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2004-155 TOWN OF QUEENSBURY i it* 742 Bay Road,Queensburv,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20040155 Date Issued: Wednesday, June 02, 2004 This is to certify that work requested to be done as shown by Permit Number P20040155 has been completed. Tax Map Number: 523400-308-012-0002-035-000-0000 Location: 68 WISCONSIN Ave Owner: SCOTT & JODI ROWLAND Applicant: SCOTT ROWLAND This structure may be occupied as a: By Order of Town Board Mobile Home Out of Park TOWN OF QUEENSBURY a tej/3 4 Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay y Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040155 Application Number: A20040155 Tax Map No: 523400-308-012-0002-035-000-0000 Permission is hereby granted to: SCOTT ROWT,AND For property located at: WISCONSIN Ave 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: JOHN& LINDA WINSLOW 233 LUZERNE Rd Mobile Home Out of Park $37,700.00 Total Value $37,700.00 QUEENSBURY, NY 12804 Contractor or Builder's Name / Address Electrical Inspection Agency Plans&Specifications 2004-155 26' X 44' MOBILE HOME $72.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, April 08, 2005 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at th own Qut nsbtity; / ' , ' i ay, April 08, 2004 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit— Mobile Home Town of Queensbury, 742 Bay Road Queensbury, NY 12804 (518) 761-8256 A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant Information Office Use • Name: 5Co i-I in. ?,o )grid Yr File Permit No. 2O'/ /'5 Address: 6,N ►•t A v4- Fee Paid 7c-;( > C>U c' ry s bu?y N . 0,90 Reviewed By: Phone No. -7d/- Property Owner Information Parcel Information Proposed Date of Placement: 3--/-O V Name: ,5: ,,g. d4 A-bo,i6 Address: Property Location: W 15 `,,,,�,y.,> Road,Street,Avenue Name of Mobile Home Park: /Id//4- (if applicable) Phone No. Tax Map Number: (..L:fr / / S`'." Mobile Home Information Zoning Information Approximate Value of Home: $ 3 Zoning Classification: New Home: No Size of Property: C'° ft.by /o( ft. Replacement Home: Yes No Existing buildings: Size of Mobile Home: ,4d / ft. by 0 ft. Setbacks: front yard ft.; rear yard /o ft. Singlewide: Doublewide: . Side yards /G ft.and 16 ft. Number of Rooms: (exclude baths) 6 Number of Bedrooms: 3 Accessory Building(s): circle Number of Bathrooms: <)- Detached garage: 1 car, 2 car, car circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1 car; 2 car, car Storage building: Yes No Foundation Support: Other: TYPE ST7F&DEPTH Water Supply: well or J Piers Runners x la (2-7/q4 x 6 Is Septic Permit Required? or No Further information requested on the reverse side of this sheet Name of Installer or Mobile Home Dealer: Jeetcrt Address: /2,4i� Phone No. 7,�3 Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. 1. Insignia serial number. _.._..___ 2. Name of manufacturer: 3. Plan Approval Number : 4. Model or Component Designation: (New Home ONLY) 5. Date of Manufacture: aCo AFFIDAVIT Town of Queensbury 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 provisions of the BUILDING CODE,the ZONING ORDINANCE, and all other laws pertaining to the proposed work shall be complied with,whether specified or net, and that such work is authorized by the owner. Signature: A,' . • .er,owner's agent,architect,contractor Special Conditions of Permit Form: 11/19/1999sh Code Enforcement Officer Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256 1. OWNER INFORMATION: /� , /n� Office Use Location of installation: Li),St1�>>U_5, l�V i014---14SC„� File Permit No. Tax Map No:30 -I J'i �l / 3 S c� Fee Paid Owner's Name: Z3 c4 =06 n *' Address: 65 n1,N!Vz A44- 2. INSTALLER'S NAME : /✓N► PHONE NO.36,7-4r3 S Z--- 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily Flow 1980 or older x 150 gal/bdrm = 1980— 1991 x 130 gal/bdrm = 1991 —present , x 110 gal/bdrm = 3 3 Garbage Grinder Installed yes_ / no 9-- Spa or Hot Tub Installed yes / no 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply at san% at what depth at what depth unicival' olling oam feet feet well Steep slope clay if well; water supply %slope other from any septic-system depth: absorption is other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch 5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: /C as gallon (min. size 1,000 gal.) Tile Field: each trench., 6 5 ft. Total System Length: /Sr-0 ft. Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length andlor size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) For your protection,please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or circumstance known by or on behalf of an applicant, shall be void. I have read the regulations with respect to this application and agree to abide by these and all requirements of the own of Queensbury Sanitary Sewage Disposal Ordinance. 4aCtAld 57-0 r Signature of responsible person Date a to lc _ c\A Luz�,r T - `fin Foundation Inspection Report ��b�1 G�.� .,iO4 Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm1.1 )am Depart: /pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: � NAME: , y. ' /` PERMIT#: 01/ / LOCATION: INSPECT ON: / `� l TYPE OF STRUCTURE: O • Comments N N/A Footings Piers M olithic Slab Reinforcement in Place The contractor is responsible for providing protection from freezing for 48 hours following the placement of the concrete. Materials for this purpose on site. Foundation/Wallpour Reinforcement in Place Foundation Dampproofing Foundation/Waterproofing Type of Dampproofing/Waterproofing Footing Drain Daylight or Sump Footing Drain Stone: 12 inch width 6 inches above footing 6 mil poly for wet areas under slab Backfill Approval Plumbing Under Slab PVC/Cast/Copper Foundation Insulation Interior/Exterior R- Rough Grade 6 inch drop within 10 ft. L:1SueHemingway\Building.Codes.Inspection.FORMS\Foundation Inspection Report.doc January 28,2003 /1 Pt) Septic Inspection Report • Office No. (518) 761-8256 Date Inspection request received: Queensbury Building& Code Enforcement Arrive: am/ ni J�epart: m/pm 742 Bay Rd., Queensbury NY 12804 ., Inspector's Initials: NAME: .u' I PERMIT NO.: LOCATION: INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. _ Depth of trenches ft. Size of Stone Seepage Pits: Number 0 (\el— Size: ` Stone Size: � P� Piping p g Sip/ Building to tank 9b0 Tank to Distribution Box ��5 ` Distribution Box to Field/Pit Opening Sealed: Y/N/Partial \J Z�� n� - Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Location of System on Property: 416 er 64 FF' C - 0 K Front Rear Left Side Right Side Middle Front Middle Rear S stem Use Sta s• pproved artial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:'\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 : , l3 o .: Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/p epart: j ',e2rn/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: U NAME: - * .44 A u.r_ PERMIT NO.: C LOCATION: — , _ _ , E INSPECT ON: — /1 RECHECK: C h l l t. Th r Comments and/or diagram Soil Type lay Type of Water. ici ell Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length 1 ft. Length of each trench SU ft. Depth of trenches v ft. Size of Stone adj-? ---- Seepage Pits: Numbere r U J Ston x C�Stone Size:• q' T 4 -r l Piping Size Type Building to tank /t)e r/-7 /Vr Tank to Distribution Box Zf . qoe 36— Distribution Box to Field " a Sealed: Y/N/(A) Location/Separations Foundation to tank _ ft. Foundation to absorption ft. Separation of Pits ft. , Conforms as per Plot Plan /Y N Location of System on Property: — Front Rear Left Side Right Sid Middle Front Middle Re System Use Status: pproved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway'Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 176 Doe Run Road-Manheim,PA 17545 QG MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL Permit No. Cert. N 2 7 6 0 7 6 Cut-in Card No 5\ Owner064, Location �� S ° , /�/__' ' t Installation Consisting of 476 I l ter !' r "-gym5 ! M� Installed By -11; 46 41,5" Lic.No. The conditions following governed the issuance of this certificate,and any certificate previously issued is cancelled:- This certificate only covers the electrical equipment and installation conditions as of date. Upon tha introduction of additional equipment or alterations,application shall be promptly made for inspection. Inspectors of this Company shall have the privilege of making in - ins at any time, and if it: rules are violated,the Company shall have the right to re ke this ce / Date I,l./ INSPECTOR 1 Member N_RP.A__l.A_F..I. FINAL INSPECTION REPORT MOBILE / MODULAR Town of Queensbury Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: 3'.3° DEPART: INS)j�✓ DATE INSPECTION REQUEST RECEIVED: r- k\ NAME: �� �� M LOCATION: � C DATE:(Q. ~C/Lf_ PERMIT# v'I J'55 MOBILE HOME MODULAR HOME FOOTINGS _ FOUNDATION _ BACKFILL_ FRAMING N/A YES NO 1. foundation support, pier i ins per manuf. :; — — — 2. anchoring per manuf. — — — 3. water line shut,off — —4. sewer line support @ 4 feet ... ... — — — 5. heating crossover (dblewide) o d. — — — 6. dryer vented outside — — — 7. skirting ventilated — — 8. hot water relief valve piping outside 9. deck, porches, steps, railing _ — 10. furnace/hot water operating 11. garage fire proofing — — — 12. door closers _ —13. plumbing fixture 14, —foundation insulation (if appl.) — —. — — 15. smoke detectors — — 16. final electrical — —17. variance required — — — 18. data plate okay — — — 19. mobile HUD seal okay — — — Model # Serial# Manufacturer Date of Manufacturer OKAY TO ISSUE C/O 14 YES NO Comments: f r , (4, . j.jhIfeJ FINAL INSPECTION REPORT MOBILE / MODULAR Town of Queensbury Building & Code Enforcement 742 Bay Road CA.QQ Queensbury, NY 12804 (518) 761-8256 ARRIVE: /' /- DEPART: INSP: 0/y. DATE INSPECTION REQUEST RECEIVED: 1 NAME: C � C5W 'h�^\ LOCATION: ,0 A DATE: —! 1y PERMIT # � J MOBILE HOME MODULAR HOME FOOTINGS _ FOUNDATION _ BACKFILL _ FRAMING_ N/A YES NO 1. foundation support, pier spacing per manuf. 2. anchoring per manuf. 3. water line shut off 4. sewer line support C 4 feet 5. heating crossover (dblewide) off grd. 6. dryer vented outside 7. skirting ventilated _ 8. hot water relief valve pi sing o' ide 9. deck, porches, steps, rai ' g 10. furnace/hot water operat• _ 11. garage fire proofing 12. door closers 13. plumbing fixture . . 14. foundation insulation (if appl.)... .. 15. smoke detectors 16. final electrical 17. variance required 18. data plate okay _ _ 19. mobile HUD seal okay Model # Serial # Manufacturer Late of Manufacturer OKAY TO ISSUE C/O YES NO \1 Comments: Q..90(\oov- a- FINAL INSPECTION REPORT MOBILE / MODULAR Town of Queensbury Building & Code Enforcement 742 Bay Road 11 Queensbury, NY 12804 (518) 761-8256 ARRIVE: 3 6) DEPART: INSP: DATE INSPECTION REQUEST RECEIVED: NAME: �� `l QV Cam.:`\s't� (% LOCATION: CY 1�\\,_\0.-ON <3..-L.A_- DATE: '()1-4 PERMIT# 614155 MOBILE HOME MODULAR HOME FOOTINGS _ FOUNDATION _ BACKFILL- FRAMING_ N/A YES NO 1. foundation support, pier spacing per manuf. — 2. anchoring per manuf. — — 3. water line shut off 4. sewer line support @ 4 feet 5. heating crossover (dblewide) off grd. 6. dryer vented outside 7. skirting ventilated — 8. hot water relief valve piping outside _ _ 9. deck, porches, steps, railing — — 10. furnace/hot water operating * — 11. garage fire proofing — — 12. door closers 13. plumbing fixture / 14. foundation insulation (if appl.) 15. smoke detectors _ ✓�_ 16. final electrical 17. variance required 18. data plate okay — _,/ 19. mobile HUD seal okay GI �_/�� ✓ f_ Model # /O C� Serial # z} "OgP IVA Manufacturer !/A4 Date of Manufacturer d OKAY TO ISSUE CIO YES NO Comments: S/ j( ark_ , /u s V� ::.:Ig--...:;...Q..e..A•t•eft.::;;N:o....::::::...........„,„„:...*:... ....„........:.:...,:*... .......:.:*iir.ri :.E.S...,,,„:.::::: :- ...-...:.:: :...::.::.....:.: .:•:.:::•.:..,•::::::::„.....i.....,.,........„7„„:::::::..„,...„,....:,.....:::.,...._, :. : . . „ .. .. .,.. , . • LI::::\/11. .. i. ..„ - "' Built in Vermont • A :lvf' A)) ,,?f :i'- , S�S 2"i' {P { i .::„. y '�(��f�tk, Y i r.A,n� • � :'/{t!r ,�Y ,`/�". .;:.-.. -...:.''':-;-1!:7.i::-....:::*-r-:.;;;.....:. 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L°N �u ,r��/} ii �iraiiraiiiMwraie�iii i ii•�m.�.;;Msi�±rw,� 11 WOMBS r. j j � i l 11 01.. . ``,,,, NOIidO �����31����1 11301tliSValid0 11142001114 m� trr! J }iiir% uaorwcis%w 0-• "leo sorrow raiiiiguiratrt I iGiw.i�Gii>:iGiilG:�ii ��*,o�yrwwfarwsaae mil ,...... M�Aa/Y�t%RRAr%%�%M���:f�r • " s.„,,i�raiiii+ w fear = . W it {.. 11111111111 11 o��iaiiiinMiRii M y 'd A c..9 coE 49'8 to.,0)co cilc.‘ . 15 L C LE-, C • ►1 CI 0 ,J., .... t�- r=_ a is lU Q '4 Jwv uC°io �•� +� V a W z 8 zs$' o r;.: im_ CCU_ A ,z01-14S : T 49 a7 • 0\ - Vik.ç,C) ri, '51:„.„0:tv? 1.? : ei } S 1 T • _ y r 4- I "I have seems*observed, or believePsaw •evidence of, all objects si-I1 as houses, wells, treeifences, etc., � shown on t do ;gent. I also repres'€nt that I have personally the d'stances set forth on the diagram." ,� ?kaSt j 5C Of JP. SIGNATURE DATE QGcGIL -E ( 6t4 C 0 v‘ 44 StAilloak W Illibb'. k ` ar (ori} V w (tilt,J - L, �V(SG6"S� � �/ L �;m; s 0-1 PaVcm-wt �fx i ge i l6i vi AP Ne