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2002-899 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 CEILITIFICA:TE OF OCCUPANCY Permit Number: P20020899 Date Issued: Wednesday,December 24,2003 This is to certify that work requested to be done as shown by Permit Number P20020899 has been completed, Tax Map Number: 523400-309-009-0001-065.000.0000 Location: 67 OHIO Ave Owner: MICHEL&EDWARD TESSIER Applicant: 'TESSIER;EDWARD ANUCRISTY This structure may be occupied as a: By Order of Town Board Mobile Home Out of Park Town of QUEENSBURY Director ofBuilding&Ca a Enfor ement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020899 Application Number: A20020899 Tax Map No: 523400-309-009-0001-065-000-0000 Permission is hereby granted to: TESSIFR. FDWARD AND CRTSTY For property located at: 67 OHIO Ave 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. Tve of Construction Value Owner Address: ROBERTCLARK Mobile Home Out of Park 15,000.00 92 VAN DUSEN Rd QUEENSBURY,NY 12804 Total Value 15,000.00 Contractor or Builder's Name Address Electrical Inspection Agency Plans&Specifications BP 2002-899 Edward and Cristy Tessier Placement of their currently owned Mobile Home year 1989 on a parcel located at 67 Ohio Avenue. Edward and Cristy Tessier have a contract to purchase this property along with Michel and Doralee Tessier. The mobile home will be moved from 61 Briwood Circle,Forest MHP to 67 Ohio Avenue. $35.48 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,November 18,2003 (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 of Q nsb vember 18,2002 SIGNED BY ezpv for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1 OWNER INFORMATION: .............Office Use Location of installation: Tax Ma No. File Permit No. p Owner's Name: Pa id aid ..... ... tl_�........... ............. .........:ec. .............. Address: 2. INSTALLER'S NAME PHONE NO. 3. RESIDENCE INFORMATION:- (circle year of dwelling, indicate#bedroom(s) and multiply# of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x ConinutatiA --,4' Total Daily Flow 1980 or older x 150 gaUb 1980-1991 x 130 l/bd 1991 —present x 11.0 0 1/b Garbage Grinder Installed yes no Spa or Whirlpool Installed yes 4. PARCEL IN-FORMATION: (circle a ph ble rmation&in to m sureme Topography Soil Nature Gr d Watef Bedrock or I envious Mate Domestic Water Su Flat sand at Avh-tdofth at what Aka municipal Rolling loam feet —feet well Steep slope clay if well;water supply slope other from any septic-system depth: absorption is_ft. other Percolation Test: (To be completed by licensed professional e 'veer or architect) Rate: minute per inch 5. PROPOSED SYSTEM: For New Construction: All ind4vid sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Plannin Board approved subdivision). Add 250 gallons to the size of the septic tank and leach field for each Garbage Grinder,S a or'Whirlpool Tub. Septic Tank:, T gallon(min. size 1,000 g Tile Field: each trench ft Total S stem Length: Seepage Pit(s): number of size ofeach: ft. by Size of Stone to be used: depth or thickness feet Bed System Size: x Alternative System: length andlor size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: I Size of each: gallons TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspe6tion agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) For your protection,please note that pursuant to Section 136-29 ofthe Code of the Town of Queensbury, any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or circumstance known by or on behalf of an applicant, shall be void. I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of Sanitary Queensbury San ry Sewage Disposal Ordinance. ,y Signature of responsible person Date of (2cler.ffahtfi-y Hl'.1V(:f'S .11)(1 :iewsige Disposal ('11uptrr AI)Iwittll x (= . l AliatJ U''•I'ION I*'I FAA) SI': "A RATION RE'OI. IRE— 1I NN'I' i V 1-y 1 _ 1^lfs F.Ll_ 1!1 tIhT •ft -�--- / W - '111-Y1tT TJ15¢t}(; ��... _ to Lt•ri••! l 110vat» C QE jt�ty' Ilr> �,� G £ Z � j .� Scr•slc. �� �.y . ) �� i!t•Y IY.. A�1nSi.P(K-1 L F'IF+.t.RA ?. SIGNATURE &INFORMATION FOR"SrvNaus,.jr,rlcic-ri E Application plication for Permit— Mobile Home Town of Queensbury, 742 Bay Road, Queensbury, IVY 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 Office USJZ ECE/ Name: File Permit No. 2 Address: WMLA61z� Fee Paid OCT 5 2002 --TOWLDING jjE'BUI ENS8LET URY Reviewed E�y: AN6Gp QE Phone No. U 's e Property Owner Information Parcel Information Name:611�40ww &6 044-� oe& 6t 1z) Proposed Date of Placement: V/,vl d,m,) 7 IrRIM Location:_-0;, Address: Road,Street,Avenue I e5sie-,r y 4,-,Name of Mobile Home Par �k r/1 1-k A 0� (y applicable) Phone No. Iq Tax Map Number: Mobile Home Information Zoning Information Approximate Value of Home:$ 1<m - Zoning Classification: New Home: Yes No Size of Property: ft.by ft. Replacement Home: Yes No A* WJ 0 V_"' j A 6 ztej)�L V Existing buildings: Size of Mobile Home: ft. by ft. Setbacks: front yard & ; rear yard ft. Singlewide: Doublewide: Side yards ft.and -ft. Number of Rooms: (exclude baths) 1,0AR-, Number of Bedrooms: Y� Accessory Building(s): circle Number of Bathrooms: F Detached garage: I car; 2 car, _car circle: Gas Fireplace/Woodstove/Wood Fireplace Attached garage: I car; 2 car, car Storage building: Yes No Foundation Support: Other: TYPE SIZE&DEPTH Water Supply- well or municipal, Piers X Runners X Is Septic Permit Required? Yes or No Slab x Further information requested on the reverse side of this sheet Name of Installer or Mobile Home Dealer: vt�`�G1�c ice' c�r'l.1 Address: Phone No. !.t gib•. ''w;, Complete information below found on a"plate"or"sticker"which is affixed to the mobile home. 1. Insignia serial number. 2. Name of manufacturer Re— mAj\-., 3. Plan Approval Number: 4. Model or Component Designation: ( o� 13 DW & (!2 (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. Signature: owner,owner's agent,architect,contractor Special Conditions of Permit By- Fom 1111911999sh Code Enforcement Officer Project Name: e",0 BP# Address: Building Permit Submission SbNL-fani(y dud* Twfarrgy dudliig 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 ... ... ... ... ...... ... ... ... ...... ... . s D no D n/a 2. Energy Form or CheckM&te Energy Code Compliance Forms Complete Dyes Dno 0,n/ 3. Energy Code Inspector's Report from Checklvbte Program... yes n no n n/a 4. Septic application completely filled out(if applicab ..... . ... ... F]yes F1 no F] n/a 5. Solid Fuel Burning or Gas Appliance Form... ... ... ... ... ... ... ... ... ... ... ... .Dyes nn/a 6. Electrical Inspection Form... ... ... ... ... ... ... ... ... ......... ... ... ... ...... ... .. ❑Dyes ❑Z�� o nn/a 7. Two(2) complete sets of structural drawings... .. .....�.� Elno On/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.... ...... ... Dyes nno Dn/a location of well-or water lines,location of septic system or sewer line. 9. Setbacks from property lines to new structure ... ... ... ...... ... ... ... ... ... .. Dyes Dno nn/a to. Setbacks to neighboring wells and septic systems,including onsite well... . Dyes nno nn/a and septic systems (if applicable) it. DrivewayPermit... ... ......... ... ... ... ... ...... ... ... ... ...... ... ... ... ... ... ... Dyes a Fln/a Date: Staff Initial:. L.\Suel-lemingway\Building.Pennit.FOF,NE\Generic Checkfist.doc I L T4102 AL- ■NIMP.M=-GTVC=30 ai F*M'Pcm 'T :. IMOBitLsl�= / N%AC=DCML.JLA►VM= _ - - Tc~n- of Qu4e nstmry j Building 8k C©de Enforcem�rt# f 742 -13e y Fi43d - �► CQuoiBnst>ury, NY 12804 IJA"�E INSPLGTIC:7N R�QLJI=?ST R�.CEIVED: ME7lSILE �I®ME = M+t�DLTa..-�R HOME FOC7TII�GS FC3LJNDA'I'ION BA�K�t-L FRAMII*IG_ - W AIAI 1_ f©u_ ndatic�n suppart�. pier spacing - / _ per manuf_ - ------------- _ arch©rixxg per znariuf- -------------- 000 - 3. water Line shut off ------------------- f 4- + *uv+e r Lira slippc.srt Q? 4 fit ...... . 5_ hating cresssover (dbl+�wide) off grd_ 6- dryer vented outside- --ti------------------- 7_ skirting ventilated -------------------- 8_ hot water relief valve piping outside 9. deck, porches, steps, rAilirng .... ..... 10. furnacc--Atlot water c wpermeting. ........ 11_ garage fire prcx:fixlg -------- -- ------ 12_ dc>or cl6sers -- - ---------- ----------- --- 13- plumbing fixture --=------ - ------- ----- 14. foundation insuiaticm (if appl-)...... 15. smoke detectors --. ------------------ 16_ final electrical - __-------- -------------- 17_ variance required --- ------- - ---------- 18_ data plate okay ---------------------- - 19_ mobile HUI� seal .okay ______________ Model # Serial # - - Manufacturer I>ate. of marau.facturer # 100, ©KAY TC3 ISSUE -CIO =YES - NO- COMMONWEALTHELECTRICAL INSPECTION SERVICE� INC,0/ Main Once 176 Doe Run Road - Manheim, PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL l No, Ceft, 75965 Permit Y/IttfillfiHiriliffffftffflri!!i!!!!!! �f*•'i�• �^-� �111i!!!i//fftfi!#litfftftftrfliffffff jr W j}F 5,051 "n�+iriffff#!!lliitiiifffit ifii /lNlii#litiiiiffftff/fiiH!!i!liilrf tirirfflrfllifffff titififfftff.fa.tifif rrtfHifflfff!!i!!!lilffiffffrlffti/ifitNflttflill;fie itlf#tf /�j� fs 1 6 Location {140#11IM{iIMl1#10110111#1/fMit#i MMIffY1t+MMMllflfl off M/1li1M11M1M/MM fee lfloof fif/1l if1 Mm MOMM# {+#life f!#1lIfi/M1 ml/iiMiffflt i e f 1 rj bier i `YI #,# �ry / Installation Consisting V 1! f fni rfllMtli!!It/rfiffmuM;011111 1A.61'.464 .110001,W.. .tffMMlM/IiieMlff/+MMi1li/111MiMiM/fffMMffMMiitfitfffa Itlief•tlffll•flbfooflMlMMlialifooMllffiooli#N#o!+!f flit Hff1{fill►ifplil+eel rMMMMMi1 MI11111+/lMMiiMfMMeiM1fllM/Mf111111it.lMi oo#ffffiitbosoMf lee off 04M+ l MII.f111111 football MMef bite##f fiflilofeof a+elfeltll$bii fee liMM1/fMf IMl loggia f11.M11i11Mtrlfloll Bathe lf11f 1 if l It elf Mfll foo it got efffllff take l off oil#oo/11'iifi l lei a lM itf{f InstalledBy,,,,, M• foolfi tf flMf i1f•„oofY IIIooiMflfilooffiffffflfliflli//llilffel!l11If111 1 No. 1*fff+iMfeerfMoofooN*iMf4ff41ff1 fee boo M telff 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 i pections at any time, and if its p rules are violated, the Company shall have the righgtre ke th ificate o3ISPECTO� !iiif lolffMMlff floofffllfl/lfffoo111Mteiloci+f Mi 11{/ii 1111flooifff Ffi• Iateffi/leak/iN .lib fie ffiff{footiiiloll+fiMll lot ! Member VIA,11Air,1i, A7AJ Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: A,, 0 3 Queensbury Building&Code Enforcement Arrive: am/ n Depart: am/pm 742 Bay Rd.,Queensbuiy,NY 1,2804 Inspector's Initials: � 10 � NAME: PERMIT NO.: /)a—� LOCATION: ?s INSPECT ON: XAd. ! RECHECK: 'Comments and/or diagram Soil Type: Sand J Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance _ft. �^ Well separation distance ft. Other wells: ft. Absorption Field: Total length ft Length of each trench ft. f Depth of trenches ft. Size of Stone -Seepage Pits: Number Size: x Stone Size: Piping S'4ea Type Building to tank G Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/NI Partial Location/Separations �± `� G c^► �- Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Location of System on Property:. Front aront Left Side Right Side 1 Middl Middle Rear System Use Stat Ap roved P rtial Approved and needs to be re-inspected,please call the Building&Codes Office isapproved LASueHcmingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Foundation Inspection Report Office No. (518)761-8256 Date Inspection request recdived- Queensbury Building*&Code Enforcement Arrive: am/ Depart: pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: Z4z dNAME: PERMIT#: mlc LOCATION: INSPECT ON: g> TYPE OF STRUCTURE: Comments Y N N/A Footings Pie 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 Foundation Dampproofing Foundation/Waterproofing Type of Dampproofing/Waterproofing Footing Drain Daylight or Sump, Footing Drain Stone: 12 inch width 6 inches above footing 6 mil of for wet areas under slab Backfill Approval Plumbing Under Slab PVC/Cast/Copper Foundation Insulation Interior Exterior R- Rough Grade 6 inch drop within 10 ft. L:\SucHeiningway\Building.Codes.Inspection.FORMS\Foundation Inspection Report.doc January 28,2003 Al (,J RECEIVED OCT 2 5 2002 Fain TOWN O ENSBURY BUILDING AND CODE xl 7 h (11n a� M Kitchen- . Master opt. (.uv�ng� YP I Bedroomw v D I Bookcase Room LFU 01 J 'L _ . Upt W-0- 5 Y1762A 140802) Approx. 959 Sq.Ft. Moz 1 ENM � 2 � L opG � Ng I er Bath Opt• i Alternate Nast Deluxe D 1�.►,' . �w TOWN 4F QUEENS.BURY Bay at Hav#and Road, Queensbury, NY 12844-9725--51&n2 W2 TOWN OF QUEENSBURY BUILDING DEFT. PROPER METHOD FOR SUPPORTING A MOBILE HOME SHOWN. FOR USE WITH A SINGLE WIDE MOBILE HOME ONLY FOR -USE WITH A DOUBLE WIDE USE SAME METHOD UNDER EACH SIDE SLAB TO -RUN FULL LENGTH OF THE TRAILER AS SHOuN . TRAILER BODY TRAILER FRAME WOoi7 CEMENT BLOCKS • c dPT/ov t5ht Mf Vf rOWN OF'QUEENSSUM RECEiVEr) MAY 151991 BLDG. & CODE DEPT. Aa s F- r 1 I a C P i ( Jkme= t-god'C A Cam-.. (es��r TOWN OF QUE`NSSURY 1 d�'Si17E 6•a acr-e.5 SUILDIfVG 8e S D PT® REVIEWED BY \I (Jo I l DATE 6 �7 l CON S 17A2�' o TGYr :r,?r t 11 1 d— S3U+'t`BUl GihaG EPARTMENT e+&d on our limited examim bon, compliance vdth our commer s shall { r, not be construed as indiCatin, Ehe ivty L f 7 d pans and Specificatrons are' fi>rd I� c rr!I:!iarce Mth the erode. � r NOTICE ANCHORING OF MOBILE HOM FRAME IS REQUIRED P „ IJIANUFACTURERSSPECIfICA NS f i NOTICE FOAM INSULATION MUST BE COVERED BY A 15 MINUTE THERMAL BARRIER NOTICE KRAFT PAPER INSULATION MUST BE COVERED BY NON-COMBUSTIBLE BARRIER