97-012 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW PORK
Date June 9 19 97
.5-10
This is to certify that work requested to be done as shown by Permit No. 9 C 1
has been completed.
This structure may be occupied as a MOBILE HOME
LOT 111 HOMESTEAD VILLAGF
Location
Owner T-T!1 MT'T.Tggn
By Order Town Board
TAX MAP NO. 93 2-11. 1.
TOWN OF QUEENSBURY
LGz
Director of Bldg. & Code Enforcement
` S` '`,
4,...
TOWN WN OF' Q ULLNS I3 UIZ 17 1997
REVIEWED BY: I - �. fL ,,,,. F...�C9Q
FEE PAID: :
PERMIT NO. _9_T=:_QL2
APPLICATION FOR PERMIT
MOBILE HOME OR MODULAR
A BUILDING PERMIT MUST BE OBTAINED BEFORE PLACEMENT OF MOBILE HOME.
NO INSPECTIONS WILL BE MADE UNTIL A VALID BUILDING PERMIT HAS BEEN ISSUED.
The owner of this property is: I) c C< 72-tys.-‘1°
Li P.O. Address: ►c Phone Number.7 .1_2_...Lfo 0
Property Location Tax Map No. / /
NAME OF APPLICANT: X' p
Address of Applicant: I) I ig-AC,V '
All applicants spaces on this application MUST be completed and the
signature of the applicant MUST appear on the reverse side of this application.
PERSON RESPONSIBLE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES:
MOBILE HOME INFORMATION APPROXIMATE VALUE OF HOME: $ ;23
New Home Yes No (tok ZONING INFORMATION:
Replacement Home/glow) _411, Si ze of Property: ft x ft
Size of mobile home ��ftx )�ft :` .
,;f.
Existing Buildings: �;
Singlewide V Doublewide
No. of rooms (� Proposed building-distance from property line:
(exclude baths) Front Yard ft Rear Yard ft.
No. bedrooms 'D Side Yards ft and ft.
No. of bathrooms Z Occupancy Information: '
Primary dwelling: Yes No
Fireplace ---Woodstove
Accessory Building(s) :
Foundation style and size: Detached garage (one car /two car car)
Attached garage (one car/two car car)
Piers-No. of Size ft x •ft Storage building —
Otlrer
Depth below grade ft
* * * * * * * * * * * * * * * * *
Foundation-Footing size x "
Proposed date of placement:
Wall material
Wall thickness " Height " Water Supply: Well Municipal
Total depth below grade ft. Septic permit required?
Grade to home floor level ft.
•
FURTHER INFORMATION REQUESTED ON THE REVERSE SIDE OF THIS SHEET
NAME OF INSTALLER/MOBILE HOME DEALER: bs.,,,c2_4,e_L___
ADDRESS/PHONE NUMBER i2 )4eti2?Z'U'iV.\ < , t)q it
STATE OF NEW YORK DIVISION OF HOUSING AND COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF THE STATE BUILDING CODE
1. Insignia serial number `� � k`t)C-Td
2. Name of Manufacturer
3. Plan Approval Number
4. Model or Component Designation •
5. Date of Manufacture tCrC&
`b
All the above information is to be found on a plate or sticker which
should be affixed to the Mobile Home. Complete above with that information.
•
Town of Queensbury State of New York
County of Warren
AFFIDAVIT
. 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 bq. 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 aut orized by the owne .
Signature
Owner, owner' s agent, architect,
contractor
SPECIAL CONDITIONS OF PERMIT:
By
Code Enforcement Officer
DECLARATION: Please sign below after you have carefully read the statement.
To 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 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 noted, and
that such work is authorized by the owner. Further, it is understood that 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:
•
(owner, owner's agent, architect, contractor)
BUILDING PERMIT
VALUE $ 23000TOWN OF QUEENSBURY No 97012
TAX MAP NO. 93. —2-11 . 1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to LEE , MICHELLE
OWNER of property located at LOT 111 HOMESTEAD VILLAGE Street, Road or Ave.
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 Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
LOT 111 HOMESTEAD VILLAGE
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
GLENS FALLS MOBILE HOME INC.
3. CONTRACTOR or BUILDER'S Address
39 SARATOGA RD
GANSEVOORT , NY
4. ARCHITECT'S Name
NEW YORK BOARD
5. ARCHITECT'S Address
NEW YORK BOARD OF FIRE UNDERWRITERS
6. TYPE of Construction—(Please indicate by X)
MOBILE HOME
( 1 Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
70 'NOX14 ' MOBILE HOME AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
MOBILE HOME
$ 35 PERMIT FEE PAID —THIS PERMIT EXPIRES January 24 ,19 99
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 24 Day of January 19 97
SIGNED BY45�� ��� for the Town of Queensbury
Building a • Zoning Inspector
BLDG.PERMIT NO. 9 7-012 -
APPLICATION FOR A TEMPORARY CERTIFICATE OF OCCUPANCY
A TEMPORARY CERTIFICATE OF OCCUPANCY is hereby requested for the property
located at; Lot '111 Homestead Village Melissa Lee
for the following uses: Mobile Home
4) /07
DATE SIGNATURE.OF APPLICANT
TEMPORARY CERTIFICATE OF OCCUPANCY
The TEMPORARY CERTIFICATE OF OCCUPANCY is hereby (v1 PPROVED
( )DISAPPROVED
with the following conditions: Certificate of Occupancy to be
issued upon completion o : -Anchoring, Skirting,
venting and drainage thru skirting
pf'r be corm)],ater3 i n snri r3A1 of 1997
TEMPORARY CERTIFICAT OF OCCUPANCY FE • 10.00 DE° SIT: kr 00.00
received on
C �O 2 f`
Date of Iss an a Director of Bld & ode Enforcement
THIS TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES 9.0 DAYS
FROM THE DATE OF ISSUANCE.
NOTE: This Certificate is NOT VALID unless signed by the Director of Bldg. & Code
Enforcement or his designee.
THE NEW YORK BOARD OF FIRE UNDERWRITERS ''`- 't' -'
BUREAU OF ELECTRICITY
111 WASHINGTON AVENUE,SUITE 704,ALBANY NY 12210 ,�
�' J?llilrIr." il.. [.'+°'n' Ell.°Dd� 1✓"' Iraqi f§.' 1.2,Y3t:t )
Date Application No.on file
�' PERU t T Ni . C)'S,_t.1'z,
THIS CERTIFIES THAT •
: only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
iR1=111'<i. . i 1'i 3 1.11.0.aP.WF: .PO, tiAlfi .C7yVA9 r.i . i''$.'Er. .,
UT 'i
.'" in the following location; ❑ Basement ❑ lst Fl. ❑ 2nd Fl. OUTSection Block Lot ' l ;" ;
1ArilIAli- t n:I.4'_i7
�: was examined on ' and found to be in compliance with the National Electrical Code.
►' FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
• OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 4
•' 'i
'el.:
DRYERS FURNACE MOTORS •
FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS '
X' AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G.- AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS AMT. WATTS '-,
i' - NO.OF REST 'i
i' SERVICE DISCONNECT _ NO.OF - - S -_- . —E -R - - - V-
!, AMT. AMP. TYPE MEQUR 1 2 2W 1 p 3W 3 if 3W 3.8 4W NO.OPER 1COND. OF CCC.W.CHID.; NO.OF HI-LEG OF Ale NO.OF NEUTRALS OF NEUTRA G. L ••
ic• I
OTHERc
E APPARATUS: ` 7 t' ii
.i:'Jieial.FF R", {1. 11. 1111:0 . TO 1,'�F 3.'j."` . 'i
1;.:: i
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1.
K' •,i
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�. BRANCH MANAGER
: il.cti`.I t+:ti,'l2't'-k I'd`i, L28,' I_, - ;--' '•
is Per 'i
.K: 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. 'i
6i-76it-; .76 ., i.,'r, -i40 4,';•;..,.-, r 61 f.1:.= 4,•4,4 NEESESESSE MOE ME 0 .7,ei•,.i':;.i•,." ;„-,.i q,-,.,->„,•, ,• .. . ,•i-•-^,.,i, -i• -,., ,a,•�- ,• •.' 'e- ."<•
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
FINAL INSPECTION REP u:i IT " '2,!
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761=8256
ARRIVE: ' 0DEPART:3,IV IN " `
DATE INSPECTION REQUEST RECEI r'((� ( i 7
NAME: �� • _"
LOCATION / wrym / 0
DATE " PERMIT# r �'
MOBILE'H ME MODULAR HOME
FOOTINGS FOUNDATION _ BACKFILL_ FRAMING
N/A YES NO
1. foundation support, per spacing
per manuf.
2. anchoring per {
3. water line shut o ..........
4. sewer line sup' @ 4 feet _ J
5. heating crossover (dblewide) off grd.
6. dryer vented outside _ v/
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 required ///
18. data plate okay
19. mobile HUD seal okay •
_
Model # Serial #
Manufacturer •
Date of Manufacturer
OKAY TO ISSUE C/O YES NO
Comments:
1 p �� - �.
FINAL INSPECTION REPORT
MOBILE / M®4 ULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIVE: DEPART: INSP:
DATE INSPECTION REQUEST RECEIVED:
i �/f
NAME: , /1[FLU 50",
LOC A1144 11! a TES 064.
DATE: / q7 PERMIT# / / 0/2—
� J
MO:1LE KA ME MODULA +. ffHA Ill
FOOTINGS _ FOUNDATION _ BACKFILL_ FRAMING
N/A YES NO
1. foundation •upport pier spacing
per man f
2. ancho ' f. ,
3. water me shu . t
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 _ 7
16. final electrical -
17. variance required
18. data plate okay — — —
19. mobile HUD seal okay
Model # Serial #
Manufacturer
Date of Manufacturer
P
OKAY TO ISSU /O YES NO
C b/Vc,J5 c% Ccltilt 0
Comments:
44,4*),-4/6 a1t1/e774.1.6 4 U -A..irf )c
—"DRktA1.4-6 G •7?,Qu
I g/y/k b .,.‹'/tiG '77
FINAL INSPECTIOINI REPORT
MOBILE / MODULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
2, (518) 761-8256
ARRIVF9' DEPART:
DATE INSPECTION REQUEST RECEIVED:
M
NAME: • • nife 4-15 C4-
LOCATION: II( dW///r6,ib UL
DATE: 7// /i 7 PERMIT# / / ---O/2--
� J
s O:ILE BIOME MODULAR HOME
FOOTINGS FOUND ION BACKFILL FRAMING
N/A YES NO
1. foundation support, pi:. pcing
per manuf.
2. anchoring per. . f. _
3. water line shut,o
4. sewer line support 4 feet
5. heating crossover (dblewide) off grd.
6. dryer vented outside
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.)
1 . 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 INLSPEc TI®N REPORT
MOBILE / M®OULAR
Town of Queensbury
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
(518) 761-8256
ARRIV:m7— DEPART INSP:'Jt`
DATE INSPECTION REQUEST RECEIVED:
NAME: l eC
i
LOCATION: 1 O ke- rF41 VI.4—
DATE: 3 I G PERMIT/I 97'v t2"----
MOBILE HOME MODULAR HOME
FOOTINGS FOUNDATION _ BACKFILL_ FRAMING
•
N/A YES NO
1. foundation support, pier spa g
per manuf. ...... _ __f 1
2. anchoring per manuf.
3. water line shut off
4. sewer line support @ 4 feet 1� f _
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 V
14. foundation insulation (if appl.) —
15. smoke detectors
16. final electrical _
17. variance required _ —
18. data plate okay _
19. mobile MUD seal okay _
Model # 19-8: g 71-���4Serial #
Manufacturer t tTk A)
Da of Manufacture 5 igsi3
`
OKAY TO ISSUE C/O YES NO
tN.t�,
Comments:A sl10Elo RA kit TO 4wp46 r 7 /'4''
*ANC r9�
t w'-5 (' Co AL Pc -r / 'oi( d 12-A
C/d 'KtSTIAi& OI W/2. k UI
-r no S r r lr✓,4L �C—C
.„.... ., ___„
. 1a\....,,,-- -,h,)of ir` '
t b m.e 1
1
. 1,r�tom ` '#�l°a
f ,
TOWN OF QUEENSBURY BUILDING DEPARTMENT
I Based on our limited examination,
compliance with our comments shall
not be construed as indicating the
1 plans and specifications are in full
compliance with the code. •
4
I
s
r APROv
Applicati®>n
z'NOTICE i
s •
3
JAN 2 199�
OINCRORING OF MOBILE ‘ • r ^"i-, .-_
SRAM REt�3liRE®P
inisuator
. , UFAG1 RS wiCATIONS
L. , `TOE ���EYdS6 I e
. ; ! i
i
JAN 17 1E.
, j "� lry. !
TOWN N OF .. sEE. ,.? URY i l•owr} O-QUE '
, BUILDNG p',.. eldinESiDEPT. i -...,.., ,
A `
REVIEWED BY Iil J� 4
DATE / -t� k
i� \ , _ +'•.,. 3--_. •. 1 i