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2003-912 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFIC ATE OF OCCUPANCY Permit Number: P20030912 Date Issued: Tuesday,January 13,2004 This is.to-certify that work requested to be done.as shown by Permit Number : :: -Y . P20030912 --, has been completed. Tax Map Number: 523400-301-020-0001-022-000-0000 Location: 32 LEO St Owner: DAVID&KATHY WHITE Applicant: DAVID&KATHY WHITE This structure may be occupied as a: By Otder of Town Board Mobile Home Out of Park TOWN OF QUEENSBURY Director of Building&Code Enfoteement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030912 Application Number: A20030912 Tax Map No: 523400-301-020-0001-022-000-0000 Permission is hereby granted to: DAVID &KATHY.WFUTF For property located at: 32 LEO St 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: DAVID &KATHY WHITE Mobile Home Out of Park $59,000.00 32 LEO St Total Value $59,000.00 QUEENSBURY,NY .12804 Contractor or Builder's Name Address Electrical Inspection Agency Plans&Specifications 2003-912 1560 SQ FT MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS with new septic system $96.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, November 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 the T 0 u;eens 4; November 03,2003 SIGNED BY r the Town of Queensbury. . .v N, Director of Building&Code Enforcement Applicatioil'for Permit— Mobile Home , Town.of Queensbury, 742 Bay Dour, Oueenshury, NY-12804 {518) 76I-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: File Permit No. Address: = u Fee Paid Reviewed By: .. 1%0 9 r 0K Phone No. J l S`t �6� P b �UIL�oN GA Cp� Property Owner Information Parcellnformation � ! � Proposed Date of Placement: ' 0 a 3 4 Name: . Property Location: Address: `3.Z L&O �� K_'. ,� Road;Street;Avewe l)L VIX 6h 5 0 "111 VLlf-16 q Name of Mobile Home Park:`. . Wapplicable)" Phone No. Sl 9 7ca b S1—Z-- Tax Map Number: j0 Mobile Horne Information Zoning Information Approximate Value of Home;S , d Zoning Classification: New Home:` Yes No ,.-0 Size of Property: _ft.by $. Replacement Home: Yes No Existing buildings: Size bf Mobile Home: ^(; ft. by (0 ft. Setbacks: front yard- ft.;.rear yard & Sin' .OWide: Double-wide: Side yards fL and�. ft. gl Numberof Rooms: (exclude baths) Number.of Bedrooms:. ' v Accessory Building(s): circle Number of Bathrooms: Detached garage: I car-, 2.car, car. circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: l 2 car, car Storage building: Yes, No Foundation Support: Other: TYPE SIZE&-DEPTH --m Water Supply: well orr umcrpalJ : - Piers x t. , Runners x Is Septic Permit Required? Yes or No Slab x 6 Further information requested on the reverse sine of this sheet Name of Installer or Mobile Home Dealer: Address: r� i Phone No. l -f-z 6 Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. I. ' ' Insignia serial number_ -� �— 1 '='" 0 �{ ► �-- S ..F/ ..- --_. 2: Name of manufacturer- 3- Plan Approval Number: o 76 - C9 ,1 d"? 4. Model or Component Designation: 'J, (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 1 shall be complied with,whether specified or not, and that such work is` authorized by the owner. Signature: owner,owner's agent,architect,contractor, .Special Conditions of Permit By: Farm: I1l19t1999sh Cade Enforcement Officer FROM :NORTHWINDS MOBILE PARK FRX NO. :7925938 Oct. 31 2003 12:40PM P1 Application for Permit--Septic Disposal System Tawtt o,f QU00hsZWry 742 Pay Road Queensbury,NY I2804 (518) 761-82$6 1. OWNER INB'012 "TIOw: Location ofinxtallation: Z- S-rM-i, -� 4ifice ITsa Tax lvtap No. / ! , File Permit No. Owner's Narr=: W-12 Fee paid Address: 3 y L e,<> E-,-A 2. INSTALLER'S NAME : PRONE NO. 3_ RESIDENCL;FNFORMATI.ON: (circle year of dwelling,indicate 9 bedroo ms)and multiply#of bedrooms with applicable gallons per bcdroOnt to equal total dailyfl`ow) �'eaY of Y�ouse= Na of 8cdreaoms x Cotamutatioti — Total-,�aikyF[gw 1980 or older x 150 gsl&drm a 1980— 1991 x 134 gai/bdrm = 1991 —present x 110 gah/bdrxia Garbage Grinder Installed ye's_— 1 no —1, Spa or act Tub Iamned yes ! no 4. PARCEL INFOR) ATION: (circle applicalAz information&indicate meaSuremants) Tcooeamw oil WammGround Bedrock'or jMpmumis Materialat Sumly tat at what depth at wham depth rarer hg rd,�pA- �feet yeetsweep slope if Well;water supply _%slope abcorp on�Lt Estefft t other 11crcola-ion Test: ('o be-completed by licensed professional eaeginerer or archite3w Rate: Minuta per inch S. PROPOSED SYSTEM; For New C stria ion: All,individual sewaga disposal sy9rc:vs must be designed by a liccosed professional enjinocr or arclateot;(unless installed in a PLsWWW D card aPProvcd subdivision)- Add 250 gallons to the size of the septic tank and lcacb field for cads 0arbagc Grinder,Spa or Whirlpooi Tub. Septic Tank: gallon(Min.size),Odd gal.) �j Tile Field: each trench_.Yo_._--.ft'. Total System Length: eaG o Seepage 11it(s): number of !7 size of each. Size 9f Stone to be used, # ! depth or thickne-vy feet Bed Symem Size: x . Al"xnativc System: length andtor sits 6. HOZ..DING TANK SYSTEM: (if requarcd) Number of tanks: / Size of each: gallons !TOTAL Capacity: gallons Note. ,Alarm.System and associated electrical work must be inspected by a Town approved cuctrical inspccticn agency. ?. SIGNATMtS &WFORMA.TION POR RESPONSIBLE PERSON(please read) For your protection,please note 0wt pursuant to Section 136 29 of the Code of the Town of Qaeensbtny,any permit or approval granted%Oldchh is based upon or is granted in reliance upon any material misrepresentation or failure to malce a material fact or circumstance known by or on behalf of an applicant,shall be void. I have re, a regulations wi r eet to this application and agree to abide by these, and all rcauircm is 0 the Town o£Q cn ury Sarnia Sewage Disposal Ordinance. o F=R"AOMLL- R"gMl=l= -rc>wn cA C)uca nst3ury Oullclino a Ck>dEa F=Fnfoirceomant say F:tc)aLci C:)uoc--nsk:)ury, NY - 12804 (518) 761-8256 DATE INSPECTI©N REQ[JEST RECEIVED: �6b-3- -VIES jL fcpxmdatjc>3a support, pier spar--ma perrrutrillf. .................. . .. ... perrriat-kAAF- ---- ----------- NAt.-tuar llixxt-- shut off --------------- -- -- 4- sf_--wt_-r lijav-- support (W 4 feet - ------ 6. CIS-yt-_X- -VV--Kjte:4d ------------- ------- -7- skirting vcrxtilate�4d - -------------------- 9- 11c>t water relief valve piping Caltsich-- 9. deck, p<>rx--I-Ic-s, steps, railing -------- lo_ furnacelliot %w.,,atje--r cip<--ratirxg -------- ---------- --- - --- - doorc--Ic>sf--rs ---- ---- --------- - - --------- 13- plxxnml:xilns fixture- -------- - - --- ---- --- -- 14- fiDvmxdaticwi ixistflaticizi (if uPPI-). . .. .. 15. srxxoRe- detectors ..... ......... ... ...... 16- final electrical --------------w. ........ 17- variance reaqtxirecl .......... . ........... 18. data plate cskay --------- ------------ -- 19- xxc>j:),jlp- I-T-LYIE> sf--al --- --- - ------- Model # *--rial Af X-7t73-Ak-,A N4 oLrixxFar--t-xx-rt---v j:>.-tlb-- of N4a-TxuL-fix4--tLxvt--r OKAY TO ISSIIJI-3 C/C� -jrIES Foundation Inspection Report Office No. (518)761-8256 Date Inspection req t rec ed: Queensbury Building&Code Enforcement Arrive: a pm. epart: 742 Bay Rd.,-Queensbury,NV 12804 Inspector's Initi ' NAME: '� — RMIT#: rD . LOCATION: INSPECT ON: - TYPE OF STRUC Comme s : Y. N N/A F gs Piers Monolithic Slab ' Reinforcement in Place The contractor is responsible f providing protection from freezing for 48 hours following the placement of thetconcrete.Materials-for this p ose on site. Foundation-/Wallpour Reinforcement in Place Foundation Dampproofing . Foundation.L Waterproofing Type of Darnpproofma/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 I Cast/Copper Foundation Insulation Interior/Exterior R- Rough Graded inch drop within 10 ft. L:\SueHemingway\Building,Codes,lnspeciion.PORMS\Foundation Inspection Rdport.doc January 28,2003 Septic Inspection Report Office No. (S 18)761-8256 Date Inspection reque c ' ed: Queensbury Building&Code Enforcement Arrive: pz De rt: In 742 Bay Rd., Queensbury,NY 12804 In cto 's Initia s: / e� NAME: _ L. f,�J�.c� P IT NO.: 0 LOCATION: _ �✓'- ECT ON: RECHECK: Comm en s and/or di Soil T San la l Type of :jN4unicipal^ell Water t " C3C3 Waterline separa 'on diOnce ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length Al ft. Length of each trench ' ft. Depth of trenches Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box ` Distribution-Box to Field 1 Pit Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits Zft. Conforms as per Plot Plan V Y N Location of System on Property: F Rear Left Side Right Side Middle Front Middle Rear System Use St us.• Approved 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 COMMONWEALT}I ELECTRICAL INSPECTION SERVICE,INC. I Main Ofiire 176 Doe Ran Road-Manhelm,PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL i Permit No.,..........» .........,»......Cent, N 79840 Cut-in Card No—_*,...... .......... Owner.. .._.._._... A.V.J.C? ......lrl.l.lrg tiG. ,.... ..»...... »,»......»... p Location... ..... ...3a.......... �af.'.A__.,+�ti'ad'Fi;Uica......�._p� Inata Wfon Consisting of.... ..............._..............».................................».................»,»_...»..,......................I..................».......... Installed By....., .. , ,x.tl 4!'!r.......................... , ...... -_.._Lic. .. No.. .............� .. ..»»»».». The conditions following governed the issuance of this certificate,and any certificate previously issued is cancelled:- i This certificate only covers the cieotrical equipment and installation conditions as of;datc. tlpon the introduction of additional equipment or alterations,application shall be promptly trade fo inspection.j Inspectors of this Company shall have the privilege of making inWcdpns at any ime. and if its rules are violated,the Company shall have the right to revoke this certificate, ».................llV3PECTOR.�, ��� � ,..»......».. .. . Member N,FRA.,1 A.LL zQ 39ad wswnw Noa POS T86L L0:b 1 beef; C Y/Te atura of respor iblo person Date �w3 SC.ST ins. �'aazitaiLC TOO/TOO @] 777 1 � 4�T� sY _ Q1 f C,? .rt F3F C R p )l OCT 2 9 2003 BUILDI NG o Tclftj O OU Fn;SSi in REVIEWED BBC ' DATE TOWN OF OUC.pl; ,6i11CG1 F3asc)c �r �a�ir limited o tdC DE NT of ty'.c yyith our ca�'aminatian, construed mments shall pins �G,.cr as Indicating the Q nt�ir' n G itf1 the Building Codes Yortc State. C ?� FILE COPY c� -- __a e 1 iC loo n _ r, eD F`+✓ 0 �_TIQ,p �DIUTD` j KfTCN - VW90ROOM 3� BEDROOM # 10'- T. &" a e T �k4. CATHEMAL THiU•CUT BEDROOM UVING'ROOM ii DEN BEDROOM 19'-0° i� 12� No.3 p 13'-0" n 12' A09 6 3 ROOMi 314BATH5• EQitA RU•0 1,456 SQ T,) _ ,10/21/2003 09:11 7986681 PAGE '01 200v'�.e�ie .iMOXITY INISURAN�"r�,Nc, 045� ""P, ll ► ;Lg Z 09/10/03 FI!omUCER HI! ERTIFICATE U CUP INrORMA ONLY AND COMPOR!NO RiONTS UPON THE CRIVIVICATE COsglttn!ty Insuraxaeo AgenciEto HOLDER.THIS CORTIPICATS DOOR NOT AMINO,EXTEND OR cx 8P Saratoga Agra, PC Sox 1309 ALTER THE COVKRAQE APFORDIO VYTNC POLICIES BELOW. Bo. along ra11a my 1=803-1339 INaLtRERdAFRORO1NOCovERAG! Fhaaeo9li-993-9503 3'axr618-793-453i_ INIUICIRA: DAyDwr 1ltO'TO'AL 1' 0171mc Ii CO Volu mansfu, so g�usingi weUMo. ea9Vm ar abi'I IN906RC: cx Aaasd MY 10800 INBURERO: EdIURER E: OOYEIEAOEi THE POLICIES OFINSURANCEIIITIDIEI.OWHAVEBEENimlU®TOTHC:INBURIDNANEOAEOVEFORTNIPOLICYPEFtiCOINDIDATED.NOr NSTANDIt;# ANY RICUIRIMEHT,TERM Oh CONDITION OF ANYC'ONTRACTOR OTHER CQCUMENTATIN RIIPECT TO WHICH T'Hfs CU"lCATE CMYse Mao DR MAYPIiiRTNN,Tt•lKINOURANCIAPPOROID EMS POLICIES ORNRINDNEI NISv;JxjECTTOALLTNfTRRM1,vWAUS NSANDCONRITICNBOFIUOM POUOIEE,AGGREGATRUMITS SHOWN MAV HAVE NON REDUCED IYFMID CLAMS. TYPEOPINWRANCK POLICYNUMEEFI N LIr�17 oENERALLIA"Iff EACNO000RaINCK If 7,000000 JL ]C CfMifilm' 'GuawuAlm" 19043,1509 09/18/03 00/1$/0* PIREDAMASK AnEmfiinr> 1111106 CLA"MAN , �C oQtXIR MIDERP* one SIC l0 PERQMLS ACV[WRY 61000000 QE ISMAOOREOATE 12000000 9 ��tR GCMLAOCIRlDATEtMetTAPPLI&lPER. PROtILIC+9•CQWMPA90 $2000000 POLICY P T tCrc r 0L*FN3,3!jF ANYAUTOiJe"TM W INGLOLIL" I BUILDI e41\I®GCppL ALLQWNEOAUT06 "-• •.... BCHIOULEOAUTOS i `PO«DItFly 6 NIRW AUT08 I IWU NON-OWNEDAUT08 l It�Y I ma adOIAMAO I OARAOILUIIILYtY AUTOQIyLY•EAACCIDENT I ANY AAI TO OTHlR7p��AN' FA ADD I AUTOONLYI AGO I 1i1tRMLaAERfiY EACHOCCVRRENCE i CCCUR F7 CAM WADE ADMOATE F MOVOTISLE RETINTION I WGJkXvRi 60MrENEATIONMV EMPLOVOW LtARILITY $Y IMITE ! ML,EACH ACOVENT .{ 61,CHIME,I&A 1hv&0v!4 i OTHER iL DIIBAE!•FOIICYtfLitF ! t t I QII47IlTIOPIOP NAiIEal7tCt >►Y DDR88twE7ltfEFSONL wSms um #AMR CEMIPJQAlOHOLOlR N• AVWIONALINGVRlMIlN$URIRI.Er=: CANCELLATION Qpga�j-� SHOULD ANY OF THE AIOVODIECAEED POLICIES DECANCILLEOIEFOR6 THE ENFIRATION OATSTm"WM rHEMI+G=11RER WILL ENONAvORToVXL SO_SAvswEPfIIN Town of guoouebarl► w"MIOTHEO NAME07OTNILEFT.WVAILURITODQs00NALL )42 say Road IMPOPSNOQILIOA NOR OMAWf TNCINEUR6R,ITAAOENTIOR Gusensburp b1Y 1280; REFRIEENTATIVII, t r 1 A NOlr+ilCiRlPNII A, Ivatra= . ",,v +�•.. wr...:+:_- •. ,,':fit IS'.�'.;J ACOR0 2S4(Wl7j OACORO CORPORATION 1 WI