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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: ,���b11 ► F � Mobs � C� 0 -� — RECENED APR 0 2 2003 N_Or-qVE SBURY JE— AND COO Z Z C V,/ Ll FILE C -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 ' / 1 BUILDING-AND-CODE d� J 1 , J ! f I r i ti � i 49 �j ►�1 I\ 1' A j W49-4 V J ` ; es OFALI LO EQ. Le m Q %totPC nWMAaDA-Isaav4 WH tO:TT Z@0Z-02-100