved Plans & Specifications,
and all other applicable laws codes, ordinances,standards &/or regulations.
/. FNF�y 1t
1cuRo 47Revi tfull s mit ed;
_AGE 6 O
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� ..,� � GEORGE KUROSAKA JR. , P.E.
��` NYS PE Lic. No. 35869
CC: so N
A �•ass69 F.
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QUEENSBURY TOWN OFFICE BUILDINGJown, Queewlary
ti -�� ~
YZS� BAY AT HAVILAND ROAD
QUEENSBURY, NEW YORK, 12801
TELEPHONE: (518) 792-5832
•
DATE: December 19, 1986
TO: MICHAEL GIBSON
RE: Building Permit No. 86-864
This permit is. being issued with the following ,
stipulations:
The foundation for this home is in place and has
passed inspection by the Building Department.
Before the home is placed on the existing
foundation, this office must receive and approve,
building plans that bear the seal and signature of
a New York State licensed architect or engineer,
indicating conformance to New York State regulations
regarding building code and energy conservation code.
•
•
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SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE
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