2000-447 BUILDING PERMIT
Town of Queensbury, 742 Bay Road., Queensbury, NY 12804
County of Warren (518) 761-9256
- - Building Permit No._ c bib 4t4r7
Permission is hereby granted to rn mm.,,! f 3Fx s 3 7
Owner of property located at LCYx &Is ptr cm� Lny%r
in the Town of Queensbury, to constructor place a rob&LEAMNNE
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the NYS Uniform Budding Codes and the Queensbury Zoning Ordinance-
Owner's ss: „ _ w .
Contractor or Builder's Name:
Contractor or Builder'
ardft Tbel
4
Electrical Inspection Agency:
we
Type of Construction:
Plans and Soccifications.
Proposed Use:
$ _PERMIT FEE PAID - THIS PERMIT EXPIRES o /
(If a longer period is requirrA an application for an extencson must be made to the Code Enforcement
Officer of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this Day of 3V;LYkk Caw o
SIGNER BY .__.S n "/1 1 for the Town of Queensbury
Enforcement Officer
Application for Permit --- Mobile Home
Town of Queensbury, 742 Bay Roag Queensbury, NY 12804 (518) 76I-8.2.56
A building pewnit must be obtained before placement of mobile home on parcel. No inspections will be made
until a valid building' permit has been issued. :
Appliccanat Ir formation
Office Use
Name: L'r!Q l 43 C" File Permit No
s
Address: .ze 11 ,�s I'"iyr .R�.nJ-- ,-- Fee Paid.
y:
Phone No .S1 &' 93, i .3 S'S JUN �
Property Owner Information W _ r Parcel Information
Name: Proposed Date of Placement:
Property location s� I. A Address: Sheet, Avenue +
Name of Mobile Home Park: (492W�.S t,,�
Phone No. Tax. Map Number: d I 1 (,G' !
Mobile Home Information ,Zoning Information
Approxitnate Value of Home: S
e + y' Zoning Classification:
New Home: Yes No { i
Size of Property: ft. by ft.
R place meirt Home: Yes No , -;L
5 Existing buildings.
Size of Mobile Home: ft. by ft.
Set_ba�: f-aut yard $ ; rear yard &
Smglewide: Doublewide: r'<_ - Side yards ft. and ft.
Number of Rooms: (exclude baths) la
Number of Bedrooms: - 3 Accessory Buddmg(s): circle
Number of Bathrooms:
Detached ,garage: 1 car; 2 car, car
circle: Gas Fireplace or Woodstove .Attached garage: 1 car; 2 car, car
Storage building: Yes No
Foundation Support: Other:
TYPEAs'ZE Eppm Waters i circle
Piers � Supply:
Runners
Slab well ; municipal
Further information requested on the reverse side of this sheet 111110"
Name of Installer or Mobile Horne Dealer: A161> Ct 's
Address: ,c- C� C_3ac ki"_' 12,e 3
Phone No.
State of New 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.
1 . Insignia serial number: 157 2�
2_ Name of manufacturer: &M �t
3 . Plan Approval Number :
4. Model or Component Designation: ��.+`' 4ee 3
(New Home ONLY)
5. Date of Manufacture:
AFFIDAVIT
"Town of Cueensb ry 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
ZONIlNG 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,
Signa
owner, o e slgdIt architect, contmalor
Special Conditions of Permit
By:
Form: 11n8r1999sn .. Code Enforcement Officer
FINAL IN@P�CTiON RIEPORT
RJiC7@iLe / NId�ULAi�
Town of +Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, IVY 12804
(518) 761 -8256
ARR L5E DEPART: V24L�N8P:
DATE INSPECTION REQUEST RECEIV
NAME: ymqA
LOCATION:
'�} h('�� '�y,ry��+
DATE: .1 �Jo PERMIT �0�
MOBILE HOMB MODO-LAR HOMR
FOOTINGS . FO AIlON% SACKFILI. ' FRAMING _
N/A YES NO
I . foundations support, pier spacm
per manuf. .. ... 7. . - 400
_
2. anchoring per manu . .. . .. .. .. .4 ..
3. waterline shut off .. .. .. .. ., . »» —
4» sewer line support feet — —
5. heating crossover (dbl % ) off grd. —
6. dryer vented outside . »; .. . .. .. .. . .. .. .. . _
7» skirting ventilated . .. .. .. .. . _
8. hot water relief valve pipin ide _
9. deck, porches, steps, railing . . .. .. —
10, furnace/hot water operating _ ,r
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 #
Manufacturer
Date of Manufacturer
OKAY TO ISSUE CIO ES NO
Comments:
THE NEW YORK BOARD OF FIRE UNDERWRITERS Vomasex,
t3�+641s94 BUREAU OF ELECTRICITYF 40 FULTON STREET, NEW YORK, NY 10038ale 1i11.Y 1 ! , r( 1NApplication No. an file to 4f VIN ITHIS CERTIFIES THAT
only the elecal'cal egafpment as described below send introduced by the applicant named an the above application number i i the
Mr,SI•x8e 4&) Qt PPEN:3HURY V1t.d.AG7E, r elF�r.N:sI3I3RY ; rl
in the follawing location; ❑ Basement FJ 1st FR ❑ 2nd Fl, f sll`1' Section Block .Lot
was examined on ,l t f 1 ;Y 1 i. r 2'000 and found to be in compliance with the National Electrical Code. -
FD=RE FIXTURES RANGES COIOKING DECKS OVENS DISH WASHERS EXHAI/ST FANS
CKJTLETS RECEPTACLES SWITCHES
PLUORE'3CEN7 OTXER AMc. K.W. AM7. K.W. AMT. I K.W. I AMT. I K.W. AMtt. H.P.
DRYERS FURNACE IYII}TC3RS FUTURE APPLIANCE FEEDERS SPECIAL REC71. TIME CLOCKS 6ELL UNIT HEATERS MULE I-CUTLET DIMMERS
AMT. ic.w. OIL H.P. GAS H.P. AMT. rtO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P_ YSTEMS
NO. OF FEET AMT- WATiS
SERVICE DISCONNECT METER S E R V I C E
AMT.. AMP. TYPE EQUIP. 1 2 11 a SW 3 e !W ' 0 4W NO- 0F1 CGQ :ONO. pF CC- ONG. Na. OF XI_LEG 4i NI-LEG NO. OF N RA FUFLS OF NEUTRAL
OTHER APPARATUS:
1-K)BIl.F1 HCI-fk:- I
tiLl!ildfi F`Al.,1 .`.i lfi?}}3] I ,I'; /I-t[}I}l.l€,iV }•y •+•�--• � ��t.
i13 SAkA`I";A RD .
GANSMWO7ON`L' , NY r 1 2.8-i I GENERAL MANAGER
_J*4
Per
This certificate must not be altered in any manner, return to the office of the Board if incorrect. Inspectors may be Identified by their credentials.
COPY FOR SUILDTNG - DEPARTMENT ``HIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
dun-01-00 . (19 :49am From—EMPIRE HOMES 5IRT512240 T-121 P. 03/03 F-224
NOTICE
ANCHORING OF MOBILE HOME _ JUN 2 2 COQQ
FRAME IS REQUIRED PER ' ' T"JA,'.` • c) -
MANUFACTURERS SPECIFICATIONS
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C TOWN OF QUEENSBURY
Tl7Wly 0a! ed on our k «�: i L r-.c Tlul llr BUILDING & Q�
�.~
Based an our km�ed exarranatiarr, T.
compliancewlth our cortuYoents shall REVIEWED B 'p
not be construed as indicating the
plans and specifications are in fulf DATE Gil
cornpliancP with the code
cpt or )H
` UN22 2D
N ; ✓ !?(T
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MOBILE HC M
N7/22/9Drawn : MITCHELL
Scale: 1 500
H A A N E N E N G I N E E R John L. Haanen , PE Thomas W. Noce, F
Q U E E N S B L1 R Y N E W Y 0
VanDusen & Steves
1 ? MAP # 9.2043 LAND" SURVEYORS, CL-ENS FALLS
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