2001-639 TOWN OF QUEENSBURY
Flvis 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20010639 Date Issued: Monday, September 10, 2001
This is to certify that work requested to be done as shown by Permit Number P20010639
has been completed.
Tax Map Number: 523400-308-006-0001-061-000-0000
Location: PETRIE Ln
Owner: SAMUEL &VIOLA WAHNON
Applicant: JOHN BROWN
This structure may be occupied as a:
By Order of Town Board
Mobile Home In Park TOWN OF QUEENSBURY
.11
Ai\_.
Director of Building&C o i e Enl'k, cement
11 ' - �, TOWN OF QUEENSBURY
f 1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010639 Application Number: A20010639
Tax Map No: 523400-308-006-0001-061-000-0000
Permission is hereby granted to: JOHN BROWN
For property located at: PETRIE Ln
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: SAMUEL &VIOLA WAHNON Mobile Home In Park 17,000.00
39 SARATOGA ROAD Total Value 17,000.00
GANSEVOORT,NY 12831
1
Contractor or Builder's Name/ Address Electrical Inspection Agency
NEW YORK BOARD OF FIRE UNDEI
Plans &Specifications
2001-639 Jack Brown
Lot 26 Petrie Lane, Queensbury Mobile Home Park
A used mobile home (year 1987)to be placed on a vacant lot.
,I 980 SQ FT MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS
$35.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday, September 04,2002
(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 Town of Q ensbury T esday, September 04,2001
i,o
SIGNED Breiiv 4 for the Town of Queensbury.
Director of Buil ' g& ode Enforcement
741111111641/4
RECEIVE:*
AUG 2.3 2001
Application for Permit— Mobile Home
'Town of Queensbuty, 742 Bay Road, Queensbury, IVY 12804 (518) 767 O� �����B11HY
ILDING AP1D CO®E
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• ................_._�.._....__._..__..
U01ce Use
Name: lick_ A W 0 File Permit Noscaial' 6,51 .
. : Address: 31 ytki. A4 O&' Fee Paid
. d O
:_a_5
�.
`. 1 $ l' I[S Reviewed By: _._..... ....._.--- --
Phone No. 1-145—----S if T )
• Property Owner Information Parcel information
Name: SW 0 l4i 0 Ov Proposed Date of Placement: PQ cS (-
Address: �+ /� fJ Property Location: L T 4, _
_. _ 1 a c 3f zLE_ti e.i) Road.,Street,Avenue
. 0 e 46 o 1e-' 1V Name of Mobile Home Park: Q (JLx44-4
(if applicahle)
Phone No. 7q 2YO I�
Tax Map Number: , .z _/ G ! S9
Mobile Home Information , Zoning Information
���—Approximate Value of Home:$_1 1 Q (7 ���
o�f Zoning Classification:
New Home: Yes No o\GLt
- Tnn��`L��i Size of Property: ft.by ft.
Replacement Home: Yes No J' \V 1q$
l ( .' Existing buildings:
Size of Mobile Home: 1 0 ft. by N-i •ft. ifr -"`
X ' .1 Setbacks: front yard ft. ; rear yard it5inglewide: Doublewide: If Side yards ft.and ft.
Number of Rooms:(exclu a baths) `i
Number of Bedrooms: Accessory Building(s): circle -
Number of Bathrooms:.. j
Detached garage: I car; 2 car, car
circle: Gas.Fireplace or Wnodstove Attached garage: 1 car; 2 car, car
Storage building: Yes No
Foundation Support: Other:
TYPE 817g//.'DEPTH Water Supply: circle
Piers
Rwmcts
Slab well ; municipal
• Further information requested on the reverse side of this sheet IIIW
ZO 'd PE:h l fH.i, AO-A i-AfN
Name of Installer or Mobile Home Dealer: 1/Q.Q.A..4-9-04_,(11-1 _, ._
Address: 39 u_M-0,,,k
Phone No. 9 d 2_,rU I
State ofNew York Division of Housing&Community Renewal
Insignia of Approval of the State Building Code
Complete information below found on a`plate"or"sticker"which should be affixed to the
mobile home.
l. Insignia serial number: ) rl'
•
2. Name of manufacturer: _ r rOcA42-
3. Plan Approval Number: Dq('
4. . i or Component D,,ignation:
(New Home ONLY)•
,q
5. •'Da ' :nufacture: —v b — D
•
'• 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.
Signature:. E 1't`' _
owner,owner's agent,architect contractor ••
•
• Special Conditions of Permit
•
By:
• Fcun: ,1/1811999gh Code Enforcement Officer
•
= (i :hi nil! RA-RI-AnN
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury ..
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: ' c DEPART::DON
DATE INSPECTION REQUEST RECEIVED
NAME': �.. � , 4.) Ill ' )�
LOCATION: ".!I__•. r ' `. ( 31
DATE:9,- 0-"►` ! PERMIT#0("
MOBILE HOME MODULAR HOME
FOOTINGS _ FOUNDATION _ BACKFILL_ FRAMING_
N/A YES NO
1. foundation support, pier .lacing
per manuf.
2. anchoring per manuf. _ •
_
3. water line shut off
4. sewer line support Q 4 '-•t
5. heating.crossover (dble ;de) off d. _ •
6. dryer vented outside
7. skirting yen• ••
8. hot water relief va ve pip',g outside
9. deck, porches, steps, railin;.
10. furnace/hot water operating — _ _
11. garage fire proofing
12. door closers
13. plumbing fixture ...... fj\a- _
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 C/O .YES NO
Comments:
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury r I D-r\
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: INS'. 14 '1.-
DATE INSPECTION REQUEST RECEIVED:,
NAME: I lam. .1 2
LOCATION: Lo 2 Pa 2-_�
DATE: C " '----c7ltaDi PERMIT/0 I' (039
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION BACKFILL FRAMING
N/A , YES NO
1. foundation support, •er spa • g
per manuf. —
_f
2. anchoring per manuf. ,/¢ — •
3. water line shut off
4. sewer line support 4 f t .. l
5. heating crossover (dblewid o grd. •f _
6. dryer vented outside —
/
7. skirting ventilated _ _
8. hot water relief v lye pip' ou ide _ i
9. deck, porches, step , 'mg ..... .: _ / _
10. furnace/hot water operating J
11. garage fire proofing _
12. door closers
13. plumbing fixture —
14. foundation insulation (if appl.)
15. smoke detectors V
—
16. final electrical
17. variance required —
18. data plate okay
19. mobile HUD seal okay J 4 _
Model # Serial #
Manufacturer
Cate of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments: L)EE� T6. \ \V._
V-NV\C V`PIOC�1 i
AcT3C7 N_ `
1- A
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL G/\
Panel Board No Cert. N2 70160 Cut-in Card No
Owner (C.�/ � ,��� /l6�2fr 6" C,X-zisrcv
Location /��!L� !J
Installation Consisting of.f l-1I #7L� Se-A&7 Cl °2 vEO
Installed Byf • /7/6 -', Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of makin_A'ik pections at any time, and if it:
rules are violated,the Company shall have the right toorr v e thi cat-.
Date..g'Sr"''o-( INSPECTOR O /
!
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: INS°: -
DATE INSPECTION REQUEST RECEIVE 9.
NAME: -=- r
LOCATION: 4.6 ?.t., 1 1►.�
DATE: --ra V-- 1 PERMIT# (.930)
M® ILE HOME MODULAR HOME
FOOTINGS _ FOUNDATION _ BACKFILL_ FRAMING_
\ N/A . YES NO
1. foundation support,,pierr spacing
per manuf. V
2. anchoring per manuf �!
3. water line shut off
4. sewer line support @ 4 feet .. .... _ _
5. heating crossover (dblevide) off grd.
6. dryer vented outside ..w
7. skirting ventilated _
8. hot water relief val e pip outside
9. deck, porches, steps, rai m
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 # Serial # SS //
Manufacturer )4( /I &✓,
rate of Manufacturer 7 t 9
L
le.A
OKAY T YES NO
Comments: \ g 7 1 10 i 1 140 - C
-
0 441 . 09.2_0„0....e_____),
.i•
LEC
TOWN OF QUEENSBURY Buutt4p DEPARTMENT
Ba3ed.01compliatil our)imicewitt tr _4_:xillr4611101'11
our comments shall .
not be construedis'1!..: ' 'the
/ /
plans and specifical7 are in full 1,1 .
1 • .
. •
---- .) i..-•,'.-,• with the 4!•. 1''
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RE�.-,EivED
AUG 2 3 2001
TOWN OF QUEENSBURY ;
BUILDING AND CODE
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