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2008-257 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 (zt Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF OCCLT-A-N- CY Permit Number. P20080257 Date Issued: Tuesday, December 09, 2008 This is to certify that work requested to be done as shown by Permit Number P20080257 has been completed. Location: 69 MINNESOTA Ave Tax Map Number. 523400-308-012-0002-013-000-0000 Owner. RONALD O. MOREHOUSE Applicant: JEAN FLEWELLING This structure may be occupied as a: Mobile Home Out of Park By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, ! e Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20080257 Application Number. A20080257 Tax Map No: 523400-308-012-0002-013-000-0000 Permission is hereby granted to: JEAN FLEWELLING For property located at: 69 MINNESOTA 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. Tyne of Construction Value Owner Address: JEAN FLEWELLING 69 MINNESOTA Ave Mobile Home Out of Park $15,000.00 QUEENSBURY, NY 12804 Total value $15,000.00 Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2008-257 1540 SQ FT MOBILE HOME $96.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,June 10, 2009 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the own `Que busy; a y,June 10, 2008 4)SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement -.- ...."e=="=' ....................................................... •/ + ems =.Ir x1. s,1 1 'TAX MAP "/��2OFFICE S ONLY PERMIT NO. 5DATE ISSUED: , / I PERMIT FEES APPROVALS: ZONING TOWN CLERK ' �ti�1� wry ... ..ww=www=..www.w.....ww.+................. ' UlJlLl�I:a�9 ` Jr4, ....w=w.....w MOBILE HOME -APPLICATION FOR PERMIT: A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. A licant Information Property Owner Information Name:. Address: Address: '� p l3 u-� Phone No. Phone No. Parcel Information Proposed Date of Placement: IV Property Location: &/jr;2 `T Road,Street,Avenue Name of Mobile Home Park: (irapplicabie) Tax Map Number. F3 :............._.....-........................_........_.--..... ---....._........................_....................- __.........-_— _ --f -- - ----- -..._.._-___....._......................---.......... -- Mobile Home Information Zoning Information Approximate Value of Home:$ J r Oo Zoning Classification: New Home: Yes Size of Property: ft.by ft. Replacement Home: es No Existing buildings: Size of Mobile Home: 5.� ft. by�ft. Setbacks: front yard it. rear yard ft. side yards ft.and ft. Singlewide: Doublewide: Number of Rooms: (exclude baths) G - Accessory Building(s): circle Number of Bedrooms: Number of Bathrooms:_2_ Detached garage: 1-car 2-car car Circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: 1-car 2-car car Foundation Support: Storage building: Yes No Type Size & Depth Other. Piers Ru ers J- ` Water Supply well municipal Slab Is Septic Permit Required? Yes r No _..._..........._...............__............_.-............_......................_..__...._..._...._...._..._ ._ _..__.—..__..__._._...__. Continued on bade Toznn of Queensbury- Community Development Office - 742 Bay Road, Queensoury, iv x izau* Name of Installer or Mobile Home Dealer. ClS�r� j u Address: 0��5 w�611- Phone:-5 r �S ?/ C � J 27 r Complete information below found on"/Pla te"or"Sticker'which is affixed to the mobile home: � Av ELp ✓ Insignia serial number: � ' Z Y A� 13 (� Name of manufacturer: 7 Cam. C ✓ Plan Approval Number. ✓ Model or Component Designation: / V (New home onl ) ✓ Date of Manufacture: L�:_._._._�:_._._._v._vi.�i_r�:_:_:SiS'.!:_^.!:_•'�•'�_._d�._�:_._r«�.5:_Fe..:_:.•����.�.:�a•:_•'�.S'.2i�O�.,y AFFIDAVIT J J Town of Queensbury State of New York County of Warren s c y $ ti J it swear that to the best of my knowledge and belief the statements contained in this application, together with the plans c 4 and specifications submitted, are a true and complete statement of all proposed work to be done on the described premises and J that all provisions of the BUILDING CODE, the ZONING ORDINANCE, and all other laws pertaining to the proposed work y shall be complied with, whether specified or not, and that such s work is authorized by the ow s J 4 J N Signature. �wner�Qwner's Agent,Architect,Contractor d J SPECIAL CONDITIONS OF PERMIT By: Code En cement Officer Town of Queenstnsnj• Community DevelopmeItOffice• 742 Ba Road, Queensbury, NY 12804 J Y r Community Development Office Town of Queensbury - 742 Bay Road • Queensbury, New York•12804 Marilyn Ryba, Executive Director- David Hatin,Director of Building&Codes Craig Brown,Zoning Administrator PROCEDURE FOR PLACING AND OCCUPYING A MOBILE HOME OR MODULAR HOME: 1. Application is submitted and reviewed. a. Two (2) copies of plot plan and two (2) copies of layout must accompany application, along with septic application (if needed). 2. Permit is issued. a. Permit card is placed on property. 3. Footing forms are inspected before pouring concrete (Outside mobile home park). a. Home is placed on foundation or piers. 4. Arrange for electrical inspection (see Electrical Inspectors on reverse) 5. Septic Inspection if needed. 6. Final Electrical Inspection. 7. Stairs and platform covering door width and door swing with handrails on both sides of platform and stairs are required for all exterior doors. 8. Final Inspection by Building & Codes Department. 9. All mobile/manufactured housing must be anchored to the ground upon which they are sited per manufacture requirements. 10.If anchoring is not possible due to weather conditions or any other item, a Temporary Certificate of Occupancy will be issued. a. Fee: $10.00 b. Deposit: $100 (refunded when all items are complete) QUESTIONS? CALL 761-8256 OR EMAIL codesODgueensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION wwW.auensburv.net i 4 Community Development Office Qown of Queensbury - 742 Bay Road - Queensbury, New York -12804 Marilyn Ryba, Executive Director- David Hatin,Director of Building&Codes Craig Brown,Zoning Administrator Electrical In, THE FOLLOWING ELECTRICAL INSPECTION AGENCIES ARE CERTIFIED BY THE TOWN OF QUEENSBURY TO PERFORM ELECTRICAL INSPECTIONS: NAME&ADDRESS OF BUSINESS INSPECTOR CONTACT NUMBER(S) Commonwealth Electrical Inspection Services D Lovela Main Office: 1-800-732-0043 357 Elwyn Terrace Ron umbl Local Office:1-800-562-9934 o Manheim, PA 17545 Ron: 518-798-0905 Middle Department Main Office: 1-800-873-6432 143 Troy Schenectady Road Joseph Holmes Local Office: 1-800-479-4504 Watervliet, NY 12189 Joe: 518-273-0861 The Inspector, LLC Main Office: 1-800-487-0535 4755 McConchie Rd. Richard Moon Local Office: (518)882-6140 Galway, NY 12074 Richard:518-857-6233 New York Board of Fire Underwriters 40 Fulton Street-6t'Street Walter Sonntag Local Office: (518)463-2122 New York, New York 12210 PLEASE NOTE: WE CANNOT RECOMMEND AN INSPECTOR, HOWEVER, PLEASE ASK YOUR CONTRACTOR WHO HE PREFERS TO INSPECT HIS WORK. TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5902 518-761-8201 AFFIDAVIT TOWN OF QUEENSBURY STATE OF NEW YORK COUNTY OF WARREN I swear that the following used mobile home that will be transported into the Town of Queensbury for placement will have the following. A building permit approved and issued, meet all zoning requirements, the mobile home's HUD sticker affixed to mobile home and meet HUD requirements for the Middle Zone. As the person responsible for the transport and placement of this mobile home, I accept total responsibility for removal of the mobile home from The Town of Queensbury, if it does not meet the requirements for placement. Signature: Date: o Mobile Hom Owner, Owner's Agent, Mobile Home Contractor Signature: Dat . Town of Queensbury Code Enforcement Officer "HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE" SETTLED 1763 30C� FINAL INSPECTION REPORT MOBILE / MODULAR Town of Queenstxjry BW"ng &Code Enforcement 742 Bay Road Queensbtuy, NY 12804 (518) 761-8256 '7'J,:�k-r-)FPART_- ARRIVE: DATE INSPECTION REQUEST REC NAME: U- LOCATION: DATE-. PERM"# U0151LE HOME MOWAAR HOME FOOTINGS FOUNDATION BACKFELL 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 a 4 feet ....... S. heating crossover(dblewide) off grd. 6. dryer vented outside x................... _ 7. skirting ventilated .................... — 8. hot water relief valve piping outside 9. deck, porches, steps. railing ........ 10. furnace/hot water operating ........ 11. garage fire,proofing .................. 7, 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 CIO _VYES NO Comments: FINAL- INSPECTION REPORT MOBILE / MOOLILAR Town of Queer>sbury Building &Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: DEPART: -7y j��; INSP_ ,r DATE INSPECTION REQUnEST RECEIV L-4 NAME: LOCATION: DATE: / , �� PERMIT# MOBILE HOME MODULAR HOME FOOTINGS _ FOUNDATION _ BACKFRL _ 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 a 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 .............. Model #2 I Serial# Manufacturer CC j�414 Date of Manufacturer OKAY TO ISSUE CIO YES NO Comments: ©C> 3fL17 43�� %AWw-rj- � C� 2 Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: ��.-� Queensbury Building &Code Enforcement Arrive: am/DM -Depart: � am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: PERMIT N .: LOCATION: r INSPECT ON: — - RECHECK: Comments and/or diagram Soil T Loam / Clay Ty of Water• uni ' / Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length two ft. Length of each trench Im ft. Depth of trenches '' ft. Size of Stone Seepage Pits: Number Size: Stone Size: Piping i T Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: N End Cap N Inlet/Outlet Pipes&Baffles N Location Separations 1 . Foundation to tank ft. 7 Foundation to absorption ft. Separation of Pits Conforms as per Plot Plan Y N Engineer Report and As-Built Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear S m U s: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 U\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc G- x-) / vL,SZ.)^.1 44ve- FINAL INSPECTION RE82ORY MOBILE / MODULAR Town of Queensbury Bul7ding & Code Enforcement f(� -2 S� 742 Bay Road QUeenSbUrll. NY 12804 (518) 761-8256 ARRIVE:.?rR/ DEPART. INSP. DATE INSPECTION REQUEST RECEIVED: NAME: n I oCATION: S' M e- 71 DATE: >" U PERMIT/{ MOBILE HOME MODULAR HOUR F007INGS_ FOUNDATION- BACKFU L _ 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 a 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. fumaceAx t 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 # 3Serial # 4 /� Manufacturer Date of Manufacturer OKAY TO ISSUE CIO YES NO 0Comments: Z 4 ��R N' Fl-;Ia-7 jd�� Foundation Inspection Report Office No.(518)761-8256 Date Inspection request received: _ Queensbury Building&Code Enforcement Arrive: am/pm Depart: 4 /pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: /qz;. / NAME: PERMIT#: 0 7 LOCATION: INSPECT ON: TYPE OF STRUCTURE: Comments Y N N/A Footings Pi Monolithic Sla 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 Footing Dowels or Keyway in place Foundation Dampproofmg Foundation Waterproofing Footing Drain Daylight or Sump Footing Drain Stone: 12 inch width 6 inches above footing 6 mil po!y 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:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc Last printed 12/20/2005 9:24:00 AM 9 } NIL:_ 77 ri iy � AJ 3. tf _ `� FE r '.y t l y_