2003-100 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building& Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20030100 Date Issued: Tuesday, April 29, 2003
This is to certify that work requested to be done as shown by Permit Number P20030100 _
_- has-beem completed. LL
Tax Map Number: 523400-308-014-0001-052-000-0000
-Location: 41 GRFGWOO CIRCLE
Owner: ARC4BFND, L.L.C.
Applicant: KENNETH ROBLEE
This structure may be occupied as a:
'By Order of Town Board
Mobile Home In Park TOWN OF QUEENSBURY
Director of Building&Code Enforcement
r
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030100 Application Number: A20030100
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: KENNETH ROBLEE
For property located at: 183 PITCHER Rd
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: ARC4BFND,L.L.C.
PROPERTY TAX DEPARTMENT Mobile Home In Park $6, 00. 0
PO BOX 13244 Total value $600000
EL PASO, TX 79913-3244
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2003-100 KENNETH ROBLEE 41 GREGWOOD CIRCLE
14' X 70' MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS
$60.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,April 03,2004
(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 wn of Q ens ury; hursday,April 03,2003
SIGNED for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit— Mobile Home
Town of Queensbury, 742 Bay Road Queensbwy, 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 In
n Office Use
Name: Keoc)a�, EoNee—, File Permit Noz�-DQU3 10d
Address: 1 e4 L1CQ O r-c -e, Fee Paid S
U Stu r I z�D Reviewed B
Phone No. 6 G/ 9-
Property Owner Information Parce Information
Name: Proposed Date of Placement: -� d
Property Location: -T l y o?wobts �—
Address: ''�� Road,Stteet,Avenue
Name of Mobile Home Park: F�re Sf Pk"
Phone No.
(ifapplicable)
Tax Map Number:
Mobile Home Information Zoning Information
Approximate Value of Home:S
Zoning Classification:
New Home: Yes No
Size of Property: ft.by ft.
Replacement Home: Yes
Existing buildings:
Size of Mobile Home: ft. by ft.
Setbacks: front yard ft. ; rear yard ft.
Singlewide: Doublewide. Side yards ft.and ft.
Number of Rooms: (exclude baths) 4
Number of Bedrooms: 7/ 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 §1ZE&DEPTH Water Supply: well o municipal
Piers x :ZQ
Runners x
Slab x Is Septic Permit Required? Yes
Further information requested on the reverse side of this sheet
Name of Installer or Mobile Home Dealer:
Address:
Phone No.
Complete information below found on a"plate'or"sticker"which is affixed to the mobile home.
1. Insignia serial number. _ -2-2- �-1 7'1
2. Name of manufacture —Rejtivl�r-,..�r-
3. Plan Approval Number:
4. Model or Component Designation:
(New Home ONLY
5. Date of Manufacture:
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 not, and that such work is
authorized by the owner
Signatur
e:
Owner,owner's agent,arc 'test,contractor
.................................................................................................................................
Special Conditions of Permit
By.
Form: 11/19/1999sh Code Enforcement Officer
33DProject Name: BP# 3 00
Address: ve
Building Permit Submission
Single famly dwelling
Tvofian2dy dwelling
Checklist
All items below must be checked either yes,no or not applicable prior to submission of any building
permit to the Town of QueensburyBuilding Department. If any of the below items are lacking,the permit
will not be accepted until such time as the application is deemed complete for submission.
1. Building Permit Application Completed ... ...
2. Energy Form or CheckMate Energy Code Compliance Forms Complete.. ❑ yesFn
3. Energy Code Inspector's Report from CheckM&te Program... ... ... ... ... .. ❑ yes
4. Septic application completely filled out(if applicable)... ... ... ..
❑ yes
5. Solid Fuel Burning or Gas Appliance Form... ... ... ... ... ... ... ... ... ... ... ... .❑yes6. Electrical Inspection Form... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ❑yes7. Two (2) complete sets of structural drawings... .. ... ... ... ... ... ... ... ... ... ... . ❑yes
a) floor plan;b)foundation plan;c) cross sections:d) elevations;
e)window end door schedule `
8. Two(2) site plans showing location of the structure to be built,... ... ... ... ❑yes ❑n/a
location of well or water lines,location of septic system or sewer line. `
9. Setbacks from property lines to new structure... ... ... ... ... ... ... ... ... ... .. yes Ono ❑n/a
10. Setbacks to neighboring wells and septic systems,including onsite well... . ❑yes ❑n/a
and septic systems (if applicable)
11. Driveway Permit... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ❑yes ❑n/a
Date:
Staff Initial:
L:\SueHemingway\BuildingYemut.FORMS\Generic Checklist.doc
Rough Plumbing / Ins.ulation Inspection Repo t
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/p epart: am/pm
742 Bay Road, Queensbury,NY 12804 Inspector's Initials:
NAME: ND PERMIT #:
LOCATION: n INSPECT ON:�
TYPE OF STRUCTURE:
Y N N/A
fast
: R-1,R-2,R-3,R-4 Drain/Vents
Iron, Co er Drain/Vent/Comm.
mbin Vent/Vents in Place AJ5rA4--L
Rou h Plumbing/Nail Plates
1 % inch min.Drain Size
Washing Machine Drain 2 inch min.
Head or Air Supply Test
Drain and Vents
5 PSI or 10 feet above highest
connection for 15 minutes
Cleanout every 100 feet/change of direction
Water Supply Piping
Cooper Commercial
Cooper,CPVC,Pex One and Two-Family
-Ins Lion/Residential Check/ Commercia heck
ro er Vent;Attic Vent �� �— pr -2� ,.
Duct/Hot Water Piping Insulation I f
If required unheated spaces
n <
Combustion Air Supply for Furnace
Duct work sealed properly/No duct tape
COMMENTS:
L:\SueHemingway\Building.Codes.Inspection.FORMS\Rough Plumbing Insulation Report.doc November 17,2003
Framing / Firestopping Inspection Report C41
Office N . (51auury;,NY
Date Inspection request received: J
Queensb ry BEnforcement Arrive: am/ epart:am/p
742 Bay oad 12804 Inspector's Initials:�� /✓
Co✓ ,.
NAME: PERMIT#:
LOCATION: INSPECT ON:
TYPE OF STRUCTURE:
Y N /'N/A COMMENTS
raming
-Jack Studs/Headers
Bracing/Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12"O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Headroom 6 ft. 8 in. J l
Notches/Holes/Bearing Walls 0 1
Metal Strapping for Notches Top Plate
1 %2(w) 16 gauge (8) 16D nails each side
Draft stopping 1,000 sq. ft. floor trusses
Anchor Bolts 6 ft. or less on center
Ice and snow shield 24 inches from wall
Fire separation 1, 2, 3 hour
're wall 2, 3,4 how' ��---
Firestopping )
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side %2 inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space/Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above/below grade
5.0 sf grade
LASuelIemingway\Building.Codes.Inspection.FORMS\Framing Firestopping Inspection Report.doc January 29,2003
Foundation Inspection Report
Office No. (51S) 761-8256 Date Inspection request received:
t/—
Queensbury Building&Code Enforcement Arrive: am/pm D pa m/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: PERMIT#: U
LOCATION: CA INSPECT ON:
TYPE OF STRUC ��.�� ,.�
Comments
Y N N/A
Footings
Piers
Monolithic 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
d
Foundation Dampproofmg
Foundation/Waterproofing
Type of Dampproofing/Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
mches above footing
6 mil poly for wet V6aslmder slab
Bacicfill Approval IQ + �, '
Plumbing Under Slab C� 1�kw
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Glade 6 inch drop within 10 ft.
L;\SueHemingway\Building.Codes.Inspecdon.FORMS\roundation Inspection Report.doc January 28,2003
FINAL INSPECTION REPORT
MOBILE / MOOULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME: i -Qvin
LOCATION:
DATE: PERMIT#
MOBILE HOME MODiJLAR 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 .......... .....1.. —
4, sewer line support @ 4 feet .. L — —
5. heating crossover (dblewidei off grd. — —
dryer vented outside ..:......
skirting ventilated ......... . ........ — —
8. hot water relief valve piping outside _
0 deck, porches, steps, railing ........
10. furnace/hot water operating ........
11. garage fire proofrrfg .......... ....... _ —
12. door closers ........................... —
13. plumbing fixture ............... ...... — —_
14. foundation insulatiop�(if�cpp )......
15 smoke detector.�
l)Anal electrical �P,z`CJ. -
17. variance required .............r ......
18. data plate okay
19. mobile HUD seal okay ..............
Model # Serial #
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments:
FINAL INSPECTION REPORT
MOBILE / MOOULAR
Town of Queensbury /
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518).761
518),761-825
ARRIVE: DEPART ,� INSP:
DATE INSPECTION REQUEST RECEIVED:
NAM E:
LOCATION: r O "'
DATE: / —0, fir
PERMIT/f
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 ..ti...................
7. skirting ventilated .................... _— — ✓
8. hot water relief valve piping outside — —
9. deck, porches, steps, railing ........
10. f imace/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 requir
18. data plate okay ....................... — —
19. mobile HUD seal-okay ..............
Model # Serial #
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O -YES NO
Comments:
( vim� � �d
FINAL INSPECTION REIMOR
MOBILE / MOOULAF!
Town of Queensbury �e,j�-6 e'L
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256`
ARRIVE: DEPART. INSP.
DATE INSPECTION REQUEST RECEIVED:
NAME: r J
LOCATION: 14 ,-)-0UJ" ( �U
DATE: `D PERMIT# Pf—y67 v
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 ..ti....................
7. skirting ventilated .................... _
8. hot water relief valve piping outside — — —
9. deck, porches, steps, railing ........ _ _ —
10. f imace/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 # 1 9Z�2 77 5
Manufacturer
Date of Manufacturer l
OKAY TO ISSUE'C/O YES NO
Comments:
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-TONNN OF QU T%'S(,,F QUEENSBURY BUILDING DEPARTMENT
Based on our limited examination,
• compliance with our comments shall
BUILDING not be construed as indicating the
plans and specifications are in full
REVIEWED compliance with the code,
DATE
1
' � J
i
> > _ RECEIVED
' MAR 9 H 2003
( ' TOWWOF QUEENSBURY
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