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2002-764 TOWN OF QUEENSBURY 742 Bay Road,QueensbmT,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761.8256 CEIRTIFICIIATLE OF OCCUPANCY Permit Number: P20020764 Date Issued: Friday,May 30,2003 This is to certify that work requested to be done as shown by Permit Number P20020764 has been completed, Tax Map Number: 523400.296-014.0001-007-000-0000 Location: 78 MONTRAY Rd Owner: GRAYSON PROPERTIES LLC Applicant: GRAYSON PROPERTIES LLC This structure may be occupied as a: By Order of Town Board Mobile Home In Park TOWN OF QUEENSBURY Director of Building&eode E rcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&'Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020764 Application Number: A20020764 Tax Map No: 523400-296-014-0001-007-000-0000 Permission is hereby granted to: GRAYSON PROPERTIES T,I.0 For property located at: 78 MONTRAY 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. . Type of Construction Value Owner Address: GRAYSON PROPERTIES LLC Mobile Home In Park 1004 CHESTNUT St Total Value MECHANICVILLE,,NY 12118 Contractor or Builder's Name Address Electrical Inspection Agency Plans&Specifications 2002-764 78 Montray Rd.,Lot 18 Placement of a 840 sq. ft. used mobile home (Year 1982)on a parcel with existing septic system on site as per plot plan and specifications. $25.40 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, October 01,2003 (If a longer period is required,an Application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the To n of eens a ctober 01,2002 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Pemift— Mobile Home Town of Queensbwy, 742 Bay Roag Queensbury, NY 12804 (518) 761-8256 A building permit must be obtained before placement of mobile home on parcel. No inspections will be made until a valid building permit has been issued. Applicant Information z Office Use, Name: Q, S 0 0 File Permit No -LO02-- i E VVED 1 C/o SEP 0 —Address: S? R-ch Fee PaidG25 F 200 2 v Arn z XNN Reviewed P : eexy .......... Phone No. Property Owner Information Parcel Information Name: TL 0-h 145:6 h 2 ?a-Q Q Q 114/2 < Proposed Date of Placement: Property Location:7 6 N+Q I Address: 0 0 Q+.V,3 L4+ 8 �m Road,Steet,Avenue Name of Mobile Home Park: C--V I Tre (if applicable) Phone No. G C I — lz� ) C� Tax Map Number: a9 6 J - 7 JLV Mobile Home Infiormafion Zoning Information # ,v o Approximate Value of Home:$ 8 P Zoning Classification: 5�, New Home: YesNo � Size of Property: /cU�ft.by 70 ft. oy—V Replacement Home: e No Size of Mobile Home: ft. by ft. Existing buildings: Setbacks: front yard A? I; rear yard Y 7A. Singlewide: Doublewide: Side yards A7 fL and ft. Number of Rooms: (exclude baths) Ll Number of Bedrooms: -Accessory Building(s): circle Number of Bathrooms: Detached garage: 1 car; 2 car, car circle: (jj��Fireplace Woodstove/Wood Fireplace Attached garage: I car; 2 car, car Storage building: (a) No Foundation Support: Other: TYPE SIZE&DEPTH Water Supply: well or<:mm municipal Piers 14 x J4 Runners X Slab x Is Septic Permit Required? Yes or Further information requested on the reverse side of this sheet Name of Installer or Mobile Home Dealer: r��&ZL() Z e0plo  Address: C va 6( - C psi�yy i lxd- Phone No. rG � _�l\Z Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. 1. Insignia serial number. 7 P 6 a f r 2. Name of manufacturer. f Q�� /q r 1 ICI`—, 3. Plan Approval Number: 4. Model or Component Designation: (New Home 0AEY) �} 5. Date of Manufacture: 7 , 13 AFFIDAVIT Town of Queensbury State of New York County of*anren r 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 no and that such work is authorized by the owner. SigIIature' wner,owner's agent,architect,contractor Special Conditions of Permit By. Form: 1111911999sh Code Enforcement Officer a Project BP#c;2� Address: Building Permit Submission SbEL-fa?7dy du&U�g RzECE�Vi,:D, Tuafandy dud* Checklist SEP 10 2002 TQ1qAj OF Of 1-r- All items below must be checked either yes,no or not applicable prior to sd�- s10rUQ the permit to the Town of QueensburyBuilding Department. If anyof the below items-are'fackin tL�r"- 9, e permit will not be accepted until such time as the application is deemed complete for submission. 1. Building Permit Application Completed ... ... ... ... ... ... ...... ... ... ... ... . K!yes F]no 0 n/a 2. Energy Form or ClieckM&te Energy Code Compliance Forms Complete.. Elyes El no X1 n/a 3. Energy Code inspector's Report from Clieckb&te Program.... ... ... ... ... .. [:1 yes [:1 no n/a 4. Septic application completely filled out(if applicable)... ... ... ...... ... ... ... n yes F]no n/a 5. Solid Fuel Burning or Gas Appliance Form... ... ... ... ... ... ... ... ...... ... ... .[:]yes [:]no 6. Electrical Inspection Form... ............ ... ... ... ... ... ......... ... ... ... ... ... .. [:]yes [:]no Mn/a 7. Two (2) complete sets of structural drawings... .. ... ... ...... ... ... ... ... ... ... .Oyes Ono a a)floor plan,b)foundation plan;c) cross sections:d) elevations; e)-window and door schedule 8. Two(2)site plans showing location of the structure to be built.... ... ... ... E]yes LJno Lkn/a location of well or water lines,location of septic system or sewer line. 9. Setbacks from property lines to new structure... ... ... ......... ... ... ... ... .. F13,es Elno �n/a 10. Setbacks to neighboring wells and septic systems,including onsite well.... nyes []no qn/a and septic systems (if applicable) 11. DrivewayPennit... ... ... ....... ... ......... ... ... ... ... ... ......... ... ... ... ... ... E]yes nno ®n/a Date: 91101cl) 10 Staff InitiaI6� L-\Sucandagway\BuAding.Pemiit.FORME\Generic Ueckhst.doc Tc►wn of 40u+e+ensbury " ` - Bui#ciing & _Codei _Enfarcame_-nt- _ 742 �2iy FRoad Queensbury,_-- Y -12804 - _ - _ XX �►A'TE I N'SF"ECTIt�N R�QIJI�S'T R.EC�IVBI� - _ NAME: - _ LOMATTON: • � 1bi+iC��I1['..� :�,##�M� - 14�ii�3�U'�..A►R =:E�i�►1b+iE. _ �=t�o'I-I1�It35 � �F©Ul�I7ATIC�N BACK�'�T-T- �Z2A1rrIZNG NIA _ YIESr NO ' 1_ foundati€�z: support, pier spacing perrazatziir_ --=------------ ----- - 3. water Line shtat -off ;.................. . _^4_ sewer lixie support +� 4 feet 5. heating crossover {dblev�ride� -off grti_ - � - 6_ dryer vented outside _••_ _--___-_-•- - 7_ s;�rt�r+g ventilated - ---------•------- _ 8, hot water relief valve piping outside 9= d$ck, p�irches, sups, railiag -----_ - t 1t3, fuaraac+�lhot water operating • ......... - 11. garage fire pr<3"f ng .................. 12. dooi- closers ._ ---------- ........ ------ �- 13_ -plum'biag fbXture -:_-_ --------------- " 14~ foundatiora irisulatiora {if appl-)-- - - 15. smoke detectors :---- ---------• _ - 16_ final electrical --------------•_ ---------- 1?: variaace required .--. - -- ------- 1$�„ data plate okay ......... ............. 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