98-527 CERTIFICATE TE OF Cvf%"M.0CUPAN GY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
October 28 98
�^; ` 1Date 19
i ' 98527
This is to certify that work requested to be done as shown by Permit No.
has been completed,
MOBILE HOME
This structure may be occupied as a
21 SUGARBUSH RD .
Location
MERWIN , ROBERT & EDNA
Owner
TAX MAP NO . 9 3 . - 2 - 9 . / 7 5 2 By Order "Town Board
TOWN OF QUEEN'SBURY
Director oof BIdg. Ze Code Enfor+eement
BUILDING PERMIT
VALUE $ 37273 TOWN OF QUEENSBURY moo. 98527
TAX MAP NO . 93 . - 2 - 9 . / 752 WARREN COUNTYr [NEW YORK
PERMISSION is hereby granted to
OWNER of property located at 21 ST,.UGARBUSH RD Street. Road or Ave.
.
in the Town of Oueensburi To Construct or Place a lYlO$ILE HOME
at the above location in accordance to application together with plot Plans and other information hereto filled and
approved and in compliance with the Town of Queerrsbury Building and Zoning Ordinance.
1. OWNER'S ACICIM s is
21 SUGARBUSH ROAD
QUEENSBURYr NY 12804
2. CONTRACTOR or BUI LDERS Name
TODAI MODERN HOMES
M CONTRACTOR or Su1LDER'S Address
54 RT 9
GANSEVOORT , NY 12831
4 ARCHtTECT"S Nara
NEW YORK BOARD
5. ARCHITECT"S Address
NEW YORK BOARD OF FIRE UNDERWRITERS
6. TYPE or Construction — iPlaatse Indicate by Xl MOBILE NOME
1 1 Wood Frame t I Masonry 1 1 Steel f l
T. PLANS and Specifications
23 + 489 MOBILE HOME AS PER PLOT PLAN SPECIFZCCATIQINS
r
Proposed Use
MOBILE HOME
41 August 28 2000
$
PERMIT FEE PAID - THIS PERMIT EXPIRES . 19
t1f a lonysr p+r4od is npuired an agplirttbn fa an extension muse be made to tf+e f3uiWirq and Zonina inspector of the
sown of Ousen stel before she aMplratlen date.l August
199 8
28
f)ay of x9
Dated at the Town of OueerlsburV this: ►,,�� ��,r�j
SIGNED BY ��]�Kq 6� '1r for the Town of Que*nsbury
11dina artd Inspoetar
TOWN 01 " QUEENSBURY
l
REVIEWED BY :
FEE PAID : C
`}
PERMIT NO .
APPLICATION FOR PERMIT
MOBILE HOME OR MODULAR
A BUILDING PERMIT MUST BE OBTAINED BEFORE PLACEMENT OF MOBILE IIOME .
NO INSPECTIONS WILL BE MADE UNTIL A VALID BUILDING PERMIT iIAS BEEN ISSUED .
. . . . . . .
The owner of this property is .
P . O . Address : G-. U7�! /i�� s•� L7`e Phone Number
Property Location P- 0 &YX Z22L Tax Map No .
NAME OF APPLICANT :
Address of Applicant : �?J�'u rf /-
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 RESPONS113LE FOR SUPERVISION OF WORK AS REGARDS BUILDING CODES : DV� A,)J4r'} �
3 3 75J
MOBILE 110ME INFjMM8T1ON APPROXIMATE VALUE OF ITOME : $ 07 .2 73
IMB
New Hame Yes Na ZONING INFORMATION .
Replacement acement Home Yes No r
P Size of Property : �S ft x jt
Size of mobile home ftxft� Existing Buildings :
Singlewide Doublewide
r - Proposed building-distance from property line :
Now of rooms ( exclude baths ) Front Yard 31 ft Rear Yard C-3 / ft .
No . bedrooms Side Yards z - ft and I G7 ft .
No . of bathrooms Occupancy Iingot 3
Primary dwelllling . Y s No
Fireplace Woodstove Accessory Building ( s ) .
Foundation style and size : Detached garage one car / two car car
y Attached garage one car'/ two car car
�yt'r� -Tr� la tSL S �,/ " a"�-Storage building T'
Piers- No . of Size ft x f t Other
- .oft► 4 4 rV,c� ,G -� eooew -ns
Depth below grade ft
Foundation-- Footing size x "
Proposed date frplacement :
Wall material
Wall thickness Height Water Supply : Well Municipa l
Total depth below grade ft , Septic permit required ? Wa) C7
Grade to home floor. level ft .
FURTIIER INFORMATION REQUESTED ON TIIE REVERSE SIDE OF TIIIS SHEET
NAME OF INSTALLER/MOBILE 11OME DEALER : J � ✓Yt! f
ADDRESS/PHONE NUMBER -at � lgyovsi Eyoi � `� � 29 J 71F6
STATE OF NEW YORK DIVISION OF HOUSING AND COMMUNITY RENEWAL
INSIGNIA OF APPROVAL OF TIIE STATE BUILDING CODE
I . Insignia serial number
2 . Name of Manufacturer ` '' � /..1 C
3 . Plan Approval number
4 . Model or Component Designation
5 . Date of Manufacture /'(} ?
All the above information is to be found on a plate or sticker which
should be affixed to the Mobile } tome . Complete above with that informaLion .
¢tiJ LJ / L L
co co LSE
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 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 aLiLh ized by liq ownevy.
Signature
Owner , own p
s anent , arcl tect ,
con tracLor
SPECIAL CONDITIONS OF PERMIT :
By
Code Enforcement Officer
DECLARATION.* Please sign below after you luxve carefully read t1te statenreat.
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 PLAT PLAN by
a lieensed surveyor; drawn to scale, showing actual location of project on premises.
Signature:
(owner, owner's agent, architect, contractor)
RESIDENTIAL FINAL INSPECTION REPORT
r
Office No. (518) 761-8256 Date inspection request received: /Q
Building & Code Enforcement
Dept. of Community Development Arrive ff& amipm Depart aWpm
Town of Queensbury Inspector's Initials
742 Bay Road
Queensbury, New York 12804
NAME +"'_e 4�;; 4 s� � �1 ' PERMIT f0 6 /
LOCATION DATE r s
TYPE, OF s'iRUC'I E7RE
NIA YES NO COMMENTS
Chimney HeightP B" Vent/Direct Vent Location .
Fresh Air Intake
Plumb Vent through roof ,
Roof Complete
Exterior Finish Complete fifi "
Interior/Exterior Railings 30" to 3C1
Exterior Handrails, balconies, landing 18 im or more
Interior Handrails stairs both sides 3 or more risers.
Grade 2% awav from foundation
8" clearance to sill plate SA
Gas Valve shut-off' exposed/regulator I ' above grade {
Gas Furnace shut-off within 30 feet or with line of site f * /L e� �"'e
Oil Furnace shut-off entraneE to ��
Furnace/Hot Water Heater opera
Relief Valve(s) installed
Headroom, 6 fi. 6 in, on stairs
Basement stairs, 6 f - 4 in.
Handrail exterior stairs both sides more than 3 risers
Interior privacy/trim/doors/mam entrance 36" � e /'J Z
Floor Finish C^ �/
BathroonvRitchen watertight
Interior Handrails Balconies/Landing 18 in. or more �� � e b e
Railing across window in stairwells
Smoke Detectors-
every
every level
every bedroom
outside every bedroom
inter connected
Bathroom fans
Plumbing fixtures
Foundation insulation
3/4 hour fire door/door closer
Garage fireproofing
Garage penetrations sealed
Furnace in separate room protected (in garage)
Light ventilation per morn
Safety glazing 187' or less f-om floor
Final Electrical
Site Plan/Variance required
Final Survey Plot Plan
As Built Septic System layout required
Okay to issue C/C (Certif. of-Compliance)
Okav to issue temp. CIO (Certif. of Occupancy)
Okay to issue permanent C/O (Certif. of Occupancy)
4149.) b;, THE NEW YO► RK BOARD OF FIRE UNDERWRITERS
BUREAU OF EL TRICITY
111 WASHINGTON AVE., S E 70 ALBANY, NY 12210
Date OCT 13ER 06 , 1996 4262?69Po/ 98 A 1 :37e�45
Appppl:cation No. on }rre
THIS CERTIFIES THAT L' R1iTT NU 3t3 5 -2 7
only the electrical equipment as described below and introduced by th applicant med on the above application number is in the premises of
ROBERT & FTiNA 11RRWIN , 21 80GARI3USH , QEFf ENsBUR , NY
in the following location, ❑ Basement ❑ 1st Fl. ❑ 2nd vi, OUT Section Block Lot
was examined on OC".'l"C313E1t 01 , 1 G98 and found to be In compliance with the National Electrical G'ode,
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCE FLUORESCENT OTHER AM7. K,W. AMT. K.W- AMT. K.W, AMT. 11 K.W. AMT, H-P,
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC7T. TIME CLOCKS SELL UNIT HEATERS MULTI-OUTLET
AMT. K.W. OIL H.P. GAS H.P- AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS DIMMERS
s NO. OF FEET AMT, WATTS
SERVICE DISCONNECT NO. OF S E
� E
METER R V I
RMT. AMP, TYPE RQUIP. 1 B 2W 1 1 dW S B 3W 3 B /W NO- OF CC COND. A. W, G. HD- OF XI-LE6 A'- W. A. W. G.
PER B OF CC. COLA, OF XI-LE6 NO, OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
FEEDER r #2 #4 FROM MCB TO 11H- 1
51 t11CHAk:D.. ROAD L L
FORT EDWARD , Ny , 2. 2828 GENERAL. MANAGER
239
per
This certificate must not be altered in any manner, return to The office of the Board if incorFacf_ Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
RIIVAL IIVSI�ECT'ICiIV +FSEr�r�r� r
MOi@�ILL� / Mi7131.JLAR
Town of Queensbury
Building & Code Enforcement
742 Say Road " � 1 r '}
Queensbury, NY 12804 ` - • Ji ! ,
(518) 761"8256
ARRIVE: JOLNIDEPART-. �j'IN5P:
DATE INSPECTION REQUEST RECEIVED;
NAME:
LOCATION: + �•$ -y� ! � ,
PERMIT # ,
MOSII.E If011lL+ MOD=*AIlt Home
FOOTINGS F NJNDATION $ACKFtLL i FRAMING
N/A YES No
1, foundation pi spar
per
2. anchoring per . . .. .. . . . _
3. water line shut, o . .... . .. .. ... .. .
4. sewer line a 04 feet . .
5. heating crossov (dblewide) off grd.
6. dryer vented ou
71 skirting ventilated ..... .. .. .. ... .. ..
».
86 hot water relief valve piping_outside
9. deck, porches, s -7
10. furnace/hot water operating . ..... ..
11. garage fire proofing . ... .. .. .... . .... .
12. door clatCais
13. plumbing fixture . —
14. foundation insulation (if appl.). ..
15* smoke detectors ....Y� ). ft:ki _
16# final electrical Y 00`d
17. variance required .. ....... .. .. . . . .. .. .
18. data plate okay ... .. ... .... .. .. .. . .. .. --
19. mobile H M seal okay . .. .. ... .. .. .. — —
Model # Serial #
Manufacturer
Date of Manufacturer
OKAY TO ISSLTE CIO YES N(7
Comments:
GENERAL IN,SPECTIQN „REPORT
Town of Queensbury
Dept. of Community Development Date inspection request received:
Building & Code Enforcement
742 say Road
Queensbary, NY 12804 Arrive 1 Z inL�.--fir Depart
Inspector's In
NAME: PERMIT # ~� 15
LOCATION: DATE
TYPE OF STRUCTURE:
RECHECK
N/A YES NO COMMENTS
Footings/Piers 0 1
Monol4iWc Pour Form
orcement in Place
The contractor is a for
provj
oYet' n from ing
far foll g the t
of thete.
Materiis site
Foundll ur
Rei
Foundation/Da fin
BackSi —
PlumbiSlab _
Plumbi ents in PlaceRough it
Heating Rough4n
lnsulation
Foundation 'Walls Interior R-
Foundation Walls Exterior R-
Floors R-
Walls R-
Ceilin,g R-
Duct work or piping in
unheated spaces R-
Proper Vent, Attic Vent
Framin
Jack 5tuds/I Leaders
Bracing./Bridging,
Joist Hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1, 2, 3, hour
Penetration Sealed
Fire Walt 2, 3, 4 hour
Firestoppm
GENERAL INSPECTION REPORT
Town of Queensbury
Dept. of Community Development Date inspection request received:
Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804 Arrlve�:7 �a�+rmt Dep
Inspector's snit
NAME: �V(` 1 (� PERMIT # I
LC7CATIOR: 1`* DATE .
TYPE OF STRU
RECHFrcK
NIA YES NO COMMENTS
ocmings/Piers
Monolithic Four Form D
Reinforcement in Place _ '�� ► �b� t� �' Ede ' { Ht�
The contractor is responsible for C--)L ., F c,�--
providing protection fro Mg
for 48 hours Mowing p ment �' 1 '�►�� �1 kfij
of the concrete.
Materials for thus n si
FoundationlWall
Reinforcement in Place
Foundabion/Dampproob
pk;;ZZ�
Backfill Approval
Plumbing Under Slab
Plumbing VcntlVcnts Place
Rough Plumbing
Heating Rough-In
Insulation
Foundation Walls Interior R-
Foundation Waits Exterior R-
Floors R-
Walls R-
Ceiling R-
Duct work or piping in
unheated spaces R-
Pr,oper Vent, Attic Vent
Framing
Jack Studs/Headers
Bracing/Bridging
Joist hangers
Jack Posts/Main Beam
Air Infiltration Barrier
Fire Separation 1 , 2, 3, hour
Penetration Sealed
Fire Wall 2, 3, 4 hour
Firestoppin
S
FILE '
r AUG ,� i
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UR1Y }�` >tJ .:�' S•'y f�}}},,,,,,���
TOW�lBul no- ! h R• + �.
may, v
tF• y s f � tM
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DATE
L- uzerne Rd. Phone:
Queensbury, NY 12801 WOOF WMWMMWMET792-5838
Bssod oa� ! �a�nationi
t =pha a with our eaaam►ts shall
riot 5e w&uW as iwdbbng the
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WASH/DRY MIR -- i L
OPT.
ITIi IT KITCHEN BEDROOM
at 14`-8" A1a. 2
_ 9 4'
T �.� DfNlNG
o AREA
o CATHEDRAL THRU-00
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LIVING ROOM
$ MASTER 14'-$� BEDROOM
BEDROOM No. 3
13'-2" �
6801CT/4824 BBEDRDDM - 2BATHS - CATHEDRAL THRU-OUT (1,096 SUT,1
551
New 1999
23' X 48'
HUD Code
Horne 31
Existing
Septic
Nip,I:wh .
..
[ ` 4
Power
22 '
Existing 10 ' 110,
22 X 39
Slab
31 '
existing 0
driveway Wa er
Details of the Merin Slab
0 21 Sugarbush
addition to slab c�
existing slab
112" rebar
22' X 40' 22' x -'
existing slab to ab
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