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2000-807 TOWN OF OUEENSBURY 742 Bay Road, Queensburt�, NY 12804-5902 (518) 761-8201 Community Development = Building & Codes (51$) 7G142% CERTIFICATE OF OCCUP.A.N. CY Permit Number: P20000807 Date Issued; Friday, December 29, 2000 This is to certify that work requested to be done as shown by Permit Number P20000807 has been completed. ( �51 Tax Map Number: 523400-127-000-0003-004-000=0000 Location: 67 ILLINOIS Ave Owner: JOHN DALY A This structure may be occupied as a: Mobile Home Out of Park By Order of Town Board TOWN OF QUEENSBURY Director of Building & Code Enfotcernent TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY t2804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20000807 Application Number: A20000807 Tax Map No: 523400- 127-000-0003-004-000-0000 Permission is hereby granted to : REBECCA FLINT For property located at: ILLINOIS 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. Type of Construction Value Owner Address: JOHN DALY JR Mobile Home Out of Park 40,274.00 27 CENTRAL Ave Total Value 407274400 QUEENSBURY2 NY 12804 Contractor or Builder's Name I Address Electrical Inspection Agency Plans & Specifications 2000-807 Mobile Home with new septic system Rebecca Flint purchasing land from J. Daly (sale pending) $66.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday, October 19, 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 To ueens ry; Thursday,, October 19, 2000 w SIGNED BY :2 for the Town of Queensbury. Director of Building &Cod&Enforeement Application for Permit -- Septic Disposal System Towle o,f+Quee►tsbury 742 Buy Road Queensbury, NY 12804 (S 18) 761.8256 L OWNER INFORMATION: -.._........__..................._._................................................ Location of installation: - - _ �l . l y�J jeo � OiEice Use p r It ` I _ File Permit No Tax Ma No, { Owner's Name. Fee Paid w. �................_................. Address: -_J/7 G l eon r' %Z /1VW--fJ- 7 2. INSTA.LLER'S NAME : .fie Ct��urr-C L�� rn PHONE NO. S'96 Z 3, RESIDENCE INFORMATION: (circle year of dwelling, indicate # bedroom(s) and multiply # of bedrooms with applicable gallons per bedroom to equal total daily flaw) -year of House No of Bedrooms x _,.Computation Total Daily Flow 1980 or older x 150 gallbdnn = 1980 — 1991 x 130 gal/bdrm = 1991 — present x 1 10 gallbdrm = G?__-- Garbage Grinder Installed yes l no Spa or Whirlpool Installed yes / no 4, PARCEL INFORMATION: (circle applicable information & indicate measurements) Toro ' C).rV{ttlilatVC Ei9S3roC1t p_r ItrnpprJGiV_t!@. pl�ri�� b9ni Ater_SuI�p1Y l 'lat and ut whor depth tit wish delrth N11t.tprrl Rolling o �-- feet feel Steep slope clay well; water •srepply slope other from any septic-system depth: absorption is fl. other Percolation Test: (To be completed by licensed prt fessional engineer or architect) Rate: minute per Inch 5, PROPOSED SYSTEM* For New Construction: All ittclividuai sewage disposal systems trust be designed by n liccttscd professional engineer or arclutcct (unless instolled in a Planning Board approved subdivision). Add 250 gallons 10 the sizc of the septic tank and leach held for cacti Garbage Urindcr, Spa or Wltirlptxrl Tub. Septic Tank. e eOO gallon (min. size 1, 000 gal.,) Tile Fiold: each trench ft, Total System Length: Seepage Pit(s): number of size of each: fi. by _ _ft. Size of Stone to be used: !! / depth or thlcknes•s , ._, _•---- firet Bed System Size: x Alternative Systerrl: length and/or size C HOLDINGI TANK SYSTEM: (if required) Number of tanks: / Size of each: ,gallons f TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency, 7. SIGNATURE & INFORMATION FOR RESPONSIBLE PERSON (please read) For your protection, please note that pursuant to Section 136-29 of the Code of the Tower of Queensbury, any porn:it or approval granted which is based upon or is granted in relianco tepon 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 thOTown of Queensbury Sanitary Sewage Disposal Ordinance. o0e , S1 atur of rearplonsible person I bate Application for Permit — Mobile Home Town of Queensbury, 742 Bay Roads, C?ueensbury. 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 Office Use Name: V.. 'C" File Permit N r '� __ r 7 G �� Address: ^^ n ,r +.SG� �1 Fee.P. id. �'' /'�� ' �l d if-4t as, Reviewed By: U Phone No. Z Parcel Information Property Owner Information � _ , Proposed Date of Placemem:: Name: c'��C�-,+.--+t"_ G+- "�-G`c'-.` Property Location: .21114r 10 l.1 T Address: Road, ste=t,, Avenue Name of Mobile Home Park: (if applicable) Phone No_ Tax Map Number: 4W �3 ! Mobile Home Information Zoning Information Approximate Value of Home: S 1—/0, 2 7]' 2 Zoning Classification: �__ szw New Horne: oYes No Size of Property: 60 ft. by !00 ft. Replacement Horne: Yes Na Existing buildings: _ /L1fJrr/e✓ Size of Mobile Home: 92 ft. by Y$ ft- 16 ft. Setbacks: front yard •3 � ff ; rear yard Singlewide: Doublewide: Side yards ? ` ft_ and /D ft. Number of Rooms: (exclude baths) �7 Number of Bedrooms: �,3 ,Accessory Building(s): circle Number of Bathrooms: _ Detached garage: I car; 2 car, car circle: Gas Fireplace / Woodstove / Wood. Fireplace Attached garage: 1 car; 2 car, car Storage building: Yes No Foundation Support: other: ]aTE SIZE & nEPT i Water Supply: well or municipal Piers s Runners � Y -� is Septic Permit Required? Yes r No Slab Further information requested on the reverse side of this sheet MOO" Name of Installer or Mobile Home Dealer; p,.,2 of JLJOA am / Address; Phone No. eJca i -7 9d rG7G,7S� Complete information below found on a "plate" or "sticker" which is affixed to the mobile home. 1 _ Insignia serial number; UL -Z yq 4�0 7 f2' 2. Name of manufacturer. 3 . Plan Approval Number 92 V lr rye 4a 4. Model or Component Designation: LA 0 1v' (New Home OAEY) / 5_ Date of Manufacture. Z AFFIDAVIT Town of Queensberry 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 BUELDING 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_ Sigaahare: r, own 's agent, archi contractor - Special Conditions of Permit By- Form: IV19li999sh Code Enforcement Officer PIIVAL � Bp tCTICiN RLPOitRT MC301LE / MC3C3UL ^M Town of Queensbury Building & Code Enforcernent r� ,. �, �r►� 742 Bay Road Queensbury, NY 12804 (518) 761-8256 ARRIVE: + DEPART: (+ 4t 'INSP. I)ATE INSPECTION REQUEST RECEIVE c (N 6 NAME: f,,,., LOCATION: 6G DATE: f ;)- 02 d P .RMTT # c W0101I.E HOME DV-LAIL 390MM FC?QrCINGS__ FOUND BACKF1L.t. FRAMING N/A YE5 MCI 1, foundation support, pier ing permaauf. . . . . .. .. .. . 2. anchoring Per maauf. . .. » . .. .» .. .. — /r 3. water line shut Off , .. .. 4. sewer line support a 4 feet 5, hating crossover (dblevAde) off grd. 6. dryer vented outside ..: ... .. .. 7, skirting ventilated hot water relief valve piping tstde 94 deck: porches, steps, railing .. 10. furnace/hot water operating ~� l ] . garage fire proofing .. .. . .. . . . . .. .. J j 12. door closers .». .. _, . . .. .. .. . 13. plumbing fixture . .. .. .. .. . . . . . .. . . .. . .' 14* foundation insulation (if appl.). . 15. smoke detectors .. .. .. . . .. ... . . .. . ... .. 16. final. electrical . . .4 .. .. .. .• • • . . . . .. 17. variance required . .. .. .. .. .. . . . . . .. ». . I g. data plate okay . .. .. .. .. .. .. . . . ._. ... . 19_ mobile HUD seal okay , .. .. .... .., ». —�/ Model # �y-r (S?j =CnL. Serial # ?kVkti'aU t t •- lvlanufacturer ])ate of Manufacturer OKAY TO ISSUE CKQ YES NO C"ommients: TOM OF QUEENSBURY BUILDING ,& .CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM! INSPECTION Name Location Date � Qu - SOIL TYPE: Sand- Loam- Clay- Results of PercoI at ' Test- ( if applicable ) R e- Mi ute/ Inch TYPE OF SYSTEM!: ABSORPTI FIELD : Total ength Length of h tr nch Depth of trenc Size of stone SEEPAGE PITS : Num er- Size - • _ ft0 s ft _ Stone size PIPING : _.._.._Size hype Bldg . to Tank 0 Tank to Dist . Box Je Dist _ Box to Field i ' Openings Sealed ? a No artia LOCATION/SEPARATI Foundation to Tank feet Foundation to Absorplion feet Separatism of Pits feet Conforms as per Pl of , Plan es No LOCATION OF SYSTEM Olk PROPER le one } ront R ar Left Side Right Side e Front - ar COMMENTS : ASYSTEM APPROY YES NO u.2 ding Iptliector a Revised septic system 12I20100 100' Power pole TOWN OF QUEE U1 10' . � BUILDING & S PT. ti:,r,r,ry REVIEWED BY ��` �• DATE .� D-Box P i • S Sj L 8� "1 have seen or observed, or believe I saw evidence of, b all objs such as houses, wells, trees, fences, etc., Nshown on this document. I also represent taut I have 0 personally measured the distances set forth on t ie diag, am." 60 Water line Y n S 13 SIG ATURE ATE A 23 X 48 V ss' New HUD Code Home 16' E • ti tif• •S 6 X8 •r fl w 4' ' stone r ti•1•S•'f 5 X 12 drivewa This drywell has ; 10° a traffic cover 10 4' 1 = 10' i Rebecca Flint Tax Map #42039 I Illinois Ave Queensbury, NY 12804 1271, ■ i TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (5t8) 761-9256 SEPTIC DISPOSAL SYSTEM INSPECTION Named Location � ��} � i , A\l Date 1? - R~z r x Permit # ZrAnn : r, z? SOIL TYPE : Sand- Loam y- Results of Percolation Test- ( if applicable ) Rat Mi ute/ Inch TYPE OF SYSTEM: ABSORPTION FIELD : To al Length Length of each trenc Depth of trenches Size of stone SEEPAGE PI Num r Size - x ft . Stone size PIPING : i ze ype Bldg . to Tank Tank to Dist . Box Dist . Box to Field/Pit Openings Sealed ? Yes o Partial LOCATION/SEPARATIONS : Foundation to Tank feet Foundation to Absorption feet Separation of Pits feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROP RTY: ( circle one ) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS : �^ �1 � ��.� �ram" 1 1 G ���`•'�1, SYSTEM USE APPROVED : YES NO ArrDepiv . C J di ng pA c or MIAMI THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY F 40 FULTON STREET, N Y 1003E hate 1AP"IC"E?-t1:sEP 2000 Application No.k file4i1 ` 00 F 1li.l ATHIS CERTIFIES THAT -PE;f3t-?:J T NI } , 00 -Fit) only thus electrical equipment as described below and introduced by the applicant maned on the above application number is in the premises of PAVE's , Q(1E '4WBB(ff14Y , 14Y in the fallowing location; ❑ basement ❑ is, FL ❑ 2nd FL 4 iI i'!' Section Block Lot was examined on 1)F {`I' 1tF11.Ir I, !i , :?{}Ig{? and found to be in compliance with the National Electrical Code. , FfXTURE FIXTURES RANGES COOIaNG DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES FLLlDaT OTHER ANT, E.W. ANT. K.W. ANT. K.W. AMr. K.W.. AMr.. X.I. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS JSKCIAL ItEC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A_ W. e. ANT.. AMP_ AMT. AMPS. TRANS. Am. M.P. SYSTEMS ,. WATTS NO. OF FEET SERVICE DISCONNECT NO. OF S E R V I C E METER No. OF CC COND. A. W. G. A. W. 6. A. W. a. ANT. ASRP. TYPE GOUIP. 1 A 2Yt 1 • 31013111 SW 3 M M1N FEQ • Of CC. Como, NO. OF XI-LEG OF HFAEQ NO. OF NEUTRALS OF NEUTRAL DITHER APPARATUS: .11mT 4S: #4€ H'J-t(.]?4 tiAIN C:IHi1il''1' - 1 13HKAKHM 11Y) ,f4c3r_'sJ IAA 1f0ft 4 - # !i+3 3]i 3I]`i E <�A.N:i 1!:VT3� rlt`1' , my , J :�i3 3 # GENERAL MANAGER :' :39 Per This ceriflcate must not be altered in any manner; return to Me office of the Board if incorrect. Inspectors may be €dentifiad by their credentials. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. f,,iEdWERAL INSPECTION REPORT ( 518 ) 761 - 8256 Town of Queenslaury Dept. of Community Development Date innRtC request received: Building. & Code Enforcement 742 Buy Road `� Queensbury, NY 12904 Arrive am/pm Depart. Inspector's Initials O NAME: bz,,k� `7 Q .' ,PERMIT # '� Z) LOCATION, 3,` DATE : TRYPE OF STRUCTURE& RECHECK � NIA S N COMMENTS oatings/Piers I Monolithic Pour Form Reinforcement in Place _ The contractor is responsible f r providing protection front freezing for 48 hours following the placement of the concrete. t Materials for this purpose on site Foundation/Wallpour Reinforcement in Place Foundation/Dampproofin Backfill Approval Plumbing Linder Slab Plumbing Vent/Vents in P _ Rough Plumbing Heating Rough-In Insulation Foundation Walls Interior R- Foundation Walls Ext4irior R- Floors R- Wails R- +Ceiling Duct work or piping in unheated spaces R- Proper Vent, Attar: Vent Frarm Jack Studs/14eaders Bracing/Bridging, Joist Bangers Jack Posts/Main Be n Air Infiltration Barrier Fire Separation 1, 2, 3, hour. Penetration Sealers ; Fire Wall 2, 37 4 hour Fireskopping GENERAL REPORT ( 5l8 ) 761 - 8256 Town of Queensbury Dept. of Community Development 'Date inspection request received: It y� Building & Code Enforcement 742 Bay Road Queensbury, NY 1 �4� yArrive am/pni Bart in ��Gam.- tv7 ctor's InE" .IVI PERIT t3 / LOCATION: DATE : L TYPE OF STR RECHECK 9r1^ L. +...t...--r` rL /r N/A YES NO MMENTS FootijIgUPiers Reinforcement in Place C1/ The contractor is responsible for providing protection from Racing � RV4 J0 f>j for 48 hours following the placemen L of the concrete. Materials for this purpose on site Foundation/Wallpour, Reinforcement in Place FoundationMampproo Backfill Approval Plumbing Under Slab Plumbing VenVVents in Place Rough Plumbing Heating Rough-In Insulation Foundation Walls Interior R- Foundation Walls Exterior R- Floors R- Walls R- Ceiling R- Duct work or piping in unheated spaces R- Proper Vent, Attic Vent Framing Jack Studs/Headers Bracing/Bridging Joist Hangers Jack Posts/Main Beam .'b Air Infiltration Barrier Fire Separation 1, 2, 3, hour Penetration Sealed Fire Wall 2, 3, 4 hour Fire wA r WIN 00T, -- - OFT, t1TIiI KITCHEN BEDROOM P7[) Il. 1. A No, 2 4 J i DINING 1 � AREA NMI WHEDRAL TNRU-00 N N J B MASTER LIVING ROOM '14'4" BEDROOM BEDROOM Na, 3 t OPT. No. 1 745 116 13'-2" - I ' v LU 6801CTI4824 3BEDROOM - 2BATHS - CATHEDRAL THRU-OUT (1,096 SO&FT.) a �7 ..1.� H l ML T 47' 37' 25' 13' 1 ' H E NOTE: N these measurements are from the hitch end of the HOME not the slab T T T Front Door Side Anchor Locations for # 6801 too See the anchor instruction sheet for details NOTES: 1) This slab is smaller than the home, The sklrHng will go from the home to the ground. Utilites can be brought out of the ground between the slab and the skirting, 2) The surface of the slab must be at least bull floated, if not power troweled, to provide a smooth setting for the support piers. 3) The six inch thickness Is a minimum dimension, and does not provide for frost protection. Footers or other protection should be considered. 4) Fiberglass fibers may be used in place of wire mesh, b} If anchoring the home, imbed the F anchors in the concrete, see diagram, ram; Q, Slab Line c� Home Outline —• 47' Minimum 6' Thick Overall Home Dimensions: 22' 10' X 48' Regular Slab for Model 6801 Overall Slab Dimensions: 21' 10' X 47 X 6' Thick (minimum) Reinforce with 6' X 6' Wire Mesh 2r27t�;