1999-671 4
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date November 15 19 99
This is to certify that work requested to be done as shown by Permit No. q q F 71
. has been completed.
• This structure may be occupied as a MOBILE HOME
LocationLOT 19 HOMESTEAD VILLAGE
Owner 1AI'TAT(71(1CT4 nal/Tr
TAX MAP NO. 9 3 . -2-11 . 1 By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 25000 Building Permit No. 99671
TAX MAP NO. 93 . -2-11 . 1
Permission is hereby granted to MCINTOSH, DAVID
Owner of property located at LU Z ERNE RD.
in the Town of Queensbury,to construct or place a MOBILE HOME
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 Building Codes and the Queensbury Zoning Ordinance.
Owner's Address:
LOT 19 HOMESTEAD VILLAGE
QUEENSBURY, NY 12804
Contractor or Builder's Name:
_ COMBS TRUCKING
Contractor or Builder's Address:
VAN DUSEN ROAD
QUEENSBURY, NY 12804
Electrical Inspection Agency:
COMMONWEALTH ELECTRICAL AGENCY
PO BOX 706
HAGUE, NY 12836 _.
Type of Construction:
MOBILE HOME
•
Plans and Specifications:
980 SQ FT MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
MOBILE HOME
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$ 35 October 29 2001
PERMIT FEE PAID—THIS PERMIT EXPIRES
(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 Queensbury this 29 Day of October. 1999
SIGNED BY As:-)OkOf',43(01/41/1/4.,‘,2- for the To of Queensbury
Code Enforcement Officer
•0 . TOWN Od Q1J ENs'13URY
!.
REVIEWED BY:
rC
FEE PAID: $ v,).
PERMIT NO. ,clICl—(42--) /
APPLICATION-FOR PERMIT
MOBILE .IIOME OR MODULAR
A BUILDING PERMIT MUST BE OBTAINED BEFORE PLACEMENT OF MOBILE HOME.
NO INSPECTIONS WILL BE MADE UNTIL A VALID UDILUING PERMIT HAS BEEN ISSUED.
The owner of this. property is: Pa-fis.c,r-a (,\,x, 9
P.O. Address: - P c ) 5 cl _ iquaA Ail y 0 99/°/ Phone Number .7/‘a.0 -6/36
Property Location Mes e�l�21/4 ;��
.7c: QveevAS 8a,rY Tax Map No. / /
NAME OF APPLICANT: �Iro;r‘ M cLtiNta3 if -- _ a aj
Address of Applicant: �
1� slot' e g ;'il y,,y 5)r ,L le AvaerA A0e: /G S'y�l
J
All applicants spaces on this application MUST be completed tadjp=---- ie
signature of the applicant MUST appear on the reverse side or this applica° i:�ir
PERSON RESPONSIBLE FOIL SUPERVISION OF WORK AS REGARDS BUILDING CODES:OCT
T 214.t, 2coF 1999
MOBILE. iIOME INFORMATION v��
APPROXIMATE VALUE OF 110ME: $ a:3:od c)
New llama . Yes OD
ZONING INFORMATION:
Replacement Ilonie Yes
Size of Property: ft x ft
Size of mobile home /Z( ftx')afl
Existing Buildings: "TR.,; l€rs (g and Q.6
Singlewide )( ,Doublewide . ������ cK
No. of rooms (exclude baths) Proposed building-distance from property line:
Front Yard 3-1 ft Rear Yard Zs-- Ft.
No. bedrooms Side Yards ya ft and cA! 4.. B e ,c �
Occupancy Information:
No. of bathrooms /
Primary dwelling: es No
Fireplace_ y Woodstove ,40
Accessory Bullding(s) :
Detached garage one car /two car_ car)Foundation style. and size:
Attached garage (one
car~/two car car
Piers-No, of Size ft xStorage building — )
ft / 0tller shied,
Depth below grade _ ft .
* * * * * * * * * 4, 4, 4, 4, A * * *
Foundation-Footing size " x• "
Wall material Proposed date of placement:
Wall thickness / " Ileight-rb " Water Supply: Well Munlcipal ?C
Total depth below grade ft. Septic permit required?
Grade to home floor. level ft.
FURTHER INFORMATION REQUESTED ON THE REVERSE SIDE OF TilIS SHEET .
•
NAME OF INSTALLER/MOBILE HOME DEALER: 60a) 6s �T��,�, ,� ' ;
a .
ADDRESS/PHONE NUMBER Uar1 t,setl k. (NS 11 v r'� Y
q - 575g' •
STATE OF NEW YORK DIVISION OF HOUSING AND COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
1 . Insignia serial number (t,5 'Og. .500 J -
2. Name of Manufacturer r-cXyls`4� k�a.e.zr- tt- K -Ark
3. Plan Approval Number TT��
4. Model or Component Designation Sky 1/a q
5. Date of Manufacture 4F-16 •--2)
Al 1 the above information is to he found on a plate or s Li cker which
should be affixed to the Mobile Home. Complete above with that information.
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•
•
•
•
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Town of Queensbury • State of New York
County of Warren
AFFIDAVIT
I swear that to the hest of my knowledge an(I belief the statements contained
in this application, together with the plates and specifications submitted,
are a I.rue and complete statement of all proposed work to bq, (lone on the
described premises and that all provIslotts of the BUILDING COI)I: , the ZONING
ORDINANCE, and all other laws pertaining to the proposed work shall he comps led
with, whether specified or not , and that such work Is authorized by the owner.
Signature p� L4
Owner, owner' s agent, architect,
contractor
SPECIAL_ CONDITIONS OF PERMIT:
By
Code L•nforcement Officer
DECLARATION: Please sign below after you have carefidly read the statement.
'I'o the best of my knowledge 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 clone on
the described premises and that all provisions of the Building Code, the Zoning Ordinance and all
other anus pertaining to the proposal work shall be complied with, whether specified or noted, and
that such work is authorized by the owner. further, it is understood OW I/we shall submit prior to a
Certificate of Occupancy or Certificate of Compliance being issued, an AS BUILT PLOT PLAN by
a licensed surveyor; drawn to scale, showing actual location of project on premises.
Signature: Rf7)1 L
(owner, owner's agent, architect, contractor) '
\ •_l'.•• • '•:L:_l fi •..Q.!)_.0cl5,•ti �1 ., •_l •^l'J.L•l AQJ_•_l.0. •A AQ�S. t:'.0. .• '•0.0. J•_l' •l •_VAQ Al';!••Ar.Al'•_l..).Ak.:AR J Q'),,... 46.4rAl."7.•L'J,•_l!.l J.• ).•.F:'J.•.l'l/,
1i
e THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE
8080779 BUREAU OF ELECTRICITY A
111 WASHINGTON AVE., SUITE 704, ALBANY, NY 12210 i
1 t1%!)jfF,'!• R 02,10 g - 460? 29c) 9.9 11 4a56i 49
Date Application No. on file i
THIS CERTIFIES THAT L 7
11 only the electrical equipment as described below and introduced by the applicant named on th above ap ication number is in the premises of IA,
DAVE . iCI.NTOSH, LUZE3t,'�.'1E RD. LOT 1$. 1.211E�`.NZBif 'Y, Err 4
`, Ih
-41
in the following location; ❑ Basement ❑ 1st FL ❑ 2nd Fl. OUT Section Block Lot 1�'
,•�.{ii was examined on )! 1"d�l E 29..1. ti and found to be in compliance with the National Electrical Code.• ij•_,�
•
Wi FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS i
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS MULTI-OUTLET DIMMERS I�UNIT HEATERS
BELL }I
.N" AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. E2 H.P. NO.OFSYSTEMFEET AMT. WATTS
ij1■■■.■■.-.■■■■■.■_■
'd SERVICE DISCONNECT NO.OF S E R V I C E r
_<! Oi
I-S' AMT. AMP. TYPE MEER NO.OF CC COND. A.W.G.. A.W.G. A.W.G.
EQUIP. 1 ®2WIrEN 3 0 3W 3 4W PER 0 OF CC.COND. NO.OF HI-LEG OF HI-LEG NO.OF NEUTRALS OF NEUTRAL
f'' . .7 4,
OTHER APPARATUS: ..
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WI oi:
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IA
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Si+ 4= .R11 %' O. HITCHCOCK f L � �• .
•i s ''1',,`*t1"A *ra r�4, g GENERAL MANAGER I+
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ii1 .� ` .� Per '}i
l 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. iTT.t
%1YYYY ,7Y YI i Yl iY7YYYT YYYLYYYYYIY 'Y,YY, ;7Y 'iYYYYYYYY,64- YYYYYI"Y,giti ¢ li -i- YYYI'Y,Y-w•tift,1 ,Y'YYYr YY
• • �Y,• Y• Y• Y• •Y • • • • • • • •_ • • • •.X•Y • •Y • � • • • Y•, •, •., • • Y•YY•,7• Y• • • • • • •Y_• •,Ya_L• X
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
FINAL INSPECTION REPORT
MOBILE / MODULAR Town of Queensbury /i3(
sC
Building & Code Enforcement �
742 Bay Road
Queensbury, NY 12804
(518) 761-8256 ,/._:
ARRIVE: }ti v,:_f'DEPART: Z ZPNS :
DATE INSPECTION REQUEST RECEIVED
NAME: 11114 ) ME
1 , .; 1
'
LOCATION: , . iir/lV FAO �l.
DATE: t l C�q I PERMIT #� j 1— 9 /l
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION _ BACKFILL_ FRAMING
N/A YES NO
1. foundation support, pier spa,4 g /
per manuf. -
2. anchoring per manuf.
3. water line shut off _ t 4. sewer line suppo i @ 4 f-: / —
5. heating crossover •: -• -) off grd. ✓ —
_ _6. dryer vented outside ..ti — —
7. skirting ventilated —
8. hot water relief valve p".ing outside —
9. deck, porches, steps, r. ling —
10. furnace/hot water opera ing ✓ — —
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 — 7/ _
19. mobile HUD seal okay — V
Model # Serial #
Manufacturer
Date of Manufacturer
OKAY TO ISSUE C/O \/YES NO
Comments:
FINAL INSPECTION REPORTU
MOBILE / MODULAR
Town of Queensbury 9 1 'HO A0
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: 41(DEPART: INSP:
DATE INSPECTION REQUEST RECEIVED:
NAME:
1 i )
LOCATION: �� y 1 �v' '����`-'Y 1
DATE:\\r) b.) -9,.9 PERMIT.# J
MO:ILE HOME MODULAR HOME
FOOTINGS FOUNDATION _ BACKFILL FRAMING
N/A , YES NO
1. foundation support, pier spacing
per manuf. .— /
2. anchoring per manuf. — �/
3. water line shut off 4. sewer line support ®4 feet .. /
5. heating crossover (dblewide) o rd. Y —
6. dryer vented outside — —
7. skirting ventilated — —
8. hot water reliefalve pipin utside / —
9. deck, porches, steps, railing — - —
10. fumace/hot water operat' f —
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 kay — — —
Model # �) 9 -4, Serial # .//5--OZszi-L
Manufacturer 3-X 7 m-e
•
Date of Manufacturer /(,/.7
OKAY TO ISSUE C/O YES I/NO
Comments:
FINAL INSPECTION REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART j1)• INSP: CV&
DATE INSPECTION REQUEST RECEIVED:
NAME: -D At)L tAk,G )Arri*-`(t
LOCATION:
DATE: / {t PERMIT II U V Of'
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION _ BACKFILL_ FRAMING
N/A , YES NO
1. foundation support, pier spacing
per manuf. — — —
2. anchoring per manuf. — — •
—
3. water line shut off — — —
4. sewer line support @ 4 feet — — —
5. heating crossover (dblewide) off grd. — — —
6. dryer vented outside -
7. skirting ventilated — —8. hot water relief valve piping outside — — —
9. deck, porches, steps, railing _ — —
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 required18. data plate okay — _/ —
19. mobile HUD seal okay — 1/
Model # !`6-A Serial # it i=D Z5-3 'L'
Manufacturer 10,u1/1.JC
Date of Manufacturer e3//&/7 2
OKAY TO ISSUE C/O YES NO
Comments: P/2f-—IR64 it)5,7r
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